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Sample records for acl reconstruction technique

  1. 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.

  2. Evidence-Based ACL Reconstruction

    PubMed Central

    Rodriguez-Merchan, E. Carlos

    2015-01-01

    There is controversy in the literature regarding a number of topics related to anterior cruciate ligament (ACL) reconstruction. The purpose of this article is to answer the following questions: 1) Bone-patellar tendon-bone reconstruction (BPTB-R) or hamstrimg reconstruction (H-R); 2) Double bundle or single bundle; 3) Allograft or authograft; 4) Early or late reconstruction; 5) Rate of return to sports after ACL reconstruction; 6) Rate of osteoarthritis after ACL reconstruction. A Cochrane Library and PubMed (MEDLINE) search of systematic reviews and meta-analysis related to ACL reconstruction was performed. The key words were: ACL reconstruction, systematic reviews and meta-analysis. The main criteria for selection were that the articles were systematic reviews and meta-analyses focused on the aforementioned questions. Sixty-nine articles were found, but only 26 were selected and reviewed because they had a high grade (I-II) of evidence. BPTB-R was associated with better postoperative knee stability but with a higher rate of morbidity. However, the results of both procedures in terms of functional outcome in the long-term were similar. The double-bundle ACL reconstruction technique showed better outcomes in rotational laxity, although functional recovery was similar between single-bundle and double-bundle. Autograft yielded better results than allograft. There was no difference between early and delayed reconstruction. 82% of patients were able to return to some kind of sport participation. 28% of patients presented radiological signs of osteoarthritis with a follow-up of minimum 10 years. PMID:25692162

  3. Evidence-Based ACL Reconstruction.

    PubMed

    Rodriguez-Merchan, E Carlos

    2015-01-01

    There is controversy in the literature regarding a number of topics related to anterior cruciate ligament (ACL) reconstruction. The purpose of this article is to answer the following questions: 1) Bone-patellar tendon-bone reconstruction (BPTB-R) or hamstrimg reconstruction (H-R); 2) Double bundle or single bundle; 3) Allograft or authograft; 4) Early or late reconstruction; 5) Rate of return to sports after ACL reconstruction; 6) Rate of osteoarthritis after ACL reconstruction. A Cochrane Library and PubMed (MEDLINE) search of systematic reviews and meta-analysis related to ACL reconstruction was performed. The key words were: ACL reconstruction, systematic reviews and meta-analysis. The main criteria for selection were that the articles were systematic reviews and meta-analyses focused on the aforementioned questions. Sixty-nine articles were found, but only 26 were selected and reviewed because they had a high grade (I-II) of evidence. BPTB-R was associated with better postoperative knee stability but with a higher rate of morbidity. However, the results of both procedures in terms of functional outcome in the long-term were similar. The double-bundle ACL reconstruction technique showed better outcomes in rotational laxity, although functional recovery was similar between single-bundle and double-bundle. Autograft yielded better results than allograft. There was no difference between early and delayed reconstruction. 82% of patients were able to return to some kind of sport participation. 28% of patients presented radiological signs of osteoarthritis with a follow-up of minimum 10 years. PMID:25692162

  4. Gait analysis in patients undergoing ACL reconstruction according to Kenneth Jones' technique.

    PubMed

    Bacchini, Massimo; Cademartiri, Carola; Soncini, Giovanni

    2009-08-01

    The anterior cruciate ligament is essential for knee stability, and its injury, both acute and in the case of chronic knee instability, promotes meniscal degenerative alterations, as well as the onset and progression of gonarthrosis. In this retrospective study, young adults engaged in nonprofessional sportive activities undergoing ACL reconstruction by the Kenneth-Jones technique were assessed clinically and with gait analysis, to detect any deficits persisting even after rehabilitation at a follow- up of approximately 6 months. Eight patients who had undergone elective ligament reconstruction by Kenneth-Jones were assessed between the 5th and 7th month postsurgery with clinical-anamnestic investigation, including the Hughston Clinic subjective knee questionnaire and by gait analysis with the EL.I.Te. system. Gait analysis showed a reduction of ACL protection mechanisms during initial stance; furthermore, the operated limb globally exhibited greater difficulty in muscle recruitment. Residual deficits in muscle recruitment, exposing the reconstructed ligament to possible injuries, persist after a rehabilitation program and after resuming ofpre-surgery activities, thus adjustment of the rehabilitative program on the basis of these findings is recommended.

  5. Predicting success in ACL reconstruction.

    PubMed

    Shalvoy, Robert M

    2014-11-03

    Anterior Cruciate Ligament (ACL) injury and ACL reconstruction is common in the United States. However, when compared to the standards of other orthopedics procedures today, ACL reconstruction is NOT predictably successful in restoring patients to their pre-injury state. Only 60-70% of reconstructed patients resume their previous level of activity and many patients experience some degree of osteoarthritis. The reasons for such limitations of success are many. A recent renewal of interest in the many variables affecting ACL reconstruction and the understanding of the varying needs of patients with ACL injury holds promise for improving success even today as well as ultimately providing a normal knee for patients after ACL reconstruction.

  6. Graft Diameter matters in Hamstring ACL reconstruction

    PubMed Central

    Clatworthy, Mark

    2016-01-01

    Objective: Recently techniques have been developed to increase graft diameter in hamstring ACL reconstruction with the hope to decrease graft failure. To date there is limited evidence to show that a smaller graft diameter results in a higher ACL failure rate. Method: The factors for failure in 1480 consecutive single surgeon hamstring ACL reconstructions were evaluated prospectively. Patients were followed for 2-15 years. A multivariate analysis was performed which looked at graft size, age, sex, time to surgery, meniscal integrity, meniscal repair and ACL graft placement to determine whether graft diameter matters in determining the failure of hamstring ACL reconstruction. Results: Graft diameters ranged from 6-10 mm. The mean graft diameter for all patients was 7.75 mm. 83 ACL reconstructions failed. The mean size of graft failures was 7.55 mm ACL reconstructions that failed had a significantly smaller hamstring graft diameter p=0.001. The Hazard Ratio for a smaller diameter graft is 0.517 p=<0.0001. For every 1 mm decrease in graft diameter there is a 48.3% higher chance of failure. The multivariate analysis showed a hazard ratio of 0.543 p=0.002. For every 1 mm decrease in graft diameter there is a 45.7% higher chance of failure. Conclusion: Smaller diameter hamstring grafts do have a higher failure rate. Grafts ≤ 7.5 mm had twice the failure rate of grafts ≥8 mm using a multivariate analysis for every 1 mm decrease in graft diameter there is a 45.7% higher chance of failure.

  7. PRP Augmentation for ACL Reconstruction.

    PubMed

    Andriolo, Luca; Di Matteo, Berardo; Kon, Elizaveta; Filardo, Giuseppe; Venieri, Giulia; Marcacci, Maurilio

    2015-01-01

    Current research is investigating new methods to enhance tissue healing to speed up recovery time and decrease the risk of failure in Anterior Cruciate Ligament (ACL) reconstructive surgery. Biological augmentation is one of the most exploited strategies, in particular the application of Platelet Rich Plasma (PRP). Aim of the present paper is to systematically review all the preclinical and clinical papers dealing with the application of PRP as a biological enhancer during ACL reconstructive surgery. Thirty-two studies were included in the present review. The analysis of the preclinical evidence revealed that PRP was able to improve the healing potential of the tendinous graft both in terms of histological and biomechanical performance. Looking at the available clinical evidence, results were not univocal. PRP administration proved to be a safe procedure and there were some evidences that it could favor the donor site healing in case of ACL reconstruction with patellar tendon graft and positively contribute to graft maturation over time, whereas the majority of the papers did not show beneficial effects in terms of bony tunnels/graft area integration. Furthermore, PRP augmentation did not provide superior functional results at short term evaluation. PMID:26064903

  8. 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

  9. Maximizing quadriceps strength after ACL reconstruction.

    PubMed

    Palmieri-Smith, Riann M; Thomas, Abbey C; Wojtys, Edward M

    2008-07-01

    The primary objectives of ACL surgery and rehabilitation are to restore knee function to preinjury levels and promote long-term joint health. Often these goals are not achieved, however. The quadriceps is critical to dynamic joint stability, and weakness of this muscle group is related to poor functional outcomes. Because of this, identifying strategies to minimize quadriceps weakness following ACL injury and reconstruction is of great clinical interest. This article reviews the current literature and critically discusses current rehabilitation approaches to restore quadriceps muscle function after ACL reconstruction.

  10. Knee stability, athletic performance and sport-specific tasks in non-professional soccer players after ACL reconstruction: comparing trans-tibial and antero-medial portal techniques

    PubMed Central

    Tudisco, Cosimo; Bisicchia, Salvatore; Cosentino, Andrea; Chiozzi, Federica; Piva, Massimo

    2015-01-01

    Summary Background a wrong position of bone tunnels, in particular on the femur, is one of the most frequent causes of a failed anterior cruciate ligament (ACL) reconstruction. Several studies demonstrated that drilling the femoral tunnel through the antero-medial portal (AMP) allows a more anatomical placement on the lateral femoral condyle and higher knee stability, compared to trans-tibial (TT) technique. The aim of this study was to retrospectively evaluate two groups of soccer players operated on for ACL reconstruction according to either one of these two techniques. Methods two groups of non-professional soccer players operated on for a single bundle ACL reconstruction with hamstrings autograft using either a TT (20 patients) or an AMP (23 patients) technique were retrospectively evaluated with KT-1000 arthrometer, manual pivot shift test, isokinetic test, the incremental treadmill-running test, athletic and sport specific tasks, and knee scores (IKDC, Lysholm and KOOS). Results the AMP group showed better results at pivot shift test and KOOS, but lower flexion angles at single leg squat test. There were no differences in all the other considered outcomes. Conclusions the better rotational stability of the knee achieved in AMP group did not lead to significantly better clinical and functional results in our patients. Level of evidence III. Treatment study Case-control study. PMID:26605191

  11. Abnormal landing strategies after ACL reconstruction.

    PubMed

    Gokeler, A; Hof, A L; Arnold, M P; Dijkstra, P U; Postema, K; Otten, E

    2010-02-01

    The objective was to analyze muscle activity and movement patterns during landing of a single leg hop for distance after anterior cruciate ligament (ACL) reconstruction. Nine (six males, three females) ACL-reconstructed patients 6 months after surgery and 11 (eight males, three females) healthy control subjects performed the hop task. Electromyographic signals from lower limb muscles were analyzed to determine onset time before landing. Biomechanical data were collected using an Optotrak Motion Analysis System and force plate. Matlab was used to calculate kinetics and joint kinematics. Side-to-side differences in ACL-reconstructed patients and healthy subjects as well as differences between the patients and control group were analyzed. In ACL-reconstructed limbs, significantly earlier onset times were found for all muscles, except vastus medialis, compared with the uninvolved side. The involved limbs had significantly reduced knee flexion during the take-off and increased plantarflexion at initial contact. The knee extension moment was significantly lower in the involved limb. In the control group, significantly earlier onset times were found for the semitendinosus, vastus lateralis and medial gastrocnemius of the non-dominant side compared with the dominant side. Muscle onset times are earlier and movement patterns are altered in the involved limb 6 months after ACL reconstruction.

  12. ACL mismatch reconstructions: influence of different tunnel placement strategies in single-bundle ACL reconstructions on the knee kinematics.

    PubMed

    Herbort, Mirco; Lenschow, Simon; Fu, Freddie H; Petersen, Wolf; Zantop, Thore

    2010-11-01

    To evaluate the influence of tibial and femoral tunnel position in ACL reconstruction on knee kinematics, we compared ACL reconstruction with a tibial and femoral tunnel in anteromedial (AM-AM reconstruction) and in posterolateral footprint (PL-PL reconstruction) with a reconstruction technique with tibial posterolateral and femoral anteromedial tunnel placement (PL-AM reconstruction). In 9 fresh-frozen human cadaveric knees, the knee kinematics under simulated Lachman (134 N anterior tibial load) and a simulated pivot shift test (10 N/m valgus and 4 N/m internal tibial torque) were determined at 0°, 30°, 60°, and 90° of flexion. Kinematics were recorded for intact, ACL-deficient, and single-bundle ACL reconstructed knees using three different reconstruction strategies in randomized order: (1) PL-AM, (2) AM-AM and (3) PL-PL reconstructions. Under simulated Lachman test, single-bundle PL-AM reconstruction and PL-PL reconstructions both showed significantly increased anterior tibial translation (ATT) at 60° and 90° when compared to the intact knee. At all flexion angles, AM-AM reconstruction did not show any statistical significant differences in ATT compared to the intact knee. Under simulated pivot shift, PL-AM reconstruction resulted in significantly higher ATT at 0°, 30°, and 60° knee flexion and AM-AM reconstructions showed significantly higher ATT at 30° compared to the intact knee. PL-PL reconstructions did not show any significant differences to the intact knee. AM-AM reconstructions restore the intact knee kinematics more closely when compared to a PL-AM technique resembling a transtibial approach. PL-PL reconstructions showed increased ATT at higher flexion angles, however, secured the rotational stability at all flexion angles. Due to the independent tibial and femoral tunnel location, a medial portal technique may be superior to a transtibial approach. PMID:20461359

  13. NFL Combine Athletic Performance after ACL Reconstruction

    PubMed Central

    Marshall, Nathan E.; Keller, Robert A.; Mehran, Nima; Austin, William; Moutzouros, Vasilios

    2016-01-01

    Objectives: The purpose of this study was to determine the functional performance of NFL combine participants after ACL reconstruction compared with an age-, size-, and position-matched control group. The hypothesis was that there would be no difference between players after ACL reconstruction as compared with controls in functional athletic performance. Methods: A total of 98 NFL-caliber athletes who had undergone primary ACL reconstruction and participated in the NFL scouting combine between 2010 and 2014 were reviewed and compared with an age-, size-, and position-matched control group. Data recorded for each player included a 40-yard dash, vertical leap, broad jump, shuttle drill, and 3-cone drill. Results: With regard to speed and acceleration, the mean 40-yard dash time for ACL-reconstructed players was 4.74 seconds (range, 4.33-5.55 seconds) compared with controls at 4.74 seconds (range, 4.34-5.38 seconds; P = .96). Jumping performance was also similar, with a mean vertical leap for ACL-reconstructed players of 33.35 inches (range, 23-43 inches) and broad jump of 113.9 inches (range, 96-136 inches) compared with respective values for the controls of 33.22 inches (range, 23.5-43.5 inches; P = .84) and 113.9 inches (range, 92-134 inches; P = .99). Agility and quickness testing measures also did not show a statistically significantly difference, with ACL-reconstructed players performing the shuttle drill in 4.37 seconds (range, 4.02-4.84 seconds) and the 3-cone drill in 7.16 seconds (range, 6.45-8.14 seconds), respectively, compared with respective times for the controls of 4.37 seconds (range, 3.96-5.00 seconds; P = .91) and 7.18 seconds (range, 6.64-8.24 seconds; P = .75). Conclusion: This study suggests that after ACL reconstruction, high-caliber athletes can achieve equivalent levels of perfor- mance with no statistically significant differences compared with matched controls. This information is unique when advising high-level athletes on athletic

  14. Over the top or endobutton for ACL reconstruction?

    PubMed

    Verdano, Michele Arcangelo; Pedrabissi, Bianca; Lunini, Enricomaria; Pellegrini, Andrea; Ceccarelli, Francesco

    2012-08-01

    There are an estimated 80-100,000 ACL repairs in the US each year: most ACL tears occurs from noncontact injuries. The 3.9% of the knee ligament injuries undergoes surgery: in the 80% of these patients, this means ACL reconstruction. The purpose of this study is to compare two surgical techniques normally used for acl recustruction; the first one is the intra- extra articular technique with single bundle fixed with staples and the second one is the intra-articular technique with double bundle and endobutton post-fixation. We evaluate the clinical outcome of our patients at the time of 4 years follow up. From January 2006 to April 2009 40 patients underwent to ACL reconstruction, all operated by using hamstring tendons: 20 patients with an average age of 28,75 years (12 men and 8 women) underwent surgery using the intra-extra articular technique, whereas the remaining 20 patients with an average age of 34,5 years (11 men and 9 women) benefited the intra-articular technique with double bundle ligament and endobutton post-fixation. Our study shows no substancial difference between these'two technique, but clinical outcome measures (I.K.D.C., Lysholm and Tegner) estimated better results for the double bundle technique with Endobutton post-fixation. (www.actabiomedica.it).

  15. Femoral tunnel malposition in ACL revision reconstruction.

    PubMed

    Morgan, Joseph A; Dahm, Diane; Levy, Bruce; Stuart, Michael J

    2012-11-01

    The Multicenter Anterior Cruciate Ligament (ACL) Revision Study (MARS) group was formed to study a large cohort of revision ACL reconstruction patients. The purpose of this subset analysis study of the MARS database is to describe specific details of femoral tunnel malposition and subsequent management strategies that surgeons chose in the revision setting. The design of this study is a case series. The multicenter MARS database is compiled from a questionnaire regarding 460 ACL reconstruction revision cases returned by 87 surgeons. This subset analysis described technical aspects and operative findings in specifically those cases in which femoral tunnel malposition was cited as the cause of primary ACL reconstruction failure. Of the 460 revisions included for study, 276 (60%) cases cited a specific "technical cause of failure." Femoral tunnel malposition was cited in 219 (47.6%) of 460 cases. Femoral tunnel malposition was cited as the only cause of failure in 117 cases (25.4%). Surgeons judged the femoral tunnel too vertical in 42 cases (35.9%), too anterior in 35 cases (29.9%), and too vertical and anterior in 31 cases (26.5%). Revision reconstruction involved the drilling of an entirely new femoral tunnel in 91 cases (82.1%). For primary reconstruction, autograft tissue was used in 82 cases (70.1%). For revision reconstruction, autograft tissue was used in 61 cases (52.1%) and allograft tissue in 56 cases (47.9%). Femoral tunnel malposition in primary ACL reconstruction was the most commonly cited reason for graft failure in this cohort. Graft selection is widely variable among surgeons.

  16. Femoral Tunnel Malposition in ACL Revision Reconstruction

    PubMed Central

    Morgan, Joseph A.; Dahm, Diane; Levy, Bruce; Stuart, Michael J.

    2013-01-01

    The Multicenter Anterior Cruciate Ligament (ACL) Revision Study (MARS) group was formed to study a large cohort of revision ACL reconstruction patients. The purpose of this subset analysis study of the MARS database is to describe specific details of femoral tunnel malposition and subsequent management strategies that surgeons chose in the revision setting. The design of this study is a case series. The multicenter MARS database is compiled from a questionnaire regarding 460 ACL reconstruction revision cases returned by 87 surgeons. This subset analysis described technical aspects and operative findings in specifically those cases in which femoral tunnel malposition was cited as the cause of primary ACL reconstruction failure. Of the 460 revisions included for study, 276 (60%) cases cited a specific “technical cause of failure.” Femoral tunnel malposition was cited in 219 (47.6%) of 460 cases. Femoral tunnel malposition was cited as the only cause of failure in 117 cases (25.4%). Surgeons judged the femoral tunnel too vertical in 42 cases (35.9%), too anterior in 35 cases (29.9%), and too vertical and anterior in 31 cases (26.5%). Revision reconstruction involved the drilling of an entirely new femoral tunnel in 91 cases (82.1%). For primary reconstruction, autograft tissue was used in 82 cases (70.1%). For revision reconstruction, autograft tissue was used in 61 cases (52.1%) and allograft tissue in 56 cases (47.9%). Femoral tunnel malposition in primary ACL reconstruction was the most commonly cited reason for graft failure in this cohort. Graft selection is widely variable among surgeons. PMID:23150344

  17. 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

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

    PubMed

    Alentorn-Geli, Eduard; Samitier, Gonzalo; Alvarez, Pedro; Steinbacher, Gilbert; Cugat, Ramón

    2010-06-01

    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

  19. Risk Factors and Predictors Of Subsequent ACL Injury After ACL Reconstruction: Prospective Analysis Of 2801 Primary ACL Reconstructions

    PubMed Central

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

    2014-01-01

    Objectives: Retear of an ACL after an ACL reconstruction (ACLR) is devastating for all involved. Understanding risk factors and predictors of subsequent ACL tear after an ACLR is vital for patient education of subsequent risk of injury and if a predictor is modifiable, to make adjustments to minimize the risk of repeat ACL tear. The objectives of this study were 1) to identify the risk factors and predictors for ispilateral and contralateral ACL tears after primary ACLR and 2) to compare retear risk between the 2002/03 and 2007/08 cohorts. This is the largest and most comprehensive prospective analysis of this kind in the literature. Methods: Data from the 2002-2008 MOON database was used to identify risk factors for ACL retear. Subjects who had a primary ACLR with no history of contralateral knee surgery and had 2 year follow-up data were included. Subjects who had multiligament surgery were excluded. Graft type (auto-BTB, auto-hamstring, allograft), age, Marx score at time of index surgery, sport played post ACLR, sex, smoking status, lateral meniscus tear at the time of ACLR, medial meniscus tear at the time of ACLR, BMI, and MOON site were evaluated to determine their contribution to both ipsilateral retear and contralateral ACL tear. The analysis was repeated using the 2002/3 and 2007/8 cohort and included age, graft, sex, and Marx. An ANOVA with post-hoc analysis was performed to detect significant differences in age and Marx score by graft type over time. Results: A total of 2801 subjects met all inclusion/exclusion criteria. There were 165/2801 (5.89%) ipsilateral and 177/2801 (6.32%) contralateral ACL tears identified in the cohort at the two year follow-up. The odds of ipsilateral retear are 1.68 times greater for hamstring autograft (p=0.04) and 4.67 times greater for an allograft (p<0.001) compared to auto-BTB. The odds of ipsilateral retear decrease by 8% for every yearly increase in age (p < 0.001) and increases by 6% for every increased point on the

  20. Update on rehabilitation following ACL reconstruction

    PubMed Central

    Nyland, John; Brand, Emily; Fisher, Brent

    2010-01-01

    As anterior cruciate ligament (ACL) reconstruction has evolved to less invasive, more anatomical approaches, rehabilitation of the injured athlete has likewise become more progressive and innovative, with a sound understanding of graft and fixation strength and biologic healing-remodeling constraints. This review discusses these innovations including specific considerations before surgery, when planning rehabilitation timetables, and the importance of reestablishing nonimpaired active and passive knee range of motion and biarticular musculotendinous extensibility in positions of function. Concepts of self-efficacy or confidence and reestablishing the “athlete role” are also addressed. Since ACL injury and reinjury are largely related to the influence of structure-form-function on dynamic knee joint stability, the interrelationships between sensorimotor, neuromuscular, and conventional resistance training are also discussed. Although pivot shift “giving way” relates to function loss following ACL injury, anterior translational laxity often does not. Although there is growing evidence that progressive eccentric training may benefit the patient following ACL reconstruction, there is less evidence supporting the use of functional ACL knee braces. Of considerable importance is selecting and achieving a criteria-based progression to sports-specific training, reestablishing osseous homeostasis and improved bone density, blending open and closed kinetic chain exercises at the appropriate time period, and appreciating the influence of the trunk, upper extremities, and sports equipment use on knee loads. We believe that knee dysfunction and functional recovery should be considered from a local, regional, and global perspective. These concepts are consolidated into our approach to prepare patients for return to play including field testing and maintenance training. PMID:24198553

  1. ACL Reconstruction With Autografts Weighing Performance Considerations and Postoperative Care.

    PubMed

    Grant, John A; Mohtadi, Nicholas G

    2003-04-01

    Anterior cruciate ligament (ACL) reconstruction is the treatment of choice for patients who experience episodes of instability and a decreased quality of life after ACL rupture. The bone-patellar tendon-bone and hamstring autografts are the current standards for ACL reconstruction. Primary care physicians, especially sports medicine clinicians, are the first-line providers of nonoperative care for patients who have ACL injuries. Care providers need to know the biologic and biomechanic properties of these grafts, clinical indications for each graft, and rehabilitation considerations to appropriately counsel their patients. PMID:20086463

  2. Rehabilitation Predictors of Clinical Outcome following Revision ACL Reconstruction

    PubMed Central

    Wright, Rick W.; Group, Mars

    2016-01-01

    Objectives: Revision ACL reconstruction has been documented to have worse outcomes compared with primary ACL reconstructions. The reasons why remain unknown. The purpose of this study was to determine whether rehabilitation-related factors prescribed at the time of ACL revision reconstruction significantly influence two year outcomes, as well as the incidence of incurring a subsequent re-operation. Our hypothesis was that immediate versus passive, active range of motion (ROM) and weightbearing will result in improved outcomes without incidence of subsequent surgery. Use of postoperative and functional return to sport braces will not improve return to sports function. Methods: Revision ACL reconstruction patients were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, surgical technique and pathology, prescribed post-op and rehabilitation instructions (ie. timing of weightbearing, timing of passive and active ROM, use of postoperative and return to sport braces) and a series of validated patient reported outcome instruments (IKDC, KOOS, and Marx activity rating score). Patients were followed up for 2 years, and asked to complete the identical set of outcome instruments. Because meniscal repair, meniscal transplants, HTOs, concurrent ligamentous reconstructions, and certain chondral treatments (ie. microfracture, abrasion arthroplasty, mosiacplasty, etc) are known to affect prescribed rehab treatments, patients with these pathologies were excluded from the analyses. Regression analysis was used to control for age, gender, activity level, baseline outcome scores, and the above-mentioned rehabilitation-related variables, in order to assess the risk factors for clinical outcomes 2 years after revision ACL reconstruction. Results: A total of 843 patients met the inclusion criteria and were successfully enrolled. 482 (57%) were males, with a median cohort age of 27 years. Baseline characteristics of the cohort are

  3. ACL reconstruction: patellar tendon versus hamstring grafts--economical aspects.

    PubMed

    Forssblad, Magnus; Valentin, Anders; Engström, Björn; Werner, Suzanne

    2006-06-01

    The aim of the present investigation was to compare the costs for the use of patellar tendon versus hamstring tendons as grafts for anterior cruciate ligament (ACL) reconstruction including the different fixation methods. The background is that during recent years there has been a dramatic shift from patellar tendon to hamstring tendons in ACL reconstructions in Sweden. All our patients with ACL reconstructions performed during 1 year (2004) were included. Knee joints numbering 440 in 439 patients were primary ACL reconstructions. A hamstring graft was used in 345 knee joints (78.4%) and a patellar tendon graft in 95 (21.6%) of the patients (Table 2). On average 34 (SD 12.9; range 14-63) ACL reconstructions per surgeon were performed by a total of 14 surgeons. The average cost for patellar tendon procedure was 197 euros compared to 436 euros for the hamstring procedure. Mean time for surgery in primary reconstructions was 11.5 min shorter (P<0.001) for patellar tendon reconstructions (71.3+/-31 min) compared to hamstring reconstructions (83.2+/-27 min). This means a difference in cost of 90 euros. The total additional cost (fixation and surgery time) for the hamstring method compared to the patellar tendon method was on an average 329 euros. From a strict economic point of view we therefore recommend or at least consider the use of the patellar tendon as a graft in ACL reconstructions. PMID:16570193

  4. 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

  5. Cross-exercise on quadriceps deficit after ACL reconstruction.

    PubMed

    Papandreou, Maria; Billis, Evdokia; Papathanasiou, George; Spyropoulos, Panagiotis; Papaioannou, Nikos

    2013-02-01

    A few studies concerning the improvement of quadriceps muscle strength deficit (QD) at an early stage following anterior cruciate ligament (ACL) reconstruction have been conducted whereas, ACL rehabilitation protocols based on contralateral quadriceps strength (QS) do not exist. Given these, the goals of our study were (1) to evaluate the effects of cross-eccentric exercise (CEE) on QD on ACL reconstructed knees, and (2) to explore any changes in QD following CEE provided at the frequencies of 3 or 5 times per week. For this study, 42 ACL-reconstructed patients were randomly assigned into 3 groups, two experimental and one control and followed an 8-week rehabilitation program. Additionally, the experimental groups received CEE for 3 and 5 days per week for 8 weeks in their uninjured knees. QS was evaluated with an isokinetic/isometric test, at 60 degrees of knee flexion of both limbs before and after completion of CEE. Two-factor ANOVA showed a significant improvement of QD between groups (F = 5.16, p = 0.01) after CEE completion on ACL reconstructed knees. Statistically significant results arose from the 3 days per week (D = 18.60, p = 0.01) and 5 days per week (D = 15.12, p = 0.04) experimental groups, whereas the control group did not yield any statistically significant differences. CEE used as an adjunct to the ACL traditional rehabilitation program at the weekly frequencies of 3 and 5 times at the early stage of reconstruction significantly improved QD.

  6. Stability Outcomes following Computer-Assisted ACL Reconstruction

    PubMed Central

    Christino, Melissa A.; Vopat, Bryan G.; Matson, Andrew P.; Reinert, Steven E.; Shalvoy, Robert M.

    2015-01-01

    Purpose. The purpose of this study was to determine whether intraoperative prereconstruction stability measurements and/or patient characteristics were associated with final knee stability after computer-assisted ACL reconstruction. Methods. This was a retrospective review of all patients who underwent computer-assisted single-bundle ACL reconstruction by a single surgeon. Prereconstruction intraoperative stability measurements were correlated with patient characteristics and postreconstruction stability measurements. 143 patients were included (87 male and 56 female). Average age was 29.8 years (SD ± 11.8). Results. Females were found to have significantly more pre- and postreconstruction internal rotation than males (P < 0.001 and P = 0.001, resp.). Patients with additional intra-articular injuries demonstrated more prereconstruction anterior instability than patients with isolated ACL tears (P < 0.001). After reconstruction, these patients also had higher residual anterior translation (P = 0.01). Among all patients with ACL reconstructions, the percent of correction of anterior translation was found to be significantly higher than the percent of correction for internal or external rotation (P < 0.001). Conclusion. Anterior translation was corrected the most using a single-bundle ACL reconstruction. Females had higher pre- and postoperative internal rotation. Patients with additional injuries had greater original anterior translation and less operative correction of anterior translation compared to patients with isolated ACL tears. PMID:25883804

  7. 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

  8. 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.

  9. Precision of ACL tunnel placement using traditional and robotic techniques.

    PubMed

    Burkart, A; Debski, R E; McMahon, P J; Rudy, T; Fu, F H; Musahl, V; van Scyoc, A; Woo, S L

    2001-01-01

    The objective of this study was to examine the precision of ACL tunnel placement using: (1) CASPAR (orto MAQUET GmbH Co. KG)--an active robotic system, and (2) four orthopedic surgeons with various levels of experience (between 100 and 3,500 ACL reconstructions). The robotic system and each surgeon drilled tunnels for ACL reconstruction in 10 plastic knees (total n = 50) that included a reference cube in the medial aspect of the proximal tibia and distal femur. For the robotic system, the placement of each tunnel was planned preoperatively using custom software and CT data for each femur and tibia. The robotic system then drilled the tunnels in the femur and tibia based on the preoperative plan. For the surgeons, tunnel placement was accomplished using their preferred technique, which was based on the one-incision arthroscopic technique. The distribution of intra-articular points on the tibia was contained within a sphere of radius 2.0 mm (robot system), 2.1 mm (Fellow 1), 2.4 mm (Fellow 2), 3.4 mm (Experienced Surgeon 1), or 2.0 mm (Experienced Surgeon 2). On the femur, no significant differences in the distribution of intra-articular points could be demonstrated between the robotic system (2.1 mm), Fellow 1 (4.5 mm), Fellow 2 (4.1 mm), Experienced Surgeon 1 (2.3 mm), and Experienced Surgeon 2 (3.0 mm). The direction of the tunnels drilled in the femur and tibia was different with the robotic and traditional techniques. However, the robotic system had the most consistent tunnel directions, while the surgeons' tunnels were more dispersed. Variation in surgeon precision of tunnel placement for ACL reconstruction is greater on the femur than the tibia, and this can be correlated with experience. Our data also suggest that the robotic system has the same precision as the most experienced surgeons. PMID:11892003

  10. Gait adaptation in ACL deficient patients before and after anterior cruciate ligament reconstruction surgery.

    PubMed

    Knoll, Zsolt; Kiss, Rita M; Kocsis, László

    2004-06-01

    The objective of this study is to determine how kinematical parameters and electromyography data of selected muscles may change as a result of anterior cruciate ligament (ACL) deficiency and following ACL reconstruction. The study was conducted on 25 anterior cruciate ligament deficient subjects prior to and 6 weeks, 4 months, 8 months and 12 months following ACL reconstructive surgery using the bone-patellar tendon-bone technique. Gait analysis was performed by applying the zebris three-dimensional ultrasound-based system with surface electromyograph (zebris). Kinematic data were recorded for the lower limb. The muscles surveyed include vastus lateralis and medialis, biceps femoris and adductor longus. The results obtained from the injured subjects were compared with those of 51 individuals without any ACL damage whatsoever. Acute ACL deficient patients exhibited a quadriceps avoidance pattern prior to and 6 weeks following surgery. No quadriceps avoidance phenomenon develops in chronic ACL deficient patients. In operated individuals, tempo-spatial parameters and the knee angle regained a normal pattern for the ACL-deficient limb during gait as early as 4 months following surgery. However, the relative ACL movement parameter, which describes the tibial translation into the direction of ACL, and the EMG traces show no significant statistical difference compared with the same values of the healthy control group just 8 months following surgery. The analysis of spatial-temporal parameters and EMG traces show that the development of a quadriceps avoidance pattern is less common than previously reported. These data suggest that anterior cruciate ligament deficiency and reconstruction produce considerable changes in the lower extremity gait pattern. The results suggest that gait parameters tend to shift towards a normal value pattern; and the re-establishment of pre-injury gait patterns-including the normal biphase of muscles-takes at least 8 months to occur.

  11. Stress fractures of the femur after ACL reconstruction with transfemoral fixation.

    PubMed

    Arriaza, Rafael; Señaris, Jose; Couceiro, Gonzalo; Aizpurua, Jesus

    2006-11-01

    The ACL reconstruction with hamstring tendons has become increasingly popular, in part because it is assumed that the complication rate associated with the technique and their severity are lower than with patellar tendon. Two cases of stress reaction of the medial supracondylar area of the femur after ACL reconstruction with hamstring tendons using BioTransfix (Arthrex, Naples, FL, USA) devices for fixation within femur are presented. Both patients were professional athletes (one soccer and one basketball player), and it is hypothesized that the accelerated rehabilitation program used might have represented a risk factor for stress fractures when associated with the guide pin exit hole in the medial femoral cortex. To our knowledge, no such cases have been published to date, but it is important to consider this possibility if an unexplained pain arises in the rehabilitation process of an ACL reconstruction using transfemoral fixation.

  12. Extra-articular extraosseous migration of a bioabsorbable femoral interference screw after ACL reconstruction.

    PubMed

    Sharma, Vivek; Curtis, Christine; Micheli, Lyle

    2008-10-01

    Anterior cruciate ligament (ACL) reconstruction is quite commonly used to treat anterior knee instability. Surgeon preference and patient functional goals determine graft selection and graft fixation techniques. Interference screws are considered a safe and effective device for graft fixation in surgical ACL reconstruction. Poly-L-lactide acid (PLLA) bioabsorbable interference screws are becoming increasingly popular in ACL reconstruction surgery. There are several reasons why they may be more advantageous than metallic screws, including reduced graft laceration during insertion, ease of performance of revision procedures, avoidance of graft injury encountered with aperture fixation using metallic screws, and fewer artifacts on magnetic resonance images (MRI). Few studies describe complications associated with PLLA bioabsorbable screws, particularly extra-articular screw migration. This article presents a case of an extra-articular extraosseous migration of the femoral bioabsorbable interference screw. This case further demonstrates the problem of the femoral bioabsorbable interference screw.

  13. Transverse femoral implant prominence: four cases demonstrating a preventable complication for ACL reconstruction.

    PubMed

    Argintar, Evan; Scherer, Benjamin; Jordan, Tom; Klimkiewicz, John

    2010-12-01

    Anterior cruciate ligament (ACL) tear is a commonly occurring injury that often demands surgical reconstruction. Although the utility of this operation is widely accepted, many specific components, including graft fixation technique, remain controversial. Many clinicians favor transverse femoral implant fixation for soft tissue ACL grafts. This technique can be accomplished successfully; however, in a minority of the cases, the femoral implant can be excessively prominent, leading to iatrogenic postoperative iliotibial band syndrome. This article presents 4 patients that developed postoperative iliotibial band syndrome resulting from transverse femoral implant prominence. Despite achievement of knee ligamentous stability, implant prominence compromised final clinical results following ACL reconstruction. Through change in Lysholm value, we reviewed the clinical outcomes of these patients following femoral implant hardware removal for treatment of iliotibial band syndrome. On hardware removal, all patients demonstrated complete symptomatic improvement, mirroring an average Lysholm value increase of 38. We believe transverse femoral implant prominence is avoidable, and subsequent iliotibial band syndrome is a preventable postoperative complication.

  14. Knee instability scores for ACL reconstruction.

    PubMed

    Rahnemai-Azar, Ata A; Naendrup, Jan-Hendrik; Soni, Ashish; Olsen, Adam; Zlotnicki, Jason; Musahl, Volker

    2016-06-01

    Despite abundant biological, biomechanical, and clinical research, return to sport after anterior cruciate ligament (ACL) injury remains a significant challenge. Residual rotatory knee laxity has been identified as one of the factors responsible for poor functional outcome. To improve and standardize the assessment of knee instability, a variety of instability scoring systems is available. Recently, devices to objectively quantify static and dynamic clinical exams have been developed to complement traditional subjective grading systems. These devices enable an improved evaluation of knee instability and possible associated injuries. This additional information may promote the development of new treatment algorithms and allow for individualized treatment. In this review, the different subjective laxity scores as well as complementary objective measuring systems are discussed, along with an introduction of injury to an individualized treatment algorithm. PMID:26980119

  15. Incidence of Second ACL Injuries 2 Years After Primary ACL Reconstruction and Return to Sport

    PubMed Central

    Paterno, Mark V.; Rauh, Mitchell J.; Schmitt, Laura C.; Ford, Kevin R.; Hewett, Timothy E.

    2014-01-01

    Background The incidence of second anterior cruciate ligament (ACL) injuries in the first 12 months after ACL reconstruction (ACLR) and return to sport (RTS) in a young, active population has been reported to be 15 times greater than that in a previously uninjured cohort. There are no reported estimates of whether this high relative rate of injury continues beyond the first year after RTS and ACLR. Hypothesis The incidence rate of a subsequent ACL injury in the 2 years after ACLR and RTS would be less than the incidence rate reported within the first 12 months after RTS but greater than the ACL injury incidence rate in an uninjured cohort of young athletes. Study Design Cohort study; Level of evidence, 2. Methods Seventy-eight patients (mean age, 17.1 ± 3.1 years) who underwent ACLR and were ready to return to a pivoting/ cutting sport and 47 controls (mean age, 17.2 ± 2.6 years) who also participated in pivoting/cutting sports were prospectively enrolled. Each participant was followed for injury and athlete exposure (AE) data for a 24-month period after RTS. Twenty-three ACLR and 4 control participants suffered an ACL injury during this time. Incidence rate ratios (IRRs) were calculated to compare the rates (per 1000 AEs) of ACL injury in athletes in the ACLR and control groups. For the ACLR group, similar comparisons were conducted for side of injury by sex. Results The overall incidence rate of a second ACL injury within 24 months after ACLR and RTS (1.39/1000 AEs) was nearly 6 times greater (IRR, 5.71; 95% CI, 2.0–22.7; P = .0003) than that in healthy control participants (0.24/1000 AEs). The rate of injury within 24 months of RTS for female athletes in the ACLR group was almost 5 times greater (IRR, 4.51; 95% CI, 1.5–18.2; P = .0004) than that for female controls. Although only a trend was observed, female patients within the ACLR group were twice as likely (IRR, 2.43; 95% CI, 0.8–8.6) to suffer a contralateral injury (1.13/1000 AEs) than an

  16. Rash After ACL Reconstruction: Asking the Right Questions.

    PubMed

    Smith, Andrew H; Bach, Bernard R

    2004-10-01

    A 40-year-old recreational athlete injured his left knee on a "moon bouncer" at his child's birthday party. Before the injury, he regularly went hiking and downhill skiing and played basketball and tennis. Because the injury caused persistent symptoms of knee instability, he elected to undergo an anterior cruciate ligament (ACL) reconstruction using allograft. At the time of surgery, the patient's skin examination was unremarkable, and no surgical complications were noted. The patient went home on the day of surgery.

  17. 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

  18. Successful feed-forward strategies following ACL injury and reconstruction.

    PubMed

    Bryant, Adam L; Newton, Robert U; Steele, Julie

    2009-10-01

    The purpose of this study was to elucidate the most successful feed-forward strategies responsible for enhancing dynamic restraint following anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR). Ten male ACL deficient (ACLD) subjects (18-35 years) together with 27 matched males who had undergone ACLR (14 using a patella tendon graft and 13 using a combined semitendinosus and gracilis graft) and 22 matched-control subjects were recruited. After their knee functionality (0- to 100-point scale) was rated using the Cincinnati Knee Rating System, each subject performed a maximal, countermovement hop for distance on their involved limb while EMG data were collected from the vastus lateralis (VL), vastus medialis (VM), semitendinosus (ST) and biceps femoris (BF) muscles. Acceleration transients at the proximal tibia were recorded using a uniaxial accelerometer mounted at the level of the tibial tuberosity. Whilst pre-programmed muscle activation strategies and tibial acceleration transients when landing from a single-leg long hop for distance were not contingent upon ACL status, a number of significant correlations were identified between neuromuscular variables and knee functionality of ACLD and ACLR subjects. Increased hamstring preparatory activity together with a greater ability to control tibial motion during dynamic deceleration was associated with higher levels of knee functionality in the ACLD subjects. Successful feed-forward strategies following ACLR were related to graft selection; STGT subjects with superior knee function activated their quadriceps earlier and were better able to synchronise peak hamstring muscle activity closer to initial ground contact whilst more functional PT subjects demonstrated enhanced tibial control despite a lack of evidence supporting modified pre-programmed muscular activation patterns. Our conclusion was that more functional individuals used sensory feedback to build treatment-specific, feed-forward strategies to

  19. Performance and return-to-sport after ACL reconstruction in NFL quarterbacks.

    PubMed

    Erickson, Brandon J; Harris, Joshua D; Heninger, Jacob R; Frank, Rachel; Bush-Joseph, Charles A; Verma, Nikhil N; Cole, Brian J; Bach, Bernard R

    2014-08-01

    Anterior cruciate ligament (ACL) rupture is a significant injury in National Football League (NFL) quarterbacks. The purpose of this study was to determine (1) return-to-sport (RTS) rate in NFL quarterbacks following ACL reconstruction, (2) performance upon RTS, and (3) the difference in RTS and performance between players who underwent ACL reconstruction and controls. Thirteen quarterbacks (14 knees) who met inclusion criteria underwent ACL reconstruction while in the NFL. Matched controls were selected from the NFL during the same time span to compare and analyze age, body mass index (BMI), position, performance, and NFL experience. Student t tests were performed for analysis of within- and between-group variables. Bonferroni correction was used in the setting of multiple comparisons. Twelve quarterbacks (13 knees; 92%) were able to RTS in the NFL. Mean player age was 27.2±2.39 years. Mean career length in the NFL following ACL reconstruction was 4.85±2.7 years. Only 1 player needed revision ACL reconstruction. In both cases and controls, player performance was not significantly different from preinjury performance after ACL reconstruction (or index year in controls). There was also no significant performance difference between case and control quarterbacks following ACL reconstruction (or index year in controls). There is a high rate of RTS in the NFL following ACL reconstruction. In-game performance following ACL reconstruction was not significantly different from preinjury or from controls.

  20. Comparison of volumetric bone mineral density in the tibial region of interest for ACL reconstruction.

    PubMed

    Klein, Scott A; Nyland, John; Caborn, David N M; Kocabey, Yavuz; Nawab, Akbar

    2005-12-01

    Adequate tibial bone mineral density (BMD) is essential to soft tissue graft fixation during anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to compare volumetric bone plug density measurements at the tibial region of interest for ACL reconstruction using a standardized immersion technique and Archimedes' principle. Cancellous bone cores were harvested from the proximal, middle, and distal metaphyseal regions of the lateral tibia and from the standard tibial tunnel location used for ACL reconstruction of 18 cadaveric specimens. Proximal tibial cores displayed 32.6% greater BMD than middle tibial cores and 31.8% greater BMD than distal tibial cores, but did not differ from the BMD of the tibial tunnel cores. Correlational analysis confirmed that the cancellous BMD in the tibial tunnel related to the cancellous BMD of the proximal and distal lateral tibial metaphysis. In conjunction with its adjacent cortical bone, the cancellous BMD of the region used for standard tibial tunnel placement provides an effective foundation for ACL graft fixation. In tibia with poor BMD, bicortical fixation that incorporates cortical bone from the distal tibial tunnel region is recommended. PMID:16237489

  1. ALL‐EPIPHYSEAL ACL RECONSTRUCTION: A THREE‐YEAR FOLLOW‐UP

    PubMed Central

    Akinleye, Sheriff D.; Sewick, Amy

    2013-01-01

    Background/Introduction: With an increasing number of pre‐adolescents participating in sports, anterior cruciate ligament injuries and resultant reconstruction in the skeletally immature athlete are becoming more common. Many different surgical techniques and rehabilitation protocols have been proposed for the treatment of anterior cruciate ligament (ACL) injuries, but there is a lack of agreement as to which approach results in the best outcome. Rehabilitation protocols have marked variation regarding postoperative weight bearing, immobilization, bracing, and length. Case description: This is a case of a ten year old female who sustained bilateral ACL tears within the period of a year. The purpose of this case report is to describe the early result and subsequent rehabilitation following bilateral physeal‐sparing all‐epiphyseal ACL reconstructions on a skeletally immature patient with a three‐year follow‐up. Outcomes: The early post‐surgical recovery period on the first injured knee was complicated by knee stiffness requiring manipulation. Following this minor setback, the patient met all physical therapy goals and had no additional complications. The rehabilitation after the second surgery followed a typical course. At three‐year follow‐up, the patient had grown an additional seven inches, with radiographic evidence of symmetric physeal growth and joint stability. She has returned to playing competitive sports. Discussion and Conclusion: This innovative physeal‐sparing technique has huge implications as, historically; the feared complication of growth disturbance and angular deformity from transphyseal ACL reconstruction has complicated the management of ACL injuries in children and pre‐adolescents. This case report demonstrates the success of this technique, and the subsequent rehabilitation, as this patient did not experience a reduction in long‐term bone growth. Level of Evidence: 5 Case Report PMID:23772346

  2. Fifteen Year Prospective Comparison of Patellar & Hamstring Tendon Grafts for ACL Reconstruction

    PubMed Central

    Roe, Justin; Salmon, Lucy; Kok, Alison; Linklater, James; Pinczewski, Leo

    2016-01-01

    Objective: This prospective longitudinal study compares isolated endoscopic ACL reconstruction utilizing 4-strand hamstring tendon (HT) or patellar tendon (PT) autograft over a 15-year period with respect to clinical outcomes and the development of osteoarthritis. Method: 90 consecutive patients with isolated ACL rupture were reconstructed with a PT autograft and 90 patients received HT autograft, with an identical surgical technique. Patients were assessed at 2, 5, 7, 10 and 15 years. Assessment included the IKDC Knee Ligament Evaluation including radiographic evaluation, KT1000, kneeling pain, and clinical outcomes. Results: Subjects who received the PT graft had significantly worse outcomes at 15 years for the variables of radiologically detectable osteoarthritis (p=0.001), motion loss (p=0.02), single leg hop test (p=0.002), participation in strenuous activity (p=0.03), knee related decrease in activity level (p=0.002) and kneeling pain (p=0.03). There was no significant difference between the HT and PT groups in overall IKDC grade (p=0.28). ACL graft rupture occurred in 16% of HT group and 8% of the PT group (p=0.10). Contralateral ACL rupture occurred in significantly more PT patients (24%) than HT patients (12%) (p=0.03). Conclusion: Significant differences have developed at 15 years after surgery which were not seen at earlier reviews. Compared to the HT Group, the PT group had significantly worse outcomes with respect to radiological osteoarthritis, range of motion and functional tests but no significant difference in laxity was identified. There was a high incidence of ACL injury after reconstruction, to both the reconstructed and the contralateral knee.

  3. A canine hybrid double-bundle model for study of arthroscopic ACL reconstruction.

    PubMed

    Cook, James L; Smith, Patrick A; Stannard, James P; Pfeiffer, Ferris M; Kuroki, Keiichi; Bozynski, Chantelle C; Cook, Cristi R

    2015-08-01

    Development and validation of a large animal model for pre-clinical studies of intra-articular anterior cruciate ligament (ACL) reconstruction that addresses current limitations is highly desirable. The objective of the present study was to investigate a translational canine model for ACL reconstruction. With institutional approval, adult research hounds underwent arthroscopic debridement of the anteromedial bundle (AMB) of the ACL, and then either received a tendon autograft for "hybrid double-bundle" ACL reconstruction (n = 12) or no graft to remain ACL/AMB-deficient (n = 6). Contralateral knees were used as non-operated controls (n = 18) and matched canine cadaveric knees were used as biomechanical controls (n = 6). Dogs were assessed using functional, diagnostic imaging, gross, biomechanical, and histologic outcome measures required for pre-clinical animal models. The data suggest that this canine model was able to overcome the major limitations of large animal models used for translational research in ACL reconstruction and closely follow clinical aspects of human ACL reconstruction. The "hybrid double-bundle" ACL reconstruction allowed for sustained knee function without the development of osteoarthritis and for significantly improved functional, diagnostic imaging, gross, biomechanical, and histologic outcomes in grafted knees compared to ACL/AMB-deficient knees.

  4. Quality of Movement for Athletes Six Months Post ACL Reconstruction

    PubMed Central

    deMille, Polly; Nguyen, Joseph; Brown, Allison; Do, Huong; Selvaggio, Elizabeth; Chiaia, Theresa

    2016-01-01

    Objectives: Anterior cruciate ligament (ACL) injury prevention programs evaluate quality of movement (QM) to identify and correct high-risk movement patterns. However, return to play (RTP) decisions post-ACL reconstruction (ACLR) are often based on non-sport relatedquantitative measures such as isokinetic tests and/or time from surgery, with six months post-ACLR being a common expectation for RTP. The purpose of this study was to evaluate whether athletes are ready to RTP 6 months post ACLR using a QM assessment (QMA). Methods: A QMA including nine dynamic tasks (squat, single leg [SL] stance, step down, SL squat, jump in place, side to side jump, broad jump, hop to opposite, SL hop) progressing from double- to single-limb vertical and horizontal movements was administered to 136 athletes at five to seven months post-ACLR. Tasks were viewed from the frontal and sagittal planes by a physical therapist and performance specialist. Movements were evaluated live for risk factors associated with ACL injury (strategy, depth, control, symmetry, and alignment). The proportion of patients exhibiting risky movement patterns for each task was calculated. Fisher’s Exact test was used to determine if there were differences in movement patterns between males and females. Results: The proportion of patients demonstrating risky movement patterns for a task ranged from 48% to 100%. All 136 patients exhibited risky movement patterns for at least one task and 60% of patients displayed risky movement patterns in five or more of the nine tasks. Rates of risky movement patterns were not different between males and females for all tasks (P>0.1 for all tasks). Conclusion: Six months has been cited as a probable time for RTP post-ACLR; thus this is the expectation of the athlete. Our data show that athletes demonstrate multiple QM patterns associated with initial ACL injury, as well as 2nd injury at five to seven months post-operatively. Altered movement patterns evident in tasks as

  5. Acute Vs Delayed ACL Reconstruction. Early Differences and Preliminary Two Year Results

    PubMed Central

    Eriksson, Karl; Barenius, Björn

    2016-01-01

    Objectives: Historically acute ACL reconstruction has been avoided due to reports of early rehabilitation problems with stiffness. Are these reports still valid today with modern arthroscopic techniques? Methods: 70 patients with a high recreational activity level (Tegner ≥6) who presented with a acute ACL injury were randomized to an acute reconstruction within 8 days from the injury or delayed reconstruction after 6-10 weeks. Four surgeons performed the ACL reconstructions with quadrupled semitendinosus tendon grafts and endobutton and metallic interference screw fixation. The rehabilitation training was performed at the same physiotherapy center for all patients. The follow up at 6 and 24 months included ROM, Lachman, Rolimeter, pivot shift, one leg hop, IKDC, KOOS, Lysholm and Tegner activity level. Results: There were no differences between the groups in ROM, IKDC, activity level or laxity at 6 months. Four patients had a combined extension and flexion deficit of more than 15 degrees, two from each group. In the acute group 79% had an objective IKDC grade A or B compared with 73% in the delayed group. The one leg hop index above 90% was found in 50% in the acute group and 24% in the delayed group (p=0.04). Functional data for the 2-year follow up are not available at the time of abstract writing. The median activity level according to Tegner was restored to pre-injury levels in both groups after one year, and was stationary at 2 years. The visual analogue scale (VAS) response to the question “How is your knee working on a scale from 0-100? (100 = best)” revealed 81 in the acute and 71 in the delayed group (p=0.1). To the question “How does your knee affect your activity level on a scale from 0-100? (100 = no affection)” the mean score was 75 in the acute group and 67 in the delayed group (p=0.3). At one and two years the KOOS was statistically similar between the groups but with slightly higher subscale “Sport and recreation” scores, 85 in the

  6. Increased Platelet Concentration does not Improve Functional Graft Healing in Bio-Enhanced ACL Reconstruction

    PubMed Central

    Fleming, Braden C.; Proffen, Benedikt L.; Vavken, Patrick; Shalvoy, Matthew R.; Machan, Jason T.; Murray, Martha M.

    2014-01-01

    Purpose The use of an extra-cellular matrix scaffold (ECM) combined with platelets to enhance healing of an ACL graft (“bio-enhanced ACL reconstruction”) has shown promise in animal models. However, the effects of platelet concentration on graft healing remains unknown. The objectives of this study were to determine if increasing the platelet concentration in the ECM scaffold would; 1) improve the graft biomechanical properties, and 2) decrease cartilage damage after surgery. Methods Fifty-five adolescent minipigs were randomized to 5 treatment groups; untreated ACL transection (n=10), conventional ACL reconstruction (n=15), and bio-enhanced ACL reconstruction using 1X (n=10), 3X (n=10) or 5X (n=10) platelet-rich plasma. The graft biomechanical properties, anteroposterior (AP) knee laxity, graft histology and macroscopic cartilage integrity were measured at 15 weeks. Results The mean linear stiffness of the bio-enhanced ACL reconstruction procedure using the 1X preparation was significantly greater than traditional reconstruction while the 3X and 5X preparations were not. The failure loads of all the ACL reconstructed groups were equivalent but significantly greater than untreated ACL transection. There were no significant differences in the ligament maturity index or AP laxity between reconstructed knees. Macroscopic cartilage damage was relatively minor, though significantly less when the ECM-platelet composite was used. Conclusions Only the 1X platelet concentration improved healing over traditional ACL reconstruction. Increasing the platelet concentration from 1X to 5X in the ECM scaffold did not further improve the graft mechanical properties. The use of an ECM-platelet composite decreased the amount of cartilage damage seen after ACL surgery. PMID:24633008

  7. Prognosis and Predictors of ACL Reconstructions using the MOON Cohort: A Model for Comparative Effectiveness Studies

    PubMed Central

    Spindler, Kurt P.; Parker, Richard D.; Andrish, Jack T.; Kaeding, Christopher C.; Wright, Rick W.; Marx, Robert G.; McCarty, Eric C.; Amendola, Annunziato; Dunn, Warren R.; Huston, Laura J.; Harrell, Frank E.

    2012-01-01

    Injury to the anterior cruciate ligament (ACL) threatens an active lifestyle and exposes the patient to risk of early osteoarthritis (OA). ACL reconstruction is typically chosen by individuals to allow a return to their previous work and sports activities. Primary ACL reconstruction (ACLR) has in general been effective at restoring functional stability, but patients’ modifiable predictors of both short- and long-term validated outcomes and OA are largely unknown. The Multicenter Orthopaedic Outcomes Network (MOON) consortium was established in 2002 to enroll and longitudinally follow a population cohort of ACL reconstructed patients. The objective was to establish patient-specific predictive models of clinically important outcomes. Over the past 10 years, the overarching aims of this NIAMS-funded prospective multicenter cohort of ACL reconstructions has been three-fold: 1) to identify both short- and long-term prognosis and predictors of sports function, activity level, and general health through validated patient-reported outcomes, 2) to identify the symptoms and signs of OA, and 3) to quantify the incidence of ACL reconstruction graft and/or contralateral ACL failures and additional surgical procedures. This manuscript summarizes the Kappa Delta Ann Doner Vaughan Award paper and presentation at the 2012 ORS/AAOS Annual Meeting. PMID:22912340

  8. Bone tunnel enlargement after ACL reconstruction using autologous hamstring tendons: a CT study

    PubMed Central

    Iorio, Raffaele; Vadalà, Antonio; Argento, Giuseppe; Di Sanzo, Vincenzo

    2006-01-01

    Purpose: To evaluate prospectively the increase in the size of the tibial and femoral bone tunnel following arthroscopic anterior cruciate ligament (ACL) reconstruction with quadrupled-hamstring autograft. Methods: Twenty-five consecutive patients underwent arthroscopic ACL reconstruction with quadrupled-hamstring autograft. Preoperative clinical evaluation was performed using the Lysholm knee score, Tegner activity level, and International Knee Documentation Committee forms and a KT-1000 arthrometer (side to side). Computed tomography (CT) of the femoral and tibial tunnel was performed on the day after operation in all cases and at mean follow-up of 10 months (range 9–11 months).Results: All of the clinical evaluation scales performed showed an overall improvement. The postoperative anterior laxity difference was <3 mm in 16 patients (70%) and 3–5 mm in seven patients (30%). The mean average femoral tunnel diameter increased significantly (3%) from 9.04±0.05 mm postoperatively to 9.3±0.8 mm at 10 months; tibial tunnel increased significantly (11%) from 9.03±0.04 mm to 10±0.8 mm. There were no statistically significant differences between tunnel enlargement, clinical results, and arthrometer evaluation. Conclusions: The rate of tunnel widening observed in this study seems to be lower than that reported in previous studies that used different techniques. We conclude that an anatomical surgical technique and a less aggressive rehabilitation process influenced the amount of tunnel enlargement after ACL reconstruction with doubled hamstrings. PMID:16683112

  9. Knee Hyperextension as a Predictor of Failure in Revision ACL Reconstruction

    PubMed Central

    Cooper, Daniel E.; Dunn, Warren R.; Wright, Rick W.; Haas, Amanda; Huston, Laura J.

    2016-01-01

    Objectives: We studied the minimum 2 year follow-up outcomes in an ACL revision cohort. The hypothesis is that knees that hyperextend will have a worse outcome and greater odds of graft failure than knees that do not hyperextend. The null hypothesis is that there is no difference in outcomes or graft rupture between the two groups. Methods: Revision ACL reconstruction patients were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, surgical technique and pathology, and a series of validated patient reported outcome instruments (IKDC, KOOS, WOMAC, and Marx activity rating score). Patients were followed up for 2 years, and asked to complete the identical set of outcome instruments. A regression model using graft failure as the dependent variable included graft type, age, and hyperextension greater than or equal to 5 degrees yes/no (HE) in order to assess these potential surgical risk factors for clinical outcomes 2 years after revision ACL reconstruction. Results: There were 1,145 subjects included in the analyses. The median age of the cohort was 26 (IQR= 20, 35), and 58% were male. The proportion that were enrolled for their first revision surgery was 88%, their second 10%, and third or greater 2%. The number of subjects categorized as HE was 375 (33%). The median age of subjects that failed was 18, compared to 26 for those with intact grafts. All three variables included in our regression model were significant predictors of graft failure: younger age, inter-quartile range odds ratio (IQROR) = 3.32 (95%CI 1.5, 7.2) p= 0.002; use of allograft OR = 3.1 (95%CI 1.4, 6.9) p= 0.01, and HE 2.1 (95%CI 1.02, 4.42) p= 0.04. Conclusion: The MARS Study Group has previously reported that young age and the use of allograft as a graft source are independent predictors (over 3X odds ratio) of graft rupture after revision ACLR. This study found that knee hyperextension greater than or equal to 5 degrees is present in 1/3 of

  10. Positive culture in allograft ACL-reconstruction: what to do?

    PubMed

    Díaz-de-Rada, P; Barriga, A; Barroso, J L; García-Barrecheguren, E; Alfonso, M; Valentí, J R

    2003-07-01

    The transmission of disease or infection from the donor to the recipient is always a risk with the use of allografts. We carried out a research study on the behavioural pattern of implanted allografts, which were initially stored in perfect conditions (all cultures being negative) but later presented positive cultures at the implantation stage. Because there is no information available on how to deal with this type of situation, our aim was to set guidelines on the course of action which would be required in such a case. We conducted a retrospective study of 181 patients who underwent an ACL reconstruction using BPTB allografts. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV were negative. An allograft sample was taken for culture in the operating theatre just before its implantation. The results of the cultures were obtained 3-5 days after the operation. We had 24 allografts with positive culture (13.25%) after the implantation with no clinical infection in any of these patients. Positive cultures could be caused by undetected contamination while harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment-other than an antibiotic protocol-would be required when facing a case of positive culture of a graft piece after its implantation.

  11. Positive culture in allograft ACL-reconstruction: what to do?

    PubMed

    Díaz-de-Rada, P; Barriga, A; Barroso, J L; García-Barrecheguren, E; Alfonso, M; Valentí, J R

    2003-07-01

    The transmission of disease or infection from the donor to the recipient is always a risk with the use of allografts. We carried out a research study on the behavioural pattern of implanted allografts, which were initially stored in perfect conditions (all cultures being negative) but later presented positive cultures at the implantation stage. Because there is no information available on how to deal with this type of situation, our aim was to set guidelines on the course of action which would be required in such a case. We conducted a retrospective study of 181 patients who underwent an ACL reconstruction using BPTB allografts. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV were negative. An allograft sample was taken for culture in the operating theatre just before its implantation. The results of the cultures were obtained 3-5 days after the operation. We had 24 allografts with positive culture (13.25%) after the implantation with no clinical infection in any of these patients. Positive cultures could be caused by undetected contamination while harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment-other than an antibiotic protocol-would be required when facing a case of positive culture of a graft piece after its implantation. PMID:12827226

  12. Treatment of persistent extraarticular infection using a temporary cement spacer on the tibia after ACL reconstruction.

    PubMed

    Jung, Kwang Am; Lee, Soo Chan; Song, Moon Bok; Lee, Choon Key

    2008-01-01

    Postoperative infection after anterior cruciate ligament (ACL) reconstruction is an uncommon but serious complication. Although several treatments for intraarticular infection have been reported, no report has been recorded on the treatment of persistent extraarticular infections. The authors experienced reconstructed graft removal due to a refractory extraarticular infection on tibia. Early ACL reimplantation was performed using a temporary cement spacer containing antibiotics and a irradiated bone patellar tendon bone allograft.

  13. Treatment of persistent extraarticular infection using a temporary cement spacer on the tibia after ACL reconstruction.

    PubMed

    Jung, Kwang Am; Lee, Soo Chan; Song, Moon Bok; Lee, Choon Key

    2008-01-01

    Postoperative infection after anterior cruciate ligament (ACL) reconstruction is an uncommon but serious complication. Although several treatments for intraarticular infection have been reported, no report has been recorded on the treatment of persistent extraarticular infections. The authors experienced reconstructed graft removal due to a refractory extraarticular infection on tibia. Early ACL reimplantation was performed using a temporary cement spacer containing antibiotics and a irradiated bone patellar tendon bone allograft. PMID:17899003

  14. Quadriceps function relates to muscle size following ACL reconstruction.

    PubMed

    Kuenze, Christopher M; Blemker, Silvia S; Hart, Joseph M

    2016-09-01

    It remains unclear what role reduced volume and cross-section area (CSA) of individual quadriceps muscles may play in persistent quadriceps weakness and more global dysfunction following ACL reconstruction (ACLR). The purpose of this investigation was to establish the relationship between cross-sectional area of the quadriceps muscle group and measures of knee related and quadriceps function following ACLR. Thirty participants with a history of primary, unilateral ACLR experiencing persistent quadriceps activation failure participated in this cohort study. Clinical factors including International Knee Documentation Committee (IKDC) score, normalized knee extension MVIC torque (Nm/kg) and quadriceps central activation ratio (CAR, %) were assessed in addition to CSA. Quadriceps CSA was measured via magnetic resonance imaging (MRI; Siemens Avanto 1.5T). Quadriceps CSA (cm(2) ) and quadriceps volume (cm(3) ) as well as individual muscle estimates were identified within a 10 cm mid-thigh capture area. Pearson's product-moment correlation coefficients (r) established relationships between CSA and all other variables. Stepwise linear regression established which CSA factors were able to successfully predict clinical factors. Knee extension MVIC torque was strongly correlated with Vastus Intermedius (VI; r =  0.857, p < 0.001) CSA as well as partial VI (r = 0.849, p < 0.001) and quadriceps (r = 0.830, p < 0.001) volume. Partial VI (r = 0.365, p = 0.047) volume was weakly correlated with IKDC score. Knee extension MVIC torque was strongly predicted using VI CSA alone (R(2)  = 0.725) or in combination with Vastus Medialis CSA (VM; R(2)  = 0.756). Statement of Clinical Significance: Atrophy of the VI and VM muscles negatively impacts knee extension strength following ACLR. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1656-1662, 2016.

  15. Return to sport after ACL reconstruction: how, when and why? A narrative review of current evidence.

    PubMed

    Zaffagnini, Stefano; Grassi, Alberto; Serra, Margherita; Marcacci, Maurilio

    2015-01-01

    Allowing a patient to return to sport and unrestricted physical activity after ACL injury and reconstruction is one of the most challenging and difficult decisions an orthopaedic surgeon has to make. Indeed, many factors have to be taken into account before it can be considered safe for a patients to load a reconstructed knee. The current literature contains plenty of studies aimed at evaluating return to sport, and the factors that may affect or predict this outcome, e.g. intrinsic factors like genetics, biology, type of lesion, anatomical features, motivation and psychology, and extrinsic factors such as graft type, surgical technique, rehabilitation protocols, and biological support. It is possible that awareness of these issues could help the clinician to optimise outcomes, and possibly avoid failures too, although as yet no universal criteria for resuming sport have been produced. PMID:26151036

  16. Return to sport after ACL reconstruction: how, when and why? A narrative review of current evidence

    PubMed Central

    ZAFFAGNINI, STEFANO; GRASSI, ALBERTO; SERRA, MARGHERITA; MARCACCI, MAURILIO

    2015-01-01

    Allowing a patient to return to sport and unrestricted physical activity after ACL injury and reconstruction is one of the most challenging and difficult decisions an orthopaedic surgeon has to make. Indeed, many factors have to be taken into account before it can be considered safe for a patients to load a reconstructed knee. The current literature contains plenty of studies aimed at evaluating return to sport, and the factors that may affect or predict this outcome, e.g. intrinsic factors like genetics, biology, type of lesion, anatomical features, motivation and psychology, and extrinsic factors such as graft type, surgical technique, rehabilitation protocols, and biological support. It is possible that awareness of these issues could help the clinician to optimise outcomes, and possibly avoid failures too, although as yet no universal criteria for resuming sport have been produced. PMID:26151036

  17. 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

  18. Postinfectious ankylosis of the knee after bacterial arthritis following routine anterior cruciate ligament (ACL) reconstruction

    PubMed Central

    Mester, Bastian; Schoepp, Christian; Glombitza, Martin; Rixen, Dieter

    2016-01-01

    Aims and Objectives: Knee arthroscopy is a very common surgical procedure. It belongs to the most frequently performed procedures in orthopedics and traumatology and is considered to have a low complication rate. The risk of postoperative knee infection following ACL reconstrucion is estimated 1-2 %. Thereby the ACL reconstruction cannot always be preserved. Persistent defects after healing and postinfectios osteoarthritis are observed. We present the case of an adolescent patient suffering from postoperative knee infection following routine ACL reconstruction, who is developing - while infection is decreasing - a complete bony ankylosis of the knee, clinically meaning a severe constraint to joint function with complete stiffness of the knee. Materials and Methods: The 13-year-old male patient sustained a distorsion of the right knee during sports at school, after clinical examination magnetic resonance tomography showed a complete tear of the ACL. Single bundle ACL reconstruction was done using autologous hamstrings in Transfix technique. After 5 days at hospital the patient was discharged without any complications. Shortly afterwards the patient was admitted to hospital again presenting a postoperative knee infection. After primary operative revision the patient was shifted to our intensive care unit in a septic condition for stabilization. During 4 month of stay at our hospital multiple operative revisions were performed as arthrotomy, debridement, insertion of antibiotic carriers, complete removal of the autograft and total synovectomy. We found a severe bacterial infection (staphylococcus aureus) of the knee joint, classified Gaechter IV, histopathologically mostly avital cartilage tissue and chronic synovialitis. After decrease of the infection we could discharge the patient from hospital. Results: During the following 8 month under ongoing physiotherapy the patient was developing an increasing stiffness of the knee, finally fixed at 30 degrees of flexion and

  19. Effects of ACL Reconstructive Surgery on Temporal Variations of Cytokine Levels in Synovial Fluid.

    PubMed

    Bigoni, Marco; Turati, Marco; Gandolla, Marta; Sacerdote, Paola; Piatti, Massimiliano; Castelnuovo, Alberto; Franchi, Silvia; Gorla, Massimo; Munegato, Daniele; Gaddi, Diego; Pedrocchi, Alessandra; Omeljaniuk, Robert J; Locatelli, Vittorio; Torsello, Antonio

    2016-01-01

    Anterior cruciate ligament (ACL) reconstruction restores knee stability but does not reduce the incidence of posttraumatic osteoarthritis induced by inflammatory cytokines. The aim of this research was to longitudinally measure IL-1β, IL-6, IL-8, IL-10, and TNF-α levels in patients subjected to ACL reconstruction using bone-patellar tendon-bone graft. Synovial fluid was collected within 24-72 hours of ACL rupture (acute), 1 month after injury immediately prior to surgery (presurgery), and 1 month thereafter (postsurgery). For comparison, a "control" group consisted of individuals presenting chronic ACL tears. Our results indicate that levels of IL-6, IL-8, and IL-10 vary significantly over time in reconstruction patients. In the acute phase, the levels of these cytokines in reconstruction patients were significantly greater than those in controls. In the presurgery phase, cytokine levels in reconstruction patients were reduced and comparable with those in controls. Finally, cytokine levels increased again with respect to control group in the postsurgery phase. The levels of IL-1β and TNF-α showed no temporal variation. Our data show that the history of an ACL injury, including trauma and reconstruction, has a significant impact on levels of IL-6, IL-8, and IL-10 in synovial fluid but does not affect levels of TNF-α and IL-1β. PMID:27313403

  20. Effects of ACL Reconstructive Surgery on Temporal Variations of Cytokine Levels in Synovial Fluid

    PubMed Central

    Bigoni, Marco; Gandolla, Marta; Sacerdote, Paola; Piatti, Massimiliano; Castelnuovo, Alberto; Franchi, Silvia; Gorla, Massimo; Munegato, Daniele; Gaddi, Diego; Pedrocchi, Alessandra; Omeljaniuk, Robert J.; Locatelli, Vittorio; Torsello, Antonio

    2016-01-01

    Anterior cruciate ligament (ACL) reconstruction restores knee stability but does not reduce the incidence of posttraumatic osteoarthritis induced by inflammatory cytokines. The aim of this research was to longitudinally measure IL-1β, IL-6, IL-8, IL-10, and TNF-α levels in patients subjected to ACL reconstruction using bone-patellar tendon-bone graft. Synovial fluid was collected within 24–72 hours of ACL rupture (acute), 1 month after injury immediately prior to surgery (presurgery), and 1 month thereafter (postsurgery). For comparison, a “control” group consisted of individuals presenting chronic ACL tears. Our results indicate that levels of IL-6, IL-8, and IL-10 vary significantly over time in reconstruction patients. In the acute phase, the levels of these cytokines in reconstruction patients were significantly greater than those in controls. In the presurgery phase, cytokine levels in reconstruction patients were reduced and comparable with those in controls. Finally, cytokine levels increased again with respect to control group in the postsurgery phase. The levels of IL-1β and TNF-α showed no temporal variation. Our data show that the history of an ACL injury, including trauma and reconstruction, has a significant impact on levels of IL-6, IL-8, and IL-10 in synovial fluid but does not affect levels of TNF-α and IL-1β. PMID:27313403

  1. Avoiding Complications and Technical Variability During Arthroscopically Assisted Transtibial ACL Reconstructions by Using a C-Arm With Image Intensifier

    PubMed Central

    Trentacosta, Natasha; Fillar, Allison Liefeld; Liefeld, Cynthia Pierce; Hossack, Michael D.; Levy, I. Martin

    2014-01-01

    adjustment of the tibial tunnel and knee flexion angle. Incremental adjustment was essential to accomplish this. Importantly, a C-arm with image intensifier can be used with any ACL reconstruction that incorporates tunnels in the technique, with the expectation of increase in accuracy and precision and the elimination of common complications. Clinical Relevance: The use of an image intensifier during transtibial ACL reconstruction will substantially reduce the common complications associated with the procedure and improve both accuracy and precision of tibial and femoral tunnel placement. Use of an image intensifier unit is generalizable to an individual surgeon’s preferences for graft choices and drilling techniques and will be especially valuable when the intercondylar architecture is altered from injury, time, or prior surgery. PMID:26535320

  2. Anatomic ACL reconstruction: rectangular tunnel/bone-patellar tendon-bone or triple-bundle/semitendinosus tendon grafting.

    PubMed

    Shino, Konsei; Mae, Tatsuo; Tachibana, Yuta

    2015-05-01

    Anatomic ACL reconstruction is the reasonable approach to restore stability without loss of motion after ACL tear. To mimic the normal ACL like a ribbon, our preferred procedures is the anatomic rectangular tunnel (ART) technique with a bone-patellar tendon-bone (BTB) graft or the anatomic triple bundle (ATB) procedure with a hamstring (HS) tendon graft. It is important to create tunnel apertures inside the attachment areas to lessen the tunnel widening. To identify the crescent-shaped ACL femoral attachment area, the upper cartilage margin, the posterior cartilage margin and the resident's ridge are used as landmarks. To delineate the C-shaped tibial insertion, medial intercondylar ridge, Parson's knob and anterior horn of the lateral meniscus are helpful. In ART-BTB procedure which is suitable for male patients engaged in contact sports, the parallelepiped tunnels with rectangular apertures are made within the femoral and tibial attachment areas. In ATB-HS technique which is mainly applied to female athletes engaged in non-contact sports including skiing or basketball, 2 femoral and 3 tibial round tunnels are created inside the attachment areas. These techniques make it possible for the grafts to run as the native ACL without impingement to the notch or PCL. After femoral fixation with an interference screw or cortical fixation devices including Endobutton, the graft is pretensioned in situ by repetitive manual pulls at 15-20° of flexion, monitoring the graft tension with tensioners on a tensioning boot installed on the calf. Tibial fixation with pullout sutures is achieved using Double Spike Plate and a screw at the pre-determined amount of tension of 10-20N. While better outcomes with less failure rate are being obtained compared to those in the past, higher graft tear rate remains a problem. Improved preventive training may be required to avoid secondary ACL injuries.

  3. Anatomic ACL reconstruction: rectangular tunnel/bone-patellar tendon-bone or triple-bundle/semitendinosus tendon grafting.

    PubMed

    Shino, Konsei; Mae, Tatsuo; Tachibana, Yuta

    2015-05-01

    Anatomic ACL reconstruction is the reasonable approach to restore stability without loss of motion after ACL tear. To mimic the normal ACL like a ribbon, our preferred procedures is the anatomic rectangular tunnel (ART) technique with a bone-patellar tendon-bone (BTB) graft or the anatomic triple bundle (ATB) procedure with a hamstring (HS) tendon graft. It is important to create tunnel apertures inside the attachment areas to lessen the tunnel widening. To identify the crescent-shaped ACL femoral attachment area, the upper cartilage margin, the posterior cartilage margin and the resident's ridge are used as landmarks. To delineate the C-shaped tibial insertion, medial intercondylar ridge, Parson's knob and anterior horn of the lateral meniscus are helpful. In ART-BTB procedure which is suitable for male patients engaged in contact sports, the parallelepiped tunnels with rectangular apertures are made within the femoral and tibial attachment areas. In ATB-HS technique which is mainly applied to female athletes engaged in non-contact sports including skiing or basketball, 2 femoral and 3 tibial round tunnels are created inside the attachment areas. These techniques make it possible for the grafts to run as the native ACL without impingement to the notch or PCL. After femoral fixation with an interference screw or cortical fixation devices including Endobutton, the graft is pretensioned in situ by repetitive manual pulls at 15-20° of flexion, monitoring the graft tension with tensioners on a tensioning boot installed on the calf. Tibial fixation with pullout sutures is achieved using Double Spike Plate and a screw at the pre-determined amount of tension of 10-20N. While better outcomes with less failure rate are being obtained compared to those in the past, higher graft tear rate remains a problem. Improved preventive training may be required to avoid secondary ACL injuries. PMID:25753837

  4. USE OF SPATIOTEMPORAL GAIT PARAMETERS TO DETERMINE RETURN TO SPORTS AFTER ACL RECONSTRUCTION

    PubMed Central

    LEPORACE, GUSTAVO; METSAVAHT, LEONARDO; ZEITOUNE, GABRIEL; MARINHO, THIAGO; OLIVEIRA, TAINÁ; PEREIRA, GLAUBER RIBEIRO; OLIVEIRA, LISZT PALMEIRA DE; BATISTA, LUIZ ALBERTO

    2016-01-01

    Objective : To compare gait spatiotemporal parameters of healthy and ACL reconstructed subjects in order to classify the status of gait normality. Methods : Fourteen healthy subjects and eight patients submitted to ACL reconstruction walked along a walkway while the lower limbs movement was captured by an infrared camera system. The frames where the initial contact and toe-off took place were determined and the following dependent variables, which were compared between groups through the Mann-Whitney test (a=0.05) were calculated: percentage of time in initial double stance, percentage of time in single stance, percentage of time in terminal double stance, stride length and gait velocity. Initially, all variables were compared between groups using a Mann-Whitney test. A logistic regression was applied, including all dependent variables, to create a model that could differentiate healthy and ACL reconstructed subjects. Results : ACL reconstructed group showed no differences in any spatiotemporal parameter of gait (p > 0.05) in relation to the control group, although the angular kinematic differences of the knee remained altered, as evidenced in a study with a similar sample. Conclusion : The regression classified all subjects as healthy, including the ACL reconstructed group, suggesting the spatiotemporal variables should not be used as the sole criterion of return to sports activities at the same level as prior to injury. Level of Evidence III, Case Control Study. PMID:26981039

  5. Functional Performance Testing and Patient Reported Outcomes following ACL Reconstruction: A Systematic Scoping Review.

    PubMed

    Almangoush, Adel; Herrington, Lee

    2014-01-01

    Objective. A systematic scoping review of the literature to identify functional performance tests and patient reported outcomes for patients who undergo anterior cruciate ligament (ACL) reconstruction and rehabilitation that are used in clinical practice and research during the last decade. Methods. A literature search was conducted. Electronic databases used included Medline, PubMed, Cochrane Library, EMBASE, CINAHL, SPORTDiscus, PEDro, and AMED. The inclusion criteria were English language, publication between April 2004 and April 2014, and primary ACL reconstruction with objective and/or subjective outcomes used. Two authors screened the selected papers for title, abstract, and full-text in accordance with predefined inclusion and exclusion criteria. The methodological quality of all papers was assessed by a checklist of the Critical Appraisal Skills Programme (CASP). Results. A total of 16 papers were included with full-text. Different authors used different study designs for functional performance testing which led to different outcomes that could not be compared. All papers used a measurement for quantity of functional performance except one study which used both quantity and quality outcomes. Several functional performance tests and patient reported outcomes were identified in this review. Conclusion. No extensive research has been carried out over the past 10 years to measure the quality of functional performance testing and control stability of patients following ACL reconstruction. However this study found that the measurement of functional performance following ACL reconstruction consisting of a one-leg hop for a set distance or a combination of different hops using limb symmetry index (LSI) was a main outcome parameter of several studies. A more extensive series of tests is suggested to measure both the quantitative and qualitative aspects of functional performance after the ACL reconstruction. The KOOS and the IKDC questionnaires are both measures that

  6. Functional Performance Testing and Patient Reported Outcomes following ACL Reconstruction: A Systematic Scoping Review

    PubMed Central

    Herrington, Lee

    2014-01-01

    Objective. A systematic scoping review of the literature to identify functional performance tests and patient reported outcomes for patients who undergo anterior cruciate ligament (ACL) reconstruction and rehabilitation that are used in clinical practice and research during the last decade. Methods. A literature search was conducted. Electronic databases used included Medline, PubMed, Cochrane Library, EMBASE, CINAHL, SPORTDiscus, PEDro, and AMED. The inclusion criteria were English language, publication between April 2004 and April 2014, and primary ACL reconstruction with objective and/or subjective outcomes used. Two authors screened the selected papers for title, abstract, and full-text in accordance with predefined inclusion and exclusion criteria. The methodological quality of all papers was assessed by a checklist of the Critical Appraisal Skills Programme (CASP). Results. A total of 16 papers were included with full-text. Different authors used different study designs for functional performance testing which led to different outcomes that could not be compared. All papers used a measurement for quantity of functional performance except one study which used both quantity and quality outcomes. Several functional performance tests and patient reported outcomes were identified in this review. Conclusion. No extensive research has been carried out over the past 10 years to measure the quality of functional performance testing and control stability of patients following ACL reconstruction. However this study found that the measurement of functional performance following ACL reconstruction consisting of a one-leg hop for a set distance or a combination of different hops using limb symmetry index (LSI) was a main outcome parameter of several studies. A more extensive series of tests is suggested to measure both the quantitative and qualitative aspects of functional performance after the ACL reconstruction. The KOOS and the IKDC questionnaires are both measures that

  7. The Effects of Balance Training on Static and Dynamic Postural Stability Indices After Acute ACL Reconstruction

    PubMed Central

    Akbari, Asghar; Ghiasi, Fateme; Mir, Mohsen; Hosseinifar, Mohammad

    2016-01-01

    Background: Proprioception and postural stability play an important role in knee movements. However, there are controversies about the overall recovery time of proprioception following knee surgery and onset of balance and neuromuscular training after ACL reconstruction. Therefore, it is necessary to evaluate the effect of balance training in early stage of knee rehabilitation after anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to evaluate the effect of balance exercises on postural stability indices in subjects with anterior cruciate ligament (ACL) reconstruction. Methods: The study was a controlled randomized trial study. Twenty four patients who had ACL reconstructed (balance training group) and twenty four healthy adults without any knee injury (control group) were recruited in the study. The balance exercises group performed balance exercises for 2 weeks. Before and after the interventions, overall, anteroposterior, and mediolateral stability indices were measured with a Biodex Balance System in bilateral and unilateral stance positions with the eyes open and closed. T-tests were used for statistical analysis (p<0.05). Results: Results showed that amount of static stability indices did not change after training and there were not significant differences in static stability indices before and after balance training (p>0.05). Although amount of dynamic stability indices decreased, there were not significant differences in dynamic stability indices before and after balance training (p>0.05). Amount of dynamic stability indices were decreased in balance training group, however, there were not significant differences between groups (p>0.05). Conclusion: These results support that balance exercise could partially improved dynamic stability indices in early stage of ACL reconstruction rehabilitation. The results of this study suggest that balance exercises should be part of the rehabilitation program following ACL reconstruction. PMID

  8. 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

  9. Two-Stage Revision Anterior Cruciate Ligament Reconstruction: Bone Grafting Technique Using an Allograft Bone Matrix.

    PubMed

    Chahla, Jorge; Dean, Chase S; Cram, Tyler R; Civitarese, David; O'Brien, Luke; Moulton, Samuel G; LaPrade, Robert F

    2016-02-01

    Outcomes of primary anterior cruciate ligament (ACL) reconstruction have been reported to be far superior to those of revision reconstruction. However, as the incidence of ACL reconstruction is rapidly increasing, so is the number of failures. The subsequent need for revision ACL reconstruction is estimated to occur in up to 13,000 patients each year in the United States. Revision ACL reconstruction can be performed in one or two stages. A two-stage approach is recommended in cases of improper placement of the original tunnels or in cases of unacceptable tunnel enlargement. The aim of this study was to describe the technique for allograft ACL tunnel bone grafting in patients requiring a two-stage revision ACL reconstruction. PMID:27274452

  10. Two-Stage Revision Anterior Cruciate Ligament Reconstruction: Bone Grafting Technique Using an Allograft Bone Matrix.

    PubMed

    Chahla, Jorge; Dean, Chase S; Cram, Tyler R; Civitarese, David; O'Brien, Luke; Moulton, Samuel G; LaPrade, Robert F

    2016-02-01

    Outcomes of primary anterior cruciate ligament (ACL) reconstruction have been reported to be far superior to those of revision reconstruction. However, as the incidence of ACL reconstruction is rapidly increasing, so is the number of failures. The subsequent need for revision ACL reconstruction is estimated to occur in up to 13,000 patients each year in the United States. Revision ACL reconstruction can be performed in one or two stages. A two-stage approach is recommended in cases of improper placement of the original tunnels or in cases of unacceptable tunnel enlargement. The aim of this study was to describe the technique for allograft ACL tunnel bone grafting in patients requiring a two-stage revision ACL reconstruction.

  11. 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.

  12. Perturbation training prior to ACL reconstruction improves gait asymmetries in non-copers.

    PubMed

    Hartigan, Erin; Axe, Michael J; Snyder-Mackler, Lynn

    2009-06-01

    We investigated whether preoperative perturbation training would help anterior cruciate ligament (ACL) deficient individuals who complain of knee instability ("non-copers") regain quadriceps strength and walk normally after ACL reconstruction. Nineteen non-copers with acute ACL injury were randomly assigned into a perturbation group (PERT) or a strengthening group (STR). The PERT group received specialized neuromuscular training and progressive quadriceps strength training, whereas the STR group received progressive quadriceps strength training only. We compared quadriceps strength indexes and knee excursions during the mid-stance phase of gait preoperatively to data collected 6 months after ACL reconstruction. Analyses of Variance with repeated measures (time/limb) were conducted to compare quadriceps strength index values over time (time x group) and differences in knee excursions in limbs between groups over time (limb x time x group). If significance was found, post hoc analyses were performed using paired and independent t-tests. Quadriceps strength indexes before intervention (Pert: 87.2%; Str: 75.8%) improved 6 months after ACL reconstruction in both groups (Pert: 97.1%; Str: 94.4%). Non-copers who received perturbation training preoperatively had no differences in knee excursions between their limbs 6 months after ACL reconstruction (p = 0.14), whereas those who received just strength training continued to have smaller knee excursions during the mid-stance phase of gait (p = 0.007). Non-copers strength and knee excursions were more symmetrical 6 months postoperatively in the group that received perturbation training and progressive quadriceps strength training than the group who received strength training alone.

  13. Selective anteromedial bundle reconstruction in partial ACL tears: a series of 36 patients with mean 24 months follow-up.

    PubMed

    Sonnery-Cottet, Bertrand; Lavoie, F; Ogassawara, R; Scussiato, R G; Kidder, J F; Chambat, P

    2010-01-01

    The purpose of this study was to describe an original technique of reconstruction of the anteromedial bundle preserving the posterolateral bundle and to report the results of a consecutive 36 patients series with mean 24 months follow-up. Our hypothesis is that this selective reconstruction of ACL partial tears could restore knee stability and function. In a consecutive series of 256, ACL reconstructions, 36 patients in which intact ACL fibers remained in the location corresponding to the posterolateral bundle were perioperatively diagnosed. These patients (21 women and 15 men) underwent isolated reconstruction of the anteromedial bundle while keeping the remaining fibers intact. AM bundle reconstructions were performed by the same surgeon using an outside-in technique. A quadrupled hamstring graft was used in 20 patients and a doubled semitendinosus graft in 16 patients. The mean age of the patients at the time of surgery was 32 years (min 15, max 53). The delay between injury and surgery was 6.6 months (min 2, max 35). Patients were assessed with the IKDC ligament evaluation form. Instrumented knee testing was performed with the Rolimeter arthrometer. Statistical analysis was performed to compare the preoperative and postoperative objective evaluation. Eleven concomitant meniscal lesions at the time of reconstruction were found. One patient who underwent a traumatic graft rupture at 4 months post surgery and two patients with previous contralateral ACL reconstruction were excluded, leaving 33 patients for final evaluation. Three reoperations were performed, including two arthrolysis for cyclops syndrome and one revision for a traumatic graft rupture. At last follow-up, 24 (73%) patients were graded A, 8 (24%) graded B and 1 C (3%) at IKDC objective evaluation. Mean side to side instrumented laxity was 4.8 mm (min 3, max 6) preoperatively and 0.8 mm (min 0, max 2) postoperatively. AM bundle reconstruction with an outside-in technique remains simple and

  14. High intensity running results in an impaired neuromuscular response in ACL reconstructed individuals.

    PubMed

    Patras, Kostas; Ziogas, Giorgos; Ristanis, Stavros; Tsepis, Elias; Stergiou, Nicholas; Georgoulis, Anastasios D

    2009-08-01

    Anterior cruciate ligament (ACL) reconstruction reestablishes electromyographic activity during moderate activities such as walking but is unclear if this is also the case in sports activities such as high intensity running that results in accumulation of metabolic fatigue. Nine bone-patella tendon-bone ACL reconstructed athletes were evaluated 19.2 (5.7) months post-operatively using a telemetric electromyographic system. The neuromuscular response of vastus lateralis and biceps femoris muscles was tested bilaterally on separate occasions during 10 min running at moderate intensity (20% below the lactate threshold) and 10 min running at high intensity (40% above the lactate threshold). During moderate intensity running, electromyographic activity did not change for either leg. During high intensity running, electromyographic activity did not change for the vastus lateralis of the ACL reconstructed leg [267.8 (142.8)-263.8 (128.9) microV, P > 0.05] while it increased significantly [294.2 (120.6)-317.1 (140.5) microV, P = 0.03] for the vastus lateralis of the intact leg. High intensity exercise that is associated with accumulation of metabolic fatigue, results in an impaired neuromuscular response for the vastus lateralis muscle of the ACL reconstructed leg.

  15. A tale of 10 European centres – 2010 APOSSM travelling fellowship review in ACL surgery

    PubMed Central

    2012-01-01

    The purpose of ESSKA- APOSSM Travelling fellowship is to better understand the epidemiology, management and surgical techniques for sports across continents. There has been a progressive evolution in ACL reconstruction and there is variation in technique in ACL reconstruction amongst the most experienced surgeons in different continents. During this one month fellowship, we saw various ACL reconstruction techniques using different graft sources, with a variety of graft fixation methods, with the common aim of recreating an anatomical ACL reconstruction. PMID:22839644

  16. 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

  17. Recovery of Psychological Readiness May Differ Between Genders Following ACL Reconstruction in Adolescent Athletes

    PubMed Central

    Milewski, Matthew David; Kostyun, Regina; Iannicelli, Julie P.; Kostyun, Kyle J.; Solomito, Matthew; Nissen, Carl W.

    2016-01-01

    Objectives: Injury to the anterior cruciate ligament (ACL) is a traumatic and emotional event for adolescent athletes. Preparation to return to play (RTP) and the potential risk of re-injury are often equally as emotional as the injury, and have been identified as possible limiting factors to a successful rehabilitation and RTP. In order to create a comprehensive rehabilitation model, further understanding of psychological readiness following surgical intervention is needed. The purpose of this study was to determine if clinical outcomes of subjective knee function and psychological readiness differ between genders following ACL reconstruction surgery in adolescent athletes, and if higher knee function and physiological readiness was associated with an earlier to RTP. Methods: Athletes who underwent ACL reconstruction surgery and were successfully returned back to unrestricted sport were included in the analysis. At approximately six months post surgery, knee function was assessed using the validated International Knee Documentation Committee (IKDC) Subjective Form, and psychological readiness was assessed using the validated ACL-Return to Sport after Injury (ACL-RSI) scale. Formal clearance to resume unrestricted sport was obtained from clinic notes. A T-test was used to determine if demographics, IKDC and ACL-RSI scores between genders. A mixed effects random intercept regression model was used to determine the association of time to RTP with IKDC and ACL-RSI scores. Results: A total of 45 adolescent athletes (23 females) were included in this analysis. No significant differences were found between males and females for age (16.2±1.5 years, 16.3±2.2 years) and average time to RTP (7.3±2.0 months, 7.3±1.8 months). No significant differences in IKDC scores were found between males and females (88±10%, 87±10%). A trend was identified that males demonstrated higher ACL-RSI scores at six month post surgery than females (81±14%, 72±17%, p = 0.063). In females

  18. 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

  19. Strength Asymmetry and Landing Mechanics at Return to Sport after ACL Reconstruction

    PubMed Central

    Schmitt, Laura C.; Paterno, Mark V.; Ford, Kevin R.; Myer, Gregory D.; Hewett, Timothy E.

    2014-01-01

    Purpose Evidence-based quadriceps femoris muscle (QF) strength guidelines for return to sport following anterior cruciate ligament (ACL) reconstruction are lacking. This study investigated the impact of QF strength asymmetry on knee landing biomechanics at the time of return to sport following ACL reconstruction. Methods Seventy-seven individuals (17.4 years) at the time of return to sport following primary ACL reconstruction (ACLR group) and 47 uninjured control individuals (17.0 years) (CTRL group) participated. QF strength was assessed and Quadriceps Index calculated (QI = [involved strength/uninvolved strength]*100%). The ACLR group was sub-divided based on QI: High Quadriceps (HQ, QI≥90%) and Low-Quadriceps (LQ, QI<85%). Knee kinematic and kinetic variables were collected during a drop vertical jump maneuver. Limb symmetry during landing, and discrete variables were compared among the groups with multivariate analysis of variance and linear regression analyses. Results The LQ group demonstrated worse asymmetry in all kinetic and ground reaction force variables compared to the HQ and CTRL groups, including reduced involved limb peak knee external flexion moments (p<.001), reduced involved limb (p=.003) and increased uninvolved limb (p=.005) peak vertical ground reaction forces, and higher uninvolved limb peak loading rates (p<.004). There were no differences in the landing patterns between the HQ and CTRL groups on any variable (p>.05). In the ACLR group, QF strength estimated limb symmetry during landing after controlling for graft type, meniscus injury, knee pain and symptoms. Conclusion At the time of return to sport, individuals post-ACL reconstruction with weaker QF demonstrate altered landing patterns. Conversely, those with nearly symmetrical QF strength demonstrate landing patterns similar to uninjured individuals. Consideration of an objective QF strength measure may aid clinical decision-making to optimize sports participation following ACL

  20. A modified arthroscopic anterior cruciate ligament double-bundle reconstruction technique with autogenous quadriceps tendon graft: remnant-preserving technique.

    PubMed

    Kim, Sung-Jae; Jo, Seung-Bae; Kim, Tai-Won; Chang, Ji-Hoon; Choi, Heon-Sik; Oh, Kyung-Soo

    2009-03-01

    Several techniques of anterior cruciate ligament (ACL) double-bundle reconstruction have been introduced to improve the functional outcome and restore normal kinematics of the knee. Meanwhile, a remnant-preserving technique was developed to preserve the proprioception and to enhance the revascularization of the reconstructed ACL. We developed double-bundle ACL reconstruction technique using autogenous quadriceps tendon graft while preserving the remnant. With this technique, two femoral sockets and one tibial tunnel are made. To preserve the remnant of the ACL, the rotational direction of the reamer was set to counterclockwise just before perforation of the tibial tunnel. To pass the graft more easily without disturbance of the remnant, the graft passage was achieved through the tibial tunnel. We suggest that the remnant-preserving technique could be an effective alternative considering its mechanical stability as well as the proprioception and vascularization recovery in arthroscopic double-bundle ACL reconstruction.

  1. Predictors of Lateral Compartment Joint Space Difference at a Minimum of Two Years after ACL Reconstruction

    PubMed Central

    Jones, Morgan H.; Reinke, Emily; Duryea, Jeffrey; Fleming, Braden C.; Obuchowski, Nancy; Winalski, Carl S.; Spindler, Kurt P.

    2016-01-01

    Objectives: ACL reconstruction effectively restores knee stability and allows a return to athletic activities after ACL injury, but patients are still at higher risk of developing post-traumatic OA. Patient reported outcomes from the Multicenter Orthopaedic Outcomes Network (MOON) prospective longitudinal cohort of over 1500 patients undergoing ACL reconstruction showed no increase in OA symptoms (KOOS subscale) at 2 or 6 years after surgery. Therefore, identification of structural changes of OA that may precede the onset of symptoms is of critical importance for determining risk factors for the initiation and progression of post-traumatic OA in addition to measuring the effectiveness of potential disease-modifying treatments. One structural measure of OA is radiographic joint space width (JSW). We previously demonstrated that meniscus treatment and age predict narrower medial compartment JSW. Methods: 335 patients from the MOON cohort (154 males, 181 females, median age 18 years at the time of surgery) were recruited at a minimum of 2 years following surgery for on-site evaluations including bilateral metatarsophalangeal joint (MTP) radiographs to assess JSW. To minimize bias related to pre-existing knee injury or OA, subjects were 35 years or younger, were injured playing a sport, had primary ACL reconstruction without prior meniscus or articular cartilage surgery, did not undergo subsequent ACL revision, and had a surgically normal contralateral knee. Radiographic JSW was measured in the lateral compartment of both knees using a validated semiautomated method. The association of age, sex, BMI, meniscus treatment, and articular cartilage treatment with lateral compartment JSW differences (JSD) between the reconstructed and normal knees was examined using multivariable generalized linear models. The Holm-Bonferroni method was used to account for multiple comparisons. Results: The mean lateral compartment JSW was 7.73 mm and (95% CI 7.61-7.85 mm) for ACL

  2. 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

  3. 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

  4. Magnetic Resonance Imaging of Cartilage Contact and Bound Water in ACL-Deficient and ACL Reconstructed Knees

    PubMed Central

    Baer, Geoffrey Scott; Kaiser, Jarred; Vignos, Michael; Liu, Fang; Smith, Colin Robert; Kijowski, Richard; Thelen, Darryl

    2016-01-01

    Objectives: Osteoarthritis (OA) is common following ACL-reconstructive (ACLR) surgery (6). The cause of early OA is not understood, but theories have focused on osteochondral damage at the time of injury (2) and abnormal joint mechanics following surgical repair (7). In this study, we investigate the inter-relationship of cartilage mechanics and biomarkers of OA in both ACL-deficient (ACLD) and ACLR knees. Our approach employs a novel dynamic MR sequence to measure joint mechanics (3) and the recently developed mcDESPOT to assess regional variations in water bound to proteoglycan (PG) (5). We hypothesize that bound water will be diminished in the cartilage of ACLD knees and, after surgery, will continue to adapt in a manner that reflects altered cartilage loading. This abstract presents initial observations on a cross-section of healthy, ACLD and ACLR knees. Methods: The dominant knees of 8 healthy controls, ACLD knees of 5 patients and ACLR knees of 8 patients were imaged in a 3 T MRI scanner (Table). Controls had no history of pain, injury, or surgery to their knee. Patients had no additional ligament injury and no meniscal damage. ACLD subjects were imaged prior to reconstructive surgery. Femoral and tibial cartilage were segmented from MR images and cartilage thickness was calculated. The mcDESPOT sequence provided a fraction map of water bound to PG (Fpg). Subjects flexed their knee against an inertial load at 0.5 Hz, while a SPGR-VIPR sequence continuously acquired volumetric data. Kinematics were obtained using model tracking of the dynamic images (3). Cartilage was registered to the bone segments for all frames, and contact patterns were characterized by the proximity between surfaces. Spatial representations of tibial cartilage contact, thickness and Fpg were co-registered for each subject. Results: Our initial images suggest lower Fpg values in ACLD knees, primarily on the posterior-lateral tibia. This is also observed in ACLR knees, with additional

  5. Pre-operative factors predicting good outcome in terms of health-related quality of life after ACL reconstruction.

    PubMed

    Månsson, O; Kartus, J; Sernert, N

    2013-02-01

    The life situation of many patients changes after an anterior cruciate ligament (ACL) rupture and subsequent reconstruction, and this may affect their health-related quality of life in many ways. It is well known that the overall clinical results after ACL reconstruction are considered good, but pre-operative predictive factors for a good post-operative clinical outcome after ACL reconstruction have not been studied in as much detail. The purpose of this study was to identify pre-operative factors that predict a good post-operative outcome as measured by the Short Form 36 (SF-36) and Knee Osteoarthritis Outcome Score (KOOS) 3-6 years after ACL reconstruction. Seventy-three patients scheduled for ACL reconstruction were clinically examined pre-operatively. The SF-36 and KOOS questionnaires were sent by mail to these patients 3-6 years after reconstruction. Predictive factors for health-related quality of life were investigated using a stepwise regression analysis. In conclusion, pre-operative factors, such as pivot shift, knee function, and range of motion, may predict a good post-operative outcome and explain up to 25% in terms of health-related quality of life after ACL reconstruction. Furthermore, it appears that the patients' pre-injury and pre-operative Tegner activity levels are important predictors of post-operative health-related quality of life.

  6. Use of ultra-high molecular weight polycaprolactone scaffolds for ACL reconstruction.

    PubMed

    Leong, Natalie L; Kabir, Nima; Arshi, Armin; Nazemi, Azadeh; Jiang, Jie; Wu, Ben M; Petrigliano, Frank A; McAllister, David R

    2016-05-01

    Previously, we reported on the implantation of electrospun polycaprolactone (PCL) grafts for use in ACL tissue engineering in a small animal model. In the present study, we hypothesized that grafts fabricated from ultra-high molecular weight polycaprolactone (UHMWPCL) would have similarly favorable biologic properties but superior mechanical properties as compared to grafts fabricated from PCL. Two forms of polycaprolactone were obtained (UHMWPCL, MW = 500 kD, and PCL, MW = 80 kD) and electrospun into scaffolds that were used to perform ACL reconstruction in 7-8 week old male Lewis rats. The following groups were examined: UHMWPCL, PCL, flexor digitorum longus (FDL) allograft, native ACL, as well as sham surgery in which the ACL was transsected. At 16 weeks post-operatively, biomechanical testing, histology, and immunohistochemistry (IHC) were performed. Analysis of cellularity indicated that there was no significant difference among the UHMWPCL, PCL, and FDL allograft groups. Quantification of birefringence from picrosirius red staining demonstrated significantly more aligned collagen fibers in the allograft than the PCL group, but no difference between the UHMWPCL and allograft groups. The peak load to failure of the UHMWPCL grafts was significantly higher than PCL, and not significantly different from FDL allograft. This in vivo study establishes the superiority of the higher molecular weight version of polycaprolactone over PCL as a scaffold material for ACL reconstruction. By 16 weeks after implantation, the UHMWPCL grafts were not significantly different from the FDL allografts in terms of cellularity, peak load to failure, stiffness, and collagen fiber alignment. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:828-835, 2016. PMID:26497133

  7. A medium to long-term follow-up of ACL reconstruction using double gracilis and semitendinosus grafts.

    PubMed

    Ferretti, Andrea; Monaco, Edoardo; Giannetti, Silvio; Caperna, Ludovico; Luzon, David; Conteduca, Fabio

    2011-03-01

    This paper reports the results of our approach to ACL tears and knee laxity, based on 30 years of experience in ACL reconstruction with hamstrings and founded on the following cornerstones: the use of doubled semitendinosus and gracilis as a free graft; the use of an out-in technique for femoral drilling and of very strong and stiff fixation devices; the careful examination and repair or reconstruction of the lateral compartment in selected patients; and the use of unaggressive rehabilitation. We prospectively evaluated a series of 100 consecutive patients who underwent ACL reconstruction between 2001 and 2002. A clinical and radiological follow-up was performed at a minimum of 6 years. After 6 years, the International Knee Documentation Committee score demonstrated good-to-excellent results (A and B) in 98% of patients. However, arthrometric results using the KT-1000 demonstrated that 6/80 patients (7.5%) had >5 mm manual maximum side-to-side difference. The median Tegner activity score was 5 (range 1-9); the median Lysholm score was 96 (range 81-100); and the median subjective IKDC score was 94 (range 66-100). We reported 6/80 failures as revealed by a 2+ or 3+ pivot-shift test result and/or KT-1000 side-to-side difference of more than 5 mm. The IKDC score revealed excellent results in all women who underwent extra-articular tenodesis. Radiographic evaluation demonstrated early signs of osteoarthritis in 9% of patients.

  8. 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. PMID:26981302

  9. 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

  10. 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

  11. Adverse effect of femoral nerve blockade on quadriceps strength and function after ACL reconstruction.

    PubMed

    Krych, Aaron; Arutyunyan, Grigoriy; Kuzma, Scott; Levy, Bruce; Dahm, Diane; Stuart, Michael

    2015-02-01

    The purpose of this study was to determine if quadriceps strength and functional outcomes were similar at 6 months following anterior cruciate ligament [ACL] reconstruction in patients receiving a continuous 48-hour femoral nerve blockade for postoperative analgesia (FNB group) versus patients with no FNB (control group). A retrospective cohort was designed including athletes who underwent primary ACL reconstruction with patellar tendon autograft between 2005 and 2010 at our institution with identical rehabilitation protocols. The FNB group included 96 patients with an average age of 21 years and the control group included 100 patients with an average age of 20 years. At 6 months following ACL reconstruction, isokinetic strength (slow and fast activation) and functional tests including vertical jump, single hop, triple hop, and return to sport were analyzed with an α value < 0.05 as significant. Multivariate regression models were used to compare these outcomes between the FNB and control groups after adjusting for gender and competitive athlete status. At 6 months, fast extension isokinetic strength was inferior in the FNB group (78 vs. 85%; p < 0.01). After adjusting for gender and competitive athlete status, fast (p = 0.002) and slow extension strength (p = 0.01), vertical jump (p = 0.03) and single jump (p = 0.02) were also inferior in the FNB group. There were no significant differences in full return to sport between the two groups (86% at 7.5 months in the FNB group vs. 93% at 7.3 months in the control group). In this retrospective comparative study, the hypothesis that patients treated with continuous FNB for postoperative analgesia following ACL reconstruction with patellar tendon autograft will have inferior knee extension (quadriceps) strength and function at 6 months follow-up was affirmed. However, no differences were observed in return to sport, bringing into question whether these statistical differences translate into

  12. Cross-cultural comparison of patients undergoing ACL reconstruction in the United States and Norway.

    PubMed

    Magnussen, Robert A; Granan, Lars-Petter; Dunn, Warren R; Amendola, Annunziato; Andrish, Jack T; Brophy, Robert; Carey, James L; Flanigan, David; Huston, Laura J; Jones, Morgan; Kaeding, Christopher C; McCarty, Eric C; Marx, Robert G; Matava, Matthew J; Parker, Richard D; Vidal, Armando; Wolcott, Michelle; Wolf, Brian R; Wright, Rick W; Spindler, Kurt P; Engebretsen, Lars

    2010-01-01

    Data from large prospectively collected anterior cruciate ligament (ACL) cohorts are being utilized to address clinical questions regarding ACL injury demographics and outcomes of ACL reconstruction. These data are affected by patient and injury factors as well as surgical factors associated with the site of data collection. The aim of this article is to compare primary ACL reconstruction data from patient cohorts in the United States and Norway, demonstrating the similarities and differences between two large cohorts. Primary ACL reconstruction data from the Multicenter Orthopaedic Outcomes Network (MOON) in the United States and the Norwegian National Knee Ligament Registry (NKLR) were compared to identify similarities and differences in patient demographics, activity at injury, preoperative Knee injury and Osteoarthritis Outcome Score (KOOS), time to reconstruction, intraarticular pathology, and graft choice. Seven hundred and thirteen patients from the MOON cohort were compared with 4,928 patients from the NKLR. A higher percentage of males (NKLR 57%, MOON 52%; P < 0.01) and increased patient age (NKLR 27 years, MOON 23 years; P\\0.001) were noted in the NKLR population. The most common sports associated with injury in the MOON cohort were basketball (20%), soccer (17%), and American football (14%); while soccer (42%), handball (26%), and downhill skiing (10%) were most common in the NKLR. Median time to reconstruction was 2.4 (Interquartile range [IQR] 1.2-7.2) months in the MOON cohort and 7.9 (IQR 4.2-17.8) months in the NKLR cohort (P < 0.001). Both meniscal tears (MOON 65%, NKLR 48%; P < 0.001) and articular cartilage defects (MOON 46%, NKLR 26%; P < 0.001) were more common in the MOON cohort. Hamstring autografts (MOON 44%, NKLR 63%) and patellar tendon autografts (MOON 42%, NKLR 37%) were commonly utilized in both cohorts. Allografts were much more frequently utilized in the MOON cohort (MOON 13%, NKLR 0.04%; P < 0.001). Significant diversity in patient

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. Neuromuscular adaptations and correlates of knee functionality following ACL reconstruction.

    PubMed

    Bryant, Adam L; Kelly, Jason; Hohmann, Erik

    2008-01-01

    The objective of this research was to examine the dynamic restraint mechanism by establishing the neuromuscular characteristics of lower extremity muscles in anterior cruciate ligament reconstruction (ACLR) subjects. This study also investigated neuromuscular variables that relate to post-ACLR functional outcome. Thirteen patients having undergone ACLR using the bone patella tendon bone graft at least 6 months prior participated in this study. Knee functionality (0- to 100-point scale) was rated using the Cincinnati Knee Rating System. The median frequency of the electromyographic (EMG) recordings from the vastus medialis (VM) and vastus lateralis (VL) muscles together with the isokinetic quadriceps torque generated in 10 degrees intervals between 80 degrees and 10 degrees knee flexion was determined for the noninvolved and involved limbs. Lower limb musculotendinous stiffness was also assessed for the noninvolved and involved limbs. Limb symmetry indexes were calculated for each of the physiological measures. Compared to the noninvolved limb, the median frequency of the EMG from the involved limb VM and VL muscles was significantly lower as was the quadriceps torque generated at the seven knee flexion intervals. In contrast, musculotendinous stiffness was significantly higher in the involved lower limb compared to the noninvolved limb. Significant, moderate correlations were identified between knee functionality and symmetry indexes for all variables except for the isokinetic quadriceps torque produced between 80 degrees -70 degrees and 20 degrees -10 degrees knee flexion. More functional ACLR subjects demonstrated enhanced motor unit recruitment reflective of less quadriceps muscle fiber atrophy together with increased quadriceps strength and musculotendinous stiffness of the lower limb musculature.

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

    PubMed

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

    2013-12-01

    We compared muscle activity of the quadriceps, hamstring, and gastrocnemius muscles when ACL-intact (ACL(INT)) and ACL-reconstructed (ACL(REC)) 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 and 78 ms earlier in ACL(INT) than in ACL(REC) subjects, respectively. Biceps femoris (BF) peak timing was 90 ms earlier in ACL(INT) than in ACL(REC) subjects and 75 ms earlier in females than in males. Medial gastrocnemius (MG) muscle peak timing was 77 ms earlier in ACL(INT) than in ACL(REC) 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 ACL(REC) than in ACL(INT) subjects. There was evidence suggesting that the loading phase quadriceps:hamstring (quad:ham) muscle activity ratio was greater in ACL(REC) than in ACL(INT) subjects. Finally, the injury risk phase quad:ham muscle activity ratio was 4.8 times greater in females than in males. In conclusion, differences exist in muscle activity related to ACL status and sex that could potentially help explain graft failure risk and the sex bias.

  20. ACL reconstruction

    MedlinePlus

    Anterior cruciate ligament repair ... Micheo W, Amy E, Sepuleveda F. Anterior cruciate ligament tear. In: Frontera, WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation . 3rd ed. Philadelphia, PA: Elsevier Saunders; 2015: ...

  1. Comparison of the postural control between football players following ACL reconstruction and healthy subjects

    PubMed Central

    Pahnabi, Gholamreza; Akbari, Mohammad; Ansari, Noureddin Nakhostin; Mardani, Mahmoud; Ahmadi, Mehdi; Rostami, Mohamad

    2014-01-01

    Background: Rupture of the Anterior Cruciate Ligment (ACL) is a common knee injury. The purpose of this study was to determine the balance control in football players with and without ACL reconstruction in posture of injury. Methods: Sway of the center of gravity of 15 patients with ACL reconstruction was compared with 15 healthy, age and sex-matched subjects as the control group. All tests were done unilaterally in the posture of injury, using a kistler force plate with the open and -closed eye conditions. Results: The knee of the operated side of the case group showed more displacement of the center of gravity when compared to the non-operated side in the same subject for all variables of the force plate. The operated side of the case group showed more displacement of the center of gravity for all variables of the force plate in comparison with the dominant side of knees in control group. There were significant differences between the non-operated side in the case group and the dominant side of the control group. Conclusion: All together, postural control in the operated side of the case group was weaker than the nonoperated side of the same group and the dominant limb of the control group, which might have resulted from poor proprioception. The postural control was even weaker in the non-operated side of the case group as compared with the dominant limb of the control group, which can justify the hypo mobility of limb for several months after the surgery. PMID:25664302

  2. 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.

  3. Validation of GAITRite and PROMIS as High-Throughput Physical Function Outcome Measures Following ACL Reconstruction

    PubMed Central

    Papuga, M. Owen; Beck, Christopher A.; Kates, Stephen L.; Schwarz, Edward M.; Maloney, Michael D.

    2014-01-01

    New healthcare demands for quality measures of elective procedures, such as anterior cruciate ligament (ACL) reconstructive surgery, warrant the establishment of high through-put outcomes for high volume clinics. To this end we evaluated the PROMIS and GAITRite as physical function outcome measures to quantify early healing and post-operative complications in 106 patients at pre-op and 3, 10, 20 and 52 weeks post-ACL reconstruction with bone-tendon-bone autograft, and compared the results to the current IKDC validated outcome measure. The results showed that both PROMIS and GAITRite were significantly quicker to administer versus IKDC (p < 0.0001). Additional advantages were that PROMIS and GAITRite detected a significant decrease in physical function at 3 weeks post-op, and a significant improvement at 10 weeks post-op, versus pre-op (p<0.001), which were not detected with IKDC. GAITRite was limited by a low ceiling that could not detect improvement of physical function beyond 20 weeks, while both PROMIS and IKDC detected significant improvement out to 52 weeks postop (p<0.001). Linear regressions demonstrated a significant relationship between IKDC and PROMIS, with a combined correlation value of 0.8954 (p<.001) for all time points. Finally, ROC curve analysis demonstrated that PROMIS is a diagnostic test for poor outcomes. PMID:24532421

  4. 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

  5. ACL reconstructed patients with a BPTB graft present an impaired vastus lateralis neuromuscular response during high intensity running.

    PubMed

    Patras, Kostas; Ziogas, Giorgos; Ristanis, Stavros; Tsepis, Elias; Stergiou, Nicholas; Georgoulis, Anastasios D

    2010-11-01

    The purpose of the present study was to investigate whether the electromyographic response of the vastus lateralis (VL) muscle in the anterior cruciate ligament (ACL) reconstructed leg is similar to that of the intact contralateral leg and healthy controls, during moderate and high intensity running. Fourteen bone-patellar tendon-bone (BPTB) ACL reconstructed amateur soccer players and fourteen healthy control amateur soccer players volunteered to participate in the study. Electromyographic (EMG) traces from the vastus lateralis (VL) muscle were collected bilaterally, as athletes ran on a treadmill for 10 min on separate occasions, at moderate and high intensity. The dependent variable examined was the EMG amplitude during stance. During the moderate intensity running, EMG amplitude of the VL did not increase with time for any of the tested legs. During the high intensity running, the EMG amplitude of the VL increased significantly with time for the intact (F=6.747, p=0.001) and the control leg (F=4.258, p=0.008), but remained unchanged for the ACL reconstructed leg. During moderate intensity running, there was no difference in the neuromuscular response of the VL in the reconstructed leg compared to the intact and control leg. High intensity running resulted in an impaired neuromuscular response of the VL in the reconstructed leg compared to the intact and control leg. It seems that potential impairments of the neuromuscular response after ACL reconstruction should be tested under high rather than moderate intensity efforts.

  6. 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

  7. 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

  8. Is there significant variation in the material properties of four different allografts implanted for ACL reconstruction.

    PubMed

    Penn, David; Willet, Thomas L; Glazebrook, Mark; Snow, Martyn; Stanish, William D

    2009-03-01

    The aims of our study were to: (1) determine if there are differences in the material properties of tendon obtained from implanted tibialis anterior, achilles, bone-patella- bone and tibialis posterior allografts; (2) determine the variability in material properties between the implanted specimens. A total of 60 specimens were collected from fresh frozen allografts implanted at ACL reconstruction. Specimens collected included 15 tibialis anterior, 15 tibialis posterior, 15 achilles and 15 bone-patella-bone tendons. Each specimen was mounted in a custom made cryogrip. The mounted specimens were loaded onto a MTS Testline servo-hydraulic testing machine in a uni-axial tensile test configuration. Specimens were subjected to a strain rate of 5% per second until the ultimate tensile stress (UTS), failure strain and high strain modulus was calculated for each specimen after being normalized for specimen dimensions. Individual material properties were tested using one way analysis of variance (ANOVA) and post hoc Tukey's B test with a P value of <0.05 considered significant. Homogeneity of variance was assessed using the Levene's test. As a result, no significant difference was found between all four grafts with regards to UTS, failure strain or high strain linear modulus. The UTS was plotted against the modulus demonstrating a linear relationship which is typical of soft tissues. Significant variability in the results were observed. In conclusion, there was no significant statistical difference between the material properties of the four tendon allografts tested. But significant variability in results was observed within groups and between groups, which may provide one explanation for the range of results in allograft ACL reconstruction reported in the literature.

  9. Predictive mathematical modeling of knee static laxity after ACL reconstruction: in vivo analysis.

    PubMed

    Signorelli, C; Bonanzinga, T; Grassi, A; Lopomo, N; Zaffagnini, S; Marcacci, M

    2016-11-01

    Previous studies did not take into consideration such large variety of surgery variables which describe the performed anterior cruciate ligament (ACL) reconstruction and the interaction among them in the definition of postoperative outcome. Seventeen patients who underwent navigated Single Bundle plus Lateral Plasty ACL reconstruction were enrolled in the study. Static laxity was evaluated as the value of anterior/posterior displacement at 30° and at 90° of flexion, internal/external rotation at 30° and 90° of knee flexion, varus/valgus test at 0° and 30° of flexion. The evaluated surgical variables were analyzed through a multivariate analysis defining the following models: AP30estimate, AP90estimate, IE30estimate, IE90estimate, VV0estimate, VV30estimate. Surgical variables has been defined as the angles between the tibial tunnel and the three planes, the lengths of the tunnel and the relationship between native footprints and tunnels. An analogous characterization was performed for the femoral side. Performance and significance of the defined models have been quantified by the correlation ratio (η(2)) and the corresponding p-value (*p < 0.050). The analyzed models resulted to be statistically significant (p < 0.05) for prediction of postoperative static laxity values. The only exception was the AP90estimate model. The η(2) ranged from 0.568 (IE90estimate) to 0.995 (IE30estimate). The orientation of the tibial tunnel resulted to be the most important surgical variable for the performed laxity estimation. Mathematical models for postoperative knee laxity is a useful tool to evaluate the effects of different surgical variables on the postoperative outcome.

  10. Is there significant variation in the material properties of four different allografts implanted for ACL reconstruction.

    PubMed

    Penn, David; Willet, Thomas L; Glazebrook, Mark; Snow, Martyn; Stanish, William D

    2009-03-01

    The aims of our study were to: (1) determine if there are differences in the material properties of tendon obtained from implanted tibialis anterior, achilles, bone-patella- bone and tibialis posterior allografts; (2) determine the variability in material properties between the implanted specimens. A total of 60 specimens were collected from fresh frozen allografts implanted at ACL reconstruction. Specimens collected included 15 tibialis anterior, 15 tibialis posterior, 15 achilles and 15 bone-patella-bone tendons. Each specimen was mounted in a custom made cryogrip. The mounted specimens were loaded onto a MTS Testline servo-hydraulic testing machine in a uni-axial tensile test configuration. Specimens were subjected to a strain rate of 5% per second until the ultimate tensile stress (UTS), failure strain and high strain modulus was calculated for each specimen after being normalized for specimen dimensions. Individual material properties were tested using one way analysis of variance (ANOVA) and post hoc Tukey's B test with a P value of <0.05 considered significant. Homogeneity of variance was assessed using the Levene's test. As a result, no significant difference was found between all four grafts with regards to UTS, failure strain or high strain linear modulus. The UTS was plotted against the modulus demonstrating a linear relationship which is typical of soft tissues. Significant variability in the results were observed. In conclusion, there was no significant statistical difference between the material properties of the four tendon allografts tested. But significant variability in results was observed within groups and between groups, which may provide one explanation for the range of results in allograft ACL reconstruction reported in the literature. PMID:19039574

  11. Predictive mathematical modeling of knee static laxity after ACL reconstruction: in vivo analysis.

    PubMed

    Signorelli, C; Bonanzinga, T; Grassi, A; Lopomo, N; Zaffagnini, S; Marcacci, M

    2016-11-01

    Previous studies did not take into consideration such large variety of surgery variables which describe the performed anterior cruciate ligament (ACL) reconstruction and the interaction among them in the definition of postoperative outcome. Seventeen patients who underwent navigated Single Bundle plus Lateral Plasty ACL reconstruction were enrolled in the study. Static laxity was evaluated as the value of anterior/posterior displacement at 30° and at 90° of flexion, internal/external rotation at 30° and 90° of knee flexion, varus/valgus test at 0° and 30° of flexion. The evaluated surgical variables were analyzed through a multivariate analysis defining the following models: AP30estimate, AP90estimate, IE30estimate, IE90estimate, VV0estimate, VV30estimate. Surgical variables has been defined as the angles between the tibial tunnel and the three planes, the lengths of the tunnel and the relationship between native footprints and tunnels. An analogous characterization was performed for the femoral side. Performance and significance of the defined models have been quantified by the correlation ratio (η(2)) and the corresponding p-value (*p < 0.050). The analyzed models resulted to be statistically significant (p < 0.05) for prediction of postoperative static laxity values. The only exception was the AP90estimate model. The η(2) ranged from 0.568 (IE90estimate) to 0.995 (IE30estimate). The orientation of the tibial tunnel resulted to be the most important surgical variable for the performed laxity estimation. Mathematical models for postoperative knee laxity is a useful tool to evaluate the effects of different surgical variables on the postoperative outcome. PMID:27123692

  12. Differences in Mechanisms of Failure, Intraoperative Findings, and Surgical Characteristics Between Single- and Multiple-Revision ACL Reconstructions

    PubMed Central

    Chen, James L.; Allen, Christina R.; Stephens, Thomas E.; Haas, Amanda K.; Huston, Laura J.; Wright, Rick W.; Feeley, Brian T.

    2013-01-01

    Background The factors that lead to patients failing multiple anterior cruciate ligament (ACL) reconstructions are not well understood. Hypothesis Multiple-revision ACL reconstruction will have different characteristics than first-time revision in terms of previous and current graft selection, mode of failure, chondral/meniscal injuries, and surgical charactieristics. Study Design Case-control study; Level of evidence, 3. Methods A prospective multicenter ACL revision database was utilized for the time period from March 2006 to June 2011. Patients were divided into those who underwent a single-revision ACL reconstruction and those who underwent multiple-revision ACL reconstructions. The primary outcome variable was Marx activity level. Primary data analyses between the groups included a comparison of graft type, perceived mechanism of failure, associated injury (meniscus, ligament, and cartilage), reconstruction type, and tunnel position. Data were compared by analysis of variance with a post hoc Tukey test. Results A total of 1200 patients (58% men; median age, 26 years) were enrolled, with 1049 (87%) patients having a primary revision and 151 (13%) patients having a second or subsequent revision. Marx activity levels were significantly higher (9.77) in the primary-revision group than in those patients with multiple revisions (6.74). The most common cause of reruptures was a traumatic, noncontact ACL graft injury in 55% of primary-revision patients; 25% of patients had a nontraumatic, gradual-onset recurrent injury, and 11% had a traumatic, contact injury. In the multiple-revision group, a nontraumatic, gradual-onset injury was the most common cause of recurrence (47%), followed by traumatic noncontact (35%) and nontraumatic sudden onset (11%) (P < .01 between groups). Chondral injuries in the medial compartment were significantly more common in the multiple-revision group than in the single-revision group, as were chondral injuries in the patellofemoral

  13. Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction With Remnant Preservation Using Outside-In Technique

    PubMed Central

    Lee, Byung-Ill; Kwon, Sai-Won; Choi, Hyung-Suk; Chun, Dong-Il; Kim, Yong-Beom; Kim, Byoung-Min

    2015-01-01

    This report describes a modified anatomic single-bundle anterior cruciate ligament (ACL) reconstruction technique using the FlipCutter guide pin (Arthrex, Naples, FL) as a retrograde drill and a cortical suspensory fixation device (TightRope; Arthrex) with an adjustable graft loop length. Preservation of the ACL remnant as a biological sleeve for the graft is an important issue from the viewpoints of acceleration of revascularization and ligamentization, preservation of the proprioceptive nerve fibers, enhancement of the biological environment for healing, and maintenance of the anchor point at the native tibial attachment, in addition to yielding a lower incidence of tibial bone tunnel enlargement. The goal of our technique is to obtain some advantages of the remnant-preserving technique through an anatomic single-bundle ACL reconstruction, which is performed to minimize damage to the ACL tibial remnant. PMID:26759771

  14. Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction With Remnant Preservation Using Outside-In Technique.

    PubMed

    Lee, Byung-Ill; Kwon, Sai-Won; Choi, Hyung-Suk; Chun, Dong-Il; Kim, Yong-Beom; Kim, Byoung-Min

    2015-08-01

    This report describes a modified anatomic single-bundle anterior cruciate ligament (ACL) reconstruction technique using the FlipCutter guide pin (Arthrex, Naples, FL) as a retrograde drill and a cortical suspensory fixation device (TightRope; Arthrex) with an adjustable graft loop length. Preservation of the ACL remnant as a biological sleeve for the graft is an important issue from the viewpoints of acceleration of revascularization and ligamentization, preservation of the proprioceptive nerve fibers, enhancement of the biological environment for healing, and maintenance of the anchor point at the native tibial attachment, in addition to yielding a lower incidence of tibial bone tunnel enlargement. The goal of our technique is to obtain some advantages of the remnant-preserving technique through an anatomic single-bundle ACL reconstruction, which is performed to minimize damage to the ACL tibial remnant. PMID:26759771

  15. Meniscus treatment and age associated with narrower radiographic joint space width 2 – 3 years after ACL reconstruction: Data from the MOON onsite cohort

    PubMed Central

    Jones, Morgan H.; Spindler, Kurt P.; Fleming, Braden C.; Duryea, Jeffrey; Obuchowski, Nancy A.; Scaramuzza, Erica A.; Oksendahl, Heidi L.; Winalski, Carl S.; Duong, Carol L.; Huston, Laura J.; Parker, Richard D.; Kaeding, Christopher C.; Andrish, Jack T.; Flanigan, David C.; Dunn, Warren R.; Reinke, Emily K.

    2015-01-01

    Objective To identify risk factors for radiographic signs of post-traumatic OA 2–3 years after ACL reconstruction through multivariable analysis of minimum joint space width (mJSW) differences in a specially designed nested cohort. Methods A nested cohort within the Multicenter Orthopaedic Outcomes Network cohort included 262 patients (148 females, average age 20) injured in sport who underwent ACL reconstruction in a previously uninjured knee, were 35 or younger, and did not have ACL revision or contralateral knee surgery. mJSW on semi-flexed radiographs was measured in the medial compartment using a validated computerized method. A multivariable generalized linear model was constructed to assess mJSW difference between the ACL reconstructed and contralateral control knees while adjusting for potential confounding factors. Results Unexpectedly, we found the mean mJSW was 0.35 mm wider in ACL reconstructed than in control knees (5.06 mm (95% CI 4.96 – 5.15 mm) versus 4.71 mm (95% CI 4.62 – 4.80 mm), p<0.001). However, ACL reconstructed knees with meniscectomy had narrower mJSW compared to contralateral normal knees by 0.64 mm (95% C.I. 0.38 – 0.90 mm) (p<0.001). Age (p<0.001) and meniscus repair (p=0.001) were also significantly associated with mJSW difference. Conclusion Semi-flexed radiographs can detect differences in mJSW between ACL reconstructed and contralateral normal knees 2–3 years following ACL reconstruction, and the unexpected wider mJSW in ACL reconstructed knees may represent the earliest manifestation of post-traumatic osteoarthritis and warrants further study. PMID:25559582

  16. Post-operative imaging of anterior cruciate ligament reconstruction techniques across the spectrum of skeletal maturity.

    PubMed

    Zbojniewicz, Andrew M; Meyers, Arthur B; Wall, Eric J

    2016-04-01

    Due to an increased frequency of anterior cruciate ligament (ACL) injuries in young patients and improved outcomes in athletic performance following ACL reconstruction, surgery is increasingly being performed across the spectrum of skeletal maturity. We present a review of the range of reconstruction techniques performed in skeletally immature patients (physeal sparing techniques, which may involve epiphyseal tunnels or the utilization of an iliotibial band autograft), those performed in patients nearing skeletal maturity (transphyseal techniques), and the more conventional ACL reconstruction techniques performed in skeletally mature adolescents. It is important that radiologists be aware of the range of techniques being performed throughout the spectrum of skeletal maturity in order to accurately characterize the expected post-operative appearance as well as to identify complications, including those unique to this younger population. PMID:26646675

  17. Nonoperative management of a partial patellar tendon rupture after bone-patellar tendon-bone graft harvest for ACL reconstruction.

    PubMed

    Benner, Rodney W; Shelbourne, K Donald; Freeman, Heather

    2013-12-01

    This is a case report of a young athlete who sustained a partial tear of the patellar tendon after anterior cruciate ligament (ACL) reconstruction with a bone-patellar tendon-bone (BPTB) autograft. The injury, diagnostic workup, and decision-making process that lead to the choice of nonsurgical treatment are described. Furthermore, the rehabilitation process is described in detail. The patient returned to his previous level of sports activity and had a good clinical outcome as measured by range of motion, isokinetic quadriceps muscle strength testing, single leg hop testing, and the modified Noyes survey. In the absence of extensor mechanism incompetence or radiographic evidence of significant patella alta, partial ruptures of the patella tendon after ACL reconstruction using a BPTB autograft may be treated nonoperatively.

  18. The location-specific healing response of damaged articular cartilage after ACL reconstruction: short-term follow-up.

    PubMed

    Nakamura, Norimasa; Horibe, Shuji; Toritsuka, Yukiyoshi; Mitsuoka, Tomoki; Natsu-ume, Takashi; Yoneda, Kenji; Hamada, Masayuki; Tanaka, Yoshinari; Boorman, Richard S; Yoshikawa, Hideki; Shino, Konsei

    2008-09-01

    Although many different interventions have been proposed for treating cartilage lesions at the time of ACL reconstruction, the normal healing response of these injuries has not been well documented. To address this point, we compared the arthroscopic status of chondral lesions at the time of ACL reconstruction with that obtained at second-look arthroscopy. We hypothesized that there might be a location-specific difference in the healing response of damaged articular cartilage. Between September 1998 and March 2000, 383 patients underwent arthroscopically-assisted hamstring ACL reconstruction without any intervention to the articular cartilage. Among these patients, 84 patients underwent second-look arthroscopy (ranging from 6 to 52 months following initial surgery) and make up the population of the present study. Chondral injuries, left untreated at ACL reconstruction, were arthroscopically evaluated using the Outerbridge classification, and were again evaluated at second-look arthroscopy. At second-look arthroscopy, there was significant recovery of chondral lesions by Outerbridge grading on both the medial and lateral femoral condyles. Among the recovered chondral lesions, 69% of cases of the medial femoral condyle, 88% of cases of the lateral femoral condyle were partial thickness injuries (grade I and II). Conversely, there was no significant recovery of chondral lesions observed at the patello-femoral joint or tibial plateaus. Our study revealed that there was a location-specific difference in the natural healing response of chondral injury. Untreated cartilage lesions on the femoral condlyes had a superior healing response compared to those on the tibial plateaus, and in the patello-femoral joint.

  19. Effect of 12 Weeks of Accelerated Rehabilitation Exercise on Muscle Function of Patients with ACL Reconstruction of the Knee Joint.

    PubMed

    Lee, Joong-Chul; Kim, Ji Youn; Park, Gi Duck

    2013-12-01

    [Purpose] To examine changes in the knee joint's isokinetic muscle functions following systematic and gradual rehabilitation exercises lasting for 12 weeks for male and female patients who underwent anterior cruciate ligament (ACL) reconstruction. Differences in muscle functions between the uninvolved side (US) and the involved side (IS) before surgery, differences in muscle functions between US and IS after rehabilitation exercises lasting for 12 weeks, and changes in muscle functions on US and IS between before and after surgery were analyzed to examine the effects of accelerated rehabilitation exercises after ACL reconstruction. [Subjects] The study subjects were 10 patients, five females and five males, who underwent ACL reconstruction performed by the same surgeon. [Methods] As a measuring tool, a Biodex Multi-joint system 3pro (USA), which is an isokinetic measuring device, was used to examine the flexion and extension forces of the knee joint. During isokinetic muscle strength evaluation, the ROM of US was set to be the same as that of IS for consistency of measurement. [Results] At 60°/s, the isokinetic muscle functions of the females did not show any significant change between before and after surgery in any of the variables on both US and IS. At 60°/s, the isokinetic muscle functions of the males did not show any significant change between before and after surgery in the peak torque, average power, and entire work done on US. In extension, peak torque on IS did not show any significant change.

  20. 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.

  1. An Integrated Approach to Change the Outcome Part II: Targeted Neuromuscular Training Techniques to Reduce Identified ACL Injury Risk Factors

    PubMed Central

    Myer, Gregory D.; Ford, Kevin R.; Brent, Jensen L.; Hewett, Timothy E.

    2014-01-01

    Prior reports indicate that female athletes who demonstrate high knee abduction moments (KAMs) during landing are more responsive to neuromuscular training designed to reduce KAM. Identification of female athletes who demonstrate high KAM, which accurately identifies those at risk for noncontact anterior cruciate ligament (ACL) injury, may be ideal for targeted neuromuscular training. Specific neuromuscular training targeted to the underlying biomechanical components that increase KAM may provide the most efficient and effective training strategy to reduce noncontact ACL injury risk. The purpose of the current commentary is to provide an integrative approach to identify and target mechanistic underpinnings to increased ACL injury in female athletes. Specific neuromuscular training techniques will be presented that address individual algorithm components related to high knee load landing patterns. If these integrated techniques are employed on a widespread basis, prevention strategies for noncontact ACL injury among young female athletes may prove both more effective and efficient. PMID:22580980

  2. Single-Bundle Anterior Cruciate Ligament Reconstruction with Semitendinosus Tendon Using the PINN-ACL CrossPin System: Minimum 4-Year Follow-up

    PubMed Central

    Baek, Seung-Gil; Lee, Byoung-Joo; Lee, Chang-Hwa

    2015-01-01

    Purpose This study evaluated mid-term results of anterior cruciate ligament (ACL) reconstruction using the PINN-ACL CrossPin system that allowed for short graft fixation. Materials and Methods Forty-three patients underwent single-bundle ACL reconstruction with a 4-strand semitendinosus tendon graft using the PINN-ACL CrossPin system. Femoral fixation was done using the PINN-ACL CrossPin system, and the tibial side was fixed with post-tie and a bioabsorbable interference screw. The mean follow-up period was 50 months. Evaluation was done using the Lachman test, pivot-shift test, International Knee Documentation Committee (IKDC) score and grade. Anterior displacement was assessed. Results There was improvement in the Lachman test and pivot-shift test at final follow-up, form grade II (n=40) or III (n=3) to grade I (n=3) or 0 (n=40) and from grade I (n=20) or II (n=10) to grade I (n=8) or 0 (n=22), respectively. The mean IKDC score was 88.7, and grade A and B were 93.0% at final follow-up. Side-to-side difference was improved from 6.7 mm to 2.1 mm at final follow-up. Complications occurred in 3 patients, a re-ruptured due to trauma at 2 years after surgery and a deep infection and a superficial infection. Conclusions The mid-term follow-up results of ACL reconstruction with the PINN-ACL CrossPin system were satisfactory. The PINN-ACL CrossPin can be considered as a useful instrument for short graft fixation. PMID:25750893

  3. Anatomical Single-bundle Anterior Cruciate Ligament Reconstruction Using a Freehand Transtibial Technique

    PubMed Central

    Nha, Kyung-Wook; Han, Jae-Hwi; Kwon, Jae-Ho; Kang, Kyung-Woon; Park, Hyung-Joon

    2015-01-01

    Purpose In anatomical single-bundle (SB) anterior cruciate ligament (ACL) reconstruction, the traditional transtibial approach can limit anatomical placement of the femoral tunnel. Surgical Technique We present a novel three-point freehand technique that allows for anatomic SB ACL reconstruction with the transtibial technique. Materials and Methods Between January 2012 and December 2012, 55 ACL reconstructions were performed using the three-point freehand technique. All the patients were followed for a minimum of 12 months post-operatively. Clinical evaluation was done using the Lysholm score and International Knee Documentation Committee (IKDC) grade. All patients were analyzed by 3-dimensional computed tomography (3D CT) at 1 week after surgery. Results The mean Lysholm score improved from 68.2±12.7 points preoperatively to 89.2±8.2 points at final follow-up. At final follow-up, the IKDC grade was normal in 42 patients and nearly normal in 13 patients. None of the patients had a positive pivot shift test, anterior drawer test and Lachman test at final follow-up. The anatomical position of the femoral tunnel was confirmed on 3D CT scans. Conclusions The three-point freehand technique for SB transtibial ACL reconstruction is a simple, anatomic technique showing good clinical results. PMID:26060611

  4. 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

  5. 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.

  6. 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.

  7. 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

  8. Effect of graft choice on the outcome of revision anterior cruciate ligament reconstruction in the Multicenter ACL Revision Study (MARS) Cohort

    PubMed Central

    Wright, Rick W.; Huston, Laura J.; Haas, Amanda K.; Spindler, Kurt P.; Nwosu, Sam K.; Allen, Christina R.; Anderson, Allen F.; Cooper, Daniel E.; DeBerardino, Thomas M.; Dunn, Warren R.; Lantz, Brett (Brick) A.; Stuart, Michael J.; Garofoli, Elizabeth A.; Albright, John P.; Amendola, Annunziato (Ned); Andrish, Jack T.; Annunziata, Christopher C.; Arciero, Robert A.; Bach, Bernard R.; Baker, Champ L.; Bartolozzi, Arthur R.; Baumgarten, Keith M.; Bechler, Jeffery R.; Berg, Jeffrey H.; Bernas, Geoffrey A.; Brockmeier, Stephen F.; Brophy, Robert H.; Bush-Joseph, Charles A.; Butler, J. Brad; Campbell, John D.; Carey, James L.; Carpenter, James E.; Cole, Brian J.; Cooper, Jonathan M.; Cox, Charles L.; Creighton, R. Alexander; Dahm, Diane L.; David, Tal S.; Flanigan, David C.; Frederick, Robert W.; Ganley, Theodore J.; Gatt, Charles J.; Gecha, Steven R.; Giffin, James Robert; Hame, Sharon L.; Hannafin, Jo A.; Harner, Christopher D.; Harris, Norman Lindsay; Hechtman, Keith S.; Hershman, Elliott B.; Hoellrich, Rudolf G.; Hosea, Timothy M.; Johnson, David C.; Johnson, Timothy S.; Jones, Morgan H.; Kaeding, Christopher C.; Kamath, Ganesh V.; Klootwyk, Thomas E.; Levy, Bruce A.; Ma, C. Benjamin; Maiers, G. Peter; Marx, Robert G.; Matava, Matthew J.; Mathien, Gregory M.; McAllister, David R.; McCarty, Eric C.; McCormack, Robert G.; Miller, Bruce S.; Nissen, Carl W.; O'Neill, Daniel F.; Owens, Brett D.; Parker, Richard D.; Purnell, Mark L.; Ramappa, Arun J.; Rauh, Michael A.; Rettig, Arthur C.; Sekiya, Jon K.; Shea, Kevin G.; Sherman, Orrin H.; Slauterbeck, James R.; Smith, Matthew V.; Spang, Jeffrey T.; Svoboda, Steven J.; Taft, Timothy N.; Tenuta, Joachim J.; Tingstad, Edwin M.; Vidal, Armando F.; Viskontas, Darius G.; White, Richard A.; Williams, James S.; Wolcott, Michelle L.; Wolf, Brian R.; York, James J.

    2015-01-01

    Background Most surgeons believe that graft choice for ACL reconstruction is an important factor related to outcome. Although graft choice may be limited in the revision setting based on previously used grafts, it is still felt to be important. Hypothesis The purpose of this study was to determine if revision ACL graft choice predicts outcomes related to sports function, activity level, OA symptoms, graft re-rupture, and reoperation at two years following revision reconstruction. We hypothesized that autograft use would result in increased sports function, increased activity level, and decreased OA symptoms (as measured by validated patient reported outcome instruments). Additionally, we hypothesized that autograft use would result in decreased graft failure and reoperation rate 2 years following revision ACL reconstruction. Study Design Prospective cohort study; Level of evidence, 2. Methods Revision ACL reconstruction patients were identified and prospectively enrolled by 83 surgeons over 52 sites. Data collected included baseline demographics, surgical technique and pathology, and a series of validated patient reported outcome instruments (IKDC, KOOS, WOMAC, and Marx activity rating score). Patients were followed up at 2 years, and asked to complete the identical set of outcome instruments. Incidence of additional surgery and reoperation due to graft failure were also recorded. Multivariate regression models were used to determine the predictors (risk factors) of IKDC, KOOS, WOMAC, Marx scores, graft re-rupture, and reoperation rate at 2 years following revision surgery. Results 1205 patients were successfully enrolled with 697 (58%) males. Median age was 26. In 88% this was their first revision. 341 (28%) were undergoing revision by the surgeon that had performed the previous reconstruction. 583 (48%) underwent revision reconstruction utilizing an autograft, 590 (49%) allograft, and 32 (3%) both autograft and allograft. Median time since their last ACL

  9. Blob-enhanced reconstruction technique

    NASA Astrophysics Data System (ADS)

    Castrillo, Giusy; Cafiero, Gioacchino; Discetti, Stefano; Astarita, Tommaso

    2016-09-01

    A method to enhance the quality of the tomographic reconstruction and, consequently, the 3D velocity measurement accuracy, is presented. The technique is based on integrating information on the objects to be reconstructed within the algebraic reconstruction process. A first guess intensity distribution is produced with a standard algebraic method, then the distribution is rebuilt as a sum of Gaussian blobs, based on location, intensity and size of agglomerates of light intensity surrounding local maxima. The blobs substitution regularizes the particle shape allowing a reduction of the particles discretization errors and of their elongation in the depth direction. The performances of the blob-enhanced reconstruction technique (BERT) are assessed with a 3D synthetic experiment. The results have been compared with those obtained by applying the standard camera simultaneous multiplicative reconstruction technique (CSMART) to the same volume. Several blob-enhanced reconstruction processes, both substituting the blobs at the end of the CSMART algorithm and during the iterations (i.e. using the blob-enhanced reconstruction as predictor for the following iterations), have been tested. The results confirm the enhancement in the velocity measurements accuracy, demonstrating a reduction of the bias error due to the ghost particles. The improvement is more remarkable at the largest tested seeding densities. Additionally, using the blobs distributions as a predictor enables further improvement of the convergence of the reconstruction algorithm, with the improvement being more considerable when substituting the blobs more than once during the process. The BERT process is also applied to multi resolution (MR) CSMART reconstructions, permitting simultaneously to achieve remarkable improvements in the flow field measurements and to benefit from the reduction in computational time due to the MR approach. Finally, BERT is also tested on experimental data, obtaining an increase of the

  10. The Effects of High-Intensity versus Low-Intensity Resistance Training on Leg Extensor Power and Recovery of Knee Function after ACL-Reconstruction

    PubMed Central

    Aue Sobol, Nanna; Andersen, Lars L.; Kiel, Peter; Løfholm, Peter; Magnusson, S. Peter; Krogsgaard, Michael R.

    2014-01-01

    Objective. Persistent weakness is a common problem after anterior cruciate ligament- (ACL-) reconstruction. This study investigated the effects of high-intensity (HRT) versus low-intensity (LRT) resistance training on leg extensor power and recovery of knee function after ACL-reconstruction. Methods. 31 males and 19 females were randomized to HRT (n = 24) or LRT (n = 26) from week 8–20 after ACL-reconstruction. Leg extensor power, joint laxity, and self-reported knee function were measured before and 7, 14, and 20 weeks after surgery. Hop tests were assessed before and after 20 weeks. Results. Power in the injured leg was 90% (95% CI 86–94%) of the noninjured leg, decreasing to 64% (95% CI 60–69%) 7 weeks after surgery. During the resistance training phase there was a significant group by time interaction for power (P = 0.020). Power was regained more with HRT compared to LRT at week 14 (84% versus 73% of noninjured leg, resp.; P = 0.027) and at week 20 (98% versus 83% of noninjured leg, resp.; P = 0.006) without adverse effects on joint laxity. No other between-group differences were found. Conclusion. High-intensity resistance training during rehabilitation after ACL-reconstruction can improve muscle power without adverse effects on joint laxity. PMID:24877078

  11. Histological Predictors of Maximum Failure Loads Differ Between the Healing ACL and ACL Grafts After 6 and 12 Months In Vivo

    PubMed Central

    Proffen, Benedikt L.; Fleming, Braden C.; Murray, Martha M.

    2013-01-01

    Background: Bioenhanced anterior cruciate ligament (ACL) repair, where the suture repair is supplemented with a biological scaffold, is a promising novel technique to stimulate healing after ACL rupture. However, the histological properties of a successfully healing ACL and how they relate to the mechanical properties have not been fully described. Purpose: To determine which histological features best correlate with the mechanical properties of the healing ACL repairs and ACL grafts in a porcine model at 6 and 12 months after injury. Study Design: Controlled laboratory study. Methods: A total of 48 Yucatan mini-pigs underwent ACL transection followed by: (1) conventional ACL reconstruction with bone–patellar tendon–bone (BPTB) allograft, (2) bioenhanced ACL reconstruction with BPTB allograft using a bioactive scaffold, or (3) bioenhanced ACL repair using the same bioactive scaffold. After 6 and 12 months of healing, structural properties of the ACL or graft (yield and failure load, linear stiffness) were measured. Following mechanical testing, ACL specimens were histologically analyzed for cell and vascular density and qualitatively assessed using the advanced Ligament Maturity Index. Results: After 6 months of healing, the cellular organization subscore was most predictive of yield load (r 2 = 0.98), maximum load (r 2 = 0.89), and linear stiffness (r 2 = 0.95) of the healing ACL, while at 12 months, the collagen subscore (r 2 = 0.68) became the best predictor of maximum load. For ACL grafts, the reverse was true, with the collagen subscore predictive of yield and maximum loads at 6 months (r 2 = 0.55) and graft cellularity predictive of maximum load of the graft at 12 months (r 2 = 0.50). Conclusion: These findings suggest there may be key biological differences in development and maintenance of ACL tissue after repair or reconstruction, with early ligament function dependent on cellular population of the repair but early graft function dependent on the

  12. Risk Factors at Time of Primary ACL Reconstruction that Contribute to Significant Chondral Surface Change at Time of Revision ACL Reconstruction

    PubMed Central

    Kaeding, Christopher C.; Group, Mars

    2016-01-01

    Objectives: Articular cartilage health is an important issue following primary anterior cruciate ligament reconstruction (ACLR). It is not clear what risk factors at the time of primary reconstruction affect future articular cartilage health. The purpose of this study was to examine risk factors affecting chondral surface change in a cohort from the time of primary ACLR to revision ACLR. Methods: Subjects who had both primary and revision data contained in the MOON and MARS registries were included. Data included chondral surface status (grade and size) at time of primary and revision, meniscal status (no treatment/repair, ≤33% excision, >33% excision) at time of primary, time from primary to revision ACLR, and age, sex, BMI, Marx, KOOS, and IKDC at time of revision. Significant chondral surface change was defined as >25% deterioration between time of primary and revision in the femoral condyle, tibial plateau, patella, or trochlea. Logistic regression was used to test each variable’s contribution to significant chondral surface change in the medial compartment, lateral compartment, and patellofemoral compartment. Results: 134 subjects met our inclusion criteria. 34/134 (25.4%) had significant lateral compartment chondral surface change, 32/134 (23.9%) had significant medial compartment chondral surface change, and 31/134 (23.1%) had significant patellofemoral chondral surface change. Median age at time of revision was 19.5 years [IQ range 17-25] and median time from primary to revision was 462.5 days [IQ range 292-1049]. KOOS and IKDC at revision were not associated with significant chondral surface change in any compartment. Patients with >33% of their lateral meniscus excised had 13.5 times the odds of having significant lateral compartment surface change compared to subjects who either did not have lateral meniscal damage, had it repaired, or had an excision of ≤33% controlling for age (p<0.001). Patients with ≤33% excision of their medial meniscus had

  13. What is the best candidate allograft for ACL reconstruction? An in vitro mechanical and histologic study in a canine model.

    PubMed

    Qu, Jin; Thoreson, Andrew R; An, Kai-Nan; Amadio, Peter C; Zhao, Chunfeng

    2015-07-16

    The knee joint is generally characterized by very low friction and high wear resistance. Several previous studies have compared ACL with the commonly used allografts from tensile properties perspective. No study has reported about the graft tendons from a frictional perspective, which is an important parameter for ACL functional performance. Twenty hind legs were used to harvest FDP tendon, ACL, ACH, and patellar tendon. Samples were evaluated with surface friction testing, indentation testing for tendon compressive moduli, lubricin immunohistochemistry, and histologic analysis. Frictional force of FDP tendon and ACL was significantly less than that of patellar tendon and ACH at first and fifth cycles. At the tenth cycle, the FDP tendon, ACL, and ACH showed significantly less frictional force than patellar tendon; after 100 cycles, the FDP tendon and ACL showed significantly less frictional force than patellar tendon. The compressive moduli of the FDP tendon, ACL, and ACH were significantly greater than that of patellar tendon. Histologic results showed that FDP tendon and ACL had a smooth surface with a thin layer of epitenon cells; patellar tendon and ACH had a rough surface and a layer of paratenon. Lubricin was found on the surface and extracellular matrix of FDP tendon and ACL. There was only limited lubricin expression on the surface and extracellular matrix of the ACH and patellar tendon. The FDP tendon has friction force and lubricin expression similar to those of native ACL. However, patellar tendon and ACH show higher friction force and less lubricin expression than ACL. PMID:25981102

  14. Graft impingement in anterior cruciate ligament reconstruction.

    PubMed

    Iriuchishima, Takanori; Shirakura, Kenji; Fu, Freddie H

    2013-03-01

    Anterior cruciate ligament (ACL) graft impingement is one of the most troubling complications in ACL reconstruction. In the previous strategy of isometric "non-anatomical" ACL reconstruction, posterior tibial tunnel placement and notchplasty were recommended to avoid graft impingement. Recently, the strategy of ACL reconstruction is shifting towards "anatomical" reconstruction. In anatomical ACL reconstruction, the potential risk of graft impingement is higher than in non-anatomical reconstruction because the tibial tunnel is placed at a more anterior portion on the tibia. However, there have been few studies reporting on graft impingement in anatomical ACL reconstruction. This study will provide a review of graft impingement status in both non-anatomical and the more recent anatomical ACL reconstruction techniques. In conclusion, with the accurate creation of bone tunnels within ACL native footprint, the graft impingement might not happen in anatomical ACL reconstruction. For the clinical relevance, to prevent graft impingement, surgeons should pay attention of creating correct anatomical tunnels when they perform ACL reconstruction. Level of evidence IV.

  15. ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING THE DOUBLE-BUNDLE TECHNIQUE – EVALUATION IN THE BIOMECHANICS LABORATORY

    PubMed Central

    D'Elia, Caio Oliveira; Bitar, Alexandre Carneiro; Castropil, Wagner; Garofo, Antônio Guilherme Padovani; Cantuária, Anita Lopes; Orselli, Maria Isabel Veras; Luques, Isabela Ugo; Duarte, Marcos

    2015-01-01

    Objective: The objective of this study was to describe the methodology of knee rotation analysis using biomechanics laboratory instruments and to present the preliminary results from a comparative study on patients who underwent anterior cruciate ligament (ACL) reconstruction using the double-bundle technique. Methods: The protocol currently used in our laboratory was described. Three-dimensional kinematic analysis was performed and knee rotation amplitude was measured on eight normal patients (control group) and 12 patients who were operated using the double-bundle technique, by means of three tasks in the biomechanics laboratory. Results: No significant differences between operated and non-operated sides were shown in relation to the mean amplitudes of gait, gait with change in direction or gait with change in direction when going down stairs (p > 0.13). Conclusion: The preliminary results did not show any difference in the double-bundle ACL reconstruction technique in relation to the contralateral side and the control group. PMID:27027003

  16. Functional Outcome Following Arthroscopic ACL Reconstruction with Rigid Fix: A Retrospective Observational Study

    PubMed Central

    Shervegar, Satish; Nagaraj, Prashanth; Grover, Amit; DJ, Niranthara Ganesh; Ravoof, Abdul

    2015-01-01

    Background: No uniform consensus exists to decide type of fixation for arthroscopic anterior cruciate ligament reconstruction. Hypothsis: There is similar functional outcome after rigid fix compared to other methods of fixation which has been published. Study design: Retrospective observational study. Methods: A total of 50 patients underwent arthroscopic anterior cruciate ligament reconstruction with hamstring tendons using femoral Rigid fix cross-pin and interference screw tibial fixation. The evaluation methods were clinical examination, IKDC scores, Lysholm and pre injury and post reconstruction Tegner score. Patients were followed up from minimum of 6 months to 4 year seven months. Results: C In our study of sample size 50 we found that mean age of patients was 30.8 Years with male preponderance. Mean post operative IKDC and Lysholm score has been 75.6 and 84.4 respectively. Mean Tegner pre-injury score and post reconstruction score has been 5.4 and 4.26. Box plot comparison of pre injury and post operativeTegner score reveals a statistically significant difference with respect to paired t test P<0.001. Conclusions: Arthroscopic anterior cruciate ligament reconstruction with femoral rigid fix cross pins and tibial interference screws results in comparable short term to midterm functional results compared to other types of fixation PMID:26550591

  17. Functional tests should be accentuated more in the decision for ACL reconstruction.

    PubMed

    Eitzen, Ingrid; Moksnes, Håvard; Snyder-Mackler, Lynn; Engebretsen, Lars; Risberg, May Arna

    2010-11-01

    A high pre-injury activity level, the desire of the patient to continue pivoting sports and fear of future give-way episodes are considered the most significant factors affecting the decision to perform anterior cruciate ligament reconstruction. However, since the functional status of the knee at the time of surgery affects the final outcome, assessments of knee function should be considered in the decision making for surgery. Individuals with anterior cruciate ligament injury can be classified as potential copers or non-copers from an existing screening examination. The purpose of this study was to investigate whether the functional tests incorporated in the original screening examination could contribute to explain those who later go through anterior cruciate ligament reconstruction and to examine whether changes to the content or the time of conducting the screening examination (before or after ten sessions of exercise therapy) could improve its explanatory value. One-hundred and forty-five individuals were included and prospectively followed for 15 months, after where 51% had gone through anterior cruciate ligament reconstruction and 49% were managed non-operatively. The only significant baseline differences between those who later went through anterior cruciate ligament reconstruction and those who were non-operatively treated were that those who had surgery were younger and had a higher activity level (P < 0.05). Regression analyses revealed that the explanatory value for those who later went through anterior cruciate ligament reconstruction significantly improved when the original screening examination was considered compared to only age, activity level and give-way episodes. Changes to the content further improved the explanatory value, with quadriceps muscle strength as the single variable with the highest impact. Finally, conducting the screening examination after ten sessions of progressive exercise therapy gave the overall highest explanatory values

  18. Anatomical anterior cruciate ligament reconstruction: transtibial versus outside-in technique

    PubMed Central

    MATASSI, FABRIZIO; SIRLEO, LUIGI; CARULLI, CHRISTIAN; INNOCENTI, MASSIMO

    2015-01-01

    Purpose the aim of this study was to compare clinical results and location of the femoral tunnel with transtibial (TT) and outside-in (OI) techniques in anterior cruciate ligament (ACL) reconstruction using in vivo 3D CT analysis. Methods we prospectively followed up 40 ACL reconstructions in which femoral tunnel placement was performed using two different techniques: TT [20] and OI [20]. Clinical evaluation was based on IKDC and KOOS scores and radiographic analysis with specific 3D CT scans. Tunnel coordinates were calculated using the Bernard-Hertel quadrant method to define the insertion point of the ACL. Results excellent clinical results were achieved in both groups, which showed comparable IKDC and KOOS scores. Two failures were recorded, both in the TT group. In the high-to-low direction, the position of the femoral tunnel, as measured using the quadrant method, was too high in the TT group, compared to what was observed in the OI group: 10.5 ± 6.9% (0–29%) and 30.2 ± 5.4% (19–42%), (p=0.043). Conclusions we found that with the TT technique, compared with the OI technique, the femoral tunnel was located higher in the high-to-low direction and was in a slightly shallower position in the deep-to-shallow direction. Using the OI technique the femoral tunnel was in a position closer to the anatomical ACL footprint than with the TT technique. A femoral tunnel position far from the anatomical footprint of the native ACL would result in a higher failure rate. Level of evidence level II, prospective comparative study. PMID:26151033

  19. Two-Stage Revision Anterior Cruciate Ligament Reconstruction.

    PubMed

    Erickson, Brandon J; Cvetanovich, Gregory; Waliullah, Khalid; Khair, Michael; Smith, Patrick; Bach, Bernard; Sherman, Seth

    2016-05-01

    The number of primary anterior cruciate ligament (ACL) tears is rapidly increasing. In patients who wish to return to their preoperative level of function, specifically as it pertains to participation in sports, the gold standard of treatment following an ACL tear remains an anterior cruciate ligament (ACL) reconstruction. Despite a majority of good/excellent results following primary ACL reconstruction, there is a growing subset of patients with persistent or recurrent functional instability who require revision ACL reconstruction. Preoperative planning for revision ACL reconstruction requires a careful understanding of the root cause of ACL failure, including possible technical causes of primary ACL failure and the presence of combined knee pathology that was not addressed at the index ACL reconstruction. The decision to perform 2-stage revision ACL reconstruction is multifactorial and is reached by technical considerations that may make a 1-stage revision less optimal, including tunnel widening, arthrofibrosis, active infection, and others. Concomitant knee pathology such as meniscal deficiency, malalignment (including an increase in posterior tibial slope), chondral lesions, and other ligamentous laxity may also require a staged approach to treatment. This evidence-based review covers the indications for 2-stage revision ACL reconstruction, surgical techniques, evidence for and technique of bone grafting prior ACL tunnels, and outcomes of 2-stage revision stratified by initial cause of ACL reconstruction failure. With proper preoperative planning and an understanding of the cause of failure following the primary ACL reconstruction, revision ACL reconstruction can offer excellent outcomes in the motivated patient. [Orthopedics. 2016; 39(3):e456-e464.]. PMID:27045480

  20. Electromechanical delay of the knee extensor muscles is not altered after harvesting the patellar tendon as a graft for ACL reconstruction: implications for sports performance.

    PubMed

    Georgoulis, A D; Ristanis, S; Papadonikolakis, A; Tsepis, E; Moebius, U; Moraiti, C; Stergiou, N

    2005-09-01

    Although the scar tissue, which heals the donor site defect, has different elasticity from the neighbouring patellar tissue, it remains unclear if this scar tissue can lead to the changes of the electromechanical delay (EMD) of the knee extensor muscles. If such changes do exist, they can possibly affect both the utilization of the stored energy in the series elastic component, as well as the optimal performance of the knee joint movement. The purpose of this study was to investigate the influence of harvesting the patellar tendon during anterior cruciate ligament (ACL) reconstruction and the associated patellar tendon scar tissue development on the EMD of the rectus femoris (RF) and vastus medialis (VM) muscles. Seventeen patients who underwent an ACL reconstruction using the medial third of the patellar tendon were divided in two groups based upon their post-operative time interval. Maximal voluntary contraction from the knee extensors, surface EMG activity, and ultrasonographic measurements of the patellar tendon cross-section area were obtained from both knees. Our results revealed that no significant changes for the maximal voluntary contraction of the knee extensors and for the EMD of the RF and the VM muscles due to patellar scar tissue development after harvesting the tendon for ACL reconstruction. The EMD, as a component of the stretch reflex, is important for the utilization of the stored energy in the series elastic component and thus, optimal sports performance. However, from our results, it can be implied that the ACL reconstruction using a patellar tendon graft would not impair sports performance as far as EMD is concerned.

  1. 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

  2. BIOMECHANICAL STUDY OF TRANSCORTICAL OR TRANSTRABECULAR BONE FIXATION OF PATELLAR TENDON GRAFT WITH BIOABSORBABLE PINS IN ACL RECONSTRUCTION IN SHEEP

    PubMed Central

    Albano, Mauro Batista; Borges, Paulo César; Namba, Mario Massatomo; da Silva, João Luiz Vieira; de Assis Pereira Filho, Francisco; Filho, Edmar Stieven; Matias, Jorge Eduardo Fouto

    2015-01-01

    Objective: To determine the initial resistance of fixation using the Rigid Fix® system, and compare it with traditional fixation methods using metal interference screws; and to evaluate the resistance of the fixation with the rigid fix system when the rotational position of the bone block is altered in the interior of the femoral tunnel. Methods: forty ovine knee specimens (stifle joints) were submitted to anterior cruciate ligament reconstruction (ACL) using a bone-tendon-bone graft. In twenty specimens, the Rigid Fix method was used; this group was subdivided into two groups: ten knees the pins transfixed only the spongious area of the bone block, and ten for fixation passing through the layer of cortical bone. In the twenty remaining specimens, the graft was fixed with 9mm metal interference screws. Results: comparison of the RIGIDFIX® method with the metal interference screw fixation method did not show any statistically significant differences in terms of maximum load and rigidity; also, there were no statistically significant differences when the rotational position of the bone block was altered inside the femoral tunnel. For these evaluations, a level of significance of p < 0.017 was considered. Conclusion: fixation of the bone-tendon-bone graft with 2 bioabsorbable pines, regardless of the rotational position inside the femoral tunnel, gave a comparable fixation in terms of initial resistance to the metal interference screw, in this experimental model. PMID:27027081

  3. 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

  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. Adolescent ACL injury: treatment considerations.

    PubMed

    Pavlovich, Raymond; Goldberg, Steven H; Bach, Bernard R

    2004-04-01

    Anterior cruciate ligament (ACL) injury in a skeletally immature patient presents unique treatment challenges. In many cases, conservative treatment with bracing and physical therapy fails, resulting in recurrent instability, pain, swelling, and meniscal and chondral injury. The goal of surgical reconstruction is to recreate ACL stability without causing growth plate arrest, leg-length discrepancy, or angular deformity. Patient characteristics such as skeletal age, Tanner stage, onset of menses, family member height, growth spurt, recent change in foot size, and growth charts can help the surgeon approximate the degree of skeletal maturity and aid in selecting the timing and safest type of reconstruction. Numerous surgical techniques, ranging from an extra-articular reconstruction to intra-articular graft passage without physeal violation to standard transtibial and transfemoral tunnel placement with physeal violation, have been popularized. The majority of existing studies are retrospective case series, describing a particular author's specific technique experience. This article reviews the basic science and clinical literature, presents a treatment algorithm, and provides several case studies.

  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. Individualized anatomic anterior cruciate ligament reconstruction.

    PubMed

    van Eck, Carola F; Widhalm, Harrald; Murawski, Christopher; Fu, Freddie H

    2015-02-01

    Anterior cruciate ligament (ACL) injuries are often seen in young participants in sports such as soccer, football, and basketball. Treatment options include conservative management as well as surgical intervention, with the goal of enabling the patient to return to cutting and pivoting sports and activities. Individualized anatomic ACL reconstruction is a surgical technique that tailors the procedure to the individual patient using preoperative measurements on plain radiographs and magnetic resonance imaging and intraoperative measurement to map the patients' native ACL anatomy in order to replicate it as closely as possible. Anatomic ACL reconstruction, therefore, is defined as reconstruction of the ACL to its native dimensions, collagen orientation, and insertion site. The surgical reconstruction is followed by a specific rehabilitation protocol that is designed to enable the patient to regain muscle strength and proprioception while facilitating healing of the reconstructed ACL prior to the patient's returning to sports activities.

  8. Treatment of Type 3 Arthrofibrosis Following Arthroscopic Reconstruction of ACL and Posterolateral Corner Injury with Tibia Plateau Fracture in a Professional Dancer

    PubMed Central

    Aksu, Neslihan; Abay, Burak; Soydan, Ramazan; Atansay, Vefa

    2014-01-01

    Objectives: Arthrofibrosis is a serious complication following the reconstruction of anterior cruciate ligament (ACL) and posterolateral corner (PLC) injury. Loss of motion caused by arthrofibrosis can be disabling in young and active patients. We report the clinical results of the treatment of arthrofibrosis following arthroscopic reconstruction of ACL with ipsilateral hamstring tendon graft and surgically repairing PLC with 2 suture anchors in a 30 year-old professional dancer, treated with surgical lysis and manipulation under general anesthesia followed by aggressive physical therapy. Methods: A 30 year-old male professional dancer presented with pain, effusion and severe instability in his left knee after falling in a dance event. The pain was evaluated on Visual analog scale (VAS) as 6 to 8. At the physical examination, anterior drawer test was evaluated as grade 3, pivot shift test, varus test, dial test and posterolateral drawer test were found positive. The Tegner Lysholm score was evaluated as 22 (poor). Under general anesthesia, left knee had tendency to external rotation and recurvatum when leg was suspended by toes. A magnetic resonance image (MRI) revealed the presence of a total ACL rupture, PLC injury and a fracture of lateral tibia plateau. The patient was treated with arthroscopic reconstruction of ACL with ipsilateral hamstring tendon graft fixed with endobutton through femoral tunnel and bio interference screw through tibial tunnel and PLC injury was treated with 2 suture anchors. Postoperatively first day, quadriceps musculature and active and passive ROM exercises was trained. During postoperatively third week, the patient was allowed to mobilize nonweight bearing with the use of two crutches without functional knee brace. At the sixth week, arthroscopic lysis was performed due to type 3 arthrofibrosis. At the tenth week, manipulation was performed to the left knee under general anesthesia. Results: At the 3 month- follow-up, the patient

  9. Are Articular Cartilage Lesions and Meniscus Tears Predictive of IKDC, KOOS, and Marx Activity Level Outcomes after ACL Reconstruction? A 6-Year Multicenter Cohort Study

    PubMed Central

    Cox, Charles L.; Huston, Laura J.; Dunn, Warren R.; Reinke, Emily K.; Nwosu, Samuel K.; Parker, Richard D.; Wright, Rick W.; Kaeding, Christopher C.; Marx, Robert G.; Amendola, Annunziata; McCarty, Eric C.; Wolf, Brian R.; Harrell, Frank E.; Spindler, Kurt P.

    2014-01-01

    Background Identifying risk factors for inferior outcomes after ACL reconstruction (ACLR) is important for prognosis and future treatment. The goal of this study was to determine whether articular cartilage and meniscal variables are predictive of 3 validated sports outcome instruments after ACLR. Hypothesis/Purpose We hypothesized that articular cartilage lesions and meniscus tears/treatment would be predictors of the IKDC, KOOS (all 5 subscales), and Marx activity level at 6 years following ACLR. Study Design Prospective cohort, Level 1 Methods Between 2002 and 2004, 1512 ACLR subjects were prospectively enrolled and followed longitudinally with the IKDC, KOOS, and Marx activity score completed at entry, 2, and 6 years. A logistic regression model was built incorporating variables from patient demographics, surgical technique, articular cartilage injuries, and meniscus tears/treatment to determine the predictors (risk factors) of IKDC, KOOS, and Marx at 6 years. Results We completed a minimum follow-up on 86% (1307/1512) of our cohort at 6 years. The cohort was 56% male, had a median age of 23 years at the time of enrollment, with 76% reporting a non-contact injury mechanism. Incidence of concomitant pathology at the time of surgery consisted of the following: articular cartilage (medial femoral condyle [MFC]-25%, lateral femoral condyle [LFC]-20%, medial tibial plateau [MTP]-6%, lateral tibial plateau [LTP]-12%, patella-20%, trochlear-9%) and meniscal (medial-38%, lateral-46%). Both articular cartilage lesions and meniscal tears were significant predictors of 6-year outcomes on IKDC and KOOS. Grade 3 or 4 articular cartilage lesions (excluding patella) significantly reduced IKDC and KOOS scores at 6 years. IKDC demonstrated worse outcomes with the presence of a grade 3-4 chondral lesion on the MFC, MTP, and LFC. Likewise, KOOS was negatively affected by cartilage injury. The sole significant predictor of reduced Marx activity was the presence of a grade 4 lesion

  10. Effects of Single-Bundle and Double-Bundle ACL Reconstruction on Tibiofemoral Compressive Stresses and Joint Kinematics During Simulated Squatting

    PubMed Central

    Mulcahey, Mary K.; Monchik, Keith O.; Yongpravat, Charlie; Badger, Gary J.; Fadale, Paul D.; Hulstyn, Michael J.; Fleming, Braden C.

    2011-01-01

    The purpose of this study was to compare tibiofemoral (TF) kinematics and TF compressive stresses between single bundle- (SB-) and double bundle-ACL reconstruction (DB-ACLR) during simulated squatting. Twelve matched pairs of fresh frozen cadaver knees were utilized. A simulated squat through 100° of knee flexion was performed in the ACL-intact joint. The ACL was transected and SB- and DB-ACLR procedures were performed in one knee of each pair. The squat was repeated. Knee kinematics were measured using a motion tracking system and the TF compressive forces were measured using thin film pressure sensors. The posterior shifts of the tibia for SB- and DB-ACLR knees were significantly greater than the ACL-intact condition for knee flexion angles 0° to 40° (p<.05). However, there was no difference between the SB- and DB-ACLR knees at any flexion angle (0° to 100°; p=.37). SB- and DB-ACLR knees had greater IE rotation than intact knees from 90° through 50° of flexion (p<.05), but not between 40° and full extension. There was no difference between SB- and DB-ACLR knees (p=.68). The TF compressive stresses of the DB-ACLR were significantly lower than intact for all angles except 10° (p=.06), whereas SB-ACLR knees did not differ from intact at flexion angles between 30° and 50° (p>.32). There were no significant differences between the two reconstruction conditions (p=.74). This study showed that there was no difference in the TF kinematics or compressive stresses between SB- and DB-ACLR, and only minor differences when compared to the intact state. PMID:21696962

  11. Increased Risk of Revision after ACL Reconstruction with Soft Tissue Allograft Compared to Autograft

    PubMed Central

    Maletis, Gregory; Chen, Jason; Inacio, Maria Carolina Secorun; Love, Rebecca; Funahashi, Tadashi Ted

    2016-01-01

    Objectives: The use of allograft tissue for anterior cruciate ligament reconstruction (ACLR) remains controversial. Numerous meta-analysis and systematic reviews of small clinical studies have not found differences between autograft and allograft outcomes but large registry studies have shown an increased risk of revision with allografts. The purpose of this study was to compare the risk of aseptic revision between bone-patellar tendon-bone (BPTB) autografts, hamstring tendon autografts and soft tissue allografts. Methods: A retrospective cohort study of prospectively collected data was conducted using an US ACLR Registry. A cohort of primary unilateral ACLR cases reconstructed with BPTB autografts, hamstring autografts and soft tissue allografts (from any site) was identified. Aseptic revision was the end point of the study. Type of graft and allograft processing methods (non-processed, <1.8Mrads with and without chemical processing (Allowash or AlloTrue methods), >1.8 Mrads irradiation with and without chemical processing, and chemical processing alone (BioCleanse)) were the exposures of interest evaluated. Time from surgery was evaluated as an effect modifier. All analyses were adjusted for age, gender, and race. Kaplan-Meier curves and Cox proportional hazard models were employed. Hazard ratios (HR), 95% confidence intervals (CI) are provided. Results: The cohort had 14015 cases, 8924 (63.7%) were male, 6397 (45.6%) were White, 4557 (32.5%) cases used BPTB autograft, 3751 (26.8%) cases used soft tissue allograft and 5707 (40.7%) cases used hamstring autograft. The median age was 34.6 years-old (IQR 24.1-43.2) for allograft cases and 24.3 years-old (IQR 17.7-33.8) for hamstring autograft cases, and 22.0 years-old (IQR 17.6-30.0) for BPTB autograft cases. Compared to hamstring tendon autografts, an increased risk of revision was found in allografts processed with >1.8Mrads without chemical processing after 2.5 years (HR: 3.88 95%CI 1.48-10.12), and >1.8Mrads with

  12. Do early quadriceps exercises affect the outcome of ACL reconstruction? A randomised controlled trial.

    PubMed

    Shaw, Triston; Williams, Marie T; Chipchase, Lucy S

    2005-01-01

    A prospective, blinded, randomised controlled trial investigated the effectiveness of quadriceps exercises following anterior cruciate ligament reconstruction. A treatment group (Quadriceps exercise group) performed straight leg raises and isometric quadriceps contractions throughout the first two postoperative weeks, and a second group (No quadriceps exercise group) did not. A battery of outcome measures assessed subjects postoperatively at day one, two weeks, and one, three and six months. A total of 103 patients (Quadriceps exercise n = 48, No quadriceps exercise n = 55) commenced the study with 91 subjects available at final follow up (Quadriceps exercise n = 47, No quadriceps exercise n = 44). Performance of quadriceps exercises significantly improved a number of knee flexion and extension range of motion measurements (p = 0.01 to 0.04). No significant differences were found between the two groups at any postoperative period for quadriceps lag (p = 0.36), functional hop testing (p = 0.49 to 0.51), isokinetic quadriceps strength (p = 0.70 to 0.72), the majority of numerical analogue scores (p = 0.1 to 0.94) and Cincinnati scores (p = 0.10 to 0.84). Subjects performing quadriceps exercises reported significantly higher pain scores with exercise on the first postoperative day (p = 0.02). At six months postoperatively, the Quadriceps exercise subjects reported significantly more favourable Cincinnati scores for symptoms (p = 0.005) and problems with sport (p = 0.05). While average knee laxity was not significantly different between treatment groups over time (p = 0.27 to 0.94), quadriceps exercise performance was associated with a significantly lower incidence of abnormal knee laxity. Isometric quadriceps exercises and straight leg raises can be safely prescribed during the first two postoperative weeks and confer advantages for faster recovery of knee range of motion and stability. It remains to be proven whether the magnitude of differences between groups is

  13. 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

  14. Tibial press-fit fixation of the hamstring tendons for ACL-reconstruction.

    PubMed

    Jagodzinski, M; Scheunemann, K; Knobloch, K; Albrecht, K; Krettek, C; Hurschler, C; Zeichen, J

    2006-12-01

    Press-fit fixation of patellar tendon bone anterior cruciate ligament autografts is an interesting technique because no hardware is necessary to achieve fixation. Up till the present point, there is no biomechanical data available for the tibial press-fit fixation of the hamstring tendons. Hamstring tendons of 21 human cadavers (age: 41.9 +/- 13.1 years) were used. A press-fit fixation with looped semitendinosus and gracilis tendons secured by a tape (T) over a bone bridge, or by a baseball-stitched suture (S), was compared with degradable interference screw fixation (I) in 21 porcine tibiae. The constructs were cyclically strained and subsequently loaded to failure. The maximum load to failure, stiffness, and elongation during cyclical loading were measured. The maximum load to failure was highest for the T-fixation at 970 +/- 83 N, followed by the I-fixation with 544 +/- 109 N, and the S-fixation with 402 +/- 78 N (P < 0.03). Stiffness of the constructs averaged 78 +/- 13 N/mm for T, 108 +/- 18 N/mm for S, and 162 +/- 27 N/mm for I (P < 0.03). Elongation during initial cyclical loading was 2.0 +/- 0.6 mm for T, 3.3 +/- 1.1 mm for S, and 1.4 +/- 0.5 mm for I (S inferior to I and T, P<0.05). Elongation between the 20th and 1,500th loading cycle was lower for T (2.2 +/- 0.7 mm) compared with I (4.1 +/- 2.7 mm) and S (4.8 +/- 0.7 mm; P < 0.001). The T-fixation technique exhibited a significantly higher failure load than the S-, and I- techniques. All techniques exhibited larger elongation during initial cyclical loading than is reported in the literature for grafts with bone blocks. Only one technique (T) showed satisfactory elongation behavior during long-term cyclic loading. Interference screw fixation demonstrated significantly higher stiffness. Only one of the investigated techniques (T) seemed to exhibit adequate mechanical properties necessary for early aggressive rehabilitation programs.

  15. 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

  16. ACL reconstruction - discharge

    MedlinePlus

    ... sleeping without the brace and removing it for showers. When the brace is off for any reason, ... dressing and bandage clean and dry . You can shower again after your dressing is removed. When you ...

  17. The Potentially Positive Role of PRPs in Preventing Femoral Tunnel Widening in ACL Reconstruction Surgery Using Hamstrings: A Clinical Study in 51 Patients

    PubMed Central

    Starantzis, Konstantinos A.; Mastrokalos, Dimitrios; Koulalis, Dimitrios; Papakonstantinou, Olympia; Soucacos, Panayiotis N.; Papagelopoulos, Panayiotis J.

    2014-01-01

    Purpose. In this study, the early and midterm clinical and radiological results of the anterior cruciate ligament (ACL) reconstruction surgery with or without the use of platelet rich plasma (PRP) focusing on the tunnel-widening phenomenon are evaluated. Methods. This is a double blind, prospective randomized study. 51 patients have completed the assigned protocol. Recruited individuals were divided into two groups: a group with and a group without the use of PRPs. Patients were assessed on the basis of MRI scans, which were performed early postoperatively and repeated at least one-year postoperatively. The diameter was measured at the entrance, at the bottom, and at the mid distance of the femoral tunnel. Results. Our study confirmed the existence of tunnel widening as a phenomenon. The morphology of the dilated tunnels was conical in both groups. There was a statistical significant difference in the mid distance of the tunnels between the two groups. This finding may support the role of a biologic response secondary to mechanical triggers. Conclusions. The use of RPRs in ACL reconstruction surgery remains a safe option that could potentially eliminate the biologic triggers of tunnel enlargement. The role of mechanical factors, however, remains important. PMID:26464895

  18. Anterolateral Extra-articular Soft Tissue Reconstruction in Anterolateral Rotatory Instability of the Knee.

    PubMed

    Kernkamp, Willem A; van de Velde, Samuel K; Bakker, Eric W P; van Arkel, Ewoud R A

    2015-12-01

    Anterolateral rotatory instability (ALRI) occurs after injury to the anterior cruciate ligament (ACL) and the anterolateral structures of the knee. We present a technique for anterolateral extra-articular soft-tissue (ALES) reconstruction of the knee that can be used in revision ACL reconstruction cases, cases of persistent ALRI after adequate ACL reconstruction, and cases with severe ALRI after primary ACL rupture. The surgeon performs ALES reconstruction with a strip of iliotibial tract autograft while respecting the anatomic origin and insertion of the anterolateral ligament. The purpose of this reconstruction is to restore the normal anterolateral rotatory stability of the knee in ALES-deficient patients. PMID:27284525

  19. All-inside anterior cruciate ligament reconstruction.

    PubMed

    Blackman, Andrew J; Stuart, Michael J

    2014-10-01

    All-inside anterior cruciate ligament (ACL) reconstruction has undergone a series of modifications over the past 20 years. Current techniques offer the advantages of improved cosmesis, less postoperative pain, decreased bone removal, and gracilis preservation. Few all-inside ACL reconstruction outcome studies are available; therefore, additional research is necessary to compare the results to conventional techniques. The purpose of this article is to review the evolution of all-inside ACL reconstruction, the advantages and disadvantages, our preferred technique, and clinical experience to date.

  20. Early versus late start of open kinetic chain quadriceps exercises after ACL reconstruction with patellar tendon or hamstring grafts: a prospective randomized outcome study.

    PubMed

    Heijne, Annette; Werner, Suzanne

    2007-04-01

    The purpose of the present investigation was to evaluate physical outcome after anterior cruciate ligament (ACL) reconstruction with early versus late initiation of open kinetic chain (OKC) exercises for the quadriceps in patients operated on either patellar tendon or hamstring grafts. Sixty-eight patients, 36 males and 32 females, with either patellar tendon graft (34 patients) or hamstring graft (34 patients) were enrolled in this study. All patients were randomly allocated to either early (the 4th postoperative week) or late (the 12th postoperative week) start of OKC exercises for the quadriceps, resulting in four subgroups: patellar tendon reconstruction, early start (P4) or late start (P12) of OKC quadriceps exercises, hamstring tendon reconstruction, early start (H4) or late start (H12) of quadriceps OKC exercises. Prior to surgery and 3, 5 and 7 months later, assessments of range of motion (goniometer), anterior knee laxity (KT-1000), postural sway (KAT 2000), thigh muscle torques (Kin-Com dynamometer) and anterior knee pain (anterior knee pain score) were evaluated. No significant group differences were found in terms of range of motion 3, 5 and 7 months postoperatively. The H4 group showed a significantly higher mean difference of laxity over time of 1.0 mm (CI: 0.18-1.86) than the P4 group (P=0.04). Within the same type of surgery, the H4 against the H12, the mean difference over time was 1.2 mm (0.37-2.1) higher in the H4 group than in the H12 group (P=0.01). There were no significant group differences in terms of postural sway or anterior knee pain at the different test occasions. Significant differences in trends (changes over time) were found when comparing the four groups, for both quadriceps muscle torques (P<0.001) and hamstring muscle torques (P<0.001). All groups, except the P4 group, reached preoperative values of quadriceps muscle torques at the 7 months follow-up. In the H4 and the H12 groups, significantly lower hamstring muscle torques at

  1. Medial Patellofemoral Ligament Reconstruction: Fixation Technique Biomechanics.

    PubMed

    Russo, Franco; Doan, Joshua; Chase, Derek C; Farnsworth, Christine L; Pennock, Andrew T

    2016-05-01

    Introduction The medial patellofemoral ligament (MPFL) is the primary soft-tissue stabilizer of the patella and it is often reconstructed in patients with recurrent patella instability. This biomechanical analysis evaluates the integrity of four methods of MPFL reconstruction subjected to cyclic loading using a porcine model. Methods Four techniques of MPFL reconstruction were analyzed using a 4 mm flexor tendon graft, all with two points of patellar fixation to best recreate the native MPFL anatomy. The four techniques were: (1) interference screw technique, (2) suture anchor technique, (3) converging tunnel technique, and (4) two bone tunnel technique. Maximum load, yield load, and stiffness of the graft fixation/bone complex were analyzed, and statistics were performed with SPSS and significance set at a p-value of < 0.05. Results The converging tunnel technique demonstrated the highest maximum load and yield load, significantly higher than the interference screw or suture anchor groups (p = 0.007). In addition, the converging tunnel technique demonstrated the greatest stiffness with significantly greater stiffness than the two bone tunnel techniques (p = 0.016). Conclusion The combination of strength and stiffness, the avoidance of patella implants, and the creation of a single transosseous tunnel make the converging tunnel technique a desirable technique for MPFL reconstructions. PMID:26190788

  2. Effect of Intraoperative Platelet-Rich-Plasma Treatment on Post Operative Donor Site Knee Pain in Patellar Tendon Autograft ACL Reconstruction

    PubMed Central

    Walters, Brian L.; Hobart, Sarah; Porter, David; Hogan, Daniel E.; McHugh, Malachy P.; Bedford, Benjamin B.; Nicholas, Stephen J.; Klein, Devon; Harousseau, Kendall

    2016-01-01

    Objectives: Donor site morbidity in the form of anterior knee pain is a frequent complication after bone-patellar tendon-bone (BPTB) autograft ACL reconstruction. The purpose of this Level I study was to examine the effect of the intraoperative administration of platelet-rich plasma on post operative knee pain and patellar defect healing. Methods: Fifty-nine patients (29±12 y/o) undergoing BPTB ACL reconstruction and eligible to enter the study, were randomized to the treatment (PRP; n=31) or non treatment (sham n=28) arms of the study just prior to surgery. In either case, 10 cc of venous blood was drawn prior to the induction of anesthesia and either discarded (sham) or processed (PRP) for preparation of a PRP gel to be later mixed with donor site bone chips and inserted into the patellar defect. At 12 weeks and 6 months after surgery, patients completed IKDC forms and VAS pain scores for ADLs and kneeling (0-10 scale). Healing indices at the donor site were assessed by MRI at 6 months and included the following measurements taken from axial sequences: AP tendon dimensions at the level of the superior tibial cortex, roof of the intercondylar notch and width at the largest patella graft deficit. Mixed model ANOVA was used to assess the effect of PRP on patient symptoms and MRI indices of donor site healing. The primary dependent variable was VAS kneeling pain. It was estimated that with 25 patients per group there would be 80% power to detect a 1.5-point difference in kneeling pain between treatments at P<0.05. A between group difference of 1.5-points in VAS for kneeling pain was deemed to represent a clinically relevant difference. Results: VAS Kneeling Pain at 12 weeks tended to be lower in the PRP versus placebo group (4.5±3.6 vs. 6.2±2.4, P=0.051) but no difference was apparent at 6 months (3.7±3.2 vs. 4.4±2.9, P=0.41). Kneeling pain decreased from 12 weeks to 6 months (P<0.001) with a trend for a greater decrease in the placebo group (Time by Treatment P

  3. 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

  4. Direct Visualization of Existing Footprint and Outside-In Drilling of the Femoral Tunnel in Anterior Cruciate Ligament Reconstruction in the Knee

    PubMed Central

    Sutter, E. Grant; Anderson, John A.; Garrett, William E.

    2015-01-01

    Improper femoral tunnel placement in anterior cruciate ligament (ACL) reconstruction is a significant problem and may be a cause of ACL graft failure and abnormal kinematics, which may lead to late degenerative changes after reconstruction. Recently, there has been concern that the transtibial approach may contribute to nonanatomic placement of the femoral tunnel, resulting in abnormal knee kinematics. Tibial-independent techniques can provide more anatomic placement of the ACL graft, but these can be technically demanding. This technical note describes the senior author's technique to directly identify the femoral ACL remnant and use the center of the femoral ACL footprint and retrograde drilling to create an anatomic femoral socket for single-bundle reconstruction. This technique provides femoral tunnel placement based on identification of a patient-specific ACL footprint instead of averaged anatomic measurements from large groups. This technique has been shown to produce anatomic ACL graft position and orientation and restore more normal knee kinematics. PMID:26052485

  5. Tissue transfer techniques in reconstructive urology

    PubMed Central

    Bryk, Darren J; Yamaguchi, Yuka

    2015-01-01

    Tissue transfer techniques are an essential part of the reconstructive urologist's armamentarium. Flaps and graft techniques are widely used in genital and urethral reconstruction. A graft is tissue that is moved from a donor site to a recipient site without its native blood supply. The main types of grafts used in urology are full thickness grafts, split thickness skin grafts and buccal mucosa grafts. Flaps are transferred from the donor site to the recipient site on a pedicle containing its native blood supply. Flaps can be classified based on blood supply, elevation methods or the method of transfer. The most used flaps in urology include penile, preputial, and scrotal skin. We review the various techniques used in reconstructive urology and the outcomes of these techniques. PMID:26175866

  6. COMPLICATIONS OF THE SCREW/WASHER TIBIAL FIXATION TECHNIQUE FOR KNEE LIGAMENT RECONSTRUCTION

    PubMed Central

    Almeida, Alexandre; Roveda, Gilberto; Valin, Márcio Rangel; Almeida, Nayvaldo Couto de; Sartor, Vanderlei; Alves, Soraya Melina

    2015-01-01

    To evaluate the presence of pain at the site of the surgical incision and the need to remove the tibial fixation screw in anterior cruciate ligament (ACL) reconstruction, in relation to sex and body mass index (BMI). Methods: A group of 265 patients who underwent ACL reconstruction with ipsilateral flexor tendon grafts from the thigh in which the tibial fixation technique consisted of using a cortical screw and metal washer, between July 2000 and November 2007, were evaluated. Results: 176 patients were evaluated for an average of 33.3 ± 19.5 months; median of 29.5 months; IIQ: 17-45 months; minimum of 8 and maximum of 87 months. There was no statistical difference regarding complaints of pain at the site of the screw (p = 0.272) and the need to remove the tibial screw (p = 0.633) between sexes. There was no statistical difference regarding complaints of pain at the site of the screw (p = 0.08) and the need to remove the tibial screw (p = 0.379) according to BMI. Conclusion: The pain complaint rate at the screw site from the screw and metal washer method used for tibial fixation in ACL reconstruction was of the order of 25%, and the screw had to be removed in 10.8% of the cases. There was no predominance of pain complaints at the surgical wound between the sexes. There was a greater tendency to complain about pain among patients with BMI < 25. There was no predominance of screw and washer removal between the sexes or between individuals with different BMIs. PMID:27022587

  7. Revision anterior cruciate ligament reconstruction with bone-patellar tendon-bone allograft and extra-articular iliotibial band tenodesis.

    PubMed

    Mascarenhas, Randy; McConkey, Mark O; Forsythe, Brian; Harner, Christopher D

    2015-04-01

    Revision anterior cruciate ligament (ACL) reconstruction is a technically demanding procedure with outcomes that generally fail to reach those seen with primary ACL reconstruction. With most index procedures using autograft tissue, it is not uncommon for allograft tissue to be required for revision ACL reconstruction. Compared with autografts, allografts take longer to incorporate and lead to more episodes of instability. In this article, we describe ipsilateral iliotibial band tenodesis performed to augment use of bone-patellar tendon-bone allograft in revision ACL reconstruction. This technique adds rotational stability to protect the allograft tissue while it incorporates. PMID:25844596

  8. Revision anterior cruciate ligament reconstruction with bone-patellar tendon-bone allograft and extra-articular iliotibial band tenodesis.

    PubMed

    Mascarenhas, Randy; McConkey, Mark O; Forsythe, Brian; Harner, Christopher D

    2015-04-01

    Revision anterior cruciate ligament (ACL) reconstruction is a technically demanding procedure with outcomes that generally fail to reach those seen with primary ACL reconstruction. With most index procedures using autograft tissue, it is not uncommon for allograft tissue to be required for revision ACL reconstruction. Compared with autografts, allografts take longer to incorporate and lead to more episodes of instability. In this article, we describe ipsilateral iliotibial band tenodesis performed to augment use of bone-patellar tendon-bone allograft in revision ACL reconstruction. This technique adds rotational stability to protect the allograft tissue while it incorporates.

  9. Pseudoglottis procedure: update and secondary reconstruction techniques.

    PubMed

    Sisson, G A; Goldman, M E

    1980-07-01

    Since our first report of 12 cases in 1977, we have added 37 cases and continue to modify our primary procedure for the reconstruction of a pseudoglottis after total laryngectomy. It has been and continues to be applied to a growing number of patients. We have also introduced a procedure modified after Staffieri for the secondary reconstruction of a pseudoglottis after total laryngectomy. A review of our cases reveals that a high percentage have achieved a good voice. Complications and problems continue and are further examined in this report. The current techniques and indications for the secondary reconstruction procedures are discussed. Even with the continuing problems, we believe that the use of Staffieri techniques or modifications thereof continues to be promising and may well become an accepted procedure in American laryngeal surgery.

  10. Pancreatectomy with vein reconstruction: technique matters

    PubMed Central

    Dua, Monica M; Tran, Thuy B; Klausner, Jill; Hwa, Kim J; Poultsides, George A; Norton, Jeffrey A; Visser, Brendan C

    2015-01-01

    Background A variety of techniques have been described for portal vein (PV) and/or superior mesenteric vein (SMV) resection/reconstruction during a pancreatectomy. The ideal strategy remains unclear. Methods Patients who underwent PV/SMV resection/reconstruction during a pancreatectomy from 2005 to 2014 were identified. Medical records and imaging were retrospectively reviewed for operative details and outcomes, with particular emphasis on patency. Results Ninety patients underwent vein resection/reconstruction with one of five techniques: (i) longitudinal venorrhaphy (LV, n = 17); (ii) transverse venorrhaphy (TV, n = 9); (iii) primary end-to-end (n = 28); (iv) patch venoplasty (PV, n = 17); and (v) interposition graft (IG, n = 19). With a median follow-up of 316 days, thrombosis was observed in 16/90 (18%). The rate of thrombosis varied according to technique. All patients with primary end-to-end or TV remained patent. LV, PV and IG were all associated with significant rates of thrombosis (P = 0.001 versus no thrombosis). Comparing thrombosed to patent, there were no differences with respect to pancreatectomy type, pre-operative knowledge of vein involvement and neoadjuvant therapy. Prophylactic aspirin was used in 69% of the total cohort (66% of patent, 81% of thrombosed) and showed no protective benefit. Conclusions Primary end-to-end and TV have superior patency than the alternatives after PV/SMV resection and should be the preferred techniques for short (<3 cm) reconstructions. PMID:26223388

  11. Anterior cruciate ligament tears: reconstruction and rehabilitation.

    PubMed

    Smith, Mary Atkinson; Smith, W Todd; Kosko, Paul

    2014-01-01

    Tears of the anterior cruciate ligament (ACL) are common knee injuries experienced by athletes and people with active lifestyles. It is important for members of the healthcare team to take an evidence-based approach to the diagnosis, surgical management, and postoperative rehabilitation of patients with an ACL-deficient knee. Mechanism of ACL injury and diagnostic testing is consistent throughout the literature. Patients frequently opt for ACL reconstruction, and many surgical techniques for ACL reconstruction are available with no clear consensus regarding superiority. Surgeon preference dictates the type of reconstruction and graft choice utilized. No standardized pre- and postoperative rehabilitation protocol exists. However, rehabilitation plays an important role in functional outcomes. A comprehensive rehabilitation program is needed pre- and postoperatively to produce positive patient outcomes.

  12. 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.

  13. Indian hedgehog signaling and the role of graft tension in tendon-to-bone healing: Evaluation in a rat ACL reconstruction model.

    PubMed

    Carbone, Andrew; Carballo, Camila; Ma, Richard; Wang, Hongsheng; Deng, Xianghua; Dahia, Chitra; Rodeo, Scott

    2016-04-01

    The structure and composition of the native enthesis is not recapitulated following tendon-to-bone repair. Indian Hedgehog (IHH) signaling has recently been shown to be important in enthesis development in a mouse model but no studies have evaluated IHH signaling in a healing model. Fourteen adult male rats underwent ACL reconstruction using a flexor tendon graft. Rats were assigned to two groups based on whether or not they received 0N or 10N of pre-tension of the graft. Specimens were evaluated at 3 and 6 weeks post-operatively using immunohistochemistry for three different protein markers of IHH signaling. Quantitative analysis of staining area and intensity using custom software demonstrated that IHH signaling was active in interface tissue formed at the healing tendon-bone interface. We also found increased staining area and intensity of IHH signaling proteins at 3 weeks in animals that received a pre-tensioned tendon graft. No significant differences were seen between the 3-week and 6-week time points. Our data suggests that the IHH signaling pathway is active during the tendon-bone healing process and appears to be mechanosensitive, as pre-tensioning of the graft at the time of surgery resulted in increased IHH signaling at three weeks. PMID:26447744

  14. 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

  15. Hamstring pain and muscle strains following anterior cruciate ligament reconstruction: a prospective, randomized trial comparing hamstring graft harvest techniques.

    PubMed

    D'Alessandro, Peter; Wake, Giulia; Annear, Peter

    2013-04-01

    There is limited information in the literature regarding hamstring pain and muscle strains in patients following anterior cruciate ligament (ACL) reconstruction using hamstring autograft. We sought to investigate whether dividing hamstring tendons distal to the musculotendinous junction rather than forcefully stripping tendons away from the muscle belly during graft harvest resulted in a lower incidence of hamstring pain, muscle strains, and leg flexion strength deficit following commencement of sport-specific training postoperatively. Patients were randomized to either the "Cut" or "Push" groups of hamstring tendon harvesting. All other operative techniques were uniform. A total of 34 (cut = 20, push = 14) patients had a mean follow-up of 30 months, and assessments were conducted by a blinded single practitioner. A customized hamstring strain questionnaire and visual analogue pain score provided information for the study's primary focus: evaluation of postoperative hamstring pain and muscle strains. Leg flexion strength was also measured and a full knee assessment was conducted. The Cincinnati sports activity rating scale (SARS) was used to account for varying degrees of sporting participation and intensity since reconstruction. The "Cut" group's mean visual analogue score was 10.05 mm, significantly lower than the "Push" group (24.66 mm, p = 0.0398). The Cut group also recorded a significant reduction in the incidence of hamstring strains following ACL reconstruction (5/20 patients 25%) compared with the Push group (7/14 patients 50%, p = 0.045). There was no difference in leg flexion strength between the groups. Of the patients who reported hamstring strains, there was no significant difference in the mean Cincinnati SARS between the groups, nor any difference in overall knee function. The incidence of hamstring pain and muscle strains was significantly reduced in patients receiving the "cut" technique of harvesting hamstring tendons in ACL reconstruction

  16. Adaptive techniques in electrical impedance tomography reconstruction.

    PubMed

    Li, Taoran; Isaacson, David; Newell, Jonathan C; Saulnier, Gary J

    2014-06-01

    We present an adaptive algorithm for solving the inverse problem in electrical impedance tomography. To strike a balance between the accuracy of the reconstructed images and the computational efficiency of the forward and inverse solvers, we propose to combine an adaptive mesh refinement technique with the adaptive Kaczmarz method. The iterative algorithm adaptively generates the optimal current patterns and a locally-refined mesh given the conductivity estimate and solves for the unknown conductivity distribution with the block Kaczmarz update step. Simulation and experimental results with numerical analysis demonstrate the accuracy and the efficiency of the proposed algorithm.

  17. Intracranial blister aneurysms: clip reconstruction techniques.

    PubMed

    Barrow, Daniel L; Pradilla, Gustavo; McCracken, D Jay

    2015-07-01

    Intracranial blister aneurysms are difficult to treat cerebrovascular lesions that typically affect the anterior circulation. These rare aneurysms can lead to acute rupture which usually cannot be treated via endovascular methods, but still require urgent surgical intervention. Surgical options are limited given their unique pathology and often require a combination of wrapping and clip reconstruction. In this video we present two patients with acute subarachnoid hemorrhage secondary to ruptured blister aneurysms. We demonstrate several surgical techniques for repairing the vascular defect with and without intraoperative rupture. The video can be found here: http://youtu.be/nz-JM45uKQU.

  18. What I have learned about the ACL: utilizing a progressive rehabilitation scheme to achieve total knee symmetry after anterior cruciate ligament reconstruction.

    PubMed

    Shelbourne, K Donald; Klotz, Christine

    2006-05-01

    Anterior cruciate ligament surgery and rehabilitation have changed drastically during the past 30 years. The patellar tendon autograft fixed with buttons provides tight bone-to-bone placement of the graft and quick bony healing, which allows accelerated rehabilitation to obtain full range of motion and strength. Although surgical stability is easily reproducible, long-term patient satisfaction is difficult to guarantee. Full knee range of motion should be compared to that of the contralateral normal knee, including full hyperextension. We followed the progress of all patients to gauge the utility of our rehabilitation program. In order of importance, the lack of normal knee range of motion (within 2 degrees extension and 5 degrees of flexion compared with that of the normal knee), partial or total medial meniscectomy, partial or total lateral meniscectomy, and articular cartilage damage were related to lower subjective scores. Rehabilitation after ACL reconstruction must first strive to achieve full symmetrical knee range of motion before aggressive strengthening can begin. Our current perioperative rehabilitation starts at the time of injury and preoperatively includes aggressive swelling reduction, hyperextension exercises, gait training, and mental preparation. Goals after surgery are to control swelling while regaining full knee range of motion. After quadriceps strengthening goals are reached, patients can shift to sport-specific exercises. When using a graft from the contralateral knee, the conflicting goals of strengthening the donor site and achieving full knee range of motion are divided between the knees. Thus, normal range of motion and strength can be achieved more easily and more quickly than when using an ipsilateral graft. Regardless of the graft source, a systematic rehabilitation program that emphasizes the return to symmetrical knee motion, including hyperextension, is necessary to achieve the optimum result.

  19. Biomechanics of the anterior cruciate ligament: Physiology, rupture and reconstruction techniques.

    PubMed

    Domnick, Christoph; Raschke, Michael J; Herbort, Mirco

    2016-02-18

    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.

  20. 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

  1. Tripeptide-copper complex GHK-Cu (II) transiently improved healing outcome in a rat model of ACL reconstruction.

    PubMed

    Fu, Sai-Chuen; Cheuk, Yau-Chuk; Chiu, Wai-Yin Vivien; Yung, Shu-Hang; Rolf, Christer G; Chan, Kai-Ming

    2015-07-01

    After anterior cruciate ligament reconstruction (ACLR), the biological healing of the graft is a rate-limiting step which can contribute to graft failure. The tripeptide-copper complex glycyl-L-histidyl-L-lysine-Cu(II) (GHK-Cu) is a well-known activator of tissue remodeling. We investigated whether GHK-Cu can improve graft healing following ACLR. Seventy-two rats underwent unilateral ACLR were randomized to saline, 0.3 or 3 mg/ml GHK-Cu groups (n = 24). Post-operational intra-articular injections were given from week 2, once a week, for 4 weeks. Gait analysis was performed pre-injury and at harvesting time. At 6 or 12 weeks post-operation, knee specimens were harvested for knee laxity test, graft pull-out test, and histology. At 6 weeks post-ACLR, GHK-Cu groups resulted in a smaller side-to-side difference in knee laxity as compared to the saline group (p = 0.009), but there was no significant difference at 12 weeks post-operation. The graft complex in the 0.3 mg/ml GHK-Cu group had higher stiffness than saline group at 6 weeks post-operation (p = 0.026), but there was no significant difference in ultimate load, gait parameters, and histological scores among treatment groups. All grafts failed mid-substance during pull-out test. Intra-articular supplementation with a bioactive small molecule GHK-Cu improved graft healing following ACLR in rat, but the beneficial effects could not last as treatment discontinued. PMID:25731775

  2. Does Gracilis Tendon Harvest During ACL Reconstruction with a Hamstring Autograft Affect Torque of Muscles Responsible for Shin Rotation?

    PubMed Central

    Królikowska, Aleksandra; Czamara, Andrzej; Kentel, Maciej

    2015-01-01

    Background A growing body of evidence indicates that in patients after anterior cruciate ligament reconstruction (ACLR) with a combined semitendinosus and gracilis (STGR) graft there are large deficits in the internal rotation strength, which has led some authors to recommend harvest of only ST tendon whenever possible. The purpose of this study was to assess the isometric (IT) and peak torque (PT) of the muscles responsible for shin rotation in patients after ACLR with an ST or with an STGR graft. Material/Methods Twenty patients with an ST graft and 20 patients with a combined STGR graft underwent a 6-month postoperative rehabilitation program after ACLR. At the end of the rehabilitation program, the IT and PT of the muscles responsible for internal (IR) and external rotation (ER) of the shin were measured. The results were compared to the results of a control group. Additionally, to determine the reliability of the dynamometer for clinical research, a test-retest assessment was performed. Results There were no statistically significant differences between the 3 groups of participants. Nevertheless, in the STGR group there was a statistically significant difference between the IT of muscles internally rotating the shin in the involved knee and uninvolved knee at 25° of the internal shin rotation. Conclusions Comparison of IT and PT measurements performed after 24 weeks of postoperative rehabilitation generally showed no differences between patients after ACLR with the use of ST graft and patients who received a combination graft consisting of STGR. Nevertheless, there was an influence of GR harvest on internal shin rotation torque at a deep internal rotation angle. PMID:26190033

  3. The relationship between subjective knee scores, isokinetic testing, and functional testing in the ACL-reconstructed knee.

    PubMed

    Wilk, K E; Romaniello, W T; Soscia, S M; Arrigo, C A; Andrews, J R

    1994-08-01

    It is important to examine the functional relationships between commonly performed clinical tests and to resolve inconsistencies in previous investigative results. The purpose of this study was to determine if a correlation exists between three commonly performed clinical tests: isokinetic isolated knee concentric muscular testing, the single-leg hop test, and the subjective knee score in anterior cruciate ligament reconstructed knees. To determine if a relationship exists would be beneficial to clinicians in determining patient progression, treatment modification, and return-to-sport objective parameters. Several investigators have analyzed two of these parameters, but no one has investigated three parameters to date. Additionally, this study explored the concept of limb acceleration and deceleration during high-speed isokinetics and its relationship to function. Fifty patients were randomly selected (29 males) with a mean age of 23.7 years (range 15-52). The subjects completed a subjective knee score questionnaire that rated symptoms (pain, swelling, giving way) and specific sport function and completed an overall knee score assessment. The patients were then evaluated performing three one-legged functional tests: 1) hop for distance, 2) timed hop, and 3) cross-over triple hop. Isokinetic testing was performed on a Biodex dynamometer at 180, 300, and 450 degrees/sec for knee extension/flexion. The patients' mean value of the self-assessed knee rating was 86 points. Sixty-four percent of the patients exhibited normal limb symmetry (within 85%) on all three single-leg hop tests. Sixteen percent exhibited quadriceps strength at least 90% of the contralateral limb isokinetically. A positive correlation was noted between isokinetic knee extension peak torque (180, 300 degrees/sec) and subjective knee scores, and the three hop tests (p < 0.001). A statistical trend was noted between knee extension acceleration and deceleration range at 180 and 300 degrees/sec for the

  4. [Indications and techniques of reconstruction after mastectomy].

    PubMed

    Koch, Nathalie; Delaloye, Jean-François; Raffoul, Wassim

    2012-10-24

    Reconstructive surgery takes an important place in breast cancer treatment. Immediate breast reconstruction is performed during the same operation as mastectomy. It is contraindicated following radiotherapy. Reconstruction performed after mastectomy is called differed breast reconstruction. It is completed 6 months after chemotherapy and 1 year after radiotherapy. Prosthetic breast reconstruction is indicated when tissues are of good qualities and breast are small. Autologous reconstruction is performed in case of radiotherapy or large breast. After breast reconstruction, imperfections can be corrected with autologous fat injection.

  5. Reconstruction techniques of holograms from Spacelab 3

    NASA Technical Reports Server (NTRS)

    Witherow, William K.

    1987-01-01

    Fluid transport effects in a ground-based laboratory are fairly well known. Bouyancy driven transport occurs when there is a local density change in the fluid. In a low-g environment these density changes become less important, and other transport mechanisms dominate. To better understand fluid flows in a low-g environment, a fluid experiment system (FES) was designed to fly aboard the Shuttle orbiter in Spacelab. The FES is a holographic system designed for acquisition of the maximum amount of data from an experiment. The FES flew for the first time in May 1985 on Spacelab 3 for investigation of triglycine sulfate (TGS) crystal growth in low-g. This paper describes the FES optical system. The reconstruction techniques of the holograms are examined in detail, and the multiuser and reflight capabilities are discussed. Proposed future experiments are mentioned.

  6. Repaired ACL More Likely to Tear Again in Young Women

    MedlinePlus

    ... risk for a repeat tear of the knee's anterior cruciate ligament (ACL) after surgery to repair it, a new study says. The study included just over 500 male and female athletes who underwent ACL reconstruction with a hamstring graft and were followed for ...

  7. Neuromuscular training techniques to target deficits before return to sport after anterior cruciate ligament reconstruction.

    PubMed

    Myer, Gregory D; Paterno, Mark V; Ford, Kevin R; Hewett, Timothy E

    2008-05-01

    Surgical intervention and early-phase rehabilitation after anterior cruciate ligament (ACL) reconstruction have undergone a relatively rapid and global evolution over the past 25 years. Despite the advances that have significantly improved outcomes, decreases in healthcare coverage (limited visits allowed for physical therapy) have increased the role of the strength and conditioning specialist in the rehabilitation of athletes returning to sport after ACL reconstruction. In addition, there is an absence of standardized, objective criteria to accurately assess an athlete's ability to progress through the end stages of rehabilitation and safely return to sport. The purpose of this Scientific Commentary is to present an example of a progressive, end-stage return to sport protocol that is targeted to measured deficits of neuromuscular control, strength, power, and functional symmetry that are rehabilitative landmarks after ACL reconstruction. The proposed return to sport training protocol incorporates quantitative measurement tools that will provide the athlete with objective feedback and targeted goal setting. Objective feedback and targeted goal setting may aid the strength and conditioning specialist with exercise selection and progression. In addition, a rationale for exercise selection is outlined to provide the strength and conditioning specialist with a flexible decision-making approach that will aid in the modification of return to sport training to meet the individual athlete's abilities and to target objectively measured deficits. This algorithmic approach may improve the potential for athletes to return to sport after ACL reconstruction at the optimal performance level and with minimized risk of reinjury.

  8. Review of evolution of tunnel position in anterior cruciate ligament reconstruction

    PubMed Central

    Rayan, Faizal; Nanjayan, Shashi Kumar; Quah, Conal; Ramoutar, Darryl; Konan, Sujith; Haddad, Fares S

    2015-01-01

    Anterior cruciate ligament (ACL) rupture is one of the commonest knee sport injuries. The annual incidence of the ACL injury is between 100000-200000 in the United States. Worldwide around 400000 ACL reconstructions are performed in a year. The goal of ACL reconstruction is to restore the normal knee anatomy and kinesiology. The tibial and femoral tunnel placements are of primordial importance in achieving this outcome. Other factors that influence successful reconstruction are types of grafts, surgical techniques and rehabilitation programmes. A comprehensive understanding of ACL anatomy has led to the development of newer techniques supplemented by more robust biological and mechanical concepts. In this review we are mainly focussing on the evolution of tunnel placement in ACL reconstruction, focusing on three main categories, i.e., anatomical, biological and clinical outcomes. The importance of tunnel placement in the success of ACL reconstruction is well researched. Definite clinical and functional data is lacking to establish the superiority of the single or double bundle reconstruction technique. While there is a trend towards the use of anteromedial portals for femoral tunnel placement, their clinical superiority over trans-tibial tunnels is yet to be established. PMID:25793165

  9. 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

  10. 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

  11. Tibial Tunnel Cyst Formation after Anterior Cruciate Ligament Reconstruction Using a Non-Bioabsorbable Interference Screw.

    PubMed

    Joshi, Yogesh V; Bhaskar, Deepu; Phaltankar, Padmanabh M; Charalambous, Charalambos P

    2015-12-01

    Tibial cyst formation following the use of bioabsorbable interference screws in anterior cruciate ligament (ACL) reconstruction is well-described; however, cyst formation after the use of metallic interference screws is not well-documented. We describe a case of osteolytic lesion of the proximal tibia presenting to us 20 years after ACL reconstruction using an autologous bone-tendon-bone graft. The original graft fixation technique was interference fixation with a metal screw in the tibial and femoral tunnels. A two-stage revision reconstruction of the ACL was undertaken with curettage and bone grafting of the tibial lesion in the first stage and reconstruction using a four-strand hamstring tendon in the second stage. The patient recovered satisfactorily with complete healing of the cyst and returned to pre-injury level of activities. We have reviewed case reports and case series that describe the aetiology of intra-osseous cyst formation following ACL reconstruction. PMID:26673117

  12. Computational Techniques in Radio Neutrino Event Reconstruction

    NASA Astrophysics Data System (ADS)

    Beydler, M.; ARA Collaboration

    2016-03-01

    The Askaryan Radio Array (ARA) is a high-energy cosmic neutrino detector constructed with stations of radio antennas buried in the ice at the South Pole. Event reconstruction relies on the analysis of the arrival times of the transient radio signals generated by neutrinos interacting within a few kilometers of the detector. Because of its depth dependence, the index of refraction in the ice complicates the interferometric directional reconstruction of possible neutrino events. Currently, there is an ongoing endeavor to enhance the programs used for the time-consuming computations of the curved paths of the transient wave signals in the ice as well as the interferometric beamforming. We have implemented a fast, multi-dimensional spline table lookup of the wave arrival times in order to enable raytrace-based directional reconstructions. Additionally, we have applied parallel computing across multiple Graphics Processing Units (GPUs) in order to perform the beamforming calculations quickly.

  13. Tibial inlay posterior cruciate ligament reconstruction: surgical technique and results.

    PubMed

    McAllister, David R; Hussain, Suleman M

    2010-12-01

    Posterior cruciate ligament (PCL) injuries occur much less frequently than other ligament injuries of the knee such as anterior cruciate ligament injuries. There is general agreement for nonoperative treatment for lower grade injuries such as type I PCL injuries. However, for more severe injuries which may require surgery, there is no consensus on an optimal reconstruction method. Multiple arthroscopic and open techniques exist to reconstruct the PCL. Limited clinical outcomes data reveals good short-term clinical results with different reconstruction options. Biomechanical data has helped further the understanding regarding the performance of different reconstructions. This article will present a surgical technique for single bundle tibial inlay reconstruction of the PCL along with the objective biomechanical data that supports this reconstruction.

  14. Advanced Techniques for Fourier Transform Wavefront Reconstruction

    SciTech Connect

    Poyneer, L A

    2002-08-05

    The performance of Fourier transform (FT) reconstructors in large adaptive optics systems with Shack-Hartmann sensors and a deformable mirror is analyzed. FT methods, which are derived for point-based geometries, are adapted for use on the continuous systems. Analysis and simulation show how to compensate for effects such as misalignment of the deformable mirror and wavefront sensor gain. Further filtering methods to reduce noise and improve performance are presented. All these modifications can be implemented at the filtering stage, preserving the speed of FT reconstruction. Simulation of a large system shows how compensated FT methods can have equivalent or better performance to slower vector-matrix-multiply reconstructions.

  15. Sterilization with electron beam irradiation influences the biomechanical properties and the early remodeling of tendon allografts for reconstruction of the anterior cruciate ligament (ACL).

    PubMed

    Schmidt, Tanja; Hoburg, Arnd; Broziat, Christine; Smith, Mark D; Gohs, Uwe; Pruss, Axel; Scheffler, Sven

    2012-08-01

    Although allografts for anterior cruciate ligament (ACL) replacement have shown advantages compared to autografts, their use is limited due to the risk of disease transmission and the limitations of available sterilization methods. Gamma sterilization has shown detrimental effects on graft properties at the high doses required for sufficient pathogen inactivation. In our previous in vitro study on human patellar tendon allografts, Electron beam (Ebeam) irradiation showed less detrimental effects compared to gamma sterilization (Hoburg et al. in Am J Sports Med 38(6):1134-1140, 2010). To investigate the biological healing and restoration of the mechanical properties of a 34 kGy Ebeam treated tendon allograft twenty-four sheep underwent ACL replacement with either a 34 kGy Ebeam treated allograft or a non-sterilized fresh frozen allograft. Biomechanical testing of stiffness, ultimate failure load and AP-laxity as well as histological analysis to investigate cell, vessel and myofibroblast-density were performed after 6 and 12 weeks. Native sheep ACL and hamstring tendons (HAT, each n = 9) served as controls. The results of a previous study analyzing the remodeling of fresh frozen allografts (n = 12) and autografts (Auto, n = 18) with the same study design were also included in the analysis. Statistics were performed using Mann-Whitney U test followed by Bonferroni-Holm correction. Results showed significantly decreased biomechanical properties during the early remodeling period in Ebeam treated grafts and this was accompanied with an increased remodeling activity. There was no recovery of biomechanical function from 6 to 12 weeks in this group in contrast to the results observed in fresh frozen allografts and autografts. Therefore, high dose Ebeam irradiation investigated in this paper cannot be recommended for soft tissue allograft sterilization.

  16. Gait patterns before and after anterior cruciate ligament reconstruction.

    PubMed

    Knoll, Zsolt; Kocsis, László; Kiss, Rita M

    2004-01-01

    The aim of this study is to determine how selected gait parameters may change as a result of anterior cruciate ligament (ACL) deficiency and following ACL reconstruction. The study was performed on 25 ACL-deficient subjects prior to and 6 weeks, 4 months, 8 months and 12 months after ACL reconstructive surgery by the bone-patellar tendon-bone technique. Gait analysis was performed using the zebris three-dimensional ultrasound-based system with surface electromyograph (zebris Medizintechnik GmbH, Germany). Kinematic data were recorded for the lower limb. The muscles examined include vastus lateralis and medialis, biceps femoris and adductor longus. The results obtained from the injured subjects were compared with those of 51 individuals without ACL damage. The acute ACL-deficient patients exhibited a quadriceps avoidance pattern prior to and 6 weeks after surgery. The quadriceps avoidance phenomenon does not develop in chronic ACL-deficient patients. In the individuals operated on, the spatial-temporal parameters and the knee angle had already regained a normal pattern for the ACL-deficient limb during gait 4 months after surgery. However, the relative ACL movement parameter-which describes the tibial translation into the direction of ACL-and the EMG traces show no significant statistical difference compared with the values of healthy control group just 8 months after surgery. The results suggest that: (1) development of a quadriceps avoidance pattern is less common than previously reported, (2) anterior cruciate ligament deficiency and reconstruction significantly alter the lower extremity gait pattern, (3) the gait parameters shift towards the normal value pattern, and (4) the re-establishment of pre-injury gait patterns--including the normal biphase of muscles--takes at least 8 months to occur.

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

    PubMed Central

    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. PMID:18523530

  18. Anatomic Reconstruction Technique for a Plantar Calcaneonavicular (Spring) Ligament Tear.

    PubMed

    Palmanovich, Ezequiel; Shabat, Shay; Brin, Yaron S; Feldman, Viktor; Kish, Benny; Nyska, Meir

    2015-01-01

    Acquired flatfoot deformity in adults is usually due to partial or complete tearing of the posterior tibial tendon, with secondary failure of other structures such as the plantar calcaneonavicular (spring) ligament (SL), which maintain the medial longitudinal arch. In flexible cases, the tibialis posterior can be replaced with the flexor digitorum longus. It is common practice to suture the SL directly in the case of a tear; however, if the tear is complete, suturing directly to the ligament alone will not be possible. Reconstruction of the ligament is needed; however, no validated methods are available to reconstruct this ligament. The operative technique of SL reconstruction described in this report as a part of acquired flatfoot deformity reconstruction consists of augmenting remnants of the spring from the navicularis to the sustentaculum tali and suspending it to the medial malleolus using 2-mm-wide, long-chain polyethylene suture tape. This technique results in the firm anatomic reconstruction of the SL, in addition to "classic" medial arch reconstruction. We recommend SL reconstruction for medial arch reconstruction when the SL is torn. PMID:26253476

  19. Anterolateral Ligament Reconstruction Technique: An Anatomic-Based Approach.

    PubMed

    Chahla, Jorge; Menge, Travis J; Mitchell, Justin J; Dean, Chase S; LaPrade, Robert F

    2016-06-01

    Restoration of anteroposterior laxity after an anterior cruciate ligament reconstruction has been predictable with traditional open and endoscopic techniques. However, anterolateral rotational stability has been difficult to achieve in a subset of patients, even with appropriate anatomic techniques. Therefore, differing techniques have attempted to address this rotational laxity by augmenting or reconstructing lateral-sided structures about the knee. In recent years, there has been a renewed interest in the anterolateral ligament as a potential contributor to residual anterolateral rotatory instability in anterior cruciate ligament-deficient patients. Numerous anatomic and biomechanical studies have been performed to further define the functional importance of the anterolateral ligament, highlighting the need for surgical techniques to address these injuries in the unstable knee. This article details our technique for an anatomic anterolateral ligament reconstruction using a semitendinosus tendon allograft. PMID:27656361

  20. Nipple-areola complex reconstruction techniques: A literature review.

    PubMed

    Sisti, A; Grimaldi, L; Tassinari, J; Cuomo, R; Fortezza, L; Bocchiotti, M A; Roviello, F; D'Aniello, C; Nisi, G

    2016-04-01

    Many techniques for nipple-areola complex (NAC) reconstruction are described. Clarity is required on the currently available options. Since a complete list of all the techniques described until now is not available, a possibly comprehensive literature overview was carried out from 75 papers (years 1946-2015). The local flap was the most frequently described technique for the nipple reconstruction with no significant difference in complications' rate among the various types of techniques. Complications in nipple reconstruction were 46.9% after graft, 7.9% after local flap, and 5.3% in case of flaps with autologous graft/alloplastic/allograft augmentation, while complications in areola reconstruction were 10.1% after graft, and 1.6% after areola tattoo. Flaps appear to be more reliable than grafts in nipple reconstruction, while tattoo is thought to be safer than graft in areola reconstruction. The loss of projection, although considerable (45%-75%), had not significant impact on patients' satisfaction. Due to contraction, overcorrection of 25-50% of the desired result is advisory when adopting local flaps, in order to prevent loss of projection. The use of flaps with autologous graft/alloplastic/allograft augmentation (cartilage, fat, calcium hydroxylapatite, acellular dermal matrix, polymethylmethacrylate, biologic collagen) showed a minor loss of nipple projection but may expose to a relative increased number of postoperative flap necrosis. PMID:26868167

  1. Editorial Commentary: Medial Collateral Ligament and Posteromedial Corner Reconstruction Techniques Vary and Indications Are Not Clear.

    PubMed

    Lubowitz, James H

    2015-11-01

    Medial collateral ligament (MCL) and posteromedial corner (PMC) reconstruction techniques vary. Anatomic reconstruction results in outcomes superior to nonanatomic reconstruction, but it remains unclear as to when reconstruction is indicated versus MCL and PMC primary repair. PMID:26542207

  2. Ulnar Collateral Ligament Reconstruction of the Elbow: The Docking Technique.

    PubMed

    Camp, Christopher L; Dines, Joshua S; Voleti, Pramod B; James, Evan W; Altchek, David W

    2016-06-01

    Reconstruction of the ulnar collateral ligament (UCL) is one of the most commonly performed surgical procedures in overhead throwing athletes. Since its initial description, the procedure has undergone a number of technical modifications and advancements. This has resulted in multiple described techniques for UCL reconstruction. One of the most commonly performed UCL reconstruction methods is the docking technique. It has the advantages of minimizing injury to the flexor-pronator mass, avoiding the ulnar nerve, allowing robust graft tensioning, and reducing the amount of bone removed from the medial epicondyle compared with previously described techniques. This article provides a detailed description and video demonstration of how to perform this technique. When precise surgical steps are followed and postoperative rehabilitation appropriately progresses, this procedure has a well-documented history of reliably returning athletes to competitive throwing. PMID:27656372

  3. Ulnar Collateral Ligament Reconstruction of the Elbow: The Docking Technique.

    PubMed

    Camp, Christopher L; Dines, Joshua S; Voleti, Pramod B; James, Evan W; Altchek, David W

    2016-06-01

    Reconstruction of the ulnar collateral ligament (UCL) is one of the most commonly performed surgical procedures in overhead throwing athletes. Since its initial description, the procedure has undergone a number of technical modifications and advancements. This has resulted in multiple described techniques for UCL reconstruction. One of the most commonly performed UCL reconstruction methods is the docking technique. It has the advantages of minimizing injury to the flexor-pronator mass, avoiding the ulnar nerve, allowing robust graft tensioning, and reducing the amount of bone removed from the medial epicondyle compared with previously described techniques. This article provides a detailed description and video demonstration of how to perform this technique. When precise surgical steps are followed and postoperative rehabilitation appropriately progresses, this procedure has a well-documented history of reliably returning athletes to competitive throwing.

  4. A local technique based on vectorized surfaces for craniofacial reconstruction.

    PubMed

    Tilotta, Françoise M; Glaunès, Joan A; Richard, Frédéric J P; Rozenholc, Yves

    2010-07-15

    In this paper, we focus on the automation of facial reconstruction. Since they consider the whole head as the object of interest, usual reconstruction techniques are global and involve a large number of parameters to be estimated. We present a local technique which aims at reaching a good trade-off between bias and variance following the paradigm of non-parametric statistics. The estimation is localized on patches delimited by surface geodesics between anatomical points of the skull. The technique relies on a continuous representation of the individual surfaces embedded in the vectorial space of extended normal vector fields. This allows to compute deformations and averages of surfaces. It consists in estimating the soft-tissue surface over patches. Using a homogeneous database described in [31], we obtain results on the chin and nasal regions with an average error below 1mm, outperforming the global reconstruction techniques.

  5. Bilateral Medial Tibial Plateau Fracture after Arthroscopic Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Cho, Chul Hyun; Lee, Kyung Jae; Jeon, Jong Hyuk

    2015-01-01

    Tibial plateau fractures after arthroscopic anterior cruciate ligament (ACL) reconstruction are rare, and only isolated cases have been reported. The authors describe a case of bilateral medial tibial plateau fracture following a minor motorcycle accident in a patient who underwent arthroscopic ACL reconstruction in the past. Two years and four months before the accident, the patient underwent an arthroscopically assisted ACL reconstruction using double-bundle technique on his left knee at a hospital. He had the same surgery using single-bundle technique on his right knee about eight months ago at another hospital. The fractures in his both involved knees occurred through the tibial tunnel and required open reduction with internal fixation. At three weeks after fixation, a second-look arthroscopy revealed intact ACLs in both knees. At five months follow-up, he was able to walk without instability on physical examination. Follow-up radiographs of the patient showed callus formations with healed fractures. PMID:26060613

  6. Surgical treatment of combined PCL-ACL medial and lateral side injuries (global laxity): surgical technique and 2- to 18-year results.

    PubMed

    Fanelli, Gregory C; Edson, Craig J

    2012-09-01

    The multiple ligament injured knee is a severe injury that may also involve neurovascular injuries, fractures, and other systemic injuries. Surgical treatment offers good functional results documented in the literature by physical examination, arthrometer testing, stress radiography, and knee ligament rating scales. Mechanical tensioning devices are helpful with cruciate ligament tensioning. Some low grade medial collateral ligament (MCL) complex injuries may be amenable to brace treatment, while high grade medial side injuries require combined surgical repair-reconstruction. Lateral posterolateral injuries are most successfully treated with combined surgical repair-reconstruction. Surgical timing in acute multiple ligament injured knee cases depends on the ligaments injured, injured extremity vascular status, skin condition of the extremity, degree of instability, and the patients overall health. Allograft tissue is preferred for these complex surgical procedures. Delayed reconstruction of 2 to 3 weeks may decrease the incidence of arthrofibrosis, and it is important to address all components of the instability. Currently, there is no conclusive evidence that double-bundle posterior cruciate ligament (PCL) reconstruction provides superior results to single-bundle PCL reconstruction in the multiple ligament injured knee. The purpose of this article is to discuss G.F.'s surgical technique for combined PCL and anterior cruciate ligament, medial, and lateral side reconstructions in acute and chronic multiple ligament injured knees with global laxity. This article will focus on recognizing and defining the instability pattern, the use of external fixation, surgical timing, graft selection and preparation, G.F.'s preferred surgical technique, mechanical graft tensioning, perioperative antibiotics, specialized operating teams, postoperative rehabilitation, and our results of treatment in these complex surgical cases.

  7. Experimental investigation of iterative reconstruction techniques for high resolution mammography

    NASA Astrophysics Data System (ADS)

    Vengrinovich, Valery L.; Zolotarev, Sergei A.; Linev, Vladimir N.

    2014-02-01

    The further development of the new iterative reconstruction algorithms to improve three-dimensional breast images quality restored from incomplete and noisy mammograms, is provided. The algebraic reconstruction method with simultaneous iterations - Simultaneous Algebraic Reconstruction Technique (SART) and the iterative method of statistical reconstruction Bayesian Iterative Reconstruction (BIR) are referred here as the preferable iterative methods suitable to improve the image quality. For better processing we use the Graphics Processing Unit (GPU). Method of minimizing the Total Variation (TV) is used as a priori support for regularization of iteration process and to reduce the level of noise in the reconstructed image. Preliminary results with physical phantoms show that all examined methods are capable to reconstruct structures layer-by-layer and to separate layers which images are overlapped in the Z- direction. It was found that the method of traditional Shift-And-Add tomosynthesis (SAA) is worse than iterative methods SART and BIR in terms of suppression of the anatomical noise and image blurring in between the adjacent layers. Despite of the fact that the measured contrast/noise ratio in the presence of low contrast internal structures is higher for the method of tomosynthesis SAA than for SART and BIR methods, its effectiveness in the presence of structured background is rather poor. In our opinion the optimal results can be achieved using Bayesian iterative reconstruction BIR.

  8. Feedback Techniques to Target Functional Deficits Following Anterior Cruciate Ligament Reconstruction: Implications for Motor Control and Reduction of Second Injury Risk

    PubMed Central

    Benjaminse, Anne; Hewett, Timothy E.; Paterno, Mark V.; Ford, Kevin R.; Otten, Egbert; Myer, Gregory D.

    2014-01-01

    Primary anterior cruciate ligament (ACL) injury prevention training has been shown to reduce the risk of injury. Less is known about the effect of prevention on second injury after ACL reconstruction (ACLR). Given recent findings that second injury rates exceed 20 % in only the first year following the return to sport, it is imperative that rehabilitation after ACLR is scrutinized so that second injury preventative strategies can be optimized. A potential limitation of current rehabilitative processes following ACLR could be a deficiency in the transition from conscious awareness achieved during rehabilitation sessions to unexpected and automatic movements required for athletic activities on the field. Learning strategies with an internally directed focus have traditionally been utilized but may be less suitable for acquisition of control of complex motor skills required for sport reintegration. Conversely, an externally focused rehabilitation strategy may enhance skill acquisition more efficiently and increase the potential to transfer to competitive sport. This article presents new insights gained from the motor learning domain that may improve neuromuscular training programmes via increased retention from improved techniques and may ultimately reduce the incidence of second ACL injuries. PMID:24062274

  9. Anterior Cruciate Ligament Remnant–Preserving Reconstruction Using a “Lasso-Loop” Knot Configuration

    PubMed Central

    Boutsiadis, Achilleas; Karampalis, Christos; Tzavelas, Anastasios; Vraggalas, Vasileios; Christodoulou, Pavlos; Bisbinas, Ilias

    2015-01-01

    Anterior cruciate ligament (ACL) rupture predisposes to altered kinematics and possible knee joint degeneration. Graft fiber maturation and ligamentization may eliminate this risk during ACL reconstruction procedures. ACL remnant–sparing techniques support the theory that the preserved tissue enhances revascularization, preserves the mechanoreceptors, and leads to anatomic remodeling. The purpose of this article is to present a simple and reproducible technique of tensioning the preserved ACL remnant over the femur. A nonabsorbable suture is passed through the ACL remnant with a “lasso-loop” technique using a curved rotator cuff hook. Femoral and tibial tunnel preparation is performed according to a standard surgical technique for the EndoButton device (Smith & Nephew Endoscopy, Andover, MA). The free ends of the ACL remnant suture are retrieved through the tibial tunnel and passed through each outside hole of the EndoButton device. The hamstring graft is passed through the tibial and femoral tunnels and fixed to the femoral cortex by flipping the EndoButton and to the tibia by an interference screw. Finally, non-sliding half-stitch locking knots are made to secure the ACL remnant suture on the EndoButton device, by use of a knot pusher. This technique offers simple and secure tensioning of the ACL remnant on the fixation device. PMID:26870656

  10. Anterior Cruciate Ligament Remnant-Preserving Reconstruction Using a "Lasso-Loop" Knot Configuration.

    PubMed

    Boutsiadis, Achilleas; Karampalis, Christos; Tzavelas, Anastasios; Vraggalas, Vasileios; Christodoulou, Pavlos; Bisbinas, Ilias

    2015-12-01

    Anterior cruciate ligament (ACL) rupture predisposes to altered kinematics and possible knee joint degeneration. Graft fiber maturation and ligamentization may eliminate this risk during ACL reconstruction procedures. ACL remnant-sparing techniques support the theory that the preserved tissue enhances revascularization, preserves the mechanoreceptors, and leads to anatomic remodeling. The purpose of this article is to present a simple and reproducible technique of tensioning the preserved ACL remnant over the femur. A nonabsorbable suture is passed through the ACL remnant with a "lasso-loop" technique using a curved rotator cuff hook. Femoral and tibial tunnel preparation is performed according to a standard surgical technique for the EndoButton device (Smith & Nephew Endoscopy, Andover, MA). The free ends of the ACL remnant suture are retrieved through the tibial tunnel and passed through each outside hole of the EndoButton device. The hamstring graft is passed through the tibial and femoral tunnels and fixed to the femoral cortex by flipping the EndoButton and to the tibia by an interference screw. Finally, non-sliding half-stitch locking knots are made to secure the ACL remnant suture on the EndoButton device, by use of a knot pusher. This technique offers simple and secure tensioning of the ACL remnant on the fixation device. PMID:26870656

  11. 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

  12. 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…

  13. Reconstruction Techniques for Sparse Multistatic Linear Array Microwave Imaging

    SciTech Connect

    Sheen, David M.; Hall, Thomas E.

    2014-06-09

    Sequentially-switched linear arrays are an enabling technology for a number of near-field microwave imaging applications. Electronically sequencing along the array axis followed by mechanical scanning along an orthogonal axis allows dense sampling of a two-dimensional aperture in near real-time. In this paper, a sparse multi-static array technique will be described along with associated Fourier-Transform-based and back-projection-based image reconstruction algorithms. Simulated and measured imaging results are presented that show the effectiveness of the sparse array technique along with the merits and weaknesses of each image reconstruction approach.

  14. 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

  15. Minimally Invasive Techniques for Total Aortic Arch Reconstruction.

    PubMed

    Faulds, Jason; Sandhu, Harleen K; Estrera, Anthony L; Safi, Hazim J

    2016-01-01

    The cumulative experience with endovascular aortic repair in the descending thoracic and infrarenal aorta has led to increased interest in endovascular aortic arch reconstruction. Open total arch replacement is a robust operation that can be performed with excellent results. However, it requires cardiopulmonary bypass and circulatory arrest and, therefore, may not be tolerated by all patients. Minimally invasive techniques have been considered as an alternative and include hybrid arch debranching, parallel stent graft deployment in the chimney and snorkel configurations, and complete endovascular branched reconstruction with multi-branched devices. This review discusses the evolving use of endovascular techniques in the management of aortic arch pathology and considers their relevance in an era of safe and durable open aortic arch reconstruction.

  16. Minimally Invasive Techniques for Total Aortic Arch Reconstruction

    PubMed Central

    Faulds, Jason; Sandhu, Harleen K.; Estrera, Anthony L.; Safi, Hazim J.

    2016-01-01

    The cumulative experience with endovascular aortic repair in the descending thoracic and infrarenal aorta has led to increased interest in endovascular aortic arch reconstruction. Open total arch replacement is a robust operation that can be performed with excellent results. However, it requires cardiopulmonary bypass and circulatory arrest and, therefore, may not be tolerated by all patients. Minimally invasive techniques have been considered as an alternative and include hybrid arch debranching, parallel stent graft deployment in the chimney and snorkel configurations, and complete endovascular branched reconstruction with multi-branched devices. This review discusses the evolving use of endovascular techniques in the management of aortic arch pathology and considers their relevance in an era of safe and durable open aortic arch reconstruction. PMID:27127562

  17. FIRT: Filtered iterative reconstruction technique with information restoration.

    PubMed

    Chen, Yu; Zhang, Yan; Zhang, Kai; Deng, Yuchen; Wang, Shengliu; Zhang, Fa; Sun, Fei

    2016-07-01

    Electron tomography (ET) combining subsequent sub-volume averaging has been becoming a unique way to study the in situ 3D structures of macromolecular complexes. However, information missing in electron tomography due to limited angular sampling is still the bottleneck in high-resolution electron tomography application. Here, based on the understanding of smooth nature of biological specimen, we present a new iterative image reconstruction algorithm, FIRT (filtered iterative reconstruction technique) for electron tomography by combining the algebra reconstruction technique (ART) and the nonlinear diffusion (ND) filter technique. Using both simulated and experimental data, in comparison to ART and weight back projection method, we proved that FIRT could generate a better reconstruction with reduced ray artifacts and significant improved correlation with the ground truth and partially restore the information at the non-sampled angular region, which was proved by investigating the 90° re-projection and by the cross-validation method. This new algorithm will be subsequently useful in the future for both cellular and molecular ET with better quality and improved structural details. PMID:27134004

  18. Algebraic Reconstruction Technique (ART) for parallel imaging reconstruction of undersampled radial data: Application to cardiac cine

    PubMed Central

    Li, Shu; Chan, Cheong; Stockmann, Jason P.; Tagare, Hemant; Adluru, Ganesh; Tam, Leo K.; Galiana, Gigi; Constable, R. Todd; Kozerke, Sebastian; Peters, Dana C.

    2014-01-01

    Purpose To investigate algebraic reconstruction technique (ART) for parallel imaging reconstruction of radial data, applied to accelerated cardiac cine. Methods A GPU-accelerated ART reconstruction was implemented and applied to simulations, point spread functions (PSF) and in twelve subjects imaged with radial cardiac cine acquisitions. Cine images were reconstructed with radial ART at multiple undersampling levels (192 Nr x Np = 96 to 16). Images were qualitatively and quantitatively analyzed for sharpness and artifacts, and compared to filtered back-projection (FBP), and conjugate gradient SENSE (CG SENSE). Results Radial ART provided reduced artifacts and mainly preserved spatial resolution, for both simulations and in vivo data. Artifacts were qualitatively and quantitatively less with ART than FBP using 48, 32, and 24 Np, although FBP provided quantitatively sharper images at undersampling levels of 48-24 Np (all p<0.05). Use of undersampled radial data for generating auto-calibrated coil-sensitivity profiles resulted in slightly reduced quality. ART was comparable to CG SENSE. GPU-acceleration increased ART reconstruction speed 15-fold, with little impact on the images. Conclusion GPU-accelerated ART is an alternative approach to image reconstruction for parallel radial MR imaging, providing reduced artifacts while mainly maintaining sharpness compared to FBP, as shown by its first application in cardiac studies. PMID:24753213

  19. Reconstruction techniques for sparse multistatic linear array microwave imaging

    NASA Astrophysics Data System (ADS)

    Sheen, David M.; Hall, Thomas E.

    2014-06-01

    Sequentially-switched linear arrays are an enabling technology for a number of near-field microwave imaging applications. Electronically sequencing along the array axis followed by mechanical scanning along an orthogonal axis allows dense sampling of a two-dimensional aperture in near real-time. The Pacific Northwest National Laboratory (PNNL) has developed this technology for several applications including concealed weapon detection, groundpenetrating radar, and non-destructive inspection and evaluation. These techniques form three-dimensional images by scanning a diverging beam swept frequency transceiver over a two-dimensional aperture and mathematically focusing or reconstructing the data into three-dimensional images. Recently, a sparse multi-static array technology has been developed that reduces the number of antennas required to densely sample the linear array axis of the spatial aperture. This allows a significant reduction in cost and complexity of the linear-array-based imaging system. The sparse array has been specifically designed to be compatible with Fourier-Transform-based image reconstruction techniques; however, there are limitations to the use of these techniques, especially for extreme near-field operation. In the extreme near-field of the array, back-projection techniques have been developed that account for the exact location of each transmitter and receiver in the linear array and the 3-D image location. In this paper, the sparse array technique will be described along with associated Fourier-Transform-based and back-projection-based image reconstruction algorithms. Simulated imaging results are presented that show the effectiveness of the sparse array technique along with the merits and weaknesses of each image reconstruction approach.

  20. Reconstruction of transoral robotic surgery defects: principles and techniques.

    PubMed

    de Almeida, John Rukshan; Park, Richard Chan Woo; Genden, Eric M

    2012-09-01

    Early functional and oncological outcome studies suggest that transoral robotic surgery (TORS) may have a role for early stage cancers of the oropharynx. Unlike with traditional mandibular swing or pharyngotomy approaches, access to the oropharynx for reconstruction in TORS cases is limited. Maintaining a good functional result necessitates preserving physiological function where possible. The principles that should guide reconstructive surgeons include maintaining a velopharyngeal sphincter to prevent velopharyngeal insufficiency, maintaining sensate mucosa and restoring bulk in the tongue base to prevent aspiration, maintaining separation between the cervical and pharyngeal components, and covering exposed vessels in the pharynx. We present here principles and surgical techniques of TORS to reconstruct oropharyngeal defects using a subsite-based approach using secondary healing, local musculomucosal flaps, and free tissue transfer guided by the above principles. PMID:22744899

  1. Optimisation techniques for digital image reconstruction from their projections

    NASA Astrophysics Data System (ADS)

    Durrani, T. S.; Goutis, C. E.

    1980-09-01

    A method is proposed for the digital reconstruction of images from their projections based on optimizing specified performance criteria. The reconstruction problem is embedded into the framework of constrained optimization and its solution is shown to lead to a relationship between the image and the one-dimensional Lagrange functions associated with each cost criterion. Two types of geometries (the parallel-beam and fan-beam systems) are considered for the acquisition of projection data and the constrained-optimization problem is solved for both. The ensuing algorithms allow the reconstruction of multidimensional objects from one-dimensional functions only. For digital data a fast reconstruction algorithm is proposed which exploits the symmetries inherent in both a circular domain of image reconstruction and in projections obtained at equispaced angles. Computational complexity is significantly reduced by the use of fast-Fourier-transform techniques, as the underlying relationship between the available projection data and the associated Lagrange multipliers is shown to possess a block circulant matrix structure.

  2. An efficient simultaneous reconstruction technique for tomographic particle image velocimetry

    NASA Astrophysics Data System (ADS)

    Atkinson, Callum; Soria, Julio

    2009-10-01

    To date, Tomo-PIV has involved the use of the multiplicative algebraic reconstruction technique (MART), where the intensity of each 3D voxel is iteratively corrected to satisfy one recorded projection, or pixel intensity, at a time. This results in reconstruction times of multiple hours for each velocity field and requires considerable computer memory in order to store the associated weighting coefficients and intensity values for each point in the volume. In this paper, a rapid and less memory intensive reconstruction algorithm is presented based on a multiplicative line-of-sight (MLOS) estimation that determines possible particle locations in the volume, followed by simultaneous iterative correction. Reconstructions of simulated images are presented for two simultaneous algorithms (SART and SMART) as well as the now standard MART algorithm, which indicate that the same accuracy as MART can be achieved 5.5 times faster or 77 times faster with 15 times less memory if the processing and storage of the weighting matrix is considered. Application of MLOS-SMART and MART to a turbulent boundary layer at Re θ = 2200 using a 4 camera Tomo-PIV system with a volume of 1,000 × 1,000 × 160 voxels is discussed. Results indicate improvements in reconstruction speed of 15 times that of MART with precalculated weighting matrix, or 65 times if calculation of the weighting matrix is considered. Furthermore the memory needed to store a large weighting matrix and volume intensity is reduced by almost 40 times in this case.

  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. A Technique of Improved Medial Meniscus Visualization by Anterior Cruciate Ligament Graft Placement in Chronic Anterior Cruciate Deficient Knees.

    PubMed

    Vertullo, Christopher J; Wijenayake, Lahann; Grayson, Jane E

    2016-04-01

    It is customary to perform medial meniscus repair before anterior cruciate ligament (ACL) graft placement when undertaken as a combined procedure. However, in chronic ACL-deficient knees, intraoperative anterior tibiofemoral translation can cause the medial meniscus repair to be more technically challenging. Intraoperative anterior tibiofemoral translation can both reduce the visualization of the medial meniscus and make its reduction unstable. An operative sequence alteration of ACL graft placement and tensioning before medial meniscal repair improves medial meniscus visualization in chronically ACL-deficient knees by using the ACL graft's ability to prevent anterior tibiofemoral translation. The technique sequence is as follows: (a) the medial meniscus is reduced, (b) ACL reconstruction is undertaken using a hamstring graft without final tibia fixation, PMID:27354950

  5. Combined anterolateral ligament and anatomic anterior cruciate ligament reconstruction of the knee.

    PubMed

    Smith, James O; Yasen, Sam K; Lord, Breck; Wilson, Adrian J

    2015-11-01

    Although anatomic anterior cruciate ligament (ACL) reconstruction is established for the surgical treatment of anterolateral knee instability, there remains a significant cohort of patients who continue to experience post-operative instability. Recent advances in our understanding of the anatomic, biomechanical and radiological characteristics of the native anterolateral ligament (ALL) of the knee have led to a resurgent interest in reconstruction of this structure as part of the management of knee instability. This technical note describes our readily reproducible combined minimally invasive technique to reconstruct both the ACL and ALL anatomically using autologous semitendinosus and gracilis grafts. This method of ALL reconstruction can be easily integrated with all-inside ACL reconstruction, requiring minimal additional operative time, equipment and expertise. Level of evidence V.

  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. PMID:26258041

  7. 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.

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

    PubMed Central

    Deo, Shaneel; Getgood, Alan

    2015-01-01

    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. PMID:26258041

  9. A new simplified onlay technique for posterior cruciate ligament reconstruction.

    PubMed

    Salim, Rodrigo; Fogagnolo, Fabricio; Kfuri, Mauricio

    2014-08-01

    The integrity of posterior cruciate ligament (PCL) is essential for the normal kinematics of the knee. Injury to the PCL has adverse consequences, with worsening of functional performance and an increased risk to develop osteoarthritis. Conservative treatment is sometimes adopted, not only because it is an acceptable option for selected patients but also due to the lack of consensus in the orthopedic literature regarding the best surgical method. Hereby we describe a simplified technique for onlay PCL reconstruction pointing out possible advantages if compared with the traditional transtibial or inlay techniques.

  10. Evaluation of the spline reconstruction technique for PET

    SciTech Connect

    Kastis, George A. Kyriakopoulou, Dimitra; Gaitanis, Anastasios; Fernández, Yolanda; Hutton, Brian F.; Fokas, Athanasios S.

    2014-04-15

    Purpose: The spline reconstruction technique (SRT), based on the analytic formula for the inverse Radon transform, has been presented earlier in the literature. In this study, the authors present an improved formulation and numerical implementation of this algorithm and evaluate it in comparison to filtered backprojection (FBP). Methods: The SRT is based on the numerical evaluation of the Hilbert transform of the sinogram via an approximation in terms of “custom made” cubic splines. By restricting reconstruction only within object pixels and by utilizing certain mathematical symmetries, the authors achieve a reconstruction time comparable to that of FBP. The authors have implemented SRT in STIR and have evaluated this technique using simulated data from a clinical positron emission tomography (PET) system, as well as real data obtained from clinical and preclinical PET scanners. For the simulation studies, the authors have simulated sinograms of a point-source and three digital phantoms. Using these sinograms, the authors have created realizations of Poisson noise at five noise levels. In addition to visual comparisons of the reconstructed images, the authors have determined contrast and bias for different regions of the phantoms as a function of noise level. For the real-data studies, sinograms of an{sup 18}F-FDG injected mouse, a NEMA NU 4-2008 image quality phantom, and a Derenzo phantom have been acquired from a commercial PET system. The authors have determined: (a) coefficient of variations (COV) and contrast from the NEMA phantom, (b) contrast for the various sections of the Derenzo phantom, and (c) line profiles for the Derenzo phantom. Furthermore, the authors have acquired sinograms from a whole-body PET scan of an {sup 18}F-FDG injected cancer patient, using the GE Discovery ST PET/CT system. SRT and FBP reconstructions of the thorax have been visually evaluated. Results: The results indicate an improvement in FWHM and FWTM in both simulated and real

  11. Prosthetic Reconstruction of the Auricle: Indications, Techniques, and Results

    PubMed Central

    Giot, Jean-Philippe; Labbé, Daniel; Soubeyrand, Eric; Pacini, Régine; Guillou-Jamard, Marie-Reine; Compère, Jean-François; Bénateau, Hervé

    2011-01-01

    Extensive defects of the ear require satisfactory cosmetic reconstruction to enable the patient to achieve full social integration. Although surgical procedures are the gold standard for reconstruction of the ear, in some cases they cannot be performed because of extended scars, threatening tumor, or congenital tissue abnormalities. Prosthetic reconstruction of the auricle is an established and reliable alternative technique to autologous surgical reconstructions. Since studies performed by Brånemark, osseointegrated implants have been widely used to provide a reliable and stable anchorage for a prosthesis (prosthesis anchored to bone). To allow good osseointegration of the titanium screw implants, two stages are necessary. After careful preparation for the surgical procedure (local and general examination, computed tomography scan, skin preparation), screws are implanted into bone, which are then covered by a skin flap. During the second stage, the skin is incised, and penetrating fixtures are attached to the screw implants, which allow fixation of the prosthesis. This procedure is reliable and reproducible, with good to excellent results and stability over time. PMID:23115532

  12. Continuous analog of multiplicative algebraic reconstruction technique for computed tomography

    NASA Astrophysics Data System (ADS)

    Tateishi, Kiyoko; Yamaguchi, Yusaku; Abou Al-Ola, Omar M.; Kojima, Takeshi; Yoshinaga, Tetsuya

    2016-03-01

    We propose a hybrid dynamical system as a continuous analog to the block-iterative multiplicative algebraic reconstruction technique (BI-MART), which is a well-known iterative image reconstruction algorithm for computed tomography. The hybrid system is described by a switched nonlinear system with a piecewise smooth vector field or differential equation and, for consistent inverse problems, the convergence of non-negatively constrained solutions to a globally stable equilibrium is guaranteed by the Lyapunov theorem. Namely, we can prove theoretically that a weighted Kullback-Leibler divergence measure can be a common Lyapunov function for the switched system. We show that discretizing the differential equation by using the first-order approximation (Euler's method) based on the geometric multiplicative calculus leads to the same iterative formula of the BI-MART with the scaling parameter as a time-step of numerical discretization. The present paper is the first to reveal that a kind of iterative image reconstruction algorithm is constructed by the discretization of a continuous-time dynamical system for solving tomographic inverse problems. Iterative algorithms with not only the Euler method but also the Runge-Kutta methods of lower-orders applied for discretizing the continuous-time system can be used for image reconstruction. A numerical example showing the characteristics of the discretized iterative methods is presented.

  13. Quadriceps tendon-patellar bone autograft for anterior cruciate ligament reconstruction: a technical note.

    PubMed

    Franceschi, Francesco; Longo, Umile Giuseppe; Ruzzini, Laura; Papalia, Rocco; Maffulli, Nicola; Denaro, Vincenzo

    2008-01-01

    The quadriceps tendon autograft can be used for primary and revision anterior cruciate ligament (ACL) reconstruction. Despite several successful clinical reports, graft fixation issues remain, and the ideal technique for fixation continues to be controversial. We present a technique of ACL reconstruction with quadriceps tendon autograft (QTA) using a patellar bone block. The tendon end is fixed in the femoral tunnel and the bone plug in the tibial tunnel using reabsorbable interference screws. The advantages of this technique are related to the increase in stiffness of the graft, the achievement of a more anatomic fixation, and a reduction in synovial fluid leakage.

  14. The anatomic coracoclavicular ligament reconstruction: surgical technique and indications.

    PubMed

    Carofino, Brad C; Mazzocca, Augustus D

    2010-03-01

    The anatomic coracoclavicular ligament reconstruction (ACCR) is a surgical procedure to address acriomioclavicular joint instability. The coracoclavicular ligaments are reconstructed using a semitendinosus allograft passed beneath the coracoid and through bone tunnels in the clavicle. The graft is secured with interference screw fixation, and the acromioclavicular joint is retained. Here we describe the authors' surgical technique, indications, and rehabilitation protocol. Also, a preliminary case series of seventeen patients is presented. Patients demonstrated significant improvement in pain levels and function. The mean ASES score increased from 52 preoperatively to 92. The Constant Murley rose from 66.6 to 94.7. There were three failures in this series, and two required revision surgery. PMID:20188267

  15. 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

  16. High tibial osteotomy in the ACL-deficient knee with medial compartment osteoarthritis.

    PubMed

    Herman, Benjamin V; Giffin, J Robert

    2016-09-01

    High tibial osteotomy (HTO) has traditionally been used to treat varus gonarthrosis in younger, active patients. Varus malalignment increases the risk of progression of medial compartment osteoarthritis and an HTO can be performed to realign the mechanical axis of the lower limb towards the lateral compartment, thereby decreasing contact pressures in the medial compartment. Anterior cruciate ligament (ACL) insufficiency may lead to post-traumatic arthritis due to altered joint loading and associated injuries to the menisci and articular cartilage. Understanding the importance of posterior tibial slope and its role in sagittal knee stability has led to the development of biplane osteotomies designed to flatten the posterior tibial slope in the ACL deficient knee. Altering the alignment in both the sagittal and coronal planes helps improve stability as well as alter the load in the medial compartment. Detailed history, physical exam and radiographic analysis guide treatment decisions in this high demand patient population. Lateral closing wedge (LCW) and medial opening wedge (MOW) HTOs have been performed and their potential advantages and disadvantages have been well described. Given the triangular shape of the proximal tibia, it is imperative that the surgeon pay close attention to the geometry of the osteotomy "gap" when performing MOW HTO to avoid inadvertently increasing the posterior tibial slope. Simultaneous ACL reconstruction may require technique modifications depending on the type of HTO and ACL graft chosen. With appropriate patient selection and good surgical technique, it is reasonable to expect patients to return to activities of daily living and recreational sports without debilitating pain or instability. PMID:27358200

  17. 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

  18. Application of algebraic reconstruction techniques to geophysical problems

    NASA Astrophysics Data System (ADS)

    Peterson, J. E., Jr.

    1986-04-01

    Algebraic Reconstruction Techniques (ART), introduced in medical radiology, are extended in this study to seismic travel time data. The algorithms based on these techniques, developed initially for use with X-rays, must be modified for acoustic wave data. The convergence properties of these algorithms to an adequate solution and the reliability of this solution are also investigated. The algorithms developed are initially tested on synthetically derived travel time data. Travel time data from simplistic velocity models are used to determine the general behavior of the algorithms and to estimate the reliability of the reconstructed velocity field. More complex models simulate realistic velocity distributions. Results from these studies provide critical guidelines for the inversion of real travel time data. The study also investigates the amount of detail that may be determined by this method with realistic structures. Two high quality travel time data sets are inverted using ART. The experiments were carried out at the Retsof salt mine in New York and at the underground radioactive waste repository study site in Sweden (Stripa). The Stripa data set is unique in that it consists of two suites of travel time measurements; one taken while the medium was being heated by a simulated waste canister, and the other some months after the heat had been turned off. This tests the use of ART as a monitoring technique using seismic waves.

  19. Basket-Weave Technique for Medial Patellofemoral Ligament Reconstruction

    PubMed Central

    Kodkani, Pranjal S.

    2015-01-01

    The anatomy of the medial patellofemoral ligament (MPFL) has been well defined, with parts of its uppermost fibers having a soft-tissue insertion onto the vastus intermedius. Bone tunnels and implants on the patellar side therefore cannot replicate this anatomic construct precisely. Because of implants and tunnels, complications have been reported with bone tunnel fracture. Similarly, on the femoral side, rigid fixation with implants can result in over-constraint with compromised results. Moreover, bone tunnels cannot be used in skeletally immature cases. To overcome issues related to bone tunneling and implants, as well as to reconstruct the MPFL in a precise anatomic manner, an all–soft-tissue fixation technique was devised. Bony landmarks were used as reference points instead of radiologic markers to achieve a more precise construct and to eliminate intraoperative radiography. Hamstring graft was used to reconstruct the MPFL. Special suturing techniques were used to achieve optimal graft fixation with minimal suture knots. A special tissue elevator–suture passer device was designed to facilitate graft passage and ease in performing the procedure. This technique permits differential tensioning, and therefore one achieves stability throughout the range of motion. PMID:26258044

  20. Fast Multigrid Techniques in Total Variation-Based Image Reconstruction

    NASA Technical Reports Server (NTRS)

    Oman, Mary Ellen

    1996-01-01

    Existing multigrid techniques are used to effect an efficient method for reconstructing an image from noisy, blurred data. Total Variation minimization yields a nonlinear integro-differential equation which, when discretized using cell-centered finite differences, yields a full matrix equation. A fixed point iteration is applied with the intermediate matrix equations solved via a preconditioned conjugate gradient method which utilizes multi-level quadrature (due to Brandt and Lubrecht) to apply the integral operator and a multigrid scheme (due to Ewing and Shen) to invert the differential operator. With effective preconditioning, the method presented seems to require Omicron(n) operations. Numerical results are given for a two-dimensional example.

  1. Performance validation of phase diversity image reconstruction techniques

    NASA Astrophysics Data System (ADS)

    Hirzberger, J.; Feller, A.; Riethmüller, T. L.; Gandorfer, A.; Solanki, S. K.

    2011-05-01

    We present a performance study of a phase diversity (PD) image reconstruction algorithm based on artificial solar images obtained from MHD simulations and on seeing-free data obtained with the SuFI instrument on the Sunrise balloon borne observatory. The artificial data were altered by applying different levels of degradation with synthesised wavefront errors and noise. The PD algorithm was modified by changing the number of fitted polynomials, the shape of the pupil and the applied noise filter. The obtained reconstructions are evaluated by means of the resulting rms intensity contrast and by the conspicuousness of appearing artifacts. The results show that PD is a robust method which consistently recovers the initial unaffected image contents. The efficiency of the reconstruction is, however, strongly dependent on the number of used fitting polynomials and the noise level of the images. If the maximum number of fitted polynomials is higher than 21, artifacts have to be accepted and for noise levels higher than 10-3 the commonly used noise filtering techniques are not able to avoid amplification of spurious structures.

  2. 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.

  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. 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. PMID:27517028

  5. Anterior Cruciate Ligament (ACL) Injuries

    MedlinePlus

    ... get ACL injuries usually play contact sports (like football) or sports that feature swift, abrupt movements such ... the things you love — like running or playing football, field hockey, or softball — can be frustrating. Recovering ...

  6. Combined anterior cruciate ligament and posterolateral reconstruction of the knee using allograft tissue in chronic knee injuries.

    PubMed

    Fanelli, Gregory C; Fanelli, David G; Edson, Craig J; Fanelli, Matthew G

    2014-10-01

    Combined anterior cruciate ligament (ACL) and posterolateral injury of the knee can result in significant functional instability for the affected individual. Both components of the instability must be treated to maximize the probability of success for the surgical procedure. Higher failure rates of the ACL reconstruction have been reported when the posterolateral instability has been left untreated. The purpose of this article is to describe our surgical technique, and present the results of 34 chronic combined ACL posterolateral reconstructions in 34 knees using allograft tissue, and evaluating these patient outcomes with KT 1000 knee ligament arthrometer, Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scales. In addition, observations regarding patient demographics with combined ACL posterolateral instability, postoperative range of motion loss, postinjury degenerative joint disease, infection rate, return to function, and the use of radiated and nonirradiated allograft tissues will be presented.

  7. Combined anterior cruciate ligament and posterolateral reconstruction of the knee using allograft tissue in chronic knee injuries.

    PubMed

    Fanelli, Gregory C; Fanelli, David G; Edson, Craig J; Fanelli, Matthew G

    2014-10-01

    Combined anterior cruciate ligament (ACL) and posterolateral injury of the knee can result in significant functional instability for the affected individual. Both components of the instability must be treated to maximize the probability of success for the surgical procedure. Higher failure rates of the ACL reconstruction have been reported when the posterolateral instability has been left untreated. The purpose of this article is to describe our surgical technique, and present the results of 34 chronic combined ACL posterolateral reconstructions in 34 knees using allograft tissue, and evaluating these patient outcomes with KT 1000 knee ligament arthrometer, Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scales. In addition, observations regarding patient demographics with combined ACL posterolateral instability, postoperative range of motion loss, postinjury degenerative joint disease, infection rate, return to function, and the use of radiated and nonirradiated allograft tissues will be presented. PMID:24949986

  8. Improving gated cardiac scanning using limited-angle reconstruction technique

    SciTech Connect

    Tam, K.C.; Perez-Mendez, V.

    1983-02-01

    Selected phases of the cardiac cycle can be imaged by the method of gated cardiac scanning using whole body scanners. However, since there is no synchronization between the random heart beats and the CT machine, the output will have gaps in the angular coverage of each scan. The missing projections in these gaps result in artifacts in the reconstructed images. In this paper, the technique of limited-angle reconstruction is employed to fill in the missing projections to remove the artifacts. The object is transformed back and forth between the object space and the projection space, being corrected in each step by the constraints of the finite spatial extent and of the upper and lower bounds of the object in the object space, and the known projections in the projection space. It is found that by using the proposed algorithm the rms errors of the limited-angle images are reduced to a level comparable to those of the complete-angle images. The same iteration algorithm can also be used to reduce the fan beam scanning angle from 360 degree to 180 degree without sacrificing much image quality.

  9. Three Dimensional Iterative Reconstruction Techniques in Positron Tomography.

    NASA Astrophysics Data System (ADS)

    Sloka, Scott

    The acquisition of positron tomographic data in three dimensions is an improvement over the two dimensional acquisition of data because the greater the number of measurements taken of a stochastic process, the more accurately determined the desired parameter may be. This research pursues the goal of three dimensional image reconstruction in Positron Tomography using an iterative approach. This thesis has followed a systematic approach to the exploration of a system for three dimensional iterative reconstruction. System design parameters were discussed such as the advantages and disadvantages of iterative vs analytic methods, the implementation of two, three dimensional iterative algorithms, the selection of a ray passing method, and the choice of an analytic method for comparison to the iterative methods. Several qualitative and quantitative tests were used/developed and performed to analyse and compare the results. Three dimensional reconstruction in Positron Tomography using two iterative techniques (ART and ML-EM) was demonstrated. The ML-EM algorithm was adapted to satisfy the objective of equalizing the estimates with the measurements via division of the sampling density. A new multi-objective function methodology was developed for two dimensions and its extension to three dimensions discussed. A smoothly-varying Gaussian phantom was created for comparing artifacts from different ray passing methods. The analysis of voxel trends over many iterations was used. The use of the output from a two dimensional filtered backprojection algorithm as the seed for three dimensional algorithms to accelerate the reconstruction the was explored. The importance of the selection of a good ray ordering in ART and its effects on the total squared error were explored. For the phantoms studied in this thesis, the ML -EM algorithm tended to perform better under most conditions. This algorithm is slower than ART to achieve both a low total squared error and good contrast, but the

  10. Novel techniques and the future of skull base reconstruction.

    PubMed

    Meier, Joshua C; Bleier, Benjamin S

    2013-01-01

    The field of endoscopic skull base surgery has evolved considerably in recent years fueled largely by advances in both imaging and instrumentation. While the indications for these approaches continue to be extended, the ability to reconstruct the resultant defects has emerged as a rate-limiting obstacle. Postoperative failures with current multilayer grafting techniques remain significant and may increase as the indications for endoscopic resections continue to expand. Laser tissue welding represents a novel method of wound repair in which laser energy is applied to a chromophore doped biologic solder at the wound edge to create a laser weld (fig. 1). These repairs are capable of withstanding forces far exceeding those exerted by intracranial pressure with negligible collateral thermal tissue injury. Recent clinical trials have demonstrated the safety and feasibility of endoscopic laser welding while exposing the limitations of first generation hyaluronic acid based solders. Novel supersaturated gel based solders are currently being tested in clinical trials and appear to possess significantly improved viscoelastic properties. While laser tissue welding remains an experimental technique, continued success with these novel solder formulations may catalyze the widespread adoption of this technique for skull base repair in the near future.

  11. Biomechanical Analysis of a Novel Acetabulum Reconstruction Technique with Acetabulum Reconstruction Cage and Threaded Rods after Type II Pelvic Resections

    PubMed Central

    Singh, Vivek Ajit; Elbahri, Hassan; Shanmugam, Rukmanikanthan

    2016-01-01

    Background. Periacetabular resections with reconstruction has high rates of complications due to the complexity of the reconstruction. We have improvised a novel technique of reconstruction for type II and type II + III pelvic resections with the use of a commercially available acetabulum reconstruction cage (gap II, Stryker) and threaded rods. Objectives. The aim of our study is to determine the biomechanical strength of our reconstruction compared to the traditional cemented total hip replacement (THR) designs in normal acetabulum and establish its mode of failure. Methods. Five sets of hemipelvises were biomechanically tested (Instron® 3848, MA, USA). These constructs were subjected to cyclic loading and load to failure. Results. The reconstructed acetabulum was stiffer and required a higher load to failure compared to the intact pelvis with a standard THR. The mean stiffness of the reconstructed pelvis was 1738.6 ± 200.3 Nmm−1 compared to the intact pelvis, which was 911.4 ± 172.7 Nmm−1 (P value = 0.01). The mean load to failure for the standard acetabular cup construct was 3297.3 ± 117.7 N while that of the reconstructed pelvis with the acetabulum cage and threaded rods was 4863.8 ± 7.0 N. Conclusion. Reconstruction of the pelvis with an acetabular reconstruction cage and threaded rods is a biomechanical viable option. PMID:27340368

  12. Biomechanical Analysis of a Novel Acetabulum Reconstruction Technique with Acetabulum Reconstruction Cage and Threaded Rods after Type II Pelvic Resections.

    PubMed

    Singh, Vivek Ajit; Elbahri, Hassan; Shanmugam, Rukmanikanthan

    2016-01-01

    Background. Periacetabular resections with reconstruction has high rates of complications due to the complexity of the reconstruction. We have improvised a novel technique of reconstruction for type II and type II + III pelvic resections with the use of a commercially available acetabulum reconstruction cage (gap II, Stryker) and threaded rods. Objectives. The aim of our study is to determine the biomechanical strength of our reconstruction compared to the traditional cemented total hip replacement (THR) designs in normal acetabulum and establish its mode of failure. Methods. Five sets of hemipelvises were biomechanically tested (Instron® 3848, MA, USA). These constructs were subjected to cyclic loading and load to failure. Results. The reconstructed acetabulum was stiffer and required a higher load to failure compared to the intact pelvis with a standard THR. The mean stiffness of the reconstructed pelvis was 1738.6 ± 200.3 Nmm(-1) compared to the intact pelvis, which was 911.4 ± 172.7 Nmm(-1) (P value = 0.01). The mean load to failure for the standard acetabular cup construct was 3297.3 ± 117.7 N while that of the reconstructed pelvis with the acetabulum cage and threaded rods was 4863.8 ± 7.0 N. Conclusion. Reconstruction of the pelvis with an acetabular reconstruction cage and threaded rods is a biomechanical viable option.

  13. 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

  14. Arthroscopic anterior cruciate ligament reconstruction with the tibial-remnant preserving technique using a hamstring graft.

    PubMed

    Lee, Byung-Ill; Min, Kyung-Dae; Choi, Hyung-Suk; Kim, Jun-Bum; Kim, Seong-Tae

    2006-03-01

    We propose that the tibial remnant of the anterior cruciate ligament (ACL) is able to enhance the revascularization and cellular proliferation of the graft, to preserve proprioceptive function, and to be able to acquire anatomic placement of the graft without roof impingement. Therefore, it seems reasonable to assume that preserving the tibial remnant as much as possible as a source of reinnervation, if technically possible without causing impingement, would be of potential benefit to the patient. Our surgical technique was developed to maximize the preservation of the tibial remnant. The distally attached semitendinosus and gracilis tendons are harvested using the tendon stripper. After satisfactory placement of 2 guide pins convergently, a closed-end socket in the lateral femoral condyle is created using an adequately sized curved curette. For anatomic placement of the graft, the tibial tunnel should be positioned within the boundaries of the normal ACL tibial remnant. The reamer must be advanced very carefully to minimize injury to the residual remnant at the intra-articular margin of the tibial tunnel. Penetration should stop at the base of the stump. The folded grafts are then pulled intra-articularly through the tibial tunnel, the tibial remnant, and the femoral socket by pulling sutures under arthroscopic visualization. The ACL tibial remnant is compacted by the tendon passage. The graft is secured proximally by tying sutures in the lateral femoral condyle and distally at the tibia with double staples by a belt-buckle method. The advantages of our technique include maximal preservation of the tibial remnant, no roof impingement caused by intrasynovial anatomic placement of the graft, the simplicity of the procedure, the minimal need for hardware or special instruments, the economic benefit, and the potential prevention of tibial tunnel enlargement by preventing synovial fluid leakage. PMID:16517320

  15. Anterolateral Ligament of the Knee: Back to the Future in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Bonasia, Davide Edoardo; D’Amelio, Andrea; Pellegrino, Pietro; Rosso, Federica; Rossi, Roberto

    2015-01-01

    Although the importance of the anterolateral stabilizing structures of the knee in the setting of anterior cruciate ligament (ACL) injuries has been recognized since many years, most of orthopedic surgeons do not take into consideration the anterolateral structures when performing an ACL reconstruction. Anatomic single or double bundle ACL reconstruction will improve knee stability, but a small subset of patients may experience some residual anteroposterior and rotational instability. For this reason, some researchers have turned again towards the anterolateral aspect of the knee and specifically the anterolateral ligament. The goal of this review is to summarize the existing knowledge regarding the anterolateral ligament of the knee, including anatomy, histology, biomechanics and imaging. In addition, the most common anterolateral reconstruction/tenodesis techniques are described together with their respective clinical outcomes. PMID:26330991

  16. All-arthroscopic iliotibial band autograft harvesting and labral reconstruction technique.

    PubMed

    Deshmane, Prashant P; Kahlenberg, Cynthia A; Patel, Ronak M; Han, Brian; Terry, Michael A

    2013-02-01

    The labrum is essential for stability, movement, and prevention of arthritis in the hip. In cases of labral damage where repair of a labral tear is not possible, reconstruction can be a useful alternative. Several different autografts have been used, including the iliotibial band (ITB), the ligamentum teres capitis, and the gracilis tendon. Authors have reported both open and arthroscopic techniques for reconstruction with good preliminary results. However, an all-arthroscopic labral reconstruction technique including the graft harvest and reconstruction portions of a labral reconstruction procedure using an ITB autograft has not been previously described. We describe a technique for an all-arthroscopic labral reconstruction performed using a novel method for arthroscopic harvest of the ITB. The decreased invasiveness of our described technique for labral reconstruction may potentially minimize scarring, bodily disfigurement, infection, and postoperative pain associated with the graft harvesting incision.

  17. A Novel Nipple Reconstruction Technique for Maintaining Nipple Projection: The Boomerang Flap

    PubMed Central

    Kim, Young-Eun; Hong, Ki Yong; Minn, Kyung Won

    2016-01-01

    Nipple-areolar complex (NAC) reconstruction is the final step in the long journey of breast reconstruction for mastectomy patients. Successful NAC reconstruction depends on the use of appropriate surgical techniques that are simple and reliable. To date, numerous techniques have been used for nipple reconstruction, including contralateral nipple sharing and various local flaps. Recently, it has been common to utilize local flaps. However, the most common nipple reconstruction problem encountered with local flaps is the loss of nipple projection; there can be approximately 50% projection loss in reconstructed nipples over long-term follow-up. Several factors might contribute to nipple projection loss, and we tried to overcome these factors by performing nipple reconstructions using a boomerang flap technique, which is a modified C–V flap that utilizes the previous mastectomy scar to maintain long-term nipple projection. PMID:27689057

  18. A Novel Nipple Reconstruction Technique for Maintaining Nipple Projection: The Boomerang Flap.

    PubMed

    Kim, Young-Eun; Hong, Ki Yong; Minn, Kyung Won; Jin, Ung Sik

    2016-09-01

    Nipple-areolar complex (NAC) reconstruction is the final step in the long journey of breast reconstruction for mastectomy patients. Successful NAC reconstruction depends on the use of appropriate surgical techniques that are simple and reliable. To date, numerous techniques have been used for nipple reconstruction, including contralateral nipple sharing and various local flaps. Recently, it has been common to utilize local flaps. However, the most common nipple reconstruction problem encountered with local flaps is the loss of nipple projection; there can be approximately 50% projection loss in reconstructed nipples over long-term follow-up. Several factors might contribute to nipple projection loss, and we tried to overcome these factors by performing nipple reconstructions using a boomerang flap technique, which is a modified C-V flap that utilizes the previous mastectomy scar to maintain long-term nipple projection. PMID:27689057

  19. A Novel Nipple Reconstruction Technique for Maintaining Nipple Projection: The Boomerang Flap

    PubMed Central

    Kim, Young-Eun; Hong, Ki Yong; Minn, Kyung Won

    2016-01-01

    Nipple-areolar complex (NAC) reconstruction is the final step in the long journey of breast reconstruction for mastectomy patients. Successful NAC reconstruction depends on the use of appropriate surgical techniques that are simple and reliable. To date, numerous techniques have been used for nipple reconstruction, including contralateral nipple sharing and various local flaps. Recently, it has been common to utilize local flaps. However, the most common nipple reconstruction problem encountered with local flaps is the loss of nipple projection; there can be approximately 50% projection loss in reconstructed nipples over long-term follow-up. Several factors might contribute to nipple projection loss, and we tried to overcome these factors by performing nipple reconstructions using a boomerang flap technique, which is a modified C–V flap that utilizes the previous mastectomy scar to maintain long-term nipple projection.

  20. 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

    2013-03-01

    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. PMID:23467876

  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. Compression of the Popliteal Artery after Posterior Cruciate Ligament Reconstruction Using the Tibial Inlay Technique

    PubMed Central

    Seo, Seung Suk; Kim, Do Hun; Park, Byung Yoon

    2015-01-01

    Popliteal artery compression rarely occurs after posterior cruciate ligament (PCL) reconstruction using the tibial inlay technique that allows for direct visualization of the surgical field. However, we experienced a popliteal artery compression after PCL reconstruction performed using the technique, which eventually required re-operation. Here, we report this rare case and discuss reasons of popliteal artery compression. PMID:26673356

  3. A modified surgical technique for reconstruction of an acute acromioclavicular joint dislocation

    PubMed Central

    Marchie, Anthony; Kumar, Arun; Catre, Melanio

    2009-01-01

    We report a modified surgical technique for reconstruction of coracoclavicular and acromioclavicular ligaments after acute dislocation of acromioclavicular joint using suture anchors. We have repaired 3 consecutive type III acromioclavicular dislocations with good results. This technique is simple and safe and allows anatomical reconstruction of the ligaments in acute dislocations. PMID:20671868

  4. Sex, Age, and Graft Size as Predictors of ACL Re-tear

    PubMed Central

    Nguyen, Duong

    2016-01-01

    Objectives: The minimum size required for a successful quadrupled hamstring autograft ACL reconstruction remains controversial. The risks of ACL re-tear in younger patients who tend to participate in a higher level of sports activity, and female athletes who have numerous predisposing factors, are poorly defined. Purpose: To identify risk factors for graft re-tears within 2 years of ACL surgery. The hypotheses are that female sex, a smaller size graft, and younger patients will increase the odds of failure. Study Design Cohort Study. Level of evidence, 3. Methods: A cohort of 503 athletes undergoing primary, autograft hamstring ACL reconstruction, performed by a single surgeon using the same surgical technique and rehabilitation protocol, between September-December 2012, was followed for a total duration of 2 years. Return to play was allowed between 6 and 12 months post-surgery upon completion of functional testing. Exclusion criteria included infections, revisions, double bundle techniques, multi-ligament injuries, non-compliance, BTB/allografts/hybrid grafts. Primary outcome consisted of binary data (ACL graft re-tear or no tear) as measured on physical exam (Lachman and pivot shift) and MRI. Multivariate logistic regression statistical analysis with model fitting was used to investigate the predictive value of sex, age, and graft size on ACL re-tear. Secondary sensitivity analyses were performed on the adolescent subgroup, age and graft size as categorical variables, and testing for interactions among variables. Sample size was calculated based on the rule of 10 events per independent variable for logistic regression. Results: The mean age of the 503 athletes was 27.5 (SD 10.6; range = 12-61). There were 235 females (47%) and 268 males (53%) with a 6% rate of re-tears (28 patients; 17 females). Mean graft size was 7.9 (SD 0.6; range = 6-10). Univariate analyses of graft size, sex, and age only in the model showed that younger age (odds ratio [OR] = 0.86; 95

  5. Double bundle posterior cruciate ligament reconstruction: surgical technique and results.

    PubMed

    Fanelli, Gregory C; Beck, John D; Edson, Craig J

    2010-12-01

    The keys to successful posterior cruciate ligament reconstruction are to identify and treat all pathology, use strong graft material, accurately place tunnels in anatomic insertion sites, minimize graft bending, use a mechanical graft tensioning device, use primary and back-up graft fixation, and use the appropriate postoperative rehabilitation program. Adherence to these technical principles results in successful single and double-bundle arthroscopic transtibial tunnel posterior cruciate ligament reconstruction based upon stress radiography, arthrometer, knee ligament rating scales, and patient satisfaction measurements.

  6. Does the posterolateral bundle influence rotational movement more than the anteromedial bundle in anterior cruciate ligament reconstruction?: a clinical study.

    PubMed

    Komzák, M; Hart, R; Okál, F; Safi, A

    2012-10-01

    The biomechanical function of the anteromedial (AM) and posterolateral (PL) bundles of the anterior cruciate ligament (ACL) remains controversial. Some studies report that the AM bundle stabilises the knee joint in anteroposterior (AP) translation and rotational movement (both internal and external) to the same extent as the PL bundle. Others conclude that the PL bundle is more important than the AM in controlling rotational movement. The objective of this randomised cohort study involving 60 patients (39 men and 21 women) with a mean age of 32.9 years (18 to 53) was to evaluate the function of the AM and the PL bundles of the ACL in both AP and rotational movements of the knee joint after single-bundle and double-bundle ACL reconstruction using a computer navigation system. In the double-bundle group the patients were also randomised to have the AM or the PL bundle tensioned first, with knee laxity measured after each stage of reconstruction. All patients had isolated complete ACL tears, and the presence of a meniscal injury was the only supplementary pathology permitted for inclusion in the trial. The KT-1000 arthrometer was used to apply a constant load to evaluate the AP translation and the rolimeter was used to apply a constant rotational force. For the single-bundle group deviation was measured before and after ACL reconstruction. In the double-bundle group deviation was measured for the ACL-deficient, AM- or PL-reconstructed first conditions and for the total reconstruction. We found that the AM bundle in the double-bundle group controlled rotation as much as the single-bundle technique, and to a greater extent than the PL bundle in the double-bundle technique. The double-bundle technique increases AP translation and rotational stability in internal rotation more than the single-bundle technique.

  7. Hybrid single-beam reconstruction technique for slow and fast varying wave fields.

    PubMed

    Falaggis, Konstantinos; Kozacki, Tomasz; Kujawinska, Malgorzata

    2015-06-01

    An iterative single-beam wave field reconstruction technique that employs both non-paraxial, wave propagation based and paraxial deterministic phase retrieval techniques is presented. This approach overcomes two major obstacles that exist in the current state of the art techniques: iterative methods do not reconstruct slowly varying wave fields due to slow convergence and stagnation, and deterministic methods have paraxial limits, making the reconstructions of quickly varying object features impossible. In this work, a hybrid approach is reported that uses paraxial wave field corrections within iterative phase retrieval solvers. This technique is suitable for cases ranging from slow to fast varying wave fields, and unlike the currently available methods, can also reconstruct measurement objects with different regions of both slowly and quickly varying object features. It is further shown that this technique gives a higher accuracy than current single-beam phase retrieval techniques, and in comparison to the iterative methods, has a higher convergence speed.

  8. Relationship between quadriceps femoris muscle volume and muscle torque at least 18 months after anterior cruciate ligament reconstruction.

    PubMed

    Konishi, Y; Oda, T; Tsukazaki, S; Kinugasa, R; Fukubayashi, T

    2012-12-01

    The purpose of this study was to evaluate motor unit recruitment in the quadriceps femoris (QF) after anterior cruciate ligament (ACL) rupture and repair. Subjects included 24 patients at ≥ 18 months after ACL reconstruction and 22 control subjects with no history of knee injury. A series of cross-sectional magnetic resonance images were obtained to compare the QF of patients' injured side with that of their uninjured sides and that of uninjured control subjects. Muscle torque per muscle volume was calculated as isokinetic peak torque divided by QF muscle volume (cm(3)). The mean muscle torque per unit volume of the injured side of patients was not significantly different from that of the uninjured side or control subjects (one-way ANOVA) Results of the present study were contrary to the results of a previous study that evaluated patients at ≤ 12 months after ACL reconstruction. The present study found that high-threshold motor unit recruitment was restored at ≥ 18 months after ACL reconstruction. Thus, clinicians must develop techniques that increase the recruitment of high-threshold motor units in the QF from the period immediately after the injury until approximately 18 months after ACL reconstruction.

  9. Regularized versus non-regularized statistical reconstruction techniques

    NASA Astrophysics Data System (ADS)

    Denisova, N. V.

    2011-08-01

    An important feature of positron emission tomography (PET) and single photon emission computer tomography (SPECT) is the stochastic property of real clinical data. Statistical algorithms such as ordered subset-expectation maximization (OSEM) and maximum a posteriori (MAP) are a direct consequence of the stochastic nature of the data. The principal difference between these two algorithms is that OSEM is a non-regularized approach, while the MAP is a regularized algorithm. From the theoretical point of view, reconstruction problems belong to the class of ill-posed problems and should be considered using regularization. Regularization introduces an additional unknown regularization parameter into the reconstruction procedure as compared with non-regularized algorithms. However, a comparison of non-regularized OSEM and regularized MAP algorithms with fixed regularization parameters has shown very minor difference between reconstructions. This problem is analyzed in the present paper. To improve the reconstruction quality, a method of local regularization is proposed based on the spatially adaptive regularization parameter. The MAP algorithm with local regularization was tested in reconstruction of the Hoffman brain phantom.

  10. Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Autograft With Preserved Insertions.

    PubMed

    Gupta, Ravi; Bahadur, Raj; Malhotra, Anubhav; Masih, Gladson David; Gupta, Parmanand

    2016-04-01

    We present a technique for anterior cruciate ligament (ACL) reconstruction using hamstring tendon autograft with preserved tibial insertions. The tendons, harvested with an open-ended tendon stripper while their tibial insertions are preserved, are looped around to prepare a quadrupled graft. The femoral tunnel is drilled independently through a transportal technique, whereas the tibial tunnel is drilled in a standard manner. The length of the quadrupled graft and loop of the RetroButton is adjusted so that it matches the calculated length of both tunnels and the intra-articular part of the proposed ACL graft. After the RetroButton is flipped, the graft is manually tensioned with maximal stretch on the free end, which is then sutured to the other end with preserved insertions. We propose that preserving the insertions is more biological and may provide better proprioception. The technique eliminates the need for a tibial-side fixation device, thus reducing the cost of surgery. Furthermore, tibial-side fixation of the free graft is the weakest link in the overall stiffness of the reconstructed ACL, and this technique circumvents this problem. Postoperative mechanical stability and functional outcome with this technique need to be explored and compared with those of ACL reconstruction using free hamstring autograft. PMID:27354946

  11. Baseline Predictors of Health-Related Quality of Life After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Dunn, Warren R.; Wolf, Brian R.; Harrell, Frank E.; Reinke, Emily K.; Huston, Laura J.; Spindler, Kurt P.; Nwosu, Samuel K.; Kaeding, Christopher C.; Parker, Richard D.; Wright, Rick W.; Andrish, Jack T.; McCarty, Eric C.; Amendola, Annunziato; Marx, Robert G.; Wolcott, Michelle L.; Liu, Zhouwen; Alvarez, JoAnn M.

    2015-01-01

    Background: Limited information exists regarding predictors of general quality of life following anterior cruciate ligament (ACL) reconstruction with up to six-year follow-up. We hypothesized that certain variables evaluated at the time of ACL reconstruction will predict the general quality of life as measured by the Short Form-36 (SF-36). Methods: All unilateral ACL reconstructions from 2002 to 2004 in patients currently enrolled in a prospective multicenter cohort were evaluated. Patients preoperatively completed the SF-36 validated outcome instrument. Surgeons documented intra-articular pathological conditions and treatment, as well as the ACL reconstruction surgical technique. At baseline and at a minimum of two and six years postoperatively, patients completed the SF-36. Longitudinal analysis was performed for the two-year and six-year end points. Results: Of the initial 1512 subjects, at least one follow-up questionnaire was obtained from 1411 subjects (93%). The cohort was 44% female, and the median patient age at enrollment was twenty-three years. The mean scores were 41.9 points for the Physical Component Summary (PCS) and 51.7 points for the Mental Component Summary (MCS) at baseline, 53.6 points for the PCS and 52.0 points for the MCS at two years, and 54.0 points for the PCS and 52.4 points for the MCS at six years. Significant predictors of a higher PCS score were a higher baseline PCS score, younger age, lower baseline body mass index, having >50% of the lateral meniscus excised, or having no treatment done on a lateral meniscal tear. In contrast, significant predictors of a lower PCS score were a shorter follow-up time since surgery, revision ACL reconstruction, smoking at baseline, fewer years of education, and chondromalacia of the lateral tibial plateau. The mean utility gained at six years after ACL reconstruction was 5.3 quality-adjusted life years (QALYs). Conclusions: Large improvements in the PCS (with an effect size of 1.2) were noted at two

  12. Arthroscopic Technique for Acetabular Labral Reconstruction Using Iliotibial Band Autograft.

    PubMed

    Chahla, Jorge; Soares, Eduardo; Bhatia, Sanjeev; Mitchell, Justin J; Philippon, Marc J

    2016-06-01

    The dynamic function of the acetabular labrum makes it an important structure for both hip stability and motion. Because of this, injuries to the labrum can cause significant dysfunction, leading to altered hip kinematics. Labral repair is the gold standard for symptomatic labral tears to keep as much labral tissue as possible; however, in cases where the labrum has been injured to such a degree that it is either deficient or repair is not possible, arthroscopic labral reconstruction is preferred. This article describes our preferred approach for reconstruction of the acetabular labrum using iliotibial band autograft.

  13. Arthroscopic Technique for Acetabular Labral Reconstruction Using Iliotibial Band Autograft.

    PubMed

    Chahla, Jorge; Soares, Eduardo; Bhatia, Sanjeev; Mitchell, Justin J; Philippon, Marc J

    2016-06-01

    The dynamic function of the acetabular labrum makes it an important structure for both hip stability and motion. Because of this, injuries to the labrum can cause significant dysfunction, leading to altered hip kinematics. Labral repair is the gold standard for symptomatic labral tears to keep as much labral tissue as possible; however, in cases where the labrum has been injured to such a degree that it is either deficient or repair is not possible, arthroscopic labral reconstruction is preferred. This article describes our preferred approach for reconstruction of the acetabular labrum using iliotibial band autograft. PMID:27656395

  14. The female ACL: why is it more prone to injury?

    PubMed

    Ireland, Mary Lloyd

    2002-10-01

    Multiple factors are responsible for ACL tears. The key factor in the gender discrepancy appears to be dynamic, not static, and proximal, not distal. The factors involved in evaluating the female ACL are multiple. However, it is the dynamic movement patterns ot hip and knee position with increased flexion and a coordinated proximal muscle firing pattern to keep the body in a safe landing position that are the most critical factors. An ACL injury at an early age is a life-changing event. We can very successfully reconstruct and rehabilitate an ACL, but we cannot stop there. We must now go into the prevention arena. In the United States there is tremendous variation in the exposure and acquisition of skills of physical activities in our youth. Today, children are often playing inside, using computers and watching television-missing out on the opportunity to learn safe movement patterns. Therefore, physical movement classes should occur very early in life, teaching children to land safely and in control, similar to the cry of "get down, stay down" routinely heard during youth soccer. Similarly, specific strength training programs can address landing as well as foot movements during cutting in basketball. Coaches should issue stern warnings when athletes demonstrate a high-risk movement patterns such as one-leg landings, out-of-control baseline landings, or straight-leg landings. The warnings may serve to keep the athlete from "touching the hot stove again" for fear of getting burned. No athlete feels she will be the one to get injured. Therefore, prospective analysis is likely to be received more warmly by the athletes if the program is presented with an emphasis on performance improvement rather than injury prevention. With increased participation in these programs, multiple-center analysis will have the power necessary to determine which factors significantly predispose athletes to ACL injury. The future for injury prevention is bright. We must rise to the challenge.

  15. Arthroscopic anterior cruciate ligament reconstruction with quadriceps tendon autograft: clinical outcome in 4-7 years.

    PubMed

    Chen, Chih-Hwa; Chuang, Tai-Yuan; Wang, Kun-Chuang; Chen, Wen-Jer; Shih, Chun-Hsiung

    2006-11-01

    Surgical reconstruction of the anterior cruciate ligament (ACL) is indicated in the ACL-deficient knee with symptomatic instability and multiple ligaments injuries. In the present study, we describe the clinical results of quadriceps tendon-patellar bone autograft for ACL reconstruction. From 1996 to 1998, the graft has been used in 38 patients. Thirty-four patients with complete final follow-up for 4-7 years were analyzed. The average follow-up time was 62 (48-84) months. Thirty-two patients (94%) achieved good or excellent results by Lysholm knee rating. Twenty-six patients (76%) could return to moderate or strenuous activity after reconstruction. Twenty-eight patients (82%) had ligament laxity of less than 2 mm. Finally; 31 patients (91%) were assessed as normal or nearly normal rating by IKDC guideline. Twenty-five patients (73%) had less than 10 mm difference in thigh girth between their reconstructed and normal limbs. Thirty-two (94%) and 31 (91%) patients could achieve recovery of the extensor and flexor muscle strength in the reconstructed knee to 80% or more of normal knee strength, respectively. A statistically significant difference exists in thigh girth difference, extensor strength ratio, and flexor strength ratio before and after reconstruction. Tunnel expansion with more than 1 mm was identified in 2 (6%) tibial tunnels. Our study revealed satisfactory clinical subjective and objective results at 4-7 years follow-up. Quadriceps tendon autograft has the advantage of being self-available, relatively easier arthroscopic technique, and having a suitable size, making it an acceptable graft choice for ACL reconstruction. There is little quadriceps muscle strength loss after quadriceps harvest. A quadriceps tendon-patellar autograft is an adequate graft choice to ACL reconstruction.

  16. All-Arthroscopic Technique for Reconstruction of Acute Acromioclavicular Joint Dislocations

    PubMed Central

    Cutbush, Kenneth; Hirpara, Kieran M.

    2015-01-01

    Acromioclavicular joint dislocations are a common injury particularly among contact sports players. There has been an increasing trend toward arthroscopic management of these injuries. To date, these reconstructions have primarily addressed superoinferior instability by reconstructing the coracoclavicular ligaments. We describe an all-arthroscopic technique for reconstruction of the coracoclavicular ligaments using Arthrex ABS TightRopes (Arthrex, Naples, FL), with additional stabilization of the superior acromioclavicular joint capsule using an anchor-based suture bridge to address anteroposterior instability. PMID:26697307

  17. Anterior cruciate ligament reconstruction and rehabilitation: predictors of functional outcome

    PubMed Central

    DELLA VILLA, FRANCESCO; RICCI, MARGHERITA; PERDISA, FRANCESCO; FILARDO, GIUSEPPE; GAMBERINI, JACOPO; CAMINATI, DANIELE; DELLA VILLA, STEFANO

    2015-01-01

    Surgical reconstruction of an injured anterior cruciate ligament (ACL) leads to full recovery of function and sports activity in a high percentage of cases. The aim of the present study was to analyze variables related to the patient, the surgical technique and the post-surgical rehabilitation methods, seeking to identify predictors of outcome and recovery time after ACL reconstruction. One hundred and four patients (81 M, 23 F) undergoing a step-based rehabilitation protocol after ACL reconstruction were evaluated. 43.2% of them had an isolated ACL lesion, whereas 56.8% had one or more concurrent injuries. Data relating to personal characteristics, surgery and post-operative management were collected and analyzed for correlation. Clinical outcome was evaluated with IKDC subjective score and the Tegner score, and the time to reach full recovery was noted as well. Young patients with a higher pre-injury Tegner activity level or who practice sport at professional level, no concurrent capsular lesions and no postoperative knee bracing had better clinical results and took shorter time to recover. Also, a higher percentage of on-the-field rehabilitation sessions, and absence of significant muscle strength deficits at the first knee isokinetic test emerged as rehabilitation-related factors leading to a better post-surgical outcome. Personal, surgical and rehabilitation factors should be considered in order to optimize patient management and maximize the expected results. Further studies are needed to find the strongest factors in different patients. Level of evidence Level IV, retrospective study. PMID:26904523

  18. Medial Patellofemoral Ligament Reconstruction Using a Femoral Loop Button Fixation Technique

    PubMed Central

    Godin, Jonathan A.; Karas, Vasili; Visgauss, Julia D.; Garrett, William E.

    2015-01-01

    Medial patellofemoral ligament (MPFL) reconstruction is a common procedure used to treat both acute and chronic patellar instability. Although many variations of MPFL reconstruction have been described, there is no consensus regarding the optimal surgical technique. We describe a technique for MPFL reconstruction with a looped gracilis tendon autograft using suture anchors to secure the graft to the patella and a suspensory loop button system for fixation to the femur. This technique replicates the native shape of the MPFL while minimizing the risk of patellar fracture and allowing for gradual tensioning of the graft. PMID:26900561

  19. Comparison of Surgical Techniques for Ulnar Collateral Ligament Reconstruction in Overhead Athletes.

    PubMed

    Chang, Edward S; Dodson, Christopher C; Ciccotti, Michael G

    2016-03-01

    Several surgical techniques and modifications for ulnar collateral ligament (UCL) reconstruction have been proposed since this procedure was first performed in 1974. The goal of these techniques has been restoration of stability to the medial elbow with minimal alteration to the surrounding anatomy. Outcome studies and systematic reviews on modified techniques for UCL reconstruction have shown a trend toward increased return to play in patients, particularly overhead athletes. Abandonment of flexor pronator mass detachment in favor of a muscle-splitting or muscle-elevating approach, minimal handling of the ulnar nerve, and the docking technique may result in improved outcomes and decreased complications without diminished performance. Several biomechanical studies have compared the structural properties of these techniques with those of the native UCL. However, a clear, concise surgical algorithm for UCL reconstruction is lacking. Additional studies that use sport-specific outcome measures and performance metrics may better demonstrate the true return to preinjury performance after UCL reconstruction in overhead athletes.

  20. Joint infection unique to hamstring tendon harvester used during anterior cruciate ligament reconstruction surgery.

    PubMed

    Tuman, Jeffrey; Diduch, David R; Baumfeld, Joshua A; Rubino, L Joseph; Hart, Joseph M

    2008-05-01

    Joint infection after anterior cruciate ligament (ACL) reconstruction is a rare but important clinical issue that must be resolved quickly to prevent secondary joint damage and preserve the graft. After careful analysis, we observed 3 infection cases within a 12-month period after ACL reconstruction, which represented an abnormally elevated risk. All reconstructions were performed by the same surgeon and used hamstring tendon allograft. For each surgery, the Target Tendon Harvester (DePuy Mitek, Raynham, MA) was used to harvest hamstring tendons. Through our review, we learned that this instrument was sterilized while assembled. It is our belief that ineffective sterilization of this hamstring graft harvester served as the origin for these infections. We have determined that appropriate sterilization technique involves disassembly of this particular hamstring tendon harvester before sterilization because of the tube-within-a-tube configuration. We have since continued to use the Target Tendon Harvester, disassembling it before sterilization. There have been no infections in the ensuing 12 months during which the surgeon performed over 40 primary ACL reconstructions via hamstring autograft. The information from this report is intended to provide arthroscopists with information about potential sources of infection after ACL reconstruction surgery. PMID:18442698

  1. Joint infection unique to hamstring tendon harvester used during anterior cruciate ligament reconstruction surgery.

    PubMed

    Tuman, Jeffrey; Diduch, David R; Baumfeld, Joshua A; Rubino, L Joseph; Hart, Joseph M

    2008-05-01

    Joint infection after anterior cruciate ligament (ACL) reconstruction is a rare but important clinical issue that must be resolved quickly to prevent secondary joint damage and preserve the graft. After careful analysis, we observed 3 infection cases within a 12-month period after ACL reconstruction, which represented an abnormally elevated risk. All reconstructions were performed by the same surgeon and used hamstring tendon allograft. For each surgery, the Target Tendon Harvester (DePuy Mitek, Raynham, MA) was used to harvest hamstring tendons. Through our review, we learned that this instrument was sterilized while assembled. It is our belief that ineffective sterilization of this hamstring graft harvester served as the origin for these infections. We have determined that appropriate sterilization technique involves disassembly of this particular hamstring tendon harvester before sterilization because of the tube-within-a-tube configuration. We have since continued to use the Target Tendon Harvester, disassembling it before sterilization. There have been no infections in the ensuing 12 months during which the surgeon performed over 40 primary ACL reconstructions via hamstring autograft. The information from this report is intended to provide arthroscopists with information about potential sources of infection after ACL reconstruction surgery.

  2. Vasculobiliary complications following adult right lobe split liver transplantation from the perspective of reconstruction techniques.

    PubMed

    Mabrouk Mourad, Moustafa; Liossis, Christos; Kumar, Senthil; Gunson, Bridget K; Mergental, Hynek; Isaac, John; Bramhall, Simon R; Muiesan, Paolo; Mirza, Darius F; Thamara P R Perera, M

    2015-01-01

    Split liver transplantation (SLT) compensates for the organ shortage and provides an alternative solution for recipients disadvantaged by a smaller body size. Variations in the hepatic arterial anatomy and reconstructive techniques may lead to more technical complications, and we sought to analyze the incidence and risk factors of vasculobiliary complications with respect to reconstructive techniques. We identified 171 adult right lobe SLT procedures and 1412 whole liver transplantation (WLT) procedures between January 2000 and June 2012 and compared the results of these 2 groups. In the SLT group, arterial reconstruction techniques were classified into 4 subgroups (I-IV), and biliary reconstruction was classified into 2 groups [duct-to-duct (DD) anastomosis and Roux-en-Y hepaticojejunostomy (RH)]. Specific surgical complications were analyzed against reconstruction techniques. The overall incidence of vascular and biliary complications in the SLT group was greater than that in the WLT group (P = 0.009 and P = 0.001, respectively). There was no difference in hepatic artery thrombosis (HAT), but we saw a tendency toward early HAT in the presence of multiple hepatic arteries supplying the right lobe graft (group IV; 20%) in comparison with the other arterial reconstruction groups (P = 0.052). No difference was noticed in the overall incidence of biliary complications in either DD or RH recipients across 4 arterial reconstruction groups. When the arterial reconstruction involved a right hepatic artery (groups II and III) combined with a DD biliary anastomosis, there was a significant preponderance of biliary complications (P = 0.04 and P = 0.01, respectively). There was no survival difference between SLT and WLT grafts. In conclusion, the complications of SLT are directly related to arterial and biliary reconstruction techniques, and this classification helps to identify high-risk reconstructive techniques. PMID:25302412

  3. 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

  4. 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.

  5. ACL-Injured Subjects Have Smaller ACLs Than Matched Controls: An MRI Study

    PubMed Central

    Chaudhari, Ajit M.W.; Zelman, Eric A.; Flanigan, David C.; Kaeding, Christopher C.; Nagaraja, Haikady N.

    2013-01-01

    Background Very few studies examining the predisposing anatomical factors leading to anterior cruciate ligament (ACL) injuries have examined the ACL itself, and none of these directly examined the difference in ACL properties between injured and matched control subjects. Hypothesis ACL total volume of people who have experienced a non-contact ACL injury is smaller than that of matched controls. Methods Contours of the ACL were manually identified in sagittal MR images and volumes were calculated for 27 contralateral, healthy knees of individuals after non-contact ACL injury and for 27 control subjects matched for gender, height, age, and weight. Validation of this method was performed on 5 porcine knees. Stepwise multiple regression was used to determine the difference in ACL volume between injured and control subjects while considering gender, height, weight, and age as potential covariates. Results Contralateral ACL volume for injured subjects was significantly smaller than non-injured subjects (p=0.0208) by 231 mm3 after adjusting for weight, which was also a significant contributor to ACL volume (p<0.0001). At the average body mass of 72.7kg, subjects with a non-contact ACL injury had an average contralateral ACL volume of 1921 mm3, while the corresponding control group had an average volume of 2151 mm3. Gender, height, and age were not significant when weight was included in the regression model. Conclusions This study shows that there are anthropometric differences between the knees of subjects with a non-contact ACL injury and those without an ACL injury, suggesting that ACL volume may play a direct role in non-contact ACL injury. PMID:19307330

  6. 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

  7. Fixation techniques for the anterior cruciate ligament reconstruction: early follow-up. A systematic review of level I and II therapeutic studies.

    PubMed

    Speziali, Andrea; Delcogliano, Marco; Tei, Matteo; Placella, Giacomo; Bartoli, Matteo; Menghi, Amerigo; Cerulli, Giuliano

    2014-12-01

    The purpose of our study was that to systematically review the fixation techniques for the ACL reconstruction and associated clinical outcomes at the early follow-up. Systematic search on three electronic databases (Cochrane register, Medline and Embase) of fixation devices used for primary ACL reconstruction with doubled semitendinosus and gracilis and bone-patellar tendon-bone autografts in randomized clinical trials of level I and II of evidence published from January 2001 to December 2011. Therapeutic studies collected were with a minimum 12-month follow-up, and the clinical outcomes were evaluated by at least one of International Knee Documentation Committee, Lysholm and Tegner functional scales and at least one of the following knee stability tests: arthrometric AP tibial translation, Lachman test and pivot-shift test. Nineteen articles met the inclusion criteria. At the femoral side cross-pin, metallic interference screw, bioabsorbable interference screw, and suspensory device were used in 32.3, 27.3, 24.8, 15.5% of patients, respectively. At the tibial side fixation was achieved with metallic interference screw, bioabsorbable interference screw, screw and plastic sheath, screw post and cross-pin in 38.7, 31, 15.7, 12.8, and 1.7% of patients, respectively. Side-to-side anterior-posterior tibial translation was 1.9 ± 0.9, 1.5 ± 0.9, 1.5 ± 0.8, 2.2 ± 0.4 mm for metallic interference screw, bioabsorbable screw, cross-pin and suspensory device, respectively. At least two-third of all the patients achieved good-to-excellent clinical outcomes. Rate of failure was 6.1, 3.3, 1.7 and 1.2% for bioabsorbable interference screw, metallic interference screw, cross-pin and suspensory device, respectively. Clinical outcomes are good to excellent in almost two-third of the patients but several pitfalls that affect the current fixation techniques as graft tensioning such as graft-tunnel motion are still unaddressed. PMID:25269758

  8. Outcome of combined autologous chondrocyte implantation and anterior cruciate ligament reconstruction

    PubMed Central

    Dhinsa, Baljinder S; Nawaz, Syed Z; Gallagher, Kieran R; Skinner, John; Briggs, Tim; Bentley, George

    2015-01-01

    Background: Instability of the knee joint, after anterior cruciate ligament (ACL) injury, is contraindication to osteochondral defect repair. This prospective study is to investigate the role of combined autologous chondrocyte implantation (ACI) with ACL reconstruction. Materials and Methods: Three independent groups of patients with previous ACL injuries undergoing ACI were identified and prospectively followed up. The first group had ACI in combination with ACL reconstruction (combined group); the 2nd group consisted of individuals who had an ACI procedure having had a previously successful ACL reconstruction (ACL first group); and the third group included patients who had an ACI procedure to a clinically stable knee with documented nonreconstructed ACL disruption (No ACL group). Their outcomes were assessed using the modified cincinnati rating system, the Bentley functional (BF) rating system (BF) and a visual analog scale (VAS). Results: At a mean followup of 64.24 months for the ACL first group, 63 months for combined group and 78.33 months for the No ACL group; 60% of ACL first patients, 72.73% of combined group and 83.33% of the No ACL group felt their outcome was better following surgery. There was no significant difference demonstrated in BF and VAS between the combined and ACL first groups. Results revealed a significant affect of osteochondral defect size on outcome measures. Conclusion: The study confirms that ACI in combination with ACL reconstruction is a viable option with similar outcomes as those patients who have had the procedures staged. PMID:26015603

  9. Combined Reconstruction of the Medial Collateral Ligament and Anterior Cruciate Ligament Using Ipsilateral Quadriceps Tendon-Bone and Bone-Patellar Tendon-Bone Autografts.

    PubMed

    Hetsroni, Iftach; Mann, Gideon

    2016-06-01

    The exclusive autograft choice for medial collateral ligament (MCL) reconstruction that has been described until today is the semitendinosus tendon. However, this has some potential disadvantages in a knee with combined MCL-anterior cruciate ligament (ACL) injury, including weakening of the hamstring's anterior restraining action in an already ACL-injured knee and nonanatomic distal MCL graft insertion when leaving the semitendinosus insertion intact at the pes anserinus during reconstruction. Moreover, because some surgeons prefer to use the hamstring for autologous ACL reconstruction, the contralateral uninjured knee hamstring needs to be harvested as a graft source for the MCL reconstruction if autografts and not allografts are the surgeons' preference. We describe a technique for performing combined reconstruction of the MCL and ACL using ipsilateral quadriceps tendon-bone and bone-patellar tendon-bone autografts. This technique of MCL reconstruction spares the hamstring tendons and benefits from the advantage provided by bone-to-bone healing on the femur with distal and proximal MCL tibial fixation that closely reproduces the native MCL tibia insertion. PMID:27656381

  10. Combined Reconstruction of the Medial Collateral Ligament and Anterior Cruciate Ligament Using Ipsilateral Quadriceps Tendon-Bone and Bone-Patellar Tendon-Bone Autografts.

    PubMed

    Hetsroni, Iftach; Mann, Gideon

    2016-06-01

    The exclusive autograft choice for medial collateral ligament (MCL) reconstruction that has been described until today is the semitendinosus tendon. However, this has some potential disadvantages in a knee with combined MCL-anterior cruciate ligament (ACL) injury, including weakening of the hamstring's anterior restraining action in an already ACL-injured knee and nonanatomic distal MCL graft insertion when leaving the semitendinosus insertion intact at the pes anserinus during reconstruction. Moreover, because some surgeons prefer to use the hamstring for autologous ACL reconstruction, the contralateral uninjured knee hamstring needs to be harvested as a graft source for the MCL reconstruction if autografts and not allografts are the surgeons' preference. We describe a technique for performing combined reconstruction of the MCL and ACL using ipsilateral quadriceps tendon-bone and bone-patellar tendon-bone autografts. This technique of MCL reconstruction spares the hamstring tendons and benefits from the advantage provided by bone-to-bone healing on the femur with distal and proximal MCL tibial fixation that closely reproduces the native MCL tibia insertion.

  11. Hybrid Graft Anterior Cruciate Ligament Reconstruction: A Predictable Graft for Knee Stabilization.

    PubMed

    Alvarez-Pinzon, Andres M; Barksdale, Leticia; Krill, Michael K; Leo, Brian M

    2015-06-01

    Trauma to the anterior cruciate ligament (ACL) is a season-ending injury and involves months of activity modification and rehabilitation. The annual incidence of ACL tears in the United States is approximately 200,000, which allows for a broad range of individualized treatment options. Various surgical techniques, including transtibial and independent tunnel drilling, allograft and autograft tissue, and various implants, have been described in the literature. This article describes the indications and technique for a hybrid soft tissue graft for ACL reconstruction. Autologous grafts eliminate the risk of disease transmission and have recently been shown to have a lower rerupture rate, particularly in younger, active patients; however, the harvesting of autologous hamstring grafts carries a risk of donor-site morbidity, iatrogenic injury of the graft, and inadequate graft size. In contrast to a traditional autologous soft tissue graft, the hybrid graft allows for graft size customization for a desired reconstruction, especially in cases where autograft hamstrings may be iatrogenically damaged or of inadequate size when harvested. The goal of a hybrid graft ACL reconstruction is to provide a favorable-sized graft with clinical outcomes comparable with autologous soft tissue grafts. In contrast to a traditional autologous soft tissue graft, this technique provides another option in the event of unforeseen deficiencies or complications associated with harvesting and preparation of the autologous gracilis and semitendinosis soft tissue graft. PMID:26091219

  12. Hybrid Graft Anterior Cruciate Ligament Reconstruction: A Predictable Graft for Knee Stabilization.

    PubMed

    Alvarez-Pinzon, Andres M; Barksdale, Leticia; Krill, Michael K; Leo, Brian M

    2015-06-01

    Trauma to the anterior cruciate ligament (ACL) is a season-ending injury and involves months of activity modification and rehabilitation. The annual incidence of ACL tears in the United States is approximately 200,000, which allows for a broad range of individualized treatment options. Various surgical techniques, including transtibial and independent tunnel drilling, allograft and autograft tissue, and various implants, have been described in the literature. This article describes the indications and technique for a hybrid soft tissue graft for ACL reconstruction. Autologous grafts eliminate the risk of disease transmission and have recently been shown to have a lower rerupture rate, particularly in younger, active patients; however, the harvesting of autologous hamstring grafts carries a risk of donor-site morbidity, iatrogenic injury of the graft, and inadequate graft size. In contrast to a traditional autologous soft tissue graft, the hybrid graft allows for graft size customization for a desired reconstruction, especially in cases where autograft hamstrings may be iatrogenically damaged or of inadequate size when harvested. The goal of a hybrid graft ACL reconstruction is to provide a favorable-sized graft with clinical outcomes comparable with autologous soft tissue grafts. In contrast to a traditional autologous soft tissue graft, this technique provides another option in the event of unforeseen deficiencies or complications associated with harvesting and preparation of the autologous gracilis and semitendinosis soft tissue graft.

  13. Tibial translation and muscle activation during rehabilitation exercises 5 weeks after anterior cruciate ligament reconstruction.

    PubMed

    Tagesson, S; Oberg, B; Kvist, J

    2010-02-01

    The aim of this study was to compare different rehabilitation exercises with respect to dynamic anterior tibial translation and muscle activation 5 weeks after an anterior cruciate ligament (ACL) reconstruction. Another aim was to compare the ACL-reconstructed knee with the ACL-injured and the uninjured knees for differences in anterior tibial translation and muscle activation during the exercises. Sagittal tibial translation and muscle activation were measured during the Lachman test (static translation) and during seven rehabilitation exercises (dynamic translation) in 19 patients. Results obtained 5 weeks after ACL reconstruction were compared with those obtained before the ACL reconstruction (ACL-deficient and uninjured knee). After ACL reconstruction the seated knee extension produced more anterior tibial translation than the straight leg raise and standing on one leg. The ACL reconstruction reduced the static and the dynamic tibial translation and the tibial translations measured in ACL-reconstructed knees were similar to those measured in uninjured knees. After ACL reconstruction, the patients used a joint stiffening strategy that used more hamstring activation and reduced the dynamic tibial translation. Although all exercises tested are suitable for rehabilitation after ACL reconstruction, to protect the graft from excessive strain, the straight leg raise and squat on one leg are preferable for quadriceps training in the early phase of rehabilitation.

  14. 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.

  15. Acoustic holography: Problems associated with construction and reconstruction techniques

    NASA Technical Reports Server (NTRS)

    Singh, J. J.

    1978-01-01

    The implications of the difference between the inspecting and interrogating radiations are discussed. For real-time, distortionless, sound viewing, it is recommended that infrared radiation of wavelength comparable to the inspecting sound waves be used. The infrared images can be viewed with (IR visible) converter phosphors. The real-time display of the visible image of the acoustically-inspected object at low sound levels such as are used in medical diagnosis is evaluated. In this connection attention is drawn to the need for a phosphor screen which is such that its optical transmission at any point is directly related to the incident electron beam intensity at that point. Such a screen, coupled with an acoustical camera, can enable instantaneous sound wave reconstruction.

  16. Influence of thermofixation on artificial ACL ligament dimensional and mechanical properties

    NASA Astrophysics Data System (ADS)

    Ben Abdessalem, S.; Jedda, H.; Skhiri, S.; Karray, S.; Dahmen, J.; Boughamoura, H.

    2005-11-01

    The anterior cruciate ligament (ACL) is the major articular ligamentous structure of the knee, it functions as a joint stabilizer. When ruptured, the natural ACL ligament can be replaced by a textile synthetic ligament such as a braid, knitted cord, or woven cord. Theses structures are composed of biocompatible materials such as polyester or Gore-Tex filaments. The success of an ACL replacement is widely linked to its mechanical and dimensional properties such as tensile strength, dimensional stability and resistance to abrasion. We introduced an additional treatment in the manufacturing of textile ACL ligaments based on the thermofixation of the textile structure by using textile industry stabilization techniques. Boiling water, saturated vapor and dry heat have been tested to stabilize a braided ligament made of Dacron polyester. The application of these three techniques led to shrinkage and an increase of breaking strength of the textile structure.

  17. Thoracic sympathetic nerve reconstruction for compensatory hyperhidrosis: the Melbourne technique

    PubMed Central

    Hensman, Chris; Leong, James

    2014-01-01

    Background Compensatory hyperhidrosis (CH) is a potential complication following endoscopic thoracic sympathectomy (ETS) in the management of primary hyperhidrosis. CH is considered a permanent condition with significant psychosocial impacts but with few treatment options. Various reversal surgical techniques, aimed at reconstituting sympathetic pathways, have been developed but results have been inconsistent. Objective We present two case reports of a novel technique of reversal surgery, the Melbourne technique, which was employed to treat severe CH that developed within 3-5 months following ETS. Both patients were followed-up to 8 years. Methods The Melbourne technique employs an endoscopic approach to expose previously sympathectomized or sympathotomized thoracic sympathetic chains. In these two cases it was performed on the right side only. Instead of an interpositional nerve graft, an autogenous vein graft was simultaneously harvested and used as a nerve conduit to bridge the secondary nerve defect after neuroma excision. Long-term outcomes were assessed using the dermatology life quality index (DLQI) and the quality of life (QoL) questionnaires, which are validated for hyperhidrosis. Results In both cases, patients reported postoperative improvements in QoL scores. However, the improvement was more marked in one case compared with the other. There were no significant immediate and long-term postoperative complications. Conclusions The Melbourne technique shows promise as an alternative to interpositional nerve grafts or nerve transfers employed in other endoscopic reversal surgeries for CH. PMID:25333020

  18. Exploring Childhood Memories with Adult Survivors of Sexual Abuse: Concrete Reconstruction and Visualization Techniques.

    ERIC Educational Resources Information Center

    Roland, Catherine B.

    1993-01-01

    Describes two memory-enhancing techniques, visualization and concrete reconstruction, that have been successful in counseling adult survivors of sexual abuse. Includes suggested implementations, case examples, and implications for incorporating memory techniques into counseling process. Describes various risk factors involved in using these…

  19. Reconstruction of elongated bubbles fusing the information from multiple optical probes through a Bayesian inference technique.

    PubMed

    Chakraborty, Shubhankar; Roy Chaudhuri, Partha; Das, Prasanta Kr

    2016-07-01

    In this communication, a novel optical technique has been proposed for the reconstruction of the shape of a Taylor bubble using measurements from multiple arrays of optical sensors. The deviation of an optical beam passing through the bubble depends on the contour of bubble surface. A theoretical model of the deviation of a beam during the traverse of a Taylor bubble through it has been developed. Using this model and the time history of the deviation captured by the sensor array, the bubble shape has been reconstructed. The reconstruction has been performed using an inverse algorithm based on Bayesian inference technique and Markov chain Monte Carlo sampling algorithm. The reconstructed nose shape has been compared with the true shape, extracted through image processing of high speed images. Finally, an error analysis has been performed to pinpoint the sources of the errors. PMID:27475597

  20. Reconstruction of elongated bubbles fusing the information from multiple optical probes through a Bayesian inference technique.

    PubMed

    Chakraborty, Shubhankar; Roy Chaudhuri, Partha; Das, Prasanta Kr

    2016-07-01

    In this communication, a novel optical technique has been proposed for the reconstruction of the shape of a Taylor bubble using measurements from multiple arrays of optical sensors. The deviation of an optical beam passing through the bubble depends on the contour of bubble surface. A theoretical model of the deviation of a beam during the traverse of a Taylor bubble through it has been developed. Using this model and the time history of the deviation captured by the sensor array, the bubble shape has been reconstructed. The reconstruction has been performed using an inverse algorithm based on Bayesian inference technique and Markov chain Monte Carlo sampling algorithm. The reconstructed nose shape has been compared with the true shape, extracted through image processing of high speed images. Finally, an error analysis has been performed to pinpoint the sources of the errors.

  1. Reconstruction of elongated bubbles fusing the information from multiple optical probes through a Bayesian inference technique

    NASA Astrophysics Data System (ADS)

    Chakraborty, Shubhankar; Roy Chaudhuri, Partha; Das, Prasanta Kr.

    2016-07-01

    In this communication, a novel optical technique has been proposed for the reconstruction of the shape of a Taylor bubble using measurements from multiple arrays of optical sensors. The deviation of an optical beam passing through the bubble depends on the contour of bubble surface. A theoretical model of the deviation of a beam during the traverse of a Taylor bubble through it has been developed. Using this model and the time history of the deviation captured by the sensor array, the bubble shape has been reconstructed. The reconstruction has been performed using an inverse algorithm based on Bayesian inference technique and Markov chain Monte Carlo sampling algorithm. The reconstructed nose shape has been compared with the true shape, extracted through image processing of high speed images. Finally, an error analysis has been performed to pinpoint the sources of the errors.

  2. Stochastic mass-reconstruction: a new technique to reconstruct resonance masses of heavy particles decaying into tau lepton pairs

    SciTech Connect

    Maruyama, Sho

    2015-12-15

    The invariant mass of tau lepton pairs turns out to be smaller than the resonant mass of their mother particle and the invariant mass distribution is stretched wider than the width of the resonant mass as significant fraction of tau lepton momenta are carried away by neutrinos escaping undetected at collider experiments. This paper describes a new approach to reconstruct resonant masses of heavy particles decaying to tau leptons at such experiments. A typical example is a Z or Higgs boson decaying to a tau pair. Although the new technique can be used for each tau lepton separately, I combine two tau leptons to improve mass resolution by requiring the two tau leptons are lined up in a transverse plane. The method is simple to implement and complementary to the collinear approximation technique that works well when tau leptons are not lined up in a transverse plane. The reconstructed mass can be used as another variable in analyses that already use a visible tau pair mass and missing transverse momentum as these variables are not explicitly used in the stochastic mass-reconstruction to select signal-like events.

  3. [Perforator flaps--the evolution of a reconstructive surgical technique].

    PubMed

    Klein, S; Hage, J J; de Weerd, L

    2005-10-22

    Trauma, oncological resections and pressure sores can cause major soft tissue defects. The evolution of cutaneous, myocutaneous, and fasciocutaneous flaps currently makes possible the restoration of contour and, in many cases, function. This evolution was closely related to the increased understanding of the vascular anatomy of the skin and subcutis and has led to the development of perforator flaps. A perforator flap is a large flap of skin that survives on a single vascular stalk that perforates the muscle, referred to in briefas a 'perforator'. This has its origin in a larger vascular stalk that runs beneath the muscle. The vascular stalk of such a perforator flap can be lengthened by dissecting the perforator from the muscle in continuity with the vessels running beneath the muscle. Moreover, the larger diameter of these vessels facilitates the creation of a vascular anastomosis in the receptor area. By the use of such perforator flaps, proper innervation and a good blood supply to the flap can be combined with less morbidity at the donor site. Important possibilities include the filling of a dorsal (decubitus) defect and breast reconstruction.

  4. Dynamic medial patellofemoral ligament reconstruction in recurrent patellar instability: A surgical technique

    PubMed Central

    Kiran, Kopuri Ravi; Srikanth, I Muni; Chinnusamy, Lenin; Deepti, K

    2015-01-01

    The medial patellofemoral ligament (MPFL) is the primary stabilizer of the patellofemoral joint; its reconstruction has been recommended in adults over the past decade after recurrent patellar instability. However, there has been no standardized technique for reconstruction, therefore, ideal graft and technique for reconstruction are yet undetermined. However, dynamic MPFL reconstruction studies claim to be superior to other procedures as it is more anatomical. This preliminary study aims at assessing the outcomes of MPFL reconstruction in a dynamic pattern using hamstring graft. We performed this procedure in four consecutive patients with chronic patellar instability following trauma. MPFL reconstruction was done with hamstring tendons detached distally and secured to patellar periosteum after being passed through a bony tunnel in the patella without an implant and using the medial collateral ligament as a pulley. In all 4 knees, the MPFL reconstruction was isolated and was not associated with any other realignment procedures. No recurrent episodes of dislocation or subluxation were reported at 24 months followup. PMID:26806970

  5. Novel Reconstruction Technique for New Physics Processes with Initial State Radiation

    SciTech Connect

    Alwall, Johan; Hiramastsu, Kenji; Nojiri, Mihoko M.; Shimizu, Yasuhiro

    2009-10-09

    The production of heavy particles at hadron colliders is associated with radiation of additional quarks and gluons from incoming partons. They can have significant transverse momenta and the additional initial state radiation (ISR) jets complicate the reconstruction of new particle masses. Taking gluino pair production and decay at the Large Hadron Collider as an example, we develop a novel technique to reduce these effects, allowing for a better reconstruction of masses through the measurement of kinematical end points.

  6. Operative and nonoperative treatment options for ACL tears in the adult patient: a conceptual review.

    PubMed

    Bogunovic, Ljiljana; Matava, Matthew J

    2013-11-01

    Injury to the anterior cruciate ligament (ACL) is common among athletic individuals. Both nonoperative and operative treatment options exist. The optimal treatment of an adult with an ACL tear depends on several patient-specific factors, including age, occupation, and desired activity level. In less active patients with sedentary jobs, nonoperative management, consisting of physical therapy, bracing, and activity modification can yield successful results. In active patients who want to resume participation in jumping, cutting, or pivoting sports, patients who have physically demanding occupations, or patients who fail a trial of nonoperative management, ACL reconstruction is recommended. Reconstruction utilizing autograft tissue is preferred over allograft, especially in the younger athlete, but allograft tissue is a reasonable option in the older (aged > 40 years) and less active adult, as well. Successful results have been achieved with both patellar tendon and hamstring grafts. The optimal treatment in adult patients with ACL tears should be based on careful consideration of the patient's goals for return to activity, knee-specific comorbidities, such as coexistent meniscal pathology or osteoarthritis, and his or her willingness to follow a detailed rehabilitation regimen. Our article provides an overview of current nonoperative and operative treatment options for adults with ACL tears, considers the outcomes of both nonoperative and operative strategies, and provides general recommendations as to the ideal management for a given patient. PMID:24231595

  7. Hip Labral Reconstruction: The "Kite Technique" for Improved Efficiency and Graft Control.

    PubMed

    Bhatia, Sanjeev; Chahla, Jorge; Dean, Chase S; Ellman, Michael B

    2016-04-01

    Although the merits of labral reconstruction have been well established, the technical difficulty of presently used reconstruction techniques-particularly with graft passage and fixation-limit its efficacy and potentiates the risk of iatrogenic damage within the hip joint. The unwieldy nature of a floating labral graft anchored on one end may impede accurate fixation of the other end, which is critical for restoration of the fluid hip seal and preservation of graft integrity. In this technique narrative, we present a "kite technique" for introduction, control, and efficient fixation of a labral reconstruction graft. The principles of this method are founded on the belief that a soft-tissue graft in an arthroscopic environment is much easier to guide into position with 2 control sutures using a pulley system similar to flying a kite with 2 fly lines. Although we herein detail the technique as it applies to labral reconstruction in the hip, the concept of the kite technique may also be employed in arthroscopic-assisted soft-tissue reconstructions of other joints. PMID:27354954

  8. Computer-Assisted Mandibular Reconstruction using a Patient-Specific Reconstruction Plate Fabricated with Computer-Aided Design and Manufacturing Techniques

    PubMed Central

    Wilde, Frank; Cornelius, Carl-Peter; Schramm, Alexander

    2014-01-01

    We investigated the workflow of computer-assisted mandibular reconstruction that was performed with a patient-specific mandibular reconstruction plate fabricated with computer-aided design and computer-aided manufacturing (CAD/CAM) techniques and a fibula flap. We assessed the feasibility of this technique from virtual planning to the completion of surgery. Computed tomography (CT) scans of a cadaveric skull and fibula were obtained for the virtual simulation of mandibular resection and reconstruction using ProPlan CMF software (Materialise®/DePuy Synthes®). The virtual model of the reconstructed mandible provided the basis for the computer-aided design of a patient-specific reconstruction plate that was milled from titanium using a five-axis milling machine and CAM techniques. CAD/CAM techniques were used for producing resection guides for mandibular resection and cutting guides for harvesting a fibula flap. Mandibular reconstruction was simulated in a cadaveric wet laboratory. No problems were encountered during the procedure. The plate was fixed accurately to the residual bone without difficulty. The fibula segments were attached to the plate rapidly and reliably. The fusion of preoperative and postoperative CT datasets demonstrated high reconstruction precision. Computer-assisted mandibular reconstruction with CAD/CAM-fabricated patient-specific reconstruction plates appears to be a promising approach for mandibular reconstruction. Clinical trials are required to determine whether these promising results can be translated into successful practice and what further developments are needed. PMID:25045420

  9. Minimally invasive reconstruction of lateral tibial plateau fractures using the jail technique: a biomechanical study

    PubMed Central

    2013-01-01

    Background This study described a novel, minimally invasive reconstruction technique of lateral tibial plateau fractures using a three-screw jail technique and compared it to a conventional two-screw osteosynthesis technique. The benefit of an additional screw implanted in the proximal tibia from the anterior at an angle of 90° below the conventional two-screw reconstruction after lateral tibial plateau fracture was evaluated. This new method was called the jail technique. Methods The two reconstruction techniques were tested using a porcine model (n = 40). Fracture was simulated using a defined osteotomy of the lateral tibial plateau. Load-to-failure and multiple cyclic loading tests were conducted using a material testing machine. Twenty tibias were used for each reconstruction technique, ten of which were loaded in a load-to-failure protocol and ten cyclically loaded (5000 times) between 200 and 1000 N using a ramp protocol. Displacement, stiffness and yield load were determined from the resulting load displacement curve. Failure was macroscopically documented. Results In the load-to-failure testing, the jail technique showed a significantly higher mean maximum load (2275.9 N) in comparison to the conventional reconstruction (1796.5 N, p < 0.001). The trend for better outcomes for the novel technique in terms of stiffness and yield load did not reach statistical significance (p > 0.05). In cyclic testing, the jail technique also showed better trends in displacement that were not statistically significant. Failure modes showed a tendency of screws cutting through the bone (cut-out) in the conventional reconstruction. No cut-out but a bending of the lag screws at the site of the additional third screw was observed in the jail technique. Conclusions The results of this study indicate that the jail and the conventional technique have seemingly similar biomechanical properties. This suggests that the jail technique may be a feasible alternative to

  10. A facial reconstruction and identification technique for seriously devastating head wounds.

    PubMed

    Joukal, Marek; Frišhons, Jan

    2015-07-01

    Many authors have focused on facial identification techniques, and facial reconstructions for cases when skulls have been found are especially well known. However, a standardized facial identification technique for an unknown body with seriously devastating head injuries has not yet been developed. A reconstruction and identification technique was used in 7 cases of accidents involving trains striking pedestrians. This identification technique is based on the removal of skull bone fragments, subsequent fixation of soft tissue onto a universal commercial polystyrene head model, precise suture of dermatomuscular flaps, and definitive adjustment using cosmetic treatments. After reconstruction, identifying marks such as scars, eyebrows, facial lines, facial hair and partly hairstyle become evident. It is then possible to present a modified picture of the reconstructed face to relatives. After comparing the results with photos of the person before death, this technique has proven to be very useful for identifying unknown bodies when other identification techniques are not available. This technique is useful for its being rather quick and especially for its results.

  11. A facial reconstruction and identification technique for seriously devastating head wounds.

    PubMed

    Joukal, Marek; Frišhons, Jan

    2015-07-01

    Many authors have focused on facial identification techniques, and facial reconstructions for cases when skulls have been found are especially well known. However, a standardized facial identification technique for an unknown body with seriously devastating head injuries has not yet been developed. A reconstruction and identification technique was used in 7 cases of accidents involving trains striking pedestrians. This identification technique is based on the removal of skull bone fragments, subsequent fixation of soft tissue onto a universal commercial polystyrene head model, precise suture of dermatomuscular flaps, and definitive adjustment using cosmetic treatments. After reconstruction, identifying marks such as scars, eyebrows, facial lines, facial hair and partly hairstyle become evident. It is then possible to present a modified picture of the reconstructed face to relatives. After comparing the results with photos of the person before death, this technique has proven to be very useful for identifying unknown bodies when other identification techniques are not available. This technique is useful for its being rather quick and especially for its results. PMID:25965304

  12. Retrograde intra-vesical reconstructive surgery (RIVRS): A novel technique.

    PubMed

    Laddha, Abhishek; Ganpule, Arvind; Mishra, Sahshikant; Sabnis, Ravindra; Desai, Mahesh

    2016-01-01

    Management of distal ureter by en block resection during radical nephrectomy for upper urinary tract transitional cell carcinoma (TCC) is considered as standard of care. In this report, we describe our technique for management of lower ureter which utilizes both the endoscopic and laparoscopic approach. The nephrectomy including the dissection of the lower ureter was completed laproscopically. The ureteral orifice was scored using a hook passed through a 24 Fr nephroscope and secured .Transurethral suturing of the defect with SewRight SR5 device passed through the working channel of the 24 Fr nephroscope was done. Our report highlights the fact that management of lower ureter in TCC pelvis can be done endoscopically/laproscopically without compromising the oncological principles. Our novel technique demonstrates feasibility of intra mural resection of the ureter and primary closure of the bladder endoscopically. PMID:27279408

  13. Retrograde intra-vesical reconstructive surgery (RIVRS): A novel technique

    PubMed Central

    Laddha, Abhishek; Ganpule, Arvind; Mishra, Sahshikant; Sabnis, Ravindra; Desai, Mahesh

    2016-01-01

    Management of distal ureter by en block resection during radical nephrectomy for upper urinary tract transitional cell carcinoma (TCC) is considered as standard of care. In this report, we describe our technique for management of lower ureter which utilizes both the endoscopic and laparoscopic approach. The nephrectomy including the dissection of the lower ureter was completed laproscopically. The ureteral orifice was scored using a hook passed through a 24 Fr nephroscope and secured .Transurethral suturing of the defect with SewRight SR5 device passed through the working channel of the 24 Fr nephroscope was done. Our report highlights the fact that management of lower ureter in TCC pelvis can be done endoscopically/laproscopically without compromising the oncological principles. Our novel technique demonstrates feasibility of intra mural resection of the ureter and primary closure of the bladder endoscopically. PMID:27279408

  14. Current concept in dysplastic hip arthroplasty: Techniques for acetabular and femoral reconstruction.

    PubMed

    Bicanic, Goran; Barbaric, Katarina; Bohacek, Ivan; Aljinovic, Ana; Delimar, Domagoj

    2014-09-18

    Adult patients with developmental dysplasia of the hip develop secondary osteoarthritis and eventually end up with total hip arthroplasty (THA) at younger age. Because of altered anatomy of dysplastic hips, THA in these patients represents technically demanding procedure. Distorted anatomy of the acetabulum and proximal femur together with conjoined leg length discrepancy present major challenges during performing THA in patients with developmental dysplasia of the hip. In addition, most patients are at younger age, therefore, soft tissue balance is of great importance (especially the need to preserve the continuity of abductors) to maximise postoperative functional result. In this paper we present a variety of surgical techniques available for THA in dysplastic hips, their advantages and disadvantages. For acetabular reconstruction following techniques are described: Standard metal augments (prefabricated), Custom made acetabular augments (3D printing), Roof reconstruction with vascularized fibula, Roof reconstruction with pedicled iliac graft, Roof reconstruction with autologous bone graft, Roof reconstruction with homologous bone graft, Roof reconstruction with auto/homologous spongious bone, Reinforcement ring with the hook in combination with autologous graft augmentation, Cranial positioning of the acetabulum, Medial protrusion technique (cotyloplasty) with chisel, Medial protrusion technique (cotyloplasty) with reaming, Cotyloplasty without spongioplasty. For femoral reconstruction following techniques were described: Distraction with external fixator, Femoral shortening through a modified lateral approach, Transtrochanteric osteotomies, Paavilainen osteotomy, Lesser trochanter osteotomy, Double-chevron osteotomy, Subtrochanteric osteotomies, Diaphyseal osteotomies, Distal femoral osteotomies. At the end we present author's treatment method of choice: for acetabulum we perform cotyloplasty leaving only paper-thin medial wall, which we break during acetabular

  15. Establishing the skill of climate field reconstruction techniques for precipitation with pseudoproxy experiments

    NASA Astrophysics Data System (ADS)

    Gómez-Navarro, Juan José; Werner, Johannes; Wagner, Sebastian; Luterbacher, Jürg; Zorita, Eduardo

    2015-09-01

    This study aims at assessing the skill of several climate field reconstruction techniques (CFR) to reconstruct past precipitation over continental Europe and the Mediterranean at seasonal time scales over the last two millennia from proxy records. A number of pseudoproxy experiments are performed within the virtual reality of a regional paleoclimate simulation at 45 km resolution to analyse different aspects of reconstruction skill. Canonical Correlation Analysis (CCA), two versions of an Analog Method (AM) and Bayesian hierarchical modeling (BHM) are applied to reconstruct precipitation from a synthetic network of pseudoproxies that are contaminated with various types of noise. The skill of the derived reconstructions is assessed through comparison with precipitation simulated by the regional climate model. Unlike BHM, CCA systematically underestimates the variance. The AM can be adjusted to overcome this shortcoming, presenting an intermediate behaviour between the two aforementioned techniques. However, a trade-off between reconstruction-target correlations and reconstructed variance is the drawback of all CFR techniques. CCA (BHM) presents the largest (lowest) skill in preserving the temporal evolution, whereas the AM can be tuned to reproduce better correlation at the expense of losing variance. While BHM has been shown to perform well for temperatures, it relies heavily on prescribed spatial correlation lengths. While this assumption is valid for temperature, it is hardly warranted for precipitation. In general, none of the methods outperforms the other. All experiments agree that a dense and regularly distributed proxy network is required to reconstruct precipitation accurately, reflecting its high spatial and temporal variability. This is especially true in summer, when a specifically short de-correlation distance from the proxy location is caused by localised summertime convective precipitation events.

  16. Reconstruction of the density field using the Colored Background Oriented Schlieren Technique (CBOS)

    NASA Astrophysics Data System (ADS)

    Sourgen, F.; Leopold, F.; Klatt, D.

    2012-01-01

    In this paper the improved Background Oriented Schlieren technique called CBOS (Colored Background Oriented Schlieren) is described and used to reconstruct density fields of three-dimensional flows. The Background Oriented Schlieren technique (BOS) allows to measure the light deflection caused by density gradients in a compressible flow. For this purpose the local image displacements of the image of a background pattern observed through the flow is used. In order to increase the performance of the conventional Background Oriented Schlieren technique, the monochromatic background is replaced by a colored dot pattern. The different colors are treated separately using suitable correlation algorithms. Therefore, the accuracy and the spatial resolution can be increased. A tomographic reconstruction method is then used to reconstruct the density field in three-dimensional flows from CBOS measurements.

  17. A novel data processing technique for image reconstruction of penumbral imaging

    NASA Astrophysics Data System (ADS)

    Xie, Hongwei; Li, Hongyun; Xu, Zeping; Song, Guzhou; Zhang, Faqiang; Zhou, Lin

    2011-06-01

    CT image reconstruction technique was applied to the data processing of the penumbral imaging. Compared with other traditional processing techniques for penumbral coded pinhole image such as Wiener, Lucy-Richardson and blind technique, this approach is brand new. In this method, the coded aperture processing method was used for the first time independent to the point spread function of the image diagnostic system. In this way, the technical obstacles was overcome in the traditional coded pinhole image processing caused by the uncertainty of point spread function of the image diagnostic system. Then based on the theoretical study, the simulation of penumbral imaging and image reconstruction was carried out to provide fairly good results. While in the visible light experiment, the point source of light was used to irradiate a 5mm×5mm object after diffuse scattering and volume scattering. The penumbral imaging was made with aperture size of ~20mm. Finally, the CT image reconstruction technique was used for image reconstruction to provide a fairly good reconstruction result.

  18. Iliotibial band friction syndrome after anterior cruciate ligament reconstruction using the transfix device: report of two cases and review of the literature.

    PubMed

    Pelfort, Xavier; Monllau, Joan C; Puig, Lluís; Cáceres, Enric

    2006-06-01

    The use of hamstrings is increasing as a treatment for anterior cruciate ligament (ACL) injuries. There are a lot of new devices and techniques that try to fix the graft without causing further injury or increased morbidity. We report two cases in relation to the transfix device for reconstructing the ACL. The first case is a 38-year-old female who was treated with an autologous hamstring graft for chronic ACL instability brought on by a sport trauma. The patient developed iliotibial band friction syndrome 3 months after the operation. MRI showed incorrect positioning and a rupture of the femoral bio-absorbable cross-pin. The hamstring graft always had good fixation and did not produce instability of the knee. We removed the cross-pin fragment in a second surgery and the patient returned to her daily lifestyle after 3 weeks. The second case is a 52-year-old female with a painful and unstable knee due to a previous lateral meniscectomy and failure of an ACL reconstruction. We performed an ACL reconstruction with an autologous hamstring graft and a lateral meniscus transplantation. Some months after the procedure she also developed this syndrome. MRI showed the same features as shown in the first case and a second surgery was needed. To our knowledge this clinical and technical problem has not been previously described.

  19. All-Inside Posterior Cruciate Ligament Reconstruction: GraftLink Technique

    PubMed Central

    Prince, Matthew R.; Stuart, Michael J.; King, Alexander H.; Sousa, Paul L.; Levy, Bruce A.

    2015-01-01

    Posterior cruciate ligament (PCL) injuries account for nearly 20% of knee ligament injuries. PCL injuries can occur in isolation or, more commonly, in the setting of multiligamentous knee injuries. Isolated PCL disruptions are commonly treated nonoperatively; however, symptomatic grade III injuries, as well as PCL injuries found in multiligamentous injuries, are frequently treated surgically. Several reconstructive techniques exist for the treatment of PCL deficiency without a clear optimal approach. We describe our preferred operative technique to reconstruct the PCL using an all-inside arthroscopic approach with a quadrupled tibialis anterior or peroneus longus allograft with both tibial and femoral suspensory fixation. PMID:26900564

  20. All-Inside Posterior Cruciate Ligament Reconstruction: GraftLink Technique.

    PubMed

    Prince, Matthew R; Stuart, Michael J; King, Alexander H; Sousa, Paul L; Levy, Bruce A

    2015-10-01

    Posterior cruciate ligament (PCL) injuries account for nearly 20% of knee ligament injuries. PCL injuries can occur in isolation or, more commonly, in the setting of multiligamentous knee injuries. Isolated PCL disruptions are commonly treated nonoperatively; however, symptomatic grade III injuries, as well as PCL injuries found in multiligamentous injuries, are frequently treated surgically. Several reconstructive techniques exist for the treatment of PCL deficiency without a clear optimal approach. We describe our preferred operative technique to reconstruct the PCL using an all-inside arthroscopic approach with a quadrupled tibialis anterior or peroneus longus allograft with both tibial and femoral suspensory fixation. PMID:26900564

  1. Proximal anterior cruciate ligament tears: the healing response technique versus conservative treatment.

    PubMed

    Wasmaier, Johann; Kubik-Huch, Rahel; Pfirrmann, Christian; Grehn, Holger; Bieg, Christian; Eid, Karim

    2013-08-01

    The healing response technique (HRT) is a nonreconstructive method to promote healing in proximal anterior cruciate ligament (ACL) tears. The study reviews clinical and radiological long-term results. Thirty patients (average age 31 years) were treated according to the protocol described by Steadman et al. For comparison, an age- and gender-matched control group of conservatively treated patients (CST; n = 127) was selected. At follow-up (mean: 4 years), all patients were evaluated using Kneelax-3-arthrometer, magnetic resonance imaging (MRI), and by clinical examination. Two HRT patients were lost to follow-up and 10 (36%) patients needed definitive ACL reconstruction. The rate of secondary ACL reconstruction in the initial CST group was 56% (71 of 127). Nineteen of the conservatively treated patients were selected according to above-mentioned criteria. The average Lysholm score in the HRT group was 91 (CST group = 90), and the Orthopaedische Arbeitsgemeinschaft Knie score was 93 (CST group = 92). Tegner score decreased from 6.8 before injury to 5.7 at the time of follow-up (CST group: 6.0 to 5.1). Kneelax-3-arthrometer showed a significant higher anterior knee laxity compared with the noninjured side in both groups. MRI showed improvement of the ACL in both groups. HRT in adult patients is associated with a high revision rate of 36% secondary ACL reconstruction, comparable with primary conservative treatment (p = 0.056). For the remaining patients (64%), HRT did not result in better outcomes than conservative treatment.

  2. Gait patterns after anterior cruciate ligament reconstruction.

    PubMed

    Bulgheroni, P; Bulgheroni, M V; Andrini, L; Guffanti, P; Giughello, A

    1997-01-01

    The aim of this study is to analyse the changes in select gait parameters following anterior cruciate ligament (ACL) reconstruction. The study was performed on 15 subjects who underwent ACL reconstruction by the bone-patellar tendon-bone technique. Gait analysis was performed using the Elite three-dimensional (3D) optoelectronic system (BTS), a Kistler force platform and the Telemg telemetric electromyograph (BTS). Kinematic data were recorded for the principal lower limb joints (hip, knee and ankle). The examined muscles include vastus lateralis, rectus femoris, biceps femoris and semitendinosus. The results obtained from the operated subjects were compared with those of 10 untreated subjects and 5 subjects without ACL damage. In the operated subjects the knee joint angular values regained a normal flexion pattern for the injured limb during the stance phase. The analysis of joint moments shows: (a) sagittal plane: recovery of the knee flexion moment at loading response and during preswing; (b) frontal plane: recovery of the normal patterns for both hip and knee adduction-abduction moments during the entire stance phase. The examination of ground reaction forces reveals the recovery of frontal component features. The EMG traces show the normal biphasic pattern for the operated subjects as compared to the untreated subjects. The results suggest that the gait parameters shift towards normal value patterns.

  3. New signal processing technique for density profile reconstruction using reflectometry

    SciTech Connect

    Clairet, F.; Bottereau, C.; Ricaud, B.; Briolle, F.; Heuraux, S.

    2011-08-15

    Reflectometry profile measurement requires an accurate determination of the plasma reflected signal. Along with a good resolution and a high signal to noise ratio of the phase measurement, adequate data analysis is required. A new data processing based on time-frequency tomographic representation is used. It provides a clearer separation between multiple components and improves isolation of the relevant signals. In this paper, this data processing technique is applied to two sets of signals coming from two different reflectometer devices used on the Tore Supra tokamak. For the standard density profile reflectometry, it improves the initialization process and its reliability, providing a more accurate profile determination in the far scrape-off layer with density measurements as low as 10{sup 16} m{sup -1}. For a second reflectometer, which provides measurements in front of a lower hybrid launcher, this method improves the separation of the relevant plasma signal from multi-reflection processes due to the proximity of the plasma.

  4. Development of acoustic model-based iterative reconstruction technique for thick-concrete imaging

    NASA Astrophysics Data System (ADS)

    Almansouri, Hani; Clayton, Dwight; Kisner, Roger; Polsky, Yarom; Bouman, Charles; Santos-Villalobos, Hector

    2016-02-01

    Ultrasound signals have been used extensively for non-destructive evaluation (NDE). However, typical reconstruction techniques, such as the synthetic aperture focusing technique (SAFT), are limited to quasi-homogenous thin media. New ultrasonic systems and reconstruction algorithms are in need for one-sided NDE of non-homogenous thick objects. An application example space is imaging of reinforced concrete structures for commercial nuclear power plants (NPPs). These structures provide important foundation, support, shielding, and containment functions. Identification and management of aging and degradation of concrete structures is fundamental to the proposed long-term operation of NPPs. Another example is geothermal and oil/gas production wells. These multi-layered structures are composed of steel, cement, and several types of soil and rocks. Ultrasound systems with greater penetration range and image quality will allow for better monitoring of the well's health and prediction of high-pressure hydraulic fracturing of the rock. These application challenges need to be addressed with an integrated imaging approach, where the application, hardware, and reconstruction software are highly integrated and optimized. Therefore, we are developing an ultrasonic system with Model-Based Iterative Reconstruction (MBIR) as the image reconstruction backbone. As the first implementation of MBIR for ultrasonic signals, this paper document the first implementation of the algorithm and show reconstruction results for synthetically generated data.1

  5. Development of Acoustic Model-Based Iterative Reconstruction Technique for Thick-Concrete Imaging

    SciTech Connect

    Almansouri, Hani; Clayton, Dwight A; Kisner, Roger A; Polsky, Yarom; Bouman, Charlie; Santos-Villalobos, Hector J

    2016-01-01

    Ultrasound signals have been used extensively for non-destructive evaluation (NDE). However, typical reconstruction techniques, such as the synthetic aperture focusing technique (SAFT), are limited to quasi-homogenous thin media. New ultrasonic systems and reconstruction algorithms are in need for one-sided NDE of non-homogenous thick objects. An application example space is imaging of reinforced concrete structures for commercial nuclear power plants (NPPs). These structures provide important foundation, support, shielding, and containment functions. Identification and management of aging and degradation of concrete structures is fundamental to the proposed long-term operation of NPPs. Another example is geothermal and oil/gas production wells. These multi-layered structures are composed of steel, cement, and several types of soil and rocks. Ultrasound systems with greater penetration range and image quality will allow for better monitoring of the well's health and prediction of high-pressure hydraulic fracturing of the rock. These application challenges need to be addressed with an integrated imaging approach, where the application, hardware, and reconstruction software are highly integrated and optimized. Therefore, we are developing an ultrasonic system with Model-Based Iterative Reconstruction (MBIR) as the image reconstruction backbone. As the first implementation of MBIR for ultrasonic signals, this paper document the first implementation of the algorithm and show reconstruction results for synthetically generated data.

  6. Development of Acoustic Model-Based Iterative Reconstruction Technique for Thick-Concrete Imaging

    SciTech Connect

    Almansouri, Hani; Clayton, Dwight A; Kisner, Roger A; Polsky, Yarom; Bouman, Charlie; Santos-Villalobos, Hector J

    2015-01-01

    Ultrasound signals have been used extensively for non-destructive evaluation (NDE). However, typical reconstruction techniques, such as the synthetic aperture focusing technique (SAFT), are limited to quasi-homogenous thin media. New ultrasonic systems and reconstruction algorithms are in need for one-sided NDE of non-homogenous thick objects. An application example space is imaging of reinforced concrete structures for commercial nuclear power plants (NPPs). These structures provide important foundation, support, shielding, and containment functions. Identification and management of aging and degradation of concrete structures is fundamental to the proposed long-term operation of NPPs. Another example is geothermal and oil/gas production wells. These multi-layered structures are composed of steel, cement, and several types of soil and rocks. Ultrasound systems with greater penetration range and image quality will allow for better monitoring of the well s health and prediction of high-pressure hydraulic fracturing of the rock. These application challenges need to be addressed with an integrated imaging approach, where the application, hardware, and reconstruction software are highly integrated and optimized. Therefore, we are developing an ultrasonic system with Model-Based Iterative Reconstruction (MBIR) as the image reconstruction backbone. As the first implementation of MBIR for ultrasonic signals, this paper document the first implementation of the algorithm and show reconstruction results for synthetically generated data.

  7. 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

  8. Trends in primary and revision anterior cruciate ligament reconstruction among National Basketball Association team physicians.

    PubMed

    Mall, Nathan A; Abrams, Geoffrey D; Azar, Frederick M; Traina, Steve M; Allen, Answorth A; Parker, Richard; Cole, Brian J

    2014-06-01

    Anterior cruciate ligament (ACL) tears are common in athletes. Techniques and methods of treatment for these injuries continue to vary among surgeons. Thirty National Basketball Association (NBA) team physicians were surveyed during the NBA Pre-Draft Combine. Survey questions involved current and previous practice methods of primary and revision ACL reconstruction, including technique, graft choice, rehabilitation, and treatment of combined ACL and medial collateral ligament injuries. Descriptive parametric statistics, Fisher exact test, and logistic regression were used, and significance was set at α = 0.05. All 30 team physicians completed the survey. Eighty-seven percent indicated they use autograft (81% bone-patellar tendon-bone) for primary ACL reconstruction in NBA athletes, and 43% indicated they use autograft for revision cases. Fourteen surgeons (47%) indicated they use an anteromedial portal (AMP) for femoral tunnel drilling, whereas 5 years earlier only 4 (13%) used this technique. There was a significant (P = .009) positive correlation between fewer years in practice and AMP use. NBA team physicians' use of an AMP for femoral tunnel drilling has increased over the past 5 years.

  9. An improved technique for immediate retropectoral reconstruction after subcutaneous mastectomy.

    PubMed

    Maillard, G F; Garey, L J

    1987-09-01

    Subcutaneous mastectomy is becoming an operation of choice in certain cases of premalignant and other breast pathology. We describe a technique for simultaneous subcutaneous mastectomy and retropectoral implantation of a silicone prosthesis. Gentle blunt prepectoral, retromammary dissection is performed through an axillary incision as far inferiorly as the inframammary fold, where a fibrous bridge between the anterior surface of the pectoralis major muscle and the skin prevents dissection any lower. Through the same incision, the retropectoral space is dissected to about 5 cm below the inframammary fold. A second incision is made in the inframammary fold to join the retromammary plane of the first dissection. The gland is then dissected subcutaneously and removed through the inframammary incision. A silicone implant is introduced retropectorally through the axillary incision, thus avoiding splitting the pectoralis major. Satisfactory results have been obtained in 23 bilateral and 14 unilateral cases; it is important that the dissection be performed carefully in order to prevent the implant from riding up too high in its musculoaponeurotic sling.

  10. [Regeneration of the ocular surface: stem cells and reconstructive techniques].

    PubMed

    Fernández, A; Moreno, J; Prósper, F; García, M; Echeveste, J

    2008-01-01

    The cornea is a transparent tissue microscopically constituted by 5 well differentiated layers. The corneal epithelium is essential for corneal transparency and is found in a state of constant renovation throughout life on the basis of the population of limbocorneal stem cells. The localisation of these limbocorneal stem cells seems to be in the basal layers of the limbocorneal epithelium, of vital importance for maintaining the micro-environment of these limbocorneal stem cells, which depend on a variety of intrinsic and extrinsic factors. Limbic insufficiency occurs when there is a partial or total loss of these limbocorneal stem cells. These clinical features lead to a corneal clouding with a resulting loss of vision. In these cases, corneal transplant only represents a temporary replacement of the corneal epithelium; it is necessary to carry out a prior treatment involving transplant of the autologous or allogeneic limbus, which enables regeneration of the population of damaged limbocorneal cells. To reduce the risk involved in the transplant of the limbus of the donor eye, techniques of cultivation of limbocorneal cells on the basis of small limbocorneal biopsies are proposed. PMID:18496580

  11. Fuzzy zoning for feature matching technique in 3D reconstruction of nasal endoscopic images.

    PubMed

    Rattanalappaiboon, Surapong; Bhongmakapat, Thongchai; Ritthipravat, Panrasee

    2015-12-01

    3D reconstruction from nasal endoscopic images greatly supports an otolaryngologist in examining nasal passages, mucosa, polyps, sinuses, and nasopharyx. In general, structure from motion is a popular technique. It consists of four main steps; (1) camera calibration, (2) feature extraction, (3) feature matching, and (4) 3D reconstruction. Scale Invariant Feature Transform (SIFT) algorithm is normally used for both feature extraction and feature matching. However, SIFT algorithm relatively consumes computational time particularly in the feature matching process because each feature in an image of interest is compared with all features in the subsequent image in order to find the best matched pair. A fuzzy zoning approach is developed for confining feature matching area. Matching between two corresponding features from different images can be efficiently performed. With this approach, it can greatly reduce the matching time. The proposed technique is tested with endoscopic images created from phantoms and compared with the original SIFT technique in terms of the matching time and average errors of the reconstructed models. Finally, original SIFT and the proposed fuzzy-based technique are applied to 3D model reconstruction of real nasal cavity based on images taken from a rigid nasal endoscope. The results showed that the fuzzy-based approach was significantly faster than traditional SIFT technique and provided similar quality of the 3D models. It could be used for creating a nasal cavity taken by a rigid nasal endoscope.

  12. Local and Non-local Regularization Techniques in Emission (PET/SPECT) Tomographic Image Reconstruction Methods.

    PubMed

    Ahmad, Munir; Shahzad, Tasawar; Masood, Khalid; Rashid, Khalid; Tanveer, Muhammad; Iqbal, Rabail; Hussain, Nasir; Shahid, Abubakar; Fazal-E-Aleem

    2016-06-01

    Emission tomographic image reconstruction is an ill-posed problem due to limited and noisy data and various image-degrading effects affecting the data and leads to noisy reconstructions. Explicit regularization, through iterative reconstruction methods, is considered better to compensate for reconstruction-based noise. Local smoothing and edge-preserving regularization methods can reduce reconstruction-based noise. However, these methods produce overly smoothed images or blocky artefacts in the final image because they can only exploit local image properties. Recently, non-local regularization techniques have been introduced, to overcome these problems, by incorporating geometrical global continuity and connectivity present in the objective image. These techniques can overcome drawbacks of local regularization methods; however, they also have certain limitations, such as choice of the regularization function, neighbourhood size or calibration of several empirical parameters involved. This work compares different local and non-local regularization techniques used in emission tomographic imaging in general and emission computed tomography in specific for improved quality of the resultant images.

  13. Pseudocyclops: two cases of ACL graft partial tears mimicking cyclops lesions on MRI.

    PubMed

    Simpfendorfer, Claus; Miniaci, Anthony; Subhas, Naveen; Winalski, Carl S; Ilaslan, Hakan

    2015-08-01

    Arthroscopic reconstruction of the anterior cruciate ligament (ACL) using autografts or allografts is a common surgical procedure, particularly in young athletes. Although the procedure has excellent success rates, complications such as mechanical impingement, graft rupture, and arthrofibrosis can occur, often necessitating additional surgery. Magnetic resonance (MR) imaging has become a valuable tool in evaluating complications after ACL reconstruction. We report two cases of ACL reconstruction complicated by arthroscopically proven partial graft tears. In both cases the torn anterior graft fibers were flipped into the intercondylar notch, mimicking anterior arthrofibrosis, i.e., a "cyclops lesion," on MR imaging. Careful review of the direction of graft fibers on MR imaging in the "pseudocyclops" lesions can help differentiate these partial tears from the fibrosis of a true cyclops. The "pseudocyclops" lesion is a previously undescribed MR imaging sign of partial ACL graft tear. Larger studies are required to determine the sensitivity and specificity of the sign, as well as the clinical importance of these partial graft tears. PMID:25620690

  14. Super-resolution phase reconstruction technique in electron holography with a stage-scanning system

    NASA Astrophysics Data System (ADS)

    Lei, Dan; Mitsuishi, Kazutaka; Harada, Ken; Shimojo, Masayuki; Ju, Dongying; Takeguchi, Masaki

    2014-02-01

    Super-resolution image reconstruction is a digital signal processing technique that allows creating a high-resolution image from multiple low-resolution images taken at slightly different positions. We introduce the super-resolution image reconstruction technique into electron holography for reconstructing phase images as follows: the studied specimen is shifted step-wise with a high-precision piezo holder, and a series of holograms is recorded. When the step size is not a multiple of the CCD pixel size, processing of the acquired series results in a higher pixel density and spatial resolution as compared to the phase image obtained with conventional holography. The final resolution exceeds the limit of the CCD pixel size divided by the magnification.

  15. Patient Demographics and Surgical Characteristics in ACL Revision: A Comparison of French, Norwergian, and North American Cohorts

    PubMed Central

    Magnussen, Robert A.; Trojani, Christophe; Granan, Lars-Petter; Neyret, Philippe; Colombet, Philippe; Engebretsen, Lars; Wright, Rick W.; Kaeding, Christopher C.

    2014-01-01

    Purpose The goal of this paper is to compare patient factors, intra-operative findings, and surgical techniques between patients followed in large cohorts in France, Norway, and North America. Methods Data collected on 2286 patients undergoing revision ACLR were obtained. These data included 1216 patients enrolled in the Multicenter ACL Revision Study (MARS) in North America, 793 patients undergoing revision ACLR and recorded in the Norwegian Knee Ligament Registry (NKLR), and 277 patients recorded in the revision ACL database of the Société Française d’Arthroscopie (SFA) in France. Data collected from each database included patient demographics (age, sex, height, and weight), graft choice and reason for failure of the primary ACLR, time from primary to revision ACLR, pre-revision patient-reported outcome scores (KOOS, subjective IKDC), associated intra-articular findings and treatments at revision, and graft choice for revision reconstruction. Results Patient demographics in the three databases were relatively similar. Graft choice for primary and revision ACLR varied significantly, with more allografts used in the MARS cohort. Hamstring autograft was favored in the NKRL, while BTB autograft was most common in the SFA cohort. Reasons for failure of the primary ACLR were comparable, with recurrent trauma noted in 46 to 56% of patients in each of the three cohorts. Technical error was cited in 44 to 51% of patients in the MARS and SFA cohorts, but was not clearly elucidated in the NKLR cohort. Biologic failure of the primary graft was more common in the MARS cohort. Differences in associated intra-articular findings were noted at the time of revision ACLR, with significantly more high grade cartilage lesions noted in the MARS group. Conclusions Significant differences exist between patient populations followed in revision ACL cohorts throughout the world that should be considered when applying findings from such cohorts to different patient populations. PMID

  16. A constrained reconstruction technique of hyperelasticity parameters for breast cancer assessment

    NASA Astrophysics Data System (ADS)

    Mehrabian, Hatef; Campbell, Gordon; Samani, Abbas

    2010-12-01

    In breast elastography, breast tissue usually undergoes large compression resulting in significant geometric and structural changes. This implies that breast elastography is associated with tissue nonlinear behavior. In this study, an elastography technique is presented and an inverse problem formulation is proposed to reconstruct parameters characterizing tissue hyperelasticity. Such parameters can potentially be used for tumor classification. This technique can also have other important clinical applications such as measuring normal tissue hyperelastic parameters in vivo. Such parameters are essential in planning and conducting computer-aided interventional procedures. The proposed parameter reconstruction technique uses a constrained iterative inversion; it can be viewed as an inverse problem. To solve this problem, we used a nonlinear finite element model corresponding to its forward problem. In this research, we applied Veronda-Westmann, Yeoh and polynomial models to model tissue hyperelasticity. To validate the proposed technique, we conducted studies involving numerical and tissue-mimicking phantoms. The numerical phantom consisted of a hemisphere connected to a cylinder, while we constructed the tissue-mimicking phantom from polyvinyl alcohol with freeze-thaw cycles that exhibits nonlinear mechanical behavior. Both phantoms consisted of three types of soft tissues which mimic adipose, fibroglandular tissue and a tumor. The results of the simulations and experiments show feasibility of accurate reconstruction of tumor tissue hyperelastic parameters using the proposed method. In the numerical phantom, all hyperelastic parameters corresponding to the three models were reconstructed with less than 2% error. With the tissue-mimicking phantom, we were able to reconstruct the ratio of the hyperelastic parameters reasonably accurately. Compared to the uniaxial test results, the average error of the ratios of the parameters reconstructed for inclusion to the middle

  17. [Technique and immediate results of the Moreno Gonzalez-Carboni reconstruction after total gastrectomy].

    PubMed

    Carboni, M; Catarci, M; Proposito, D; Saputelli, A; Zaraca, F; Gossetti, F; Flati, G; Guadagni, S; Tuscano, D; Negro, P

    1992-04-01

    Reconstruction following total gastrectomy for gastric cancer is still matter of debate. The Roux-en-Y esophagojejunostomy and the interposed loop esophago-jejunoduodenostomy are the techniques commonly employed. The Authors describe their modification of Henley's jejunal interposition and report early results achieved in a series of 60 consecutive patients.

  18. Anterior cruciate ligament allograft transplantation. Long-term function, histology, revascularization, and operative technique.

    PubMed

    Nikolaou, P K; Seaber, A V; Glisson, R R; Ribbeck, B M; Bassett, F H

    1986-01-01

    In recent years much effort has been devoted to finding a satisfactory replacement for the injured ACL. None of the reconstruction techniques used in the past can be considered ideal because of their inability to duplicate the complex geometry, structure, and function of the ligament. Current advances in allograft transplantation and cryopreservation have led us to design and implement an experimental model for testing the feasibility of cryopreserved ACL allotransplantation. Groups of dogs were used to evaluate the effect of cryopreservation on ligament strength and to compare the relative performance of both autograft and allograft ACL transplants up to 18 months after implantation. The ligaments were examined mechanically, histologically, and microangiographically. The cryopreservation process and duration of storage had no effect on the biomechanical or structural properties of the ligament. The mechanical integrity of the allografts was similar to that of the autografts, with both achieving nearly 90% of control ligament strength by 36 weeks. Revascularization approached normal by 24 weeks in both autograft and allograft. No evidence of structural degradation or immunological reaction was seen. Based on these results, we believe that a cryopreserved ACL allograft can provide the ideal material for ACL reconstruction. We have outlined a surgical technique for harvesting and implanting this graft clinically.

  19. Anterior cruciate ligament allograft transplantation. Long-term function, histology, revascularization, and operative technique.

    PubMed

    Nikolaou, P K; Seaber, A V; Glisson, R R; Ribbeck, B M; Bassett, F H

    1986-01-01

    In recent years much effort has been devoted to finding a satisfactory replacement for the injured ACL. None of the reconstruction techniques used in the past can be considered ideal because of their inability to duplicate the complex geometry, structure, and function of the ligament. Current advances in allograft transplantation and cryopreservation have led us to design and implement an experimental model for testing the feasibility of cryopreserved ACL allotransplantation. Groups of dogs were used to evaluate the effect of cryopreservation on ligament strength and to compare the relative performance of both autograft and allograft ACL transplants up to 18 months after implantation. The ligaments were examined mechanically, histologically, and microangiographically. The cryopreservation process and duration of storage had no effect on the biomechanical or structural properties of the ligament. The mechanical integrity of the allografts was similar to that of the autografts, with both achieving nearly 90% of control ligament strength by 36 weeks. Revascularization approached normal by 24 weeks in both autograft and allograft. No evidence of structural degradation or immunological reaction was seen. Based on these results, we believe that a cryopreserved ACL allograft can provide the ideal material for ACL reconstruction. We have outlined a surgical technique for harvesting and implanting this graft clinically. PMID:3777311

  20. Re-Tensioning Technique to Cover the Graft With Remnant in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Noh, Jung Ho; Yoon, Kyoung Ho; Song, Sang Jun; Roh, Young Hak

    2014-01-01

    A number of remnant-preserving techniques to restore proprioceptive function in anterior cruciate ligament reconstruction have been described. However, they might not cover the significant amount of the graft with the synovium of the remnant in many cases. We introduce a simple technique that can cover nearly the entire graft with the synovium by re-tensioning the remnant, which might enhance synovialization of the graft and restoration of proprioception. PMID:25685673

  1. Phase-shifted distributed feedback laser with linearly chirped grating fabricated by reconstruction equivalent chirp technique

    NASA Astrophysics Data System (ADS)

    Li, Lianyan; Lu, Linlin; Li, Simin; Guo, Renjia; Shi, Yuechun; Chen, Xiangfei

    2014-09-01

    The phase-shifted distributed feedback (DFB) semiconductor laser with linearly chirped grating based on reconstruction equivalent chirp (REC) technique is theoretically analyzed and experimentally demonstrated for the first time. The asymmetric property of the lasing spectrum is analyzed according to the normalized threshold gain, and the different spectra from each facet of the laser are compared. Due to the low cost and fabrication flexibility, REC technique provides a promising way for the future practical applications of DFB lasers with chirped gratings.

  2. Fast and accurate computation of system matrix for area integral model-based algebraic reconstruction technique

    NASA Astrophysics Data System (ADS)

    Zhang, Shunli; Zhang, Dinghua; Gong, Hao; Ghasemalizadeh, Omid; Wang, Ge; Cao, Guohua

    2014-11-01

    Iterative algorithms, such as the algebraic reconstruction technique (ART), are popular for image reconstruction. For iterative reconstruction, the area integral model (AIM) is more accurate for better reconstruction quality than the line integral model (LIM). However, the computation of the system matrix for AIM is more complex and time-consuming than that for LIM. Here, we propose a fast and accurate method to compute the system matrix for AIM. First, we calculate the intersection of each boundary line of a narrow fan-beam with pixels in a recursive and efficient manner. Then, by grouping the beam-pixel intersection area into six types according to the slopes of the two boundary lines, we analytically compute the intersection area of the narrow fan-beam with the pixels in a simple algebraic fashion. Overall, experimental results show that our method is about three times faster than the Siddon algorithm and about two times faster than the distance-driven model (DDM) in computation of the system matrix. The reconstruction speed of our AIM-based ART is also faster than the LIM-based ART that uses the Siddon algorithm and DDM-based ART, for one iteration. The fast reconstruction speed of our method was accomplished without compromising the image quality.

  3. An improved technique for the reconstruction of former glacier mass-balance and dynamics

    NASA Astrophysics Data System (ADS)

    Carr, Simon; Coleman, Christopher

    2007-11-01

    The recognition of past glacier extent and dynamics is a fundamental aspect of investigations of the climatic sensitivity of glaciers, especially when examining short-lived climate events such as the Younger Dryas or Little Ice Age. Existing approaches to the reconstruction of glacier form and dynamics depend on speculative reasoning of key glacier dynamic parameters, including the role of basal slip and subglacial deformation in glacier mass-transfer. This study reviews approaches to glacier reconstruction, derivation of former glacier equilibrium line altitudes (ELA's) and estimation of mass-balance and dynamics, concluding that most reconstructions of glacier mass-balance are compromised by a lack of glaciological considerations. An alternative approach to glacier reconstruction is presented, demonstrated and discussed, by which an empirical relationship between ablation gradient and mass loss at the ELA is used to derive mass-balance, mass-flux through the ELA and average balance velocity at the ELA. This 'glaciological' approach is applied to four reconstructed glaciers to test previous interpretations that each reflects Younger Dryas glaciation in the UK. The study concludes that this approach provides a more robust technique for reconstructing former glacier dynamics, and may be applied to test geomorphological interpretations of former mountain glaciation.

  4. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement

    PubMed Central

    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

    2014-01-01

    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. PMID:18539658

  5. 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.

  6. 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

  7. Allograft safety in anterior cruciate ligament reconstruction.

    PubMed

    Cohen, Steven B; Sekiya, Jon K

    2007-10-01

    Allograft tissue seems to provide an excellent option for reconstruction of the ACL in the primary and revision setting. Although in general the risks of using allograft tissue in ACL reconstruction are low, the consequences of complications associated with disease or infection transmission or of recurrent instability secondary to graft failure are large. Surgeons should provide patients with the information available regarding allograft risks and should have thorough knowledge of the source and preparation of the grafts by their tissue bank before implantation for ACL reconstruction.

  8. Allograft safety in anterior cruciate ligament reconstruction.

    PubMed

    Cohen, Steven B; Sekiya, Jon K

    2007-10-01

    Allograft tissue seems to provide an excellent option for reconstruction of the ACL in the primary and revision setting. Although in general the risks of using allograft tissue in ACL reconstruction are low, the consequences of complications associated with disease or infection transmission or of recurrent instability secondary to graft failure are large. Surgeons should provide patients with the information available regarding allograft risks and should have thorough knowledge of the source and preparation of the grafts by their tissue bank before implantation for ACL reconstruction. PMID:17920955

  9. Esophagogastric reconstruction using remnant stomach with a single vessel pedicel: Technique and outcomes

    PubMed Central

    You, Bin; Hou, Sheng-cai; Li, Hui; Hu, Bin

    2014-01-01

    Esophageal cancer with a history of distal gastrectomy is a clinical problem. To our knowledge there have been no reports of remnant stomach fed from the left gastroepiploic artery being used in esophageal reconstruction. We, herein, report four cases of esophagogastric reconstruction using remnant stomach with a single left gastroepiploic vascular pedicel. It is more functional to use the remnant stomach than other replacements. Meanwhile, the gastric conduit fed from the left gastroepiploic artery showed sufficient vascularity and stable gastroesophageal anastomosis. The technique and outcomes in follow-up have proven feasible and save time. PMID:26767000

  10. Anterior Cruciate Ligament Reconstruction in Ehlers-Danlos Syndrome.

    PubMed

    Williams, John; Hutt, Jonathan; Rickman, Mark

    2015-01-01

    This report details the reconstruction of the anterior cruciate ligament in an 18-year-old man with Ehlers-Danlos syndrome (EDS). The reduced mechanical properties of the tissue in EDS can pose a challenge to the orthopaedic surgeon. In this case, we describe the use of a hamstring autograft combined with a Ligament Advanced Reinforcement System (LARS). There was a good radiographical, clinical, and functional outcome after two years. This technique gave a successful outcome in the reconstruction of the ACL in a patient with EDS and therefore may help surgeons faced with the same clinical scenario. PMID:26221555

  11. Techniques of the Tympanomastoidectomy with Reconstruction of the Posterior Bone Wall of the External Auditory Canal.

    PubMed

    Dankuc, Dragan; Vlaški, Ljiljana; Pejaković, Nemanja

    2015-01-01

    A combined tympanoplasty method, the mobile-bridge tympanoplasty, has been applied at the Clinic for Ear, Nose and Throat Diseases in Novi Sad since 1998. Mobile-bridge tympanoplasty is performed at our Clinic by applying Feldmann's procedure utilizing a microsurgical oscillating saw. It is a combination of closed and open techniques for surgical treatment of middle ear diseases. In addition to this technique, a method for reconstruction of the posterior bone wall of the external auditory canal was introduced. This procedure is applied in cases of damage or impairment of the bony ear canal wall using mastoid cortical temporal bone graft or modeled cartilage of the concha. Maintenance of general anatomical relations in the middle ear enables good ventilation of pneumatic spaces of the middle ear and Eustachian tube permeability, thus providing good conditions for ossicular chain reconstruction. The incidence of recurrent cholesteatoma in combined mobile-bridge tympanoplasty and tympanoplasty with reconstruction of the posterior bone wall was 6% in total. The incidence values for the recurrent cholesteatoma in closed tympanoplasty and in cases of open techniques were 10%. Mobile-bridge tympanoplasty and reconstruction of the posterior bone wall of external auditory canal are methods of choice in surgical treatment of middle ear cholesteatoma that progressed to the attic space, sinus tympani and facial recess. PMID:26506763

  12. New horizons for study of the cardiopulmonary and circulatory systems. [image reconstruction techniques

    NASA Technical Reports Server (NTRS)

    Wood, E. H.

    1976-01-01

    The paper discusses the development of computer-controlled three-dimensional reconstruction techniques designed to determine the dynamic changes in the true shape and dimensions of the epi- and endocardial surfaces of the heart, along with variable time base (stop-action to real-time) displays of the transmural distribution of the coronary microcirculation and the three-dimensional anatomy of the macrovasculature in all regions of the body throughout individual cardiac and/or respiratory cycles. A technique for reconstructing a cross section of the heart from multiplanar videoroentgenograms is outlined. The capability of high spatial and high temporal resolution scanning videodensitometry makes possible measurement of the appearance, mean transit and clearance of roentgen opaque substances in three-dimensional space through the myocardium with a degree of simultaneous anatomic and temporal resolution not obtainable by current isotope techniques. The distribution of a variety of selected chemical elements or biologic materials within a body portion can also be determined.

  13. Healing of the goat anterior cruciate ligament after a new suture repair technique and bioscaffold treatment.

    PubMed

    Nguyen, D Tan; Geel, Jurre; Schulze, Martin; Raschke, Michael J; Woo, Savio L-Y; van Dijk, C Niek; Blankevoort, Leendert

    2013-10-01

    technique and SIS. The mechanical outcome is not worse than previously reported for ACL reconstruction. In conclusion, the approach of using a new suture technique, with or without a bioscaffold to heal the ACL is promising. PMID:23725556

  14. Restriction in Hip Internal Rotation is Associated with an Increased Risk of ACL Injury in NFL Combine Athletes: A Clinical and Biomechanical Study

    PubMed Central

    Bedi, Asheesh; Warren, Russell F.; Oh, Youkeun K.; Wojtys, Edward M.; Oltean, Hanna N.; Ashton-Miller, James A.; Kelly, Bryan T.

    2013-01-01

    the risk of ACL injury due to the increased resistance to femoral internal axial rotation during a dynamic maneuver such as a pivot landing. This insight may lead to better interventions to prevent ACL injury and improved understanding of ACL reconstruction failure in the absence of clear technical errors.

  15. Gated cardiac scanning using limited-angle image reconstruction technique and information in the neighboring phases

    SciTech Connect

    Tam, K.C.; MacDonald, B.; Perez-Mendez, V.

    1984-02-01

    It is known that there are gaps in scan angle in gated cardiac scanning due to lack of synchronization between heart beat and CT machine rotation. The missing projections in these gaps result in artifacts in the reconstructed images. In a previous paper an iterative limited-angle reconstruction technique was employed to fill in the missing projections to remove the artifacts. It was found there that the root-mean-square errors of the limited-angle images were reduced to a level comparable to those of reconstructions using complete-angle information. In the present paper the results are further improved by using the scans of a neighboring portion of the cardiac cycle as a first estimate of the missing scans in the phase of interest when initializing the iterations. Such a modification provides a better starting point for the iterations.

  16. An algebraic iterative reconstruction technique for differential X-ray phase-contrast computed tomography.

    PubMed

    Fu, Jian; Schleede, Simone; Tan, Renbo; Chen, Liyuan; Bech, Martin; Achterhold, Klaus; Gifford, Martin; Loewen, Rod; Ruth, Ronald; Pfeiffer, Franz

    2013-09-01

    Iterative reconstruction has a wide spectrum of proven advantages in the field of conventional X-ray absorption-based computed tomography (CT). In this paper, we report on an algebraic iterative reconstruction technique for grating-based differential phase-contrast CT (DPC-CT). Due to the differential nature of DPC-CT projections, a differential operator and a smoothing operator are added to the iterative reconstruction, compared to the one commonly used for absorption-based CT data. This work comprises a numerical study of the algorithm and its experimental verification using a dataset measured at a two-grating interferometer setup. Since the algorithm is easy to implement and allows for the extension to various regularization possibilities, we expect a significant impact of the method for improving future medical and industrial DPC-CT applications.

  17. Long-term outcomes of allograft reconstruction of the anterior cruciate ligament.

    PubMed

    Lenehan, Eric A; Payne, W Barrett; Askam, Brad M; Grana, William A; Farrow, Lutul D

    2015-05-01

    Recent studies have found higher rates of failed reconstruction of the anterior cruciate ligament (ACL) with use of allograft when compared with autograft reconstruction. To evaluate the long-term outcomes of allograft ACL reconstruction, we retrospectively reviewed the cases of all patients who underwent allograft (n=99) or autograft (n=24) ACL reconstruction by 2 senior surgeons at a single institution over an 8-year period. Seventeen (17%) of the 99 allograft reconstructions required additional surgery. Reoperation and revision ACL reconstruction rates (30.8% and 20.5%, respectively) were much higher for patients 25 years of age or younger than for patients older than 25 years. In our cohort of NCAA (National Collegiate Athletic Association) Division I athletes, the revision ACL reconstruction rate was 62% for allograft ACL reconstruction and 0% for autograft reconstruction. Our study found that reoperation and revision rates for irradiated soft-tissue allograft ACL reconstruction were higher than generally quoted for autograft reconstruction. Given the extremely high graft failure rates in patients younger than 25 years, we recommend against routine use of irradiated soft-tissue allograft for ACL reconstruction in younger patients. PMID:25950536

  18. Long-term outcomes of allograft reconstruction of the anterior cruciate ligament.

    PubMed

    Lenehan, Eric A; Payne, W Barrett; Askam, Brad M; Grana, William A; Farrow, Lutul D

    2015-05-01

    Recent studies have found higher rates of failed reconstruction of the anterior cruciate ligament (ACL) with use of allograft when compared with autograft reconstruction. To evaluate the long-term outcomes of allograft ACL reconstruction, we retrospectively reviewed the cases of all patients who underwent allograft (n=99) or autograft (n=24) ACL reconstruction by 2 senior surgeons at a single institution over an 8-year period. Seventeen (17%) of the 99 allograft reconstructions required additional surgery. Reoperation and revision ACL reconstruction rates (30.8% and 20.5%, respectively) were much higher for patients 25 years of age or younger than for patients older than 25 years. In our cohort of NCAA (National Collegiate Athletic Association) Division I athletes, the revision ACL reconstruction rate was 62% for allograft ACL reconstruction and 0% for autograft reconstruction. Our study found that reoperation and revision rates for irradiated soft-tissue allograft ACL reconstruction were higher than generally quoted for autograft reconstruction. Given the extremely high graft failure rates in patients younger than 25 years, we recommend against routine use of irradiated soft-tissue allograft for ACL reconstruction in younger patients.

  19. Reconstruction of the mandible and the maxilla: the evolution of surgical technique.

    PubMed

    Genden, Eric M

    2010-01-01

    The upper and lower jaws play an essential role in mastication, articulation, and cosmetic form. The mandible provides support for tongue position and elevation of the larynx during swallowing, while the maxilla provides support for the nasal structures as well as an opposing structure to the mandible during mastication. The evolution of mandibular and maxillary reconstruction dates back to the early 19th century. Before the introduction of free tissue transfer, a variety of local flaps, regional flaps, and prosthetics were introduced, yet each was met with eventual failure. Since the introduction of free tissue transfer, mandibular and maxillary reconstruction has become as much of an art as it has a science. Whether the mandibular or the palatomaxillary defects are a result of trauma, congenital deformity, or tumor extirpation, the resultant effect often disrupts both form and function. With these considerations taken together, jaw reconstruction is a unique undertaking in which the artistic reconstruction of the facial skeleton is met with the science of reestablishing the mechanics of mastication. The site, size, and associated soft-tissue defects represent the 3 most important factors in determining the impact of a given defect on function and aesthetics. There is also an inherent difference between defects that are sustained in a controlled fashion, such as during cancer ablation, and those that result from trauma. The consideration of these complexities in jaw reconstruction is reflected in the wide variety of approaches and techniques that have evolved over the past century. PMID:20231587

  20. Application of the maximum entropy technique in tomographic reconstruction from laser diffraction data to determine local spray drop size distribution

    NASA Astrophysics Data System (ADS)

    Yongyingsakthavorn, Pisit; Vallikul, Pumyos; Fungtammasan, Bundit; Dumouchel, Christophe

    2007-03-01

    This work proposes a new deconvolution technique to obtain local drop size distributions from line-of-sight intensity data measured by laser diffraction technique. The tomographic reconstruction, based on the maximum entropy (ME) technique, is applied to forward scattered light signal from a laser beam scanning horizontally through the spray on each plane from the center to the edge of spray, resulting in the reconstructed scattered light intensities at particular points in the spray. These reconstructed intensities are in turn converted to local drop size distributions. Unlike the classical method of the onion peeling technique or other mathematical transformation techniques that yield unrealistic negative scattered light intensity solutions, the maximum entropy constraints ensure positive light intensity. Experimental validations to the reconstructed results are achieved by using phase Doppler particle analyzer (PDPA). The results from the PDPA measurements agree very well with the proposed ME tomographic reconstruction.

  1. [The effect of central anatomical single-bundle versus anatomical double-bundle reconstruction of the anterior cruciate ligament on knee stability. a clinical study].

    PubMed

    Komzák, M; Hart, R; Smíd, P; Puskeiler, M

    2014-01-01

    PURPOSE OF THE STUDY A comparison of the efficacy of central anatomical single-bundle (CASB) reconstruction with that of double-bundle (DB) repair of the anterior cruciate ligament (ACL) in relation to knee stability in anteroposterior translation (APT), internal rotation (IR) and external rotation (ER) of the joint. MATERIAL AND METHODS A total of 40 patients were evaluated; 20 had ACL reconstruction by the CASB technique using hamstrings and 20 underwent DB repair surgery. The average age was 31.3 years, and the group included 22 men and 18 women with 19 right and 21 left knees. The KT-1000 test was used to assess the amount of APT in the knee and rotational deviations were measured by the Rolimeter. In the DB patients, measurements were performed before surgery (on joints with ACL injury), then after reconstruction of the anteromedial (AM) or the posterolateral (PL) bundle and subsequently after repair of both ACL bundles. The CASB patients were assessed before and after graft insertion. RESULTS The average APT value was 18.5 mm for the pre-operative knees and it fell to 8.9 mm after AM bundle reconstruction. However, when the PL bundle was inserted in the first place, the average APT value was 13.1 mm only. The average values recorded after the DB and CASB reconstructions were 6.1 mm and 9.1 mm, respectively. The average IR range of motion in the pre-operative joints was 18.6 degrees. After AM bundle reconstruction it was 13.9 degrees and after PL bundle repair it was 15.3 degrees. In DB reconstruction the average IR value achieved 10.4 degrees, and in CASB repair surgery it was 13.7 degrees. The average ER range of motion in the pre-operative joints was 17.8 degrees. After AM bundle reconstruction it was 14.5 degrees and after PL bundle repair it was 14.9 degrees. In DB reconstruction the average ER value achieved 11.4 degrees, and in CASB repair surgery it was 14.5 degrees. DISCUSSION Rotational stability of the knee after ACL reconstruction is one of the

  2. Force reconstruction using the sum of weighted accelerations technique -- Max-Flat procedure

    SciTech Connect

    Carne, T.G.; Mayes, R.L.; Bateman, V.I.

    1993-12-31

    Force reconstruction is a procedure in which the externally applied force is inferred from measured structural response rather than directly measured. In a recently developed technique, the response acceleration time-histories are multiplied by scalar weights and summed to produce the reconstructed force. This reconstruction is called the Sum of Weighted Accelerations Technique (SWAT). One step in the application of this technique is the calculation of the appropriate scalar weights. In this paper a new method of estimating the weights, using measured frequency response function data, is developed and contrasted with the traditional SWAT method of inverting the mode-shape matrix. The technique uses frequency response function data, but is not based on deconvolution. An application that will be discussed as part of this paper is the impact into a rigid barrier of a weapon system with an energy-absorbing nose. The nose had been designed to absorb the energy of impact and to mitigate the shock to the interior components.

  3. Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature

    PubMed Central

    Keyhani, Sohrab; Vaziri, Arash Sharafat; shafiei, Hossein; Mardani-Kivi, Mohsen

    2015-01-01

    A rare and devastating complication following anterior cruciate ligament (ACL) revision reconstruction is femoral fracture. A 35-year old male soccer player with a history of ACL tear from one year ago, who underwent arthroscopic ACL reconstruction and functioned well until another similar injury caused ACL re-rupture. Revision of ACL reconstruction was performed and after failure of graft tension during the pumping, a fluoroscopic assessment showed a femoral condyle fracture. The patient referred to our knee clinic and was operated on in two stages first fixation of the fracture and then ACL re-revision after fracture healing was complete. Not inserting multiple guide pins, keeping a safe distance from the posterior cortex and giving more attention during graft tensioning, especially in revision surgeries, are all small points that can reduce the risk of fracture during the revision of ACL reconstruction. PMID:26110183

  4. Double figure-of-eight reconstruction technique for chronic anterior sternoclavicular joint dislocation.

    PubMed

    Kawaguchi, Kohei; Tanaka, Sayo; Yoshitomi, Hiroki; Nagai, Ichiro; Sato, Wakyo; Karita, Tasturo; Kondo, Taiji

    2015-05-01

    Sternoclavicular joint dislocations account for <5 % of all dislocations of the shoulder girdle. Whereas most cases of anterior dislocation do not experience symptoms, some patients with anterior instability remain symptomatic and require reconstructive surgery to stabilize the sternoclavicular joint. We present the case of a 57-year-old male diagnosed with sternoclavicular joint anterior dislocation and unusual swallowing difficulty while bending the neck forward. The patient was treated using a new and effective surgical technique of sternoclavicular joint reconstruction named "double figure-of-eight" using the ipsilateral gracilis tendon. Surgical outcome was successful, based on the Rockwood SC joint rating scale, and the patient maintained excellent stability even after 2 years. This new surgical technique offers superior stability, without harvest site morbidity, to patients with rare, severe, and chronic sternoclavicular joint dislocation. Level of evidence IV. PMID:24722676

  5. Patients With Isolated PCL Injuries Improve From Surgery as Much as Patients With ACL Injuries After 2 Years

    PubMed Central

    Owesen, Christian; Sivertsen, Einar Andreas; Engebretsen, Lars; Granan, Lars-Petter; Årøen, Asbjørn

    2015-01-01

    Background: Reports on outcome after posterior cruciate ligament (PCL) reconstruction often contain both isolated PCL and combined knee ligament injuries. This makes it difficult to conclude on the outcome after reconstruction of isolated PCL injuries. Purpose: To investigate the outcome after PCL reconstruction in patients with an isolated PCL injury and to compare this with the outcome of patients treated with reconstruction after isolated anterior cruciate ligament (ACL) injuries. Study Design: Cohort study; Level of evidence, 3. Methods: Seventy-one patients with an isolated PCL injury that was reconstructed surgically and who had registered in the Norwegian Knee Ligament Registry between 2004 and 2010 were included in this study. Patients with isolated ACL reconstructions (n = 9661) who had registered in the same period were included for comparison. Knee Injury and Osteoarthritis Outcome Score (KOOS) was used as the patient-reported outcome measure. Preoperative and 2-year postoperative KOOS scores were compared. Changes in KOOS score reported by the PCL patients were compared with changes reported by the ACL patients. Results: At the 2-year postoperative follow-up of the PCL-reconstructed patients, the patient-reported outcome was improved, measured by KOOS as follows: pain, 15.1 (95% CI, 8.5-21.8; P < .001); symptoms, 0.9 (95% CI, –6.6 to 8.3; P = .82); activities of daily living, 13.2 (95% CI, 6.6-13.9; P < .001); sports, 20.7 (95% CI, 11.8-29.4; P < .001); and quality of life, 26.6 (95% CI, 18.9-34.2; P < .001). According to the KOOS, the incremental improvements were similar for PCL and ACL patients. Time from injury to surgery was longer for the PCL patients compared with ACL patients (median, 21.5 vs 8.0 months; P < .001). Conclusion: Patients undergoing PCL reconstruction can expect the same improvements in KOOS score as patients undergoing ACL reconstruction. However, PCL patients start out with an inferior score on average and consequently end up

  6. Reconstruction of medial patello-femoral ligament: Comparison of two surgical techniques.

    PubMed

    Criscenti, G; De Maria, C; Sebastiani, E; Tei, M; Placella, G; Speziali, A; Vozzi, G; Cerulli, G

    2016-06-01

    The medial patello-femoral ligament is considered the most important passive patellar stabilizer and its proper functionality is essential for the patello-femoral joint stability. In this work, 18 human knees were randomly divided into two groups and reconstructed through two different surgical techniques: the "Through tunnel tendon" and the "Double converging tunnel" reconstructions. Subsequently, the samples were mechanically tested to evaluate the structural properties of reconstructed femur-MPFL-Patella complex (rFMPC). Particular attention was given to maintain the anatomical orientation between the patella and the graft. Both procedures showed lower stiffness and higher ultimate strain and absorbed energy compared to the native MPFL, but the advantages of the double converging tunnel technique are related to the restoration of the native MPFL sail-shape, to a better stress distribution on the patella, to the use of a single interference screw as fixation device and to the simplicity, rapidity and cost-effectivity of the surgical procedure. The evaluation of the structural properties of rMPFL is fundamental to evaluate the adequacy of the different techniques to restore the physiological structural properties of the native MPFL. PMID:26894660

  7. A software channel compression technique for faster reconstruction with many channels.

    PubMed

    Huang, Feng; Vijayakumar, Sathya; Li, Yu; Hertel, Sarah; Duensing, George R

    2008-01-01

    In magnetic resonance imaging, highly parallel imaging using coil arrays with a large number of elements is an area of growing interest. With increasing channel numbers for parallel acquisition, the increased reconstruction time and extensive computer memory requirements have become significant concerns. In this work, principal component analysis (PCA) is used to develop a channel compression technique. This technique efficiently reduces the size of parallel imaging data acquired from a multichannel coil array, thereby significantly reducing the reconstruction time and computer memory requirement without undermining the benefits of multichannel coil arrays. Clinical data collected with a 32-channel cardiac coil are used in all of the experiments. The performance of the proposed method on parallel, partially acquired data, as well as fully acquired data, was evaluated. Experimental results show that the proposed method dramatically reduces the processing time without considerable degradation in the quality of reconstructed images. It is also demonstrated that this PCA technique can be used to perform intensity correction in parallel imaging applications.

  8. Computer vision techniques for semi-automatic reconstruction of ripped-up documents

    NASA Astrophysics Data System (ADS)

    De Smet, Patrick; De Bock, Johan; Corluy, Els

    2003-08-01

    This paper investigates the use of computer vision techniques to aid in the semi-automatic reconstruction of torn or ripped-up documents. First, we discuss a procedure for obtaining a digital database of a given set of paper fragments using a flatbed image scanner, a brightly coloured scanner background, and a region growing algorithm. The contour of each segmented piece of paper is then traced around using a chain code algorithm and the contours are annotated by calculating a set of feature vectors. Next, the contours of the fragments are matched against each other using the annotated feature information and a string matching algorithm. Finally, the matching results are used to reposition the paper fragments so that a jigsaw puzzle reconstruction of the document can be obtained. For each of the three major components, i.e., segmentation, matching, and global document reconstruction, we briefly discuss a set of prototype GUI tools for guiding and presenting the obtained results. We discuss the performance and the reconstruction results that can be obtained, and show that the proposed framework can offer an interesting set of tools to forensic investigators.

  9. Wavefront printing technique with overlapping approach toward high definition holographic image reconstruction

    NASA Astrophysics Data System (ADS)

    Wakunami, K.; Oi, R.; Senoh, T.; Sasaki, H.; Ichihashi, Y.; Yamamoto, K.

    2016-06-01

    A hologram recording technique, generally called as "wavefront printer", has been proposed by several research groups for static three-dimensional (3D) image printing. Because the pixel number of current spatial light modulators (SLMs) is not enough to reconstruct the entire wavefront in recording process, typically, hologram data is divided into a set of subhologram data and each wavefront is recorded sequentially as a small sub-hologram cell in tiling manner by using X-Y motorized stage. However since previous works of wavefront printer do not optimize the cell size, the reconstructed images were degraded by obtrusive split line due to visible cell size caused by too large cell size for human eyesight, or by diffraction effect due to discontinuity of phase distribution caused by too small cell size. In this paper, we introduce overlapping recording approach of sub-holograms to achieve both conditions: enough smallness of apparent cell size to make cells invisible and enough largeness of recording cell size to suppress diffraction effect by keeping the phase continuity of reconstructed wavefront. By considering observing condition and optimization of the amount of overlapping and cell size, in the experiment, the proposed approach showed higher quality 3D image reconstruction while the conventional approach suffered visible split lines and cells.

  10. Autologous Cricoid Cartilage as a Graft for Airway Reconstruction in an Emergent Technique - A Case Report

    PubMed Central

    Izadi, Farzad; Vaghardoost, Reza; Derakhshandeh, Vita; Sobouti, Behnam; Ghavami, Yaser

    2016-01-01

    Introduction: Laryngotracheal stenosis can be caused after traumatic injuries to the neck from the subglottic larynx to the trachea. Patients with laryngotracheal stenosis often need a tracheotomy and occasionally may become tracheotomy dependent. Different procedures have been described for the management of these lesions. Management options include techniques of endoscopic dilation, laser resection, laryngo-fissure, and an innovative array of plastic reconstructions with or without the use of stents. Case Report: This paper presents airway reconstruction in a young patient with severe subglottic stenosis due to a blunt trauma to the neck, who was treated using particles of an autologous fractured cricoid cartilage as the source for airway augmentation. An incision was made in the anterior midline of the cricoid lamina and deepened through the scar tissue to the posterior cricoid lamina. Then two lateral incisions (right & left) were made in the cricoid lamina and fractured cartilage particles and the scar tissue were removed via these two lateral incisions. The mucosal lining at the right and left of the midline incision, after debulking, were sutured to a lateral position. Thereafter three cartilage particles were used to reconstruct the anterior cricoid lamina and augment the lumen. Conclusion: It is worth to mention that an autologus cartilage graft can be used for certain cases with traumatic airway stenosis. Further follow up and more patients are needed to approve this method of reconstructive surgery in emergent situations. PMID:27280104

  11. 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,…

  12. [The ACL tear from the pre-operative analysis to a 2-year follow-up, influence of the graft choice on the subjective and objective evaluation].

    PubMed

    Dejour, D; Potel, J-F; Gaudot, F; Panisset, J-C; Condouret, J

    2008-12-01

    This study is a synthesis of three series. The first study was prospective on 418 patients with an anterior cruciate ligament (ACL) tear (group I). Two population of ACL ruptures were identified. One population with a postero-lateral bundle preserved in 16%, the mean medial anterior tibial translation side to side was 4.97 mm, the Lachman test was delayed in 40% with no or glide pivot shift in 73%. The second population with a complete ACL tear had a mean medial anterior tibial translation side to side of 7.93 mm, the Lachman test was soft in 98% with gross pivot shift in 80%. The second study was a retrospective study on 258 patients (group II) at 26 months follow-up, it correlated the impact of the type of graft on the clinical objective and subjective results. Twenty-eight percent had anterior knee pain, 33% for the patellar tendon and 25% for the hamstrings, the subjective IKDC was significantly lower for the painful knees, and 68% of the patellar tendon had a hypoesthesia and only 32% for the hamstrings. The ability to walk on the knee was 68% for the hamstrings and 35% for the patellar tendon. The third study was retrospective on 127 patients, 24 months after ACL reconstruction (group III), all were tested on a isokinetic machine for the extensor, the flexor and the internal rotator. In the total population, a 10% extensor and flexor deficit and a 5% rotator deficit was noted. A significant difference between patellar tendon and hamstrings in terms of muscular recovery was found. It pointed out that a more specific rehabilitation should be done on the hamstring group. The muscular recovery was correlated to the highest subjective score. This study allowed the surgeon to be more specific in the ACL tear definition, to adapt the graft choice to the type of sport activity but also to the type of work the patient does and finally to modify the rehabilitation protocol for the hamstring technique.

  13. An improved phase shift reconstruction algorithm of fringe scanning technique for X-ray microscopy

    SciTech Connect

    Lian, S.; Yang, H.; Kudo, H.; Momose, A.; Yashiro, W.

    2015-02-15

    The X-ray phase imaging method has been applied to observe soft biological tissues, and it is possible to image the soft tissues by using the benefit of the so-called “Talbot effect” by an X-ray grating. One type of the X-ray phase imaging method was reported by combining an X-ray imaging microscope equipped by a Fresnel zone plate with a phase grating. Using the fringe scanning technique, a high-precision phase shift image could be obtained by displacing the grating step by step and measuring dozens of sample images. The number of the images was selected to reduce the error caused by the non-sinusoidal component of the Talbot self-image at the imaging plane. A larger number suppressed the error more but increased radiation exposure and required higher mechanical stability of equipment. In this paper, we analyze the approximation error of fringe scanning technique for the X-ray microscopy which uses just one grating and proposes an improved algorithm. We compute the approximation error by iteration and substitute that into the process of reconstruction of phase shift. This procedure will suppress the error even with few sample images. The results of simulation experiments show that the precision of phase shift image reconstructed by the proposed algorithm with 4 sample images is almost the same as that reconstructed by the conventional algorithm with 40 sample images. We also have succeeded in the experiment with real data.

  14. A Novel Technique to Reconstruct Tricuspid Valve Anterior Leaflet in Massive Endocarditis.

    PubMed

    Di Giammarco, Gabriele; Marinelli, Daniele; Foschi, Massimiliano; Di Mauro, Michele

    2016-01-01

    Tricuspid valve (TV) endocarditis is a common complication in intravenous drug addicts. In case of TV replacement, the main issue is the high risk of new endocarditis on TV prosthesis. On November 2014, a 44 year-old male patient with a history of intravenous drug addiction was referred for TV endocarditis owing to Staphylococcus aureus and severe regurgitation complicated by pulmonary embolism and heart failure. Preoperative echocardiography showed a large vegetation of the anterior leaflet (1.95 × 0.92 cm) covering a huge hole in the leaflet itself. Herein, a novel technique for the treatment of massive endocarditis of the TV is described. Complete anterior leaflet reconstruction was achieved with a huge equine pericardium patch along with native chordae tendinae reimplantation onto the free edge of the patch. Finally, a ring annuloplasty was performed to stabilize the valve reconstruction. The postoperative course was uneventful with evidence of trivial tricuspid regurgitation and no signs of IE recurrence. Complete reconstruction of the anterior leaflet with a patch of xenopericardium and native chordae tendinae reimplantation might be an alternative technique to TV replacement. PMID:27612147

  15. Multiple Looping Technique for Tibial Fixation in Posterior Cruciate Ligament Reconstruction of the Knee

    PubMed Central

    Noh, Jung Ho; Yoon, Kyoung Ho; Song, Sang Jun; Roh, Young Hak; Lee, Jae Woo

    2015-01-01

    The outcomes of posterior cruciate ligament reconstruction may be negatively affected by insufficient tibial tunnel fixation due to relatively lower bone density of the proximal tibia. We introduce a new technique of tibial fixation for posterior cruciate ligament reconstruction using free tendon Achilles allograft that is less affected by the bone density of the tibial metaphysis. PMID:25973367

  16. Reconstruction of Congenital Isolated Alar Defect Using Mutaf Triangular Closure Technique in Pediatric Patients.

    PubMed

    Temel, Metin; Gunal, Ertan; Kahraman, Serif Samil

    2016-06-01

    Congenital isolated alar defects are extremely rare, occurring in approximately 1 in 20,000 to 40,000 live births. The patients are presented here of 2 pediatric patients operated on for congenital isolated alar defect. The reconstruction of congenital isolated alar defects was made in a 3-layered fashion. The skin defects were covered using the Mutaf triangular closure technique in which 2 cutaneous local flaps are designed in an unequal Z-plasty manner. Conchal cartilage graft was used between the skin and mucosal closure to replace the missing part of the lower lateral cartilage in these patients. The early results were promising in Patient 1, but sufficient improvement was detected in the alar cartilage postoperative follow-up period in Patient 2. Hence, this patient required revision 1 to 2 years postoperatively. This technique provides excellent aesthetic and functional results, except for this problem in Tessier 2 cleft patients. The use of the Stair step flap technique with Mutaf triangle closure technique achieved cosmetically and functionally excellent results in the reconstruction and repair of a large, irregular, narrow cleft, in the inadequate rotation of the lateral part of the lower lateral cartilage. However, because of this problem, evaluation of the long-term follow-up of patients is necessary. PMID:27192642

  17. An effective data mining technique for reconstructing gene regulatory networks from time series expression data.

    PubMed

    Ma, Patrick C H; Chan, Keith C C

    2007-06-01

    Recent development in DNA microarray technologies has made the reconstruction of gene regulatory networks (GRNs) feasible. To infer the overall structure of a GRN, there is a need to find out how the expression of each gene can be affected by the others. Many existing approaches to reconstructing GRNs are developed to generate hypotheses about the presence or absence of interactions between genes so that laboratory experiments can be performed afterwards for verification. Since, they are not intended to be used to predict if a gene in an unseen sample has any interactions with other genes, statistical verification of the reliability of the discovered interactions can be difficult. Furthermore, since the temporal ordering of the data is not taken into consideration, the directionality of regulation cannot be established using these existing techniques. To tackle these problems, we propose a data mining technique here. This technique makes use of a probabilistic inference approach to uncover interesting dependency relationships in noisy, high-dimensional time series expression data. It is not only able to determine if a gene is dependent on another but also whether or not it is activated or inhibited. In addition, it can predict how a gene would be affected by other genes even in unseen samples. For performance evaluation, the proposed technique has been tested with real expression data. Experimental results show that it can be very effective. The discovered dependency relationships can reveal gene regulatory relationships that could be used to infer the structures of GRNs.

  18. Experience with new techniques for extraanatomic arterial reconstruction of the lower limb.

    PubMed

    Katsamouris, A N; Giannoukas, A D; Alamanos, E; Karniadakis, S; Petrakis, I; Drositis, I; Touloupakis, E; Mouloudi, E; Siatitsas, I

    2000-09-01

    The aim of this report is to present our experience with new techniques for extraanatomic lower limb arterial reconstruction. Two techniques are described here of construction of an extraanatomical bypass for lower limb revascularization either through the wing of the iliac bone or underneath the iliopsoas fascia through the muscular lacuna close to the anterior superior spine of the iliac crest. Both techniques are recommended for the treatment of a severely injured groin, such as in patients with pelvic malignancy and/or an acute groin bleeding due to postirradiation femoral artery erosion or an infected femoropopliteal bypass graft with severe upper medial thigh sepsis. These techniques were used in nine patients (five with malignancy and four with an infected femoropopliteal bypass graft). Our results showed that the transosseous route through the wing of the iliac bone or underneath the iliopsoas fascia through the muscular lacuna may be considered effective alternate routes for lower limb arterial extraanatomic reconstruction when the common femoral cannot be used for arterial inflow.

  19. Optical asymmetric cryptography based on elliptical polarized light linear truncation and a numerical reconstruction technique.

    PubMed

    Lin, Chao; Shen, Xueju; Wang, Zhisong; Zhao, Cheng

    2014-06-20

    We demonstrate a novel optical asymmetric cryptosystem based on the principle of elliptical polarized light linear truncation and a numerical reconstruction technique. The device of an array of linear polarizers is introduced to achieve linear truncation on the spatially resolved elliptical polarization distribution during image encryption. This encoding process can be characterized as confusion-based optical cryptography that involves no Fourier lens and diffusion operation. Based on the Jones matrix formalism, the intensity transmittance for this truncation is deduced to perform elliptical polarized light reconstruction based on two intensity measurements. Use of a quick response code makes the proposed cryptosystem practical, with versatile key sensitivity and fault tolerance. Both simulation and preliminary experimental results that support theoretical analysis are presented. An analysis of the resistance of the proposed method on a known public key attack is also provided.

  20. Modified flexor digitorum superficialis slip technique for A4 pulley reconstruction.

    PubMed

    Odobescu, A; Radu, A; Brutus, J-P; Gilardino, M S

    2010-07-01

    We describe a variation in the A4 pulley reconstruction technique using one slip of the flexor digitorum superficialis insertion and report the results of a biomechanical analysis of this reconstruction in cadavers. While conserving the distal bony insertion, one slip of flexor digitorum superficialis is transferred over the flexor digitorum profundus tendon and sutured to the contralateral superficialis slip insertion. This creates a new pulley at the base of the original A4 pulley that can be adjusted to accommodate an FDP repair of increased bulk. We found a 57% reduction in excess excursion due to bowstringing when compared with no repair. Furthermore the repairs were sturdy, 94% of specimens maintaining their integrity when a proximally directed force of 50 N was applied. PMID:20427405

  1. Medial Femoral Condyle Free Flap for Nasal Reconstruction: New Technique for Full-Thickness Nasal Defects

    PubMed Central

    Battaglia, Paolo; Turri-Zenoni, Mario; Tamborini, Federico; Giudice, Marco; Sallam, Davide; Corno, Martina; Pietrobon, Giacomo; Valdatta, Luigi; Castelnuovo, Paolo

    2016-01-01

    Summary: The nose is a functionally complex organ implicated in breathing, olfaction, and phonation, with a critical role also in the aesthetic appearance of a person. This latter aspect should be carefully considered whenever a total or subtotal rhinectomy is performed for resection of locally advanced nasal cancer. To reconstruct large nasal defects, several techniques were described, including the use of cartilaginous grafts, bony grafts, local flaps, and free flaps. In cases of extensive full-thickness resections, free flaps probably represent the most adequate option. The aim of this report is to present the functional and aesthetical outcomes of a reconstruction of the nose after rhinectomy, using the medial femoral condyle free flap associated with the forehead flap. PMID:27757320

  2. A prototype system and reconstruction algorithms for electrical impedance technique in medical body imaging.

    PubMed

    Kim, Y; Woo, H W

    1987-01-01

    We have developed an impedance imaging system to reconstruct cross-sectional images of the body's electrical characteristics based on static tissue impedance. The hardware system consists of a data collection subsystem and the Intel 380 host microcomputer system with an Intel 80286 microprocessor, an Intel 80287 numeric data processor, and an Intel 80186 microprocessor-based display board. The system is capable of initiating a data collection from an array of current-sensing electrodes and reconstructing impedance images based on these data measurements. We have tested the data collection subsystem with physical phantom models, and we have found that the prototype system is capable of discriminating high resistivity regions in contrast with the low resistivity background. Our system is flexible in that each electrode's function (sensing currents, applying voltages, grounding body surfaces, and disconnected from the body) can be programmed individually so that a variety of electrode configurations for different projection techniques can be tested for optimal system performance. Various reconstruction algorithms have been developed and tested particularly for this imaging modality. Since a computer body model is needed for some impedance reconstruction algorithms, we have created two- and three-dimensional computer body models based on the finite element method approach, and verified our finite element modelling technique by building physical phantoms and comparing measured experimental results with simulation results predicted by the computer model. We have found that the sensitivity is a function of position, pixel size (image resolution) and background resistivity. We have also tried to compensate the low sensitivity of impedance changes in the central region.(ABSTRACT TRUNCATED AT 250 WORDS)

  3. How to avoid the risk of intraoperative cartilage damage in anatomic four tunnel double bundle anterior cruciate ligament reconstruction.

    PubMed

    Siebold, Rainer; Benetos, Ioannis S; Sartory, Nico; He, Zhenming; Hariri, Nawid; Pässler, Hans H

    2010-01-01

    Double bundle (DB) anterior cruciate ligament (ACL) reconstruction is technically demanding. In order to create four anatomical anteromedial (AM) and posterolateral (PL) bone tunnels many surgeons adopt new ways of tibial and femoral bone tunnel drilling. From surgical experience, these technical changes might increase the risk for intraoperative pitfalls. An intraoperative articular cartilage damage to the medial femoral condyle or the medial tibial plateau could be disastrous for the patient. It may be caused by an insufficient anteromedial portal technique for femoral AM and PL bone tunnel drilling or flat tibial AM or PL bone tunnel reaming. Potential pitfalls may be avoided by small modifications to the surgical technique. In this present technical note, a sequence of surgical steps are described, which may help to avoid articular cartilage damage to the medial femoral condyle and medial tibial plateau in anatomical four tunnel DB ACL reconstruction.

  4. 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

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

    PubMed

    Krishnan, Chandramouli; Theuerkauf, Paul

    2015-08-01

    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.

  6. Hamstring graft fixation in MPFL reconstruction at the patella using a transosseous suture technique.

    PubMed

    Siebold, Rainer; Chikale, Shivanand; Sartory, Nico; Hariri, Nawid; Feil, Sven; Pässler, Hans H

    2010-11-01

    Controversy still exists about fixation methods of a hamstring graft to the patella in case of medial patellofemoral ligament (MPFL) reconstruction. This article presents a surgical technique of hamstring tendon graft fixation to the anatomical MPFL insertion on the patella using transosseous sutures. A superficial bony sulcus is created at the anatomical MPFL insertion site on the medial patellar rim with a bur. A looped hamstring tendon graft is fixed to this superficial sulcus by a pair of nonresorbable transosseous sutures passed across the patella. The retinaculum is sutured on top of the hamstring tendon graft at the level of the patella for additional fixation. The technique avoids bone tunnels as well as hardware at the patella. It reduces the risk of intraoperative or postoperative patella fracture or implant-related complications. The stable transosseous fixation technique allows for early rehabilitation.

  7. Optical implementation of improved resolution with intermediate-view reconstruction technique based on integral imaging

    NASA Astrophysics Data System (ADS)

    Lee, Keong-Jin; Lee, Sang-Tae; Oh, Yong-Seok; Hong, Suk-Pyo; Kim, Chang-Keun; Kim, Eun-Soo

    2008-02-01

    To overcome the viewing resolution limit defined by the Nyquist sampling theorem for a given lenslet pitch, a Moving Array-Lens Technique (MALT) was developed in 3-D integral imaging technique. Even though the MALT is an effective method for resolution improvement of Integral Imaging, this cannot be applied to a real-time 3-D integral imaging display system because of its mechanical movement. In this paper, we propose an integral imaging display using a computational pick-up method based on Intermediate-View Reconstruction Technique instead of optical moving pickup. We show that the proposed system can provide optically resolution-improved 3-D images of integral imaging by use of EIs generated by the IVRT through the optical experiments.

  8. Septic arthritis following anterior cruciate ligament reconstruction using tendon allografts--Florida and Louisiana, 2000.

    PubMed

    2001-12-01

    In the United States, approximately 50,000 knee surgeries are performed each year for repairing anterior cruciate ligament (ACL) injuries. Tissue allografts frequently are used for ACL reconstruction, and septic arthritis is a rare complication of such procedures. This report describes four patients who acquired postsurgical septic arthritis probably associated with contaminated bone-tendon-bone allografts used for ACL reconstruction. Effective sterilization methods that do not functionally alter musculoskeletal tissue are needed to prevent allograft-related infections.

  9. Results of meniscectomy and meniscal repair in anterior cruciate ligament reconstruction

    PubMed Central

    DELEDDA, DAVIDE; ROSSO, FEDERICA; COTTINO, UMBERTO; BONASIA, DAVIDE EDOARDO; ROSSI, ROBERTO

    2015-01-01

    Meniscal tears are commonly associated with anterior cruciate ligament (ACL) injuries. A deficient medial meniscus results in knee instability and could lead to higher stress forces on the ACL reconstruction. Comparison of results in meniscectomy and meniscal repairs revealed worse clinical outcomes in meniscectomy, but higher re-operation rates in meniscal repairs. Our aim was to review the results of ACL reconstruction associated with meniscectomy or meniscal repair. PMID:26889472

  10. Septic arthritis following anterior cruciate ligament reconstruction using tendon allografts--Florida and Louisiana, 2000.

    PubMed

    2001-12-01

    In the United States, approximately 50,000 knee surgeries are performed each year for repairing anterior cruciate ligament (ACL) injuries. Tissue allografts frequently are used for ACL reconstruction, and septic arthritis is a rare complication of such procedures. This report describes four patients who acquired postsurgical septic arthritis probably associated with contaminated bone-tendon-bone allografts used for ACL reconstruction. Effective sterilization methods that do not functionally alter musculoskeletal tissue are needed to prevent allograft-related infections. PMID:11770503

  11. Evaluation of image collection requirements for 3D reconstruction using phototourism techniques on sparse overhead data

    NASA Astrophysics Data System (ADS)

    Ontiveros, Erin; Salvaggio, Carl; Nilosek, David; Raqueño, Nina; Faulring, Jason

    2012-06-01

    Phototourism is a burgeoning field that uses collections of ground-based photographs to construct a three-dimensional model of a tourist site, using computer vision techniques. These techniques capitalize on the extensive overlap generated by the various visitor-acquired images from which a three-dimensional point cloud can be generated. From there, a facetized version of the structure can be created. Remotely sensed data tends to focus on nadir or near nadir imagery while trying to minimize overlap in order to achieve the greatest ground coverage possible during a data collection. A workflow is being developed at Digital Imaging and Remote Sensing (DIRS) Group at the Rochester Institute of Technology (RIT) that utilizes these phototourism techniques, which typically use dense coverage of a small object or region, and applies them to remotely sensed imagery, which involves sparse data coverage of a large area. In addition to this, RIT has planned and executed a high-overlap image collection, using the RIT WASP system, to study the requirements needed for such three-dimensional reconstruction efforts. While the collection was extensive, the intention was to find the minimum number of images and frame overlap needed to generate quality point clouds. This paper will discuss the image data collection effort and what it means to generate and evaluate a quality point cloud for reconstruction purposes.

  12. Saft-reconstruction in ultrasonic immersion technique using phased array transducers

    NASA Astrophysics Data System (ADS)

    Kitze, J.; Prager, J.; Boehm, R.; Völz, U.; Montag, H.-J.

    2012-05-01

    The two main preconditions for the application of the Synthetic Aperture Focusing Technique (SAFT) are: (i) a large divergence of the sound beam of the transducer and (ii) an exact knowledge about the sound propagation path. These requirements are easily fulfilled for point sources directly mounted on the surface of the specimen. In many cases, however, the transducer is wedge mounted and/or coupled using a water delay line, e.g. in immersion technique. These delay lines change the beam index and the propagation path has to be evaluated for each pixel separately considering Fermat's principle. Using phased array transducers, a sector scan can improve the divergence of the sound beam. The introduced method combines the advantages of using a phased array transducer in immersion technique to improve SAFT reconstruction. An algorithm is presented accounting the influence of the delay line on the reconstruction method. The applicability of the algorithm is shown by validation with simulated echo responses and with experimental results collected from a specimen with artificial flaws.

  13. Reconstruction of a energy wave spectrum using a non-intrusive technique

    NASA Astrophysics Data System (ADS)

    Vargas, Diana; Lugo, Adolfo; Mendoza, Edgar; Silva, Rodolfo

    2014-11-01

    For studies taken in a wave flume, it is frequent to use wave gauges to measure directly the free surface fluctuations. Sometimes these gauges can interfere the measures because this probes act as obstacles to water. Therefore we designed a non intrusive technique using a bubble curtain. In this work we pretend to reconstruct the energy wave spectrum of regular and irregular waves, generated in a wave flume, assuming linear and non linear wave theory by analyzing the time series of the bubbles velocity field given with the aid of PIV.

  14. Dynamically adaptive mesh refinement technique for image reconstruction in optical tomography.

    PubMed

    Soloviev, Vadim Y; Krasnosselskaia, Lada V

    2006-04-20

    A novel adaptive mesh technique is introduced for problems of image reconstruction in luminescence optical tomography. A dynamical adaptation of the three-dimensional scheme based on the finite-volume formulation reduces computational time and balances the ill-posed nature of the inverse problem. The arbitrary shape of the bounding surface is handled by an additional refinement of computational cells on the boundary. Dynamical shrinking of the search volume is introduced to improve computational performance and accuracy while locating the luminescence target. Light propagation in the medium is modeled by the telegraph equation, and the image-reconstruction algorithm is derived from the Fredholm integral equation of the first kind. Stability and computational efficiency of the introduced method are demonstrated for image reconstruction of one and two spherical luminescent objects embedded within a breastlike tissue phantom. Experimental measurements are simulated by the solution of the forward problem on a grid of 5x5 light guides attached to the surface of the phantom.

  15. Uncertainty assessment of imaging techniques for the 3D reconstruction of stent geometry.

    PubMed

    Cosentino, Daria; Zwierzak, Iwona; Schievano, Silvia; Díaz-Zuccarini, Vanessa; Fenner, John W; Narracott, Andrew J

    2014-08-01

    This paper presents a quantitative assessment of uncertainty for the 3D reconstruction of stents. This study investigates a CP stent (Numed, USA) used in congenital heart disease applications with a focus on the variance in measurements of stent geometry. The stent was mounted on a model of patient implantation site geometry, reconstructed from magnetic resonance images, and imaged using micro-computed tomography (CT), conventional CT, biplane fluoroscopy and optical stereo-photogrammetry. Image data were post-processed to retrieve the 3D stent geometry. Stent strut length, separation angle and cell asymmetry were derived and repeatability was assessed for each technique along with variation in relation to μCT data, assumed to represent the gold standard. The results demonstrate the performance of biplanar reconstruction methods is comparable with volumetric CT scans in evaluating 3D stent geometry. Uncertainty on the evaluation of strut length, separation angle and cell asymmetry using biplanar fluoroscopy is of the order ±0.2mm, 3° and 0.03, respectively. These results support the use of biplanar fluoroscopy for in vivo measurement of 3D stent geometry and provide quantitative assessment of uncertainty in the measurement of geometric parameters.

  16. Class of backpropagation techniques for limited-angle reconstruction in microwave tomography

    SciTech Connect

    Paladhi, P. Roy; Tayebi, A.; Udpa, L.; Udpa, S.; Sinha, A.

    2015-03-31

    Filtered backpropagation (FBPP) is a well-known technique used in Diffraction Tomography (DT). For accurate reconstruction using FBPP, full 360° angular coverage is necessary. However, it has been shown that using some inherent redundancies in the projection data in a tomographic setup, accurate reconstruction is still possible with 270° coverage which is called the minimal-scan angle range. This can be done by applying weighing functions (or filters) on projection data of the object to eliminate the redundancies and accurately reconstruct the image from 270° coverage. This paper demonstrates procedures to generate many general classes of these weighing filters. These are all equivalent at 270° coverage but vary in performance at lower angular coverages and in presence of noise. This paper does a comparative analysis of different filters when angular coverage is lower than minimal-scan angle of 270°. Simulation studies have been done to find optimum weight filters for sub-minimal angular coverage (<270°)

  17. Weighted simultaneous algebraic reconstruction technique for tomosynthesis imaging of objects with high-attenuation features

    SciTech Connect

    Levakhina, Y. M.; Mueller, J.; Buzug, T. M.; Duschka, R. L.; Vogt, F.; Barkhausen, J.

    2013-03-15

    Purpose: This paper introduces a nonlinear weighting scheme into the backprojection operation within the simultaneous algebraic reconstruction technique (SART). It is designed for tomosynthesis imaging of objects with high-attenuation features in order to reduce limited angle artifacts. Methods: The algorithm estimates which projections potentially produce artifacts in a voxel. The contribution of those projections into the updating term is reduced. In order to identify those projections automatically, a four-dimensional backprojected space representation is used. Weighting coefficients are calculated based on a dissimilarity measure, evaluated in this space. For each combination of an angular view direction and a voxel position an individual weighting coefficient for the updating term is calculated. Results: The feasibility of the proposed approach is shown based on reconstructions of the following real three-dimensional tomosynthesis datasets: a mammography quality phantom, an apple with metal needles, a dried finger bone in water, and a human hand. Datasets have been acquired with a Siemens Mammomat Inspiration tomosynthesis device and reconstructed using SART with and without suggested weighting. Out-of-focus artifacts are described using line profiles and measured using standard deviation (STD) in the plane and below the plane which contains artifact-causing features. Artifacts distribution in axial direction is measured using an artifact spread function (ASF). The volumes reconstructed with the weighting scheme demonstrate the reduction of out-of-focus artifacts, lower STD (meaning reduction of artifacts), and narrower ASF compared to nonweighted SART reconstruction. It is achieved successfully for different kinds of structures: point-like structures such as phantom features, long structures such as metal needles, and fine structures such as trabecular bone structures. Conclusions: Results indicate the feasibility of the proposed algorithm to reduce typical

  18. CT reconstruction techniques for improved accuracy of lung CT airway measurement

    SciTech Connect

    Rodriguez, A.; Ranallo, F. N.; Judy, P. F.; Gierada, D. S.; Fain, S. B.

    2014-11-01

    Purpose: To determine the impact of constrained reconstruction techniques on quantitative CT (qCT) of the lung parenchyma and airways for low x-ray radiation dose. Methods: Measurement of small airways with qCT remains a challenge, especially for low x-ray dose protocols. Images of the COPDGene quality assurance phantom (CTP698, The Phantom Laboratory, Salem, NY) were obtained using a GE discovery CT750 HD scanner for helical scans at x-ray radiation dose-equivalents ranging from 1 to 4.12 mSv (12–100 mA s current–time product). Other parameters were 40 mm collimation, 0.984 pitch, 0.5 s rotation, and 0.625 mm thickness. The phantom was sandwiched between 7.5 cm thick water attenuating phantoms for a total length of 20 cm to better simulate the scatter conditions of patient scans. Image data sets were reconstructed using STANDARD (STD), DETAIL, BONE, and EDGE algorithms for filtered back projection (FBP), 100% adaptive statistical iterative reconstruction (ASIR), and Veo reconstructions. Reduced (half) display field of view (DFOV) was used to increase sampling across airway phantom structures. Inner diameter (ID), wall area percent (WA%), and wall thickness (WT) measurements of eight airway mimicking tubes in the phantom, including a 2.5 mm ID (42.6 WA%, 0.4 mm WT), 3 mm ID (49.0 WA%, 0.6 mm WT), and 6 mm ID (49.0 WA%, 1.2 mm WT) were performed with Airway Inspector (Surgical Planning Laboratory, Brigham and Women’s Hospital, Boston, MA) using the phase congruency edge detection method. The average of individual measures at five central slices of the phantom was taken to reduce measurement error. Results: WA% measures were greatly overestimated while IDs were underestimated for the smaller airways, especially for reconstructions at full DFOV (36 cm) using the STD kernel, due to poor sampling and spatial resolution (0.7 mm pixel size). Despite low radiation dose, the ID of the 6 mm ID airway was consistently measured accurately for all methods other than STD

  19. “The Superficial Quad Technique” for Medial Patellofemoral Ligament Reconstruction: The Surgical Video Technique

    PubMed Central

    Goyal, Deepak

    2015-01-01

    With the introduction of the superficial quad technique, there has been a recent revival of interest in the quadriceps tendon as a graft choice for medial patellofemoral ligament (MPFL) reconstruction. The superficial quad technique has many anatomic advantages because the length, breadth, and thickness of the graft are similar to those of the native MPFL; moreover, the graft provides a continuous patellar attachment at the superior half of the medial border of the patella. The technique requires neither a patellar bony procedure nor patellar hardware. Biomechanically, the mean strength and stiffness of the graft are very similar to those of the native MPFL. The anatomic and biomechanical advantages depend on correct identification of the anatomic superficial lamina of the quadriceps tendon; hence the correct harvesting technique for the superficial lamina is crucial. Various sub-techniques for harvesting the quadriceps graft have emerged recently, such as superficial strip, pedicled, or partial graft harvesting; these can create confusion for surgeons. Additional confusion related to the preparation and fixation of the graft should also be addressed to avoid any potential complications. A step-by-step video of the superficial quad technique is presented, covering the exact dissection of the graft material and its preparation, delivery, and fixation. PMID:26900556

  20. Distal thumb reconstruction with a great toe partial-nail preserving transfer technique.

    PubMed

    Woo, S H; Seul, J H

    1998-01-01

    The great toe partial-nail preserving transfer technique is another modification for distal thumb reconstruction in composite defects at or below the interphalangeal joint of the thumb. Noting the size difference of the nail width between the great toe and thumb, the authors dissected only a thumb nail width and skin flap from the great toe, leaving the remainder of the medial skin flap and nail of the great toe at the donor site. A total of 25 cases between 1993 and 1996 were performed using this technique, and the mean follow-up period was more than 12 months. The reconstructed thumb had a better cosmesis with a more natural appearance. At long-term follow-up, the thumb nail width decreased an average of 1.8 mm, but the pulp volume was almost the same as that of the normal contralateral side. The average static 2-point discrimination was less than 9.0 mm. In cases with preserved interphalangeal joint, an average of 48 degrees of range of motion with key-pinch of 80 percent of that of the normal contralateral thumb was achieved. The final appearance of the donor site with partial nail looks like a brachymetatarsia. PMID:9427924

  1. 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].

  2. Popliteus function in ACL-deficient patients.

    PubMed

    Weresh, M J; Gabel, R H; Brand, R A; Tearse, D S

    1997-02-01

    Anterior cruciate ligament (ACL) injuries commonly result in anterolateral rotary instability and a 'pivot shift' phenomenon. Since popliteus muscle stimulation causes a pivot shift, some postulate the popliteus muscle plays a role in causing pivot shifts. To see if patients with pivot shifts exhibited excessive popliteus muscle activity, we studied fine-wire EMGs of the popliteus in 16 normal subjects and 10 ACL-deficient subjects. Subjects performed six activities (level walking and jogging, ascending walking and jogging, and descending walking and jogging). Except for minor timing differences in ascending treadmill and ascending jogging, the signals were similar for injured and uninjured limbs; similar variance ratios suggested similar pattern variability. Thus, we observed only minor popliteus EMG signal differences in this group of patients. We conclude that the popliteus muscle does not actively contribute to instability in the studied activities.

  3. Adaptive noise suppression technique for dense 3D point cloud reconstructions from monocular vision

    NASA Astrophysics Data System (ADS)

    Diskin, Yakov; Asari, Vijayan K.

    2012-10-01

    Mobile vision-based autonomous vehicles use video frames from multiple angles to construct a 3D model of their environment. In this paper, we present a post-processing adaptive noise suppression technique to enhance the quality of the computed 3D model. Our near real-time reconstruction algorithm uses each pair of frames to compute the disparities of tracked feature points to translate the distance a feature has traveled within the frame in pixels into real world depth values. As a result these tracked feature points are plotted to form a dense and colorful point cloud. Due to the inevitable small vibrations in the camera and the mismatches within the feature tracking algorithm, the point cloud model contains a significant amount of misplaced points appearing as noise. The proposed noise suppression technique utilizes the spatial information of each point to unify points of similar texture and color into objects while simultaneously removing noise dissociated with any nearby objects. The noise filter combines all the points of similar depth into 2D layers throughout the point cloud model. By applying erosion and dilation techniques we are able to eliminate the unwanted floating points while retaining points of larger objects. To reverse the compression process, we transform the 2D layer back into the 3D model allowing points to return to their original position without the attached noise components. We evaluate the resulting noiseless point cloud by utilizing an unmanned ground vehicle to perform obstacle avoidance tasks. The contribution of the noise suppression technique is measured by evaluating the accuracy of the 3D reconstruction.

  4. Popliteus function in ACL-deficient patients.

    PubMed

    Weresh, M J; Gabel, R H; Brand, R A; Tearse, D S

    1994-01-01

    Anterior cruciate ligament (ACL) injuries commonly result in anterolateral instability, resulting in a "pivot shift" phenomenon. Given that popliteus muscle stimulation results in a pivot shift, others have postulated that the popliteus muscle has a role in the pivot shift phenomenon. We hypothesized that patients with instability from ACL injuries may have excessive popliteus muscle activity. Therefore, we studied the EMG activity (using fine wire electrodes) of the popliteus muscle in sixteen normal subjects and ten ACL-deficient subjects. We recorded the EMG in six activities (level walking and jogging, ascending walking and jogging, and descending walking and jogging). Person's Product Moment Correlations were above 0.7, except in the case of ascending the treadmill (r = 0.427) and ascending jogging (r = 0.645), suggesting that the timing of the signals was similar for injured and uninjured limbs. Variance ratios for the injured and uninjured limbs were statistically similar, suggesting similar variability of patterns. Thus, we observed only minor popliteus EMG signal differences in this group of patients. We conclude that the popliteus muscle does not contribute to instability in the studied activities.

  5. Bypass flap reconstruction, a novel technique for distal revascularization: outcome of first 10 clinical cases.

    PubMed

    Malikov, Serguei; Magnan, Pierre-Edouard; Casanova, Dominique; Lepantalo, Mauri; Valerio, Nicolas; Ayari, Raouf; Champsaur, Pierre; Branchereau, Alain

    2009-01-01

    Combined distal venous bypass grafting and free flap transfer can achieve successful treatment of soft tissue defects due to advanced leg ischemia. However, this combined approach is a complex technique involving multiple anastomoses on the same arterial axis with an increased risk of thrombosis. To reduce this risk, we have proposed a new bypass-flap (BF) reconstruction technique using an arterial graft and a free flap supplied by a collateral branch of the graft. The purpose of this report is to document the outcome in the first 10 patients treated using the BF reconstruction technique. From 2002 to 2004, a total of 10 patients with a mean age of 67 years (range 55-78) were treated using a BF. All patients presented critical ischemia with soft tissue defects resulting in exposure of tendons and muscles on the foot or ankle. Distal anastomosis was made between the distal branch of the BF and the pedal artery in five cases, the posterior tibial artery or plantar artery in four cases, and the peroneal artery in one case. In six cases proximal anastomosis was performed between the leg artery and arterial autograft. In the remaining four cases proximal anastomosis required extension of the bypass using a venous graft. The mean duration of hospitalization was 25 days. During the postoperative period, one patient died due to stercoral peritonitis and one patient required major amputation due to unrelenting sepsis. Bypass occlusion was not observed. Mean follow-up was 24 months (range 14-36). No patient was lost to follow-up and no patient died after the first 30 postoperative days. Follow-up examinations including clinical assessment and Doppler ultrasound imaging were performed at 3 months and every 6 months thereafter. Findings demonstrated bypass patency and healing of the covered defect in all cases. Outcome in this initial series demonstrates the clinical feasibility of the new BF reconstruction technique, which allows revascularization and coverage of tissue

  6. Influence of the crosshead rate on the mechanical properties of fixation systems of ACL tendon grafts.

    PubMed

    Martel, Oscar; Cárdenes, Juan F; Garcés, Gerardo; Carta, José A

    2009-11-01

    Anterior cruciate ligament (ACL) reconstruction is one of the most important aspects of knee surgery. For this purpose, several fixation devices have been developed, although the interference screw is the most frequently used. The most typical biomechanical test of these devices consists of placing them in a testing machine and subjecting them to a pull-out test. However, insufficient attention has been paid to the influence of the displacement test rate on the mechanical properties of the fixation system. The aim of this study is to compare the influence of the crosshead rate in the biomechanical test of two different devices for the fixation of ACL tendon grafts. One hundred in vitro tests were performed using porcine tibiae and bovine tendons. The fixation devices used were (1) an interference screw and (2) a new expansion device. All ACL reconstructions were subjected to pull-out test to failure. Five crosshead rates were employed in a range from 30 mm/min to 4000 mm/min. Statistical analyses of the results show that, for the two devices, the rate has a significant effect on both maximum force and stiffness. Moreover, the new expansion device showed lesser dependency on the crosshead rate than the interference screw.

  7. A novel technique for cheek mucosa defect reconstruction using a pedicled buccal fat pad and buccinator myomucosal island flap.

    PubMed

    Ferrari, Silvano; Ferri, Andrea; Bianchi, Bernardo; Copelli, Chiara; Magri, Alice Sara; Sesenna, Enrico

    2009-01-01

    Reconstruction of cheek mucosa defects following tumor resections can be approached with several techniques, depending on size of the defect. Fasciocutaneous and perforators free flaps are widely employed today for such reconstructions. However, small defects or general health of the patient may limit their indications. Furthermore, approaching moderate size defects, some techniques, like temporalis muscle or fascia pedicled flaps, lead to contracture with limitation of mouth opening or trisma, and others, like intraoral local flaps, do not provide enough tissue for the reconstructions. In this work the authors propose, for reconstructing these kind of defects, the use of a buccinator myomucosal island flap and a buccal fat pad pedicled flap association. A case is reported and the surgical technique is explained. This new reconstructive technique can easily be used for reconstructing moderate-sized cheek defects, achieving optimal results: the internal mucosal lining is restored in few weeks without any retraction, contracture, of scars on the face limiting the aesthetic outcome and mouth opening. PMID:18620893

  8. Assessing post-anterior cruciate ligament reconstruction ambulation using wireless wearable integrated sensors.

    PubMed

    Arosha Senanayake, S M N; Ahmed Malik, Owais; Mohammad Iskandar, Pg; Zaheer, Dansih

    2013-11-01

    Abstract A hardware/software co-design for assessing post-Anterior Cruciate Ligament (ACL) reconstruction ambulation is presented. The knee kinematics and neuromuscular data during walking (2-6 km h(-1)) have been acquired using wireless wearable motion and electromyography (EMG) sensors, respectively. These signals were integrated by superimposition and mixed signals processing techniques in order to provide visual analyses of bio-signals and identification of the recovery progress of subjects. Monitoring overlapped signals simultaneously helps in detecting variability and correlation of knee joint dynamics and muscles activities for an individual subject as well as for a group. The recovery stages of subjects have been identified based on combined features (knee flexion/extension and EMG signals) using an adaptive neuro-fuzzy inference system (ANFIS). The proposed system has been validated for 28 test subjects (healthy and ACL-reconstructed). Results of ANFIS showed that the ambulation data can be used to distinguish subjects at different levels of recuperation after ACL reconstruction. PMID:24117351

  9. SIMPLIFIED TECHNIQUE FOR RECONSTRUCTION OF THE DIGESTIVE TRACT AFTER TOTAL AND SUBTOTAL GASTRECTOMY FOR GASTRIC CANCER

    PubMed Central

    ZILBERSTEIN, Bruno; JACOB, Carlos Eduardo; BARCHI, Leandro Cardoso; YAGI, Osmar Kenji; RIBEIRO-JR, Ulysses; COIMBRA, Brian Guilherme Monteiro Marta; CECCONELLO, Ivan

    2014-01-01

    Background Laparoscopic surgery has been increasingly applied to gastric cancer surgery. Gastrointestinal tract reconstruction totally done by laparoscopy also has been a challenge for those who developed this procedure. Aim To describe simplified reconstruction after total or subtotal gastrectomy for gastric cancer by laparoscopy and the results of its application in a series of cases. Methods In the last four years, 75 patients were operated with gastric cancer and two with GIST. Thirty-four were women and 43 men. The age ranged from 38 to 77 years with an average of 55 years. In two patients with GIST a total and a subtotal gastrectomy were performed. In the other 75 patients were done 21 total gastrectomies and 54 subtotal. In all cancers, gastrectomy with D2 lymphadenectomy was completed with at least 37 lymph nodes removed. Was used in these operations a modified laparoscopic technique proposed by the authors consisting in a latero lateral esophagojejunal anastomosis with linear stapler in TG as well in STG, and reconstruction of the digestive continuity also in the upper abdomen. Results The intraoperative and immediate postoperative course were uneventful, except for one case of bleeding due to an opening clip, necessitating re-intervention. The operative time was 300 minutes, with no difference between total or subtotal gastrectomy. The number of lymph nodes removed varied from 28 to 69, averaging 37. Postoperative staging showed one case in T4 N2 M0; 13 in T2 N0 MO; 27 in T2 N1 M0; 24 in T3 N1 M0 and 10 in T3 N2 M0. Complication in only one case was observed on the 10th postoperative day with a small anastomotic leakage in esophagojejunal anastomose with spontaneous closure. Conclusion The patient's evolution with no complications, no mortality and just one small anastomotic leakage with no systemic repercussions is a strong indication of the liability and feasibility of this innovative technical method. PMID:25004292

  10. Applications of the Medipix3-CT in combination with iterative reconstruction techniques

    NASA Astrophysics Data System (ADS)

    Fischer, F.; Procz, S.; Fauler, A.; Fiederle, M.

    2016-02-01

    The pixelated semiconductor detectors of the Medipix family with their photon-counting abilities offer the possibility of high quality X-ray radiography as well as computed tomography. The generated signal from each photon is amplified and shaped before it is compared to an energy threshold. For a photon with an energy above the threshold the counter is incremented by one count. Photons below the operator-defined threshold do not increment the counter and therefore do not participate in the image formation. Furthermore, compared to other detectors like scintillators, an additional conversion step is dispensed due to the direct converting nature of photon-counting detectors, leading to a higher signal-to-noise-ratio. Additionally, the photon processing capabilities of photon-counting detectors allow photons to be weighted equally and not proportional to their energy as it is the case for charge integrating devices, where high energy photons are weighted stronger than low energy photons. Compared to integrating devices, this leads to an increase in contrast for images of both high and low contrast objects, hence improve object information. The use of photon-counting detectors in combination with iterative reconstruction techniques based on OSEM (ordered subset expectation maximization) algorithms is the basis of our computed tomography scans for material analysis. Due to its ability to operate with highly undersampled data sets, iterative reconstruction offers the possibility to decrease dose in CT scans. In order to identify the limits of the data set reduction, a first series of scans was performed to test, under real conditions, the CT-image quality when a strongly reduced amount of projections is used for reconstruction. In addition, the effect of a total variation minimization tool on these undersampled data sets was evaluated. Furthermore, this paper includes a number of recent CT-results with scans performed at two different setups within our facility.

  11. The Weak Link in Anterior Cruciate Ligament Reconstruction: What is the Evidence for Graft Fixation Devices?

    PubMed

    Campbell, Kirk A; Looze, Christopher; Bosco, Joseph A; Strauss, Eric J

    2016-03-01

    Anterior cruciate ligament (ACL) rupture is a common injury that mostly affects young adults. The mechanisms of injury and surgical treatment have been extensively studied in both the laboratory and clinical arenas; however, great controversy still exists in regards to the best surgical technique, graft choice, and graft fixation device. In the area graft fixation, multiple breakthroughs have occurred in terms of fixation devices. These devices generally fall within the broad categories of interference screw, cross-pins, or cortical-based devices. Furthermore, some of these devices are available in either metal or bioabsorbable materials, which adds to the already great variety of options. Although biomechanically these devices have been shown to be able to withstand the typical forces experienced by the ACL graft during the early phases of rehabilitation before the graft has fully incorporated into the bone, little is known about the clinical outcomes. It is well recognized that graft fixation is the weakest link in the early postoperative period after ACL reconstruction. This review of the outcomes of ACL fixation devices explores some of the evidence available for the different devices. PMID:26977545

  12. Synchronous quadriceps tendon rupture and unilateral ACL tear in a weightlifter, associated with anabolic steroid use.

    PubMed

    Fenelon, Christopher; Dalton, David M; Galbraith, John G; Masterson, Eric L

    2016-05-06

    Synchronous quadriceps tendon rupture is rare. A 29-year-old man, an amateur weight lifter, taking androgenic-anabolic steroids (AAS), developed sudden onset bilateral pain and swelling of his anterior thighs when attempting to squat 280 kg (620 lb). Examination revealed gross swelling superior to the patella and palpable gaps in both quadriceps tendons. He underwent successful operative repair. MRI revealed a partial tear of the anterior cruciate ligament (ACL) of the right knee. This was not reconstructed. Only a few case reports of the association between AAS and quadriceps rupture exist in the literature, with none to the best of our knowledge in the past 10 years. ACL rupture coexisting is very rare, with only two reported cases.

  13. Synchronous quadriceps tendon rupture and unilateral ACL tear in a weightlifter, associated with anabolic steroid use.

    PubMed

    Fenelon, Christopher; Dalton, David M; Galbraith, John G; Masterson, Eric L

    2016-01-01

    Synchronous quadriceps tendon rupture is rare. A 29-year-old man, an amateur weight lifter, taking androgenic-anabolic steroids (AAS), developed sudden onset bilateral pain and swelling of his anterior thighs when attempting to squat 280 kg (620 lb). Examination revealed gross swelling superior to the patella and palpable gaps in both quadriceps tendons. He underwent successful operative repair. MRI revealed a partial tear of the anterior cruciate ligament (ACL) of the right knee. This was not reconstructed. Only a few case reports of the association between AAS and quadriceps rupture exist in the literature, with none to the best of our knowledge in the past 10 years. ACL rupture coexisting is very rare, with only two reported cases. PMID:27154985

  14. 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.

  15. Analysis of algebraic reconstruction technique for accurate imaging of gas temperature and concentration based on tunable diode laser absorption spectroscopy

    NASA Astrophysics Data System (ADS)

    Hui-Hui, Xia; Rui-Feng, Kan; Jian-Guo, Liu; Zhen-Yu, Xu; Ya-Bai, He

    2016-06-01

    An improved algebraic reconstruction technique (ART) combined with tunable diode laser absorption spectroscopy(TDLAS) is presented in this paper for determining two-dimensional (2D) distribution of H2O concentration and temperature in a simulated combustion flame. This work aims to simulate the reconstruction of spectroscopic measurements by a multi-view parallel-beam scanning geometry and analyze the effects of projection rays on reconstruction accuracy. It finally proves that reconstruction quality dramatically increases with the number of projection rays increasing until more than 180 for 20 × 20 grid, and after that point, the number of projection rays has little influence on reconstruction accuracy. It is clear that the temperature reconstruction results are more accurate than the water vapor concentration obtained by the traditional concentration calculation method. In the present study an innovative way to reduce the error of concentration reconstruction and improve the reconstruction quality greatly is also proposed, and the capability of this new method is evaluated by using appropriate assessment parameters. By using this new approach, not only the concentration reconstruction accuracy is greatly improved, but also a suitable parallel-beam arrangement is put forward for high reconstruction accuracy and simplicity of experimental validation. Finally, a bimodal structure of the combustion region is assumed to demonstrate the robustness and universality of the proposed method. Numerical investigation indicates that the proposed TDLAS tomographic algorithm is capable of detecting accurate temperature and concentration profiles. This feasible formula for reconstruction research is expected to resolve several key issues in practical combustion devices. Project supported by the Young Scientists Fund of the National Natural Science Foundation of China (Grant No. 61205151), the National Key Scientific Instrument and Equipment Development Project of China (Grant

  16. Analysis of algebraic reconstruction technique for accurate imaging of gas temperature and concentration based on tunable diode laser absorption spectroscopy

    NASA Astrophysics Data System (ADS)

    Hui-Hui, Xia; Rui-Feng, Kan; Jian-Guo, Liu; Zhen-Yu, Xu; Ya-Bai, He

    2016-06-01

    An improved algebraic reconstruction technique (ART) combined with tunable diode laser absorption spectroscopy(TDLAS) is presented in this paper for determining two-dimensional (2D) distribution of H2O concentration and temperature in a simulated combustion flame. This work aims to simulate the reconstruction of spectroscopic measurements by a multi-view parallel-beam scanning geometry and analyze the effects of projection rays on reconstruction accuracy. It finally proves that reconstruction quality dramatically increases with the number of projection rays increasing until more than 180 for 20 × 20 grid, and after that point, the number of projection rays has little influence on reconstruction accuracy. It is clear that the temperature reconstruction results are more accurate than the water vapor concentration obtained by the traditional concentration calculation method. In the present study an innovative way to reduce the error of concentration reconstruction and improve the reconstruction quality greatly is also proposed, and the capability of this new method is evaluated by using appropriate assessment parameters. By using this new approach, not only the concentration reconstruction accuracy is greatly improved, but also a suitable parallel-beam arrangement is put forward for high reconstruction accuracy and simplicity of experimental validation. Finally, a bimodal structure of the combustion region is assumed to demonstrate the robustness and universality of the proposed method. Numerical investigation indicates that the proposed TDLAS tomographic algorithm is capable of detecting accurate temperature and concentration profiles. This feasible formula for reconstruction research is expected to resolve several key issues in practical combustion devices. Project supported by the Young Scientists Fund of the National Natural Science Foundation of China (Grant No. 61205151), the National Key Scientific Instrument and Equipment Development Project of China (Grant

  17. Jet Results and Jet Reconstruction Techniques in p+p and Their Prospects in Pb+Pb Collisions in Cms

    NASA Astrophysics Data System (ADS)

    Salur, Sevil

    Copious production of very energetic jets is expected at the LHC due to the large increase in collision energy. Jet reconstruction at these high center of mass energies will provide crucial leverage to map out the QCD evolution of parton energy loss and a unique insight into the nature of the hot QCD matter. This article presents jet reconstruction techniques and the preliminary jet results in p+p collisions at √ {s} = 7 {TeV} collected by the CMS experiment at the LHC. Jet reconstruction prospects for the heavy ion collisions are also discussed.

  18. The application of rapid prototyping techniques in cranial reconstruction and preoperative planning in neurosurgery.

    PubMed

    Müller, Adolf; Krishnan, Kartik G; Uhl, Eberhard; Mast, Gerson

    2003-11-01

    The value of rapid prototype models of the skull in our craniofacial and neurosurgical practice was analyzed. Individual skull models of 52 patients were produced by means of rapid prototyping techniques and used in various procedures. Patients were divided into three groups as follows: group I (26 patients) requiring corrective cranioplasty 1) after resection of osseous tumors (15 patients) and 2) with congenital and posttraumatic craniofacial deformities (11 patients), group II (10 patients) requiring reconstructive cranioplasty, and group III (16 patients) requiring planning of difficult skull base approaches. The utility of the stereolithographic models was assessed using the Gillespie scoring system. The esthetic and clinical outcomes were assessed by means of the esthetic outcome score and the Glasgow Outcome Score, respectively. Simulation of osteotomies for advancement plasty and craniofacial reassembly in the model before surgery in group I reduced operating time and intraoperative errors. In group II, the usefulness of the models depended directly on the size and configuration of the cranial defect. The planning of approaches to uncommon and complex skull base tumors (group III) was significantly influenced by the stereolithographic models. The esthetic outcome was pleasing. The indications for the manufacture of individual three-dimensional models could be cases of craniofacial dysmorphism that require meticulous preoperative planning and skull base surgery with difficult anatomical and reconstructive problems. The stereolithographic models provide 1) better understanding of the anatomy, 2) presurgical simulation, 3) intraoperative accuracy in localization of lesions, 4) accurate fabrication of implants, and 5) improved education of trainees. PMID:14600634

  19. [Intra-articular reinforcement of a partially torn anterior cruciate ligament (ACL) using newly developed UHMWPE biomaterial in combination with Hexalon ACL/PCL screws: ex-vivo mechanical testing of an animal knee model].

    PubMed

    Fedorová, P; Srnec, R; Pěnčík, J; Dvořák, M; Krbec, M; Nečas, A

    2015-01-01

    PURPOSE OF THE STUDY Recent trends in the experimental surgical management of a partial anterior cruciate ligament (ACL) rupture in animals show repair of an ACL lesion using novel biomaterials both for biomechanical reinforcement of a partially unstable knee and as suitable scaffolds for bone marrow stem cell therapy in a partial ACL tear. The study deals with mechanical testing of the newly developed ultra-high-molecular-weight polyethylene (UHMWPE) biomaterial anchored to bone with Hexalon biodegradable ACL/PCL screws, as a new possibility of intra-articular reinforcement of a partial ACL tear. MATERIAL AND METHODS Two groups of ex vivo pig knee models were prepared and tested as follows: the model of an ACL tear stabilised with UHMWPE biomaterial using a Hexalon ACL/PCL screw (group 1; n = 10) and the model of an ACL tear stabilised with the traditional, and in veterinary medicine used, extracapsular technique involving a monofilament nylon fibre, a clamp and a Securos bone anchor (group 2; n = 11). The models were loaded at a standing angle of 100° and the maximum load (N) and shift (mm) values were recorded. RESULTS In group 1 the average maximal peak force was 167.6 ± 21.7 N and the shift was on average 19.0 ± 4.0 mm. In all 10 specimens, the maximum load made the UHMWPE implant break close to its fixation to the femur but the construct/fixation never failed at the site where the material was anchored to the bone. In group 2, the average maximal peak force was 207.3 ± 49.2 N and the shift was on average 24.1 ± 9.5 mm. The Securos stabilisation failed by pullout of the anchor from the femoral bone in nine out of 11 cases; the monofilament fibre ruptured in two cases. CONCLUSIONS It can be concluded that a UHMWPE substitute used in ex-vivo pig knee models has mechanical properties comparable with clinically used extracapsular Securos stabilisation and, because of its potential to carry stem cells and bioactive substances, it can meet the requirements for

  20. [Intra-articular reinforcement of a partially torn anterior cruciate ligament (ACL) using newly developed UHMWPE biomaterial in combination with Hexalon ACL/PCL screws: ex-vivo mechanical testing of an animal knee model].

    PubMed

    Fedorová, P; Srnec, R; Pěnčík, J; Dvořák, M; Krbec, M; Nečas, A

    2015-01-01

    PURPOSE OF THE STUDY Recent trends in the experimental surgical management of a partial anterior cruciate ligament (ACL) rupture in animals show repair of an ACL lesion using novel biomaterials both for biomechanical reinforcement of a partially unstable knee and as suitable scaffolds for bone marrow stem cell therapy in a partial ACL tear. The study deals with mechanical testing of the newly developed ultra-high-molecular-weight polyethylene (UHMWPE) biomaterial anchored to bone with Hexalon biodegradable ACL/PCL screws, as a new possibility of intra-articular reinforcement of a partial ACL tear. MATERIAL AND METHODS Two groups of ex vivo pig knee models were prepared and tested as follows: the model of an ACL tear stabilised with UHMWPE biomaterial using a Hexalon ACL/PCL screw (group 1; n = 10) and the model of an ACL tear stabilised with the traditional, and in veterinary medicine used, extracapsular technique involving a monofilament nylon fibre, a clamp and a Securos bone anchor (group 2; n = 11). The models were loaded at a standing angle of 100° and the maximum load (N) and shift (mm) values were recorded. RESULTS In group 1 the average maximal peak force was 167.6 ± 21.7 N and the shift was on average 19.0 ± 4.0 mm. In all 10 specimens, the maximum load made the UHMWPE implant break close to its fixation to the femur but the construct/fixation never failed at the site where the material was anchored to the bone. In group 2, the average maximal peak force was 207.3 ± 49.2 N and the shift was on average 24.1 ± 9.5 mm. The Securos stabilisation failed by pullout of the anchor from the femoral bone in nine out of 11 cases; the monofilament fibre ruptured in two cases. CONCLUSIONS It can be concluded that a UHMWPE substitute used in ex-vivo pig knee models has mechanical properties comparable with clinically used extracapsular Securos stabilisation and, because of its potential to carry stem cells and bioactive substances, it can meet the requirements for

  1. Rehabilitation concerns following anterior cruciate ligament reconstruction.

    PubMed

    Frndak, P A; Berasi, C C

    1991-11-01

    Rehabilitation following anterior cruciate ligament reconstruction is a subject of controversy in the orthopaedic and rehabilitation literature. With an increasing number of these operations currently being performed and with the advent of arthroscopically assisted ACL reconstruction over the past several years, particular rehabilitation needs and problems have been identified in association with these patients. Various authors have stressed one or a combination of a few basic themes which outline the basic rehabilitation concerns following ACL reconstruction. The most fundamental concern is the need to initiate motion very soon after surgery. Prolonged postoperative immobilisation is known to cause serious complications after ACL reconstruction which can be avoided by early motion. Positions or activities which may apply excessive stress to a newly reconstructed ACL must also be considered. The amount of protection required by the graft will vary depending upon the type of graft used and the quality of fixation obtained intraoperatively. Most authors agree that nonweightbearing, active resistive quadriceps exercises should be avoided for an extended period, while closed chain exercises may be initiated much earlier. Strength recovery is obviously important for the quadriceps postoperatively, but maximal strength returns of all of the muscles about the knee must be pursued. Hamstring strength is of particular concern as this may provide an active support to the reconstructed ACL. Sensory loss in the knee after ACL disruption should also be addressed during rehabilitation, prior to a patient's return to full athletic activity. Progressive neuromuscular re-education exercises which rely on sensory input from intact pericapsular structures are encouraged. A final concern is the role of bracing after ACL reconstruction.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1763251

  2. Graft selection in anterior cruciate ligament reconstruction.

    PubMed

    Miller, Suzanne L; Gladstone, James N

    2002-10-01

    Selecting the appropriate graft for ACL reconstruction depends on numerous factors including surgeon philosophy and experience, tissue availability (affected by anatomical anomalies or prior injury or surgery), and patient activity level and desires. Although the patella tendon autograft has the widest experience in the literature, and is probably the most commonly used graft source, this must be tempered with the higher reported incidences of potential morbidity and pitfalls associated with its use. The hamstring tendons are gaining increasing popularity, mostly due to reduced harvest morbidity and improved soft tissue fixation techniques, and many recent studies in the literature report equal results to BTB ACL reconstruction with respect to functional outcome and patient satisfaction. On the other hand, many of these studies report higher degrees of instrument (KT-100) tested laxity for hamstring reconstruction, and some have reported lower returns to preinjury levels of activity. One question that remains to be addressed is how closely objectively measured laxity tests correlate with subjectively assessed outcomes and ability to return to high levels of competitive sports. Allograft use, which decreased in popularity during the 1990s, appears to be undergoing a resurgence, with better sterilization processes and new graft sources (tibialis tendons), leading to increased availability and improved fixation techniques. The benefits of decreased surgical morbidity and easier rehabilitation must be weighed against the potential for greater failure of biologic incorporation, infection, and possibly slower return to activities. In our practice, for high-demand individuals (those playing cutting, pivoting, or jumping sports and skiing) BTB tends to be the graft of choice. For lower demand or older individuals, hamstring reconstructions will be performed. Allograft tissue will be used in older individuals (generally over 45 years old), those with signs of arthritis (and

  3. Graft selection in anterior cruciate ligament reconstruction.

    PubMed

    Miller, Suzanne L; Gladstone, James N

    2002-10-01

    Selecting the appropriate graft for ACL reconstruction depends on numerous factors including surgeon philosophy and experience, tissue availability (affected by anatomical anomalies or prior injury or surgery), and patient activity level and desires. Although the patella tendon autograft has the widest experience in the literature, and is probably the most commonly used graft source, this must be tempered with the higher reported incidences of potential morbidity and pitfalls associated with its use. The hamstring tendons are gaining increasing popularity, mostly due to reduced harvest morbidity and improved soft tissue fixation techniques, and many recent studies in the literature report equal results to BTB ACL reconstruction with respect to functional outcome and patient satisfaction. On the other hand, many of these studies report higher degrees of instrument (KT-100) tested laxity for hamstring reconstruction, and some have reported lower returns to preinjury levels of activity. One question that remains to be addressed is how closely objectively measured laxity tests correlate with subjectively assessed outcomes and ability to return to high levels of competitive sports. Allograft use, which decreased in popularity during the 1990s, appears to be undergoing a resurgence, with better sterilization processes and new graft sources (tibialis tendons), leading to increased availability and improved fixation techniques. The benefits of decreased surgical morbidity and easier rehabilitation must be weighed against the potential for greater failure of biologic incorporation, infection, and possibly slower return to activities. In our practice, for high-demand individuals (those playing cutting, pivoting, or jumping sports and skiing) BTB tends to be the graft of choice. For lower demand or older individuals, hamstring reconstructions will be performed. Allograft tissue will be used in older individuals (generally over 45 years old), those with signs of arthritis (and

  4. Influence of patellar ligament insertion angle on quadriceps usage during walking in anterior cruciate ligament reconstructed subjects.

    PubMed

    Shin, Choongsoo S; Chaudhari, Ajit M; Dyrby, Chris O; Andriacchi, Thomas P

    2009-06-01

    Reduced quadriceps contraction has been suggested as an adaptation to prevent anterior tibial translation in anterior cruciate ligament (ACL)-deficient knees. This theory has been supported by a recent study that peak knee flexion moment (thought to be created by a decrease of quadriceps contraction) during walking was negatively correlated with patellar ligament insertion angle (PLIA) in ACL-deficient knees, but not in contralateral, uninjured knees. In addition, the PLIA was significantly smaller in ACL-deficient knees than in contralateral, uninjured knees. However, it is unknown whether ACL reconstruction restores the PLIA or whether the relationship between the PLIA and knee flexion moments previously observed in ACL-deficient knees disappears. This study tested the following hypotheses: (1) The PLIA of ACL-reconstructed knees is significantly smaller than the PLIA of uninjured contralateral knees; (2) Peak knee flexion moment (balanced by net quadriceps moment) during walking is negatively correlated with the PLIA in ACL-reconstructed knees. The PLIA of 24 ACL-reconstructed and contralateral knees were measured using MRI, and peak knee flexion moments during walking were measured. Results showed that the PLIA of ACL-reconstructed (22.9 +/- 4.4 degrees) knees was not significantly smaller (p = 0.09, power = 0.99) than the PLIA of contralateral (24.1 +/- 4.8 degrees) knees. Peak knee flexion moment was not correlated with the PLIA following ACL reconstruction (R2 = 0.016, power = 0.99). However, the magnitude of the knee flexion moment remained significantly lower in ACL-reconstructed knees. In summary, this study has shown that the PLIA of ACL-reconstructed knees returned to normal and that patients no longer adapt their gait in response to the PLIA, though quadriceps function did not return to normal levels.

  5. Three-Class EEG-Based Motor Imagery Classification Using Phase-Space Reconstruction Technique

    PubMed Central

    Djemal, Ridha; Bazyed, Ayad G.; Belwafi, Kais; Gannouni, Sofien; Kaaniche, Walid

    2016-01-01

    Over the last few decades, brain signals have been significantly exploited for brain-computer interface (BCI) applications. In this paper, we study the extraction of features using event-related desynchronization/synchronization techniques to improve the classification accuracy for three-class motor imagery (MI) BCI. The classification approach is based on combining the features of the phase and amplitude of the brain signals using fast Fourier transform (FFT) and autoregressive (AR) modeling of the reconstructed phase space as well as the modification of the BCI parameters (trial length, trial frequency band, classification method). We report interesting results compared with those present in the literature by utilizing sequential forward floating selection (SFFS) and a multi-class linear discriminant analysis (LDA), our findings showed superior classification results, a classification accuracy of 86.06% and 93% for two BCI competition datasets, with respect to results from previous studies. PMID:27563927

  6. Reconstruction of multiplanar deformity of the hindfoot and midfoot with internal fixation techniques.

    PubMed

    Dreher, Thomas; Hagmann, Sebastién; Wenz, Wolfram

    2009-09-01

    Reconstruction surgery of the midand hindfoot is a demanding challenge for foot surgeons. Satisfactory results depend not only on surgical technique and skills but also on the knowledge of underlying disorders, pathomechanics, and indication criteria. The cavovarus foot, the planovalgus foot, and Charcot's foot are some of the most challenging foot deformities, requiring different surgical strategies for their correction. Most of the osteotomies and fusions in children and adults can be fixed with transcutaneous Kirschner wires, which are inexpensive and easy to use and remove. The use of alternative fixation systems such as cannulated screws, compression screws, or angle-stable locking plates depends on patient age, vascular situation, risk for nonunion, and underlying pathology.

  7. Emerging techniques and efficacy of endoscopic esophageal reconstruction and lumen restoration for complete esophageal obstruction

    PubMed Central

    Perbtani, Yaseen; Suarez, Alejandro L.; Wagh, Mihir S.

    2016-01-01

    Background and study aims: Complete esophageal obstruction (CEO) is a rare occurrence characterized by progressive esophageal stricture, which eventually causes lumen obliteration. With recent advances in flexible endoscopy, various innovative techniques exist for restoring luminal continuity. The primary aim of this study was to assess the efficacy and safety of patients undergoing combined antegrade-retrograde endoscopic dilation for CEO at our institution. The secondary aim was to review and highlight emerging techniques, outcomes, and adverse events after endoscopic treatment of CEO. Patients and methods: Our electronic endoscopy database was retrospectively reviewed to identify patients who underwent combined antegrade and retrograde endoscopy for CEO. Patient and procedural data collected included gender, age, technical success, pre- and post-dysphagia scores, and adverse events. Results: Six patients (67 % male, mean age 71.6 years [range 63 – 80]) underwent technically successful esophageal reconstruction with combined antegrade-retrograde endoscopy. All patients noted improvement in dysphagia with mean pre-procedure dysphagia score of 4 reduced to 1.33 (range 0 – 3) post-procedure. There were no adverse events and mean follow-up time was 17.3 months (range 3 – 48). Conclusions: Combined antegrade and retrograde endoscopic therapy for CEO is feasible and safe. We present our experience with endoscopic management of complete esophageal obstruction, and highlight emerging techniques, outcomes and adverse events related to this minimally invasive modality. PMID:26878039

  8. Breast volumetric analysis for aesthetic planning in breast reconstruction: a literature review of techniques

    PubMed Central

    Rozen, Warren Matthew; Spychal, Robert T.; Hunter-Smith, David J.

    2016-01-01

    Background Accurate volumetric analysis is an essential component of preoperative planning in both reconstructive and aesthetic breast procedures towards achieving symmetrization and patient-satisfactory outcome. Numerous comparative studies and reviews of individual techniques have been reported. However, a unifying review of all techniques comparing their accuracy, reliability, and practicality has been lacking. Methods A review of the published English literature dating from 1950 to 2015 using databases, such as PubMed, Medline, Web of Science, and EMBASE, was undertaken. Results Since Bouman’s first description of water displacement method, a range of volumetric assessment techniques have been described: thermoplastic casting, direct anthropomorphic measurement, two-dimensional (2D) imaging, and computed tomography (CT)/magnetic resonance imaging (MRI) scans. However, most have been unreliable, difficult to execute and demonstrate limited practicability. Introduction of 3D surface imaging has revolutionized the field due to its ease of use, fast speed, accuracy, and reliability. However, its widespread use has been limited by its high cost and lack of high level of evidence. Recent developments have unveiled the first web-based 3D surface imaging program, 4D imaging, and 3D printing. Conclusions Despite its importance, an accurate, reliable, and simple breast volumetric analysis tool has been elusive until the introduction of 3D surface imaging technology. However, its high cost has limited its wide usage. Novel adjunct technologies, such as web-based 3D surface imaging program, 4D imaging, and 3D printing, appear promising. PMID:27047788

  9. Multiplanar and three-dimensional reconstruction techniques in CT: impact on chest diseases.

    PubMed

    Remy, J; Remy-Jardin, M; Artaud, D; Fribourg, M

    1998-01-01

    The purpose of this review is to capture the current state-of-the art of the technical aspects of multiplanar and three-dimensional (3D) images and their thoracic applications. Planimetric and volumetric analysis resulting from volumetric data acquisitions obviates the limitations of segmented transverse images. Among the 3D reconstruction techniques currently available, the most recently introduced technique, i. e., volume rendering, has to be evaluated in comparison with 3D shaded surface display and maximum or minimum intensity projection. Slabs are useful in detecting and localizing micronodular or microtubular patterns and in analyzing mild forms of uneven attenuation of the lungs. Three-dimensional angiography is helpful in the pretherapeutic evaluation and posttreatment follow-up of pulmonary arteriovenous malformations, in the comprehension of the postoperative reorientation of the pulmonary vessels, in the surgical planning of pulmonary tumors, and in the diagnosis of marginated thrombi. The systemic supply to the lung and superior vena cava syndromes are also relevant to these techniques. In acquired or congenital tracheobronchial diseases including stenosis, extraluminal air and complex airway anatomy, multiplanar and 3D reformations have a complementary role to both transaxial images and endoscopy. New developments are also expected in various topics such as 3D conformal radiation therapy, planning of intraluminal bronchoscopic therapy, virtual endoscopy, and functional imaging of the bronchial tree. Miscellaneous clinical applications are promising in the analysis of diaphragmatic morphology and pathophysiology, in the volumetric quantification of the lung parenchyma, and in the vascular components of the thoracic outlet syndromes.

  10. Towards a myocardial contraction force reconstruction technique for heart disease assessment and therapy planning

    NASA Astrophysics Data System (ADS)

    Haddad, Seyyed M. H.; Drangova, Maria; White, James A.; Samani, Abbas

    2014-03-01

    Cardiac ischemic injuries can be classified into two main categories: reversible and irreversible. Treatment of reversible damages is possible through revascularization therapies. Clinically, it is quite vital to determine the reversibility of ischemic injuries and local efficiency using accurate diagnostics techniques. For this purpose, a number of imaging techniques have been developed. To our knowledge, while some of these techniques are capable of assessing tissue viability which is believed to be correlated with ischemic injuries reversibility, none of them are capable of providing information about local myocardial tissue efficiency. Note that this efficiency indicates the local tissue contribution to the overall (global) heart mechanical function which is characterized by parameters such as ejection fraction. While contraction force generation of the myocardium is a reliable and straightforward mechanical measure for the local myocardium functionality, it is also hypothesized that the level of damage reversibility expected from therapy is proportional to the intensity and distribution of these forces. As such this research involves developing a new imaging technique for cardiac contraction force quantification. This work is also geared towards another application, namely Cardiac Resynchronization Therapy (CRT), specifically for electrode leads configuration optimization. The latter has not been tackled through a systematic technique thus far. In the proposed method, contraction force reconstruction is accomplished by an inverse problem algorithm solved through an optimization framework which uses forward mechanical modelling of the myocardium iteratively to obtain the contraction forces field. As a result, the method requires a forward mechanical model of the myocardium which is computationally efficient and robust against divergence. Therefore, we developed such a model which considers all aspects of the myocardial mechanics including hyperelasticity

  11. The influence of hamstring autograft size on patient reported outcomes and risk of revision following anterior cruciate ligament reconstruction: A MOON cohort study

    PubMed Central

    Mariscalco, Michael W.; Flanigan, David C.; Mitchell, Joshua; Pedroza, Angela D.; Jones, Morgan H.; Andrish, Jack T.; Parker, Richard D.; Kaeding, Christopher C.; Magnussen, Robert A.

    2013-01-01

    Purpose The purpose of this study is to evaluate the effect of graft size on patient-reported outcomes and revision risk following ACL reconstruction. Methods A retrospective chart review of prospectively collected cohort data, 263 of 320 consecutive patients (82.2%) undergoing primary ACL reconstruction with hamstring autograft were evaluated. Graft size, femoral tunnel drilling technique, patient age, sex, and BMI at the time of ACL reconstruction, pre-operative and 2-year post-operative KOOS and IKDC scores, and whether each patient underwent revision ACL reconstruction during the 2 year follow-up period were recorded. Revision was used as a marker for graft failure. The relationship between graft size and patient-reported outcomes was determined by multiple linear regression. The relationship between graft size and risk of revision was determined by dichotomizing graft size at 8mm and stratifying by age. Results After controlling for age, sex, operative side, surgeon, BMI, graft choice, and femoral tunnel drilling technique, a 1 mm increased in graft size was noted to correlate with 3.3-point increase in the KOOS-pain subscale (p = 0.003), a 2.0-point increased in the KOOS activities of daily living subscale (p = 0.034), a 5.2-point increase in the KOOS-sport/recreation function subscale (p = 0.004), and a 3.4-point increase in the subjective IKDC score (p = 0.026). Revision was required in 0 of 64 patients (0.0%) with grafts greater than 8mm in diameter and 14 of 199 patients (7.0%) with 8 mm or smaller grafts (p = 0.037). Among patients age 18 and under, revision was required in 0 of 14 patients (0.0%) with grafts greater than 8mm in diameter and 13 of 71 patients (18.3 %) with 8 mm or smaller grafts. Conclusions Smaller hamstring autograft size is a predictor of poorer KOOS Sport and Recreation function 2 years following primary ACL reconstruction. Larger sample size is required to confirm the relationship between graft size and risk of revision ACL

  12. 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

  13. The adaptive statistical iterative reconstruction-V technique for radiation dose reduction in abdominal CT: comparison with the adaptive statistical iterative reconstruction technique

    PubMed Central

    Cho, Jinhan; Oh, Jongyeong; Kim, Dongwon; Cho, Junghyun; Kim, Sanghyun; Lee, Sangyun; Lee, Jihyun

    2015-01-01

    Objective: To investigate whether reduced radiation dose abdominal CT images reconstructed with adaptive statistical iterative reconstruction V (ASIR-V) compromise the depiction of clinically competent features when compared with the currently used routine radiation dose CT images reconstructed with ASIR. Methods: 27 consecutive patients (mean body mass index: 23.55 kg m−2 underwent CT of the abdomen at two time points. At the first time point, abdominal CT was scanned at 21.45 noise index levels of automatic current modulation at 120 kV. Images were reconstructed with 40% ASIR, the routine protocol of Dong-A University Hospital. At the second time point, follow-up scans were performed at 30 noise index levels. Images were reconstructed with filtered back projection (FBP), 40% ASIR, 30% ASIR-V, 50% ASIR-V and 70% ASIR-V for the reduced radiation dose. Both quantitative and qualitative analyses of image quality were conducted. The CT dose index was also recorded. Results: At the follow-up study, the mean dose reduction relative to the currently used common radiation dose was 35.37% (range: 19–49%). The overall subjective image quality and diagnostic acceptability of the 50% ASIR-V scores at the reduced radiation dose were nearly identical to those recorded when using the initial routine-dose CT with 40% ASIR. Subjective ratings of the qualitative analysis revealed that of all reduced radiation dose CT series reconstructed, 30% ASIR-V and 50% ASIR-V were associated with higher image quality with lower noise and artefacts as well as good sharpness when compared with 40% ASIR and FBP. However, the sharpness score at 70% ASIR-V was considered to be worse than that at 40% ASIR. Objective image noise for 50% ASIR-V was 34.24% and 46.34% which was lower than 40% ASIR and FBP. Conclusion: Abdominal CT images reconstructed with ASIR-V facilitate radiation dose reductions of to 35% when compared with the ASIR. Advances in knowledge: This study represents the first

  14. Digital infrared thermal imaging following anterior cruciate ligament reconstruction.

    PubMed

    Barker, Lauren E; Markowski, Alycia M; Henneman, Kimberly

    2012-03-01

    This case describes the selective use of digital infrared thermal imaging for a 48-year-old woman who was being treated by a physical therapist following left anterior cruciate ligament (ACL) reconstruction with a semitendinosus autograft. PMID:22383168

  15. WE-G-18C-08: Real Time Tumor Imaging Using a Novel Dynamic Keyhole MRI Reconstruction Technique

    SciTech Connect

    Lee, D; Pollock, S; Whelan, B; Keall, P; Greer, P; Kim, T

    2014-06-15

    Purpose: To test the hypothesis that the novel Dynamic Keyhole MRI reconstruction technique can accelerate image acquisition whilst maintaining high image quality for lung cancer patients. Methods: 18 MRI datasets from 5 lung cancer patients were acquired using a 3T MRI scanner. These datasets were retrospectively reconstructed using (A) The novel Dynamic Keyhole technique, (B) The conventional keyhole technique and (C) the conventional zero filling technique. The dynamic keyhole technique in MRI refers to techniques in which previously acquired k-space data is used to supplement under sampled data obtained in real time. The novel Dynamic Keyhole technique utilizes a previously acquired a library of kspace datasets in conjunction with central k-space datasets acquired in realtime. A simultaneously acquired respiratory signal is utilized to sort, match and combine the two k-space streams with respect to respiratory displacement. Reconstruction performance was quantified by (1) comparing the keyhole size (which corresponds to imaging speed) required to achieve the same image quality, and (2) maintaining a constant keyhole size across the three reconstruction methods to compare the resulting image quality to the ground truth image. Results: (1) The dynamic keyhole method required a mean keyhole size which was 48% smaller than the conventional keyhole technique and 60% smaller than the zero filling technique to achieve the same image quality. This directly corresponds to faster imaging. (2) When a constant keyhole size was utilized, the Dynamic Keyhole technique resulted in the smallest difference of the tumor region compared to the ground truth. Conclusion: The dynamic keyhole is a simple and adaptable technique for clinical applications requiring real-time imaging and tumor monitoring such as MRI guided radiotherapy. Based on the results from this study, the dynamic keyhole method could increase the imaging frequency by a factor of five compared with full k

  16. Three-dimensional reconstruction of flame temperature and emissivity distribution using optical tomographic and two-colour pyrometric techniques

    NASA Astrophysics Data System (ADS)

    Moinul Hossain, Md; Lu, Gang; Sun, Duo; Yan, Yong

    2013-07-01

    This paper presents an experimental investigation, visualization and validation in the three-dimensional (3D) reconstruction of flame temperature and emissivity distributions by using optical tomographic and two-colour pyrometric techniques. A multi-camera digital imaging system comprising eight optical imaging fibres and two RGB charged-couple device (CCD) cameras are used to acquire two-dimensional (2D) images of the flame simultaneously from eight equiangular directions. A combined logical filtered back-projection (LFBP) and simultaneous iterative reconstruction and algebraic reconstruction technique (SART) algorithm is utilized to reconstruct the grey-level intensity of the flame for the two primary colour (red and green) images. The temperature distribution of the flame is then determined from the ratio of the reconstructed grey-level intensities and the emissivity is estimated from the ratio of the grey level of a primary colour image to that of a blackbody source at the same temperature. The temperature measurement of the system was calibrated using a blackbody furnace as a standard temperature source. Experimental work was undertaken to validate the flame temperature obtained by the imaging system against that obtained using high-precision thermocouples. The difference between the two measurements is found no greater than ±9%. Experimental results obtained on a laboratory-scale propane fired combustion test rig demonstrate that the imaging system and applied technical approach perform well in the reconstruction of the 3D temperature and emissivity distributions of the sooty flame.

  17. Irradiated homologous tarsal plate banking: A new alternative in eyelid reconstruction. Part I. Technique and animal research

    SciTech Connect

    Jordan, D.R.; Tse, D.T.; Anderson, R.L.; Hansen, S.O. )

    1990-01-01

    Reconstruction of full thickness eyelid defects requires the correction of both posterior lamella (tarsus, conjunctiva) and anterior lamella (skin, muscle). Tarsal substitutes including banked sclera, nasal cartilage, ear cartilage, and periosteum can be beneficial for posterior lamellar repair, while anterior lamellar replacement, including skin grafts, pedicle flaps, advancement flaps, etc., is important to cover the posterior reconstructed portion. At times, due to extensive tissue loss, the eyelid reconstruction can be particularly challenging. We have found an alternative posterior lamellar reconstructive technique utilizing irradiated homologous tarsal plate that can be particularly useful in selected cases of severe tissue loss. The experimental surgical procedure in monkeys and the histological fate of the implanted tarsus is described in Part I, and followed in Part II by our experience with this tissue in six human patients.

  18. Material damage diagnosis and characterization for turbine rotors using three-dimensional adaptive ultrasonic NDE data reconstruction techniques.

    PubMed

    Guan, Xuefei; Zhang, Jingdan; Rasselkorde, El Mahjoub; Abbasi, Waheed A; Kevin Zhou, S

    2014-02-01

    Damage diagnosis for turbine rotors plays an essential role in power plant management. Ultrasonic non-destructive examinations (NDEs) have increasingly been utilized as an effective tool to provide comprehensive information for damage diagnosis. This study presents a general methodology of damage diagnosis for turbine rotors using three-dimensional adaptive ultrasonic NDE data reconstruction techniques. Volume reconstruction algorithms and data fusion schemes are proposed to map raw ultrasonic NDE data back to the structural model of the object being examined. The reconstructed volume is used for automatic damage identification and quantification using region-growing algorithms and the method of distance-gain-size. Key reconstruction parameters are discussed and suggested based on industrial experiences. A software tool called AutoNDE Rotor is developed to automate the overall analysis workflow. Effectiveness of the proposed methods and AutoNDE Rotor are explored using realistic ultrasonic NDE data.

  19. Material damage diagnosis and characterization for turbine rotors using three-dimensional adaptive ultrasonic NDE data reconstruction techniques.

    PubMed

    Guan, Xuefei; Zhang, Jingdan; Rasselkorde, El Mahjoub; Abbasi, Waheed A; Kevin Zhou, S

    2014-02-01

    Damage diagnosis for turbine rotors plays an essential role in power plant management. Ultrasonic non-destructive examinations (NDEs) have increasingly been utilized as an effective tool to provide comprehensive information for damage diagnosis. This study presents a general methodology of damage diagnosis for turbine rotors using three-dimensional adaptive ultrasonic NDE data reconstruction techniques. Volume reconstruction algorithms and data fusion schemes are proposed to map raw ultrasonic NDE data back to the structural model of the object being examined. The reconstructed volume is used for automatic damage identification and quantification using region-growing algorithms and the method of distance-gain-size. Key reconstruction parameters are discussed and suggested based on industrial experiences. A software tool called AutoNDE Rotor is developed to automate the overall analysis workflow. Effectiveness of the proposed methods and AutoNDE Rotor are explored using realistic ultrasonic NDE data. PMID:23978617

  20. Reconstructing source terms from atmospheric concentration measurements: Optimality analysis of an inversion technique

    NASA Astrophysics Data System (ADS)

    Turbelin, Grégory; Singh, Sarvesh Kumar; Issartel, Jean-Pierre

    2014-12-01

    In the event of an accidental or intentional contaminant release in the atmosphere, it is imperative, for managing emergency response, to diagnose the release parameters of the source from measured data. Reconstruction of the source information exploiting measured data is called an inverse problem. To solve such a problem, several techniques are currently being developed. The first part of this paper provides a detailed description of one of them, known as the renormalization method. This technique, proposed by Issartel (2005), has been derived using an approach different from that of standard inversion methods and gives a linear solution to the continuous Source Term Estimation (STE) problem. In the second part of this paper, the discrete counterpart of this method is presented. By using matrix notation, common in data assimilation and suitable for numerical computing, it is shown that the discrete renormalized solution belongs to a family of well-known inverse solutions (minimum weighted norm solutions), which can be computed by using the concept of generalized inverse operator. It is shown that, when the weight matrix satisfies the renormalization condition, this operator satisfies the criteria used in geophysics to define good inverses. Notably, by means of the Model Resolution Matrix (MRM) formalism, we demonstrate that the renormalized solution fulfils optimal properties for the localization of single point sources. Throughout the article, the main concepts are illustrated with data from a wind tunnel experiment conducted at the Environmental Flow Research Centre at the University of Surrey, UK.

  1. La reconstruction du sourcil par greffon composite du cuir chevelu: une astuce pour faciliter la technique

    PubMed Central

    El Omari, Mounia; El Mazouz, Samir; Gharib, Noureddine; EL Abbassi, Abdallah

    2015-01-01

    Les sourcils jouent un rôle important dans l’équilibre esthétique du visage. Leur reconstruction ou ophriopoïése, après séquelle de brûlure fait partie intégrante du programme de réhabilitation de la face brûlée. Plusieurs techniques ont été décrites. Nous insistons ici sur l'intérêt d'une technique simple, à la portée de tous les chirurgiens, et dont la méthode et les résultats peuvent être améliorés par un dessin bien planifié des zones donneuse et receveuse: la greffe composite prélevée au niveau du cuir chevelu dessinée à l'aide d'un calque du sourcil controlatéral. PMID:26401195

  2. Reduction in radiation dose with reconstruction technique in the brain perfusion CT

    NASA Astrophysics Data System (ADS)

    Kim, H. J.; Lee, H. K.; Song, H.; Ju, M. S.; Dong, K. R.; Chung, W. K.; Cho, M. S.; Cho, J. H.

    2011-12-01

    The principal objective of this study was to verify the utility of the reconstruction imaging technique in the brain perfusion computed tomography (PCT) scan by assessing reductions in the radiation dose and analyzing the generated images. The setting used for image acquisition had a detector coverage of 40 mm, a helical thickness of 0.625 mm, a helical shuttle mode scan type and a rotation time of 0.5 s as the image parameters used for the brain PCT scan. Additionally, a phantom experiment and an animal experiment were carried out. In the phantom and animal experiments, noise was measured in the scanning with the tube voltage fixed at 80 kVp (kilovolt peak) and the level of the adaptive statistical iterative reconstruction (ASIR) was changed from 0% to 100% at 10% intervals. The standard deviation of the CT coefficient was measured three times to calculate the mean value. In the phantom and animal experiments, the absorbed dose was measured 10 times under the same conditions as the ones for noise measurement before the mean value was calculated. In the animal experiment, pencil-type and CT-dedicated ionization chambers were inserted into the central portion of pig heads for measurement. In the phantom study, as the level of the ASIR changed from 0% to 100% under identical scanning conditions, the noise value and dose were proportionally reduced. In our animal experiment, the noise value was lowest when the ASIR level was 50%, unlike in the phantom study. The dose was reduced as in the phantom study.

  3. Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Arcuri, Francisco; Barclay, Fernando; Nacul, Ivan

    2015-01-01

    Introduction: The most recent advances in ACL reconstruction try to reproduce the anatomic femoral and tibial footprints as close as possible. Creating independent tunnels would allow an optimal of the entry point and the femoral tunnel obliquity, and together with an adequate reamer diameter they wouldreproduce with greater certainty the anatomy. Objective: To compare the radiographic parameters of the femoral and tibial tunnel positions in two groups of patients, one operated with a transtibial and other with transportal anatomic techniques. Materials and Methods: From December 2012 to December 2013, 59 patients with a primary ACL reconstruction divided in two groups, a trans tibial technique (TT), 19 patients, and an transportal one (TP) with 40 patients were prospectively evaluated with AP and lateral X-rays. The femoral tunnel angle, the insertion site with respect of the Blumensaat line, the trans osseous distance, the tibial tunnel position as a percentage of the tibial plateau in the AP and lateral views. And finally the tibial tunnel angle in the AP and Lateral views. Results: The femoral tunnel angle was in the TP group of 45,92º and in the TT one 24,53º, p 0,002. The insertion site percentage of the Blumensaat line was of 20,96 in TP and 20,74 in the TT, p 0,681.Trans osseous distance was in the TP of 3,43 cm and in the TT of 4,79 cm, p <0,000. The tibial tunnel position as a percentage in the AP tibial plateau was of 44,35 in TP and of 40,80 TT with a p of 0,076. The tibial tunnel position as a percentage of the lateral tibial plateau was of 28,70 in TP and 34,53 in TT with a p 0,367. Tibial tunnel angle in the AP was of 73,48º in TP and 62,81 in TT with a p of 0,002, and in the lateral plateau of 114,69º in TP and 112,79º in TT with a p of 0,427. Conclusion: It is possible to create tibial and femoral tunnel in optimal positions but not equal between both groups. Creating independent tunnels allow a more anterior and vertical tibial tunnel

  4. Autologous Hamstring Anterior Cruciate Ligament Graft Failure Using the Anteromedial Portal Technique With Suspensory Femoral Fixation

    PubMed Central

    Galdi, Balazs; Reyes, Allan; Brabston, Eugene W.; Levine, William N.

    2015-01-01

    Background: The anteromedial portal technique for drilling of the femoral tunnel during anterior cruciate ligament (ACL) reconstruction has been advocated by many surgeons as allowing improved access to the anatomical footprint. Furthermore, suspensory fixation of soft tissue grafts has become popularized because of complications associated with cross-pin fixation. Concerns regarding the use of both have recently arisen. Purpose: To raise awareness of the increased risk of graft failure when using the anteromedial portal technique with suspensory femoral fixation during ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: From November 1998 to August 2012, a total of 465 primary ACL reconstructions were performed using quadrupled hamstring autograft tendons, with drilling of the femoral tunnel performed via the transtibial portal. Graft fixation on the femur was achieved with cross-pin fixation, while interference screw fixation was used on the tibia. From September 2012 to October 2013, there were 69 reconstructions performed through an anteromedial portal. While there was no change in graft choice, a change was made to using suspensory femoral fixation. No other surgical or postoperative rehabilitation changes were made. Results: During the 14-year period in which ACL reconstructions were performed via the transtibial portal and with cross-pin fixation, 2 graft failures (0.4% failure rate) were reported. After switching to the anteromedial portal with suspensory fixation, 7 graft failures (10.1% failure rate) were reported over a 13-month period. These were 5 male and 2 female patients, with a mean age of 18.8 years—all elite athletes. The same surgical technique was used in all patients, and all patients had at least an 8 mm–diameter graft. Patients were cleared to return to sport at an average of 8.4 months postoperatively, after completing functional performance tests. Of the 7 patients, 6 sustained a rerupture of the graft within

  5. The Correlation of Tunnel Position, Orientation and Tunnel Enlargement in Outside-in Single-Bundle Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Ko, Young Won; Rhee, Seung Jun; Kim, In Woo

    2015-01-01

    Purpose Tunnel widening after anterior cruciate ligament (ACL) reconstruction is a frequently described phenomenon. The possible etiology is multi-factorial with some mechanical and biological factors. Among those, we intended to determine the relation between the location and orientation of the femoral tunnel and the femoral tunnel enlargement after outside-in single-bundle ACL reconstruction. Materials and Methods A retrospective study including 42 patients who received single-bundle ACL reconstruction with the outside-in technique was conducted. Femoral and tibial tunnel locations were evaluated with the quadrant method and bird's-eye view using volume-rendering computed tomography. The angle and diameter of bone tunnel and the degree of tunnel enlargement were evaluated using standard radiographs. Results The degree of femoral tunnel enlargements were 42% and 36% on the anteroposterior (AP) and lateral radiographs, respectively, and the degree of tibial tunnel enlargements were 22% and 23%, respectively. Shallower location of the femoral tunnel was significantly correlated with greater femoral tunnel enlargement on the AP radiograph (r=0.998, p=0.004) and the lateral radiograph (r=0.72, p=0.005) as was the higher location of the femoral tunnel on the AP radiograph (r=-0.47, p=0.01) and the lateral radiograph (r=-0.36, p=0.009) at 12 months after surgery. Conclusions This study revealed that more anterior and higher location and more horizontal orientation of the femoral tunnel in coronal plane could result in widening of the femoral tunnel in outside-in single-bundle ACL reconstruction. PMID:26672479

  6. Anterior cruciate ligament reconstruction by using otogenous [correction of otogeneous] hamstring tendons with home-based rehabilitation.

    PubMed

    Ugutmen, E; Ozkan, K; Kilincoglu, V; Ozkan, F U; Toker, S; Eceviz, E; Altintas, F

    2008-01-01

    We investigated patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction using otogenous hamstring tendons with a cross-pin technique to compare a post-operative home-based rehabilitation programme with a clinic-based programme. ACL reconstruction was performed on 104 patients (103 male) by the same surgeon. The mean age of the patients was 31.5 years (range 18 - 43 years) and the mean time interval between injury and operation was 34.3 months. Patients were randomly allocated to either a home-based (n = 52) or clinic-based rehabilitation programme (n = 52). Mean follow-up was 31.1 months (range 12 - 66 months). Patients underwent a series of examinations before and after surgery in order to evaluate functional recovery of their injured knee. The results demonstrated that using otogeneous hamstring tendons for ACL reconstruction was safe and produced satisfactory results. The study also demonstrated that a home-based rehabilitation programme was as effective as a clinic-based programme.

  7. "Custom-fit" versus "off-the-shelf" ACL functional braces.

    PubMed

    Wojtys, E M; Huston, L J

    2001-01-01

    Many sports medicine practitioners believe "custom-fit" functional braces are superior in performance to "off-the-shelf" braces for anterior cruciate ligament (ACL)-deficient knees. However, this is not well substantiated. This study compares a Donjoy custom-fit ACL brace (CE 2000), Donjoy off-the-shelf brace (Goldpoint), and an athletic taping technique to determine their role in our clinical practice. Five patients (3 men and 2 women) with isolated, unilateral, chronic ACL tears with an average age of 27 years (range: 19-35 years) were used to evaluate these three restraint systems. Anterior tibial laxity, quadriceps and hamstrings strength, endurance, standing long jump, brace migration with exercise, and pattern of muscle response to forced anterior tibial displacement were studied. Each patient was tested without a brace and then in each of the three test conditions (custom brace, off-the-shelf brace, and tape), with the order of testing randomized. The Donjoy custom-fit ACL functional brace did not reduce anterior laxity or improve standing long jump, muscle strength, endurance, or muscle response times significantly more than the off-the-shelf ACL brace. Both braces improved anterior stability over knee taping when the knee muscles were contracted under the low forces used in this study. After 1 hour of exercise, brace migration was significantly greater (P=.03) for the CE-2000 custom brace (18.6 mm) than for the Goldpoint off-the-shelf brace (4.5 mm). There appears to be no advantage to the more expensive custom-fit knee brace over the off-the-shelf brace.

  8. Arthroscopic Labral Reconstruction of the Hip Using Iliotibial Band Allograft and Front-to-Back Fixation Technique.

    PubMed

    White, Brian J; Herzog, Mackenzie M

    2016-02-01

    Labral repair has been shown to be an effective treatment option with excellent early outcomes; however, in cases of severe labral damage or when the labral tissue is too large or diminutive, labral repair may be less effective. The purpose of this article is to present a modified technique for hip labral reconstruction using iliotibial band allograft tissue and a front-to-back fixation technique. The described technique is modified from the original report of a technique for arthroscopic labral reconstruction. The front-to-back technique allows the surgeon to make a graft that is longer than necessary and cut excess graft after front-to-back fixation, resulting in the correct graft size and a reproducible procedure. Allograft tissue offers several advantages, including the ability to control graft thickness and length, as well as the ability to eliminate donor-site morbidity. This procedure adds to the available techniques for treatment of labral pathology by providing a labral reconstruction technique using allograft tissue.

  9. Arthroscopic Labral Reconstruction of the Hip Using Iliotibial Band Allograft and Front-to-Back Fixation Technique

    PubMed Central

    White, Brian J.; Herzog, Mackenzie M.

    2016-01-01

    Labral repair has been shown to be an effective treatment option with excellent early outcomes; however, in cases of severe labral damage or when the labral tissue is too large or diminutive, labral repair may be less effective. The purpose of this article is to present a modified technique for hip labral reconstruction using iliotibial band allograft tissue and a front-to-back fixation technique. The described technique is modified from the original report of a technique for arthroscopic labral reconstruction. The front-to-back technique allows the surgeon to make a graft that is longer than necessary and cut excess graft after front-to-back fixation, resulting in the correct graft size and a reproducible procedure. Allograft tissue offers several advantages, including the ability to control graft thickness and length, as well as the ability to eliminate donor-site morbidity. This procedure adds to the available techniques for treatment of labral pathology by providing a labral reconstruction technique using allograft tissue. PMID:27073784

  10. Arthroscopic Labral Reconstruction of the Hip Using Iliotibial Band Allograft and Front-to-Back Fixation Technique.

    PubMed

    White, Brian J; Herzog, Mackenzie M

    2016-02-01

    Labral repair has been shown to be an effective treatment option with excellent early outcomes; however, in cases of severe labral damage or when the labral tissue is too large or diminutive, labral repair may be less effective. The purpose of this article is to present a modified technique for hip labral reconstruction using iliotibial band allograft tissue and a front-to-back fixation technique. The described technique is modified from the original report of a technique for arthroscopic labral reconstruction. The front-to-back technique allows the surgeon to make a graft that is longer than necessary and cut excess graft after front-to-back fixation, resulting in the correct graft size and a reproducible procedure. Allograft tissue offers several advantages, including the ability to control graft thickness and length, as well as the ability to eliminate donor-site morbidity. This procedure adds to the available techniques for treatment of labral pathology by providing a labral reconstruction technique using allograft tissue. PMID:27073784

  11. Reconstruction of Kuwada grade IV chronic achilles tendon rupture by minimally invasive technique

    PubMed Central

    Miao, Xudong; Wu, Yongping; Tao, Huimin; Yang, Disheng; Huang, Lu

    2016-01-01

    Background: Transfer of a flexor hallucis longus (FHL) tendon can not only reconstruct the Achilles tendon but also provide ischemic tendinous tissues with a rich blood supply to enhance wound healing. This retrospective study aims to investigate clinical outcomes in patients who underwent repair of Kuwada grade IV chronic Achilles tendon rupture with long hallucis longus tendons harvested using a minimally invasive technique. Materials and Methods: 35 patients who were treated for Kuwada grade IV Achilles tendon injuries from July 2006 to June 2011 were included in this retrospective study. The age ranged between 23 and 71 years. The duration from primary injury to surgery ranged from 29 days to 34 months (mean value, 137.6 days). All 35 patients had difficulties in lifting their calves. Thirty two were followed up for a mean 32.2 months (range 18–72 months), whereas three were lost to followup. Magnetic resonance imaging (MRI) showed that the tendon rupture gap ranged from 6.0 to 9.2 cm. During surgery, a 2.0 cm minor incision was made vertically in the medial plantar side of the midfoot, and a 1.5 cm minor transverse incision was made in the plantar side of the interphalangeal articulation of the great toe to harvest the FHL tendon, and the tendon was fixed to the calcaneus with suture anchors. Postoperative appearance and function were evaluated by physiotherapists based American Orthopedic Foot and Ankle Society-ankle and hindfoot score (AOFAS-AH), and Leppilahti Achilles tendon ratings. Results: Results were assessed in 32 patients. Except for one patient who suffered complications because of wound disruption 10 days after the operation, all other patients had primary wound healing, with 28 of 32 able to go up on their toes at last followup. The AOFAS-AH score was increased from preoperative (51.92 ± 7.08) points to (92.56 ± 6.71) points; Leppilahti Achilles tendon score was increased from preoperative (72.56 ± 7.43) to (92.58 ± 5.1). There were

  12. Clinical outcomes of allograft versus autograft in anterior cruciate ligament reconstruction.

    PubMed

    Baer, Geoffrey S; Harner, Christopher D

    2007-10-01

    Anterior cruciate ligament (ACL) injuries are the most common complete ligamentous injury to the knee. The optimal graft should be able to reproduce the anatomy and biomechanics of the ACL, be incorporated rapidly with strong initial fixation, and cause low graft-site morbidity. This article reviews the literature comparing the clinical outcomes following allograft and autograft ACL reconstruction and examines current issues regarding graft choice.

  13. Clinical outcomes of allograft versus autograft in anterior cruciate ligament reconstruction.

    PubMed

    Baer, Geoffrey S; Harner, Christopher D

    2007-10-01

    Anterior cruciate ligament (ACL) injuries are the most common complete ligamentous injury to the knee. The optimal graft should be able to reproduce the anatomy and biomechanics of the ACL, be incorporated rapidly with strong initial fixation, and cause low graft-site morbidity. This article reviews the literature comparing the clinical outcomes following allograft and autograft ACL reconstruction and examines current issues regarding graft choice. PMID:17920959

  14. Iliotibial band irritation caused by the EndoButton after anatomic double-bundle anterior cruciate ligament reconstruction: report of two cases.

    PubMed

    Taketomi, Shuji; Inui, Hiroshi; Hirota, Jinso; Nakamura, Kensuke; Sanada, Takaki; Masuda, Hironari; Tanaka, Sakae; Nakagawa, Takumi

    2013-08-01

    Two patients underwent arthroscopic anatomic double-bundle anterior cruciate ligament (ACL) reconstruction using the EndoButton for femoral fixation. The femoral tunnels were created by the inside-out technique through a far anteromedial portal. The patients postoperatively developed moderate lateral knee pain without instability. At the second-look arthroscopic evaluation, the two EndoButtons were removed. Both patients were completely asymptomatic several months after implant removal, implying that the EndoButtons caused the mechanical irritation in the iliotibial band. This is the first report describing removal of EndoButtons because of pain caused by friction with the iliotibial band. In anatomic ACL reconstruction, if the femoral tunnel exit is positioned near the lateral femoral epicondyle, care should be taken to prevent iliotibial band friction syndrome that could result because of the EndoButton.

  15. Techniques of Proximal Root Reconstruction and Outcomes Following Repair of Acute Type A Aortic Dissection

    PubMed Central

    Gunn, Tyler M.; Stamou, Sotiris C.; Kouchoukos, Nicholas T.; Lobdell, Kevin W.; Khabbaz, Kamal; Patzelt, Lawrence H.; Hagberg, Robert C.

    2016-01-01

    Background The goal of this study was to compare the early and late outcomes of different techniques of proximal root reconstruction during the repair of acute Type A aortic dissection, including aortic valve (AV) resuspension, aortic valve replacement (AVR), and a root replacement procedure. Methods All patients who underwent acute Type A aortic dissection repair between January 2000 and October 2010 at four academic institutions were compiled from each institution’s Society of Thoracic Surgeons Database. This included 189 patients who underwent a concomitant aortic valve (AV) procedure; 111, 21, and 57 patients underwent AV resuspension, AVR, and the Bentall procedure, respectively. The median age of patients undergoing a root replacement procedure was significantly younger than the other two groups. Early clinical outcomes and 10-year actuarial survival rates were compared. Trends in outcomes and surgical techniques throughout the duration of the study were also analyzed. Results The operative mortality rates were 17%, 29%, and 18%, for AV resuspension, AVR, and root replacement, respectively. Operative mortality (p = 0.459) was comparable between groups. Hemorrhage related re-exploration did not differ significantly between groups (p = 0.182); however, root replacement procedures tended to have decreased rates of bleeding when compared to AVR (p = 0.067). The 10-year actuarial survival rates for the AV resuspension, Bentall, and AVR groups were 72%, 56%, and 36%, respectively (log-rank p = 0.035). Conclusions The 10-year actuarial survival was significantly lower in those receiving AVR compared to those receiving root replacement procedures or AV resuspension. Operative mortality was comparable between the three groups. PMID:27757401

  16. Assessment of sub-milli-sievert abdominal computed tomography with iterative reconstruction techniques of different vendors

    PubMed Central

    Padole, Atul; Sainani, Nisha; Lira, Diego; Khawaja, Ranish Deedar Ali; Pourjabbar, Sarvenaz; Lo Gullo, Roberto; Otrakji, Alexi; Kalra, Mannudeep K

    2016-01-01

    AIM: To assess diagnostic image quality of reduced dose (RD) abdominal computed tomography (CT) with 9 iterative reconstruction techniques (IRTs) from 4 different vendors to the standard of care (SD) CT. METHODS: In an Institutional Review Board approved study, 66 patients (mean age 60 ± 13 years, 44 men, and 22 women) undergoing routine abdomen CT on multi-detector CT (MDCT) scanners from vendors A, B, and C (≥ 64 row CT scanners) (22 patients each) gave written informed consent for acquisition of an additional RD CT series. Sinogram data of RD CT was reconstructed with two vendor-specific and a vendor-neutral IRTs (A-1, A-2, A-3; B-1, B-2, B-3; and C-1, C-2, C-3) and SD CT series with filtered back projection. Subjective image evaluation was performed by two radiologists for each SD and RD CT series blinded and independently. All RD CT series (198) were assessed first followed by SD CT series (66). Objective image noise was measured for SD and RD CT series. Data were analyzed by Wilcoxon signed rank, kappa, and analysis of variance tests. RESULTS: There were 13/50, 18/57 and 9/40 missed lesions (size 2-7 mm) on RD CT for vendor A, B, and C, respectively. Missed lesions includes liver cysts, kidney cysts and stone, gall stone, fatty liver, and pancreatitis. There were also 5, 4, and 4 pseudo lesions (size 2-3 mm) on RD CT for vendor A, B, and C, respectively. Lesions conspicuity was sufficient for clinical diagnostic performance for 6/24 (RD-A-1), 10/24 (RD-A-2), and 7/24 (RD-A-3) lesions for vendor A; 5/26 (RD-B-1), 6/26 (RD-B-2), and 7/26 (RD-B-3) lesions for vendor B; and 4/20 (RD-C-1) 6/20 (RD-C-2), and 10/20 (RD-C-3) lesions for vendor C (P = 0.9). Mean objective image noise in liver was significantly lower for RD A-1 compared to both RD A-2 and RD A-3 images (P < 0.001). Similarly, mean objective image noise lower for RD B-2 (compared to RD B-1, RD B-3) and RD C-3 (compared to RD C-1 and C-2) (P = 0.016). CONCLUSION: Regardless of IRTs and MDCT vendors

  17. A comparison of quantitative reconstruction techniques for PIXE-tomography analysis applied to biological samples

    NASA Astrophysics Data System (ADS)

    Beasley, D. G.; Alves, L. C.; Barberet, Ph.; Bourret, S.; Devès, G.; Gordillo, N.; Michelet, C.; Le Trequesser, Q.; Marques, A. C.; Seznec, H.; da Silva, R. C.

    2014-07-01

    The tomographic reconstruction of biological specimens requires robust algorithms, able to deal with low density contrast and low element concentrations. At the IST/ITN microprobe facility new GPU-accelerated reconstruction software, JPIXET, has been developed, which can significantly increase the speed of quantitative reconstruction of Proton Induced X-ray Emission Tomography (PIXE-T) data. It has a user-friendly graphical user interface for pre-processing, data analysis and reconstruction of PIXE-T and Scanning Transmission Ion Microscopy Tomography (STIM-T). The reconstruction of PIXE-T data is performed using either an algorithm based on a GPU-accelerated version of the Maximum Likelihood Expectation Maximisation (MLEM) method or a GPU-accelerated version of the Discrete Image Space Reconstruction Algorithm (DISRA) (Sakellariou (2001) [2]). The original DISRA, its accelerated version, and the MLEM algorithm, were compared for the reconstruction of a biological sample of Caenorhabditis elegans - a small worm. This sample was analysed at the microbeam line of the AIFIRA facility of CENBG, Bordeaux. A qualitative PIXE-T reconstruction was obtained using the CENBG software package TomoRebuild (Habchi et al. (2013) [6]). The effects of pre-processing and experimental conditions on the elemental concentrations are discussed.

  18. Assessing reconstruction techniques of the Atlantic Ocean circulation variability during the last millennium

    NASA Astrophysics Data System (ADS)

    Moreno-Chamarro, Eduardo; Ortega, Pablo; González-Rouco, Fidel; Montoya, Marisa

    2016-04-01

    We assess the use of the meridional thermal-wind transport estimated from zonal density gradients to reconstruct the oceanic circulation variability during the last millennium in a forced simulation with the ECHO-G coupled climate model. Following a perfect-model approach, model-based pseudo-reconstructions of the Atlantic meridional overturning circulation (AMOC) and the Florida Current volume transport (FCT) are evaluated against their true simulated variability. The pseudo-FCT is additionally verified as proxy for AMOC strength and compared with the available proxy-based reconstruction. The thermal-wind component reproduces most of the simulated AMOC variability, which is mostly driven by internal climate dynamics during the preindustrial period and by increasing greenhouse gases afterwards. The pseudo-reconstructed FCT reproduces well the simulated FCT and reasonably well the variability of the AMOC strength, including the response to external forcing. The pseudo-reconstructed FCT, however, underestimates/overestimates the simulated variability at deep/shallow levels. Density changes responsible for the pseudo-reconstructed FCT are mainly driven by zonal temperature differences; salinity differences oppose but play a minor role. These results thus support the use of the thermal-wind relationship to reconstruct the oceanic circulation past variability, in particular at multidecadal timescales. Yet model-data comparison highlights important differences between the simulated and the proxy-based FCT variability. ECHO-G simulates a prominent weakening in the North Atlantic circulation that contrasts with the reconstructed enhancement. Our model results thus do not support the reconstructed FC minimum during the Little Ice Age. This points to a failure in the reconstruction, misrepresented processes in the model, or an important role of internal ocean dynamics.

  19. Central Breast Excision With Immediate Autologous Reconstruction for Recurrent Periductal Sepsis: An Application of Oncoplastic Surgical Techniques

    PubMed Central

    Gore, Sinclair M.; Wishart, Gordon C.; Malata, Charles M.

    2012-01-01

    Objective: The aim of this procedure was to definitively treat periductal mastitis and periareolar sepsis which was previously resistant to multiple surgical procedures and nonoperative treatment of chronic nipple sepsis. Methods: We employed a multidisciplinary approach to the treatment of end-stage periductal mastitis using a combination of central breast excision and immediate autologous latissimus dorsi flap reconstruction. Results: Clearance of periductal mastitis and infection has been achieved with no recurrence at 3 years. Good symmetry of breast shape and volume has been achieved using this technique. Conclusions: This method of partial breast reconstruction, commonly used for reconstruction of breast cancer ablative defects, may also provide good outcomes in nonmalignant disease. PMID:22893784

  20. Addition of Autologous Mesenchymal Stem Cells to Whole Blood for Bio-Enhanced ACL Repair has No Benefit in the Porcine Model

    PubMed Central

    Proffen, Benedikt L.; Vavken, Patrick; Haslauer, Carla M.; Fleming, Braden C.; Harris, Chad E.; Machan, Jason T.; Murray, Martha M.

    2015-01-01

    Background Co-culture of mesenchymal stem cells (MSCs) from the retropatellar fat pad and peripheral blood has been shown to stimulate anterior cruciate ligament (ACL) fibroblast proliferation and collagen production in vitro. Current techniques of bio-enhanced ACL repair in animal studies involve adding a biologic scaffold, in this case an extracellular matrix based scaffold saturated with auto