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Sample records for acl reconstruction performed

  1. ACL reconstruction

    MedlinePlus

    ... This increases the chance you may have a meniscus tear. ACL reconstruction may be used for these ... When other ligaments are also injured When your meniscus is torn Before surgery, talk to your health ...

  2. ACL reconstruction - discharge

    MedlinePlus

    Anterior cruciate ligament reconstruction - discharge; ACL reconstruction - discharge ... had surgery to reconstruct your anterior cruciate ligament (ACL). The surgeon drilled holes in the bones of ...

  3. ACL Reconstruction

    MedlinePlus

    ... of the major ligaments in your knee. ACL injuries most commonly occur during sports that involve sudden stops and changes in direction — such as basketball, soccer, football, tennis, downhill skiing, volleyball and gymnastics. In ...

  4. Mycotic Infection post ACL Reconstruction

    PubMed Central

    Costa-Paz, Matias; Ayerza, Miguel; Carbo, Lisandro; Sanchez, Marisa; Yacuzzi, Carlos; Muscolo, Luis

    2017-01-01

    Objectives: There are several studies in literature of septic arthritis after the ACL arthroscopic reconstruction related to bacterial germs. However, fungi infection is likely infrequent generating a massive bone loss with a catastrophic result. The purpose of this study was to describe preventive measures to decrease the mycotic infection after ACL reconstruction. Methods: Since 2005, we have diagnosed and treated 22 immunocompetent patients who underwent a surgery of an ACL lesion in other institutions in the country. Form these cases, we analyzed 19 which developed mycotic infection and an oncologic debridement was performed to control the pathology. In this series, we considered the initial surgery, the number of toilettes performed until their referral, magnitude of bone loss and final outcome. There were 5 other patients who consulted for mucormycosis, who finally were treated in other hospitals. Results: Epidemiology of mucormycosis is not clear. The exact cause is unknown due to heterogeneous data, different places and surgeons, facilities and type of surgical instruments in this series. In spite of not knowing the cause of the infection, several alternatives were evaluated in a non systematic way. Most of them related to the surgery room, sterilization place of the surgical tools, use of sterilizing liquids, cleanliness of lumen and cannulated bits. Instruments used during surgery were also evaluated: fields, shaver blades, drill types, ACL reconstruction fixation method. It is doubtful if the type of graft to reconstruct the ACL had any relation with infections. Among ideal preventive measures, the following are described: Surgery room with temperature and humidity control. Not using sterilizing liquids. Optimal preparation of surgical tools with adequate cleanliness of lumen and cannulated bits performed by adequate personnel. Sterilize in the same place where the surgery will be performed. Use of adequate instruments. The use of the central third of

  5. Which one Enhances Muscular Performance in ACL Reconstructed Subjects

    PubMed Central

    Harput, Gulcan; Ulusoy, Burak; Atay, Ahmet Ozgur; Baltacı, Gul

    2014-01-01

    Objectives: The aim of this study was to investigate the effects of functional knee brace and kinesiotaping on muscular performance in anterior cruciate ligament reconstructed subjects who reached return to sport phase of the rehabilitation. Methods: Twenty (17 males, 3 females, Age: 24.7±7.1 years, Body weight: 74.4±12.0 kg, Height: 177.9±6.5 cm, BMI: 23.9±3.6 kg/m2) subjects who underwent anterior cruciate ligament reconstruction by using hamstring tendon auto graft were included in this study. When the subjects reached the return to sports phase of rehabilitation which was 6th months after surgery, knee muscle strength, jump performance and balance tests were performed 3 times: bare, with knee brace and with kinesio taping. The order of the tests were randomized to eliminate the effects of fatigue and motor learning. Quadriceps and hamstring muscle strength was measured on an isokinetic dynamometer at 180 °/s and 60°/s angular velocities. Vertical Jump (VJ) and One Leg Hop Tests (OLHT) were used to assess jump performance. Star Excursion Balance Test (SEBT) with anterior, posteromedial and posterolateral reach distance was used to assess the dynamic balance. When all tests were performed, the subjects were asked under which test condition they felt more confident. Repeated measures of ANOVA was used to analyze the difference among three test conditions (bare, kinesiotaping, knee brace). Bonferroni post hoc test was used for pairwise comparison. Results: SEBT posteromedial (PM)and posterolateral (PL) reach distances were found significantly different among three test conditions(PM: F(2,38)=3.42,p=0.04), PL: F(2,38)=4.37,p=0.02). Kinesiotaping increased posteromedial reach distance (p=0.03). On the other hand, brace decreased posterolateral reach distance (p=0.04). VJ and OLHT performance were also found significantly different between three test conditions (VJ: F (2,38)=3.44,p=0.04, OLHT: (F(2,38)=4.04,p=0.02). Kinesio taping increased one leg hop distance

  6. THE CLINICAL UTILITY OF FUNCTIONAL PERFORMANCE TESTS WITHIN ONE-YEAR POST-ACL RECONSTRUCTION: A SYSTEMATIC REVIEW

    PubMed Central

    Narducci, Elizabeth; Waltz, Amanda; Gorski, Katheryn; Leppla, Lucas

    2011-01-01

    Introduction: A tear of the anterior cruciate ligament (ACL) represents a significant injury for an athlete that requires substantial time away from sport, and significant rehabilitation after reconstruction. The physical therapist is responsible to determine when a patient is capable of tolerating the physical demands of daily activities and to attempt to prevent re-injury. Physical or functional performance tests (FPTs) are one mechanism used to evaluate the athlete's physical skills and capabilities prior to returning to sports participation. The purpose of this systematic review is to critically examine the clinical utility of functional performance tests used with patients less than or equal to one year post ACL reconstruction. Methods: A systematic review of the relevant literature was performed using PRISMA guidelines. A total of twelve studies were included for analysis. Results: Two independent blinded reviewers then analyzed and rated the final included articles (n=12) utilizing the Newcastle-Ottawa Scale (NOS). Percent overall agreement between raters for the NOS was 88% with a fixed-marginal kappa (κ) of 0.80. Of the 12 included articles, the FPTs were utilized as an outcome measure within the study design (41.7%) or studied as a measure of function (58.3%). Among those studies that used FPTs as a “measure of function” 71.4% studied a battery of FPTs, while 28.6% studied a single test. None of the studies utilized FPTs as a measure to determine readiness to return to sport. Discussion: FPTs are being utilized with patients, less than or equal to one year post ACL reconstruction, either as an assessment of functional performance or as an outcome measure. No studies identified a FPT or test battery that has construct or predictive validity for “return to sport” in athletic population one-year post-ACL reconstruction. The identification of the critical elements within the return to sport construct may allow lower extremity performance tests to be

  7. KNEE KINEMATICS FOLLOWING ACL RECONSTRUCTION IN FEMALES; THE EFFECT OF VISION ON PERFORMANCE DURING A CUTTING TASK

    PubMed Central

    Di Fabio, Richard P.

    2011-01-01

    Purpose/Background: Specific movement patterns have been identified as influential in ACL injury; however several key kinematic variables that might be predictive of future performance have not been fully investigated. The purpose of this research was to: 1) determine if subjects with ACL reconstruction display different displacement, velocity, and time to peak ground reaction force (GRF) during cutting activities than healthy subjects, 2) observe if subjects with visual disruption display differences in these variables, and 3) determine if visual disruption alters these variables in subjects with ACL reconstruction relative to healthy subjects. Methods: Seventeen healthy female subjects and 17 female subjects with unilateral ACL reconstruction (ACLR) performed 40 trials of a cutting movement during which knee position was measured via a 3D electromagnetic system. Visual conditions were randomized to disrupt vision for 1 second as the subject began the cutting movement, or allow full vision for movement duration. Independent variables were lead/push off leg (ACLR limb or healthy non-dominant limb) and vision (disrupted or full). 2-way ANOVAs were utilized to determine differences between knee kinematics using dependent variables of displacement (m), absolute velocity (m/sec), and time to reach peak GRF (% of cut). Results: Knee displacement was significantly less for ACLR (.76±.11; .75±.16) than non-dominant (.85±.08; .87±.12). Knee velocity was significantly slower for ACLR (.81±.14; .84±.16) than non-dominant (.92±.11; .97±.14). A significant interaction was noted for displacement and average velocity (p<.05). Time to reach peak GRF was significantly longer for ACLR (79.41±2.28) than non-dominant (76.65±4.41). Conclusions: Subjects with ACLR displayed less knee displacement, slower velocity, and an increased time to reach peak GRF relative to healthy subjects' non-dominant knee. Visual disruption appeared to have some effect on movement, as noted by

  8. Quadriceps Strength Asymmetry Following ACL Reconstruction Alters Knee Joint Biomechanics and Functional Performance at Time of Return to Activity

    PubMed Central

    Palmieri-Smith, RM; Lepley, LK

    2016-01-01

    Background Quadriceps strength deficits are observed clinically following anterior cruciate injury and reconstruction and are often not overcome despite rehabilitation. Given that quadriceps strength may be important for achieving symmetrical joint biomechanics and promoting long-term joint health, determining the magnitude of strength deficits that lead to altered mechanics is critical. Purpose To determine if the magnitude of quadriceps strength asymmetry alters knee and hip biomechanical symmetry, as well as functional performance and self-reported function. Study Design Cross-Sectional study. Methods Seventy-three patients were tested at the time they were cleared for return to activity following ACL reconstruction. Quadriceps strength and activation, scores on the International Knee Documentation Committee form, the hop for distance test, and sagittal plane lower extremity biomechanics were recorded while patients completed a single-legged hop. Results Patients with high and moderate quadriceps strength symmetry had larger central activation ratios as well as greater limb symmetry indices on the hop for distance compared to patients with low quadriceps strength symmetry (P<0.05). Similarly, knee flexion angle and external moment symmetry was higher in the patients with high and moderate quadriceps symmetry compared to those with low symmetry (P<0.05). Quadriceps strength was found to be associated with sagittal plane knee angle and moment symmetry (P<0.05). Conclusion Patients with low quadriceps strength displayed greater movement asymmetries at the knee in the sagittal plane. Quadriceps strength was related to movement asymmetries and functional performance. Rehabilitation following ACL reconstruction needs to focus on maximizing quadriceps strength, which likely will lead to more symmetrical knee biomechanics. PMID:25883169

  9. Partial ACL tears: anatomic reconstruction versus nonanatomic augmentation surgery.

    PubMed

    Buda, Roberto; Ruffilli, Alberto; Parma, Alessandro; Pagliazzi, Gherardo; Luciani, Deianira; Ramponi, Laura; Castagnini, Francesco; Giannini, Sandro

    2013-09-01

    Treatment of partial anterior cruciate ligament (ACL) tears requires ACL remnant preservation. The goal of this study was to compare the outcome of anatomic reconstruction of the torn bundle with nonanatomic augmentation using the over-the-top femoral route. Fifty-two athletes (mean age, 23.3 years) with partial ACL lesions underwent anatomic reconstruction (n=26) or nonanatomic augmentation (n=26). Intraoperative damage of the healthy bundle that required a standard ACL reconstruction occurred in 2 patients in the anatomic reconstruction group. International Knee Documentation Committee (IKDC) score, Tegner score, and arthrometer evaluation were used pre-operatively and at follow-up for up to 5 years postoperatively. One failure occurred in the anatomic reconstruction group. Mean IKDC subjective score at follow-up was 88.2 ± 5.7 in the anatomic reconstruction group and 90.2 ± 4.7 in the nonanatomic augmentation group. According to the IKDC objective score at final follow-up, 96% of knees in the nonanatomic augmentation group were normal vs 87.5% in the anatomic reconstruction group. No significative differences were observed between the 2 groups at final follow-up. Anteromedial bundle reconstruction showed significantly lower IKDC subjective and objective scores and higher residual instability values as evaluated with the arthrometer compared with posterolateral bundle reconstruction (P=.017). The surgical treatment of ACL partial tears is demanding. Adapted portals, perfect control of the tunnel drilling process, and intercondylar space management are required in anatomic reconstruction. The nonanatomic augmentation technique is simpler, providing excellent durable results over time with a lower complication rate. Anteromedial bundle reconstruction is associated with a poorer outcome, especially when performed with anatomic reconstruction.

  10. Isokinetic Testing in Evaluation Rehabilitation Outcome After ACL Reconstruction

    PubMed Central

    Cvjetkovic, Dragana Dragicevic; Bijeljac, Sinisa; Palija, Stanislav; Talic, Goran; Radulovic, Tatjana Nozica; Kosanovic, Milkica Glogovac; Manojlovic, Slavko

    2015-01-01

    Introduction: Numerous rehab protocols have been used in rehabilitation after ACL reconstruction. Isokinetic testing is an objective way to evaluate dynamic stability of the knee joint that estimates the quality of rehabilitation outcome after ACL reconstruction. Our investigation goal was to show importance of isokinetic testing in evaluation thigh muscle strength in patients which underwent ACL reconstruction and rehabilitation protocol. Subjects and methods: In prospective study, we evaluated 40 subjects which were divided into two groups. Experimental group consisted of 20 recreational males which underwent ACL reconstruction with hamstring tendon and rehabilitation protocol 6 months before isokinetic testing. Control group (20 subjects) consisted of healthy recreational males. In all subjects knee muscle testing was performed on a Biodex System 4 Pro isokinetic dynamo-meter et velocities of 60°/s and 180°/s. We followed average peak torque to body weight (PT/BW) and classic H/Q ratio. In statistical analysis Student’s T test was used. Results: There were statistically significant differences between groups in all evaluated parameters except of the mean value of PT/BW of the quadriceps et velocity of 60°/s (p>0.05). Conclusion: Isokinetic testing of dynamic stabilizers of the knee is need in diagnostic and treatment thigh muscle imbalance. We believe that isokinetic testing is an objective parameter for return to sport activities after ACL reconstruction. PMID:25870471

  11. ACL reconstruction in children: a transphyseal technique.

    PubMed

    Lemaitre, G; Salle de Chou, E; Pineau, V; Rochcongar, G; Delforge, S; Bronfen, C; Haumont, T; Hulet, C

    2014-06-01

    The annual incidence of ACL tears is increasing steadily in pediatric patients. Chronic anterior instability causes meniscal lesions at a frequency that increases significantly with the injury-to-surgery interval. Conservative therapy, simple suturing, and isolated extra-articular tendon reconstruction are associated with high failure rates. Intra-articular arthroscopy-assisted tendon reconstruction is a good treatment method, although several different techniques have been described. We used a transphyseal technique with a hamstring tendon graft to treat 14 knees in 13 patients with a mean age of 13 years and 7 months. Mean injury-to-surgery interval was 6 months. Strict compliance with technical rules is required when using this technique. Bone tunnel diameter must not exceed 8 mm. Bone tunnels must be as vertical and central as possible. The fixation material must not bridge the physis (at the femur, cortical fixation; and at the tibia, fixation using a resorbable screw no longer than 25 mm combined with a staple). Meniscal lesions were present in half the knees and meniscal preservation considered mandatory. Conservative treatment of concomitant lesions was performed routinely. After a mean follow-up of 15 months, no recurrent tears or revision procedures for meniscectomy had been recorded. The IKDC grade was A or B in 93% of knees. The mean subjective IKDC score was 83.3 and the Lysholm score was in the excellent or good range in 93% of knees. Of the 14 knees, 2 exhibited signs suggesting femoral epiphysiodesis, with 4° of valgus deformity compared to the contra-lateral knee and no clinical consequences. Transphyseal reconstruction with open physes conducted in strict compliance with technical rules can be performed to control the instability and preserve the menisci. Nevertheless, this technique carries a risk of epiphysiodesis, chiefly at the femur.

  12. Transphyseal ACL Reconstruction in Skeletally Immature Patients

    PubMed Central

    Cruz, Aristides I.; Lakomkin, Nikita; Fabricant, Peter D.; Lawrence, J. Todd R.

    2016-01-01

    Background: Most studies examining the safety and efficacy of transphyseal anterior cruciate ligament (ACL) reconstruction for skeletally immature patients utilize transtibial drilling. Independent femoral tunnel drilling may impart a different pattern of distal femoral physeal involvement. Purpose: To radiographically assess differences in distal femoral physeal disruption between transtibial and independent femoral tunnel drilling. We hypothesized that more oblique tunnels associated with independent drilling involve a significantly larger area of physeal disruption compared with vertically oriented tunnels. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We analyzed skeletally immature patients aged between 10 and 15 years who underwent transphyseal ACL reconstruction utilizing an independent femoral tunnel drilling technique between January 1, 2008, and March 31, 2011. These patients were matched with a transtibial technique cohort based on age and sex. Radiographic measurements were recorded from preoperative magnetic resonance imaging and postoperative radiographs. Results: Ten patients in each group were analyzed. There were significant differences between independent drilling and transtibial drilling cohorts in the estimated area of physeal disruption (1.64 vs 0.74 cm2; P < .001), femoral tunnel angles (32.1° vs 72.8°; P < .001), and medial/lateral location of the femoral tunnel (24.2 vs 36.1 mm from lateral cortex; P = .001), respectively. There was a significant inverse correlation between femoral tunnel angle and estimated area of distal femoral physeal disruption (r = –0.8255, P = .003). Conclusion: Femoral tunnels created with an independent tunnel drilling technique disrupt a larger area of the distal femoral physis and create more eccentric tunnels compared with a transtibial technique. Clinical Relevance: As most studies noting the safety of transphyseal ACL reconstruction have utilized a central, vertical femoral tunnel

  13. ACL reconstruction in a teenage athlete with fibular hemimelia.

    PubMed

    Mascarenhas, Randy; Simon, David; Forsythe, Brian; Harner, Christopher D

    2014-03-01

    Fibular hemimelia exists as a rare cause of ACL insufficiency. This case report concerns the diagnosis and treatment of anterior cruciate ligament insufficiency in a teenage football player with fibular hemimelia. While ACL reconstruction has been described to allow activities of daily living in this patient population, this is the first report in the literature of anterior cruciate ligament reconstruction in an athlete with fibular hemimelia. We believe that ACL reconstruction is a viable and beneficial treatment option in the care of a symptomatic patient with congenital absence of the ACL and can allow athletes with this condition to return not only to their previous functional level, but also to their previous level of play.

  14. PROPRIOCEPTION, BODY BALANCE AND FUNCTIONALITY IN INDIVIDUALS WITH ACL RECONSTRUCTION

    PubMed Central

    Furlanetto, Tássia Silveira; Peyré-Tartaruga, Leonardo Alexandre; do Pinho, Alexandre Severo; Bernardes, Emanuele da Silva; Zaro, Milton Antonio

    2016-01-01

    Objective : To evaluate and compare proprioception, body balance and knee functionality of individuals with or without unilateral anterior cruciate ligament (ACL) reconstruction. Methods : Forty individuals were divided in two groups: Experimental group, 20 individuals with ACL reconstruction at six months postoperative, and control group, 20 individuals with no history of lower limb pathologies. In the experimental group, we assessed lower limbs with reconstructed ACL and contralateral limb; in the control group the dominant and the non-dominant lower limbs were assessed. All subjects were submitted to joint position sense test to evaluate proprioception, postural control measure in single-limb, and step up and down (SUD) test for functional assessment. Results : There were no deficits in proprioception and postural control. In the SUD test, a 5% decrease in lift up force was found in reconstructed ACL lower limbs, however, a statistically not significant difference. The impact and step down force during the course of test were 30% greater in anatomic ACL than in control lower limbs. Conclusion : The individuals with ACL reconstruction at six months postoperative did not show changes in proprioception and postural control, but showed motor control changes, influencing knee functionality. Level of Evidence IV, Prognostic Studies. PMID:26981038

  15. Physeal Disruption During ACL Reconstruction in Skeletally Immature Patients

    PubMed Central

    Cruz, Aristides Ignacio; Lakomkin, Nikita; Fabricant, Peter D.; Lawrence, John Todd R.

    2016-01-01

    Objectives: The purpose of this study was to radiographically assess differences in distal femoral physeal disruption between transtibial and independent femoral tunnel drilling techniques following ACL reconstruction in skeletally immature patients. Methods: A retrospective, matched comparative cohort study was performed of skeletally immature patients who underwent transphyseal ACL reconstruction between January 1, 2008 and March 31, 2011. All skeletally immature patients between ten and fifteen years old who underwent independent femoral tunnel drilling and had adequate baseline and post-operative radiographs were analyzed. These patients were matched with a transtibial technique cohort based on age and sex. Demographic characteristics and peri-operative metrics were collected. Radiographic measurements were recorded from pre-operative MRI and post-operative plain radiographs. Results: Twenty patients were analyzed. Between groups, there were significant differences between independent tunnel drilling and transtibial tunnel drilling in the estimated area of physeal disruption (1.64 cm2 vs. 0.74 cm2, P<0.001), femoral (32.1º vs. 72.8º, P<0.001) and tibial (50.1º vs. 60.5º, P=0.003) tunnel angles, medial/lateral location of the femoral tunnel (24.2 mm vs. 36.1 mm from lateral cortex, P=0.001), and distance from the lateral aspect of the distal femoral physis and the femoral tunnel exit (4.7 mm vs. 26.7 mm from the perichondrial ring, P<0.001), respectively. All patients who underwent femoral tunnel drilling at an angle of less than 25º from the transverse axis experienced a greater than 6% disruption of physeal area. There was a significant inverse correlation between femoral tunnel angle and estimated area of femoral physeal involvement (r=-0.8255, P=0.003). Conclusion: With femoral tunnel drilling techniques that create more oblique tunnels, the area of distal femoral physeal damage is larger, more eccentric and closer to the perichondrial ring. Since most

  16. Knee extension torque variability after exercise in ACL reconstructed knees.

    PubMed

    Goetschius, John; Kuenze, Christopher M; Hart, Joseph M

    2015-08-01

    The purpose of this study was to compare knee extension torque variability in patients with ACL reconstructed knees before and after exercise. Thirty two patients with an ACL reconstructed knee (ACL-R group) and 32 healthy controls (control group) completed measures of maximal isometric knee extension torque (90° flexion) at baseline and following a 30-min exercise protocol (post-exercise). Exercise included 30-min of repeated cycles of inclined treadmill walking and hopping tasks. Dependent variables were the coefficient of variation (CV) and raw-change in CV (ΔCV): CV = (torque standard deviation/torque mean x 100), ΔCV = (post-exercise - baseline). There was a group-by-time interaction (p = 0.03) on CV. The ACL-R group demonstrated greater CV than the control group at baseline (ACL-R = 1.07 ± 0.55, control = 0.79 ± 0.42, p = 0.03) and post-exercise (ACL-R = 1.60 ± 0.91, control = 0.94 ± 0.41, p = 0.001). ΔCV was greater (p = 0.03) in the ACL-R group (0.52 ± 0.82) than control group (0.15 ± 0.46). CV significantly increased from baseline to post-exercise (p = 0.001) in the ACL-R group, while the control group did not (p = 0.06). The ACL-R group demonstrated greater knee extension torque variability than the control group. Exercise increased torque variability more in the ACL-R group than control group.

  17. Asymmetrical lower extremity loading after ACL reconstruction: more than meets the eye.

    PubMed

    Chmielewski, Terese L

    2011-06-01

    Sports fans know that movement patterns are important for athletic performance. Similarly, clinicians know that addressing abnormal movement patterns after an anterior cruciate ligament (ACL) reconstruction is important for a successful return to sport. The kinematic (motion) component of movement patterns is more easily observed than the kinetic (forces) component, thus more commonly addressed in ACL reconstruction rehabilitation. Ignoring the kinetic component, though, could impede a successful return to sport. Asymmetrical lower extremity loading has been reported in a variety of activities following ACL reconstruction, and may contribute to both short- and long-term consequences. It is important that clinicians become aware of the potential for asymmetrical lower extremity loading to affect patient outcomes and for researchers to enlarge the body of knowledge.

  18. Growth disturbances without growth arrest after ACL reconstruction in children.

    PubMed

    Chotel, Franck; Henry, Julien; Seil, Romain; Chouteau, Julien; Moyen, Bernard; Bérard, Jérôme

    2010-11-01

    Growth arrest is a major concern after ACL reconstruction in children. It usually occurs in patients near to closure of the growth plates. Growth disturbances without growth arrest are also possible and more vicious; the authors analyse the mechanism of two patients with growth disturbance due to overgrowth following ACL reconstruction. One was a symmetrical overgrowth process with 15 mm limb length discrepancy treated with percutaneous epiphysiodesis. Full correction at the time of skeletal maturity was achieved. The second patient developed an asymmetrical overgrowth with progressive tibial valgus deformity. This mechanism was similar to a posttraumatic tibial valgus deformity. After nonoperative treatment, a spontaneous correction of the deformity was noticed. Both children were young (7 and 10 years old) at the time of ACL reconstruction with an autologous iliotibial band graft. The clinical relevance of overgrowth disturbance is usually limited when compared to growth arrest but could require a second surgical procedure as reported in this study. Parents must be informed that even in experienced hands, and despite the use of a physeal sparing technique, this specific risk of growth disturbance is still present.

  19. Risk Factors and Predictors of Subsequent ACL Injury in either Knee after ACL Reconstruction: Prospective Analysis of 2488 Primary ACL Reconstructions from the MOON Cohort

    PubMed Central

    Kaeding, Christopher C.; Pedroza, Angela D.; Reinke, Emily K.; Huston, Laura J.; Spindler, Kurt P.

    2015-01-01

    Background Anterior cruciate ligament (ACL) re-injury results in worse outcomes and increases risk of post-traumatic osteoarthritis. Objectives To identify the risk factors for both ipsilateral and contralateral ACL tears after primary ACL reconstruction (ACLR). Study Design Cohort study; Level of evidence, 3. Methods Data from the Multicenter Orthopaedic Outcomes Network (MOON), a prospective longitudinal cohort, were used to identify risk factors for ACL retear. Subjects with primary ACLR, no history of contralateral knee surgery, and a minimum of 2-year follow-up data were included. Age, sex, Marx activity score, graft type, lateral meniscus tear, medial meniscus tear, sport played at index injury, and surgical facility were evaluated to determine their contribution to both ipsilateral retear and contralateral ACL tear. Results A total of 2683 subjects with average age of 27 ± 11 years (1498 men; 56%) met all study inclusion/exclusion criteria. Overall there were 4.4% ipsilateral graft tears and 3.5% contralateral ACL tears. The odds of ipsilateral retear were 5.2 times greater for an allograft (p<0.01) compared with a bone-patellar tendon-bone (BTB) autograft; the odds of retear were not significantly different between BTB autograft and hamstring autograft (p=0.12). The odds of an ipsilateral ACL retear decreased by 0.09 for every yearly increase in age (p<0.01) and increased by 0.11 for every increased point on the Marx score (p< 0.01). The odds were not significantly influenced by sex, smoking status, sport played, medial or lateral meniscus tear, or consortium site (p>0.05). The odds of a contralateral ACL tear decreased by 0.04 for every yearly increase in age (p=0.04) and increased by 0.12 for every increased point on the Marx score (p<0.01); these odds were not significantly different between sex, smoking status, sport played, graft type, medial meniscal tear, and lateral meniscal tear (p>0.05). Conclusions Younger age, higher activity level, and

  20. ACL reconstruction with BPTB autograft and irradiated fresh frozen allograft*

    PubMed Central

    Sun, Kang; Tian, Shao-qi; Zhang, Ji-hua; Xia, Chang-suo; Zhang, Cai-long; Yu, Teng-bo

    2009-01-01

    Objective: To analyze the clinical outcomes of arthroscopic anterior cruciate ligament (ACL) reconstruction with irradiated bone-patellar tendon-bone (BPTB) allograft compared with non-irradiated allograft and autograft. Methods: All BPTB allografts were obtained from a single tissue bank and the irradiated allografts were sterilized with 2.5 mrad of irradiation prior to distribution. A total of 68 patients undergoing arthroscopic ACL reconstruction were prospectively randomized consecutively into one of the two groups (autograft and irradiated allograft groups). The same surgical technique was used in all operations done by the same senior surgeon. Before surgery and at the average of 31 months of follow-up (ranging from 24 to 47 months), patients were evaluated by the same observer according to objective and subjective clinical evaluations. Results: Of these patients, 65 (autograft 33, irradiated allograft 32) were available for full evaluation. When the irradiated allograft group was compared to the autograft group at the 31-month follow-up by the Lachman test, the anterior drawer test (ADT), the pivot shift test, and KT-2000 arthrometer test, statistically significant differences were found. Most importantly, 87.8% of patients in the autograft group and just only 31.3% in the irradiated allograft group had a side-to-side difference of less than 3 mm according to KT-2000. The failure rate of the ACL reconstruction with irradiated allograft (34.4%) was higher than that with autograft (6.1%). The anterior and rotational stabilities decreased significantly in the irradiated allograft group. According to the overall International Knee Documentation Committee (IKDC), functional and subjective evaluations, and activity level testing, no statistically significant differences were found between the two groups. Besides, patients in the irradiated allograft group had a shorter operation time and a longer duration of postoperative fever. When the patients had a fever, the

  1. From open to arthroscopic anatomical ACL-reconstructions: the long way round. A statement paper.

    PubMed

    Arnold, Markus P; Friederich, Niklaus F; Müller, Werner; Hirschmann, Michael T

    2013-07-01

    The single-incision anterior cruciate ligament (ACL) reconstruction evidently has its shortcomings. In an attempt to improve the biomechanical but also the biological state of the knees after an ACL-reconstruction, double, even triple-bundle reconstructions have been popularised recently. As a positive side effect, details concerning ACL-insertion anatomy were brought back into the focus. In our opinion it would be more straight forward and logical to replace the non-anatomical single-incision technique with a more anatomic single-bundle ACL-reconstruction technique.

  2. Outcome of ACL Reconstruction for Chronic ACL Injury in Knees without the Posterior Horn of the Medial Meniscus: Comparison with ACL Reconstructed Knees with An Intact Medial Meniscus

    PubMed Central

    Syam, Kevin; Chouhan, Devendra K.; Dhillon, Mandeep Singh

    2017-01-01

    Purpose Cadaveric studies have shown that deficiency of the posterior horn of the medial meniscus (PHMM) increases strain on the anterior cruciate ligament (ACL) graft. However, its influence on the clinical and radiological outcome after ACL reconstruction is less discussed and hence evaluated in this study. Materials and Methods This study included 77 cases of ACL reconstruction with a minimum 18-month follow-up. Of the 77 cases, 41 patients with intact menisci were compared clinically and radiologically with 36 patients with an injury to the PHMM that required various grades of meniscectomy. The knees were evaluated using subjective International Knee Documentation Committee (IKDC) score and Orthopadische Arbeitsgruppe Knie (OAK) score. Results Cases with intact menisci showed better stability (p=0.004) at an average of 44.51 months after surgery. No significant differences were noted in the overall OAK score, subjective IKDC score, and functional OAK score (p=0.082, p=0.526, and p=0.363, respectively). The incidence of radiological osteoarthrosis was significantly higher in the posterior horn deficient knees (p=0.022). Conclusions The tendency toward relatively higher objective instability and increased incidence of osteoarthrosis in the group with absent posterior horn reinforces its importance as a secondary stabiliser of the knee. PMID:28231647

  3. Utilization of Modified NFL Combine Testing to Identify Functional Deficits in Athletes Following ACL Reconstruction

    PubMed Central

    MYER, GREGORY D.; SCHMITT, LAURA C.; BRENT, JENSEN L.; FORD, KEVIN R.; BARBER FOSS, KIM D.; SCHERER, BRADLEY J.; HEIDT, ROBERT S.; DIVINE, JON G.; HEWETT, TIMOTHY E.

    2012-01-01

    STUDY DESIGN Case control. OBJECTIVES To use modified NFL Combine testing methodology to test for functional deficits in athletes following anterior cruciate ligament (ACL) reconstruction following return to sport. BACKGROUND There is a need to develop objective, performance-based, on-field assessment methods designed to identify potential lower extremity performance deficits and related impairments in this population. METHODS Eighteen patients (mean ± SD age, 16.9 ± 2.1 years; height, 170.0 ± 8.7 cm; body mass, 71.9 ± 21.8 kg) who returned to their sport within a year following ACL reconstruction (95% CI: 7.8 to 11.9 months from surgery) participated (ACLR group). These individuals were asked to bring 1 or 2 teammates to serve as control participants, who were matched for sex, sport, and age (n = 20; mean ± SD age, 16.9 ± 1.1 years; height, 169.7 ± 8.4 cm; body mass, 70.1 ± 20.7 kg). Functional performance was tested using the broad jump, vertical jump, modified long shuttle, modified pro shuttle, modified agility T-test, timed hop, triple hop, single hop, and crossover hop tests. A 1-way multivariate analysis of variance (MANOVA) was used to evaluate group differences for dependent performance variables. RESULTS The functional performance measurements of skills requiring bilateral involvement of both lower extremities showed no group differences between the ACLR and control groups (P>.05). An overall group difference (P = .006) was observed for the combined limb symmetry index (LSI) measures. However, the modified double-limb performance tasks (long shuttle, modified agility T-test, and pro shuttle) were not, independently, sufficiently sensitive to detect limb deficits in individuals with ACL reconstruction. Conversely, the LSI on the distance measures of the single-limb performance tasks all provided moderate to large effect sizes to differentiate between the ACLR and control groups, as the individuals who had ACL reconstruction demonstrated involved

  4. Return to sports after ACL reconstruction: a new functional test protocol

    PubMed Central

    Bisciotti, Gian Nicola; Quaglia, Alessandro; Belli, Andrea; Carimati, Giulia; Volpi, Piero

    2016-01-01

    Summary Background In literature, there are lack of studies proposing clear and rationally designed test battery to be performed after an ACL reconstruction. Methods From 2006 to 2015, 80 football players were subjected, after ACL reconstruction, to a newly conceived test battery analyzing: Isometric and isokinetic force production The different phases during the jump The correct control of the landing phase after jump The control of valgus during landing after jump and cutting movements. Results The isokinetic and isometric test do not show any significant relationship with the another test. The laboratory test as well the field test showed them a significant correlation. Conclusions The results showed that a normal force production during the laboratory does not guarantee an equally satisfactory production of force during the field test. Study design Case series (Level III). PMID:28217573

  5. Correlation between fixation systems elasticity and bone tunnel widening after ACL reconstruction

    PubMed Central

    Giorgio, Nicola; Moretti, Lorenzo; Pignataro, Paolo; Carrozzo, Massimiliano; Vicenti, Giovanni; Moretti, Biagio

    2016-01-01

    Summary Background Femoral and tibial tunnel widening (TW) after ACL reconstruction is a phenomenon increasing talk in the literature. It is underlying biological and mechanical causes. Objective The aim of this study was to evaluate the relationship between bone tunnel enlargement and two different ACL fixation systems. Patients and Methods 40 patient underwent ACL reconstruction with hamstring; randomly divided into group A with 20 patients treated with stiff systems (femoral Rigidfix and tibial interference screw), and into group B, with 20 patients treated with morel elastic system (femoral and tibial Tight-rope). Evaluated postoperatively with knee MRI at 40 days, 3 months, 6 months to measure bone tunnel diameters widening. Results At 40 days tunnel widening between two groups shows no statistically difference. At 3 months postoperatively, femoral bone tunnel widening amounted on average to 1.84 mm in middle of tunnel and 1 mm at the mouth in joint in group A, and respectively 3.2 mm and 2.5 mm in group B (p<0.05). Tibial tunnel widening was 1.24 mm at the mouth in joint and 1.3 mm in middle in group A and respectively 2.26 mm and 2.43 mm in group B (p<0.05). At 6 months femoral tunnel widening amounted on average to 2.45 mm in middle and 1.35 mm at the mouth in joint in group A and respectively 3.5 mm and 2.7 mm in group B (p<0.01). Tibial tunnel widening amounted on average to 1.27 at mouth in joint and 1 mm in middle of tunnel in group A and respectively 2.6 mm and 2.3 mm in group B (p<0.01). Conclusions This study results suggest elastic fixation system increases bone tunnel enlargement after ACL reconstruction with hamstring without correlation with worse clinical performance. Level of evidence IV. PMID:28217568

  6. PATIENT-SPECIFIC AND SURGERY-SPECIFIC FACTORS THAT AFFECT RETURN TO SPORT AFTER ACL RECONSTRUCTION

    PubMed Central

    Lynch, Andrew; Rabuck, Stephen; Lynch, Brittany; Davin, Sarah; Irrgang, James

    2016-01-01

    Context Anterior cruciate ligament (ACL) reconstruction is frequently performed to allow individuals to return to their pre-injury levels of sports participation, however, return to pre-injury level of sport is poor and re-injury rates are unacceptably high. Re-injury is likely associated with the timeframe and guidelines for return to sport (RTS). It is imperative for clinicians to recognize risk factors for re-injury and to ensure that modifiable risk factors are addressed prior to RTS. The purpose of this commentary is to summarize the current literature on the outcomes following return to sport after ACL reconstruction and to outline the biologic and patient-specific factors that should be considered when counseling an athlete on their progression through rehabilitation. Evidence Acquisition A comprehensive literature search was performed to identify RTS criteria and RTS rates after ACL reconstruction with consideration paid to graft healing, anatomic reconstruction, and risk factors for re-injury and revision. Results were screened for relevant original research articles and review articles, from which results were summarized. Study Design Clinical Review of the Literature Results Variable RTS rates are presented in the literature due to variable definitions of RTS ranging from a high threshold (return to competition) to low threshold (physician clearance for return to play). Re-injury and contralateral injury rates are greater than the risk for primary ACL injury, which may be related to insufficient RTS guidelines based on time from surgery, which do not allow for proper healing or resolution of post-operative impairments and elimination of risk factors associated with both primary and secondary ACL injuries. Conclusions RTS rates to pre-injury level of activity after ACLR are poor and the risk for graft injury or contralateral injury requiring an additional surgery is substantial. Resolving impairments while eliminating movement patterns associated with

  7. ACL reconstruction: in vivo measurement of patellar tendon graft elongation.

    PubMed

    Berruto, M; Howe, J G; Beynnon, B D; Johnson, R J; Nichols, C E; Pope, M H

    1991-06-01

    The implantation of a free autogenous patellar tendon graft is the surgical technique that currently offers the best results in anterior cruciate ligament reconstruction. However, numerous aspects regarding both technique and postoperative rehabilitation can still be improved. The aim of this study was to measure the elongation of the patellar tendon in vivo in the operating room after reconstructive surgery, subjecting the knee to normal strain such as passive mobilization or anterior displacement of the tibia. Three volunteers were studied. Our results were different from those reported in a previous study conducted in vivo on a normal anterior cruciate ligament (ACL). In spite of the isometric position of the tendon, passive mobilization provoked a progressive increase in the elongation of the graft within each cycle of flexion-extension and between one cycle and the next. This also occurred during the Lachman test. These findings suggest that the graft undergoes a process of tensile adjustment when it is first put under strain. Continued elongation once this process appears stabilized raises doubts as to the reliability of isometric measuring devices.

  8. Knee functional recovery and limb-to-limb symmetry restoration after anterior cruciate ligament (ACL) rupture and ACL reconstruction

    NASA Astrophysics Data System (ADS)

    Nawasreh, Zakariya Hussein

    Anterior cruciate ligament (ACL) rupture is a common sport injury of young athletes who participate in jumping, cutting, and pivoting activities. Although ACL reconstruction (ACLR) surgery has the goal of enabling athletes to return to preinjury activity levels, treatment results often fall short of this goal. The outcomes after ACLR are variable and less than optimal with low rate of return to preinjury activity level and high risk for second ACL injury. Factors related to the knee functional limitations, strength deficits, and limb-to-limb movement asymmetry may be associated with poor outcomes after ACLR. Additionally, the criteria that are used to determine a patient's readiness to return to the preinjury activity level are undefined which may also be associated with poor outcomes after ACLR. The clinical decision-making to clear patients' for safe and successful return to high physical activities should be based on a universal comprehensive set of objective criteria that ensure normal knee function and limb-to-limb symmetry. A battery of return to activity criteria (RTAC) that emphases normal knee function and limb-to-limb movement symmetry has been constituted to better ensure safe and successful return to preinjury activity level. Yet, only variables related to patients' demographics, concomitant injuries, and treatment measures have been used to predict return to preinjury activity levels after ACLR. However, the ability of RTAC variables that ensure normal knee function and limb movement symmetry to predict the return to participate in the same preinjury activity level after ACLR has not been investigated. In light of this background, the first aim of the present study was to compare functional knee performance-based and patient-reported measures of those who PASS and who FAIL on RTAC at 6 months (6-M) following ACLR with those at 12 months (12-M) and 24 months (24-M) following ACLR and to determine how performance-based and patient-reported measures

  9. Pretibial Cyst Formation after ACL Reconstruction. A series of 14 cases with different etiologies

    PubMed Central

    Zicaro, Juan Pablo; Ranalletta, Maximiliano; Avila, Christian Garcia; Yacuzzi, Carlos; Costa-Paz, Matias

    2017-01-01

    Objectives: Among complications following an ACL reconstruction, the formation of a pre-tibial cyst in the site of the tibial tunnel is rare and might happen even years after surgery. The purpose of this study was to analyze 14 patients with pretibial cyst after ACL reconstruction. Methods: We retrospectively evaluated patients between 2008 and 2016. The inclusion criteria were patients who underwent an ACL reconstruction, and developed an extra-articular cyst at the tibial tunnel level. For recurrence evaluation, patients with less than one-year follow-up were excluded. A pre and postoperative clinical and radiological evaluation was performed. We analyzed the graft selection and surgical technique for ACL reconstruction, the time between primary surgery and onset of symptoms, and the clinical presentation. A pre and postoperative radiological evaluation was performed for every patient. Surgical technique for cyst excision, histological analysis and culture results were also analyzed. The recurrence rate was evaluated at final follow-up. Results: Nine patients were male, with an average age of 38 years. The average follow-up was of 35 months. All ACL reconstructions were performed using hamstrings graft and a trans-tibial technique. Tibial fixation was performed with a biodegradable screw in 9 patients, three of them associated with the use of a staple. In four patients hamstrings tibial insertion was left in situ with an open stripper and fixed in the tibia using non-absorbable Ethibond 2 sutures. The average time between primary ACL surgery and onset of the cyst was 29 months. All patients presented a palpable tumor at proximal tibia and a stable knee. The cyst size varied between 1 and 3 cm. In all cases, Rx and MRI showed a widening of the tibial tunnel, though no articular communication could be confirmed. The arthroscopic evaluation revealed no graft loosening. All cysts were approached through the previous tibial incision and staples or screws where removed

  10. Deficits in Quadriceps Strength and Patient-Oriented Outcomes at Return to Activity After ACL Reconstruction

    PubMed Central

    Lepley, Lindsey K.

    2015-01-01

    Context: Side-to-side quadriceps strength deficits are linked to hazardous lower extremity mechanics and reduced function at a time when individuals are returned to activity after anterior cruciate ligament (ACL) reconstruction. As a result, generalized criteria have emerged in the literature, wherein researchers are recommending that patients be cleared for participation once side-to-side differences in strength are ≤10% of the noninjured limb. Similar recommendations exist for patient-oriented outcomes (ie, self-reported function and hop tests), where deficits of ≤10% are considered ideal at return to activity. It is unclear how many studies actually achieve these clinically recommended results. Evidence Acquisition: Articles that reported quadriceps strength deficits as compared to the contralateral limb were collected from peer-reviewed sources available on Medline and Web of Science databases (1990 through August 2014). Search terms included the following: anterior cruciate ligament OR ACL AND muscle weakness, anterior cruciate ligament OR ACL AND strength; return-to-activity AND strength; anterior cruciate ligament OR ACL AND quadriceps. Study Design: Clinical review. Level of Evidence: Level 4. Results: Average side-to-side strength deficits at 6 months postreconstruction were 23% ± 8% (range, 3%-40%), while the average at 12 months postsurgery was found to be 14% ± 6% (range, 3%-28%). The average deficits in self-reported function at 6 months (mean, 14% ± 5%) and 12 months postsurgery (mean, 13% ± 6%) were also found to be >10%. Performance on hop tests was found to be less than optimal at 6 months postsurgery (mean, 11% ± 7%), but improved at 12 months postsurgery (mean, 1.3% ± 2%). Conclusion: This review provides an up-to-date account of the typical deficits in strength and patient-oriented outcomes that exist when formalized physical therapy concludes after ACL reconstruction. Based on the studies included, it seems pertinent that researchers

  11. Comparison of grafts for anatomical reconstruction of the ACL: patellar versus semitendinosus/gracilis☆

    PubMed Central

    Bitun, Patrícia Barros; Miranda, Carlos Roberto; Escudero, Ricardo Boso; Araf, Marcelo; de Souza, Daphnis Gonçalves

    2015-01-01

    Objective To compare the functional results from surgical treatment for anatomical reconstruction of the anterior cruciate ligament (ACL) with a single band, using two types of autologous grafts. Methods Twenty-seven patients who underwent anatomical reconstruction of the ACL by means of the Chambat technique were evaluated prospectively. They were divided into two groups: A, with 14 patients, using grafts from flexor tendons; and B, with 13 patients, using grafts from the patellar tendon. In both groups, fixation was performed using an absorbable interference screw. Results Based on the Lysholm score, group A presented a mean score of 71.6 in the first month, while B presented 75. At the end of the sixth month, both groups presented 96.6. Evaluation of the total IKDC showed that in the first month, the majority of the patients, both in group A (85.7%) and in group B (76.9%), presented a knee assessment that was close to normal. In the sixth month, 92.9% of group A had normal presentations, and 100% of group B. Conclusion According to the Lysholm functional evaluation and the IKDC subjective assessment, there was no statistically significant difference in the results between the groups, and the results were better in the sixth month. PMID:26229896

  12. Hop tests correlate with IKDC and KOOS at minimum of 2 years after primary ACL reconstruction

    PubMed Central

    Reinke, Emily K.; Lorring, Dawn; Jones, Morgan H.; Schmitz, Leah; Flanigan, David C.; An, Angel Qi; Quiram, Amanda R.; Preston, Emily; Martin, Michael; Schroeder, Bettina; Parker, Richard D.; Kaeding, Christopher C.; Borzi, Lynn; Pedroza, Angela; Huston, Laura J.; Harrell, Frank E.; Dunn, Warren R.

    2012-01-01

    Purpose The hypothesis of this study was that single-legged horizontal hop test ratios would correlate with IKDC, KOOS, and Marx activity level scores in patients 2 years after primary ACL reconstruction. Methods Individual patient-reported outcome tools and hop test ratios on 69 ACL reconstructed patients were compared using correlations and multivariable modeling. Correlations between specific questions on the IKDC and KOOS concerning the ability to jump and hop ratios were also performed. Results The triple-hop ratio was moderately but significantly correlated with the IKDC, KOOS Sports and Recreation subscale, and the KOOS Knee Related Quality of Life subscale, as well as with the specific questions related to jumping. Similar but weaker relationship patterns were found for the single-hop ratio and timed hop. No significant correlations were found for the Marx activity level or crossover-hop ratio. Multivariable modeling showed almost no significant additional contribution to predictability of the IKDC or KOOS subscores by gender, BMI, or the number of faults on either leg. Conclusions The triple-hop test is most significantly correlated with patient-reported outcome scores. Multivariable modeling indicates that less than a quarter of the variability in outcome scores can be explained by hop test results. This indicates that neither test can serve as a direct proxy for the other; however, assessment of patient physical function by either direct report using validated outcome tools or by the hop test will provide relatively comparable data. Level of evidence II. PMID:21445595

  13. In vivo bone tunnel evaluation of nanoparticle-grafts using an ACL reconstruction rabbit model.

    PubMed

    Grant, Sheila A; Smith, Sarah E; Schmidt, Hilary; Pfeiffer, Ferris; Kuroki, Kei; Sherman, Seth; White, Richard; Grant, David A

    2017-04-01

    Acellular human gracilis tendons conjugated with gold nanoparticles (AuNP) and hydroxyapatite nanoparticles (nano-HAp) were used as a graft in an anterior cruciate ligament (ACL) reconstruction rabbit model. The ACLs of 11 New Zealand rabbits were reconstructed using grafts conjugated without nanoparticles, with AuNP only, and with both AuNP and nano-HAp. Semi-quantitative histological scoring of bone tunnel portion of grafts was performed after 14 weeks. Bone tunnels were scored for graft degeneration, graft remodeling, percentage of new host fibrous connective, collateral connection, head-to-head connection, graft collagen fiber organization, new host fibrous connective tissue organization, and graft and interface vascularity. All grafts were intact at 14 weeks. Results of bone tunnel scoring indicate remodeling in all graft types with new organized host fibrous connective tissue, head-to-head connection to bone and mild inflammation associated with remodeling. Components of the 20 nm AuNP grafts have significantly more graft degeneration, more new host fibrous connective tissue, and more vascularity compared to crosslinked grafts. Comparison between femoral and tibial tunnel scores indicate more degeneration in femoral tunnels compared to tibial tunnels. Overall results indicated potentially enhanced remodeling from the use of 20 nm AuNP grafts. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 1071-1082, 2017.

  14. Gait Patterns Differ Between ACL-Reconstructed Athletes Who Pass Return-to-Sport Criteria and Those Who Fail

    PubMed Central

    Di Stasi, Stephanie L.; Logerstedt, David; Gardinier, Emily S.; Snyder-Mackler, Lynn

    2013-01-01

    Background The current standard of practice for an athlete to return to sport after anterior cruciate ligament (ACL) reconstruction is varied. Attempt to return to activity is typically advised 6 months after surgery, but functional performance deficits and gait abnormalities are often still evident and may have important implications on future function. Hypothesis When comparing the involved and uninvolved limbs, patients who failed return-to-sport (RTS) criteria would demonstrate (1) smaller peak knee angles, extensor moments, and peak power absorption at the knee of the involved limb and (2) larger peak hip angles, extensor moments, and peak power generation of the involved limb. Study Design Controlled laboratory study. Methods A total of 42 patients completed functional and biomechanical gait assessment 6 months after ACL reconstruction. Functional testing involved an isometric quadriceps strength test, 4 single-legged hop tests, and 2 self-report questionnaires. Three-dimensional motion analysis was used to measure sagittal plane kinematics and kinetics of the hip and knee. A mixed-model analysis of variance and post hoc t tests were used to compare the limb symmetry of those who passed and those who did not pass RTS criteria. Minimal clinically important differences were calculated from healthy gait data and used to further define meaningful limb asymmetries. Results Twenty of the 42 (48%) patients passed RTS criteria 6 months after ACL reconstruction. Patients who did not pass the criteria demonstrated statistically significant differences between limbs on all kinematic and kinetic variables at the knee (P ≤ .027). Clinically meaningful asymmetries at the hip were also identified in this group. Only kinetic asymmetries at the knee were identified in the patients who passed RTS criteria. Conclusion Athletes who demonstrate superior functional performance 6 months after ACL reconstruction may have fewer abnormal and asymmetrical gait behaviors than their

  15. Anterior cruciate ligament reconstruction using cryopreserved irradiated bone-ACL-bone-allograft transplants.

    PubMed

    Goertzen, M J; Clahsen, H; Schulitz, K P

    1994-01-01

    Bone-ACL-bone allograft transplantation has been investigated as a potential solution to reconstruction of the anterior cruciate ligament (ACL). To minimize disease transmission (e.g. the acquired immuno deficiency syndrome), bony and collagenous tissues should be sterilized. Recent animal studies indicate that gamma irradiation and ethylene oxide sterilization result in diminished histological and biomechanical properties. The purpose of the present study was biomechanical and histological determination of the fate of deep-frozen gamma-irradiated (2.5 Mrad) canine bone-ACL-bone allografts with argon gas protection. Particular attention was paid to collagenous and neuroanatomical morphology 3, 6 and 12 months after implantation, by comparison to a non-irradiated control group. Sixty skeletally mature foxhounds were operated on in this study, divided up in two groups of 30 dogs each. In group A animals the ACL was replaced by a deep-frozen (-80 degrees C) bone-ACL-bone LAD-augmented allograft subjected to 2.5 Mrad gamma irradiation with argon gas protection. The animals in group B received an LAD-augmented ACL-allograft transplant without gamma irradiation. All knees from both groups were evaluated 3, 6 and 12 months after implantation in regard to biomechanical properties, collagen morphology and routine histology (haematoxylin and eosin stain, polarization microscopy), neuroanatomical morphology (silver and gold chloride stain) and microvasculature (modified Spalteholz technique). The irradiated ACL allografts withstood a maximum load that was 63.8% (718.3 N) of the maximum load of normal ACLs after 12 months. By contrast, the non-irradiated allografts failed at 69.1% (780.1 N) of the maximum load of normal control ACLs.(ABSTRACT TRUNCATED AT 250 WORDS)

  16. KNEE SYNERGISM DURING GAIT REMAIN ALTERED ONE YEAR AFTER ACL RECONSTRUCTION

    PubMed Central

    LEPORACE, GUSTAVO; METSAVAHT, LEONARDO; PEREIRA, GLAUBER RIBEIRO; OLIVEIRA, LISZT PALMEIRA DE; CRESPO, BERNARDO; BATISTA, LUIZ ALBERTO

    2016-01-01

    ABSTRACT Objective: To compare the activation of the vastus lateralis (VL) and biceps femoris (BF) muscles during gait, as well VL/BF muscular co-contraction (MCC) between healthy (CG) and anterior cruciate ligament reconstructed (ACL-R) subjects. Methods: Nineteen subjects, ten controls and nine ACL-R patients had a VL and BF electromyogram (EMG) captured to calculate the MCC ratio. A Principal Component (PC) Analysis was applied to reduce the dimensionality effect of each of the MCC, VL and BF curves for both healthy and ACL reconstructed groups. The PC scores were used to calculate the standard distance (SD). SD values were employed in order to compare each dependent variable (MCC, VL and BF) between the two groups using unpaired t-test. Results: ACL-R group presented a lower VL activation at the beginning and at the end of the gait cycle, as compared to the control group. However, no difference was found for BF or VL/BF MCC. Conclusion: The gait analysis of ACL reconstructed patients demonstrated a persistent deficit in VL activation when compared to the control group, even one year after surgery. Level of Evidence III. Case Control Study PMID:27217814

  17. Modified Transtibial versus Anteromedial Portal Technique in Single Bundle ACL Reconstruction

    PubMed Central

    Salinas, Emiliano Alvarez; Etcheto, Horacio Rivarola; Blanchod, Cristian Collazo; Escobar, Gonzalo; Zordan, Jesuan; Autorino, Carlos María

    2017-01-01

    Objectives: The aim of this study is to determine whether it is possible to achieves a similar anatomical placement of the femoral tunnel with a modified transtibial ACL single bundle reconstruction tecnique compared to anteromedial transportal technique. Results were evaluated by tomographic comparisons between patients from both groups. Methods: 36 patients (36 knees) who were candidates for an ACL single bundle reconstruction with patellar bone graft were included in the study. Patients were randomly allocated using a computerized sequence into two groups. 18 patients were assigned each group (modified transtibial vs AM transportal technique). Surgery was performed by the same surgical team in both groups. Femoral tunnel quadrant placement, oblicuity in the coronal and sagittal planes and diameter of the femoral tunnel were assesed tomographically blinded by two observers and statistical comparison between groups was realized. Results: Average distance measured from posterior edge of the condyle to the femoral tunnel ( measured as a proportion respect to the T line) was similar in both groups ( Group I : 32.7 % +- 5.1% ; Group 2: 32.4 % +-4.4% , p = 0.85). Average distance measured from the Blumensaat line to the femoral tunnel (measured as a proportion respect to the H line) was similar in both groups ( Group I: 28.5% 4.49 % Group II , 31.5% of 4.83% p = 0.06). Average angulation values of the femoral tunnel in the coronal plane were lower in Group I than in Group II (Group I = 34.8 ° range 32.7 ° - 38.6 ° and 41.2 ° range Group II 36.7 ° - 43.1 ° P = 0.0016 ). Average angulation values of the femoral tunnel in the sagittal plane were similar in both groups (Group I 40.2 ° range 38.4 ° - 43.4 ° ; Group II 38 1 ° range 36.6 ° - 40.2 ° p = 0.17).. The average diameter of the femoral tunnel was significantly higher in group I than in Group II (Group I 11 mm 0.84 mm and 10.2 mm Group II 0.65mm p = 0.007) . Conclusion: The modified transtibial technique

  18. An intelligent recovery progress evaluation system for ACL reconstructed subjects using integrated 3-D kinematics and EMG features.

    PubMed

    Malik, Owais A; Senanayake, S M N Arosha; Zaheer, Dansih

    2015-03-01

    An intelligent recovery evaluation system is presented for objective assessment and performance monitoring of anterior cruciate ligament reconstructed (ACL-R) subjects. The system acquires 3-D kinematics of tibiofemoral joint and electromyography (EMG) data from surrounding muscles during various ambulatory and balance testing activities through wireless body-mounted inertial and EMG sensors, respectively. An integrated feature set is generated based on different features extracted from data collected for each activity. The fuzzy clustering and adaptive neuro-fuzzy inference techniques are applied to these integrated feature sets in order to provide different recovery progress assessment indicators (e.g., current stage of recovery, percentage of recovery progress as compared to healthy group, etc.) for ACL-R subjects. The system was trained and tested on data collected from a group of healthy and ACL-R subjects. For recovery stage identification, the average testing accuracy of the system was found above 95% (95-99%) for ambulatory activities and above 80% (80-84%) for balance testing activities. The overall recovery evaluation performed by the proposed system was found consistent with the assessment made by the physiotherapists using standard subjective/objective scores. The validated system can potentially be used as a decision supporting tool by physiatrists, physiotherapists, and clinicians for quantitative rehabilitation analysis of ACL-R subjects in conjunction with the existing recovery monitoring systems.

  19. The use of platelets to affect functional healing of an anterior cruciate ligament (ACL) autograft in a caprine ACL reconstruction model.

    PubMed

    Spindler, Kurt P; Murray, Martha M; Carey, James L; Zurakowski, David; Fleming, Braden C

    2009-05-01

    Many anterior cruciate ligament (ACL) reconstructions have increased laxity postoperatively. We hypothesized that enhancing an ACL graft with a collagen-platelet composite (CPC) would improve knee laxity and graft structural properties. We also hypothesized the platelet concentration in the CPC would affect these parameters. Twelve goats underwent ACL reconstruction with autologous patellar tendon graft. In six goats, a collagen-platelet composite was placed around the graft (CPC group). In the remaining six goats, the collagen scaffold only was used (COLL group). Three goats were excluded due to complications. After 6 weeks in vivo, anterior-posterior (AP) laxity and tensile properties of the ACL reconstructed knees were measured and normalized against the contralateral intact knee. At a knee flexion angle of 30 degrees, the average increase in AP laxity was 40% less in the CPC group than the COLL group (p = 0.045). At 60 degrees, the AP laxity was 30% less in the CPC group, a difference that was close to statistical significance (p = 0.080). No differences were found between treatment groups with respect to the structural properties (p > 0.30). However, there were significant correlations between serum platelet concentration and AP laxity (R2 = 0.643; p = 0.009), maximum load (R2 = 0.691; p = 0.006), and graft stiffness (R2 = 0.840; p < 0.001). In conclusion, use of a CPC to enhance healing of an allograft ACL reconstruction inversely correlated with early sagittal plane laxity and the systemic platelet count was highly predictive of ACL reconstruction graft strength and stiffness at 6 weeks. These findings emphasize the importance of further research on delineating the effect of platelets in treating of ACL injuries.

  20. The effect of platelet concentrates on graft maturation and graft-bone interface healing in ACL reconstruction in human patients

    PubMed Central

    Vavken, Patrick; Sadoghi, Patrick; Murray, Martha M

    2011-01-01

    Purpose To systematically review the current evidence for effects of platelet concentrates on (1) graft maturation and (2) graft-bone interface healing in ACL reconstruction in human, controlled trials, and for ensuing differences in clinical outcomes. Methods A systematic search of PubMed, CINAHL, EMBASE, CCTR and CDSR was performed for controlled trials of human ACL reconstruction with and without platelet concentrates. Data validity was assessed and data were collected on graft maturation, graft-bone interface healing and clinical outcome. Results Eight studies met the inclusion criteria. Seven studies reported on graft maturation with significantly better outcomes in the platelet groups in four, and large differences in means in two (underpowered) studies. Five studies report on tunnel healing, but four found no difference between groups. Three studies assessed clinical outcome but found no differences, regardless whether they had shown a benefical (1/3) or no effect (2/3) of platelets on graft and tunnel healing. Conclusion The current best evidence suggests that the addition of platelet concentrates to ACL reconstruction may have a beneficial effect on graft maturation and could improve it by 20–30% on average, but with substantial variability. The most likely mode of action is that treatment with platelets accelerates graft repopulation and remodeling, and this interpretation is supported by the existing data and biologically plausible. However, the current evidence also shows only a very limited influence of platelet concentrates on graft-bone interface healing and no significant difference in clinical outcomes. Clinical Relevance This systematic review collected evidence that the use of platelet concentrates may be a safe and inexpensive way to optimize graft maturation after ACL reconstruction, but there is no evidence for improved graft-bone interface healing or a significant difference in clinical outcomes. Level of Evidence Level IV, systematic

  1. In vivo analysis of the pivot shift phenomenon during computer navigated ACL reconstruction.

    PubMed

    Lane, Clayton G; Warren, Russell F; Stanford, Fatima C; Kendoff, Daniel; Pearle, Andrew D

    2008-05-01

    ACL insufficiency can be documented clinically with the pivot shift maneuver, but the specific pathologic kinematics of the pivot shift is difficult to quantify. Navigation provides an opportunity to analyze in vivo the motions that comprise the pivot shift and the kinematic changes that are inherent after ACL reconstruction. We hypothesized that tibial rotation, anterior tibial translation (ATT), acceleration of posterior translation (APT) and the newly described angle of P, quantified during navigated pivot shift examination, correlate with clinical grading of the pivot shift phenomena. Navigation data from 12 patients who underwent navigated ACL surgery were retrospectively reviewed. A characteristic P-shaped track of motion is recorded by the navigation software during the pivot-shift examination. The "angle of P" was developed as a means characterizing this track of motion and was measured in all cases. The tibial rotation, maximum anterior tibial translation and acceleration of posterior translation during the pivot shift were also measured. The charts of these patients were reviewed to obtain information on the clinical grading of the pivot-shift before and after ACL reconstruction. Spearman correlation analysis was then used to identify significant correlations between clinical grade of the pivot shift and the angle of p measured with computer navigation. After reconstruction, the clinical grade of the pivot shift was zero in all patients. The tibial rotation, maximum ATT, APT and the angle of p also decreased. On analysis of 24 EUAs, 12 before reconstruction and 12 after, there was excellent and significant correlation between the clinical grade of pivot shift examination and the angle of P (R2 = 0.97, p < 0.001). Only good correlation was noted between the clinical pivot shift and the rotation (R2 = 0.77, p < 0.0001), maximum ATT (R2 = 0.87, p < 0.0001) and APT (R2 = 0.81, p < 0.0001). There was a stepwise increase of 6-7 mm of translation and 5-6 degrees

  2. Bioresorbable scaffolds for anterior cruciate ligament reconstruction: do we need an off-the-shelf ACL substitute?

    PubMed

    Richmond, John C; Weitzel, Paul P

    2010-03-01

    Currently available anterior cruciate ligament (ACL) graft sources, autograft and allograft, present potential problems that a natural biomaterial ACL graft might be able to solve. Earlier efforts in the development of synthetic ACL grafts were less than optimal, and those devices have largely been abandoned. We can learn from these past failures, and potentially develop a bioresorbable scaffold for ACL reconstruction, which will provide immediate stability, promote and direct tissue in growth, and degrade at an appropriate rate, without harmful wear debris. We have developed a modified silk scaffold, which is currently being evaluated in humans in a pilot study.

  3. Giant Cell Tumor within the Proximal Tibia after ACL Reconstruction.

    PubMed

    Takahashi, Takashi; MacCormick, Lauren; Ellermann, Jutta; Clohisy, Denis; Marette, Shelly

    2016-01-01

    26-year-old female with prior anterior cruciate ligament reconstruction developed an enlarging lytic bone lesion around the tibial screw with sequential imaging over the course of one year demonstrating progression of this finding, which was confirmed histologically to be a giant cell tumor of bone. The lesion originated around the postoperative bed, making the diagnosis challenging during the early course of the presentation. The case demonstrates giant cell tumor which originated in the metaphysis and subsequently grew to involve the epiphysis; therefore, early course of the disease not involving the epiphysis should not exclude this diagnosis.

  4. Giant Cell Tumor within the Proximal Tibia after ACL Reconstruction

    PubMed Central

    Takahashi, Takashi; MacCormick, Lauren; Ellermann, Jutta; Clohisy, Denis; Marette, Shelly

    2016-01-01

    26-year-old female with prior anterior cruciate ligament reconstruction developed an enlarging lytic bone lesion around the tibial screw with sequential imaging over the course of one year demonstrating progression of this finding, which was confirmed histologically to be a giant cell tumor of bone. The lesion originated around the postoperative bed, making the diagnosis challenging during the early course of the presentation. The case demonstrates giant cell tumor which originated in the metaphysis and subsequently grew to involve the epiphysis; therefore, early course of the disease not involving the epiphysis should not exclude this diagnosis. PMID:26981302

  5. Anterior cruciate ligament- and hamstring tendon-derived cells: in vitro differential properties of cells involved in ACL reconstruction.

    PubMed

    Ghebes, Corina Adriana; Kelder, Cindy; Schot, Thomas; Renard, Auke J; Pakvis, Dean F M; Fernandes, Hugo; Saris, Daniel B

    2015-03-11

    Anterior cruciate ligament (ACL) reconstruction involves the replacement of the torn ligament with a new graft, often a hamstring tendon (HT). Described as similar, the ACL and HT have intrinsic differences related to their distinct anatomical locations. From a cellular perspective, identifying these differences represents a step forward in the search for new cues that enhance recovery after the reconstruction. The purpose of this study was to characterize the phenotype and multilineage potential of ACL- and HT-derived cells. ACL- and HT-derived cells were isolated from tissue harvest from patients undergoing total knee arthroplasty (TKA) or ACL reconstruction. In total, three ACL and three HT donors were investigated. Cell morphology, self-renewal potential (CFU-F), surface marker profiling, expression of tendon/ligament-related markers (PCR) and multilineage potential were analysed for both cell types; both had fibroblast-like morphology and low self-renewal potential. No differences in the expression of tendon/ligament-related genes or a selected set of surface markers were observed between the two cell types. However, differences in their multilineage potential were observed: while ACL-derived cells showed a high potential to differentiate into chondrocytes and adipocytes, but not osteoblasts, HT-derived cells showed poor potential to form adipocytes, chondrocytes and osteoblasts. Our results demonstrated that HT-derived cells have low multilineage potential compared to ACL-derived cells, further highlighting the need for extrinsic signals to fully restore the function of the ACL upon reconstruction. Copyright © 2015 John Wiley & Sons, Ltd.

  6. THE ROLE AND IMPLEMENTATION OF ECCENTRIC TRAINING IN ATHLETIC REHABILITATION: TENDINOPATHY, HAMSTRING STRAINS, AND ACL RECONSTRUCTION

    PubMed Central

    Reiman, Michael

    2011-01-01

    The benefits and proposed physiological mechanisms of eccentric exercise have previously been elucidated and eccentric exercise has been used for well over seventy years. Traditionally, eccentric exercise has been used as a regular component of strength training. However, in recent years, eccentric exercise has been used in rehabilitation to manage a host of conditions. Of note, there is evidence in the literature supporting eccentric exercise for the rehabilitation of tendinopathies, muscle strains, and in anterior cruciate ligament (ACL) rehabilitation. The purpose of this Clinical Commentary is to discuss the physiologic mechanism of eccentric exercise as well as to review the literature regarding the utilization of eccentric training during rehabilitation. A secondary purpose of this commentary is to provide the reader with a framework for the implementation of eccentric training during rehabilitation of tendinopathies, muscle strains, and after ACL reconstruction. PMID:21655455

  7. Assessing the progress of rehabilitation in patients with ACL reconstruction using the International Knee Documentation Committee Subjective Knee Form

    NASA Astrophysics Data System (ADS)

    Leguizamon, J. H.; Braidot, A.; Catalfamo Formento, P.

    2011-12-01

    There are numerous assessment tools designed to provide information on the results of reconstructive surgery of anterior cruciate ligament (ACL). They are also used for monitoring progress and facilitating clinical decision-making during the rehabilitation process. A brief summary of some existing tools specifically designed to evaluate knee ligament injuries is presented in this article. Then, one of those outcome measures, the International Knee Documentation Committee Subjective Knee Form (IKDC) was applied to a group of patients (N = 10) who had undergone surgery for ACL reconstruction. The patients attended the same physiotherapy service and followed a unified rehabilitation protocol. The assessment was performed twice: four and six months after surgery. The results showed an improvement in the rehabilitation of most patients tested (verified by a difference equal to or greater than 9 points on the IKDC outcome between measurements 1 and 2). The IKDC probed to be an instrument of quick and easy application. It provided quantitative data about the progress of rehabilitation and could be applied in everyday clinical physiotherapy practice. However, the results suggested considering the IKDC as one component of an evaluation kit to make decisions regarding the progress of the rehabilitation treatment.

  8. Rehabilitation of Patients Following Autogenic Bone-Patellar Tendon-Bone ACL Reconstruction: A 20-Year Perspective

    PubMed Central

    De Carlo, Mark S.; McDivitt, Ryan

    2006-01-01

    Rehabilitation of patients following anterior cruciate ligament (ACL) reconstruction has undergone remarkable improvements over the past two decades. During this time, ACL research has been at the forefront of many orthopaedic and sports physical therapy clinics. With over 20 years of ACL rehabilitation experience (senior author) and prior collaboration with accelerated ACL rehabilitation pioneer K. Donald Shelbourne, the authors wish to present a unique perspective on the evolution of ACL rehabilitation. Prior to the classic article by Paulos et al in 1981,1 literature on ACL rehabilitation was quite sparse. The basis for ACL rehabilitation at this time was founded in basic science studies conducted with animal models. In an effort to protect the graft, emphasis was placed on immobilization, extension limitation, restricted weight bearing, and delayed return to activity. Despite achieving good ligamentous stability, patients often experienced a spectrum of complications. In 1990, Shelbourne and Nitz2 proposed an accelerated rehabilitation protocol following ACL reconstruction based on clinical experience. Their program emphasized delayed surgery, earlier range of motion and weight bearing, and full extension. As a result, patients experienced better clinical outcomes while maintaining knee stability. The rehabilitation program presented in this paper is still largely based on the principles of the accelerated protocol. As evidence-based practice and the call for prospective, randomized clinical research continues, the continued progress in treating patients with this injury will be enhanced. Furthermore, clinicians are urged not to lose sight of the clinical reasoning that helped evolve the ACL rehabilitation process where it is today. PMID:21522223

  9. The anatomy of the proximal tibia in pediatric and adolescent patients: implications for ACL reconstruction and prevention of physeal arrest.

    PubMed

    Shea, Kevin G; Apel, Peter J; Pfeiffer, Ronald P; Traughber, Paul D

    2007-04-01

    Although the treatment of anterior cruciate ligament (ACL) tears in skeletally immature patients is still controversial, several studies have advocated ACL reconstruction in selected patients to prevent secondary injury. The proximal tibial physis is a structure at risk during ACL reconstruction in young patients, and physeal growth complications have been reported after surgery in this area. The relationship between the ACL and the proximal tibial physeal/apophyseal regions is poorly understood. This study examined the MRI anatomy of the ACL and the proximal tibia apophysis and epiphysis. MRIs of 59 skeletally immature knees were reviewed (Average age = 12.75 years, range 6-15) to define the anatomy of the epiphyseal and apophyseal regions. Measurements were recorded in three parasagittal planes: (1) at the lateral border of the patellar tendon, (2) the lateral edge of the ACL insertion, and (3) the medial edge of the ACL insertion. A single three-dimensional (3D) computed tomography (CT) scan was used to evaluate the position of standard drill holes used in ACL reconstruction to assess for potential degree of injury to the epiphyseal and apophyseal growth plates. In the parasagittal planes, the average height of the epiphysis was 19.6, 20.7, and 21.5 mm at the lateral border of the patellar tendon, the lateral border of the ACL, and the medial border of the ACL, respectively. At the level of the same landmarks, the apophysis extended below the physis at an average of 20.2, 16.8, and 7.0 mm, respectively. Expressed as a percentage of epiphysis height this was an average of 104, 82, and 33%, respectively. Examination of 3D CT images revealed that variations in drill hole placement had effects on the volume of injury to the proximal tibial physis and apophysis. Drill holes that started more medial, distal, and with a steeper angle of inclination reduced the amount of physis and apophysis violated when compared with holes placed more lateral, proximal, and with a

  10. Combination of Eccentric Exercise and Neuromuscular Electrical Stimulation to Improve Quadriceps Function Post-ACL Reconstruction

    PubMed Central

    Lepley, Lindsey K.; Wojtys, Edward M.; Palmieri-Smith, Riann M.

    2014-01-01

    Background Neuromuscular electrical stimulation (NMES) has been shown to reduce quadriceps activation failure (QAF), and eccentric exercise has been shown lessen muscle atrophy post-ACL reconstruction. Given that these are two critical components of quadriceps strength, intervention combining these therapies may be effective at reinstituting quadriceps function post-anterior cruciate ligament (ACL) reconstruction. Objectives To evaluate the effectiveness of a combined NMES and eccentric exercise intervention to improve the recovery of quadriceps activation and strength post-reconstruction. Design Parallel longitudinal design. Setting Laboratory. Participants Thirty-six individuals post-injury were placed into four treatment groups (N&E, NMES and eccentrics; E-only, eccentrics only; N-only, NMES-only; STND, standard of care) and ten healthy controls participated. Intervention N&E and N-only received the NMES protocol 2x per week for the first six weeks post-reconstruction. N&E and E-only received the eccentric exercise protocol 2x per week beginning six weeks post-reconstruction. Main outcome measure Quadriceps activation was assessed via the superimposed burst technique and quantified via the central activation ratio. Quadriceps strength was assessed via maximal voluntary isomeric contractions (Nm/kg). Data was gathered on three occasions: pre-operative, 12-weeks-post-surgery and at return-to-play. Results No differences in pre-operative measures existed (P>0.05). E-only recovered quadriceps activation better than N-only or STND (P<0.05). N&E and E-only recovered strength better than N-only or the STND (P<0.05) and had strength values that were similar to healthy individuals at return-to-play (P>0.05). Conclusion Eccentric exercise was capable of restoring levels of quadriceps activation and strength that were similar to those of healthy adults and better than NMES alone. PMID:25819154

  11. Correlation between body mass index and quadrupled hamstring tendon autograft size in ACL reconstruction

    PubMed Central

    ATBAŞI, ZAFER; ERÇIN, ERSIN; ERDEM, YUSUF; EMRE, TULUHAN YUNUS; ATILLA, HALIS ATIL; PARLAK, ADEM

    2016-01-01

    Purpose the aim of this study was to assess the relationship of patient weight, height and body mass index (BMI) with the size of the quadrupled hamstring tendon used in anterior cruciate ligament (ACL) reconstruction. Methods from patient records, we retrospectively assessed the weight, height, BMI and graft sizes of 126 patients who underwent ACL reconstruction using a quadrupled hamstring tendon autograft between January 2010 and January 2013 at our institution. The data obtained from perioperative measurements were studied using correlation analysis. Results statistically significant relationships were found between patient height and graft diameter (p = 0.033, r = 0.19) and between patient weight and graft diameter (p < 0.0001, r = 0.33). No statistically significant relationships were found between graft diameter and BMI or between graft length and patient height, weight and BMI (p > 0.05). Conclusions patient height and weight were found to be related to quadrupled hamstring graft diameter in our patient population. BMI was not related to the quadrupled hamstring graft size. The exact size of the graft cannot be predicted preoperatively on the basis of these variables. Level of evidence Level IV, retrospective case series. PMID:28217655

  12. Persons with reconstructed ACL exhibit altered knee mechanics during high-speed maneuvers.

    PubMed

    Lee, S-P; Chow, J W; Tillman, M D

    2014-06-01

    Anterior cruciate ligament (ACL) injury is a sports trauma that causes long-term disability. The function of the knee during dynamic activities can be severely limited even after successful surgical reconstruction. This study examined the effects of approach velocity during side-step cutting on knee joint mechanics in persons with reconstructed ACL (ACLR). 22 participants (11 with unilateral ACLR, 11 matched-controls) participated. Knee joint mechanics were tested in 3 approach conditions: counter-movement, one-step, and running. Dependent variables, including peak knee flexion, extension, valgus, varus, internal rotation, external rotation angles and corresponding peak joint moments, were assessed during the stance phase of cutting. Two 2×3 ("group" by "approach condition") mixed MANOVA tests were used to examine the effects of ACLR and approach velocity on knee mechanics. ACLR participants exhibited higher knee internal rotator moment (0.22 vs. 0.13 Nm/kg, p=0.003). Inter-group comparisons revealed that the ACLR participants exhibited significantly higher abductor and internal rotator moments only in the running condition (1.86 vs. 1.16 Nm/kg, p=0.018; 0.28 vs. 0.17 Nm/kg, p=0.010, respectively). Our findings suggested that patients with ACLR may be at increased risk of re-injury when participating in high-demand physical activities. Task demand should be considered when prescribing progressive therapeutic interventions to ACLR patients.

  13. FUNCTIONAL TESTING TO DETERMINE READINESS TO DISCONTINUE BRACE USE, ONE YEAR AFTER ACL RECONSTRUCTION

    PubMed Central

    Hunter‐Giordano, Airelle; Axe, Michael J.; Snyder‐Mackler, Lynn

    2013-01-01

    Background: While the use of functional knee braces for return to sports or high level physical activity after ACL reconstruction (ACLR) is controversial, brace use is still prevalent.1,2,3,4,5 All active patients in the practice are braced after ACLR and must pass a battery of sports tests before they return to play in their brace. Criteria include a 90% score on 4 one‐legged hop tests9 burst superimposition strength test,10 Knee Outcome Survey Activities of Daily Living Scale,8 and a global rating of knee function. Purpose: The purpose of this study was to describe the use of criterion‐based guidelines to determine if athletes who had undergone an ACLR function better with or without their functional brace, one year after surgery. Study Design: Cross‐Sectional Study Methods: Sixty‐four patients post ACLR performed 4 one‐legged hop tests,9 burst superimposition strength test,10 and completed the Knee Outcome Survey Activities of Daily Living Scale,8 and a global rating of knee function one year after surgery with and without their brace. Results: Participants included 35 men and 29 women with a mean age of 25 years. The Mean Knee Outcome Survey Activities of Daily Living score was 98%, and the global rating was 97%. Of the subjects, one patient failed hop testing by at least one criterion with and without the brace. Three additional patients failed the test while braced but passed un‐braced, and one patient passed with the brace, but failed without the brace. Subjects performed significantly better un‐braced than braced in all hop tests: single leg hop braced = 101%; un‐braced = 107% (p<0.001); cross‐over hop braced = 100%; un‐braced = 105% (p<0.001); triple hop braced = 99%; un‐braced = 101% (p=0.003); timed hop braced = 98%; un‐braced = 103% (p = 0.004). Conclusions: Sixty‐two of 64 patients continued to score above return to play criteria one year after ACLR. All but two subjects in the cohort performed better un‐braced than braced

  14. Degeneration in ACL Injured Knees with and without Reconstruction in Relation to Muscle Size and Fat Content—Data from the Osteoarthritis Initiative

    PubMed Central

    Baum, Thomas; Nevitt, Michael C.; Nardo, Lorenzo; Gersing, Alexandra S.; Lane, Nancy E.; McCulloch, Charles E.; Rummeny, Ernst J.; Link, Thomas M.

    2016-01-01

    Background Anterior cruciate ligaments (ACL) injuries represent a major risk factor for early osteoarthritis (OA). Purpose To evaluate the prevalence and 4-year progression of knee OA measured with 3T MR-imaging in individuals with ruptured, reconstructed or normal ACL and to assess the impact of thigh muscle characteristics. Methods A total of 54 knees (23/54 male, 31/54 female) were recruited from the Osteoarthritis Initiative (OAI). At baseline, 15/54 subjects had prevalent ACL ruptures and 15/54 subjects had prevalent ACL reconstruction (24/54 normal ACL). Western Ontario and McMasters Universities Arthritis Index (WOMAC) scores, Physical Activity Scores of the Elderly (PASE) and thigh muscle characteristics including strength, fat infiltration (Goutallier score) and thigh muscle cross-sectional area (CSA) MR measurements were obtained at baseline. Whole-organ MR-imaging Scores (WORMS) were obtained at baseline and at a 4-year follow-up time-point. Multivariate regression models, adjusting for covariates (age, gender, body mass index), were used for statistical analysis. Results At baseline, subjects with prevalent ACL ruptures had worse WORMS total scores (mean±SEM, 44.1±3.5) than subjects with ACL reconstruction (30.8±4.0; P = 0.015) and worse than subjects with normal ACL (21.3±3.0; P<0.001). Cartilage scores were worse in both femorotibial compartments in ACL injured knees than in knees with normal ACL (P<0.05). Knees with ACL reconstruction showed an increased degeneration of the medial meniscus (P = 0.036), cartilage degeneration at the medial femoral condyle (P = 0.011). In a multivariate regression model, including both ACL groups and total muscle characteristics as influence parameters, high thigh muscle CSA, high muscle/ fat ratio and low Goutallier scores were associated with less degenerative changes at the knee, independent of ACL status. Knees with ACL reconstruction showed an increased progression of cartilage degeneration at the medial tibia

  15. Frontal plane knee mechanics and medial cartilage MR relaxation times in individuals with ACL reconstruction : A pilot study

    PubMed Central

    Kumar, Deepak; Kothari, Abbas; Souza, Richard B.; Wu, Samuel; Ma, C. Benjamin; Li, Xiaojuan

    2014-01-01

    Background The objective of this pilot study was to evaluate cartilage T1ρ and T2 relaxation times and knee mechanics during walking and drop-landing for individuals with anterior cruciate ligament reconstruction (ACL-R). Methods Nine patients (6 men and 3 women, Age 35.8±5.4 years, BMI 23.5±2.5 kg/m2) participated 1.5±0.8 years after single-bundle two-tunnel ACL reconstruction. Peak knee adduction moment (KAM), flexion moment (KFM), extension moment (KEM), and peak varus were calculated from kinematic and kinetic data obtained during walking and drop-landing tasks. T1ρ and T2 times were calculated for medial femur (MF), and medial tibia (MT) cartilage and compared between subjects with low KAM and high KAM. Biomechanical variables were compared between limbs. Results The high KAM group had higher T1ρ for MT (p = 0.01), central MT (p = 0.05), posterior MF (p = 0.04), posterior MT (p = 0.01); and higher T2 for MT (p = 0.02), MF (p = 0.05) posterior MF (p = 0.002) and posterior MT (p = 0.01). During walking, ACL-R knees had greater flexion at initial contact (p =0.04), and lower KEM (p = 0.02). During drop-landing, the ACL-R knees had lower KAM (p = 0.03) and KFM (p = 0.002). Conclusion Patients with ACL-R who have higher KAM during walking had elevated MR relaxation times in the medial knee compartments. These data suggest that those individuals who have undergone ACL-R and have higher frontal plane loading, may be at a greater risk of knee osteoarthritis. PMID:24993277

  16. Sex-specific gait adaptations prior to and up to six months after ACL reconstruction

    PubMed Central

    Stasi, Stephanie L. Di; Hartigan, Erin H.; Snyder-Mackler, Lynn

    2015-01-01

    STUDY DESIGN Controlled longitudinal laboratory study. OBJECTIVES Compare sagittal plane gait mechanics of men and women before and up to 6 months after anterior cruciate ligament reconstruction (ACLR). BACKGROUND Aberrant gait patterns are ubiquitous after anterior cruciate ligament (ACL) rupture and persist after ACLR despite skilled physical therapy. Sex influences post-operative function and second ACL injury risk, but its influence on gait adaptations after injury have not been investigated. METHODS Sagittal plane knee and hip joint excursions during midstance and internal knee and hip extension moments at peak knee flexion were collected on 12 women and 27 men using 3-dimensional gait analysis before (Screen) and after pre-operative physical therapy (Pre-sx), and 6 months after ACLR (6mo). Repeated measures analysis of variance models were used to determine whether limb asymmetries changed differently over time in men and women. RESULTS Significant time x limb x sex interactions were identified for hip and knee excursions and internal knee extension moments (P≤.007). Both sexes demonstrated smaller knee excursions on the involved compared to the uninvolved knee at each time point (P≤.007), but only women demonstrated a decrease in the involved knee excursion from pre-sx to 6mo (P=.03). Women also demonstrated smaller hip excursions (P<.001) and internal knee extension moments (P=.005) on the involved limb compared to the uninvolved limb at 6mo. Men demonstrated smaller hip excursions and knee moments on the involved limb compared to the uninvolved limb (main effects, P<.001). CONCLUSION The persistence of limb asymmetries in men and women 6 months after ACLR indicates that current rehabilitation efforts are inadequate for some individuals following ACLR. PMID:25627155

  17. Evaluation of an intact, an ACL-deficient, and a reconstructed human knee joint finite element model.

    PubMed

    Vairis, Achilles; Stefanoudakis, George; Petousis, Markos; Vidakis, Nectarios; Tsainis, Andreas-Marios; Kandyla, Betina

    2016-02-01

    The human knee joint has a three-dimensional geometry with multiple body articulations that produce complex mechanical responses under loads that occur in everyday life and sports activities. Understanding the complex mechanical interactions of these load-bearing structures is of use when the treatment of relevant diseases is evaluated and assisting devices are designed. The anterior cruciate ligament (ACL) in the knee is one of four main ligaments that connects the femur to the tibia and is often torn during sudden twisting motions, resulting in knee instability. The objective of this work is to study the mechanical behavior of the human knee joint and evaluate the differences in its response for three different states, i.e., intact, ACL-deficient, and surgically treated (reconstructed) knee. The finite element models corresponding to these states were developed. For the reconstructed model, a novel repair device was developed and patented by the author in previous work. Static load cases were applied, as have already been presented in a previous work, in order to compare the calculated results produced by the two models the ACL-deficient and the surgically reconstructed knee joint, under the exact same loading conditions. Displacements were calculated in different directions for the load cases studied and were found to be very close to those from previous modeling work and were in good agreement with experimental data presented in literature. The developed finite element model for both the intact and the ACL-deficient human knee joint is a reliable tool to study the kinematics of the human knee, as results of this study show. In addition, the reconstructed human knee joint model had kinematic behavior similar to the intact knee joint, showing that such reconstruction devices can restore human knee stability to an adequate extent.

  18. Preoperative Predictors for Noncopers to Pass Return to Sports Criteria After ACL Reconstruction

    PubMed Central

    Zeni, Joseph; Di Stasi, Stephanie; Axe, Michael J.; Snyder-Mackler, Lynn

    2013-01-01

    Less than 50% of athletes pass criteria to return to sports (RTS) 6 months after ACL reconstruction (ACLR). Using data on 38 noncopers, we hypothesized that preoperative age, quadriceps strength index (QI), and knee flexion moments (KFM) during gait would predict the ability to pass/fail RTS criteria and that preoperative quadriceps strength gains would be predictive of passing RTS criteria. Gait analysis and strength data were collected before and after a preoperative intervention and 6 months after ACLR. Age, QI, and KFM each contributed to the predictability to pass or fail RTS criteria 6 months after ACLR. Collectively, the variables predict 69% who would pass and 82% who would fail RTS criteria 6 months after ACLR. Younger athletes who have symmetrical quadriceps strength and greater KFM were more likely to pass RTS criteria. Further, 63% of those who increased preoperative quadriceps strength passed RTS criteria, whereas 73% who did not failed. Increasing quadriceps strength in noncopers before ACLR seems warranted. PMID:22983930

  19. Evaluation of strength muscle recovery with isokinetic, squat jump and stiffness tests in athletes with ACL reconstruction: a case control study.

    PubMed

    Jacopetti, Marco; Pasquini, Andrea; Costantino, Cosimo

    2016-05-06

    BackgroundThe anterior cruciate ligament (ACL) rupture accounting for about 50% of all knee ligament injuries. The rehabilitation program requires a long time to rebuild muscle strength and to reestablish joint mobility and neuromuscular control. The purpose of the study is to evaluate the muscle strength recovery in athletes with ACL reconstruction. MethodsWe enrolled soccer atlethes, with isolated anterior cruciate ligament rupture treated with bone-patellar tendon-bone autograft artroscopic reconstruction. Each patients were evaluated comparing operated and controlateral limb by isokinetic test and triaxial accelerometer test. Isokinetic movements tested were knee flexion-extension with concentric-concentric contraction. Accelerometer test were Squat Jump Test (SJT)  and Stiffness Test (ST). Results17 subjects were selected, there was no significant difference in isokinetic quadriceps and hamstrings results in strength and endurance values. Parameters of ST were comparable between the operated and unoperated side. In SJT a significant statistical difference was in height of jump (p=0,02) no statistical difference was evidenced in the other measures.ConclusionCurrently complete recovery of symmetric explosive strength seems to be an important parameter for evaluating the performance after ACL reconstruction and the symmetry in test results jump could be associated with an adequate return to sports. In our study the explosive strenght is lower in the limb operated than the healthy one. Explosive strength recovery with pliometric training should be included in the post-surgical rehabilitation protocol and its measurement should be performed to assess the full recovery before the restart of sport activities.

  20. Whole Body Vibration Exercise Protocol versus a Standard Exercise Protocol after ACL Reconstruction: A Clinical Randomized Controlled Trial with Short Term Follow-Up

    PubMed Central

    Berschin, Gereon; Sommer, Björn; Behrens, Antje; Sommer, Hans-Martin

    2014-01-01

    The suitability and effectiveness of whole body vibration (WBV) exercise in rehabilitation after injury of the anterior cruciate ligament (ACL) was studied using a specially designed WBV protocol. We wanted to test the hypothesis if WBV leads to superior short term results regarding neuromuscular performance (strength and coordination) and would be less time consuming than a current standard muscle strengthening protocol. In this prospective randomized controlled clinical trial, forty patients who tore their ACL and underwent subsequent ligament reconstruction were enrolled. Patients were randomized to the whole body vibration (n=20) or standard rehabilitation exercise protocol (n=20). Both protocols started in the 2nd week after surgery. Isometric and isokinetic strength measurements, clinical assessment, Lysholm score, neuromuscular performance were conducted weeks 2, 5, 8 and 11 after surgery. Time spent for rehabilitation exercise was reduced to less than a half in the WBV group. There were no statistically significant differences in terms of clinical assessment, Lysholm score, isokinetic and isometric strength. The WBV group displayed significant better results in the stability test. In conclusion, preliminary data indicate that our whole body vibration muscle exercise protocol seems to be a good alternative to a standard exercise program in ACL-rehabilitation. Despite of its significant reduced time requirement it is at least equally effective compared to a standard rehabilitation protocol. Key points In this prospective randomized controlled clinical trial, we tested the hypothesis if WBV leads to superior short term results regarding neuromuscular performance (strength and coordination) and would be less time consuming than a current standard muscle strengthening protocol in forty patients who underwent ACL reconstruction. Time spent for rehabilitation exercise was reduced to less than a half in the WBV group as compared to the standard exercise group. Both

  1. Effects of ACL reconstruction surgery on muscle activity of the lower limb during a jump-cut maneuver in males and females

    PubMed Central

    Coats-Thomas, Margaret S.; Miranda, Daniel L.; Badger, Gary J.; Fleming, Braden C.

    2013-01-01

    We compared muscle activity of the quadriceps, hamstring, and gastrocnemius muscles when ACL-intact (ACLINT) and ACL-reconstructed (ACLREC) male and female subjects performed a jump-cut task. Surface electromyography sensors were used to evaluate time to peak muscle activity and muscle activity ratios. Rectus femoris (RF) and vastus medialis (VM) peak timing was 71 ms and 78 ms earlier in ACLINT than in ACLREC subjects, respectively. Biceps femoris (BF) peak timing was 90 ms earlier in ACLINT than in ACLREC subjects and 75 ms earlier in females than in males. Medial gastrocnemius (MG) muscle peak timing was 77 ms earlier in ACLINT than in ACLREC subjects. Lateral gastrocnemius (LG) and MG muscle peak times were 106 ms and 87 ms earlier in females than in males, respectively. The RF, VM, BF and MG peaked later in ACLREC than in ACLINT subjects. There was evidence suggesting that the loading phase quadriceps:hamstring (quad:ham) muscle activity ratio was greater in ACLREC than in ACLINT subjects. Finally, the injury risk phase quad:ham muscle activity ratio was found to be 4.8 times greater in females than in males. In conclusion, there are differences in muscle activity related to ACL status and sex that could potentially help explain graft failure risk and the sex bias. PMID:23966333

  2. Lower limb asymmetry in mechanical muscle function: A comparison between ski racers with and without ACL reconstruction.

    PubMed

    Jordan, M J; Aagaard, P; Herzog, W

    2015-06-01

    Due to a high incidence of anterior cruciate ligament (ACL) re-injury in alpine ski racers, this study aims to assess functional asymmetry in the countermovement jump (CMJ), squat jump (SJ), and leg muscle mass in elite ski racers with and without anterior cruciate ligament reconstruction (ACL-R). Elite alpine skiers with ACL-R (n = 9; 26.2 ± 11.8 months post-op) and uninjured skiers (n = 9) participated in neuromuscular screening. Vertical ground reaction force during the CMJ and SJ was assessed using dual force plate methodology to obtain phase-specific bilateral asymmetry indices (AIs) for kinetic impulse (CMJ and SJ phase-specific kinetic impulse AI). Dual x-ray absorptiometry scanning was used to assess asymmetry in lower body muscle mass. Compared with controls, ACL-R skiers had increased AI in muscle mass (P < 0.001), kinetic impulse AI in the CMJ concentric phase (P < 0.05), and the final phase of the SJ (P < 0.05). Positive associations were observed between muscle mass and AI in the CMJ concentric phase (r = 0.57, P < 0.01) as well as in the late SJ phase (r = 0.66, P < 0.01). Future research is required to assess the role of the CMJ and SJ phase-specific kinetic impulse AI as a part of a multifaceted approach for improving outcome following ACL-R in elite ski racers.

  3. Persistent Biomechanical Alterations After ACL Reconstruction Are Associated With Early Cartilage Matrix Changes Detected by Quantitative MR

    PubMed Central

    Amano, Keiko; Pedoia, Valentina; Su, Favian; Souza, Richard B.; Li, Xiaojuan; Ma, C. Benjamin

    2016-01-01

    Background: The effectiveness of anterior cruciate ligament (ACL) reconstruction in preventing early osteoarthritis is debated. Restoring the original biomechanics may potentially prevent degeneration, but apparent pathomechanisms have yet to be described. Newer quantitative magnetic resonance (qMR) imaging techniques, specifically T1ρ and T2, offer novel, noninvasive methods of visualizing and quantifying early cartilage degeneration. Purpose: To determine the tibiofemoral biomechanical alterations before and after ACL reconstruction using magnetic resonance imaging (MRI) and to evaluate the association between biomechanics and cartilage degeneration using T1ρ and T2. Study Design: Cohort study; Level of evidence, 2. Methods: Knee MRIs of 51 individuals (mean age, 29.5 ± 8.4 years) with unilateral ACL injuries were obtained prior to surgery; 19 control subjects (mean age, 30.7 ± 5.3 years) were also scanned. Follow-up MRIs were obtained at 6 months and 1 year. Tibial position (TP), internal tibial rotation (ITR), and T1ρ and T2 were calculated using an in-house Matlab program. Student t tests, repeated measures, and regression models were used to compare differences between injured and uninjured sides, observe longitudinal changes, and evaluate correlations between TP, ITR, and T1ρ and T2. Results: TP was significantly more anterior on the injured side at all time points (P < .001). ITR was significantly increased on the injured side prior to surgery (P = .033). At 1 year, a more anterior TP was associated with elevated T1ρ (P = .002) and T2 (P = .026) in the posterolateral tibia and with decreased T2 in the central lateral femur (P = .048); ITR was associated with increased T1ρ in the posteromedial femur (P = .009). ITR at 6 months was associated with increased T1ρ at 1 year in the posteromedial tibia (P = .029). Conclusion: Persistent biomechanical alterations after ACL reconstruction are related to significant changes in cartilage T1ρ and T2 at 1 year

  4. ACL Revision in Synthetic ACL graft failure

    PubMed Central

    Etcheto, H. Rivarola; Zordán, J.; Escobar, G.; Collazo, C.; Palanconi, M.; Autorino, C.; Salinas, E. Alvarez

    2017-01-01

    The development of synthetic grafts as an alternative to biological grafts for reconstruction of the anterior cruciate ligament dates from 1980. The interest is awakened due to the potential advantages of: The absence of morbidity associated with donor site, and early return to sport. However, this surgical technique has had multiple complications associated with graft: mechanical failures (synthetic graft failure, loss of fixation), synovial foreign body reaction, recurrent stroke, recurrent instability and ultimately, early osteoarthritis. Objectives: We describe the synthetic graft failure LCA, intraoperative findings and details of surgical technique. Methods: Patient 35 years old, with a history of ACL reconstruction four years of evolution in another health center, consultation with the Service knee arthroscopy for acute knee pain left knee during secondary sporting event to a rotation mechanism with fixed foot. On physical examination, presents and positive Lachman maneuver Pivot. Radiografia in a widening of the tibial tunnel is observed. NMR shows a discontinuity of fibers of synthetic graft. Results: First time arthroscopic revision where synthetic plastic LCA identifies with Disruption fiber pattern. Intraoperatively, hypertrophic chronic synovitis localized predominantly in intercóndilo is observed. debridement thereof is performed, and proceeds to the extraction of the synthetic ligament. Then he was made prior cruentado and revival of the edges of the tunnel, filling them with non-irradiated structural bone allograft. At four months as planned and after confirmation by studies incorporating bone graft was performed the second time with the new plastic ACL. It was planned like a primary graft surgery with autologous hamstring prepared in fourfold form, and fixation with modified transtibial technique Biotransfix system proximal and distal screw Biocomposite (arthrex®). A quadruple graft 9 mm was obtained, making good positioning of tunnels and stable

  5. Effect of Calcium Phosphate–Hybridized Tendon Graft in Anatomic Single-Bundle ACL Reconstruction in Goats

    PubMed Central

    Mutsuzaki, Hirotaka; Fujie, Hiromichi; Nakajima, Hiromi; Fukagawa, Makoto; Nomura, Shunsuke; Sakane, Masataka

    2016-01-01

    Background: We previously developed a novel technique using an alternate soaking process that improves tendon-bone healing by hybridizing the tendon graft with calcium phosphate (CaP). However, the effects of the CaP-hybridized tendon graft on anatomic single-bundle anterior cruciate ligament (ACL) reconstruction remain unclear. Purpose: To determine the effects of CaP-hybridized tendon grafts compared with untreated tendon grafts 6 months after anatomic single-bundle ACL reconstruction using a goat model. Study Design: Controlled laboratory study. Methods: Animals were divided into a CaP group (n = 5 goats) and a control group (n = 5 goats), and we analyzed (1) knee kinematics and in situ forces under applied anterior tibial loads of 50 N and internal tibial torque of 2.0 N·m in the grafts at full extension and at 60° and 90° of knee flexion, (2) the mean percentage of bone tunnel enlargement using computed tomography (CT), and (3) the histology of the tendon-bone interface. Results: The in situ forces under applied anterior tibial loads of 50 N at 60° and 90° of knee flexion in the CaP group were greater than those in the control group (P < .05). The red safranin-O–stained area, indicating glycosaminoglycans in the cartilage layers at the joint aperture sites of the anterior femoral and posterior tibial bone tunnel, was greater in the CaP group than that in the control group (P < .05). The lengths of the nonbonding gap area between the anterior femoral and posterior tibial bone tunnels in the control group were greater than those in the CaP group (P < .05). No significant difference could be detected in the mean percentage of bone tunnel enlargement between the 2 groups. Conclusion: The CaP-hybridized tendon graft enhanced tendon-bone healing at the joint aperture site in both anterior femoral and posterior tibial tunnels 6 months after anatomic single-bundle ACL reconstruction in goats. The in situ forces under applied anterior tibial loads at greater

  6. Do Newer-Generation Bioabsorbable Screws Become Incorporated into Bone at Two Years After ACL Reconstruction with Patellar Tendon Graft?

    PubMed Central

    Cox, Charles L.; Spindler, Kurt P.; Leonard, James P.; Morris, Brent J.; Dunn, Warren R.; Reinke, Emily K.

    2014-01-01

    Background: Bioabsorbable interference screws are used frequently for graft fixation in ACL (anterior cruciate ligament) reconstruction. The resorption properties of many available screws that are marketed as bioabsorbable are not well defined. The CALAXO (Smith & Nephew Endoscopy) and MILAGRO (DePuy Synthes) bioabsorbable screws contain polymers of poly(lactic-co-glycolic acid) (PLGA) plus additives to encourage osseointegration over time. The purpose of this study was to evaluate radiographic and magnetic resonance imaging (MRI) properties and compare patient-reported outcomes at a minimum of two years of follow-up after ACL reconstruction using CALAXO or MILAGRO bioabsorbable interference screws. Methods: A cohort of patients who underwent ACL reconstruction in which the fixation used was either CALAXO or MILAGRO screws returned for repeat radiographs for evaluation of tunnel widening, repeat MRI for evaluation of graft integrity and screw breakdown, and completion of the pain and symptom items of the KOOS (Knee injury and Osteoarthritis Outcome Score) questionnaire. Results: At a mean of three years (range, 2.5 to 4.0 years) after surgery, thirty-one patients with sixty-two CALAXO screws and thirty-six patients with seventy-two MILAGRO screws returned for repeat evaluation. Two blinded, independent reviewers found no significant differences between the two screw types when comparing radiographs for tibial or femoral tunnel widening or MRIs for graft integrity, tibial and femoral foreign body reactions, or femoral screw degradation. Both reviewers found a significant difference between the two screw types when comparing tibial screw degradation properties (p < 0.01). All analyzed CALAXO screws were rated as partially intact or degraded; the MILAGRO screws were more likely to be rated as intact. No significant differences were noted between the two screw types when comparing the two KOOS subscales. Conclusions: CALAXO screws in the tibial tunnel were more likely

  7. Assessing 3D tunnel position in ACL reconstruction using a novel single image 3D-2D registration

    NASA Astrophysics Data System (ADS)

    Kang, X.; Yau, W. P.; Otake, Y.; Cheung, P. Y. S.; Hu, Y.; Taylor, R. H.

    2012-02-01

    The routinely used procedure for evaluating tunnel positions following anterior cruciate ligament (ACL) reconstructions based on standard X-ray images is known to pose difficulties in terms of obtaining accurate measures, especially in providing three-dimensional tunnel positions. This is largely due to the variability in individual knee joint pose relative to X-ray plates. Accurate results were reported using postoperative CT. However, its extensive usage in clinical routine is hampered by its major requirement of having CT scans of individual patients, which is not available for most ACL reconstructions. These difficulties are addressed through the proposed method, which aligns a knee model to X-ray images using our novel single-image 3D-2D registration method and then estimates the 3D tunnel position. In the proposed method, the alignment is achieved by using a novel contour-based 3D-2D registration method wherein image contours are treated as a set of oriented points. However, instead of using some form of orientation weighting function and multiplying it with a distance function, we formulate the 3D-2D registration as a probability density estimation using a mixture of von Mises-Fisher-Gaussian (vMFG) distributions and solve it through an expectation maximization (EM) algorithm. Compared with the ground-truth established from postoperative CT, our registration method in an experiment using a plastic phantom showed accurate results with errors of (-0.43°+/-1.19°, 0.45°+/-2.17°, 0.23°+/-1.05°) and (0.03+/-0.55, -0.03+/-0.54, -2.73+/-1.64) mm. As for the entry point of the ACL tunnel, one of the key measurements, it was obtained with high accuracy of 0.53+/-0.30 mm distance errors.

  8. Athletic Performance at the National Basketball Association Combine After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Mehran, Nima; Williams, Phillip N.; Keller, Robert A.; Khalil, Lafi S.; Lombardo, Stephen J.; Kharrazi, F. Daniel

    2016-01-01

    Background: Anterior cruciate ligament (ACL) injuries are significant injuries in elite-level basketball players. In-game statistical performance after ACL reconstruction has been demonstrated; however, few studies have reviewed functional performance in National Basketball Association (NBA)–caliber athletes after ACL reconstruction. Purpose: To compare NBA Combine performance of athletes after ACL reconstruction with an age-, size-, and position-matched control group of players with no previous reported knee injury requiring surgery. We hypothesized that there is no difference between the 2 groups in functional performance. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 1092 NBA-caliber players who participated in the NBA Combine between 2000 and 2015 were reviewed. Twenty-one athletes were identified as having primary ACL reconstruction prior to participation in the combine. This study group was compared with an age-, size-, and position-matched control group in objective functional performance testing, including the shuttle run test, lane agility test, three-quarter court sprint, vertical jump (no step), and maximum vertical jump (running start). Results: With regard to quickness and agility, both ACL-reconstructed athletes and controls scored an average of 11.5 seconds in the lane agility test and 3.1 seconds in the shuttle run test (P = .745 and .346, respectively). Speed and acceleration was measured by the three-quarter court sprint, in which both the study group and the control group averaged 3.3 seconds (P = .516). In the maximum vertical jump, which demonstrates an athlete’s jumping ability with a running start, the ACL reconstruction group had an average height of 33.6 inches while the controls averaged 33.9 inches (P = .548). In the standing vertical jump, the ACL reconstruction group averaged 28.2 inches while the control group averaged 29.2 inches (P = .067). Conclusion: In athletes who are able to return to sport

  9. Analytical performances of Hemoclot Protein C Reagent on ACL TOP analyzer.

    PubMed

    Calmette, Leyla; Charpentier, Nicole; Tircot, Caroline; Bigot, Delphine; Dunois, Claire; Amiral, Jean; Tetegan, Marcelle; Sep Hieng, Sonnthida; Peltier, Jean-Yves

    2016-12-01

    Our study aimed to evaluate and validate according to standard NF EN ISO 15189 the original protocol ajustement of Hemoclot Protein C (PC) (Hyphen BioMed), clotting-based assay of PC on ACL TOP analyzer (Werfen/Instrumentation Laboratory). We evaluated the performance in terms of imprecision and we validate additional parameters in range B required by the SH GTA 04 (COFRAC): repeatability, reproducibility, detection and quantification limits, limits of linearity, stability, inter-samples and inter-reagents contamination, inaccuracy, evaluation of interferences (hemolysis, bilirubinemia and chyles). A comparison with Hemoclot PC on STA Compact analyzer (Stago) was performed. Coefficients of variation were lower than 5 %. Detection and quantification limits were respectively 8.3 % and 9.3 %. Superior limit of linearity was 140 %. The test didn't diplay any inter-samples and inter-reagents contamination. Reagent after reconstitution was stable 6 hours on ACL TOP. No interferences were observed for hemoglobin lower than 500 mg/dL, for bilirubin lower than and for chyles lower than 300 mg/dL. Comparison with Hemoclot PC on STA analyzer (Stago) was satisfactory. Hemoclot PC adjusted on ACL TOP analyzer showed satisfactory analytical performances with criteria chosen in our study. These data allow a better knowledge of the performances of this test and were useful to make a validation file in range B as recommended by SH GTA 04.

  10. Can course format influence the performance of students in an advanced cardiac life support (ACLS) program?

    PubMed

    Garrido, F D; Romano, M M D; Schmidt, A; Pazin-Filho, A

    2011-01-01

    Advanced cardiac life support (ACLS) is a problem-based course that employs simulation techniques to teach the standard management techniques of cardiovascular emergencies. Its structure is periodically revised according to new versions of the American Heart Association guidelines. Since it was introduced in Brazil in 1996, the ACLS has been through two conceptual and structural changes. Detailed documented reports on the effect of these changes on student performance are limited. The objective of the present study was to evaluate the effect of conceptual and structural changes of the course on student ACLS performance at a Brazilian training center. This was a retrospective study of 3266 students divided into two groups according to the teaching model: Model 1 (N = 1181; 1999-2003) and Model 2 (N = 2085; 2003-2007). Model 2 increased practical skill activities to 75% of the total versus 60% in Model 1. Furthermore, the teaching material provided to the students before the course was more objective than that used for Model 1. Scores greater than 85% in the theoretical evaluation and approval in the evaluation of practice by the instructor were considered to be a positive outcome. Multiple logistic regression was used to adjust for potential confounders (specialty, residency, study time, opportunity to enhance practical skills during the course and location where the course was given). Compared to Model 1, Model 2 presented odds ratios (OR) indicating better performance in the theoretical (OR = 1.34; 95%CI = 1.10-1.64), practical (OR = 1.19; 95%CI = 0.90-1.57), and combined (OR = 1.38; 95%CI = 1.13-1.68) outcomes. Increasing the time devoted to practical skills did not improve the performance of ACLS students.

  11. Neuromuscular Coordination Deficit Persists 12 Months after ACL Reconstruction But Can Be Modulated by 6 Weeks of Kettlebell Training: A Case Study in Women's Elite Soccer

    PubMed Central

    Andersen, Christoffer H.; Bencke, Jesper; Ørntoft, Christina; Linnebjerg, Connie; Hölmich, Per

    2017-01-01

    The aim of the present single-case study was to investigate the effect of 6 weeks' kettlebell training on the neuromuscular risk profile for ACL injury in a high-risk athlete returning to sport after ACL reconstruction. A female elite soccer player (age 21 years) with no previous history of ACL injury went through neuromuscular screening as measured by EMG preactivity of vastus lateralis and semitendinosus during a standardized sidecutting maneuver. Subsequently, the player experienced a noncontact ACL injury. The player was screened again following postreconstruction rehabilitation, then underwent 6-week kettlebell training, and was subsequently screened again at 6-week follow-up. Prior to and after postreconstruction rehabilitation the player demonstrated a neuromuscular profile during sidecutting known to increase the risk for noncontact ACL injury, that is, reduced EMG preactivity for semitendinosus and elevated EMG preactivity for vastus lateralis. Subsequently, the 6-week kettlebell training increased semitendinosus muscle preactivity during sidecutting by 38 percentage points to a level equivalent to a neuromuscular low-risk profile. An ACL rehabilitated female athlete with a high-risk neuromuscular profile changed to low-risk in response to 6 weeks of kettlebell training. Thus, short-term kettlebell exercise with documented high levels of medial hamstring activation was found to transfer into high medial hamstring preactivation during a sidecutting maneuver. PMID:28197354

  12. Neuromuscular Coordination Deficit Persists 12 Months after ACL Reconstruction But Can Be Modulated by 6 Weeks of Kettlebell Training: A Case Study in Women's Elite Soccer.

    PubMed

    Zebis, Mette K; Andersen, Christoffer H; Bencke, Jesper; Ørntoft, Christina; Linnebjerg, Connie; Hölmich, Per; Thorborg, Kristian; Aagaard, Per; Andersen, Lars L

    2017-01-01

    The aim of the present single-case study was to investigate the effect of 6 weeks' kettlebell training on the neuromuscular risk profile for ACL injury in a high-risk athlete returning to sport after ACL reconstruction. A female elite soccer player (age 21 years) with no previous history of ACL injury went through neuromuscular screening as measured by EMG preactivity of vastus lateralis and semitendinosus during a standardized sidecutting maneuver. Subsequently, the player experienced a noncontact ACL injury. The player was screened again following postreconstruction rehabilitation, then underwent 6-week kettlebell training, and was subsequently screened again at 6-week follow-up. Prior to and after postreconstruction rehabilitation the player demonstrated a neuromuscular profile during sidecutting known to increase the risk for noncontact ACL injury, that is, reduced EMG preactivity for semitendinosus and elevated EMG preactivity for vastus lateralis. Subsequently, the 6-week kettlebell training increased semitendinosus muscle preactivity during sidecutting by 38 percentage points to a level equivalent to a neuromuscular low-risk profile. An ACL rehabilitated female athlete with a high-risk neuromuscular profile changed to low-risk in response to 6 weeks of kettlebell training. Thus, short-term kettlebell exercise with documented high levels of medial hamstring activation was found to transfer into high medial hamstring preactivation during a sidecutting maneuver.

  13. COMPARATIVE STUDY OF ACL RECONSTRUCTION WITH ANATOMICAL POSITIONING OF THE TUNNELS USING THE PATELLAR TENDON VERSUS HAMSTRING TENDON

    PubMed Central

    de Pádua, Vitor Barion Castro; Maldonado, Hilário; Vilela, Júlio César Rodrigues; Provenza, Alexandre Ribeira; Monteiro, Cleverson; de Oliveira Neto, Heleno Cavalcante

    2015-01-01

    Objective: To compare ACL reconstruction with anatomical positioning of the tunnels using the hamstring or patellar tendons. Methods: We prospectively evaluated 52 patients who underwent ACL reconstruction using the Chambat's technique, with anatomical positioning of the tunnels drilled outside in. They were divided into group A, with 27 patients, using the patellar tendon as a graft, and group B, with 25 patients, using the hamstring. Results: In group A 26 patients were very satisfied or satisfied and 1 unhappy, in group B. 25 patients were very satisfied or satisfied with the procedure (p = 0.990). According to the Lysholm scale, group A had a mean score of 96.11 and group B, 95.32 (p=0.594). In relation to preoperative IKDC, 100% of the patients in group A and 92% of those in group B were IKDC C or D (p = 0.221); in the assessment with a minimum of two-year follow-up, 96% of group A and 92% of group B were IKDC A or B (p = 0.256). The Lachman test, pivot shift, return to sports activities, and the comparative difference in anterior translation (RolimeterTM) also showed no statistically significant difference. In group A, 5 patients (18.5%) were unable to kneel on a hard surface, whereas no patient in group B had this complaint. Conclusion: The anterior cruciate ligament reconstruction presents similar results using the hamstring or patellar tendon with anatomical positioning of the tunnels. Drilling the femoral tunnel outside in is a reproducible and accurate option in the correct placement the femoral tunnel. PMID:27027082

  14. Anatomic Anterolateral Ligament Reconstruction Improves Postoperative Clinical Outcomes Combined with Anatomic Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Qiu, Man; Zhou, Aiguo; Zhang, Jian; Jiang, Dianming

    2016-01-01

    A significant cohort of patients is plagued by postoperative rotational instability after the anatomic anterior cruciate ligament (ACL) reconstruction surgery. Anatomic anterolateral ligament (ALL) reconstruction was performed in this study with the aim to assess the clinical role of ALL in knee’s stability and joint functions. Sixty patients were recruited and divided into three groups to perform the operations of anatomic single-bundle ACL reconstruction, anatomic double-bundle ACL reconstruction, and anatomic single-bundle ACL reconstruction + anterolateral ligament reconstruction, respectively. And then postoperative knee’s stability and joint functions were evaluated to compare the clinical outcomes among the three different kind of operations. The postoperative knee’s stability and joint functions of the anatomic double-bundle ACL reconstruction group and the anatomic single-bundle ACL reconstruction + ALL reconstruction group were better than the anatomic single-bundle ACL reconstruction group. No significant difference was observed between the anatomic double-bundle ACL reconstruction group and the anatomic single-bundle ACL reconstruction + ALL reconstruction group. The anatomic anterolateral ligament reconstruction could improve the clinical outcomes after patients performed the anatomic single-bundle anterior cruciate ligament reconstruction. This indicates that the anterolateral ligament plays a crucial role in knee’s stability and joint function, especially the rotational stability. Key points Anatomic anterolateral ligament reconstruction combined with anatomic anterior cruciate ligament reconstruction was performed to treat the patients with ACL rupture. Compared to the anatomic single-bundle ACL reconstruction group, the anatomic single-bundle ACL reconstruction + ALL reconstruction group achieve a better clinical outcomes. The results suggest that the anterolateral ligament plays a crucial role in knee’s stability and joint function

  15. ACL Revision

    PubMed Central

    Costa-Paz, Matias; Dubois, Julieta Puig; Zicaro, Juan Pablo; Rasumoff, Alejandro; Yacuzzi, Carlos

    2017-01-01

    Objectives: The purpose of this study was to evaluate a series of patients one year after an ACL revision with clinical evaluation and MRI, to consider their condition before returning to sports activities. Methods: A descriptive, prospective and longitudinal study was performed. A series of patients who underwent an ACL revision between March 2014 and March 2015 were evaluated after one year post surgery. They were evaluated using the Lysholm score, IKDC, Tegner, artrometry and MRI (3.0 t). A signal pattern and osteointegration was determined in the MRI. Graft signal intensity of the ACL graft using the signal/noise quotient value (SNQ) was also determined to evaluate the ligamentatization process state. Results: A total of 18 male patients were evaluated with a mean age of 31 years old.Average scores were: Lysholm 88 points, IKDC 80 points, Pre-surgical Tegner 9 points and postoperative 4 points. Artrhometry (KT1000) at 20 newtons showed a side to side difference of less than 3 mm in 88%. Only 44% of patients returned to their previous sport activity one year after revision.The MRI showed a heterogeneous signal in neoligaments in 34% of patients. SNQ showed graft integration in only 28%. Synovial fluid was found in bone-graft interphase in 44% of tunnels, inferring partial osteointegration. The heterogeneous signal was present in 50% of patients who did not return to the previous sport level activity. (Fisher statistics: p = 0.043) There were no meaningful differences in patients with auto or allografts. Conclusion: Although the clinical evaluation was satisfactory, only 44% of patients returned to the previous level of sport activity one year after the ACL surgery. The ligamentatization process was found in 28% of knees evaluated with MRI one year later. Partial osteointegration is inferred in 44%. Results showed a meaningful relation between the signal of neoligaments in the MRI and the return to sport activity in said series of patients. MRI is a useful tool

  16. Calcium phosphate-hybridized tendon graft to enhance tendon-bone healing two years after ACL reconstruction in goats

    PubMed Central

    2011-01-01

    Background We developed a novel technique to improve tendon-bone attachment by hybridizing calcium phosphate (CaP) with a tendon graft using an alternate soaking process. However, the long-term result with regard to the interface between the tendon graft and the bone is unclear. Methods We analyzed bone tunnel enlargement by computed tomography and histological observation of the interface and the tendon graft with and without the CaP hybridization 2 years after anterior cruciate ligament (ACL) reconstruction in goats using EndoButton and the postscrew technique (CaP, n = 4; control, n = 4). Results The tibial bone tunnel enlargement rates in the CaP group were lower than those in the control group (p < 0.05). In the CaP group, in the femoral and tibial bone tunnels at the anterior and posterior of the joint aperture site, direct insertion-like formation that contained a cartilage layer without tidemarks was more observed at the tendon-bone interface than in the control group (p < 0.05). Moreover, the gap area between the tendon graft and the bone was more observed at the femoral bone tunnel of the joint aperture site in the control group than in the CaP group (p < 0.05). The maturation of the tendon grafts determined using the ligament tissue maturation index was similar in both groups. Conclusions The CaP-hybridized tendon graft enhanced the tendon-bone healing 2 years after ACL reconstruction in goats. The use of CaP-hybridized tendon grafts can reduce the bone tunnel enlargement and gap area associated with the direct insertion-like formation in the interface near the joint. PMID:22166674

  17. A Novel Mass-Spring-Damper Model Analysis to Identify Landing Deficits in Athletes Returning to Sport after ACL Reconstruction.

    PubMed

    Schneider, Daniel K; Gokeler, Alli; Otten, Bert; Ford, Kevin R; Hewett, Timothy E; Divine, Jon; Colosimo, Angelo J; Heidt, Robert S; Myer, Gregory D

    2016-07-19

    A mass-spring-damper model may serve as an extension of biomechanical data from three-dimensional motion analysis and epidemiological data which help to delineate populations at-risk for anterior cruciate ligament (ACL) injuries. The purpose of this study was to evaluate such a model.\\Thirty-six ACL reconstruction (ACLR) group subjects and 67 controls (CTRL) completed single-leg drop landing and single-leg broad jump tasks. Landing ground reaction force data were collected and analyzed with a mass-spring damper model. Medians, interquartile ranges, and limb symmetry indices were calculated and comparisons were made within and between groups.During a single-leg drop landing, the ACLR group had a lower spring LSI than the CTRL group (P = 0.015) and landed with decreased stiffness in the involved limb relative to the uninvolved limb (P = 0.021). The ACLR group also had an increased damping LSI relative to the CTRL group (P = 0.045). The ACLR subjects landed with increased stiffness (P = 0.006) and decreased damping (P = 0.003) in their involved limbs compared to CTRL subjects non-dominant limbs. During a single-leg forward broad jump, the ACLR group had a greater spring LSI value than the CTRL group (P = 0.045). The CTRL group also recorded decreased damping values on their non-dominant limbs compared to the involved limbs of the ACLR group (P = 0.046).Athletes who have undergone ACLR display different lower limb dynamics than healthy controls according to a mass-spring damper model. Quadriceps dominance and leg dominance are components of ACLR athletes' landing strategies and may be identified with a mass-spring-damper model and addressed during rehabilitation.

  18. Functional Performance Testing After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Abrams, Geoffrey D.; Harris, Joshua D.; Gupta, Anil K.; McCormick, Frank M.; Bush-Joseph, Charles A.; Verma, Nikhil N.; Cole, Brian J.; Bach, Bernard R.

    2014-01-01

    Background: When to allow an athlete to return to unrestricted sporting activity after anterior cruciate ligament (ACL) reconstruction remains controversial. Purpose: To report the results of functional performance testing reported in the literature for individuals at differing time points following ACL reconstruction and to examine differences between graft types. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of Medline, Scopus, and Cochrane Central Register of Controlled Trials was performed using PRISMA guidelines. Inclusion criteria were English-language studies that examined any functional rehabilitation test from 6 months to 2 years following ACL reconstruction. All patient-, limb-, and knee-specific demographics were extracted from included investigations. All functional rehabilitation tests were analyzed and compared when applicable. Results: The search term returned a total of 890 potential studies, with 88 meeting inclusion and exclusion criteria. A total of 4927 patients were included, of which 66% were male. The mean patient age was 26.5 ± 3.4 years. The predominant graft choices for reconstruction were bone–patellar tendon–bone (BPTB) autograft (59.8%) and hamstring autograft (37.9%). The most commonly reported functional tests were the hop tests. The results of these functional tests, as reported in the Limb Symmetry Index (LSI), improved with increasing time, with nearly all results greater than 90% at 1 year following primary ACL reconstruction. At 6 months postoperatively, a number of isokinetic strength measurements failed to reach 80% LSI, most commonly isokinetic knee extension testing in both BPTB and hamstring autograft groups. The knee flexion strength deficit was significantly less in the BPTB autograft group as compared with those having hamstring autograft at 1 year postoperatively, while no significant differences were found in isokinetic extension strength between the 2 groups. Conclusion: Hop

  19. Hamstring Contracture After ACL Reconstruction Is Associated With an Increased Risk of Cyclops Syndrome

    PubMed Central

    Pinto, Francisco Guerra; Thaunat, Mathieu; Daggett, Matt; Kajetanek, Charles; Marques, Tiago; Guimares, Tales; Quelard, Bénédicte; Sonnery-Cottet, Bertrand

    2017-01-01

    Background: Cyclops syndrome is characterized by loss of terminal knee extension due to proliferative fibrous nodule formation in the intercondylar notch. This complication occurs in the early postoperative period after anterior cruciate ligament reconstruction (ACLR). The pathogenesis of Cyclops syndrome is not well understood. Hypothesis: Persistent hamstring contracture after ACLR is associated with an increased risk of subsequent Cyclops syndrome. Study Design: Case-control study; Level of evidence, 3. Methods: The files of 45 patients who underwent arthroscopic debridement of a Cyclops lesion after ACLR were analyzed. Recorded data included demographic information and technical details of surgery. Preoperative magnetic resonance images were also analyzed, and patients with femoral bone bruising were identified. Passive and active range of motion were recorded in all patients preoperatively and at 3 and 6 weeks after surgery to address the Cyclops lesion. Passive extension deficit was evaluated in comparison with the contralateral limb and classified as secondary to hamstring contracture when contracture was observed and palpated in the prone position and when the extension deficit was reversed after exercises performed to fatigue the hamstrings. A control group was selected using a random numbers table among our entire ACLR cohort. Statistical analysis was performed to analyze differences between the 2 groups. Results: There was no significant difference between the groups with regard to age at ACLR, sex distribution, time from injury to surgery (P > .05), proportion of professional athletes, presence of femoral bone bruise, or technical aspects of surgery. The overall extension deficit incidence was significantly higher in the Cyclops group at 3 weeks (Cyclops, 71%; control, 22%) (P < .001) and at 6 weeks (Cyclops, 60%; control, 7%) (P < .001). The extension deficit related to hamstring contracture was significantly higher in the Cyclops group at 3 weeks

  20. Biomechanical Deficiencies in Women with Semitendinosus-Gracilis ACL Reconstruction During Drop Jumps

    PubMed Central

    Ortiz, Alexis; Capo-Lugo, Carmen E.; Venegas-Rios, Heidi L.

    2014-01-01

    Objective To compare landing mechanics and neuromuscular recruitment strategies between women with semitendinosus-gracilis anterior cruciate ligament reconstruction (SG-ACLr) and non-injured women during double and single-legged drop jumps. Design Cross-sectional biomechanical study Setting Single university-based biomechanics laboratory Participants Fourteen women 1–5 years post SG-ACLr and 16 non-injured women participated in this study. Methods After anthropometric measurements, warm-up, and familiarization procedures, participants performed five trials of a double and single-legged drop jumps. Main Outcome Measurements Dynamic knee valgus was measured as the distance between knee joints during the landing phase of the double-leg drop jumps. Medial knee displacement was the outcome considered during the landing phase of the single-leg drop jumps. For both drop jumps tasks neuromuscular recruitment was evaluated through rectified normalized electromyography (EMG) activity of the quadriceps and hamstrings (amplitude and latency), and quadriceps/hamstrings EMG co-contraction ratio. Results Although the SG- ACLr group demonstrated a tendency towards a greater dynamic knee valgus during both drop jumps, these differences did not reach statistical significance. EMG data revealed different neuromuscular strategies for each group depending on the specific jump. Conclusions These findings suggest that women with SG-ACLr have a tendency towards greater dynamic knee valgus which could predispose to additional knee injuries. Rehabilitation specialists need to be aware of existing kinematic and neuromuscular deficiencies years after SG-ACLr. Taking this into consideration will aid in prescribing appropriate interventions designed to prevent re-injury. PMID:25043260

  1. Anterolateral Ligament Reconstruction

    PubMed Central

    Zordan, J.; Etcheto, H. Rivarola; Blanchod, C. Collazo; Palanconi, M.; Salinas, E. Álvarez; Autorino, CM; Escobar, G.

    2017-01-01

    Anterior cruciate ligament (ACL) reconstruction is a common procedure in daily practice with 75 to 97% excellent long-term results. But in certain cases, some patients perceive rotational instability, for this reason the revision rate can be 10 to 15%. Objectives: evaluate functional outcome in revisions of ACL reconstruction associated with ALL. Methods: Between July 2015 and February 2016 (11 knees) Eleven Revision ACL reconstruction were performed with ALL with double incision technique performed by the same surgical team. Inclusion criteria were: ACL reconstruction failures with a grade 2 or 3 Lachman test, a grade 3 pivot-shift without other ligamentary injury lesions associated and complete range of motion. Results: The concept of rotational instability associated with ACL injury has been described more than a decade ago. However, there is no consensus on how to quantify rotational instability in ACL injuries; so when associating an extracapsular technique. Currently there is a lack of high-level evidence comparing isolated ACL repair and associated with the modified reconstruction of ALL that allows us to define therapeutic approaches. The ALL reconstruction associate an ACL reconstruction remains a matter of study. Conclusion: We obtain excellent results in antero – posterior and rotational stability after performing the procedure.

  2. In vivo bone tunnel remodeling in symptomatic patients after ACL reconstruction: a retrospective comparison of articular and extra-articular fixation

    PubMed Central

    Mathis, Dominic T.; Rasch, Helmut; Hirschmann, Michael T.

    2015-01-01

    Summary Background there is only a paucity of studies dealing with bone remodeling within the tunnels after anterior cruciate ligament (ACL) reconstruction. The objective of this study was to evaluate the influence of tendon graft type and surgical fixation technique on bone tunnel remodeling in patients with symptomatic knees after ACL reconstruction. Methods in a retrospective study 99mTc-HDP bone tracer uptake (BTU) in SPECT/CT of 57 knees with symptoms of pain and/or instability after ACL reconstruction was investigated. All 57 knees were subdivided according their anatomy (femur and tibia), fixation (articular versus extra-articular fixation) and graft types into eight groups: femoral-articular versus extra-articular fixation using bone-patellar tendon-bone (BPTB) and hamstring autografts; tibial-articular versus extra-articular fixation using patellar tendon and hamstring autografts; BTU grading for each area of the localisation scheme were recorded. Tunnel diameter and length was measured in the CT scans. Results BTU was higher for the articular fixation in the femur and for the extra-articular fixation in the tibial tunnel. Patellar tendon graft fixation showed a significantly higher BTU in the superior-lateral and posterior-central area of the tibia, meaning the areas of the tibial tunnel near the entrance into the joint. Tunnel enlargement correlated significantly with increased BTU (p<0.05). Conclusion assessment of in vivo bone tunnel remodelling in symptomatic patients after ACL reconstruction revealed different patterns of BTU with regards to graft and fixation method. PMID:26958543

  3. The Influence of Task Complexity on Knee Joint Kinetics Following ACL Reconstruction

    PubMed Central

    Schroeder, Megan J.; Krishnan, Chandramouli; Dhaher, Yasin Y.

    2015-01-01

    Background Previous research indicates that subjects with anterior cruciate ligament reconstruction exhibit abnormal knee joint movement patterns during functional activities like walking. While the sagittal plane mechanics have been studied extensively, less is known about the secondary planes, specifically with regard to more demanding tasks. This study explored the influence of task complexity on functional joint mechanics in the context of graft-specific surgeries. Methods In 25 participants (10 hamstring tendon graft, 6 patellar tendon graft, 9 matched controls), three-dimensional joint torques were calculated using a standard inverse dynamics approach during level walking and stair descent. The stair descent task was separated into two functionally different sub-tasks—step-to-floor and step-to-step. The differences in external knee moment profiles were compared between groups; paired differences between the reconstructed and non-reconstructed knees were also assessed. Findings The reconstructed knees, irrespective of graft type, typically exhibited significantly lower peak knee flexion moments compared to control knees during stair descent, with the differences more pronounced in the step-to-step task. Frontal plane adduction torque deficits were graft-specific and limited to the hamstring tendon knees during the step-to-step task. Internal rotation torque deficits were also primarily limited to the hamstring tendon graft group during stair descent. Collectively, these results suggest that task complexity was a primary driver of differences in joint mechanics between anterior cruciate ligament reconstructed individuals and controls, and such differences were more pronounced in individuals with hamstring tendon grafts. Interpretation The mechanical environment experienced in the cartilage during repetitive, cyclical tasks such as walking and other activities of daily living has been argued to contribute to the development of degenerative changes to the joint

  4. Predictors of Revision Surgery After Primary Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Yabroudi, Mohammad A.; Björnsson, Haukur; Lynch, Andrew D.; Muller, Bart; Samuelsson, Kristian; Tarabichi, Majd; Karlsson, Jón; Fu, Freddie H.; Harner, Christopher D.; Irrgang, James J.

    2016-01-01

    Background: Revision anterior cruciate ligament (ACL) reconstruction surgery occurs in 5% to 15% of individuals undergoing ACL reconstruction. Identifying predictors for revision ACL surgery is of essence in the pursuit of creating adequate prevention programs and to identify individuals at risk for reinjury and revision. Purpose: To determine predictors of revision ACL surgery after failed primary ACL reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 251 participants (mean age ± SD, 26.1 ± 9.9 years) who had undergone primary ACL reconstruction 1 to 5 years earlier completed a comprehensive survey to determine predictors of revision ACL surgery at a mean 3.4 ± 1.3 years after the primary ACL reconstruction. Potential predictors that were assessed included subject characteristics (age at the time of surgery, time from injury to surgery, sex, body mass index, preinjury activity level, return to sport status), details of the initial injury (mechanism; concomitant injury to other ligaments, menisci, and cartilage), surgical details of the primary reconstruction (Lachman and pivot shift tests under anesthesia, graft type, femoral drilling technique, reconstruction technique), and postoperative course (length of rehabilitation, complications). Univariate and multivariate logistic regression analyses were performed to identify factors that predicted the need for revision ACL surgery. Results: Overall, 21 (8.4%) subjects underwent revision ACL surgery. Univariate analysis showed that younger age at the time of surgery (P = .003), participation in sports at a competitive level (P = .023), and double-bundle ACL reconstruction (P = .024) predicted increased risk of revision ACL surgery. Allograft reconstructions also demonstrated a trend toward greater risk of revision ACL surgery (P = .076). No other variables were significantly associated with revision ACL surgery. Multivariate analysis revealed that revision ACL surgery was

  5. Changes of early post-traumatic osteoarthritis in an ovine model of simulated ACL reconstruction are associated with transient acute post-injury synovial inflammation and tissue catabolism.

    PubMed

    Heard, B J; Solbak, N M; Achari, Y; Chung, M; Hart, D A; Shrive, N G; Frank, C B

    2013-12-01

    The study described here tested the hypothesis that early intra-articular inflammation is associated with the development of post-traumatic osteoarthritis (PTOA) in a sheep model. We extended previously published work in which we investigated joint gross morphology and synovial mRNA expression of inflammatory and catabolic molecules 2 weeks after anatomic Anterior cruciate ligament (ACL) autograft reconstructive surgery (ACL-R). The same variables have been analyzed at 20 weeks post surgery together with new experimental variables at both time points. Animals were sacrificed at 20 weeks post ACL-R surgery and their joints graded for signs of PTOA. Synovial samples were harvested for histological grading plus mRNA and protein analysis for a panel of inflammatory and catabolic molecules. The mRNA expression levels for this panel plus connective tissue matrix turnover molecules were also investigated in cartilage samples. Results of gross morphological assessments at 20 weeks post surgery showed some changes consistent with early OA, but indicated little progression of damage from the 2 week time point. While significant alterations in mRNA levels for synovial inflammatory and catabolic molecules were detected at 2 weeks, values had normalized by 20 weeks. Similarly, all mRNA expression levels for inflammatory and catabolic molecules in articular cartilage had returned to normal levels by 20 weeks post ACL-R surgery. We conclude that synovial inflammatory processes are initiated very early after ACL-R surgery and may instigate events that lead to the gross cartilage and joint abnormalities observed as early as 2 weeks. However, the absence of sustained inflammation and joint instability may prevent OA progression.

  6. The immunosuppressive effect of Siglecs on tendon-bone healing after ACL reconstruction.

    PubMed

    Hu, Jiang; Yao, Bin; Yang, Xiao; Ma, Fang

    2015-01-01

    The quality of the bone-tendon healing is very important to the surgery outcome after anterior cruciate ligament reconstruction. The necrosis of autograft and local new blood vessels occur after the surgery. The fibroblasts and mesenchymal cells presenting in the tendon-bone interface as well as the infiltrated of neutrophils and macrophages improve the biomechanical properties of the healing. We hypothesize that immunosuppressive effect of Siglecs which present on the surface of neutrophils and macrophages play the important roles to regulate acute local inflammatory reaction, maintain the physiological environment and induce the differentiation of the pluripotent cells to form the accepted histologic structure healing of the tendon-bone interface. It might be helpful to understand the mechanism of tendon-bone healing.

  7. Anteromedial portal versus transtibial drilling techniques in ACL reconstruction: a blinded cross-sectional study at two- to five-year follow-up

    PubMed Central

    Alentorn-Geli, Eduard; Samitier, Gonzalo; Álvarez, Pedro; Steinbacher, Gilbert

    2010-01-01

    Drilling of the femoral tunnel with the transtibial (TT) technique is widely used in bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction. Recent studies suggest higher knee stability with the use of the anteromedial portal (AMP). The purpose of this study was to compare functional and clinical outcomes of BPTB ACL reconstruction using the TT or the AMP technique for drilling the femoral tunnel. All ACL reconstructions between January 2003 and April 2006 were approached for eligibility. Forty-seven patients met inclusion criteria (21 TT group and 26 AMP group). Blinded assessments of IKDC score, knee stability and range of motion, one-leg hop test, mid-quadriceps circumference, VAS for satisfaction with surgery, Lysholm and Tegner scores, and SF-12 questionnaire were obtained for both groups. Data on preoperative and postoperative surgical timing were retrospectively reviewed through the charts. The AMP group demonstrated a significantly lower recovery time from surgery to walking without crutches (p < 0.01), to return to normal life (p < 0.03), to return jogging (p < 0.03), to return training (p < 0.03), and to return to play (p < 0.03). Knee stability values measured with KT-1000, Lachman test, pivot-shift sign, and objective IKDC score assessments were significantly better for the AMP compared to TT group (p < 0.002, p < 0.03, p < 0.02, p < 0.015, respectively). No differences were found for VAS for satisfaction with surgery, Lysholm, Tegner, and SF-12 between both groups. The use of the AMP technique significantly improved the anterior-posterior and rotational knee stability, IKDC scores, and recovery time from surgery compared to the TT technique. PMID:20401753

  8. ACL Injury, Return To Play And Reinjury In The Elite, Collegiate Athlete: An Analysis Of A Single, Division I NCAA Cohort

    PubMed Central

    Kamath, Ganesh V.; Murphy, Timothy; Creighton, Robert A.; Taft, Timothy N.; Spang, Jeffrey T.

    2014-01-01

    Objectives: Graft survivorship, reinjury rates, and career length are poorly understood after ACL reconstruction in the elite, NCAA Division-I athlete. The purpose of this study was to examine the outcomes of ACL reconstruction in a Division-I athlete cohort. Methods: Retrospective chart review was performed of all Division-I athletes at a single, public university from 2000 to 2009 until completion of eligibility. Athletes with a Pre-collegiate (PC) and Intra-collegiate (IC) ACL reconstruction were separated into two cohorts. Graft survivorship, reoperation rates, and career length information was collected. Results: 35 athletes were identified with a pre-collegiate (PC) ACL reconstruction; 60 with an intra-collegiate (IC) reconstruction. The PC group had a 17.1% injury rate to the original graft, with a 20.0% rate of contralateral ACL injury. For the IC group, the reinjury rates were 1.9% to the ACL graft, with a 9.2% rate of contralateral ACL injury after an IntraCollegiate ACL reconstruction. The PC group used 78% of their total eligibility (avg 3.11 yrs). Athletes in the IC group used an average of 77% of their remaining NCAA eligibility. 88.3% of the IC group played an additional non-redshirt year after their injury. Reoperation rate for the PC group was 51.4% and 20.3% for the IC group. Conclusion: Reoperation and reinjury rates are high after ACL reconstruction in the Division-I athlete. Pre-collegiate ACL reconstruction is associated with a very high rate of repeat ACL reinjury to the graft or opposite knee (37.1%). The majority of athletes are able to return to play after successful reconstruction.

  9. Comparison of traditional advanced cardiac life support (ACLS) course instruction vs. a scenario-based, performance oriented team instruction (SPOTI) method for Korean paramedic students.

    PubMed

    Lee, Christopher C; Im, Mark; Kim, Tae Min; Stapleton, Edward R; Kim, Kyuseok; Suh, Gil Joon; Singer, Adam J; Henry, Mark C

    2010-01-01

    Current Advanced Cardiac Life Support (ACLS) course instruction involves a 2-day course with traditional lectures and limited team interaction. We wish to explore the advantages of a scenario-based performance-oriented team instruction (SPOTI) method to implement core ACLS skills for non-English-speaking international paramedic students. The objective of this study was to determine if scenario-based, performance-oriented team instruction (SPOTI) improves educational outcomes for the ACLS instruction of Korean paramedic students. Thirty Korean paramedic students were randomly selected into two groups. One group of 15 students was taught the traditional ACLS course. The other 15 students were instructed using a SPOTI method. Each group was tested using ACLS megacode examinations endorsed by the American Heart Association. All 30 students passed the ACLS megacode examination. In the traditional ACLS study group an average of 85% of the core skills were met. In the SPOTI study group an average of 93% of the core skills were met. In particular, the SPOTI study group excelled at physical examination skills such as airway opening, assessment of breathing, signs of circulation, and compression rates. In addition, the SPOTI group performed with higher marks on rhythm recognition compared to the traditional group. The traditional group performed with higher marks at providing proper drug dosages compared to the SPOTI students. However, the students enrolled in the SPOTI method resulted in higher megacode core compliance scores compared to students trained in traditional ACLS course instruction. These differences did not achieve statistical significance due to the small sample size.

  10. Bone marrow edema-like lesions (BMELs) are associated with higher T1ρ and T2 values of cartilage in anterior cruciate ligament (ACL)-reconstructed knees: a longitudinal study

    PubMed Central

    Gong, Jingshan; Pedoia, Valentina; Facchetti, Luca; Link, Thomas M.; Ma, C. Benjamin

    2016-01-01

    Background To evaluate the longitudinal changes of bone marrow edema-like lesions (BMELs) in patients after anterior cruciate ligament (ACL) reconstruction and to investigate the effect of BMELs on cartilage matrix composition changes measured using MR T1ρ and T2 mapping. Methods Patients with acute ACL tear were enrolled in a prospective study. MR imaging was performed at baseline (before surgeries) and at 6-month, 1-year and 2-year after ACL reconstruction. MR imaging included sagittal high-resolution, 3D fast spin-echo (CUBE) sequences for BMEL evaluation, and 3D T1ρ mapping and T2 mapping for cartilage assessment. BMELs were assessed using whole-organ magnetic resonance imaging score (WORMS), and the volume of BMELs was measured by a semi-automatic method. Generalized estimating equation (GEE) was used to explore association between BMELs at baseline and cartilage changes during follow-up. Results Fifty four patients were included in the present study and 39 patients had completed 2-year follow-up. BMELs were noted in 42 injured knees (77.8%) with 105 lesions and in 7 contralateral knees (13.0%) with 9 lesions (χ2=45.763, P<0.001) at the baseline. The WORMS and volume of BMELs of the injured knees were 2.36±0.65 and 386.98±382.54 mm3 (r=0.681, P<0.001), respectively. 87 BMELs were found at baseline in 34 patients (87.2%) of the 39 patients who had completed 2 years follow-up. During the follow-up, 18 (20.7%), 12 (13.8%), and 5 (5.7%) baseline lesions were still seen at 6-month, 1-year and 2-year, respectively. The changes of BMELs prevalence regarding bone compartments over time points were statistically significant (χ2=163.660, P<0.001). Except T2 value at 6 months, T1ρ and T2 values of cartilage overlying baseline BMELs in the injured knees were higher than that of anatomically matched cartilage in the contralateral knees at baseline and each follow-up time-point. In the injured knees, GEE analysis showed that baseline BMELs were significantly

  11. 50 CFR 648.290 - Tilefish Annual Catch Limit (ACL).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... detailed review of fishery performance relative to the sector ACLs at least every 5 years. (1) If the ACL... recommendations to the MAFMC for changes in measures intended to ensure ACLs are not as frequently exceeded. (2...) Performance reviews shall not substitute for annual reviews that occur to ascertain if prior year ACLs...

  12. 50 CFR 648.290 - Tilefish Annual Catch Limit (ACL).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... detailed review of fishery performance relative to the sector ACLs at least every 5 years. (1) If the ACL... recommendations to the MAFMC for changes in measures intended to ensure ACLs are not as frequently exceeded. (2...) Performance reviews shall not substitute for annual reviews that occur to ascertain if prior year ACLs...

  13. 50 CFR 648.290 - Tilefish Annual Catch Limit (ACL).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... detailed review of fishery performance relative to the sector ACLs at least every 5 years. (1) If the ACL... recommendations to the MAFMC for changes in measures intended to ensure ACLs are not as frequently exceeded. (2...) Performance reviews shall not substitute for annual reviews that occur to ascertain if prior year ACLs...

  14. Patients With Ligament Hiperlaxity With Rupture Of Previous Plastic For ACL. Reconstruction With Intra-articular And Extra-articular Combined Technics

    PubMed Central

    Astore, Ignacio; Agotegaray, Juan Ignacio; Comba, Ignacio; Bisiach, Luciana

    2017-01-01

    Introduction: In cases of patients with ligament hiperlaxity with rupture of ACL, the use of a BTB graft is recommended for its reconstruction. Our job consists of the clinical and functional assessment of a group of 10 patients with ligament laxaty according to Beighton scale, who, after surgery for ACL rupture with BTB technique, suffered a rupture of the plastic. For its reconstruction a combination of intra-articular and extra-articular techniques was used with a BTB graft in the contralateral knee, associated with a modified Lemaire technique. Methods: The series consists of 10 patients, male, average age of 24.2 years, amateur athletes, operated for a second time in March, 2011 and November, 2013, with a minimum follow-up of 24 months. They were evaluated before surgery and 24 months after surgery based on Lysholm scale, IKDC evaluation form and a physical exam (Lachman - Pivot Shift). Results: After surgery, the average in Lysholm scale was of 87.6 and 86.3 for the IKDC subjetive form. In the physical exam, 8 patients showed Lachman 1+, while none of the patients showed Pivot Shift positive. 7 patients were able to return to their usual sport activities. As a postoperative disadvantage, 6 patients reported pain in the external face of the knee in the first 6 months. And 4 patients reported a subjetive loss of full extension that did not interfere with their sport activities. Conclusion: Based on our experience and literature, we believe that the combination of both techniques, intra-articular (BTB) and extra-articular (Lemaire), is a good alternative for patients with ligament laxaty, providing positive clinical and functional results.

  15. Effect of ACL graft material on joint forces during a simulated in vivo motion in the porcine knee: examining force during the initial cycles.

    PubMed

    Boguszewski, Daniel V; Wagner, Christopher T; Butler, David L; Shearn, Jason T

    2014-11-01

    This study compared three-dimensional forces in knees containing anterior cruciate ligament (ACL) graft materials versus the native porcine ACL. A six-degree-of-freedom (DOF) robot simulated gait while recording the joint forces and moments. Knees were subjected to 10 cycles of simulated gait in intact, ACL-deficient, and ACL-reconstructed knee states to examine time zero biomechanical performance. Reconstruction was performed using bone-patellar tendon-bone allograft (BPTB), reconstructive porcine tissue matrix (RTM), and an RTM-polymer hybrid (Hybrid). Forces and moments were examined about anatomic DOFs throughout the gait cycle and at three key points during gait: heel strike (HS), mid stance (MS), toe off (TO). Compared to native ACL, each graft restored antero-posterior (A-P) forces throughout gait. However, all failed to mimic normal joint forces in other DOFs. For example, each reconstructed knee showed greater compressive forces at HS and TO compared to the native ACL knee. Overall, the Hybrid graft restored more of the native ACL forces following reconstruction than did BPTB, while RTM grafts were the least successful. If early onset osteoarthritis is in part caused by altered knee kinematics, then understanding how reconstruction materials restore critical force generation during gait is an essential step in improving a patient's long-term prognosis.

  16. Anterior Cruciate Ligament (ACL) Injuries

    MedlinePlus

    ... Week of Healthy Breakfasts Shyness Anterior Cruciate Ligament (ACL) Injuries KidsHealth > For Teens > Anterior Cruciate Ligament (ACL) ... and Recovery Coping With an ACL Injury About ACL Injuries A torn anterior cruciate ligament (ACL) is ...

  17. Revision Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Wilde, Jeffrey; Bedi, Asheesh; Altchek, David W.

    2014-01-01

    Context: Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures, with more than 200,000 ACL tears occurring annually. Although primary ACL reconstruction is a successful operation, success rates still range from 75% to 97%. Consequently, several thousand revision ACL reconstructions are performed annually and are unfortunately associated with inferior clinical outcomes when compared with primary reconstructions. Evidence Acquisition: Data were obtained from peer-reviewed literature through a search of the PubMed database (1988-2013) as well as from textbook chapters and surgical technique papers. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinical outcomes after revision ACL reconstruction are largely based on level IV case series. Much of the existing literature is heterogenous with regard to patient populations, primary and revision surgical techniques, concomitant ligamentous injuries, and additional procedures performed at the time of the revision, which limits generalizability. Nevertheless, there is a general consensus that the outcomes for revision ACL reconstruction are inferior to primary reconstruction. Conclusion: Excellent results can be achieved with regard to graft stability, return to play, and functional knee instability but are generally inferior to primary ACL reconstruction. A staged approach with autograft reconstruction is recommended in any circumstance in which a single-stage approach results in suboptimal graft selection, tunnel position, graft fixation, or biological milieu for tendon-bone healing. Strength-of-Recommendation Taxonomy (SORT): Good results may still be achieved with regard to graft stability, return to play, and functional knee instability, but results are generally inferior to primary ACL reconstruction: Level B. PMID:25364483

  18. RELIABILITY AND VALIDITY OF A MODIFIED ISOMETRIC DYNAMOMETER IN THE ASSESSMENT OF MUSCULAR PERFORMANCE IN INDIVIDUALS WITH ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

    PubMed Central

    de Vasconcelos, Rodrigo Antunes; Bevilaqua-Grossi, Débora; Shimano, Antonio Carlos; Paccola, Cleber Jansen; Salvini, Tânia Fátima; Prado, Christiane Lanatovits; Junior, Wilson A. Mello

    2015-01-01

    Objectives: The aim of this study was to evaluate the reliability and validity of a modified isometric dynamometer (MID) in performance deficits of the knee extensor and flexor muscles in normal individuals and in those with ACL reconstructions. Methods: Sixty male subjects were invited to participate of the study, being divided into three groups with 20 subjects each: control group (GC), group of individuals with ACL reconstruction with patellar tendon graft (GTP, and group of individuals with ACL reconstruction with hamstrings graft (GTF). All individuals performed isometric tests in the MID, muscular strength deficits collected were subsequently compared to the tests performed on the Biodex System 3 operating in the isometric and isokinetic mode at speeds of 60°/s and 180o/s. Intraclass ICC correlation calculations were done in order to assess MID reliability, specificity, sensitivity and Kappa's consistency coefficient calculations, respectively, for assessing the MID's validity in detecting muscular deficits and intra- and intergroup comparisons when performing the four strength tests using the ANOVA method. Results: The modified isometric dynamometer (MID) showed excellent reliability and good validity in the assessment of the performance of the knee extensor and flexor muscles groups. In the comparison between groups, the GTP showed significantly greater deficits as compared to the GTF and GC groups. Conclusion: Isometric dynamometers connected to mechanotherapy equipments could be an alternative option to collect data concerning performance deficits of the extensor and flexor muscles groups of the knee in subjects with ACL reconstruction. PMID:27004175

  19. The effect of neuromuscular electrical stimulation on quadriceps strength and knee function in professional soccer players: return to sport after ACL reconstruction.

    PubMed

    Taradaj, J; Halski, T; Kucharzewski, M; Walewicz, K; Smykla, A; Ozon, M; Slupska, L; Dymarek, R; Ptaszkowski, K; Rajfur, J; Pasternok, M

    2013-01-01

    The aim of this study was to assess the clinical efficacy and safety of NMES program applied in male soccer players (after ACL reconstruction) on the quadriceps muscle. The 80 participants (NMES = 40, control = 40) received an exercise program, including three sessions weekly. The individuals in NMES group additionally received neuromuscular electrical stimulation procedures on both right and left quadriceps (biphasic symmetric rectangular pulses, frequency of impulses: 2500 Hz, and train of pulses frequency: 50 Hz) three times daily (3 hours of break between treatments), 3 days a week, for one month. The tensometry, muscle circumference, and goniometry pendulum test (follow-up after 1 and 3 months) were applied. The results of this study show that NMES (in presented parameters in experiment) is useful for strengthening the quadriceps muscle in soccer athletes. There is an evidence of the benefit of the NMES in restoring quadriceps muscle mass and strength of soccer players. In our study the neuromuscular electrical stimulation appeared to be safe for biomechanics of knee joint. The pathological changes in knee function were not observed. This trial is registered with Australian and New Zealand Clinical Trials Registry ACTRN12613001168741.

  20. The Effect of NeuroMuscular Electrical Stimulation on Quadriceps Strength and Knee Function in Professional Soccer Players: Return to Sport after ACL Reconstruction

    PubMed Central

    Taradaj, J.; Halski, T.; Kucharzewski, M.; Walewicz, K.; Smykla, A.; Ozon, M.; Slupska, L.; Dymarek, R.; Ptaszkowski, K.; Rajfur, J.; Pasternok, M.

    2013-01-01

    The aim of this study was to assess the clinical efficacy and safety of NMES program applied in male soccer players (after ACL reconstruction) on the quadriceps muscle. The 80 participants (NMES = 40, control = 40) received an exercise program, including three sessions weekly. The individuals in NMES group additionally received neuromuscular electrical stimulation procedures on both right and left quadriceps (biphasic symmetric rectangular pulses, frequency of impulses: 2500 Hz, and train of pulses frequency: 50 Hz) three times daily (3 hours of break between treatments), 3 days a week, for one month. The tensometry, muscle circumference, and goniometry pendulum test (follow-up after 1 and 3 months) were applied. The results of this study show that NMES (in presented parameters in experiment) is useful for strengthening the quadriceps muscle in soccer athletes. There is an evidence of the benefit of the NMES in restoring quadriceps muscle mass and strength of soccer players. In our study the neuromuscular electrical stimulation appeared to be safe for biomechanics of knee joint. The pathological changes in knee function were not observed. This trial is registered with Australian and New Zealand Clinical Trials Registry ACTRN12613001168741. PMID:24381943

  1. Continuous ACL graft, results

    PubMed Central

    Díaz, Jorge Luis; Vega, Marcelo; Matesevach, Ivan

    2017-01-01

    Objectives: describe our technique using hamstring graft that respects the proximal continuity of Semitendinosus and uses the superior biological potential of the distal periosteum., preserving and stressing the ST reinforce the retropulsión and dynamic control of external rotation of the knee. Here the technique, results, difficulties and foundations. Methods: The sample of this research was composed of 229 cases operated between 01/03/97 and 01/03/13 in Arthroscopy Private Center., 166 male and 63 female, the postop follow-up was 86 months. Evaluated with IKDC, Lysholm, Hamstring EMG. Comparative histology study in rabbits. Results: IKDC and Lysholm score showed 93% of very good results. Conclusion: Dynamic ACL reconstruction achieves a static-dynamic stabilization of the knee. Grafts have a plus in their biological potential (proximal continuity - osteo-periosteal insertion of the tendons in the femoral tunnel). The hamstring maintains its functionality (EMG). 93% satisfactory results (IKDC, Lysholm). It is a valid surgical option in ACL injuries.

  2. Physeal-Sparing Technique for Femoral Tunnel Drilling in Pediatric Anterior Cruciate Ligament Reconstruction Using a Posteromedial Portal

    PubMed Central

    Lemos, Stephen E.; Keating, Patrick M.; Scott, Timothy P.; Siwiec, Ryan M.

    2013-01-01

    Pediatric anterior cruciate ligament (ACL) tears present a technical dilemma for orthopaedic surgeons. Multiple surgical techniques have been described to protect the distal femoral and proximal tibial physes. We present an ACL reconstruction technique performed on a 12-year-old girl with open physes who sustained an ACL tear after a noncontact twisting injury while playing soccer. A hamstring autograft reconstruction was performed by use of a posteromedial portal to drill the femoral tunnel in an all-epiphyseal fashion at the anatomic footprint of the native ACL. This case provides a new surgical technique to achieve anatomic fixation for ACL reconstruction in a skeletally immature individual using a posteromedial portal to drill a physeal-sparing lateral femoral tunnel for anatomic ACL reconstruction. This advancement may make drilling the femoral tunnel less technically challenging compared with other proposed methods while maintaining the lateral wall of the distal femur. PMID:24892013

  3. Incidence and Characterization of Injury to the Infrapatellar Branch of the Saphenous Nerve after ACL Reconstruction: A Prospective Study

    PubMed Central

    Cohen, Steven B.; Ciccotti, Michael C.; Dodson, Christopher C.; Tjoumakaris, Fotios P.; Salvo, John P.; Marchetto, Paul A.; Watson, Ryan A.; Salminen, Matthew Robert; Flato, Russell R.; O'Brien, Daniel Francis

    2014-01-01

    Objectives: The infrapatellar branch of the saphenous nerve is commonly injured in anterior cruciate ligament reconstruction (ACLR) causing sensory deficits around the knee. The primary purpose of this prospective study was to determine the incidence of patient reported sensory deficits around the knee following ACLR. The secondary purpose was to determine if sensory deficits caused by intraoperative injury present at 6 weeks changed in severity and total area after 6 months and 1 year postoperatively. Methods: Two-hundred and fifty patients that underwent ACLR with or without meniscal repair were prospectively enrolled. Variables for each patient included: type of graft, direction of tibial incision, number of portals, and length of surgical incision. The grafts used were categorized into three types: Allograft (allo), hamstring autograft (HS), or patella tendon autograft (BTB). At 6 weeks, patients completed a questionnaire to ascertain any sensory deficits over their knee. Patients rated their sensory deficit on a scale from 0-10 (“0” = (no deficit) to “10” (complete lack of sensation) and shaded areas on a picture of a knee split into nine rectangular segments (3 by 3 grid) to determine the location of any numbness. Patients completed the same questionnaire at 6 months and 1 year. Any patient that was noted to have no stated numbness at 6 weeks or 6 months was noted to have completed the study. A mixed effects linear regression model was used to identify variables which were predictors for the patient-reported severity of numbness. Results: Overall, 67/221 (30.3%) patients who underwent ACLR stated that they had no numbness at 6 weeks. Of those patients who reported numbness at 6 weeks, 16.6% (25/151) considered their numbness completely resolved by six months. At 1 year, 73.2% (90/123) reported their numbness had gotten better and 14.2% (18/123) considered their numbness resolved. The most common location of numbness was along the inferolateral aspect

  4. FUNCTIONAL PERFORMANCE AND KNEE LAXITY IN NORMAL INDIVIDUALS AND IN INDIVIDUALS SUBMITTED TO ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

    PubMed Central

    de Vasconcelos, Rodrigo Antunes; Bevilaqua-Grossi, Débora; Shimano, Antonio Carlos; Jansen Paccola, Cleber Antonio; Salvini, Tânia Fátima; Prado, Christiane Lanatovits; Mello Junior, Wilson A.

    2015-01-01

    The aim of this study was to analyze the correlation between deficits in the isokinetic peak torque of the knee extensors and flexors with hop tests, postoperative knee laxity and functional scores in normal and ACL- reconstructed subjects with patellar tendon and hamstring tendon autografts. Methods: Sixty male subjects were enrolled and subdivided into three groups: Twenty subjects without knee injuries (GC group) and two groups of 20 subjects submitted to ACL reconstruction with patellar tendon (GTP group) and hamstrings autograft (GTF group). Results: The results showed significant correlation between knee extensors peak torque and performance in the hop tests for GTF and GC groups. There are no significantly correlations between post op knee laxity and Lysholm score compared with the hop tests and peak torque deficits. Concerning the differences between groups, the GTP group showed greater peak torque deficits in knee extensors, worst Lysholm scores and higher percentage of individuals with lower limb symmetry index (ISM) < 90% in both hop tests when compared to the other two groups. Conclusion: It is not recommendable to use only one measurement instrument for the functional evaluation of ACL-reconstructed patients, because significant correlation between peak torque, subject's functional score, knee laxity and hop tests were not observed in all groups. PMID:26998464

  5. The anatomy of the anterior cruciate ligament and its relevance to the technique of reconstruction.

    PubMed

    Śmigielski, R; Zdanowicz, U; Drwięga, M; Ciszek, B; Williams, A

    2016-08-01

    Anterior cruciate ligament (ACL) reconstruction is commonly performed and has been for many years. Despite this, the technical details related to ACL anatomy, such as tunnel placement, are still a topic for debate. In this paper, we introduce the flat ribbon concept of the anatomy of the ACL, and its relevance to clinical practice. Cite this article: Bone Joint J 2016;98-B:1020-6.

  6. Strength and Functional Performance Recovery After Anterior Cruciate Ligament Reconstruction in Preadolescent Athletes

    PubMed Central

    Greenberg, Elliot M.; Greenberg, Eric T.; Ganley, Theodore J.; Lawrence, J. Todd R.

    2014-01-01

    Background: In the skeletally immature population, the incidence of anterior cruciate ligament (ACL) injuries and ACL reconstructions appears to be increasing. Differences in surgical techniques, physiology, and emotional maturity may alter the rehabilitation progression and impact the outcomes when compared with adults. Reports of objective strength recovery and performance-based outcome measures after pediatric ACL reconstruction (ACLR) are limited. Study Design: Retrospective case series. Level of Evidence: Level 4. Methods: All patients that underwent all-epiphyseal ACLR from January 2008 to August 2010 were identified. Isokinetic peak quadriceps/hamstring torque values and functional performance measures in unilateral hopping tasks were extracted and compared with the noninjured limb. A limb symmetry index (LSI) of ≥90% was considered satisfactory. Results: Complete data were available for 16 patients (mean age, 12.28 years; range, 8.51-14.88 years). By a mean 7 months (range, 3.02-12.56 years) postoperatively, only 9 of 16 (56%) were able to achieve a satisfactory LSI for quadriceps strength. For hamstring strength, 15 of 16 (94%) were able to achieve satisfactory LSI. By a mean of 12 months (range, 5.39-24.39 months) postoperatively, only 6 of 16 subjects (38%) were able to achieve satisfactory performance on all functional hop tests. At a mean 15.42 months (range, 8.58-24.39 months) postsurgery, only 4 of 16 (25%) subjects were able to achieve an LSI of ≥90% on all testing parameters. Conclusion: For some pediatric patients, significant strength and functional deficits may be present at greater than 1 year after ACLR. This population may require more prolonged rehabilitation programs to allow for adequate recovery of strength and function because of unique characteristics of normal growth and development. PMID:24982702

  7. Enhancement of tendon-bone healing for anterior cruciate ligament (ACL) reconstruction using bone marrow-derived mesenchymal stem cells infected with BMP-2.

    PubMed

    Dong, Yu; Zhang, Qingguo; Li, Yunxia; Jiang, Jia; Chen, Shiyi

    2012-10-22

    At present, due to the growing attention focused on the issue of tendon-bone healing, we carried out an animal study of the use of genetic intervention combined with cell transplantation for the promotion of this process. Here, the efficacy of bone marrow stromal cells infected with bone morphogenetic protein-2 (BMP-2) on tendon-bone healing was determined. A eukaryotic expression vector containing the BMP-2 gene was constructed and bone marrow-derived mesenchymal stem cells (bMSCs) were infected with a lentivirus. Next, we examined the viability of the infected cells and the mRNA and protein levels of BMP-2-infected bMSCs. Gastrocnemius tendons, gastrocnemius tendons wrapped by bMSCs infected with the control virus (bMSCs+Lv-Control), and gastrocnemius tendons wrapped by bMSCs infected with the recombinant BMP-2 virus (bMSCs+Lv-BMP-2) were used to reconstruct the anterior cruciate ligament (ACL) in New Zealand white rabbits. Specimens from each group were harvested four and eight weeks postoperatively and evaluated using biomechanical and histological methods. The bMSCs were infected with the lentivirus at an efficiency close to 100%. The BMP-2 mRNA and protein levels in bMSCs were significantly increased after lentiviral infection. The bMSCs and BMP-2-infected bMSCs on the gastrocnemius tendon improved the biomechanical properties of the graft in the bone tunnel; specifically, bMSCs infected with BMP-2 had a positive effect on tendon-bone healing. In the four-week and eight-week groups, bMSCs+Lv-BMP-2 group exhibited significantly higher maximum loads of 29.3 ± 7.4 N and 45.5 ± 11.9 N, respectively, compared with the control group (19.9 ± 6.4 N and 21.9 ± 4.9 N) (P = 0.041 and P = 0.001, respectively). In the eight-week groups, the stiffness of the bMSCs+Lv-BMP-2 group (32.5 ± 7.3) was significantly higher than that of the bMSCs+Lv-Control group (22.8 ± 7.4) or control groups (12.4 ± 6.0) (p = 0.036 and 0.001, respectively). Based on the histological

  8. High-Performance Phylogeny Reconstruction

    SciTech Connect

    Tiffani L. Williams

    2004-11-10

    Under the Alfred P. Sloan Fellowship in Computational Biology, I have been afforded the opportunity to study phylogenetics--one of the most important and exciting disciplines in computational biology. A phylogeny depicts an evolutionary relationship among a set of organisms (or taxa). Typically, a phylogeny is represented by a binary tree, where modern organisms are placed at the leaves and ancestral organisms occupy internal nodes, with the edges of the tree denoting evolutionary relationships. The task of phylogenetics is to infer this tree from observations upon present-day organisms. Reconstructing phylogenies is a major component of modern research programs in many areas of biology and medicine, but it is enormously expensive. The most commonly used techniques attempt to solve NP-hard problems such as maximum likelihood and maximum parsimony, typically by bounded searches through an exponentially-sized tree-space. For example, there are over 13 billion possible trees for 13 organisms. Phylogenetic heuristics that quickly analyze large amounts of data accurately will revolutionize the biological field. This final report highlights my activities in phylogenetics during the two-year postdoctoral period at the University of New Mexico under Prof. Bernard Moret. Specifically, this report reports my scientific, community and professional activities as an Alfred P. Sloan Postdoctoral Fellow in Computational Biology.

  9. The potential for primary repair of the ACL

    PubMed Central

    Vavken, Patrick; Murray, Martha M

    2011-01-01

    The objective of this work is to assess the feasibility of successfully repairing the torn ACL. Two major motivators for developing a new treatment for ACL injuries are the recently reported high rates of osteoarthritis after conventional ACL reconstruction as well as the problem of how to safely treat skeletally immature patients. A key factor in developing such a technique was the identification of the main inhibitor of intrinsic ACL healing – the lack of clot formation between the two torn ends of the ligament. A bioactive and biocompatible scaffold which could be placed in the wound site to enhance cellular proliferation and biosynthesis was developed. This biomaterial has shown promising functional outcomes in several large animal models of primary repair of partial and complete ACL transection over 4 to 14 weeks, suggesting potential for a successful, future clinical application. PMID:21293237

  10. Review of NASA ACLS research

    NASA Technical Reports Server (NTRS)

    Daugherty, R. H.

    1983-01-01

    An experimental investigation was conducted to evaluate a method of maintaining stability of an air cushion vehicle and also to evaluate several concepts to brake and steer an ACLS-equipped vehicle. The investigation used a modified airboat equipped with an air cushion landing system. The pressure relief door stability concept was characterized by the ACLS pressure time histories. The pressure relief doors vented excess cavity and lobe pressures and consistently maintained vehicle heave and pitch stability. Braking concepts were characterized by the average deceleration of the vehicle. Reduced lobe flow and cavity venting braking concepts were evaluated in this program. The cavity venting concept demonstrated the best performance, producing decelerations on the test vehicle on the same order as moderate braking with conventional wheel brakes. Steering concepts were evaluated by recording the path taken while attempting to follow a prescribed maneuver. The steering concepts evaluated included using rudders only, using differential lobe flow, and using rudders combined with a lightly loaded, nonsteering center wheel. The latter concept proved to be the most accurate means of steering the vehicle on the ACLS, producing translational deviations which, while two to three times higher than those from conventional nose gear steering, were still felt to provide reasonably precise steering control for this type vehicle.

  11. Does the lateral intercondylar ridge disappear in ACL deficient patients?

    PubMed

    van Eck, Carola F; Morse, Kenneth R; Lesniak, Bryson P; Kropf, Eric J; Tranovich, Michael J; van Dijk, C Niek; Fu, Freddie H

    2010-09-01

    The aim of this study was to determine whether there is a difference in the presence of the lateral intercondylar ridge and the lateral bifurcate ridge between patients with sub-acute and chronic ACL injuries. We hypothesized that the ridges would be present less often with chronic ACL deficiency. Twenty-five patients with a chronic ACL injury were matched for age and gender to 25 patients with a sub-acute ACL injury. The lateral intercondylar ridge and lateral bifurcate ridge were scored as either present, absent, or indeterminate due to insufficient visualization by three blinded observers. The kappa for the three observers was .61 for the lateral intercondylar ridge and .58 for the lateral bifurcate ridge. The lateral intercondylar ridge was present in 88% of the sub-acute patients and 88% of the chronic patients. The lateral bifurcate ridge was present in 48% of the sub-acute and 48% of the chronic patients. This matched-pairs case-control study was unable to show a difference in the presence of the femoral bony ridges between patients with acute and chronic ACL injuries. The authors would suggest looking for the ridges as a landmark of the native ACL insertion site during ACL reconstruction in both acute and chronic ACL injuries.

  12. Performance-based assessment of reconstructed images

    SciTech Connect

    Hanson, Kenneth

    2009-01-01

    During the early 90s, I engaged in a productive and enjoyable collaboration with Robert Wagner and his colleague, Kyle Myers. We explored the ramifications of the principle that tbe quality of an image should be assessed on the basis of how well it facilitates the performance of appropriate visual tasks. We applied this principle to algorithms used to reconstruct scenes from incomplete and/or noisy projection data. For binary visual tasks, we used both the conventional disk detection and a new challenging task, inspired by the Rayleigh resolution criterion, of deciding whether an object was a blurred version of two dots or a bar. The results of human and machine observer tests were summarized with the detectability index based on the area under the ROC curve. We investigated a variety of reconstruction algorithms, including ART, with and without a nonnegativity constraint, and the MEMSYS3 algorithm. We concluded that the performance of the Raleigh task was optimized when the strength of the prior was near MEMSYS's default 'classic' value for both human and machine observers. A notable result was that the most-often-used metric of rms error in the reconstruction was not necessarily indicative of the value of a reconstructed image for the purpose of performing visual tasks.

  13. Hip and knee joint kinematics during a diagonal jump landing in anterior cruciate ligament reconstructed females.

    PubMed

    Delahunt, Eamonn; Prendiville, Anna; Sweeney, Lauren; Chawke, Mark; Kelleher, Judy; Patterson, Matt; Murphy, Katie

    2012-08-01

    Anterior cruciate ligament (ACL) injury is a common injury encountered by sport medicine clinicians. Surgical reconstruction is the recommended treatment of choice for those athletes wishing to return to full-contact sports participation and for sports requiring multi-directional movement patterns. The aim of ACL reconstruction is to restore knee joint mechanical stability such that the athlete can return to sporting participation. However, knowledge regarding the extent to which lower limb kinematic profiles are restored following ACL reconstruction is limited. In the present study the hip and knee joint kinematic profiles of 13 ACL reconstructed (ACL-R) and 16 non-injured control subjects were investigated during the performance of a diagonal jump landing task. The ACL-R group exhibited significantly less peak knee joint flexion (P=0.01). Significant between group differences were noted for time averaged hip joint sagittal plane (P<0.05) and transverse plane (P<0.05) kinematic profiles, as well as knee joint frontal plane (P<0.05) and sagittal plane (P<0.05) kinematic profiles. These results suggest that aberrant hip and knee joint kinematic profiles are present following ACL reconstruction, which could influence future injury risk.

  14. The characteristics of EEG power spectra changes after ACL rupture

    PubMed Central

    Miao, Xin; Huang, Hongshi; Hu, Xiaoqing; Li, Dai; Yu, Yuanyuan; Ao, Yingfang

    2017-01-01

    Background Reestablishing knee stability is the core of the treatment of ACL (Anterior Cruciate Ligament) injury. Some patients still have a feeling of instability of the knee after ACL injury treatment. This unstable feeling may be caused by central nervous system changes after ACL rupture. Methods To identify the central changes after ACL rupture, EEG spectra were recorded to compare ACL patients and healthy controls when they were walking, jogging, and landing. Results There was a significant increase in delta, theta, alpha and beta band power during walking, jogging and landing in ACL patients. We also found an asymmetry phenomenon of EEG only in the ACL patients, mainly in the frontal area and central-parietal area. The asymmetry of beta band power extended to the frontal and the central area during jogging and landing task. Conclusions There were significant differences in EEG power spectra between the ACL patients and healthy people. ACL patients showed high EEG band power activities and an asymmetry phenomenon. EEG power changes were affected by movements, the asymmetry extended when performing more complicated movements. PMID:28182627

  15. Anterior cruciate ligament reconstruction and knee osteoarthritis

    PubMed Central

    Paschos, Nikolaos K

    2017-01-01

    Anterior cruciate ligament (ACL) injury is a traumatic event that can lead to significant functional impairment and inability to participate in high-level sports-related activities. ACL reconstruction is considered the treatment of choice for symptomatic ACL-deficient patients and can assist in full functional recovery. Furthermore, ACL reconstruction restores ligamentous stability to normal, and, therefore, can potentially fully reinstate kinematics of the knee joint. As a consequence, the natural history of ACL injury could be potentially reversed via ACL reconstruction. Evidence from the literature is controversial regarding the effectiveness of ACL reconstruction in preventing the development of knee cartilage degeneration. This editorial aims to present recent high-level evidence in an attempt to answer whether ACL injury inevitably leads to osteoarthritis and whether ACL reconstruction can prevent this development or not. PMID:28361013

  16. Effect of ACL Transection on Internal Tibial Rotation in an in Vitro Simulated Pivot Landing

    PubMed Central

    Oh, Youkeun K.; Kreinbrink, Jennifer L.; Ashton-Miller, James A.; Wojtys, Edward M.

    2011-01-01

    Background: The amount of resistance provided by the ACL (anterior cruciate ligament) to axial tibial rotation remains controversial. The goal of this study was to test the primary hypotheses that ACL transection would not significantly affect tibial rotation under the large impulsive loads associated with a simulated pivot landing but would increase anterior tibial translation. Methods: Twelve cadaveric knees (mean age of donors [and standard deviation] at the time of death, 65.0 ± 10.5 years) were mounted in a custom testing apparatus to simulate a single-leg pivot landing. A compound impulsive load was applied to the distal part of the tibia with compression (∼800 N), flexion moment (∼40 N-m), and axial tibial torque (∼17 N-m) in the presence of five trans-knee muscle forces. A differential variable reluctance transducer mounted on the anteromedial aspect of the ACL measured relative strain. With the knee initially in 15° of flexion, and after five combined compression and flexion moment (baseline) loading trials, six trials were conducted with the addition of either internal or external tibial torque (internal or external loading), and then six baseline trials were performed. The ACL was then sectioned, six baseline trials were repeated, and then six trials of either the internal or the external loading condition, whichever had initially resulted in the larger relative ACL strain, were carried out. Tibiofemoral kinematics were measured optoelectronically. The results were analyzed with a nonparametric Wilcoxon signed-rank test. Results: Following ACL transection, the increase in the normalized internal tibial rotation was significant but small (0.7°/N-m ± 0.3°/N-m to 0.8°/N-m ± 0.3°/N-m, p = 0.012), while anterior tibial translation increased significantly (3.8 ± 2.9 to 7.0 ± 2.9 mm, p = 0.017). Conclusions: ACL transection leads to a small increase in internal tibial rotation, equivalent to a 13% decrease in the dynamic rotational resistance

  17. Relationship Between Posterior-Inferior Tibial Slope and Bilateral Noncontact ACL Injury.

    PubMed

    Hendrix, Steven T; Barrett, Austin M; Chrea, Bopha; Replogle, William H; Hydrick, Josie M; Barrett, Gene R

    2016-10-18

    Is there a correlation between increased posterior-inferior tibial slope angle and noncontact anterior cruciate ligament (ACL) injury? Does increasing the posterior-inferior tibial slope angle increase the risk of bilateral ACL injury? A computerized relational database (Access 2007; Microsoft Inc, Redmond, Washington) was used to conduct a retrospective review of patients undergoing bilateral or unilateral ACL reconstruction surgery or treatment by a single surgeon between 1995 and 2013. Included in the study were patients with bilateral and unilateral ACL injuries and patellofemoral pain syndrome with no associated ACL deficiency. Exclusion criteria included concomitant ligament injury, previous ACL reconstruction, and previous knee surgery. Also excluded were patients who did not have plain lateral radiographs. Fifty patients were randomly selected from each group. After controlling for age and Tegner activity level, the authors found that the posterior-inferior tibial slope angle was a significant predictor (P=.002) of noncontact ACL injury. Mean posterior-inferior tibial slope angle for the bilateral, unilateral, and control groups was 11.8°±2.3°, 9.3°±2.4°, and 7.5°±2.3°, respectively. In the group with unilateral ACL injury vs the group without ACL deficiency, a 1° increase in posterior-inferior tibial slope angle (P=.03) was associated with a 20% increase in unilateral ACL injury. In those with bilateral ACL injury vs those without ACL deficiency, a 1° increase in posterior-inferior tibial slope angle (P=.001) increased bilateral knee injury by 34%. The difference between the mean angles of the control group without ACL deficiency and both the bilateral injury and unilateral injury cohorts was statistically significant (P=.003). Increased posterior-inferior tibial slope angle is associated with an increased risk of noncontact bilateral and unilateral ACL injury. [Orthopedics. 201x; xx(x):xx-xx.].

  18. Evaluating iterative reconstruction performance in computed tomography

    SciTech Connect

    Chen, Baiyu Solomon, Justin; Ramirez Giraldo, Juan Carlos; Samei, Ehsan

    2014-12-15

    Purpose: Iterative reconstruction (IR) offers notable advantages in computed tomography (CT). However, its performance characterization is complicated by its potentially nonlinear behavior, impacting performance in terms of specific tasks. This study aimed to evaluate the performance of IR with both task-specific and task-generic strategies. Methods: The performance of IR in CT was mathematically assessed with an observer model that predicted the detection accuracy in terms of the detectability index (d′). d′ was calculated based on the properties of the image noise and resolution, the observer, and the detection task. The characterizations of image noise and resolution were extended to accommodate the nonlinearity of IR. A library of tasks was mathematically modeled at a range of sizes (radius 1–4 mm), contrast levels (10–100 HU), and edge profiles (sharp and soft). Unique d′ values were calculated for each task with respect to five radiation exposure levels (volume CT dose index, CTDI{sub vol}: 3.4–64.8 mGy) and four reconstruction algorithms (filtered backprojection reconstruction, FBP; iterative reconstruction in imaging space, IRIS; and sinogram affirmed iterative reconstruction with strengths of 3 and 5, SAFIRE3 and SAFIRE5; all provided by Siemens Healthcare, Forchheim, Germany). The d′ values were translated into the areas under the receiver operating characteristic curve (AUC) to represent human observer performance. For each task and reconstruction algorithm, a threshold dose was derived as the minimum dose required to achieve a threshold AUC of 0.9. A task-specific dose reduction potential of IR was calculated as the difference between the threshold doses for IR and FBP. A task-generic comparison was further made between IR and FBP in terms of the percent of all tasks yielding an AUC higher than the threshold. Results: IR required less dose than FBP to achieve the threshold AUC. In general, SAFIRE5 showed the most significant dose reduction

  19. Acute effects of static stretching of hamstring on performance and ACL injury risk during stop-jump and cutting tasks in female athletes.

    PubMed

    Ruan, Mianfang; Zhang, Qiang; Wu, Xie

    2017-01-11

    There is limited research investigating antagonist stretch. The purpose of this study was to evaluate the influence of SSH on performance and ACL injury risk during stop-jump and 180° cutting tasks. Twelve female college athletes (age 20.8 ± 0.7 years; height 1.61 ± 0.05 m; mass 54.25 ± 4.22 kg) participated in this study. Subjects performed stop-jump and 180° cutting tasks under two conditions: after warm-up with 4×30 s SSH or after warm-up without SSH. Three-dimensional kinematic and kinetic data as well as EMG of biceps femoris (BF), rectus femoris (RF), vastus medialis (VM), and gastrocnemius medialis (GM) were collected during testing. SSH significantly enhanced jump height by 5.1% (P = 0.009), but did not change the takeoff speed of cutting. No significant changes in peak knee adduction moment or peak anterior tibia shear force were observed with SSH regardless of the task. The peak lateral tibia shear force during cutting was significantly (P = 0.036) reduced with SSH. The co-contraction of hamstring and quadriceps during the preactivation (stop-jump: P = 0.04; cutting: P = 0.05) and downward phases (stop-jump: P = 0.04; cutting: P = 0.05) was significantly reduced after SSH regardless of the task. The results suggest that SSH enhanced the performance of stop-jump due to decreased co-contraction of hamstring and quadriceps, but did not change the performance of cutting. In addition, SSH did not increase ACL injury risk during stop-jump and cutting tasks and even reduced medial-lateral knee loading during cutting.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

  20. Fungal osteomyelitis after arthroscopic anterior cruciate ligament reconstruction: a case report with review of the literature.

    PubMed

    Sun, Lei; Zhang, Lei; Wang, Kai; Wang, Wei; Tian, Min

    2012-10-01

    Fungal osteomyelitis is a very rare complication after anterior cruciate ligament (ACL) reconstruction associated with catastrophic consequences. Herein, we present a case of such disastrous complication after ACL reconstruction. A 23-year-old man developed fever, swelling and pain of the affected knee from 18 days after arthroscopic ACL reconstruction. Therefore, he underwent arthroscopic debridement, removal of the graft and internal fixators, irrigation and suction drainage, successively. Negative results for serial bacterial cultures and smear examinations are obtained. However, computer tomography and X-ray examination showed massive bone destruction at 48 days after ACL reconstruction. As the first open debridement was performed at 50 days after ACL reconstruction, fungal infection was diagnosed based on finding Aspergillus hyphae in pathologic examination of the debrided bone sample. After the final debridement, a 12-cm bone loss in the distal femur was treated by Ilizarov's bone transport. The patient got solid arthrodesis of the affected knee without clinical infection at a year after the initial operation. In addition, a review of the literature regarding case reports of fungal osteomyelitis after ACL reconstruction is presented.

  1. Neuromuscular efficiency of the vastus medialis obliquus and postural balance in professional soccer athletes after anterior cruciate ligament reconstruction

    PubMed Central

    Chaves, Shalimá Figueirêdo; Marques, Natália Pereira; Silva, Rômulo Lemos e; Rebouças, Nahra Santos; de Freitas, Luise Monteiro; de Paula Lima, Pedro Olavo; de Oliveira, Rodrigo Ribeiro

    2012-01-01

    Summary The purpose of this study was to evaluate the neuromuscular efficiency of the vastus medialis obliquus and postural balance in high-performance soccer athletes after anterior cruciate ligament (ACL) reconstruction, compared to the uninvolved leg. A cross-sectional study was conducted with 22 male professional soccer players after ACL reconstruction (4–12 months postoperatively). The athletes were submitted to functional rehabilitation with an accelerated protocol on the soccer team. They were evaluated using isokinetic dynamometer, surface electromyography and electronic baropodometer. There was no decrease or difference between neuromuscular efficiency of the VMO when comparing both the limbs after ACL reconstruction in the professional soccer athletes under treatment. The same result was found in postural balance. It can be concluded that the NME of the VMO in the involved member and postural balance were successfully re-established after the reconstruction procedure of the ACL in the sample group studied. PMID:23738285

  2. Anterior cruciate ligament reconstruction tunnel size: causes of tunnel enlargement and implications for single versus two-stage revision reconstruction.

    PubMed

    Rizer, Magda; Foremny, Gregory Brian; Rush, Augustus; Singer, Adam D; Baraga, Michael; Kaplan, Lee D; Jose, Jean

    2017-02-01

    Anterior cruciate ligament (ACL) reconstructions have increased over the past 25 years. The increased incidence of ACL reconstructions has translated into a larger number of graft failures and revision ACL procedures. It is important to understand the causes of graft failure when evaluating for a revision ACL reconstruction and to appreciate changes in tunnel anatomy over time prior to planning revision surgery. In this manuscript, tunnel size for ACL reconstruction and implications for single-stage versus two-stage revision ACL reconstruction will be discussed, as well as causes of tunnel enlargement, including mechanical and biological factors.

  3. Bridge-Enhanced ACL Repair: A Review of the Science and the Pathway through FDA Investigational Device Approval

    PubMed Central

    Proffen, Benedikt L.; Perrone, Gabriel S.; Roberts, Gordon; Murray, Martha M.

    2016-01-01

    Injuries to the anterior cruciate ligament (ACL) are currently treated with replacement of the torn ligament with a graft of tendon harvested from elsewhere in the knee. This procedure, called "ACL reconstruction," is excellent for restoring gross stability to the knee; however, there are relatively high graft failure rates in adolescent patients,4, 12, 60 and the ACL reconstruction procedure does not prevent the premature osteoarthritis seen in patients after an ACL injury.1, 46, 52 Thus, new solutions are needed for ACL injuries. Researchers have been investigating the use of scaffolds, growth factors and cells to supplement a suture repair of the ACL (bio-enhanced repair). In this paper, we will review the varied approaches, which have been investigated for stimulating ACL healing and repair in preclinical models and how one of these technologies was able to move from promising preclinical results to FDA acceptance of an Investigational Device Exemption (IDE) application for a first-in-human study. PMID:25631206

  4. Intermediate- to Long-Term Results of Combined Anterior Cruciate Ligament Reconstruction and Autologous Chondrocyte Implantation

    PubMed Central

    Pike, Andrew N.; Bryant, Tim; Ogura, Takahiro; Minas, Tom

    2017-01-01

    Background: Cartilage injury associated with anterior cruciate ligament (ACL) ruptures is common; however, relatively few reports exist on concurrent cartilage repair with ACL reconstruction. Autologous chondrocyte implantation (ACI) has been utilized successfully for treatment of moderate to large chondral defects. Hypothesis: ACL insufficiency with relatively large chondral defects may be effectively managed with concurrent ACL reconstruction and ACI. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing concurrent ACL primary or revision reconstruction with ACI of single or multiple cartilage defects were prospectively evaluated for a minimum 2 years. Pre- and postoperative outcome measures included the modified Cincinnati Rating Scale (MCRS), Western Ontario and McMaster Universities Osteoarthritis Index, visual analog pain scales, and postsurgery satisfaction surveys. ACI graft failure or persistent pain without functional improvement were considered treatment failures. Results: Twenty-six patients were included, with 13 primary and 13 revision ACL reconstructions performed. Mean defect total surface area was 8.4 cm2, with a mean follow-up of 95 months (range, 24-240 months). MCRS improved from 3.62 ± 1.42 to 5.54 ± 2.32, Western Ontario and McMaster Universities Osteoarthritis Index from 45.31 ± 17.27 to 26.54 ± 17.71, and visual analog pain scale from 6.19 ± 1.27 to 3.65 ± 1.77 (all Ps <.001). Eight patients were clinical failures, 69% of patients were improved at final follow-up, and 92% stated they would likely undergo the procedure again. No outcome correlation was found with regard to age, body mass index, sex, defect size/number, follow-up time, or primary versus revision ACL reconstruction. In subanalysis, revision ACL reconstructions had worse preoperative MCRS scores and greater defect surface areas. However, revision MCRS score improvements were greater, resulting in similar final functional scores when compared with

  5. Between-leg differences in challenging single-limb balance performance one year following anterior cruciate ligament reconstruction.

    PubMed

    Hatton, Anna L; Crossley, Kay M; Clark, Ross A; Whitehead, Timothy S; Morris, Hayden G; Culvenor, Adam G

    2017-02-01

    Following anterior cruciate ligament (ACL) rupture, reconstructive surgery (ALCR) is often performed to mechanically stabilise the knee, however functional deficits often persist long after surgery. Impaired single-limb standing balance has been observed in the ACLR limb compared to healthy individuals. However, it remains inconclusive as to whether these same balance deficits exist between the injured and contralateral uninjured limbs, during challenging balance tasks, and at a time when patients are permitted to return to sport. 100 adults who had undergone a primary hamstring-tendon ACLR 12 months previously (68 male; median[IQR] age: 28.1[14.1] years) performed tests of single-limb standing with the knee in a functional position of 20-30° flexion, with their eyes closed, over 20s (Nintendo Wii Balance Board). Two repetitions were performed on the ACLR and uninjured limb. Measures of postural control included centre of pressure (CoP) path velocity, anterior-posterior and mediolateral range and standard deviation, and were averaged across the two trials. Wilcoxon signed-rank tests showed no significant between-leg differences in single-limb balance for any of the CoP measures of interest (all P values>0.686). Further, multiple linear regression analyses showed no significant associations between concomitant meniscectomy or chondral lesions noted at the time of ACLR and measures of single-limb balance on the ACLR limb one year later (all P values>0.213). In the context of prior research, these findings suggest bilateral balance deficits may exist prior to ACL injury, or appear post ACL-injury or ACLR. Treatment of balance deficits should therefore consider both limbs after ACLR.

  6. The effects of ACL injury on quadriceps and hamstring torque, work and power.

    PubMed

    Pincivero, Danny M; Heller, Brandan M; Hou, Su-I

    2002-09-01

    The aim of this study was to assess isokinetic torque, work and power between non-injured, ACL (anterior cruciate ligament)-deficient and ACL-reconstructed individuals. Ten healthy, non-injured individuals, seven unilateral ACL-deficient individuals and six unilateral ACL-reconstructed individuals were assessed for isokinetic quadriceps and hamstring strength at 1.05 and 3.14 rad.s-1. Peak torque, total work, average power and the ratio of peak torque to body mass were computed for both velocities. Peak torque was also corrected for body mass, using allometric modelling. The non-injured individuals showed significantly greater quadriceps peak torque to body mass ratios than the ACL-deficient and ACL-reconstructed individuals at both velocities, and greater hamstring peak torque to body mass ratios than the ACL-deficient group at 3.14 rad.s-1 (P < 0.05). The ACL-deficient individuals displayed greater quadriceps and hamstring peak torque, total work and average power than the non-injured individuals at 1.05 rad.s-1 (P < 0.05). The ACL-deficient individuals also displayed significantly greater peak torque, total work and average power than the ACL-reconstructed individuals for the quadriceps at both velocities (P < 0.05). The ACL-deficient individuals demonstrated greater hamstring peak torque and total work than the non-injured individuals at both velocities (P < 0.05). The allometrically modelled peak torques at both isokinetic velocities demonstrated that the quadriceps muscle values were significantly higher in the non-involved than the involved limb. The hamstring peak torques corrected for body mass were significantly higher in the non-involved than the involved limb only at 1.05 rad.s-1. The main finding from the present study is that isokinetic measures in ratio-scaled or absolute units yield a different outcome and, hence, interpretation compared with the allometric approach.

  7. Lower Limb Kinematics and Dynamic Postural Stability in Anterior Cruciate Ligament-Reconstructed Female Athletes

    PubMed Central

    Delahunt, Eamonn; Chawke, Mark; Kelleher, Judy; Murphy, Katie; Prendiville, Anna; Sweeny, Lauren; Patterson, Matt

    2013-01-01

    Context: Deficits in lower limb kinematics and postural stability are predisposing factors to the development of knee ligamentous injury. The extent to which these deficits are present after anterior cruciate ligament (ACL) reconstruction is still largely unknown. The primary hypothesis of the present study was that female athletes who have undergone ACL reconstruction and who have returned to sport participation would exhibit deficits in dynamic postural stability as well as deficiencies in hip- and knee-joint kinematics when compared with an age-, activity-, and sex-matched uninjured control group. Objective: To investigate dynamic postural stability as quantified by the Star Excursion Balance Test (SEBT) and simultaneous hip- and knee-joint kinematic profiles in female athletes who have undergone ACL reconstruction. Design: Descriptive laboratory study. Setting: University motion-analysis laboratory. Patients or Other Participants: Fourteen female athletes who had previously undergone ACL reconstruction (ACL-R) and 17 age- and sex-matched uninjured controls. Intervention(s): Each participant performed 3 trials of the anterior, posterior-medial, and posterior-lateral directional components of the SEBT. Main Outcome Measure(s): Reach distances for each directional component were quantified and expressed as a percentage of leg length. Simultaneous hip- and knee-joint kinematic profiles were recorded using a motion-analysis system. Results: The ACL-R group had decreased reach distances on the posterior-medial (P < .01) and posterior-lateral (P < .01) directional components of the SEBT. During performance of the directional components of the SEBT, ACL-R participants demonstrated altered hip-joint frontal-, sagittal-, and transverse-plane kinematic profiles (P < .05), as well as altered knee-joint sagittal-plane kinematic profiles (P < .05). Conclusions: Deficits in dynamic postural stability and concomitant altered hip- and knee-joint kinematics are present after ACL

  8. Computer-assisted anterior cruciate ligament reconstruction. Four generations of development and usage.

    PubMed

    Klos, Tiburtius V S

    2014-12-01

    The purpose of this paper is to review the literature about the contribution of navigation in anterior cruciate ligament (ACL) reconstruction. The evolution of computer-assisted surgery (CAS) for ACL reconstruction has undergone several steps. These steps were divided into 4 subsequent developments: (1) positioning of ACL graft placement; (2) laxity measurement of ACL reconstruction (quality control); (3) kinematic evaluation during ACL reconstruction (navigated pivot shift); (4) case-specific individual ACL reconstruction with adjustments and additional reconstruction options. CAS has shown to improve femoral tunnel positioning, even if clinical outcomes do not improve results of manual techniques. CAS technology has helped researchers better understand the effects of different ACL reconstruction techniques and bundles replacements on joint laxity and to describe tunnel positioning in relation to native ACL insertion. CAS in ACL surgery can improve results at time zero and can improve knowledge in this field.

  9. KOOS Pain as a Marker for Significant Knee Pain Two and Six Years after Primary ACL Reconstruction: A Multicenter Orthopaedic Outcomes Network (MOON) Prospective Longitudinal Cohort Study

    PubMed Central

    Wasserstein, D; Huston, LJ; Nwosu, S; Spindler, KP

    2015-01-01

    Objective The prevalence of radiographic osteoarthritis (OA) after anterior cruciate ligament reconstruction (ACLR) approaches 50%, yet the prevalence of significant knee pain is unknown. We applied three different models of Knee injury and Osteoarthritis Outcome Score (KOOS) thresholds for significant knee pain to an ACLR cohort to identify prevalence and risk factors. Design Multicenter Orthopaedic Outcomes Network (MOON) prospective cohort patients with a unilateral primary ACLR and normal contralateral knee were assessed at 2 and 6 years. Independent variables included patient demographics, validated Patient Reported Outcomes (PRO; Marx activity score, KOOS), and surgical characteristics. Models included: (1) KOOS criteria for a painful knee = quality of life subscale <87.5 and ≥2 of: KOOSpain <86.1, KOOSsymptoms <85.7, KOOSADL <86.8, or KOOSsports/rec <85.0; (2) KOOSpain subscale score ≤72 (≥2 standard deviations below population mean); (3) 10-point KOOSpain drop from 2 to 6 years. Proportional odds models (alpha≤0.05) were used. Results 1,761 patients of median age 23 years, median BMI 24.8 kg/m2 and 56% male met inclusion, with 87% (1530/1761) and 86% (1506/1761) follow-up at 2 and 6 years, respectively. At 6 years, n=592 (39%), n=131 (9%) and n=169 (12%) met criteria for models #1 through #3, respectively. The most consistent and strongest independent risk factor at both time-points was subsequent ipsilateral knee surgery. Low 2-year Marx activity score increased the odds of a painful knee at 6 years. Conclusions Significant knee pain is prevalent after ACLR; with those who undergo subsequent ipsilateral surgery at greatest risk. The relationship between pain and structural OA warrants further study. PMID:26072385

  10. Femoral and Tibial Tunnel Diameter and Bioabsorbable Screw Findings After Double-Bundle ACL Reconstruction in 5-Year Clinical and MRI Follow-up

    PubMed Central

    Kiekara, Tommi; Paakkala, Antti; Suomalainen, Piia; Huhtala, Heini; Järvelä, Timo

    2017-01-01

    Background: Tunnel enlargement is frequently seen in short-term follow-up after anterior cruciate ligament reconstruction (ACLR). According to new evidence, tunnel enlargement may be followed by tunnel narrowing, but the long-term evolution of the tunnels is currently unknown. Hypothesis/Purpose: The hypothesis was that tunnel enlargement is followed by tunnel narrowing caused by ossification as seen in follow-up using magnetic resonance imaging (MRI). The purpose of this study was to evaluate the ossification pattern of the tunnels, the communication of the 2 femoral and 2 tibial tunnels, and screw absorption findings in MRI. Study Design: Case series; Level of evidence, 4. Methods: Thirty-one patients underwent anatomic double-bundle ACLR with hamstring grafts and bioabsorbable interference screw fixation and were followed with MRI and clinical evaluation at 2 and 5 years postoperatively. Results: The mean tunnel enlargement at 2 years was 58% and reduced to 46% at 5 years. Tunnel ossification resulted in evenly narrowed tunnels in 44%, in conical tunnels in 48%, and fully ossified tunnels in 8%. Tunnel communication increased from 13% to 23% in the femur and from 19% to 23% in the tibia between 2 and 5 years and was not associated with knee laxity. At 5 years, 54% of the screws were not visible, with 35% of the screws replaced by a cyst and 19% fully ossified. Tunnel cysts were not associated with worse patient-reported outcomes or knee laxity. Patients with a tibial anteromedial tunnel cyst had higher Lysholm scores than patients without a cyst (93 and 84, P = .03). Conclusion: Tunnel enlargement was followed by tunnel narrowing in 5-year follow-up after double-bundle ACLR. Tunnel communication and tunnel cysts were frequent MRI findings and not associated with adverse clinical evaluation results. PMID:28203605

  11. Effect of Timing of Surgery in Partially Injured ACLs.

    PubMed

    Li, Bin; Bai, Lunhao; Fu, Yonghui; Wang, Guangbin; He, Ming; Wang, Jiashi

    2012-05-01

    The purpose of this study was to explore the optimal timing for surgical intervention of partially injured anterior cruciate ligaments (ACL). Thirty-eight patients were divided into early (n=17) or delayed (n=21) surgery groups based on the interval between injury and surgery. Minimum follow-up was 2 years. The outcome measures used were the International Knee Documentation Committee score, Lysholm knee score, Tegner activity rating, range of motion, and arthrometer measurements. The findings of this study indicate that early surgical reconstruction of partially ruptured ACLs did not result in arthrofibrosis but may prevent secondary loosening of the intact bundles and further meniscal and chondral injury.

  12. Anterior Cruciate Ligament (ACL) Injuries

    MedlinePlus

    ... what the surgeon advises. previous continue Rehab and Recovery Recovery from ACL surgery can take from 6 months ... frequent therapy, but they won't necessarily speed recovery. In the early stages of recovery, a doctor ...

  13. Anterior cruciate ligament (ACL) injury

    MedlinePlus

    ... proper techniques when playing sports or exercising. Some college sports programs teach athletes how to reduce stress placed on the ACL. The use of knee braces during vigorous athletic activity ( ...

  14. Muscle function is associated with future patient-reported outcomes in young adults with ACL injury

    PubMed Central

    Flosadottir, Vala; Roos, Ewa M; Ageberg, Eva

    2016-01-01

    Background/aim Consequences of an anterior cruciate ligament (ACL) injury include worse patient-reported outcomes (PROs) and a decrease in activity level. Muscle function can be improved by targeted exercise. Our aims were to investigate cross-sectional and longitudinal associations among lower extremity muscle function and PROs after ACL injury. Methods Fifty-four participants (15 women, mean 30 years) with ACL injury or reconstruction, from the Knee Anterior Cruciate Ligament, Nonsurgical versus Surgical Treatment (KANON) trial (ISRCTN84752559), were assessed with hop performance, muscle power and postural orientation 3 years (SD 0.85) after ACL injury. PROs at 3 and 5 years after injury included Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales Function in sport and recreation (KOOS Sport/rec) and Knee-related Quality of life (KOOS QoL), KOOS item Q3 (KOOS Q3), Tegner Activity Scale and Activity Rating Scale (ARS). Partial Spearman's rank-order correlation was used to analyse correlations between muscle function and PROs, controlling for gender and treatment. Results Numerous cross-sectional correlations were observed between muscle function and PROs (rsp≈0.3–0.5, p≤0.045). Worse hop performance and worse postural orientation were associated with worse KOOS scores 2 years later (rsp≥0.280, p≤0.045). Worse muscle power was associated with lower future ARS scores (rsp=0.281, p=0.044). Conclusions The moderate associations suggest that improving muscle function during rehabilitation could improve present and future PROs. PMID:27900196

  15. Healing of the Acutely Injured Anterior Cruciate Ligament: Functional Treatment with the ACL-Jack, a Dynamic Posterior Drawer Brace

    PubMed Central

    Reischl, Nikolaus; Rönn, Karolin; Magnusson, Robert A.; Gautier, Emanuel; Jakob, Roland P.

    2016-01-01

    Background. The injured anterior cruciate ligament (ACL) has a limited healing capacity leading to persisting instability. Hypothesis/Purpose. To study if the application of a brace, producing a dynamic posterior drawer force, after acute ACL injury reduces initial instability. Study Design. Cohort study. Methods. Patients treated with the ACL-Jack brace were compared to controls treated with primary ACL reconstruction und controls treated nonsurgically with functional rehabilitation. Measurements included anterior laxity (Rolimeter), clinical scores (Lysholm, Tegner, and IKDC), and MRI evaluation. Patients were followed up to 24 months. Results. Patients treated with the ACL-Jack brace showed a significant improvement of anterior knee laxity comparable to patients treated with ACL reconstruction, whereas laxity persisted after nonsurgical functional rehabilitation. The failure risk (secondary reconstruction necessary) of the ACL-Jack group was however 21% (18 of 86) within 24 months. Clinical scores were similar in all treatment groups. Conclusion. Treatment of acute ACL tears with the ACL-Jack brace leads to improved anterior knee laxity compared to nonsurgical treatment with functional rehabilitation. PMID:28053787

  16. Healing of the Acutely Injured Anterior Cruciate Ligament: Functional Treatment with the ACL-Jack, a Dynamic Posterior Drawer Brace.

    PubMed

    Jacobi, Matthias; Reischl, Nikolaus; Rönn, Karolin; Magnusson, Robert A; Gautier, Emanuel; Jakob, Roland P

    2016-01-01

    Background. The injured anterior cruciate ligament (ACL) has a limited healing capacity leading to persisting instability. Hypothesis/Purpose. To study if the application of a brace, producing a dynamic posterior drawer force, after acute ACL injury reduces initial instability. Study Design. Cohort study. Methods. Patients treated with the ACL-Jack brace were compared to controls treated with primary ACL reconstruction und controls treated nonsurgically with functional rehabilitation. Measurements included anterior laxity (Rolimeter), clinical scores (Lysholm, Tegner, and IKDC), and MRI evaluation. Patients were followed up to 24 months. Results. Patients treated with the ACL-Jack brace showed a significant improvement of anterior knee laxity comparable to patients treated with ACL reconstruction, whereas laxity persisted after nonsurgical functional rehabilitation. The failure risk (secondary reconstruction necessary) of the ACL-Jack group was however 21% (18 of 86) within 24 months. Clinical scores were similar in all treatment groups. Conclusion. Treatment of acute ACL tears with the ACL-Jack brace leads to improved anterior knee laxity compared to nonsurgical treatment with functional rehabilitation.

  17. Knee biomechanics during a jump-cut maneuver: Effects of gender & ACL surgery

    PubMed Central

    Miranda, Daniel L.; Fadale, Paul D.; Hulstyn, Michael J.; Shalvoy, Robert M.; Machan, Jason T.; Fleming, Braden C.

    2012-01-01

    Purpose The purpose of this study was to compare kinetic and knee kinematic measurements from male and female ACL-intact (ACLINT) and ACL-reconstructed (ACLREC) subjects during a jump-cut maneuver using biplanar videoradiography. Methods Twenty subjects were recruited; 10 ACLINT (5 males, 5 females) and 10 ACLREC (4 males, 6 females; five years post surgery). Each subject performed a jump-cut maneuver by landing on a single leg and performing a 45° side-step cut. Ground reaction force was measured by a force plate and expressed relative to body weight. Six-degree-of-freedom knee kinematics were determined from a biplanar videoradiography system and an optical motion capture system. Results ACLINT female subjects landed with a larger peak vertical GRF (p<0.001) compared to ACLINT male subjects. ACLINT subjects landed with a larger peak vertical GRF (p≤0.036) compared to ACLREC subjects. Regardless of ACL reconstruction status, female subjects underwent less knee flexion angle excursion (p=0.002) and had an increased average rate of anterior tibial translation (0.05±0.01%/millisecond; p=0.037) after contact compared to male subjects. Furthermore, ACLREC subjects had a lower rate of anterior tibial translation compared to ACLINT subjects (0.05±0.01%/millisecond; p=0.035). Finally, no striking differences were observed in other knee motion parameters. Conclusion Women permit a smaller amount of knee flexion angle excursion during a jump-cut maneuver, resulting in a larger peak vertical GRF and increased rate of anterior tibial translation. Notably, ACLREC subjects also perform the jump cut maneuver with lower GRF than ACLINT subjects five years post surgery. This study proposes a causal sequence whereby increased landing stiffness (larger peak vertical GRF combined with less knee flexion angle excursion) leads to an increased rate of anterior tibial translation while performing a jump-cut maneuver. PMID:23190595

  18. Effect of ACL graft material on anterior knee force during simulated in vivo ovine motion applied to the porcine knee: An in vitro examination of force during 2000 cycles.

    PubMed

    Boguszewski, Daniel V; Wagner, Christopher T; Butler, David L; Shearn, Jason T

    2015-12-01

    This study determined how anterior cruciate ligament (ACL) reconstruction affected the magnitude and temporal patterns of anterior knee force and internal knee moment during 2000 cycles of simulated gait. Porcine knees were tested using a six degree-of-freedom robot, examining three porcine allograft materials compared with the native ACL. Reconstructions were performed using: (1) bone-patellar tendon-bone allograft (BPTB), (2) reconstructive porcine tissue matrix (RTM), or (3) an RTM-polymer hybrid construct (Hybrid). Forces and moments were measured over the entire gait cycle and contrasted at heel strike, mid stance, toe off, and peak flexion. The Hybrid construct performed the best, as magnitude and temporal changes in both anterior knee force and internal knee moment were not different from the native ACL knee. Conversely, the RTM knees showed greater loss in anterior knee force during 2000 cycles than the native ACL knee at heel strike and toe off, with an average force loss of 46%. BPTB knees performed the least favorably, with significant loss in anterior knee force at all key points and an average force loss of 61%. This is clinically relevant, as increases in post-operative knee laxity are believed to play a role in graft failure and early onset osteoarthritis.

  19. Hydrogel fibers for ACL prosthesis: design and mechanical evaluation of PVA and PVA/UHMWPE fiber constructs.

    PubMed

    Bach, Jason S; Detrez, Fabrice; Cherkaoui, Mohammed; Cantournet, Sabine; Ku, David N; Corté, Laurent

    2013-05-31

    Prosthetic devices for anterior cruciate ligament (ACL) reconstruction have been unsuccessful due to mechanical failure or chronic inflammation. Polymer hydrogels combine biocompatibility and unique low friction properties; however, their prior use for ligament reconstruction has been restricted to coatings due to insufficient tensile mechanics. Here, we investigate new constructs of polyvinyl alcohol (PVA) hydrogel fibers. In water, these fibers swell to an equilibrium water content of 50% by weight, retaining a tensile modulus greater than 40 MPa along the fiber axis at low strain. Rope constructs were assembled for ACL replacement and mechanical properties were compared with data from the literature. Pure PVA hydrogel constructs closely reproduce the non-linear tensile stiffness of the native ACL with an ultimate strength of about 2000 N. An additional safety factor in tensile strength was achieved with composite braids by adding ultrahigh molecular weight polyethylene (UHMWPE) fibers around a core of PVA cords. Composition and braiding angle are adjusted to produce a non-linear tensile behavior within the range of the native ligament that can be predicted by a simple rope model. This design was found to sustain over one million cycles between 50 and 450 N with limited damage and less than 20% creep. The promising mechanical performances of these systems provide justification for more extensive in vivo evaluation.

  20. Panoramic Measurement and Analysis of Strain Distribution in the Human ACL Using a Photoelastic Coating Method

    NASA Astrophysics Data System (ADS)

    Hirokawa, Shunji; Yamamoto, Kouji; Kawada, Takashi

    Large and highly variable deformations of the ACL cannot be adequately quantified by one-dimensional and/or localized measurements. Since the complex anatomy of the ACL makes uniform loading of all fiber bundles almost impossible, strains on specific portions being tested are considerably altered during knee movement. To observe the ACL's entire surface, we propose a photoelastic coating method. A simulator jig was used to allow a natural motion of the knee whose medial and lateral femoral bone parts were removed in order to expose the ACL for observation. The simulator jig with the knee was mounted on a universal stand which allows tilt and swivel rotations, so that the exposed ACL might be viewed from any direction. Measurements were performed on the strain distributions over the ACL at various knee angles. The panoramic images of the photoelastic fringe patterns yielded significant results. Special attention was paid for insight into the relation between strain distribution and the directions of fiber run.

  1. The ACL Message Passing Library

    SciTech Connect

    Painter, J.; McCormick, P.; Krogh, M.; Hansen, C.; Colin de Verdiere, G.

    1995-09-01

    This paper presents the ACL (Advanced Computing Lab) Message Passing Library. It is a high throughput, low latency communications library, based on Thinking Machines Corp.`s CMMD, upon which message passing applications can be built. The library has been implemented on the Cray T3D, Thinking Machines CM-5, SGI workstations, and on top of PVM.

  2. Is bone tunnel osseointegration in hamstring tendon autograft anterior cruciate ligament reconstruction important?

    PubMed

    Logan, Martin; Williams, Andy; Myers, Peter

    2003-10-01

    A 27-year-old man underwent anterior cruciate ligament (ACL) reconstruction using 4-strand hamstring autograft with femoral and tibial interference screw fixation. Four weeks after surgery, he developed a discharging hematoma through the graft harvest-tibial tunnel incision, which persisted. The patient required further surgical intervention 7 weeks after the initial surgery. The wound was debrided, the tibial interference screw was removed, and the tibial tunnel was completely cleared of graft remnants. Arthroscopy of the knee was performed, in which the ACL graft appeared healthy and viable. No evidence of intra-articular sepsis was found. Postoperatively, the rehabilitation program was uneventful and, at 36 months, the patient has unrestricted activity and no clinical evidence of excessive ACL laxity. This case supports the importance of marginal articular surface healing of the ACL graft, suggesting that tibial intratunnel healing becomes redundant.

  3. Long Term Gait Deviations in Anterior Cruciate Ligament Reconstructed Females

    PubMed Central

    Noehren, Brian; Wilson, Hilary; Miller, Casey; Lattermann, Christian

    2015-01-01

    Purpose Little is known of the potential long term gait alterations that occur after an anterior cruciate ligament (ACL) reconstruction. In particular, variables such as impact loading which have been previously associated with joint deterioration have not been studied in walking and running after an ACL reconstruction. The purpose of this study was to define the alterations in impact forces, loading rates, and the accompanying sagittal plane kinematic and kinetic mechanics at the time of impact between the ACL reconstructed group and a healthy control group. Methods 40 females (20 ACL reconstruction, 20 controls) participated in the study. An instrumented gait analysis was performed on all subjects. Between group and limb comparisons were made for initial vertical impact force, loading rate, sagittal plane knee and hip angles as well as moments. Results During walking and running the ACL cohort had significantly greater initial vertical impact force (p=0.002 and p= 0.001), and loading rates (p=0.03 and p= 0.01), as well as a smaller knee extensor moment and hip angle during walking (p=0.000 and p=0.01). There was a trend towards a smaller knee moment and hip angle during running (p=0.08 and p=0.06) as well as a larger hip extensor moment during walking (p=0.06) in the ACL group. No differences were found for hip extensor moment during running, knee angles between groups during walking or running. Lastly, no between limb differences were found for any variable. Conclusion Gait deviations such as elevated impact loading and loading rates do not resolve long term after the individual has resumed previous activity levels and may contribute to the greater risk of early joint degeneration in this population. PMID:23568090

  4. Postural stability and responses to vibrations in patients after anterior cruciate ligament surgical reconstruction.

    PubMed

    Hirjaková, Z; Šingliarová, H; Bzdúšková, D; Kimijanová, J; Bučková, K; Valkovič, P; Hlavačka, F

    2016-10-24

    The aim of the study was to evaluate the effect of surgical reconstruction of anterior cruciate ligament (ACL) on postural stability and responses to lower limb (LL) muscles vibrations. Centre of pressure (CoP) was measured in 17 subjects during stance on firm/foam surface with eyes open/closed and during unilateral vibrations of LL muscles (m. triceps surae - TS, m. quadriceps femoris - Q, m. quadriceps femoris and hamstrings simultaneously - QH). The measurements were performed: 1) preoperatively, 2) six weeks and 3) three months after the reconstruction. Decreased postural stability was documented six weeks after the reconstruction compared to preoperative measurement. Three months after the reconstruction significant improvement was observed during stance on foam surface with eyes closed. Preoperatively, altered reactions of LL with ACL lesion compared to intact LL were manifested by slower response in first 3 s of TS vibration and by increased CoP shift in last 5 s of QH vibration. After the reconstruction, we observed slower CoP reaction and decreased CoP shift during TS vibration of LL with ACL lesion compared to preoperative level. Posturography during quiet stance and during TS vibration reliably detect postural changes due to ACL reconstruction and can be potentially useful in clinical practice.

  5. How Are We Measuring Patient Satisfaction After Anterior Cruciate Ligament Reconstruction?

    PubMed Central

    Kahlenberg, Cynthia A.; Nwachukwu, Benedict U.; Ferraro, Richard A.; Schairer, William W.; Steinhaus, Michael E.; Allen, Answorth A.

    2016-01-01

    Background: Reconstruction of the anterior cruciate ligament (ACL) is one of the most common orthopaedic operations in the United States. The long-term impact of ACL reconstruction is controversial, however, as longer term data have failed to demonstrate that ACL reconstruction helps alter the natural history of early onset osteoarthritis that occurs after ACL injury. There is significant interest in evaluating the value of ACL reconstruction surgeries. Purpose: To examine the quality of patient satisfaction reporting after ACL reconstruction surgery. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the MEDLINE database was performed using the PubMed interface. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines as well as the PRISMA checklist were employed. The initial search yielded 267 studies. The inclusion criteria were: English language, US patient population, clinical outcome study of ACL reconstruction surgery, and reporting of patient satisfaction included in the study. Study quality was assessed using the Newcastle-Ottawa scale. Results: A total of 22 studies met the inclusion criteria. These studies comprised a total of 1984 patients with a mean age of 31.9 years at the time of surgery and a mean follow-up period of 59.3 months. The majority of studies were evidence level 4 (n = 18; 81.8%), had a mean Newcastle-Ottawa scale score of 5.5, and were published before 2006 (n = 17; 77.3%); 5 studies (22.7%) failed to clearly describe their method for determining patient satisfaction. The most commonly used method for assessing satisfaction was a 0 to 10 satisfaction scale (n = 11; 50.0%). Among studies using a 0 to 10 scale, mean satisfaction ranged from 7.4 to 10.0. Patient-reported outcome and objective functional measures for ACL stability and knee function were positively correlated with patient satisfaction. Degenerative knee change was negatively correlated with satisfaction

  6. Electrospinning polymer blends for biomimetic scaffolds for ACL tissue engineering

    NASA Astrophysics Data System (ADS)

    Garcia, Vanessa Lizeth

    The anterior cruciate ligament (ACL) rupture is one of the most common knee injuries. Current ACL reconstructive strategies consist of using an autograft or an allograft to replace the ligament. However, limitations have led researchers to create tissue engineered grafts, known as scaffolds, through electrospinning. Scaffolds made of natural and synthetic polymer blends have the potential to promote cell adhesion while having strong mechanical properties. However, enzymes found in the knee are known to degrade tissues and affect the healing of intra-articular injuries. Results suggest that the natural polymers used in this study modify the thermal properties and tensile strength of the synthetic polymers when blended. Scanning electron microscopy display bead-free and enzyme biodegradability of the fibers. Raman spectroscopy confirms the presence of the natural and synthetic polymers in the scaffolds while, amino acid analysis present the types of amino acids and their concentrations found in the natural polymers.

  7. Unilateral Stance Strategies of Athletes With ACL Deficiency

    PubMed Central

    Di Stasi, Stephanie L.; Hartigan, Erin H.; Snyder-Mackler, Lynn

    2013-01-01

    Aberrant movement strategies are characteristic of ACL-deficient athletes with recurrent knee instability (non-copers), and may instigate premature or accelerate joint degradation. Biomechanical evaluation of kinematic changes over time may elucidate noncopers’ responses to neuromuscular intervention and ACL reconstruction (ACLR). Forty noncopers were randomized into a perturbation group or a strength training only group. We evaluated the effects of perturbation training, and then gender on knee angle and tibial position during a unilateral standing task before and after ACLR. No statistically significant interactions were found. Before surgery, the strength training only group demonstrated knee angle asymmetry, but 6 months after ACLR, both groups presented with similar knee flexion between limbs. Aberrant and asymmetrical tibial position was found only in females following injury and ACLR. Neither treatment group showed distinct unilateral standing strategies following intervention; however, males and female noncopers appear to respond uniquely to physical therapy and surgery. PMID:22983931

  8. ATLAS Muon Identification and Reconstruction Performance in 2016

    NASA Astrophysics Data System (ADS)

    Bergsten, Laura; Atlas Collaboration

    2017-01-01

    This talk aims to describe the ATLAS muon identification and reconstruction performance in 2016. Reconstruction and isolation efficiencies as well as the transverse momentum scale and transverse momentum resolution are measured from LHC proton-proton collision data recorded by ATLAS in 2016 at a center-of-mass-energy of 13 TeV. The measurements are performed by studying the abundantly produced and well known J / Ψ and Z-boson resonances decaying into two oppositely-charged muons. Muon momenta ranging from 5 to a few hundred GeV and covering the pseudo-rapidity range | η | < 2 . 5 are found to be in good agreement with tuned detector simulations. Furthermore, the performance of the detector for data collected in 2016 is compared to the performance for data collected during 2015.

  9. Bayesian image reconstruction for improving detection performance of muon tomography.

    PubMed

    Wang, Guobao; Schultz, Larry J; Qi, Jinyi

    2009-05-01

    Muon tomography is a novel technology that is being developed for detecting high-Z materials in vehicles or cargo containers. Maximum likelihood methods have been developed for reconstructing the scattering density image from muon measurements. However, the instability of maximum likelihood estimation often results in noisy images and low detectability of high-Z targets. In this paper, we propose using regularization to improve the image quality of muon tomography. We formulate the muon reconstruction problem in a Bayesian framework by introducing a prior distribution on scattering density images. An iterative shrinkage algorithm is derived to maximize the log posterior distribution. At each iteration, the algorithm obtains the maximum a posteriori update by shrinking an unregularized maximum likelihood update. Inverse quadratic shrinkage functions are derived for generalized Laplacian priors and inverse cubic shrinkage functions are derived for generalized Gaussian priors. Receiver operating characteristic studies using simulated data demonstrate that the Bayesian reconstruction can greatly improve the detection performance of muon tomography.

  10. Magnetic resonance imaging after anterior cruciate ligament reconstruction: A practical guide

    PubMed Central

    Grassi, Alberto; Bailey, James R; Signorelli, Cecilia; Carbone, Giuseppe; Tchonang Wakam, Andy; Lucidi, Gian Andrea; Zaffagnini, Stefano

    2016-01-01

    Anterior cruciate ligament (ACL) reconstruction is one of the most common orthopedic procedures performed worldwide. In this regard, magnetic resonance imaging (MRI) represents a useful pre-operative tool to confirm a disruption of the ACL and to assess for potential associated injuries. However, MRI is also valuable post-operatively, as it is able to identify, in a non-invasive way, a number of aspects and situations that could suggest potential problems to clinicians. Graft signal and integrity, correct tunnel placement, tunnel widening, and problems with fixation devices or the donor site could all compromise the surgical outcomes and potentially predict the failure of the ACL reconstruction. Furthermore, several anatomical features of the knee could be associated to worst outcomes or higher risk of failure. This review provides a practical guide for the clinician to evaluate the post-surgical ACL through MRI, and to analyze all the parameters and features directly or indirectly related to ACL reconstruction, in order to assess for normal or pathologic conditions. PMID:27795945

  11. Knee Contact Force Asymmetries in Patients Who Failed Return-to-Sport Readiness Criteria 6 Months After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Gardinier, Emily S.; Di Stasi, Stephanie; Manal, Kurt; Buchanan, Thomas S.; Snyder-Mackler, Lynn

    2015-01-01

    Background After anterior cruciate ligament (ACL) injury, contact forces are decreased in the injured knee when compared with the uninjured knee. The persistence of contact force asymmetries after ACL reconstruction may increase the risk of reinjury and may play an important role in the development of knee osteoarthritis in these patients. Functional performance may also be useful in identifying patients who demonstrate potentially harmful joint contact force asymmetries after ACL reconstruction. Hypothesis Knee joint contact force asymmetries would be present during gait after ACL reconstruction, and performance on a specific set of validated return-to-sport (RTS) readiness criteria would discriminate between those who demonstrated contact force asymmetries and those who did not. Study Design Descriptive laboratory study. Methods A total of 29 patients with ACL ruptures participated in gait analysis and RTS readiness testing 6 months after reconstruction. Muscle and joint contact forces were estimated using an electromyography (EMG)–driven musculoskeletal model of the knee. The magnitude of typical limb asymmetry in uninjured controls was used to define limits of meaningful limb asymmetry in patients after ACL reconstruction. The RTS testing included isometric quadriceps strength testing, 4 unilateral hop tests, and 2 self-report questionnaires. Paired t tests were used to assess limb symmetry for peak medial and tibiofemoral contact forces in all patients, and a mixed-design analysis of variance was used to analyze the effect of passing or failing RTS testing on contact force asymmetry. Results Among all patients, neither statistically significant nor meaningful contact force asymmetries were identified. However, patients who failed RTS testing exhibited meaningful contact force asymmetries, with tibiofemoral contact force being significantly lower for the involved knee. Conversely, patients who passed RTS testing exhibited neither significant nor meaningful

  12. Revision Anterior Cruciate Ligament Reconstruction in Military Personnel.

    PubMed

    Balazs, George C; Grimm, Patrick D; Donohue, Michael A; Keblish, David J; Rue, John-Paul

    2016-08-01

    This study aims to report the clinical and functional outcomes of revision anterior cruciate ligament (ACL) reconstruction in a young, active duty military population. Patients undergoing revision ACL reconstruction were enrolled in an institutional clinical database and followed prospectively. The primary outcomes were patients' scores on a timed run, as compared with recorded scores before reinjury. Secondary outcomes included scores on the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the International Knee Documentation Committee subjective (IKDC subjective), the Short Form - 36 health survey (SF-36) version 2, the Single Assessment Numeric Evaluation (SANE), and the Tegner activity scale. A total of 13 patients were identified who met the inclusion criteria and had complete follow-up. The mean age at revision ACL reconstruction was 20.5 years (range, 19-22 years), and mean follow-up was 40.2 months (range, 13-66 months). All patients underwent a single stage revision ACL reconstruction with ipsilateral bone-patellar tendon-bone autograft, ipsilateral hamstring autograft, or bone-tendon-bone allograft. Mean physical readiness test (PRT) score at final follow-up was not statistically different than documented preinjury PRT score (77.9 vs. 85.5, p > 0.05), nor was the mean run time (7:12 vs. 6:43/mile, p > 0.05). Significant improvements exceeding published minimal clinically important differences were seen in SANE score, SF-36 physical component summary score, KOOS sports and recreation, KOOS quality of life, WOMAC pain score, and WOMAC function score. Patients undergoing revision ACL reconstruction at our facility show good recovery of baseline physical performance as measured by the semiannual PRT and timed run test, and significant improvements in patient-reported outcome scores. Level of Evidence Level IV, case series.

  13. Quantitative analysis of the reconstruction performance of interpolants

    NASA Technical Reports Server (NTRS)

    Lansing, Donald L.; Park, Stephen K.

    1987-01-01

    The analysis presented provides a quantitative measure of the reconstruction or interpolation performance of linear, shift-invariant interpolants. The performance criterion is the mean square error of the difference between the sampled and reconstructed functions. The analysis is applicable to reconstruction algorithms used in image processing and to many types of splines used in numerical analysis and computer graphics. When formulated in the frequency domain, the mean square error clearly separates the contribution of the interpolation method from the contribution of the sampled data. The equations provide a rational basis for selecting an optimal interpolant; that is, one which minimizes the mean square error. The analysis has been applied to a selection of frequently used data splines and reconstruction algorithms: parametric cubic and quintic Hermite splines, exponential and nu splines (including the special case of the cubic spline), parametric cubic convolution, Keys' fourth-order cubic, and a cubic with a discontinuous first derivative. The emphasis in this paper is on the image-dependent case in which no a priori knowledge of the frequency spectrum of the sampled function is assumed.

  14. Anterior Cruciate Ligament Reconstruction Using a Combination of Autograft and Allograft Tendon

    PubMed Central

    Darnley, James E.; Léger-St-Jean, Benjamin; Pedroza, Angela D.; Flanigan, David C.; Kaeding, Christopher C.; Magnussen, Robert A.

    2016-01-01

    Background: Anterior cruciate ligament (ACL) reconstruction with hamstring autografts less than 8.5 mm in diameter is associated with worse patient-reported outcome scores and increased risk of revision surgery compared with reconstructions performed with larger grafts. One proposed solution to small autograft harvest is to create a hybrid graft by augmenting autografts with allograft tissue to increase graft diameter. Purpose: To compare hybrid autograft/allograft ACL reconstruction to autograft ACL reconstruction, specifically analyzing the patient-reported outcome scores and the risk of revision surgery at 2 years postoperative. Study Design: Cohort study; Level of evidence, 3. Methods: From the years 2002 to 2009, a total of 34 patients were identified from a prospectively collected database as having undergone hybrid ACL reconstruction. Twenty-seven of 34 (79.4%) patients had a 2-year follow-up. These 27 patients were matched by age (within 1 year) and sex to 27 patients who underwent hamstring autograft ACL reconstruction during the same period. At the 2-year mark, revision surgery risk and patient-reported outcome scores were compared between the 2 groups. Results: The mean age for the hybrid and matched groups (±SD) was 20.9 ± 7.0 years. Both the hybrid and control groups had 17 males and 10 females. There was no significant difference in preoperative patient-reported outcome scores, meniscus tears, or cartilage lesions between the 2 groups. Graft size was larger in the hybrid group (9.5 ± 0.6 mm) than in the autograft group (8.4 ± 0.9 mm) (P < .001). At 2 years postoperative, patient-reported outcome scores were similar between the hybrid and autograft groups. Revision surgery was required in 5 (18.5%) patients who underwent hybrid reconstruction compared with 2 (7.4%) of those who underwent autograft reconstruction (P = .26). Conclusion: Patients who undergo ACL reconstruction with hybrid hamstring grafts and hamstring autografts report similar

  15. Industrial applications of high-performance computing for phylogeny reconstruction

    NASA Astrophysics Data System (ADS)

    Bader, David A.; Moret, Bernard M.; Vawter, Lisa

    2001-07-01

    Phylogenies (that is, tree-of-life relationships) derived from gene order data may prove crucial in answering some fundamental open questions in biomolecular evolution. Real-world interest is strong in determining these relationships. For example, pharmaceutical companies may use phylogeny reconstruction in drug discovery for discovering synthetic pathways unique to organisms that they wish to target. Health organizations study the phylogenies of organisms such as HIV in order to understand their epidemiologies and to aid in predicting the behaviors of future outbreaks. And governments are interested in aiding the production of such foodstuffs as rice, wheat and potatoes via genetics through understanding of the phylogenetic distribution of genetic variation in wild populations. Yet few techniques are available for difficult phylogenetic reconstruction problems. Appropriate tools for analysis of such data may aid in resolving some of the phylogenetic problems that have been analyzed without much resolution for decades. With the rapid accumulation of whole genome sequences for a wide diversity of taxa, especially microbial taxa, phylogenetic reconstruction based on changes in gene order and gene content is showing promise, particularly for resolving deep (i.e., ancient) branch splits. However, reconstruction from gene-order data is even more computationally expensive than reconstruction from sequence data, particularly in groups with large numbers of genes and highly-rearranged genomes. We have developed a software suite, GRAPPA, that extends the breakpoint analysis (BPAnalysis) method of Sankoff and Blanchette while running much faster: in a recent analysis of chloroplast genome data for species of Campanulaceae on a 512-processor Linux supercluster with Myrinet, we achieved a one-million-fold speedup over BPAnalysis. GRAPPA can use either breakpoint or inversion distance (computed exactly) for its computation and runs on single-processor machines as well as

  16. ACLS.

    PubMed

    Handley, A J

    2001-09-01

    It must be emphasised that the published International Guidelines 2000 contain an in-depth presentation of the scientific evidence behind advanced life support. The exact interpretation of this evidence, and the algorithms adopted by a national resuscitation council will depend upon various factors such as local interpretation of the evidence, local practice and availability of drugs. The ERC is publishing its own summaries of the guideline changes and the sequences of action for both BLS and ALS and these papers are recommended for further reading.

  17. Quadriceps Muscle Function After Rehabilitation With Cryotherapy in Patients With Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Hart, Joseph M.; Kuenze, Christopher M.; Diduch, David R.; Ingersoll, Christopher D.

    2014-01-01

    Context: Persistent muscle weakness after anterior cruciate ligament (ACL) reconstruction may be due to underlying activation failure and arthrogenic muscle inhibition (AMI). Knee-joint cryotherapy has been shown to improve quadriceps function transiently in those with AMI, thereby providing an opportunity to improve quadriceps muscle activation and strength in patients with a reconstructed ACL. Objective: To compare quadriceps muscle function in patients with a reconstructed ACL who completed a 2-week intervention including daily cryotherapy (ice bag), daily exercises, or both. Design: Cross-sectional study. Setting: Laboratory. Patients or Other Participants: A total of 30 patients with reconstructed ACLs who were at least 6 months post-index surgery and had measurable quadriceps AMI. Intervention(s): The patients attended 4 supervised visits over a 2-week period. They were randomly assigned to receive 20 minutes of knee-joint cryotherapy, 1 hour of therapeutic rehabilitation exercises, or cryotherapy followed by exercises. Main Outcome Measure(s): We measured quadriceps Hoffmann reflex, normalized maximal voluntary isometric contraction torque, central activation ratio using the superimposed-burst technique, and patient-reported outcomes before and after the intervention period. Results: After the 2-week intervention period, patients who performed rehabilitation exercises immediately after cryotherapy had higher normalized maximal voluntary isometric contraction torques (P = .002, Cohen d effect size = 1.4) compared with those who received cryotherapy alone (P = .16, d = 0.58) or performed exercise alone (P = .16, d = 0.30). Conclusions: After ACL reconstruction, patients with AMI who performed rehabilitation exercises immediately after cryotherapy experienced greater strength gains than those who performed cryotherapy or exercises alone. PMID:25299442

  18. Integrated Main Propulsion System Performance Reconstruction Process/Models

    NASA Technical Reports Server (NTRS)

    Lopez, Eduardo; Elliott, Katie; Snell, Steven; Evans, Michael

    2013-01-01

    The Integrated Main Propulsion System (MPS) Performance Reconstruction process provides the MPS post-flight data files needed for postflight reporting to the project integration management and key customers to verify flight performance. This process/model was used as the baseline for the currently ongoing Space Launch System (SLS) work. The process utilizes several methodologies, including multiple software programs, to model integrated propulsion system performance through space shuttle ascent. It is used to evaluate integrated propulsion systems, including propellant tanks, feed systems, rocket engine, and pressurization systems performance throughout ascent based on flight pressure and temperature data. The latest revision incorporates new methods based on main engine power balance model updates to model higher mixture ratio operation at lower engine power levels.

  19. Customized mandibular reconstruction plates improve mechanical performance in a mandibular reconstruction model

    PubMed Central

    Gutwald, Ralf; Jaeger, Raimund; Lambers, Floor M.

    2017-01-01

    Abstract The purpose of this paper was to analyze the biomechanical performance of customized mandibular reconstruction plates with optimized strength. The best locations for increasing bar widths were determined with a sensitivity analysis. Standard and customized plates were mounted on mandible models and mechanically tested. Maximum stress in the plate could be reduced from 573 to 393 MPa (−31%) by increasing bar widths. The median fatigue limit was significantly greater (p < 0.001) for customized plates (650 ± 27 N) than for standard plates (475 ± 27 N). Increasing bar widths at case-specific locations was an effective strategy for increasing plate fatigue performance. PMID:27887036

  20. Posteromedial Corner Reconstruction

    PubMed Central

    Ferrer, Gonzalo; Leon, Agustín; Wirth, Hans; Mena, Adolfo; Tuca, María José; Espinoza, Gonzalo

    2017-01-01

    Objective: Report the experience, after 1-year follow-up, of 30 patients who underwent anatomical knee reconstruction of posteromedial corner (PMC) injuries, using La Prade´s Technique. Methods: Retrospective cohort study of 30 consecutive patients with PMC injuries operated between November 2010 and May 2014 by the same surgical team. Inclusion criteria: patients with clinical presentation and images (stress radiographs and MRI) compatible with PMC injury, who maintained a grade III chronic instability in spite of at least 3 months of orthopedic treatment, who were reconstructed using La Prade’s anatomical technique, and completed at least 12 months of follow-up. Exclusion criteria: discordance between clinical and image studies, grade I or II medial instability, and surgery performed through a different technique. Data was collected by reviewing the electronic files and images. Functional scores (IKDC and Lysholm) were applied and registered in the preoperative evaluation, and then 6 and 12 months after surgery. Results: Thirty patients (28 men and 2 women) met the inclusion criteria. Mean age was 43 years (24-69). The vast majority (28 patients) had a high-energy mechanism of injury. Twenty patients were diagnosed in the acute setting, while 10 had a delayed diagnosis after poor results of concomitant ligament reconstructions. With the exception of 2 patients, who presented with isolated PMC injury, the majority had associated injuries as detailed: 11 cases had PMC + anterior cruciate ligament (ACL) injury, 3 patients had PMC + posterior cruciate ligament (PCL) injury, 3 patients had PMC + meniscal tears, 9 patients had PMC + ACL + PCL injuries, and there were 2 cases of PMC + ACL + PCL + lateral collateral ligament injuries. Mean time for PMC reconstruction surgery was 5 months (range 2-32). Lysholm and IKDC scores were 18,2 (2-69) and 24,3 (9,2-52,9) respectively in the preoperative setting, improving to 76,7 (44-94) and 70,7 (36,8-95,4) after 1-year follow

  1. Relationship of ACL Injury and Posterior Tibial Slope With Patient Age, Sex, and Race

    PubMed Central

    Waiwaiole, Alana; Gurbani, Ajay; Motamedi, Kambiz; Seeger, Leanne; Sim, Myung Shin; Nwajuaku, Patricia; Hame, Sharon L.

    2016-01-01

    Background: Posterior tibial slope (PTS) has been proposed as a potential risk factor for anterior cruciate ligament (ACL) injury; however, studies that have examined this relationship have provided inconclusive and sometimes contradictory results. Further characterization of this relationship may enable the medical community to identify individuals at greater risk for ACL injury and possibly characterize an anatomic target during surgical reconstruction. Purpose: The primary goal was to investigate the relationship between PTS and ACL injury. The secondary goal was to determine whether there are any patient factors, such as age, race, or sex, that correlate with ACL injury and PTS. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Medical records of 221 patients who underwent magnetic resonance imaging (MRI) of the knee between January 2003 and December 2009 were reviewed. Patients were separated into 2 groups: a study group of those subjects who had undergone surgery for ACL injury (n = 107) and a control group of patients diagnosed with patellofemoral syndrome (n = 114). Demographic data were collected, and MRI images from both groups were analyzed using imaging software to obtain medial and lateral tibial slope measurements. Data were then analyzed using analysis of variance (ANOVA) comparison and a multivariable regression model to determine which, if any, patient factors were related to probability of having an ACL injury. Results: ANOVA comparison demonstrated that the study group had significantly greater values for lateral PTS (6° ± 4°; P < .001) and medial PTS (7° ± 4°; P = .002) compared with controls (5° ± 3° and 5° ± 4°, respectively). After stepwise elimination of nonsignificant variables, the final multivariable logistic regression model determined that age (odds ratio [OR], 0.94; P < .001) and lateral PTS (OR, 1.12; P = .002) had statistically significant relationships with ACL injury. Medial PTS, race, and sex were not

  2. An Athlete's Nightmare: Tearing the ACL

    MedlinePlus

    ... women's knees tends to bend inward when women land." Some researchers believe that this inward bend may ... any athlete suffers ACL damage is because they land in a flat-footed position, as opposed to ...

  3. Evaluation of pediatric CPR course on knowledge of pediatric residents--before and after ACLS course.

    PubMed

    Soltani, Alireza Ebrahim; Khan, Zahid Hussain; Arbabi, Shahriar; Hossini, Babak; Nahvi, Hedaiatollah; Agamohammadi, Asghar

    2009-02-01

    An evaluation was conducted on the knowledge gained by pediatric residents on CPR, before and after a PALS (Pediatric Advanced Cardiac Life Support) course. Following an examination of all pediatric residents at Tehran University of Medical Sciences, they were divided into two groups: non-trained (Group 1) and a group scheduled to undergone training (Group 2). A course on ACLS was conducted. Examination were performed before and after the ACLS course. The mean of the examination prior to the course in Group 1 and 2 was low, reflecting no significant differences between the Groups. Examination after the ACLS course showed a statistically significant improvement in Group 2 (P < or = 0.05). It is concluded that knowledge of pediatric residents was low before ACLS course and enhanced after the course.

  4. Pain Assessment After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Okoroha, Kelechi R.; Keller, Robert A.; Jung, Edward K.; Khalil, Lafi; Marshall, Nathan; Kolowich, Patricia A.; Moutzouros, Vasilios

    2016-01-01

    Background: Anterior cruciate ligament (ACL) reconstruction is a common outpatient procedure that is accompanied by significant postoperative pain. Purpose: To determine differences in acute pain levels between patients undergoing ACL reconstruction with bone–patellar tendon–bone (BTB) versus hamstring tendon (HS) autograft. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 70 patients who underwent primary ACL reconstruction using either BTB or HS autografts consented to participate. The primary outcome of the study was postoperative pain levels (visual analog scale), which were collected immediately after surgery and for 3 days postoperatively. Secondary outcome measures included opioid consumption (intravenous morphine equivalents), hours slept, patient satisfaction, reported breakthrough pain, and calls to the physician. Results: Patients treated with BTB had increased pain when compared with those treated with HS in the acute postoperative period (mean ± SD: day 0, 6.0 ± 1.7 vs 5.2 ± 2.0 [P = .066]; day 1, 5.9 ± 1.7 vs 4.9 ±1.7 [P = .024]; day 2, 5.2 ± 1.9 vs 4.1 ± 2.0 [P = .032]; day 3, 4.8 ± 2.1 vs 3.9 ± 2.3 [P = .151]). There were also significant increases in reported breakthrough pain (day 0, 76% vs 43% [P = .009]; day 1, 64% vs 35% [P = .003]) and calls to the physician due to pain (day 1, 19% vs 0% [P = .041]) in the BTB group. There were no significant differences in narcotic requirements or sleep disturbances. Overall, the BTB group reported significantly less satisfaction with pain management on days 0 and 1 (P = .024 and .027, respectively). Conclusion: A significant increase in acute postoperative pain was found when performing ACL reconstruction with BTB compared with HS. Patients treated with BTB were more likely to have breakthrough pain, decreased satisfaction with their pain management, and to contact their physician due to pain. These findings suggest a difference in early postoperative pain between the 2 most

  5. Quantitative topographic anatomy of the femoral ACL footprint: a micro-CT analysis.

    PubMed

    Norman, Daniel G; Getgood, Alan; Thornby, John; Bird, Jonathan; Turley, Glen A; Spalding, Tim; Williams, Mark A

    2014-11-01

    The femoral footprint of the anterior cruciate ligament (ACL) is a much-studied anatomic structure, predominantly due to its importance during ACL reconstruction surgery. A new technique utilising high-resolution micro-computed tomography (micro-CT) is described, allowing detailed three-dimensional (3D) quantitative analysis of this structure. Seven cadaveric knees were scanned using micro-CT, yielding 3D data with a reconstructed voxel size of 60 μm. A novel method of 3D surface extraction was developed and validated, facilitating both qualitative observation of surface details and quantitative topographic assessment using colour-coded relief maps. Images were displayed on an immersive 3D visualisation wall, and ten experienced ACL clinicians were surveyed as to the presence and morphology of osseous landmarks, providing qualitative assessment of whether such features can be reliably identified for navigation during surgery. Both quantitative analysis and qualitative assessment of the footprints in this study showed significant variability in the presence and morphology of osseous landmarks, with the lateral intercondylar ridge being objectively present in four out of seven relief maps, although reportedly seen in six out of seven cases in the qualitative study, suggesting an element of subjectivity and interpretation. This is the first study to utilise micro-CT in the study of ACL anatomy.

  6. ACL Tears on The Rise Among Kids, Especially Girls

    MedlinePlus

    ... page: https://medlineplus.gov/news/fullstory_163730.html ACL Tears on the Rise Among Kids, Especially Girls ... A common knee injury -- an anterior cruciate ligament (ACL) tear -- has steadily increased among 6- to 18- ...

  7. Multi-rater Agreement in the Assessment of Anterior Cruciate Ligament Reconstruction Failure. A Radiographic and Video Analysis of the MARS Cohort

    PubMed Central

    Matava, Matthew J.; Arciero, Robert A.; Baumgarten, Keith M.; Carey, James L.; DeBerardino, Thomas M.; Hame, Sharon L.; Hannafin, Jo A.; Miller, Bruce S.; Nissen, Carl W.; Taft, Timothy N.; Wolf, Brian R.; Wright, Rick W.

    2015-01-01

    Background ACL reconstruction failure occurs in up to 10% of cases. Technical errors are considered the most common cause of graft failure despite the absence of validated studies. There is limited data regarding the agreement among orthopedic surgeons in terms of the etiology of primary ACL reconstruction failure and accuracy of graft tunnel placement. Purpose The purpose of this study is to test the hypothesis that experienced knee surgeons have a high level of inter-observer reliability in the agreement of the etiology of the primary ACL reconstruction failure, anatomical graft characteristics, tunnel placement. Methods Twenty cases of revision ACL reconstruction were randomly selected from the MARS database. Each case included the patient's history, standardized radiographs, and a concise 30-second arthroscopic video taken at the time of revision demonstrating the graft remnant and location of the tunnel apertures. 10 MARS surgeons not involved with the primary surgery reviewed all 20 cases. Each surgeon completed a two-part questionnaire dealing with each surgeon's training and practice as well as the placement of the femoral and tibial tunnels, condition of the primary graft, and the surgeon's opinion as to the etiology of graft failure. Inter-rater agreement was determined for each question. Inter-rater agreement was determined for each question with the kappa coefficient and prevalence adjusted bias adjusted kappa (PABAK). Results The 10 reviewers were in practice an average of 14 years. All performed at least 25 ACL reconstructions per year and 9 were fellowship-trained in sports medicine. There was wide variability in agreement among knee experts as to the specific etiology of ACL graft failure. When specifically asked about technical error as the cause for failure, inter-observer agreement was only slight (prevalence adjusted bias adjusted kappa [PABAK]: 0.26). There was fair overall agreement on ideal femoral tunnel placement (PABAK: 0.55), but only

  8. Reducing the Risk of ACL Injury in Female Athletes

    ERIC Educational Resources Information Center

    McDaniel, Larry W.; Rasche, Adrienna; Gaudet, Laura; Jackson, Allen

    2010-01-01

    The Anterior Cruciate Ligament (ACL) is located behind the kneecap (patella) and connects the thigh bone (femur) to the shin bone (tibia). Stabilizing the knee joint is the primary responsibility of the ACL. Injuries that affect the ACL are three to five times more common in females than males. This is a result of anatomical, biomechanical,…

  9. 50 CFR 648.120 - Scup Annual Catch Limit (ACL).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... shall recommend to the MAFMC separate ACLs for the commercial and recreational scup fisheries, the sum... and recreational fishing sector ACLs will be established consistent with the allocation guidelines... recreational sector ACLs may be established on an annual basis for up to 3 years at a time, dependent...

  10. 50 CFR 648.120 - Scup Annual Catch Limit (ACL).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... shall recommend to the MAFMC separate ACLs for the commercial and recreational scup fisheries, the sum... and recreational fishing sector ACLs will be established consistent with the allocation guidelines... recreational sector ACLs may be established on an annual basis for up to 3 years at a time, dependent...

  11. 50 CFR 648.120 - Scup Annual Catch Limit (ACL).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... shall recommend to the MAFMC separate ACLs for the commercial and recreational scup fisheries, the sum... and recreational fishing sector ACLs will be established consistent with the allocation guidelines... recreational sector ACLs may be established on an annual basis for up to 3 years at a time, dependent...

  12. Effect of ski boot rear stiffness (SBRS) on maximal ACL force during injury prone landing movements in alpine ski racing: A study with a musculoskeletal simulation model.

    PubMed

    Eberle, Robert; Heinrich, Dieter; Kaps, Peter; Oberguggenberger, Michael; Nachbauer, Werner

    2017-06-01

    A common anterior cruciate ligament (ACL) injury situation in alpine ski racing is landing back-weighted after a jump. Simulated back-weighted landing situations showed higher ACL-injury risk for increasing ski boot rear stiffness (SBRS) without considering muscles. It is well known that muscle forces affect ACL tensile forces during landing. The purpose of this study is to investigate the effect of different SBRS on the maximal ACL tensile forces during injury prone landings considering muscle forces by a two-dimensional musculoskeletal simulation model. Injury prone situations for ACL-injuries were generated by the musculoskeletal simulation model using measured kinematics of a non-injury situation and the method of Monte Carlo simulation. Subsequently, the SBRS was varied for injury prone landings. The maximal ACL tensile forces and contributing factors to the ACL forces were compared for the different SBRS. In the injury prone landings the maximal ACL tensile forces increased with increasing SBRS. It was found that the higher maximal ACL force was caused by higher forces acting on the tibia by the boot and by higher quadriceps muscle forces both due to the higher SBRS. Practical experience suggested that the reduction of SBRS is not accepted by ski racers due to performance reasons. Thus, preventive measures may concentrate on the reduction of the quadriceps muscle force during impact.

  13. Effect of knee angle on quadriceps strength and activation after anterior cruciate ligament reconstruction

    PubMed Central

    Theuerkauf, Paul

    2015-01-01

    Quadriceps strength and activation deficits after anterior cruciate ligament (ACL) injury or surgery are typically evaluated at joint positions that are biomechanically advantageous to the quadriceps muscle. However, the effect of knee joint position and the associated changes in muscle length on strength and activation is currently unknown in this population. Here, we examined the effect of knee angle on quadriceps strength, activation, and electrically evoked torque in individuals with ACL reconstruction. Furthermore, we evaluated whether knee angle mediated the relationship between quadriceps weakness and functional performance after ACL reconstruction. Knee strength and activation were tested bilaterally at 90° and 45° of knee flexion in 11 subjects with ACL reconstruction using an interpolated triplet technique. The magnitude of electrically evoked torque at rest was used to quantify peripheral muscle contractile property changes, and the single-leg hop for distance test was used to evaluate functional performance. The results indicated that although quadriceps strength deficits were similar between knee angles, voluntary activation deficits were significantly higher in the reconstructed leg at 45° of knee flexion. On the contrary, the side-to-side evoked torque at rest ratio [i.e., (reconstructed/nonreconstructed) × 100] was significantly lower at 90° than at 45° of knee flexion. The association between quadriceps strength and functional performance was stronger at 45° of knee flexion. The results provide novel evidence that quadriceps activation is selectively affected at 45° of knee flexion and emphasize the importance of assessing quadriceps strength and activation at this position when feasible because it better captures activation deficits. PMID:25997949

  14. Performance improvements in temperature reconstructions of 2-D tunable diode laser absorption spectroscopy (TDLAS)

    NASA Astrophysics Data System (ADS)

    Choi, Doo-Won; Jeon, Min-Gyu; Cho, Gyeong-Rae; Kamimoto, Takahiro; Deguchi, Yoshihiro; Doh, Deog-Hee

    2016-02-01

    Performance improvement was attained in data reconstructions of 2-dimensional tunable diode laser absorption spectroscopy (TDLAS). Multiplicative Algebraic Reconstruction Technique (MART) algorithm was adopted for data reconstruction. The data obtained in an experiment for the measurement of temperature and concentration fields of gas flows were used. The measurement theory is based upon the Beer-Lambert law, and the measurement system consists of a tunable laser, collimators, detectors, and an analyzer. Methane was used as a fuel for combustion with air in the Bunsen-type burner. The data used for the reconstruction are from the optical signals of 8-laser beams passed on a cross-section of the methane flame. The performances of MART algorithm in data reconstruction were validated and compared with those obtained by Algebraic Reconstruction Technique (ART) algorithm.

  15. Performances of JEM-EUSO: energy and X max reconstruction

    NASA Astrophysics Data System (ADS)

    Adams, J. H.; Ahmad, S.; Albert, J.-N.; Allard, D.; Anchordoqui, L.; Andreev, V.; Anzalone, A.; Arai, Y.; Asano, K.; Ave Pernas, M.; Baragatti, P.; Barrillon, P.; Batsch, T.; Bayer, J.; Bechini, R.; Belenguer, T.; Bellotti, R.; Belov, K.; Berlind, A. A.; Bertaina, M.; Biermann, P. L.; Biktemerova, S.; Blaksley, C.; Blanc, N.; Błȩcki, J.; Blin-Bondil, S.; Blümer, J.; Bobik, P.; Bogomilov, M.; Bonamente, M.; Briggs, M. S.; Briz, S.; Bruno, A.; Cafagna, F.; Campana, D.; Capdevielle, J.-N.; Caruso, R.; Casolino, M.; Cassardo, C.; Castellinic, G.; Catalano, C.; Catalano, G.; Cellino, A.; Chikawa, M.; Christl, M. J.; Cline, D.; Connaughton, V.; Conti, L.; Cordero, G.; Crawford, H. J.; Cremonini, R.; Csorna, S.; Dagoret-Campagne, S.; de Castro, A. J.; De Donato, C.; de la Taille, C.; De Santis, C.; del Peral, L.; Dell'Oro, A.; De Simone, N.; Di Martino, M.; Distratis, G.; Dulucq, F.; Dupieux, M.; Ebersoldt, A.; Ebisuzaki, T.; Engel, R.; Falk, S.; Fang, K.; Fenu, F.; Fernández-Gómez, I.; Ferrarese, S.; Finco, D.; Flamini, M.; Fornaro, C.; Franceschi, A.; Fujimoto, J.; Fukushima, M.; Galeotti, P.; Garipov, G.; Geary, J.; Gelmini, G.; Giraudo, G.; Gonchar, M.; González Alvarado, C.; Gorodetzky, P.; Guarino, F.; Guzmán, A.; Hachisu, Y.; Harlov, B.; Haungs, A.; Hernández Carretero, J.; Higashide, K.; Ikeda, D.; Ikeda, H.; Inoue, N.; Inoue, S.; Insolia, A.; Isgrò, F.; Itow, Y.; Joven, E.; Judd, E. G.; Jung, A.; Kajino, F.; Kajino, T.; Kaneko, I.; Karadzhov, Y.; Karczmarczyk, J.; Karus, M.; Katahira, K.; Kawai, K.; Kawasaki, Y.; Keilhauer, B.; Khrenov, B. A.; Kim, J.-S.; Kim, S.-W.; Kim, S.-W.; Kleifges, M.; Klimov, P. A.; Kolev, D.; Kreykenbohm, I.; Kudela, K.; Kurihara, Y.; Kusenko, A.; Kuznetsov, E.; Lacombe, M.; Lachaud, C.; Lee, J.; Licandro, J.; Lim, H.; López, F.; Maccarone, M. C.; Mannheim, K.; Maravilla, D.; Marcelli, L.; Marini, A.; Martinez, O.; Masciantonio, G.; Mase, K.; Matev, R.; Medina-Tanco, G.; Mernik, T.; Miyamoto, H.; Miyazaki, Y.; Mizumoto, Y.; Modestino, G.; Monaco, A.; Monnier-Ragaigne, D.; Morales de los Ríos, J. A.; Moretto, C.; Morozenko, V. S.; Mot, B.; Murakami, T.; Murakami, M. Nagano; Nagata, M.; Nagataki, S.; Nakamura, T.; Napolitano, T.; Naumov, D.; Nava, R.; Neronov, A.; Nomoto, K.; Nonaka, T.; Ogawa, T.; Ogio, S.; Ohmori, H.; Olinto, A. V.; Orleański, P.; Osteria, G.; Panasyuk, M. I.; Parizot, E.; Park, I. H.; Park, H. W.; Pastircak, B.; Patzak, T.; Paul, T.; Pennypacker, C.; Perez Cano, S.; Peter, T.; Picozza, P.; Pierog, T.; Piotrowski, L. W.; Piraino, S.; Plebaniak, Z.; Pollini, A.; Prat, P.; Prévôt, G.; Prieto, H.; Putis, M.; Reardon, P.; Reyes, M.; Ricci, M.; Rodríguez, I.; Rodríguez Frías, M. D.; Ronga, F.; Roth, M.; Rothkaehl, H.; Roudil, G.; Rusinov, I.; Rybczyński, M.; Sabau, M. D.; Sáez-Cano, G.; Sagawa, H.; Saito, A.; Sakaki, N.; Sakata, M.; Salazar, H.; Sánchez, S.; Santangelo, A.; Santiago Crúz, L.; Sanz Palomino, M.; Saprykin, O.; Sarazin, F.; Sato, H.; Sato, M.; Schanz, T.; Schieler, H.; Scotti, V.; Segreto, A.; Selmane, S.; Semikoz, D.; Serra, M.; Sharakin, S.; Shibata, T.; Shimizu, H. M.; Shinozaki, K.; Shirahama, T.; Siemieniec-Oziȩbło, G.; Silva López, H. H.; Sledd, J.; Słomińska, K.; Sobey, A.; Sugiyama, T.; Supanitsky, D.; Suzuki, M.; Szabelska, B.; Szabelski, J.; Tajima, F.; Tajima, N.; Tajima, T.; Takahashi, Y.; Takami, H.; Takeda, M.; Takizawa, Y.; Tenzer, C.; Tibolla, O.; Tkachev, L.; Tokuno, H.; Tomida, T.; Tone, N.; Toscano, S.; Trillaud, F.; Tsenov, R.; Tsunesada, Y.; Tsuno, K.; Tymieniecka, T.; Uchihori, Y.; Unger, M.; Vaduvescu, O.; Valdés-Galicia, J. F.; Vallania, P.; Valore, L.; Vankova, G.; Vigorito, C.; Villaseñor, L.; von Ballmoos, P.; Wada, S.; Watanabe, J.; Watanabe, S.; Watts, J.; Weber, M.; Weiler, T. J.; Wibig, T.; Wiencke, L.; Wille, M.; Wilms, J.; Włodarczyk, Z.; Yamamoto, T.; Yamamoto, Y.; Yang, J.; Yano, H.; Yashin, I. V.; Yonetoku, D.; Yoshida, K.; Yoshida, S.; Young, R.; Zotov, M. Yu.; Zuccaro Marchi, A.

    2015-11-01

    The Extreme Universe Space Observatory (EUSO) on-board the Japanese Experimental Module (JEM) of the International Space Station aims at the detection of ultra high energy cosmic rays from space. The mission consists of a UV telescope which will detect the fluorescence light emitted by cosmic ray showers in the atmosphere. The mission, currently developed by a large international collaboration, is designed to be launched within this decade. In this article, we present the reconstruction of the energy of the observed events and we also address the X max reconstruction. After discussing the algorithms developed for the energy and X max reconstruction, we present several estimates of the energy resolution, as a function of the incident angle, and energy of the event. Similarly, estimates of the X max resolution for various conditions are presented.

  16. Rehabilitation After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Kruse, L.M.; Gray, B.; Wright, R.W.

    2012-01-01

    Background: Rigorous rehabilitation after anterior cruciate ligament (ACL) reconstruction is necessary for a successful surgical outcome. A large number of clinical trials continue to assess aspects of this rehabilitation process. Prior systematic reviews evaluated fifty-four Level-I and II clinical trials published through 2005. Methods: Eighty-five articles from 2006 to 2010 were identified utilizing multiple search engines. Twenty-nine Level-I or II studies met inclusion criteria and were evaluated with use of the CONSORT (Consolidated Standards of Reporting Trials) criteria. Topics included in this review are postoperative bracing, accelerated strengthening, home-based rehabilitation, proprioception and neuromuscular training, and six miscellaneous topics investigated in single trials. Results: Bracing following ACL reconstruction remains neither necessary nor beneficial and adds to the cost of the procedure. Early return to sports needs further research. Home-based rehabilitation can be successful. Although neuromuscular interventions are not likely to be harmful to patients, they are also not likely to yield large improvements in outcomes or help patients return to sports faster. Thus, they should not be performed to the exclusion of strengthening and range-of-motion exercises. Vibration training may lead to faster and more complete proprioceptive recovery but further evidence is needed. Conclusions: Several new modalities for rehabilitation after ACL reconstruction may be helpful but should not be performed to the exclusion of range-of-motion, strengthening, and functional exercises. Accelerated rehabilitation does not appear to be harmful but further investigation of rehabilitation timing is warranted. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. PMID:23032584

  17. Classification of gait kinematics of anterior cruciate ligament reconstructed subjects using principal component analysis and regressions modelling.

    PubMed

    Leporace, Gustavo; Batista, Luiz Alberto; Muniz, Adriane M; Zeitoune, Gabriel; Luciano, Thiago; Metsavaht, Leonardo; Nadal, Jurandir

    2012-01-01

    The aim of this study was to compare the knee kinematics of anterior cruciate ligament reconstructed (ACL-R) and healthy subjects (CG) during gait and classify the status of normality. Ten healthy and six ACL-R subjects had their gait analyzed at 60 fps. 3D knee angles were calculated and inserted into three separate matrices used to perform the principal component (PC) analysis. The scores of PCs retained in each analysis were used to calculate the standard distances (SD) of each participant in relation to the center of the CG. The PC scores of the three planes were used in a logistic regression to define normality. In the sagittal plane there was no difference between groups. In the frontal and transverse planes ACL-R subjects showed higher SD values than CG. PCs identified that ACL-R subjects showed increased adduction, internal and external rotation. All these subjects had their gait classified as abnormal by logistic regression. Therefore, in the studied ACL-R subjects the gait pattern did not return to normal levels after surgery. This may lead to degenerative injuries, as osteoarthritis, in the future.

  18. Biomechanical Outcomes After Bio-enhanced Anterior Cruciate Ligament Repair and Anterior Cruciate Ligament Reconstruction Are Equal in a Porcine Model

    PubMed Central

    Vavken, Patrick; Fleming, Braden C.; Mastrangelo, Ashley N.; Machan, Jason T.; Murray, Martha M.

    2011-01-01

    Purpose The objective of this study was to compare the biomechanical outcomes of a new method of anterior cruciate ligament (ACL) treatment, bio-enhanced ACL repair, with ACL reconstruction in a large animal model. Methods Twenty-four skeletally immature pigs underwent unilateral ACL transection and were randomly allocated to receive bio-enhanced ACL repair with a collagen-platelet composite, allograft (bone–patellar tendon– bone) reconstruction, or no further treatment (n = 8 for each group). The structural properties and anteroposterior laxity of the experimental and contralateral ACL-intact knees were measured 15 weeks postoperatively. All dependent variables were normalized to those of the contralateral knee and compared by use of generalized linear mixed models. Results After 15 weeks, bio-enhanced ACL repair and ACL reconstruction produced superior biomechanical outcomes to ACL transection. However, there were no significant differences between bio-enhanced ACL repair and ACL reconstruction for maximum load (P = .4745), maximum displacement (P = .4217), or linear stiffness (P = .6327). There were no significant differences between the 2 surgical techniques in anteroposterior laxity at 30° (P = .7947), 60° (P = .6270), or 90° (P = .9008). Conclusions Bio-enhanced ACL repair produced biomechanical results that were not different from ACL reconstruction in a skeletally immature, large animal model, although the variability associated with both procedures was large. Both procedures produced significantly improved results over ACL transection, showing that both were effective in this model. Clinical Relevance Bio-enhanced ACL repair may 1 day provide an alternative treatment option for ACL injury. PMID:22261137

  19. Prehospital ACLS--does it work?

    PubMed

    Maheshwari, Alok; Mehrotra, Avanti; Gupta, Anoop K; Thakur, Ranjan K

    2002-11-01

    Cardiac disease is the most common cause of death in the United States, and sudden cardiac arrest frequently claims the lives of men and women during their most productive years. It is believed that much better survival rates can be achieved for victims of cardiac arrest through optimizing the "chain of survival" as described by the American Heart Association. The relative and incremental benefit of full prehospital ACLS over basic life support and defibrillation is unproven, however. This is an important issue in this era of cost containment. Some of the ongoing studies including the OPALS study may clarify the cost effectiveness and relative efficacy of rapid defibrillation and full ACLS programs for victims of prehospital cardiac arrest [6].

  20. ACLED Country Report: Central African Republic

    DTIC Science & Technology

    2015-01-01

    violence between January 1997 and September 2014. Almost 8,000 fatalities have occurred during this time, making it the fourteenth most fatal country in...the dataset in this regard. However, violence has escalated sharply in recent years: the majority of these events occurred since the outbreak of the...CAR) is the fifteenth most violent country in the ACLED dataset, with over 2,000 recorded events of political violence between January 1997 and

  1. THE EFFECT OF CONSERVATIVELY TREATED ACL INJURY ON KNEE JOINT POSITION Sense

    PubMed Central

    Herrington, Lee

    2016-01-01

    ABSTRACT Background Proprioception is critical for effective movement patterns. However, methods of proprioceptive measurement in previous research have been inconsistent and lacking in reliability statistics making it applications to clinical practice difficult. Researchers have suggested that damage to the anterior cruciate ligament (ACL) can alter proprioceptive ability due to a loss of functioning mechanoreceptors. The majority of patients opt for reconstructive surgery following this injury. However, some patients chose conservative rehabilitation options rather than surgical intervention. Purpose The purpose of this study was to determine the effect of ACL deficiency on knee joint position sense following conservative, non-operative treatment and return to physical activity. A secondary purpose was to report the reliability and measurement error of the technique used to measure joint position sense, (JPS) and comment on the clinical utility of this measurement. Study Design Observational study design using a cross-section of ACL deficient patients and matched uninjured controls. Methods Twenty active conservatively treated ACL deficient patients who had returned to physical activity and twenty active matched controls were included in the study. Knee joint position sense was measured using a seated passive-active reproductive angle technique. The average absolute angle of error score, between 10 °-30 ° of knee flexion was determined. This error score was derived from the difference between the target and repositioning angle. Results The ACL deficient patients had a greater error score (7.9 °±3.6) and hence poorer static proprioception ability that both the contra-lateral leg (2.0 °±1.6; p = 0.0001) and the control group (2.6 °±0.9; p = 0.0001). The standard error of the mean (SEM) of this JPS technique was 0.5 ° and 0.2 ° and the minimum detectable change (MDC) was 1.3 ° and 0.4 ° on asymptomatic and symptomatic subjects

  2. Sagittal Plane Knee Biomechanics and Vertical Ground Reaction Forces Are Modified Following ACL Injury Prevention Programs

    PubMed Central

    Padua, Darin A.; DiStefano, Lindsay J.

    2009-01-01

    Context: Injuries to the anterior cruciate ligament (ACL) occur because of excessive loading on the knee. ACL injury prevention programs can influence sagittal plane ACL loading factors and vertical ground reaction force (VGRF). Objective: To determine the influence of ACL injury prevention programs on sagittal plane knee biomechanics (anterior tibial shear force, knee flexion angle/moments) and VGRF. Data Sources: The PubMed database was searched for studies published between January 1988 and June 2008. Reference lists of selected articles were also reviewed. Study Selection: Studies were included that evaluated healthy participants for knee flexion angle, sagittal plane knee kinetics, or VGRF after performing a multisession training program. Two individuals reviewed all articles and determined which articles met the selection criteria. Approximately 4% of the articles fulfilled the selection criteria. Data Extraction: Data were extracted regarding each program’s duration, frequency, exercise type, population, supervision, and testing procedures. Means and variability measures were recorded to calculate effect sizes. One reviewer extracted all data and assessed study quality using PEDro (Physiotherapy Evidence Database). A second reviewer (blinded) verified all information. Results: There is moderate evidence to indicate that knee flexion angle, external knee flexion moment, and VGRF can be successfully modified by an ACL injury prevention program. Programs utilizing multiple exercises (ie, integrated training) appear to produce the most improvement, in comparison to that of single-exercise programs. Knee flexion angle was improved following integrated training (combined balance and strength exercises or combined plyometric and strength exercises). Similarly, external knee flexion moment was improved following integrated training consisting of balance, plyometric, and strength exercises. VGRF was improved when incorporating supervision with instruction and

  3. Kinesiophobia After Anterior Cruciate Ligament Rupture and Reconstruction: Noncopers Versus Potential Copers

    PubMed Central

    Hartigan, Erin H.; Lynch, Andrew D.; Logerstedt, David S.; Chmielewski, Terese L.; Snyder-Mackler, Lynn

    2016-01-01

    STUDY DESIGN Secondary-analysis, longitudinal cohort study. OBJECTIVES To compare kinesiophobia levels in noncopers and potential copers at time points spanning pre– and post–anterior cruciate ligament (ACL) reconstruction and to examine the association between changes in kinesiophobia levels and clinical measures. BACKGROUND After ACL injury, a screening examination may be used to classify patients as potential copers or noncopers based on dynamic knee stability. Quadriceps strength, single-leg hop performance, and self-reported knee function are worse in noncopers. High kinesiophobia levels after ACL reconstruction are associated with poorer self-reported knee function and lower return-to-sport rates. Kinesiophobia levels have not been examined before ACL reconstruction, across the transition from presurgery to postsurgery, or based on potential coper and noncoper classification. METHODS Quadriceps strength indexes, single-leg hop score indexes, self-reported knee function (Knee Outcome Survey activities of daily living subscale, global rating scale), and kinesiophobia (Tampa Scale of Kinesiophobia [TSK-11]) scores were compiled for potential copers (n = 50) and noncopers (n = 61) from 2 clinical trial databases. A repeated-measures analysis of variance was used to compare TSK-11 scores between groups and across 4 time points (before preoperative treatment, after preoperative treatment, 6 months post–ACL reconstruction, and 12 months post–ACL reconstruction). Correlations determined the association of kinesiophobia levels with other clinical measures. RESULTS Presurgery TSK-11 scores were significantly higher in noncopers than in potential copers. Postsurgery, no group differences existed. TSK-11 scores in both groups decreased across all time points; however, TSK-11 scores decreased more in noncopers in the interval between presurgery and postsurgery. In noncopers, the decreases in TSK-11 scores from presurgery to postsurgery and after surgery were

  4. LARS Artificial Ligament Versus ABC Purely Polyester Ligament for Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Iliadis, Dimitrios Ph.; Bourlos, Dimitrios N.; Mastrokalos, Dimitrios S.; Chronopoulos, Efstathios; Babis, George C.

    2016-01-01

    Background: Graft choice for anterior cruciate ligament (ACL) reconstruction is of critical importance. Various grafts have been used so far, with autografts long considered the optimal solution for the treatment of ACL-deficient knees. Limited data are available on the long-term survivorship of synthetic grafts. Purpose: To compare the functional outcome and survivorship of ACL reconstructions performed using the LARS (ligament augmentation and reconstruction system) ligament and the ABC (active biosynthetic composite) purely polyester ligament. Study Design: Case series; Level of evidence, 4. Methods: The results of 72 patients who underwent primary arthroscopic ACL reconstruction with the LARS ligament and 31 cases with an ABC purely polyester ligament were reviewed. The mean follow-up periods for the LARS and ABC groups were 9.5 and 5.1 years, respectively. A survivorship analysis of the 2 synthetic grafts was performed using the Kaplan-Meier method with a log-rank test (Mantel-Cox, 95% CI). Lysholm, Tegner activity, Knee injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) scores as well as laxity measurements obtained using a KT-1000 arthrometer were recorded for all intact grafts, and a Mann-Whitney U test was used for comparison reasons. Results: The rupture rates for LARS and ABC grafts were 31% (95% CI, 20%-42%) and 42% (95% CI, 25%-59%), respectively. For intact grafts, the mean Lysholm score was good for both groups (90 for the LARS group and 89 for the ABC group), with the majority of patients returning to their preinjury level of activities, and the mean IKDC score was 90 for the LARS group and 86 for the ABC group. Conclusion: The rupture rates of both LARS and ABC grafts were both high. However, the LARS ligament provided significantly better survivorship compared with the ABC ligament at short- to midterm follow-up (95% CI). PMID:27453894

  5. Evaluation of Infection after Anterior Cruciate Ligament Reconstruction during a Short Period

    PubMed Central

    Kim, Hee-June; Lee, Hyun-Joo; Lee, Jong-Chul; Min, Seung-Gi; Kyung, Hee-Soo

    2017-01-01

    Purpose We encountered 7 cases (7.1%) of infection (5 deep and 2 superficial) in 98 cases of anterior cruciate ligament (ACL) reconstruction using hamstring autografts in a 17-month period. The aim of this study was to analyze the causes of infection and to introduce our treatment strategy. Materials and Methods We investigated the shelf-life of the fixation implants, the order of surgery, previous knee surgery, infectious pathogen, treatment of infection, and results of treatment. Results There was no problem with the expiration date of the fixation implants. The order of surgery was either the last or second to the last of all those performed on the same day. One patient had undergone knee surgery 8 months previously. The treatment after infection included aggressive debridement in all cases. Revision ACL reconstruction with graft removal was performed in 1 case of persistent infection with methicillin-resistant Staphylococcus aureus. All cases had satisfactory clinical results without recurrence during a mean 24.9 months of follow-up. Conclusions We could not verify the exact cause of the high incidence of infection during the 17-month period. However, preventive measures are important to decrease the incidence of infection after ACL reconstruction. PMID:28231648

  6. Should critical care nurses be ACLS-trained?

    PubMed

    Hagyard-Wiebe, Tammy

    2007-01-01

    The aim of resuscitation is to sustain life with intact neurological functioning and the same quality of life previously experienced by the patient. Advanced cardiac life support (ACLS) was designed to achieve this aim. However the requirement for ACLS training for critical care nurses working in Canadian critical care units is inconsistent across the country. The purposes of this article are to explore the evidence surrounding ACLS training for critical care nurses and its impact on resuscitation outcomes, and to review the evidence surrounding ACLS knowledge and skill degradation with strategies to support code blue team efficiency for an effective resuscitation. Using the search terms ACLS training, resuscitation, critical care, and nursing, two databases, CINAHL and MEDLINE, were used. The evidence supports the need for ACLS training for critical care nurses. The evidence also supports organized ongoing refresher courses, multidisciplinary mock code blue practice using technologically advanced simulator mannequins, and videotaped reviews to prevent knowledge and skill degradation for effective resuscitation efforts.

  7. 78 FR 76753 - Standards of Performance for Petroleum Refineries for Which Construction, Reconstruction, or...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-19

    ... AGENCY 40 CFR Part 60 RIN 2060-AS03 Standards of Performance for Petroleum Refineries for Which... direct final action to amend the Standards of Performance for Petroleum Refineries for Which Construction... Performance for Petroleum Refineries for Which Construction, Reconstruction or Modification Commenced...

  8. 78 FR 76788 - Standards of Performance for Petroleum Refineries for Which Construction, Reconstruction, or...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-19

    ... AGENCY 40 CFR Part 60 RIN 2060-AS03 Standards of Performance for Petroleum Refineries for Which... amend the Standards of Performance for Petroleum Refineries for Which Construction, Reconstruction, or... to take action on amendments to the standards of performance for petroleum refineries at 40 CFR...

  9. Arthroscopic anatomical double bundle anterior cruciate ligament reconstruction: A prospective longitudinal study

    PubMed Central

    Devgan, Ashish; Singh, Amanpreet; Gogna, Paritosh; Singla, Rohit; Magu, Narender Kumar; Mukhopadhyay, Reetadyuti

    2015-01-01

    Background: Single bundle anterior cruciate ligament (ACL) reconstruction has been the current standard of treatment for ACL deficiency. However, a significant subset of patients continue to report residual symptoms of instability with a poor pivot control. Cadaveric biomechanical studies have shown double bundle (DB) ACL reconstructions to restore the knee kinematics better. This study evaluates the outcome of DB ACL reconstruction. Materials and Methods: 30 consecutive patients who underwent anatomic DB ACL reconstruction were included in this prospective longitudinal study. There were all males with a mean age of 25 ± 7.45 years. All patients were prospectively evaluated using GeNouRoB (GNRB) arthrometer, functional knee scores (International Knee Documentation Committee [IKDC] and Lysholm) and postoperative magnetic resonance imaging (MRI) for comparing the graft orientation and footprint of the reconstructed ACL with that of the normal knee. Results: The average followup was 36.2 months. At the time of final followup the mean Lysholm score was 93.13 ± 3.31. As per the objective IKDC score, 26 patients (86.6%) were in Group A while 4 patients (13.3%) were in Group B. The mean differential anterior tibial translation by GNRB, arthrometer was 1.07 ± 0.8 mm (range 0.1-2.3 mm). All cases had a negative pivot shift test. MRI scans of operated and the contralateral normal knee showed the mean sagittal ACL tibial angle coronal ACL tibial angle and tibial ACL footprint to be in accordance with the values of the contralateral, normal knee. Conclusion: The study demonstrates that DB ACL reconstruction restores the ACL anatomically in terms of size and angle of orientation. However, long term studies are needed to further substantiate its role in decreasing the incidence of early osteoarthritic changes compared to the conventional single bundle reconstructions. PMID:26015600

  10. Comparing Transtibial and Anteromedial Drilling Techniques for Single-bundle Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Sukur, Erhan; Akman, , Yunus Emre; Senel, , Ahmet; Unkar, Ethem Ayhan; Topcu, , Huseyin Nevzat; Ozturkmen, , and Yusuf

    2016-01-01

    Background: Among the many factors that determine the outcome following anterior cruciate ligament (ACL) reconstruction, the position of the femoral tunnel is known to be critically important and is still the subject of extensive research. Objective: We aimed to retrospectively compare the outcomes of arthroscopic ACL reconstruction using transtibial (TT) or anteromedial (AMP) drilling techniques for femoral tunnel placement. Methods: ACL reconstruction was performed using the TT technique in 49 patients and the AMP technique in 56 patients. Lachman and pivot-shift tests, the Lysholm Knee Scale, International Knee Documentation Committee (IKDC) score, Tegner activity scale and visual analog scale (VAS) were used for the clinical and functional evaluation of patients. Time to return to normal life and time to jogging were assessed in addition to the radiological evaluation of femoral tunnel placement. Results: In terms of the Lysholm, IKDC, Tegner score, and stability tests, no significant differences were found between the two groups (p > 0.05). Statistical analysis revealed reduced time to return to normal life and jogging in the AMP group (p < 0.05). The VAS score was also significantly reduced in the AMP group (p < 0.05). The position of the femoral tunnel was anatomically appropriate in 51 patients in the AMP group and 5 patients in the TT group. Conclusion: The AMP technique is superior to the TT technique in creating anatomical femoral tunnel placement during single-bundle ACL reconstruction and provides faster recovery in terms of return to normal life and jogging at short-term follow-up. PMID:27733884

  11. The effect of the variation in ACL constitutive model on joint kinematics and biomechanics under different loads: a finite element study.

    PubMed

    Wan, Chao; Hao, Zhixiu; Wen, Shizhu

    2013-04-01

    The biomechanics and function of the anterior cruciate ligament (ACL) have been widely studied using both experimental and simulation methods. It is known that a constitutive model of joint tissue is a critical factor in the numerical simulation. Some different ligament constitutive models have been presented to describe the ACL material behavior. However, the effect of the variation in the ligament constitutive model on joint kinematics and biomechanics has still not been studied. In this paper, a three-dimensional finite element model of an intact tibiofemoral joint was reconstructed. Three ACL constitutive models were compared under different joint loads (such as anterior tibial force, varus tibial torque, and valgus tibial torque) to investigate the effect of the change of the ACL constitutive model. The three constitutive models corresponded to an isotropic hyperelasticity model, a transversely isotropic hyperelasticity model with neo-Hookean ground substance description, and a transversely isotropic hyperelastic model with nonlinear ground substance description. Although the material properties of these constitutive equations were fitted on the same uniaxial tension stress-strain curve, the change of the ACL material constitutive model was found to induce altered joint kinematics and biomechanics. The effect of different ACL constitutive equations on joint kinematics depended on both deformation direction and load type. The variation in the ACL constitutive models would influence the joint kinematic results greatly in both the anterior and internal directions under anterior tibial force as well as some other deformations such as the anterior and medial tibial translations under valgus tibial torque, and the medial tibial translation and internal rotation under varus torque. It was revealed that the transversely isotropic hyperelastic model with nonlinear ground substance description (FE model III) was the best representation of the realistic ACL property by a

  12. A Wearable Neuromuscular Device Reduces ACL Injury Risk in Female Soccer Athletes

    PubMed Central

    Decker, Michael John; Shaw, Matthew; Maddan, Casey; Campbell, Julie; Davidson, Bradley

    2016-01-01

    Objectives: Female soccer athletes have a three-fold greater risk of sustaining an ACL injury compared with their male counterparts yet only 1 in 5 teams engage in ACL risk reduction programs due to several participation barriers. The purpose of this study was to determine the effects of a wearable neuromuscular (WNM) device on postural control, performance and ACL injury risk in female soccer athletes. Methods: Seventy-nine elite youth and collegiate female soccer athletes (age range: 12-25 y) trained with a WNM device that applied bi-lateral, topical pressure to the medial quadriceps and hamstrings muscles (Topical Gear, Austin, TX). The athletes performed 7-9 weeks of pre-season training with the WNM device consisting of strength and conditioning exercises and on-field team practices (46-64 total hours of exposure). Postural control was measured in 15 athletes with and without the WNM device before and after the training program; and performance was measured in 25 athletes without the WNM device before and after the training program. Postural control was determined from a single-leg landing on a force plate from a horizontal distance normalized to leg length. The athletes were instructed to gain their balance as fast as possible upon landing and remain balanced for 5 seconds. The peak ground reaction forces (GRF) and the medial-lateral, anterior-posterior and net center of pressure (COP) velocities and displacement ranges were calculated during 2 seconds of single-leg stance. Performance measures including speed, power and endurance were measured from the 40 yard dash, vertical jump for height and the Beep test, respectively. A two-way repeated measures ANOVA and post-hoc comparisons were used to compare the postural variables; and t-tests were used to compare the performance tests (p=.05). ACL injury rates, the absolute risk reduction (ARR) and the number needed to treat (NNT) to prevent one ACL injury were calculated between the WNM intervention group and 11

  13. Mean squared error performance of MFBD nonlinear scene reconstruction using speckle imaging in horizontal imaging applications

    NASA Astrophysics Data System (ADS)

    Archer, Glen E.; Bos, Jeremy P.; Roggemann, Michael C.

    2012-05-01

    Terrestrial imaging over very long horizontal paths is increasingly common in surveillance and defense systems. All optical systems that operate in or through the atmosphere suffer from turbulence induced image blur. This paper explores the Mean-Square-Error (MSE) performance of a multi-frame-blind-deconvolution-based reconstruction technique using a non-linear optimization strategy to recover a reconstructed object. Three sets of 70 images representing low, moderate and severe turbulence degraded images were simulated from a diffraction limited image taken with a professional digital camera. Reconstructed objects showed significant, 54, 22 and 14 percent improvement in mean squared error for low, moderate, and severe turbulence cases respectively.

  14. Performance of τq-lepton reconstruction and identification in CMS

    SciTech Connect

    Chatrchyan, Serguei; et al.

    2012-01-01

    The performance of tau-lepton reconstruction and identification algorithms is studied using a data sample of proton-proton collisions at sqrt(s)=7 TeV, corresponding to an integrated luminosity of 36 inverse picobarns collected with the CMS detector at the LHC. The tau leptons that decay into one or three charged hadrons, zero or more short-lived neutral hadrons, and a neutrino are identified using final-state particles reconstructed in the CMS tracker and electromagnetic calorimeter. The reconstruction efficiency of the algorithms is measured using tau leptons produced in Z-boson decays. The tau-lepton misidentification rates for jets and electrons are determined.

  15. Tibiofemoral cartilage contact biomechanics in patients after reconstruction of a ruptured anterior cruciate ligament.

    PubMed

    Hosseini, Ali; Van de Velde, Samuel; Gill, Thomas J; Li, Guoan

    2012-11-01

    We investigated the in vivo cartilage contact biomechanics of the tibiofemoral joint in patients after reconstruction of a ruptured anterior cruciate ligament (ACL). A dual fluoroscopic and MR imaging technique was used to investigate the cartilage contact biomechanics of the tibiofemoral joint during in vivo weight-bearing flexion of the knee in eight patients 6 months following clinically successful reconstruction of an acute isolated ACL rupture. The location of tibiofemoral cartilage contact, size of the contact area, cartilage thickness at the contact area, and magnitude of the cartilage contact deformation of the ACL-reconstructed knees were compared with those previously measured in intact (contralateral) knees and ACL-deficient knees of the same subjects. Contact biomechanics of the tibiofemoral cartilage after ACL reconstruction were similar to those measured in intact knees. However, at lower flexion, the abnormal posterior and lateral shift of cartilage contact location to smaller regions of thinner tibial cartilage that has been described in ACL-deficient knees persisted in ACL-reconstructed knees, resulting in an increase of the magnitude of cartilage contact deformation at those flexion angles. Reconstruction of the ACL restored some of the in vivo cartilage contact biomechanics of the tibiofemoral joint to normal. Clinically, recovering anterior knee stability might be insufficient to prevent post-operative cartilage degeneration due to lack of restoration of in vivo cartilage contact biomechanics.

  16. Anterior cruciate ligament reconstruction, rehabilitation, and return to play: 2015 update

    PubMed Central

    Nyland, John; Mattocks, Alma; Kibbe, Shane; Kalloub, Alaa; Greene, Joe W; Caborn, David N M

    2016-01-01

    Anatomical discoveries and a growing appreciation of the knee as a complex organ are driving innovations in patient care decision-making following anterior cruciate ligament (ACL) injury. Surgeons are increasing their efforts to restore combined mechanical-neurosensory ACL function and placing more consideration on when to reconstruct versus repair native anatomical structures. Surgical options now include primary repair with or without reinforcing the injured ACL with suture-based internal bracing, and growing evidence supports biological augmentation using platelet-rich plasma and mesenchymal stem cells to enhance tissue healing. Physical therapists and athletic trainers are increasing their efforts to facilitate greater athlete cognitive engagement during therapeutic exercise performance to better restore nonimpaired neuromuscular control activation amplitude and timing. Knee brace design and use needs to evolve to better match these innovations and their influence on the rehabilitation plan timetable. There is a growing appreciation for the multifaceted characteristics of the rehabilitation process and how they influence neuromuscular, educational, and psychobehavioral treatment goal achievement. Multiple sources may influence the athlete during the return to sports process and clinical outcome measures need to be refined to better evaluate these influences. This update summarizes contemporary ACL surgical, medical, and rehabilitation interventions and future trends. PMID:26955296

  17. Tibial plateau fracture following gracilis-semitendinosus anterior cruciate ligament reconstruction: The tibial tunnel stress-riser.

    PubMed

    Sundaram, R O; Cohen, D; Barton-Hanson, N

    2006-06-01

    Tibial plateau fractures following anterior cruciate ligament (ACL) reconstruction are extremely rare. This is the first reported case of a tibial plateau fracture following four-strand gracilis-semitendinosus autograft ACL reconstruction. The tibial tunnel alone may behave as a stress riser which can significantly reduce bone strength.

  18. High-performance parallel image reconstruction for the New Vacuum Solar Telescope

    NASA Astrophysics Data System (ADS)

    Li, Xue-Bao; Liu, Zhong; Wang, Feng; Jin, Zhen-Yu; Xiang, Yong-Yuan; Zheng, Yan-Fang

    2015-06-01

    Many technologies have been developed to help improve spatial resolution of observational images for ground-based solar telescopes, such as adaptive optics (AO) systems and post-processing reconstruction. As any AO system correction is only partial, it is indispensable to use post-processing reconstruction techniques. In the New Vacuum Solar Telescope (NVST), a speckle-masking method is used to achieve the diffraction-limited resolution of the telescope. Although the method is very promising, the computation is quite intensive, and the amount of data is tremendous, requiring several months to reconstruct observational data of one day on a high-end computer. To accelerate image reconstruction, we parallelize the program package on a high-performance cluster. We describe parallel implementation details for several reconstruction procedures. The code is written in the C language using the Message Passing Interface (MPI) and is optimized for parallel processing in a multiprocessor environment. We show the excellent performance of parallel implementation, and the whole data processing speed is about 71 times faster than before. Finally, we analyze the scalability of the code to find possible bottlenecks, and propose several ways to further improve the parallel performance. We conclude that the presented program is capable of executing reconstruction applications in real-time at NVST.

  19. An Ecological Study of Anterior Cruciate Ligament Reconstruction, Part 2

    PubMed Central

    McGrath, Timothy M.; Waddington, Gordon; Scarvell, Jennie M.; Ball, Nick; Creer, Rob; Woods, Kevin; Smith, Damian; Adams, Roger

    2017-01-01

    Background: Additional high-quality prospective studies are needed to better define the objective criteria used in relation to return-to-sport decisions after anterior cruciate ligament (ACL) reconstruction in active populations. Purpose: To investigate prospectively the relationship between functional performance test results at 24 weeks postoperative and return-to-sport activity (Tegner activity score) at 12 and 24 months, respectively, after synthetic (ligament advanced reinforcement system [LARS]) and autograft (doubled semitendinosus/gracilis [2ST/2GR]) ACL reconstructions. Study Design: Case series; Level of evidence, 4. Methods: A total of 64 patients who underwent ACL reconstruction (32 LARS, 32 2ST/2GR autograft; mean age, 27.9 years; body mass index [BMI], 24.9 kg/m2) were assessed preoperatively and at staged intervals postoperatively up to 24 weeks for isokinetic testing of quadriceps and hamstring average power per repetition at 60 deg/s and 180 deg/s, a battery of hop tests, peak vertical ground-reaction force (vGRF), and time to peak vGRF (in seconds) during a step- and jump-down task onto a force platform and peak speed (m/s) using a global positioning system (GPS unit) during a running task. A cohort of 32 healthy matched participants (mean age, 26.31 years; BMI, 25.7 kg/m2) were also tested to act as reference. Pearson correlation was calculated to assess correlation of each performance measure at 24 weeks postoperative with activity outcomes (Tegner score) at 12 and 24 months. Results: The strongest correlation between physical performance tests and return-to-sport outcomes was observed with peak speed during running. Large correlations were also observed for hamstring isokinetic power and hop test for distance. Moderate correlations were observed for timed hop, peak vGRF during a jump-down task, and quadriceps isokinetic power. No statistical correlations were observed for time to peak vGRF during a step-down and jump-down task as well as peak v

  20. New perspectives on ACL injury: On the role of repetitive sub-maximal knee loading in causing ACL fatigue failure.

    PubMed

    Wojtys, Edward M; Beaulieu, Mélanie L; Ashton-Miller, James A

    2016-12-01

    In this paper, we review a series of studies that we initiated to examine mechanisms of anterior cruciate ligament (ACL) injury in the hope that these injuries, and their sequelae, can be better prevented. First, using the earliest in vitro model of a simulated single-leg jump landing or pivot cut with realistic knee loading rates and trans-knee muscle forces, we identified the worst-case dynamic knee loading that causes the greatest peak ACL strain: Combined knee compression, flexion, and internal tibial rotation. We also identified morphologic factors that help explain individual susceptibility to ACL injury. Second, using the above knee loading, we introduced a possible paradigm shift in ACL research by demonstrating that the human ACL can fail by a sudden rupture in response to repeated sub-maximal knee loading. If that load is repeated often enough over a short time interval, the failure tended to occur proximally, as observed clinically. Third, we emphasize the value of a physical exam of the hip by demonstrating how limited internal axial rotation at the hip both increases the susceptibility to ACL injury in professional athletes, and also increases peak ACL strain during simulated pivot landings, thereby further increasing the risk of ACL fatigue failure. When training at-risk athletes, particularly females with their smaller ACL cross-sections, rationing the number and intensity of worst-case knee loading cycles, such that ligament degradation is within the ACL's ability to remodel, should decrease the risk for ACL rupture due to ligament fatigue failure.© 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2059-2068, 2016.

  1. Anatomical reconstruction of the anterior cruciate ligament: a logical approach.

    PubMed

    Gali, Julio Cesar

    2015-01-01

    We describe the surgical approach that we have used over the last years for anterior cruciate ligament (ACL) reconstruction, highlighting the importance of arthroscopic viewing through the anteromedial portal (AMP) and femoral tunnel drilling through an accessory anteromedial portal (AMP). The AMP allows direct view of the ACL femoral insertion site on the medial aspect of the lateral femoral condyle, does not require guides for anatomic femoral tunnel reaming, prevents an additional lateral incision in the distal third of the thigh (as would be unavoidable when the outside-in technique is used) and also can be used for double-bundle ACL reconstruction.

  2. Anatomical reconstruction of the anterior cruciate ligament: a logical approach

    PubMed Central

    Gali, Julio Cesar

    2015-01-01

    We describe the surgical approach that we have used over the last years for anterior cruciate ligament (ACL) reconstruction, highlighting the importance of arthroscopic viewing through the anteromedial portal (AMP) and femoral tunnel drilling through an accessory anteromedial portal (AMP). The AMP allows direct view of the ACL femoral insertion site on the medial aspect of the lateral femoral condyle, does not require guides for anatomic femoral tunnel reaming, prevents an additional lateral incision in the distal third of the thigh (as would be unavoidable when the outside-in technique is used) and also can be used for double-bundle ACL reconstruction. PMID:26417571

  3. High-Performance 3D Compressive Sensing MRI Reconstruction Using Many-Core Architectures

    PubMed Central

    Kim, Daehyun; Trzasko, Joshua; Smelyanskiy, Mikhail; Haider, Clifton; Dubey, Pradeep; Manduca, Armando

    2011-01-01

    Compressive sensing (CS) describes how sparse signals can be accurately reconstructed from many fewer samples than required by the Nyquist criterion. Since MRI scan duration is proportional to the number of acquired samples, CS has been gaining significant attention in MRI. However, the computationally intensive nature of CS reconstructions has precluded their use in routine clinical practice. In this work, we investigate how different throughput-oriented architectures can benefit one CS algorithm and what levels of acceleration are feasible on different modern platforms. We demonstrate that a CUDA-based code running on an NVIDIA Tesla C2050 GPU can reconstruct a 256 × 160 × 80 volume from an 8-channel acquisition in 19 seconds, which is in itself a significant improvement over the state of the art. We then show that Intel's Knights Ferry can perform the same 3D MRI reconstruction in only 12 seconds, bringing CS methods even closer to clinical viability. PMID:21922017

  4. Performance of the Rayleigh task based on the posterior probability of tomographic reconstructions

    SciTech Connect

    Hanson, K.M.

    1991-01-01

    We seek the best possible performance of the Rayleigh task in which one must decide whether a perceived object is a pair of Gaussian-blurred points or a blurred line. Two Bayesian reconstruction algorithms are used, the first based on a Gaussian prior-probability distribution with a nonnegativity constraint and the second based on an entropic prior. In both cases, the reconstructions are found that maximize the posterior probability. We compare the performance of the Rayleigh task obtained with two decision variables, the logarithm of the posterior probability ratio and the change in the mean-squared deviation from the reconstruction. The method of evaluation is based on the results of a numerical testing procedure in which the stated discrimination task is carried out on reconstructions of a randomly generated sequence of images. The ability to perform the Rayleigh task is summarized in terms of a discrimination index that is derived from the area under the receiver-operating characteristic (ROC) curve. We find that the use of the posterior probability does not result in better performance of the Rayleigh task than the mean-squared deviation from the reconstruction. 10 refs., 6 figs.

  5. Cost of Outpatient Arthroscopic Anterior Cruciate Ligament Reconstruction Among Commercially Insured Patients in the United States, 2005-2013

    PubMed Central

    Herzog, Mackenzie M.; Marshall, Stephen W.; Lund, Jennifer L.; Pate, Virginia; Spang, Jeffrey T.

    2017-01-01

    Background: Despite the significance of anterior cruciate ligament (ACL) injuries, these conditions have been under-researched from a population-level perspective. It is important to determine the economic effect of these injuries in order to document the public health burden in the United States. Purpose: To describe the cost of outpatient arthroscopic ACL reconstruction and health care utilization among commercially insured beneficiaries in the United States. Study Design: Economic and decision analysis; Level of evidence, 3. Methods: The study used the Truven Health Analytics MarketScan Commercial Claims and Encounters database, an administrative claims database that contains a large sample (approximately 148 million) of privately insured individuals aged <65 years and enrolled in employer-sponsored plans. All claims with Current Procedural Terminology (CPT) code 29888 (arthroscopically aided ACL reconstruction or augmentation) from 2005 to 2013 were included. “Immediate procedure” cost was computed assuming a 3-day window of care centered on date of surgery. “Total health care utilization” cost was computed using a 9-month window of care (3 months preoperative and 6 months postoperative). Results: There were 229,446 outpatient arthroscopic ACL reconstructions performed over the 9-year study period. Median immediate procedure cost was $9399.49. Median total health care utilization cost was $13,403.38. Patients who underwent concomitant collateral ligament (medial [MCL], lateral [LCL]) repair or reconstruction had the highest costs for both immediate procedure ($12,473.24) and health care utilization ($17,006.34). For patients who had more than 1 reconstruction captured in the database, total health care utilization costs were higher for the second procedure than the first procedure ($16,238.43 vs $15,000.36), despite the fact that immediate procedure costs were lower for second procedures ($8685.73 vs $9445.26). Conclusion: These results provide a

  6. Landing Mechanics During Side Hopping and Crossover Hopping Maneuvers in Noninjured Women and Women With Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Ortiz, Alexis; Olson, Sharon; Trudelle-Jackson, Elaine; Rosario, Martin; Venegas, Heidi L.

    2011-01-01

    Objective To compare, landing mechanics and electromyographic activity of the lower extremities during side hopping and crossover hopping maneuvers, in noninjured women and women with anterior cruciate ligament (ACL) reconstruction. Design A case-control study. Setting A 3-dimensional motion analysis laboratory. Participants Twenty-eight young women (range, 21–35 years) (15 control subjects and 13 subjects with ACL reconstruction). Patients and Methods All participants performed a side-to-side hopping task that consisted of hopping single-legged 10 times consecutively from side to side across 2 lines marked 30 cm apart on 2 individual force plates. The task was designated as a side hopping when the hop was to the opposite side of the stance leg and as crossover hopping when the hop was toward the side of the stance leg. Main Outcome Measurements Peak hip-/knee-joint angles; peak knee extension/abduction joint moments; electromyographic studies of the gluteus maximus, gluteus medius, rectus femoris, and hamstring muscles; and quadriceps/hamstring co-contraction ratio were compared between the groups by means of 2 × 2 multivariate analysis of variance tests (group × maneuver). Results Noninjured women and women with ACL reconstruction exhibited similar hip-and knee-joint angles during both types of hopping. Hip-joint angles were greater during the crossover hopping in both groups, and knee-joint angles did not differ between the groups or hops. Knee-joint moments demonstrated a significant group × maneuver interaction. Greater knee extension and valgus moments were noted in the control group during crossover hopping, and greater knee abduction moments were noted in the ACL group during side hopping. Electromyographic data revealed no statistically significantly differences between the groups. Conclusions Women with ACL reconstruction exhibited the restoration of functional biomechanical movements such as hip-/knee-joint angles and lower extremity neuromuscular

  7. Clinical Results of Technique for Double Bundle Anterior Cruciate Ligament Reconstruction Using Hybrid Femoral Fixation and Retroscrew

    PubMed Central

    Kim, Doo-Sup; Yi, Chang-Ho; Chung, Hoi-Jung

    2011-01-01

    Background Anatomic anterior cruciate ligament (ACL) reconstruction has been presented as a means to more accurately restore the native anatomy of this ligament. This article describes a new method that uses a double bundle to perform ACL reconstruction and to evaluate the clinical outcome. Methods Grafts are tibialis anterior tendon allograft for anteromedial bundle (AMB) and hamstring tendon autograft without detachment of the tibial insertion for posterolateral bundle (PLB). This technique creates 2 tunnels in both the femur and tibia. Femoral fixation was done by hybrid fixation using Endobutton and Rigidfix for AMB and by biointerference screw for PLB. Tibial fixations are done by Retroscrew for AMB and by native insertion of hamstring tendon for PLB. Both bundles are independently and differently tensioned. We performed ACL reconstruction in 63 patients using our new technique. Among them, 47 participated in this study. The patients were followed up with clinical examination, Lysholm scales and International Knee Documentation Committee (IKDC) scoring system and radiological examination with a minimum 12 month follow-up duration. Results Significant improvement was seen on Lachman test and pivot-shift test between preoperative and last follow-up. Only one of participants had flexion contracture about 5 degrees at last follow-up. In anterior drawer test by KT-1000, authors found improvement from average 8.3 mm (range, 4 to 18 mm) preoperatively to average 1.4 mm (range, 0 to 6 mm) at last follow-up. Average Lysholm score of all patients was 72.7 ± 8.8 (range, 54 to 79) preoperatively and significant improvement was seen, score was 92.2 ± 5.3 (range, 74 to 97; p < 0.05) at last follow-up. Also IKDC score was normal in 35 cases, near normal in 11 cases, abnormal in 1 case at last follow-up. Conclusions Our new double bundle ACL reconstruction technique used hybrid fixation and Retroscrew had favorable outcomes. PMID:22162791

  8. Deconstructing and reconstructing cognitive performance in sleep deprivation.

    PubMed

    Jackson, Melinda L; Gunzelmann, Glenn; Whitney, Paul; Hinson, John M; Belenky, Gregory; Rabat, Arnaud; Van Dongen, Hans P A

    2013-06-01

    Mitigation of cognitive impairment due to sleep deprivation in operational settings is critical for safety and productivity. Achievements in this area are hampered by limited knowledge about the effects of sleep loss on actual job tasks. Sleep deprivation has different effects on different cognitive performance tasks, but the mechanisms behind this task-specificity are poorly understood. In this context it is important to recognize that cognitive performance is not a unitary process, but involves a number of component processes. There is emerging evidence that these component processes are differentially affected by sleep loss. Experiments have been conducted to decompose sleep-deprived performance into underlying cognitive processes using cognitive-behavioral, neuroimaging and cognitive modeling techniques. Furthermore, computational modeling in cognitive architectures has been employed to simulate sleep-deprived cognitive performance on the basis of the constituent cognitive processes. These efforts are beginning to enable quantitative prediction of the effects of sleep deprivation across different task contexts. This paper reviews a rapidly evolving area of research, and outlines a theoretical framework in which the effects of sleep loss on cognition may be understood from the deficits in the underlying neurobiology to the applied consequences in real-world job tasks.

  9. Accumulation of irrigation fluid in the calf as a complication during high tibial osteotomy combined with simultaneous arthroscopic anterior cruciate ligament reconstruction.

    PubMed

    Marti, C B; Jakob, R P

    1999-01-01

    Extravasation of irrigation fluid during arthroscopy is a well-known complication. We report a case of accumulation of fluid into the calf during open wedge high tibial osteotomy combined with simultaneous arthroscopic anterior cruciate ligament (ACL) reconstruction. The main cause for fluid extravasation was the drilling of the tibial tunnel, which allowed the fluid to cross the osteotomy gap and invade the flexor compartments. Although an elevation of the intracompartmental pressure was measured, there was no clinical evidence of compartment syndrome. A subcutaneous release of the flexor compartment of the leg was performed. The patient suffered no further sequelae. High tibial osteotomy combined with simultaneous arthroscopic ACL reconstruction has to be performed carefully, and potential complications must be detected immediately to prevent compartment syndrome.

  10. Improvement of the CMS Muon Reconstruction Performance due to Precise Track-based Alignment

    NASA Astrophysics Data System (ADS)

    Brown, Malachi

    2017-01-01

    The performance of the CMS muon system depends on a precise knowledge of the positions and orientations of all its elements. The muon tracks reconstructed in proton-proton collision data at the LHC are used to align the individual muon detectors with respect to the inner silicon tracker. The alignment procedure measures these positions and provides geometries of the muon system that must be validated to ensure the performance of the detectors. In this report we present a set of sophisticated validation tools, developed to test the accuracy of a given muon system geometry with data from collisions. The validation procedure uses events with pairs of muons from Z-boson decays and events with very high pT muons, in order to quantify the reconstruction performance of the muon system for a given geometry. Kinematic properties of muons reconstructed using information from the muon system are compared to the properties of muons built using information from the tracker. We demonstrate improvements of the muon reconstruction performance after track-based alignment procedures are performed with 2016 data.

  11. The addition of clonidine to bupivacaine in combined femoral-sciatic nerve block for anterior cruciate ligament reconstruction.

    PubMed

    Couture, Darren J; Cuniff, Heather M; Maye, John P; Pellegrini, Joseph

    2004-08-01

    Clonidine has been shown to prolong sensory analgesia when given as an adjunct to peripheral nerve blocks but has not been evaluated when given in conjunction with a femoral-sciatic nerve block. The purpose of this investigation was to determine whether the addition of clonidine to a femoral-sciatic nerve block would prolong the duration of sensory analgesia in groups of patients undergoing anterior cruciate ligament (ACL) reconstruction. This prospective, randomized, double-blind investigation was performed on 64 subjects undergoing ACL reconstruction. Patients were assigned randomly to receive a femoral-sciatic nerve block using 30 mL of 0.5% bupivacaine with 1:200,000 epinephrine (control group) or 30 mL of 0.5% bupivacaine with 1:200,000 epinephrine and 1 microg/kg of clonidine (experimental group). Variables measured included demographics, timed pain intensity measurements, postoperative analgesic consumption, duration of analgesia, and patient satisfaction. No significant differences were noted between groups for pain intensity scores, duration of sensory analgesia, postoperative analgesic requirements, or overall patient satisfaction. Both groups reported minimal amounts of postoperative pain and high analgesic satisfaction scores. Based on our results, we do not recommend the addition of clonidine to a femoral-sciatic nerve block when given to facilitate postoperative analgesia in patients undergoing ACL reconstruction.

  12. The effect of knee brace on coordination and neuronal leg muscle control: an early postoperative functional study in anterior cruciate ligament reconstructed patients.

    PubMed

    Rebel, M; Paessler, H H

    2001-09-01

    Two studies were carried out after anterior cruciate ligament (ACL) reconstruction to determine the effect of a knee brace on coordination (test 1) and electromyographic muscle activity in drop jumps (test 2). Test 1 studied 25 patients with ACL reconstruction under three test conditions (one-leg static, two-legged static, two-legged dynamic) compared with a control (n=30). The results showed highly significant improvements in all braced conditions. In test 2 ten patients with ACL reconstruction and ten healthy subjects performed a two-legged drop-jump; this was repeated 15 times and again 15 times with a knee brace worn on the reconstructed limb. Changes in electromyographically determined muscle activity (vastus medialis, vastus lateralis, biceps femoris, gastrocnemius) were observed, but they were significant in only few cases because of high variability. Drop-jumps with knee brace improved jumping height, increased the maximum knee angle in the ground contact phase, and reduced the maximum knee angle in the landing phase. Patients thus develop an increased confidence in the stability of their knees. We conclude that the benefits of the knee brace are due to the mechanical action, an enhanced coordination, and a psychological effect.

  13. Cramer-Rao lower bound and object reconstruction performance evaluation for intensity interferometry

    NASA Astrophysics Data System (ADS)

    Dolne, Jean J.; Gerwe, David R.; Crabtree, Peter N.

    2014-07-01

    This paper addresses the fundamental performance limits of object reconstruction methods using intensity interferometry measurements. It shows examples of reconstructed objects obtained with the FIIRE (Forward-model Interferometry Image Reconstruction Estimator) code developed by Boeing for AFRL. It considers various issues when calculating the multidimensional Cramér-Rao lower bound (CRLB) when the Fisher information matrix (FIM) is singular. In particular, when comparing FIIRE performance, characterized as the root mean square difference between the estimated and pristine objects with the CRLB, we found that FIIRE performance improved as the singularity became worse, a result not expected. We found that for invertible FIM, FIIRE yielded lower root mean squared error than the square root of the CRLB (by a factor as large as 100). This may be due to various regularization constraints (positivity, support, sharpness, and smoothness) included in FIIRE, rendering it a biased estimator, as opposed to the unbiased CRLB framework used. Using the sieve technique to mitigate false high frequency content inherent in point-by-point object reconstruction methods, we also show further improved FIIRE performance on some generic objects. It is worth noting that since FIIRE is an iterative algorithm searching to arrive at an object estimate consistent with the collected data and various constraints, an initial object estimate is required. In our case, we used a completely random initial object guess consisting of a 2-D array of uniformly distributed random numbers, sometimes multiplied with a 2-D Gaussian function.

  14. Relationship between jump landing kinematics and peak ACL force during a jump in downhill skiing: a simulation study.

    PubMed

    Heinrich, D; van den Bogert, A J; Nachbauer, W

    2014-06-01

    Recent data highlight that competitive skiers face a high risk of injuries especially during off-balance jump landing maneuvers in downhill skiing. The purpose of the present study was to develop a musculo-skeletal modeling and simulation approach to investigate the cause-and-effect relationship between a perturbed landing position, i.e., joint angles and trunk orientation, and the peak force in the anterior cruciate ligament (ACL) during jump landing. A two-dimensional musculo-skeletal model was developed and a baseline simulation was obtained reproducing measurement data of a reference landing movement. Based on the baseline simulation, a series of perturbed landing simulations (n = 1000) was generated. Multiple linear regression was performed to determine a relationship between peak ACL force and the perturbed landing posture. Increased backward lean, hip flexion, knee extension, and ankle dorsiflexion as well as an asymmetric position were related to higher peak ACL forces during jump landing. The orientation of the trunk of the skier was identified as the most important predictor accounting for 60% of the variance of the peak ACL force in the simulations. Teaching of tactical decisions and the inclusion of exercise regimens in ACL injury prevention programs to improve trunk control during landing motions in downhill skiing was concluded.

  15. Implementation of Open and Closed Kinetic Chain Quadriceps Strengthening Exercises after Anterior Cruciate Ligament Reconstruction.

    ERIC Educational Resources Information Center

    Ross, Michael D.; Denegar, Craig R.; Winzenried, Jay A.

    2001-01-01

    Reviews the effects of open kinetic chain (OKC) and closed kinetic chain (CKC) exercise on anterior cruciate ligament (ACL) strain and patellofemoral joint stress, suggesting a combination of the two for quadriceps strengthening after ACL reconstruction. Both OKC and CKC exercises may be modified and implemented for quadriceps strengthening after…

  16. Performance study of Lagrangian methods: reconstruction of large scale peculiar velocities and baryonic acoustic oscillations

    NASA Astrophysics Data System (ADS)

    Keselman, J. A.; Nusser, A.

    2017-01-01

    NoAM for "No Action Method" is a framework for reconstructing the past orbits of observed tracers of the large scale mass density field. It seeks exact solutions of the equations of motion (EoM), satisfying initial homogeneity and the final observed particle (tracer) positions. The solutions are found iteratively reaching a specified tolerance defined as the RMS of the distance between reconstructed and observed positions. Starting from a guess for the initial conditions, NoAM advances particles using standard N-body techniques for solving the EoM. Alternatively, the EoM can be replaced by any approximation such as Zel'dovich and second order perturbation theory (2LPT). NoAM is suitable for billions of particles and can easily handle non-regular volumes, redshift space, and other constraints. We implement NoAM to systematically compare Zel'dovich, 2LPT, and N-body dynamics over diverse configurations ranging from idealized high-res periodic simulation box to realistic galaxy mocks. Our findings are (i) Non-linear reconstructions with Zel'dovich, 2LPT, and full dynamics perform better than linear theory only for idealized catalogs in real space. For realistic catalogs, linear theory is the optimal choice for reconstructing velocity fields smoothed on scales {buildrel > over {˜}} 5 h^{-1}{Mpc}.(ii) all non-linear back-in-time reconstructions tested here, produce comparable enhancement of the baryonic oscillation signal in the correlation function.

  17. Mechanoreceptor Reinnervation of Autografts Versus Allografts After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Young, Simon W.; Valladares, Roberto D.; Loi, Florence; Dragoo, Jason L.

    2016-01-01

    Background: Loss of proprioceptive function occurs after anterior cruciate ligament (ACL) rupture. Clinical, motor, and proprioceptive function is known to improve after ACL reconstruction but does not return to normal. While histological studies of human ACL allografts have been unable to demonstrate mechanoreceptor reinnervation, animal data suggest that reinnervation may occur when an autograft is used. Purpose: To compare the presence or absence of mechanoreceptors between allograft versus autograft after ACL reconstruction in humans. Study Design: Cohort study; Level of evidence, 3. Methods: Ten patients with previous ACL reconstruction presenting for either revision ACL surgery or knee arthroscopy for other reasons were enrolled in a prospective, comparative study. Five patients had a previous autograft ACL and 5 patients had an allograft. Biopsies, either from intact or ruptured grafts, were taken from identical locations as close to the femoral and tibial insertions as possible. Specimens were stained with hematoxylin-eosin (H-E) and monoclonal antibodies against neurofilament protein (NFP), known to be present in mechanoreceptor tissue. Immunohistochemical examination was carried out, and the number of NFP+ neural tissue analogs was counted and compared with that of native ACL tissue. Results: The mean time between original graft and biopsy was 6.9 years (range, 0.5-15 years). Histological examination showed significantly less NFP+ neural analogs in allograft and autograft patients than control tissue (mean number of NFP+ analogs per high-power field, 0.7 ± 0.9 [allograft] and 0.5 ± 0.8 [autograft] vs 4.7 ± 0.9 [controls]; P < .0001). There was no significant difference in NFP analogs between autograft and allograft tissue. Conclusion: We found a reduced concentration of NFP+ neural analogs in ACL grafts compared with native ACL tissue. This deficit exists irrespective of whether allograft or autograft is used. These findings may explain the continued

  18. Automatic Carrier Landing System (ACLS) Category 3 Certification Manual

    DTIC Science & Technology

    1982-07-01

    INSTRUMENT LANDING SYSTEM .... ......... J-1 APPENDIX K: FRESNEL LENS OPTICAL LANDING SYSTEM .. ......... K-I APPENDIX L: PILOT ACLS RATINGS...surface elements of the ACLS consist of the AN/SPN-42A Landing Control Central with the AN/SPN-41 Instrument Landing System and Fresnel Lens Optical...radar antennas. c. The Fresnel lens calibration pole and three hand held radios be provided. d. Instrumentation seivicing and recording playback

  19. Performance analysis of different surface reconstruction algorithms for 3D reconstruction of outdoor objects from their digital images.

    PubMed

    Maiti, Abhik; Chakravarty, Debashish

    2016-01-01

    3D reconstruction of geo-objects from their digital images is a time-efficient and convenient way of studying the structural features of the object being modelled. This paper presents a 3D reconstruction methodology which can be used to generate photo-realistic 3D watertight surface of different irregular shaped objects, from digital image sequences of the objects. The 3D reconstruction approach described here is robust, simplistic and can be readily used in reconstructing watertight 3D surface of any object from its digital image sequence. Here, digital images of different objects are used to build sparse, followed by dense 3D point clouds of the objects. These image-obtained point clouds are then used for generation of photo-realistic 3D surfaces, using different surface reconstruction algorithms such as Poisson reconstruction and Ball-pivoting algorithm. Different control parameters of these algorithms are identified, which affect the quality and computation time of the reconstructed 3D surface. The effects of these control parameters in generation of 3D surface from point clouds of different density are studied. It is shown that the reconstructed surface quality of Poisson reconstruction depends on Samples per node (SN) significantly, greater SN values resulting in better quality surfaces. Also, the quality of the 3D surface generated using Ball-Pivoting algorithm is found to be highly depend upon Clustering radius and Angle threshold values. The results obtained from this study give the readers of the article a valuable insight into the effects of different control parameters on determining the reconstructed surface quality.

  20. High performance computing approaches for 3D reconstruction of complex biological specimens.

    PubMed

    da Silva, M Laura; Roca-Piera, Javier; Fernández, José-Jesús

    2010-01-01

    Knowledge of the structure of specimens is crucial to determine the role that they play in cellular and molecular biology. To yield the three-dimensional (3D) reconstruction by means of tomographic reconstruction algorithms, we need the use of large projection images and high processing time. Therefore, we propose the use of the high performance computing (HPC) to cope with the huge computational demands of this problem. We have implemented a HPC strategy where the distribution of tasks follows the master-slave paradigm. The master processor distributes a slab of slices, a piece of the final 3D structure to reconstruct, among the slave processors and receives reconstructed slices of the volume. We have evaluated the performance of our HPC approach using different sizes of the slab. We have observed that it is possible to find out an optimal size of the slab for the number of processor used that minimize communications time while maintaining a reasonable grain of parallelism to be exploited by the set of processors.

  1. Arthroscopically assisted meniscal allograft transplantation with and without combined anterior cruciate ligament reconstruction.

    PubMed

    Yoldas, Erol A; Sekiya, Jon K; Irrgang, James J; Fu, Freddie H; Harner, Christopher D

    2003-05-01

    The menisci provide a vital role in load transmission across the knee joint as well as contribute to knee stability, particularly in the ACL-deficient knee. Loss of the meniscus, in part or in total, significantly alters joint function and predisposes the articular cartilage to degenerative changes, which has been well documented both clinically and radiographically. This study examined clinical and patient-reported outcomes following meniscal allograft transplantation with and without combined ACL reconstruction in a select group of 31 patients with complaints of pain and/or instability (34 meniscal allografts); 11 underwent isolated meniscal transplantation and 20 meniscal transplantation combined with ACL reconstruction. Bony fixation was performed with bone plugs for medial transplants and using a bone bridge for lateral transplants. All patients completed several knee-specific and general measures of health-related quality of life and underwent a comprehensive physical examination. Flexion weightbearing PA radiographs at latest follow-up were compared to those obtained preoperatively. Mean follow-up was 2.9 years (range 2-5.5 years). The Activities of Daily Living and Sports Activities Scale scores were 86+/-11 and 78+/-16, respectively, and the average Lysholm score was 84+/-14. There were no significant differences in these scores based upon which meniscus (medial or lateral) was transplanted, concurrent ACL reconstruction, or the degree of chondrosis at arthroscopy. SF-36 scores indicated that patients were functioning at a level similar to the age- and sex-matched population. Twenty-two patients stated they were greatly improved, 8 were somewhat improved, 1 was without change. All but one patient reported that knee function and level of activity were normal or nearly normal. The average loss of motion compared to the noninvolved side was 3 degrees for extension and 9 degrees for flexion. All but one patient had a negative or 1+ Lachman's test. The

  2. Gender Dimorphic ACL Strain In Response to Combined Dynamic 3D Knee Joint Loading: Implications for ACL Injury Risk

    PubMed Central

    Mizuno, Kiyonori; Andrish, Jack T.; van den Bogert, Antonie J.; McLean, Scott G.

    2009-01-01

    While gender-based differences in knee joint anatomies/laxities are well documented, the potential for them to precipitate gender-dimorphic ACL loading and resultant injury risk has not been considered. To this end, we generated gender-specific models of ACL strain as a function of any six degrees of freedom (6DOF) knee joint load state via a combined cadaveric and analytical approach. Continuously varying joint forces and torques were applied to five male and five female cadaveric specimens and recorded along with synchronous knee flexion and ACL strain data. All data (~10,000 samples) were submitted to specimen-specific regression analyses, affording ACL strain predictions as a function of the combined 6 DOF knee loads. Following individual model verifications, generalized gender-specific models were generated and subjected to 6 DOF external load scenarios consistent with both a clinical examination and a dynamic sports maneuver. The ensuing model-based strain predictions were subsequently examined for gender-based discrepancies. Male and female specimen specific models predicted ACL strain within 0.51% ± 0.10% and 0.52% ± 0.07% of the measured data respectively, and explained more than 75% of the associated variance in each case. Predicted female ACL strains were also significantly larger than respective male values for both of simulated 6 DOF load scenarios. Outcomes suggest that the female ACL will rupture in response to comparatively smaller external load applications. Future work must address the underlying anatomical/laxity contributions to knee joint mechanical and resultant ACL loading, ultimately affording prevention strategies that may cater to individual joint vulnerabilities. PMID:19464897

  3. Amiodarone for ACLS: a critical evaluation.

    PubMed

    Stewart, C E

    2001-09-01

    Years ago, William Osler taught physicians, "Be not the first nor the last to adopt a therapy." This continues to be sage advice. Clinicians should be cautious in considering the use of amiodarone in a field setting for cardiac arrest until studies clearly show a benefit over drugs currently in use. The endpoint of the only cardiac arrest study available shows improved survival when amiodarone is combined with other drugs over placebo until the patient gets to the emergency department, but is not a comparison with other current drugs nor had any effect on long-term survival or functioning neurologic status. As previously cited, amiodarone was comparable with bretylium in treating recurrent VT/VF in one controlled study. Further study of this and other ACLS drugs is imperative. In summary, amiodarone should be reclassified as either a class indeterminate agent when used alone ("no harm but no benefit ... evidence insufficient to support final class decision") or a class IIb agent ("acceptable and useful ... supported by fair to good evidence") when used in addition to other therapies in the treatment of ventricular fibrillation and pulseless ventricular tachycardia. There is not sufficient evidence to move amiodarone to first-line therapy in the "out-of-hospital" cardiac arrest. This evidence may be available in the future and would then change this recommendation.

  4. High-performance computing and networking as tools for accurate emission computed tomography reconstruction.

    PubMed

    Passeri, A; Formiconi, A R; De Cristofaro, M T; Pupi, A; Meldolesi, U

    1997-04-01

    It is well known that the quantitative potential of emission computed tomography (ECT) relies on the ability to compensate for resolution, attenuation and scatter effects. Reconstruction algorithms which are able to take these effects into account are highly demanding in terms of computing resources. The reported work aimed to investigate the use of a parallel high-performance computing platform for ECT reconstruction taking into account an accurate model of the acquisition of single-photon emission tomographic (SPET) data. An iterative algorithm with an accurate model of the variable system response was ported on the MIMD (Multiple Instruction Multiple Data) parallel architecture of a 64-node Cray T3D massively parallel computer. The system was organized to make it easily accessible even from low-cost PC-based workstations through standard TCP/IP networking. A complete brain study of 30 (64x64) slices could be reconstructed from a set of 90 (64x64) projections with ten iterations of the conjugate gradients algorithm in 9 s, corresponding to an actual speed-up factor of 135. This work demonstrated the possibility of exploiting remote high-performance computing and networking resources from hospital sites by means of low-cost workstations using standard communication protocols without particular problems for routine use. The achievable speed-up factors allow the assessment of the clinical benefit of advanced reconstruction techniques which require a heavy computational burden for the compensation effects such as variable spatial resolution, scatter and attenuation. The possibility of using the same software on the same hardware platform with data acquired in different laboratories with various kinds of SPET instrumentation is appealing for software quality control and for the evaluation of the clinical impact of the reconstruction methods.

  5. Computed Tomographic Image Analysis Based on FEM Performance Comparison of Segmentation on Knee Joint Reconstruction

    PubMed Central

    Jang, Seong-Wook; Seo, Young-Jin; Yoo, Yon-Sik

    2014-01-01

    The demand for an accurate and accessible image segmentation to generate 3D models from CT scan data has been increasing as such models are required in many areas of orthopedics. In this paper, to find the optimal image segmentation to create a 3D model of the knee CT data, we compared and validated segmentation algorithms based on both objective comparisons and finite element (FE) analysis. For comparison purposes, we used 1 model reconstructed in accordance with the instructions of a clinical professional and 3 models reconstructed using image processing algorithms (Sobel operator, Laplacian of Gaussian operator, and Canny edge detection). Comparison was performed by inspecting intermodel morphological deviations with the iterative closest point (ICP) algorithm, and FE analysis was performed to examine the effects of the segmentation algorithm on the results of the knee joint movement analysis. PMID:25538950

  6. Computed tomographic image analysis based on FEM performance comparison of segmentation on knee joint reconstruction.

    PubMed

    Jang, Seong-Wook; Seo, Young-Jin; Yoo, Yon-Sik; Kim, Yoon Sang

    2014-01-01

    The demand for an accurate and accessible image segmentation to generate 3D models from CT scan data has been increasing as such models are required in many areas of orthopedics. In this paper, to find the optimal image segmentation to create a 3D model of the knee CT data, we compared and validated segmentation algorithms based on both objective comparisons and finite element (FE) analysis. For comparison purposes, we used 1 model reconstructed in accordance with the instructions of a clinical professional and 3 models reconstructed using image processing algorithms (Sobel operator, Laplacian of Gaussian operator, and Canny edge detection). Comparison was performed by inspecting intermodel morphological deviations with the iterative closest point (ICP) algorithm, and FE analysis was performed to examine the effects of the segmentation algorithm on the results of the knee joint movement analysis.

  7. Modified Cone Reconstruction of the Tricuspid Valve for Ebstein Anomaly as Performed in Siberia.

    PubMed

    Krivoshchekov, Evgeny V; Ackerman, Jaeger P; Yanulevich, Olga S; Sokolov, Alexander A; Ershova, Nadezhda V; Dearani, Joseph A; Cetta, Frank

    2017-02-01

    The cone reconstruction technique, first described by da Silva and modified by Dearani and by others, has become the repair method of choice in patients with Ebstein anomaly of the tricuspid valve. This report details the outcome of the modified cone reconstruction technique in 6 children who underwent surgical correction of Ebstein anomaly at the Tomsk Institute of Cardiology in Siberia. From 2012 through 2015, 4 boys and 2 girls (age range, 11 mo-12 yr) underwent surgery to correct Ebstein anomaly. All had presented with cyanosis, exertional dyspnea, fatigue, or new-onset atrial arrhythmia, and none had undergone previous cardiac surgery. All survived the operation. One patient needed tricuspid valve replacement with a bioprosthesis after early breakdown of the cone reconstruction. As of December 2016, all the patients had no symptoms, tricuspid stenosis, or arrhythmia. This series indicates that cone reconstruction-the most anatomic repair technique for the dysmorphic Ebstein tricuspid valve-can be successfully performed in pediatric heart centers with a large experience.

  8. Augmented Performance Environment for Enhancing Interagency Coordination in Stability, Security, Transition, and Reconstruction (SSTR) Operations

    DTIC Science & Technology

    2009-02-01

    1997; DiStefano & Maznevski, 2000; Rubinstein, 2003). In cases where cross-cultural interaction involves a history of exchange across groups, the...cross-cultural knowledge (e.g., DiStefano & Maznevski, 2000), but it is insufficient for enhancing multicultural collective task performance (e.g...Department of Defense. Directive 3000.05: Military Support for Stability, Security, Transition, and Reconstruction Operations, Nov 2005. DiStefano

  9. Anterior cruciate ligament reconstruction: a look at prosthetics--past, present and possible future.

    PubMed

    Mascarenhas, Randy; MacDonald, Peter B

    2008-01-01

    Biological tissue autograft reconstruction using the patellar tendon or quadrupled semitendinosus/gracilis tendons has become the most popular procedure in surgical treatment of a ruptured ACL. This article provides a review of the history of the use of prosthetics with respect to ACL reconstruction grafts including Carbon Fibre, Gore-Tex and Dacron prosthetics as well as the Leeds-Keio Artificial Ligament and the Kennedy Ligament Augmentation Device (LAD). Emphasis is placed on the Ligament Advanced Reinforcement System (LARS) as preliminary investigations of its use have been encouraging. Significant progress has been made recently with respect to the understanding of ACL anatomy, composition, biomechanics, and healing processes, leading to innovative techniques using approaches based in tissue engineering principles and computer - assisted surgery. While research into improved ACL treatment options continues, the synthesis of recent advancements provides a new optimism towards the regeneration of an ACL mirroring its original stability, function, and longevity.

  10. Frontal plane comparison between drop jump and vertical jump: implications for the assessment of ACL risk of injury.

    PubMed

    Cesar, Guilherme M; Tomasevicz, Curtis L; Burnfield, Judith M

    2016-11-01

    The potential to use the vertical jump (VJ) to assess both athletic performance and risk of anterior cruciate ligament (ACL) injury could have widespread clinical implications since VJ is broadly used in high school, university, and professional sport settings. Although drop jump (DJ) and VJ observationally exhibit similar lower extremity mechanics, the extent to which VJ can also be used as screening tool for ACL injury risk has not been assessed. This study evaluated whether individuals exhibit similar knee joint frontal plane kinematic and kinetic patterns when performing VJs compared with DJs. Twenty-eight female collegiate athletes performed DJs and VJs. Paired t-tests indicated that peak knee valgus angles did not differ significantly between tasks (p = 0.419); however, peak knee internal adductor moments were significantly larger during the DJ vs. VJ (p < 0.001). Pearson correlations between the DJ and VJ revealed strong correlations for knee valgus angles (r = 0.93, p < 0.001) and for internal knee adductor moments (r = 0.82, p < 0.001). Our results provide grounds for investigating whether frontal plane knee mechanics during VJ can predict ACL injuries and thus can be used as an effective tool for the assessment of risk of ACL injury in female athletes.

  11. High performance graphics processor based computed tomography reconstruction algorithms for nuclear and other large scale applications.

    SciTech Connect

    Jimenez, Edward Steven,

    2013-09-01

    The goal of this work is to develop a fast computed tomography (CT) reconstruction algorithm based on graphics processing units (GPU) that achieves significant improvement over traditional central processing unit (CPU) based implementations. The main challenge in developing a CT algorithm that is capable of handling very large datasets is parallelizing the algorithm in such a way that data transfer does not hinder performance of the reconstruction algorithm. General Purpose Graphics Processing (GPGPU) is a new technology that the Science and Technology (S&T) community is starting to adopt in many fields where CPU-based computing is the norm. GPGPU programming requires a new approach to algorithm development that utilizes massively multi-threaded environments. Multi-threaded algorithms in general are difficult to optimize since performance bottlenecks occur that are non-existent in single-threaded algorithms such as memory latencies. If an efficient GPU-based CT reconstruction algorithm can be developed; computational times could be improved by a factor of 20. Additionally, cost benefits will be realized as commodity graphics hardware could potentially replace expensive supercomputers and high-end workstations. This project will take advantage of the CUDA programming environment and attempt to parallelize the task in such a way that multiple slices of the reconstruction volume are computed simultaneously. This work will also take advantage of the GPU memory by utilizing asynchronous memory transfers, GPU texture memory, and (when possible) pinned host memory so that the memory transfer bottleneck inherent to GPGPU is amortized. Additionally, this work will take advantage of GPU-specific hardware (i.e. fast texture memory, pixel-pipelines, hardware interpolators, and varying memory hierarchy) that will allow for additional performance improvements.

  12. Performance assessment of different pulse reconstruction algorithms for the ATHENA X-ray Integral Field Unit

    NASA Astrophysics Data System (ADS)

    Peille, Philippe; Ceballos, Maria Teresa; Cobo, Beatriz; Wilms, Joern; Bandler, Simon; Smith, Stephen J.; Dauser, Thomas; Brand, Thorsten; den Hartog, Roland; de Plaa, Jelle; Barret, Didier; den Herder, Jan-Willem; Piro, Luigi; Barcons, Xavier; Pointecouteau, Etienne

    2016-07-01

    The X-ray Integral Field Unit (X-IFU) microcalorimeter, on-board Athena, with its focal plane comprising 3840 Transition Edge Sensors (TESs) operating at 90 mK, will provide unprecedented spectral-imaging capability in the 0.2-12 keV energy range. It will rely on the on-board digital processing of current pulses induced by the heat deposited in the TES absorber, as to recover the energy of each individual events. Assessing the capabilities of the pulse reconstruction is required to understand the overall scientific performance of the X-IFU, notably in terms of energy resolution degradation with both increasing energies and count rates. Using synthetic data streams generated by the X-IFU End-to-End simulator, we present here a comprehensive benchmark of various pulse reconstruction techniques, ranging from standard optimal filtering to more advanced algorithms based on noise covariance matrices. Beside deriving the spectral resolution achieved by the different algorithms, a first assessment of the computing power and ground calibration needs is presented. Overall, all methods show similar performances, with the reconstruction based on noise covariance matrices showing the best improvement with respect to the standard optimal filtering technique. Due to prohibitive calibration needs, this method might however not be applicable to the X-IFU and the best compromise currently appears to be the so-called resistance space analysis which also features very promising high count rate capabilities.

  13. Performance of the reconstruction algorithms of the FIRST experiment pixel sensors vertex detector

    NASA Astrophysics Data System (ADS)

    Rescigno, R.; Finck, Ch.; Juliani, D.; Spiriti, E.; Baudot, J.; Abou-Haidar, Z.; Agodi, C.; Alvarez, M. A. G.; Aumann, T.; Battistoni, G.; Bocci, A.; Böhlen, T. T.; Boudard, A.; Brunetti, A.; Carpinelli, M.; Cirrone, G. A. P.; Cortes-Giraldo, M. A.; Cuttone, G.; De Napoli, M.; Durante, M.; Gallardo, M. I.; Golosio, B.; Iarocci, E.; Iazzi, F.; Ickert, G.; Introzzi, R.; Krimmer, J.; Kurz, N.; Labalme, M.; Leifels, Y.; Le Fevre, A.; Leray, S.; Marchetto, F.; Monaco, V.; Morone, M. C.; Oliva, P.; Paoloni, A.; Patera, V.; Piersanti, L.; Pleskac, R.; Quesada, J. M.; Randazzo, N.; Romano, F.; Rossi, D.; Rousseau, M.; Sacchi, R.; Sala, P.; Sarti, A.; Scheidenberger, C.; Schuy, C.; Sciubba, A.; Sfienti, C.; Simon, H.; Sipala, V.; Tropea, S.; Vanstalle, M.; Younis, H.

    2014-12-01

    Hadrontherapy treatments use charged particles (e.g. protons and carbon ions) to treat tumors. During a therapeutic treatment with carbon ions, the beam undergoes nuclear fragmentation processes giving rise to significant yields of secondary charged particles. An accurate prediction of these production rates is necessary to estimate precisely the dose deposited into the tumours and the surrounding healthy tissues. Nowadays, a limited set of double differential carbon fragmentation cross-section is available. Experimental data are necessary to benchmark Monte Carlo simulations for their use in hadrontherapy. The purpose of the FIRST experiment is to study nuclear fragmentation processes of ions with kinetic energy in the range from 100 to 1000 MeV/u. Tracks are reconstructed using information from a pixel silicon detector based on the CMOS technology. The performances achieved using this device for hadrontherapy purpose are discussed. For each reconstruction step (clustering, tracking and vertexing), different methods are implemented. The algorithm performances and the accuracy on reconstructed observables are evaluated on the basis of simulated and experimental data.

  14. 3D Surface Reconstruction of Plant Seeds by Volume Carving: Performance and Accuracies

    PubMed Central

    Roussel, Johanna; Geiger, Felix; Fischbach, Andreas; Jahnke, Siegfried; Scharr, Hanno

    2016-01-01

    We describe a method for 3D reconstruction of plant seed surfaces, focusing on small seeds with diameters as small as 200 μm. The method considers robotized systems allowing single seed handling in order to rotate a single seed in front of a camera. Even though such systems feature high position repeatability, at sub-millimeter object scales, camera pose variations have to be compensated. We do this by robustly estimating the tool center point from each acquired image. 3D reconstruction can then be performed by a simple shape-from-silhouette approach. In experiments we investigate runtimes, theoretically achievable accuracy, experimentally achieved accuracy, and show as a proof of principle that the proposed method is well sufficient for 3D seed phenotyping purposes. PMID:27375628

  15. Performance analysis of multi-frequency topological derivative for reconstructing perfectly conducting cracks

    NASA Astrophysics Data System (ADS)

    Park, Won-Kwang

    2017-04-01

    This paper concerns a fast, one-step iterative technique of imaging extended perfectly conducting cracks with Dirichlet boundary condition. In order to reconstruct the shape of cracks from scattered field data measured at the boundary, we introduce a topological derivative-based electromagnetic imaging functional operated at several nonzero frequencies. The structure of the imaging functionals is carefully analyzed by establishing relationships with infinite series of Bessel functions for the configurations of both symmetric and non-symmetric incident field directions. Identified structure explains why the application of incident fields with symmetric direction operated at multiple frequencies guarantees a successful reconstruction. Various numerical simulations with noise-corrupted data are conducted to assess the performance, effectiveness, robustness, and limitations of the proposed technique.

  16. An ambulatory method of identifying anterior cruciate ligament reconstructed gait patterns.

    PubMed

    Patterson, Matthew R; Delahunt, Eamonn; Sweeney, Kevin T; Caulfield, Brian

    2014-01-07

    The use of inertial sensors to characterize pathological gait has traditionally been based on the calculation of temporal and spatial gait variables from inertial sensor data. This approach has proved successful in the identification of gait deviations in populations where substantial differences from normal gait patterns exist; such as in Parkinsonian gait. However, it is not currently clear if this approach could identify more subtle gait deviations, such as those associated with musculoskeletal injury. This study investigates whether additional analysis of inertial sensor data, based on quantification of gyroscope features of interest, would provide further discriminant capability in this regard. The tested cohort consisted of a group of anterior cruciate ligament reconstructed (ACL-R) females and a group of non-injured female controls, each performed ten walking trials. Gait performance was measured simultaneously using inertial sensors and an optoelectronic marker based system. The ACL-R group displayed kinematic and kinetic deviations from the control group, but no temporal or spatial deviations. This study demonstrates that quantification of gyroscope features can successfully identify changes associated with ACL-R gait, which was not possible using spatial or temporal variables. This finding may also have a role in other clinical applications where small gait deviations exist.

  17. Early anterior cruciate ligament reconstruction can save meniscus without any complications

    PubMed Central

    Hur, Chang-Ik; Song, Eun-Kyoo; Kim, Sung-Kyu; Lee, Seung-Hun; Seon, Jong-Keun

    2017-01-01

    Background: Early ACL reconstruction, before retuning to activity eliminates recurrent episodes of instability and thereby decreases chances of meniscal and cartilage injury. However, there are no clear and uniform guidelines regarding the timing of ACL reconstruction or clarity in the definition of early and delayed reconstruction to reduce the complications after reconstruction in the ACL injured knee. The purpose of this study was to compare the clinical outcome, stability, muscle power, and postural control after early and delayed anterior cruciate ligament (ACL) reconstruction. Materials and Methods: Patients who had ACL reconstruction with a quadruple hamstring tendon with a minimum 2-year followup were evaluated. Early (within 3 weeks) reconstruction group was 48 knees and delayed (more than 3 months) group was 43 knees. We compared the two groups with regard to Lysholm knee score, range of motion (ROM), Lachman test, Tegner activity scale, associated meniscal or chondral injuries, and anterior laxity. We also compared muscle strength with an isokinetic dynamometer and postural control with computed dynamic posturography at the final followup. Results: While 50% of early and 70% of delayed group had meniscal injuries (P = 0.06), of which were reparable in 42% of early group and 17% of delayed group (P = 0.04). However, there was no significant difference in cartilage injury (P = 0.14). At the final followup, no significant differences were found between two groups for Lysholm score (P = 0.28), Tegner activity scale (P = 0.27), and ROM. The stabilities regarding Lachman and pivot-shift tests, and anterior laxity also showed no significant differences between two groups. The mean extension and flexion muscles power, and postural control showed no significant inter-group differences (P > 0.05). Conclusions: Early ACL reconstruction had excellent clinical results and stability as good as delayed reconstruction without the problem of knee motion, muscle power

  18. Aging affects spatial reconstruction more than spatial pattern separation performance even after extended practice.

    PubMed

    Clark, Rachel; Tahan, Asli C; Watson, Patrick D; Severson, Joan; Cohen, Neal J; Voss, Michelle

    2017-03-21

    Although the hippocampus experiences age-related anatomical and functional deterioration, the effects of aging vary across hippocampal-dependent cognitive processes. In particular, whether or not the hippocampus is known to be required for a spatial memory process is not an accurate predictor on its own of whether aging will affect performance. Therefore, the primary objective of this study was to compare the effects of healthy aging on a test of spatial pattern separation and a test of spatial relational processing, which are two aspects of spatial memory that uniquely emphasize the use of multiple hippocampal-dependent processes. Spatial pattern separation supports spatial memory by preserving unique representations for distinct locations. Spatial relational processing forms relational representations of objects to locations or between objects and other objects in space. To test our primary objective, 30 young (18-30 years; 21F) and 30 older participants (60-80 years; 21F) all completed a spatial pattern separation task and a task designed to require spatial relational processing through spatial reconstruction. To ensure aging effects were not due to inadequate time to develop optimal strategies or become comfortable with the testing devices, a subset of participants had extended practice across three sessions on each task. Results showed that older adults performed more poorly than young on the spatial reconstruction task that emphasized the use of spatial relational processing, and that age effects persisted even after controlling for pattern separation performance. Further, older adults performed more poorly on spatial reconstruction than young adults even after three testing sessions each separated by 7-10 days, suggesting effects of aging are resistant to extended practice and likely reflect genuine decline in hippocampal memory abilities.

  19. Management of Acute Combined ACL-Medial and Posteromedial Instability of the Knee.

    PubMed

    Medvecky, Michael J; Tomaszewski, Paul

    2015-06-01

    Medial collateral ligament (MCL) injuries are the most common ligamentous injury of the knee. The extent of injury can range from a minor first-degree (1-degree) sprain to an extensive third-degree (3-degree) sprain that can propagate across the knee, rupturing one or both cruciate ligaments, and result in a knee subluxation or dislocation. A common pattern involves the combined anterior cruciate ligament (ACL) and MCL injury that is the focus of this chapter. The vast majority of these combined medial-sided injuries are treated nonoperatively with delayed reconstruction of the ACL injury in athletically active individuals. The MCL and associated medial structures are carefully assessed on physical examination, and classification of injury is based upon abnormal limits of joint motion. In vitro cadaveric biomechanical testing has given us a better understanding of ligament deficiency and altered joint motion. Consistency in terminology is necessary for proper classification of injury and reproducible categorization of injury patterns to be able to compare both nonoperative and operative treatment of various injury patterns.

  20. Performances of JEM-EUSO: angular reconstruction. The JEM-EUSO Collaboration

    NASA Astrophysics Data System (ADS)

    Adams, J. H.; Ahmad, S.; Albert, J.-N.; Allard, D.; Anchordoqui, L.; Andreev, V.; Anzalone, A.; Arai, Y.; Asano, K.; Ave Pernas, M.; Baragatti, P.; Barrillon, P.; Batsch, T.; Bayer, J.; Bechini, R.; Belenguer, T.; Bellotti, R.; Belov, K.; Berlind, A. A.; Bertaina, M.; Biermann, P. L.; Biktemerova, S.; Blaksley, C.; Blanc, N.; Błȩcki, J.; Blin-Bondil, S.; Blümer, J.; Bobik, P.; Bogomilov, M.; Bonamente, M.; Briggs, M. S.; Briz, S.; Bruno, A.; Cafagna, F.; Campana, D.; Capdevielle, J.-N.; Caruso, R.; Casolino, M.; Cassardo, C.; Castellinic, G.; Catalano, C.; Catalano, G.; Cellino, A.; Chikawa, M.; Christl, M. J.; Cline, D.; Connaughton, V.; Conti, L.; Cordero, G.; Crawford, H. J.; Cremonini, R.; Csorna, S.; Dagoret-Campagne, S.; de Castro, A. J.; De Donato, C.; de la Taille, C.; De Santis, C.; del Peral, L.; Dell'Oro, A.; De Simone, N.; Di Martino, M.; Distratis, G.; Dulucq, F.; Dupieux, M.; Ebersoldt, A.; Ebisuzaki, T.; Engel, R.; Falk, S.; Fang, K.; Fenu, F.; Fernández-Gómez, I.; Ferrarese, S.; Finco, D.; Flamini, M.; Fornaro, C.; Franceschi, A.; Fujimoto, J.; Fukushima, M.; Galeotti, P.; Garipov, G.; Geary, J.; Gelmini, G.; Giraudo, G.; Gonchar, M.; González Alvarado, C.; Gorodetzky, P.; Guarino, F.; Guzmán, A.; Hachisu, Y.; Harlov, B.; Haungs, A.; Hernández Carretero, J.; Higashide, K.; Ikeda, D.; Ikeda, H.; Inoue, N.; Inoue, S.; Insolia, A.; Isgrò, F.; Itow, Y.; Joven, E.; Judd, E. G.; Jung, A.; Kajino, F.; Kajino, T.; Kaneko, I.; Karadzhov, Y.; Karczmarczyk, J.; Karus, M.; Katahira, K.; Kawai, K.; Kawasaki, Y.; Keilhauer, B.; Khrenov, B. A.; Kim, J.-S.; Kim, S.-W.; Kim, S.-W.; Kleifges, M.; Klimov, P. A.; Kolev, D.; Kreykenbohm, I.; Kudela, K.; Kurihara, Y.; Kusenko, A.; Kuznetsov, E.; Lacombe, M.; Lachaud, C.; Lee, J.; Licandro, J.; Lim, H.; López, F.; Maccarone, M. C.; Mannheim, K.; Maravilla, D.; Marcelli, L.; Marini, A.; Martinez, O.; Masciantonio, G.; Mase, K.; Matev, R.; Medina-Tanco, G.; Mernik, T.; Miyamoto, H.; Miyazaki, Y.; Mizumoto, Y.; Modestino, G.; Monaco, A.; Monnier-Ragaigne, D.; Morales de los Ríos, J. A.; Moretto, C.; Morozenko, V. S.; Mot, B.; Murakami, T.; Murakami, M. Nagano; Nagata, M.; Nagataki, S.; Nakamura, T.; Napolitano, T.; Naumov, D.; Nava, R.; Neronov, A.; Nomoto, K.; Nonaka, T.; Ogawa, T.; Ogio, S.; Ohmori, H.; Olinto, A. V.; Orleański, P.; Osteria, G.; Panasyuk, M. I.; Parizot, E.; Park, I. H.; Park, H. W.; Pastircak, B.; Patzak, T.; Paul, T.; Pennypacker, C.; Perez Cano, S.; Peter, T.; Picozza, P.; Pierog, T.; Piotrowski, L. W.; Piraino, S.; Plebaniak, Z.; Pollini, A.; Prat, P.; Prévôt, G.; Prieto, H.; Putis, M.; Reardon, P.; Reyes, M.; Ricci, M.; Rodríguez, I.; Rodríguez Frías, M. D.; Ronga, F.; Roth, M.; Rothkaehl, H.; Roudil, G.; Rusinov, I.; Rybczyński, M.; Sabau, M. D.; Sáez-Cano, G.; Sagawa, H.; Saito, A.; Sakaki, N.; Sakata, M.; Salazar, H.; Sánchez, S.; Santangelo, A.; Santiago Crúz, L.; Sanz Palomino, M.; Saprykin, O.; Sarazin, F.; Sato, H.; Sato, M.; Schanz, T.; Schieler, H.; Scotti, V.; Segreto, A.; Selmane, S.; Semikoz, D.; Serra, M.; Sharakin, S.; Shibata, T.; Shimizu, H. M.; Shinozaki, K.; Shirahama, T.; Siemieniec-Oziȩbło, G.; Silva López, H. H.; Sledd, J.; Słomińska, K.; Sobey, A.; Sugiyama, T.; Supanitsky, D.; Suzuki, M.; Szabelska, B.; Szabelski, J.; Tajima, F.; Tajima, N.; Tajima, T.; Takahashi, Y.; Takami, H.; Takeda, M.; Takizawa, Y.; Tenzer, C.; Tibolla, O.; Tkachev, L.; Tokuno, H.; Tomida, T.; Tone, N.; Toscano, S.; Trillaud, F.; Tsenov, R.; Tsunesada, Y.; Tsuno, K.; Tymieniecka, T.; Uchihori, Y.; Unger, M.; Vaduvescu, O.; Valdés-Galicia, J. F.; Vallania, P.; Valore, L.; Vankova, G.; Vigorito, C.; Villaseñor, L.; von Ballmoos, P.; Wada, S.; Watanabe, J.; Watanabe, S.; Watts, J.; Weber, M.; Weiler, T. J.; Wibig, T.; Wiencke, L.; Wille, M.; Wilms, J.; Włodarczyk, Z.; Yamamoto, T.; Yamamoto, Y.; Yang, J.; Yano, H.; Yashin, I. V.; Yonetoku, D.; Yoshida, K.; Yoshida, S.; Young, R.; Zotov, M. Yu.; Zuccaro Marchi, A.

    2015-11-01

    Mounted on the International Space Station(ISS), the Extreme Universe Space Observatory, on-board the Japanese Experimental Module (JEM-EUSO), relies on the well established fluorescence technique to observe Extensive Air Showers (EAS) developing in the earth's atmosphere. Focusing on the detection of Ultra High Energy Cosmic Rays (UHECR) in the decade of 1020eV, JEM-EUSO will face new challenges by applying this technique from space. The EUSO Simulation and Analysis Framework (ESAF) has been developed in this context to provide a full end-to-end simulation frame, and assess the overall performance of the detector. Within ESAF, angular reconstruction can be separated into two conceptually different steps. The first step is pattern recognition, or filtering, of the signal to separate it from the background. The second step is to perform different types of fitting in order to search for the relevant geometrical parameters that best describe the previously selected signal. In this paper, we discuss some of the techniques we have implemented in ESAF to perform the geometrical reconstruction of EAS seen by JEM-EUSO. We also conduct thorough tests to assess the performances of these techniques in conditions which are relevant to the scope of the JEM-EUSO mission. We conclude by showing the expected angular resolution in the energy range that JEM-EUSO is expected to observe.

  1. Description and performance of track and primary-vertex reconstruction with the CMS tracker

    NASA Astrophysics Data System (ADS)

    The CMS Collaboration

    2014-10-01

    A description is provided of the software algorithms developed for the CMS tracker both for reconstructing charged-particle trajectories in proton-proton interactions and for using the resulting tracks to estimate the positions of the LHC luminous region and individual primary-interaction vertices. Despite the very hostile environment at the LHC, the performance obtained with these algorithms is found to be excellent. For tbar t events under typical 2011 pileup conditions, the average track-reconstruction efficiency for promptly-produced charged particles with transverse momenta of pT > 0.9GeV is 94% for pseudorapidities of |η| < 0.9 and 85% for 0.9 < |η| < 2.5. The inefficiency is caused mainly by hadrons that undergo nuclear interactions in the tracker material. For isolated muons, the corresponding efficiencies are essentially 100%. For isolated muons of pT = 100GeV emitted at |η| < 1.4, the resolutions are approximately 2.8% in pT, and respectively, 10μm and 30μm in the transverse and longitudinal impact parameters. The position resolution achieved for reconstructed primary vertices that correspond to interesting pp collisions is 10-12μm in each of the three spatial dimensions. The tracking and vertexing software is fast and flexible, and easily adaptable to other functions, such as fast tracking for the trigger, or dedicated tracking for electrons that takes into account bremsstrahlung.

  2. Description and performance of track and primary-vertex reconstruction with the CMS tracker

    SciTech Connect

    Chatrchyan, Serguei

    2014-10-16

    A description is provided of the software algorithms developed for the CMS tracker both for reconstructing charged-particle trajectories in proton-proton interactions and for using the resulting tracks to estimate the positions of the LHC luminous region and individual primary-interaction vertices. Despite the very hostile environment at the LHC, the performance obtained with these algorithms is found to be excellent. For tbar t events under typical 2011 pileup conditions, the average track-reconstruction efficiency for promptly-produced charged particles with transverse momenta of pT > 0.9GeV is 94% for pseudorapidities of |η| < 0.9 and 85% for 0.9 < |η| < 2.5. The inefficiency is caused mainly by hadrons that undergo nuclear interactions in the tracker material. For isolated muons, the corresponding efficiencies are essentially 100%. For isolated muons of pT = 100GeV emitted at |η| < 1.4, the resolutions are approximately 2.8% in pT, and respectively, 10μm and 30μm in the transverse and longitudinal impact parameters. The position resolution achieved for reconstructed primary vertices that correspond to interesting pp collisions is 10–12μm in each of the three spatial dimensions. The tracking and vertexing software is fast and flexible, and easily adaptable to other functions, such as fast tracking for the trigger, or dedicated tracking for electrons that takes into account bremsstrahlung.

  3. Description and performance of track and primary-vertex reconstruction with the CMS tracker

    DOE PAGES

    Chatrchyan, Serguei

    2014-10-16

    A description is provided of the software algorithms developed for the CMS tracker both for reconstructing charged-particle trajectories in proton-proton interactions and for using the resulting tracks to estimate the positions of the LHC luminous region and individual primary-interaction vertices. Despite the very hostile environment at the LHC, the performance obtained with these algorithms is found to be excellent. For tbar t events under typical 2011 pileup conditions, the average track-reconstruction efficiency for promptly-produced charged particles with transverse momenta of pT > 0.9GeV is 94% for pseudorapidities of |η| < 0.9 and 85% for 0.9 < |η| < 2.5. Themore » inefficiency is caused mainly by hadrons that undergo nuclear interactions in the tracker material. For isolated muons, the corresponding efficiencies are essentially 100%. For isolated muons of pT = 100GeV emitted at |η| < 1.4, the resolutions are approximately 2.8% in pT, and respectively, 10μm and 30μm in the transverse and longitudinal impact parameters. The position resolution achieved for reconstructed primary vertices that correspond to interesting pp collisions is 10–12μm in each of the three spatial dimensions. The tracking and vertexing software is fast and flexible, and easily adaptable to other functions, such as fast tracking for the trigger, or dedicated tracking for electrons that takes into account bremsstrahlung.« less

  4. Modified Cone Reconstruction of the Tricuspid Valve for Ebstein Anomaly as Performed in Siberia

    PubMed Central

    Krivoshchekov, Evgeny V.; Ackerman, Jaeger P.; Yanulevich, Olga S.; Sokolov, Alexander A.; Ershova, Nadezhda V.; Dearani, Joseph A.

    2017-01-01

    The cone reconstruction technique, first described by da Silva and modified by Dearani and by others, has become the repair method of choice in patients with Ebstein anomaly of the tricuspid valve. This report details the outcome of the modified cone reconstruction technique in 6 children who underwent surgical correction of Ebstein anomaly at the Tomsk Institute of Cardiology in Siberia. From 2012 through 2015, 4 boys and 2 girls (age range, 11 mo–12 yr) underwent surgery to correct Ebstein anomaly. All had presented with cyanosis, exertional dyspnea, fatigue, or new-onset atrial arrhythmia, and none had undergone previous cardiac surgery. All survived the operation. One patient needed tricuspid valve replacement with a bioprosthesis after early breakdown of the cone reconstruction. As of December 2016, all the patients had no symptoms, tricuspid stenosis, or arrhythmia. This series indicates that cone reconstruction—the most anatomic repair technique for the dysmorphic Ebstein tricuspid valve—can be successfully performed in pediatric heart centers with a large experience. PMID:28265211

  5. The use of autologous chondrocyte implantation following and combined with anterior cruciate ligament reconstruction

    PubMed Central

    Bartlett, W.; Gooding, C. R.; Sood, M.; Skinner, J. A.; Carrington, R. W.J.; Briggs, T. W.R.; Bentley, G.

    2005-01-01

    We report our experience of using autologous chondrocyte implantation (ACI) to treat osteochondral defects of the knee in combination with anterior cruciate ligament (ACL) reconstruction. The outcome of symptomatic osteochondral lesions treated with ACI following previous successful ACL reconstruction is also reviewed. Patients were followed for a mean of 23 months. Nine patients underwent ACL reconstruction in combination with ACI. Mean modified Cincinnati knee scores improved from 42 to 69 following surgery. Seven patients described their knee as better and two as the same. A second group of nine patients underwent ACI for symptomatic articular cartilage defects following previous ACL reconstruction. In this group, the mean modified Cincinnati knee score improved from 53 to 62 after surgery. Six patients described their knee as better and three as worse. Combined treatment using ACI with ACL reconstruction is technically feasible and resulted in sustained improvement in pain and function. The results following previous ACL reconstruction also resulted in clinical improvement, although results were not as good as following the combined procedure. PMID:16320051

  6. A Technique of Superficial Medial Collateral Ligament Reconstruction Using an Adjustable-Loop Suspensory Fixation Device.

    PubMed

    Deo, Shaneel; Getgood, Alan

    2015-06-01

    This report describes superficial medial collateral ligament reconstruction of the knee using a novel method of graft fixation with the ACL Tightrope RT (Arthrex, Naples, FL). After tibial fixation with either a standard interference screw or staple, femoral fixation of the semitendinosus tendon is performed with the adjustable-loop suspensory fixation device, which allows for both initial graft tensioning and re-tensioning after cyclical knee range of motion. This provides the ability for the graft to accommodate for resultant soft-tissue creep and stress relaxation, thereby allowing for optimal soft-tissue tension and reduction in laxity at the end of the procedure.

  7. Quantifying Quadriceps Muscle Strength in Patients With ACL Injury, Focal Cartilage Lesions, and Degenerative Meniscus Tears

    PubMed Central

    Eitzen, Ingrid; Grindem, Hege; Nilstad, Agnethe; Moksnes, Håvard; Risberg, May Arna

    2016-01-01

    Background: Reduced quadriceps strength influences knee function and increases the risk of knee osteoarthritis. Thus, it is of significant clinical relevance to precisely quantify strength deficits in patients with knee injuries. Purpose: To evaluate isokinetic concentric quadriceps muscle strength torque values, assessed both from peak torque and at specific knee flexion joint angles, in patients with anterior cruciate ligament (ACL) injury, focal cartilage lesions, and degenerative meniscus tears. Study Design: Cohort study; Level of evidence, 3. Methods: Data were synthesized from patients included in 3 previously conducted research projects: 2 prospective cohort studies and 1 randomized controlled trial. At the time of inclusion, all patients were candidates for surgery. Isokinetic concentric quadriceps muscle strength measurements (60 deg/s) were performed at baseline (preoperative status) and after a period of progressive supervised exercise therapy (length of rehabilitation period: 5 weeks for ACL injury, 12 weeks for cartilage lesions and degenerative meniscus). Outcome measures were peak torque and torque at specific knee flexion joint angles from 20° to 70°. All patients had unilateral injuries, and side-to-side deficits were calculated. For comparisons between and within groups, we utilized 1-way analysis of variance and paired t tests, respectively. Results: In total, 250 patients were included. At baseline, cartilage patients had the most severe deficit (39.7% ± 24.3%; P < .001). Corresponding numbers for ACL and degenerative meniscus subjects were 21.7% (±13.2%) and 20.7% (±16.3%), respectively. At retest, there was significant improvement in all groups (P < .001), with remaining deficits of 24.7% (±18.5%) for cartilage, 16.8% (±13.9%) for ACL, and 3.3% (±17.8%) for degenerative meniscus. Peak torque was consistently measured at 60° of knee flexion, whereas the largest mean deficits were measured at 30° at baseline and 70° at retest for the

  8. Reconstruction of the Mars Science Laboratory Parachute Performance and Comparison to the Descent Simulation

    NASA Technical Reports Server (NTRS)

    Cruz, Juan R.; Way, David W.; Shidner, Jeremy D.; Davis, Jody L.; Adams, Douglas S.; Kipp, Devin M.

    2013-01-01

    The Mars Science Laboratory used a single mortar-deployed disk-gap-band parachute of 21.35 m nominal diameter to assist in the landing of the Curiosity rover on the surface of Mars. The parachute system s performance on Mars has been reconstructed using data from the on-board inertial measurement unit, atmospheric models, and terrestrial measurements of the parachute system. In addition, the parachute performance results were compared against the end-to-end entry, descent, and landing (EDL) simulation created to design, develop, and operate the EDL system. Mortar performance was nominal. The time from mortar fire to suspension lines stretch (deployment) was 1.135 s, and the time from suspension lines stretch to first peak force (inflation) was 0.635 s. These times were slightly shorter than those used in the simulation. The reconstructed aerodynamic portion of the first peak force was 153.8 kN; the median value for this parameter from an 8,000-trial Monte Carlo simulation yielded a value of 175.4 kN - 14% higher than the reconstructed value. Aeroshell dynamics during the parachute phase of EDL were evaluated by examining the aeroshell rotation rate and rotational acceleration. The peak values of these parameters were 69.4 deg/s and 625 deg/sq s, respectively, which were well within the acceptable range. The EDL simulation was successful in predicting the aeroshell dynamics within reasonable bounds. The average total parachute force coefficient for Mach numbers below 0.6 was 0.624, which is close to the pre-flight model nominal drag coefficient of 0.615.

  9. OpenCL: a viable solution for high-performance medical image reconstruction?

    NASA Astrophysics Data System (ADS)

    Siegl, Christian; Hofmann, H. G.; Keck, B.; Prümmer, M.; Hornegger, J.

    2011-03-01

    Reconstruction of 3-D volumetric data from C-arm CT projections is a computationally demanding task. For interventional image reconstruction, hardware optimization is mandatory. Manufacturers of medical equipment use a variety of high-performance computing (HPC) platforms, like FPGAs, graphics cards, or multi-core CPUs. A problem of this diversity is that many different frameworks and (vendor-specific) programming languages are used. Furthermore, it is costly to switch the platform, since the code has to be re-written, verified, and optimized. OpenCL, a relatively new industry standard for HPC, promises to enable portable code. Its key idea is to abstract hardware in a way that allows an efficient mapping onto real CPUs, GPUs, and other hardware. The code is compiled for the actual target by the device driver. In this work we investigated the suitability of OpenCL as a tool to write portable code that runs efficiently across different hardware. The problems chosen are back- and forward-projection, the most time-consuming parts of (iterative) reconstruction. We present results on three platforms, a multi-core CPU system and two GPUs, and compare them against manually optimized native implementations. We found that OpenCL allows to share a common framework in one language across platforms. However, considering differences in the underlying architecture, a hardware-oblivious implementation cannot be expected to deliver maximal performance. By optimizing the OpenCL code for the specific hardware we reached over 90% of native performance for both problems, back- and forward-projection, on all platforms.

  10. Orthopedic Practice Patterns Relating to Anterior Cruciate Ligament Reconstruction in Elite Athletes.

    PubMed

    Erickson, Brandon J; Harris, Joshua D; Fillingham, Yale A; Cvetanovich, Gregory L; Bush-Joseph, Charles; Cole, Brian J; Bach, Bernard R; Verma, Nikhil N

    2015-12-01

    We conducted an online survey of National Hockey League (NHL), Major League Soccer (MLS), and US Olympic/World Cup Ski/Snowboard (Olympic) team orthopedic surgeons to determine practice patterns relating to anterior cruciate ligament (ACL) reconstruction in elite athletes. Of the 94 team orthopedic surgeons surveyed, 47 (50%) responded. Mean (SD) experience as a team physician was 7.73 (5.33) years for NHL, 6.77 (6.64) years for MLS, and 1.14 (0.36) years for Olympic. Mean (SD) number of ACL reconstructions performed in 2012 was 101 (51) for NHL, 78 (38) for MLS, and 110 (105) for Olympic. Overall, 33 surgeons (70.2%) indicated they would use bone-patellar tendon-bone (BPTB) autograft to treat their starting athletes. Twenty-one (44.7%) drilled the femoral tunnel through a transtibial portal, 36.2% through an anteromedial portal, and 12.8% by a 2-incision technique. All the surgeons used a single-bundle technique. Thirty-three (70.2%) did not recommend a brace for their elite athletes during play on return to sport (RTS). Twenty-seven NHL and MLS surgeons (81.8%) recommended RTS only after an athlete has passed a series of RTS tests (eg, Vail, single-leg hop). Most of the NHL, MLS, and Olympic team orthopedic surgeons who were surveyed perform their ACL reconstructions using BPTB autograft, using a single-bundle technique, and through a transtibial portal, and do not require bracing for their athletes returning to sport. Most required their athletes to complete a series of RTS tests before resuming competitive play.

  11. EXERCISES THAT FACILITATE OPTIMAL HAMSTRING AND QUADRICEPS CO-ACTIVATION TO HELP DECREASE ACL INJURY RISK IN HEALTHY FEMALES: A SYSTEMATIC REVIEW OF THE LITERATURE.

    PubMed Central

    Dedinsky, Rachel; Baker, Lindsey; Imbus, Samuel; Bowman, Melissa

    2017-01-01

    Background Anterior cruciate ligament (ACL) injury is common among females due to many anatomic, hormonal, and neuromuscular risk factors. One modifiable risk factor that places females at increased risk of ACL injury is a poor hamstrings: quadriceps (H:Q) co-activation ratio, which should be 0.6 or greater in order to decrease the stress placed on the ACL. Exercises that produce more quadriceps dominant muscle activation can add to the tension placed upon the ACL, potentially increasing the risk of ACL injury. Hypothesis/Purpose The purpose of this systematic review was to compare quadriceps and hamstring muscle activation during common closed kinetic chain therapeutic exercises in healthy female knees to determine what exercises are able to produce adequate H:Q co-activation ratios. Study Design Systematic Review Methods Multiple online databases were systematically searched and screened for inclusion. Eight articles were identified for inclusion. Data on mean electromyography (EMG) activation of both quadriceps and hamstring muscles, % maximal voluntary isometric contraction (MVIC), and H:Q co-activation ratios were extracted from the studies. Quality assessment was performed on all included studies. Results Exercises analyzed in the studies included variations of the double leg squat, variations of the single leg squat, lateral step-up, Fitter, Stairmaster® (Core Health and Fitness, Vancouver, WA), and slide board. All exercises, except the squat machine with posterior support at the level of the scapula and feet placed 50 cm in front of the hips, produced higher quadriceps muscle activation compared to hamstring muscle activation. Conclusion Overall, two leg squats demonstrate poor H:Q co-activation ratios. Single leg exercises, when performed between 30 and 90 degrees of knee flexion, produce adequate H:Q ratios, thereby potentially reducing the risk of tensile stress on the ACL and ACL injury. Level of Evidence 2a- Systematic Review of Cohort Studies PMID

  12. CT performance as a variable function of resolution, noise, and task property for iterative reconstructions

    NASA Astrophysics Data System (ADS)

    Chen, Baiyu; Richard, Samuel; Christianson, Olav; Zhou, Xiaodong; Samei, Ehsan

    2012-03-01

    The increasing availability of iterative reconstruction (IR) algorithms on clinical scanners is creating a demand for effectively and efficiently evaluating imaging performance and potential dose reduction. In this study, the location- and task-specific evaluation was performed using detectability index (d') by combining a task function, the task transfer function (TTF), and the noise power spectrum (NPS). Task function modeled a wide variety detection tasks in terms of shape and contrast. The TTF and NPS were measured from a physical phantom as a function of contrast and dose levels. Measured d' values were compared between three IRs (IRIS, SAFIRE3 and SAFIRE5) and conventional filtered back-projection (FBP) at various dose levels, showing an equivalent performance of IR at lower dose levels. AUC further calculated from d' showed that compared to FBP, SAFIRE5 may reduce dose by up to 50-60%; SAFIRE3 and IRIS by up to 20-30%. This study provides an initial framework for the localized and task-specific evaluation of IRs in CT and a guideline for the identification of optimal operating dose point with iterative reconstructions.

  13. A comparative study of effect of autograft versus allograft anterior cruciate ligament reconstruction onexpressions ofLOXsand MMPs.

    PubMed

    Wang, Wei-Ming; Ma, Xiao-Jun; Huang, Shi-Bo; Ren, Liu-Bao; Liu, Yu-Peng

    2017-03-08

    This study aimed to compare the effect of autograft or allograft anterior cruciate ligament (ACL) reconstruction on the expressions of LOXs and MMPs in a New Zealand white rabbit model. New Zealand white rabbits were divided randomly into control, sham, autograft and allograft groups At the 4th and 8th week after operation, biomechanical testing was performed to measure the primary length, cross-sectional area, maximum tensile load and stiffness of ACL, and HE staining was used to observe cell morphology and fibre alignment of ACL. At the 2nd, 4th and 8th week after operation, qRT-PCR, Western blotting and immunohistochemistry were applied to detect LOXs and MMPs expressions, and expressions of APC/Wnt signaling pathway-related proteins. At the 4th and 8th week after operation, the maximum tensile load and stiffness were higher in the autograft group than in the allograft group, and the values at the 8th week were higher than those at the 4th week after operation. The fibroblast proliferation in the allograft group was more significant than that in the autograft group. Compared with the control group, LOXs and MMPs expressions, and the positive expression rates of LOXs and MMPs proteins were elevated, and the values in the allograft group were higher than those in the autograft group at all time points. At 8th week after operation, compared with the autograft group, Wnt expression was higher and APC expression lower in the allograft group. Autograft and allograft ACL reconstruction can promote LOXs and MMPs expressions by activating the APC/Wnt signaling pathway.

  14. All-inside ACL: retroconstruction controversies.

    PubMed

    Lubowitz, James H

    2010-03-01

    All-inside anterior cruciate ligament reconstruction is controversial because the technique is new; as a result, evidence-based clinical outcome studies have yet to be published. The purpose of this article is to consider the following controversies (considered alphabetically): anatomy, biomechanics, biology, bioabsorbables, divergence of the femoral interference screw, expansion or widening of tunnels, fixation, future considerations, graft choice, the learning curve, technique, tensioning, and tibia blow-out fracture. The technique should be learned in stages. In the opinion of the author, the history of sports medicine and arthroscopy has been a progression toward less invasive techniques. In the future, all-inside anterior cruciate ligament reconstruction techniques should become more simple and reproducible, and clinical outcomes must be analyzed with long-term follow-up.

  15. Performance of Canonical Correlation Analysis (CCA) and Bayesian Hierarchical Modelling (BHM) for European temperature field reconstructions

    NASA Astrophysics Data System (ADS)

    Werner, J. P.; Smerdon, J. E.; Luterbacher, J.

    2011-12-01

    A Pseudoproxy comparison is presented for two statistical methods used to derive annual climate field reconstructions (CFR) for europe. The employed methods use the canonical correlation analysis (CCA) procedure presented by Smerdon et al. (2010, J. Climate) and the Bayesian Hierarchical Model (BHM) based method adopted from Tingley and Huybers (2010a,b, J. Climate). Pseudoproxy experiments are constructed from modelled temperature data sampled from the 1250-year paleo-run of the NCAR CCSM 1.4 model (Ammann et al. 2007, PNAS). The pseudoproxies approximate the distribution of the Mann et al. (1998, Nature) multi-proxy network and use Gaussian white noise to mimic the combined signal and noise properties of real-world proxies. The derived CFRs are tested by comparing the mean temperature bias, the reconstructed temperature variability and two error measures: the cross correlation and the root mean square error. The results show that the BHM method performs much better than the CCA method in areas with good proxy coverage. The BHM method also delivers the added value over the more traditional CCA method by providing objective error estimates. Reconstructions of key years are also analysed. While CCA returns estimates for the full climate field even for areas with sparse data, the more flexible model used in the BHM method returns results that are closer to the target for most of the reconstruction area, albeit with higher uncertainties in data sparse regions. Based on the success of these current BHM results, the algorithm will be extended to make use of proxies with different temporal resolution (cf. Li et al. 2010) in order to reconstruct the temperature and precipitation fields over Europe and the Mediterranean covering much of the common-era period. Ammann, C. et al. (2007), PNAS 104, 3713--3718 Li, B. et al. (2010), J. Am. Stat. Assoc. 105, 883-911 Mann, M. et al. (1998), Nature 392, 779-787 Smerdon, J. et al. (2010), J. Climate 24, 1284-1309 Tingley, M. and

  16. Cranial myology and bite force performance of Erlikosaurus andrewsi: a novel approach for digital muscle reconstructions

    PubMed Central

    Lautenschlager, Stephan

    2013-01-01

    The estimation of bite force and bite performance in fossil and extinct animals is a challenging subject in palaeontology and is highly dependent on the reconstruction of the cranial myology. Furthermore, the morphology and arrangement of the adductor muscles considerably affect feeding processes and mastication and thus also have important dietary and ecological ramifications. However, in the past, the reconstruction of the (cranial) muscles was restricted to the identification of muscle attachment sites or simplified computer models. This study presents a detailed reconstruction of the adductor musculature of the Cretaceous therizinosaur Erlikosaurus andrewsi based on a stepwise and iterative approach. The detailed, three-dimensional models of the individual muscles allow for more accurate measurements of the muscle properties (length, cross-section, attachment angle and volume), from which muscle and bite force estimates are calculated. Bite force estimations are found to be the lowest at the tip of the snout (43–65 N) and respectively higher at the first (59–88 N) and last tooth (90–134 N) position. Nevertheless, bite forces are comparatively low for E. andrewsi, both in actual numbers as well as in comparison with other theropod dinosaurs. The results further indicate that the low bite performance was mainly used for leaf-stripping and plant cropping, rather than active mastication or chewing processes. Muscle and thus bite force in E. andrewsi (and most likely all therizinosaurs) is considerably constrained by the cranial anatomy and declines in derived taxa of this clade. This trend is reflected in the changes of dietary preferences from carnivory to herbivory in therizinosaurs. PMID:23061752

  17. 50 CFR 648.100 - Summer flounder Annual Catch Limit (ACL).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...) The Summer Flounder Monitoring Committee shall recommend to the MAFMC separate ACLs for the commercial... recommended by the SSC. (1) Sector allocations. The commercial and recreational fishing sector ACLs will be... sector ACLs may be established on an annual basis for up to 3 years at a time, dependent on whether...

  18. 50 CFR 648.64 - Yellowtail flounder sub-ACLs and AMs for the scallop fishery.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false Yellowtail flounder sub-ACLs and AMs for...-ACLs and AMs for the scallop fishery. (a) As specified in § 648.55(d), and pursuant to the biennial... Georges Bank and Southern New England/Mid-Atlantic stocks of yellowtail flounder. The sub-ACLs for...

  19. 50 CFR 648.100 - Summer flounder Annual Catch Limit (ACL).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...) The Summer Flounder Monitoring Committee shall recommend to the MAFMC separate ACLs for the commercial... recommended by the SSC. (1) Sector allocations. The commercial and recreational fishing sector ACLs will be... sector ACLs may be established on an annual basis for up to 3 years at a time, dependent on whether...

  20. 50 CFR 648.230 - Spiny dogfish Annual Catch Limits (ACLs).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 50 Wildlife and Fisheries 12 2012-10-01 2012-10-01 false Spiny dogfish Annual Catch Limits (ACLs... Management Measures for the Spiny Dogfish Fishery § 648.230 Spiny dogfish Annual Catch Limits (ACLs). (a) The... make recommendations to the Councils for changes in measures intended to ensure ACLs are not...

  1. Preventing ACL Injuries in Females: What Physical Educators Need to Know

    ERIC Educational Resources Information Center

    Toscano, Lisa; Carroll, Brianne

    2015-01-01

    Anterior cruciate ligament (ACL) injuries happen at a frequent rate, especially in girls and women. While there are many factors that contribute to ACL tears, teaching proper landing techniques and strengthening certain muscles can decrease the incidence of ACL tears, especially in women. This article reviews some of the high-risk factors that…

  2. 50 CFR 648.140 - Black sea bass Annual Catch Limit (ACL).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Black Sea Bass Monitoring Committee shall recommend to the MAFMC separate ACLs for the commercial and...) Sector allocations. The commercial and recreational fishing sector ACLs will be established consistent... Management Plan. (2) Periodicity. The black sea bass commercial and recreational sector ACLs may...

  3. 50 CFR 648.100 - Summer flounder Annual Catch Limit (ACL).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) The Summer Flounder Monitoring Committee shall recommend to the MAFMC separate ACLs for the commercial... recommended by the SSC. (1) Sector allocations. The commercial and recreational fishing sector ACLs will be... sector ACLs may be established on an annual basis for up to 3 years at a time, dependent on whether...

  4. 50 CFR 648.64 - Yellowtail flounder sub-ACLs and AMs for the scallop fishery.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 50 Wildlife and Fisheries 12 2013-10-01 2013-10-01 false Yellowtail flounder sub-ACLs and AMs for...-ACLs and AMs for the scallop fishery. (a) As specified in § 648.55(d), and pursuant to the biennial... Georges Bank and Southern New England/Mid-Atlantic stocks of yellowtail flounder. The sub-ACLs for...

  5. 50 CFR 648.140 - Black sea bass Annual Catch Limit (ACL).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Black Sea Bass Monitoring Committee shall recommend to the MAFMC separate ACLs for the commercial and...) Sector allocations. The commercial and recreational fishing sector ACLs will be established consistent... Management Plan. (2) Periodicity. The black sea bass commercial and recreational sector ACLs may...

  6. 50 CFR 648.230 - Spiny dogfish Annual Catch Limits (ACLs).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 50 Wildlife and Fisheries 12 2013-10-01 2013-10-01 false Spiny dogfish Annual Catch Limits (ACLs... Management Measures for the Spiny Dogfish Fishery § 648.230 Spiny dogfish Annual Catch Limits (ACLs). (a) The... make recommendations to the Councils for changes in measures intended to ensure ACLs are not...

  7. 50 CFR 648.140 - Black sea bass Annual Catch Limit (ACL).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Black Sea Bass Monitoring Committee shall recommend to the MAFMC separate ACLs for the commercial and...) Sector allocations. The commercial and recreational fishing sector ACLs will be established consistent... Management Plan. (2) Periodicity. The black sea bass commercial and recreational sector ACLs may...

  8. 50 CFR 648.230 - Spiny dogfish Annual Catch Limits (ACLs).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false Spiny dogfish Annual Catch Limits (ACLs... Management Measures for the Spiny Dogfish Fishery § 648.230 Spiny dogfish Annual Catch Limits (ACLs). (a) The... make recommendations to the Councils for changes in measures intended to ensure ACLs are not...

  9. Anterior cruciate ligament- specialized post-operative return-to-sports (ACL-SPORTS) training: a randomized control trial

    PubMed Central

    2013-01-01

    Background Anterior cruciate ligament reconstruction (ACLR) is standard practice for athletes that wish to return to high-level activities; however functional outcomes after ACLR are poor. Quadriceps strength weakness, abnormal movement patterns and below normal knee function is reported in the months and years after ACLR. Second ACL injuries are common with even worse outcomes than primary ACLR. Modifiable limb-to-limb asymmetries have been identified in individuals who re-injure after primary ACLR, suggesting a neuromuscular training program is needed to improve post-operative outcomes. Pre-operative perturbation training, a neuromuscular training program, has been successful at improving limb symmetry prior to surgery, though benefits are not lasting after surgery. Implementing perturbation training after surgery may be successful in addressing post-operative deficits that contribute to poor functional outcomes and second ACL injury risk. Methods/Design 80 athletes that have undergone a unilateral ACLR and wish to return to level 1 or 2 activities will be recruited for this study and randomized to one of two treatment groups. A standard care group will receive prevention exercises, quadriceps strengthening and agility exercises, while the perturbation group will receive the same exercise program with the addition of perturbation training. The primary outcomes measures will include gait biomechanics, clinical and functional measures, and knee joint loading. Return to sport rates, return to pre-injury level of activity rates, and second injury rates will be secondary measures. Discussion The results of this ACL-Specialized Post-Operative Return To Sports (ACL-SPORTS) Training program will help clinicians to better determine an effective post-operative treatment program that will improve modifiable impairments that influence outcomes after ACLR. Trial registration Randomized Control Trial NIH 5R01AR048212-07. ClinicalTrials.gov: NCT01773317 PMID:23522373

  10. Quadriceps Strength, Muscle Activation Failure, and Patient-Reported Function at the Time of Return to Activity in Patients Following Anterior Cruciate Ligament Reconstruction: A Cross-sectional Study

    PubMed Central

    Lepley, Lindsey K.; Palmieri-Smith, Riann M.

    2016-01-01

    Study Design Cross-sectional. Objectives To determine if quadriceps activation failure (QAF) moderates the relationship between quadriceps strength and physical function in individuals post-anterior cruciate ligament (ACL) reconstruction. Background QAF may impair the recovery of physical function post ACL reconstruction, given that QAF reduces strength, and strength is related to physical function. Evidence of this relationship has been found in individuals with knee osteoarthritis, wherein patients with lower strength and greater QAF had lower levels of physical function. Methods Participants consisted of 52 individuals who were cleared for return to activity at an average ± SD of 7.4 ± 1.2 months post ACL reconstruction. QAF was assessed using the superimposed burst technique and quadriceps strength was assessed using concentric isokinetic contractions (Nm/kg). Physical function was quantified using a combined variable of physical (single leg hop for distance) and self-reported function (International Knee Documentation Committee form) calculated using a principal component analysis (PCPF). Simple correlations were then performed to determine the order in which variables were entered into the regression model to evaluate if QAF moderates the relationship between quadriceps strength and physical function. Results The combination of quadriceps strength and the interaction of strength-by-QAF predicted 30% of the variance in physical function (R2=0.30, P<.001; PCPF = -0.61strength + 0.20interaction - 1.896); however the interaction of strength-by-QAF only accounted for 7% of the capabilities of the model (P=.023). Conclusion Physical function is largely influenced by the recovery of quadriceps strength and minimally attenuated by QAF. These data suggest that QAF may affect individuals post ACL reconstruction differently, and to a lesser extent, than knee individuals with knee osteoarthritis. PMID:26471854

  11. Success of free flap anastomoses performed within the zone of trauma in acute lower limb reconstruction.

    PubMed

    Bendon, Charlotte L; Giele, Henk P

    2016-07-01

    Traditionally, in free flap cover of lower limb injuries, every attempt is made to perform anastomoses proximal to the zone of injury. We report on the success of anastomoses within the zone of trauma, at the level of the fracture, avoiding further dissection and exposure. The records of free flap reconstructions for fractures of the lower extremity at a tertiary trauma centre between 2004 and 2010 were retrospectively reviewed. A total of 48 lower limb fractures required free flap reconstruction, performed at 28 days post injury (0-275 days). Anastomoses were proximal (21), distal (5) or within the zone of trauma (22). There was no significant difference (p > 0.05) in return to theatre, revision of anastomosis or flap survival between groups. Of the 22 performed within the zone of injury, five returned to theatre but only two for revision of anastomosis and 20 (91%) of these flaps survived. Of the 48 free flaps, arterial anastomoses were end to end in 34 (71%) and end to side in 14 (30%). There was no significant difference (p > 0.05) in return to theatre, revision of anastomosis or flap survival between the end-to-end and end-to-side groups. There was a tendency for arterial anastomoses to be performed end to end outside the zone of trauma (23/26) compared to within the zone of trauma (11/22). Our data suggest that free flap anastomoses can be performed safely in the zone of trauma in lower limb injuries.

  12. Loss of neuromuscular control related to motion in the acutely ACL-injured knee: an experimental study.

    PubMed

    Bonsfills, N; Gómez-Barrena, E; Raygoza, J J; Núñez, A

    2008-10-01

    Ligamentomuscular and muscular stretch reflexes are known to contribute to knee joint stability. After anterior cruciate ligament (ACL) injury, a more intense and adjusted muscular response is required to maintain joint stability, but this neuromuscular control of the knee has not been clearly proved. The aim of the study is to record electromyography (EMG) signal and muscular fibre length variations in quadriceps and hamstrings of the knee with and without ACL, and to analyze and integrate the ligament strain and the muscular reaction to forced anterior tibial translation (ATT). In 17 knees from 12 cats, EMG electrodes and ultrasonomicrometry crystals were inserted into four main periarticular muscles, with strain gauges on periarticular ligament insertions. Their output signal was compared before and after ACL surgical section in series of ATT (at 90 degrees and 30 degrees knee flexion), and also during knee flexion and extension. Linear regression analysis was performed between the EMG signal and muscular fibre length variations, and between the EMG signal and the strain on ligament insertions, in the search of this reflex neuromuscular response. In the ACL deficient knees, the studied muscles showed a poor adjustment to motion of EMG firing, inversely to controls. The muscle stretch reflexes showed poorer correlation with post-peak EMG activity than the ligaments. ATT control depended mainly on hamstrings activity in control knees, whereas in unstable knees, quadriceps activity was associated with more tibial translation. Acute ACL-deficient knees showed poor neuromuscular control with weak ligamentomuscular reflexes and no muscular stretch reflexes, suggesting the ineffectiveness of acute muscular reaction to provide early mechanical knee stabilization after injury.

  13. Performance evaluation of iterative reconstruction algorithms for achieving CT radiation dose reduction - a phantom study.

    PubMed

    Dodge, Cristina T; Tamm, Eric P; Cody, Dianna D; Liu, Xinming; Jensen, Corey T; Wei, Wei; Kundra, Vikas; Rong, X John

    2016-03-08

    The purpose of this study was to characterize image quality and dose performance with GE CT iterative reconstruction techniques, adaptive statistical iterative recontruction (ASiR), and model-based iterative reconstruction (MBIR), over a range of typical to low-dose intervals using the Catphan 600 and the anthropomorphic Kyoto Kagaku abdomen phantoms. The scope of the project was to quantitatively describe the advantages and limitations of these approaches. The Catphan 600 phantom, supplemented with a fat-equivalent oval ring, was scanned using a GE Discovery HD750 scanner at 120 kVp, 0.8 s rotation time, and pitch factors of 0.516, 0.984, and 1.375. The mA was selected for each pitch factor to achieve CTDIvol values of 24, 18, 12, 6, 3, 2, and 1 mGy. Images were reconstructed at 2.5 mm thickness with filtered back-projection (FBP); 20%, 40%, and 70% ASiR; and MBIR. The potential for dose reduction and low-contrast detectability were evaluated from noise and contrast-to-noise ratio (CNR) measurements in the CTP 404 module of the Catphan. Hounsfield units (HUs) of several materials were evaluated from the cylinder inserts in the CTP 404 module, and the modulation transfer function (MTF) was calculated from the air insert. The results were con-firmed in the anthropomorphic Kyoto Kagaku abdomen phantom at 6, 3, 2, and 1mGy. MBIR reduced noise levels five-fold and increased CNR by a factor of five compared to FBP below 6mGy CTDIvol, resulting in a substantial improvement in image quality. Compared to ASiR and FBP, HU in images reconstructed with MBIR were consistently lower, and this discrepancy was reversed by higher pitch factors in some materials. MBIR improved the conspicuity of the high-contrast spatial resolution bar pattern, and MTF quantification confirmed the superior spatial resolution performance of MBIR versus FBP and ASiR at higher dose levels. While ASiR and FBP were relatively insensitive to changes in dose and pitch, the spatial resolution for MBIR

  14. The ACLS Survey of Scholars: Views on Publications, Computers, Libraries.

    ERIC Educational Resources Information Center

    Morton, Herbert C.; Price, Anne Jamieson

    1986-01-01

    Reviews results of a survey by the American Council of Learned Societies (ACLS) of 3,835 scholars in the humanities and social sciences who are working both in colleges and universities and outside the academic community. Areas highlighted include professional reading, authorship patterns, computer use, and library use. (LRW)

  15. The Humanities in the Schools. ACLS Occasion Paper, No. 20.

    ERIC Educational Resources Information Center

    American Council of Learned Societies, New York, NY.

    Designed to serve as a record of the initial public activity of the American Council of Learned Societies (ACLS) Program in Humanities Curriculum Development, this collection of three articles offers different perspectives on the humanities in the schools. In the first article, "The Humanities and Public Education," Stanley N. Katz discusses the…

  16. Individuality of Item Interpretation in Interchangeable ACL Scales

    ERIC Educational Resources Information Center

    Fiske, Donald W.; Barack, Leonard I.

    1976-01-01

    The diversity among interpretations of single items in personality questionnaires has been noted previously. Using adjectives from the Adjective Check List (ACL), the study sought evidence bearing on these questions: Does such diversity make the responses to an item not comparable across subjects? If so, what are the implications for scores based…

  17. New concepts of rehabilitation following anterior cruciate reconstruction.

    PubMed

    Stanish, W D; Lai, A

    1993-01-01

    Can a knee joint with a torn ACL of 2 years' duration ever be able to return to high performance? Very unlikely indeed. Some realistic expectations follow: 1. The knee joint can never be normal after an ACL reconstruction. 2. Surgery must take place as early after the injury as possible, before secondary joint degeneration takes place. 3. The surgery must employ a tissue that best matches the normal ACL in strength and structure. 4. The surgery must involve as little trauma as possible while restoring knee joint mechanics. 5. Stress, although guarded, must be faced by the knee joint as soon as possible after surgery. 6. Progressive weight bearing starts immediately, combined with quadriceps isometrics. ROM of the knee joint, particularly full extension, is conserved and protected. 7. Progressive active ROM without formal resistance continues for 4 weeks. 8. Progressive formal resistance exercises continue for at least 1 year. 9. Sport-specific tasks commence at 16 weeks, depending on the requirement of the sport and the response of the individual athlete. 10. Recovery will plateau at several stages, with the final plateau at approximately 18 months. Knee instability is an exciting but perplexing problem. Although we have advanced profoundly from the era of Jones, Smiley, and others, we still face many of the same challenges as our predecessors. New technology should not fool us. We are still addressing a major structural failure within the knee joint. Our attempts have been non-surgical and surgical, with repair, reconstruction, and replacement. However, fundamental to all of these hopes has been the reconditioning of the extremity after ACL surgery. Can we do better than our forefathers like Licht and others? No one is certain. This article offers an approach, in some areas our approach, but should not be perceived as a cookbook. Individual responses by our patients, athletes, dictate whether any protocol is too hasty or tardy. It is fundamental that we listen to

  18. Anterior cruciate ligament reconstruction with a novel porcine xenograft: the initial Italian experience

    PubMed Central

    ZAFFAGNINI, STEFANO; GRASSI, ALBERTO; MUCCIOLI, GIULIO MARIA MARCHEGGIANI; DI SARSINA, TOMMASO ROBERTI; RAGGI, FEDERICO; BENZI, ANDREA; MARCACCI, MAURILIO

    2015-01-01

    At the current state of the art in anterior cruciate ligament (ACL) reconstruction, multiple techniques have been presented but none has given clearly defined and improved results. One of the main issues concerns the choice of graft. The concept of using xenograft tissue, defined as a graft tissue from one species and destined for implantation in an unlike species, was introduced in order to try to overcome the mechanical and biological concerns associated with synthetic materials and the safety and quality concerns and availability problems of allograft tissue. Xenograft tissue carries the risk of producing an immunological reaction. In order to try to overcome or attenuate the immune response against porcine xenograft tissue, the Z-Process® (Aperion Biologics Inc, San Antonio, Texas, USA) has been developed and used to produce the Z-Lig® family of devices for ACL reconstruction procedures. Z-Lig® is a tendon graft with or without bone blocks, sourced from animal tissue in a manner consistent with what has normally been sourced from human tissue, and processed to overcome anti-Gal-mediated rejection and to attenuate other immunological recognition in humans. All this while ensuring sterility, viral inactivation and preservation of mechanical proprieties appropriate for an ACL reconstruction device. The Z-Lig® device has been tested in skeletally mature monkeys and given interesting and promising results from the preclinical performance and safety profile point of view. On this basis, it was possible to proceed with the first clinical trial involving humans, which gave similar encouraging results. The Z-Lig® device has also been implanted in Italy at the Rizzoli Orthopaedic Institute in Bologna, as a part of international multicenter prospective randomized blinded controlled study aimed at comparing xenograft with allograft tissue. PMID:26605257

  19. Multivariable robust controller design of ACLS using loop-shaping approach

    NASA Astrophysics Data System (ADS)

    Dong, Chaoyang; Cui, Haihua; Wang, Qing

    2008-10-01

    In this paper a multivariable robust controller design approach of the ACLS is accomplished by using robust loop-shaping techniques. In order to avoid the inefficient way of choosing the weight functions by trial-and-error method, the structured genetic algorithm (SGA) approach is introduced, which is capable of simultaneously searching the orders and coefficients of the pre- and post-compensator for weight matrices. According to this approach, engineers can achieve an ideal loop-shape which lies in an appropriate region relating to the desired performance specifications. The effectiveness of this approach is illustrated by the longitudinal equations of a carrier-based aircraft's motion design example.

  20. Performances of the signal reconstruction in the ATLAS Hadronic Tile Calorimeter

    NASA Astrophysics Data System (ADS)

    Meoni, E.

    2013-08-01

    The Tile Calorimeter (TileCal) is the central section of the hadronic calorimeter of ATLAS. It is a key detector for the reconstruction of hadrons, jets, tau leptons and missing transverse energy. TileCal is a sampling calorimeter using steel as an absorber and plastic scintillators as an active medium. The scintillators are read-out by wavelength shifting fibers coupled to photomultiplier tubes (PMTs). The analogue signals from the PMTs are amplified, shaped and digitized by sampling the signal every 25 ns. The read-out system is designed to reconstruct the data in real time fulfilling the tight time constraint imposed by the ATLAS first level trigger rate (100 kHz). The signal amplitude and phases for each channel are measured using Optimal Filtering algorithms both at online and offline level. We present the performances of these techniques on the data collected in the proton-proton collisions at center-of-mass energy of 7 TeV. We show in particular the measurements of low amplitudes, close to the pedestal value, using as probe high transverse momenta muons produced in the proton-proton collisions.

  1. Optoacoustic Imaging and Tomography: Reconstruction Approaches and Outstanding Challenges in Image Performance and Quantification

    PubMed Central

    Lutzweiler, Christian; Razansky, Daniel

    2013-01-01

    This paper comprehensively reviews the emerging topic of optoacoustic imaging from the image reconstruction and quantification perspective. Optoacoustic imaging combines highly attractive features, including rich contrast and high versatility in sensing diverse biological targets, excellent spatial resolution not compromised by light scattering, and relatively low cost of implementation. Yet, living objects present a complex target for optoacoustic imaging due to the presence of a highly heterogeneous tissue background in the form of strong spatial variations of scattering and absorption. Extracting quantified information on the actual distribution of tissue chromophores and other biomarkers constitutes therefore a challenging problem. Image quantification is further compromised by some frequently-used approximated inversion formulae. In this review, the currently available optoacoustic image reconstruction and quantification approaches are assessed, including back-projection and model-based inversion algorithms, sparse signal representation, wavelet-based approaches, methods for reduction of acoustic artifacts as well as multi-spectral methods for visualization of tissue bio-markers. Applicability of the different methodologies is further analyzed in the context of real-life performance in small animal and clinical in-vivo imaging scenarios. PMID:23736854

  2. Performance study of Cascade Reconstruction at the Glashow Resonance in IceCube

    NASA Astrophysics Data System (ADS)

    Niederhausen, Hans

    2012-05-01

    IceCube is a one cubic kilometer neutrino telescope at the South Pole. Its primary goal is to discover high energy cosmic neutrinos and anti-neutrinos from astrophysical sources. Observation of the spectrum near the characteristic energy Eν ≈ 6:3PeV of the Glashow resonance, the interaction of anti-neutrinos with atomic electrons via ν e + e- → W-, is of particular interest. Since the cross section for this process can be calculated from first principles, it is possible to quantify separately the fluxes for neutrinos and anti-neutrinos if the resonance is observed above a continuum. In turn, such a separation will give unique insights into the astrophysics properties of the sources. We conducted the first IceCube performance studies and optimizations for likelihood-based algorithms to reconstruct (anti-)neutrino-induced particle showers (cascades) in the energy range of the Glashow resonance using simulated data from electron (anti-)neutrino Monte Carlo generators and detector response simulations. For hadronic showers in the energy range 1PeV < E ν < 10PeV that are well contained within the IceCube instrumented volume, we achieved an energy resolution of 10% < σ (ΔE/E) < 14% depending on the ice model and the shower position in the detector. The position and direction resolution varied between 1:1m < σ (Δxy z) < 4:2m and 8° < θRMS < 27°, respectively. We verified and refined the methods on experimental data using an in-situ laser as a pulsed light source with constant brightness and a single wavelength of λ = 337 nm. The energy resolution for reconstructed laser events was found to be σ (ΔE/E) = 1:8% from the reconstructed energy of E ± δ Estat = (527 ± 9) TeV, where the uncertainty is statistical

  3. Arterial complications, venous thromboembolism and deep venous thrombosis prophylaxis after anterior cruciate ligament reconstruction: A systematic review

    PubMed Central

    Janssen, Rob Paulus Augustinus; Reijman, Max; Janssen, Daan Martijn; van Mourik, Jan Bernardus Antonius

    2016-01-01

    AIM To summarize the current knowledge on vascular complications and deep venous thrombosis (DVT) prophylaxis after anterior cruciate ligament (ACL) reconstruction. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. MEDLINE, EMBASE, Cochrane, Web of Science, CINAHL, PubMed publisher, and Google scholar medical literature databases were searched up to November 10, 2015. Any arthroscopic surgical method of primary or revision intra-articular ACL reconstruction of all graft types in humans was included. A risk of bias assessment was determined. RESULTS Fourty-seven studies were included in the review. Pseudaneurysms were the most frequently reported arterial complication after ACL reconstruction, irrespective of graft type or method of graft fixation with an incidence of 0.3%. The time to diagnosis of arterial complications after ACL reconstruction varied from days to mostly weeks but even years. After ACL reconstruction without thromboprophylaxis, the incidence of DVT was 9.7%, of which 2.1% was symptomatic. The incidence of pulmonary embolism was 0.1%. Tourniquet time > 2 h was related to venous thromboembolism. Thromboprophylaxis is indicated in patients with risk factors for venous thromboembolism. CONCLUSION After ACL reconstruction, the incidence of arterial complications, symptomatic DVT and pulmonary embolism was 0.3%, 2.1% and 0.1% respectively. Arterial complications may occur with all types of arthroscopic ACL reconstruction, methods of graft fixation as well as any type of graft. Patients considered to be at moderate or high risk of venous thromboembolism should routinely receive thromboprophylaxis after ACL reconstruction. PMID:27672574

  4. The Effects of a Valgus Collapse Knee Position on In Vivo ACL Elongation

    PubMed Central

    Utturkar, G. M.; Irribarra, L. A.; Taylor, K. A.; Spritzer, C. E.; Taylor, D. C.; Garrett, W. E.; DeFrate, Louis E.

    2013-01-01

    There are conflicting data regarding what motions increase ACL injury risk. More specifically, the mechanical role of valgus collapse positions during ACL injury remains controversial. Our objective was to evaluate ACL elongation in a model that mimics knee movements thought to occur during ACL injury. Eight healthy male subjects were imaged using MR and biplanar fluoroscopy to measure the in vivo elongation of the ACL and its functional bundles during three static knee positions: full extension, 30° of flexion, and a position intended to mimic a valgus collapse position described in the literature. For this study, the valgus collapse position consisted of 30° of knee flexion, internal rotation of the hip, and 10° of external tibial rotation. ACL length decreased significantly from full extension (30.2 ± 2.6 mm) to 30° of flexion (27.1 ± 2.2 mm). ACL length further decreased in the valgus collapse position (25.6 ± 2.4 mm). Both functional bundles of the ACL followed similar trends with regards to decreases in length in each of the three positions. Since strain would follow patterns of ACL length, landing on an extended knee may be a more relevant risk factor for ACL injuries than the valgus collapse position in males. Future studies should evaluate the effects of dynamic motion patterns on in vivo ACL strains. PMID:22855117

  5. The effects of a valgus collapse knee position on in vivo ACL elongation.

    PubMed

    Utturkar, G M; Irribarra, L A; Taylor, K A; Spritzer, C E; Taylor, D C; Garrett, W E; Defrate, Louis E

    2013-01-01

    There are conflicting data regarding what motions increase ACL injury risk. More specifically, the mechanical role of valgus collapse positions during ACL injury remains controversial. Our objective was to evaluate ACL elongation in a model that mimics knee movements thought to occur during ACL injury. Eight healthy male subjects were imaged using MR and biplanar fluoroscopy to measure the in vivo elongation of the ACL and its functional bundles during three static knee positions: full extension, 30° of flexion, and a position intended to mimic a valgus collapse position described in the literature. For this study, the valgus collapse position consisted of 30° of knee flexion, internal rotation of the hip, and 10° of external tibial rotation. ACL length decreased significantly from full extension (30.2 ± 2.6 mm) to 30° of flexion (27.1 ± 2.2 mm). ACL length further decreased in the valgus collapse position (25.6 ± 2.4 mm). Both functional bundles of the ACL followed similar trends with regards to decreases in length in each of the three positions. Since strain would follow patterns of ACL length, landing on an extended knee may be a more relevant risk factor for ACL injuries than the valgus collapse position in males. Future studies should evaluate the effects of dynamic motion patterns on in vivo ACL strains.

  6. Efficacy of Osteoconductive Ceramics in Bioresorbable Screws for Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Barth, Johannes; Akritopoulos, Panagiotis; Graveleau, Nicolas; Barthelemy, Renaud; Toanen, Cécile; Saffarini, Mo

    2016-01-01

    Background: Osteoconductive additives are used in resorbable interference screws for anterior cruciate ligament (ACL) reconstruction to improve graft incorporation and mitigate adverse effects. There are no published studies that compare biological performances of bioresorbable and biocomposite screws without artifacts due to different follow-up times and intrinsic patient characteristics. Purpose/Hypothesis: The purpose of this study was to evaluate the efficacy of osteoconductive agents in bioresorbable screws for ACL reconstruction at minimum follow-up of 2 years by intrapatient comparison. The hypothesis was that osteoconductive ceramics would result in slower resorption, improved ossification, and less tunnel widening. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 28 ACL reconstructions at 2 centers were randomly assigned into 2 comparable groups: (1) the graft was fixed in the tibia using standard bioresorbable screws and in the femur using biocomposite screws with osteoconductive agents (biphasic calcium phosphate), and (2) the graft was fixed in the femur using a standard bioresorbable screw and in the tibia using a biocomposite screw with osteoconductive agents. Results: Twenty-seven patients completed evaluations at 29.9 ± 4.0 months. Resorption was complete for more bioresorbable (81%) than biocomposite (37%) screws (P = .0029), whereas satisfactory ossification was observed in more biocomposite (52%) than bioresorbable (15%) screws (P = .0216). The tunnel shape was normal in more biocomposite (81%) than bioresorbable (48%) screws (P = .0126), and marked cortical formation was twice more frequent for biocomposite (78%) than bioresorbable (37%) screws (P = .0012). Bioresorbable screws exhibited faster resorption in the femur (P = .0202) but not in the tibia (not significant). Conversely, biocomposite screws demonstrated better ossification, less tunnel widening, and more cortical formation in the tibia (P < .0001, P = .0227, and P

  7. Posterior Wall Blowout in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Mitchell, Justin J.; Dean, Chase S.; Chahla, Jorge; Menge, Travis J.; Cram, Tyler R.; LaPrade, Robert F.

    2016-01-01

    Violation of the posterior femoral cortex, commonly referred to as posterior wall blowout, can be a devastating intraoperative complication in anterior cruciate ligament (ACL) reconstruction and lead to loss of graft fixation or early graft failure. If cortical blowout occurs despite careful planning and adherence to proper surgical technique, a thorough knowledge of the anatomy and alternative fixation techniques is imperative to ensure optimal patient outcomes. This article highlights anatomic considerations for femoral tunnel placement in ACL reconstruction and techniques for avoidance and salvage of a posterior wall blowout. PMID:27335885

  8. Model observers to predict human performance in LROC studies of SPECT reconstruction using anatomical priors

    NASA Astrophysics Data System (ADS)

    Lehovich, Andre; Gifford, Howard C.; King, Michael A.

    2008-03-01

    We investigate the use of linear model observers to predict human performance in a localization ROC (LROC) study. The task is to locate gallium-avid tumors in simulated SPECT images of a digital phantom. Our study is intended to find the optimal strength of smoothing priors incorporating various degrees of anatomical knowledge. Although humans reading the images must perform a search task, our models ignore search by assuming the lesion location is known. We use area under the model ROC curve to predict human area under the LROC curve. We used three models, the non-prewhitening matched filter (NPWMF), the channelized nonprewhitening (CNPW), and the channelized Hotelling observer (CHO). All models have access to noise-free reconstructions, which are used to compute the signal template. The NPWMF model does a poor job of predicting human performance. The CNPW and CHO model do a somewhat better job, but still do not qualitatively capture the human results. None of the models accurately predicts the smoothing strength which maximizes human performance.

  9. Failure of Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Samitier, Gonzalo; Marcano, Alejandro I.; Alentorn-Geli, Eduard; Cugat, Ramon; Farmer, Kevin W; Moser, Michael W

    2015-01-01

    The present review classifies and describes the multifactorial causes of anterior cruciate ligament (ACL) surgery failure, concentrating on preventing and resolving such situations. The article particularly focuses on those causes that require ACL revision due to recurrent instability, without neglecting those that affect function or produce persistent pain. Although primary ACL reconstruction has satisfactory outcome rates as high as 97%, it is important to identify the causes of failure, because satisfactory outcomes in revision surgery can drop to as much as 76%. It is often possible to identify a primary or secondary cause of ACL surgery failure; even the most meticulous planning can give rise to unexpected findings during the intervention. The adopted protocol should therefore be sufficiently flexible to adapt to the course of surgery. Preoperative patient counseling is essential. The surgeon should limit the patient’s expectations for the outcome by explaining the complexity of this kind of procedure. With adequate preoperative planning, close attention to details and realistic patient expectations, ACL revision surgery may offer beneficial and satisfactory results for the patient. PMID:26550585

  10. Performance analysis of model based iterative reconstruction with dictionary learning in transportation security CT

    NASA Astrophysics Data System (ADS)

    Haneda, Eri; Luo, Jiajia; Can, Ali; Ramani, Sathish; Fu, Lin; De Man, Bruno

    2016-05-01

    In this study, we implement and compare model based iterative reconstruction (MBIR) with dictionary learning (DL) over MBIR with pairwise pixel-difference regularization, in the context of transportation security. DL is a technique of sparse signal representation using an over complete dictionary which has provided promising results in image processing applications including denoising,1 as well as medical CT reconstruction.2 It has been previously reported that DL produces promising results in terms of noise reduction and preservation of structural details, especially for low dose and few-view CT acquisitions.2 A distinguishing feature of transportation security CT is that scanned baggage may contain items with a wide range of material densities. While medical CT typically scans soft tissues, blood with and without contrast agents, and bones, luggage typically contains more high density materials (i.e. metals and glass), which can produce severe distortions such as metal streaking artifacts. Important factors of security CT are the emphasis on image quality such as resolution, contrast, noise level, and CT number accuracy for target detection. While MBIR has shown exemplary performance in the trade-off of noise reduction and resolution preservation, we demonstrate that DL may further improve this trade-off. In this study, we used the KSVD-based DL3 combined with the MBIR cost-minimization framework and compared results to Filtered Back Projection (FBP) and MBIR with pairwise pixel-difference regularization. We performed a parameter analysis to show the image quality impact of each parameter. We also investigated few-view CT acquisitions where DL can show an additional advantage relative to pairwise pixel difference regularization.

  11. Genome-wide association screens for Achilles tendon and ACL tears and tendinopathy

    PubMed Central

    Roos, Thomas R.; Roos, Andrew K.; Kleimeyer, John P.; Ahmed, Marwa A.; Goodlin, Gabrielle T.; Fredericson, Michael; Ioannidis, John P. A.; Avins, Andrew L.; Dragoo, Jason L.

    2017-01-01

    Achilles tendinopathy or rupture and anterior cruciate ligament (ACL) rupture are substantial injuries affecting athletes, associated with delayed recovery or inability to return to competition. To identify genetic markers that might be used to predict risk for these injuries, we performed genome-wide association screens for these injuries using data from the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort consisting of 102,979 individuals. We did not find any single nucleotide polymorphisms (SNPs) associated with either of these injuries with a p-value that was genome-wide significant (p<5x10-8). We found, however, four and three polymorphisms with p-values that were borderline significant (p<10−6) for Achilles tendon injury and ACL rupture, respectively. We then tested SNPs previously reported to be associated with either Achilles tendon injury or ACL rupture. None showed an association in our cohort with a false discovery rate of less than 5%. We obtained, however, moderate to weak evidence for replication in one case; specifically, rs4919510 in MIR608 had a p-value of 5.1x10-3 for association with Achilles tendon injury, corresponding to a 7% chance of false replication. Finally, we tested 2855 SNPs in 90 candidate genes for musculoskeletal injury, but did not find any that showed a significant association below a false discovery rate of 5%. We provide data containing summary statistics for the entire genome, which will be useful for future genetic studies on these injuries. PMID:28358823

  12. A comparison of the outcome of CPR according to AHA 2005 ACLS and AHA 2010 ACLS guidelines in cardiac arrest: multicenter study.

    PubMed

    Ocal, Oktay; Ozucelik, Dogac Niyazi; Avci, Akkan; Yazicioglu, Mustafa; Aydin, Yilmaz; Ayvaci, Baris Murat; Dogan, Halil; Aciksari, Kurtulus; Cukurova, Zafer

    2015-01-01

    The aim of this study was to evaluate whether there is a difference in the return of spontaneous circulation (ROSC) and survival with sequel-free recovery rates between the patients who underwent cardiopulmonary resuscitation (CPR) according to 2005 and 2010 guidelines. This study was conducted in the Bakırköy Dr. Sadi Konuk and Kartal Lütfi Kırdar Training and Research Hospital between dates of October 2010 and 28 February 2011 after approval of Ethics Committee. In the first months of the study, CPR was performed according to AHA 2005 ACLS guidelines (Group-1), while CPR was performed according to AHA 2010 ACLS guidelines after November 2010 (Group-2). Patients were assessed for neurological deficit with Cerebral Performance Categories Scale. Mean age was found as 69.01±13.05 (minimum: 21, maximum: 92) in 86 patients included. Of the 33 patients underwent CPR in the Group 1, ROSC was achieved in 51.5%; and 6.1% of these patients were discharged. Of the 53 patients underwent CPR in the Group 2, ROSC was achieved in 37.7%; and 9.4% of these patients were discharged. Although the number of living patients in Group 2 was higher than Group 1, the difference was not found statistically significant (5 versus 2), (P>0.05). But, neurological outcomes were found better with 2010 compared to 2005 guidelines (3/7 versus 0/2 good cerebral performance). It was found that the 2005 CPR guidelines practices in ED were more successful than the 2010 CPR guidelines practices in ROSC, but less successful in the rate of discharge from hospital and neurological sequel-free discharge rate.

  13. Assessment of volumetric noise and resolution performance for linear and nonlinear CT reconstruction methods

    SciTech Connect

    Chen, Baiyu; Christianson, Olav; Wilson, Joshua M.; Samei, Ehsan

    2014-07-15

    Purpose: For nonlinear iterative image reconstructions (IR), the computed tomography (CT) noise and resolution properties can depend on the specific imaging conditions, such as lesion contrast and image noise level. Therefore, it is imperative to develop a reliable method to measure the noise and resolution properties under clinically relevant conditions. This study aimed to develop a robust methodology to measure the three-dimensional CT noise and resolution properties under such conditions and to provide guidelines to achieve desirable levels of accuracy and precision. Methods: The methodology was developed based on a previously reported CT image quality phantom. In this methodology, CT noise properties are measured in the uniform region of the phantom in terms of a task-based 3D noise-power spectrum (NPS{sub task}). The in-plane resolution properties are measured in terms of the task transfer function (TTF) by applying a radial edge technique to the rod inserts in the phantom. The z-direction resolution properties are measured from a supplemental phantom, also in terms of the TTF. To account for the possible nonlinearity of IR, the NPS{sub task} is measured with respect to the noise magnitude, and the TTF with respect to noise magnitude and edge contrast. To determine the accuracy and precision of the methodology, images of known noise and resolution properties were simulated. The NPS{sub task} and TTF were measured on the simulated images and compared to the truth, with criteria established to achieve NPS{sub task} and TTF measurements with <10% error. To demonstrate the utility of this methodology, measurements were performed on a commercial CT system using five dose levels, two slice thicknesses, and three reconstruction algorithms (filtered backprojection, FBP; iterative reconstruction in imaging space, IRIS; and sinogram affirmed iterative reconstruction with strengths of 5, SAFIRE5). Results: To achieve NPS{sub task} measurements with <10% error, the

  14. Association Between Previous Meniscal Surgery and the Incidence of Chondral Lesions at Revision Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Brophy, Robert H.; Wright, Rick W.; David, Tal S.; McCormack, Robert G.; Sekiya, Jon K.; Svoboda, Steven J.; Huston, Laura J.; Haas, Amanda K.; Steger-May, Karen

    2013-01-01

    Background Knees undergoing revision anterior cruciate ligament (ACL) reconstruction typically have more intra-articular injuries than do knees undergoing primary reconstruction. Hypothesis Previous partial meniscectomy (PM) is associated with a higher rate of chondral lesions at revision ACL reconstruction, whereas previous meniscal repair (MR) is not associated with a higher rate of chondral lesions at revision ACL reconstruction, compared with knees undergoing revision ACL with no previous meniscal surgery. Study design Cohort study (Prevalence); Level of evidence, 2. Methods Data from a multicenter cohort was reviewed to determine the history of prior meniscal surgery (PM/MR) and the presence of grade II/III/IV chondral lesions at revision ACL reconstruction. The association between previous meniscal surgery and the incidence of chondral lesions was examined. Patient age was included as a covariate to determine if surgery type contributes predictive information independent of patient age. Results The cohort included 725 ACL revision surgeries. Chondrosis was associated with patient age (P < .0001) and previous meniscal surgery (P < .0001). After adjusting for patient age, knees with previous PM were more likely to have chondrosis than knees with previous MR (P = .003) or no previous meniscal surgery (P < .0001). There was no difference between knees without previous meniscal surgery and knees with previous MR (P = .7). Previous partial meniscectomy was associated with a higher rate of chondrosis in the same compartment compared with knees without previous meniscal surgery (P < .0001) and knees with previous MR (P ≤ .03). Conclusion The status of articular cartilage at the time of revision ACL reconstruction relates to previous meniscal surgery independent of the effect of patient age. Previous partial meniscectomy is associated with a higher incidence of articular cartilage lesions, whereas previous meniscal repair is not. Although this association may

  15. Infections in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Stucken, Charlton; Garras, David N.; Shaner, Julie L.; Cohen, Steven B.

    2013-01-01

    Context: Anterior cruciate ligament (ACL) reconstruction is a safe, common, and effective method of restoring stability to the knee after injury, but evolving techniques of reconstruction carry inherent risk. Infection after ACL reconstruction, while rare, carries a high morbidity, potentially resulting in a poor clinical outcome. Evidence Acquisition: Data were obtained from previously published peer-reviewed literature through a search of the entire PubMed database (up to December 2012) as well as from textbook chapters. Results: Treatment with culture-specific antibiotics and debridement with graft retention is recommended as initial treatment, but with persistent infection, consideration should be given to graft removal. Graft type likely has no effect on infection rates. Conclusion: The early diagnosis of infection and appropriate treatment are necessary to avoid the complications of articular cartilage damage and arthrofibrosis. PMID:24427432

  16. A new technique for femoral and tibial tunnel bone grafting using the OATS harvesters in revision anterior cruciate ligament reconstruction.

    PubMed

    Said, Hatem G; Baloch, Khalid; Green, Marcus

    2006-07-01

    Revision anterior cruciate ligament (ACL) reconstruction is becoming more frequent, especially in specialized centers, because of the large numbers of primary ACL procedures performed. In 2-stage revisions, bone grafting of the tunnels may be undertaken if the primary position was inaccurate or if osteolysis has caused widening of the tunnels. This will allow the desired placement of the new tunnels without the risk of loss of structural integrity. It is technically difficult to deliver and impact bone graft into the femoral tunnel with the standard surgical and arthroscopic instruments. We describe a new technique for femoral and tibial tunnel impaction grafting in 2-stage ACL revisions, using the OATS grafting instruments (Osteochondral Autologous Transfer System; Arthrex, Naples, FL). The appropriately sized OATS harvester is chosen 1 mm larger than the tunnel size and is used to harvest bone graft from the iliac crest through a percutaneous approach. This provides a cylindrical graft, which is delivered to the femoral tunnel through the arthroscopic portal. The inside punch of the harvester is tapped and this allows delivery of the graft in a controlled manner and its impaction into the tunnel. The same is repeated for the tibial tunnel while providing support for the proximal end of the tunnel.

  17. Performance comparison of wavefront reconstruction and control algorithms for Extremely Large Telescopes.

    PubMed

    Montilla, I; Béchet, C; Le Louarn, M; Reyes, M; Tallon, M

    2010-11-01

    Extremely Large Telescopes (ELTs) are very challenging with respect to their adaptive optics (AO) requirements. Their diameters and the specifications required by the astronomical science for which they are being designed imply a huge increment in the number of degrees of freedom in the deformable mirrors. Faster algorithms are needed to implement the real-time reconstruction and control in AO at the required speed. We present the results of a study of the AO correction performance of three different algorithms applied to the case of a 42-m ELT: one considered as a reference, the matrix-vector multiply (MVM) algorithm; and two considered fast, the fractal iterative method (FrIM) and the Fourier transform reconstructor (FTR). The MVM and the FrIM both provide a maximum a posteriori estimation, while the FTR provides a least-squares one. The algorithms are tested on the European Southern Observatory (ESO) end-to-end simulator, OCTOPUS. The performance is compared using a natural guide star single-conjugate adaptive optics configuration. The results demonstrate that the methods have similar performance in a large variety of simulated conditions. However, with respect to system misregistrations, the fast algorithms demonstrate an interesting robustness.

  18. Evaluation of the Microsoft Kinect for screening ACL injury.

    PubMed

    Stone, Erik E; Butler, Michael; McRuer, Aaron; Gray, Aaron; Marks, Jeffrey; Skubic, Marjorie

    2013-01-01

    A study was conducted to evaluate the use of the skeletal model generated by the Microsoft Kinect SDK in capturing four biomechanical measures during the Drop Vertical Jump test. These measures, which include: knee valgus motion from initial contact to peak flexion, frontal plane knee angle at initial contact, frontal plane knee angle at peak flexion, and knee-to-ankle separation ratio at peak flexion, have proven to be useful in screening for future knee anterior cruciate ligament (ACL) injuries among female athletes. A marker-based Vicon motion capture system was used for ground truth. Results indicate that the Kinect skeletal model likely has acceptable accuracy for use as part of a screening tool to identify elevated risk for ACL injury.

  19. Powered Flight Design and Reconstructed Performance Summary for the Mars Science Laboratory Mission

    NASA Technical Reports Server (NTRS)

    Sell, Steven; Chen, Allen; Davis, Jody; San Martin, Miguel; Serricchio, Frederick; Singh, Gurkirpal

    2013-01-01

    The Powered Flight segment of Mars Science Laboratory's (MSL) Entry, Descent, and Landing (EDL) system extends from backshell separation through landing. This segment is responsible for removing the final 0.1% of the kinetic energy dissipated during EDL and culminating with the successful touchdown of the rover on the surface of Mars. Many challenges exist in the Powered Flight segment: extraction of Powered Descent Vehicle from the backshell, performing a 300m divert maneuver to avoid the backshell and parachute, slowing the descent from 85 m/s to 0.75 m/s and successfully lowering the rover on a 7.5m bridle beneath the rocket-powered Descent Stage and gently placing it on the surface using the Sky Crane Maneuver. Finally, the nearly-spent Descent Stage must execute a Flyaway maneuver to ensure surface impact a safe distance from the Rover. This paper provides an overview of the powered flight design, key features, and event timeline. It also summarizes Curiosity's as flown performance on the night of August 5th as reconstructed by the flight team.

  20. Statistical model based iterative reconstruction (MBIR) in clinical CT systems: Experimental assessment of noise performance

    SciTech Connect

    Li, Ke; Tang, Jie; Chen, Guang-Hong

    2014-04-15

    Purpose: To reduce radiation dose in CT imaging, the statistical model based iterative reconstruction (MBIR) method has been introduced for clinical use. Based on the principle of MBIR and its nonlinear nature, the noise performance of MBIR is expected to be different from that of the well-understood filtered backprojection (FBP) reconstruction method. The purpose of this work is to experimentally assess the unique noise characteristics of MBIR using a state-of-the-art clinical CT system. Methods: Three physical phantoms, including a water cylinder and two pediatric head phantoms, were scanned in axial scanning mode using a 64-slice CT scanner (Discovery CT750 HD, GE Healthcare, Waukesha, WI) at seven different mAs levels (5, 12.5, 25, 50, 100, 200, 300). At each mAs level, each phantom was repeatedly scanned 50 times to generate an image ensemble for noise analysis. Both the FBP method with a standard kernel and the MBIR method (Veo{sup ®}, GE Healthcare, Waukesha, WI) were used for CT image reconstruction. Three-dimensional (3D) noise power spectrum (NPS), two-dimensional (2D) NPS, and zero-dimensional NPS (noise variance) were assessed both globally and locally. Noise magnitude, noise spatial correlation, noise spatial uniformity and their dose dependence were examined for the two reconstruction methods. Results: (1) At each dose level and at each frequency, the magnitude of the NPS of MBIR was smaller than that of FBP. (2) While the shape of the NPS of FBP was dose-independent, the shape of the NPS of MBIR was strongly dose-dependent; lower dose lead to a “redder” NPS with a lower mean frequency value. (3) The noise standard deviation (σ) of MBIR and dose were found to be related through a power law of σ ∝ (dose){sup −β} with the component β ≈ 0.25, which violated the classical σ ∝ (dose){sup −0.5} power law in FBP. (4) With MBIR, noise reduction was most prominent for thin image slices. (5) MBIR lead to better noise spatial

  1. Gait Asymmetries Persist 1 Year After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    White, Kathleen; Logerstedt, David; Snyder-Mackler, Lynn

    2013-01-01

    Background: After anterior cruciate ligament reconstruction (ACLR), motivation to return to previous levels of activity is high. Very few studies have used return-to-activity criteria to determine when to permit athletic play. Return-to-activity measures objectively evaluate functional limb symmetry; however, previous biomechanical studies have found gait deviations in these individuals that persist up to 2 years after surgery. Purpose: To evaluate gait biomechanics in a specific cohort of ACL patients 1 year after surgery and retrospectively compare individuals who pass return-to-activity criteria 6 months after surgery with those who fail. Study Design: Prospective analysis. Methods: A total of 40 athletes who participated regularly (>50 h/y) in cutting, jumping, and pivoting activities and who sustained an isolated, unilateral ACL rupture were included in this study. All participants underwent reconstruction by the same surgeon and received individualized postoperative rehabilitation. Performance-based and self-report data were measured 6 months after surgery to assess readiness to return to activity (90% outcome required to pass); 20 subjects passed return-to-activity criteria and 20 subjects did not. Motion analysis was performed 1 year after surgery, and knee flexion angles, moments, and excursions were measured during gait and evaluated for all subjects. Results: There was no limb × group interaction or effect of group for all measures. Decreased knee measures were seen on the involved limb compared with the uninvolved limb for all subjects, and failed subjects demonstrated larger differences between limbs. Conclusion: Patients continued to demonstrate biomechanical limb asymmetries 1 year after ACLR, regardless of performance-based measures at 6 months. Early return to activity did not ensure limb symmetry at 1 year. Clinical Relevance: Gait asymmetries were seen in all subjects 1 year after surgery regardless of status at 6 months. Potentially prolonging

  2. Rehabilitation After Anterior Cruciate Ligament Reconstruction in the Female Athlete

    PubMed Central

    Wilk, Kevin E.; Arrigo, Christopher; Andrews, James R.; Clancy, William G.

    1999-01-01

    Objective: To discuss the rehabilitation program after anterior cruciate ligament (ACL) reconstruction in the female athlete. In addition, we will discuss 8 unique characteristics identified in the female athlete and specific training drills to address and correct the potentially deleterious effects of these unique characteristics. Background: The female athlete appears to be more susceptible to noncontact ACL injuries than the male athlete. There seem to be many differences between the female and male athlete that may contribute to the increased injury rate in the female athlete. These variations include anatomical and neuromuscular considerations and differences. Description: Based on the unique characteristics of the female athlete and the anatomical and neuromuscular dissimilarities, a specially designed rehabilitation program has been established for the female athlete after ACL surgery. Clinical Advantages: The rehabilitation drills discussed in this article challenge the neuromuscular system through proprioception, kinesthesia, dynamic joint stability, neuromuscular control, and perturbation training activities. Improving the female athlete's neuromuscular system will, we believe, expedite the injured athlete's recovery after ACL injury or surgery. Although the concepts discussed are part of a postoperative rehabilitation program after ACL surgery, these concepts may also be implemented as a preventive program to assist in reducing the incidence of ACL injuries in the female athlete. ImagesFigure 1.Figure 2.Figure 4.Figure 5.Figure 6.Figure 7.Figure 8.Figure 9.Figure 10.Figure 11.Figure 12.Figure 13.Figure 14.Figure 15.Figure 16.Figure 17.Figure 18.Figure 19.Figure 20.Figure 21.Figure 22.Figure 23. PMID:16558561

  3. Femur performed better than tibia in autologous transplantation during hemipelvis reconstruction

    PubMed Central

    2014-01-01

    Background Pelvic reconstruction after hemipelvectomy can greatly improve the weight-bearing stability of the supporting skeleton and improve patients’ quality of life. Although an autograft can be used to reconstruct pelvic defects, the most suitable choice of autograft, i.e., the use of either femur or tibia, has not been determined. We aimed to analyze the mechanical stresses of a pelvic ring reconstructed using femur or tibia after hemipelvectomy using finite element (FE) analysis. Methods FE models of normal and reconstructed pelvis were established based on computed tomography images, and the stress distributions were analyzed under physiological loading from 0 to 500 N in both intact and restored pelvic models using femur or tibia. Results The vertical displacement of the intact pelvis was less than that of reconstructed pelvis, but there was no significant difference between the two reconstructed models. In FE analysis, the stress distribution of the intact pelvic model was bilaterally symmetric and the maximum stresses were located at the sacroiliac joint, arcuate line, ischiatic ramus, and ischial tuberosity. The maximum stress in each part of the reconstructed pelvis greatly exceeded that of the intact model. The maximum von Mises stress of the femur was 13.9 MPa, and that of the tibia was 6.41 MPa. However, the stress distribution was different in the two types of reconstructed pelvises. The tibial reconstruction model induced concentrated stress on the tibia shaft making it more vulnerable to fracture. The maximum stress on the femur was concentrated on the connections between the femur and the screws. Conclusions From a biomechanical point of view, the reconstruction of hemipelvic defects with femur is a better choice. PMID:24387189

  4. Understanding and preventing acl injuries: current biomechanical and epidemiologic considerations - update 2010.

    PubMed

    Hewett, Timothy E; Ford, Kevin R; Hoogenboom, Barbara J; Myer, Gregory D

    2010-12-01

    This invited clinical commentary summarizes the current state of knowledge in the area of prevention of anterior cruciate ligament (ACL) injuries. ACL injuries occur with a four to six fold greater incidence in female compared to male athletes playing the same high risk sports. The combination of increased risk of ACL injury and a 10-fold increase in sports participation since the enactment of Title IX in 1972 has led to an almost epidemic rise in ACL injuries in female athletes. Examination of the mechanisms responsible for this sex disparity in ACL rupture accelerated in the last two decades. A summary of these findings and a synthesis and framework for understanding the results of the intense investigation of this research are detailed herein. This clinical commentary focuses on the current understanding, identification and interventional targeting of the primary neuromuscular and biomechanical risk factors associated with the ACL injury mechanism in high-risk individuals.

  5. Complete Immediate Paraplegia Reversal after Performing Aorto-Lumbar Bypass on the Patient who Underwent Aortoiliac Reconstruction.

    PubMed

    Banzic, Igor; Sladojevic, Milos; Ilic, Nikola; Koncar, Igor; Davidovic, Lazar; Brankovic, Milos

    2016-08-01

    Although both internal iliac arteries were saved during operation, the patient developed paraplegia immediately after aortoiliac reconstruction due to the spinal cord ischemia. We report a successfully treated immediate postoperative paraplegia by performing second operation and creating bypass from the bifurcated Dacron graft to the previously detected nonpaired huge lumbar artery.

  6. Suggestions from the field for return-to-sport rehabilitation following anterior cruciate ligament reconstruction: alpine skiing.

    PubMed

    Kokmeyer, Dirk; Wahoff, Michael; Mymern, Matt

    2012-04-01

    Alpine skiing is a high-risk sport for injuries to the anterior cruciate ligament (ACL). While descending a hill, a skier must resist large centrifugal forces at a high velocity, while the knees are positioned in postures that place the ACL at risk of injury. Skiers who undergo ACL reconstructive surgery are prone to a high rate of reinjury to the same knee and even ACL injury in the uninjured knee. A rehabilitation program that integrates the best current evidence of ACL rehabilitation and the science of skiing is essential to a successful return to alpine skiing. Unlike rehabilitation programs developed for court or field athletes, a skiing program must place a large emphasis on slow eccentric-loading and weight-bearing (closed-chain) power and endurance. The purpose of this clinical commentary is to provide the rehabilitation specialist such a program directed toward safely returning the athlete to alpine skiing.

  7. 50 CFR 648.64 - Yellowtail flounder sub-ACLs and AMs for the scallop fishery.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 50 Wildlife and Fisheries 12 2012-10-01 2012-10-01 false Yellowtail flounder sub-ACLs and AMs for...-ACLs and AMs for the scallop fishery. (a) As specified in § 648.55(d), and pursuant to the biennial... specified in § 648.90(a)(4)(iii)(C) of the NE multispecies regulations, the sub-ACLs for the 2011...

  8. Anterior Cruciate Ligament Reconstruction: Clinical Outcomes of Patella Tendon and Hamstring Tendon Grafts

    PubMed Central

    Gulick, Dawn T.; Yoder, Heather N.

    2002-01-01

    An injury to the ACL can result in significant functional impairment. It has been estimated that more than 100,000 new ACL injuries occur each year. Surgeons employ numerous techniques for reconstruction of the ACL. Of critical importance is the source of the graft to replace the damaged ACL. The graft choices include autografts (the patient's own tissue), allografts (donor tendon), and synthetic/prosthetic ligaments. Tissue harvest sites for autografting include the middle third of the patella tendon, the quadriceps tendon, semitendinosus tendon, gracilis tendon, iliotibial band, tensor fascia lata, and the Achilles tendon. Selection of the type of graft material is predicated upon the tissue's ability to tolerate high levels of stress. Likewise, the clinical presentation and functional outcome is related to the graft material selected. This manuscript specifically examined the patella tendon and hamstring tendon grafts. Numerous manuscripts that studied the outcomes of these graft materials were compiled to help the clinician appreciate the advantages and disadvantages of each of the graft materials. Outcome measures such as thigh circumference, knee range of motion, isokinetic strength, knee stability, pain, and vertical jump/1-leg hop were incorporated. The purpose of this manuscript was to compare and contrast the clinical presentation of patients who underwent an ACL reconstruction using the patella tendon versus the hamstring tendons. This information can be valuable to the clinician when considering the rehabilitation protocol after ACL reconstruction. PMID:24701126

  9. Suggestions from the field for return to sports participation following anterior cruciate ligament reconstruction: basketball.

    PubMed

    Waters, Eric

    2012-04-01

    The purpose of this paper is to outline the final, functional phases of rehabilitation that address exercises, drills, and return-to-play criteria for the sport of basketball, following anterior cruciate ligament (ACL) reconstruction. ACL injuries can be debilitating and affect the quality of life for recreational and elite athletes alike. Tears of the ACL are common in both male and female basketball players, with a higher incidence rate in females. Incidence of a retear to the existing graft or contralateral knee within 5 years of ACL reconstruction with patellar tendon autograft in young (less than 18 to 25 years of age), active basketball players can be as high as 52%. Reducing the number of ACL injuries or reinjury, of which there are an estimated 80 000 per year at an associated cost of over a billion dollars, can have significant potential long-term fiscal and health benefits. Following surgical reconstruction of the ACL, implementing a tailored rehabilitation protocol can ensure a successful return to sport. When searching the literature for such protocols, clinicians may struggle to find specific exercises, drills, and return-to-play criteria for particular sports. The intent of this manuscript is to present such a rehabilitation protocol for basketball.

  10. The Effect of Laser Surface Reconstruction of Disordered Carbons on Performance

    SciTech Connect

    EVEN JR., WILLIAM R.; GUIDOTTI, RONALD A.

    1999-10-06

    The reconstruction of the surface of disordered carbons was examined by heating carbons derived from polymethacrylonitrile (PMAN) and divinylbenzene (DVB) with a pulsed infrared laser in an argon or helium atmosphere, both fluidized and under static conditions. By graphitizing the outer surface of the carbons, it was hoped to reduce the high first-cycle losses associated with such disordered materials in Li-ion cells. The power to the sample was varied to observed the effects on surface morphology and electrochemical performance in 1M LiPF{sub 6} ethylene carbonate-dimethyl carbonate. The use various reactive atmosphere such as ethylene, 2-vinylpyridine, pyrrole, and furfuryl alcohol were also evaluated as an alternative means of hopefully forming a thin graphitic layer on the carbon particles to reduce first-cycle irreversibility. While some improvement was realized, these losses were still unacceptably high. The laser heating did improve the rate capabilities of the carbons, however. More work in this area is necessary to fully understand surface and bulk effects.

  11. Tomopy: A Python toolbox to perform X-Ray data proessing and image reconstruction.

    SciTech Connect

    2014-01-30

    Tomopy is a Python toolbox to perform x-ray data processing, image reconstruction and data exchange tasks at synchrotron facilities. The dependencies of the software are currently as follows: -Python related python standard library (http://docs.python.org/2/library/) numpy (http://www.numpy.org/) scipy (http://scipy.org/) matplotlib (http://matplotlip.org/) sphinx (http://sphinx-doc.org) pil (http://www.pythonware.com/products/pil/) pyhdf (http://pysclint.sourceforge.net/pyhdf/) h5py (http://www.h5py.org) pywt (http://www.pybytes.com/pywavelets/) file.py (https://pyspec.svn.sourceforge.net/svnroot/pyspec/trunk/pyspec/ccd/files.py) -C/C++ related: gridec (anonymous?? C-code written back in 1997 that uses standard C library) fftw (http://www.fftw.org/) tomoRecon (multi-threaded C++ verion of gridrec. Author: Mark Rivers from APS. http://cars9.uchicago.edu/software/epics/tomoRecon.html) epics (http://www.aps.anl.gov/epics/)

  12. Assessing performance and seasonal bias of pollen-based climate reconstructions in a perfect model world

    NASA Astrophysics Data System (ADS)

    Rehfeld, Kira; Trachsel, Mathias; Telford, Richard J.; Laepple, Thomas

    2016-12-01

    Reconstructions of summer, winter or annual mean temperatures based on the species composition of bio-indicators such as pollen, foraminifera or chironomids are routinely used in climate model-proxy data comparison studies. Most reconstruction algorithms exploit the joint distribution of modern spatial climate and species distribution for the development of the reconstructions. They rely on the space-for-time substitution and the specific assumption that environmental variables other than those reconstructed are not important or that their relationship with the reconstructed variable(s) should be the same in the past as in the modern spatial calibration dataset. Here we test the implications of this "correlative uniformitarianism" assumption on climate reconstructions in an ideal model world, in which climate and vegetation are known at all times. The alternate reality is a climate simulation of the last 6000 years with dynamic vegetation. Transient changes of plant functional types are considered as surrogate pollen counts and allow us to establish, apply and evaluate transfer functions in the modeled world. We find that in our model experiments the transfer function cross validation r2 is of limited use to identify reconstructible climate variables, as it only relies on the modern spatial climate-vegetation relationship. However, ordination approaches that assess the amount of fossil vegetation variance explained by the reconstructions are promising. We furthermore show that correlations between climate variables in the modern climate-vegetation relationship are systematically extended into the reconstructions. Summer temperatures, the most prominent driving variable for modeled vegetation change in the Northern Hemisphere, are accurately reconstructed. However, the amplitude of the model winter and mean annual temperature cooling between the mid-Holocene and present day is overestimated and similar to the summer trend in magnitude. This effect occurs because

  13. 50 CFR 640.28 - Annual catch limits (ACLs) and accountability measures (AMs).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE SPINY LOBSTER FISHERY OF THE GULF... accountability measures (AMs). For recreational and commercial spiny lobster landings combined, the ACL is...

  14. Performance of the moving voxel image reconstruction (MVIR) method in the fixed site detection system (FSDS) prototype

    SciTech Connect

    Estep, Robert J.

    2012-05-31

    We have developed a dynamic image reconstruction method called MVIR (Moving Voxel Image Reconstruction) for lane detection in multilane portal monitor systems. MVIR was evaluated for use in the Fixed Site Detection System, a prototype three-lane portal monitor system for EZ-pass toll plazas. As a baseline, we compared MVIR with a static image reconstruction method in analyzing the same real and simulated data sets. Performance was judged by the distributions of image intensities for source and no-source vehicles over many trials as a function of source strength. We found that MVIR produced significantly better results in all cases. The performance difference was greatest at low count rates, where source/no-source distributions were well separated with the MVIR method, allowing reliable source vehicle identification with a low probability of false positive identifications. Static reconstruction of the same data produced overlapping distributions that made source vehicle identification unreliable. The performance of the static method was acceptable at high count rates. Both algorithms reliably identified two strong sources passing through at nearly the same time.

  15. A Comparison between Clinical Results of Selective Bundle and Double Bundle Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Yoo, Yon-Sik; Song, Si Young; Yang, Cheol Jung; Ha, Jong Mun; Kim, Yoon Sang

    2016-01-01

    Purpose The purpose of this study was to compare the clinical outcomes of arthroscopic anatomical double bundle (DB) anterior cruciate ligament (ACL) reconstruction with either selective anteromedial (AM) or posterolateral (PL) bundle reconstruction while preserving a relatively healthy ACL bundle. Materials and Methods The authors evaluated 98 patients with a mean follow-up of 30.8±4.0 months who had undergone DB or selective bundle ACL reconstructions. Of these, 34 cases underwent DB ACL reconstruction (group A), 34 underwent selective AM bundle reconstruction (group B), and 30 underwent selective PL bundle reconstructions (group C). These groups were compared with respect to Lysholm and International Knee Documentation Committee (IKDC) score, side-to-side differences of anterior laxity measured by KT-2000 arthrometer at 30 lbs, and stress radiography and Lachman and pivot shift test results. Pre- and post-operative data were objectively evaluated using a statistical approach. Results The preoperative anterior instability measured by manual stress radiography at 90° of knee flexion in group A was significantly greater than that in groups B and C (all p<0.001). At last follow-up, mean side-to-side instrumented laxities measured by the KT-2000 and manual stress radiography were significantly improved from preoperative data in all groups (all p<0.001). There were no significant differences between the three groups in anterior instability measured by KT-2000 arthrometer, pivot shift, or functional scores. Conclusion Selective bundle reconstruction in partial ACL tears offers comparable clinical results to DB reconstruction in complete ACL tears. PMID:27401652

  16. Transphyseal anterior cruciate ligament reconstruction in a skeletally immature knee using anterior tibialis allograft.

    PubMed

    Cho, Yool; Jang, Soo-Jin; Son, Jung-Hwan

    2011-05-18

    Anterior cruciate ligament (ACL) injury in the skeletally immature individual is being recognized with increasing frequency. Nonoperative treatment of ACL injuries in skeletally immature patients have not been favorable. Surgical treatment options for complete ACL tears include primary ligament repair, extraarticular tenodesis, transphyseal reconstruction, partial transphyseal reconstruction, and physeal-sparing reconstruction. The advantage of transphyseal reconstruction is placement of the graft tissue in an isometric position, which provides better results, according to the literature. The potential disadvantage is angular or limb-length discrepancy caused by physeal violation. Controversy exists in allograft selection about whether bone or soft tissue passes into physes. The use of standard tunnels provides reliable results, but carries the risk of iatrogenic growth disturbance from physeal injury.This article presents 4 cases of transphyseal ACL reconstruction using anterior tibialis allograft in skeletally immature patients that had satisfactory functional outcomes with no growth disturbances. This is the first report of transphyseal ACL reconstruction using anterior tibialis allograft in skeletally immature patients in the English-speaking literature. All patients underwent transphyseal ACL reconstruction using anterior tibialis tendon allograft. None of the patients had angular deformities. No early physeal arrest was measured between the preoperative and postoperative radiographs. At last follow-up, the results of the Lachman test were normal for 3 patients and nearly normal for 1 patient. All patients demonstrated full range of knee motion (comparing the reconstructed knee to the contralateral knee). The results of the pivot-shift test were normal for 3 patients and nearly normal for 1 patient. No patients reported giving way.

  17. High Performance 3D PET Reconstruction Using Spherical Basis Functions on a Polar Grid

    PubMed Central

    Cabello, J.; Gillam, J. E.; Rafecas, M.

    2012-01-01

    Statistical iterative methods are a widely used method of image reconstruction in emission tomography. Traditionally, the image space is modelled as a combination of cubic voxels as a matter of simplicity. After reconstruction, images are routinely filtered to reduce statistical noise at the cost of spatial resolution degradation. An alternative to produce lower noise during reconstruction is to model the image space with spherical basis functions. These basis functions overlap in space producing a significantly large number of non-zero elements in the system response matrix (SRM) to store, which additionally leads to long reconstruction times. These two problems are partly overcome by exploiting spherical symmetries, although computation time is still slower compared to non-overlapping basis functions. In this work, we have implemented the reconstruction algorithm using Graphical Processing Unit (GPU) technology for speed and a precomputed Monte-Carlo-calculated SRM for accuracy. The reconstruction time achieved using spherical basis functions on a GPU was 4.3 times faster than the Central Processing Unit (CPU) and 2.5 times faster than a CPU-multi-core parallel implementation using eight cores. Overwriting hazards are minimized by combining a random line of response ordering and constrained atomic writing. Small differences in image quality were observed between implementations. PMID:22548047

  18. Single-Stage Reconstruction of Both Cruciate Ligaments

    PubMed Central

    Andreoli, Mauro; Zicaro, Juan Pablo; Yacuzzi, Carlos; Costa-Paz, Matias

    2017-01-01

    Objectives: Isolated Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL), or central pivot lesions are rare. These are frequently associated with collateral ligaments injuries. The purpose of this retrospective study was to evaluate clinical and functional outcomes of 4 patients with acute ACL and PCL injury who underwent a simultaneous single-stage arthroscopic reconstruction. Methods: The inclusion criteria were patients with isolated ACL and PCL injuries, with a minimum follow-up of 2 years. We evaluated the type of graft used, the surgical technique and postoperative complications. The scales used for clinical evaluation were the Knee Society Score (KSS), IKDC, Lysholm and Tegner. Knee stability was assessed using the KT-1000 arthrometer. Results: Three men and one woman, with an average age of 48 years (45 to 56 years) were evaluated. Three presented a sport injury and one a car accident. Mean follow-up was 8 years. In all patients allograft was used for ligament reconstruction. Average postoperative results were: KSS 74-82, Lysholm 76, IKDC 63 and Tegner 6. KT-1000 arthrometer showed an average difference of 4mm compared to the contralateral knee. One patient underwent reintervention due to meniscal injury. Conclusion: ACL and PCL simultaneous single-stage reconstruction is a really demanding surgery. We achieved good results using allograft for both ligaments reconstruction. No clinical or functional postoperative complications were recorded.

  19. Radiation risk from fluoroscopically-assisted anterior cruciate ligament reconstruction

    PubMed Central

    Chitnavis, JP; Karthikesaligam, A; Macdonald, A; Brown, C

    2010-01-01

    INTRODUCTION Precise tunnel positioning is crucial for success in anterior cruciate ligament (ACL) reconstruction. The use of intra-operative fluoroscopy has been shown to improve the accuracy of tunnel placement. Although radiation exposure is a concern, we lack information on the radiation risk to patients undergoing fluoroscopically-assisted ACL reconstruction with a standard C-arm. The aim of our study was to determine the mean radiation doses received by our patients. PATIENTS AND METHODS Radiation doses were recorded for 18 months between 1 April 2007 and 30 September 2008 for 58 consecutive patients undergoing ACL reconstruction assisted by intra-operative fluoroscopy. Dose area product (DAP) values were used to calculate the entrance skin dose (ESD), an indicator of potential skin damage and the effective dose (ED), an indicator of long-term cancer risk, for each patient. RESULTS The median age of 58 patients included in data analysis was 28 years (range, 14–52 years), of whom 44 were male (76%). The mean ESD during intra-operative fluoroscopy was 0.0015 ± 0.0029 Gy. The mean ED was 0.001 ± 0.002 mSv. No results exceeded the threshold of 2 Gy for skin damage, and the life-time risk of developing new cancer due to intra-operative fluoroscopy is less than 0.0001%. CONCLUSIONS Radiation doses administered during fluoroscopically-assisted ACL reconstruction were safe and do not represent a contra-indication to the procedure. PMID:20501019

  20. Impact of Cn2 profile on tomographic reconstruction performance: application to E-ELT wide field AO systems

    NASA Astrophysics Data System (ADS)

    Costille, A.; Fusco, T.

    2012-07-01

    New techniques of Adaptive Optics (AO), generically called Wide Field AO, have been developed in the frame of the design study for new instruments for Extremely Large Telescopes (ELI). Concepts such as Multi-Conjugate AO are based on a tomographic reconstruction of the turbulent volume followed by a projection onto DM(s) in order to ensure a good correction in a large Field of View. These systems require a 3D phase reconstruction and a statistical representation of the turbulent volume through the knowledge of the Cn2 profile, which has a strong impact on performance. We focus our study on the analysis of the impact of the structure and the parameters, which define the Cn2 profile, on the performance of a given tomographic system for an ELI. In this article, we perform simulation to emphasize the terms which are directly linked to the knowledge of the true input Cn2 profile, which simulates the input turbulent perturbations, and to the Cn2 profile which is used as a model in the reconstruction process. We determine and discuss the level of the accuracy needed on the Cn2 profile to limit the tomographic error term and to ensure a good performance. We show that a good sampling of the input turbulence is required to ensure performance of the system.

  1. Amiodarone supplants lidocaine in ACLS and CPR protocols.

    PubMed

    Mizzi, Anna; Tran, Thanh; Mangar, Devanand; Camporesi, Enrico M

    2011-09-01

    Amiodarone is an antiarrhythmic medication used to treat and prevent certain types of serious, life-threatening ventricular arrhythmias. Amiodarone gained slow acceptance outside the specialized field of cardiac antiarrhythmic surgery because the side-effects are significant. Recent adoption of amiodarone in the ACLS (Advanced Cardiac Life Support) protocol has somewhat popularized this class of antiarrhythmics. Its use is slowly expanding in the acute medicine setting of anesthetics. This article summarizes the use of Amiodarone by anesthesiologists in the operating room and during cardiopulmonary resuscitation.

  2. ACLS 2000: overview of changes to the guidelines.

    PubMed

    Cleland, Michelle A; Hynes-Gay, Patricia

    2002-01-01

    Emergency treatment measures in the setting of a cardiopulmonary arrest have recently been reclassified according to the strength of evidence in support of their use. As a result, there are new recommendations that must be incorporated, both in the management of patients in cardiac arrest and those with clinical findings that have the potential to deteriorate and become life-threatening. This article provides an overview of the 2000 ACLS guidelines, with particular emphasis on new developments in the management of patients with acute coronary syndromes, changes in the tachycardia algorithms, and recommendations pertaining to endotracheal intubation.

  3. Dual ACL Ganglion Cysts: Significance of Detailed Arthroscopy.

    PubMed

    Mittal, Samarth; Singla, Amit; Nag, H L; Meena, Sanjay; Lohiya, Ramprakash; Agarwal, Abhinav

    2014-01-01

    Intra-articular ganglion cysts of the knee joint are rare and most frequently are an incidental finding on MRI and arthroscopy. Most of the previous studies have reported a single ganglion cyst in the knee. There have been previous reports of more than one cyst in the same knee but not in the same structure within the knee. We are reporting a case of dual ACL (anterior cruciate ligament) ganglion cysts one of which was missed on radiological examination but later detected during arthroscopy. To the best of our knowledge, no such case has been reported in the indexed English literature till date.

  4. Association Between Lateral Posterior Tibial Slope, Body Mass Index, and ACL Injury Risk

    PubMed Central

    Bojicic, Katherine M.; Beaulieu, Mélanie L.; Imaizumi Krieger, Daniel Y.; Ashton-Miller, James A.; Wojtys, Edward M.

    2017-01-01

    Background: While body mass index (BMI), a modifiable parameter, and knee morphology, a nonmodifiable parameter, have been identified as risk factors for anterior cruciate ligament (ACL) rupture, the interaction between them remains unknown. An understanding of this interaction is important because greater compressive axial force (perhaps due to greater BMI) applied to a knee that is already at an increased risk because of its geometry, such as a steep lateral posterior tibial slope, could further increase the probability of ACL injury. Purpose: To quantify the relationship between BMI and select knee morphological parameters as potential risk factors for ACL injury. Study Design: Case-control study; Level of evidence, 3. Methods: Sagittal knee magnetic resonance imaging (MRI) files from 76 ACL-injured and 42 uninjured subjects were gathered from the University of Michigan Health System’s archive. The posterior tibial slope (PTS), middle cartilage slope (MCS), posterior meniscus height (PMH), and posterior meniscus bone angle (MBA) in the lateral compartment were measured using MRI. BMI was calculated from demographic data. The association between the knee structural factors, BMI, and ACL injury risk was explored using univariate and multivariate logistic regression. Results: PTS (P = .043) and MCS (P = .037) significantly predicted ACL injury risk. As PTS and MCS increased by 1°, odds of sustaining an ACL injury increased by 12% and 13%, respectively. The multivariate logistic regression analysis, which included PTS, BMI centered around the mean (cBMI), and their interaction, showed that this interaction predicted the odds of ACL rupture (P = .050; odds ratio, 1.03). For every 1-unit increase in BMI from the average that is combined with a 1° increase in PTS, the odds of an ACL tear increased by 15%. Conclusion: An increase in BMI was associated with increased risk of ACL tear in the presence of increased lateral posterior tibial slope. Larger values of PTS or

  5. Osteoarthritis Prevalence Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Numbers-Needed-to-Treat Analysis

    PubMed Central

    Luc, Brittney; Gribble, Phillip A.; Pietrosimone, Brian G.

    2014-01-01

    Objective: To determine the prophylactic capability of anterior cruciate ligament (ACL) reconstruction in decreasing the risk of knee osteoarthritis (OA) when compared with ACL-deficient patients, as well as the effect of a concomitant meniscectomy. We also sought to examine the influence of study design, publication date, and graft type as well as the magnitude of change in physical activity from preinjury Tegner scores in both cohorts. Data Sources: We searched Web of Science and PubMed databases from 1960 through 2012 with the search terms osteoarthritis, meniscectomy, anterior cruciate ligament, anterior cruciate ligament reconstruction, and anterior cruciate ligament deficient. Study Selection: Articles that reported the prevalence of tibiofemoral or patellofemoral OA based on radiographic assessment were included. We calculated numbers needed to treat and relative risk reduction with associated 95% confidence intervals for 3 groups (1) patients with meniscal and ACL injury, (2) patients with isolated ACL injury, and (3) total patients (groups 1 and 2). Data Extraction: A total of 38 studies met the criteria. Of these, 27 assessed the presence of tibiofemoral osteoarthritis in patients treated with anterior cruciate ligament reconstruction. Data Synthesis: Overall, ACL reconstruction (ACL-R) yielded a numbers needed to treat to harm of 16 with a relative risk increase of 16%. Anterior cruciate ligament reconstruction along with meniscectomy yielded a numbers needed to treat to benefit of 15 and relative risk reduction of 11%. Isolated ACL-R showed a numbers needed to treat to harm of 8 and relative risk increase of 43%. Activity levels were decreased in both ACL-R (d = −0.90; 95% confidence interval = 0.77, 1.13) and ACL-deficient (d = −1.13; 95% confidence interval = 0.96, 1.29) patients after injury. Conclusions: The current literature does not provide substantial evidence to suggest that ACL-R is an adequate intervention to prevent knee osteoarthritis

  6. High-Performance Fluorescence Molecular Tomography through Shape-Based Reconstruction Using Spherical Harmonics Parameterization

    PubMed Central

    Wang, Daifa; He, Jin; Qiao, Huiting; Song, Xiaolei; Fan, Yubo; Li, Deyu

    2014-01-01

    Fluorescence molecular tomography in the near-infrared region is becoming a powerful modality for mapping the three-dimensional quantitative distributions of fluorochromes in live small animals. However, wider application of fluorescence molecular tomography still requires more accurate and stable reconstruction tools. We propose a shape-based reconstruction method that uses spherical harmonics parameterization, where fluorophores are assumed to be distributed as piecewise constants inside disjointed subdomains and the remaining background. The inverse problem is then formulated as a constrained nonlinear least-squares problem with respect to shape parameters, which decreases ill-posedness because of the significantly reduced number of unknowns. Since different shape parameters contribute differently to the boundary measurements, a two-step and modified block coordinate descent optimization algorithm is introduced to stabilize the reconstruction. We first evaluated our method using numerical simulations under various conditions for the noise level and fluorescent background; it showed significant superiority over conventional voxel-based methods in terms of the spatial resolution, reconstruction accuracy with regard to the morphology and intensity, and robustness against the initial estimated distribution. In our phantom experiment, our method again showed better spatial resolution and more accurate intensity reconstruction. Finally, the results of an in vivo experiment demonstrated its applicability to the imaging of mice. PMID:24732826

  7. Improving Functional Performance and Muscle Power 4-to-6 Months After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Souissi, Sabrine; Wong, Del P.; Dellal, Alexandre; Croisier, Jean-Louis; Ellouze, Zied; Chamari, Karim

    2011-01-01

    The purpose of this study was to examine the effects of 8-week retraining programs, with either two or three training sessions per week, on measures of functional performance and muscular power in athletes with anterior cruciate ligament reconstruction (ACLR). Sixteen male athletes were randomly assigned to two groups after ACLR: a functional training group (FTG, n = 8) training 2 intense sessions per week (4hrs/week), and a control group (CG, n = 8) training 3 sessions per week with moderate intensity (6hrs/week). The two groups were assessed at four and six months post-ACLR and the effects of retraining were measured using the following assessments: the functional and the muscular power tests, and the agility T-test. After retraining, the FTG had improved more than the CG in the operated leg in the single leg hop test (+34.64% vs. +10.92%; large effect), the five jump test (+8.87% vs. +5.03%; medium effect), and single leg triple jump (+32.15% vs. +16.05%; medium effect). For the agility T-test, the FTG had larger improvements (+17.26% vs. +13.03%, medium effect) as compared to the CG. For the bilateral power tests, no significant training effects were shown for the two groups in the squat jump (SJ), the counter movement jump (CMJ) and the free arms CMJ (Arm CMJ). On the other hand, the unilateral CMJ test with the injured and the uninjured legs showed a significant increase for the FTG with respect to CG (p < 0.05). The present study introduces a new training modality in rehabilitation after ACLR that results in good recovery of the operated limb along with the contra-lateral leg. This may allow the athletes to reach good functional and strength performance with only two physical training sessions per week, better preparing them for a return to sport activity at 6 months post- ACLR and eventually sparing time for a possible progressive introduction of the sport specific technical training. Key points Functional training (plyometrics, neuromuscular

  8. High-performance image reconstruction in fluorescence tomography on desktop computers and graphics hardware.

    PubMed

    Freiberger, Manuel; Egger, Herbert; Liebmann, Manfred; Scharfetter, Hermann

    2011-11-01

    Image reconstruction in fluorescence optical tomography is a three-dimensional nonlinear ill-posed problem governed by a system of partial differential equations. In this paper we demonstrate that a combination of state of the art numerical algorithms and a careful hardware optimized implementation allows to solve this large-scale inverse problem in a few seconds on standard desktop PCs with modern graphics hardware. In particular, we present methods to solve not only the forward but also the non-linear inverse problem by massively parallel programming on graphics processors. A comparison of optimized CPU and GPU implementations shows that the reconstruction can be accelerated by factors of about 15 through the use of the graphics hardware without compromising the accuracy in the reconstructed images.

  9. Bandgap Tailoring via Si Doping in Inverse-Garnet Mg3Y2Ge3O12:Ce(3+) Persistent Phosphor Potentially Applicable in AC-LED.

    PubMed

    Lin, Hang; Xu, Ju; Huang, Qingming; Wang, Bo; Chen, Hui; Lin, Zebin; Wang, Yuansheng

    2015-10-07

    The state-of-the-art alternating-current light-emitting diode (AC-LED) technique suffers from adverse lighting flicker during each AC cycle. Aiming to compensate the dimming time of AC-LED, herein, we report a novel Mg3Y2(Ge1-xSix)3O12:Ce(3+) inverse-garnet persistent phosphor whose afterglow is efficiently activated by blue light with persistent luminescence in millisecond range. It is experimentally demonstrated that Si doping tailors the host bandgap, so that both the electron charging and detrapping in the persistent luminescence process are optimized. To explore the origin of the millisecond afterglow, we performed a series of thermoluminescence analyses, revealing three types of continuously distributed traps in the host. Finally, an AC-LED prototype device was fabricated, which exhibits the warm white emission with a reduced percent flicker of 71.7%. These results demonstrate that the newly developed persistent phosphor might be a promising candidate applicable in low flickering AC-LED which has advantages of cheaper price, longer lifetime, and higher energy utilization efficiency.

  10. Role of the ACL2 locus in flower stalk elongation in Arabidopsis thaliana.

    PubMed

    Kato, Hiroaki; Komeda, Yoshibumi; Saito, Tamao; Ito, Hidetaka; Kato, Atsushi

    2015-01-01

    The acaulis2 (acl2) mutant of Arabidopsis thaliana shows a defect in flower stalk elongation. We identified the mutation point of acl2 by map-based cloning. The ACL2 locus is located within an approximately 320-kb region at around 100 map units on chromosome 1. One nucleotide substitution was detected in this region in the acl2 mutant, but no significant open reading frames were found around this mutation point. When wild-type DNA fragments containing the mutation point were introduced into acl2 mutant plants, some transgenic plants partially or almost completely recovered from the defect in flower stalk elongation. 3'-RACE experiments showed that bidirectional transcripts containing the acl2 mutation point were expressed, and the Plant MPSS database revealed that several small RNAs were produced from this region. Microarray analysis showed that transcription of many genes is activated in flower stalks of acl2 mutant plants. Overexpression of some of these genes caused a dwarf phenotype in wild-type plants. These results suggest the following novel mechanism for control of the elongation of flower stalks. Bidirectional non-coding RNAs are transcribed from the ACL2 locus, and small RNAs are generated from them in flower stalks. These small RNAs repress the transcription of a set of genes whose expression represses flower stalk elongation, and flower stalks are therefore fully elongated.

  11. ACL injury mechanisms and related factors in male and female carving skiers: a retrospective study.

    PubMed

    Ruedl, G; Webhofer, M; Linortner, I; Schranz, A; Fink, C; Patterson, C; Nachbauer, W; Burtscher, M

    2011-10-01

    In recreational alpine skiing, ACL injury risk is 3 times greater in females. However, since the introduction of carving skis ACL injury risk seems to have decreased. No study has yet investigated the distribution of ACL injury mechanisms in male and female carving skiers. Therefore, the aim of the study was to investigate potential gender specific differences of ACL injury mechanisms and related factors among carving skiers. In total, 220 recreational carving skiers (59 males and 161 females) suffering from an ACL injury volunteered for this study. Demographic data, skiing ability, equipment related and environmental factors, circumstances and causes for the fall, and type of fall (injury mechanisms) were collected by questionnaire. The forward twisting fall is the most reported ACL injury mechanism in both gender (p=0.672) accounting for 54% of all injuries, although male and female skiers differed significantly with regard to circumstances of fall (p=0.001) and actions when ACL injury occurred (p=0.04). Bindings not releasing at the time point of accident occurred 2.6 times more with females than with males (p=0.005). The forward twisting fall seems to have become the dominant ACL injury mechanism both in male and female recreational skiers since the introduction of carving skis.

  12. Role of gastrocnemius activation in knee joint biomechanics: gastrocnemius acts as an ACL antagonist.

    PubMed

    Adouni, M; Shirazi-Adl, A; Marouane, H

    2016-01-01

    Gastrocnemius is a premier muscle crossing the knee, but its role in knee biomechanics and on the anterior cruciate ligament (ACL) remains less clear when compared to hamstrings and quadriceps. The effect of changes in gastrocnemius force at late stance when it peaks on the knee joint response and ACL force was initially investigated using a lower extremity musculoskeletal model driven by gait kinematics-kinetics. The tibiofemoral joint under isolated isometric contraction of gastrocnemius was subsequently analyzed at different force levels and flexion angles (0°-90°). Changes in gastrocnemius force at late stance markedly influenced hamstrings forces. Gastrocnemius acted as ACL antagonist by substantially increasing its force. Simulations under isolated contraction of gastrocnemius confirmed this role at all flexion angles, in particular, at extreme knee flexion angles (0° and 90°). Constraint on varus/valgus rotations substantially decreased this effect. Although hamstrings and gastrocnemius are both knee joint flexors, they play opposite roles in respectively protecting or loading ACL. Although the quadriceps is also recognized as antagonist of ACL, at larger joint flexion and in contrast to quadriceps, activity in gastrocnemius substantially increased ACL forces (anteromedial bundle). The fact that gastrocnemius is an antagonist of ACL should help in effective prevention and management of ACL injuries.

  13. Perspectives on the Humanities and School-Based Curriculum Development. ACLS Occasional Paper No. 24.

    ERIC Educational Resources Information Center

    Blackman, Sandra; Chodorow, Stanley; Ohmann, Richard; Okura, Sandra; Purrington, Sandra Sanchez; Stein, Robert

    This paper records three plenary sessions held at the American Council of Learned Societies (ACLS) National Education Conference, August 27-29, 1993. The conference built on what was learned in the first year of the project and reported in ACLS Occasional Paper 20. Sessions allowed participants to talk with colleagues who had been project…

  14. 50 CFR 648.64 - Yellowtail flounder sub-ACLs and AMs for the scallop fishery.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 50 Wildlife and Fisheries 10 2011-10-01 2011-10-01 false Yellowtail flounder sub-ACLs and AMs for the scallop fishery. 648.64 Section 648.64 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT...-ACLs and AMs for the scallop fishery. (a) As specified in § 648.55(d), and pursuant to the...

  15. Liberal Arts Colleges in American Higher Education: Challenges and Opportunities. ACLS Occasional Paper, No. 59

    ERIC Educational Resources Information Center

    American Council of Learned Societies, 2005

    2005-01-01

    This American Council of Learned Societies (ACLS) Occasional Paper presents the proceedings of a conference on "Liberal Arts Colleges in American Higher Education: Challenges and Opportunities" convened by ACLS in November 2003 in Williamstown, Massachusetts with the support of the Oakley Center for the Humanities and Social Sciences at…

  16. 50 CFR 660.410 - Conservation objectives, ACLs, and de minimis control rules.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 50 Wildlife and Fisheries 13 2012-10-01 2012-10-01 false Conservation objectives, ACLs, and de... COAST STATES West Coast Salmon Fisheries § 660.410 Conservation objectives, ACLs, and de minimis control... Limits. Annual management measures will be designed to ensure escapement levels at or higher than...

  17. 50 CFR 660.410 - Conservation objectives, ACLs, and de minimis control rules.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 50 Wildlife and Fisheries 13 2013-10-01 2013-10-01 false Conservation objectives, ACLs, and de... COAST STATES West Coast Salmon Fisheries § 660.410 Conservation objectives, ACLs, and de minimis control... Limits. Annual management measures will be designed to ensure escapement levels at or higher than...

  18. Enhancing proliferation and ECM expression of human ACL fibroblasts by sonic vibration.

    PubMed

    Jiang, Yuan-Yuan; Park, Jung-Keug; Yoon, Hee-Hoon; Choi, Hynjin; Kim, Chan-Wha; Seo, Young-Kwon

    2015-01-01

    Effects of mechanical vibration on cell activity and behavior remain controversial: There has been evidence on both positive and negative effects. Furthermore, research on the anterior cruciate ligament (ACL) has as yet been limited and the frequency-related effects remain unknown, even though ACL injury is common and an injured ACL hardly spontaneously recovers. The object of this work was to address the influence of mechanical vibration on ACL fibroblasts, to determine the effects of frequencies, and to further study this effect at the cellular level. We found that sonic vibration affected ACL fibroblasts' proliferation and metabolism in a frequency-dependent manner, and 20 Hz gave rise to the most ACL cell activity and comprehensively increased extracellular matrix (ECM) contents, including collagen type I, collagen type III, fibronectin, elastin, tenascin, glycosaminoglycan (GAG), and the cytoskeleton protein vimentin. Thus, our results indicate that sonic vibration possesses frequency-dependent effects on proliferation and productivity of ACL fibroblast with an optimal frequency of 20 Hz under the present stimulation conditions, providing further information for future research in how vibrational stimulation manipulates ACL cellular behavior.

  19. Evaluating ACLS Algorithms for the International Space Station (ISS) - A Paradigm Revisited

    NASA Technical Reports Server (NTRS)

    Alexander, Dave; Brandt, Keith; Locke, James; Hurst, Victor, IV; Mack, Michael D.; Pettys, Marianne; Smart, Kieran

    2007-01-01

    The ISS may have communication gaps of up to 45 minutes during each orbit and therefore it is imperative to have medical protocols, including an effective ACLS algorithm, that can be reliably autonomously executed during flight. The aim of this project was to compare the effectiveness of the current ACLS algorithm with an improved algorithm having a new navigation format.

  20. Anterior Cruciate Ligament Reconstruction With Autologous Hamstring

    PubMed Central

    Grawe, Brian M.; Williams, Phillip N.; Burge, Alissa; Voigt, Marcia; Altchek, David W.; Hannafin, Jo A.; Allen, Answorth A.

    2016-01-01

    Background: Recent clinical investigations have identified inadequate autograft hamstring graft diameter (<8 mm) to be predictive of failure after reconstruction of the anterior cruciate ligament (ACL). Purpose/Hypothesis: The objective of this study was to determine the utility of preoperative magnetic resonance imaging (MRI) variables of the hamstring tendons for the prediction of graft diameter at the time of surgery. The hypothesis was that cross-sectional area (CSA) of the hamstring tendon measured on MRI could accurately predict graft diameter, and threshold measurements could be established to predict graft diameter at the time of surgery. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 84 consecutive skeletally mature patients prospectively enrolled in our ACL reconstruction patient registry were identified for study purposes. Patients were included if they underwent an MRI of the affected knee at our institution prior to ACL reconstruction with hamstring (HT) autograft. Graft preparation was performed via a standard quadrupled hamstring technique after harvesting both the gracilis and semitendinosus (4-GST). The smallest diameter end of the HT autograft was then utilized for measurement analysis. Total CSA was calculated for both hamstring tendons using the “region of interest tool” on the corresponding proton density–weighted axial image of the knee at the widest condylar dimension. Three independent reviewers measured the MRI scans so that intra- and interrater reliability of the measurements could be determined. A trend analysis was then undertaken to establish correlations between the MRI CSA and graft diameter. Predictive analysis was then performed to establish threshold MRI measurement values for specific graft diameters and determine whether any patient-specific factors would affect graft diameter (age, sex, and body mass index). Results: Mean patient age at the time of surgery was 36 years (range, 11

  1. Allograft tissue irradiation and failure rate after anterior cruciate ligament reconstruction: A systematic review

    PubMed Central

    Dashe, Jesse; Parisien, Robert L; Cusano, Antonio; Curry, Emily J; Bedi, Asheesh; Li, Xinning

    2016-01-01

    AIM: To evaluate whether anterior cruciate ligament (ACL) allograft irradiation is effective for sterility without compromising graft integrity and increasing failure rate. METHODS: A literature search was conducted using PubMed, Cochrane, and Google. The following search terms were used: “Gamma irradiation AND anterior cruciate ligament AND allograft” with a return of 30 items. Filters used included: English language, years 1990-2015. There were 6 hits that were not reviewed, as there were only abstracts available. Another 5 hits were discarded, as they did not pertain to the topic of interest. There were 9 more articles that were excluded: Three studies were performed on animals and 6 studies were meta-analyses. Therefore, a total of 10 articles were applicable to review. RESULTS: There is a delicate dosing crossover where gamma irradiation is both effective for sterility without catastrophically compromising the structural integrity of the graft. Of note, low dose irradiation is considered less than 2.0 Mrad, moderate dose is between 2.1-2.4 Mrad, and high dose is greater than or equal to 2.5 Mrad. Based upon the results of the literature search, the optimal threshold for sterilization was found to be sterilization at less than 2.2 Mrad of gamma irradiation with the important caveat of being performed at low temperatures. The graft selection process also must include thorough donor screening and testing as well as harvesting the tissue in a sterile fashion. Utilization of higher dose (≥ 2.5 Mrad) of irradiation causes greater allograft tissue laxity that results in greater graft failure rate clinically in patients after ACL reconstruction. CONCLUSION: Allograft ACL graft gamma irradiated with less than 2.2 Mrad appears to be a reasonable alternative to autograft for patients above 25 years of age. PMID:27335815

  2. Reconstruction versus conservative treatment after rupture of the anterior cruciate ligament: cost effectiveness analysis

    PubMed Central

    2011-01-01

    Background The decision whether to treat conservatively or reconstruct surgically a torn anterior cruciate ligament (ACL) is an ongoing subject of debate. The high prevalence and associated public health burden of torn ACL has led to continuous efforts to determine the best therapeutic approach. A critical evaluation of benefits and expenditures of both treatment options as in a cost effectiveness analysis seems well-suited to provide valuable information for treating physicians and healthcare policymakers. Methods A literature review identified four of 7410 searched articles providing sufficient outcome probabilities for the two treatment options for modeling. A transformation key based on the expert opinions of 25 orthopedic surgeons was used to derive utilities from available evidence. The cost data for both treatment strategies were based on average figures compiled by Orthopaedic University Hospital Balgrist and reinforced by Swiss national statistics. A decision tree was constructed to derive the cost-effectiveness of each strategy, which was then tested for robustness using Monte Carlo simulation. Results Decision tree analysis revealed a cost effectiveness of 16,038 USD/0.78 QALY for ACL reconstruction and 15,466 USD/0.66 QALY for conservative treatment, implying an incremental cost effectiveness of 4,890 USD/QALY for ACL reconstruction. Sensitivity analysis of utilities did not change the trend. Conclusion ACL reconstruction for reestablishment of knee stability seems cost effective in the Swiss setting based on currently available evidence. This, however, should be reinforced with randomized controlled trials comparing the two treatment strategies. PMID:22098703

  3. 50 CFR 622.12 - Annual catch limits (ACLs) and accountability measures (AMs) for Caribbean island management...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... lb (26,524 kg). (R) Spiny lobster—327,920 lb (148,742 kg). (ii) Recreational ACLs. The following ACLs... (15,242 kg). (N) Triggerfish and filefish, combined—24,980 lb (11,331 kg). (O) Spiny lobster—107,307...). (O) Spiny lobster—104,199 lb (47,264 kg). (ii) (4) Caribbean EEZ— (i) ACLs. The following ACLs...

  4. 50 CFR 622.12 - Annual catch limits (ACLs) and accountability measures (AMs) for Caribbean island management...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... lb (26,524 kg). (R) Spiny lobster—327,920 lb (148,742 kg). (ii) Recreational ACLs. The following ACLs... (15,242 kg). (N) Triggerfish and filefish, combined—24,980 lb (11,331 kg). (O) Spiny lobster—107,307...). (O) Spiny lobster—104,199 lb (47,264 kg). (ii) (4) Caribbean EEZ— (i) ACLs. The following ACLs...

  5. Anterior Cruciate Ligament Tear in an Athlete: Does Increased Heel Loading Contribute to ACL Rupture?

    PubMed Central

    Burkhart, Bradd; Ford, Kevin R.; Heidt, Robert S.; Hewett, Timothy E.

    2008-01-01

    Rupture to the anterior cruciate ligament is a common athletic injury in American football. The lower extremity biomechanics related to increased ACL injury risk are not completely understood. However, foot landing has been purported to be a significant contributing factor to the ACL injury mechanism. In this case report, information is presented on an athlete previously tested for in-shoe loading patterns on artificial turf and subsequently went on to non-contact ACL rupture on the same surface. This case report describes the specific findings in a study participant who suffered an ACL rupture after testing and suggests that flatfoot tendency in running and cutting maneuvers might lead to an increased risk of ACL injury. PMID:20333261

  6. Performance of Simulated El Niño-Southern Oscillation Climate Reconstructions over the Last Millennium: Comparison of Methods

    NASA Astrophysics Data System (ADS)

    Wahl, Eugene R.; Amrhein, Dan E.; Smerdon, Jason E.; Ammann, Caspar M.

    2010-05-01

    ). The enhanced performance of the CFR method during this time is due at least in part to the fact that the CFR reconstructions better capture the 20th century trend than the reconstructions in strategies (1) and (2) (note that the pre-whitening process leaves the trend largely intact), and may also be due to the greater proxy richness exploited in the CFR method. This enhanced performance during the real-world time of calibration and verification should also lead to the caveat that it might suggest performance during such a limited period that gives an over-optimistic view of its true potential over the full millennium.

  7. A comparative study based on image quality and clinical task performance for CT reconstruction algorithms in radiotherapy.

    PubMed

    Li, Hua; Dolly, Steven; Chen, Hsin-Chen; Anastasio, Mark A; Low, Daniel A; Li, Harold H; Michalski, Jeff M; Thorstad, Wade L; Gay, Hiram; Mutic, Sasa

    2016-07-01

    CT image reconstruction is typically evaluated based on the ability to reduce the radiation dose to as-low-as-reasonably-achievable (ALARA) while maintaining acceptable image quality. However, the determination of common image quality metrics, such as noise, contrast, and contrast-to-noise ratio, is often insufficient for describing clinical radiotherapy task performance. In this study we designed and implemented a new comparative analysis method associating image quality, radiation dose, and patient size with radiotherapy task performance, with the purpose of guiding the clinical radiotherapy usage of CT reconstruction algorithms. The iDose4iterative reconstruction algorithm was selected as the target for comparison, wherein filtered back-projection (FBP) reconstruction was regarded as the baseline. Both phantom and patient images were analyzed. A layer-adjustable anthropomorphic pelvis phantom capable of mimicking 38-58 cm lateral diameter-sized patients was imaged and reconstructed by the FBP and iDose4 algorithms with varying noise-reduction-levels, respectively. The resulting image sets were quantitatively assessed by two image quality indices, noise and contrast-to-noise ratio, and two clinical task-based indices, target CT Hounsfield number (for electron density determination) and structure contouring accuracy (for dose-volume calculations). Additionally, CT images of 34 patients reconstructed with iDose4 with six noise reduction levels were qualitatively evaluated by two radiation oncologists using a five-point scoring mechanism. For the phantom experiments, iDose4 achieved noise reduction up to 66.1% and CNR improvement up to 53.2%, compared to FBP without considering the changes of spatial resolution among images and the clinical acceptance of reconstructed images. Such improvements consistently appeared across different iDose4 noise reduction levels, exhibiting limited interlevel noise (<5 HU) and target CT number variations (<1 HU). The radiation

  8. A comparative study based on image quality and clinical task performance for CT reconstruction algorithms in radiotherapy.

    PubMed

    Li, Hua; Dolly, Steven; Chen, Hsin-Chen; Anastasio, Mark A; Low, Daniel A; Li, Harold H; Michalski, Jeff M; Thorstad, Wade L; Gay, Hiram; Mutic, Sasa

    2016-07-08

    CT image reconstruction is typically evaluated based on the ability to reduce the radiation dose to as-low-as-reasonably-achievable (ALARA) while maintaining acceptable image quality. However, the determination of common image quality metrics, such as noise, contrast, and contrast-to-noise ratio, is often insufficient for describing clinical radiotherapy task performance. In this study we designed and implemented a new comparative analysis method associating image quality, radiation dose, and patient size with radiotherapy task performance, with the purpose of guiding the clinical radiotherapy usage of CT reconstruction algorithms. The iDose4 iterative reconstruction algorithm was selected as the target for comparison, wherein filtered back-projection (FBP) reconstruction was regarded as the baseline. Both phantom and patient images were analyzed. A layer-adjustable anthropomorphic pelvis phantom capable of mimicking 38-58 cm lateral diameter-sized patients was imaged and reconstructed by the FBP and iDose4 algorithms with varying noise-reduction-levels, respectively. The resulting image sets were quantitatively assessed by two image quality indices, noise and contrast-to-noise ratio, and two clinical task-based indices, target CT Hounsfield number (for electron density determination) and structure contouring accuracy (for dose-volume calculations). Additionally, CT images of 34 patients reconstructed with iDose4 with six noise reduction levels were qualitatively evaluated by two radiation oncologists using a five-point scoring mechanism. For the phantom experiments, iDose4 achieved noise reduction up to 66.1% and CNR improvement up to 53.2%, compared to FBP without considering the changes of spatial resolution among images and the clinical acceptance of reconstructed images. Such improvements consistently appeared across different iDose4 noise reduction levels, exhibiting limited interlevel noise (< 5 HU) and target CT number variations (< 1 HU). The radiation

  9. PERI-INCISIONAL DYSESTHESIA FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING CENTRAL THIRD OF PATELLAR TENDON

    PubMed Central

    de Carvalho Júnior, Lúcio Honório; Machado, Soares Luiz Fernando; Gonçalves, Matheus Braga Jacques; Júnior, Paulo Randal Pires; Baumfeld, Daniel Soares; Pereira, Marcelo Lobo; Lessa, Rodrigo Rosa; Costa, Lincoln Paiva; Bisinoto, Henrique Barra

    2015-01-01

    Objective: To evaluate the prevalence and type of dysesthesia around the incision used to obtain the patellar tendon for anterior cruciate ligament (ACL) reconstruction surgery. Methods: Out of a population of 1368 ACL reconstructions using the central third of the patellar tendon, 102 patients (111 knees) were evaluated by means of telephone interview. Results: The mean follow-up was 52 months (ranging from 12 to 88 months). The patients' ages ranged from 16 to 58 years (mean: 34.7 years). There was some degree of peri-incisional dysesthesia in 66 knees (59.46%). In 40.54% of the knees, this condition was not found. In all the cases of dysesthesia, the type encountered was Highet's type II. Conclusion: Peri-incisional dysesthesia following ACL reconstruction using the central third of the patellar tendon is highly prevalent. It affected more than half of the cases in this series. PMID:27026983

  10. Drop-Landing Performance and Knee-Extension Strength After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Kuenze, Christopher M.; Foot, Nathaniel; Saliba, Susan A.; Hart, Joseph M.

    2015-01-01

    Context Individuals with a history of anterior cruciate ligament reconstruction (ACLR) are at greater risk of reinjury and developing early-onset osteoarthritis due to persistent abnormal joint loading. Real-time clinical assessment tools may help identify patients experiencing abnormal movement patterns after ACLR. Objective To compare performance on the Landing Error Scoring System (LESS) between participants with ACLR and uninjured control participants and to determine the relationship between LESS score and knee-extension strength in these participants. Design Controlled laboratory study. Setting Research laboratory. Patients or Other Participants Forty-six recreationally active participants, consisting of 22 with ACLR (12 men, 10 women; age = 22.5 ± 5.0 years, height = 172.8 ± 7.2 cm, mass = 74.2 ± 15.6 kg, body mass index = 24.6 ± 4.0) and 24 healthy control participants (12 men, 12 women; age = 21.7 ± 3.6 years, height = 168.0 ± 8.8 cm, mass = 69.2 ± 13.6 kg, body mass index = 24.3 ± 3.2) were enrolled. Main Outcome Measure(s) Bilateral normalized knee-extension maximal voluntary isometric contraction (MVIC) torque (Nm/kg) and LESS scores were measured during a single testing session. We compared LESS scores between groups using a Mann-Whitney U test and the relationships between LESS scores and normalized knee-extension MVIC torque using Spearman ρ bivariate correlations. Results The ACLR participants had a greater number of LESS errors (6.0 ± 3.6) than healthy control participants (2.8 ± 2.2; t44 = −3.73, P = .002). In ACLR participants, lower normalized knee-extension MVIC torque in the injured limb (ρ = −0.455, P = .03) was associated with a greater number of landing errors. Conclusions Participants with ACLR displayed more errors while landing. The occurrence of landing errors was negatively correlated with knee-extension strength, suggesting that weaker participants had more landing errors. Persistent quadriceps weakness commonly

  11. 77 FR 10668 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Sub-ACL (Annual Catch...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-23

    ... Northeastern United States; Atlantic Herring Fishery; Sub-ACL (Annual Catch Limit) Harvested for Management... harvest and processing, U.S. at-sea processing, border transfer, and sub-ACLs for each management area. The 2012 Domestic Annual Harvest is 91,200 metric tons (mt); the 2012 sub-ACL allocated to Area 2...

  12. 76 FR 61059 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Sub-ACL (Annual Catch...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-03

    ... Northeastern United States; Atlantic Herring Fishery; Sub-ACL (Annual Catch Limit) Harvested for Management... calendar day until January 1, 2012, when the 2012 sub-ACL for Area 1B becomes available, except when... Atlantic herring sub-ACL allocated to Area 1B for 2011 is projected to be harvested by October 1,...

  13. 78 FR 21071 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Sub-ACL (Annual Catch...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-09

    ... Northeastern United States; Atlantic Herring Fishery; Sub-ACL (Annual Catch Limit) Harvested for Management.... at-sea processing, border transfer, and sub-ACLs for each management area. The 2013 Domestic Annual Harvest is 91,200 metric tons (mt); the 2013 sub-ACL allocated to Area 2 is 22,146 mt, and 0 mt of the...

  14. 76 FR 61061 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Sub-ACL (Annual Catch...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-03

    ... Northeastern United States; Atlantic Herring Fishery; Sub-ACL (Annual Catch Limit) Harvested for Management... day until January 1, 2012, when the 2012 sub-ACL (annual catch limit) for Area 3 becomes available... percent of the herring sub-ACL allocated to Area 3 for 2011 is projected to be harvested by October...

  15. 77 FR 61299 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Sub-ACL (Annual Catch...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-09

    ... Northeastern United States; Atlantic Herring Fishery; Sub-ACL (Annual Catch Limit) Harvested for Management..., domestic harvest and processing, U.S. at-sea processing, border transfer, and the sub-ACL for each management area. The 2012 Domestic Annual Harvest was set as 91,200 metric tons (mt); the sub-ACL...

  16. 77 FR 66746 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Sub-ACL (Annual Catch...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-07

    ... Northeastern United States; Atlantic Herring Fishery; Sub-ACL (Annual Catch Limit) Harvested for Management..., domestic harvest and processing, U.S. at-sea processing, border transfer, and the sub-ACL for each management area. The 2012 Domestic Annual Harvest was set as 91,200 metric tons (mt); the sub-ACL...

  17. 76 FR 66654 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Sub-ACL (Annual Catch...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-27

    ... Northeastern United States; Atlantic Herring Fishery; Sub-ACL (Annual Catch Limit) Harvested for Management..., domestic harvest and processing, U.S. at-sea processing, border transfer, and sub-ACLs for each management area. The 2011 Domestic Annual Harvest is 91,200 metric tons (mt); the 2011 sub-ACL allocated to...

  18. 50 CFR 648.53 - Acceptable biological catch (ABC), annual catch limits (ACL), annual catch targets (ACT), DAS...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... catch limits (ACL), annual catch targets (ACT), DAS allocations, and individual fishing quotas (IFQ... limits (ACL), annual catch targets (ACT), DAS allocations, and individual fishing quotas (IFQ). (a... limited access scallop fishery shall be allocated 94.5 percent of the ACL specified in paragraph (a)(1)...

  19. 50 CFR 622.496 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 50 Wildlife and Fisheries 12 2013-10-01 2013-10-01 false Annual catch limits (ACLs), annual catch.... Virgin Islands § 622.496 Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs). See § 622.12 for applicable ACLs and AMs....

  20. 50 CFR 622.457 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 50 Wildlife and Fisheries 12 2013-10-01 2013-10-01 false Annual catch limits (ACLs), annual catch.... Virgin Islands § 622.457 Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs). See § 622.12 for applicable ACLs and AMs....

  1. 50 CFR 648.53 - Acceptable biological catch (ABC), annual catch limits (ACL), annual catch targets (ACT), DAS...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... divided as sub-ACLs between limited access vessels, limited access vessels that are fishing under a... limited access fishery sub-ACLs for fishing years 2011 through 2013 are: (A) 2011: 24,954 mt. (B) 2012: 26... catch, observer set-aside, and research set-aside, as specified in this paragraph (a). The LAGC ACLs...

  2. 50 CFR 622.439 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false Annual catch limits (ACLs), annual catch.... Virgin Islands § 622.439 Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs). See § 622.12 for applicable ACLs and AMs....

  3. 50 CFR 622.439 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 50 Wildlife and Fisheries 12 2013-10-01 2013-10-01 false Annual catch limits (ACLs), annual catch.... Virgin Islands § 622.439 Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs). See § 622.12 for applicable ACLs and AMs....

  4. 50 CFR 622.193 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false Annual catch limits (ACLs), annual catch... Region § 622.193 Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures... commercial ACLs, in round weight, are 284,680 lb (129,129 kg) for 2012, 315,920 lb (143,299 kg) for 2013,...

  5. 50 CFR 622.457 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false Annual catch limits (ACLs), annual catch.... Virgin Islands § 622.457 Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs). See § 622.12 for applicable ACLs and AMs....

  6. 50 CFR 622.41 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false Annual catch limits (ACLs), annual catch....41 Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs). (a... sector for the remainder of that fishing year. (3) The stock complex ACLs for Other SWG, in gutted...

  7. 50 CFR 648.53 - Acceptable biological catch (ABC), annual catch limits (ACL), annual catch targets (ACT), DAS...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... divided as sub-ACLs between limited access vessels, limited access vessels that are fishing under a LAGC... adjustment. (i) The limited access fishery sub-ACLs for fishing years 2014 and 2015 are: (A) 2014: 18,885 mt...). (i) The ACLs for fishing years 2014 and 2015 for LAGC IFQ vessels without a limited access...

  8. 50 CFR 648.53 - Acceptable biological catch (ABC), annual catch limits (ACL), annual catch targets (ACT), DAS...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... divided as sub-ACLs between limited access vessels, limited access vessels that are fishing under a LAGC... adjustment. (i) The limited access fishery sub-ACLs for fishing years 2013 and 2014 are: (A) 2013: 19,093 mt... paragraph (a). (i) The ACLs for fishing years 2013 and 2014 for LAGC IFQ vessels without a limited...

  9. 50 CFR 622.496 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false Annual catch limits (ACLs), annual catch.... Virgin Islands § 622.496 Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs). See § 622.12 for applicable ACLs and AMs....

  10. Biomechanics of the anterior cruciate ligament: Physiology, rupture and reconstruction techniques

    PubMed Central

    Domnick, Christoph; Raschke, Michael J; Herbort, Mirco

    2016-01-01

    The influences and mechanisms of the physiology, rupture and reconstruction of the anterior cruciate ligament (ACL) on kinematics and clinical outcomes have been investigated in many biomechanical and clinical studies over the last several decades. The knee is a complex joint with shifting contact points, pressures and axes that are affected when a ligament is injured. The ACL, as one of the intra-articular ligaments, has a strong influence on the resulting kinematics. Often, other meniscal or ligamentous injuries accompany ACL ruptures and further deteriorate the resulting kinematics and clinical outcomes. Knowing the surgical options, anatomic relations and current evidence to restore ACL function and considering the influence of concomitant injuries on resulting kinematics to restore full function can together help to achieve an optimal outcome. PMID:26925379

  11. EFFECT OF THE GRAFTING SECTION AREA ON ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION SURGERY – HISTOLOGICAL STUDY ON DOGS

    PubMed Central

    Pereira, Ricardo Violante; Müller, Sérgio Swain; Vannini, Rodrigo; Felisbino, Sérgio Luiz; Curcelli, Emilio Carlos; Pereira, Gilberto José Caçdo; de Almeida Silvares, Paulo Roberto

    2015-01-01

    Objective: To correlate the initial grafting section area with the outcomes from anterior cruciate ligament (ACL) reconstruction surgery. Eight dogs underwent operations, divided into two groups according to graft size: Group A, 25% and Group B, 40% of the patellar ligament (PL) width. Methods: After eight months, the dogs were sacrificed for macroscopic and histological analysis on the reconstructed ligaments. Each dog's contralateral knee was used as a control. Results: In both groups, all the reconstructed ligaments were seen to be viable and hypertrophied. The morphology of the PL grafting had changed, which was observed by measuring the crimp and cellularity, and it resembled that of the ACL. Conclusion: The grafting section area did not influence the histological outcomes from ACL reconstruction surgery in dogs. PMID:27047857

  12. Performance of the CMS missing transverse momentum reconstruction in pp data at $\\sqrt{s}$ = 8 TeV

    SciTech Connect

    Khachatryan, Vardan

    2015-02-12

    The performance of missing transverse energy reconstruction algorithms is presented by our team using√s=8 TeV proton-proton (pp) data collected with the CMS detector. Events with anomalous missing transverse energy are studied, and the performance of algorithms used to identify and remove these events is presented. The scale and resolution for missing transverse energy, including the effects of multiple pp interactions (pileup), are measured using events with an identified Z boson or isolated photon, and are found to be well described by the simulation. Novel missing transverse energy reconstruction algorithms developed specifically to mitigate the effects of large numbers of pileup interactions on the missing transverse energy resolution are presented. These algorithms significantly reduce the dependence of the missing transverse energy resolution on pileup interactions. Furthermore, an algorithm that provides an estimate of the significance of the missing transverse energy is presented, which is used to estimate the compatibility of the reconstructed missing transverse energy with a zero nominal value.

  13. Performance of the CMS missing transverse momentum reconstruction in pp data at $$\\sqrt{s}$$ = 8 TeV

    DOE PAGES

    Khachatryan, Vardan

    2015-02-12

    The performance of missing transverse energy reconstruction algorithms is presented by our team using√s=8 TeV proton-proton (pp) data collected with the CMS detector. Events with anomalous missing transverse energy are studied, and the performance of algorithms used to identify and remove these events is presented. The scale and resolution for missing transverse energy, including the effects of multiple pp interactions (pileup), are measured using events with an identified Z boson or isolated photon, and are found to be well described by the simulation. Novel missing transverse energy reconstruction algorithms developed specifically to mitigate the effects of large numbers of pileupmore » interactions on the missing transverse energy resolution are presented. These algorithms significantly reduce the dependence of the missing transverse energy resolution on pileup interactions. Furthermore, an algorithm that provides an estimate of the significance of the missing transverse energy is presented, which is used to estimate the compatibility of the reconstructed missing transverse energy with a zero nominal value.« less

  14. Laser-guided placement of the tibial guide in the transtibial technique for anterior cruciate ligament reconstruction.

    PubMed

    Takahashi, Toshiaki; Takeda, Haruhiko; Watanabe, Seiji; Yamamoto, Haruyasu

    2009-02-01

    In anterior cruciate ligament (ACL) reconstruction, it is important to determine the location and direction of the femoral bone tunnel when using the transtibial technique. Accurately identifying the anatomic location at which to make the femoral bone tunnel for double-bundle ACL reconstruction is not a straightforward procedure. We describe a new method in which the centrum of the femoral tunnel is marked with an awl and a laser beam-guided technique is used to place the tibial pin. This procedure allows us to mark the desired location of the femoral tunnel before drilling the tibial bone tunnel when using the transtibial technique. This is the first report of a laser-guided technique used in arthroscopic surgery. We used a laser beam to determine the location of the femoral tunnel--the anatomic site needed to perform the intra-articular drilling in the tibia. In this technique, a laser pointer is set at the tibial guide, which reflects the laser beam and illuminates the point where the femoral bone tunnel should be made. Our method offers an easy and accurate way to reconfirm the tibial placement before drilling.

  15. EVALUATION OF THE RESULTS OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING FLEXOR TENDONS AND RIGID GUIDE TRANSVERSE SCREW

    PubMed Central

    de Castro, Renato Luiz Bevilacqua; Acras, Sandor Dosa

    2015-01-01

    Objective: The aim of this study was to analyze the results of ACL (anterior cruciate ligament) reconstruction using quadruple flexor tendons as grafts, with ligament fixation in the femur using a rigid guide transverse screw and in the tibia, using a cancellous screw with a fixing washer. Methods: 173 knees (166 from males and seven from females) that had undergone surgery with ACL reconstruction using this technique between December 2002 and February 2007 were evaluated. The mean age was 30 years (from 13 to 56 years), and the mean follow-up time was 30 months (6-55 months). We divided the knees into three groups, which were assessed using the Lysholm scale: Group A with six months of follow-up; Group B with 12 months of follow-up; and Group C with 24 months of follow-up. Results: We evaluated the results, and groups A, B and C received 94, 95 and 95 points respectively on the Lysholm scale. Conclusions: The surgical technique proved to be safe and easy to perform, with good results and a low complication rate. Also, its results were maintained throughout the study period of 24 months. PMID:27027002

  16. Association Between Meniscal and Chondral Lesions and Timing of Anterior Cruciate Ligament Reconstruction

    PubMed Central

    de Campos, Gustavo Constantino; Nery, Wilton; Teixeira, Paulo Eduardo Portes; Araujo, Paulo Henrique; Alves, Wilson de Mello

    2016-01-01

    Background: Rupture of the anterior cruciate ligament (ACL) is a common sports injury and is known to be associated with an increased risk of knee osteoarthritis. Several studies have indicated that the risk of additional injuries to the menisci and articular cartilage increases with delays in the treatment of ACL tears. However, no consensus has been reached regarding the ideal timing for ACL reconstruction in terms of preventing secondary lesions. Purpose: To determine how the time elapsed between an ACL lesion and its reconstruction affects the incidence of meniscal and chondral lesions. Study Design: Case series; Level of evidence, 4. Methods: Medical records of 764 patients who underwent primary ACL reconstruction were reviewed. Data from arthroscopic findings that included information about meniscal lesions and full-thickness articular cartilage lesions at the time of surgery were collected. The association between time elapsed between ACL lesion and reconstruction surgery and incidence of articular cartilage and meniscal lesions was analyzed by chi-square or Fisher exact test. The risk of secondary lesion was calculated by odds ratios (ORs) obtained from simple logistic regression analysis. Results: A positive correlation was observed between time after injury and the presence of any articular lesions (P = .003), cartilage lesions (P = .01), and medial meniscus lesions (P < .001). When analyzing the risk of secondary lesion relative to the reference period (<2 months), it was observed that the odds of finding any articular injury at the time of ACL reconstruction increased when the time from ACL injury to surgery was between 12 and 24 months (OR = 2.62) and >24 months (OR = 5.88). Furthermore, the odds of lesions on the medial meniscus increased when the timing between injury and surgery was 6 to 12 months (OR = 2.71) and continued to increase when the timing was 12 to 24 months (OR = 3.78) and >24 months (OR = 9.07). Conclusion: Associated articular lesions

  17. Single-leg balance and core motor control in children: when does the risk for ACL injury occurs?

    PubMed Central

    Hutchinson, Allison B; Yao, Paul; Hutchinson, Mark R

    2016-01-01

    Introduction While numerous publications have demonstrated the correlation of poor single-leg balance and core motor control with an increased risk of anterior cruciate ligament (ACL) injuries in skeletally mature female athletes, few have analysed the preadolescent population regarding when indeed comparative deficits in balance and core control actually occur. The purpose of this study was to assess whether the neuromotor factors that place mature females at increased risk of ACL injury actually are present in preadolescents and if so when. Methods This study used simplified modifications of classic drop-jump testing as well as single-leg balance tests performed on stable and unstable surfaces to assess balance and core motor control. 84 children (males and females) ranging in age from 6 to 13 years were divided into 4 equally sized groups based on their academic classes. Each group was compared with each other, and compared with a cohort of 205 collegiate athletes. The latter served as a comparative norm of mature athletes who had performed the same or similar testing. Results Outcomes revealed that the preadolescent population performed poorly on the tests when compared with the collegiate population but the children matured with age until the eldest subgroups compared more favourably with the college-aged athletes. Girls appear to mature at a slightly earlier pace than boys. This study focusing on preadolescent children concluded that the neuromuscular changes that place females at greater risk of injury do not appear to occur prior to adolescence. Conclusions Based on the outcomes of this study, it is suggested that sex differences regarding balance and core control deficits that can increase risk of ACL injuries likely occur after grade school (age 12–13). PMID:27900188

  18. Biomechanical Deficit Profiles Associated with ACL Injury Risk in Female Athletes

    PubMed Central

    Pappas, Evangelos; Shiyko, Mariya P.; Ford, Kevin R.; Myer, Gregory D.; Hewett, Timothy E.

    2015-01-01

    Purpose To quantify the prevalence of biomechanical deficit patterns associated with ACL injury risk and their inter-connections in a large cohort of female athletes during an unanticipated cutting task. Methods High school female athletes (N=721) performed an unanticipated cutting task in the biomechanics laboratory. Trunk and lower extremity 3D kinetics and kinematics were measured and entered into a latent profile analysis model. Results Approximately 40% of female athletes demonstrated no biomechanical deficits and were categorized into the low risk group. The second most prevalent profile (24%) demonstrated a combination of high quadriceps and leg dominance deficits and was labeled as quadriceps-leg. The third most prevalent profile (22%) demonstrated a combination of trunk and leg dominance deficits and to lesser extent ligament dominance deficits, and was labeled as trunk-leg-ligament. Finally, the fourth profile (14%) demonstrated very high ligament dominance deficits only and it was labeled as ligament dominance profile. Conclusions This is the first study to identify the most common biomechanical profiles associated with ACL injury during a cutting task in a large cohort of female athletes. Approximately 60% of female athletes belong to one of the high-risk profiles. With the exception of the ligament dominance profile, the current analysis indicates that risk profiles consist of a combination of biomechanical deficits. The findings provide important insight into the prevalence of biomechanical deficits and future directions for the development of injury prevention programs. The findings can be used to guide the development of quick and easy tests that accurately categorize athletes into one of the profiles and subsequently prescribe tailored injury prevention programs that will be more effective and efficient than the current generic ones. PMID:26258858

  19. Current Concepts for Injury Prevention in Athletes After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Hewett, Timothy E.; Di Stasi, Stephanie L.; Myer, Gregory D.

    2013-01-01

    Ligament reconstruction is the current standard of care for active patients with an anterior cruciate ligament (ACL) rupture. Although the majority of ACL reconstruction (ACLR) surgeries successfully restore the mechanical stability of the injured knee, postsurgical outcomes remain widely varied. Less than half of athletes who undergo ACLR return to sport within the first year after surgery, and it is estimated that approximately 1 in 4 to 1 in 5 young, active athletes who undergo ACLR will go on to a second knee injury. The outcomes after a second knee injury and surgery are significantly less favorable than outcomes after primary injuries. As advances in graft reconstruction and fixation techniques have improved to consistently restore passive joint stability to the preinjury level, successful return to sport after ACLR appears to be predicated on numerous postsurgical factors. Importantly, a secondary ACL injury is most strongly related to modifiable postsurgical risk factors. Biomechanical abnormalities and movement asymmetries, which are more prevalent in this cohort than previously hypothesized, can persist despite high levels of functional performance, and also represent biomechanical and neuromuscular control deficits and imbalances that are strongly associated with secondary injury incidence. Decreased neuromuscular control and high-risk movement biomechanics, which appear to be heavily influenced by abnormal trunk and lower extremity movement patterns, not only predict first knee injury risk but also reinjury risk. These seminal findings indicate that abnormal movement biomechanics and neuromuscular control profiles are likely both residual to, and exacerbated by, the initial injury. Evidence-based medicine (EBM) strategies should be used to develop effective, efficacious interventions targeted to these impairments to optimize the safe return to high-risk activity. In this Current Concepts article, the authors present the latest evidence related to risk

  20. In vitro biomechanical testing of anterior cruciate ligament reconstruction: traditional versus physiologically relevant load analysis.

    PubMed

    Trump, Mark; Palathinkal, Darren M; Beaupre, Lauren; Otto, Dave; Leung, Paul; Amirfazli, A

    2011-06-01

    Various anterior cruciate ligament (ACL) graft-fixation devices exist. In this in vitro study a comparison of biomechanical characteristics of the cross-pin and button type fixation devices under practical rehabilitation loads was done. Forty bovine knees and hoof extensor tendons were harvested. After disarticulation, the femoral end of an ACL was prepared with either fixation, using the extensor tendon as graft. The mechanical test was either a single load to failure or load to failure after cycling loads. Twenty specimens were loaded to failure at a rate of 1mm/s, remaining specimens were cycled between 50 and 250 N for 1000 cycles then failure tested in a similar manner. Results show that both forms of fixation are able to withstand loads that exceed those observed in performing functional activities. Activity-specific stiffness (loads comparable to walking, jogging and stair descent) was lower than linear stiffness for both endobutton and cross-pin, without prior cycling. After cycling, activity-specific stiffness increased to linear stiffness values for the cross-pin for all activities. Thus, suggesting that the cross-pin provides a more rigid fixation after initial implantation over a wider range of activities, which would theoretically permit a more aggressive rehabilitation protocol and possibly an earlier return to regular activity. In contrast, activity-specific stiffness increased above linear stiffness values for the endobutton only under heavier loads (jogging and stair descent). Dynamic stiffness was higher and displacement lower for cross-pin throughout the cycle test. These results indicate, in ACL reconstruction, that graft complex stiffness should be considered at relevant loads only.

  1. Reconstruction of the anterior cruciate ligament in skeletally immature patients: an individualized approach☆☆☆

    PubMed Central

    Lopes Júnior, Osmar Valadão; Saggin, Paulo Renato; Matos do Nascimento, Gilberto; Kuhn, André; Saggin, José; Inácio, André Manoel

    2014-01-01

    Objective to evaluate a series of skeletally immature patients who underwent three surgical techniques for anterior cruciate ligament (ACL) reconstruction according to each patient's growth potential. Methods a series of 23 skeletally immature patients who underwent ACL reconstruction surgery at ages ranging from 7 to 15 years was evaluated prospectively. The surgical technique was individualized according to the Tanner sexual maturity score. The surgical techniques used were transphyseal reconstruction, partial transphyseal reconstruction and extraphyseal reconstruction. Four patients underwent the extraphyseal technique, seven the partial transphyseal technique and twelve the full transphyseal technique, on the ACL. The postoperative evaluation was based on the Lysholm score, clinical analysis on the knee and the presence of angular deformity or dysmetria of the lower limb. Results the mean Lysholm score was 96.34 (±2.53). None of the patients presented differences in length and/or clinical or radiographic misalignment abnormality of the lower limbs. Conclusion ACL reconstruction using flexor tendon grafts in skeletally immature patients provided satisfactory functional results. Use of individualized surgical techniques according to growth potential did not give rise to physeal lesions capable of causing length discrepancies or misalignments of the lower limbs, even in patients with high growth potential. PMID:26229809

  2. Injury to the Anterior Tibial Artery during Bicortical Tibial Drilling in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Kim, Sang Bum; Lim, Jin Woo; Seo, Jeong Gook

    2016-01-01

    Many complications have been reported during or after anterior cruciate ligament (ACL) reconstruction, including infection, bleeding, tibial tunnel widening, arthrofibrosis, and graft failure. However, arterial injury has been rarely reported. This paper reports a case of an anterior tibial arterial injury during bicortical tibial drilling in arthroscopic ACL reconstruction, associated with an asymptomatic occlusion of the popliteal artery. The patient had a vague pain which led to delayed diagnosis of compartment syndrome and delayed treatment with fasciotomy. All surgeons should be aware of these rare but critical complications because the results may be disastrous like muscle necrosis as in this case. PMID:26929808

  3. Reconstruction of anterior cruciate ligament and anterolateral ligament using interlinked hamstrings - technical note.

    PubMed

    Ferreira, Marcio de Castro; Zidan, Flavio Ferreira; Miduati, Francini Belluci; Fortuna, Caio Cesar; Mizutani, Bruno Moreira; Abdalla, Rene Jorge

    2016-01-01

    Recent anatomical and biomechanical studies on the anterolateral ligament (ALL) of the knee have shown that this structure has an important function in relation to joint stability, especially when associated with anterior cruciate ligament (ACL) injury. However, the criteria for its reconstruction have not yet been fully established and the surgical techniques that have been described present variations regarding anatomical points and fixation materials. This study presents a reproducible technique for ALL and ACL reconstruction using hamstring tendons, in which three interference screws are used for fixation.

  4. Kinematic and kinetic interactions during normal and ACL-deficient gait: a longitudinal in vivo study.

    PubMed

    Atarod, Mohammad; Frank, Cyril B; Shrive, Nigel G

    2014-03-01

    The interactions between different tissues within the knee joint and between different kinematic DOF and joint flexion during normal gait were investigated. These interactions change following ACL transection, in both short (4 weeks) and long (20 weeks) term. Ten skeletally mature sheep were used in control (N = 5) and experimental (N = 5) groups. The 6-DOF stifle joint motion was first measured during normal gait. The control group were then euthanized and mounted on a unique robotic testing platform for kinetic measurements. The experimental group underwent ACL transection surgery, and kinematics measurements were repeated 4 and 20 weeks post-operatively. The experimental group were then euthanized and underwent kinetic assessment using the robotic system. Results indicated significant couplings between joint flexion vs. abduction and internal tibial rotation, as well as medial, anterior, and superior tibial translations during both normal and ACL-deficient gait. Distinct kinetic interactions were also observed between different tissues within the knee joint. Direct relationships were found between ACL vs. LM/MM, and PCL vs. MCL loads during normal gait; inverse relationships were detected between ACL vs. PCL and PCL vs. LM/MM loads. These kinetic interaction patterns were considerably altered by ACL injury. Significant inter-subject variability in joint kinematics and tissue loading patterns during gait was also observed. This study provides further understanding of the in vivo function of different tissues within the knee joint and their couplings with joint kinematics during normal gait and over time following ACL transection.

  5. Comparison of ACL strain estimated via a data-driven model with in vitro measurements.

    PubMed

    Weinhandl, Joshua T; Hoch, Matthew C; Bawab, Sebastian Y; Ringleb, Stacie I

    2016-11-01

    Computer modeling and simulation techniques have been increasingly used to investigate anterior cruciate ligament (ACL) loading during dynamic activities in an attempt to improve our understanding of injury mechanisms and development of injury prevention programs. However, the accuracy of many of these models remains unknown and thus the purpose of this study was to compare estimates of ACL strain from a previously developed three-dimensional, data-driven model with those obtained via in vitro measurements. ACL strain was measured as the knee was cycled from approximately 10° to 120° of flexion at 20 deg s(-1) with static loads of 100, 50, and 50 N applied to the quadriceps, biceps femoris and medial hamstrings (semimembranosus and semitendinosus) tendons, respectively. A two segment, five-degree-of-freedom musculoskeletal knee model was then scaled to match the cadaver's anthropometry and in silico ACL strains were then determined based on the knee joint kinematics and moments of force. Maximum and minimum ACL strains estimated in silico were within 0.2 and 0.42% of that measured in vitro, respectively. Additionally, the model estimated ACL strain with a bias (mean difference) of -0.03% and dynamic accuracy (rms error) of 0.36% across the flexion-extension cycle. These preliminary results suggest that the proposed model was capable of estimating ACL strains during a simple flexion-extension cycle. Future studies should validate the model under more dynamic conditions with variable muscle loading. This model could then be used to estimate ACL strains during dynamic sporting activities where ACL injuries are more common.

  6. Moa diet fits the bill: virtual reconstruction incorporating mummified remains and prediction of biomechanical performance in avian giants

    PubMed Central

    Attard, Marie R. G.; Wilson, Laura A. B.; Worthy, Trevor H.; Scofield, Paul; Johnston, Peter; Parr, William C. H.; Wroe, Stephen

    2016-01-01

    The moa (Dinornithiformes) are large to gigantic extinct terrestrial birds of New Zealand. Knowledge about niche partitioning, feeding mode and preference among moa species is limited, hampering palaeoecological reconstruction and evaluation of the impacts of their extinction on remnant native biota, or the viability of exotic species as proposed ecological ‘surrogates'. Here we apply three-dimensional finite-element analysis to compare the biomechanical performance of skulls from five of the six moa genera, and two extant ratites, to predict the range of moa feeding behaviours relative to each other and to living relatives. Mechanical performance during biting was compared using simulations of the birds clipping twigs based on muscle reconstruction of mummified moa remains. Other simulated food acquisition strategies included lateral shaking, pullback and dorsoventral movement of the skull. We found evidence for limited overlap in biomechanical performance between the extant emu (Dromaius novaehollandiae) and extinct upland moa (Megalapteryx didinus) based on similarities in mandibular stress distribution in two loading cases, but overall our findings suggest that moa species exploited their habitats in different ways, relative to both each other and extant ratites. The broad range of feeding strategies used by moa, as inferred from interspecific differences in biomechanical performance of the skull, provides insight into mechanisms that facilitated high diversities of these avian herbivores in prehistoric New Zealand. PMID:26763698

  7. Developing a 6-DOF robot to investigate multi-axis ACL injuries under valgus loading coupled with tibia internal rotation.

    PubMed

    Ren, Yupeng; Jacobs, Benjamin J; Nuber, Gordon W; Koh, Jason L; Zhang, Li-Qun

    2010-01-01

    Anterior cruciate ligament (ACL) injuries have become more common in recent years as more young people participate in risky sporting activities [1]. Most ACL injuries occur as a result of noncontact mechanisms. Previous in vitro studies of ACL strain have found significant increases in ACL strain primarily with anterior directed force on the tibia relative to the femur and with internal rotation and often with valgus torque [2,3]. However, there remains significant controversy over the mechanisms of ACL failure and the forces on the knee that lead to injury. Some studies have also shown that isolated valgus loading may not load the ACL strongly. The goal of this study was to investigate the mechanism underlying valgus-related ACL injuries. An improved understanding of ACL failure may lead to improved ACL injury prevention programs. A novel 6 degrees of freedom (DOF) knee driving robot was developed in this study with a unique multi-axis simultaneous torque/position control. It was found that pure valgus torque caused a torque that internally rotated the tibia and thus increased ACL strain markedly, which may be an important mechanism underlying the rather common seemingly valgus-related ACL injuries.

  8. Preferential Loading of the ACL Compared With the MCL During Landing

    PubMed Central

    Quatman, Carmen E.; Kiapour, Ata M.; Demetropoulos, Constantine K.; Kiapour, Ali; Wordeman, Samuel C.; Levine, Jason W.; Goel, Vijay K.; Hewett, Timothy E.

    2014-01-01

    Background Strong biomechanical and epidemiological evidence associates knee valgus collapse with isolated, noncontact anterior cruciate ligament (ACL) injuries. However, a concomitant injury to the medial collateral ligament (MCL) would be expected under valgus collapse, based on the MCL’s anatomic orientation and biomechanical role in knee stability. Purpose/Hypothesis The purpose of this study was to investigate the relative ACL to MCL strain patterns during physiological simulations of a wide range of high-risk dynamic landing scenarios. We hypothesized that both knee abduction and internal tibial rotation moments would generate a disproportionate increase in the ACL strain relative to the MCL strain. However, the physiological range of knee abduction and internal tibial rotation moments that produce ACL injuries are not of sufficient magnitude to compromise the MCL’s integrity consistently. Study Design Controlled laboratory study. Methods A novel in sim approach was used to test our hypothesis. Seventeen cadaveric lower extremities (mean age, 45 ± 7 years; 9 female and 8 male) were tested to simulate a broad range of landings after a jump under anterior tibial shear force, knee abduction, and internal tibial rotation at 25° of knee flexion. The ACL and MCL strains were quantified using differential variable reluctance transducers. An extensively validated, detailed finite element model of the lower extremity was used to help better interpret experimental findings. Results Anterior cruciate ligament failure occurred in 15 of 17 specimens (88%). Increased anterior tibial shear force and knee abduction and internal tibial rotation moments resulted in significantly higher ACL:MCL strain ratios (P < .05). Under all modes of single-planar and multiplanar loading, the ACL:MCL strain ratio remained greater than 1.7, while the relative ACL strain was significantly higher than the relative MCL strain (P < .01). Relative change in the ACL strain was demonstrated

  9. Performance of Tracking, b-tagging and Jet/MET reconstruction at the CMS High Level Trigger

    NASA Astrophysics Data System (ADS)

    Tosi, Mia

    2015-12-01

    The trigger systems of the LHC detectors play a crucial role in determining the physics capabilities of experiments. In 2015, the center-of-mass energy of proton-proton collisions will reach 13 TeV up to an unprecedented luminosity of 1 × 1034 cm-2s-1. A reduction of several orders of magnitude of the event rate is needed to reach values compatible with detector readout, offline storage and analysis capabilities. The CMS experiment has been designed with a two-level trigger system: the Level-1 Trigger (L1T), implemented on custom-designed electronics, and the High Level Trigger (HLT), a streamlined version of the offline reconstruction software running on a computer farm. A software trigger system requires a trade-off between the complexity of the algorithms, the sustainable output rate, and the selection efficiency. With the computing power available during the 2012 data taking the maximum reconstruction time at HLT was about 200 ms per event, at the nominal L1T rate of 100 kHz. Tracking algorithms are widely used in the HLT in the object reconstruction through particle-flow techniques as well as in the identification of b-jets and lepton isolation. Reconstructed tracks are also used to distinguish the primary vertex, which identifies the hard interaction process, from the pileup ones. This task is particularly important in the LHC environment given the large number of interactions per bunch crossing: on average 25 in 2012, and expected to be around 40 in Run II with a large contribution from out-of-time particles. In order to cope with tougher conditions the tracking and vertexing techniques used in 2012 have been largely improved in terms of timing and efficiency in order to keep the physics reach at the level of Run I conditions. We will present the performance of these newly developed algorithms, discussing their impact on the b-tagging performances as well as on the jet and missing transverse energy reconstruction.

  10. Track reconstruction and performance of DRIFT directional dark matter detectors using alpha particles

    NASA Astrophysics Data System (ADS)

    Burgos, S.; Forbes, J.; Ghag, C.; Gold, M.; Kudryavtsev, V. A.; Lawson, T. B.; Loomba, D.; Majewski, P.; Muna, D.; Murphy, A. StJ.; Nicklin, G. G.; Paling, S. M.; Petkov, A.; Plank, S. J. S.; Robinson, M.; Sanghi, N.; Smith, N. J. T.; Snowden-Ifft, D. P.; Spooner, N. J. C.; Sumner, T. J.; Turk, J.; Tziaferi, E.

    2008-01-01

    First results are presented from an analysis of data from the DRIFT-IIa and DRIFT-IIb directional dark matter detectors at Boulby Mine in which alpha particle tracks were reconstructed and used to characterise detector performance—an important step towards optimising directional technology. The drift velocity in DRIFT-IIa was 59.3±0.2 (stat)±7.5 (sys) ms-1 based on an analysis of naturally occurring alpha-emitting background. The drift velocity in DRIFT-IIb was 57±1 (stat)±3 (sys) ms-1 determined by the analysis of alpha particle tracks from a 210Po source. Three-dimensional range reconstruction and range spectra were used to identify alpha particles from the decay of 222Rn, 218Po, 220Rn and 216Po. This study found that (22±2)% of 218Po progeny (from 222Rn decay) did not plate out and remained suspended in the 40 Torr CS 2 gas fill until they decayed. A likely explanation for this is that some of the polonium progeny are produced in an uncharged state. For 216Po progeny (from 220Rn decay) the undeposited fraction was apparently much higher at (100-35+0)% most likely due to a shorter lifetime, causing a larger fraction of the progeny to decay whilst drifting to the cathode plane. This explanation implies a much slower drift time for positively charged polonium progeny compared to CS2- ions.

  11. Assessment of MLC tracking performance during hypofractionated prostate radiotherapy using real-time dose reconstruction

    NASA Astrophysics Data System (ADS)

    Fast, M. F.; Kamerling, C. P.; Ziegenhein, P.; Menten, M. J.; Bedford, J. L.; Nill, S.; Oelfke, U.

    2016-02-01

    By adapting to the actual patient anatomy during treatment, tracked multi-leaf collimator (MLC) treatment deliveries offer an opportunity for margin reduction and healthy tissue sparing. This is assumed to be especially relevant for hypofractionated protocols in which intrafractional motion does not easily average out. In order to confidently deliver tracked treatments with potentially reduced margins, it is necessary to monitor not only the patient anatomy but also the actually delivered dose during irradiation. In this study, we present a novel real-time online dose reconstruction tool which calculates actually delivered dose based on pre-calculated dose influence data in less than 10 ms at a rate of 25 Hz. Using this tool we investigate the impact of clinical target volume (CTV) to planning target volume (PTV) margins on CTV coverage and organ-at-risk dose. On our research linear accelerator, a set of four different CTV-to-PTV margins were tested for three patient cases subject to four different motion conditions. Based on this data, we can conclude that tracking eliminates dose cold spots which can occur in the CTV during conventional deliveries even for the smallest CTV-to-PTV margin of 1 mm. Changes of organ-at-risk dose do occur frequently during MLC tracking and are not negligible in some cases. Intrafractional dose reconstruction is expected to become an important element in any attempt of re-planning the treatment plan during the delivery based on the observed anatomy of the day.

  12. RISKS AND CONSEQUENCES OF USING THE TRANSPORTAL TECHNIQUE IN RECONSTRUCTING THE ANTERIOR CRUCIATE LIGAMENT: RELATIONSHIPS BETWEEN THE FEMORAL TUNNEL, LATERAL SUPERIOR GENICULAR ARTERY AND LATERAL EPICONDYLE OF THE FEMORAL CONDYLE

    PubMed Central

    Astur, Diego Costa; Aleluia, Vinicius; Santos, Ciro Veronese; Arliani, Gustavo Gonçalves; Badra, Ricardo; Oliveira, Saulo Gomes; Kaleka, Camila Cohen; Cohen, Moisés

    2015-01-01

    Objective: Define a security zone to avoid possibles vascular and ligamentar complications during anterior cruciate ligament reconstruction. Methods: Arthroscopic reconstruction using the transtibial and transportal technique in cadaver knees was performed followed by dissection and measurement of the distance between the femoral tunnel and the proximal attachment of the lateral collateral ligament and the femoral tunnel and the lateral superior genicular artery. Results: The measure of the analysed distances show us an aproximation between the major branch of the lateral superior genicular artery and the femoral insertion of the colateral lateral ligament and the femoral tunnel during the transportal technique. Conclusion: We realize that the use of technical ship it to arthroscopic ACL reconstruction has a higher probability of injury to the lateral geniculate artery and insertion of the lateral collateral ligament, promoting post-surgical complications such as instability of the knee, osteonecrosis of the femoral condyle and ligamentização graft. PMID:27047873

  13. Characterization of thigh and shank segment angular velocity during jump landing tasks commonly used to evaluate risk for ACL injury.

    PubMed

    Dowling, Ariel V; Favre, Julien; Andriacchi, Thomas P

    2012-09-01

    The dynamic movements associated with anterior cruciate ligament (ACL) injury during jump landing suggest that limb segment angular velocity can provide important information for understanding the conditions that lead to an injury. Angular velocity measures could provide a quick and simple method of assessing injury risk without the constraints of a laboratory. The objective of this study was to assess the inter-subject variations and the sensitivity of the thigh and shank segment angular velocity in order to determine if these measures could be used to characterize jump landing mechanisms. Additionally, this study tested the correlation between angular velocity and the knee abduction moment. Thirty-six healthy participants (18 male) performed drop jumps with bilateral and unilateral landing. Thigh and shank angular velocities were measured by a wearable inertial-based system, and external knee moments were measured using a marker-based system. Discrete parameters were extracted from the data and compared between systems. For both jumping tasks, the angular velocity curves were well defined movement patterns with high inter-subject similarity in the sagittal plane and moderate to good similarity in the coronal and transverse planes. The angular velocity parameters were also able to detect differences between the two jumping tasks that were consistent across subjects. Furthermore, the coronal angular velocities were significantly correlated with the knee abduction moment (R of 0.28-0.51), which is a strong indicator of ACL injury risk. This study suggested that the thigh and shank angular velocities, which describe the angular dynamics of the movement, should be considered in future studies about ACL injury mechanisms.

  14. FUNCTIONAL HOP TESTS AND TUCK JUMP ASSESSMENT SCORES BETWEEN FEMALE DIVISION I COLLEGIATE ATHLETES PARTICIPATING IN HIGH VERSUS LOW ACL INJURY PRONE SPORTS: A CROSS SECTIONAL ANALYSIS

    PubMed Central

    Hoog, Philipp; Warren, Meghan; Smith, Craig A.

    2016-01-01

    Background Although functional tests including the single leg hop (SLH), triple hop (TH), cross over hop (COH) for distance, and the tuck jump assessment (TJA) are used for return to play (RTP) criteria for post anterior cruciate ligament (ACL) injury, sport-specific baseline measurements are limited. Purpose The purpose of this study was to examine differences in SLH, TH, and COH distance and limb symmetry index (LSI), as well as total scores, number of jumps, and individual flaws of the TJA in 97 injury-free Division I (DI) collegiate female student athletes participating in ACL injury prone vs. non ACL injury prone sports. The hypothesis was that significant mean differences and asymmetries (LSI) would exist between the two groups in SLH, TH, COH and TJA. Study Design Cross sectional. Methods Due to research suggesting inherent ACL injury risk associated with specific sport involvement, participants were grouped into high (HR, n=57) and low (LR, n=40) ACL injury risk based on participating in a sport with high or low ACL injury rates. The HR group was composed of athletes participating in soccer, basketball, and volleyball, while the LR group athletes participated in diving, cross country, and track and field. Participants performed all standard functional tests (SFT) and side-to-side differences for each participant as well as between group differences were assessed for the hop tests. The LSI, a ratio frequently used to gauge athletes’ readiness for RTP post injury, was also assessed for between group differences. The TJA was compared between the groups on individual flaws, overall scores, and number of jumps performed. Results No between group differences for hop distances were found, with medium to large effect sizes for SLH, TH, and COH. The HR group had a higher TJA score, number of jumps, and higher proportion of the flaw of ‘foot placement not shoulder width apart’. Conclusion Although most SFT's showed no significant differences between athlete

  15. Phosphor-in-glass for high-powered remote-type white AC-LED.

    PubMed

    Lin, Hang; Wang, Bo; Xu, Ju; Zhang, Rui; Chen, Hui; Yu, Yunlong; Wang, Yuansheng

    2014-12-10

    The high-powered alternating current (AC) light-emitting diode (LED) (AC-LED), featuring low cost, high energy utilization efficiency, and long service life, will become a new economic growth point in the field of semiconductor lighting. However, flicker of AC-LED in the AC cycles is not healthy for human eyes, and therefore need to be restrained. Herein we report an innovation of persistent "phosphor-in-glass" (PiG) for the remote-type AC-LED, whose afterglow can be efficiently activated by the blue light. It is experimentally demonstrated that the afterglow decay of PiG in the microsecond range can partly compensate the AC time gap. Moreover, the substitution of inorganic glass for organic resins or silicones as the encapsulants would bring out several technological benefits to AC-LED, such as good heat-dissipation, low glare, and excellent physical/chemical stability.

  16. Regaining Native Knee Kinematics Following Joint Arthroplasty: A Novel Biomimetic Design with ACL and PCL Preservation.

    PubMed

    Zumbrunn, Thomas; Varadarajan, Kartik Mangudi; Rubash, Harry E; Malchau, Henrik; Li, Guoan; Muratoglu, Orhun K

    2015-12-01

    Lack of ACL and non-anatomic articular surfaces in contemporary total knee implants result in kinematic abnormalities. We hypothesized that such abnormalities may be addressed with a biomimetic bi-cruciate retaining (BCR) design having anatomical articular surfaces. We used dynamic computer simulations to compare kinematics among the biomimetic BCR, a contemporary BCR and cruciate-retaining implant for activities of daily living. During simulated deep knee bend, chair-sit and walking, the biomimetic BCR implant showed activity dependent kinematics similar to healthy knees in vivo. Restoring native knee geometry together with ACL preservation provided these kinematic improvements over contemporary ACL-preserving and ACL-sacrificing implants. Further clinical studies are required to determine if such biomimetic implants can result in more normal feeling knees and improve quality of life for active patients.

  17. Anatomical reference point for harvesting a flexor graft during arthroscopic reconstruction of the anterior cruciate ligament☆

    PubMed Central

    de Lima Lopes, Clécio; Arantes, Gabriel; de Oliveira, Rodrigo Victor Lapenda; Pinto, Dilamar Moreira; Gonçalves, Marcelo Carvalho Krause; Gonçalves, Romeu Carvalho Krause

    2015-01-01

    Objectives To evaluate the prevalence of a vascular network adjacent to the insertion of the pes anserinus, so that it could be used as an anatomical reference point to facilitate harvesting flexor grafts for arthroscopic reconstruction of the anterior cruciate ligament (ACL). Methods Thirty patients with ACL tears who were going to undergo ACL reconstruction using the tendons of the semitendinosus and gracilis muscles as grafts were selected randomly. During the harvesting of these tendons, the presence or absence of this anatomical reference point was noted. Results All the patients presented a vascular network of greater or lesser diameter. Conclusion The vascular network seems to be a good reference point during harvesting of the tendons of the semitendinosus and gracilis muscles, for facilitating graft harvesting. PMID:26229911

  18. Transient laxity of an anterior cruciate ligament-reconstructed knee related to pregnancy.

    PubMed

    Blecher, A M; Richmond, J C

    1998-01-01

    Transient laxity was documented around the end of pregnancy in a woman who had undergone anterior cruciate ligament (ACL) reconstruction 2 months before conception. This temporary laxity in the 3rd trimester and a few months postpartum corresponded to a time when substantial remodeling from large diameter to small diameter collagen fibers has been noted in the ACL graft ligamentization process. This is also a time of high levels of the hormone relaxin (member of the family of insulin-like growth factors), whose action in animals leads to dissociation of large collagen fibrils to smaller disorganized fibrils. The temporary laxity resolved. Careful observation of women who become pregnant in the first few months after ACL reconstruction is recommended.

  19. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement.

    PubMed

    Renstrom, P; Ljungqvist, A; Arendt, E; Beynnon, B; Fukubayashi, T; Garrett, W; Georgoulis, T; Hewett, T E; Johnson, R; Krosshaug, T; Mandelbaum, B; Micheli, L; Myklebust, G; Roos, E; Roos, H; Schamasch, P; Shultz, S; Werner, S; Wojtys, E; Engebretsen, L

    2008-06-01

    The incidence of anterior cruciate ligament (ACL) injury remains high in young athletes. Because female athletes have a much higher incidence of ACL injuries in sports such as basketball and team handball than male athletes, the IOC Medical Commission invited a multidisciplinary group of ACL expert clinicians and scientists to (1) review current evidence including data from the new Scandinavian ACL registries; (2) critically evaluate high-quality studies of injury mechanics; (3) consider the key elements of successful prevention programmes; (4) summarise clinical management including surgery and conservative management; and (5) identify areas for further research. Risk factors for female athletes suffering ACL injury include: (1) being in the preovulatory phase of the menstrual cycle compared with the postovulatory phase; (2) having decreased intercondylar notch width on plain radiography; and (3) developing increased knee abduction moment (a valgus intersegmental torque) during impact on landing. Well-designed injury prevention programmes reduce the risk of ACL for athletes, particularly women. These programmes attempt to alter dynamic loading of the tibiofemoral joint through neuromuscular and proprioceptive training. They emphasise proper landing and cutting techniques. This includes landing softly on the forefoot and rolling back to the rearfoot, engaging knee and hip flexion and, where possible, landing on two feet. Players are trained to avoid excessive dynamic valgus of the knee and to focus on the "knee over toe position" when cutting.

  20. TRITON-X is most effective among three decellularization agents for ACL tissue engineering.

    PubMed

    Vavken, Patrick; Joshi, Shilpa; Murray, Martha M

    2009-12-01

    Ruptures of the anterior cruciate ligament (ACL) are still associated with high rates of long-term complications, even in patients undergoing modern, state-of-the-art replacement. Tissue-engineering approaches have been shown to be of value in improving treatment of ACL ruptures. However, the success of tissue-engineering procedures depends on the choice of an appropriate biomaterial. Decellularized ACL tissue potentially combines the structural composition of the targeted tissue with a reduced risk of graft rejection or disease transmission. In this study, we tested the effectiveness of currently available decellularization methods based on TRITON-X, sodium dodecyl sulfate (SDS), and trypsin. After identifying the most effective decellularization method, the capacity for reseeding with ACL fibroblasts was studied. All decellularization protocols reduced DNA content, with TRITON-X treatment having the greatest effect. Concurrently, decellularization did not affect tissue collagen or total protein content, but did decrease glycosaminoglycan content. TRITON-X also resulted the least glycosaminoglycan depletion. Porcine ACL tissue after decellularization with TRITON-X could be successfully reseeded with human ACL fibroblasts as demonstrated by steady DNA content and increasing pro-collagen expression.

  1. Long-Term Data Reveal Rate and Risk Factors for Subsequent Surgeries Following Initial ACL Reconstruction

    MedlinePlus

    ... Vanderbilt University. In the Multicenter Orthopaedic Outcomes Network (MOON) study, Spindler and his colleagues followed nearly 1, ... for passing on disease is very low. The MOON findings provided further evidence of the possible hazards ...

  2. Reconstruction of the anterior cruciate ligament in the skeletally immature athlete: a review of current concepts: AAOS exhibit selection.

    PubMed

    Fabricant, Peter D; Jones, Kristofer J; Delos, Demetris; Cordasco, Frank A; Marx, Robert G; Pearle, Andrew D; Warren, Russell F; Green, Daniel W

    2013-03-06

    Intrasubstance tears of the anterior cruciate ligament (ACL) were once considered a rare injury in skeletally immature athletes but are now observed with increasing frequency. Treatment strategies have evolved as recent studies have identified unique considerations specific to the skeletally immature patient. The current literature now supports the trend toward early operative treatment to restore knee stability and prevent progressive meniscal and/or articular cartilage damage, but the optimal approach to ACL reconstruction in this age group remains controversial. Despite the reported clinical success of transphyseal reconstruction, iatrogenic growth disturbance secondary to physeal damage remains a genuine concern. The reluctance to place drill-holes across open physes has led to the development of numerous "physeal-sparing" reconstruction techniques using anatomic femoral and tibial footprints that have adequately restored anteroposterior and rotational knee stability in biomechanical studies but have demonstrated mixed results in the clinical setting. The intent of this review is to (1) highlight the unique anatomic considerations pertaining to ACL reconstruction in the skeletally immature athlete, (2) discuss preoperative clinical and radiographic assessment of the pediatric patient with a suspected ACL injury, (3) review transphyseal and physeal-sparing reconstruction techniques and highlight surgical technical considerations, (4) present clinical outcomes according to patient and technique-specific factors, and (5) review age-specific injury prevention treatment strategies and a novel treatment algorithm based on skeletal maturity. ACL reconstruction in the skeletally immature athlete typically results in a successful clinical outcome, yet the optimal surgical technique is still controversial. This review will help guide the management of ACL injuries in the pediatric athlete.

  3. Does computer navigation system really improve early clinical outcomes after anterior cruciate ligament reconstruction? A meta-analysis and systematic review of randomized controlled trials.

    PubMed

    Cheng, Tao; Zhang, Guo-You; Zhang, Xian-Long

    2012-03-01

    Inaccurate tunnel placement is an important cause of failure in conventional anterior cruciate ligament (ACL) reconstruction. Controversy currently exists over the usefulness of computer-assisted navigation systems in addressing this problem. Five randomized or quasi-randomized, controlled trials comparing computer-navigated versus conventional technique in ACL reconstructions until December 1, 2009 were identified through a systematical database search. The clinical outcomes of the trials were analyzed by Lachman test, pivot-shift test, International Knee Documentation Committee knee score, Lysholm score, and Tegner score. Mean difference or risk ratio with 95% confidence interval was calculated using a fixed-effects or random-effects model. Heterogeneity across the studies was also assessed. We found that the use of computer-assisted navigation systems led to additional operative time (8-17min). No significant differences between computer-navigated and conventional groups were found in terms of knee stability and functional assessment during short-term follow-up. The role of computer-assisted navigation systems on clinical performance and longevity needs further investigation in large sample, long-term randomized trials.

  4. Neural Excitability Alterations After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Pietrosimone, Brian G.; Lepley, Adam S.; Ericksen, Hayley M.; Clements, Amy; Sohn, David H.; Gribble, Phillip A.

    2015-01-01

    Context Neuromuscular dysfunction is common after anterior cruciate ligament reconstruction (ACL-R). However, little is known about quadriceps spinal-reflex and descending corticomotor excitability after ACL-R. Understanding the effects of ACL-R on spinal-reflex and corticomotor excitability will help elucidate the origins of neuromuscular dysfunction. Objective To determine whether spinal-reflex excitability and corticomotor excitability differed between the injured and uninjured limbs of patients with unilateral ACL-R and between these limbs and the matched limbs of healthy participants. Design Case-control study. Setting Laboratory. Patients or Other Participants A total of 28 patients with unilateral ACL-R (9 men, 19 women; age = 21.28 ± 3.79 years, height = 170.95 ± 10.04 cm, mass = 73.18 ± 18.02 kg, time after surgery = 48.10 ± 36.17 months) and 29 participants serving as healthy controls (9 men, 20 women; age = 21.55 ± 2.70 years, height = 170.59 ± 8.93 cm, mass = 71.89 ± 12.70 kg) volunteered. Main Outcome Measure(s) Active motor thresholds (AMTs) were collected from the vastus medialis (VM) using transcranial magnetic stimulation. We evaluated VM spinal reflexes using the Hoffmann reflex normalized to maximal muscle responses (H : M ratio). Voluntary quadriceps activation was measured with the superimposed-burst technique and calculated using the central activation ratio (CAR). We also evaluated whether ACL-R patients with high or low voluntary activation had different outcomes. Results The AMT was higher in the injured than in the uninjured limb in the ACL-R group (t27 = 3.32, P = .003) and in the matched limb of the control group (t55 = 2.05, P = .04). The H : M ratio was bilaterally higher in the ACL-R than the control group (F1,55 = 5.17, P = .03). The quadriceps CAR was bilaterally lower in the ACL-R compared with the control group (F1,55 = 10.5, P = .002). The ACL-R group with low voluntary activation (CAR < 0.95) had higher AMT than

  5. Longitudinal changes in knee joint biomechanics during level walking following anterior cruciate ligament reconstruction surgery.

    PubMed

    Webster, Kate E; Feller, Julian A; Wittwer, Joanne E

    2012-06-01

    Following anterior cruciate ligament reconstruction (ACL) patients have altered movement patterns in the reconstructed knee during walking. There is limited information about these alterations over an extended period of time. This study was designed to present a longitudinal analysis of gait patterns following ACL reconstruction surgery. Assessments of level walking were undertaken in 16 participants at a mean 10 months (initial assessment) and again at 3 years (follow-up assessment) after ACL reconstruction surgery. Kinematic and kinetic variables were analysed using a two factor (time, limb) repeated measures ANOVA. Kinematic data showed that patients were able to achieve greater extension about the reconstructed knee at follow-up than at initial assessment. The reconstructed knee was significantly less internally rotated than the contralateral knee at the initial assessment but not at follow-up. Kinetic data showed a significant increase in the external knee extension moment for the reconstructed limb over time. There were also significant increases in the external knee adduction moment for both limbs at the follow-up assessment. The external knee adduction moment was however smaller in the reconstructed knee than the contralateral knee at both assessments. The results indicate that gait variables do change over time and that measurement at a single time point may not reflect the long term outcome of ACL reconstruction surgery. The changes were however small and may not be clinically relevant. However, the consistently reduced external knee adduction moment seen about the reconstructed knee in this study may suggest that factors other than joint moments influence degenerative change over time.

  6. Tools to Perform Local Dense 3D Reconstruction of Shallow Water Seabed ‡

    PubMed Central

    Avanthey, Loïca; Beaudoin, Laurent; Gademer, Antoine; Roux, Michel

    2016-01-01

    Tasks such as distinguishing or identifying individual objects of interest require the production of dense local clouds at the scale of these individual objects of interest. Due to the physical and dynamic properties of an underwater environment, the usual dense matching algorithms must be rethought in order to be adaptive. These properties also imply that the scene must be observed at close range. Classic robotized acquisition systems are oversized for local studies in shallow water while the systematic acquisition of data is not guaranteed with divers. We address these two major issues through a multidisciplinary approach. To efficiently acquire on-demand stereoscopic pairs using simple logistics in small areas of shallow water, we devised an agile light-weight dedicated system which is easy to reproduce. To densely match two views in a reliable way, we devised a reconstruction algorithm that automatically accounts for the dynamics, variability and light absorption of the underwater environment. Field experiments in the Mediterranean Sea were used to assess the results. PMID:27196913

  7. Tools to Perform Local Dense 3D Reconstruction of Shallow Water Seabed.

    PubMed

    Avanthey, Loïca; Beaudoin, Laurent; Gademer, Antoine; Roux, Michel

    2016-05-17

    Tasks such as distinguishing or identifying individual objects of interest require the production of dense local clouds at the scale of these individual objects of interest. Due to the physical and dynamic properties of an underwater environment, the usual dense matching algorithms must be rethought in order to be adaptive. These properties also imply that the scene must be observed at close range. Classic robotized acquisition systems are oversized for local studies in shallow water while the systematic acquisition of data is not guaranteed with divers. We address these two major issues through a multidisciplinary approach. To efficiently acquire on-demand stereoscopic pairs using simple logistics in small areas of shallow water, we devised an agile light-weight dedicated system which is easy to reproduce. To densely match two views in a reliable way, we devised a reconstruction algorithm that automatically accounts for the dynamics, variability and light absorption of the underwater environment. Field experiments in the Mediterranean Sea were used to assess the results.

  8. Measurement of the muon reconstruction performance of the ATLAS detector using 2011 and 2012 LHC proton–proton collision data

    DOE PAGES

    Aad, G.

    2014-11-26

    This study presents the performance of the ATLAS muon reconstruction during the LHC run with pp collisions at √s = 7–8 TeV in 2011–2012, focusing mainly on data collected in 2012. Measurements of the reconstruction efficiency and of the momentum scale and resolution, based on large reference samples of J/ψ → μμ, Z → μμ and Υ → μμ decays, are presented and compared to Monte Carlo simulations. Corrections to the simulation, to be used in physics analysis, are provided. Over most of the covered phase space (muon |η| < 2.7 and 5 ≲ pT ≲ 100 GeV) the efficiencymore » is above 99% and is measured with per-mille precision. The momentum resolution ranges from 1.7% at central rapidity and for transverse momentum pT ≃ 10 GeV, to 4% at large rapidity and pT ≃ 100 GeV. The momentum scale is known with an uncertainty of 0.05% to 0.2% depending on rapidity. A method for the recovery of final state radiation from the muons is also presented.« less

  9. Measurement of the muon reconstruction performance of the ATLAS detector using 2011 and 2012 LHC proton-proton collision data.

    PubMed

    Aad, G; Abbott, B; Abdallah, J; Abdel Khalek, S; Abdinov, O; Aben, R; Abi, B; Abolins, M; AbouZeid, O S; Abramowicz, H; Abreu, H; Abreu, R; Abulaiti, Y; Acharya, B S; Adamczyk, L; Adams, D L; Adelman, J; Adomeit, S; Adye, T; Agatonovic-Jovin, T; Aguilar-Saavedra, J A; Agustoni, M; Ahlen, S P; Ahmadov, F; Aielli, G; Akerstedt, H; Åkesson, T P A; Akimoto, G; Akimov, A V; Alberghi, G L; Albert, J; Albrand, S; Alconada Verzini, M J; Aleksa, M; Aleksandrov, I N; Alexa, C; Alexander, G; Alexandre, G; Alexopoulos, T; Alhroob, M; Alimonti, G; Alio, L; Alison, J; Allbrooke, B M M; Allison, L J; Allport, P P; Almond, J; Aloisio, A; Alonso, A; Alonso, F; Alpigiani, C; Altheimer, A; Alvarez Gonzalez, B; Alviggi, M G; Amako, K; Amaral Coutinho, Y; Amelung, C; Amidei, D; Amor Dos Santos, S P; Amorim, A; Amoroso, S; Amram, N; Amundsen, G; Anastopoulos, C; Ancu, L S; Andari, N; Andeen, T; Anders, C F; Anders, G; Anderson, K J; Andreazza, A; Andrei, V; Anduaga, X S; Angelidakis, S; Angelozzi, I; Anger, P; Angerami, A; Anghinolfi, F; Anisenkov, A V; Anjos, N; Annovi, A; Antonaki, A; Antonelli, M; Antonov, A; Antos, J; Anulli, F; Aoki, M; Aperio Bella, L; Apolle, R; Arabidze, G; Aracena, I; Arai, Y; Araque, J P; Arce, A T H; Arguin, J-F; Argyropoulos, S; Arik, M; Armbruster, A J; Arnaez, O; Arnal, V; Arnold, H; Arratia, M; Arslan, O; Artamonov, A; Artoni, G; Asai, S; Asbah, N; Ashkenazi, A; Åsman, B; Asquith, L; Assamagan, K; Astalos, R; Atkinson, M; Atlay, N B; Auerbach, B; Augsten, K; Aurousseau, M; Avolio, G; Azuelos, G; Azuma, Y; Baak, M A; Baas, A; Bacci, C; Bachacou, H; Bachas, K; Backes, M; Backhaus, M; Backus Mayes, J; Badescu, E; Bagiacchi, P; Bagnaia, P; Bai, Y; Bain, T; Baines, J T; Baker, O K; Balek, P; Balli, F; Banas, E; Banerjee, Sw; Bannoura, A A E; Bansal, V; Bansil, H S; Barak, L; Baranov, S P; Barberio, E L; Barberis, D; Barbero, M; Barillari, T; Barisonzi, M; Barklow, T; Barlow, N; Barnett, B M; Barnett, R M; Barnovska, Z; Baroncelli, A; Barone, G; Barr, A J; Barreiro, F; Barreiro Guimarães da Costa, J; Bartoldus, R; Barton, A E; Bartos, P; Bartsch, V; Bassalat, A; Basye, A; Bates, R L; Batley, J R; Battaglia, M; Battistin, M; Bauer, F; Bawa, H S; Beattie, M D; Beau, T; Beauchemin, P H; Beccherle, R; Bechtle, P; Beck, H P; Becker, K; Becker, S; Beckingham, M; Becot, C; Beddall, A J; Beddall, A; Bedikian, S; Bednyakov, V A; Bee, C P; Beemster, L J; Beermann, T A; Begel, M; Behr, K; Belanger-Champagne, C; Bell, P J; Bell, W H; Bella, G; Bellagamba, L; Bellerive, A; Bellomo, M; Belotskiy, K; Beltramello, O; Benary, O; Benchekroun, D; Bendtz, K; Benekos, N; Benhammou, Y; Benhar Noccioli, E; Benitez Garcia, J A; Benjamin, D P; Bensinger, J R; Benslama, K; Bentvelsen, S; Berge, D; Bergeaas Kuutmann, E; Berger, N; Berghaus, F; Beringer, J; Bernard, C; Bernat, P; Bernius, C; Bernlochner, F U; Berry, T; Berta, P; Bertella, C; Bertoli, G; Bertolucci, F; Bertsche, C; Bertsche, D; Bessner, M; Besana, M I; Besjes, G J; Bessidskaia, O; Besson, N; Betancourt, C; Bethke, S; Bhimji, W; Bianchi, R M; Bianchini, L; Bianco, M; Biebel, O; Bieniek, S P; Bierwagen, K; Biesiada, J; Biglietti, M; Bilbao De Mendizabal, J; Bilokon, H; Bindi, M; Binet, S; Bingul, A; Bini, C; Black, C W; Black, J E; Black, K M; Blackburn, D; Blair, R E; Blanchard, J-B; Blazek, T; Bloch, I; Blocker, C; Blum, W; Blumenschein, U; Bobbink, G J; Bobrovnikov, V S; Bocchetta, S S; Bocci, A; Bock, C; Boddy, C R; Boehler, M; Boek, T T; Bogaerts, J A; Bogdanchikov, A G; Bogouch, A; Bohm, C; Bohm, J; Boisvert, V; Bold, T; Boldea, V; Boldyrev, A S; Bomben, M; Bona, M; Boonekamp, M; Borisov, A; Borissov, G; Borri, M; Borroni, S; Bortfeldt, J; Bortolotto, V; Bos, K; Boscherini, D; Bosman, M; Boterenbrood, H; Boudreau, J; Bouffard, J; Bouhova-Thacker, E V; Boumediene, D; Bourdarios, C; Bousson, N; Boutouil, S; Boveia, A; Boyd, J; Boyko, I R; Bracinik, J; Brandt, A; Brandt, G; Brandt, O; Bratzler, U; Brau, B; Brau, J E; Braun, H M; Brazzale, S F; Brelier, B; Brendlinger, K; Brennan, A J; Brenner, R; Bressler, S; Bristow, K; Bristow, T M; Britton, D; Brochu, F M; Brock, I; Brock, R; Bromberg, C; Bronner, J; Brooijmans, G; Brooks, T; Brooks, W K; Brosamer, J; Brost, E; Brown, J; Bruckman de Renstrom, P A; Bruncko, D; Bruneliere, R; Brunet, S; Bruni, A; Bruni, G; Bruschi, M; Bryngemark, L; Buanes, T; Buat, Q; Bucci, F; Buchholz, P; Buckingham, R M; Buckley, A G; Buda, S I; Budagov, I A; Buehrer, F; Bugge, L; Bugge, M K; Bulekov, O; Bundock, A C; Burckhart, H; Burdin, S; Burghgrave, B; Burke, S; Burmeister, I; Busato, E; Büscher, D; Büscher, V; Bussey, P; Buszello, C P; Butler, B; Butler, J M; Butt, A I; Buttar, C M; Butterworth, J M; Butti, P; Buttinger, W; Buzatu, A; Byszewski, M; Cabrera Urbán, S; Caforio, D; Cakir, O; Calafiura, P; Calandri, A; Calderini, G; Calfayan, P; Calkins, R; Caloba, L P; Calvet, D; Calvet, S; Camacho Toro, R; Camarda, S; Cameron, D; Caminada, L M; Caminal Armadans, R; Campana, S; Campanelli, M; Campoverde, A; Canale, V; Canepa, A; Cano Bret, M; Cantero, J; Cantrill, R; Cao, T; Capeans Garrido, M D M; Caprini, I; Caprini, M; Capua, M; Caputo, R; Cardarelli, R; Carli, T; Carlino, G; Carminati, L; Caron, S; Carquin, E; Carrillo-Montoya, G D; Carter, J R; Carvalho, J; Casadei, D; Casado, M P; Casolino, M; Castaneda-Miranda, E; Castelli, A; Castillo Gimenez, V; Castro, N F; Catastini, P; Catinaccio, A; Catmore, J R; Cattai, A; Cattani, G; Caughron, S; Cavaliere, V; Cavalli, D; Cavalli-Sforza, M; Cavasinni, V; Ceradini, F; Cerio, B; Cerny, K; Cerqueira, A S; Cerri, A; Cerrito, L; Cerutti, F; Cerv, M; Cervelli, A; Cetin, S A; Chafaq, A; Chakraborty, D; Chalupkova, I; Chang, P; Chapleau, B; Chapman, J D; Charfeddine, D; Charlton, D G; Chau, C C; Chavez Barajas, C A; Cheatham, S; Chegwidden, A; Chekanov, S; Chekulaev, S V; Chelkov, G A; Chelstowska, M A; Chen, C; Chen, H; Chen, K; Chen, L; Chen, S; Chen, X; Chen, Y; Chen, Y; Cheng, H C; Cheng, Y; Cheplakov, A; Cherkaoui El Moursli, R; Chernyatin, V; Cheu, E; Chevalier, L; Chiarella, V; Chiefari, G; Childers, J T; Chilingarov, A; Chiodini, G; Chisholm, A S; Chislett, R T; Chitan, A; Chizhov, M V; Chouridou, S; Chow, B K B; Chromek-Burckhart, D; Chu, M L; Chudoba, J; Chwastowski, J J; Chytka, L; Ciapetti, G; Ciftci, A K; Ciftci, R; Cinca, D; Cindro, V; Ciocio, A; Cirkovic, P; Citron, Z H; Citterio, M; Ciubancan, M; Clark, A; Clark, P J; Clarke, R N; Cleland, W; Clemens, J C; Clement, C; Coadou, Y; Cobal, M; Coccaro, A; Cochran, J; Coffey, L; Cogan, J G; Coggeshall, J; Cole, B; Cole, S; Colijn, A P; Collot, J; Colombo, T; Colon, G; Compostella, G; Conde Muiño, P; Coniavitis, E; Conidi, M C; Connell, S H; Connelly, I A; Consonni, S M; Consorti, V; Constantinescu, S; Conta, C; Conti, G; Conventi, F; Cooke, M; Cooper, B D; Cooper-Sarkar, A M; Cooper-Smith, N J; Copic, K; Cornelissen, T; Corradi, M; Corriveau, F; Corso-Radu, A; Cortes-Gonzalez, A; Cortiana, G; Costa, G; Costa, M J; Costanzo, D; Côté, D; Cottin, G; Cowan, G; Cox, B E; Cranmer, K; Cree, G; Crépé-Renaudin, S; Crescioli, F; 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    This paper presents the performance of the ATLAS muon reconstruction during the LHC run with [Formula: see text] collisions at [Formula: see text]-8 TeV in 2011-2012, focusing mainly on data collected in 2012. Measurements of the reconstruction efficiency and of the momentum scale and resolution, based on large reference samples of [Formula: see text], [Formula: see text] and [Formula: see text] decays, are presented and compared to Monte Carlo simulations. Corrections to the simulation, to be used in physics analysis, are provided. Over most of the covered phase space (muon [Formula: see text] and [Formula: see text] GeV) the efficiency is above [Formula: see text] and is measured with per-mille precision. The momentum resolution ranges from [Formula: see text] at central rapidity and for transverse momentum [Formula: see text] GeV, to [Formula: see text] at large rapidity and [Formula: see text] GeV. The momentum scale is known with an uncertainty of [Formula: see text] to [Formula: see text] depending on rapidity. A method for the recovery of final state radiation from the muons is also presented.

  10. Study of the radiation dose reduction capability of a CT reconstruction algorithm: LCD performance assessment using mathematical model observers

    NASA Astrophysics Data System (ADS)

    Fan, Jiahua; Tseng, Hsin-Wu; Kupinski, Matthew; Cao, Guangzhi; Sainath, Paavana; Hsieh, Jiang

    2013-03-01

    Radiation dose on patient has become a major concern today for Computed Tomography (CT) imaging in clinical practice. Various hardware and algorithm solutions have been designed to reduce dose. Among them, iterative reconstruction (IR) has been widely expected to be an effective dose reduction approach for CT. However, there is no clear understanding on the exact amount of dose saving an IR approach can offer for various clinical applications. We know that quantitative image quality assessment should be task-based. This work applied mathematical model observers to study detectability performance of CT scan data reconstructed using an advanced IR approach as well as the conventional filtered back-projection (FBP) approach. The purpose of this work is to establish a practical and robust approach for CT IR detectability image quality evaluation and to assess the dose saving capability of the IR method under study. Low contrast (LC) objects imbedded in head size and body size phantoms were imaged multiple times with different dose levels. Independent signal present and absent pairs were generated for model observer study training and testing. Receiver Operating Characteristic (ROC) curves for location known exact and location ROC (LROC) curves for location unknown as well as their corresponding the area under the curve (AUC) values were calculated. Results showed approximately 3 times dose reduction has been achieved using the IR method under study.

  11. Critical analysis of Strattice performance in complex abdominal wall reconstruction: intermediate-risk patients and early complications.

    PubMed

    Patel, Ketan M; Albino, Frank P; Nahabedian, Maurice Y; Bhanot, Parag

    2013-01-01

    The purpose of this study was to analyze the performance of a porcine-derived acellular dermal matrix (Strattice Reconstructive Tissue Matrix) in patients at increased risk for perioperative complications. We reviewed medical records for patients with complex abdominal wall reconstruction (AWR) and Strattice underlay from 2007 to 2010. Intermediate-risk patients were defined as having multiple comorbidities without abdominal infection. Forty-one patients met the inclusion criteria (mean age, 60 years; mean body mass index, 35.5 kg/m(2)). Comorbidities included coronary artery disease (63.4%), diabetes mellitus (36.6%), and chronic obstructive pulmonary disease (17.1%). Fascial closure was achieved in 40 patients (97.6%). Average hospitalization was 6.4 days (range, 1-24 days). Complications included seroma (7.3%), wound dehiscence with Strattice exposure (4.9%), cellulitis (2.4%), and hematoma (2.4%). All patients achieved abdominal wall closure with no recurrent hernias or need for Strattice removal. Patients with multiple comorbidities at intermediate risk of postoperative complications can achieve successful, safe AWR with Strattice.

  12. Measurement of the muon reconstruction performance of the ATLAS detector using 2011 and 2012 LHC proton–proton collision data

    SciTech Connect

    Aad, G.

    2014-11-26

    This study presents the performance of the ATLAS muon reconstruction during the LHC run with pp collisions at √s = 7–8 TeV in 2011–2012, focusing mainly on data collected in 2012. Measurements of the reconstruction efficiency and of the momentum scale and resolution, based on large reference samples of J/ψ → μμ, Z → μμ and Υ → μμ decays, are presented and compared to Monte Carlo simulations. Corrections to the simulation, to be used in physics analysis, are provided. Over most of the covered phase space (muon |η| < 2.7 and 5 ≲ pT ≲ 100 GeV) the efficiency is above 99% and is measured with per-mille precision. The momentum resolution ranges from 1.7% at central rapidity and for transverse momentum pT ≃ 10 GeV, to 4% at large rapidity and pT ≃ 100 GeV. The momentum scale is known with an uncertainty of 0.05% to 0.2% depending on rapidity. A method for the recovery of final state radiation from the muons is also presented.

  13. Potential for Non-Contact ACL Injury Between Step-Close-Jump and Hop-Jump Tasks.

    PubMed

    Wang, Li-I; Gu, Chin-Yi; Chen, Wei-Ling; Chang, Mu-San

    2010-01-01

    This study aimed to compare the kinematics and kinetics during the landing of hop-jump and step-close-jump movements in order to provide further inferring that the potential risk of ACL injuries. Eleven elite male volleyball players were recruited to perform hop-jump and step-close-jump tasks. Lower extremity kinematics and ground reaction forces during landing in stop-jump tasks were recorded. Lower extremity kinetics was calculated by using an inverse dynamic process. Step-close-jump tasks demonstrated smaller peak proximal tibia anterior shear forces during the landing phase. In step-close-jump tasks, increasing hip joint angular velocity during initial foot-ground contact decreased peak posterior ground reaction force during the landing phase, which theoretically could reduce the risk of ACL injury. Key pointsThe different landing techniques required for these two stop-jump tasks do not necessarily affect the jump height.Hop-jump decreased the hip joint angular velocity at initial foot contact with ground, which could lead to an increasing peak posterior GRF during the landing phase.Hop-jump decreased hip and knee joint angular flexion displacement during the landing, which could increase the peak vertical loading rate during the landing phase.

  14. School Ritual as Performance: A Reconstruction of Durkheim's and Turner's Uses of Ritual.

    ERIC Educational Resources Information Center

    Quantz, Richard A.

    1999-01-01

    Addresses the assumption that ritual performances are not as important in modern, secular, bureaucratic schools as they were in communal, sacred, tribal societies, reviving a concept forged in structuralism and redefining it as a performative text, thus taking advantage of certain poststructural insights while maintaining much of the power of its…

  15. The Performance Evaluation of Multi-Image 3d Reconstruction Software with Different Sensors

    NASA Astrophysics Data System (ADS)

    Mousavi, V.; Khosravi, M.; Ahmadi, M.; Noori, N.; Naveh, A. Hosseini; Varshosaz, M.

    2015-12-01

    Today, multi-image 3D reconstruction is an active research field and generating three dimensional model of the objects is one the most discussed issues in Photogrammetry and Computer Vision that can be accomplished using range-based or image-based methods. Very accurate and dense point clouds generated by range-based methods such as structured light systems and laser scanners has introduced them as reliable tools in the industry. Image-based 3D digitization methodologies offer the option of reconstructing an object by a set of unordered images that depict it from different viewpoints. As their hardware requirements are narrowed down to a digital camera and a computer system, they compose an attractive 3D digitization approach, consequently, although range-based methods are generally very accurate, image-based methods are low-cost and can be easily used by non-professional users. One of the factors affecting the accuracy of the obtained model in image-based methods is the software and algorithm used to generate three dimensional model. These algorithms are provided in the form of commercial software, open source and web-based services. Another important factor in the accuracy of the obtained model is the type of sensor used. Due to availability of mobile sensors to the public, popularity of professional sensors and the advent of stereo sensors, a comparison of these three sensors plays an effective role in evaluating and finding the optimized method to generate three-dimensional models. Lots of research has been accomplished to identify a suitable software and algorithm to achieve an accurate and complete model, however little attention is paid to the type of sensors used and its effects on the quality of the final model. The purpose of this paper is deliberation and the introduction of an appropriate combination of a sensor and software to provide a complete model with the highest accuracy. To do this, different software, used in previous studies, were compared and

  16. Tibial plateau fracture after anterior cruciate ligament reconstruction: Role of the interference screw resorption in the stress riser effect.

    PubMed

    Thaunat, Mathieu; Nourissat, Geoffroy; Gaudin, Pascal; Beaufils, Philippe

    2006-06-01

    We report a case of tibial plateau fracture after previous anterior cruciate ligament (ACL) reconstruction using patellar tendon autograft and bioabsorbable screws 4 years previously. The fracture occurred through the tibial tunnel. The interference screw had undergone complete resorption and the tunnel widening had increased. The resorption of the interference screw did not simultaneously promote and foster the growth of surrounding bone tissue. Therefore, the area of reactive tissue left by the screw resorption in an enlarged bone tunnel may lead to vulnerability of the tibial plateau. Stress risers would occur following ACL reconstruction if either resorption is not complete or bony integration is not complete.

  17. Isokinetic evaluation after two-stage bicruciate reconstruction

    PubMed Central

    GiglioTakaes, Igor; Inada, Mauro Mituso; de Miranda, João Batista; Cunha, Sérgio Augusto; Piedade, Sérgio Rocha

    2014-01-01

    Objective: To assess the functional balance of the knee after bicruciate reconstruction and its correlation with clinical score. Methods: 14 patients (11 men and three women), mean age 29.9±7.65 years, mean BMI 26.2±2.51 kg/m2 underwent surgical reconstruction of the Posterior Cruciate Ligament (PCL) and Anterior Cruciate Ligament (ACL) in two stages, with a mean interval of 3 months between procedures. With a mean follow-up period of 27.33 months, the isokinetic knee analysis was performed at 60°/s and 180°/s and the Lysholm and Tegner scores were applied. Results: The Lysholm score was 86.8±11.1 points and the Tegner score showed a deficit of 30% compared to pre-injury level. In isokinetic evaluation, the deficit of the operated quadriceps average torque was 17.05% at 60°/s and 12.16% at 180°/s, while the average flexor torque deficit was 3.43% at 60°/s and 5.82% at 180°/s. Although it was observed torque deficit between members, there were no statistical differences regarding the functional balance between hamstrings and quadriceps. Conclusion: Although the results of isokinetic evaluation has shown a functional balance of the knee (flexor-extensor), which may have contributed to the good subjective Lysholm score in the bicruciate two-stage reconstruction, two-stage reconstruction did not restore the pre-injury functional level. Level of Evidence IV, Case Series. PMID:24644415

  18. Functional Outcome of Transphyseal Reconstruction of the Anterior Cruciate Ligament in Skeletally Immature Patients

    PubMed Central

    Kim, Sung-Jae; Shim, Dong-Woo

    2012-01-01

    Purpose In anterior cruciate ligament (ACL) injury, conventional adult reconstruction techniques have to face the potential risk of growth disturbance or angular deformities in skeletally immature patients. The aim of this study was to evaluate the clinical outcomes of ACL reconstruction by conventional transphyseal tunnel technique. Materials and Methods On a retrospective basis, we reviewed 25 skeletally immature patients; all the patients showed skeletal maturity at last follow-up, and the mean age was 16.4 years. The average injury to surgery interval was 12.6 months. Clinical outcomes were assessed at a mean of 74.4 months postoperatively using the Lysholm Knee Scoring Scale, the Tegner activity level, the International Knee Documentation Committee (IKDC), and plain radiographs. Results All the patients had undergone transphyseal reconstruction of ACL. The mean Lysholm score was 48.36 points preoperatively and 93.32 points postoperatively; the mean Tegner activity level was changed from 3.0 points to 5.6 points. The mean IKDC level was categorized as C preoperatively and changed to A postoperatively. Conclusions Our midterm outcome at an average 6 years after surgery was satisfactory without significant leg length discrepancies or abnormal alignment of the knee joint. Transphyseal reconstruction of ACL is a good treatment modality in the skeletally immature patient. PMID:22977795

  19. Methods of Voice Reconstruction

    PubMed Central

    Chen, Hung-Chi; Kim Evans, Karen F.; Salgado, Christopher J.; Mardini, Samir

    2010-01-01

    This article reviews methods of voice reconstruction. Nonsurgical methods of voice reconstruction include electrolarynx, pneumatic artificial larynx, and esophageal speech. Surgical methods of voice reconstruction include neoglottis, tracheoesophageal puncture, and prosthesis. Tracheoesophageal puncture can be performed in patients with pedicled flaps such as colon interposition, jejunum, or gastric pull-up or in free flaps such as perforator flaps, jejunum, and colon flaps. Other flaps for voice reconstruction include the ileocolon flap and jejunum. Laryngeal transplantation is also reviewed. PMID:22550443

  20. Performance of photon reconstruction and identification with the CMS detector in proton-proton collisions at √s = 8 TeV

    SciTech Connect

    Khachatryan, Vardan

    2015-08-10

    A description is provided of the performance of the CMS detector for photon reconstruction and identification in proton-proton collisions at a centre-of-mass energy of 8 TeV at the CERN LHC. Details are given on the reconstruction of photons from energy deposits in the electromagnetic calorimeter (ECAL) and the extraction of photon energy estimates. Furthermore, the reconstruction of electron tracks from photons that convert to electrons in the CMS tracker is also described, as is the optimization of the photon energy reconstruction and its accurate modelling in simulation, in the analysis of the Higgs boson decay into two photons. In the barrel section of the ECAL, an energy resolution of about 1% is achieved for unconverted or late-converting photons from H → γγ decays. Furthermore, different photon identification methods are discussed and their corresponding selection efficiencies in data are compared with those found in simulated events.

  1. Performance of photon reconstruction and identification with the CMS detector in proton-proton collisions at √s = 8 TeV

    DOE PAGES

    Khachatryan, Vardan

    2015-08-10

    A description is provided of the performance of the CMS detector for photon reconstruction and identification in proton-proton collisions at a centre-of-mass energy of 8 TeV at the CERN LHC. Details are given on the reconstruction of photons from energy deposits in the electromagnetic calorimeter (ECAL) and the extraction of photon energy estimates. Furthermore, the reconstruction of electron tracks from photons that convert to electrons in the CMS tracker is also described, as is the optimization of the photon energy reconstruction and its accurate modelling in simulation, in the analysis of the Higgs boson decay into two photons. In themore » barrel section of the ECAL, an energy resolution of about 1% is achieved for unconverted or late-converting photons from H → γγ decays. Furthermore, different photon identification methods are discussed and their corresponding selection efficiencies in data are compared with those found in simulated events.« less

  2. Compartment pressure monitoring during anterior cruciate ligament reconstruction.

    PubMed

    Amendola, A; Faber, K; Willits, K; Miniaci, A; Labib, S; Fowler, P

    1999-09-01

    A prospective double blind randomized study was carried out using 20 healthy males with anterior cruciate ligament (ACL) insufficiency undergoing bone-patellar tendon-bone ACL reconstruction. The subjects were randomized into either water or saline irrigation and then underwent identical reconstructive procedures using an arthroscopic pump. Continuous preoperative, intraoperative, and postoperative pressures were monitored using the slit catheter technique. Blood pressure and compartment pressure measurements were continuously recorded and noted at all stages of the procedure. Mean preoperative anterior and posterior compartment pressures were similar in both groups. No significant differences were noted between the anterior and posterior compartments of each group. No difference between water and saline irrigation was identified throughout the procedure. In both groups, postoperative pressures were slightly lower in the anterior and posterior compartments compared with preoperative pressures, but not significantly.

  3. All-Epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: A Surgical Technique Using a Split Tibial Tunnel

    PubMed Central

    Lykissas, Marios G.; Nathan, Senthil T.; Wall, Eric J.

    2012-01-01

    Many techniques have been described for anterior cruciate ligament (ACL) reconstruction in skeletally immature patients, including extra-articular, complete or partial transphyseal, and physeal-sparing techniques. An all-epiphyseal technique places the tendon and its tunnels and fixation all within the child's epiphysis, leaving the growth plates untouched. We describe an all-epiphyseal quadruple-hamstring ACL reconstruction using a split tibial tunnel. The split tibial tunnels drop the tunnel size down to 4.5 to 5.5 mm from 7 to 8 mm because only half the total graft diameter passes through each of the split tunnels. This increases the safety margin for keeping the tunnel within the tibial epiphysis, in addition to avoiding damage into the growth plate. The bone bridge between the 2 tunnels serves as a solid low-profile fixation post. Femoral graft fixation is achieved with an interference screw, which allows precise tensioning and low-profile fixation entirely within the femoral tunnel. By placing the graft at the native ACL's anatomic attachment points without spanning or violating the growth plates at any step of the procedure, an all-epiphyseal ACL reconstruction with a split tibial tunnel theoretically minimizes the risk of growth disturbance in an ACL-deficient child. PMID:23766968

  4. Pain and affective distress before and after ACL surgery: a comparison of amateur and professional male soccer players in the early postoperative period.

    PubMed

    Oztekin, Haluk H; Boya, Hakan; Ozcan, Ozal; Zeren, Bulent; Pinar, Pelin

    2008-10-01

    Pain thresholds and levels of distress before and in the early postoperative period after anterior cruciate ligament surgery were measured in professional and amateur male soccer players and compared. Between June 2005 and March 2007, 30 soccer players (10 amateur, 20 professional) with acute or chronic tears of the anterior cruciate ligament who were scheduled for a bone-tendon-bone ACL reconstruction procedure were enrolled in the study. Measures of pain intensity, depression and anxiety were assessed 1 day pre-operation and 1 week and 3 weeks post-operation (T1 T2 and T3). Pain was assessed using a visual analog scale (VAS), depression with the Beck Depression Inventory (BDI), and anxiety with both the state and trait forms of the State-Trait Anxiety Inventory (STAI). Scores on the VAS, BDI, and STAI in both groups were analyzed. The mean VAS scores at T1 and T2 in professional players were not significantly higher than those in amateur players (P>0.05). Professionals had significantly higher BDI scores at T1 and T2 (P<0.05), but this difference was not significant at T3 (P=0.12). High depression scores did not correlate with high pain scores. Pain scores between professional and amateur soccer players with ACL injuries were not significantly different pre-op or in the early post-op period. Depression was more common in professionals before and after their ACL surgery, but anxiety levels were not significantly different between the two groups.

  5. The Association Between Knee Confidence and Muscle Power, Hop Performance, and Postural Orientation in People With Anterior Cruciate Ligament Injury.

    PubMed

    Ageberg, Eva; Roos, Ewa M

    2016-06-01

    Study Design Cross-sectional. Background The association between muscle function and lack of knee confidence in people with anterior cruciate ligament (ACL) injury has not been well investigated. Such knowledge would help in the design of training programs for this population. Objective To investigate associations between self-reported knee confidence and muscle function in patients with ACL injury. Methods Cross-sectional data from 54 patients (mean age, 30 years; range, 20-39 years; 28% women) with ACL injury, treated with training and reconstructive surgery (n = 36) or training only (n = 18), were assessed 3 ± 1 years after injury. Univariate and multivariable ordinal regression analyses were conducted to test the association between the patient's knee confidence (question 3 from the Knee injury and Osteoarthritis Outcome Score as the dependent variable) and performance on tests of muscle power, hop performance, and postural orientation (test for substitution patterns score) as independent variables (absolute value on the injured leg, and limb symmetry index [LSI; injured leg/uninjured leg × 100] or absolute difference between the injured and uninjured legs). Results Sixteen patients reported no trouble with lack of knee confidence, 24 mild trouble, 10 moderate trouble, and 4 severe or extreme trouble. Univariate analyses revealed significant associations between worse knee confidence and lower (worse) LSIs for knee extension power, vertical jump, and side hop, and worse test for substitution patterns scores. In the multivariable analysis, worse vertical jump LSI (P = .043) and worse side hop LSI (P = .012) significantly accounted for 25% of the variation in perceived knee confidence. Conclusion Between-leg differences during demanding tasks are associated with knee confidence in individuals with ACL injury. J Orthop Sports Phys Ther 2016;46(6):477-482. Epub 26 Apr 2016. doi:10.2519/jospt.2016.6374.

  6. Patient Outcomes and Predictors of Success After Revision Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Johnson, William R.; Makani, Amun; Wall, Andrew J.; Hosseini, Ali; Hampilos, Perry; Li, Guoan; Gill, Thomas J.

    2015-01-01

    Background: Patient outcomes and predictors of success after revision anterior cruciate ligament (ACL) reconstruction are currently limited in the literature. Existing studies either have a small study size or are difficult to interpret because of the multiple surgeons involved in the care of the study sample. Purpose: To determine patient outcomes and predictors of success or failure after a single-stage revision ACL reconstruction by a single fellowship-trained senior surgeon at a single institution. Study Design: Case series; Level of evidence, 4. Methods: A total of 78 patients who underwent revision ACL reconstruction by a single surgeon from 2010 to 2014 were contacted and available for follow-up. The mean time from revision procedure to follow-up was 52 months. Those patients who were able to participate in the study sent in a completed Tegner activity level scale, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and IKDC Current Health Assessment Form. The patients’ medical records were also thoroughly reviewed. Results: Five patients had subsequent failure after revision surgery. The median Tegner score was 6 at follow-up, and the mean subjective IKDC score was 72.5. There was no statistically significant difference in outcome scores when comparing revision graft type, body mass index, sex, need for bone grafting, and time from failure to revision. Patients with failures after primary ACL reconstruction secondary to a traumatic event were found to have statistically significantly higher IKDC scores (mean, 76.6) after revision when compared with nontraumatic failures (mean, 67.1), even when controlling for confounders (P < .017). Conclusion: Revision ACL reconstruction is effective in improving patient activity levels and satisfaction. However, the subjective IKDC results are quite variable and likely based on multiple factors. Patients with traumatic injuries contributing to graft failure after primary ACL reconstruction

  7. A Comparative Animal Study of Tendon Grafts Healing After Remnant-Preserving Versus Conventional Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Zhang, Lei; Jiang, Kan; Chai, Hao; Zhou, Mei; Bai, Jingping

    2016-01-01

    Background The aim of this study was to determine if anterior cruciate ligament (ACL) reconstruction by remnant preservation promotes cell proliferation, vascularization, proprioception recovery, and improved biomechanical properties of the tendon grafts. Material/Methods 75 New Zealand rabbits were randomly assigned into the control group (group A), conventional ACL reconstruction group (group B), ACL reconstruction using remnant preservation and graft through remnant sleeve technique group (group C), and ACL reconstruction using remnant preservation and remnant tensioning technique group (group D). The remnant and healing of tendon grafts in groups C and D were observed at 3, 6, and 12 weeks after surgery, and the mRNA expression levels of VEGF, NT-3 and GAP-43 in ACL (group A) or tendon graft samples (groups B, C, and D) were determined by real-time PCR. Tendon graft cell count, microvessel density (MVD), and proprioceptors were determined by H&E staining, CD34, and S-100 immunohistochemical staining. The biomechanical properties of the tendon graft at week 12 in groups B, C, and D were examined by using a tensile strength test. Results Remnant and tendon grafts were not healed at 3, 6, and 12 weeks after the operation in groups C and D. VEGF, NT-3, and GAP-43 mRNA expressions in groups B, C, and D were higher than those in group A (P<0.05), but no significant difference was observed between groups B, C, and D (P>0.05). Furthermore, tendon graft cell count, MVD, proprioception, and biomechanical properties showed no significant differences (P>0.05) among groups B, C, and D at various time points. Conclusions There was no significant difference in cell proliferation, vascularization, proprioception recovery, or biomechanical properties of the tendon grafts between remnant-preserving and conventional ACL reconstruction methods. PMID:27669454

  8. The Mars Science Laboratory (MSL) Entry, Descent And Landing Instrumentation (MEDLI): Hardware Performance and Data Reconstruction

    NASA Technical Reports Server (NTRS)

    Little, Alan; Bose, Deepak; Karlgaard, Chris; Munk, Michelle; Kuhl, Chris; Schoenenberger, Mark; Antill, Chuck; Verhappen, Ron; Kutty, Prasad; White, Todd

    2013-01-01

    The Mars Science Laboratory (MSL) Entry, Descent and Landing Instrumentation (MEDLI) hardware was a first-of-its-kind sensor system that gathered temperature and pressure readings on the MSL heatshield during Mars entry on August 6, 2012. MEDLI began as challenging instrumentation problem, and has been a model of collaboration across multiple NASA organizations. After the culmination of almost 6 years of effort, the sensors performed extremely well, collecting data from before atmospheric interface through parachute deploy. This paper will summarize the history of the MEDLI project and hardware development, including key lessons learned that can apply to future instrumentation efforts. MEDLI returned an unprecedented amount of high-quality engineering data from a Mars entry vehicle. We will present the performance of the 3 sensor types: pressure, temperature, and isotherm tracking, as well as the performance of the custom-built sensor support electronics. A key component throughout the MEDLI project has been the ground testing and analysis effort required to understand the returned flight data. Although data analysis is ongoing through 2013, this paper will reveal some of the early findings on the aerothermodynamic environment that MSL encountered at Mars, the response of the heatshield material to that heating environment, and the aerodynamic performance of the entry vehicle. The MEDLI data results promise to challenge our engineering assumptions and revolutionize the way we account for margins in entry vehicle design.

  9. The influence of graft placement on clinical outcome in anterior cruciate ligament reconstruction

    PubMed Central

    PADUA, ROBERTO; ALVITI, FEDERICA; VENOSA, MICHELE; MAZZOLA, CARLO; PADUA, LUCA

    2016-01-01

    Purpose the aim of the present study was to investigate the influence of graft tunnel position on both clinical outcome and instrumental knee stability in patients submitted to arthroscopic ACL reconstruction using a bone-patellar tendon-bone (BPTB) graft. Methods thirty patients (24 men and 6 women) who underwent ACL reconstruction performed using an autologous bone-patellar tendon-bone graft were studied at a mean follow-up of 18 months. Clinical outcome was assessed on the basis of the Lysholm score, Tegner activity level, International Knee Documentation Committee (IKDC) subjective form and the Short Form-36. Clinical outcomes were correlated with both femoral and tibial tunnel placement measured on standard anteroposterior and lateral knee radiographs, in accordance with established guidelines. Results tibial tunnel position on the lateral view correlated significantly with both the IKDC subjective form (r = −0.72; p<0.05) and the Lysholm score (r=−0.73; p<0.05). Tibial tunnel position on the lateral view also correlated with stability measured using a KT-1000 arthrometer at 30N of force (r=0.57; p<0.05). No correlation was found between α angle and anteroposterior (AP) laxity measured by KT-1000 arthrometer. No significant correlation was found between femoral tunnel position (on either view) and Lysholm score, IKDC score and Tegner activity level. Similarly, no correlation was found between AP laxity measured by KT-1000 arthrometer and femoral tunnel position. Conclusions these results suggest that the more anterior the placement of the tibial tunnel, the better the clinical outcome will be. On the basis of literature data and our findings, we discuss the hypothesis that there exists a “correct area” for tunnel placement, making it possible to obtain the best results. Level of evidence Level IV, case series. PMID:27386442

  10. ACL injury in football: a literature overview of the prevention programs

    PubMed Central

    Bisciotti, Gian Nicola; Chamari, Karim; Cena, Emanuele; Carimati, Giulia; Volpi, Piero

    2016-01-01

    Summary Background The ACL prevention programs are addressed to the control and/or modification of the so-called “modifiable risk factors”. All these programs focus on different intervention strategies aimed to decrease the ACL injury risk, particularly in female athletes population. Purpose To furnish an overview of the most used ACL injury prevention program through a narrative review. Conclusion In literature there are many reports on prevention programs whose common denominator is the proper alignment of the lower limb joints and proper motor control during movements that are considered at risk for ACL integrity, as the landing phase after a jump. Nevertheless, some programs would appear more effective than others. In any cases a major problem remains the lack of sufficient compliance in respect of prevention programs. Finally, it is important to remember that the ethiology of ACL injuries is multifactorial. For this reason a prevention program able to prevent all the risk situations is utopian. Study design Narrative review. PMID:28217569

  11. Biomechanical regulation of type I collagen gene expression in ACLs in organ culture.

    PubMed

    Hsieh, Adam H; Sah, Robert L; Paul Sung, K L

    2002-03-01

    In this study, an ex vivo organ culture system that allows the application of controlled loads to the anterior cruciate ligament (ACL) was designed and used to characterize the influence of a step input in mechanical load on gene expression. A procedure for isolating bone-ACL-bone (B-ACL-B) complexes from rat knees was developed. After harvest and 24 hour culture, B-ACL-B complexes exhibited percentages of viability similar to that in intact ACLs (approximately 90%). Application of a physiologically relevant load of 5 N (superimposed on a I N tare load) resulted in changes in levels of mRNA encoding type I collagen. While levels of type I collagen mRNA significantly increased 32+/-13% (mean +/- standard errors of the mean (SEM)) over controls within the first hour of loading, levels decreased significantly to 44+/-9% of control after 2 h. Displacements induced by the 5 N load were measured by video dimensional analysis. Calculated axial strains of 0.141+/-0.034 were achieved rapidly during the first hour and remained essentially unchanged thereafter. These results demonstrate the feasibility of maintaining ligaments in organ culture and illustrate the time course expression of type I collagen following the application of a mechanical load.

  12. Negative feedback regulation of auxin signaling by ATHB8/ACL5-BUD2 transcription module.

    PubMed

    Baima, Simona; Forte, Valentina; Possenti, Marco; Peñalosa, Andrés; Leoni, Guido; Salvi, Sergio; Felici, Barbara; Ruberti, Ida; Morelli, Giorgio

    2014-06-01

    The role of auxin as main regulator of vascular differentiation is well established, and a direct correlation between the rate of xylem differentiation and the amount of auxin reaching the (pro)cambial cells has been proposed. It has been suggested that thermospermine produced by ACAULIS5 (ACL5) and bushy and dwarf2 (BUD2) is one of the factors downstream to auxin contributing to the regulation of this process in Arabidopsis. Here, we provide an in-depth characterization of the mechanism through which ACL5 modulates xylem differentiation. We show that an increased level of ACL5 slows down xylem differentiation by negatively affecting the expression of homeodomain-leucine zipper (HD-ZIP) III and key auxin signaling genes. This mechanism involves the positive regulation of thermospermine biosynthesis by the HD-ZIP III protein Arabidopsis thaliana homeobox8 tightly controlling the expression of ACL5 and BUD2. In addition, we show that the HD-ZIP III protein REVOLUTA contributes to the increased leaf vascularization and long hypocotyl phenotype of acl5 likely by a direct regulation of auxin signaling genes such as like auxin resistant2 (LAX2) and LAX3. We propose that proper formation and differentiation of xylem depend on a balance between positive and negative feedback loops operating through HD-ZIP III genes.

  13. 2011 Mars Science Laboratory Trajectory Reconstruction and Performance from Launch Through Landing

    NASA Technical Reports Server (NTRS)

    Abilleira, Fernando

    2013-01-01

    The Mars Science Laboratory (MSL) mission successfully launched on an Atlas V 541 Expendable Evolved Launch Vehicle (EELV) from the Eastern Test Range (ETR) at Cape Canaveral Air Force Station (CCAFS) in Florida at 15:02:00 UTC on November 26th, 2011. At 15:52:06 UTC, six minutes after the MSL spacecraft separated from the Centaur upper stage, the spacecraft transmitter was turned on and in less than 20 s spacecraft carrier lock was achieved at the Universal Space Network (USN) Dongara tracking station located in Western Australia. MSL, carrying the most sophisticated rover ever sent to Mars, entered the Martian atmosphere at 05:10:46 SpaceCraft Event Time (SCET) UTC, and landed inside Gale Crater at 05:17:57 SCET UTC on August 6th, 2012. Confirmation of nominal landing was received at the Deep Space Network (DSN) Canberra tracking station via the Mars Odyssey relay spacecraft at 05:31:45 Earth Received Time (ERT) UTC. This paper summarizes in detail the actual vs. predicted trajectory performance in terms of launch vehicle events, launch vehicle injection performance, actual DSN/USN spacecraft lockup, trajectory correction maneuver performance, Entry, Descent, and Landing events, and overall trajectory and geometry characteristics.

  14. WE-AB-204-01: Performance Characterization of Regularized-Reconstruction Algorithm for 90Y PET/CT Images

    SciTech Connect

    Siman, W; Kappadath, S; Mawlawi, O

    2015-06-15

    Purpose: {sup 90}Y PET/CT imaging and quantification have recently been suggested as an approach of treatment verification. However, due to low positron yield (32ppm), the {sup 90}Y-PET/CT images are very noisy. Iterative reconstruction techniques that employ regularization, e.g. block sequential regularized expectation maximization (BSREM) algorithm (recently implemented on GE scanners – QClear™), has the potential to increase quantitative accuracy with lower noise penalty compared to OSEM. Our aim is to investigate the performance of RR algorithms in {sup 90}Y PET/CT studies. Methods: A NEMA IEC phantom filled with 3GBq {sup 90}YCl{sub 2} (to simulate patient treatment) was imaged on GE-D690 for 1800s/bed. The sphere-to-background ratio of 7. The data were reconstructed using OSEM and BSREM with PSF modeling and TOF correction while varying the iterations (IT) from 1–6 with fixed 24subsets. For BSREM, the edge-preservation parameter (γ ) was 2 and the penalty-parameters (β) was varied 350–950. In all cases a post-reconstruction filter of 5.2mm (2pixel) transaxial and standard z-axis were used. Sphere average activity concentration (AC) and background standard deviation (SD) were then calculated from VOIs drawn in the spheres and background. Results: Increasing IT from 1to6, the %SD in OSEM increased from 30% to 80%, whereas %SD in BSREM images increased by <5% for all βs. BSREM with β=350 didn’t offer any improvement over OSEM (convergence of mean achieved at 2 IT, in this study). Increasing β from 350 to 950 reduced the AC accuracy of small spheres (<20mm) by 10% and noise from 40% to 20%, which resulted in CNR increase from 11 to 17. Conclusion: In count-limited studies such as {sup 90}Y PET/CT, BSREM can be used to suppress image noise and increase CNR at the expense of a relatively small decrease of quantitative accuracy. The BSREM parameters need to be optimized for each study depending on the radionuclides and count densities. Research

  15. The effects of femoral graft placement on cartilage thickness after anterior cruciate ligament reconstruction.

    PubMed

    Okafor, Eziamaka C; Utturkar, Gangadhar M; Widmyer, Margaret R; Abebe, Ermias S; Collins, Amber T; Taylor, Dean C; Spritzer, Charles E; Moorman, C T; Garrett, William E; DeFrate, Louis E

    2014-01-03

    Altered joint motion has been thought to be a contributing factor in the long-term development of osteoarthritis after ACL reconstruction. While many studies have quantified knee kinematics after ACL injury and reconstruction, there is limited in vivo data characterizing the effects of altered knee motion on cartilage thickness distributions. Thus, the objective of this study was to compare cartilage thickness distributions in two groups of patients with ACL reconstruction: one group in which subjects received a non-anatomic reconstruction that resulted in abnormal joint motion and another group in which subjects received an anatomically placed graft that more closely restored normal knee motion. Ten patients with anatomic graft placement (mean follow-up: 20 months) and 12 patients with non-anatomic graft placement (mean follow-up: 18 months) were scanned using high-resolution MR imaging. These images were used to generate 3D mesh models of both knees of each patient. The operative and contralateral knee models were registered to each other and a grid sampling system was used to make site-specific comparisons of cartilage thickness. Patients in the non-anatomic graft placement group demonstrated a significant decrease in cartilage thickness along the medial intercondylar notch in the operative knee relative to the intact knee (8%). In the anatomic graft placement group, no significant changes were observed. These findings suggest that restoring normal knee motion after ACL injury may help to slow the progression of degeneration. Therefore, graft placement may have important implications on the development of osteoarthritis after ACL reconstruction.

  16. Runx2-Modified Adipose-Derived Stem Cells Promote Tendon Graft Integration in Anterior Cruciate Ligament Reconstruction.

    PubMed

    Zhang, Xin; Ma, Yong; Fu, Xin; Liu, Qiang; Shao, Zhenxing; Dai, Linghui; Pi, Yanbin; Hu, Xiaoqing; Zhang, Jiying; Duan, Xiaoning; Chen, Wenqing; Chen, Ping; Zhou, Chunyan; Ao, Yingfang

    2016-01-08

    Runx2 is a powerful osteo-inductive factor and adipose-derived stem cells (ADSCs) are multipotent. However, it is unknown whether Runx2-overexpressing ADSCs (Runx2-ADSCs) could promote anterior cruciate ligament (ACL) reconstruction. We evaluated the effect of Runx2-ADSCs on ACL reconstruction in vitro and in vivo. mRNA expressions of osteocalcin (OCN), bone sialoprotein (BSP) and collagen I (COLI) increased over time in Runx2-ADSCs. Runx2 overexpression inhibited LPL and PPARγ mRNA expressions. Runx2 induced alkaline phosphatase activity markedly. In nude mice injected with Runx2-ADSCs, promoted bone formation was detected by X-rays 8 weeks after injection. The healing of tendon-to-bone in a rabbit model of ACL reconstruction treated with Runx2-ADSCs, fibrin glue only and an RNAi targeting Runx2, was evaluated with CT 3D reconstruction, histological analysis and biomechanical methods. CT showed a greater degree of new bone formation around the bone tunnel in the group treated with Runx2-ADSCs compared with the fibrin glue group and RNAi Runx2 group. Histology showed that treatment with Runx2-ADSCs led to a rapid and significant increase at the tendon-to-bone compared with the control groups. Biomechanical tests demonstrated higher tendon pullout strength in the Runx2-ADSCs group at early time points. The healing of the attachment in ACL reconstruction was enhanced by Runx2-ADSCs.

  17. Performance of a MEMS-based AO-OCT system using Fourier Reconstruction

    SciTech Connect

    Evans, J; Zawadzki, R; Jones, S; Olivier, S; Werner, J S

    2009-01-21

    Adaptive optics (AO) and optical coherence tomography (OCT) are powerful imaging modalities that, when combined, can provide high-resolution (3.5 {micro}m isotropic), 3-D images of the retina. The AO-OCT system at UC Davis has demonstrated the utility of this technology for microscopic, volumetric, in vivo retinal imaging. The current system uses an AOptix bimorph deformable mirror (DM) for low-order, high-stroke correction and a 140-actuator Boston Micromachines DM for high-order correction. Developments to improve performance or functionality of the instrument are on-going. Based on previous work in system characterization we have focused on improved AO control. We present preliminary results and remaining challenges for a newly implemented Fourier transform reconstructor (FTR). The previously reported error budget analysis is also reviewed and updated, with consideration of how to improve both the amount of residual error and the robustness of the system. Careful characterization of the AO system will lead to improved performance and inform the design of future systems.

  18. Depression and psychiatric disease associated with outcomes after anterior cruciate ligament reconstru