Sample records for catch limits acls

  1. 50 CFR 648.53 - Acceptable biological catch (ABC), annual catch limits (ACL), annual catch targets (ACT), DAS...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... catch limits (ACL), annual catch targets (ACT), DAS allocations, and individual fishing quotas (IFQ... limits (ACL), annual catch targets (ACT), DAS allocations, and individual fishing quotas (IFQ). (a... process specified in § 648.55 and is equal to the overall scallop fishery ACL. The ABC/ACL shall be...

  2. 50 CFR 648.53 - Acceptable biological catch (ABC), annual catch limits (ACL), annual catch targets (ACT), DAS...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... catch limits (ACL), annual catch targets (ACT), DAS allocations, and individual fishing quotas (IFQ... limits (ACL), annual catch targets (ACT), DAS allocations, and individual fishing quotas (IFQ). (a... process specified in § 648.55 and is equal to the overall scallop fishery ACL. The ABC/ACL shall be...

  3. 77 FR 10668 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Sub-ACL (Annual Catch...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-23

    ...-ACL (Annual Catch Limit) Harvested for Management Area 2 AGENCY: National Marine Fisheries Service... biological catch, annual catch limit (ACL), optimum yield, domestic harvest and processing, U.S. at-sea...,200 metric tons (mt); the 2012 sub-ACL allocated to Area 2 is 22,146 mt, and 0 mt of the sub-ACL is...

  4. 76 FR 66654 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Sub-ACL (Annual Catch...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-27

    ...; Sub-ACL (Annual Catch Limit) Harvested for Management Area 1A AGENCY: National Marine Fisheries... biological catch, annual catch limit (ACL), optimum yield, domestic harvest and processing, U.S. at-sea...,200 metric tons (mt); the 2011 sub-ACL allocated to Area 1A is 26,546 mt, and 0 mt of the sub-ACL is...

  5. 77 FR 66746 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Sub-ACL (Annual Catch...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-07

    ...-ACL (Annual Catch Limit) Harvested for Management Area 1A AGENCY: National Marine Fisheries Service... catch, annual catch limit (ACL), optimum yield, domestic harvest and processing, U.S. at-sea processing, border transfer, and the sub-ACL for each management area. The 2012 Domestic Annual Harvest was set as 91...

  6. 50 CFR 648.100 - Summer flounder Annual Catch Limit (ACL).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false Summer flounder Annual Catch Limit (ACL... Management Measures for the Summer Flounder Fisheries § 648.100 Summer flounder Annual Catch Limit (ACL). (a... frequent or more specific ACL performance review criteria as part of a stock rebuilding plan following a...

  7. 50 CFR 648.120 - Scup Annual Catch Limit (ACL).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 50 Wildlife and Fisheries 12 2013-10-01 2013-10-01 false Scup Annual Catch Limit (ACL). 648.120... Measures for the Scup Fishery § 648.120 Scup Annual Catch Limit (ACL). (a) The Scup Monitoring Committee... more specific ACL performance review criteria as part of a stock rebuilding plan following a...

  8. 50 CFR 648.120 - Scup Annual Catch Limit (ACL).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false Scup Annual Catch Limit (ACL). 648.120... Measures for the Scup Fishery § 648.120 Scup Annual Catch Limit (ACL). (a) The Scup Monitoring Committee... more specific ACL performance review criteria as part of a stock rebuilding plan following a...

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 50 Wildlife and Fisheries 12 2012-10-01 2012-10-01 false Scup Annual Catch Limit (ACL). 648.120... Measures for the Scup Fishery § 648.120 Scup Annual Catch Limit (ACL). (a) The Scup Monitoring Committee... more specific ACL performance review criteria as part of a stock rebuilding plan following a...

  10. 50 CFR 648.290 - Tilefish Annual Catch Limit (ACL).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 50 Wildlife and Fisheries 12 2013-10-01 2013-10-01 false Tilefish Annual Catch Limit (ACL). 648... Measures for the Tilefish Fishery § 648.290 Tilefish Annual Catch Limit (ACL). (a) The Tilefish Monitoring Committee shall recommend to the MAFMC an ACL for the commercial tilefish fishery, which shall be equal to...

  11. 50 CFR 648.100 - Summer flounder Annual Catch Limit (ACL).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 50 Wildlife and Fisheries 12 2013-10-01 2013-10-01 false Summer flounder Annual Catch Limit (ACL... Management Measures for the Summer Flounder Fisheries § 648.100 Summer flounder Annual Catch Limit (ACL). (a... frequent or more specific ACL performance review criteria as part of a stock rebuilding plan following a...

  12. 50 CFR 648.160 - Bluefish Annual Catch Limit (ACL).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 50 Wildlife and Fisheries 12 2012-10-01 2012-10-01 false Bluefish Annual Catch Limit (ACL). 648... Measures for the Atlantic Bluefish Fishery § 648.160 Bluefish Annual Catch Limit (ACL). (a) The Bluefish Monitoring Committee shall recommend to the MAFMC an ACL for the bluefish fishery, which shall be equal to...

  13. 50 CFR 648.160 - Bluefish Annual Catch Limit (ACL).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 50 Wildlife and Fisheries 12 2013-10-01 2013-10-01 false Bluefish Annual Catch Limit (ACL). 648... Measures for the Atlantic Bluefish Fishery § 648.160 Bluefish Annual Catch Limit (ACL). (a) The Bluefish Monitoring Committee shall recommend to the MAFMC an ACL for the bluefish fishery, which shall be equal to...

  14. 50 CFR 648.160 - Bluefish Annual Catch Limit (ACL).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false Bluefish Annual Catch Limit (ACL). 648... Measures for the Atlantic Bluefish Fishery § 648.160 Bluefish Annual Catch Limit (ACL). (a) The Bluefish Monitoring Committee shall recommend to the MAFMC an ACL for the bluefish fishery, which shall be equal to...

  15. 50 CFR 648.290 - Tilefish Annual Catch Limit (ACL).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 50 Wildlife and Fisheries 12 2012-10-01 2012-10-01 false Tilefish Annual Catch Limit (ACL). 648... Measures for the Tilefish Fishery § 648.290 Tilefish Annual Catch Limit (ACL). (a) The Tilefish Monitoring Committee shall recommend to the MAFMC an ACL for the commercial tilefish fishery, which shall be equal to...

  16. 50 CFR 648.290 - Tilefish Annual Catch Limit (ACL).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false Tilefish Annual Catch Limit (ACL). 648... Measures for the Tilefish Fishery § 648.290 Tilefish Annual Catch Limit (ACL). (a) The Tilefish Monitoring Committee shall recommend to the MAFMC an ACL for the commercial tilefish fishery, which shall be equal to...

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 50 Wildlife and Fisheries 12 2012-10-01 2012-10-01 false Summer flounder Annual Catch Limit (ACL... Management Measures for the Summer Flounder Fisheries § 648.100 Summer flounder Annual Catch Limit (ACL). (a... frequent or more specific ACL performance review criteria as part of a stock rebuilding plan following a...

  18. 78 FR 63406 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Sub-Annual Catch Limit...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-24

    ...-Annual Catch Limit (ACL) Harvested for Management Area 3 AGENCY: National Marine Fisheries Service (NMFS... the overfishing limit, acceptable biological catch, annual catch limit (ACL), optimum yield, domestic.... The 2013 Domestic Annual Harvest is 107,800 metric tons (mt); the 2013 sub-ACL allocated to Area 3 is...

  19. 77 FR 7000 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Gulf of Maine Winter...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-10

    ... Biological Catches (ABCs), Annual Catch Limits (ACLs), ACL components, and sector Annual Catch Entitlements (ACEs). The ACL components include sub-ACLs for the common pool and sectors. This action is intended to... through 2012. The catch levels specified by FW 44 included OFLs, ABCs, ACLs, and ACL components, including...

  20. 50 CFR 648.140 - Black sea bass Annual Catch Limit (ACL).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false Black sea bass Annual Catch Limit (ACL... Management Measures for the Black Sea Bass Fishery § 648.140 Black sea bass Annual Catch Limit (ACL). (a) The Black Sea Bass Monitoring Committee shall recommend to the MAFMC separate ACLs for the commercial and...

  1. 50 CFR 648.140 - Black sea bass Annual Catch Limit (ACL).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 50 Wildlife and Fisheries 12 2013-10-01 2013-10-01 false Black sea bass Annual Catch Limit (ACL... Management Measures for the Black Sea Bass Fishery § 648.140 Black sea bass Annual Catch Limit (ACL). (a) The Black Sea Bass Monitoring Committee shall recommend to the MAFMC separate ACLs for the commercial and...

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 50 Wildlife and Fisheries 12 2012-10-01 2012-10-01 false Black sea bass Annual Catch Limit (ACL... Management Measures for the Black Sea Bass Fishery § 648.140 Black sea bass Annual Catch Limit (ACL). (a) The Black Sea Bass Monitoring Committee shall recommend to the MAFMC separate ACLs for the commercial and...

  3. 76 FR 61061 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Sub-ACL (Annual Catch...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-03

    ...-ACL (Annual Catch Limit) Harvested for Management Area 3 AGENCY: National Marine Fisheries Service...-ACL (annual catch limit) for Area 3 becomes available, except when transiting as described in this notice. This action is based on the determination that 95 percent of the herring sub-ACL allocated to...

  4. 77 FR 61299 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Sub-ACL (Annual Catch...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-09

    ...-ACL (Annual Catch Limit) Harvested for Management Area 3 AGENCY: National Marine Fisheries Service..., annual catch limit (ACL), optimum yield, domestic harvest and processing, U.S. at-sea processing, border transfer, and the sub-ACL for each management area. The 2012 Domestic Annual Harvest was set as 91,200...

  5. 78 FR 62331 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Sub-Annual Catch Limit...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-17

    ...-Annual Catch Limit (ACL) Harvested for Management Area 1A AGENCY: National Marine Fisheries Service (NMFS..., acceptable biological catch, annual catch limit (ACL), optimum yield, domestic harvest and processing, U.S... Harvest is 107,800 metric tons (mt); the 2013 sub-ACL allocated to Area 1A is 29,775 mt, and 0 mt of the...

  6. 50 CFR 648.70 - Surfclam and ocean quahog Annual Catch Limit (ACL).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Limit (ACL). 648.70 Section 648.70 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL... Annual Catch Limit (ACL). (a) The MAFMC staff shall recommend to the MAFMC ACLs for the surfclam and... Surfclam and Ocean Quahog FMP. The ACL for ocean quahog will then be allocated to the Maine and non-Maine...

  7. 50 CFR 648.70 - Surfclam and ocean quahog Annual Catch Limit (ACL).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Limit (ACL). 648.70 Section 648.70 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL... Annual Catch Limit (ACL). (a) The MAFMC staff shall recommend to the MAFMC ACLs for the surfclam and... Surfclam and Ocean Quahog FMP. The ACL for ocean quahog will then be allocated to the Maine and non-Maine...

  8. 50 CFR 648.70 - Surfclam and ocean quahog Annual Catch Limit (ACL).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Limit (ACL). 648.70 Section 648.70 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL... Annual Catch Limit (ACL). (a) The MAFMC staff shall recommend to the MAFMC ACLs for the surfclam and... Surfclam and Ocean Quahog FMP. The ACL for ocean quahog will then be allocated to the Maine and non-Maine...

  9. 77 FR 66744 - Temporary Rule to Increase the Commercial Annual Catch Limit for South Atlantic Yellowtail Snapper

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-07

    ... this temporary rule to increase the commercial annual catch limit (ACL) for yellowtail snapper, as... commercial ACL may be increased from 1,142,589 lb (518,270 kg) to 1,596,510 lb (724,165 kg). This temporary... Annual Catch Limit Amendment (Comprehensive ACL Amendment) to the Fishery Management Plan (FMP) for the...

  10. 50 CFR 622.457 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... OF THE CARIBBEAN, GULF OF MEXICO, AND SOUTH ATLANTIC Spiny Lobster Fishery of Puerto Rico and the U.S. Virgin Islands § 622.457 Annual catch limits (ACLs), annual catch targets (ACTs), and accountability...

  11. 50 CFR 622.439 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... OF THE CARIBBEAN, GULF OF MEXICO, AND SOUTH ATLANTIC Reef Fish Fishery of Puerto Rico and the U.S. Virgin Islands § 622.439 Annual catch limits (ACLs), annual catch targets (ACTs), and accountability...

  12. 50 CFR 622.457 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... OF THE CARIBBEAN, GULF OF MEXICO, AND SOUTH ATLANTIC Spiny Lobster Fishery of Puerto Rico and the U.S. Virgin Islands § 622.457 Annual catch limits (ACLs), annual catch targets (ACTs), and accountability...

  13. 50 CFR 622.496 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... OF THE CARIBBEAN, GULF OF MEXICO, AND SOUTH ATLANTIC Queen Conch Resources of Puerto Rico and the U.S. Virgin Islands § 622.496 Annual catch limits (ACLs), annual catch targets (ACTs), and accountability...

  14. 50 CFR 622.496 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... OF THE CARIBBEAN, GULF OF MEXICO, AND SOUTH ATLANTIC Queen Conch Resources of Puerto Rico and the U.S. Virgin Islands § 622.496 Annual catch limits (ACLs), annual catch targets (ACTs), and accountability...

  15. 50 CFR 622.439 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... OF THE CARIBBEAN, GULF OF MEXICO, AND SOUTH ATLANTIC Reef Fish Fishery of Puerto Rico and the U.S. Virgin Islands § 622.439 Annual catch limits (ACLs), annual catch targets (ACTs), and accountability...

  16. 78 FR 21071 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Sub-ACL (Annual Catch...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-09

    ...-ACL (Annual Catch Limit) Harvested for Management Area 2 AGENCY: National Marine Fisheries Service... limit (ACL), optimum yield, domestic harvest and processing, U.S. at-sea processing, border transfer...); the 2013 sub-ACL allocated to Area 2 is 22,146 mt, and 0 mt of the sub-ACL is set aside for research...

  17. 50 CFR 648.200 - Specifications.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Limit (OFL), Acceptable Biological Catch (ABC), Annual Catch Limit (ACL), Optimum yield (OY), domestic... (BT), the sub-ACL for each management area, including seasonal periods as specified at § 648.201(d... (from 0 to 3 percent of the sub-ACL from any management area). Recommended specifications shall be...

  18. 50 CFR 648.200 - Specifications.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Limit (OFL), Acceptable Biological Catch (ABC), Annual Catch Limit (ACL), Optimum yield (OY), domestic... (BT), the sub-ACL for each management area, including seasonal periods as specified at § 648.201(d... (from 0 to 3 percent of the sub-ACL from any management area). Recommended specifications shall be...

  19. 50 CFR 648.200 - Specifications.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Limit (OFL), Acceptable Biological Catch (ABC), Annual Catch Limit (ACL), Optimum yield (OY), domestic... (BT), the sub-ACL for each management area, including seasonal periods as specified at § 648.201(d... (from 0 to 3 percent of the sub-ACL from any management area). Recommended specifications shall be...

  20. 50 CFR 648.200 - Specifications.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Limit (OFL), Acceptable Biological Catch (ABC), Annual Catch Limit (ACL), Optimum yield (OY), domestic... (BT), the sub-ACL for each management area, including seasonal periods as specified at § 648.201(d... (from 0 to 3 percent of the sub-ACL from any management area). Recommended specifications shall be...

  1. 77 FR 23652 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; Comprehensive Annual Catch Limit...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-20

    ... Annual Catch Limit Amendment (Comprehensive ACL Amendment) for the Fishery Management Plan for the... the South Atlantic Fishery Management Council (Council). The Comprehensive ACL Amendment specified, in... FMP. A final rule implementing the Comprehensive ACL Amendment was published in the Federal Register...

  2. 76 FR 61995 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Emergency Rule...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-06

    ...) and Annual Catch Limit (ACL) for GB yellowtail flounder for an additional 186 days, i.e., through the... revised GB yellowtail flounder catch limits for FY 2011, as follows: A U.S. ABC of 1,458 mt; a total ACL of 1,416 mt; a groundfish sub-ACL of 1,142 mt; a scallop fishery sub-ACL of 200.8 mt; and an Other...

  3. 50 CFR 622.41 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., exceed the commercial ACL, as specified in (a)(1)(iii) of this section, the AA will file a notification... reduce the commercial ACT (commercial quota) and the commercial ACL for that following year by the amount of any commercial ACL overage in the prior fishing year. (iii) The commercial ACL for greater...

  4. 76 FR 14367 - Fisheries in the Western Pacific; Mechanism for Specifying Annual Catch Limits and Accountability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-16

    ... have statutory exceptions to the ACL and AM requirements. The intent of the amendment is end and... being exceeded, and to correct or mitigate any overages of the ACL. The ACL and AM mechanism would be... prevent ACLs from being exceeded or to mitigate overages of an ACL, including use of annual catch targets...

  5. 50 CFR 622.41 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., exceed the commercial ACL, as specified in (a)(1)(iii) of this section, the AA will file a notification... reduce the commercial ACT (commercial quota) and the commercial ACL for that following year by the amount of any commercial ACL overage in the prior fishing year. (iii) The commercial ACL for greater...

  6. 77 FR 10977 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Sub-Annual Catch Limit...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-24

    ...-Annual Catch Limit (ACL) Harvested for Management Area 1B AGENCY: National Marine Fisheries Service (NMFS... Management Area 1B per calendar day until January 1, 2013, when the 2013 sub-ACL for Area 1B becomes... that the revised Atlantic herring sub-ACL limit allocated to Area 1B for 2012 has been exceeded as of...

  7. 50 CFR 648.320 - Skate FMP review and monitoring.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... catch limit (ACL) for the skate complex set less than or equal to ABC; an annual catch target (ACT) for the skate complex set less than or equal to 75 percent of the ACL; and total allowable landings (TAL... possession limit trigger percentages or the ACL-ACT buffer, based on the accountability measures specified at...

  8. 50 CFR 648.320 - Skate FMP review and monitoring.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... catch limit (ACL) for the skate complex set less than or equal to ABC; an annual catch target (ACT) for the skate complex set less than or equal to 75 percent of the ACL; and total allowable landings (TAL... possession limit trigger percentages or the ACL-ACT buffer, based on the accountability measures specified at...

  9. 50 CFR 648.320 - Skate FMP review and monitoring.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... catch limit (ACL) for the skate complex set less than or equal to ABC; an annual catch target (ACT) for the skate complex set less than or equal to 75 percent of the ACL; and total allowable landings (TAL... possession limit trigger percentages or the ACL-ACT buffer, based on the accountability measures specified at...

  10. 50 CFR 648.320 - Skate FMP review and monitoring.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... catch limit (ACL) for the skate complex set less than or equal to ABC; an annual catch target (ACT) for the skate complex set less than or equal to 75 percent of the ACL; and total allowable landings (TAL... possession limit trigger percentages or the ACL-ACT buffer, based on the accountability measures specified at...

  11. 50 CFR 648.320 - Skate FMP review and monitoring.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... catch limit (ACL) for the skate complex set less than or equal to ABC; an annual catch target (ACT) for the skate complex set less than or equal to 75 percent of the ACL; and total allowable landings (TAL... possession limit trigger percentages or the ACL-ACT buffer, based on the accountability measures specified at...

  12. 76 FR 54385 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Regulatory Amendment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-01

    ... herring catch against the stock- wide herring annual catch limit (ACL) and herring management area sub... by a stock-wide ACL that is divided among three management areas, one of which has two sub-areas... 95 percent of a management area sub-ACL, NMFS implements a 2,000-lb (907.2-kg) possession limit for...

  13. 78 FR 25213 - Temporary Rule To Extend the Increase of the Commercial Annual Catch Limit for South Atlantic...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-30

    ... commercial annual catch limit (ACL) for yellowtail snapper implemented by a temporary rule published by NMFS on November 7, 2012. The commercial ACL for yellowtail snapper of 1,596,510 lb (724,165 kg), round... to ensure the commercial ACL for yellowtail snapper is based on the best scientific information...

  14. 78 FR 64888 - Coastal Migratory Pelagic Resources of the Gulf of Mexico and South Atlantic; Reopening of the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-30

    ... the commercial annual catch limit (ACL) (equal to the commercial quota) for king mackerel in the...:01 a.m., local time, on July 1, 2014. However, updated landings estimates indicate the commercial ACL...-Stevens Act) by regulations at 50 CFR part 622. NMFS projected that the commercial annual catch limit (ACL...

  15. 50 CFR 622.58 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... commercial ACL, then during the following fishing year, if commercial landings reach or are projected to reach the commercial ACL, the AA will file a notification with the Office of the Federal Register to close the commercial sector for the remainder of that fishing year. The commercial ACL for royal red...

  16. 50 CFR 622.58 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... commercial ACL, then during the following fishing year, if commercial landings reach or are projected to reach the commercial ACL, the AA will file a notification with the Office of the Federal Register to close the commercial sector for the remainder of that fishing year. The commercial ACL for royal red...

  17. 76 FR 34903 - Revisions to Framework Adjustment 45 to the Northeast Multispecies Fishery Management Plan and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-15

    ... Management Plan and Sector Annual Catch Entitlements; Updated Annual Catch Limits for Sectors and the Common... (ACLs) for common pool vessels (common pool sub-ACLs), ACLs for sector vessels (sector sub-ACLs), and... number of participants electing to fish in either sectors or the common pool fishery in FY 2011. DATES...

  18. 76 FR 37285 - Fisheries in the Western Pacific; Mechanism for Specifying Annual Catch Limits and Accountability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-27

    ... Limits and Accountability Measures AGENCY: National Marine Fisheries Service (NMFS), National Oceanic and... procedures and timing for specifying annual catch limits (ACLs) and accountability measures (AMs) for western... accountability measures to ensure that the ACL is not exceeded. Restrictions may include, but are not limited to...

  19. 50 CFR 622.193 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., as estimated by the SRD, reach or are projected to reach the commercial ACL (commercial quota... commercial ACL (commercial quota) specified in § 622.190(a)(2)(iii), the AA will file a notification with the... of the fishing year. After the commercial ACL for the longline component is reached or projected to...

  20. 76 FR 61059 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Sub-ACL (Annual Catch...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-03

    ...-ACL (Annual Catch Limit) Harvested for Management Area 1B AGENCY: National Marine Fisheries Service...-ACL for Area 1B becomes available, except when transiting as described in this notice. This action is based on the determination that 95 percent of the Atlantic herring sub-ACL allocated to Area 1B for 2011...

  1. 50 CFR 622.193 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., as estimated by the SRD, reach or are projected to reach the commercial ACL (commercial quota... commercial ACL (commercial quota) specified in § 622.190(a)(2)(iii), the AA will file a notification with the... of the fishing year. After the commercial ACL for the longline component is reached or projected to...

  2. 50 CFR 622.388 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ....384(b)(1) (commercial ACL), the AA will file a notification with the Office of the Federal Register to... reach the recreational ACL of 8.092 million lb (3.670 million kg), the AA will file a notification with... tracking the ACL, recreational landings will be monitored based on the commercial fishing year, July 1...

  3. 50 CFR 622.388 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ....384(b)(1) (commercial ACL), the AA will file a notification with the Office of the Federal Register to... reach the recreational ACL of 8.092 million lb (3.670 million kg), the AA will file a notification with... tracking the ACL, recreational landings will be monitored based on the commercial fishing year, July 1...

  4. 50 CFR 660.508 - Annual specifications.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., quota, Annual Catch Limit (ACL) (defined at § 600.310(f)(2)) or Annual Catch Target (ACT) (defined at... guideline, quota, ACL, or ACT, including any apportionment between the directed fishery and set-aside for..., quota, ACL or ACT will contain the following information if available or applicable: (1) The estimated...

  5. 50 CFR 660.508 - Annual specifications.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., quota, Annual Catch Limit (ACL) (defined at § 600.310(f)(2)) or Annual Catch Target (ACT) (defined at... guideline, quota, ACL, or ACT, including any apportionment between the directed fishery and set-aside for..., quota, ACL or ACT will contain the following information if available or applicable: (1) The estimated...

  6. 50 CFR 660.508 - Annual specifications.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., quota, Annual Catch Limit (ACL) (defined at § 600.310(f)(2)) or Annual Catch Target (ACT) (defined at... guideline, quota, ACL, or ACT, including any apportionment between the directed fishery and set-aside for..., quota, ACL or ACT will contain the following information if available or applicable: (1) The estimated...

  7. 50 CFR 622.2 - Definitions and acronyms.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    .... Annual catch limit (ACL) means the level of catch that serves as the basis for invoking accountability... or below the ACL. Aquacultured live rock means live rock that is harvested under a Federal...

  8. 50 CFR 622.251 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... to reach the ACL of 2 million lb (907,185 kg), round weight, the AA will file a notification with the... golden crab in or from the South Atlantic EEZ is prohibited. (2) If commercial landings exceed the ACL... the following fishing year to reduce the ACL for that following year by the amount of the overage in...

  9. 50 CFR 622.251 - Annual catch limits (ACLs), annual catch targets (ACTs), and accountability measures (AMs).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... to reach the ACL of 2 million lb (907,185 kg), round weight, the AA will file a notification with the... golden crab in or from the South Atlantic EEZ is prohibited. (2) If commercial landings exceed the ACL... the following fishing year to reduce the ACL for that following year by the amount of the overage in...

  10. 77 FR 42192 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; Comprehensive Annual Catch Limit...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-18

    ... Amendment (Comprehensive ACL Amendment) for the Fishery Management Plan for the Snapper-Grouper Fishery of... Fishery Management Council (Council). The Comprehensive ACL Amendment specified, in part, annual catch... implementing the Comprehensive ACL Amendment published on March 16, 2012, and became effective on April 16...

  11. 50 CFR 648.140 - Catch quotas and other restrictions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Catch Limit (ACL). (a) The Black Sea Bass Monitoring Committee shall recommend to the MAFMC separate... MAFMC may specify more frequent or more specific ACL performance review criteria as part of a stock...

  12. 50 CFR 648.100 - Catch quotas and other restrictions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... forth as follows: § 648.100 Summer flounder Annual Catch Limit (ACL). (a) The Summer Flounder Monitoring... are not exceeded as frequently. (2) The MAFMC may specify more frequent or more specific ACL...

  13. 78 FR 6798 - Western Pacific Fisheries; 2013 Annual Catch Limits and Accountability Measures

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-31

    ... proposes annual catch limits for western Pacific bottomfish, crustacean, precious coral, and coral reef... ACLs for bottomfish, crustacean, precious coral, and coral reef ecosystem fishery MUS in American Samoa... to 2012. NMFS is not proposing ACLs for bottomfish, crustacean, precious coral, or coral reef...

  14. 76 FR 34947 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Regulatory Amendment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-15

    ... information is necessary to monitor herring catch against the stock- wide herring annual catch limit (ACL) and... that Amendment 4 would continue to address ACL and AM requirements and specification issues, but that... (Amendment 5). The harvest of herring is managed by a stock-wide ACL that is divided between three management...

  15. 77 FR 19944 - Magnuson-Stevens Fishery Conservation and Management Act Provisions; Fisheries of the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-03

    ... will constrain catch to the recreational sub-ACL; and reduce overfishing occurring on GOM cod in...). This interim rule implements a total GOM cod total annual catch limit (ACL) of 6,700 mt and divides... implementing interim measures: Setting a total GOM cod ACL in a 6,700 to 7,500 mt range; Modifying the...

  16. 50 CFR 622.49 - Annual catch limits (ACLs) and accountability measures (AMs).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... limit (ACL), the AA will file a notification with the Office of the Federal Register, at or near the...-year ACL was exceeded. The commercial ACL for 2010 and subsequent fishing years is 138,000 lb (62,596 kg). (ii) Recreational sector. If recreational landings, as estimated by the SRD, exceed the ACL, the...

  17. 50 CFR 648.120 - Catch quotas and other restrictions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Limit (ACL). (a) The Scup Monitoring Committee shall recommend to the MAFMC separate ACLs for the... frequently exceeded. (2) The MAFMC may specify more frequent or more specific ACL performance review criteria...

  18. 76 FR 3091 - National Annual Catch Limit Science Workshop; Meeting Announcement

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-19

    ... Annual Catch Limit Science Workshop; Meeting Announcement AGENCY: National Marine Fisheries Service (NMFS...: Richard Methot, Office of Science and Technology, NMFS at [email protected] , or at (206) 860-3365. SUPPLEMENTARY INFORMATION: NOAA Fisheries Service is announcing a National Annual Catch Limit (ACL) Science...

  19. 50 CFR 648.82 - Effort-control program for NE multispecies limited access vessels.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... ACL for a particular stock to be exceeded. If such catch resulted in the overall ACL for a particular... amount of the overage of the overall ACL for that stock multiplied by the common pool's share of the overall ACL for that stock calculated...

  20. 50 CFR 622.49 - Accountability measures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... exceed the applicable annual catch limit (ACL), the AA will file a notification with the Office of the... following year by the amount the prior-year ACL was exceeded. The applicable ACLs are 105,000 lb (47,627 kg... applicable ACL, the AA will file a notification with the Office of the Federal Register reducing the length...

  1. 50 CFR 648.160 - Catch quotas and other restrictions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Limit (ACL). (a) The Bluefish Monitoring Committee shall recommend to the MAFMC an ACL for the bluefish fishery, which shall be equal to the ABC recommended by the SSC. (1) Periodicity. The bluefish fishery ACL... Monitoring Committee shall conduct a detailed review of fishery performance relative to the ACL at least...

  2. 50 CFR 648.70 - Annual individual allocations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... text is set forth as follows: § 648.70 Surfclam and ocean quahog Annual Catch Limit (ACL). (a) The... established consistent with the guidelines contained in the Atlantic Surfclam and Ocean Quahog FMP. The ACL... ACLs at least every 5 years. (1) If the surfclam or the ocean quahog ACL is exceeded with a frequency...

  3. 50 CFR 622.12 - Annual catch limits (ACLs) and accountability measures (AMs) for Caribbean island management...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... ACL, as specified in paragraph (a)(1) of this section for Puerto Rico management area species or... ensure landings do not exceed the applicable ACL. If NMFS determines the ACL for a particular species or... relative to the applicable ACL based on a moving multi-year average of landings, as described in the FMP...

  4. 77 FR 32914 - Snapper-Grouper Fishery of the South Atlantic; 2012 Recreational Accountability Measure and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-04

    ... landings from 2010 and 2011 exceeded the recreational annual catch limit (ACL) for golden tilefish. To... mitigate overages of the ACL if they occur. The final rule for Amendment 17B established ACLs for eight... implemented if these ACLs are reached or exceeded (75 FR 82280, December 30, 2010). The recreational ACL for...

  5. 50 CFR 622.12 - Annual catch limits (ACLs) and accountability measures (AMs) for Caribbean island management...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... ACL, as specified in paragraph (a)(1) of this section for Puerto Rico management area species or... ensure landings do not exceed the applicable ACL. If NMFS determines the ACL for a particular species or... relative to the applicable ACL based on a moving multi-year average of landings, as described in the FMP...

  6. 50 CFR 648.82 - Effort-control program for NE multispecies limited access vessels.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... ACL for a particular stock to be exceeded. If such catch resulted in the overall ACL for a particular... amount of the overage of the overall ACL for that stock multiplied by the common pool's share of the...

  7. 50 CFR 648.230 - Spiny dogfish Annual Catch Limits (ACLs).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Spiny Dogfish Monitoring Committee shall recommend to the Joint Spiny Dogfish Committee, an ACL for the...) recommended by the SSC as specified in § 648.20. (1) Periodicity. The spiny dogfish ACL may be established on... shall conduct a detailed review of fishery performance relative to the ACL at least every 5 years. (1...

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Spiny Dogfish Monitoring Committee shall recommend to the Joint Spiny Dogfish Committee, an ACL for the...) recommended by the SSC as specified in § 648.20. (1) Periodicity. The spiny dogfish ACL may be established on... shall conduct a detailed review of fishery performance relative to the ACL at least every 5 years. (1...

  9. 78 FR 32995 - Snapper-Grouper Fishery of the South Atlantic; 2013 Recreational Accountability Measure and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-03

    ... catch limit (ACL) for golden tilefish. Furthermore, information from 2013 recreational landings indicate that landings are projected to reach the recreational ACL on June 3, 2013. To account for the 2012 ACL overage and to prevent an ACL overage in 2013, NMFS closes the recreational sector for golden tilefish on...

  10. 50 CFR 648.230 - Spiny dogfish Annual Catch Limits (ACLs).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Spiny Dogfish Monitoring Committee shall recommend to the Joint Spiny Dogfish Committee, an ACL for the...) recommended by the SSC as specified in § 648.20. (1) Periodicity. The spiny dogfish ACL may be established on... shall conduct a detailed review of fishery performance relative to the ACL at least every 5 years. (1...

  11. 77 FR 74119 - Snapper-Grouper Fishery of the South Atlantic; 2012 Commercial Accountability Measure and Closure...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-13

    ... estimated by the Science Research Director, are projected to reach the commercial annual catch limit (ACL... of the ACL if they occur. The final rule for Amendment 17B to the FMP established ACLs for eight... commercial ACL (commercial quota) for snowy grouper is 82,900 lb (37,603 kg), gutted weight, for the current...

  12. 76 FR 61285 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; South Atlantic Snapper-Grouper...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-04

    ... reduces the 2011-2012 recreational annual catch limit (ACL) for black sea bass based on the 2010-2011 recreational ACL overage. This action is necessary to reduce overfishing of the South Atlantic black sea bass... controls to prevent ACLs from being exceeded, and correct or mitigate the ACL if an overage occurs. On...

  13. 76 FR 61284 - Accountability Measures and Reduced Season for the South Atlantic Recreational Sector of Golden...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-04

    ... catch limit (ACL) overage, and as a result closes the recreational sector. This action is necessary to... overages of the ACL if they occur. On December 30, 2010, NMFS issued a final rule (75 FR 82280) to... if these ACLs are reached or exceeded. The recreational ACL for golden tilefish, implemented through...

  14. 50 CFR 622.280 - Annual catch limits (ACLs) and accountability measures (AMs).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... commercial ACL of 1,157,001 lb (524,807 kg), round weight, the AA will file a notification with the Office of... ACL for that following year by the amount of the commercial overage in the prior fishing year. (2... recreational ACL of 14,187,845 lb (6,435,498 kg), round weight, then during the following fishing year...

  15. 50 CFR 622.280 - Annual catch limits (ACLs) and accountability measures (AMs).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... commercial ACL of 1,065,524 lb (483,314 kg), round weight, the AA will file a notification with the Office of... recreational ACL of 13,530,692 lb (6,137,419 kg), round weight, then during the following fishing year... recreational ACL in the following fishing year. However, the length of the recreational season will also not be...

  16. 75 FR 29459 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Revisions to...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-26

    ... Catch Entitlements: Updated Annual Catch Limits for Sectors and the Common Pool for Fishing Year 2010... fishing year (FY) 2010 specification of annual catch limits (ACLs) for common pool vessels (common pool... fish in the common pool for FY 2010. DATES: Effective May 21, 2010 through April 30, 2011. FOR FURTHER...

  17. 78 FR 64181 - Snapper-Grouper Fishery of the South Atlantic; Reopening of the Commercial Harvest of Gray...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-28

    ... economic zone (EEZ). NMFS previously determined the commercial annual catch limit (ACL) for gray..., on July 7, 2013. However, updated landings estimates indicate the commercial ACL for gray triggerfish... Conservation and Management Act (Magnuson-Stevens Act). Background NMFS determined that the commercial ACL for...

  18. 78 FR 68373 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; 2013 Commercial Accountability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-14

    ... Science Research Director, have reached the commercial annual catch limit (ACL). Therefore, NMFS closes... Act (Magnuson-Stevens Act) by regulations at 50 CFR part 622. The commercial ACL (commercial quota... required to close the commercial sector for gag when the commercial ACL (commercial quota) has been reached...

  19. 77 FR 73005 - Fisheries Off West Coast States; Coastal Pelagic Species Fisheries; Annual Specifications

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-07

    ... (NOAA), Commerce. ACTION: Proposed rule. SUMMARY: NMFS proposes to implement the annual catch limit (ACL...) Fishery Management Plan (FMP). The proposed 2012-2013 ACL or maximum HG for Pacific mackerel is 40,514... the fishery attains the ACT, the directed fishery will close, reserving the difference between the ACL...

  20. 77 FR 59344 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; 2012 Commercial Accountability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-27

    ... the commercial annual catch limit (ACL) on September 28, 2012. Therefore, NMFS closes the commercial... Management Act (Magnuson- Stevens Act) by regulations at 50 CFR part 622. The commercial ACL (commercial... vermilion snapper when the commercial ACL (commercial quota) for the applicable portion of the fishing year...

  1. 78 FR 57348 - Fisheries Off West Coast States; Coastal Pelagic Species Fisheries; Annual Specifications

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-18

    ... (NOAA), Commerce. ACTION: Proposed rule. SUMMARY: NMFS proposes to implement the annual catch limit (ACL... (CPS) Fishery Management Plan (FMP). The proposed 2013-2014 ACL for Pacific mackerel is 52,358 metric... fishery attains the ACT, the directed fishery will close, reserving the difference between the ACL and ACT...

  2. 78 FR 61826 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; Closure of the 2013 South...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-04

    ... annual catch limit (ACL) for red snapper on October 8, 2013. Therefore, NMFS closes the commercial sector... commercial ACL for red snapper in the South Atlantic is 21,447 lb (9,728 kg), gutted weight. This ACL was... snapper when the commercial ACL is reached, or is projected to be reached, by filing a notification to...

  3. 78 FR 25861 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; 2013 Commercial Accountability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-03

    ... commercial annual catch limit (ACL) for golden tilefish on May 5, 2013. Therefore, NMFS closes the commercial... Conservation and Management Act by regulations at 50 CFR part 622. The commercial ACL (commercial quota) for...)(1), NMFS is required to close the commercial sector for golden tilefish when the commercial ACL has...

  4. 78 FR 30779 - Snapper-Grouper Fishery of the South Atlantic; 2013 Recreational Accountability Measure and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-23

    ... landings from 2010-2012 exceeded the recreational annual catch limit (ACL) for snowy grouper. To account... Conservation and Management Act (Magnuson- Stevens Act) by regulations at 50 CFR part 622. The recreational ACL... recreational ACL is exceeded, the Assistant Administrator, NMFS (AA) will file a notification with the Office...

  5. 78 FR 18249 - Fisheries Off West Coast States; Coastal Pelagic Species Fisheries; Annual Specifications

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-26

    ... limit (ACL), harvest guideline (HG), annual catch target (ACT) and associated annual reference points... Coastal Pelagic Species (CPS) Fishery Management Plan (FMP). The 2012-2013 ACL or maximum HG for Pacific... difference between the ACL and ACT (10,128 mt) as a set aside for incidental landings in other CPS fisheries...

  6. 77 FR 36192 - Fisheries Off West Coast States; Coastal Pelagic Species Fisheries; Annual Specifications

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-18

    ... limit (ACL), harvest guideline (HG), annual catch target (ACT) and associated annual reference points... year season of July 1, 2011, through June 30, 2012. NMFS establishes the ACL, HG, and ACT under the... off the Pacific coast. The ACL (or maximum HG) for the 2011- 2012 Pacific mackerel fishing year is 40...

  7. 78 FR 39188 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; 2013 Commercial Accountability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-01

    ... annual catch limit (ACL) on July 7, 2013. Therefore, NMFS closes the commercial sector for gray... by regulations at 50 CFR part 622. The commercial ACL for gray triggerfish in the South Atlantic is... the commercial sector for gray triggerfish when the commercial ACL is reached, or is projected to be...

  8. 77 FR 68071 - Snapper-Grouper Fishery of the South Atlantic; Reopening of the 2012 Commercial Sector for South...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-15

    ... Atlantic exclusive economic zone (EEZ). NMFS previously determined the commercial annual catch limit (ACL... previously determined the commercial ACL for gag would be reached by October 20, 2012, and closed the... commercial gag ACL has been reached at this time. Therefore, NMFS is reopening the commercial sector for red...

  9. 78 FR 10122 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; Reef Fish Fishery of the Gulf of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-13

    ... recreational sector's annual catch limits (ACLs) and annual catch targets (ACTs) for gray triggerfish; revise the recreational sector accountability measures (AMs) for gray triggerfish; revise the gray triggerfish recreational bag limit; establish a commercial trip limit for gray triggerfish; and establish a...

  10. 77 FR 14697 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Trip Limit...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-13

    ... Fishery; Trip Limit Adjustments for the Common Pool Fishery AGENCY: National Marine Fisheries Service...) multispecies common pool vessels for the remainder of the 2011 fishing year (FY), through April 30, 2012. This... catch of these stocks to approach their pertinent common pool sub-annual catch limits (sub-ACLs). DATES...

  11. 76 FR 18661 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Trip Limit...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-05

    ... Fishery; Trip Limit Adjustments for the Common Pool Fishery AGENCY: National Marine Fisheries Service... (NE) multispecies common pool vessels for the 2010 fishing year (FY), through April 30, 2011. This... common pool sub-annual catch limits (sub-ACLs). This action is also intended to reduce catch rates of GOM...

  12. 77 FR 25100 - Fisheries of the Northeastern United States; Atlantic Bluefish Fishery; 2012 Atlantic Bluefish...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-27

    ... establishes the allowable 2012 harvest levels and other management measures to achieve the target fishing... catch limit (ACL), annual catch target (ACT), and total allowable landings (TAL) that will control...

  13. 77 FR 66 - Western Pacific Fisheries; 2012 Annual Catch Limits and Accountability Measures

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-03

    ... proposes annual catch limits for western Pacific bottomfish, crustacean, precious coral, and coral reef... specify ACLs for bottomfish, crustacean, precious coral, and coral reef ecosystem fishery MUS in American... bottomfish, crustacean, precious coral, or coral reef ecosystem MUS in the PRIA because commercial fishing is...

  14. 75 FR 55744 - North Pacific Fishery Management Council; Public Meetings

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-14

    ... priorities. 9. BSAI Crab Issues: Initial review Pribilof Bristol Bay Red King Crab rebuilding plan; review... Aleutian Island (BSAI Crab Stock Assessment Fishery Evaluation (SAFE) report and Overfishing Limits (OFLs): Review and approve SAFE and annual catch specifications. 4. BSAI Crab Annual Catch Limits (ACLs)/snow...

  15. 77 FR 50388 - Coastal Migratory Pelagic Resources of the Gulf of Mexico and South Atlantic; 2012-2013...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-21

    ... this temporary final rule. NMFS has determined that the commercial annual catch limit (ACL) (equal to... Conservation and Management Act (Magnuson-Stevens Act) by regulations at 50 CFR part 622. The commercial ACL... Gulf migratory group king mackerel in the western zone when the ACL (quota) is reached, or is projected...

  16. 78 FR 58248 - Coastal Migratory Pelagic Resources of the Gulf of Mexico and South Atlantic; 2013-2014...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-23

    ... this temporary final rule. NMFS has determined that the commercial annual catch limit (ACL) (equal to... Conservation and Management Act (Magnuson-Stevens Act) by regulations at 50 CFR part 622. The commercial ACL... mackerel in the western zone when the ACL (quota) is reached, or is projected to be reached, by filing a...

  17. 77 FR 73338 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; 2012 Commercial Accountability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-10

    ... catch limit (ACL). Therefore, NMFS closes the commercial sector for blue runner on December 10, 2012... CFR part 622. The commercial ACL for blue runner in the South Atlantic is 188,329 lb (85,425 kg... ACL for blue runner has been reached, or is projected to be reached, by filing a notification to that...

  18. 78 FR 68372 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; 2013 Commercial Accountability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-14

    ... annual catch limit (ACL) on November 14, 2013. Therefore, NMFS closes the commercial sector for blue... Act (Magnuson- Stevens Act) by regulations at 50 CFR part 622. The commercial ACL for blue runner in... sector for blue runner when the commercial ACL for blue runner has been reached, or is projected to be...

  19. 75 FR 44924 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Trip Limit Reduction...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-30

    ... Northeast (NE) multispecies vessels fishing under common pool regulations for the 2010 fishing year (FY... of harvest exceeding the subcomponent of the annual catch limit (ACL) allocated to the common pool (common pool sub-ACL) for each of these stocks during FY 2010 (May 1, 2010, through April 30, 2011). This...

  20. 76 FR 30035 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Trip Limit Increase...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-24

    ... Fishery; Trip Limit Increase for the Common Pool Fishery AGENCY: National Marine Fisheries Service (NMFS...) multispecies common pool vessels for the 2011 fishing year (FY), through April 30, 2012. This action is... the total catch of this stock to further approach the common pool sub-annual catch limit (sub-ACL...

  1. 77 FR 74389 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; 2012 Commercial Accountability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-14

    ... projected to reach the commercial annual catch limit (ACL) on December 19, 2012. Therefore, NMFS closes the.... Background The commercial ACL for wahoo is 64,147 lb (29,097 kg), round weight, as specified in 50 CFR 622.49... sector for wahoo when the commercial ACL for wahoo has been reached, or is projected to be reached, by...

  2. 76 FR 46719 - Western Pacific Bottomfish and Seamount Groundfish Fisheries; 2011-12 Main Hawaiian Islands Deep...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-03

    ... year, based on a proposed annual catch limit (ACL) of 346,000 lb (156,943 kg). When the fishery is... codified at 50 CFR 665.4 (76 FR 37285, June 27, 2011). The regulations require NMFS to specify an ACL for... Council's recommendation of an ACL of 346,000 lb (156,943 kg) considers the most recent bottomfish stock...

  3. 50 CFR 648.201 - AMs and harvest controls.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... projects that catch will reach 95 percent of the annual sub-ACL allocated to a management area before the end of the fishing year, or 95 percent of the Area 1A sub-ACL allocated to the first seasonal period... catch is projected to reach 95 percent of the sub-ACL, from fishing for, possessing, catching...

  4. 50 CFR 648.201 - AMs and harvest controls.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... projects that catch will reach 95 percent of the annual sub-ACL allocated to a management area before the end of the fishing year, or 95 percent of the Area 1A sub-ACL allocated to the first seasonal period... catch is projected to reach 95 percent of the sub-ACL, from fishing for, possessing, catching...

  5. 50 CFR 648.53 - Acceptable biological catch (ABC), annual catch limits (ACL), annual catch targets (ACT), DAS...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... be implemented as soon as possible after September 30 each year. (v) The Elephant Trunk Access Area shall change to an open area starting in fishing year 2011. For reference, the Elephant Trunk Access... chart depicting the area previously known as the Elephant Trunk Access Area are available from the...

  6. 50 CFR 648.53 - Acceptable biological catch (ABC), annual catch limits (ACL), annual catch targets (ACT), DAS...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... be implemented as soon as possible after September 30 each year. (v) The Elephant Trunk Access Area shall change to an open area starting in fishing year 2011. For reference, the Elephant Trunk Access... chart depicting the area previously known as the Elephant Trunk Access Area are available from the...

  7. 76 FR 6403 - Western Pacific Fishery Management Council; Public Meetings

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-04

    .... Program Planning A. Annual Catch Limit (ACL) Specification Process B. Workshop on ACLs for Coral Reef.... Coastal and Marine Spatial Planning 4. Ecosystem Monitoring and Community Issues A. Report on Coral Reef... Resources i. Coral Reef Fisheries ii. Bottomfish Fisheries iii. Crustacean Fisheries B. National Marine...

  8. 77 FR 32573 - New England Fishery Management Council (NEFMC); Public Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-01

    ... discuss the low fishing year 2012 annual catch limit (ACL) for Georges Bank yellowtail flounder and will... on fishing activity, as well as possible adjustments to sub-ACLs of Georges Bank yellowtail flounder... physically accessible to people with disabilities. Requests for sign language interpretation or other...

  9. 76 FR 65971 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Adjustment to the Atlantic...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-25

    ...; Adjustment to the Atlantic Herring Management Area 1A Sub- Annual Catch Limit AGENCY: National Marine...: Temporary rule; inseason adjustment. SUMMARY: NMFS adjusts the 2011 Fishing Year sub-annual catch limit for... transfer and sub-ACLs for each management area. The 2011 Domestic Annual Harvest is 91,200 metric tons (mt...

  10. 77 FR 65356 - Fisheries of the Caribbean, Gulf of Mexico and South Atlantic; Snapper-Grouper Fishery Off the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-26

    ... commercial annual catch limit (ACL) between the longline and hook-and-line components. Seventy-five percent... and 25 percent of the ACL, or 135,324 lb (61,382 kg), gutted weight, would be allocated to the hook... trip limit was originally intended to allow hook-and-line fishermen access to golden tilefish in the...

  11. 77 FR 41704 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Adjustment of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-16

    ... catch of GB yellowtail flounder by the scallop fishery and is consistent with a request for the ACL... multispecies, scallop, and other fisheries. The allocation to the scallop fishery, known as the sub-ACL, is..., to maximize scallop catch. The groundfish sub-ACL is determined after deducting the sub-ACL allocated...

  12. 78 FR 49190 - Magnuson-Stevens Act Provisions; Fisheries Off West Coast States; Biennial Specifications and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-13

    ...: To achieve, to the extent possible, but not exceed, annual catch limits (ACLs) of target species; and... within their targets and no inseason actions were considered. Therefore, the Council recommended and NMFS... ACLs of overfished and target species from being exceeded. No aspect of this action is controversial...

  13. 77 FR 65498 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Adjustment to the Atlantic...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-29

    ... 1A sub-ACL. Classification This action is required by 50 CFR part 648 and is exempt from review under...; Adjustment to the Atlantic Herring Management Area 1A Sub- Annual Catch Limit AGENCY: National Marine...: Temporary rule; inseason adjustment. SUMMARY: NMFS adjusts the 2012 fishing year sub-annual catch limit for...

  14. 75 FR 29678 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Reductions to Trip...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-27

    ... for Northeast (NE) multispecies vessels fishing under common pool regulations for the 2010 fishing... likelihood of harvest exceeding the subcomponent of the annual catch limit (ACL) allocated to the common pool (common pool sub-ACL) for each of these five stocks during FY 2010 (May 1, 2010, through April 30, 2011...

  15. 75 FR 55286 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Adjustment to...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-10

    ... require that any overage of the GB yellowtail flounder TAC specified for the common pool, individual... deduction will be divided between the annual catch limit (ACL) for common pool vessels (common pool sub-ACL... that ``any overages of the GB cod and GB haddock TACs specified for either the common pool or...

  16. 76 FR 54715 - Western Pacific Bottomfish and Seamount Groundfish Fisheries; 2011-12 Main Hawaiian Islands Deep...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-02

    ... Hawaiian Islands for the 2011-12 fishing year, based on an annual catch limit of 346,000 lb. The expected... in the main Hawaiian Islands (MHI) for the 2011-12 fishing year, based on an annual catch limit (ACL.... 110711384-1534-02] RIN 0648-XA470 Western Pacific Bottomfish and Seamount Groundfish Fisheries; 2011-12 Main...

  17. 76 FR 82057 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; Coastal Migratory Pelagic...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-29

    ... allocations for Atlantic migratory group cobia and establishes control rules for king mackerel, Spanish... migratory groups for cobia; and establishes annual catch limits (ACLs), annual catch targets (ACTs), and... be added back into the FMP at a later date. Cobia Migratory Groups This final rule establishes two...

  18. 77 FR 21958 - Fisheries Off West Coast States; Coastal Pelagic Species Fisheries; Annual Specifications

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-12

    ...), harvest guideline (HG), annual catch target (ACT) and associated annual reference points for Pacific... metric tons (mt). The proposed ACT, which will be the directed fishing harvest target, is 30,386 mt. If... limit (ACL) and harvest guideline (HG) and/or annual catch target (ACT) recommendations and comments...

  19. 50 CFR 648.89 - Recreational and charter/party vessel restrictions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... for that particular stock. To determine if the regulated species or ocean pout sub-ACL specified for... recreational catch to the 3-year average of the recreational sub-ACL for each stock, as follows: (i) For fishing year 2010, recreational catch shall be compared to the recreational sub-ACL for that stock for...

  20. 50 CFR 648.89 - Recreational and charter/party vessel restrictions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... for that particular stock. To determine if the regulated species or ocean pout sub-ACL specified for... recreational catch to the 3-year average of the recreational sub-ACL for each stock, as follows: (i) For fishing year 2010, recreational catch shall be compared to the recreational sub-ACL for that stock for...

  1. 77 FR 45270 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; Reef Fish Fishery of the Gulf of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-31

    ... regarding the quotas and annual catch limits (ACLs) for ``other shallow-water grouper'' (Other SWG) that... the commercial shallow-water grouper (SWG) quotas and commercial SWG ACL erroneously included in the...: Authority: 16 U.S.C. 1801 et seq. 0 2. In Sec. 622.2, the definition for ``Shallow-water grouper (SWG)'' is...

  2. 77 FR 20775 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; Reef Fish Fishery of the Gulf of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-06

    ... inconsistencies in the regulatory text regarding the quotas and annual catch limits (ACLs) for ``other shallow... shallow-water grouper (SWG) quota; --Adjust the commercial and recreational sector's ACLs for gag and red... U.S.C. 1801 et seq. 2. In Sec. 622.2, the definition for ``Shallow-water grouper (SWG)'' is revised...

  3. 78 FR 72586 - Magnuson-Stevens Act Provisions; Fisheries off West Coast States; Biennial Specifications and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-03

    ... exceed, annual catch limits (ACLs) of target species; and to foster the rebuilding of overfished stocks... would be 176 mt. This level of catch would be below the sablefish harvest target of 362 mt for the open... DTL fisheries south of 36[deg] N. lat. has been within their harvest target. The Council considered...

  4. 76 FR 24463 - Caribbean Fishery Management Council; Public Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-02

    .... Magnuson-Stevens Reauthorization Act (MSRA)/Annual Catch Limit (ACL) review of language--Overfishing Limit... decisions/motions get treated at Council level. 2. Review of decisions/logic behind 2010 amendment. a. Brief... accessible to people with disabilities. For more information or request for sign language interpretation and...

  5. 78 FR 63892 - Magnuson-Stevens Fishery Conservation and Management Act Provisions; Fisheries of the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-25

    ... social harm resulting from substantial reductions to the 2013 annual catch limits for several stocks... limit (ACL) for several Northeast (NE) multispecies (groundfish) stocks as part of Framework Adjustment... necessary to prevent overfishing and rebuild overfished groundfish stocks consistent with rebuilding plans...

  6. 76 FR 53832 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Trip Limit Decrease...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-30

    ... Fishery; Trip Limit Decrease for the Common Pool Fishery AGENCY: National Marine Fisheries Service (NMFS... (GB) cod for Northeast (NE) multispecies common pool vessels for the 2011 fishing year (FY), through... reduce the harvest of GOM and GB cod to prevent the common pool sub-annual catch limit (sub-ACL) from...

  7. 75 FR 61704 - Fisheries of the South Atlantic; South Atlantic Fishery Management Council; Public Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-06

    ... of black sea bass and golden tilefish; Amendment 24 addressing management of red grouper and Amendment 22 addressing long- term management of red snapper, and the Comprehensive Annual Catch Limit (ACL... & 10 to the Snapper Grouper Fishery Management Plan (FMP) addressing trip limits and changes to red...

  8. 50 CFR 648.163 - Bluefish Accountability Measures (AMs).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) ACL overage evaluation. The ACL will be evaluated based on a single-year examination of total catch (landings and dead discards). Both landings and dead discards will be evaluated in determining if the ACL... cause the ACL specified in § 648.160(a) to be exceeded, or if the commercial fisheries in all states...

  9. 50 CFR 648.163 - Bluefish Accountability Measures (AMs).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...) ACL overage evaluation. The ACL will be evaluated based on a single-year examination of total catch (landings and dead discards). Both landings and dead discards will be evaluated in determining if the ACL... cause the ACL specified in § 648.160(a) to be exceeded, or if the commercial fisheries in all states...

  10. 50 CFR 648.163 - Bluefish Accountability Measures (AMs).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...) ACL overage evaluation. The ACL will be evaluated based on a single-year examination of total catch (landings and dead discards). Both landings and dead discards will be evaluated in determining if the ACL... cause the ACL specified in § 648.160(a) to be exceeded, or if the commercial fisheries in all states...

  11. 50 CFR 648.233 - Spiny dogfish Accountability Measures (AMs).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... dogfish permit under this part. (b) ACL overage evaluation. The ACL will be evaluated based on a single-year examination of total catch (including both landings and dead discards) to determine if the ACL has been exceeded. (c) Overage repayment. In the event that the ACL has been exceeded in a given fishing...

  12. 76 FR 43745 - Magnuson-Stevens Fishery Conservation and Management Act (MSA) Provisions; Fisheries of the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-21

    ...NMFS hereby implements measures approved in Amendment 15 to the Scallop FMP (Amendment 15), which was developed by the New England Fishery Management Council (Council). Amendment 15 was developed primarily to implement annual catch limits (ACLs) and accountability measures (AMs) to bring the Scallop FMP into compliance with requirements of the MSA as reauthorized in 2007. Amendment 15 includes additional measures recommended by the Council, including: A revision of the overfishing definition (OFD); modification of the essential fish habitat (EFH) closed areas under the Scallop FMP; adjustments to measures for the Limited Access General Category (LAGC) individual fishing quota (IFQ) fishery; adjustments to the scallop research set- aside (RSA) program; and additions to the list of measures that can be adjusted by framework adjustments. NMFS has disapproved a provision that would have allocated additional scallop catch to the LAGC fleet because it was not consistent with National Standard 1 and the ACL requirement of the MSA.

  13. 78 FR 61838 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Removal of 2,000-lb (907.2...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-04

    ...NMFS announces a temporary removal of the 2,000-lb (907.2 kg) trip limit for the Atlantic herring fishery in Management Area 2 (Area 2) because catch data indicate that 95 percent of the total sub-annual catch limit (sub-ACL) threshold in Area 2 has not been fully attained. Vessels issued a Federal permit to harvest Atlantic herring may resume fishing for and landing herring in amounts greater than 2,000 lb (907.2 kg), consistent with their respective Atlantic herring permit categories, effective 0001 hrs, October 1, 2013.

  14. 50 CFR Table 2a to Part 660... - 2012, and beyond, Specifications of OFL, ABC, ACL, ACT and Fishery Harvest guidelines (weights in...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... ACL of ACT any allocation for the Pacific Coast treaty Indian Tribes, projected research catch... fishery (16 mt) and research catch (5 mt), resulting in a fishery HG of 1,880 mt. c/ Lingcod south... swept area biomass (2003-2008) from the NMFS NWFSC trawl survey, between the northern and southern areas...

  15. 50 CFR 648.230 - Catch quotas and other restrictions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... the Joint Spiny Dogfish Committee, an ACL for the commercial spiny dogfish fishery, which shall equal....20. (1) Periodicity. The spiny dogfish ACL may be established on an annual basis for up to 5 years at... fishery performance relative to the ACL at least every 5 years. (1) If an ACL is exceeded with a frequency...

  16. 50 CFR 648.143 - Minimum sizes.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... black sea bass fishery adopted by the ASMFC. (1) Commercial ACL overage evaluation. The commercial sector ACL will be evaluated based on a single-year examination of total catch (landings and dead discards). Both landings and dead discards will be evaluated in determining if the commercial sector ACL...

  17. 50 CFR 648.123 - Gear restrictions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... available for landing scup for the remainder of the period. (1) Commercial ACL overage evaluation. The commercial sector ACL will be evaluated based on a single-year examination of total catch (landings and dead discards). Both landings and dead discards will be evaluated in determining if the commercial sector ACL...

  18. 77 FR 53776 - Snapper-Grouper Fishery of the South Atlantic; Accountability Measures and Commercial Closures...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-04

    ... respective annual catch limit (ACLs) for the deep-water complex (including yellowedge grouper, blueline... the snapper-grouper resource. DATES: The closure for the deep-water complex as well as the porgy...-grouper fishery of the South Atlantic, which includes yellowtail snapper, gray triggerfish, the deep-water...

  19. 50 CFR 648.89 - Recreational and charter/party vessel restrictions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... regulated species or ocean pout sub-ACL specified for the recreational fishery was exceeded, the Regional... sub-ACL for each stock, as follows: (i) For fishing year 2010, recreational catch shall be compared to the recreational sub-ACL for that stock for fishing year 2010. (ii) For fishing year 2011, the average...

  20. 50 CFR 648.89 - Recreational and charter/party vessel restrictions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... regulated species or ocean pout sub-ACL specified for the recreational fishery was exceeded, the Regional... sub-ACL for each stock, as follows: (i) For fishing year 2010, recreational catch shall be compared to the recreational sub-ACL for that stock for fishing year 2010. (ii) For fishing year 2011, the average...

  1. 50 CFR 648.89 - Recreational and charter/party vessel restrictions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... regulated species or ocean pout sub-ACL specified for the recreational fishery was exceeded, the Regional... sub-ACL for each stock, as follows: (i) For fishing year 2010, recreational catch shall be compared to the recreational sub-ACL for that stock for fishing year 2010. (ii) For fishing year 2011, the average...

  2. 50 CFR 648.63 - General category Sectors and harvesting cooperatives.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... of TAC to Sectors. (i) The sector allocation shall be equal to a percentage share of the ACL... specified in § 648.53(h). The sector's percentage share of the IFQ scallop fishery ACL catch shall not change, but the amount of allocation based on the percentage share will change based on the ACL specified...

  3. 50 CFR 648.63 - General category Sectors and harvesting cooperatives.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... of TAC to Sectors. (i) The sector allocation shall be equal to a percentage share of the ACL... specified in § 648.53(h). The sector's percentage share of the IFQ scallop fishery ACL catch shall not change, but the amount of allocation based on the percentage share will change based on the ACL specified...

  4. 50 CFR 648.201 - AMs and harvest controls.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Atlantic Herring Fishery § 648.201 AMs and harvest controls. (a) AMs—(1) Herring sub-ACLs and ACL—(i) Management area closure. If NMFS projects that catch will reach 92 percent of the annual sub-ACL allocated to...-ACL allocated to a seasonal period as set forth in paragraph (d) of this section, NMFS shall prohibit...

  5. 50 CFR 648.63 - General category Sectors and harvesting cooperatives.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... of TAC to Sectors. (i) The sector allocation shall be equal to a percentage share of the ACL... specified in § 648.53(h). The sector's percentage share of the IFQ scallop fishery ACL catch shall not change, but the amount of allocation based on the percentage share will change based on the ACL specified...

  6. 50 CFR 648.201 - AMs and harvest controls.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Atlantic Herring Fishery § 648.201 AMs and harvest controls. (a) AMs—(1) Herring sub-ACLs and ACL—(i) Management area closure. If NMFS projects that catch will reach 92 percent of the annual sub-ACL allocated to...-ACL allocated to a seasonal period as set forth in paragraph (d) of this section, NMFS shall prohibit...

  7. 77 FR 4754 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; Snapper-Grouper Fishery off the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-31

    ... recreational annual catch limits (ACLs) have been met before the end of the fishing year for the past 3 fishing... lb (1,134 kg), round weight; and (3) the South Atlantic Unlimited Snapper-Grouper Permit must have... minimum size limit from 12 inches (30.5 cm), total length (TL) to 13 inches (33 cm), TL, and to increase...

  8. 76 FR 69230 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; Comprehensive Ecosystem-Based...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-08

    ... economic zone (EEZ), establish an annual catch limit (ACL) for octocorals, modify management in special... specifications in the South Atlantic region. Through CE-BA 2, NMFS also proposes to designate new Essential Fish... Flexibility Act, for this rule. The IRFA describes the economic impact that this rule, if adopted, would have...

  9. 76 FR 59373 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; Generic Annual Catch Limits...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-26

    ... Fishery Management Plans (FMPs) for Reef Fish Resources, Red Drum, Shrimp, and Coral and Coral Reefs for... Coral and Coral Reefs FMP. The majority of harvest of octocorals occurs in waters under the jurisdiction... commercial and recreational sectors within the reef fish fishery in the Gulf. Finally, the Generic ACL...

  10. 75 FR 53871 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Modification of the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-02

    ...; Modification of the Common Pool Day-at-Sea Accounting and Possession Prohibition for Witch Flounder AGENCY... fishing under common pool regulations for the 2010 fishing year (FY) when fishing in the Inshore Gulf of... exceed the subcomponent of the annual catch limit (ACL) allocated to the common pool during FY 2010 (May...

  11. 50 CFR 648.161 - Bluefish Annual Catch Targets (ACTs).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... commercial and recreational sector-specific ACTs shall be less than or equal to the fishery level ACL. The... relative to ACTs in conjunction with any ACL performance review, as outlined in § 648.160(b)(1) through (3...

  12. 50 CFR 648.161 - Bluefish Annual Catch Targets (ACTs).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... commercial and recreational sector-specific ACTs shall be less than or equal to the fishery level ACL. The... relative to ACTs in conjunction with any ACL performance review, as outlined in § 648.160(b)(1) through (3...

  13. 50 CFR 648.71 - Catch quotas.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Maine and non-Maine ocean quahog ACTs shall be less than or equal to the ACL for the corresponding stock... relative to ACTs in conjunction with any ACL performance review, as outlined in § 648.70(b)(1) through (3). ...

  14. 50 CFR 648.161 - Bluefish Annual Catch Targets (ACTs).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... commercial and recreational sector-specific ACTs shall be less than or equal to the fishery level ACL. The... relative to ACTs in conjunction with any ACL performance review, as outlined in § 648.160(b)(1) through (3...

  15. 50 CFR 648.291 - Tilefish Annual Catch Target (ACT).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... recommendation process. (1) Sectors. The ACT shall be less than or equal to the ACL. The Tilefish Monitoring... ACL performance review, as outlined in § 648.290(b)(1) through (3). [76 FR 60644, Sept. 29, 2011] ...

  16. 50 CFR 648.291 - Tilefish Annual Catch Target (ACT).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... recommendation process. (1) Sectors. The ACT shall be less than or equal to the ACL. The Tilefish Monitoring... ACL performance review, as outlined in § 648.290(b)(1) through (3). [76 FR 60644, Sept. 29, 2011] ...

  17. 50 CFR 648.291 - Tilefish Annual Catch Target (ACT).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... recommendation process. (1) Sectors. The ACT shall be less than or equal to the ACL. The Tilefish Monitoring... ACL performance review, as outlined in § 648.290(b)(1) through (3). [76 FR 60644, Sept. 29, 2011] ...

  18. 78 FR 70009 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Adjustments to 2014 Sub...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-22

    ... decreased and one sub-ACL is being increased. This would result in an increase to the overall catch... in 2000. The Herring FMP divides the stock-wide herring ACL among three management areas, one of... management area has its own sub-ACL to allow greater control of the fishing mortality on each stock component...

  19. 50 CFR 648.71 - Surfclam and ocean quahog Annual Catch Targets (ACT).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... and the sum of the Maine and non-Maine ocean quahog ACTs shall be less than or equal to the ACL for... of fishery performance relative to ACTs in conjunction with any ACL performance review, as outlined...

  20. 50 CFR 648.71 - Surfclam and ocean quahog Annual Catch Targets (ACT).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... and the sum of the Maine and non-Maine ocean quahog ACTs shall be less than or equal to the ACL for... of fishery performance relative to ACTs in conjunction with any ACL performance review, as outlined...

  1. 50 CFR 648.71 - Surfclam and ocean quahog Annual Catch Targets (ACT).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... and the sum of the Maine and non-Maine ocean quahog ACTs shall be less than or equal to the ACL for... of fishery performance relative to ACTs in conjunction with any ACL performance review, as outlined...

  2. 78 FR 71530 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; 2013 Commercial Accountability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-29

    ...) for vermilion snapper in the South Atlantic is divided into two, 6-month time periods, and is 420,252... commercial annual catch limit (ACL) for the July 1 through December 31, 2013, fishing period on December 2... period. This closure is necessary to protect the vermilion snapper resource. DATES: This rule is...

  3. 78 FR 9848 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; 2013 Commercial Accountability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-12

    ... South Atlantic is divided into two, 6-month time periods, and is 315,523 lb (143,119 kg), gutted weight... commercial annual catch limit (ACL) for the January 1 through June 30, 2013 fishing period on February 13..., fishing period. This closure is necessary to protect the vermilion snapper resource. DATES: This rule is...

  4. 50 CFR 648.231 - Spiny dogfish Annual Catch Target (ACT) and Total Allowable Level of Landings (TAL).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... ACT and TAL recommendation process. (1) The ACT shall be identified as less than or equal to the ACL... conduct a detailed review of fishery performance relative to TALs in conjunction with any ACL performance...

  5. 50 CFR 648.231 - Spiny dogfish Annual Catch Target (ACT) and Total Allowable Level of Landings (TAL).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... ACT and TAL recommendation process. (1) The ACT shall be identified as less than or equal to the ACL... conduct a detailed review of fishery performance relative to TALs in conjunction with any ACL performance...

  6. 50 CFR 648.231 - Spiny dogfish Annual Catch Target (ACT) and Total Allowable Level of Landings (TAL).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... ACT and TAL recommendation process. (1) The ACT shall be identified as less than or equal to the ACL... conduct a detailed review of fishery performance relative to TALs in conjunction with any ACL performance...

  7. 76 FR 11857 - Magnuson-Stevens Fishery Conservation and Management Act Provisions; Fisheries of the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-03

    ...NMFS proposes regulations to implement measures in Framework Adjustment (FW) 45 to the NE Multispecies Fishery Management Plan (FMP). FW 45 was developed by the New England Fishery Management Council (Council) to prevent overfishing, rebuild overfished stocks, achieve optimum yield (OY), and minimize the economic impact of management measures on affected vessels, pursuant to the Magnuson- Stevens Fishery Conservation and Management Act (Magnuson-Stevens Act). This action would revise the biological reference points and stock status for pollock, update annual catch limits (ACLs) for several stocks for fishing years (FYs) 2011-2012, adjust the rebuilding program for Georges Bank (GB) yellowtail flounder, increase scallop vessel access to the Great South Channel Exemption Area, approve five new sectors, modify the existing dockside and at-sea monitoring requirements, revise several sector administrative provisions, establish a Gulf of Maine (GOM) Cod Spawning Protection Area, and refine measures affecting the catch of limited access NE multispecies Handgear A vessels. This action would disapprove the Council's proposed catch limits for GB yellowtail flounder for FY 2011, and instead propose new catch limits for this stock through emergency action authority based on new flexibility provided by the International Fisheries Agreement Clarification Act. This action is necessary to ensure that the fishery is managed on the basis of the best available science, to comply with the acceptable biological catch (ABC) control rules adopted in Amendment 16 to the FMP, and to enhance the viability of the fishery following the transition to sector management in 2010.

  8. 50 CFR Table 1a to Part 660... - 2011, Specifications of OFL, ABC, ACL, ACT and Fishery Harvest guidelines (weights in metric tons)

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... for the Pacific Coast treaty Indian Tribes, projected research catch, deductions for fishing mortality...) and research catch (5 mt), resulting in a fishery HG of 2,059 mt. c/ Lingcod south (California). A new... deducted for the incidental open access fishery and research catch, resulting in a fishery HG of 220,995 mt...

  9. 50 CFR Table 1a to Part 660... - 2011, Specifications of OFL, ABC, ACL, ACT and Fishery Harvest guidelines (weights in metric tons)

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... for the Pacific Coast treaty Indian Tribes, projected research catch, deductions for fishing mortality...) and research catch (5 mt), resulting in a fishery HG of 2,059 mt. c/ Lingcod south (California). A new... deducted for the incidental open access fishery and research catch, resulting in a fishery HG of 220,995 mt...

  10. 76 FR 30107 - Western Pacific Fishery Management Council; Public Meetings

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-24

    .... Report on Heterocarpus Sp. Catch History 4. Hawaii Akule/Opelu Time Series 5. Precious Coral ACLs E....m. All meetings will be held in Honolulu, HI. For specific times and agendas, see SUPPLEMENTARY...

  11. 75 FR 57262 - New England and Mid-Atlantic Fishery Management Councils; Amendment 5 to the Monkfish Fishery...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-20

    ...This supplemental notice is to alert the interested public of the New England Fishery Management Council's (Council) intent to change the level of NEPA analysis for Amendment 5 to the Monkfish Fishery Management Plan (FMP) from an Environmental Impact Statement (EIS) to an EA and to provide for public comment on this course of action. The primary purpose of Amendment 5 is to address the Magnuson-Stevens Fishery Conservation and Management Act (Magnuson-Stevens Act) requirements for annual catch limits (ACLs) and accountability measures (AMs), to set multi-year specifications of days-at-sea (DAS) and trip limits, and to make other adjustments to measures in the FMP.

  12. 76 FR 5555 - Fisheries of the Northeastern United States; Monkfish; Amendment 5

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-01

    ...NMFS announces that the New England Fishery Management Council (NEFMC) has submitted Amendment 5 to the Monkfish Fishery Management Plan (FMP) (Amendment 5), incorporating a draft Environmental Assessment (EA) and an Initial Regulatory Flexibility Analysis (IRFA), for review by the Secretary of Commerce. NMFS is requesting comments from the public on Amendment 5, which was developed by the New England and Mid-Atlantic Fishery Management Councils (Councils) to bring the Monkfish FMP into compliance with the annual catch limit (ACL) and accountability measure (AM) requirements of the Magnuson-Stevens Fishery Conservation and Management Act (Magnuson-Stevens Act).

  13. 78 FR 30866 - South Atlantic Fishery Management Council; Public Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-23

    ... Committee; King & Spanish Mackerel Committee; Advisory Panel Selection Committee (CLOSED SESSION... staff on content and timing of the amendment. King & Spanish Mackerel Committee Agenda, Wednesday, June... catches versus ACLs for Atlantic group King Mackerel, Spanish Mackerel and Cobia. 2. Receive and discuss...

  14. 78 FR 52506 - South Atlantic Fishery Management Council; Public Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-23

    ... Committee; King & Spanish Mackerel Committee; Advisory Panel Selection Committee (closed session); Protected... Speckled Hind and Warsaw Grouper; and provide guidance to staff on timing of the amendment. King & Spanish... commercial and recreational catches versus ACLs for Atlantic group King Mackerel, Spanish Mackerel, and Cobia...

  15. 77 FR 31330 - South Atlantic Fishery Management Council; Public Meetings

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-25

    ... Collection Committee; King and Spanish Mackerel Committee; Advisory Panel Selection Committee (Closed Session..., beginning at 5:30 p.m. 7. King and Spanish Mackerel Committee Meeting: June 14, 2012, 8:30 a.m. Until 12 Noon The King and Spanish Mackerel Committee will receive updates on the status of catches versus ACLs...

  16. 78 FR 18187 - Magnuson-Stevens Fishery Conservation and Management Act Provisions; Fisheries of the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-25

    ... natural mortality rate (M) is 0.2 (M=0.2 model). The second assessment model assumes that M has increased... AMs (e.g., state waters). Currently, only the common pool fishery has a sub-ACL for SNE/MA windowpane flounder. The stock is not allocated to sectors, and therefore, all sector and common pool catch is...

  17. 77 FR 6988 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; Reef Fish Fishery of the Gulf of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-10

    ...; adjust the commercial ACL for SWG; establish a formula-based method for setting gag and red grouper multi... (FMP) for the Reef Fish Resources of the Gulf of Mexico (Amendment 32) prepared by the Gulf of Mexico... catch target (ACT) for 2012 through 2015 and subsequent fishing years, consistent with the gag...

  18. 75 FR 60709 - Fisheries Off West Coast States; Notice of Availability for Amendments 16-5 and 23 to the Pacific...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-01

    ...NMFS announces that the Pacific Fishery Management Council (Council) has submitted Amendments 16-5 and 23 to the Pacific Coast Groundfish Fishery Management Plan (FMP) for Secretarial review. Amendment 16-5 would modify the FMP to implement an overfished species rebuilding plan for petrale sole and revise existing overfished species rebuilding plans. In addition, Amendment 16-5 would modify the default proxy values for FMSY and BMSY as they apply to the flatfish species, including petrale sole; and the harvest control rule policies. Amendment 23 introduces a new framework for fishery specifications and other measures for establishing Annual Catch Limits (ACLs) as required by the recent amendments to the Magnuson-Stevens Fishery Conservation and Management Act (Magnuson-Stevens Act).

  19. 50 CFR 648.87 - Sector allocation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... sector's allocation of the overall ACL available to all vessels issued a limited access NE multispecies... the GB cod ACL available to all vessels issued a limited access NE multispecies permit, that sector... this example, if the overall GB cod ACL available to all vessels issued a limited access NE...

  20. Basic science of anterior cruciate ligament injury and repair

    PubMed Central

    Kiapour, A. M.; Murray, M. M.

    2014-01-01

    Injury to the anterior cruciate ligament (ACL) is one of the most devastating and frequent injuries of the knee. Surgical reconstruction is the current standard of care for treatment of ACL injuries in active patients. The widespread adoption of ACL reconstruction over primary repair was based on early perception of the limited healing capacity of the ACL. Although the majority of ACL reconstruction surgeries successfully restore gross joint stability, post-traumatic osteoarthritis is commonplace following these injuries, even with ACL reconstruction. The development of new techniques to limit the long-term clinical sequelae associated with ACL reconstruction has been the main focus of research over the past decades. The improved knowledge of healing, along with recent advances in tissue engineering and regenerative medicine, has resulted in the discovery of novel biologically augmented ACL-repair techniques that have satisfactory outcomes in preclinical studies. This instructional review provides a summary of the latest advances made in ACL repair. Cite this article: Bone Joint Res 2014;3:20–31. PMID:24497504

  1. Risk of Anterior Cruciate Ligament Fatigue Failure Is Increased by Limited Internal Femoral Rotation During In Vitro Repeated Pivot Landings

    PubMed Central

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

    2015-01-01

    Background A reduced range of hip internal rotation is associated with increased peak anterior cruciate ligament (ACL) strain and risk for injury. It is unknown, however, whether limiting the available range of internal femoral rotation increases the susceptibility of the ACL to fatigue failure. Hypothesis Risk of ACL failure is significantly greater in female knee specimens with a limited range of internal femoral rotation, smaller femoral-ACL attachment angle, and smaller tibial eminence volume during repeated in vitro simulated single-leg pivot landings. Study Design Controlled laboratory study. Methods A custom-built testing apparatus was used to simulate repeated single-leg pivot landings with a 4×-body weight impulsive load that induces knee compression, knee flexion, and internal tibial torque in 32 paired human knee specimens from 8 male and 8 female donors. These test loads were applied to each pair of specimens, in one knee with limited internal femoral rotation and in the contralateral knee with femoral rotation resisted by 2 springs to simulate the active hip rotator muscles’ resistance to stretch. The landings were repeated until ACL failure occurred or until a minimum of 100 trials were executed. The angle at which the ACL originates from the femur and the tibial eminence volume were measured on magnetic resonance images. Results The final Cox regression model (P = .024) revealed that range of internal femoral rotation and sex of donor were significant factors in determining risk of ACL fatigue failure. The specimens with limited range of internal femoral rotation had a failure risk 17.1 times higher than did the specimens with free rotation (P = .016). The female knee specimens had a risk of ACL failure 26.9 times higher than the male specimens (P = .055). Conclusion Limiting the range of internal femoral rotation during repetitive pivot landings increases the risk of an ACL fatigue failure in comparison with free rotation in a cadaveric model. Clinical Relevance Screening for restricted internal rotation at the hip in ACL injury prevention programs as well as in individuals with ACL injuries and/or reconstructions is warranted. PMID:26122384

  2. Risk of anterior cruciate ligament fatigue failure is increased by limited internal femoral rotation during in vitro repeated pivot landings.

    PubMed

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

    2015-09-01

    A reduced range of hip internal rotation is associated with increased peak anterior cruciate ligament (ACL) strain and risk for injury. It is unknown, however, whether limiting the available range of internal femoral rotation increases the susceptibility of the ACL to fatigue failure. Risk of ACL failure is significantly greater in female knee specimens with a limited range of internal femoral rotation, smaller femoral-ACL attachment angle, and smaller tibial eminence volume during repeated in vitro simulated single-leg pivot landings. Controlled laboratory study. A custom-built testing apparatus was used to simulate repeated single-leg pivot landings with a 4×-body weight impulsive load that induces knee compression, knee flexion, and internal tibial torque in 32 paired human knee specimens from 8 male and 8 female donors. These test loads were applied to each pair of specimens, in one knee with limited internal femoral rotation and in the contralateral knee with femoral rotation resisted by 2 springs to simulate the active hip rotator muscles' resistance to stretch. The landings were repeated until ACL failure occurred or until a minimum of 100 trials were executed. The angle at which the ACL originates from the femur and the tibial eminence volume were measured on magnetic resonance images. The final Cox regression model (P = .024) revealed that range of internal femoral rotation and sex of donor were significant factors in determining risk of ACL fatigue failure. The specimens with limited range of internal femoral rotation had a failure risk 17.1 times higher than did the specimens with free rotation (P = .016). The female knee specimens had a risk of ACL failure 26.9 times higher than the male specimens (P = .055). Limiting the range of internal femoral rotation during repetitive pivot landings increases the risk of an ACL fatigue failure in comparison with free rotation in a cadaveric model. Screening for restricted internal rotation at the hip in ACL injury prevention programs as well as in individuals with ACL injuries and/or reconstructions is warranted. © 2015 The Author(s).

  3. 50 CFR 648.290 - Individual fishing quota program and other restrictions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Limit (ACL). (a) The Tilefish Monitoring Committee shall recommend to the MAFMC an ACL for the...) Periodicity. The tilefish commercial ACL may be established on an annual basis for up to 3 years at a time... the sector ACLs at least every 5 years. (1) If the ACL is exceeded with a frequency greater than 25...

  4. 75 FR 18261 - Magnuson-Stevens Fishery Conservation and Management Act Provisions; Fisheries of the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-09

    ...This final rule implements measures approved under Amendment 16 to the NE Multispecies Fishery Management Plan (FMP). Amendment 16 was developed by the New England Fishery Management Council (Council) as part of the biennial adjustment process in the FMP to update status determination criteria for all regulated NE multispecies or ocean pout stocks; to adopt rebuilding programs for NE multispecies stocks newly classified as being overfished and subject to overfishing; and to revise management measures, including significant revisions to the sector management measures, necessary to end overfishing, rebuild overfished regulated NE multispecies and ocean pout stocks, and mitigate the adverse economic impacts of increased effort controls. This final rule also implements new requirements under Amendment 16 for establishing acceptable biological catch (ABC), annual catch limits (ACLs), and accountability measures (AMs) for each stock managed under the FMP, pursuant to the Magnuson-Stevens Fishery Conservation and Management Act (Magnuson-Stevens Act). Finally, this action adds Atlantic wolffish to the list of species managed by the FMP. This action is necessary to address the results of the most recent stock assessment, which indicate that several additional regulated species are overfished and subject to overfishing, and that stocks currently classified as overfished require additional reductions in fishing mortality to rebuild by the end of their rebuilding periods.

  5. 50 CFR 648.86 - NE Multispecies possession restrictions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... § 648.90(a)(4) will exceed the pertinent sub-ACL, NMFS may implement or adjust, at any time prior to or... possession limit and/or a maximum trip limit in order to prevent exceeding the common pool sub-ACL in that.... If the Regional Administrator projects that the sub-ACL of any stock allocated to the common pool...

  6. 50 CFR 648.87 - Sector allocation.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... overall ACL available to all vessels issued a limited access NE multispecies permit for these stocks pursuant to § 648.90(a)(4). For example, if a sector is allocated 10 percent of the GB cod ACL available to... GB cod ACL available to all vessels issued a limited access NE multispecies permit is 1,000 mt, of...

  7. 50 CFR 648.87 - Sector allocation.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... overall ACL available to all vessels issued a limited access NE multispecies permit for these stocks pursuant to § 648.90(a)(4). For example, if a sector is allocated 10 percent of the GB cod ACL available to... GB cod ACL available to all vessels issued a limited access NE multispecies permit is 1,000 mt, of...

  8. 50 CFR 648.87 - Sector allocation.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... overall ACL available to all vessels issued a limited access NE multispecies permit for these stocks pursuant to § 648.90(a)(4). For example, if a sector is allocated 10 percent of the GB cod ACL available to... GB cod ACL available to all vessels issued a limited access NE multispecies permit is 1,000 mt, of...

  9. 77 FR 26103 - Magnuson-Stevens Fishery Conservation and Management Act Provisions; Fisheries of the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-02

    ...NMFS approves Framework Adjustment 47 (Framework 47) to the Northeast (NE) Multispecies Fishery Management Plan (FMP) and implements the approved measures. The New England Fishery Management Council (Council) developed and adopted Framework 47 based on the biennial review process established in the NE Multispecies FMP to develop annual catch limits (ACLs) and revise management measures necessary to rebuild overfished groundfish stocks and achieve the goals and objectives of the FMP. This action also implements management measures and revises existing regulations that are not included in Framework 47, including common pool management measures for fishing year (FY) 2012, modification of the Ruhle trawl definition, and clarification of the regulations for charter/party and recreational groundfish vessels fishing in groundfish closed areas. This action is intended to prevent overfishing, rebuild overfished stocks, achieve optimum yield, and ensure that management measures are based on the best available scientific information at the time Framework 47 was submitted.

  10. 50 CFR 622.191 - Commercial trip limits.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    .... During a limited commercial fishing season, as specified in § 622.183(b)(5), and until the commercial ACL... limitations regarding red snapper after the commercial ACL is reached. (b) [Reserved] [78 FR 22952, Apr. 17...

  11. 50 CFR 622.191 - Commercial trip limits.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    .... During a limited commercial fishing season, as specified in § 622.183(b)(5), and until the commercial ACL... limitations regarding red snapper after the commercial ACL is reached. (b) [Reserved] [78 FR 22952, Apr. 17...

  12. 50 CFR 648.96 - FMP review, specification, and framework adjustment process.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Councils or the PDT may develop options for setting ABC, ACL, and OFL for each monkfish stock, as necessary... recommend to the SSC that ABC, ACL, and OFL are specified for each monkfish stock for multiple years as... not limited to, OFLs, ACLs, and management uncertainty. (ii) ACL recommendations. The Councils shall...

  13. 50 CFR 660.130 - Trawl fishery-management measures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... is a trip limit, size limit, scientific sorting designation, quota, harvest guideline, ACL or ACT or..., scientific sorting designation, quota, harvest guideline, ACL or ACT or OY applied.” The States of Washington...

  14. 50 CFR 660.130 - Trawl fishery-management measures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... limit, size limit, scientific sorting designation, quota, harvest guideline, ACL or ACT or OY, if the... designation, quota, harvest guideline, ACL or ACT or OY applied.” The States of Washington, Oregon, and...

  15. 50 CFR 660.12 - General groundfish prohibitions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., harvest guideline, ACT, ACL or OY, if the vessel fished or landed in an area during a time when such trip limit, size limit, scientific sorting designation, quota, harvest guideline, ACT, ACL or OY applied...

  16. 50 CFR 660.12 - General groundfish prohibitions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., harvest guideline, ACT, ACL or OY, if the vessel fished or landed in an area during a time when such trip limit, size limit, scientific sorting designation, quota, harvest guideline, ACT, ACL or OY applied...

  17. 50 CFR 660.12 - General groundfish prohibitions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ..., harvest guideline, ACT, ACL or OY, if the vessel fished or landed in an area during a time when such trip limit, size limit, scientific sorting designation, quota, harvest guideline, ACT, ACL or OY applied...

  18. 50 CFR 660.12 - General groundfish prohibitions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., harvest guideline, ACT, ACL or OY, if the vessel fished or landed in an area during a time when such trip limit, size limit, scientific sorting designation, quota, harvest guideline, ACT, ACL or OY applied...

  19. 50 CFR 660.230 - Fixed gear fishery-management measures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... limit, size limit, scientific sorting designation, quota, harvest guideline, ACL or ACT or OY, if the... designation, quota, harvest guideline, ACL or ACT or OY applied.” The States of Washington, Oregon, and...

  20. 50 CFR 660.230 - Fixed gear fishery-management measures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... limit, size limit, scientific sorting designation, quota, harvest guideline, ACL or ACT or OY, if the... designation, quota, harvest guideline, ACL or ACT or OY applied.” The States of Washington, Oregon, and...

  1. 50 CFR 648.293 - Tilefish trip limits.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... forth as follows: § 648.293 Tilefish accountability measures. (a) If the ACL is exceeded, the amount of the ACL overage that cannot be directly attributed to IFQ allocation holders having exceeded their IFQ allocation will be deducted from the ACL in the following fishing year. All overages directly attributable to...

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

    PubMed Central

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

    2016-01-01

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

  3. Clinical and experimental evidence suggest a link between KIF7 and C5orf42-related ciliopathies through Sonic Hedgehog signaling.

    PubMed

    Asadollahi, Reza; Strauss, Justin E; Zenker, Martin; Beuing, Oliver; Edvardson, Simon; Elpeleg, Orly; Strom, Tim M; Joset, Pascal; Niedrist, Dunja; Otte, Christine; Oneda, Beatrice; Boonsawat, Paranchai; Azzarello-Burri, Silvia; Bartholdi, Deborah; Papik, Michael; Zweier, Markus; Haas, Cordula; Ekici, Arif B; Baumer, Alessandra; Boltshauser, Eugen; Steindl, Katharina; Nothnagel, Michael; Schinzel, Albert; Stoeckli, Esther T; Rauch, Anita

    2018-02-01

    Acrocallosal syndrome (ACLS) is an autosomal recessive neurodevelopmental disorder caused by KIF7 defects and belongs to the heterogeneous group of ciliopathies related to Joubert syndrome (JBTS). While ACLS is characterized by macrocephaly, prominent forehead, depressed nasal bridge, and hypertelorism, facial dysmorphism has not been emphasized in JBTS cohorts with molecular diagnosis. To evaluate the specificity and etiology of ACLS craniofacial features, we performed whole exome or targeted Sanger sequencing in patients with the aforementioned overlapping craniofacial appearance but variable additional ciliopathy features followed by functional studies. We found (likely) pathogenic variants of KIF7 in 5 out of 9 families, including the original ACLS patients, and delineated 1000 to 4000-year-old Swiss founder alleles. Three of the remaining families had (likely) pathogenic variants in the JBTS gene C5orf42, and one patient had a novel de novo frameshift variant in SHH known to cause autosomal dominant holoprosencephaly. In accordance with the patients' craniofacial anomalies, we showed facial midline widening after silencing of C5orf42 in chicken embryos. We further supported the link between KIF7, SHH, and C5orf42 by demonstrating abnormal primary cilia and diminished response to a SHH agonist in fibroblasts of C5orf42-mutated patients, as well as axonal pathfinding errors in C5orf42-silenced chicken embryos similar to those observed after perturbation of Shh signaling. Our findings, therefore, suggest that beside the neurodevelopmental features, macrocephaly and facial widening are likely more general signs of disturbed SHH signaling. Nevertheless, long-term follow-up revealed that C5orf42-mutated patients showed catch-up development and fainting of facial features contrary to KIF7-mutated patients.

  4. 75 FR 53952 - Gulf of Mexico Fishery Management Council; Public Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-02

    .../Annual Catch Target Control Rule Working Group. DATES: The first meeting will convene at 9 a.m. on Monday.... SUPPLEMENTARY INFORMATION: The Annual Catch Limit/Annual Catch Target Control Rule Working Group will review and... limit and annual catch target. For fisheries that have the annual catch limit allocated into sectors...

  5. 50 CFR 648.86 - NE Multispecies possession restrictions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... the pertinent sub-ACL, NMFS may implement or adjust, at any time prior to or during the fishing year... maximum trip limit in order to prevent exceeding the common pool sub-ACL in that fishing year. (2... Administrator projects that the sub-ACL of any stock allocated to the common pool pursuant to § 648.90(a)(4...

  6. 78 FR 47212 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; 2013 Commercial Accountability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-05

    ... limit (ACL) (commercial quota) on August 10, 2013. Therefore, NMFS closes the commercial sector for... Act by regulations at 50 CFR part 622. The commercial ACL (equivalent to the commercial quota) for...)(1), NMFS is required to close the commercial sector for snowy grouper when the commercial ACL...

  7. No association between static and dynamic postural control and ACL injury risk among female elite handball and football players: a prospective study of 838 players.

    PubMed

    Steffen, Kathrin; Nilstad, Agnethe; Krosshaug, Tron; Pasanen, Kati; Killingmo, Aleksander; Bahr, Roald

    2017-02-01

    Research on balance measures as potential risk factors for ACL injury is limited. To assess whether postural control was associated with an increased risk for ACL injuries in female elite handball and football players. Premier league players were tested in the preseason and followed prospectively for ACL injury risk from 2007 through 2015. At baseline, we recorded player demographics, playing experience, ACL and ankle injury history. We measured centre of pressure velocity in single-leg stabilisation tests and reach distances in the Star Excursion Balance Test. To examine the stability of postural control measures over time, we examined their short-term and long-term reproducibility. We generated logistic regression models, 1 for each of the proposed risk factors. A total of 55 (6.6%) out of 838 players (age 21±4 years; height 170±6 cm; body mass 66±8 kg) sustained a non-contact ACL injury after baseline testing (1.8±1.8 years). When comparing normalised balance measures between injured and uninjured players in univariate analyses, none of the variables were statistically associated with ACL injury risk. Short-term and long-term reproducibility of the selected variables was poor. Players with a previous ACL injury had a 3-fold higher risk of sustaining a new ACL injury compared with previously uninjured players (OR 2.9, CI 1.4 to 5.7). None of postural control measures examined were associated with increased ACL injury risk among female elite handball and football players. Hence, as measured in the current investigation, the variables included cannot be used to predict ACL injury risk. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  8. 36 CFR 13.908 - Fishing limit of catch and in possession.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 36 Parks, Forests, and Public Property 1 2013-07-01 2013-07-01 false Fishing limit of catch and in possession. 13.908 Section 13.908 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF... Preserve General Provisions § 13.908 Fishing limit of catch and in possession. The limit of catch per...

  9. 36 CFR 13.908 - Fishing limit of catch and in possession.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 36 Parks, Forests, and Public Property 1 2012-07-01 2012-07-01 false Fishing limit of catch and in possession. 13.908 Section 13.908 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF... Preserve General Provisions § 13.908 Fishing limit of catch and in possession. The limit of catch per...

  10. Advanced Cardiac Life Support (ACLS) utilizing Man-Tended Capability (MTC) hardware onboard Space Station Freedom

    NASA Technical Reports Server (NTRS)

    Smith, M.; Barratt, M.; Lloyd, C.

    1992-01-01

    Because of the time and distance involved in returning a patient from space to a definitive medical care facility, the capability for Advanced Cardiac Life Support (ACLS) exists onboard Space Station Freedom. Methods: In order to evaluate the effectiveness of terrestrial ACLS protocols in microgravity, a medical team conducted simulations during parabolic flights onboard the KC-135 aircraft. The hardware planned for use during the MTC phase of the space station was utilized to increase the fidelity of the scenario and to evaluate the prototype equipment. Based on initial KC-135 testing of CPR and ACLS, changes were made to the ventricular fibrillation algorithm in order to accommodate the space environment. Other constraints to delivery of ACLS onboard the space station include crew size, minimum training, crew deconditioning, and limited supplies and equipment. Results: The delivery of ACLS in microgravity is hindered by the environment, but should be adequate. Factors specific to microgravity were identified for inclusion in the protocol including immediate restraint of the patient and early intubation to insure airway. External cardiac compressions of adequate force and frequency were administered using various methods. The more significant limiting factors appear to be crew training, crew size, and limited supplies. Conclusions: Although ACLS is possible in the microgravity environment, future evaluations are necessary to further refine the protocols. Proper patient and medical officer restraint is crucial prior to advanced procedures. Also emphasis should be placed on early intubation for airway management and drug administration. Preliminary results and further testing will be utilized in the design of medical hardware, determination of crew training, and medical operations for space station and beyond.

  11. Athymic Rat Model for Evaluation of Engineered Anterior Cruciate Ligament Grafts

    PubMed Central

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

    2015-01-01

    Anterior cruciate ligament (ACL) rupture is a common ligamentous injury that often requires surgery because the ACL does not heal well without intervention. Current treatment strategies include ligament reconstruction with either autograft or allograft, which each have their associated limitations. Thus, there is interest in designing a tissue-engineered graft for use in ACL reconstruction. We describe the fabrication of an electrospun polymer graft for use in ACL tissue engineering. This polycaprolactone graft is biocompatible, biodegradable, porous, and is comprised of aligned fibers. Because an animal model is necessary to evaluate such a graft, this paper describes an intra-articular athymic rat model of ACL reconstruction that can be used to evaluate engineered grafts, including those seeded with xenogeneic cells. Representative histology and biomechanical testing results at 16 weeks postoperatively are presented, with grafts tested immediately post-implantation and contralateral native ACLs serving as controls. The present study provides a reproducible animal model with which to evaluate tissue engineered ACL grafts, and demonstrates the potential of a regenerative medicine approach to treatment of ACL rupture. PMID:25867958

  12. Anterior cruciate ligament injury alters preinjury lower extremity biomechanics in the injured and uninjured leg: the JUMP-ACL study.

    PubMed

    Goerger, Benjamin M; Marshall, Stephen W; Beutler, Anthony I; Blackburn, J Troy; Wilckens, John H; Padua, Darin A

    2015-02-01

    Information as to how anterior cruciate ligament (ACL) injury and reconstructive surgery (ACLR) alter lower extremity biomechanics may improve rehabilitation and return to play guidelines, reducing the risk for repeat ACL injury. To compare lower extremity biomechanics before ACL injury and after subsequent ACLR for the injured and uninjured leg. Baseline unilateral lower extremity biomechanics were collected on the dominant leg of participants without ACL injury when they entered the Joint Undertaking to Monitor and Prevent ACL (JUMP-ACL) study. Thirty-one participants with subsequent ACL injury, reconstructive surgery and full return to physical activity completed repeat, follow-up biomechanical testing, as did 39 uninjured, matched controls. Not all injured participants suffered injury to the dominant leg, requiring separation of those with ACL injury into two groups: ACLR-injured leg group (n=12) and ACLR-uninjured leg group (n=19). We compared the landing biomechanics of these three groups (ACLR-injured leg, ACLR-uninjured leg, control) before ACL injury (baseline) with biomechanics after ACL injury, surgery and return to physical activity (follow-up). ACL injury and ACLR altered lower extremity biomechanics, as both ACLR groups demonstrated increases in frontal plane movement (increased hip adduction and knee valgus). The ACLR-injured leg group also exhibited decreased sagittal plane loading (decreased anterior tibial shear force, knee extension moment and hip flexion moment). No high-risk biomechanical changes were observed in control group participants. ACL injury and ACLR caused movement pattern alterations of the injured and uninjured leg that have previously shown to increase the risk for future non-contact ACL injury. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  13. 75 FR 48613 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Implementation of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-11

    ... under common pool regulations for the 2010 fishing year (FY). This action also corrects a previously published cod trip limit for common pool vessels fishing under a limited access Handgear A permit. This... common pool (common pool sub-ACL) and underharvesting the sub-ACL for pollock during FY 2010 (May 1, 2010...

  14. Biomimetic tissue-engineered anterior cruciate ligament replacement

    PubMed Central

    Cooper, James A.; Sahota, Janmeet S.; Gorum, W. Jay; Carter, Janell; Doty, Stephen B.; Laurencin, Cato T.

    2007-01-01

    There are >200,000 anterior cruciate ligament (ACL) ruptures each year in the United States, and, due to the poor healing properties of the ACL, surgical reconstruction with autograft or allograft tissue is the current treatment of these injuries. To regenerate the ACL, the ideal matrix should be biodegradable, porous, and exhibit sufficient mechanical strength to allow formation of neoligament tissue. Researchers have developed ACL scaffolds with collagen fibers, silk, biodegradable polymers, and composites with limited success. Our group has developed a biomimetic ligament replacement by using 3D braiding technology. In this preliminary in vivo rabbit model study for ACL reconstruction, the histological and mechanical evaluation demonstrated excellent healing and regeneration with our cell-seeded, tissue-engineered ligament replacement. PMID:17360607

  15. Editorial Commentary: The Downstream Effects of Limited Hip Rotation and Femoroacetabular Impingement on the Anterior Cruciate Ligament: Could a Little Hip Stretching Every Day (or Surgery) Keep the Knee Doctor Away?

    PubMed

    Boykin, Robert E

    2018-03-01

    Patients with radiographic evidence of femoroacetabular impingement and decreased hip internal rotation have a higher rate of anterior cruciate ligament (ACL) tears. Limited internal rotation of the hip increases strain and potentially resultant fatigue failure of the ACL. Although causation has not been proven, a better understanding of the lower extremity kinetic chain may allow improved ACL prevention strategies through measures (operative or nonoperative) to improve rotation of the hip. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  16. Dimensionality of the Knee Numeric-Entity Evaluation Score (KNEES-ACL): a condition-specific questionnaire.

    PubMed

    Comins, J D; Krogsgaard, M R; Kreiner, S; Brodersen, J

    2013-10-01

    The benefit of anterior cruciate ligament (ACL) reconstruction has been questioned based on patient-reported outcome measures (PROMs). Valid interpretation of such results requires confirmation of the psychometric properties of the PROM. Rasch analysis is the gold standard for validation of PROMs, yet PROMs used for ACL reconstruction have not been validated using Rasch analysis. We used Rasch analysis to investigate the psychometric properties of the Knee Numeric-Entity Evaluation Score (KNEES-ACL), a newly developed PROM for patients treated for ACL deficiency. Two-hundred forty-two patients pre- and post-ACL reconstruction completed the pilot PROM. Rasch models were used to assess the psychometric properties (e.g., unidimensionality, local response dependency, and differential item functioning). Forty-one items distributed across seven unidimensional constructs measuring impairment, functional limitations, and psychosocial consequences were confirmed to fit Rasch models. Fourteen items were removed because of statistical lack of fit and inadequate face validity. Local response dependency and differential item functioning were identified and adjusted. The KNEES-ACL is the first Rasch-validated condition-specific PROM constructed for patients with ACL deficiency and patients with ACL reconstruction. Thus, this instrument can be used for within- and between-group comparisons. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. No economic benefit of early knee reconstruction over optional delayed reconstruction for ACL tears: registry enriched randomised controlled trial data.

    PubMed

    Kiadaliri, Aliasghar A; Englund, Martin; Lohmander, L Stefan; Carlsson, Katarina Steen; Frobell, Richard B

    2016-05-01

    To analyse 5-year cost-effectiveness of early versus optional delayed acute anterior cruciate ligament (ACL) reconstruction. 121 young, active adults with acute ACL injury to a previously uninjured knee were randomised to early ACL reconstruction (n=62, within 10 weeks of injury) or optional delayed ACL reconstruction (n=59; 30 with ACL reconstruction within 6-55 months); all patients received similar structured rehabilitation. Real life data on health care utilisation and sick leave were obtained from regional and national registers. Costs and quality-adjusted life years (QALYs) were discounted at 3%. Full-analysis set (based on study randomisation) and as-treated analysis (according to actual treatment over 5 years) principles were applied. Mean cost of early ACL reconstruction was €4695 higher than optional delayed ACL reconstruction (p=0.19) and provided an additional 0.13 QALYs (p=0.11). Full-analysis set showed incremental net benefit of early versus optional delayed ACL reconstruction was not statistically significantly different from zero at any level. As-treated analysis showed that costs for rehabilitation alone were €13 650 less than early ACL reconstruction (p<0.001). Results were robust to sensitivity analyses. In young active adults with acute ACL injury, a strategy of early ACL reconstruction did not provide extra economic value over a strategy of optional delayed ACL reconstruction over a 5-year period. Results from this and previous reports of the KANON-trial imply that early identification of individuals who would benefit from either early ACL reconstruction or rehabilitation alone might reduce resource consumption and decrease risk of unnecessary overtreatment. ISRCTN84752559. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  18. DOE Office of Scientific and Technical Information (OSTI.GOV)

    Not Available

    These case studies constitute Part II of the ACL Guidance Document. They are intended to assist Regional and State personnel in exercising the discretion conferred by regulation in evaluating applications for alternate concentration limits (ACLs) submitted pursuant to 40 CFR 264.94. The document is not a regulation and should not be used as such. Regional and State personnel must exercise their discretion in using this guidance document as well as other relevant information in determining whether an ACL demonstration meets the regulatory standard.

  19. Imaging of the anterior cruciate ligament

    PubMed Central

    Ng, Wing Hung Alex; Griffith, James Francis; Hung, Esther Hiu Yee; Paunipagar, Bhawan; Law, Billy Kan Yip; Yung, Patrick Shu Hang

    2011-01-01

    The anterior cruciate ligament (ACL) is an important structure in maintaining the normal biomechanics of the knee and is the most commonly injured knee ligament. However, the oblique course of the ACL within the intercondylar fossa limits the visualization and assessment of the pathology of the ligament. This pictorial essay provides a comprehensive and illustrative review of the anatomy and biomechanics as well as updated information on different modalities of radiological investigation of ACL, particularly magnetic resonance imaging. PMID:22474639

  20. Cotton ACAULIS5 is involved in stem elongation and the plant defense response to Verticillium dahliae through thermospermine alteration.

    PubMed

    Mo, Huijuan; Wang, Xingfen; Zhang, Yan; Yang, Jun; Ma, Zhiying

    2015-11-01

    Overexpression of GhACL5 , an ACAULIS5 from cotton, in Arabidopsis increased plant height and T-Spm level. Silencing of GhACL5 in cotton exhibited a dwarf phenotype and reduced resistance to Verticillium dahliae. The Arabidopsis thaliana gene ACAULIS5 (ACL5), for which inactivation causes a defect in stem elongation, encodes thermospermine (T-Spm) synthase. However, limited information is available about improvement in plant height by the overexpression of ACL5 gene, and the biological functions of ACL5 genes in response to biotic stress. Here, this study reports that constitutive expression of the cotton ACL5 gene (GhACL5) in Arabidopsis thaliana significantly increased plant height and elevated the level of T-Spm. Silencing of that gene in cotton reduced the amount of T-Spm and led to a severe dwarf phenotype. Expression of GhACL5 was induced upon treatment with the fungal pathogen Verticillium dahliae and plant hormones salicylic acid, jasmonic acid, and ethylene in resistant cotton plants, but gene silencing in cotton enhanced their susceptibility to V. dahliae infection. Furthermore, T-Spm exposure effectively inhibited V. dahliae growth in vitro. In summary, GhACL5 expression is related to in planta levels of T-Spm and is involved in stem elongation and defense responses against V. dahliae.

  1. Longitudinal tear of the medial meniscus posterior horn in the anterior cruciate ligament-deficient knee significantly influences anterior stability.

    PubMed

    Ahn, Jin Hwan; Bae, Tae Soo; Kang, Ki-Ser; Kang, Soo Yong; Lee, Sang Hak

    2011-10-01

    Longitudinal tears of the medial meniscus posterior horn (MMPH) are commonly associated with a chronic anterior cruciate ligament (ACL) deficiency. Many studies have demonstrated the importance of the medial meniscus in terms of limiting the amount of anterior-posterior tibial translation in response to anterior tibial loads in ACL-deficient knees. An MMPH tear in an ACL-deficient knee increases the anterior-posterior tibial translation and rotatory instability. In addition, MMPH repair will restore the tibial translation to the level before the tear. Controlled laboratory study. Ten human cadaveric knees were tested sequentially using a custom testing system under 5 conditions: intact, ACL deficient, ACL deficient with an MMPH peripheral longitudinal tear, ACL deficient with an MMPH repair, and ACL deficient with a total medial meniscectomy. The knee kinematics were measured at 0°, 15°, 30°, 60°, and 90° of flexion in response to a 134-N anterior and 200-N axial compressive tibial load. The rotatory kinematics were also measured at 15° and 30° of flexion in a combined rotatory load of 5 N·m of internal tibial torque and 10 N·m of valgus torque. Medial meniscus posterior horn longitudinal tears in ACL-deficient knees resulted in a significant increase in anterior-posterior tibial translation at all flexion angles except 90° (P < .05). An MMPH repair in an ACL-deficient knee showed a significant decrease in anterior-posterior tibial translation at all flexion angles except 60° compared with the ACL-deficient/MMPH tear state (P < .05). The total anterior-posterior translation of the ACL-deficient/MMPH repaired knee was not significantly increased compared with the ACL (only)-deficient knee but was increased compared with the ACL-intact knee (P > .05). A total medial meniscectomy in an ACL-deficient knee did not increase the anterior-posterior tibial translation significantly compared with MMPH tears in ACL-deficient knees at all flexion angles (P > .05). In a combined rotatory load, tibial rotation after MMPH tears or a total medial meniscectomy in an ACL-deficient knee were not affected significantly at all flexion angles. This study shows that an MMPH longitudinal tear in an ACL-deficient knee alters the knee kinematics, particularly the anterior-posterior tibial translation. MMPH repair significantly improved anterior-posterior tibial translation in ACL-deficient knees. These findings may help improve the treatment of patients with ACL and MMPH longitudinal tear by suggesting that the medial meniscal repairs should be performed for greater longevity when combined with an ACL reconstruction.

  2. Beneficial and limiting factors for return to work following anterior cruciate ligament reconstruction: a retrospective cohort study.

    PubMed

    Groot, Judith A M; Jonkers, Freerk J; Kievit, Arthur J; Kuijer, P Paul F M; Hoozemans, Marco J M

    2017-02-01

    Evidence-based advice for return to work (RTW) after anterior cruciate ligament (ACL) reconstruction is not available. Therefore, the objectives of this study were to determine when patients achieve full RTW, and to explore the beneficial and limiting factors for fully RTW after ACL reconstruction. A retrospective cohort study was performed after ACL reconstruction among 185 patients in one hospital. Data from patient files and a questionnaire were used to explore whether patient-, injury-, surgery-, sports-, work- and rehabilitation-related factors are beneficial or limiting for fully RTW after ACL reconstruction, using a backward stepwise logistic regression analysis. Of the 125 (68%) patients that returned the questionnaire, 36 were not part of the working population. Of the remaining 89 patients, 82 patients (92%) had returned fully to work at follow-up. The median time to fully RTW was 78 days. In the final regression model, which explained 29% of the variance, a significant OR of 5.4 (90% CI 2.2-13.1) for RTW > 78 days was observed for patients performing heavy knee-demanding work compared to patients performing light knee-demanding work. In addition, a significant and positive OR (1.6, 90% CI 1.2-1.9) for the number of weeks walking with the aid of crutches for RTW > 78 days was observed in the final model. After ACL reconstruction, 92% of the patients fully return to work at a median time of 78 days. The significant predictors for fully RTW > 78 days are performing heavy knee-demanding work and a longer period of walking aided with crutches after ACL reconstruction.

  3. Fifteen-Year Survival of Endoscopic Anterior Cruciate Ligament Reconstruction in Patients Aged 18 Years and Younger.

    PubMed

    Morgan, Matthew D; Salmon, Lucy J; Waller, Alison; Roe, Justin P; Pinczewski, Leo A

    2016-02-01

    The current body of literature surrounding anterior cruciate ligament (ACL) survival and the variables contributing to further ACL injuries after primary ACL reconstruction in children and adolescents is limited, with no long-term evidence examining the incidence and contributing factors of further ACL injuries in this younger patient population. To determine the long-term survival of the ACL graft and the contralateral ACL (CACL) after primary reconstruction in patients aged ≤18 years and to identify the factors that increase the odds of subsequent ACL injuries. Case series; Level of evidence, 4. Patients having undergone primary ACL reconstruction at age ≤18 years between 1993 and 1998 who were included in a prospective database by a single surgeon were considered for this study. Single-incision endoscopic ACL reconstruction was performed with either an autologous bone-patellar tendon-bone graft or a hamstring tendon graft. At a minimum of 15 years after ACL reconstruction, patients completed a subjective survey involving the International Knee Documentation Committee (IKDC) questionnaire in addition to questions regarding current symptoms, further ACL injuries, family history of ACL injury, and current level of activity. A total of 288 adolescents (age range, 13-18 years) met the inclusion criteria, of whom 242 (84%) were reviewed at a mean of 16 years and 6 months after ACL reconstruction. Of these patients, 75 (31%) sustained a further ACL injury: 27 (11.2%) suffered an ACL graft rupture, 33 suffered a CACL injury (13.6%), and 15 sustained both an ACL graft rupture and a CACL injury (6.2%) over 15 years. Survival of the ACL graft was 95%, 92%, 88%, 85%, and 83% at 1, 2, 5, 10, and 15 years, respectively, and survival of the CACL was 99%, 98%, 90%, 83%, and 81%, respectively. Survival of the ACL graft was less favorable in those with a family history of ACL injury than in those without a family history (69% vs 90%, respectively; hazard ratio [HR], 3.6; P = .001). Survival of the CACL was less favorable in male patients than in female patients (75% vs 88%, respectively; HR, 2.1; P = .03) and in those who returned to competitive team ball sports than in those who did not (78% vs 89%, respectively; HR, 2.3; P = .05). After ACL reconstruction in patients aged ≤18 years, a further ACL injury occurred in 1 in 3 patients over 15 years. The 15-year survival rate of the ACL graft was 83%, and the 15-year survival rate of the CACL was 81%. The ACL graft and CACL were most vulnerable within the first 5 years after index surgery. A family history of ACL rupture significantly increased the risk for ACL graft ruptures, and a CACL injury was more common in male patients and those who returned to team ball sports. High IKDC scores and continued participation in sports were maintained over the long term after ACL reconstruction in the adolescent population. © 2016 The Author(s).

  4. Measurement of in vivo anterior cruciate ligament strain during dynamic jump landing

    PubMed Central

    Taylor, K.A.; Terry, M.E.; Utturkar, G.M.; Spritzer, C.E.; Queen, R.M.; Irribarra, L.A.; Garrett, W.E.; DeFrate, L.E.

    2011-01-01

    Despite recent attention in the literature, anterior cruciate ligament (ACL) injury mechanisms are controversial and incidence rates remain high. One explanation is limited data on in vivo ACL strain during high-risk, dynamic movements. The objective of this study was to quantify ACL strain during jump landing. Marker-based motion analysis techniques were integrated with fluoroscopic and magnetic resonance (MR) imaging techniques to measure dynamic ACL strain non-invasively. First, eight subjects’ knees were imaged using MR. From these images, the cortical bone and ACL attachment sites of the tibia and femur were outlined to create 3D models. Subjects underwent motion analysis while jump landing using reflective markers placed directly on the skin around the knee. Next, biplanar fluoroscopic images were taken with the markers in place so that the relative positions of each marker to the underlying bone could be quantified. Numerical optimization allowed jumping kinematics to be superimposed on the knee model, thus reproducing the dynamic in vivo joint motion. ACL length, knee flexion, and ground reaction force were measured. During jump landing, average ACL strain peaked 55 ± 14 ms (mean and 95% confidence interval) prior to ground impact, when knee flexion angles were lowest. The peak ACL strain, measured relative to its length during MR imaging, was 12 ± 7%. The observed trends were consistent with previously described neuromuscular patterns. Unrestricted by field of view or low sampling rate, this novel approach provides a means to measure kinematic patterns that elevate ACL strains and that provide new insights into ACL injury mechanisms. PMID:21092960

  5. Artificial Ligaments: Promise or Panacea?

    ERIC Educational Resources Information Center

    Lubell, Adele

    1987-01-01

    The Food and Drug Administration has approved a prosthetic ligament for limited use in persons with damaged anterior cruciate ligaments (ACL). This article addresses ligament repair, ACL tears, current treatment, development of the Gore-Tex artificial ligament, other artificial ligaments in process, and arguments for and against their use.…

  6. Altered lower extremity joint mechanics occur during the star excursion balance test and single leg hop after ACL-reconstruction in a collegiate athlete.

    PubMed

    Samaan, Michael A; Ringleb, Stacie I; Bawab, Sebastian Y; Greska, Eric K; Weinhandl, Joshua T

    2018-03-01

    The effects of ACL-reconstruction on lower extremity joint mechanics during performance of the Star Excursion Balance Test (SEBT) and Single Leg Hop (SLH) are limited. The purpose of this study was to determine if altered lower extremity mechanics occur during the SEBT and SLH after ACL-reconstruction. One female Division I collegiate athlete performed the SEBT and SLH tasks, bilaterally, both before ACL injury and 27 months after ACL-reconstruction. Maximal reach, hop distances, lower extremity joint kinematics and moments were compared between both time points. Musculoskeletal simulations were used to assess muscle force production during the SEBT and SLH at both time points. Compared to the pre-injury time point, SEBT reach distances were similar in both limbs after ACL-reconstruction except for the max anterior reach distance in the ipsilateral limb. The athlete demonstrated similar hop distances, bilaterally, after ACL-reconstruction compared to the pre-injury time point. Despite normal functional performance during the SEBT and SLH, the athlete exhibited altered lower extremity joint mechanics during both of these tasks. These results suggest that measuring the maximal reach and hop distances for these tasks, in combination with an analysis of the lower extremity joint mechanics that occur after ACL-reconstruction, may help clinicians and researchers to better understand the effects of ACL-reconstruction on the neuromuscular system during the SEBT and SLH.

  7. Trends in Pediatric and Adolescent Anterior Cruciate Ligament Injuries in Victoria, Australia 2005–2015

    PubMed Central

    Shaw, Louise; Finch, Caroline F.

    2017-01-01

    Anterior cruciate ligament (ACL) injuries in children and adolescents have been the focus of recent media attention and parental concern, given their potential for adverse long-term health outcomes and healthcare costs. However, there is limited formal evidence on trends in the incidence of ACL injuries in children. This study utilizes the Victorian Admitted Episodes Dataset (VAED) to characterize epidemiologic trends of hospital-admitted ACL injuries in those aged 5 to 14 years over a period of 10 years from 2005 to 2015. There was a total of 320 cases and the overall annual rate of ACL injuries increased by 147.8% from 2.74 per 100,000 population in 2005/2006 to 6.79 per 100,000 in 2014/2015. The majority (96.9%) of these injuries were in 10- to 14-year-olds. The main in-hospital procedure provided to over 80% of the hospitalized cases involved ACL reconstruction. Sporting activities accounted for 56.6% of ACL injuries. For females, over half (52.4%) of ACL injuries occurred whilst playing ball sports, compared to 35.4% of males. The large increase in ACL injuries in 5- to 14-year-olds in the state of Victoria, Australia over a 10-year period indicates they are a significant and emerging health burden. Population-wide ACL prevention policies are required to halt these trends. Cost effective prevention programs that involve neuromuscular training must be implemented in schools and junior sports teams. PMID:28587262

  8. 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, higher IKDC scores (p=0.013, Ɓ =-0.09) and higher ACL-RSI scores (p = 0.002, Ɓ = -0.06) were associated with an earlier time to RTP. This association was not found in male athletes. Conclusion: Although both genders felt their knee would function well during sport at approximately six months following ACL reconstruction, male athletes seem to demonstrate an overall stronger psychological readiness to RTP. However, better scores on the ACL-RSI and IKDC were associated with an earlier RTP only in female athletes. The results of this study suggest a difference in the psychological readiness to RTP between male and female adolescent athletes approximately six months following ACL reconstruction. Further investigations are warranted to investigate the psychological hurdles that face each gender when trying to RTP following an ACL injury. A better understanding of these emotional limitations could help to clinically identify patients that may benefit from counseling.

  9. A Systematic Evaluation of Field-Based Screening Methods for the Assessment of Anterior Cruciate Ligament (ACL) Injury Risk.

    PubMed

    Fox, Aaron S; Bonacci, Jason; McLean, Scott G; Spittle, Michael; Saunders, Natalie

    2016-05-01

    Laboratory-based measures provide an accurate method to identify risk factors for anterior cruciate ligament (ACL) injury; however, these methods are generally prohibitive to the wider community. Screening methods that can be completed in a field or clinical setting may be more applicable for wider community use. Examination of field-based screening methods for ACL injury risk can aid in identifying the most applicable method(s) for use in these settings. The objective of this systematic review was to evaluate and compare field-based screening methods for ACL injury risk to determine their efficacy of use in wider community settings. An electronic database search was conducted on the SPORTDiscus™, MEDLINE, AMED and CINAHL databases (January 1990-July 2015) using a combination of relevant keywords. A secondary search of the same databases, using relevant keywords from identified screening methods, was also undertaken. Studies identified as potentially relevant were independently examined by two reviewers for inclusion. Where consensus could not be reached, a third reviewer was consulted. Original research articles that examined screening methods for ACL injury risk that could be undertaken outside of a laboratory setting were included for review. Two reviewers independently assessed the quality of included studies. Included studies were categorized according to the screening method they examined. A description of each screening method, and data pertaining to the ability to prospectively identify ACL injuries, validity and reliability, recommendations for identifying 'at-risk' athletes, equipment and training required to complete screening, time taken to screen athletes, and applicability of the screening method across sports and athletes were extracted from relevant studies. Of 1077 citations from the initial search, a total of 25 articles were identified as potentially relevant, with 12 meeting all inclusion/exclusion criteria. From the secondary search, eight further studies met all criteria, resulting in 20 studies being included for review. Five ACL-screening methods-the Landing Error Scoring System (LESS), Clinic-Based Algorithm, Observational Screening of Dynamic Knee Valgus (OSDKV), 2D-Cam Method, and Tuck Jump Assessment-were identified. There was limited evidence supporting the use of field-based screening methods in predicting ACL injuries across a range of populations. Differences relating to the equipment and time required to complete screening methods were identified. Only screening methods for ACL injury risk were included for review. Field-based screening methods developed for lower-limb injury risk in general may also incorporate, and be useful in, screening for ACL injury risk. Limited studies were available relating to the OSDKV and 2D-Cam Method. The LESS showed predictive validity in identifying ACL injuries, however only in a youth athlete population. The LESS also appears practical for community-wide use due to the minimal equipment and set-up/analysis time required. The Clinic-Based Algorithm may have predictive value for ACL injury risk as it identifies athletes who exhibit high frontal plane knee loads during a landing task, but requires extensive additional equipment and time, which may limit its application to wider community settings.

  10. Anterior cruciate ligament injury/reinjury in alpine ski racing: a narrative review

    PubMed Central

    Jordan, Matthew J; Aagaard, Per; Herzog, Walter

    2017-01-01

    The purpose of the present review was to: 1) provide an overview of the current understanding on the epidemiology, etiology, risk factors, and prevention methods for anterior cruciate ligament (ACL) injury in alpine ski racing; and 2) provide an overview of what is known pertaining to ACL reinjury and return to sport after ACL injury in alpine ski racing. Given that most of the scientific studies on ACL injuries in alpine ski racing have been descriptive, and that very few studies contributed higher level scientific evidence, a nonsystematic narrative review was employed. Three scholarly databases were searched for articles on ACL injury or knee injury in alpine ski racing. Studies were classified according to their relevance in relation to epidemiology, etiology, risk factors, and return to sport/reinjury prevention. Alpine ski racers (skiers) were found to be at high risk for knee injuries, and ACL tears were the most frequent diagnosis. Three primary ACL injury mechanism were identified that involved tibial internal rotation and anteriorly directed shear forces from ski equipment and the environment. While trunk muscle strength imbalance and genetics were found to be predictive of ACL injuries in development-level skiers, there was limited scientific data on ACL injury risk factors among elite skiers. Based on expert opinion, research on injury risk factors should focus on equipment design, course settings/speed, and athlete factors (eg, fitness). While skiers seem to make a successful recovery following ACL injury, there may be persistent neuromuscular deficits. Future research efforts should be directed toward prospective studies on ACL injury/reinjury prevention in both male and female skiers and toward the effects of knee injury on long-term health outcomes, such as the early development of osteoarthritis. International collaborations may be necessary to generate sufficient statistical power for ACL injury/reinjury prevention research in alpine ski racing. PMID:28435336

  11. 75 FR 11134 - Pacific Fishery Management Council; Public Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-10

    ... limits (ACL) and accountability measures (AM). This meeting of the SAC is open to the public. DATES: The... with new ACL and AM requirements. The NS1 guidelines include recommendations for establishing several.... [FR Doc. 2010-5086 Filed 3-9-10; 8:45 am] BILLING CODE 3510-22-S ...

  12. [Arthroscopic refixation of acute proximal anterior cruciate ligament rupture using suture anchors].

    PubMed

    Achtnich, A; Rosslenbroich, S; Beitzel, K; Imhoff, A B; Petersen, W

    2017-04-01

    Arthroscopic assisted suture anchor refixation combined with microfracturing of the femoral ACL insertion zone in cases of acute proximal anterior cruciate ligament (ACL) rupture to restore anatomical and biomechanical properties of the native ACL. Acute proximal ACL rupture/avulsion, multiligament injury of the knee CONTRAINDICATIONS: Chronic (>6 weeks) proximal ACL rupture, intraligamentary rupture, as well as previous ACL surgery. Arthroscopic examination of the knee joint, debridement of the femoral insertion zone, examination of the ligament quality by a probe, insertion of a curved lasso through the ACL to place the sutures and use of a drill guide to place the anchor in the middle of the femoral ACL insertion. Microfracturing holes around the femoral footprint were made by an awl to enhance healing properties of the ACL. Partial weight bearing was permitted and crutches were used for 6 weeks, knee brace limited for the first 2 weeks 0‑0-0°, then 0‑0-90° for the following 4 weeks. A total of 20 patients who underwent acute proximal ACL suture anchor refixation were evaluated after a mean follow-up of 28 months. Regarding stability, mean values of the KT-1000 arthrometer indicated stable results (<3 mm), 3 patients had a 1+ Lachman and 4 patients had a 1+ pivot shift. IKDC (International Knee Documentation Committee) score indicated that 17 cases were very good to good (12A, 4B) and in 3 cases the results were satisfactory (3C). Magnetic resonance imaging showed that the ALC was found to be intact in 17 cases. The total rate of revision was 15 % (3/20) because of recurrent instability.

  13. 76 FR 66675 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; Amendments to the Queen Conch and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-27

    .... Each ACL would be sub-divided among the three islands/ island groups. Separate sector ACLs (commercial... sectors; revise the composition of the snapper and grouper complexes; prohibit fishing for and possession of three parrotfish species; establish recreational bag limits for snappers, groupers, and...

  14. Mechanisms of ACL injury in professional rugby union: a systematic video analysis of 36 cases.

    PubMed

    Montgomery, Connor; Blackburn, Jeff; Withers, Daniel; Tierney, Gregory; Moran, Cathal; Simms, Ciaran

    2016-12-30

    The mechanisms of ACL injury in rugby are not well defined. To describe the mechanisms of ACL injury in male professional rugby players using systematic video analysis. 36 cases from games played in top professional leagues and international matches were analysed. 5 analysts independently assessed all videos to record the estimated frame/time of initial ground contact, frame/time of ACL tear and a range of play specific variables. This included contact versus non-contact ACL injuries, injury timing, joint flexion angles and foot contact with the ground. 37 side-stepping manoeuvres from a control game were analysed to allow comparison of non-injury versus injury situations. 57% of ACL injuries occurred in a contact manner. 2 main scenarios were identified: (1) offensive running and (2) being tackled, indicating that the ball carrier might be at higher risk of ACL injury. The majority of non-contact ACL injuries resulted from a side-stepping manoeuvre. In most non-contact cases, initial ground contact was through heel strike. Statistical assessment of heel strike at initial ground contact versus non-heel strike cases showed a significant difference in injury versus non-injury outcomes, with heel strike associated with higher injury risk. Non-contact ACL injuries had lower median knee flexion angles and a more dorsiflexed ankle when compared with a control group (10° vs 20°, p≤0.001 and 10° vs 0°, p=0.033 respectively). Over half of ACL injuries in rugby in our analysis resulted from a contact mechanism. For non-contact injuries, lower knee flexion angles and heel-first ground contact in a side-stepping manoeuvre were associated with ACL injury. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  15. Return to National Basketball Association Competition Following Anterior Cruciate Ligament and Fibular Collateral Ligament Injuries: A Case Report.

    PubMed

    LaPrade, Robert F; O'Brien, Luke; Kennedy, Nicholas I; Cinque, Mark E; Chahla, Jorge

    2017-01-01

    Numerous outcome studies regarding anterior cruciate ligament (ACL) reconstruction demonstrate the ability of athletes to return to a high level of play. However, to our knowledge, there is limited literature regarding return to play following injury to both the ACL and the fibular collateral ligament (FCL). We describe the case of a National Basketball Association (NBA) player who sustained a combined ACL and FCL knee injury and subsequently underwent surgical reconstruction of both affected ligaments. He was able to return to a preinjury level of competition at 9 months postoperatively. It is possible for athletes to return to competitive basketball and maintain a high production level following a single-staged reconstruction of both the ACL and the FCL.

  16. Video Analysis of Anterior Cruciate Ligament (ACL) Injuries

    PubMed Central

    Carlson, Victor R.; Sheehan, Frances T.; Boden, Barry P.

    2016-01-01

    Background: As the most viable method for investigating in vivo anterior cruciate ligament (ACL) rupture, video analysis is critical for understanding ACL injury mechanisms and advancing preventative training programs. Despite the limited number of published studies involving video analysis, much has been gained through evaluating actual injury scenarios. Methods: Studies meeting criteria for this systematic review were collected by performing a broad search of the ACL literature with use of variations and combinations of video recordings and ACL injuries. Both descriptive and analytical studies were included. Results: Descriptive studies have identified specific conditions that increase the likelihood of an ACL injury. These conditions include close proximity to opposing players or other perturbations, high shoe-surface friction, and landing on the heel or the flat portion of the foot. Analytical studies have identified high-risk joint angles on landing, such as a combination of decreased ankle plantar flexion, decreased knee flexion, and increased hip flexion. Conclusions: The high-risk landing position appears to influence the likelihood of ACL injury to a much greater extent than inherent risk factors. As such, on the basis of the results of video analysis, preventative training should be applied broadly. Kinematic data from video analysis have provided insights into the dominant forces that are responsible for the injury (i.e., axial compression with potential contributions from quadriceps contraction and valgus loading). With the advances in video technology currently underway, video analysis will likely lead to enhanced understanding of non-contact ACL injury. PMID:27922985

  17. Failure of Anterior Cruciate Ligament Reconstruction

    PubMed Central

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

    2015-01-01

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

  18. What Strains the Anterior Cruciate Ligament During a Pivot Landing?

    PubMed Central

    Oh, Youkeun K.; Lipps, David B.; Ashton-Miller, James A.; Wojtys, Edward M.

    2015-01-01

    Background The relative contributions of an axial tibial torque and frontal plane moment to anterior cruciate ligament (ACL) strain during pivot landings are unknown. Hypothesis The peak normalized relative strain in the anteromedial (AM) bundle of the ACL is affected by the direction of the axial tibial torque but not by the direction of the frontal plane moment applied concurrently during a simulated jump landing. Study Design Controlled and descriptive laboratory studies. Methods Fifteen adult male knees with pretensioned knee muscle-tendon unit forces were loaded under a simulated pivot landing test. Compression, flexion moment, internal or external tibial torque, and knee varus or valgus moment were simultaneously applied to the distal tibia while recording the 3D knee loads and tibiofemoral kinematics. The AM-ACL relative strain was measured using a 3-mm differential variable reluctance transducer. The results were analyzed using nonparametric Wilcoxon signed–rank tests. A 3D dynamic biomechanical knee model was developed using ADAMS and validated to help interpret the experimental results. Results The mean (SD) peak AM-ACL relative strain was 192% greater (P <.001) under the internal tibial torque combined with a knee varus or valgus moment (7.0% [3.9%] and 7.0% [4.1%], respectively) than under external tibial torque with the same moments (2.4% [2.5%] and 2.4% [3.2%], respectively). The knee valgus moment augmented the AM-ACL strain due to the slope of the tibial plateau inducing mechanical coupling (ie, internal tibial rotation and knee valgus moment); this augmentation occurred before medial knee joint space opening. Conclusion An internal tibial torque combined with a knee valgus moment is the worst-case ACL loading condition. However, it is the internal tibial torque that primarily causes large ACL strain. Clinical Relevance Limiting the maximum coefficient of friction between the shoe and playing surface should limit the peak internal tibial torque that can be applied to the knee during jump landings, thereby reducing peak ACL strain and the risk for noncontact injury. PMID:22223717

  19. An adaptive confidence limit for periodic non-steady conditions fault detection

    NASA Astrophysics Data System (ADS)

    Wang, Tianzhen; Wu, Hao; Ni, Mengqi; Zhang, Milu; Dong, Jingjing; Benbouzid, Mohamed El Hachemi; Hu, Xiong

    2016-05-01

    System monitoring has become a major concern in batch process due to the fact that failure rate in non-steady conditions is much higher than in steady ones. A series of approaches based on PCA have already solved problems such as data dimensionality reduction, multivariable decorrelation, and processing non-changing signal. However, if the data follows non-Gaussian distribution or the variables contain some signal changes, the above approaches are not applicable. To deal with these concerns and to enhance performance in multiperiod data processing, this paper proposes a fault detection method using adaptive confidence limit (ACL) in periodic non-steady conditions. The proposed ACL method achieves four main enhancements: Longitudinal-Standardization could convert non-Gaussian sampling data to Gaussian ones; the multiperiod PCA algorithm could reduce dimensionality, remove correlation, and improve the monitoring accuracy; the adaptive confidence limit could detect faults under non-steady conditions; the fault sections determination procedure could select the appropriate parameter of the adaptive confidence limit. The achieved result analysis clearly shows that the proposed ACL method is superior to other fault detection approaches under periodic non-steady conditions.

  20. 75 FR 19943 - Pacific Fishery Management Council; Public Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-16

    ... limits (ACL) and accountability measures (AM). This meeting of the SAC is open to the public. DATES: The... MSA to provide guidance on how to comply with new ACL and AM requirements. The NS1 guidelines include... Sustainable Fisheries, National Marine Fisheries Service. [FR Doc. 2010-8710 Filed 4-15-10; 8:45 am] BILLING...

  1. [Use and evaluation of Action Checklist for health risk management of employees working long hours].

    PubMed

    Nakao, Tomo; Kawase, Yohei; Shinmi, Ryosuke; Yamashita, Makiko; Mitsuhashi, Akira; Fukuda, Hanako; Kawanam, Shoko; Hiro, Hisanori; Horie, Seichi

    2008-12-01

    In Japan, the Industrial Safety and Health Law requires an employer to implement medical interviews for employees working long hours. The law stipulates the criteria of the targeted workers as those whose working time exceeds the legal limit of working hours, those with accumulated fatigue, and those who desire to receive an interview from a physician. Therefore, the employers should make an appropriate system to identify the workers who require a medical interview among employees working long hours with increasing health risks. In this study, we used "The Action Checklist for health risk management of employees working long hours (ACL)" and evaluated its efficacy. We conducted two studies: a seminar study, using ACL as an educational material in the seminar targeting occupational health professionals, and an interventional study, distributing materials with ACL in one group of small-scale enterprises and not in another group. In the seminar study, we observed a greater number of practical answers to the problems hypothetically set in the seminar among the occupational health professionals who used ACL. The results of a questionnaire given after the seminar revealed ACL was favorably accepted among 80% of all the participants in the seminar as "I have fully understood the usage of ACL" and "ACL seems to be useful in my workplace". In the interventional study, we could not see positive results from the distribution of ACL, possibly because of the low response rate, short interventional term or distribution without individual explanation. Further investigation and efforts should be considered to widely diffuse ACL with individual explanations, to prevent health disorders caused or aggravated by working long hours.

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

    PubMed

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

    2010-01-01

    Current Advanced Cardiac Life Support (ACLS) course instruction involves a 2-day course with traditional lectures and limited team interaction. We wish to explore the advantages of a scenario-based performance-oriented team instruction (SPOTI) method to implement core ACLS skills for non-English-speaking international paramedic students. The objective of this study was to determine if scenario-based, performance-oriented team instruction (SPOTI) improves educational outcomes for the ACLS instruction of Korean paramedic students. Thirty Korean paramedic students were randomly selected into two groups. One group of 15 students was taught the traditional ACLS course. The other 15 students were instructed using a SPOTI method. Each group was tested using ACLS megacode examinations endorsed by the American Heart Association. All 30 students passed the ACLS megacode examination. In the traditional ACLS study group an average of 85% of the core skills were met. In the SPOTI study group an average of 93% of the core skills were met. In particular, the SPOTI study group excelled at physical examination skills such as airway opening, assessment of breathing, signs of circulation, and compression rates. In addition, the SPOTI group performed with higher marks on rhythm recognition compared to the traditional group. The traditional group performed with higher marks at providing proper drug dosages compared to the SPOTI students. However, the students enrolled in the SPOTI method resulted in higher megacode core compliance scores compared to students trained in traditional ACLS course instruction. These differences did not achieve statistical significance due to the small sample size. Copyright 2010 Elsevier Inc. All rights reserved.

  3. Return to Play and Future ACL Injury Risk Following ACL Reconstruction In Soccer Athletes From the MOON Group

    PubMed Central

    Brophy, Robert H.; Schmitz, Leah; Wright, Rick W.; Dunn, Warren R.; Parker, Richard D.; Andrish, Jack T.; McCarty, Eric C.; Spindler, Kurt P.

    2013-01-01

    Background There is limited information on outcomes and return to play (RTP) after ACL reconstruction (ACLR) in soccer athletes. Hypothesis The purpose of this study was to (i) test the hypotheses that player sex, side of injury and graft choice do not influence RTP, and (ii) define the risk for future ACL injury in soccer players after ACLR. Study design Retrospective cohort study, Level II. Methods Soccer players in a prospective cohort were contacted to determine RTP following ACLR. Information regarding if and when they returned to play, their current playing status, the primary reason they stopped playing soccer (if relevant) and incidence of subsequent ACL surgery was recorded. Results Initially, 72% of 100 soccer athletes (55 male, 45 female) with a mean age of 24.2 years at the time of ACL reconstruction returned to soccer. At average follow up of 7.0 years, 36% were still playing, a significant decrease compared to initial RTP (p<0.0001). Based on multivariate analysis, older athletes (p=0.006) and females (p=0.037) were less likely to return to play. Twelve soccer athletes had undergone further ACL surgery, including 9 on the contralateral knee and 3 on the ipsilateral knee. In a univariate analysis, females were more likely to have future ACL surgery (20% v. 5.5%, p=0.03). Soccer athletes who underwent ACLR on their non-dominant limb had a higher future rate of contra-lateral ACLR (16%) than soccer athletes who underwent ACLR on their dominant limb (3.5%) (p=0.03). Conclusion Younger and male soccer players are more likely to return to play after ACL reconstruction. Return to soccer following ACLR declines over time. PMID:23002201

  4. Sport-specific outcomes after anterior cruciate ligament reconstruction.

    PubMed

    Warner, Stephen J; Smith, Matthew V; Wright, Rick W; Matava, Matthew J; Brophy, Robert H

    2011-08-01

    Although anterior cruciate ligament (ACL) reconstruction has been studied extensively in the literature, sport-specific outcomes have not been well-documented. The purpose of this systematic review was to assess sport-specific outcomes after ACL reconstruction in the literature. We performed a systematic review of the literature to identify studies reporting sport-specific outcomes after primary ACL reconstruction. Included studies were required to have reported standardized outcomes after primary ACL reconstruction for a single sport or comparing between different sports. In total 8 studies conformed to all inclusion criteria: 2 Level II studies, 1 Level III study, and 5 Level IV case series. Only 1 study reported comparisons of standardized outcomes between different sports, whereas 7 studies reported standardized outcomes in a single sport. Return to activity was the most common sport-specific outcome reported and varied from 19% (soccer) to 100% (bicycling and rugby), although the methods of measuring this outcome differed. Whereas return to activity after ACL reconstruction appears more likely for bicycling and jogging than for cutting and pivoting sports such as soccer and football, the literature on sport-specific outcomes from ACL reconstruction is limited with minimal data. Further studies are needed to report sport-specific outcomes and return to play after ACL reconstruction. Level IV, systematic review of Level II, III, and IV studies. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  5. Evaluation of Polycaprolactone Scaffold with Basic Fibroblast Growth Factor and Fibroblasts in an Athymic Rat Model for Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Kabir, Nima; Arshi, Armin; Nazemi, Azadeh; Wu, Ben; Petrigliano, Frank A.; McAllister, David R.

    2015-01-01

    Anterior cruciate ligament (ACL) rupture is a common ligamentous injury often necessitating surgery. Current surgical treatment options include ligament reconstruction with autograft or allograft, which have their inherent limitations. Thus, there is interest in a tissue-engineered substitute for use in ACL regeneration. However, there have been relatively few in vivo studies to date. In this study, an athymic rat model of ACL reconstruction was used to evaluate electrospun polycaprolactone (PCL) grafts, with and without the addition of basic fibroblast growth factor (bFGF) and human foreskin fibroblasts. We examined the regenerative potential of tissue-engineered ACL grafts using histology, immunohistochemistry, and mechanical testing up to 16 weeks postoperatively. Histology showed infiltration of the grafts with cells, and immunohistochemistry demonstrated aligned collagen deposition with minimal inflammatory reaction. Mechanical testing of the grafts demonstrated significantly higher mechanical properties than immediately postimplantation. Acellular grafts loaded with bFGF achieved 58.8% of the stiffness and 40.7% of the peak load of healthy native ACL. Grafts without bFGF achieved 31.3% of the stiffness and 28.2% of the peak load of healthy native ACL. In this in vivo rodent model study for ACL reconstruction, the histological and mechanical evaluation demonstrated excellent healing and regenerative potential of our electrospun PCL ligament graft. PMID:25744933

  6. Quality of Life in Symptomatic Individuals After Anterior Cruciate Ligament Reconstruction, With and Without Radiographic Knee Osteoarthritis.

    PubMed

    Filbay, Stephanie R; Ackerman, Ilana N; Dhupelia, Sanjay; Arden, Nigel K; Crossley, Kay M

    2018-05-01

    Study Design Clinical measurement, cross-sectional. Background Individuals who have undergone anterior cruciate ligament (ACL) reconstruction commonly experience long-term impairments in quality of life (QoL), which may be related to persistent knee symptoms or radiographic osteoarthritis (ROA). Understanding the impact of knee symptoms and ROA on QoL after ACL reconstruction may assist in the development of appropriate management strategies. Objectives To (1) compare QoL between groups of individuals after ACL reconstruction (including those who are symptomatic with ROA, symptomatic without ROA, and asymptomatic [unknown ROA status]), and (2) identify specific aspects of QoL impairment in symptomatic individuals with and without ROA post ACL reconstruction. Methods One hundred thirteen participants completed QoL measures (Knee injury and Osteoarthritis Outcome Score QoL subscale [KOOS-QoL], Anterior Cruciate Ligament Quality of Life [ACL-QoL], Assessment of Quality of Life-8 Dimensions [AQoL-8D]) 5 to 20 years after ACL reconstruction. Eighty-one symptomatic individuals underwent radiographs, and 32 asymptomatic individuals formed a comparison group. Radiographic osteoarthritis was defined as a Kellgren-Lawrence grade of 2 or greater for the tibiofemoral and/or patellofemoral joints. Mann-Whitney U tests compared outcomes between groups. Individual ACL-QoL items were used to explore specific aspects of QoL. Results In symptomatic individuals after ACL reconstruction, ROA was related to worse knee-related outcomes on the KOOS-QoL (median, 50; interquartile range [IQR], 38-69 versus median, 69; IQR, 56-81; P<.001) and the ACL-QoL (median, 51; IQR, 38-71 versus median, 66; IQR, 50-82; P = .04). The AQoL-8D scores showed that health-related QoL was impaired in both symptomatic groups compared to the asymptomatic group. The ACL-QoL item scores revealed greater limitations and concern surrounding sport and exercise and social/emotional difficulties in the symptomatic group with ROA. Conclusion Osteoarthritis is associated with worse knee-related QoL in symptomatic individuals after ACL reconstruction. Diagnosing ROA in symptomatic individuals after ACL reconstruction may be valuable, because these individuals may require unique management. Targeted strategies to facilitate participation in satisfying activities have potential to improve QoL in symptomatic people with ROA after ACL reconstruction. J Orthop Sports Phys Ther 2018;48(5):398-408. doi:10.2519/jospt.2018.7830.

  7. Neuropsychiatric lupus erythematosus, cerebral infarctions, and anticardiolipin antibodies.

    PubMed Central

    Fields, R A; Sibbitt, W L; Toubbeh, H; Bankhurst, A D

    1990-01-01

    Anticardiolipin antibody (aCL) has been associated with thromboembolic phenomena, including stroke, in certain patients with systemic lupus erythematosus (SLE); however, the relation between this antibody and the central nervous system manifestations of SLE is unknown. Serum samples and cerebrospinal fluid from five patients with SLE and acute central nervous system manifestations were assayed for the presence of aCL. Anticardiolipin antibody was identified in sera from four of the five patients but in none of the cerebrospinal fluid samples. Nuclear magnetic resonance imaging showed 'infarct-like' lesions in these four patients. This preliminary study suggests that a correlation between serum aCL and cerebral infarcts in central nervous system lupus may potentially exist. From this limited study it seems unlikely that aCL has a direct pathogenic role in the diffuse encephalopathy of acute central nervous system lupus. Images PMID:2317112

  8. Stability of Routine Biochemical Analytes in Whole Blood and Plasma From Lithium Heparin Gel Tubes During 6-hr Storage.

    PubMed

    Monneret, Denis; Godmer, Alexandre; Le Guen, Ronan; Bravetti, Clotilde; Emeraud, Cecile; Marteau, Anthony; Alkouri, Rana; Mestari, Fouzi; Dever, Sylvie; Imbert-Bismut, Françoise; Bonnefont-Rousselot, Dominique

    2016-09-01

    The stability of biochemical analytes has already been investigated, but results strongly differ depending on parameters, methodologies, and sample storage times. We investigated the stability for many biochemical parameters after different storage times of both whole blood and plasma, in order to define acceptable pre- and postcentrifugation delays in hospital laboratories. Twenty-four analytes were measured (Modular® Roche analyzer) in plasma obtained from blood collected into lithium heparin gel tubes, after 2-6 hr of storage at room temperature either before (n = 28: stability in whole blood) or after (n = 21: stability in plasma) centrifugation. Variations in concentrations were expressed as mean bias from baseline, using the analytical change limit (ACL%) or the reference change value (RCV%) as acceptance limit. In tubes stored before centrifugation, mean plasma concentrations significantly decreased after 3 hr for phosphorus (-6.1% [95% CI: -7.4 to -4.7%]; ACL 4.62%) and lactate dehydrogenase (LDH; -5.7% [95% CI: -7.4 to -4.1%]; ACL 5.17%), and slightly decreased after 6 hr for potassium (-2.9% [95% CI: -5.3 to -0.5%]; ACL 4.13%). In plasma stored after centrifugation, mean concentrations decreased after 6 hr for bicarbonates (-19.7% [95% CI: -22.9 to -16.5%]; ACL 15.4%), and moderately increased after 4 hr for LDH (+6.0% [95% CI: +4.3 to +7.6%]; ACL 5.17%). Based on RCV, all the analytes can be considered stable up to 6 hr, whether before or after centrifugation. This study proposes acceptable delays for most biochemical tests on lithium heparin gel tubes arriving at the laboratory or needing to be reanalyzed. © 2016 Wiley Periodicals, Inc.

  9. 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

  10. 50 CFR 660.55 - Allocations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... biennial fishing period's open access allocation. (B) [Reserved] (f) Catch accounting. Catch accounting... allocations in a given biennial cycle, catch of those species are counted against the limited entry/open... fisheries—(i) Catch accounting for the trawl allocation. Any groundfish caught by a vessel registered to a...

  11. 26 CFR 1.402(g)-2 - Increased limit for catch-up contributions.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...(g)-2 Section 1.402(g)-2 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY.... § 1.402(g)-2 Increased limit for catch-up contributions. (a) General rule. Under section 402(g)(1)(C...(g) for a catch-up eligible participant (within the meaning of § 1.414(v)-1(g)), the otherwise...

  12. Design and synthesis of emodin derivatives as novel inhibitors of ATP-citrate lyase.

    PubMed

    Koerner, Steffi K; Hanai, Jun-Ichi; Bai, Sha; Jernigan, Finith E; Oki, Miwa; Komaba, Chieko; Shuto, Emi; Sukhatme, Vikas P; Sun, Lijun

    2017-01-27

    Aberrant cellular metabolism drives cancer proliferation and metastasis. ATP citrate lyase (ACL) plays a critical role in generating cytosolic acetyl CoA, a key building block for de novo fatty acid and cholesterol biosynthesis. ACL is overexpressed in cancer cells, and siRNA knockdown of ACL limits cancer cell proliferation and reduces cancer stemness. We characterized a new class of ACL inhibitors bearing the key structural feature of the natural product emodin. Structure-activity relationship (SAR) study led to the identification of 1d as a potent lead that demonstrated dose-dependent inhibition of proliferation and cancer stemness of the A549 lung cancer cell line. Computational modeling indicates this class of inhibitors occupies an allosteric binding site and blocks the entrance of the substrate citrate to its binding site. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  13. Pain in donor site after BTB-ACL reconstruction with PRGF: a randomized trial.

    PubMed

    Seijas, Roberto; Cuscó, Xavier; Sallent, Andrea; Serra, Iván; Ares, Oscar; Cugat, Ramón

    2016-06-01

    Anterior cruciate ligament (ACL) tears are highly incident injuries in young athletes within our work area. The use of the patellar graft, despite being the treatment of choice, presents post-operative problems such as anterior knee pain, which limits its use and leads to preference being taken for alternative grafts. Our aim was to evaluate if the application of PRGF reduces anterior knee pain in donor site in BTB-ACL reconstruction. 43 patients were included in the double-blinded and randomized clinical trial comparing two patient groups who underwent ACL reconstruction using patellar tendon graft, comparing anterior knee pain with and without the application of PRGF at the donor site after harvesting the graft. The PRGF group showed decreased donor site pain in comparison to the control group, with significant differences in the first two months of follow-up. The application of PRGF decreased donor site pain compared to the control group.

  14. 26 CFR 1.402(g)-2 - Increased limit for catch-up contributions.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ....402(g)-2 Section 1.402(g)-2 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY.... § 1.402(g)-2 Increased limit for catch-up contributions. (a) General rule. Under section 402(g)(1)(C...(g) for a catch-up eligible participant (within the meaning of § 1.414(v)-1(g)), the otherwise...

  15. 26 CFR 1.402(g)-2 - Increased limit for catch-up contributions.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ....402(g)-2 Section 1.402(g)-2 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY.... § 1.402(g)-2 Increased limit for catch-up contributions. (a) General rule. Under section 402(g)(1)(C...(g) for a catch-up eligible participant (within the meaning of § 1.414(v)-1(g)), the otherwise...

  16. 26 CFR 1.402(g)-2 - Increased limit for catch-up contributions.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ....402(g)-2 Section 1.402(g)-2 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY.... § 1.402(g)-2 Increased limit for catch-up contributions. (a) General rule. Under section 402(g)(1)(C...(g) for a catch-up eligible participant (within the meaning of § 1.414(v)-1(g)), the otherwise...

  17. 78 FR 79388 - Western Pacific Pelagic Fisheries; Catch and Effort Limits for the U.S. Participating Territories

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-30

    ...NMFS announces that the Western Pacific Fishery Management Council proposes to amend the Fishery Ecosystem Plan for Pelagic Fisheries of the Western Pacific Region. If approved, Amendment 7 would establish a management framework and process for specifying fishing catch and effort limits and accountability measures for pelagic fisheries in the U.S. Pacific territories (American Samoa, Guam, and the Commonwealth of the Northern Mariana Islands). The framework would authorize the government of each territory to allocate a portion of its specified catch or effort limit to a U.S. fishing vessel or vessels through a specified fishing agreement, and establish criteria, which a specified fishing agreement must satisfy. The framework also includes measures to ensure accountability for adhering to fishing catch and effort limits.

  18. Self-reported Knee Function Can Identify Athletes Who Fail Return to Activity Criteria up to 1 Year after Anterior Cruciate Ligament Reconstruction. A Delaware-Oslo ACL Cohort Study

    PubMed Central

    Logerstedt, David; Stasi, Stephanie Di; Grindem, Hege; Lynch, Andrew; Eitzen, Ingrid; Engebretsen, Lars; Risberg, May Arna; Axe, Michael J; Snyder-Mackler, Lynn

    2014-01-01

    STUDY DESIGN Cohort study, cross-sectional. OBJECTIVES To determine if self-reported knee function assessed with the International Knee Documentation Committee 2000 Subjective Knee Form (IKDC2000) could discriminate between successful and non-successful performance on return to activity criteria (RTAC) tests after anterior cruciate ligament (ACL) reconstruction. BACKGROUND Rehabilitation specialists are challenged in selecting appropriate performance-based and patient-reported tests that can detect side-to-side asymmetries, assess global knee function, and determine a participant's readiness to return to activity after ACL reconstruction. A simple tool or questionnaire that could identify athletes with neuromuscular impairments or activity limitations could provide rehabilitation specialists crucial data pertinent to their current knee function and their readiness to return to higher level activities. METHODS One hundred fifty-eight Level I/II athletes 6 months after ACL reconstruction and 141 athletes 12 months after ACL reconstruction completed a functional test battery to determine readiness to return to activity and the IKDC2000 to determine self-reported knee function. For each athlete, status on return to activity tests criteria was dichotomized as “Passed” or ”Failed” and status on the IKDC2000 scores was dichotomized as being “within” or “below age- and sex-matched normal ranges”. Comparisons were made between status on RTAC and IKDC2000 using Chi-square tests. Accuracy statistics were also calculated. RESULTS Six months after ACL reconstruction, 112 athletes (70.9%) failed RTAC and 76 (48.1%) were classified as having self-reported knee function below normal ranges. Among the 76 participants with IKDC2000 scores below normal ranges, 69 (90.8%) failed RTAC test battery (P<.001). However, among the 82 participants whose IKDC2000 scores were within normal limits at 6 months, only 39 (47.6%) passed RTAC test battery (P=.74). Twelve months after ACL reconstruction, 67 athletes (47.5%) failed RTAC and 31 (78.0%) had knee function below normal ranges. Among the 31 participants with IKDC2000 scores below normal ranges, 25 (80.6%) failed RTAC test battery (P<.001). However, among the 110 participants whose IKDC2000 scores were within normal limits at 12 months, only 68 (61.8%) passed RTAC test battery (P=.017). CONCLUSION The IKDC2000 may be a clinically relevant tool to determine the timeliness or necessity of RTAC testing. For scores obtained 6 and 12 months after ACL reconstruction, low IKDC2000 scores were reasonably indicative of failure on RTAC test battery, whereas normal IKDC2000 scores were not predictive of passing scores on the RTAC test battery. PMID:25347228

  19. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture.

    PubMed

    Kyritsis, Polyvios; Bahr, Roald; Landreau, Philippe; Miladi, Riadh; Witvrouw, Erik

    2016-08-01

    The decision as to whether or not an athlete is ready to return to sport (RTS) after ACL reconstruction is difficult as the commonly used RTS criteria have not been validated. To evaluate whether a set of objective discharge criteria, including muscle strength and functional tests, are associated with risk of ACL graft rupture after RTS. 158 male professional athletes who underwent an ACL reconstruction and returned to their previous professional level of sport were included. Before players returned to sport they underwent a battery of discharge tests (isokinetic strength testing at 60°, 180° and 300°/s, a running t test, single hop, triple hop and triple crossover hop tests). Athletes were monitored for ACL re-ruptures once they returned to sport (median follow-up 646 days, range 1-2060). Of the 158 athletes, 26 (16.5%) sustained an ACL graft rupture an average of 105 days after RTS. Two factors were associated with increased risk of ACL graft rupture: (1) not meeting all six of the discharge criteria before returning to team training (HR 4.1, 95% CI 1.9 to 9.2, p≤0.001); and (2) decreased hamstring to quadriceps ratio of the involved leg at 60°/s (HR 10.6 per 10% difference, 95% CI 10.2 to 11, p=0.005). Athletes who did not meet the discharge criteria before returning to professional sport had a four times greater risk of sustaining an ACL graft rupture compared with those who met all six RTS criteria. In addition, hamstring to quadriceps strength ratio deficits were associated with an increased risk of an ACL graft rupture. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  20. Quantitative assessment of a data-limited recreational bonefish fishery using a time-series of fishing guides reports.

    PubMed

    Santos, Rolando O; Rehage, Jennifer S; Adams, Aaron J; Black, Brooke D; Osborne, Jason; Kroloff, Emily K N

    2017-01-01

    Recreational fisheries can be prone to severe declines, yet these fisheries, particularly catch-and-release, are often data-limited, constraining our ability to conduct stock assessments. A combination of catch and effort indices derived from fisheries-dependent data (FDD) gathered from fishing logbooks could be a powerful approach to inform these data gaps. This study demonstrates the utility of using different catch metrics such as indices of abundance, species richness associated with reported catch, and the success rate of targeted trips, to assess historical shifts in the trajectory of the data-limited bonefish (Albula vulpes) fishery in Florida Bay, an economically-important recreational fishery within the Caribbean Basin. We used FDD from fishing guide reports submitted to Everglades National Park to determine temporal patterns in the bonefish population over the past 35 years. These reports indicated a decline in recreational catches in Florida Bay since the late 1980s, with an accelerated decline starting in the late 1990s-early 2000s. Analyses showed an overall 42% reduction in bonefish catches. Trends in the proportion of positive trips (i.e., the probability of catching success) followed the declining catch patterns, suggesting major population changes starting in 1999-2000. As bonefish catches declined, species richness in bonefish trips increased by 34%, suggesting a decrease in bonefish abundance and/or shift in fishing effort (e.g., giving-up time, changes in preferred species). Results provide additional resolution to a pattern of decline for bonefish in South Florida and highlight the value of reconstructing time-series for the development of hypotheses about the potential driving mechanisms of species decline. Further, the data-limited nature of most recreational fisheries, and the increase in a use of catch-and-release as a fisheries management strategy point to the need to develop further data integration tools to assess population trends and the sustainability of these fishery resources.

  1. 77 FR 42698 - Gulf of Mexico Fishery Management Council; Public Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-20

    ... vermilion snapper annual catch limits in light of revised analysis and new acceptable biological catch...'s ftp site, ftp.gulfcouncil.org . Although other non-emergency issues not on the agenda may come...

  2. Bracing can partially limit tibial rotation during stressful activities after anterior crucial ligament reconstruction with a hamstring graft.

    PubMed

    Giotis, D; Paschos, N K; Zampeli, F; Pappas, E; Mitsionis, G; Georgoulis, A D

    2016-09-01

    Hamstring graft has substantial differences with BPTB graft regarding initial mechanical strength, healing sequence, and vascularization, which may imply that a different approach during rehabilitation period is required. The purpose of this study was to investigate the influence of knee bracing on tibial rotation in ACL-reconstructed patients with a hamstring autograft during high loading activities. The hypothesis was that there would be a decrease in tibial rotation in the ACL-reconstructed braced knee as compared to the unbraced knee. Twenty male patients having undergone unilateral ACL reconstruction with a semitendinosus/gracilis autograft were assessed. Kinematic data were collected with an eight-camera optoelectronic system during two stressful tasks: (1) descending from a stair and subsequent pivoting; and (2) landing from a platform and subsequent pivoting. In each patient, three different experimental conditions were evaluated: (A) wearing a prophylactic brace (braced condition); (B) wearing a patellofemoral brace (sleeved condition); (C) without brace (unbraced condition). The intact knee without brace served as a control. Tibial rotation was significantly lower in the intact knee compared to all three conditions of the ACL-reconstructed knee (P≤0.01 for both tasks). Presence of a brace or sleeve resulted in lower tibial rotation than in the unbraced condition (p=0.003 for descending/pivot and P=0.0004 for landing/pivot). The braced condition resulted in lower rotation than the sleeved condition for descending/pivoting (P=0.031) while no differences were found for landing/pivoting (P=0.230). Knee bracing limited the excessive tibial rotation during pivoting under high loading activities in ACL-reconstructed knees with a hamstring graft. This partial restoration of normal kinematics may have a potential beneficial effect in patients recovering from ACL reconstruction with a hamstring autograft. Level III, case-control therapeutic study. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  3. Collaborative virtual reality based advanced cardiac life support training simulator using virtual reality principles.

    PubMed

    Khanal, Prabal; Vankipuram, Akshay; Ashby, Aaron; Vankipuram, Mithra; Gupta, Ashish; Drumm-Gurnee, Denise; Josey, Karen; Tinker, Linda; Smith, Marshall

    2014-10-01

    Advanced Cardiac Life Support (ACLS) is a series of team-based, sequential and time constrained interventions, requiring effective communication and coordination of activities that are performed by the care provider team on a patient undergoing cardiac arrest or respiratory failure. The state-of-the-art ACLS training is conducted in a face-to-face environment under expert supervision and suffers from several drawbacks including conflicting care provider schedules and high cost of training equipment. The major objective of the study is to describe, including the design, implementation, and evaluation of a novel approach of delivering ACLS training to care providers using the proposed virtual reality simulator that can overcome the challenges and drawbacks imposed by the traditional face-to-face training method. We compare the efficacy and performance outcomes associated with traditional ACLS training with the proposed novel approach of using a virtual reality (VR) based ACLS training simulator. One hundred and forty-eight (148) ACLS certified clinicians, translating into 26 care provider teams, were enrolled for this study. Each team was randomly assigned to one of the three treatment groups: control (traditional ACLS training), persuasive (VR ACLS training with comprehensive feedback components), or minimally persuasive (VR ACLS training with limited feedback components). The teams were tested across two different ACLS procedures that vary in the degree of task complexity: ventricular fibrillation or tachycardia (VFib/VTach) and pulseless electric activity (PEA). The difference in performance between control and persuasive groups was not statistically significant (P=.37 for PEA and P=.1 for VFib/VTach). However, the difference in performance between control and minimally persuasive groups was significant (P=.05 for PEA and P=.02 for VFib/VTach). The pre-post comparison of performances of the groups showed that control (P=.017 for PEA, P=.01 for VFib/VTach) and persuasive (P=.02 for PEA, P=.048 for VFib/VTach) groups improved their performances significantly, whereas minimally persuasive group did not (P=.45 for PEA, P=.46 for VFib/VTach). Results also suggest that the benefit of persuasiveness is constrained by the potentially interruptive nature of these features. Our results indicate that the VR-based ACLS training with proper feedback components can provide a learning experience similar to face-to-face training, and therefore could serve as a more easily accessed supplementary training tool to the traditional ACLS training. Our findings also suggest that the degree of persuasive features in VR environments have to be designed considering the interruptive nature of the feedback elements. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. 76 FR 60807 - Gulf of Mexico Fishery Management Council; Public Meeting; Correction

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-30

    ... definitions of overfishing limit (OFL) and acceptable biological catch (ABC) based on those assessments. The... Southeast Fisheries Science Center in order to reevaluate the 2012 red snapper annual catch limit during...

  5. Return to Play and Player Performance After Anterior Cruciate Ligament Injury in Elite Australian Rules Football Players

    PubMed Central

    Liptak, Matthew G.; Angel, Kevin R.

    2017-01-01

    Background: Australian Rules football is a highly aerobic and anaerobic game that at times requires players to perform cutting or pivoting maneuvers, potentially exposing them to anterior cruciate ligament (ACL) injury. At present, there are limited data available addressing the impact of ACL injury on return to play and preinjury form after ACL reconstruction. Purpose: To determine the prevalence of ACL injury and the incidence of further ACL injury, and to consider player return to play and return to preinjury form after ACL reconstruction. It was hypothesized that elite-level Australian Football League (AFL) players do not return to preinjury form until, at minimum, 2 years after returning to play. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis was undertaken on a cohort of elite AFL players who injured their ACL between 1990 and 2000. Return to play after ACL reconstruction was determined by the mean number of ball disposals, or release of the ball by the hand or foot, at 1, 2, and 3 years after return to play and compared with preinjury form. Associations between player and injury characteristics, method of reconstruction, and outcomes (return to play, preinjury form, and further ACL injury) were examined. Results: During the included seasons, a total of 2723 AFL players were listed. Of these, 131 (4.8%) sustained an ACL injury, with 115 players eligible for inclusion. Of 115 players, 26% did not return to elite competition, while 28% of those who did return experienced further ACL injury. The adjusted mean number of disposals (± standard error of the mean) was significantly lower at 1 year (12.21 ± 0.63; P = .003), 2 years (12.09 ± 0.65; P = .008), and 3 years (11.78 ± 0.77; P = .01) after return to play compared with preinjury (14.23 ± 0.67). On average, players did not return to preinjury form by 3 years (P < .01). Players aged 30 years or older were less likely to return to play compared with younger players (P = .0002), moderate-weight players were more likely to return to play compared with lighter-weight players (P = .007), and there were significantly increased odds of not returning to play if the dominant side was injured (odds ratio, 0.10; 95% CI, 0.03-0.34; P = .0002). Conclusion: On average, AFL players do not return to their preinjury form after ACL injury and reconstruction, a common injury in this sporting population. This along with the high occurrence of reinjury highlights the career-threatening nature of ACL injury for elite AFL players. PMID:28680894

  6. Return to Sport After Anterior Cruciate Ligament Reconstruction in the Skeletally Immature Athlete.

    PubMed

    Chicorelli, Anne M; Micheli, Lyle J; Kelly, Michael; Zurakowski, David; MacDougall, Robert

    2016-07-01

    Determine the percentage of skeletally immature athletes returning to sports after anterior cruciate ligament (ACL) injury and reconstruction. Retrospective case series. Boston Children's Hospital Division of Sports Medicine. Eligible participants were identified by chart review. Males and females aged ≤14 year old who were greater than 2 years after ACL reconstruction surgery seen between January 2001 and May 2009. A total of 250 patients completed the questionnaires. Age, sex, mechanism, and sport played at time of ACL injury. Response to the survey was 75% (250 of 333) which was analyzed using descriptive statistics to provide a summary of the study cohort. Kaplan-Meier survivorship analysis was applied to determine time to return to sports participation after ACL reconstruction with Greenwood formula used to calculate 95% confidence intervals around the estimated percentage returning at 6, 9, 12, 18, and 24-month follow-up. After undergoing ACL reconstruction, 96% of skeletally immature athletes are able to return to sports at the same skill level. Median time to return to sports was 9 months postoperative, with most athletes returning to sports (85%) by 12 months. After undergoing ACL reconstruction, most child athletes are able to return to sports and 50% of these athletes return within 9 months after surgery. After undergoing ACL reconstruction, 96% of athletes ≤14 year old are able to return to sports at the same skill level. Median time to return to sports was 9 months postoperative, with most athletes returning to sports (85%) by 12 months. In our study, patients cited physical limitation, loss of interest in sport, and fear of reinjury as reasons for not returning to previous level of sport. Return to sport may be improved by additional research into sports-specific training and rehabilitation in this cohort.

  7. Willingness to pay for anterior cruciate ligament reconstruction.

    PubMed

    Hall, Michael P; Chiang-Colvin, Alexis S; Bosco, Joseph A

    2013-01-01

    The outcomes of ACL reconstructions in terms of patient satisfaction and function are well known. Most orthopaedic surgeons feel that Medicare and other payors do not reimburse enough for this surgery. The purpose of this study is to determine how much patients are willing to pay for this surgery and compare it to reimbursement rates. We constructed a survey which described the function and limitations of an ACL deficient knee and the expected function of that knee after an ACL reconstruction. We then asked the volunteers how much they would be willing to pay for an ACL reconstruction if it were their knee. We also gathered data on the yearly earnings and Tegner activity level of the volunteers. In all, 143 volunteers completed the survey. We computed correlation coefficients between willingness to pay and both yearly earnings and Tegner activity level. The average amount that the volunteers were willing to pay for an ACL reconstruction was $4,867.00. There was no correlation between yearly earnings and willingness to pay. The correlation coefficient was 0.34. There was a weak correlation between Tegner activity level and willingness to pay. This correlation coefficient was 0.81. The Medicare allowable rate for ACL reconstruction (CPT 29888) in the geographic area of the study was $1,132.00. The data demonstrates that patients are willing to pay much more than traditional payors for ACL reconstruction. These payors undervalue the benefit of this surgery to the patient. There is increasing pressure on orthopaedic surgeons to not participate in insurance plans that reimburse poorly. This places an increasing financial burden on the patient. This study suggests that patients may be willing to pay more for their surgery than their insurance plan and accept more of this burden.

  8. Use of a Bioactive Scaffold to Stimulate ACL Healing Also Minimizes Post-traumatic Osteoarthritis after Surgery

    PubMed Central

    Murray, Martha M.; Fleming, Braden C.

    2013-01-01

    Background While ACL reconstruction is the treatment gold standard for ACL injury, it does not reduce the risk of post-traumatic osteoarthritis. Therefore, new treatments that minimize this postoperative complication are of interest. Bio-enhanced ACL repair, in which a bioactive scaffold is used to stimulate healing of an ACL transection, has shown considerable promise in short term studies. The long-term results of this technique and the effects of the bio-enhancement on the articular cartilage have not been previously evaluated in a large animal model. Hypothesis 1) The structural (tensile) properties of the porcine ACL at 6 and 12 months after injury are similar when treated with bio-enhanced ACL repair, bio-enhanced ACL reconstruction, or conventional ACL reconstruction, and all treatments yield results superior to untreated ACL transection. 2) After one year, macroscopic cartilage damage following bio-enhanced ACL repair is similar to bio-enhanced ACL reconstruction and less than conventional ACL reconstruction and untreated ACL transection. Study Design Controlled laboratory study (porcine model) Methods Sixty-two Yucatan mini-pigs underwent ACL transection and randomization to four experimental groups: 1) no treatment, 2) conventional ACL reconstruction, 3) “bio-enhanced” ACL reconstruction using a bioactive scaffold, and 4) “bio-enhanced” ACL repair using a bioactive scaffold. The biomechanical properties of the ligament or graft and macroscopic assessments of the cartilage surfaces were performed after 6 and 12 months of healing. Results The structural properties (i.e., linear stiffness, yield and maximum loads) of the ligament following bio-enhanced ACL repair were not significantly different from bio-enhanced ACL reconstruction or conventional ACL reconstruction, but were significantly greater than untreated ACL transection after 12 months of healing. Macroscopic cartilage damage after bio-enhanced ACL repair was significantly less than untreated ACL transection and bio-enhanced ACL reconstruction, and there was a strong trend (p=.068) that it was less than conventional ACL reconstruction in the porcine model at 12 months. Conclusions Bio-enhanced ACL repair produces a ligament that is biomechanically similar to an ACL graft and provides chondroprotection to the joint following ACL surgery. Clinical Relevance Bio-enhanced ACL repair may provide a new less invasive treatment option that reduces cartilage damage following joint injury. PMID:23857883

  9. 78 FR 10556 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Trip Limit...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-14

    ... Fishery; Trip Limit Adjustments for the Common Pool Fishery AGENCY: National Marine Fisheries Service... Northeast multispecies common pool vessels for the remainder of the 2012 fishing year. This rule also... total catch of these stocks to approach their pertinent common pool sub-annual catch limits sub-annual...

  10. 76 FR 23996 - North Pacific Fishery Management Council Public Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-29

    ... uncertainty/total catch accounting; review/approve Halibut Mortality on trawlers Exempted Fishing Permit (EFP... & Wildlife Service Report. 2. Catch Sharing Plan(CSP): Review CSP size limit algorithm. 3. BSAI Crab Draft Stock Assessment Fishery Evaluation report: Review and approve catch specifications for Norton Sound Red...

  11. 78 FR 46897 - Fisheries of the Northeastern United States; Atlantic Herring Fishery; Framework Adjustment 2 and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-02

    ...NMFS proposes regulations to implement Framework Adjustment 2 to the Atlantic herring Fishery Management Plan and the 2013-2015 fishery specifications for the Atlantic herring fishery. Framework 2 would allow the New England Fishery Management Council to split annual catch limits seasonally for the four Atlantic herring management areas, and the carryover of unharvested catch, up to 10 percent for each area's annual catch limit. The specifications would set catch specifications for the herring fishery for the 2013-2015 fishing years and would establish seasonal splits for management areas 1A and 1B as recommended to NMFS by the New England Fishery Management Council.

  12. 50 CFR 665.211 - Total Allowable Catch (TAC) limit.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 13 2014-10-01 2014-10-01 false Total Allowable Catch (TAC) limit. 665.211 Section 665.211 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE (CONTINUED) FISHERIES IN THE WESTERN PACIFIC Hawaii...

  13. 50 CFR 665.211 - Total Allowable Catch (TAC) limit.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 50 Wildlife and Fisheries 13 2012-10-01 2012-10-01 false Total Allowable Catch (TAC) limit. 665.211 Section 665.211 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE (CONTINUED) FISHERIES IN THE WESTERN PACIFIC Hawaii...

  14. 50 CFR 665.211 - Total Allowable Catch (TAC) limit.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 50 Wildlife and Fisheries 13 2013-10-01 2013-10-01 false Total Allowable Catch (TAC) limit. 665.211 Section 665.211 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE (CONTINUED) FISHERIES IN THE WESTERN PACIFIC Hawaii...

  15. 50 CFR 665.211 - Total Allowable Catch (TAC) limit.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 50 Wildlife and Fisheries 9 2010-10-01 2010-10-01 false Total Allowable Catch (TAC) limit. 665.211 Section 665.211 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE (CONTINUED) FISHERIES IN THE WESTERN PACIFIC Hawaii...

  16. 50 CFR 665.211 - Total Allowable Catch (TAC) limit.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 50 Wildlife and Fisheries 11 2011-10-01 2011-10-01 false Total Allowable Catch (TAC) limit. 665.211 Section 665.211 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE (CONTINUED) FISHERIES IN THE WESTERN PACIFIC Hawaii...

  17. Short-term complications in intra- and extra-articular anterior cruciate ligament reconstruction. Comparison with the literature on isolated intra-articular reconstruction. A multicenter study by the French Arthroscopy Society.

    PubMed

    Panisset, J C; Pailhé, R; Schlatterer, B; Sigwalt, L; Sonnery-Cottet, B; Lutz, C; Lustig, S; Batailler, C; Bertiaux, S; Ehkirch, F P; Colombet, P; Steltzlen, C; Louis, M L; D'ingrado, P; Dalmay, F; Imbert, P; Saragaglia, D

    2017-12-01

    Lateral tenodesis (LT) is performed to limit the risk of iterative tear following anterior cruciate ligament (ACL) reconstruction in at-risk patients. By adding an extra procedure to isolated ACL graft, LT reconstruction increases operating time and may complicate postoperative course. The objective of the present study was to evaluate the rate of early complications. The study hypothesis was that associating ALL reconstruction to ACL reconstruction does not increase the complications rate found with isolated ACL reconstruction. A prospective multicenter study included 392 patients: 70% male; mean age, 29.9 years; treated by associated ACL and LT reconstruction. All adverse events were inventoried. Mean hospital stay was 2 days, with 46% day-surgery. Walking was resumed at a mean 27 days, with an advantage for patients treated by the hamstring technique. The early postoperative complications rate was 12%, with 1.7% specifically implicating LT reconstruction: pain, hematoma, stiffness in flexion and extension, and infection. There was a 5% rate of surgical revision during the first year, predominantly comprising arthrolysis for extension deficit. The 1-year recurrence rate was 2.8%. The complications rate for combined intra- and extra-articular reconstruction was no higher than for isolated intra-articular ACL reconstruction, with no increase in infection or stiffness rates. The rate of complications specific to ALL reconstruction was low, at 1.7%, and mainly involved fixation error causing lateral soft-tissue impingement. IV, prospective multicenter study. Copyright © 2017. Published by Elsevier Masson SAS.

  18. Correlation of a single assessment numeric evaluation (SANE) rating with modified Cincinnati knee rating system and IKDC subjective total scores for patients after ACL reconstruction or knee arthroscopy.

    PubMed

    Shelbourne, K Donald; Barnes, Adam F; Gray, Tinker

    2012-11-01

    Limited studies exist regarding how well a single assessment numeric evaluation (SANE) rating correlates with validated knee surveys. To determine whether a SANE rating correlates positively with the International Knee Documentation Committee (IKDC) and the modified Cincinnati Knee Rating System (CKRS) total scores after knee surgery. Cohort study (Diagnosis); Level of evidence, 2. Patients undergoing either anterior cruciate ligament (ACL) reconstruction or knee arthroscopy were prospectively given subjective evaluations yearly after surgery between January 2000 and June 2011. Subjective evaluations were obtained using modified CKRS and IKDC subjective knee surveys and a SANE rating. Interclass correlation coefficient was used to determine the correlation of the SANE rating to the survey total scores. Bland-Altman method was used to access precision and limits of agreement between scores. In addition, the data were analyzed according to sex and age categories (<18, 18-24, 25-40, >40 years). A total of 11,939 surveys were collected from 3209 patients (mean, 3.7 surveys/person; range, 1-22) after ACL reconstruction with a mean survey age of 35.2 ± 11.9 years (range, 13-72). A total of 4615 surveys were collected from 1813 patients (mean, 2.6 surveys/person; range, 1-17) after knee arthroscopy with a mean survey age of 47.4 ± 14.6 years (range, 11-88). For patients who underwent ACL reconstruction, the SANE rating had a moderate positive correlation of 0.66 to the total survey scores. For patients who underwent knee arthroscopies, the SANE rating had a strong positive correlation of 0.74 to total scores. There was minimal difference in correlations based on age group or sex. Bland-Altman analysis showed that the limits of agreement between the SANE score and the 2 surveys were met for at least 94% of patients in both patient groups. The SANE ratings exhibited moderate to strong positive correlations with the modified CKRS and IKDC subjective surveys after ACL reconstruction and knee arthroscopy for patients of all ages and both sexes.

  19. Anatomical Individualized ACL Reconstruction.

    PubMed

    Rahnemai-Azar, Amir Ata; Sabzevari, Soheil; Irarrázaval, Sebastián; Chao, Tom; Fu, Freddie H

    2016-10-01

    The anterior cruciate ligament (ACL) is composed of two bundles, which work together to provide both antero-posterior and rotatory stability of the knee. Understanding the anatomy and function of the ACL plays a key role in management of patients with ACL injury. Anatomic ACL reconstruction aims to restore the function of the native ACL. Femoral and tibial tunnels should be placed in their anatomical location accounting for both the native ACL insertion site and bony landmarks. One main component of anatomical individualized ACL reconstruction is customizing the treatment according to each patient's individual characteristics, considering preoperative and intraoperative evaluation of the native ACL and knee bony anatomy. Anatomical individualized reconstruction surgery should also aim to restore the size of the native ACL insertion as well. Using this concept, while single bundle ACL reconstruction can restore the function of the ACL in some patients, double bundle reconstruction is indicated in others to achieve optimal outcome.

  20. Biomechanics Associated with Patellofemoral Pain and ACL Injuries in Sports.

    PubMed

    Weiss, Kaitlyn; Whatman, Chris

    2015-09-01

    Knee injuries are prevalent among a variety of competitive sports and can impact an athlete's ability to continue to participate in their sport or, in the worst case, end an athlete's career. The aim was to evaluate biomechanics associated with both patellofemoral pain syndrome (PFPS) and anterior cruciate ligament (ACL) injuries (in sports involving landing, change in direction, or rapid deceleration) across the three time points frequently reported in the literature: pre-injury, at the time of injury, and following injury. A search of the literature was conducted for research evaluating biomechanics associated with ACL injury and PFPS. The Web of Science, SPORTDiscus, EBSCO, PubMed, and CINAHL databases, to March 2015, were searched, and journal articles focused on ACL injuries and PFPS in sports that met the inclusion criteria were reviewed. The search methodology was created with the intent of extracting case-control, case, and cohort studies of knee injury in athletic populations. The search strategy was restricted to only full-text articles published in English. These articles were included in the review if they met all of the required selection criteria. The following inclusion criteria were used: (1) The study must report lower extremity biomechanics in one of the following settings: (a) a comparison of currently injured and uninjured participants, (b) a prospective study evaluating risk factors for injury, or (c) a study reporting on the injury event itself. (2) The study must include only currently active participants who were similar at baseline (i.e. healthy, high school level basketball players currently in-season) and include biomechanical analysis of either landing, change in direction, or rapid deceleration. (3) The study must include currently injured participants. The studies were graded on the basis of quality, which served as an indication of risk of bias. An adapted version of the 'Strengthening the Reporting of Observational Studies in Epidemiology' (STROBE) guidelines was used to rate observational research. Fifteen journal articles focusing on ACL injuries and PFPS in sports met the inclusion criteria. These included three associated with both ACL injuries and PFPS across multiple time points. There was limited evidence for an association between ankle biomechanics and knee injury, with only one ACL injury study identifying decreased plantar flexion in association with injury. Only prospective studies can determine biomechanical risk factors associated with ACL injuries and PFPS. Case studies and case-control studies do not allow for the determination of risk factors associated with both ACL injuries and PFPS as there is no certainty regarding the presence of the observed biomechanics prior to the onset of injury. Further, each study design has its own set of limitations. Lastly, the majority of the studies included in this review had adult female participants. By evaluating several different study designs looking at knee injuries during high-risk manoeuvres, we were able to obtain a holistic perspective of biomechanics associated with PFPS and ACL injuries. Looking at different biomechanical research approaches allowed us to assess not only the mechanism of injury, but also to look for commonalities in biomechanics (in particular, altered frontal plane mechanics at the knee and altered sagittal plane mechanics at the knee and hip) between injured and uninjured participants pre-injury, at the time of injury, and following injury, to better understand potential causes of PFPS and ACL injury. Development of injury prevention programmes should focus on correcting these mechanics observed across the three time points during high-risk manoeuvres as this may help decrease the prevalence of ACL injury and PFPS. Programmes focusing not only on neuromuscular training, but also skill-specific training focused on correcting mechanics during these high-risk manoeuvres may be of greatest benefit regarding prevention. Future research should consider the impact of cumulative loading on knee injury risk. Additionally, better techniques for assessing mechanics in-game are needed in order to facilitate injury prevention and screening strategies.

  1. Evaluation of Partial Transection versus Synovial Debridement of the ACL as Novel Canine Models for Management of ACL Injuries.

    PubMed

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

    2015-10-01

    A major hurdle in investigating important clinical questions in knee ligament treatment is a lack of valid translational animal models. This study characterizes the effects of partial transection versus synovial debridement of the anterior (cranial) cruciate ligament (ACL) in dogs. A total of 27 adult purpose-bred research hounds underwent surgery and were assessed over the following 8 weeks. Dogs were randomized into the following three ACL status groups: sham control (n = 9), intact ACL with synovial debridement (exposed ACL) (n = 9), and partial transection of the ACL (partial tear ACL) (n = 9). Dogs in the exposed ACL group and partial tear ACL group had significantly (p < 0.05) more severe lameness, pain, effusion, reduced function, and reduced comfortable range of motion compared with controls, with the partial tear ACL group being most severely affected. More severe ACL and whole-joint pathology, and radiographic scores for osteoarthritis were present in the partial tear ACL group compared with exposed and/or sham control group. On the basis of these findings, biologic components of ACL injury (exposed ACL) played a role in whole-joint inflammation, but the clinical and pathological effects were more severe when both biologic and biomechanical components were present (i.e., partial tear ACL). These novel canine models were successfully developed to evaluate partial transection versus synovial debridement of the ACL and these models will be used to evaluate treatment options for acute management of ACL injuries. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  2. 77 FR 6019 - Western Pacific Fisheries; 2012 Annual Catch Limits and Accountability Measures

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-07

    ... annual catch limits for western Pacific bottomfish, crustacean, precious coral, and coral reef ecosystem... coral reef ecosystem fishery management unit species (MUS) in the U.S. Exclusive Economic Zone (EEZ...,205 lb (1,000 kg). the American Samoa Exploratory Area. Coral Reef Ecosystem........ Acanthuridae...

  3. ACL reconstruction in patients aged 40 years and older: a systematic review and introduction of a new methodology score for ACL studies.

    PubMed

    Brown, Christopher A; McAdams, Timothy R; Harris, Alex H S; Maffulli, Nicola; Safran, Marc R

    2013-09-01

    Treatment of the anterior cruciate ligament (ACL)-deficient knee in older patients remains a core debate. To perform a systematic review of studies that assessed outcomes in patients aged 40 years and older treated with ACL reconstruction and to provide a new methodological scoring system that is directed at critical assessment of studies evaluating ACL surgical outcomes: the ACL Methodology Score (AMS). Systematic review. A comprehensive literature search was performed from 1995 to 2012 using MEDLINE, EMBASE, and Scopus. Inclusion criteria for studies were primary ACL injury, patient age of 40 years and older, and mean follow-up of at least 21 months after reconstruction. Nineteen studies met the inclusion criteria from the 371 abstracts from MEDLINE and 880 abstracts from Scopus. Clinical outcomes (International Knee Documentation Committee [IKDC], Lysholm, and Tegner activity scores), joint stability measures (Lachman test, pivot-shift test, and instrumented knee arthrometer assessment), graft type, complications, and reported chondral or meniscal injury were evaluated in this review. A new methodology scoring system was developed to be specific at critically analyzing ACL outcome studies and used to examine each study design. Nineteen studies describing 627 patients (632 knees; mean age, 49.0 years; range, 42.6-60.0 years) were included in the review. The mean time to surgery was 32.0 months (range, 2.9-88.0 months), with a mean follow-up of 40.2 months (range, 21.0-114.0 months). The IKDC, Lysholm, and Tegner scores and knee laxity assessment indicated favorable results in the studies that reported these outcomes. Patients did not demonstrate a significant difference between graft types and functional outcome scores or stability assessment. The mean AMS was 43.9 ± 7.2 (range, 33.5-57.5). The level of evidence rating did not positively correlate with the AMS, which suggests that the new AMS system may be able to detect errors in methodology or reporting that may not be taken into account by the classic level of evidence rating. Patients aged 40 years and older with an ACL injury can have satisfactory outcomes after reconstruction. However, the quality of currently available data is still limited, such that further well-designed studies are needed to determine long-term efficacy and to better inform our patients with regard to expected outcomes.

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

    PubMed Central

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

    2015-01-01

    Background After anterior cruciate ligament (ACL) injury, contact forces are decreased in the injured knee when compared with the uninjured knee. The persistence of contact force asymmetries after ACL reconstruction may increase the risk of reinjury and may play an important role in the development of knee osteoarthritis in these patients. Functional performance may also be useful in identifying patients who demonstrate potentially harmful joint contact force asymmetries after ACL reconstruction. Hypothesis Knee joint contact force asymmetries would be present during gait after ACL reconstruction, and performance on a specific set of validated return-to-sport (RTS) readiness criteria would discriminate between those who demonstrated contact force asymmetries and those who did not. Study Design Descriptive laboratory study. Methods A total of 29 patients with ACL ruptures participated in gait analysis and RTS readiness testing 6 months after reconstruction. Muscle and joint contact forces were estimated using an electromyography (EMG)–driven musculoskeletal model of the knee. The magnitude of typical limb asymmetry in uninjured controls was used to define limits of meaningful limb asymmetry in patients after ACL reconstruction. The RTS testing included isometric quadriceps strength testing, 4 unilateral hop tests, and 2 self-report questionnaires. Paired t tests were used to assess limb symmetry for peak medial and tibiofemoral contact forces in all patients, and a mixed-design analysis of variance was used to analyze the effect of passing or failing RTS testing on contact force asymmetry. Results Among all patients, neither statistically significant nor meaningful contact force asymmetries were identified. However, patients who failed RTS testing exhibited meaningful contact force asymmetries, with tibiofemoral contact force being significantly lower for the involved knee. Conversely, patients who passed RTS testing exhibited neither significant nor meaningful contact force asymmetries. Conclusion Joint contact force asymmetries during gait are present in some patients 6 months after ACL reconstruction. Patients who demonstrated poor functional performance on RTS readiness testing exhibited significant and meaningful contact force asymmetries. Clinical Relevance When assessing all patients together, variability in the functional status obscured significant and meaningful differences in contact force asymmetry in patients 6 months after ACL reconstruction. These specific RTS readiness criteria appear to differentiate between those who demonstrate joint contact force symmetry after ACL reconstruction and those who do not. PMID:25318940

  5. Isolation and characterization of racemase from Ensifer sp. 23-3 that acts on α-aminolactams and α-amino acid amides.

    PubMed

    Matsui, Daisuke; Fuhshuku, Ken-Ichi; Nagamori, Shingo; Takata, Momoko; Asano, Yasuhisa

    2017-11-01

    Limited information is available on α-amino-ε-caprolactam (ACL) racemase (ACLR), a pyridoxal 5'-phosphate-dependent enzyme that acts on ACL and α-amino acid amides. In the present study, eight bacterial strains with the ability to racemize α-amino-ε-caprolactam were isolated and one of them was identified as Ensifer sp. strain 23-3. The gene for ACLR from Ensifer sp. 23-3 was cloned and expressed in Escherichia coli. The recombinant ACLR was then purified to homogeneity from the E. coli transformant harboring the ACLR gene from Ensifer sp. 23-3, and its properties were characterized. This enzyme acted not only on ACL but also on α-amino-δ-valerolactam, α-amino-ω-octalactam, α-aminobutyric acid amide, and alanine amide.

  6. No difference in survivorship after unicompartmental knee arthroplasty with or without an intact anterior cruciate ligament.

    PubMed

    Boissonneault, Adam; Pandit, Hemant; Pegg, Elise; Jenkins, Cathy; Gill, Harinderjit Singh; Dodd, Christopher A F; Gibbons, Christopher L M H; Murray, David W

    2013-11-01

    Anterior cruciate ligament deficiency (ACLD) has been considered a contraindication for Oxford unicompartmental knee arthroplasty (UKA) because of the reported higher incidence of failure when implanted in ACLD knees. However, given the potential advantages of UKA over total knee arthroplasty (TKA), we have performed UKA in a limited number of patients with ACL deficiency and end-stage medial compartment osteoarthritis (OA) over the past 11 years. The primary aim of this study was to establish the clinical outcome of this cohort; the secondary aim was to compare both clinical and radiographic data with a matched cohort of ACL-intact (ACLI) patients who have undergone UKA for anteromedial OA. This retrospective observational study describes the clinical and radiological outcome in 46 medial Oxford UKAs implanted in 42 consecutive patients with ACL deficiency and concomitant symptomatic medial compartment OA at mean follow-up of 5 years. It also compares the outcomes with a matched cohort of UKA patients with an intact ACL (ACLI group). At the time of last follow-up, there was no significant difference in clinical results or survivorship between the two groups in this study. The successful short-term results of the ACLD group suggest ACL deficiency may not always be a contraindication to Oxford UKA as previously thought. Until long-term data is available, however, we maintain our recommendation that ACLD be considered a contraindication.

  7. Curve analyses reveal altered knee, hip, and trunk kinematics during drop-jumps long after anterior cruciate ligament rupture.

    PubMed

    Hébert-Losier, Kim; Schelin, Lina; Tengman, Eva; Strong, Andrew; Häger, Charlotte K

    2018-03-01

    Anterior cruciate ligament (ACL) ruptures may lead to knee dysfunctions later in life. Single-leg tasks are often evaluated, but bilateral movements may also be compromised. Our aim was to use curve analyses to examine double-leg drop-jump kinematics in ACL-reconstructed, ACL-deficient, and healthy-knee cohorts. Subjects with unilateral ACL ruptures treated more than two decades ago (17-28years) conservatively with physiotherapy (ACL PT , n=26) or in combination with reconstructive surgery (ACL R , n=28) and healthy-knee controls (n=25) performed 40-cm drop-jumps. Three-dimensional knee, hip, and trunk kinematics were analyzed during Rebound, Flight, and Landing phases. Curves were time-normalized and compared between groups (injured and non-injured legs of ACL PT and ACL R vs. non-dominant and dominant legs of controls) and within groups (between legs) using functional analysis of variance methods. Compared to controls, ACL groups exhibited less knee and hip flexion on both legs during Rebound and greater knee external rotation on their injured leg at the start of Rebound and Landing. ACL R also showed less trunk flexion during Rebound. Between-leg differences were observed in ACL R only, with the injured leg more internally rotated at the hip. Overall, kinematic curves were similar between ACL R and ACL PT . However, compared to controls, deviations spanned a greater proportion of the drop-jump movement at the hip in ACL R and at the knee in ACL PT . Trunk and bilateral leg kinematics during double-leg drop-jumps are still compromised long after ACL-rupture care, independent of treatment. Curve analyses indicate the presence of distinct compensatory mechanisms in ACL PT and ACL R compared to controls. Copyright © 2018 Elsevier B.V. All rights reserved.

  8. Anterior cruciate ligament and meniscal injuries in sports: incidence, time of practice until injury, and limitations caused after trauma.

    PubMed

    Astur, Diego Costa; Xerez, Marcos; Rozas, João; Debieux, Pedro Vargas; Franciozi, Carlos Eduardo; Cohen, Moises

    2016-01-01

    To analyze the incidence of ACL and meniscal injuries in a population of recreational and elite athletes from Brazil and the relation of these injuries with their sports activities. This was a prospective observational study of 240 patients with ACL and/or meniscal injuries submitted to surgical treatment. Data of patients and sport modality, as well as Tegner score were registered in the first clinical evaluation. The patients were divided into three groups: (1) isolated rupture of the ACL; (2) ACL injury associated with meniscal injury; (3) isolated menisci injury. The majority of the patients belonged to group 1 (44.58%), followed by group 2 (30.2%) and 3 (25%). Most patients were soccer players. The mean time from sport practice to injury in group 1 was 17.81 years. In group 2, it was 17.3 years, and in group 3, 26.91 years. Soccer athletes presented ACL injury in 0.523/1000 h of practice and meniscal injury in 0.448/1000 h of practice. Before the injury, the mean Tegner score obtained for groups 1, 2, and 3 were 7.18, 7.34, and 6.53, respectively. After knee injury, those values were 3.07, 3.18, and 2.87, respectively. Soccer was the sport that caused the majority of lesions, regardless the group. Furthermore, patients from groups 1 and 2 had less time of practice prior to the injury (17.81 and 17.3 years) than the patients of group 3 (26.91 years). Women presented a higher risk to develop ACL and meniscal injuries in 1000 h of game/practice. Running, volleyball, and weightlifting are in ascending order of risk for ACL and/or meniscal injury. Regarding the return to sport practice, the efficiency of all athletes was impaired because of the injury.

  9. The Landing Error Scoring System as a Screening Tool for an Anterior Cruciate Ligament Injury–Prevention Program in Elite-Youth Soccer Athletes

    PubMed Central

    Padua, Darin A.; DiStefano, Lindsay J.; Beutler, Anthony I.; de la Motte, Sarah J.; DiStefano, Michael J.; Marshall, Steven W.

    2015-01-01

    Context Identifying neuromuscular screening factors for anterior cruciate ligament (ACL) injury is a critical step toward large-scale deployment of effective ACL injury-prevention programs. The Landing Error Scoring System (LESS) is a valid and reliable clinical assessment of jump-landing biomechanics. Objective To investigate the ability of the LESS to identify individuals at risk for ACL injury in an elite-youth soccer population. Design Cohort study. Setting Field-based functional movement screening performed at soccer practice facilities. Patients or Other Participants A total of 829 elite-youth soccer athletes (348 boys, 481 girls; age = 13.9 ± 1.8 years, age range = 11 to 18 years), of whom 25% (n = 207) were less than 13 years of age. Intervention(s) Baseline preseason testing for all participants consisted of a jump-landing task (3 trials). Participants were followed prospectively throughout their soccer seasons for diagnosis of ACL injuries (1217 athlete-seasons of follow-up). Main Outcome Measure(s) Landings were scored for “errors” in technique using the LESS. We used receiver operator characteristic curves to determine a cutpoint on the LESS. Sensitivity and specificity of the LESS in predicting ACL injury were assessed. Results Seven participants sustained ACL injuries during the follow-up period; the mechanism of injury was noncontact or indirect contact for all injuries. Uninjured participants had lower LESS scores (4.43 ± 1.71) than injured participants (6.24 ± 1.75; t1215 = −2.784, P = .005). The receiver operator characteristic curve analyses suggested that 5 was the optimal cutpoint for the LESS, generating a sensitivity of 86% and a specificity of 64%. Conclusions Despite sample-size limitations, the LESS showed potential as a screening tool to determine ACL injury risk in elite-youth soccer athletes. PMID:25811846

  10. Kinematics of anterior cruciate ligament-deficient knees in a Chinese population during stair ascent.

    PubMed

    Zhao, Chang; Lin, Chuangxin; Wang, Wenhao; Zeng, Chun; Fang, Hang; Pan, Jianying; Cai, Daozhang

    2016-08-08

    The purpose of this study was to measure the tibiofemoral kinematics of anterior cruciate ligament (ACL) deficiency in a Chinese population and compare the kinematics with published data about a Caucasian population. Unilateral knees of 18 Chinese ACL-deficient (ACL-D) subjects were studied while subjects ascended stairs. Kinematic alteration was compared between ACL-D knees and contralateral ACL-intact (ACL-I) knees. The kinematic alteration of ACL deficiency was also compared between the Chinese population and published data about a Caucasian population. A statistical difference was found in the three-dimensional rotations between ACL-D and ACL-I knees. In the sagittal plane, ACL-I knees had a larger flexion angle than ACL-D knees during 40 to 50 % of the activity during stair ascent (P < 0.027) and throughout the gait cycle. A significant difference in rotational motion between ACL-D and ACL-I knees was also observed in the frontal plane during 40 to 60 % (P < 0.017) of the activity and in the transverse plane during 70 to 80 % (P < 0.028) of the activity. A greater tibial varus was demonstrated in the Chinese population while the published data revealed external tibial rotation and a statistical difference in translation in the Caucasian population. ACL-D knees show different kinematics than ACL-I knees in the Chinese population. ACL-I knees had a larger flexion angle than ACL-D knees in the middle stage of the activity during stair ascent. A significant difference in rotational motion between ACL-D and ACL-I knees was also observed in the frontal plane during the middle phase and in the transverse plane during the terminal phase of the activity. A greater tibial varus was demonstrated in the Caucasian population while the published data revealed external tibial rotation and a statistical difference in translation in the Caucasian population.

  11. 77 FR 72242 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; White Hake Trimester...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-05

    ... Fishery; White Hake Trimester Total Allowable Catch Area Closure for the Common Pool Fishery AGENCY... Allowable Catch (TAC) Area to all common pool groundfish vessels fishing with trawl gear, sink gillnet gear... necessary to prevent the common pool fishery from exceeding its Trimester 2 TAC or its annual catch limit...

  12. 78 FR 48075 - Western Pacific Fisheries; 2013 Annual Catch Limits and Accountability Measures; Correcting...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-07

    ... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration 50 CFR Part 665 [Docket No. 121107617-3628-03] RIN 0648-XC351 Western Pacific Fisheries; 2013 Annual Catch Limits and Accountability...-Deep 7 bottomfish fishery is not subject to in-season closure or other in- season accountability...

  13. 77 FR 15973 - Fisheries Off West Coast States; Highly Migratory Species Fisheries; Swordfish Retention Limits

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-19

    ... Magnuson-Stevens Fishery Conservation and Management Act (MSA) to modify retention limits for swordfish... (RFA). Based on the average observed annual catches by this vessel and the market values for that catch... due to this comment. The second critical comment, submitted on behalf of the Turtle Island Restoration...

  14. 36 CFR 13.908 - Fishing limit of catch and in possession.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 36 Parks, Forests, and Public Property 1 2014-07-01 2014-07-01 false Fishing limit of catch and in possession. 13.908 Section 13.908 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Denali National Park and...

  15. 36 CFR 13.908 - Fishing limit of catch and in possession.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 36 Parks, Forests, and Public Property 1 2011-07-01 2011-07-01 false Fishing limit of catch and in possession. 13.908 Section 13.908 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Denali National Park and...

  16. 36 CFR 13.908 - Fishing limit of catch and in possession.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 36 Parks, Forests, and Public Property 1 2010-07-01 2010-07-01 false Fishing limit of catch and in possession. 13.908 Section 13.908 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Denali National Park and...

  17. 50 CFR 679.64 - Harvesting sideboard limits in other fisheries.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Pacific ocean perch. (A) The Aleutian Islands Pacific ocean perch harvest limit will be equal to the 1996 through 1997 aggregate retained catch of Aleutian Islands Pacific ocean perch by catcher/processors listed... sum of the Aleutian Islands Pacific ocean perch catch in 1996 and 1997 multiplied by the remainder of...

  18. 50 CFR 679.64 - Harvesting sideboard limits in other fisheries.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Pacific ocean perch. (A) The Aleutian Islands Pacific ocean perch harvest limit will be equal to the 1996 through 1997 aggregate retained catch of Aleutian Islands Pacific ocean perch by catcher/processors listed... sum of the Aleutian Islands Pacific ocean perch catch in 1996 and 1997 multiplied by the remainder of...

  19. Amount of Minutes Played Does Not Contribute to Anterior Cruciate Ligament Injury in National Basketball Association Athletes.

    PubMed

    Okoroha, Kelechi R; Marfo, Kojo; Meta, Fabien; Matar, Robert; Shehab, Ramsy; Thompson, Terry; Moutzouros, Vasilios; Makhni, Eric C

    2017-07-01

    There is limited information on the potential risk factors for sustaining an anterior cruciate ligament (ACL) tear in National Basketball Association (NBA) athletes. This study evaluated 83 NBA players who sustained an ACL injury between 1984 and 2015 to determine the influence of minutes played on injury risk. Minutes played in the injury game, during the season, and over their career were assessed, along with the ability to return to play, player efficiency rating, and playing time after return. Athletes in the NBA played significantly fewer minutes before sustaining an ACL injury (17.1 minutes) than their average minutes per game that season (23.5 minutes; P<.01) or over their career (24.0 minutes; P<.01). One-third of all injuries occurred during the first quarter of the season (preseason to November). There was a 95% rate of return (78 players) to NBA competition the season following ACL injury. Players who were drafted as lottery picks (draft pick 1 to 15) or those who were starters played significantly more minutes the season following injury than those who were not (both P<.01). Players who returned to play had decreased player efficiency ratings when compared with matched controls. This study found that minutes played in a single NBA game did not contribute to the risk of sustaining an ACL injury. Although there was a high rate of return to NBA competition the season following injury, those who were elite athletes played more minutes per game than those who were not. Athletes who returned to play sustained a decrease in player efficiency ratings compared with similar athletes without ACL injury. [Orthopedics. 2017; 40(4):e658-e662.]. Copyright 2017, SLACK Incorporated.

  20. Is reconstruction the best management strategy for anterior cruciate ligament rupture? A systematic review and meta-analysis comparing anterior cruciate ligament reconstruction versus non-operative treatment.

    PubMed

    Smith, T O; Postle, K; Penny, F; McNamara, I; Mann, C J V

    2014-03-01

    The purpose of this study was to determine the optimal clinical and cost-effective strategy for managing people following ACL rupture. A systematic review of the published (AMED, CINAHL, MEDLINE, EMBASE, PubMed, psycINFO and the Cochrane Library) and unpublished literature (OpenGrey, the WHO International Clinical Trials Registry Platform, Current Controlled Trials and the UK National Research Register Archive) was conducted on April 2013. All randomised and non-randomised controlled trials evaluating clinical or health economic outcomes of isolated ligament reconstruction versus non-surgical management following ACL rupture were included. Methodological quality was assessed using the PEDro appraisal tool. When appropriate, meta-analysis was conducted to pool data. From a total of 943 citations, sixteen studies met the eligibility criteria. These included 1397 participants, 825 who received ACL reconstruction versus 592 who were managed non-surgically. The methodological quality of the literature was poor. The findings indicated that whilst reconstructed ACL offers significantly greater objective tibiofemoral stability (p<0.001), there appears limited evidence to suggest a superiority between reconstruction versus non-surgical management in functional outcomes. There was a small difference between the management strategies in respect to the development of osteoarthritis during the initial 20 years following index management strategy (Odds Ratio 1.56; p=0.05). The current literature is insufficient to base clinical decision-making with respect to treatment opinions for people following ACL rupture. Whilst based on a poor evidence, the current evidence would indicate that people following ACL rupture should receive non-operative interventions before surgical intervention is considered. © 2013.

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

    PubMed Central

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

    2011-01-01

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

  2. 76 FR 44155 - Pacific Halibut Fisheries; Catch Sharing Plan for Guided Sport and Commercial Fisheries in Alaska

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-22

    ...NMFS proposes regulations that would implement a catch sharing plan for the guided sport and commercial fisheries for Pacific halibut in waters of International Pacific Halibut Commission (IPHC) Regulatory Areas 2C (Southeast Alaska) and 3A (Central Gulf of Alaska). If approved, this catch sharing plan will change the annual process of allocating halibut between the guided sport and commercial fisheries in Area 2C and Area 3A, establish allocations for each sector, and specify harvest restrictions for guided sport anglers that are intended to limit harvest to the annual guided sport fishery catch limit. In order to provide flexibility for individual commercial and guided sport fishery participants, the proposed catch sharing plan also will authorize annual transfers of commercial halibut quota to charter halibut permit holders for harvest in the guided sport fishery. This action is necessary to achieve the halibut fishery management goals of the North Pacific Fishery Management Council.

  3. 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.

  4. How Anterior Cruciate Ligament Injury was averted during Knee Collapse in a NBA Point Guard

    PubMed Central

    Schilaty, Nathan D; Bates, Nathaniel A; Krych, Aaron J; Hewett, Timothy E

    2017-01-01

    Summary Non-contact anterior cruciate ligament (ACL) injuries occur with rapid decelerations and pivoting. A recent injury to a high-level National Basketball Association (NBA) player demonstrated neuromuscular control and injury-sparing mechanisms that resulted in only minor ligament injury to the medial collateral ligament. We analyzed biomechanical mechanisms via publically available orthogonal 2-D video to demonstrate how this potential ACL injury was averted. Analysis of the knee injury mechanism demonstrated that the NBA player experienced low ground reaction force, high sagittal plane flexion, and maintenance of frontal plane stability with neuromuscular control. The outcome of these factors inhibited dynamic valgus collapse of the knee throughout the fall, avoiding ACL injury – a potentially career-altering injury. Many athletes, professional and recreational, will be subjected to similar mechanisms of injury and will have improved outcomes if they can successfully utilize preventive strategies of neuromuscular control to limit injury mechanisms. PMID:28603786

  5. How Anterior Cruciate Ligament Injury was averted during Knee Collapse in a NBA Point Guard.

    PubMed

    Schilaty, Nathan D; Bates, Nathaniel A; Krych, Aaron J; Hewett, Timothy E

    2017-01-01

    Non-contact anterior cruciate ligament (ACL) injuries occur with rapid decelerations and pivoting. A recent injury to a high-level National Basketball Association (NBA) player demonstrated neuromuscular control and injury-sparing mechanisms that resulted in only minor ligament injury to the medial collateral ligament. We analyzed biomechanical mechanisms via publically available orthogonal 2-D video to demonstrate how this potential ACL injury was averted. Analysis of the knee injury mechanism demonstrated that the NBA player experienced low ground reaction force, high sagittal plane flexion, and maintenance of frontal plane stability with neuromuscular control. The outcome of these factors inhibited dynamic valgus collapse of the knee throughout the fall, avoiding ACL injury - a potentially career-altering injury. Many athletes, professional and recreational, will be subjected to similar mechanisms of injury and will have improved outcomes if they can successfully utilize preventive strategies of neuromuscular control to limit injury mechanisms.

  6. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries

    PubMed Central

    Ekås, Guri Ranum; Grindem, Hege; Moksnes, Håvard; Anderson, Allen F; Chotel, Franck; Cohen, Moises; Forssblad, Magnus; Ganley, Theodore J; Feller, Julian A; Karlsson, Jón; Kocher, Minider S; LaPrade, Robert F; McNamee, Michael; Mandelbaum, Bert; Micheli, Lyle; Mohtadi, Nicholas; Reider, Bruce; Roe, Justin; Seil, Romain; Siebold, Rainer; Witvrouw, Erik; Engebretsen, Lars

    2018-01-01

    In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric ACL injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery & Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions. PMID:29478021

  7. Healing of donor site in bone-tendon-bone ACL reconstruction accelerated with plasma rich in growth factors: a randomized clinical trial.

    PubMed

    Seijas, Roberto; Rius, Marta; Ares, Oscar; García-Balletbó, Montserrat; Serra, Iván; Cugat, Ramón

    2015-04-01

    To determine whether the use of plasma rich in growth factors accelerates healing of the donor site in bone-tendon-bone anterior cruciate ligament (ACL) reconstruction (patellar graft). The use of the patellar graft presents post-operative problems such as anterior knee pain, which limits its use and leads to preference being taken for alternative grafts. A double-blind, randomized, clinical trial was performed comparing two groups of patients who underwent ACL reconstruction using patellar tendon graft and comparing the use of plasma rich in growth factors at the donor site after graft harvest in terms of local regeneration by ultrasound assessment. The plasma rich in growth factors group shows earlier donor site regeneration in comparison with the control group (2 months earlier), with significant differences in the first 4 months of the follow-up. The application of plasma rich in growth factors shows accelerated tissue regeneration processes with respect to the control group. This fact, together with the previously published with similar conclusions, can create a knowledge basis in order to set out new recovery guidelines following ACL reconstruction. Therapeutic study, Level I.

  8. 26 CFR 1.403(b)-4 - Contribution limitations.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... described in section 415(c)(3)(E). Any age 50 catch-up contributions under paragraph (c)(2) of this section...) elective deferrals made on his or her behalf. (2) Age 50 catch-up—(i) In general. In accordance with... contributions for a participant who is age 50 by the end of the year, provided that such age 50 catch-up...

  9. Anatomical versus non-anatomical single bundle anterior cruciate ligament reconstruction: a cadaveric study of comparison of knee stability.

    PubMed

    Lim, Hong-Chul; Yoon, Yong-Cheol; Wang, Joon-Ho; Bae, Ji-Hoon

    2012-12-01

    The purpose of this study was to compare the initial stability of anatomical and non-anatomical single bundle anterior cruciate ligament (ACL) reconstruction and to determine which would better restore intact knee kinematics. Our hypothesis was that the initial stability of anatomical single bundle ACL reconstruction would be superior to that of non-anatomical single bundle ACL reconstruction. Anterior tibial translation (ATT) and internal rotation of the tibia were measured with a computer navigation system in seven pairs of fresh-frozen cadaveric knees under two testing conditions (manual maximum anterior force, and a manual maximum anterior force combined with an internal rotational force). Tests were performed at 0, 30, 60, and 90 degrees of flexion with the ACL intact, the ACL transected, and after reconstruction of one side of a pair with either anatomical or non-anatomical single bundle ACL reconstruction. Under manual maximal anterior force, both reconstruction techniques showed no significant difference of ATT when compared to ACL intact knee state at 30° of knee flexion (p > 0.05). Under the combined anterior and internal rotatory force, non-anatomical single-bundle ACL reconstruction showed significant difference of ATT compared to those in ACL intact group (p < 0.05). In contrast, central anatomical single bundle ACL reconstruction showed no significant difference of ATT compared to those in ACL intact group (p > 0.05). Internal rotation of the tibia showed no significant difference in the ACL intact, the ACL transected, non-anatomical reconstructed and anatomical reconstructed knees. Anatomical single bundle ACL reconstruction restored the initial stability closer to the native ACL under combined anterior and internal rotational forces when compared to non-anatomical ACL single bundle reconstruction.

  10. 26 CFR 1.402(g)-2 - Increased limit for catch-up contributions.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ....402(g)-2 Section 1.402(g)-2 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES Pension, Profit-Sharing, Stock Bonus Plans, Etc. § 1.402(g)-2 Increased limit for catch-up contributions. (a) General rule. Under section 402(g)(1)(C), in determining the...

  11. 76 FR 82264 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; Comprehensive Annual Catch Limit...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-30

    .... 100812345-1789-01] RIN 0648-AY73 Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; Comprehensive Annual Catch Limit Amendment for the South Atlantic AGENCY: National Marine Fisheries Service... Management Plans (FMPs) for the Snapper-Grouper Fishery of the South Atlantic Region (Snapper- Grouper FMP...

  12. Catch rates relative to angler party size with implications for monitoring angler success

    USGS Publications Warehouse

    Miranda, L.E.

    2005-01-01

    Angler catch rates often are used to monitor angler success, assess the need for additional management actions, and evaluate the effectiveness of management practices. Potential linkages between catch rate and angler party size were examined to assess how party size might affect the use of catch rate as an index of angler success in recreational fisheries. Data representing 22,355 completed interviews conducted at access points in lakes and reservoirs throughout Mississippi during 1987-2003 were analyzed. Total party catch was not proportional to total party effort; thus, catch rate decreased as party size increased. Depending on the taxa targeted, the average catch rate per angler decreased 40-50% between parties of one and parties of two, although subsequent decreases were less substantial. Because party size accounted for a considerable portion of the variability in catch rate over time and space, failure to remove this variability weakens the manager's ability to detect differences or changes in catch rates. Therefore, the use of catch rates to monitor fisheries may be inappropriate unless party size is taken into account. Party size may influence the angler's ability to catch fish through a variety of processes, including partitioning a limited number of catchable fish among members of a party and party composition. When catch rates are used to estimate total catch rather than to index angler success, party size is not a concern.

  13. Predictors for additional anterior cruciate ligament reconstruction: data from the Swedish national ACL register.

    PubMed

    Fältström, Anne; Hägglund, Martin; Magnusson, Henrik; Forssblad, Magnus; Kvist, Joanna

    2016-03-01

    To identify predictors for additional anterior cruciate ligament (ACL) reconstruction. Patients from the Swedish national ACL register who underwent ACL reconstruction between January 2005 and February 2013 (follow-up duration 6-104 months) were included. Cox regression analyses included the following independent variables regarding primary injury: age, sex, time between injury and primary ACL reconstruction, activity at primary injury, concomitant injuries, injury side, graft type, and pre-surgery KOOS and EQ-5D scores. Among ACL reconstruction procedures, 93% involved hamstring tendon (HT) autografts. Graft type did not predict additional ACL reconstruction. Final regression models only included patients with HT autograft (n = 20,824). Of these, 702 had revision and 591 contralateral ACL reconstructions. The 5-year post-operative rates of revision and contralateral ACL reconstruction were 4.3 and 3.8%, respectively. Significant predictors for additional ACL reconstruction were age (fourfold increased rate for <16-year-old patients vs. >35-year-old patients), time between injury and primary surgery (two to threefold increased rate for ACL reconstruction within 0-90 days vs. >365 days), and playing football at primary injury. This study identified younger age, having ACL reconstruction early after the primary injury, and incurring the primary injury while playing football as the main predictors for revision and contralateral ACL reconstruction. This suggests that the rate of additional ACL reconstruction is increased in a selected group of young patients aiming to return to strenuous sports after primary surgery and should be taken into consideration when discussing primary ACL reconstruction, return to sports, and during post-surgery rehabilitation. II.

  14. Risk Factors for Anthroponotic Cutaneous Leishmaniasis at the Household Level in Kabul, Afghanistan

    PubMed Central

    Reithinger, Richard; Mohsen, Mohammad; Leslie, Toby

    2010-01-01

    Background Kabul, Afghanistan, is the largest focus of anthroponotic cutaneous leishmaniasis (ACL) in the world. ACL is a protozoan disease transmitted to humans by the bite of phlebotomine sand flies. Although not fatal, ACL can lead to considerable stigmatization of affected populations. Methods Using data from a standardized survey of 872 households in 4 wards of Kabul, Afghanistan, univariate and multivariate logistic regression analyses tested associations between presence of active ACL and ACL scars with 15 household-level variables. Findings Univariate analyses showed that active ACL was positively associated with household member's age, ACL prevalence, and brick wall type, but negatively associated with household number of rooms, bednet use, and proportion of windows with screens. Multivariate analysis showed a positive association between active ACL and household member's age, ACL prevalence, and brick wall type, and a negative association with household proportion of windows with screens. Conclusion Household-level charateristics were shown to be risk factors for ACL. Monitoring a selected number of household characteristics could assist in rapid assessments of household-level variation in risk of ACL. ACL prevention and control programs should consider improving house construction, including smoothing of walls and screening of windows. PMID:20351787

  15. Intercondylar roof impingement pressure after anterior cruciate ligament reconstruction in a porcine model.

    PubMed

    Iriuchishima, Takanori; Tajima, Goro; Ingham, Sheila J M; Shen, Wei; Horaguchi, Takashi; Saito, Akiyoshi; Smolinski, Patrick; Fu, Freddie H

    2009-06-01

    Anterior cruciate ligament (ACL) graft impingement against the intercondylar roof has been postulated, but not thoroughly investigated. The roof impingement pressure changes with different tibial and femoral tunnel positions in ACL reconstruction. Anterior tibial translation is also affected by the tunnel positions of ACL reconstruction. The study design included a controlled laboratory study. In 15 pig knees, the impingement pressure between ACL and intercondylar roof was measured using pressure sensitive film before and after ACL single bundle reconstruction. ACL reconstructions were performed in each knee with two different tibial and femoral tunnel position combinations: (1) tibial antero-medial (AM) tunnel to femoral AM tunnel (AM to AM) and (2) tibial postero-lateral (PL) tunnel to femoral High-AM tunnel (PL to High-AM). Anterior tibial translation (ATT) was evaluated after each ACL reconstruction using robotic/universal force-moment sensor testing system. Neither the AM to AM nor the PL to High-AM ACL reconstruction groups showed significant difference when compared with intact ACL in roof impingement pressure. The AM to AM group had a significantly higher failure load than PL to High-AM group. This study showed how different tunnel placements affect the ACL-roof impingement pressure and anterior-posterior laxity in ACL reconstruction. Anatomical ACL reconstruction does not cause roof impingement and it has a biomechanical advantage in ATT when compared with non-anatomical ACL reconstructions in the pig knee. There is no intercondylar roof impingement after anatomical single bundle ACL reconstruction.

  16. Mucoid Degeneration of the Anterior Cruciate Ligament: Characterization of Natural History, Femoral Notch Width Index, and Patient Reported Outcome Measures.

    PubMed

    Hotchen, Andrew J; Demetriou, Charis; Edwards, Dennis; Melton, Joel T K

    2018-06-13

    The presentation and clinical course of mucoid degeneration of the anterior cruciate ligament (MD-ACL) are poorly documented within the literature. Subsequently, it is under-diagnosed and the optimal management strategy remains ill-defined. Here, we characterize the syndrome associated with MD-ACL and compare the natural clinical course with the outcomes of arthroscopic management. Thirty-one patients with radiological features of MD-ACL over a 2-year period had their clinical notes retrospectively reviewed. Seven patients underwent arthroscopic debridement of the ACL for MD. These were followed up for a minimum of 2 years and an average of 2.8 years from surgery. The remainder were managed conservatively ( n  = 24) and were followed up for a minimum of 2 years and an average of 4.0 years. The notch width index (NWI) and associated pathology was noted. Primary outcome measures were presence of knee pain and use of analgesia. Secondary outcome measures were the Oxford and Lysholm knee scores. The most commonly reported symptoms were posterior knee pain (77.4%) and limitation of terminal flexion (58.1%). All patients who underwent arthroscopic debridement were pain and analgesia free at follow-up. Of the patients who did not undergo arthroscopic surgery, three patients had knee replacement surgery and three were lost to follow-up. The remaining patients, 14/18 (77.8%), reported knee pain and regular analgesia use at follow-up, which was significantly more than the arthroscopic debridement group ( p  < 0.01). The knee scores were significantly better in the arthroscopic debridement group at follow-up (Oxford knee score: 45 vs 34; Lysholm: 92 vs 67; p  < 0.01). Furthermore, the postoperative improvement in the Oxford knee and Lysholm scores compared with preoperatively was 12.1 and 31.8 points, respectively ( p  < 0.01). The NWI was increased in patients with mild-to-severe osteoarthritis (0.266 vs 0.273; p  < 0.05). MD-ACL should be considered in patients who report posterior knee pain, limitation of terminal flexion, and it can be associated with other knee pathologies. MD-ACL can be successfully managed with arthroscopic radio frequency debulking with improvement in quality of life at follow-up. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  17. Anterior Cruciate Ligament Injuries in National Football League Athletes From 2010 to 2013: A Descriptive Epidemiology Study.

    PubMed

    Dodson, Christopher C; Secrist, Eric S; Bhat, Suneel B; Woods, Daniel P; Deluca, Peter F

    2016-03-01

    There is a high incidence of anterior cruciate ligament (ACL) injuries among National Football League (NFL) athletes; however, the incidence of reinjury in this population is unknown. This retrospective epidemiological study analyzed all publicly disclosed ACL tears occurring in NFL players between 2010 and 2013 to characterize injury trends and determine the incidence of reinjury. Descriptive epidemiological study. A comprehensive online search identified any NFL player who had suffered an ACL injury from 2010 to 2013. Position, playing surface, activity, and date were recorded. Each player was researched for any history of previous ACL injury. The NFL games database from USA Today was used to determine the incidence of ACL injuries on artificial turf and grass fields. Databases from Pro Football Focus and Pro Football Reference were used to determine the injury rate for each position. NFL players suffered 219 ACL injuries between 2010 and 2013. Forty players (18.3%) had a history of previous ACL injury, with 27 (12.3%) retears and 16 (7.3%) tears contralateral to a previous ACL injury. Five players (2.28%) suffered their third ACL tear. Receivers (wide receivers and tight ends) and backs (linebackers, fullbacks, and halfbacks) had significantly greater injury risk than the rest of the NFL players, while perimeter linemen (defensive ends and offensive tackles) had significantly lower injury risk than the rest of the players. Interior linemen (offensive guards, centers, and defensive tackles) had significantly greater injury risk compared with perimeter linemen. ACL injury rates per team games played were 0.050 for grass and 0.053 for turf fields (P > .05). In this retrospective epidemiological study of ACL tears in NFL players, retears and ACL tears contralateral to a previously torn ACL constituted a substantial portion (18.3%) of total ACL injuries. The significant majority of ACL injuries in players with a history of previous ACL injury were retears. Skilled offensive players and linebackers had the greatest injury risk, and significantly more ACL tears occurred among interior linemen than perimeter linemen. The month of August had the highest incidence of ACL injuries, probably because of expanded roster sizes at that point in the NFL season.

  18. The Dutch language anterior cruciate ligament return to sport after injury scale (ACL-RSI) - validity and reliability.

    PubMed

    Slagers, Anton J; Reininga, Inge H F; van den Akker-Scheek, Inge

    2017-02-01

    The ACL-Return to Sport after Injury scale (ACL-RSI) measures athletes' emotions, confidence in performance, and risk appraisal in relation to return to sport after ACL reconstruction. Aim of this study was to study the validity and reliability of the Dutch version of the ACL-RSI (ACL-RSI (NL)). Total 150 patients, who were 3-16 months postoperative, completed the ACL-RSI(NL) and 5 other questionnaires regarding psychological readiness to return to sports, knee-specific physical functioning, kinesiophobia, and health-specific locus of control. Construct validity of the ACL-RSI(NL) was determined with factor analysis and by exploring 10 hypotheses regarding correlations between ACL-RSI(NL) and the other questionnaires. For test-retest reliability, 107 patients (5-16 months postoperative) completed the ACL-RSI(NL) again 2 weeks after the first administration. Cronbach's alpha, Intraclass Correlation Coefficient (ICC), SEM, and SDC, were calculated. Bland-Altman analysis was conducted to assess bias between test and retest. Nine hypotheses (90%) were confirmed, indicating good construct validity. The ACL-RSI(NL) showed good internal consistency (Cronbach's alpha 0.94) and test-retest reliability (ICC 0.93). SEM was 5.5 and SDC was 15. A significant bias of 3.2 points between test and retest was found. Therefore, the ACL-RSI(NL) can be used to investigate psychological factors relevant to returning to sport after ACL reconstruction.

  19. Adolescents and female patients are at increased risk for contralateral anterior cruciate ligament reconstruction: a cohort study from the Swedish National Knee Ligament Register based on 17,682 patients.

    PubMed

    Snaebjörnsson, Thorkell; Hamrin Senorski, Eric; Sundemo, David; Svantesson, Eleonor; Westin, Olof; Musahl, Volker; Alentorn-Geli, Eduard; Samuelsson, Kristian

    2017-12-01

    The impact of different surgical techniques in index ACL reconstruction for patients undergoing contralateral ACL reconstruction was investigated. The study was based on data from the Swedish National Knee Ligament Register. Patients undergoing index ACL reconstruction and subsequent contralateral ACL reconstruction using hamstring graft under the study period were included. The following variables were evaluated: age at index surgery, gender, concomitant meniscal or cartilage injury registered at index injury, transportal femoral bone tunnel drilling and transtibial femoral bone tunnel drilling. The end-point of primary contralateral ACL surgery was analysed as well as the time-to-event outcomes using survivorship methods including Kaplan-Meier estimation and Cox proportional hazards regression models. A total of 17,682 patients [n = 10,013 males (56.6%) and 7669 females (43.4%)] undergoing primary ACL reconstruction from 1 January 2005 through 31 December 2014 were included in the study. A total of 526 (3.0%) patients [n = 260 males (49.4%) and 266 females (50.6%)] underwent primary contralateral ACL reconstruction after index ACL reconstruction during the study period. Females had a 33.7% greater risk of contralateral ACL surgery [HR 1.337 (95% CI 1.127-1.586); (P = 0 0.001)]. The youngest age group (13-15 years) showed an increased risk of contralateral ACL surgery compared with the reference (36-49) age group [HR 2.771 (95% CI 1.456-5.272); (P = 0.002)]. Decreased risk of contralateral ACL surgery was seen amongst patients with concomitant cartilage injury at index surgery [HR 0.765 (95% CI 0.623-0.939); (P = 0.010)]. No differences in terms of the risk of contralateral ACL surgery were found between anatomic and non-anatomic techniques of primary single-bundle ACL reconstruction, comparing transportal anatomic technique to transtibial non-anatomic, anatomic and partial-anatomic. Age and gender were identified as risk factors for contralateral ACL reconstruction; hence young individuals and females were more prone to undergo contralateral ACL reconstruction. Patients with concomitant cartilage injury at index ACL reconstruction had lower risk for contralateral ACL reconstruction. No significant differences between various ACL reconstruction techniques could be related to increased risk of contralateral ACL reconstruction. Retrospective Cohort Study, Level III.

  20. Generation of stem cell-based bioartificial anterior cruciate ligament (ACL) grafts for effective ACL rupture repair.

    PubMed

    Kouroupis, Dimitrios; Kyrkou, Athena; Triantafyllidi, Eleni; Katsimpoulas, Michalis; Chalepakis, George; Goussia, Anna; Georgoulis, Anastasios; Murphy, Carol; Fotsis, Theodore

    2016-09-01

    In the present study, we combined stem cell technology with a non-absorbable biomaterial for the reconstruction of the ruptured ACL. Towards this purpose, multipotential stromal cells derived either from subcutaneous human adipose tissue (hAT-MSCs) or from induced pluripotent stem cells (iPSCs) generated from human foreskin fibroblasts (hiPSC-MSCs) were cultured on the biomaterial for 21days in vitro to generate a 3D bioartifical ACL graft. Stem cell differentiation towards bone and ligament at the ends and central part of the biomaterial was selectively induced using either BMP-2/FGF-2 or TGF-β/FGF-2 combinations, respectively. The bioartificial ACL graft was subsequently implanted in a swine ACL rupture model in place of the surgically removed normal ACL. Four months post-implantation, the tissue engineered ACL graft generated an ACL-like tissue exhibiting morphological and biochemical characteristics resembling those of normal ACL. Copyright © 2016 Helmholtz Zentrum München. Published by Elsevier B.V. All rights reserved.

  1. In vitro comparison of human fibroblasts from intact and ruptured ACL for use in tissue engineering.

    PubMed

    Brune, T; Borel, A; Gilbert, T W; Franceschi, J P; Badylak, S F; Sommer, P

    2007-12-17

    The present study compares fibroblasts extracted from intact and ruptured human anterior cruciate ligaments (ACL) for creation of a tissue engineered ACL-construct, made of porcine small intestinal submucosal extracellular matrix (SIS-ECM) seeded with these ACL cells. The comparison is based on histological, immunohistochemical and RT-PCR analyses. Differences were observed between cells in a ruptured ACL (rACL) and cells in an intact ACL (iACL), particularly with regard to the expression of integrin subunits and smooth muscle actin (SMA). Despite these differences in the cell source, both cell populations behaved similarly when seeded on an SIS-ECM scaffold, with similar cell morphology, connective tissue organization and composition, SMA and integrin expression. This study shows the usefulness of naturally occurring scaffolds such as SIS-ECM for the study of cell behaviour in vitro, and illustrates the possibility to use autologous cells extracted from ruptured ACL biopsies as a source for tissue engineered ACL constructs.

  2. Twenty-Year Outcome of a Longitudinal Prospective Evaluation of Isolated Endoscopic Anterior Cruciate Ligament Reconstruction With Patellar Tendon or Hamstring Autograft.

    PubMed

    Thompson, Simon Michael; Salmon, Lucy J; Waller, Alison; Linklater, James; Roe, Justin P; Pinczewski, Leo A

    2016-12-01

    Long-term prospective studies of isolated endoscopic anterior cruciate ligament (ACL) reconstruction are limited and may include confounding factors. This study aimed to compare the outcomes of isolated ACL reconstruction using the patellar tendon (PT) autograft and the hamstring (HT) autograft in 180 patients over 20 years. Cohort study; Level of evidence, 2. A total of 180 participants undergoing isolated ACL reconstruction between 1993 and 1994 were prospectively recruited. Evaluation was performed at 1, 2, 5, 7, 10, 15, and 20 years after surgery and included the International Knee Documentation Committee (IKDC) knee ligament evaluation with radiographic evaluation, KT-1000 arthrometer side-to-side difference, and subjective scores. Over 20 years, there were 16 patients (18%) and 9 patients (10%) with an ACL graft rupture in the HT and PT groups, respectively (P = .13). ACL graft rupture was associated with male sex (odds ratio [OR], 3.9; P = .007), nonideal tunnel position (OR, 3.6; P = .019), and age <18 years at the time of surgery (OR, 4.6; P = .003). The odds of a contralateral ACL rupture were increased in patients with the PT graft compared with patients with the HT graft (OR, 2.2; P = .02) and those aged <18 years at the time of surgery (OR, 3.4; P = .001). The mean IKDC scores at 20-year follow-up were 86 and 89 for the PT and HT groups, respectively (P = .18). At 20 years, 53% and 57% of the PT and HT groups participated in strenuous or very strenuous activities (P = .55), kneeling pain was present in 63% and 20% of the PT and HT groups (P = .018), and radiographic osteoarthritic change was found in 61% and 41% of the PT and HT groups (P = .008), respectively. Compared with patients who received the HT graft, patients who received the PT graft had significantly worse outcomes with regard to radiologically detectable osteoarthritis, kneeling pain, and contralateral ACL injury. At 20-year follow-up, both HT and PT autografts continued to provide good subjective outcomes and objective stability. However, further ACL injury is common, particularly in male individuals, younger patients, and those with tunnel malposition. © 2016 The Author(s).

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

    PubMed Central

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

    2015-01-01

    Background ACL reconstruction failure occurs in up to 10% of cases. Technical errors are considered the most common cause of graft failure despite the absence of validated studies. There is limited data regarding the agreement among orthopedic surgeons in terms of the etiology of primary ACL reconstruction failure and accuracy of graft tunnel placement. Purpose The purpose of this study is to test the hypothesis that experienced knee surgeons have a high level of inter-observer reliability in the agreement of the etiology of the primary ACL reconstruction failure, anatomical graft characteristics, tunnel placement. Methods Twenty cases of revision ACL reconstruction were randomly selected from the MARS database. Each case included the patient's history, standardized radiographs, and a concise 30-second arthroscopic video taken at the time of revision demonstrating the graft remnant and location of the tunnel apertures. 10 MARS surgeons not involved with the primary surgery reviewed all 20 cases. Each surgeon completed a two-part questionnaire dealing with each surgeon's training and practice as well as the placement of the femoral and tibial tunnels, condition of the primary graft, and the surgeon's opinion as to the etiology of graft failure. Inter-rater agreement was determined for each question. Inter-rater agreement was determined for each question with the kappa coefficient and prevalence adjusted bias adjusted kappa (PABAK). Results The 10 reviewers were in practice an average of 14 years. All performed at least 25 ACL reconstructions per year and 9 were fellowship-trained in sports medicine. There was wide variability in agreement among knee experts as to the specific etiology of ACL graft failure. When specifically asked about technical error as the cause for failure, inter-observer agreement was only slight (prevalence adjusted bias adjusted kappa [PABAK]: 0.26). There was fair overall agreement on ideal femoral tunnel placement (PABAK: 0.55), but only slight agreement whether a femoral tunnel was too anterior (PABAK: 0.24) and fair agreement whether it was too vertical (PABAK: 0.46). There was poor overall agreement for ideal tibial tunnel placement (PABAK: 0.17). Conclusion This study suggests that more objective criteria are needed to accurately determine the etiology of primary ACL graft failure as well as the ideal femoral and tibial tunnel placement in patients undergoing revision ACL reconstruction. PMID:25537942

  4. The effect of isolated valgus moments on ACL strain during single-leg landing: A simulation study

    PubMed Central

    Shin, Choongsoo S.; Chaudhari, Ajit M.; Andriacchi, Thomas P.

    2009-01-01

    Valgus moments on the knee joint during single-leg landing have been suggested as a risk factor for anterior cruciate ligament (ACL) injury. The purpose of this study was to test the influence of isolated valgus moment on ACL strain during single-leg landing. Physiologic levels of valgus moments from an in vivo study of single-leg landing were applied to a three-dimensional dynamic knee model, previously developed and tested for ACL strain measurement during simulated landing. The ACL strain, knee valgus angle, tibial rotation, and medial collateral ligament (MCL) strain were calculated and analyzed. The study shows that the peak ACL strain increased nonlinearly with increasing peak valgus moment. Subjects with naturally high valgus moments showed greater sensitivity for increased ACL strain with increased valgus moment, but ACL strain plateaus below reported ACL failure levels when the applied isolated valgus moment rises above the maximum values observed during normal cutting activities. In addition, the tibia was observed to rotate externally as the peak valgus moment increased due to bony and soft-tissue constraints. In conclusion, knee valgus moment increases peak ACL strain during single-leg landing. However, valgus moment alone may not be sufficient to induce an isolated ACL tear without concomitant damage to the MCL, because coupled tibial external rotation and increasing strain in the MCL prevent proportional increases in ACL strain at higher levels of valgus moment. Training that reduces the external valgus moment, however, can reduce the ACL strain and thus may help athletes reduce their overall ACL injury risk. PMID:19100550

  5. Anterior cruciate ligament (ACL) loading in a collegiate athlete during sidestep cutting after ACL reconstruction: A case study.

    PubMed

    Samaan, Michael A; Ringleb, Stacie I; Bawab, Sebastian Y; Greska, Eric K; Weinhandl, Joshua T

    2016-08-01

    Athletes with anterior cruciate ligament (ACL) injuries usually undergo ACL-reconstruction (ACLR) in order to restore joint stability, so that dynamic maneuvers such as the sidestep cut can be performed. Despite restoration of joint stability after ACLR, many athletes do not return to pre-injury levels and may be at a high risk of a second ACL injury. The purpose of this study was to determine whether or not ACL loading, would increase after ACLR. One female Division I collegiate athlete performed bilateral unanticipated sidestep cuts both before ACL injury and 27months after ACLR. Musculoskeletal simulations were used to calculate ACL loading during the deceleration phase of the sidestep cuts. Twenty-seven months after ACLR, the athlete demonstrated higher total ACL loading in the ipsilateral limb as well as altered joint kinematics, moments, and quadriceps muscle force production. In the contralateral limb, there were no increases in total ACL loading or muscle force production yet altered lower extremity joint kinematics and moments were present after ACLR. Higher total ACL loading in the ipsilateral limb of this athlete may suggest an increased risk of second ACL injury. The results of this study provide an initial step in understanding the effects of ACLR on the risk of second ACL injury in an elite athlete and suggest that it is important to develop a better understanding of this surgical intervention on knee joint loading, in order to reduce the risk of second ACL injury while performing dynamic maneuvers. Copyright © 2016 Elsevier B.V. All rights reserved.

  6. In vivo measurement of ACL length and relative strain during walking

    PubMed Central

    Taylor, K A; Cutcliffe, H C; Queen, R M; Utturkar, G M; Spritzer, C E; Garrett, W E; DeFrate, L E

    2012-01-01

    Although numerous studies have addressed the effects of ACL injury and reconstruction on knee joint motion, there is currently little data available describing in vivo ACL strain during activities of daily living. Data describing in vivo ACL strain during activities such as gait is critical to understanding the biomechanical function of the ligament, and ultimately, to improving the surgical treatment of patients with ACL rupture. Thus, our objective was to characterize the relative strain in the ACL during both the stance and swing phases of normal level walking. Eight normal subjects were recruited for this study. Through a combination of magnetic resonance imaging, biplanar fluoroscopy, and motion capture, we created in vivo models of each subject’s normal walking movements to measure knee flexion, ACL length, and relative ACL strain during gait. Regression analysis demonstrated an inverse relationship between knee flexion and ACL length (R2=0.61, p<0.001). Furthermore, relative strain in the ACL peaked at 13±2% (mean± 95%CI) during mid-stance when the knee was near full extension. Additionally, there was a second local maximum of 10±7% near the end of swing phase, just prior to heel strike. These data are a vital step in further comprehending the normal in vivo biomechanics experienced by the ACL. In the future, this information could prove critical to improving ACL reconstruction and provide useful validation to future computational models investigating ACL function. PMID:23178040

  7. Anatomic double-bundle anterior cruciate ligament reconstruction restores patellofemoral contact areas and pressures more closely than nonanatomic single-bundle reconstruction.

    PubMed

    Tajima, Goro; Iriuchishima, Takanori; Ingham, Sheila J M; Shen, Wei; van Houten, Albert H; Aerts, Maarten M; Shimamura, Tadashi; Smolinski, Patrick; Fu, Freddie H

    2010-10-01

    To investigate the effects of anterior cruciate ligament (ACL) deficiency and nonanatomic single-bundle (SB) and anatomic double-bundle (DB) ACL reconstruction on the contact characteristics of the patellofemoral (PF) joint. By use of a materials testing system, 7 fresh-frozen human cadaveric knees were tested. The following states were tested: ACL-intact knee, nonanatomic SB ACL reconstruction, anatomic DB ACL reconstruction, and ACL-deficient knee. Hamstring autografts were used. PF contact pressures and areas were measured with pressure-sensitive film at 30°, 60°, and 90° of knee flexion with a constant 100-N load on the quadriceps tendon. The total contact area of ACL-deficient and nonanatomic SB ACL-reconstructed knees (123.8 ± 63.9 and 149.6 ± 79.3 mm(2), respectively) significantly decreased when compared with those of the intact knee (206.1 ± 83.6 mm(2)) at 30° of knee flexion. The lateral-facet peak pressure of ACL-deficient and nonanatomic SB ACL-reconstructed knees (1.12 ± 0.52 and 1.22 ± 0.54 MPa, respectively) significantly decreased when compared with those of the intact knee (0.68 ± 0.38 MPa) at 90° of knee flexion. Anatomic DB ACL reconstruction restored the contact pressures and areas to values similar to those of the intact knee (no significant difference). ACL deficiency resulted in a significant decrease in the total and medial PF contact areas and in an increase in the lateral PF contact pressure. Anatomic DB ACL reconstruction more closely restored normal PF contact area and pressure than did nonanatomic SB ACL reconstruction. Our findings suggest that the changes in the PF contact area and pressures in ACL deficiency and after nonanatomic SB ACL reconstruction may be one of the causes of PF osteoarthritis or other related PF problems found at long-term follow-up. Anatomic DB ACL reconstruction may reduce the incidence of PF problems by closely restoring the contact area and pressure. Copyright © 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  8. A Simulation-Based Program to Train Medical Residents to Lead and Perform Advanced Cardiovascular Life Support

    PubMed Central

    Stefan, Mihaela S.; Belforti, Raquel K.; Langlois, Gerard; Rothberg, Michael B.

    2014-01-01

    Background Medical residents are often responsible for leading and performing cardiopulmonary resuscitation; however, their levels of expertise and comfort as leaders of advanced cardiovascular life support (ACLS) teams vary widely. While the current American Heart Association ACLS course provides education in recommended resuscitative protocols, training in leadership skills is insufficient. In this article, we describe the design and implementation in our institution of a formative curriculum aimed at improving residents’ readiness for being leaders of ACLS teams using human patient simulation. Human patient simulation refers to a variety of technologies using mannequins with realistic features, which allows learners to practice through scenarios without putting patients at risk. We discuss the limitations of the program and the challenges encountered in implementation. We also provide a description of the initiation and organization of the program. Case scenarios and assessment tools are provided. Description of the Institutional Training Program Our simulation-based training curriculum consists of 8 simulated patient scenarios during four 1-hour sessions. Postgraduate year–2 and 3 internal medicine residents participate in this program in teams of 4. Assessment tools are utilized only for formative evaluation. Debriefing is used as a teaching strategy for the individual resident leader of the ACLS team to facilitate learning and improve performance. To evaluate the impact of the curriculum, we administered a survey before and after the intervention. The survey consisted of 10 questions answered on a 5-point Likert scale, which addressed residents’ confidence in leading ACLS teams, management of the equipment, and management of cardiac rhythms. Respondents’ mean presimulation (ie, baseline) and postsimulation (outcome) scores were compared using a 2-sample t test. Residents’ overall confidence score improved from 2.8 to 3.9 (P < 0.001; mean improvement, 1.1; 95% confidence interval, 0.7–1.6). The average score for performing and leading ACLS teams improved from 2.8 to 4 (P < 0.001; mean difference, 1.2; 95% confidence interval, 0.7–1.7). There was a uniform increase in the residents’ self-confidence in their role as effective leaders of ACLS teams, and residents valued this simulation-based training program. PMID:22056824

  9. Satisfactory outcomes following combined unicompartmental knee replacement and anterior cruciate ligament reconstruction.

    PubMed

    Volpin, Andrea; Kini, S G; Meuffels, D E

    2017-03-31

    There exist limited options for treatment of patients with combined medial compartment arthritis and anterior cruciate ligament (ACL) deficiency. Ideal treatment is one that offers lasting relief of symptoms not compromising any future surgery. Unicompartmental knee replacement has shown consistently good results in the relatively young and active population, but there is a high reported incidence of failure up to 20%, if performed in ACL-deficient knees. One of the recognized treatment modality is combined ACL reconstruction and unicompartmental arthroplasty. A systematic review was conducted looking at the demographics, techniques, complications and outcome of combined ACL reconstruction with unicompartmental knee arthroplasty. A systematic literature search within the online Medline, PubMed Database, EMBASE, Web of Science, Cochrane and Google Scholar was carried out until October 2016 to identify relevant articles. A study was defined eligible if it met the following inclusion criteria: the surgical procedure combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction; patient's clinical and/or functional outcomes were reported; any complications intra-operatively and post-operatively were reported; and the full-text articles, written in English, German, Italian, Dutch or Spanish, were available. Quality and risk of bias assessments were done using standardized criteria set. A total of 8 studies met the inclusion criteria encompassing 186 patients who were treated with simultaneous ACL reconstruction and unicompartmental knee arthroplasty. The mean age was 50.5 years (range from 44 to 56) with a mean follow-up of 37.6 months (range from 24 to 60). There was an improvement in mean Oxford Score from 27.5 to 36.8. Complications reported included tibial inlay dislocation (n = 3), conversion to a total knee arthroplasty (n = 1), infection requiring two-stage revision (n = 2), deep-vein thrombosis (n = 1), stiffness requiring manipulation under anaesthesia (n = 1), retropatellar pain requiring arthroscopic adhesiolysis (n = 1). Unicompartmental knee arthroplasty combined with ACL reconstruction can be a valid treatment option for selected patients, with combined medial unicompartmental knee osteoarthritis and ACL deficiency. Systematic Review of Level IV Studies, Level IV.

  10. Anterior Cruciate Ligament Injuries in National Football League Athletes From 2010 to 2013

    PubMed Central

    Dodson, Christopher C.; Secrist, Eric S.; Bhat, Suneel B.; Woods, Daniel P.; Deluca, Peter F.

    2016-01-01

    Background: There is a high incidence of anterior cruciate ligament (ACL) injuries among National Football League (NFL) athletes; however, the incidence of reinjury in this population is unknown. Purpose: This retrospective epidemiological study analyzed all publicly disclosed ACL tears occurring in NFL players between 2010 and 2013 to characterize injury trends and determine the incidence of reinjury. Study Design: Descriptive epidemiological study. Methods: A comprehensive online search identified any NFL player who had suffered an ACL injury from 2010 to 2013. Position, playing surface, activity, and date were recorded. Each player was researched for any history of previous ACL injury. The NFL games database from USA Today was used to determine the incidence of ACL injuries on artificial turf and grass fields. Databases from Pro Football Focus and Pro Football Reference were used to determine the injury rate for each position. Results: NFL players suffered 219 ACL injuries between 2010 and 2013. Forty players (18.3%) had a history of previous ACL injury, with 27 (12.3%) retears and 16 (7.3%) tears contralateral to a previous ACL injury. Five players (2.28%) suffered their third ACL tear. Receivers (wide receivers and tight ends) and backs (linebackers, fullbacks, and halfbacks) had significantly greater injury risk than the rest of the NFL players, while perimeter linemen (defensive ends and offensive tackles) had significantly lower injury risk than the rest of the players. Interior linemen (offensive guards, centers, and defensive tackles) had significantly greater injury risk compared with perimeter linemen. ACL injury rates per team games played were 0.050 for grass and 0.053 for turf fields (P > .05). Conclusion: In this retrospective epidemiological study of ACL tears in NFL players, retears and ACL tears contralateral to a previously torn ACL constituted a substantial portion (18.3%) of total ACL injuries. The significant majority of ACL injuries in players with a history of previous ACL injury were retears. Skilled offensive players and linebackers had the greatest injury risk, and significantly more ACL tears occurred among interior linemen than perimeter linemen. The month of August had the highest incidence of ACL injuries, probably because of expanded roster sizes at that point in the NFL season. PMID:26998501

  11. Unicondylar arthroplasty in knees with deficient anterior cruciate ligaments.

    PubMed

    Engh, Gerard A; Ammeen, Deborah J

    2014-01-01

    Historically, a functional ACL has been a prerequisite for patients undergoing unicondylar knee arthroplasty (UKA). However, this premise has not been rigorously tested. We compared (1) the survivorship free from revision and (2) the failure mechanisms of UKAs in ACL-deficient knees and UKAs in ACL-intact knees performed over the same time interval. Between November 2000 and July 2008, a fixed bearing UKA was performed in 72 patients (81 knees) with intraoperatively confirmed ACL deficiency. Five patients (five knees) with preoperative instability underwent ACL reconstruction and were excluded from analysis. Of the remaining 67 patients (76 knees) without preoperative instability, implant status was known for 68 UKAs in 60 patients. Survivorship and failure mechanisms for these knees were compared to those of 706 UKAs in ACL-intact knees performed during the same time interval by the same surgeon using the same implant system. Minimum followup for the ACL-deficient group was 2.9 years (mean, 6 years; range, 2.9-10 years). Revision rates between UKAs with and without intact ACLs were similar in the absence of clinical instability (p = 0.58). Six-year UKA survivorship was 94% (95% CI: 88%-100%) in ACL-deficient knees and 93% (95% CI: 91%-96%) in ACL-intact knees (p = 0.89). Five knees (7%) in the ACL-deficient group were revised: disease progression (two), loose tibia (one), persistent pain (one), and revised elsewhere/reason unknown (one). Thirty-six knees in the ACL-intact group underwent revision (5%): aseptic loosening (13), revised elsewhere/reason unknown (11), disease progression (three), tibial subsidence/fracture (four), infection (three), pain (one), and lateral compartment overload (one). At 6 years, deficiency of the ACL in patients without clinical knee instability did not impact the survivorship of UKAs compared to UKAs performed in knees with intact ACLs.

  12. Impact of High-Fidelity Simulation and Pharmacist-Specific Didactic Lectures in Addition to ACLS Provider Certification on Pharmacy Resident ACLS Performance.

    PubMed

    Bartel, Billie J

    2014-08-01

    This pilot study explored the use of multidisciplinary high-fidelity simulation and additional pharmacist-focused training methods in training postgraduate year 1 (PGY1) pharmacy residents to provide Advanced Cardiovascular Life Support (ACLS) care. Pharmacy resident confidence and comfort level were assessed after completing these training requirements. The ACLS training requirements for pharmacy residents were revised to include didactic instruction on ACLS pharmacology and rhythm recognition and participation in multidisciplinary high-fidelity simulation ACLS experiences in addition to ACLS provider certification. Surveys were administered to participating residents to assess the impact of this additional education on resident confidence and comfort level in cardiopulmonary arrest situations. The new ACLS didactic and simulation training requirements resulted in increased resident confidence and comfort level in all assessed functions. Residents felt more confident in all areas except providing recommendations for dosing and administration of medications and rhythm recognition after completing the simulation scenarios than with ACLS certification training and the didactic components alone. All residents felt the addition of lectures and simulation experiences better prepared them to function as a pharmacist in the ACLS team. Additional ACLS training requirements for pharmacy residents increased overall awareness of pharmacist roles and responsibilities and greatly improved resident confidence and comfort level in performing most essential pharmacist functions during ACLS situations. © The Author(s) 2013.

  13. 50 CFR 648.323 - Accountability measures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Administrative Procedure Act. (b) ACL overages-(1) If the ACL is determined to have been exceeded in any given... between ACL and ACT, initially specified at 25 percent, shall be increased by 1 percent for each 1-percent ACL overage in the second fishing year following the fishing year in which the ACL overage occurred...

  14. 50 CFR 648.96 - FMP review, specification, and framework adjustment process.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... and ACLs. (1) The Councils or the PDT may develop options for setting ABC, ACL, and OFL for each.... The Councils or the PDT may recommend to the SSC that ABC, ACL, and OFL are specified for each.... (ii) ACL recommendations. The Councils shall establish ACLs for each management area that are...

  15. 50 CFR 648.323 - Accountability measures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Administrative Procedure Act. (b) ACL overages-(1) If the ACL is determined to have been exceeded in any given... between ACL and ACT, initially specified at 25 percent, shall be increased by 1 percent for each 1-percent ACL overage in the second fishing year following the fishing year in which the ACL overage occurred...

  16. 50 CFR 648.96 - FMP review, specification, and framework adjustment process.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... and ACLs. (1) The Councils or the PDT may develop options for setting ABC, ACL, and OFL for each.... The Councils or the PDT may recommend to the SSC that ABC, ACL, and OFL are specified for each.... (ii) ACL recommendations. The Councils shall establish ACLs for each management area that are...

  17. 50 CFR 648.323 - Accountability measures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Administrative Procedure Act. (b) ACL overages-(1) If the ACL is determined to have been exceeded in any given... between ACL and ACT, initially specified at 25 percent, shall be increased by 1 percent for each 1-percent ACL overage in the second fishing year following the fishing year in which the ACL overage occurred...

  18. 50 CFR 648.96 - FMP review, specification, and framework adjustment process.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... and ACLs. (1) The Councils or the PDT may develop options for setting ABC, ACL, and OFL for each.... The Councils or the PDT may recommend to the SSC that ABC, ACL, and OFL are specified for each.... (ii) ACL recommendations. The Councils shall establish ACLs for each management area that are...

  19. 50 CFR 648.323 - Accountability measures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Administrative Procedure Act. (b) ACL overages-(1) If the ACL is determined to have been exceeded in any given... between ACL and ACT, initially specified at 25 percent, shall be increased by 1 percent for each 1-percent ACL overage in the second fishing year following the fishing year in which the ACL overage occurred...

  20. 50 CFR 648.323 - Accountability measures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Administrative Procedure Act. (b) ACL overages-(1) If the ACL is determined to have been exceeded in any given... between ACL and ACT, initially specified at 25 percent, shall be increased by 1 percent for each 1-percent ACL overage in the second fishing year following the fishing year in which the ACL overage occurred...

  1. 78 FR 27367 - New England Fishery Management Council; Public Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-10

    ... Development Team (PDT) meeting; (4) provide a presentation outlining DAS/trip limit options developed by the... (ACT--applying management uncertainty to ACL), the range of DAS/trip limit alternatives (specifications), changes to the permit category H fishery boundary and any other options for DAS changes; (6) discuss...

  2. Younger patients are at increased risk for graft rupture and contralateral injury after anterior cruciate ligament reconstruction.

    PubMed

    Webster, Kate E; Feller, Julian A; Leigh, Warren B; Richmond, Anneka K

    2014-03-01

    Graft rupture of the same knee or injury to the anterior cruciate ligament (ACL) in the contralateral knee is a devastating outcome after ACL reconstruction surgery. While a number of factors have been identified as potentially increasing the risk of subsequent ACL injury, the literature is far from definitive. To determine the rates of graft rupture and contralateral ACL injury in a large cohort and to investigate patient characteristics that may be associated with these. Case-control study; Level of evidence, 3. A consecutive cohort of 750 patients who had undergone primary ACL reconstruction surgery with a minimum 3-year follow-up were questioned about the incidence of ACL graft rupture, contralateral ACL injury, family history of ACL injury, and current activity level. Patient databases provided details for age, sex, original injury mechanism, meniscus or articular surface injury, and graft diameter. Responses were received from 561 patients (75%) at a mean ± SD follow-up time of 4.8 ± 1.1 years. Anterior cruciate ligament graft ruptures occurred in 25 patients (4.5%), and contralateral ACL injuries occurred in 42 patients (7.5%). The highest incidence of further ACL injury occurred in patients younger than 20 years at the time of surgery. In this group, 29% sustained a subsequent ACL injury to either knee. The odds for sustaining an ACL graft rupture or contralateral injury increased 6- and 3-fold, respectively, for patients younger than 20 years. Returning to cutting/pivoting sports increased the odds of graft rupture by a factor of 3.9 and contralateral rupture by a factor of 5. A positive family history doubled the odds for both graft rupture and contralateral ACL injury. Patients younger than 20 years who undergo ACL reconstruction are at significantly increased risk for both graft rupture and contralateral ACL injury. Whether age per se is a risk factor or age represents a proxy for other factors remains to be determined.

  3. 77 FR 56791 - Main Hawaiian Islands Deep 7 Bottomfish Annual Catch Limits and Accountability Measures for 2012-13

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-14

    ... of the State's bottomfish restricted areas. The analyses in the most recent (2010) MHI Deep 7.... 120628195-2414-02] RIN 0648-XC089 Main Hawaiian Islands Deep 7 Bottomfish Annual Catch Limits and... specifies a quota of 325,000 lb of Deep 7 bottomfish in the main Hawaiian Islands for the 2012-13 fishing...

  4. In Vivo Evaluation of Electrospun Polycaprolactone Graft for Anterior Cruciate Ligament Engineering

    PubMed Central

    Arom, Gabriel A.; Nazemi, Azadeh N.; Yeranosian, Michael G.; Wu, Benjamin M.; McAllister, David R.

    2015-01-01

    The anterior cruciate ligament (ACL) is critical for the structural stability of the knee and its injury often requires surgical intervention. Because current reconstruction methods using autograft or allograft tissue suffer from donor-site morbidity and limited supply, there has been emerging interest in the use of bioengineered materials as a platform for ligament reconstruction. Here, we report the use of electrospun polycaprolactone (PCL) scaffolds as a candidate platform for ACL reconstruction in an in vivo rodent model. Electrospun PCL was fabricated and laser cut to facilitate induction of cells and collagen deposition and used to reconstruct the rat ACL. Histological analysis at 2, 6, and 12 weeks postimplantation revealed biological integration, minimal immune response, and the gradual infiltration of collagen in both the bone tunnel and intra-articular regions of the scaffold. Biomechanical testing demonstrated that the PCL graft failure load and stiffness at 12 weeks postimplantation (13.27±4.20N, 15.98±5.03 N/mm) increased compared to time zero testing (3.95±0.33N, 1.95±0.35 N/mm). Taken together, these results suggest that electrospun PCL serves as a biocompatible graft for ACL reconstruction with the capacity to facilitate collagen deposition. PMID:25412879

  5. In vivo evaluation of electrospun polycaprolactone graft for anterior cruciate ligament engineering.

    PubMed

    Petrigliano, Frank A; Arom, Gabriel A; Nazemi, Azadeh N; Yeranosian, Michael G; Wu, Benjamin M; McAllister, David R

    2015-04-01

    The anterior cruciate ligament (ACL) is critical for the structural stability of the knee and its injury often requires surgical intervention. Because current reconstruction methods using autograft or allograft tissue suffer from donor-site morbidity and limited supply, there has been emerging interest in the use of bioengineered materials as a platform for ligament reconstruction. Here, we report the use of electrospun polycaprolactone (PCL) scaffolds as a candidate platform for ACL reconstruction in an in vivo rodent model. Electrospun PCL was fabricated and laser cut to facilitate induction of cells and collagen deposition and used to reconstruct the rat ACL. Histological analysis at 2, 6, and 12 weeks postimplantation revealed biological integration, minimal immune response, and the gradual infiltration of collagen in both the bone tunnel and intra-articular regions of the scaffold. Biomechanical testing demonstrated that the PCL graft failure load and stiffness at 12 weeks postimplantation (13.27±4.20N, 15.98±5.03 N/mm) increased compared to time zero testing (3.95±0.33N, 1.95±0.35 N/mm). Taken together, these results suggest that electrospun PCL serves as a biocompatible graft for ACL reconstruction with the capacity to facilitate collagen deposition.

  6. 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.

  7. Tendon Healing in Bone Tunnel after Human Anterior Cruciate Ligament Reconstruction: A Systematic Review of Histological Results.

    PubMed

    Lu, Hongbin; Chen, Can; Xie, Shanshan; Tang, Yifu; Qu, Jin

    2018-05-21

    Most studies concerning to tendon healing and incorporation into bone are mainly based on animal studies due to the invasive nature of the biopsy procedure. The evidence considering tendon graft healing to bone in humans is limited in several case series or case reports, and therefore, it is difficult to understand the healing process. A computerized search using relevant search terms was performed in the PubMed, EMBASE, Scopus, and Cochrane Library databases, as well as a manual search of reference lists. Searches were limited to studies that investigated tendon graft healing to bone by histologic examination after anterior cruciate ligament (ACL) reconstruction with hamstring. Ten studies were determined to be eligible for this systematic review. Thirty-seven cases were extracted from the included studies. Most studies showed that a fibrovascular interface would form at the tendon-bone interface at the early stage and a fibrous indirect interface with Sharpey-like fibers would be expected at the later stage. Cartilage-like tissue at tendon graft-bone interface was reported in three studies. Tendon graft failed to integrate with the surrounding bone in 10 of the 37 cases. Unexpectedly, suspensory type of fixation was used for the above failure cases. An indirect type of insertion with Sharpey-like fibers at tendon-bone interface could be expected after ACL reconstruction with hamstring. Regional cartilage-like tissue may form at tendon-bone interface occasionally. The underlying tendon-to-bone healing process is far from understood in the human hamstring ACL reconstruction. Further human studies are highly needed to understand tendon graft healing in bone tunnel after hamstring ACL reconstruction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  8. Constitutive modeling of the human Anterior Cruciate Ligament (ACL) under uniaxial loading using viscoelastic prony series and hyperelastic five parameter Mooney-Rivlin model

    NASA Astrophysics Data System (ADS)

    Chakraborty, Souvik; Mondal, Debabrata; Motalab, Mohammad

    2016-07-01

    In this present study, the stress-strain behavior of the Human Anterior Cruciate Ligament (ACL) is studied under uniaxial loads applied with various strain rates. Tensile testing of the human ACL samples requires state of the art test facilities. Furthermore, difficulty in finding human ligament for testing purpose results in very limited archival data. Nominal Stress vs. deformation gradient plots for different strain rates, as found in literature, is used to model the material behavior either as a hyperelastic or as a viscoelastic material. The well-known five parameter Mooney-Rivlin constitutivemodel for hyperelastic material and the Prony Series model for viscoelastic material are used and the objective of the analyses comprises of determining the model constants and their variation-trend with strain rates for the Human Anterior Cruciate Ligament (ACL) material using the non-linear curve fitting tool. The relationship between the model constants and strain rate, using the Hyperelastic Mooney-Rivlin model, has been obtained. The variation of the values of each coefficient with strain rates, obtained using Hyperelastic Mooney-Rivlin model are then plotted and variation of the values with strain rates are obtained for all the model constants. These plots are again fitted using the software package MATLAB and a power law relationship between the model constants and strain rates is obtained for each constant. The obtained material model for Human Anterior Cruciate Ligament (ACL) material can be implemented in any commercial finite element software package for stress analysis.

  9. Abnormal tibiofemoral contact stress and its association with altered kinematics following center-center ACL reconstruction: an in vitro study

    PubMed Central

    Imhauser, Carl; Mauro, Craig; Choi, Daniel; Rosenberg, Eric; Mathew, Stephen; Nguyen, Joseph; Ma, Yan; Wickiewicz, Thomas

    2014-01-01

    Background Abnormal tibiofemoral contact stress and aberrant kinematics may influence the progression of osteoarthritis in the ACL-deficient and the ACL-reconstructed knee. However, relationships between contact stress and kinematics following ACL reconstruction are poorly understood. Therefore, we posed the following research questions: (1) How do ACL deficiency and reconstruction affect kinematics of and contact stress in the tibiofemoral joint? (2) What kinematic differences are associated with abnormal contact stress following ACL reconstruction? Hypothesis/Purpose Center-center ACL reconstruction will not restore knee kinematics and contact stress. Correlations will exist between abnormal contact stress and aberrant kinematics following ACL reconstruction will exist. Study Design Controlled laboratory study Methods Clinical tests of anterior and rotational stability were simulated on eleven cadaveric knees using an industrial robot. Tests were conducted with the ACL intact, sectioned, and after single bundle ACL reconstruction using a quadrupled hamstring autograft with tunnels drilled through the center of the native footprints. Kinematics were recorded during the tests. Contact stress was continuously recorded from a stress transducer fixed to the tibial plateau and mean contact stress was calculated regionally. Results ACL deficiency resulted in increased mean contact stress in the posterior sectors of the medial and lateral compartments under anterior and rotational loads, respectively. Reconstruction reduced stress in these locations; however contact stress abnormalities remained. On average, kinematics were overconstrained following ACL reconstruction (≤1.8mm and ≤2.6° in all directions). However, combinations of overconstrained and underconstrained motions in ab/adduction and medial-lateral translation in response to combined moments, and axial rotation, anterior-posterior and medial-lateral translation in response to an anterior load were associated with abnormal mean contact stress. Conclusions ACL reconstruction reduces high stresses generated in the posterior compartment of the ACL-deficient knee. Abnormal contact stress following ACL reconstruction is related to multiplanar variations in knee kinematics. Clinical Relevance Clinical measures of multiplanar kinematics may help to better characterize the quality of ACL reconstruction. Such measures may help identify those at increased risk of long-term joint degeneration following this surgery. PMID:23470858

  10. 50 CFR 648.233 - Spiny dogfish Accountability Measures (AMs).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... vessels issued a spiny dogfish permit under this part. (b) ACL overage evaluation. The ACL will be... determine if the ACL has been exceeded. (c) Overage repayment. In the event that the ACL has been exceeded in a given fishing year, the exact amount in pounds by which the ACL was exceeded shall be deducted...

  11. 50 CFR 648.233 - Spiny dogfish Accountability Measures (AMs).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... vessels issued a spiny dogfish permit under this part. (b) ACL overage evaluation. The ACL will be... determine if the ACL has been exceeded. (c) Overage repayment. In the event that the ACL has been exceeded in a given fishing year, the exact amount in pounds by which the ACL was exceeded shall be deducted...

  12. 50 CFR 648.233 - Spiny dogfish Accountability Measures (AMs).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... vessels issued a spiny dogfish permit under this part. (b) ACL overage evaluation. The ACL will be... determine if the ACL has been exceeded. (c) Overage repayment. In the event that the ACL has been exceeded in a given fishing year, the exact amount in pounds by which the ACL was exceeded shall be deducted...

  13. Technical evaluation of the novel preanalytical module on instrumentation laboratory ACL TOP: advancing automation in hemostasis testing.

    PubMed

    Lippi, Giuseppe; Ippolito, Luigi; Favaloro, Emmanuel J

    2013-10-01

    Automation in hemostasis testing is entering an exciting and unprecedented phase. This study was planned to assess the performance of the new preanalytical module on the hemostasis testing system Instrumentation Laboratory ACL TOP. The evaluation included interference studies to define reliable thresholds for rejecting samples with significant concentrations of interfering substances; within-run imprecision studies of plasma indices on four different interference degrees for each index; comparison studies with reference measures of hemolysis index, bilirubin, and triglycerides on clinical chemistry analyzers; and calculation of turnaround time with and without automatic performance of preanalytical check. The upper limits for sample rejection according to our interference studies were 3.6 g/L for hemoglobin, 13.6 mg/dL for bilirubin, and 1454 mg/dL for triglycerides. We found optimal precision for all indices (0.6% to 3.1% at clinically relevant thresholds) and highly significant correlations with reference measures on clinical chemistry analyzers (from 0.985 to 0.998). The limited increase of turnaround time (i.e., +3% and +5% with or without cap-piercing), coupled with no adjunctive costs over performance of normal coagulation assays, contribute to make the automatic check of plasma indices on ACL TOP a reliable and practical approach for improving testing quality and safeguarding patient safety.

  14. Anterior cruciate ligament regeneration using braided biodegradable scaffolds: in vitro optimization studies.

    PubMed

    Lu, Helen H; Cooper, James A; Manuel, Sharron; Freeman, Joseph W; Attawia, Mohammed A; Ko, Frank K; Laurencin, Cato T

    2005-08-01

    The anterior cruciate ligament (ACL) is the most commonly injured intra-articular ligament of the knee, and limitations in existing reconstruction grafts have prompted an interest in tissue engineered solutions. Previously, we reported on a tissue-engineered ACL scaffold fabricated using a novel, three-dimensional braiding technology. A critical factor in determining cellular response to such a graft is material selection. The objective of this in vitro study was to optimize the braided scaffold, focusing on material composition and the identification of an appropriate polymer. The selection criteria are based on cellular response, construct degradation, and the associated mechanical properties. Three compositions of poly-alpha-hydroxyester fibers, namely polyglycolic acid (PGA), poly-L-lactic acid (PLLA), and polylactic-co-glycolic acid 82:18 (PLAGA) were examined. The effects of polymer composition on scaffold mechanical properties and degradation were evaluated in physiologically relevant solutions. Prior to culturing with primary rabbit ACL cells, scaffolds were pre-coated with fibronectin (Fn, PGA-Fn, PLAGA-Fn, PLLA-Fn), an important protein which is upregulated during ligament healing. Cell attachment and growth were examined as a function of time and polymer composition. While PGA scaffolds measured the highest tensile strength followed by PLLA and PLAGA, its rapid degradation in vitro resulted in matrix disruption and cell death over time. PLLA-based scaffolds maintained their structural integrity and exhibited superior mechanical properties over time. The response of ACL cells was found to be dependent on polymer composition, with the highest cell number measured on PLLA-Fn scaffolds. Surface modification of polymer scaffolds with Fn improved cell attachment efficiency and effected the long-term matrix production by ACL cells on PLLA and PLAGA scaffolds. Therefore based on the overall cellular response and its temporal mechanical and degradation properties in vitro, the PLLA braided scaffold pre-coated with Fn was found to be the most suitable substrate for ACL tissue engineering.

  15. 50 CFR 648.22 - Closure of the fishery.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... specified for a period of up to 3 years; (2) ACL; ACT including RSA, DAH, DAP; bycatch level of the TALFF... review, may be specified for a period of up to 3 years; (3) ACL; commercial ACT, including RSA, DAH, DAP... less than or equal to the OFL. (ii) ACL. The ACL or Domestic ABC is calculated using the formula ACL...

  16. Histological analysis of the tibial anterior cruciate ligament insertion.

    PubMed

    Oka, Shinya; Schuhmacher, Peter; Brehmer, Axel; Traut, Ulrike; Kirsch, Joachim; Siebold, Rainer

    2016-03-01

    This study was performed to investigate the morphology of the tibial anterior cruciate ligament (ACL) by histological assessment. The native (undissected) tibial ACL insertion of six fresh-frozen cadaveric knees was cut into four sagittal sections parallel to the long axis of the medial tibial spine. For histological evaluation, the slices were stained with haematoxylin and eosin, Safranin O and Russell-Movat pentachrome. All slices were digitalized and analysed at a magnification of 20×. The anterior tibial ACL insertion was bordered by a bony anterior ridge. The most medial ACL fibres inserted from the medial tibial spine and were adjacent to the articular cartilage of the medial tibial plateau. Parts of the bony insertions of the anterior and posterior horns of the lateral meniscus were in close contact with the lateral part of the tibial ACL insertion. A small fat pad was located just posterior to the functional ACL fibres. The anterior-posterior length of the medial ACL insertion was an average of 10.8 ± 1.1 mm compared with the lateral, which was only 6.2 ± 1.1 mm (p < 0.001). There were no central or posterolateral inserting ACL fibres. The shape of the bony tibial ACL insertion was 'duck-foot-like'. In contrast to previous findings, the functional mid-substance fibres arose from the most posterior part of the 'duck-foot' in a flat and 'c-shaped' way. The most anterior part of the tibial ACL insertion was bordered by a bony anterior ridge and the most medial by the medial tibial spine. No posterolateral fibres nor ACL bundles have been found histologically. This histological investigation may improve our understanding of the tibial ACL insertion and may provide important information for anatomical ACL reconstruction.

  17. The Influence of Knee Flexion Angle for Graft Fixation on Rotational Knee Stability During Anterior Cruciate Ligament Reconstruction: A Biomechanical Study.

    PubMed

    Debandi, Aníbal; Maeyama, Akira; Hoshino, Yuichi; Asai, Shigehiro; Goto, Bunsei; Smolinski, Patrick; Fu, Freddie H

    2016-11-01

    To evaluate the effect of knee flexion angle for hamstring graft fixation, full extension (FE), or 30°, on acceleration of the knee motion during pivot-shift testing after either anatomic or nonanatomic anterior cruciate ligament (ACL) reconstruction using triaxial accelerometry. Two types of ACL reconstructions (anatomic and nonanatomic) using 2 different angles of knee flexion during graft fixation (FE and 30°) were performed on 12 fresh-frozen human knees making 4 groups: anatomic-FE, anatomic-30°, nonanatomic-FE, and nonanatomic-30°. Manual pivot-shift testing was performed at ACL-intact, ACL-deficient, and ACL-reconstructed conditions. Three-dimensional acceleration of knee motion was recorded using a triaxial accelerometer. The anatomic-30° group showed the smallest overall magnitude of acceleration among the ACL-reconstructed groups (P = .0039). There were no significant differences among the anatomic-FE group, the nonanatomic-FE group, and the nonantomic-30° group (anatomic-FE vs nonanatomic-FE, P = .1093; anatomic-FE vs nonanatomic-30°, P = .8728; and nonanatomic-FE vs nonanatomic-30°, P = .1093). After ACL transection, acceleration was reduced by ACL reconstruction with the exception of the nonanatomic-FE group that did not show a significant difference when compared with the ACL-deficient (P = .4537). The anatomic ACL reconstruction with the graft fixed at 30° of knee flexion better restored rotational knee stability compared with FE. An ACL graft fixed with the knee at FE in anatomic position did not show a significant difference compared with the nonanatomic ACL reconstructions. Knee flexion angle at the time of graft fixation for ACL reconstruction can be considered to maximize the rotational knee stability. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  18. Analysis of change in gait in the ovine stifle: normal, injured, and anterior cruciate ligament reconstructed.

    PubMed

    Heard, B J; Beveridge, J E; Atarod, M; O'Brien, E J; Rolian, C; Frank, C B; Hart, D A; Shrive, N G

    2017-05-23

    Many patients who undergo anterior cruciate ligament (ACL) reconstructive surgery develop post-traumatic osteoarthritis (PTOA). ACL reconstructive surgery may not fully restore pre-injury joint biomechanics, thereby resulting in further joint damage and contributing to the development of PTOA. In an ovine model of idealized ACL reconstruction (ACL-R), it has been shown that signs of PTOA develop within surgical joints by 20 weeks post-surgery. The aim of the present study was to investigate whether altered kinematics contribute to early PTOA development within ACL-R joints of the ovine injury model by comparing the gait of these surgical animals to the gait of a stable normal control group, and an unstable injury group in which the ACL and medial collateral ligament (MCL) had been transected. Fifteen skeletally mature female sheep were allocated evenly into 3 treatment groups: normal control, ACL-R, and ACL/MCL Tx (each group n = 5). Each animal's gait was recorded at baseline, 4 weeks post injury, and 20 weeks post injury. Principal component analysis (PCA) was used to identify the kinematic patterns that may be discriminant between treatment groups. Results from previous studies were referenced to present the amount of gross PTOA-like changes that occurred in the joints. ACL-R and ACL/MCL transected (Tx) animals developed a similar amount of early PTOA-like changes within the surgical joints, but differed significantly in the amount of kinematic change present at 20 weeks post-surgery. We showed that the stifle joint kinematics of ACL/MCL Tx differed significantly from those of CTRL and the majority of ACL-R animals, while no significant differences in joint kinematic changes were found between ACL-R and CTRL animals. These results suggest that the early PTOA-like changes reported in the ACL-R model cannot be attributed exclusively to post-surgical kinematic changes, and therefore biologic components in the post-injury environment must be contributing significantly to PTOA development.

  19. Abnormal tibiofemoral contact stress and its association with altered kinematics after center-center anterior cruciate ligament reconstruction: an in vitro study.

    PubMed

    Imhauser, Carl; Mauro, Craig; Choi, Daniel; Rosenberg, Eric; Mathew, Stephen; Nguyen, Joseph; Ma, Yan; Wickiewicz, Thomas

    2013-04-01

    Abnormal tibiofemoral contact stress and aberrant kinematics may influence the progression of osteoarthritis in the anterior cruciate ligament (ACL)-deficient and the ACL-reconstructed knee. However, relationships between contact stress and kinematics after ACL reconstruction are poorly understood. Therefore, we posed the following research questions: (1) How do ACL deficiency and reconstruction affect the kinematics of and contact stress in the tibiofemoral joint? (2) What kinematic differences are associated with abnormal contact stress after ACL reconstruction? Center-center ACL reconstruction will not restore knee kinematics and contact stress. Correlations will exist between abnormal contact stress and aberrant kinematics after ACL reconstruction. Controlled laboratory study. Clinical tests of anterior and rotational stability were simulated on 11 cadaveric knees using an industrial robot. Tests were conducted with the ACL intact, sectioned, and after single-bundle ACL reconstruction using a quadrupled hamstring autograft with tunnels drilled through the center of the native footprints. Kinematics were recorded during the tests. Contact stress was continuously recorded from a stress transducer fixed to the tibial plateau, and mean contact stress was calculated regionally. ACL deficiency resulted in increased mean contact stress in the posterior sectors of the medial and lateral compartments under anterior and rotational loads, respectively. Reconstruction reduced stress in these locations; however, contact stress abnormalities remained. On average, kinematics were overconstrained after ACL reconstruction (≤1.8 mm and ≤2.6° in all directions). However, combinations of overconstrained and underconstrained motions in abduction/adduction and medial-lateral translation in response to combined moments, and anterior-posterior translation, medial-lateral translation, and axial rotation in response to an anterior load were associated with abnormal mean contact stress. ACL reconstruction reduces high stresses generated in the posterior compartment of the ACL-deficient knee. Abnormal contact stress after ACL reconstruction is related to multiplanar variations in knee kinematics. Clinical measures of multiplanar kinematics may help to better characterize the quality of ACL reconstruction. Such measures may help identify patients at increased risk of long-term joint degeneration following this surgery.

  20. Effect of Changing the Joint Kinematics of Knees With a Ruptured Anterior Cruciate Ligament on the Molecular Biological Responses and Spontaneous Healing in a Rat Model.

    PubMed

    Kokubun, Takanori; Kanemura, Naohiko; Murata, Kenji; Moriyama, Hideki; Morita, Sadao; Jinno, Tetsuya; Ihara, Hidetoshi; Takayanagi, Kiyomi

    2016-11-01

    The poor healing capacity of a completely ruptured anterior cruciate ligament (ACL) has been attributed to an insufficient vascular supply, cellular metabolism, and deficient premature scaffold formation because of the unique intra-articular environment. However, previous studies have focused on intra-articular factors without considering extra-articular factors, including the biomechanical aspects of ACL-deficient knees. Changing the joint kinematics of an ACL-ruptured knee will improve cellular biological responses and lead to spontaneous healing through the mechanotransduction mechanism. Controlled laboratory study. A total of 66 skeletally mature Wistar rats were randomly assigned to a sham-operated group (SO), ACL-transection group (ACL-T), controlled abnormal movement group (CAM), and an intact group (IN). The ACL was completely transected at the midportion in the ACL-T and CAM groups, and the CAM group underwent extra-articular braking to control for abnormal tibial translation. The SO group underwent skin and joint capsule incisions and tibial drilling, without ACL transection and extra-articular braking. The animals were allowed full cage activity until sacrifice at 1, 2, 4, 6, and 8 weeks postoperatively for histological, molecular biological, and biomechanical assessment. All injured ACLs in the ACL-T group were not healed, but those in the CAM group healed spontaneously, showing a typical ligament healing response. Regarding the molecular biological response, there was an upregulation of anabolic factors (ie, transforming growth factor-β) and downregulation of catabolic factors (ie, matrix metalloproteinase). Examination of the mechanical properties at 8 weeks after injury showed that >50% of the strength of the intact ACL had returned. Our results suggest that changing the joint kinematics of knees with a ruptured ACL alters the molecular biological responses and leads to spontaneous healing. These data support our hypothesis that the mechanotransduction mechanism mediates molecular responses and determines whether the ACL will heal. Elucidating the relationship between the mechanotransduction mechanism and healing responses in knees with completely ruptured ACLs may result in the development of novel nonsurgical treatment that enables the ACL to spontaneously heal in patients who are not suitable for reconstruction. © 2016 The Author(s).

  1. High-grade rotatory knee laxity may be predictable in ACL injuries.

    PubMed

    Musahl, Volker; Burnham, Jeremy; Lian, Jayson; Popchak, Adam; Svantesson, Eleonor; Kuroda, Ryosuke; Zaffagnini, Stefano; Samuelsson, Kristian

    2018-06-21

    Lateral compartment acceleration and translation have been used to quantify rotatory knee laxity in the setting of anterior cruciate ligament (ACL) injury; however, their relationship remains elusive. The purpose of this study was to examine the correlation between lateral compartment acceleration and translation during pivot shift testing. It was hypothesized that a correlation would exist in ACL-injured and uninjured knees, irrespective of sex, but would be greatest in knees with combined ACL and lateral meniscus tear. Seventy-seven patients (34 females, 25.2 ± 9.0 years) undergoing primary single-bundle ACL reconstruction were prospectively enrolled in a 2-year study across four international centers. Patients underwent preoperative examination under anesthesia of the injured and uninjured knee using Image Analysis software and surface mounted accelerometer. A moderate correlation between lateral compartment acceleration and translation was observed in ACL-injured knees [ρ = 0.36, p < 0.05), but not in uninjured knees (ρ = 0.17, not significant (n.s.)]. A moderate correlation between acceleration and translation was demonstrated in ACL-injured knees with lateral meniscus tears (ρ = 0.53, p < 0.05), but not in knees with isolated ACL-injury (ρ = 0.32, n.s.), ACL and medial meniscus tears (ρ = 0.14, n.s.), or ACL and combined medial and lateral meniscus tears (ρ = 0.40, n.s.). A moderate correlation between acceleration and translation was seen in males (ρ = 0.51, p < 0.05), but not in females (ρ = 0.21, n.s.). Largest correlations were observed in males with ACL and lateral meniscus tears (ρ = 0.75, p < 0.05). Lateral compartment acceleration and translation were moderately correlated in ACL-injured knees, but largely correlated in males with combined ACL and lateral meniscus tears. ACL and lateral meniscus injury in males might, therefore, be suspected when both lateral compartment acceleration and translation are elevated. Surgeons should have a greater degree of suspicion for high-grade rotatory knee laxity in ACL-injured males with concomitant lateral meniscus tears. Future studies should investigate how these two distinct components of rotatory knee laxity-lateral compartment acceleration and translation-are correlated with patient outcomes and affected by ACL surgery. Prospective cohort study; Level of evidence II.

  2. Incidence of Second Anterior Cruciate Ligament Tears and Identification of Associated Risk Factors From 2001 to 2010 Using a Geographic Database

    PubMed Central

    Schilaty, Nathan D.; Nagelli, Christopher; Bates, Nathaniel A.; Sanders, Thomas L.; Krych, Aaron J.; Stuart, Michael J.; Hewett, Timothy E.

    2017-01-01

    Background: The reported rate of second anterior cruciate ligament (ACL) injuries (20%-30%), including graft failure and contralateral ACL tears, after ACL reconstruction (ACLR) or nonoperative therapy indicates that multiple factors may predispose patients to subsequent ACL injuries. Purpose: To determine the incidence of second ACL injuries in a population-based cohort over a 10-year observation period (2001-2010) and to identify factors that contribute to the risk of second injuries. Study Design: Descriptive epidemiological study. Methods: International Classification of Diseases, 9th Revision (ICD-9) codes relevant to the diagnosis of an ACL tear and the procedure code for ACLR were utilized to search the Rochester Epidemiology Project, a multidisciplinary county database, between the years of 2001 and 2010. The complete medical records for all cases were reviewed to confirm diagnosis and treatment details. A total of 914 unique patients with 1019 acute, isolated ACL tears were identified. These patients were stratified by primary and secondary tears, sex, age, activity level, side of injury, sex × side of injury, and graft type of reconstruction. Results: Second ACL tears were recorded in 141 (13.8%) of the 914 patients diagnosed with an ACL tear in Olmsted County, Minnesota, USA, from 2001 to 2010; 50.4% of these occurred in the contralateral knee. A noncontact mechanism was responsible for 76.4% of all ACL injuries. A second ACL injury was influenced by factors of sex × age group, treatment type × age group, and treatment type × activity level. Nonparametric analysis of graft disruption × graft type demonstrated that a higher prevalence of second ACL tears occurred with allografts compared with hamstring autografts (P = .0054) and patellar tendon autografts (P = .0001). Conclusion: The incidence of second ACL tears in this population-based cohort was 13.8%, and half occurred to the ACL of the contralateral knee. Statistically, second ACL injuries differed by sex, occurring in female patients younger than 25 years and male patients aged 26 to 45 years. Allografts continued to be associated with a greater risk of second ACL injuries compared with hamstring and patellar tendon autografts. Nonoperative treatment carried more risk of contralateral tears than ACLR. PMID:28840155

  3. ACL-reconstructed and ACL-deficient individuals show differentiated trunk, hip, and knee kinematics during vertical hops more than 20 years post-injury.

    PubMed

    Markström, Jonas L; Tengman, Eva; Häger, Charlotte K

    2018-02-01

    Little is known regarding movement strategies in the long term following injury of the anterior cruciate ligament (ACL), and even less about comparisons of reconstructed and deficient knees in relation to healthy controls. The present purpose was to compare trunk, hip, and knee kinematics during a one-leg vertical hop (VH) ~20 years post-ACL injury between persons treated with surgery and physiotherapy (ACL R ), solely physiotherapy (ACL PT ), and controls (CTRL). Between-leg kinematic differences within groups were also investigated. Sixty-six persons who suffered unilateral ACL injury on average 23 ± 2 years ago (32 ACL R , 34 ACL PT ) and 33 controls performed the VH. Peak trunk, hip, and knee angles during Take-off and Landing phases recorded with a 3D motion capture system were analysed with multivariate statistics. Significant group effects during both Take-off and Landing were found, with ACL PT differing from CTRL in Take-off with a combination of less knee flexion and knee internal rotation, and from both ACL R and CTRL in Landing with less hip and knee flexion, knee internal rotation, and greater hip adduction. ACL R also presented different kinematics to ACL PT and CTRL in Take-off with a combination of greater trunk flexion, hip flexion, hip internal rotation, and less knee abduction, and in Landing with greater trunk flexion and hip internal rotation. Further, different kinematics and hop height were found between legs within groups in both Take-off and Landing for both ACL groups, but not for CTRL. Different kinematics for the injured leg for both ACL groups compared to CTRL and between treatment groups, as well as between legs within treatment groups, indicate long-term consequences of injury. Compensatory mechanisms for knee protection seem to prevail over time irrespective of initial treatment, possibly increasing the risk of re-injury and triggering the development of osteoarthritis. Detailed investigation of movement strategies during the VH provides important information and a more comprehensive evaluation of knee function than merely hop height. More attention should also be given to the trunk and hip in clinics when evaluating movement strategies after ACL injury. Prospective cohort study, Level II.

  4. Comparison of hamstring muscle behavior for anterior cruciate ligament (ACL) patient and normal subject during local marching

    NASA Astrophysics Data System (ADS)

    Amineldin@Aminudin, Nurul Izzaty Bt.; Rambely, A. S.

    2014-09-01

    This study aims to investigate the hamstring muscle activity after the surgery by carrying out an electromyography experiment on the hamstring and to compare the behavior of the ACL muscle activity between ACL patient and control subject. Electromyography (EMG) is used to study the behavior of muscles during walking activity. Two hamstring muscles involved which are semitendinosus and bicep femoris. The EMG data for both muscles were recorded while the subject did maximum voluntary contraction (MVC) and marching. The study concluded that there were similarities between bicep femoris of the ACL and control subjects. The analysis showed that the biceps femoris muscle of the ACL subject had no abnormality and the pattern is as normal as the control subject. However, ACL patient has poor semitendinosus muscle strength compared to that of control subject because the differences of the forces produced. The force of semitendinosus value for control subject was two times greater than that of the ACL subject as the right semitendinosus muscle of ACL subject was used to replace the anterior cruciate ligament (ACL) that was injured.

  5. Markov chain model for demersal fish catch analysis in Indonesia

    NASA Astrophysics Data System (ADS)

    Firdaniza; Gusriani, N.

    2018-03-01

    As an archipelagic country, Indonesia has considerable potential fishery resources. One of the fish resources that has high economic value is demersal fish. Demersal fish is a fish with a habitat in the muddy seabed. Demersal fish scattered throughout the Indonesian seas. Demersal fish production in each Indonesia’s Fisheries Management Area (FMA) varies each year. In this paper we have discussed the Markov chain model for demersal fish yield analysis throughout all Indonesia’s Fisheries Management Area. Data of demersal fish catch in every FMA in 2005-2014 was obtained from Directorate of Capture Fisheries. From this data a transition probability matrix is determined by the number of transitions from the catch that lie below the median or above the median. The Markov chain model of demersal fish catch data was an ergodic Markov chain model, so that the limiting probability of the Markov chain model can be determined. The predictive value of demersal fishing yields was obtained by calculating the combination of limiting probability with average catch results below the median and above the median. The results showed that for 2018 and long-term demersal fishing results in most of FMA were below the median value.

  6. Potential Market for New Meniscus Repair Strategies: Evaluation of the MOON Cohort

    PubMed Central

    Fetzer, Gary B.; Spindler, Kurt P.; Amendola, Annunziato; Andrish, Jack T.; Bergfeld, John A.; Dunn, Warren R.; Flanigan, David C.; Jones, Morgan; Kaeding, Christopher C.; Marx, Robert G.; Matava, Matthew J.; McCarty, Eric C.; Parker, Richard D.; Wolcott, Michelle; Vidal, Armando; Wolf, Brian R.; Wright, Rick W.

    2013-01-01

    Background An estimated 200,000 ACL reconstructions are performed each year in the United States. The presence of concomitant meniscus tears and subsequent treatment at the time of ACL reconstruction may determine long-term outcomes of these knees. The authors contend that a substantial number of these meniscal tears are treated in a fashion that reduces meniscal function and that new technologies are needed to treat meniscal tears in a fashion that preserves function. A large cohort of patients with meniscal tears is needed to demonstrate this need. The purpose of this study is to determine the incidence of meniscal tears, describe tear morphology, and selected treatment in the MOON prospective longitudinal cohort of ACL reconstruction. We also will demonstrate based on national statistics the large potential market that exists for future tissue engineering aimed at preserving meniscal function. Methods A multicenter cohort of 1014 patients undergoing ACL reconstruction between January 2002 and December 2003 were evaluated. All procedures were performed by nine fellowship trained sports medicine orthopaedic surgeons. Data on patient demographics, presence of a meniscus tear at time of ACL reconstruction, tear morphology, and meniscal treatment were collected prospectively. Meniscal tears were categorized into three potential tissue engineering treatment strategies: all-biologic repair, advanced repair, and scaffold replacement. Results 1014 ACL reconstructions were performed over the two year period. The median age at the time of surgery was 24 years. Thirty-six percent of the knees had medial meniscal tears and 44% of the knees had lateral meniscal tears. Longitudinal tears were the most common tear morphology. The most frequent treatment modality was partial meniscectomy (60%). Thirty percent of medial meniscal tears and 10% of lateral meniscal tears could be treated with all-biologic repair, 32% of medial meniscal tears and 28% of lateral meniscal tears could be treated with an advanced repair technique, and 35% of medial meniscal tears and 62% of lateral meniscal tears could be treated with scaffold replacement. Conclusions Although meniscal preservation is a generally accepted concept in the treatment of meniscal tears, the majority of tears in this young cohort undergoing ACL reconstruction were either not repairable types (radial) and/or in the avascular zone. Even with contemporary approaches to meniscal tear repair, we found significant limitations faced by the treating surgeon. The majority of tears in this population are currently treated by partial meniscectomy. The results of this cohort will hopefully, stimulate and focus future research and development of new tissue engineering strategies for a large potential market for meniscal function in an ACL reconstructed cohort. PMID:19634719

  7. Anterior cruciate ligament injury in female and male athletes: the relationship between foot structure and injury.

    PubMed

    Jenkins, Walter L; Killian, Clyde B; Williams, D S; Loudon, Janice; Raedeke, Suzanne G

    2007-01-01

    It has been shown that anterior cruciate ligament (ACL) injuries are more prevalent in female athletes than in male athletes. Soccer and basketball are considered high-risk sports for ACL injury in female athletes. Several studies have reported a relationship between ACL injury and measures of foot structure. This study was conducted to investigate the relationship between foot structure and ACL injury rates in female and male soccer and basketball players. One hundred five soccer and basketball players (53 women and 52 men) were recruited and divided into an ACL-normal group (n=89) and an ACL-injured group (n=16). Two measures of foot structure (subtalar joint neutral position and navicular drop test values) were recorded for each subject. An independent t test and a paired t test were used to analyze differences in ACL status, foot structure, and sex. A chi2 analysis determined whether the prevalence of ACL injury was independent of sport. No statistically significant differences were found in the foot structure measures between women and men. Female soccer and basketball players had an ACL injury rate seven times that of male players. Values derived from subtalar joint neutral position measurement and the navicular drop test were not associated with ACL injury in collegiate female and male soccer and basketball players.

  8. Fatigue injury risk in anterior cruciate ligament of target side knee during golf swing.

    PubMed

    Purevsuren, Tserenchimed; Kwon, Moon Seok; Park, Won Man; Kim, Kyungsoo; Jang, Seung Ho; Lim, Young-Tae; Kim, Yoon Hyuk

    2017-02-28

    A golf-related ACL injury can be linked with excessive golf play or practice because such over-use by repetitive golf swing motions can increase damage accumulation to the ACL bundles. In this study, joint angular rotations, forces, and moments, as well as the forces and strains on the ACL of the target-side knee joint, were investigated for ten professional golfers using the multi-body lower extremity model. The fatigue life of the ACL was also predicted by assuming the estimated ACL force as a cyclic load. The ACL force and strain reached their maximum values within a short time just after ball-impact in the follow-through phase. The smaller knee flexion, higher internal tibial rotation, increase of the joint compressive force and knee abduction moment in the follow-through phase were shown as to lead an increased ACL loading. The number of cycles to fatigue failure (fatigue life) in the ACL might be several thousands. It is suggested that the excessive training or practice of swing motion without enough rest may be one of factors to lead to damage or injury in the ACL by the fatigue failure. The present technology can provide fundamental information to understand and prevent the ACL injury for golf players. Copyright © 2017. Published by Elsevier Ltd.

  9. A comparison of MRI findings in patients with acute and chronic ACL tears.

    PubMed

    Dimond, P M; Fadale, P D; Hulstyn, M J; Tung, G A; Greisberg, J

    1998-01-01

    This retrospective study compared the magnetic resonance imaging (MRI) findings in 87 patients with acute and chronic anterior cruciate ligament (ACL) tears. Sixty patients had acute tears and 27 had chronic tears. The appearance of the torn ligament was examined on MRI, and associated meniscal and osteochondral injuries were described. All findings were verified at arthroscopy. Acute ACL tears (MRI examination was performed within 6 weeks of injury) were typified by the presence of diffuse (58%) or focal (42%) increased signal within the ligament, whereas chronic ACL tears (MRI examination was performed more than 6 months after injury) usually appeared as either a fragmented ligament (44%) or an intact band of low signal with abnormal orientation (30%). Patients with chronic ACL tears had a higher prevalence of medial meniscal tears (78% versus 40%), articular chondromalacia, and an increased posterior cruciate bow ratio (0.47 versus 0.37) in association with chronic ACL tears. A bone bruise was seen in 68% of acute ACL tears but in no case of chronic ACL tear. On MRI, there are salient differences between acute and chronic ACL tears. Chronic ACL tears are associated with a greater prevalence of meniscal and osteochondral injuries. These findings may have implications for future treatment recommendations.

  10. Lessons learned from the last 20 years of ACL-related in vivo-biomechanics research of the knee joint.

    PubMed

    Pappas, Evangelos; Zampeli, Franceska; Xergia, Sofia A; Georgoulis, Anastasios D

    2013-04-01

    Technological advances in recent years have allowed the easy and accurate assessment of knee motion during athletic activities. Subsequently, thousands of studies have been published that greatly improved our understanding of the aetiology, surgical reconstruction techniques and prevention of anterior cruciate ligament (ACL) injuries. The purpose of this review is to summarize the evidence from biomechanical studies on ACL-related research. High-impact articles that enhanced understanding of ACL injury aetiology, rehabilitation, prevention and adaptations after reconstruction were selected. The importance of restoring internal tibial rotation after ACL reconstruction has emerged in several studies. Criteria-based, individualized rehabilitation protocols have replaced the traditional time-based protocols. Excessive knee valgus, poor trunk control, excessive quadriceps forces and leg asymmetries have been identified as potential high risk biomechanical factors for ACL tear. Injury prevention programmes have emerged as low cost and effective means of preventing ACL injuries, particularly in female athletes. As a result of biomechanical research, clinicians have a better understanding of ACL injury aetiology, prevention and rehabilitation. Athletes exhibiting neuromuscular deficits predisposing them to ACL injury can be identified and enrolled into prevention programmes. Clinicians should assess ACL-reconstructed patients for excessive internal tibial rotation that may lead to poor outcomes.

  11. Prevention, treatment, and rehabilitation of anterior cruciate ligament injuries in children

    PubMed Central

    Lang, Pamela J; Sugimoto, Dai; Micheli, Lyle J

    2017-01-01

    As more children and adolescents participate in competitive organized sports, there has been an increase in the reported incidence of anterior cruciate ligament (ACL) injuries in these age groups. ACL injuries in skeletally immature athletes present a challenge, as reconstruction must preserve the physis of the distal femur and of the proximal tibia to avoid growth disturbances. Historically, a skeletally immature athlete with an ACL injury was treated with a brace and activity modification until skeletal maturity, with ACL reconstruction being performed at that time in the “non-copers” who experienced instability. More recently, evidence has shown that delayed reconstruction may lead to increased damage to the meniscus and articular cartilage. As a result, early reconstruction is favored to protect the meniscus and allow continued physical activity. While adolescents at or those near skeletal maturity may be treated with standard reconstruction techniques, they may result in growth disturbances in younger athletes with significant growth remaining. In response to the growing need for ACL reconstruction techniques in skeletally immature individuals, physeal-sparing and physeal-respecting reconstruction techniques have been developed. In addition to the advancements in surgical technique, ACL injury prevention has also gained attention. This growing interest in ACL prevention is in part related to the high risk of ACL re-tear, either of the ACL graft or of the contralateral ACL, in children and adolescents. Recent reports indicate that well-designed neuromuscular training programs may reduce the risk of primary and subsequent ACL injuries. PMID:28652828

  12. 50 CFR 665.252 - Harvest limitation program.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Lobster Grounds, Gardner Pinnacles Lobster Grounds, Maro Reef Lobster Grounds, and General NWHI Lobster... catch of spiny and slipper lobsters. (2) Be expressed in terms of numbers of lobsters. (b) Harvest guideline. (1) The Regional Administrator shall use information from daily lobster catch reports and lobster...

  13. 50 CFR 665.252 - Harvest limitation program.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Lobster Grounds, Gardner Pinnacles Lobster Grounds, Maro Reef Lobster Grounds, and General NWHI Lobster... catch of spiny and slipper lobsters. (2) Be expressed in terms of numbers of lobsters. (b) Harvest guideline. (1) The Regional Administrator shall use information from daily lobster catch reports and lobster...

  14. Sports-specific differences in postsurgical infections after arthroscopically assisted anterior cruciate ligament reconstruction.

    PubMed

    Krutsch, Werner; Zellner, Johannes; Zeman, Florian; Nerlich, Michael; Koch, Matthias; Pfeifer, Christian; Angele, Peter

    2017-12-01

    Post-operative infection after arthroscopically assisted anterior cruciate ligament (ACL) reconstruction is a rare but severe complication, particularly for young and active patients. It is unclear whether the prevalence of knee infection is correlated with the type of sports or the level of performance. From 2008 to 2012, the internal single-centre ACL registry of the FIFA Medical Centre of Excellence Regensburg was retrospectively screened for sex, age, time between isolated primary ACL rupture and surgery, surgical technique, rate of infection after ACL reconstruction and the type of sports practised. In total, 4801 ACL reconstructions had been conducted over 5 years, 4579 in amateur and 221 in professional athletes. After application of the exclusion criteria, 1809 athletes with ACL reconstruction were analysed regarding postsurgical infection and the type of sports practised. Professionals and amateurs did not significantly differ with regard to infection rates (n.s.) but in the timing of ACL repair (p < 0.001). Eleven of 1130 football players had developed postsurgical infection after ACL reconstruction (1.0%) in contrast to 557 skiers and snowboarders without infection (p = 0.02). The timing of ACL repair did not differ between the different types of sports (n.s.). Staphylococcus aureus and epidermidis were the predominant detected bacteria. All patients were hospitalised and successfully treated with arthroscopic lavage and antibiotic medication. ACL infections showed sports-related differences. Athletes practising summer outdoor sports such as football had a significantly higher risk of infection after ACL reconstruction than winter sports athletes. No difference was found between professional and amateur athletes. Relevant prevention strategies for postsurgical ACL infections should consider influencing patient factors such as the type of sports activity and attendant circumstances. III.

  15. Intra-ligamentary autologous conditioned plasma and healing response to treat partial ACL ruptures.

    PubMed

    Koch, Matthias; Matteo, Berardo Di; Eichhorn, Jürgen; Zellner, Johannes; Mayr, Felix; Krutsch, Werner; Achenbach, Leonard; Woehl, Rebecca; Nerlich, Michael; Angele, Peter

    2018-05-01

    Conservative treatment of partial ACL ruptures is associated with a high failure rate, and often patients undergo ACL reconstruction. ACL preservation by trephination of the ACL origin and application of Autologous Conditioned Plasma (ACP) seems to be an intriguing new treatment option to favour ACL tissue healing and avoid traditional reconstruction. The aim of this study was to describe the mid-term outcomes of this new ACL preserving technique. Twenty-four patients (mean age 41.8 years) affected by partial rupture of one or both ACL bundles were included in the present trial. The partial ACL tears were arthroscopically assessed and classified according to a new five step grading system. All patients were treated by trephination of the femoral ACL stump and intra-ligamentary application of ACP. The postoperative outcome was evaluated by both subjective scores and stability testing up to a mean of 25.1 months' follow-up. Adverse events and failure rate were also documented. Clinical outcome was good to excellent with IKDC subjective 82.7 (SD 11.8), Lysholm 87.6 (SD 8.1), Tegner 5.3 (SD 2.1), Cincinnati 88.7 (SD 14.8). The failure rate (i.e. persisting knee instability assessed clinically or by rolimeter) was 12.5%. At objective measurements, knee joints showed a firm endpoint in Lachman test, negative pivot shift phenomenon and a significant reduction in AP-laxity compared to pre-operative status by rolimeter testing (p = 0.002). Return to sport practice was achieved after mean 4.8 months (SD 4.1). ACL stump trephination and concomitant intra-ligamentary application of ACP revealed promising results at mid-term follow-up to treat partial ACL lesions.

  16. Isolation and Characterization of Human Anterior Cruciate Ligament-Derived Vascular Stem Cells

    PubMed Central

    Matsumoto, Tomoyuki; Ingham, Sheila M.; Mifune, Yutaka; Osawa, Aki; Logar, Alison; Usas, Arvydas; Kuroda, Ryosuke; Kurosaka, Masahiro; Fu, Freddie H.

    2012-01-01

    The anterior cruciate ligament (ACL) usually fails to heal after rupture mainly due to the inability of the cells within the ACL tissue to establish an adequate healing process, making graft reconstruction surgery a necessity. However, some reports have shown that there is a healing potential of ACL with primary suture repair. Although some reports showed the existence of mesenchymal stem cell-like cells in human ACL tissues, their origin still remains unclear. Recently, blood vessels have been reported to represent a rich supply of stem/progenitor cells with a characteristic expression of CD34 and CD146. In this study, we attempted to validate the hypothesis that CD34- and CD146-expressing vascular cells exist in hACL tissues, have a potential for multi-lineage differentiation, and are recruited to the rupture site to participate in the intrinsic healing of injured ACL. Immunohistochemistry and flow cytometry analysis of hACL tissues demonstrated that it contains significantly more CD34 and CD146-positive cells in the ACL ruptured site compared with the noninjured midsubstance. CD34+CD45− cells isolated from ACL ruptured site showed higher expansionary potentials than CD146+CD45− and CD34−CD146−CD45− cells, and displayed higher differentiation potentials into osteogenic, adipogenic, and angiogenic lineages than the other cell populations. Immunohistochemistry of fetal and adult hACL tissues demonstrated a higher number of CD34 and CD146-positive cells in the ACL septum region compared with the midsubstance. In conclusion, our findings suggest that the ACL septum region contains a population of vascular-derived stem cells that may contribute to ligament regeneration and repair at the site of rupture. PMID:21732814

  17. Do exercises used in injury prevention programmes modify cutting task biomechanics? A systematic review with meta-analysis.

    PubMed

    Pappas, Evangelos; Nightingale, Elizabeth J; Simic, Milena; Ford, Kevin R; Hewett, Timothy E; Myer, Gregory D

    2015-05-01

    Some injury prevention programmes aim to reduce the risk of ACL rupture. Although the most common athletic task leading to ACL rupture is cutting, there is currently no consensus on how injury prevention programmes influence cutting task biomechanics. To systematically review and synthesise the scientific literature regarding the influence of injury prevention programme exercises on cutting task biomechanics. The three largest databases (Medline, EMBASE and CINAHL) were searched for studies that investigated the effect of injury prevention programmes on cutting task biomechanics. When possible meta-analyses were performed. Seven studies met the inclusion criteria. Across all studies, a total of 100 participants received exercises that are part of ACL injury prevention programmes and 76 participants served in control groups. Most studies evaluated variables associated with the quadriceps dominance theory. The meta-analysis revealed decreased lateral hamstrings electromyography activity (p ≤ 0.05) while single studies revealed decreased quadriceps and increased medial hamstrings activity and decreased peak knee flexion moment. Findings from single studies reported that ACL injury prevention exercises reduce neuromuscular deficits (knee valgus moment, lateral trunk leaning) associated with the ligament and trunk dominance theories, respectively. The programmes we analysed appear most effective when they emphasise individualised biomechanical technique correction and target postpubertal women. The exercises used in injury prevention programmes have the potential to improve cutting task biomechanics by ameliorating neuromuscular deficits linked to ACL rupture, especially when they emphasise individualised biomechanical technique correction and target postpubertal female athletes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  18. Selective contribution of each hamstring muscle to anterior cruciate ligament protection and tibiofemoral joint stability in leg-extension exercise: a simulation study.

    PubMed

    Biscarini, Andrea; Botti, Fabio Massimo; Pettorossi, Vito Enrico

    2013-09-01

    A biomechanical model was developed to simulate the selective effect of the co-contraction force provided by each hamstring muscle on the shear and compressive tibiofemoral joint reaction forces, during open kinetic-chain knee-extension exercises. This model accounts for instantaneous values of knee flexion angle [Formula: see text], angular velocity and acceleration, and for changes in magnitude, orientation, and application point of external resistance. The tibiofemoral shear force (TFSF) largely determines the tensile force on anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). Biceps femoris is the most effective hamstring muscle in decreasing the ACL-loading TFSF developed by quadriceps contractions for [Formula: see text]. In this range, the semimembranosus generates the dominant tibiofemoral compressive force, which enhances joint stability, opposes anterior/posterior tibial translations, and protects cruciate ligaments. The semitendinosus force provides the greatest decreasing gradient of ACL-loading TFSF for [Formula: see text], and the greatest increasing gradient of tibiofemoral compressive force for [Formula: see text]. However, semitendinosus efficacy is strongly limited by its small physiological section. Hamstring muscles behave as a unique muscle in enhancing the PCL-loading TFSF produced by quadriceps contractions for [Formula: see text]. The levels of hamstrings co-activation that suppress the ACL-loading TFSF considerably shift when the knee angular acceleration is changed while maintaining the same level of knee extensor torque by a concurrent adjustment in the magnitude of external resistance. The knowledge of the specific role and the optimal activation level of each hamstring muscle in ACL protection and tibiofemoral stability are fundamental for planning safe and effective rehabilitative knee-extension exercises.

  19. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study.

    PubMed

    Grindem, Hege; Snyder-Mackler, Lynn; Moksnes, Håvard; Engebretsen, Lars; Risberg, May Arna

    2016-07-01

    Knee reinjury after ACL reconstruction is common and increases the risk of osteoarthritis. There is sparse evidence to guide return to sport (RTS) decisions in this population. To assess the relationship between knee reinjury after ACL reconstruction and (1) return to level I sports, (2) timing of RTS and (3) knee function prior to return. 106 patients who participated in pivoting sports participated in this prospective 2-year cohort study. Sports participation and knee reinjury were recorded monthly. Knee function was assessed with the Knee Outcome Survey-Activities of Daily Living Scale, global rating scale of function, and quadriceps strength and hop test symmetry. Pass RTS criteria were defined as scores >90 on all tests, failure as failing any. Patients who returned to level I sports had a 4.32 (p=0.048) times higher reinjury rate than those who did not. The reinjury rate was significantly reduced by 51% for each month RTS was delayed until 9 months after surgery, after which no further risk reduction was observed. 38.2% of those who failed RTS criteria suffered reinjuries versus 5.6% of those who passed (HR 0.16, p=0.075). More symmetrical quadriceps strength prior to return significantly reduced the knee reinjury rate. Returning to level I sports after ACL reconstruction leads to a more than 4-fold increase in reinjury rates over 2 years. RTS 9 months or later after surgery and more symmetrical quadriceps strength prior to return substantially reduce the reinjury rate. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  20. Three distinct mechanisms predominate in non-contact anterior cruciate ligament injuries in male professional football players: a systematic video analysis of 39 cases

    PubMed Central

    Waldén, Markus; Krosshaug, Tron; Bjørneboe, John; Andersen, Thor Einar; Faul, Oliver

    2015-01-01

    Background Current knowledge on anterior cruciate ligament (ACL) injury mechanisms in male football players is limited. Aim To describe ACL injury mechanisms in male professional football players using systematic video analysis. Methods We assessed videos from 39 complete ACL tears recorded via prospective professional football injury surveillance between 2001 and 2011. Five analysts independently reviewed all videos to estimate the time of initial foot contact with the ground and the time of ACL tear. We then analysed all videos according to a structured format describing the injury circumstances and lower limb joint biomechanics. Results Twenty-five injuries were non-contact, eight indirect contact and six direct contact injuries. We identified three main categories of non-contact and indirect contact injury situations: (1) pressing (n=11), (2) re-gaining balance after kicking (n=5) and (3) landing after heading (n=5). The fourth main injury situation was direct contact with the injured leg or knee (n=6). Knee valgus was frequently seen in the main categories of non-contact and indirect contact playing situations (n=11), but a dynamic valgus collapse was infrequent (n=3). This was in contrast to the tackling-induced direct contact situations where a knee valgus collapse occurred in all cases (n=3). Conclusions Eighty-five per cent of the ACL injuries in male professional football players resulted from non-contact or indirect contact mechanisms. The most common playing situation leading to injury was pressing followed by kicking and heading. Knee valgus was frequently seen regardless of the playing situation, but a dynamic valgus collapse was rare. PMID:25907183

  1. Functional tissue engineering of ligament healing

    PubMed Central

    2010-01-01

    Ligaments and tendons are dense connective tissues that are important in transmitting forces and facilitate joint articulation in the musculoskeletal system. Their injury frequency is high especially for those that are functional important, like the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) of the knee as well as the glenohumeral ligaments and the rotator cuff tendons of the shoulder. Because the healing responses are different in these ligaments and tendons after injury, the consequences and treatments are tissue- and site-specific. In this review, we will elaborate on the injuries of the knee ligaments as well as using functional tissue engineering (FTE) approaches to improve their healing. Specifically, the ACL of knee has limited capability to heal, and results of non-surgical management of its midsubstance rupture have been poor. Consequently, surgical reconstruction of the ACL is regularly performed to gain knee stability. However, the long-term results are not satisfactory besides the numerous complications accompanied with the surgeries. With the rapid development of FTE, there is a renewed interest in revisiting ACL healing. Approaches such as using growth factors, stem cells and scaffolds have been widely investigated. In this article, the biology of normal and healing ligaments is first reviewed, followed by a discussion on the issues related to the treatment of ACL injuries. Afterwards, current promising FTE methods are presented for the treatment of ligament injuries, including the use of growth factors, gene delivery, and cell therapy with a particular emphasis on the use of ECM bioscaffolds. The challenging areas are listed in the future direction that suggests where collection of energy could be placed in order to restore the injured ligaments and tendons structurally and functionally. PMID:20492676

  2. Low Prevalence of Anterior and Posterior Cruciate Ligament Injuries in Patients With Achondroplasia.

    PubMed

    Brooks, Jaysson T; Ramji, Alim F; Lyapustina, Tatyana A; Yost, Mary T; Ain, Michael C

    2017-01-01

    Anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries and their subsequent reconstructions are common in the general population, but there has been no research regarding ACL or PCL injuries in patients with achondroplasia, the most common skeletal dysplasia. Our goals were to (1) evaluate the prevalence of ACL and PCL injuries in adolescents and adults with achondroplasia, (2) compare this prevalence with that reported for the general population, (3) determine how many patients with ACL or PCL injuries underwent ligament reconstruction as treatment, and (4) determine patient activity levels as they relate to the rate of ACL/PCL injuries and reconstructions. We reviewed medical records of 430 patients with achondroplasia seen in the senior author's clinic from 2002 through 2014. Demographic data were reviewed, as well as any documentation of ACL or PCL injury or reconstruction. We called all 430 patients by telephone, and 148 agreed to participate in our survey, whereas 1 declined. We asked these patients about their history of ACL or PCL injury or reconstruction, as well as current and past physical activity levels. No ACL or PCL injuries were found on chart review. One patient reached by telephone reported an ACL injury that did not require reconstruction. This yielded a theoretical prevalence of 3/430 (0.7%). Of the 148 patients surveyed, 43 (29%) reported low physical activity, 75 (51%) reported moderate physical activity, and 26 (17%) reported high physical activity. There was no significant difference in the rate of ACL injury when stratified by physical activity level (P=0.102). ACL and PCL injuries and reconstructions are extremely rare in patients with achondroplasia, which cannot be completely ascribed to a low level of physical activity. One possible explanation is that patients with achondroplasia, on an average, have a more anterior tibial slope compared with those without achondroplasia, which decreases the force generated within the ACL and may protect against ACL injury. Further research is needed to explore possible causes. Level IV-retrospective review.

  3. Dynamic augmentation restores anterior tibial translation in ACL suture repair: a biomechanical comparison of non-, static and dynamic augmentation techniques.

    PubMed

    Hoogeslag, Roy A G; Brouwer, Reinoud W; Huis In 't Veld, Rianne; Stephen, Joanna M; Amis, Andrew A

    2018-02-03

    There is a lack of objective evidence investigating how previous non-augmented ACL suture repair techniques and contemporary augmentation techniques in ACL suture repair restrain anterior tibial translation (ATT) across the arc of flexion, and after cyclic loading of the knee. The purpose of this work was to test the null hypotheses that there would be no statistically significant difference in ATT after non-, static- and dynamic-augmented ACL suture repair, and they will not restore ATT to normal values across the arc of flexion of the knee after cyclic loading. Eleven human cadaveric knees were mounted in a test rig, and knee kinematics from 0° to 90° of flexion were recorded by use of an optical tracking system. Measurements were recorded without load and with 89-N tibial anterior force. The knees were tested in the following states: ACL-intact, ACL-deficient, non-augmented suture repair, static tape augmentation and dynamic augmentation after 10 and 300 loading cycles. Only static tape augmentation and dynamic augmentation restored ATT to values similar to the ACL-intact state directly postoperation, and maintained this after cyclic loading. However, contrary to dynamic augmentation, the ATT after static tape augmentation failed to remain statistically less than for the ACL-deficient state after cyclic loading. Moreover, after cyclic loading, ATT was significantly less with dynamic augmentation when compared to static tape augmentation. In contrast to non-augmented ACL suture repair and static tape augmentation, only dynamic augmentation resulted in restoration of ATT values similar to the ACL-intact knee and decreased ATT values when compared to the ACL-deficient knee immediately post-operation and also after cyclic loading, across the arc of flexion, thus allowing the null hypotheses to be rejected. This may assist healing of the ruptured ACL. Therefore, this study would support further clinical evaluation of dynamic augmentation of ACL repair.

  4. Morphologic Characteristics Help Explain the Gender Difference in Peak Anterior Cruciate Ligament Strain During a Simulated Pivot Landing

    PubMed Central

    Lipps, David B.; Oh, Youkeun K.; Ashton-Miller, James A.; Wojtys, Edward M.

    2015-01-01

    Background Gender differences exist in anterior cruciate ligament (ACL) cross-sectional area and lateral tibial slope. Biomechanical principles suggest that the direction of these gender differences should induce larger peak ACL strains in females under dynamic loading. Hypothesis Peak ACL relative strain during a simulated pivot landing is significantly greater in female ACLs than male ACLs. Study Design Controlled laboratory study. Methods Twenty cadaveric knees from height- and weight-matched male and female cadavers were subjected to impulsive 3-dimensional test loads of 2 times body weight in compression, flexion, and internal tibial torque starting at 15° of flexion. Load cells measured the 3-dimensional forces and moments applied to the knee, and forces in the pretensioned quadriceps, hamstring, and gastrocnemius muscle equivalents. A novel, gender-specific, nonlinear spring simulated short-range and longer range quadriceps muscle tensile stiffness. Peak relative strain in the anteromedial bundle of the ACL (AM-ACL) was measured using a differential variable reluctance transducer, while ACL cross-sectional area and lateral tibial slope were measured using magnetic resonance imaging. A repeated-measures Mann-Whitney signed-rank test was used to test the hypothesis. Results Female knees exhibited 95% greater peak AM-ACL relative strain than male knees (6.37% [22.53%] vs 3.26% [11.89%]; P = .004). Anterior cruciate ligament cross-sectional area and lateral tibial slope were significant predictors of peak AM-ACL relative strain (R2 = .59; P = .001). Conclusion Peak AM-ACL relative strain was significantly greater in female than male knees from donors of the same height and weight. This gender difference is attributed to a smaller female ACL cross-sectional area and a greater lateral tibial slope. Clinical Relevance Since female ACLs are systematically exposed to greater strain than their male counterparts, training and injury prevention programs should take this fact into consideration. PMID:21917612

  5. Identification of Suitable Reference Genes for Investigating Gene Expression in Anterior Cruciate Ligament Injury by Using Reverse Transcription-Quantitative PCR.

    PubMed

    Leal, Mariana Ferreira; Astur, Diego Costa; Debieux, Pedro; Arliani, Gustavo Gonçalves; Silveira Franciozi, Carlos Eduardo; Loyola, Leonor Casilla; Andreoli, Carlos Vicente; Smith, Marília Cardoso; Pochini, Alberto de Castro; Ejnisman, Benno; Cohen, Moises

    2015-01-01

    The anterior cruciate ligament (ACL) is one of the most frequently injured structures during high-impact sporting activities. Gene expression analysis may be a useful tool for understanding ACL tears and healing failure. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) has emerged as an effective method for such studies. However, this technique requires the use of suitable reference genes for data normalization. Here, we evaluated the suitability of six reference genes (18S, ACTB, B2M, GAPDH, HPRT1, and TBP) by using ACL samples of 39 individuals with ACL tears (20 with isolated ACL tears and 19 with ACL tear and combined meniscal injury) and of 13 controls. The stability of the candidate reference genes was determined by using the NormFinder, geNorm, BestKeeper DataAssist, and RefFinder software packages and the comparative ΔCt method. ACTB was the best single reference gene and ACTB+TBP was the best gene pair. The GenEx software showed that the accumulated standard deviation is reduced when a larger number of reference genes is used for gene expression normalization. However, the use of a single reference gene may not be suitable. To identify the optimal combination of reference genes, we evaluated the expression of FN1 and PLOD1. We observed that at least 3 reference genes should be used. ACTB+HPRT1+18S is the best trio for the analyses involving isolated ACL tears and controls. Conversely, ACTB+TBP+18S is the best trio for the analyses involving (1) injured ACL tears and controls, and (2) ACL tears of patients with meniscal tears and controls. Therefore, if the gene expression study aims to compare non-injured ACL, isolated ACL tears and ACL tears from patients with meniscal tear as three independent groups ACTB+TBP+18S+HPRT1 should be used. In conclusion, 3 or more genes should be used as reference genes for analysis of ACL samples of individuals with and without ACL tears.

  6. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries.

    PubMed

    Ardern, Clare L; Ekås, Guri Ranum; Grindem, Hege; Moksnes, Håvard; Anderson, Allen F; Chotel, Franck; Cohen, Moises; Forssblad, Magnus; Ganley, Theodore J; Feller, Julian A; Karlsson, Jón; Kocher, Minider S; LaPrade, Robert F; McNamee, Michael; Mandelbaum, Bert; Micheli, Lyle; Mohtadi, Nicholas; Reider, Bruce; Roe, Justin; Seil, Romain; Siebold, Rainer; Silvers-Granelli, Holly J; Soligard, Torbjørn; Witvrouw, Erik; Engebretsen, Lars

    2018-04-01

    In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric ACL injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery & Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Knee flexion with quadriceps cocontraction: A new therapeutic exercise for the early stage of ACL rehabilitation.

    PubMed

    Biscarini, Andrea; Contemori, Samuele; Busti, Daniele; Botti, Fabio M; Pettorossi, Vito E

    2016-12-08

    Quadriceps strengthening exercises designed for the early phase of anterior cruciate ligament (ACL) rehabilitation should limit the anterior tibial translation developed by quadriceps contraction near full knee extension, in order to avoid excessive strain on the healing tissue. We hypothesize that knee-flexion exercises with simultaneous voluntary contraction of quadriceps (voluntary quadriceps cocontraction) can yield considerable levels of quadriceps activation while preventing the tibia from translating forward relative to the femur. Electromyographic activity in quadriceps and hamstring muscles was measured in 20 healthy males during isometric knee-flexion exercises executed near full knee extension with maximal voluntary effort of quadriceps cocontraction and external resistance (R) ranging from 0% to 60% of the 1-repetition maximum (1RM). Biomechanical modeling was applied to derive the shear (anterior/posterior) tibiofemoral force developed in each exercise condition. Isometric knee-flexion exercises with small external resistance (R=10% 1RM) and maximal voluntary effort of quadriceps cocontraction yielded a net posterior (ACL-unloading) tibial pull (P=0.005) and levels of activation of 32%, 50%, and 45% of maximum voluntary isometric contraction, for the rectus femoris, vastus medialis, and vastus lateralis, respectively. This exercise might potentially rank as one of the most appropriate quadriceps strengthening interventions in the early phase of ACL rehabilitation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Embroidered polymer-collagen hybrid scaffold variants for ligament tissue engineering.

    PubMed

    Hoyer, M; Drechsel, N; Meyer, M; Meier, C; Hinüber, C; Breier, A; Hahner, J; Heinrich, G; Rentsch, C; Garbe, L-A; Ertel, W; Schulze-Tanzil, G; Lohan, A

    2014-10-01

    Embroidery techniques and patterns used for scaffold production allow the adaption of biomechanical scaffold properties. The integration of collagen into embroidered polylactide-co-caprolactone [P(LA-CL)] and polydioxanone (PDS) scaffolds could stimulate neo-tissue formation by anterior cruciate ligament (ACL) cells. Therefore, the aim of this study was to test embroidered P(LA-CL) and PDS scaffolds as hybrid scaffolds in combination with collagen hydrogel, sponge or foam for ligament tissue engineering. ACL cells were cultured on embroidered P(LA-CL) and PDS scaffolds without or with collagen supplementation. Cell adherence, vitality, morphology and ECM synthesis were analyzed. Irrespective of thread size, ACL cells seeded on P(LA-CL) scaffolds without collagen adhered and spread over the threads, whereas the cells formed clusters on PDS and larger areas remained cell-free. Using the collagen hydrogel, the scaffold colonization was limited by the gel instability. The collagen sponge layers integrated into the scaffolds were hardly penetrated by the cells. Collagen foams increased scaffold colonization in P(LA-CL) but did not facilitate direct cell-thread contacts in the PDS scaffolds. The results suggest embroidered P(LA-CL) scaffolds as a more promising basis for tissue engineering an ACL substitute than PDS due to superior cell attachment. Supplementation with a collagen foam presents a promising functionalization strategy. Copyright © 2014 Elsevier B.V. All rights reserved.

  9. The Relationship between Anterior Cruciate Ligament Injury and Osteoarthritis of the Knee

    PubMed Central

    Simon, David; Saltzman, Bryan M.; Rollins, Meaghan; Bach, Bernard R.; MacDonald, Peter

    2015-01-01

    Anterior cruciate ligament (ACL) tears are a common injury, particularly in the athletic and youth populations. The known association between ACL injury and subsequent osteoarthritis (OA) of the knee merits a more in-depth understanding of the relationship between the ACL-injured knee and osteoarthritis. ACL injury, especially with concomitant meniscal or other ligamentous pathology, predisposes the knee to an increased risk of osteoarthritis. ACL insufficiency results in deterioration of the normal physiologic knee bending culminating in increased anterior tibial translation and increased internal tibial rotation. This leads to increased mean contact stresses in the posterior medial and lateral compartments under anterior and rotational loading. However, surgical reconstruction of the ACL has not been shown to reduce the risk of future OA development back to baseline and has variability based on operative factors of graft choice, timing of surgery, presence of meniscal and chondral abnormalities, and surgical technique. Known strategies to prevent OA development are applicable to patients with ACL deficiency or after ACL reconstruction and include weight management, avoidance of excessive musculoskeletal loading, and strength training. Reconstruction of the ACL does not necessarily prevent osteoarthritis in many of these patients and may depend on several external variables. PMID:25954533

  10. Anterior cruciate ligament rupture: differences between males and females.

    PubMed

    Sutton, Karen M; Bullock, James Montgomery

    2013-01-01

    The rate of anterior cruciate ligament (ACL) rupture is three times higher in female athletes than in male athletes. Intrinsic factors such as increased quadriceps angle and increased posterior tibial slope may predispose girls and women to ACL injury. Compared with males, females have smaller notch widths and smaller ACL cross-sectional area; however, no conclusive correlation between ACL size and notch dimension exists, especially in relation to risk of ACL injury. Female athletes who land with the knees in inadequate flexion and in greater-than-normal valgus and external rotation are at increased risk of ACL injury. No conclusive link has been made between ACL injury and the menstrual cycle. Neuromuscular intervention protocols have been shown to reduce the rate of injury in girls and women. Females are more likely than males to have a narrow A-shaped intercondylar notch, and special surgical considerations are required in such cases. Following ACL reconstruction, female athletes are more likely than male athletes to rupture the contralateral ACL; however, males and females are equally likely to rupture the reconstructed knee. Although self-reported outcomes in the first 2 years following reconstruction are worse for females than for males, longer-term studies demonstrate no difference between males and females.

  11. Relationship Between the Risk of Suffering a First-Time Noncontact ACL Injury and Geometry of the Femoral Notch and ACL: A Prospective Cohort Study With a Nested Case-Control Analysis.

    PubMed

    Whitney, Darryl C; Sturnick, Daniel R; Vacek, Pamela M; DeSarno, Mike J; Gardner-Morse, Mack; Tourville, Timothy W; Smith, Helen C; Slauterbeck, James R; Johnson, Robert J; Shultz, Sandra J; Hashemi, Javad; Beynnon, Bruce D

    2014-08-01

    The morphometric characteristics of the anterior cruciate ligament (ACL) and the femoral intercondylar notch within which it resides have been implicated as risk factors for injuries to this important stabilizer of the knee. Prior research has produced equivocal results with differing methodologies, and consequently, it is unclear how these characteristics affect the injury risk in male and female patients. The morphometric characteristics of the ACL and femoral intercondylar notch are individually and independently associated with the risk of suffering a noncontact ACL injury, and these relationships are different in male and female patients. Case-control study; Level of evidence, 3. Magnetic resonance imaging scans of the bilateral knees were obtained on 88 case-control pairs (27 male, 61 female) matched for age, sex, and participation on the same sports team. Patients had suffered a grade III, first-time, noncontact ACL tear. The femoral notch width at 4 locations, the thickness of the bony ridge at the anteromedial outlet of the femoral notch, the femoral notch volume, ACL volume, and ACL cross-sectional area were measured. Multivariate analysis of combined data from male and female patients revealed that decreased ACL volume (odds ratio [OR], 0.829), decreased femoral notch width (OR, 0.700), and increased bony ridge thickness at the anteromedial outlet of the femoral notch (OR, 1.614) were significant independent predictors of an ACL injury. Separate analyses of male and female patients indicated that the femoral notch ridge may be more strongly associated with a risk in female patients, while ACL volume is more strongly associated with a risk in male patients. However, statistical analysis performed with an adjustment for body weight strengthened the association between ACL volume and the risk of injuries in female patients. Morphometric features of both the ACL and femoral notch combine to influence the risk of suffering a noncontact ACL injury. When included together in a multivariate model that adjusts for body weight, the effects of the morphometric measurements are similar in male and female patients. If body weight is not taken into consideration, ACL volume is not associated with a risk in female patients. © 2014 The Author(s).

  12. Structural and Anatomic Restoration of the Anterior Cruciate Ligament Is Associated With Less Cartilage Damage 1 Year After Surgery: Healing Ligament Properties Affect Cartilage Damage

    PubMed Central

    Kiapour, Ata M.; Fleming, Braden C.; Murray, Martha M.

    2017-01-01

    Background: Abnormal joint motion has been linked to joint arthrosis after anterior cruciate ligament (ACL) reconstruction. However, the relationships between the graft properties (ie, structural and anatomic) and extent of posttraumatic osteoarthritis are not well defined. Hypotheses: (1) The structural (tensile) and anatomic (area and alignment) properties of the reconstructed graft or repaired ACL correlate with the total cartilage lesion area 1 year after ACL surgery, and (2) side-to-side differences in anterior-posterior (AP) knee laxity correlate with the total cartilage lesion area 1 year postoperatively. Study Design: Controlled laboratory study. Methods: Sixteen minipigs underwent unilateral ACL transection and were randomly treated with ACL reconstruction or bridge-enhanced ACL repair. The tensile properties, cross-sectional area, and multiplanar alignment of the healing ACL or graft, AP knee laxity, and cartilage lesion areas were assessed 1 year after surgery. Results: In the reconstructed group, the normalized graft yield and maximum failure loads, cross-sectional area, sagittal and coronal elevation angles, and side-to-side differences in AP knee laxity at 60° of flexion were associated with the total cartilage lesion area 1 year after surgery (R 2 > 0.5, P < .04). In the repaired group, normalized ACL yield load, linear stiffness, cross-sectional area, and the sagittal and coronal elevation angles were associated with the total cartilage lesion area (R 2 > 0.5, P < .05). Smaller cartilage lesion areas were observed in the surgically treated knees when the structural and anatomic properties of the ligament or graft and AP laxity values were closer to those of the contralateral ACL-intact knee. Reconstructed grafts had a significantly larger normalized cross-sectional area and sagittal elevation angle (more vertical) when compared with repaired ACLs (P < .02). Conclusion: The tensile properties, cross-sectional area, and multiplanar alignment of the healing ACLs or grafts and AP knee laxity in reconstructed knees were associated with the extent of tibiofemoral cartilage damage after ACL surgery. Clinical Relevance: These data highlight the need for novel ACL injury treatments that can restore the structural and anatomic properties of the torn ACL to those of the native ACL in an effort to minimize the risk of early-onset posttraumatic osteoarthritis. PMID:28875154

  13. Biomechanical Evaluation of Knee Joint Laxities and Graft Forces After Anterior Cruciate Ligament Reconstruction by Anteromedial Portal, Outside-In, and Transtibial Techniques

    PubMed Central

    Sim, Jae Ang; Gadikota, Hemanth R.; Li, Jing-Sheng; Li, Guoan; Gill, Thomas J.

    2013-01-01

    Background Recently, anatomic anterior cruciate ligament (ACL) reconstruction is emphasized to improve joint laxity and to potentially avert initiation of cartilage degeneration. There is a paucity of information on the efficacy of ACL reconstructions by currently practiced tunnel creation techniques in restoring normal joint laxity. Study Design Controlled laboratory study. Hypothesis Anterior cruciate ligament reconstruction by the anteromedial (AM) portal technique, outside-in (OI) technique, and modified transtibial (TT) technique can equally restore the normal knee joint laxity and ACL forces. Methods Eight fresh-frozen human cadaveric knee specimens were tested using a robotic testing system under an anterior tibial load (134 N) at 0°, 30°, 60°, and 90° of flexion and combined torques (10-N·m valgus and 5-N·m internal tibial torques) at 0° and 30° of flexion. Knee joint kinematics, ACL, and ACL graft forces were measured in each knee specimen under 5 different conditions (ACL-intact knee, ACL-deficient knee, ACL-reconstructed knee by AM portal technique, ACL-reconstructed knee by OI technique, and ACL-reconstructed knee by TT technique). Results Under anterior tibial load, no significant difference was observed between the 3 reconstructions in terms of restoring anterior tibial translation (P > .05). However, none of the 3 ACL reconstruction techniques could completely restore the normal anterior tibial translations (P <.05). Under combined tibial torques, both AM portal and OI techniques closely restored the normal knee anterior tibial translation (P > .05) at 0° of flexion but could not do so at 30° of flexion (P <.05). The ACL reconstruction by the TT technique was unable to restore normal anterior tibial translations at both 0° and 30° of flexion under combined tibial torques (P <.05). Forces experienced by the ACL grafts in the 3 reconstruction techniques were lower than those experienced by normal ACL under both the loading conditions. Conclusion Anterior cruciate ligament reconstructions by AM portal, OI, and modified TT techniques are biomechanically comparable with each other in restoring normal knee joint laxity and in situ ACL forces. Clinical Relevance Anterior cruciate ligament reconstructions by AM portal, OI, and modified TT techniques result in similar knee joint laxities. Technical perils and pearls should be carefully considered before choosing a tunnel creating technique. PMID:21908717

  14. No difference between mechanical perturbation training with compliant surface and manual perturbation training on knee functional performance after ACL rupture.

    PubMed

    Nawasreh, Zakariya; Logerstedt, David; Failla, Mathew; Snyder-Mackler, Lynn

    2017-10-27

    Manual perturbation training improves dynamic knee stability and functional performance after anterior cruciate ligament rupture (ACL-rupture). However, it is limited to static standing position and does not allow time-specific perturbations at different phase of functional activities. The purpose of this study was to investigate whether administering mechanical perturbation training including compliant surface provides effects similar to manual perturbation training on knee functional measures after an acute ACL-rupture. Sixteen level I/II athletes with ACL-ruptures participated in this preliminary study. Eight patients received mechanical (Mechanical) and eight subjects received manual perturbation training (Manual). All patients completed a functional testing (isometric quadriceps strength, single-legged hop tests) and patient-reported measures (Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS), Global Rating Score (GRS), International Knee Documentation Committee 2000 (IKDC 2000) at pre- and post-training. 2 × 2 ANOVA was used for data analysis. No significant group-by-time interactions were found for all measures (p > 0.18). Main effects of time were found for single hop (Pre-testing: 85.14% ± 21.07; Post-testing: 92.49% ± 17.55), triple hop (Pre-testing: 84.64% ± 14.17; Post-testing: 96.64% ± 11.14), KOS-ADLS (Pre-testing: 81.13% ± 11.12; Post-testing: 88.63% ± 12.63), GRS (Pre-testing: 68.63% ± 15.73; Post-testing: 78.81% ± 13.85), and IKDC 2000 (Pre-testing: 66.66% ± 9.85; Post-testing: 76.05% ± 14.62) (p < 0.032). Administering mechanical perturbation training using compliant surfaces induce effects similar to manual perturbation training on knee functional performance after acute ACL-rupture. The clinical significance is both modes of training improve patients' functional-performance and limb-to-limb movement symmetry, and enhancing the patients' self-reported of knee functional measures after ACL rupture. Mechanical perturbation that provides a compliant surface might be utilized as part of the ACL rehabilitation training. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  15. Simultaneous Reconstruction of the Anterior Cruciate Ligament and Medial Collateral Ligament in Patients With Chronic ACL-MCL Lesions: A Minimum 2-Year Follow-up Study.

    PubMed

    Zhang, Hangzhou; Sun, Yu; Han, Xiaorui; Wang, Yanfeng; Wang, Lin; Alquhali, Ali; Bai, Xizhuang

    2014-07-01

    In cases of chronic anterior cruciate ligament (ACL)-medial collateral ligament (MCL) lesions, nonoperative treatment of the MCL lesion may lead to chronic valgus instability and rotatory instability. The optimal management for patients who have combined ACL-MCL injuries remains controversial. To present a case series of 21 patients who underwent simultaneous ACL-MCL reconstruction with a 2- to 5-year follow-up. Case series; Level of evidence, 4. From October 2007 to December 2010, a total of 21 patients with chronic ACL-MCL injuries, for which the 2 ligaments were reconstructed during the same surgical procedure, were studied. All patients were available for follow-up for at least 2 years. The International Knee Documentation Committee (IKDC) subjective knee scores, valgus and sagittal stability, anteromedial rotatory stability, range of motion, and complications were assessed both preoperatively and postoperatively. At follow-up, valgus and sagittal laxity were not observed in any of the patients. The mean medial knee opening was significantly reduced to 0.80 ± 0.96 mm (range, -1.2 to 2.6 mm) postoperatively compared with 8.0 ± 1.3 mm (range, 6.1 to 10.7 mm) preoperatively (P < .01). The mean postoperative side-to-side difference measured with the KT-1000 arthrometer was reduced to 0.8 ± 0.9 mm (range, -1.2 to 2.3 mm) compared with 8.4 ± 1.6 mm (range, 6.2 to 13.2 mm) preoperatively (P < .01). Preoperative anteromedial instability was seen in 71% of patients (15/21), whereas none of the patients had anteromedial rotatory instability at the last follow-up. The mean IKDC subjective score improved overall from 45.3 ± 12.0 (range, 28.7-69.0) preoperatively to 87.7 ± 8.2 (range, 65.5-100.0) at the last follow-up (P < .01). Most patients (20/21) had normal or nearly normal range of motion of the knee joint; only 1 patient (5%) had a limitation of flexion of 15° compared with the contralateral knee at the last follow-up. In patients with chronic ACL-MCL lesions, simultaneous reconstruction of the ACL and MCL can significantly improve the medial, sagittal, and rotatory stability of the knee at short-term follow-up. © 2014 The Author(s).

  16. Knee-Extension Torque Variability and Subjective Knee Function in Patients with a History of Anterior Cruciate Ligament Reconstruction.

    PubMed

    Goetschius, John; Hart, Joseph M

    2016-01-01

    When returning to physical activity, patients with a history of anterior cruciate ligament reconstruction (ACL-R) often experience limitations in knee-joint function that may be due to chronic impairments in quadriceps motor control. Assessment of knee-extension torque variability may demonstrate underlying impairments in quadriceps motor control in patients with a history of ACL-R. To identify differences in maximal isometric knee-extension torque variability between knees that have undergone ACL-R and healthy knees and to determine the relationship between knee-extension torque variability and self-reported knee function in patients with a history of ACL-R. Descriptive laboratory study. Laboratory. A total of 53 individuals with primary, unilateral ACL-R (age = 23.4 ± 4.9 years, height = 1.7 ± 0.1 m, mass = 74.6 ± 14.8 kg) and 50 individuals with no history of substantial lower extremity injury or surgery who served as controls (age = 23.3 ± 4.4 years, height = 1.7 ± 0.1 m, mass = 67.4 ± 13.2 kg). Torque variability, strength, and central activation ratio (CAR) were calculated from 3-second maximal knee-extension contraction trials (90° of flexion) with a superimposed electrical stimulus. All participants completed the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and we determined the number of months after surgery. Group differences were assessed using independent-samples t tests. Correlation coefficients were calculated among torque variability, strength, CAR, months after surgery, and IKDC scores. Torque variability, strength, CAR, and months after surgery were regressed on IKDC scores using stepwise, multiple linear regression. Torque variability was greater and strength, CAR, and IKDC scores were lower in the ACL-R group than in the control group (P < .05). Torque variability and strength were correlated with IKDC scores (P < .05). Torque variability, strength, and CAR were correlated with each other (P < .05). Torque variability alone accounted for 14.3% of the variance in IKDC scores. The combination of torque variability and number of months after surgery accounted for 21% of the variance in IKDC scores. Strength and CAR were excluded from the regression model. Knee-extension torque variability was moderately associated with IKDC scores in patients with a history of ACL-R. Torque variability combined with months after surgery predicted 21% of the variance in IKDC scores in these patients.

  17. Quantitative In Situ Analysis of the Anterior Cruciate Ligament: Length, Midsubstance Cross-sectional Area, and Insertion Site Areas.

    PubMed

    Fujimaki, Yoshimasa; Thorhauer, Eric; Sasaki, Yusuke; Smolinski, Patrick; Tashman, Scott; Fu, Freddie H

    2016-01-01

    Quantification of the cross-sectional area (CSA) of the anterior cruciate ligament (ACL) in different loading conditions is important for understanding the native anatomy and thus achieving anatomic reconstruction. The ACL insertion sites are larger than the ACL midsubstance, and the isthmus (region of the smallest CSA) location may vary with the load or flexion angle. To (1) quantify the CSA along the entire ACL, (2) describe the location of the ACL isthmus, (3) explore the relationship between ACL length and CSA, and (4) validate magnetic resonance imaging (MRI) for assessing the CSA of the midsubstance ACL. Descriptive laboratory study. Eight cadaveric knees were dissected to expose the ACL and its attachments. Knees were positioned using a robotic loading system through a range of flexion angles in 3 loading states: (1) unloaded, (2) anterior tibial translation, and (3) combined rotational load of valgus and internal torque. Laser scanning quantified the shape of the ACL and its insertion site boundaries. The CSA of the ACL was measured, and the location of the isthmus was determined; the CSA of the ACL was also estimated from MRI and compared with the laser-scanned data. The CSA of the ACL varied along the ligament, and the isthmus existed at an average (±SD) of 53.8% ± 5.5% of the distance from the tibial insertion center to the femoral insertion center. The average CSA at the isthmus was smallest in extension (39.9 ± 13.7 mm(2)) and increased with flexion (43.9 ± 12.1 mm(2) at 90°). The ACL length was shortest at 90° of flexion and increased by 18.8% ± 10.1% in unloaded extension. Application of an anterior load increased the ACL length by 5.0% ± 3.3% in extension, and application of a combined rotational load increased its length by 4.1% ± 3.0% in extension. The ACL isthmus is located almost half of the distance between the insertion sites. The CSA of the ACL at the isthmus is largest with the knee unloaded and at 90° of flexion, and the area decreases with extension and applied loads. The CSA at the isthmus represents less than half the area of the insertion sites. These results may aid surgical planning, specifically for choosing a graft size and fixation angle that most closely matches the native anatomy and function across the entire range of knee motion. © 2015 The Author(s).

  18. Quantification of bone marrow water and lipid composition in anterior cruciate ligament-injured and osteoarthritic knees using three-dimensional magnetic resonance spectroscopic imaging.

    PubMed

    Tufts, Lauren S; Shet, Keerthi; Liang, Fei; Majumdar, Sharmila; Li, Xiaojuan

    2016-06-01

    To quantitatively evaluate longitudinal changes in water and lipid in knee bone marrow with and without bone marrow edema-like lesions (BMELs) in subjects with acutely ruptured anterior cruciate ligaments (ACLs) or osteoarthritis (OA) using three-dimensional magnetic resonance spectroscopic imaging (3D MRSI). Ten ACL and 10 OA subjects who presented with BMEL and seven BMEL-free controls were scanned at 3T. All ACL and OA subjects had one-year follow-up scans. 3D MRSI was acquired in BMEL and adjacent bone marrow, and water content (WC) and unsaturated lipid index (UI) were calculated in each region of interest. At baseline, ACL BMEL WC was significantly higher than ACL non-BMEL, OA BMEL, and control WC; ACL non-BMEL WC, ACL BMEL UI, and OA BMEL WC were significantly higher than control. ACL BMEL WC decreased significantly one year post-reconstruction; UI decreased non-significantly (p=0.09). No significant changes in OA BMEL or ACL and OA non-BMEL WC and UI were observed. 3D MRSI is a powerful method of quantitatively assessing the biochemical composition of bone marrow in OA and ACL-injured knees, which may serve as imaging markers to improve comprehension of primary and secondary OA pathology. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Vertical stiffness is not related to anterior cruciate ligament elongation in professional rugby union players.

    PubMed

    Serpell, Benjamin G; Scarvell, Jennie M; Pickering, Mark R; Ball, Nick B; Perriman, Diana; Warmenhoven, John; Smith, Paul N

    2016-01-01

    Novel research surrounding anterior cruciate ligament (ACL) injury is necessary because ACL injury rates have remained unchanged for several decades. An area of ACL risk mitigation which has not been well researched relates to vertical stiffness. The relationship between increased vertical stiffness and increased ground reaction force suggests that vertical stiffness may be related to ACL injury risk. However, given that increased dynamic knee joint stability has been shown to be associated with vertical stiffness, it is possible that modification of vertical stiffness could help to protect against injury. We aimed to determine whether vertical stiffness is related to measures known to load, or which represent loading of, the ACL. This was a cross-sectional observational study of 11 professional Australian rugby players. Knee kinematics and ACL elongation were measured from a 4-dimensional model of a hopping task which simulated the change of direction manoeuvre typically observed when non-contact ACL injury occurs. The model was generated from a CT scan of the participant's knee registered frame by frame to fluoroscopy images of the hopping task. Vertical stiffness was calculated from force plate data. There was no association found between vertical stiffness and anterior tibial translation (ATT) or ACL elongation (r=-0.05; p=0.89, and r=-0.07; p=0.83, respectively). ATT was related to ACL elongation (r=0.93; p=0.0001). Vertical stiffness was not associated with ACL loading in this cohort of elite rugby players but a novel method for measuring ACL elongation in vivo was found to have good construct validity.

  20. Bone-to-bone Fixation Enhances Functional Healing of the Porcine Anterior Cruciate Ligament Using a Collagen-Platelet Composite

    PubMed Central

    Murray, Martha M.; Magarian, Elise; Zurakowski, David; Fleming, Braden C.

    2010-01-01

    Purpose The purpose of this study was to determine if providing bony stabilization between the tibia and femur would improve the structural properties of an “enhanced” ACL repair using a collagen-platelet composite when compared to the traditional (Marshall) suture technique. Methods Twelve pigs underwent unilateral ACL transection and were treated with sutures connecting the bony femoral ACL attachment site to the distal ACL stump (LIGAMENT group), or to the tibia via a bone tunnel (TIBIA group). A collagen-platelet composite was placed around the sutures to enhance the biologic repair in both groups. Anteroposterior (AP) knee laxity and the graft structural properties were measured after 15 weeks of healing in both the ACL-repaired and contralateral ACL-intact joints. Results Enhanced ACL repair with bone-to-bone fixation significantly improved yield load and linear stiffness of the ACL repairs (p<0.05) after 15 weeks of healing. However, laxity values of the knees were similar in both groups of repaired knees (p>0.10). Conclusions Using an enhanced ACL suture repair technique that includes bone-to-bone fixation to protect the repair in the initial healing stages resulted in an ACL with improved structural properties after 15 weeks in the porcine model. Clinical Relevance The healing response of an ACL suture repair using a collagen-platelet composite can be enhanced by providing bony stabilization between the tibia and femur to protect the graft during the initial healing process in a translational model. PMID:20810092

  1. 50 CFR 648.123 - Scup accountability measures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... remainder of the period. (1) Commercial ACL overage evaluation. The commercial sector ACL will be evaluated... discards will be evaluated in determining if the commercial sector ACL has been exceeded. (2) Commercial... the commercial sector ACL is exceeded. Any current year landings in excess of the commercial quota in...

  2. 50 CFR 648.123 - Scup accountability measures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... remainder of the period. (1) Commercial ACL overage evaluation. The commercial sector ACL will be evaluated... discards will be evaluated in determining if the commercial sector ACL has been exceeded. (2) Commercial... the commercial sector ACL is exceeded. Any current year landings in excess of the commercial quota in...

  3. 50 CFR 648.103 - Summer flounder accountability measures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... sector ACL to be exceeded, or if the commercial fisheries in all states have been closed. The Regional... commercial fisheries in one or more states have been reopened without causing the sector ACL to be exceeded... in that state. (1) Commercial ACL overage evaluation. The commercial sector ACL will be evaluated...

  4. 50 CFR 648.103 - Minimum fish sizes.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... determines that the inaction of one or more states will cause the commercial sector ACL to be exceeded, or if... more states have been reopened without causing the sector ACL to be exceeded. (b) State commercial...) Commercial ACL overage evaluation. The commercial sector ACL will be evaluated based on a single-year...

  5. 50 CFR 648.55 - Framework adjustments to management measures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... establish OFL, ABC, ACL, ACT, DAS allocations, rotational area management programs, percentage allocations... measures will be adjusted. (c) OFL, ABC, ACL, ACT, and AMs. The Council shall specify OFL, ABC, ACL, ACT... derive specifications for ABC, ACL, and ACT, as specified in paragraphs (c)(2) through (c)(5) of this...

  6. 50 CFR 648.123 - Scup accountability measures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... remainder of the period. (1) Commercial ACL overage evaluation. The commercial sector ACL will be evaluated... discards will be evaluated in determining if the commercial sector ACL has been exceeded. (2) Commercial... the commercial sector ACL is exceeded. Any current year landings in excess of the commercial quota in...

  7. 50 CFR 648.55 - Framework adjustments to management measures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... establish OFL, ABC, ACL, ACT, DAS allocations, rotational area management programs, percentage allocations... measures will be adjusted. (c) OFL, ABC, ACL, ACT, and AMs. The Council shall specify OFL, ABC, ACL, ACT... derive specifications for ABC, ACL, and ACT, as specified in paragraphs (c)(2) through (c)(5) of this...

  8. 50 CFR 648.103 - Summer flounder accountability measures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... sector ACL to be exceeded, or if the commercial fisheries in all states have been closed. The Regional... commercial fisheries in one or more states have been reopened without causing the sector ACL to be exceeded... in that state. (1) Commercial ACL overage evaluation. The commercial sector ACL will be evaluated...

  9. 50 CFR 648.55 - Framework adjustments to management measures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... establish OFL, ABC, ACL, ACT, DAS allocations, rotational area management programs, percentage allocations... measures will be adjusted. (c) OFL, ABC, ACL, ACT, and AMs. The Council shall specify OFL, ABC, ACL, ACT... derive specifications for ABC, ACL, and ACT, as specified in paragraphs (c)(2) through (c)(5) of this...

  10. 50 CFR 648.55 - Framework adjustments to management measures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... establish OFL, ABC, ACL, ACT, DAS allocations, rotational area management programs, percentage allocations... measures will be adjusted. (c) OFL, ABC, ACL, ACT, and AMs. The Council shall specify OFL, ABC, ACL, ACT... derive specifications for ABC, ACL, and ACT, as specified in paragraphs (a)(2) through (5) of this...

  11. 50 CFR 648.103 - Summer flounder accountability measures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... sector ACL to be exceeded, or if the commercial fisheries in all states have been closed. The Regional... commercial fisheries in one or more states have been reopened without causing the sector ACL to be exceeded... in that state. (1) Commercial ACL overage evaluation. The commercial sector ACL will be evaluated...

  12. ACL reconstruction - discharge

    MedlinePlus

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

  13. Bio-enhanced repair of the anterior cruciate ligament

    PubMed Central

    Proffen, Benedikt L.; Sieker, Jakob T.; Murray, Martha

    2015-01-01

    Suture repair of the ACL has been widely abandoned in favor of ACL reconstruction, largely due to the high rates of failure and unreliability of the outcomes following suture repair. However, there have been recent basic science studies which suggest that combining a suture repair with a biologic adjunct may improve the results of suture repair of the ACL, with several studies in large animal models showing equivalent strength of an ACL treated with bio-enhanced repaired with that of an ACL graft at 3, 6 and 12 months after surgery. In addition, the groups treated with bio-enhanced repair had significantly less osteoarthritis when compared with the animals undergoing ACL reconstruction. These findings have led to a renewed interest in bio-enhanced primary repair as a way to make repair of the ACL a viable option for a select group of patients in the future. PMID:25595694

  14. Three-Dimensional Engineered Bone–Ligament–Bone Constructs for Anterior Cruciate Ligament Replacement

    PubMed Central

    Ma, Jinjin; Smietana, Michael J.; Kostrominova, Tatiana Y.; Wojtys, Edward M.; Larkin, Lisa M.

    2012-01-01

    The anterior cruciate ligament (ACL), a major stabilizer of the knee, is commonly injured. Because of its intrinsic poor healing ability, a torn ACL is usually reconstructed by a graft. We developed a multi-phasic, or bone–ligament–bone, tissue-engineered construct for ACL grafts using bone marrow stromal cells and sheep as a model system. After 6 months in vivo, the constructs increased in cross section and exhibited a well-organized microstructure, native bone integration, a functional enthesis, vascularization, innervation, increased collagen content, and structural alignment. The constructs increased in stiffness to 52% of the tangent modulus and 95% of the geometric stiffness of native ACL. The viscoelastic response of the explants was virtually indistinguishable from that of adult ACL. These results suggest that our constructs after implantation can obtain physiologically relevant structural and functional characteristics comparable to those of adult ACL. They present a viable option for ACL replacement. PMID:21902608

  15. 50 CFR 648.163 - Gear restrictions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Bluefish Accountability Measures (AMs). (a) ACL overage evaluation. The ACL will be evaluated based on a... be evaluated in determining if the ACL has been exceeded. (b) Commercial sector EEZ closure. NMFS... inaction of one or more states will cause the ACL specified in § 648.160(a) to be exceeded, or if the...

  16. Anticardiolipin antibodies in patients from Malaysia with systemic lupus erythematosus.

    PubMed

    Jones, H W; Ireland, R; Senaldi, G; Wang, F; Khamashta, M; Bellingham, A J; Veerapan, K; Hughes, G R; Vergani, D

    1991-03-01

    Systemic lupus erythematosus (SLE) is highly prevalent in Malaysia, which has a mixed population of Malays, Chinese, and Indians. A quantitative enzyme linked immunosorbent assay (ELISA) was used to determine anticardiolipin antibody (aCL) levels (total immunoglobulin, IgG, and IgM) in 200 patients with SLE (164 Chinese, 26 Malay, and 10 Indian) attending the University Hospital of Kuala Lumpur, Malaysia, and 103 matched controls. Only 33 (16.5%) of the patients had raised aCL levels; 26 had raised IgG aCL, five IgM aCL, and two both IgG and IgM aCL. There was a low prevalence of raised levels of aCL in the population studied, which was seen in conjunction with a rare occurrence of thrombosis. The classical association of high aCL levels with thrombocytopenia and recurrent abortions was noted, though not with cerebral disease. The low prevalence of aCL in this study population of mixed racial origin contrasts with findings in European patients with SLE and lends support to the influence of local factors, be they genetic or environmental, on the clinical manifestations of this disease.

  17. The common mechanisms of anterior cruciate ligament injuries in judo: a retrospective analysis.

    PubMed

    Koshida, S; Deguchi, T; Miyashita, K; Iwai, K; Urabe, Y

    2010-09-01

    Although high prevalence of anterior cruciate ligament injuries (ACL) in judokas has been reported, there has been very little research concerning events preceding the injury. To determine the common situations and mechanisms of ACL injury in judo. A total of 43 cases of ACL injuries that had occurred during judo competition or practice were investigated, using questionnaires with interviews conducted by a single certified athletic trainer who has 20 years of judo experience to obtain information regarding the situation and mechanism in which the ACL injury occurred. The number of ACL injuries when the participant's grip style was different from the style of the opponent (ie, kenka-yotsu style) (28 cases) was significantly greater than when the participant's grip style was the same as that of the opponent (ie, ai-yotsu style) (15 cases; p<0.001). The number of ACL injuries was significantly higher when the participant was attacked by the opponent than when counterattacked or when attempting the attack (p<0.001). In addition, being attacked with osoto-gari was revealed as the leading cause of ACL injury incidence among the participants (16.8%). Grip style may be associated with ACL injury occurrence in judo. In addition, direct contact due to the opponent's attack may be a common mechanism for ACL injuries in judo.

  18. Biologic Approaches for the Treatment of Partial Tears of the Anterior Cruciate Ligament

    PubMed Central

    Dallo, Ignacio; Chahla, Jorge; Mitchell, Justin J.; Pascual-Garrido, Cecilia; Feagin, John A.; LaPrade, Robert F.

    2017-01-01

    Background: Anterior cruciate ligament reconstruction (ACLR) has been established as the gold standard for treatment of complete ruptures of the anterior cruciate ligament (ACL) in active, symptomatic individuals. In contrast, treatment of partial tears of the ACL remains controversial. Biologically augmented ACL-repair techniques are expanding in an attempt to regenerate and improve healing and outcomes of both the native ACL and the reconstructed graft tissue. Purpose: To review the biologic treatment options for partial tears of the ACL. Study Design: Review. Methods: A literature review was performed that included searches of PubMed, Medline, and Cochrane databases using the following keywords: partial tear of the ACL, ACL repair, bone marrow concentrate, growth factors/healing enhancement, platelet-rich plasma (PRP), stem cell therapy. Results: The use of novel biologic ACL repair techniques, including growth factors, PRP, stem cells, and bioscaffolds, have been reported to result in promising preclinical and short-term clinical outcomes. Conclusion: The potential benefits of these biological augmentation approaches for partial ACL tears are improved healing, better proprioception, and a faster return to sport and activities of daily living when compared with standard reconstruction procedures. However, long-term studies with larger cohorts of patients and with technique validation are necessary to assess the real effect of these approaches. PMID:28210653

  19. The Effectiveness of a Functional Knee Brace on Joint-Position Sense in Anterior Cruciate Ligament-Reconstructed Individuals.

    PubMed

    Sugimoto, Dai; LeBlanc, Jessica C; Wooley, Sarah E; Micheli, Lyle J; Kramer, Dennis E

    2016-05-01

    It is estimated that approximately 350,000 individuals undergo anterior cruciate ligament (ACL) reconstruction surgery in each year in the US. Although ACL-reconstruction surgery and postoperative rehabilitation are successfully completed, deficits in postural control remain prevalent in ACL-reconstructed individuals. In order to assist the lack of balance ability and reduce the risk of retear of the reconstructed ACL, physicians often provide a functional knee brace on the patients' return to physical activity. However, it is not known whether use of the functional knee brace enhances knee-joint position sense in individuals with ACL reconstruction. Thus, the effect of a functional knee brace on knee-joint position sense in an ACL-reconstructed population needs be critically appraised. After systematically review of previously published literature, 3 studies that investigated the effect of a functional knee brace in ACL-reconstructed individuals using joint-position-sense measures were found. They were rated as level 2b evidence in the Centre of Evidence Based Medicine Level of Evidence chart. Synthesis of the reviewed studies indicated inconsistent evidence of a functional knee brace on joint-position improvement after ACL reconstruction. More research is needed to provide sufficient evidence on the effect of a functional knee brace on joint-position sense after ACL reconstruction. Future studies need to measure joint-position sense in closed-kinetic-chain fashion since ACL injury usually occurs under weight-bearing conditions.

  20. Anterior cruciate ligament injury about 20 years post-treatment: A kinematic analysis of one-leg hop.

    PubMed

    Tengman, E; Grip, H; Stensdotter, Ak; Häger, C K

    2015-12-01

    Reduced dynamic knee stability, often evaluated with one-leg hops (OLHs), is reported after anterior cruciate ligament (ACL) injury. This may lead to long-standing altered movement patterns, which are less investigated. 3D kinematics during OLH were explored in 70 persons 23 ± 2 years after ACL injury; 33 were treated with physiotherapy in combination with ACL reconstruction (ACL(R)) and 37 with physiotherapy alone (ACL(PT)). Comparisons were made to 33 matched controls. We analyzed (a) maximal knee joint angles and range of motion (flexion, abduction, rotation); (b) medio-lateral position of the center of mass (COM) in relation to knee and ankle joint centers, during take-off and landing phases. Unlike controls, ACL-injured displayed leg asymmetries: less knee flexion and less internal rotation at take-off and landing and more lateral COM related to knee and ankle joint of the injured leg at landing. Compared to controls, ACL(R) had larger external rotation of the injured leg at landing. ACL(PT) showed less knee flexion and larger external rotation at take-off and landing, and larger knee abduction at Landing. COM was more medial in relation to the knee at take-off and less laterally placed relative to the ankle at landing. ACL injury results in long-term kinematic alterations during OLH, which are less evident for ACL(R). © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  1. Histological Analysis of the Tibial Anterior Cruciate Ligament Insertion

    PubMed Central

    Siebold, Rainer; Oka, Shinya; Traut, Ulrike; Schuhmacher, Peter; Kirsch, Joachim

    2017-01-01

    Objective: To describe the morphology of the tibial ACL insertion by histological assessment in the sagittal plane. Methods: For histology the native (undissected) tibial ACL insertion of 6 fresh-frozen cadaveric knees was cut into 4 sagittal sections parallel to the long axis of the medial tibial spine. The slices were stained with hematoxylin and eosin, Safranin O and Russell-Movat pentachrome. All slices were digitalized and analyzed at a magnification of ×20. Results: From medial to lateral the anterior-posterior lengths of the ACL insertion were an average of 10.2, 9.3, 7.6 and 5.8 mm. The anterior margin of the tibial ACL insertion raised from an anterior ridge. The most medial ACL fibers rose along with a peak of the anterior part of the medial tibial spine in which the direct insertion was adjacent to the articular cartilage. Parts of the bony insertions of the anterior and posterior horns of the lateral meniscus were in close contact to the lateral ACL insertion. A small fat pad was located just posterior to the tibial ACL insertion. There were no central or posterolateral inserting ACL fibers in the area intercondylaris anterior. Conclusion: The functional intraligamentous midsubstance ACL fibers arose from the most posterior part of its bony tibial insertion in a flat and “C-shape” way. The anterior border of this functional ACL started from a bony ‘anterior ridge’ and the medial border was along with a peak of the medial tibial spine.

  2. Diagnostic value of medical history and physical examination of anterior cruciate ligament injury: comparison between primary care physician and orthopaedic surgeon.

    PubMed

    Geraets, Stijn E W; Meuffels, Duncan E; van Meer, Belle L; Breedveldt Boer, Hans P; Bierma-Zeinstra, Sita M A; Reijman, Max

    2015-04-01

    Well-designed validity studies on the clinical diagnosis of anterior cruciate ligament (ACL) injury are scarce. Our purpose is to assess the diagnostic value of ACL-specific medical history assessment and physical examination between primary and secondary care medical specialists. Medical history assessment and physical examination were performed by both an orthopaedic surgeon and a primary care physician, both blinded to all clinical information, in a secondary care population. A knee arthroscopy was used as reference standard. A total of 60 participants were divided into an index group with an arthroscopically proven complete ACL rupture and a control group with an arthroscopically proven intact ACL. The orthopaedic surgeon recognized 94 % of the participants with an ACL rupture through a positive medical history combined with a positive physical examination; of the participants with an intact ACL, 16 % were misclassified by the orthopaedic surgeon. The primary care physician recognized 62 % of the participants with an ACL rupture and misclassified 23 % of the participants with an intact ACL. Physical examination appeared to have no additional value for the primary care physician. Combined medical history and physical examination have strong diagnostic value in ACL rupture diagnostics performed by an orthopaedic surgeon, whereas for the primary care physician, only medical history appeared to be of value. For current practice, this could mean that only orthopaedic surgeons can perform an ACL physical examination with accuracy. III.

  3. Risk Factors for Anterior Cruciate Ligament Injury in Competitive Adolescent Alpine Skiers

    PubMed Central

    Westin, Maria; Harringe, Marita L.; Engström, Björn; Alricsson, Marie; Werner, Suzanne

    2018-01-01

    Background: There is a high risk for anterior cruciate ligament (ACL) injuries in alpine skiers. To reduce or try to prevent these injuries, intrinsic and extrinsic risk factors need to be identified. Purpose: To identify possible intrinsic and extrinsic ACL injury risk factors among competitive adolescent alpine skiers. Study Design: Case-control study; Level of evidence, 3. Methods: Between 2006 and 2009, a cohort of 339 alpine ski students (176 male, 163 female) from Swedish ski high schools were prospectively observed in terms of ACL injuries. First-time ACL injuries were recorded. In September, prior to each ski season, the skiers were clinically examined according to a specific knee protocol. Results: Overall, 11 male and 14 female skiers sustained a total of 25 first-episode ACL injuries. The majority of injuries occurred in the left knee (P < .05). Skiers who had participated in alpine skiing for >13 years (hazard ratio, 0.83; 95% CI, 0.68-1.00; P < .05) had a reduced risk of sustaining an ACL injury. Eighteen ACL injuries occurred during training, 12 in the technical discipline of giant slalom, and 8 in slalom. Fourteen skiers reported not to be fatigued at all at the time of injury, and 8 skiers reported that they were somewhat fatigued. Conclusion: ACL injuries occurred more often in the left knee than the right. This should be taken into consideration in the design of ACL injury prevention programs. Those who reported a higher number of active years in alpine skiing showed a reduced risk of sustaining an ACL injury. No other factor among those studied could be identified as an independent risk factor for ACL injury. PMID:29780835

  4. Vertical stiffness is not related to anterior cruciate ligament elongation in professional rugby union players

    PubMed Central

    Serpell, Benjamin G; Scarvell, Jennie M; Pickering, Mark R; Ball, Nick B; Perriman, Diana; Warmenhoven, John; Smith, Paul N

    2016-01-01

    Background Novel research surrounding anterior cruciate ligament (ACL) injury is necessary because ACL injury rates have remained unchanged for several decades. An area of ACL risk mitigation which has not been well researched relates to vertical stiffness. The relationship between increased vertical stiffness and increased ground reaction force suggests that vertical stiffness may be related to ACL injury risk. However, given that increased dynamic knee joint stability has been shown to be associated with vertical stiffness, it is possible that modification of vertical stiffness could help to protect against injury. We aimed to determine whether vertical stiffness is related to measures known to load, or which represent loading of, the ACL. Methods This was a cross-sectional observational study of 11 professional Australian rugby players. Knee kinematics and ACL elongation were measured from a 4-dimensional model of a hopping task which simulated the change of direction manoeuvre typically observed when non-contact ACL injury occurs. The model was generated from a CT scan of the participant's knee registered frame by frame to fluoroscopy images of the hopping task. Vertical stiffness was calculated from force plate data. Results There was no association found between vertical stiffness and anterior tibial translation (ATT) or ACL elongation (r=−0.05; p=0.89, and r=−0.07; p=0.83, respectively). ATT was related to ACL elongation (r=0.93; p=0.0001). Conclusions Vertical stiffness was not associated with ACL loading in this cohort of elite rugby players but a novel method for measuring ACL elongation in vivo was found to have good construct validity. PMID:27900192

  5. Quantitative comparison of the pivot shift test results before and after anterior cruciate ligament reconstruction by using the three-dimensional electromagnetic measurement system.

    PubMed

    Nagai, Kanto; Hoshino, Yuichi; Nishizawa, Yuichiro; Araki, Daisuke; Matsushita, Takehiko; Matsumoto, Tomoyuki; Takayama, Koji; Nagamune, Kouki; Kurosaka, Masahiro; Kuroda, Ryosuke

    2015-10-01

    Tibial acceleration during the pivot shift test is a potential quantitative parameter to evaluate rotational laxity of anterior cruciate ligament (ACL) insufficiency. However, clinical application of this measurement has not been fully examined. This study aimed to measure and compare tibial acceleration before and after ACL reconstruction (ACLR) in ACL-injured patients. We hypothesized tibial acceleration would be reduced by ACLR and tibial acceleration would be consistent in the same knee at different time points. Seventy ACL-injured patients who underwent ACLR were enrolled. Tibial acceleration during the pivot shift test was measured using an electromagnetic measurement system before ALCR and at the second-look arthroscopy 1 year post-operatively. Tibial acceleration was compared to clinical grading and between ACL-injured/ACL-reconstructed and contralateral knees. Pre-operative tibial acceleration was increased stepwise with the increase in clinical grading (P < 0.01). Tibial acceleration in ACL-injured knee (1.9 ± 1.2 m/s(2)) was larger than that in the contralateral knee (0.8 ± 0.3 m/s(2), P < 0.01), and reduced to 0.9 ± 0.3 m/s(2) post-operatively (P < 0.01). There was no difference between ACL-reconstructed and contralateral knee (n.s.). Tibial acceleration in contralateral knees was consistent pre- and post-operatively (n.s.). Tibial acceleration measurement demonstrated increased rotational laxity in ACL-injured knees and its reduction by ALCR. Additionally, consistent measurements were obtained in ACL-intact knees at different time points. Therefore, tibial acceleration during the pivot shift test could provide quantitative evaluation of rotational stability before and after ACL reconstruction. III.

  6. The Cost-Effectiveness of Anterior Cruciate Ligament Reconstruction in Competitive Athletes.

    PubMed

    Stewart, Bruce A; Momaya, Amit M; Silverstein, Marc D; Lintner, David

    2017-01-01

    Competitive athletes value the ability to return to competitive play after the treatment of anterior cruciate ligament (ACL) injuries. ACL reconstruction has high success rates for return to play, but some studies indicate that patients may do well with nonoperative physical therapy treatment. To evaluate the cost-effectiveness of the treatment of acute ACL tears with either initial surgical reconstruction or physical therapy in competitive athletes. Economic and decision analysis; Level of evidence, 2. The incremental cost, incremental effectiveness, and incremental cost-effectiveness ratio (ICER) of ACL reconstruction compared with physical therapy were calculated from a cost-effectiveness analysis of ACL reconstruction compared with physical therapy for the initial management of acute ACL injuries in competitive athletes. The ACL reconstruction strategy and the physical therapy strategy were represented as Markov models. Costs and quality-adjusted life-years (QALYs) were evaluated over a 6-year time horizon and were analyzed from a societal perspective. Quality of life and probabilities of clinical outcomes were obtained from the peer-reviewed literature, and costs were compiled from a large academic hospital in the United States. One-way, 2-way, and probabilistic sensitivity analyses were used to assess the effect of uncertainty in variables on the ICER of ACL reconstruction. The ICER of ACL reconstruction compared with physical therapy was $22,702 per QALY gained. The ICER was most sensitive to the quality of life of returning to play or not returning to play, costs, and duration of follow-up but relatively insensitive to the rates and costs of complications, probabilities of return to play for both operative and nonoperative treatments, and discount rate. ACL reconstruction is a cost-effective strategy for competitive athletes with an ACL injury.

  7. Tibiofemoral joint contact area and pressure after single- and double-bundle anterior cruciate ligament reconstruction.

    PubMed

    Morimoto, Yusuke; Ferretti, Mario; Ekdahl, Max; Smolinski, Patrick; Fu, Freddie H

    2009-01-01

    The purpose of this study was to compare the tibiofemoral contact area and pressure after single-bundle (SB) and double-bundle (DB) anterior cruciate ligament (ACL) reconstruction by use of 2 femoral and 2 tibial tunnels in intact cadaveric knees. Tibiofemoral contact area and mean and maximum pressures were measured by pressure-sensitive film (Fujifilm, Valhalla, NY) inserted between the tibia and femur. The knee was subjected to a 1,000-N axial load by use of a uniaxial testing machine at 0 degrees , 15 degrees , 30 degrees , and 45 degrees of flexion. Three conditions were evaluated: (1) intact ACL, (2) SB ACL reconstruction (n = 10 knees), and (3) DB ACL reconstruction (n = 9 knees). When compared with the intact knee, DB ACL reconstruction showed no significant difference in tibiofemoral contact area and mean and maximum pressures. SB ACL reconstruction had a significantly smaller contact area on the lateral and medial tibiofemoral joints at 30 degrees and 15 degrees of flexion. SB ACL reconstruction also had significantly higher mean pressures at 15 degrees of flexion on the medial tibiofemoral joint and at 0 degrees and 15 degrees of flexion on the lateral tibiofemoral joint, as well as significantly higher maximum pressures at 15 degrees of flexion on the lateral tibiofemoral joint. SB ACL reconstruction resulted in a significantly smaller tibiofemoral contact area and higher pressures. DB ACL more closely restores the normal contact area and pressure mainly at low flexion angles. Our findings suggest that the changes in the contact area and pressures after SB ACL reconstruction may be one of the causes of osteoarthritis on long-term follow-up. DB ACL reconstruction may reduce the incidence of osteoarthritis by closely restoring contact area and pressure.

  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. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  9. 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

  10. Biologic agents for anterior cruciate ligament healing: A systematic review

    PubMed Central

    Di Matteo, Berardo; Loibl, Markus; Andriolo, Luca; Filardo, Giuseppe; Zellner, Johannes; Koch, Matthias; Angele, Peter

    2016-01-01

    AIM To systematically review the currently available literature concerning the application of biologic agents such as platelet-rich plasma (PRP) and stem cells to promote anterior cruciate ligament (ACL) healing. METHODS A systematic review of the literature was performed on the use of biologic agents (i.e., PRP or stem cells) to favor ACL healing during reconstruction or repair. The following inclusion criteria for relevant articles were used: Clinical reports of any level of evidence, written in English language, on the use of PRP or stem cells during ACL reconstruction/repair. Exclusion criteria were articles written in other languages, reviews, or studies analyzing other applications of PRP/stem cells in knee surgery not related to promoting ACL healing. RESULTS The database search identified 394 records that were screened. A total of 23 studies were included in the final analysis: In one paper stem cells were applied for ACL healing, in one paper there was a concomitant application of PRP and stem cells, whereas in the remaining 21 papers PRP was used. Based on the ACL injury pattern, two papers investigated biologic agents in ACL partial tears whereas 21 papers in ACL reconstruction. Looking at the quality of the available literature, 17 out of 21 studies dealing with ACL reconstruction were randomized controlled trials. Both studies on ACL repair were case series. CONCLUSION There is a paucity of clinical trials investigating the role of stem cells in promoting ACL healing both in case of partial and complete tears. The role of PRP is still controversial and the only advantage emerging from the literature is related to a better graft maturation over time, without documenting beneficial effects in terms of clinical outcome, bone-graft integration and prevention of bony tunnel enlargement. PMID:27672573

  11. Increased platelet concentration does not improve functional graft healing in bio-enhanced ACL reconstruction.

    PubMed

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

    2015-04-01

    The use of an extracellular matrix scaffold (ECM) combined with platelets to enhance healing of an anterior cruciate ligament (ACL) graft ("bio-enhanced ACL reconstruction") has shown promise in animal models. However, the effects of platelet concentration on graft healing remain unknown. The objectives of this study were to determine whether increasing the platelet concentration in the ECM scaffold would (1) improve the graft biomechanical properties and (2) decrease cartilage damage after surgery. Fifty-five adolescent minipigs were randomized to five treatment groups: untreated ACL transection (n = 10), conventional ACL reconstruction (n = 15) and bio-enhanced ACL reconstruction using 1× (n = 10), 3× (n = 10) or 5× (n = 10) platelet-rich plasma. The graft biomechanical properties, anteroposterior (AP) knee laxity, graft histology and macroscopic cartilage integrity were measured at 15 weeks. The mean linear stiffness of the bio-enhanced ACL reconstruction procedure using the 1× preparation was significantly greater than traditional reconstruction, while the 3× and 5× 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. Only the 1× platelet concentration improved healing over traditional ACL reconstruction. Increasing the platelet concentration from 1× to 5× 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.

  12. MRI signal intensity of anterior cruciate ligament graft after transtibial versus anteromedial portal technique (TRANSIG): design of a randomized controlled clinical trial.

    PubMed

    Ruiter, Simeon J S; Brouwer, Reinoud W; Meys, Tim W G M; Slump, Cornelis H; van Raay, Jos J A M

    2016-08-10

    There are two primary surgical techniques to reconstruct the anterior cruciate ligament (ACL), transtibial (TT) technique and anteromedial portal (AMP) technique. Currently, there is no consensus which surgical technique elicits the best clinical and functional outcomes. MRI-derived measures of the signal intensity (SI) of the ACL graft have been described as an independent predictor of graft properties. The purpose of this study is to compare the MRI derived SI measurements of the ACL graft one year after ACL reconstruction, in order to compare the outcomes of both the AMP and TT ACL reconstruction technique. Thirty-six patients will be included in a randomized controlled trial. Patients who are admitted for primary unilateral ACL reconstruction will be included in the study. Exclusion criteria are a history of previous surgery on the ipsilateral knee, re-rupture of the ipsilateral ACL graft, associated ligamentous injuries or meniscal tear of the ipsilateral knee, unhealthy contralateral knee, contra-indications for MRI and a preference for one of the two surgical techniques and/or orthopaedic surgeon. Primary outcome is MRI Signal intensity ratio (SIR) of the ACL graft. Secondary outcome measures are the International Knee Documentation Committee (IKDC) Knee Examination Form,the Knee injury and Osteoarthritis Outcome Scores (KOOS) and the Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS). Differences between MRI SIR assessment with the current MRI protocol (proton density weighted imaging protocol) and the additional T2*-weighted gradient-echo protocol will be assessed. There is no consensus regarding the TT or AMP ACL reconstruction technique. SI measurements with MRI have been used in other clinical studies for evaluation of the ACL graft and maturation after ACL reconstruction compared to clinical and functional outcomes. This randomized controlled trial has been designed to compare the TT technique with the AMP technique with the use of MRI SI of the graft after ACL reconstruction. Netherlands Trial Registry NTR5410 (registered on August 24, 2015).

  13. Differences in kinematics of single leg squatting between anterior cruciate ligament-injured patients and healthy controls.

    PubMed

    Yamazaki, J; Muneta, T; Ju, Y J; Sekiya, I

    2010-01-01

    Seventy to eighty percent of all anterior cruciate ligament (ACL) injuries are due to non-contact injury mechanisms. It has been reported that the majority of injuries due to single leg landing come from valgus positioning of the lower leg. Preventing valgus positioning during single leg landing is expected to help reduce the number of ACL injuries. We found that many ACL-deficient patients cannot perform stable single leg squatting. Therefore, we performed 3D motion analysis of the single-legged half squat for ACL-injured patients to evaluate its significance as a risk factor for ACL injuries. We evaluated the relative angles between the body, thigh, and lower leg using an electromagnetic device during single leg half squatting performed by 63 ACL-injured patients (32 males, 31 females) the day before ACL reconstruction and by 26 healthy control subjects with no knee problems. The uninjured leg of ACL-injured male subjects demonstrated significantly less external knee rotation than that of the dominant leg of the male control. The uninjured leg of ACL-injured female subjects demonstrated significantly more external hip rotation and knee flexion and less hip flexion than that of the dominant leg of the female control. Comparing injured and uninjured legs, the injured leg of male subjects demonstrated significantly less external knee and hip rotation, less knee flexion, and more knee varus than that of the uninjured leg of male subjects. The injured leg of female subjects demonstrated more knee varus than that of the uninjured leg of female subjects. Regarding gender differences, female subjects demonstrated significantly more external hip rotation and knee valgus than male subjects did in both the injured and uninjured legs (P < 0.05). The current kinematic study exhibited biomechanical characteristics of female ACL-injured subjects compared with that of control groups. Kinematic correction during single leg half squat would reduce ACL reinjury in female ACL-injured subjects.

  14. Restricted Hip Rotation Is Correlated With an Increased Risk for Anterior Cruciate Ligament Injury.

    PubMed

    VandenBerg, Curtis; Crawford, Eileen A; Sibilsky Enselman, Elizabeth; Robbins, Christopher B; Wojtys, Edward M; Bedi, Asheesh

    2017-02-01

    The primary purpose was to compare ipsilateral hip internal rotation (IR) in male and female athletes with or without an anterior cruciate ligament (ACL) tear. A secondary purpose was to compare radiographic markers of femoroacetabular impingement (FAI) in patients with or without an ACL tear. In this prospective case-control study, based on a power analysis, a convenience sample of 25 ACL-injured and 25 control patients matched by age and gender were examined over 14 months. The ACL injury group included preoperative patients 12-40 years old with an ACL rupture within the previous 3 months with no prior lower extremity injuries, ligamentous laxity, or arthralgias. Controls included patients presenting with an upper extremity complaint with no history of knee injury. In the outpatient clinic, hip axial rotation range of motion was measured with a goniometer on physical examination and hip radiographs were evaluated for morphologic variations consistent with FAI. Univariate analysis of variance was used to examine differences between groups. Each group had 13 males and 12 females, average ages of 22.8 ± 7.2 years (ACL group) versus 24.5 ± 7.9 years (controls; P = .439). The average sum of hip rotation (internal plus external) in patients with an ACL tear was 60.3 ± 12.4° compared with 72.6 ± 17.2° in controls (P = .006). ACL-injured patients had decreased hip IR compared with controls, with respective mean measurements of 23.4 ± 7.6° versus 30.4 ± 10.4° (P = .009). For every 10° increase in hip IR, the odds of having an ACL tear decreased by a factor of 0.419 (P = .015). Risk of ACL injury is associated with restricted hip IR, and as hip IR increases, the odds of having an ACL tear decreases. In addition, ACL injury is associated with FAI in a generalized population of male and female athletes, although causality cannot be determined and most ACL-injured patients do not exhibit hip complaints. Level II, prognostic, prospective cohort study. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  15. Addition of autologous mesenchymal stem cells to whole blood for bioenhanced ACL repair has no benefit in the porcine model.

    PubMed

    Proffen, Benedikt L; Vavken, Patrick; Haslauer, Carla M; Fleming, Braden C; Harris, Chad E; Machan, Jason T; Murray, Martha M

    2015-02-01

    Coculture 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 bioenhanced ACL repair in animal studies involve adding a biologic scaffold, in this case an extracellular matrix-based scaffold saturated with autologous whole blood, to a simple suture repair of the ligament. Whether the enrichment of whole blood with MSCs would further improve the in vivo results of bioenhanced ACL repair was investigated. The addition of MSCs derived from adipose tissue or peripheral blood to the blood-extracellular matrix composite, which is used in bioenhanced ACL repair to stimulate healing, would improve the biomechanical properties of a bioenhanced ACL repair after 15 weeks of healing. Controlled laboratory study. Twenty-four adolescent Yucatan mini-pigs underwent ACL transection followed by (1) bioenhanced ACL repair, (2) bioenhanced ACL repair with the addition of autologous adipose-derived MSCs, and (3) bioenhanced ACL repair with the addition of autologous peripheral blood derived MSCs. After 15 weeks of healing, the structural properties of the ACL (yield load, failure load, and linear stiffness) were measured. Cell and vascular density were measured in the repaired ACL via histology, and its tissue structure was qualitatively evaluated using the advanced Ligament Maturity Index. After 15 weeks of healing, there were no significant improvements in the biomechanical or histological properties with the addition of adipose-derived MSCs. The only significant change with the addition of peripheral blood MSCs was an increase in knee anteroposterior laxity when measured at 30° of flexion. These findings suggest that the addition of adipose or peripheral blood MSCs to whole blood before saturation of an extracellular matrix carrier with the blood did not improve the functional results of bioenhanced ACL repair after 15 weeks of healing in the pig model. Whole blood represents a practical biologic additive to ligament repair, and any other additive (including stem cells) should be demonstrated to be superior to this baseline before clinical use is considered. © 2014 The Author(s).

  16. Translation and cross-cultural adaptation of the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale into Turkish.

    PubMed

    Harput, Gulcan; Tok, Damla; Ulusoy, Burak; Eraslan, Leyla; Yildiz, Taha Ibrahim; Turgut, Elif; Demirci, Serdar; Duzgun, Irem; Tunay, Volga Bayrakci; Baltaci, Gul; Ergun, Nevin

    2017-01-01

    To translate and culturally adapt the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale into Turkish (ACL-RSI-Tr) and examine and evaluate the psychometric properties of the Turkish version in individuals who have undergone anterior cruciate ligament (ACL) reconstruction. The ACL-RSI was forward- and back-translated, culturally adapted and validated on ninety-three Turkish individuals who had undergone ACL reconstruction (5 females, 88 males; age 28.7 ± 8.6 years; body mass 80.1 ± 13.9 kg; height 178.8 ± 6.9 cm; body mass index 25.0 ± 3.7 kg/m 2 ). All patients completed the translated ACL-RSI, Tampa Scale of Kinesiophobia (TSK), Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentary Committee (IKDC) and Lysholm questionnaires. We then analysed the internal consistency, reliability and validity of the newly formed ACL-RSI-Tr scale. The ACL-RSI-Tr showed good internal consistency (Cronbach's alpha 0.86) and test-retest reliability (ICC 0.92) and was significantly correlated with the KOOS 'quality of life' (r = 0.58, p < 0.002), 'symptoms and stiffness' (r = 0.35, p = 0.001), 'pain' (r = 0.49, p < 0.001), 'sports' (r = 0.44, p < 0.001) and 'daily life' (r = 0.42, p < 0.001) subscales. The ACL-RSI-Tr also correlated significantly with the TSK (r = - 0.45, p < 0.001), Lysholm (r = 0.45, p < 0.001) and IKDC (r = 0.44, p < 0.001) scores. The Turkish version of the ACL-RSI scale was valid, discriminant, consistent and reliable in patients who had undergone ACL reconstruction. This score could be useful to evaluate the effect of psychological factors on return to sport following ACL surgery. Diagnostic study, Level I.

  17. Strain Response of the Anterior Cruciate Ligament to Uniplanar and Multiplanar Loads During Simulated Landings: Implications for Injury Mechanism.

    PubMed

    Kiapour, Ata M; Demetropoulos, Constantine K; Kiapour, Ali; Quatman, Carmen E; Wordeman, Samuel C; Goel, Vijay K; Hewett, Timothy E

    2016-08-01

    Despite basic characterization of the loading factors that strain the anterior cruciate ligament (ACL), the interrelationship(s) and additive nature of these loads that occur during noncontact ACL injuries remain incompletely characterized. In the presence of an impulsive axial compression, simulating vertical ground-reaction force during landing (1) both knee abduction and internal tibial rotation moments would result in increased peak ACL strain, and (2) a combined multiplanar loading condition, including both knee abduction and internal tibial rotation moments, would increase the peak ACL strain to levels greater than those under uniplanar loading modes alone. Controlled laboratory study. A cadaveric model of landing was used to simulate dynamic landings during a jump in 17 cadaveric lower extremities (age, 45 ± 7 years; 9 female and 8 male). Peak ACL strain was measured in situ and characterized under impulsive axial compression and simulated muscle forces (baseline) followed by addition of anterior tibial shear, knee abduction, and internal tibial rotation loads in both uni- and multiplanar modes, simulating a broad range of landing conditions. The associations between knee rotational kinematics and peak ACL strain levels were further investigated to determine the potential noncontact injury mechanism. Externally applied loads, under both uni- and multiplanar conditions, resulted in consistent increases in peak ACL strain compared with the baseline during simulated landings (by up to 3.5-fold; P ≤ .032). Combined multiplanar loading resulted in the greatest increases in peak ACL strain (P < .001). Degrees of knee abduction rotation (R(2) = 0.45; β = 0.42) and internal tibial rotation (R(2) = 0.32; β = 0.23) were both significantly correlated with peak ACL strain (P < .001). However, changes in knee abduction rotation had a significantly greater effect size on peak ACL strain levels than did internal tibial rotation (by ~2-fold; P < .001). In the presence of impulsive axial compression, the combination of anterior tibial shear force, knee abduction, and internal tibial rotation moments significantly increases ACL strain, which could result in ACL failure. These findings support multiplanar knee valgus collapse as one the primary mechanisms of noncontact ACL injuries during landing. Intervention programs that address multiple planes of loading may decrease the risk of ACL injury and the devastating consequences of posttraumatic knee osteoarthritis. © 2016 The Author(s).

  18. Posteromedial Meniscocapsular Lesions Increase Tibiofemoral Joint Laxity With Anterior Cruciate Ligament Deficiency, and Their Repair Reduces Laxity.

    PubMed

    Stephen, Joanna M; Halewood, Camilla; Kittl, Christoph; Bollen, Steve R; Williams, Andy; Amis, Andrew A

    2016-02-01

    Injury to the posteromedial meniscocapsular junction has been identified after anterior cruciate ligament (ACL) rupture; however, there is a lack of objective evidence investigating how this affects knee kinematics or whether increased laxity can be restored by repair. Such injury is often overlooked at surgery, with possible compromise to results. (1) Sectioning the posteromedial meniscocapsular junction in an ACL-deficient knee will result in increased anterior tibial translation and rotation. (2) Isolated ACL reconstruction in the presence of a posteromedial meniscocapsular junction lesion will not restore intact knee laxity. (3) Repair of the posteromedial capsule at the time of ACL reconstruction will reduce tibial translation and rotation to normal. (4) These changes will be clinically detectable. Controlled laboratory study. Nine cadaveric knees were mounted in a test rig where knee kinematics were recorded from 0° to 100° of flexion by use of an optical tracking system. Measurements were recorded with the following loads: 90-N anterior-posterior tibial forces, 5-N·m internal-external tibial rotation torques, and combined 90-N anterior force and 5-N·m external rotation torque. Manual Rolimeter readings of anterior translation were taken at 30° and 90°. The knees were tested in the following conditions: intact, ACL deficient, ACL deficient and posteromedial meniscocapsular junction sectioned, ACL deficient and posteromedial meniscocapsular junction repaired, ACL patellar tendon reconstruction with posteromedial meniscocapsular junction repair, and ACL reconstructed and capsular lesion re-created. Statistical analysis used repeated-measures analysis of variance and post hoc paired t tests with Bonferroni correction. Tibial anterior translation and external rotation were both significantly increased compared with the ACL-deficient knee after posterior meniscocapsular sectioning (P < .05). These parameters were restored after ACL reconstruction and meniscocapsular lesion repair (P > .05). Anterior and external rotational laxities were significantly increased after sectioning of the posteromedial meniscocapsular junction in an ACL-deficient knee. These were not restored after ACL reconstruction alone but were restored with ACL reconstruction combined with posterior meniscocapsular repair. Tibial anterior translation changes were clinically detectable by use of the Rolimeter. This study suggests that unrepaired posteromedial meniscocapsular lesions will allow abnormal meniscal and tibiofemoral laxity to persist postoperatively, predisposing the knee to meniscal and articular damage. © 2015 The Author(s).

  19. Diagnostic Value of Knee Arthrometry in the Prediction of Anterior Cruciate Ligament Strain During Landing

    PubMed Central

    Kiapour, Ata M.; Wordeman, Samuel C.; Paterno, Mark V.; Quatman, Carmen E.; Levine, Jason W.; Goel, Vijay K.; Demetropoulos, Constantine K.; Hewett, Timothy E.

    2014-01-01

    Background Previous studies have indicated that higher knee joint laxity may be indicative of an increased risk of anterior cruciate ligament (ACL) injuries. Despite the frequent clinical use of knee arthrometry in the evaluation of knee laxity, little data exist to correlate instrumented laxity measures and ACL strain during dynamic high-risk activities. Purpose/Hypotheses The purpose of this study was to evaluate the relationships between ACL strain and anterior knee laxity measurements using arthrometry during both a drawer test and simulated bipedal landing (as an identified high-risk injurious task). We hypothesized that a high correlation exists between dynamic ACL strain and passive arthrometry displacement. The secondary hypothesis was that anterior knee laxity quantified by knee arthrometry is a valid predictor of injury risk such that specimens with greater anterior knee laxity would demonstrate increased levels of peak ACL strain during landing. Study Design Controlled laboratory study. Methods Twenty cadaveric lower limbs (mean age, 46 ± 6 years; 10 female and 10 male) were tested using a CompuKT knee arthrometer to measure knee joint laxity. Each specimen was tested under 4 continuous cycles of anterior-posterior shear force (±134 N) applied to the tibial tubercle. To quantify ACL strain, a differential variable reluctance transducer (DVRT) was arthroscopically placed on the ACL (anteromedial bundle), and specimens were retested. Subsequently, bipedal landing from 30 cm was simulated in a subset of 14 specimens (mean age, 45 ± 6 years; 6 female and 8 male) using a novel custom-designed drop stand. Changes in joint laxity and ACL strain under applied anterior shear force were statistically analyzed using paired sample t tests and analysis of variance. Multiple linear regression analyses were conducted to determine the relationship between anterior shear force, anterior tibial translation, and ACL strain. Results During simulated drawer tests, 134 N of applied anterior shear load produced a mean peak anterior tibial translation of 3.1 ± 1.1 mm and a mean peak ACL strain of 4.9% ± 4.3%. Anterior shear load was a significant determinant of anterior tibial translation (P <.0005) and peak ACL strain (P = .04). A significant correlation (r = 0.52, P <.0005) was observed between anterior tibial translation and ACL strain. Cadaveric simulations of landing produced a mean axial impact load of 4070 ± 732 N. Simulated landing significantly increased the mean peak anterior tibial translation to 10.4 ± 3.5 mm and the mean peak ACL strain to 6.8% ± 2.8% (P <.0005) compared with the prelanding condition. Significant correlations were observed between peak ACL strain during simulated landing and anterior tibial translation quantified by knee arthrometry. Conclusion Our first hypothesis is supported by a significant correlation between arthrometry displacement collected during laxity tests and concurrent ACL strain calculated from DVRT measurements. Experimental findings also support our second hypothesis that instrumented measures of anterior knee laxity predict peak ACL strain during landing, while specimens with greater knee laxity demonstrated higher levels of peak ACL strain during landing. Clinical Relevance The current findings highlight the importance of instrumented anterior knee laxity assessments as a potential indicator of the risk of ACL injuries in addition to its clinical utility in the evaluation of ACL integrity. PMID:24275863

  20. ACL Fibers Inserting on the Lateral Intercondylar Ridge Carry the Greatest Loads - Are Modern Anatomic Femoral Tunnel Positions Too Low?

    PubMed Central

    Nawabi, Danyal H.; Imhauser, Carl; Tucker, Scott; Nguyen, Joseph; Wickiewicz, Thomas L.; Pearle, Andrew

    2014-01-01

    Objectives: Histological studies have shown that the ACL has a direct and indirect insertion on the femur [1]. The direct insertion is located along the lateral intercondylar ridge and the indirect insertion is located ‘lower’ on the lateral wall of the notch. The trend towards anatomic ACL reconstruction using the anteromedial (AM) portal technique has resulted in ‘lower’ non-isometric femoral tunnel positions and increased graft failures [2]. To our knowledge, the load transfer properties of the direct and indirect ACL insertions have not been studied. This information may help in understanding the increased failures reported with AM portal drilling. The purpose of this study was, 1) to compare the load transferred across the native ACL at the direct and indirect femoral insertions and, 2) to determine the strain behavior of ACL grafts placed at different tunnel locations within the direct and indirect insertions. Methods: Ten fresh-frozen cadaveric knees (mean age, 52.5 years; range, 29-65) were mounted to a six degree of freedom robot. A 134N anterior load at 30 and 90° flexion and a combined valgus (8Nm) and internal (4Nm) rotational moment at 15° flexion were applied. The ACL was subsequently sectioned at the femoral footprint by detaching either the direct or indirect insertion (partially sectioned state), followed by the remainder of the ACL (completely sectioned state) (Figure 1). The kinematics of the intact knee were replayed after each stage of sectioning to determine the loads transferred across the direct and indirect ACL fibers. Loads were expressed as a percentage of the total load borne by the ACL. Strain behaviour was tested by generating 3D models of the femur and tibia from CT scans of each knee. Three tunnel locations (anteromedial bundle [AM], center [C], posterolateral bundle [PL]) each were selected for the direct and indirect insertions and a virtual ACL graft was inserted. The isometry of the virtual graft was calculated through a flexion path of 0 to 90°. Results: Under an anterior tibial load at 30° flexion, the direct insertion carried 83.9% of the total ACL load compared to 16.1% in the indirect insertion (p<0.001). The direct insertion also carried more load at 90° flexion (95.2% vs 4.8%; p<0.001). Under a combined rotatory load at 15° flexion, the direct insertion carried 84.2% of the total ACL load compared to 15.8% in the indirect insertion (p<0.001). A virtual ACL graft placed at the AM position in the direct insertion demonstrated the best strain behaviour with a mean 10.9% change in length. This value was significantly lower (p<0.001) than the isometry at all 3 tunnel positions in the indirect insertion (AM = 18.5%; C = 24.9%; PL = 30.9%). Conclusion: Fibers in the direct insertion of the ACL carry more load than fibers in the indirect insertion. Virtual ACL grafts placed in the ‘higher’ direct location are more isometric than in the ‘lower’ indirect location during range of motion testing. Clinical Relevance: ‘Low’ ACL grafts in the indirect ACL insertion, resulting from AM portal drilling techniques, may experience higher loads in-vivo due to unfavorable biomechanics. With the current shift towards anatomic ACL reconstruction, it may be beneficial to create a ‘higher’ femoral tunnel within the direct insertion at the lateral intercondylar ridge. This position remains anatomical but may also be biomechanically favorable.

  1. Lateral femoral notch depth is not associated with increased rotatory instability in ACL-injured knees: a quantitative pivot shift analysis.

    PubMed

    Kanakamedala, Ajay C; Burnham, Jeremy M; Pfeiffer, Thomas R; Herbst, Elmar; Kowalczuk, Marcin; Popchak, Adam; Irrgang, James; Fu, Freddie H; Musahl, Volker

    2018-05-01

    A deep lateral femoral notch (LFN) on lateral radiographs is indicative of ACL injury. Prior studies have suggested that a deep LFN may also be a sign of persistent rotatory instability and a concomitant lateral meniscus tear. Therefore, the purpose of this study was to evaluate the relationship between LFN depth and both quantitative measures of rotatory knee instability and the incidence of lateral meniscus tears. It was hypothesized that greater LFN depth would be correlated with increased rotatory instability, quantified by lateral compartment translation and tibial acceleration during a quantitative pivot shift test, and incidence of lateral meniscus tears. ACL-injured patients enrolled in a prospective ACL registry from 2014 to 2016 were analyzed. To limit confounders, patients were only included if they had primary ACL tears, no concurrent ligamentous or bony injuries requiring operative treatment, and no previous knee injuries or surgeries to either knee. Eighty-four patients were included in the final analysis. A standardized quantitative pivot shift test was performed pre-operatively under anesthesia in both knees, and rotatory instability, specifically lateral compartment translation and tibial acceleration, was quantified using tablet image analysis software and accelerometer sensors. Standard lateral radiographs and sagittal magnetic resonance images (MRI) of the injured knee were evaluated for LFN depth. There were no significant correlations between LFN depth on either imaging modality and ipsilateral lateral compartment translation or tibial acceleration during a quantitative pivot shift test or side-to-side differences in these measurements. Patients with lateral meniscus tears were found to have significantly greater LFN depths than those without on conventional radiograph and MRI (1.0 vs. 0.6 mm, p < 0.05; 1.2 vs. 0.8 mm, p < 0.05, respectively). There was no correlation between lateral femoral notch depth on conventional radiographs or MRI and quantitative measures of rotatory instability. Concomitant lateral meniscus injury was associated with significantly greater LFN depth. Based on these findings, LFN depth should not be used as an indicator of excessive rotatory instability, but may be an indicator of lateral meniscus injury in ACL-injured patients. Prognostic level IV.

  2. 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,…

  3. 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…

  4. 78 FR 26782 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; State...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-08

    ...: Administration for Community Living, HHS. ACTION: Notice. SUMMARY: The Administration for Community Living (ACL....eop.gov , Attn: OMB Desk Officer for ACL. FOR FURTHER INFORMATION CONTACT: Elena Fazio at 202-357-3583 or email: [email protected]acl.hhs.gov . SUPPLEMENTARY INFORMATION: In compliance with 44 U.S.C. 3507, ACL...

  5. 50 CFR 648.64 - Yellowtail flounder sub-ACLs and AMs for the scallop fishery.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... framework adjustment process specified in § 648.90, the scallop fishery shall be allocated a sub-ACL for the... flounder sub-ACL for the scallop fishery is exceeded, the area defined by the following coordinates shall... the corresponding percent overage of the Georges Bank yellowtail flounder sub-ACL, as follows: (i) For...

  6. Prevention of anterior cruciate ligament injury in the female athlete

    PubMed Central

    Silvers, Holly Jacinda; Mandelbaum, Bert R

    2007-01-01

    The relationships of gender, age and training to the incidence of anterior cruciate ligament (ACL) injury are pivotal to developing a comprehensive neuromuscular and proprioceptive training programme to decrease ACL injuries in female athletes. A prophylactic neuromuscular and proprioceptive training programme may have direct benefit in decreasing the number of ACL injuries in female athletes. This research foundation endorses further epidemiological and biomechanical studies to determine the exact mechanism of ACL injury and the most effective intervention for decreasing ACL injuries in this high‐risk population. PMID:17609222

  7. Ankle-Dorsiflexion Range of Motion and Landing Biomechanics

    PubMed Central

    Fong, Chun-Man; Blackburn, J. Troy; Norcross, Marc F.; McGrath, Melanie; Padua, Darin A.

    2011-01-01

    Abstract Context: A smaller amount of ankle-dorsiflexion displacement during landing is associated with less knee-flexion displacement and greater ground reaction forces, and greater ground reaction forces are associated with greater knee-valgus displacement. Additionally, restricted dorsiflexion range of motion (ROM) is associated with greater knee-valgus displacement during landing and squatting tasks. Because large ground reaction forces and valgus displacement and limited knee-flexion displacement during landing are anterior cruciate ligament (ACL) injury risk factors, dorsiflexion ROM restrictions may be associated with a greater risk of ACL injury. However, it is unclear whether clinical measures of dorsiflexion ROM are associated with landing biomechanics. Objective: To evaluate relationships between dorsiflexion ROM and landing biomechanics. Design: Descriptive laboratory study. Setting: Research laboratory. Patients or Other Participants: Thirty-five healthy, physically active volunteers. Intervention(s): Passive dorsiflexion ROM was assessed under extended-knee and flexed-knee conditions. Landing biomechanics were assessed via an optical motion-capture system interfaced with a force plate. Main Outcome Measure(s): Dorsiflexion ROM was measured in degrees using goniometry. Knee-flexion and knee-valgus displacements and vertical and posterior ground reaction forces were calculated during the landing task. Simple correlations were used to evaluate relationships between dorsiflexion ROM and each biomechanical variable. Results: Significant correlations were noted between extended-knee dorsiflexion ROM and knee-flexion displacement (r  =  0.464, P  =  .029) and vertical (r  =  −0.411, P  =  .014) and posterior (r  =  −0.412, P  =  .014) ground reaction forces. All correlations for flexed-knee dorsiflexion ROM and knee-valgus displacement were nonsignificant. Conclusions: Greater dorsiflexion ROM was associated with greater knee-flexion displacement and smaller ground reaction forces during landing, thus inducing a landing posture consistent with reduced ACL injury risk and limiting the forces the lower extremity must absorb. These findings suggest that clinical techniques to increase plantar-flexor extensibility and dorsiflexion ROM may be important additions to ACL injury-prevention programs. PMID:21214345

  8. 50 CFR 679.81 - Rockfish Program annual harvester and processor privileges.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... amount (MRA) limits—(1) Rockfish cooperative. A vessel assigned to a rockfish cooperative and fishing... this part. (6) Maximum retainable amounts (MRA). (i) The MRA for an incidental catch species for..., shortraker and rougheye rockfish are incidental catch species and are limited to an aggregate MRA of 2.0...

  9. 50 CFR 600.1005 - Content of a request for a subsidized program.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., including any information that NMFS may supply to the requester, and take into account any limitation by... factor that the proposed program involves. (f) Specify the aggregate total allowable catch in the reduction fishery during each of the preceding 5 years and the aggregate portion of such catch harvested by...

  10. 76 FR 2665 - Caribbean Fishery Management Council; Scoping Meetings

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-14

    ... time series of catch data that is considered to be consistently reliable across all islands as defined... based on what the Council considers to be the longest time series of catch data that is consistently... preferred management reference point time series. Action 3b. Recreational Bag Limits Option 1: No action. Do...

  11. Mechanisms, Prediction, and Prevention of ACL Injuries: Cut Risk With Three Sharpened and Validated Tools

    PubMed Central

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

    2017-01-01

    Economic and societal pressures influence modern medical practice to develop and implement prevention strategies. Anterior cruciate ligament (ACL) injury devastates the knee joint leading to short term disability and long term sequelae. Due to the high risk of long term osteoarthritis in all treatment populations following ACL injury, prevention is the only effective intervention for this life-altering disruption in knee health. The “Sequence of Prevention” Model provides a framework to monitor progress towards the ultimate goal of preventing ACL injuries. Utilizing this model, our multidisciplinary collaborative research team has spent the last decade working to delineate injury mechanisms, identify injury risk factors, predict which athletes are at-risk for injury, and develop ACL injury prevention programs. Within this model of injury prevention, modifiable factors (biomechanical and neuromuscular) related to injury mechanisms likely provide the best opportunity for intervention strategies aimed to decrease the risk of ACL injury, particularly in female athletes. Knowledge advancements have led to the development of potential solutions that allow athletes to compete with lowered risk of ACL injury. Design and integration of personalized clinical assessment tools and targeted prevention strategies for athletes at high risk for ACL injury may transform current prevention practices and ultimately significantly reduce ACL injury incidence. This 2016 OREF Clinical Research Award focuses on the authors' work and contributions to the field. The author's acknowledge the many research groups who have contributed to the current state of knowledge in the fields of ACL injury mechanisms, injury risk screening and injury prevention strategies. PMID:27612195

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

    PubMed

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

    2017-04-01

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

  13. Lateral Intercondylar Ridge: Is it a reliable landmark for femoral ACL insertion?: An anatomical study.

    PubMed

    Bhattacharyya, Rahul; Ker, Andrew; Fogg, Quentin; Spencer, Simon J; Joseph, Jibu

    2018-02-01

    Incorrect femoral tunnel placement is the most common cause of graft failure during Anterior Cruciate Ligament (ACL) Reconstruction. A reliable landmark can minimize errors. To identify whether the Lateral Intercondylar Ridge (LIR) is a consistent anatomical structure and define its relationship with the femoral ACL insertion. Phase 1: we studied 23 femoral dry bone specimens macroscopically. Using a digital microscribe, the medial surface of the lateral femoral condyle was reconstructed (3D) to evaluate whether there was an identifiable bony ridge. Phase 2: 7 cadaveric specimens with intact soft tissues were dissected to identify the femoral ACL insertion. A 3D reconstruction of the femoral ACL insertion and the surface allowed us to define the relationship between the LIR and the ACL insertion. All specimens had a defined LIR on the medial surface of the lateral femoral condyle. The ridge was consistently located just anterior to the femoral ACL insertion. The ACL footprint was present in the depression between the ridge and the Inferior Articular Cartilage Margin (IACM). The mean distance from the midpoint of the IACM to the LIR was 10.1 mm. This is the first study to use the microscribe to digitally reconstruct the medial surface of the lateral femoral condyle. It shows that the LIR is a consistent anatomical structure that defines the anterior margin of the femoral ACL insertion, which guides femoral tunnel placement. Our findings support the ruler technique, which is a commonly used method for anatomic single bundle ACL reconstruction. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  14. Gender dimorphic ACL strain in response to combined dynamic 3D knee joint loading: implications for ACL injury risk.

    PubMed

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

    2009-12-01

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

  15. 3D-Printed Patient-Specific ACL Femoral Tunnel Guide from MRI.

    PubMed

    Rankin, Iain; Rehman, Haroon; Frame, Mark

    2018-01-01

    Traditional ACL reconstruction with non-anatomic techniques can demonstrate unsatisfactory long-term outcomes with regards instability and the degenerative knee changes observed with these results. Anatomic ACL reconstruction attempts to closely reproduce the patient's individual anatomic characteristics with the aim of restoring knee kinematics, in order to improve patient short and long-term outcomes. We designed an arthroscopic, patient-specific, ACL femoral tunnel guide to aid anatomical placement of the ACL graft within the femoral tunnel. The guide design was based on MRI scan of the subject's uninjured contralateral knee, identifying the femoral footprint and its anatomical position relative to the borders of the femoral articular cartilage. Image processing software was used to create a 3D computer aided design which was subsequently exported to a 3D-printing service. Transparent acrylic based photopolymer, PA220 plastic and 316L stainless steel patient-specific ACL femoral tunnel guides were created; the models produced were accurate with no statistical difference in size and positioning of the center of the ACL femoral footprint guide to MRI ( p =0.344, p =0.189, p =0.233 respectively). The guides aim to provide accurate marking of the starting point of the femoral tunnel in arthroscopic ACL reconstruction. This study serves as a proof of concept for the accurate creation of 3D-printed patient-specific guides for the anatomical placement of the femoral tunnel during ACL reconstruction.

  16. Prevalence of Radiographic Knee Osteoarthritis After Anterior Cruciate Ligament Reconstruction, With or Without Meniscectomy: An Evidence-Based Practice Article.

    PubMed

    Ruano, Jennifer S; Sitler, Michael R; Driban, Jeffrey B

    2017-06-02

    Reference:  Claes S, Hermie L, Verdonk R, Bellemans J, Verdonk P. Is osteoarthritis an inevitable consequence of anterior cruciate ligament reconstruction? A meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2013;21(9):1967-1976.   What is the prevalence of radiographic knee osteoarthritis (OA) at a mean follow-up equal to or greater than 10 years after autologous anterior cruciate ligament (ACL) reconstruction, with or without meniscectomy?   The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines were used to conduct this meta-analysis. Studies were identified by searching PubMed, MEDLINE, EMBASE, and Cochrane Library dating from their earliest file until October 2010. Key terms applied for searching were anterior cruciate ligament or ACL, autologous, follow-up, long-term, outcome, reconstruction, results, treatment, and (osteo)arthritis or osteoarthrosis. The reference lists of included studies were also manually checked to ensure that relevant articles were not omitted.   The authors limited their search to English- and French-language journals. Included studies provided radiographic outcomes after autologous ACL reconstruction and had a mean follow-up of ≥10 years. Excluded studies evaluated ACL reconstruction with major concomitant surgical procedures (eg, meniscal allograft transplantation, high tibial osteotomy). In addition, data from 2 studies completed by the same research team with identical patient populations were limited to the article with the longest follow-up. Finally, manuscripts with inaccurate or incomplete data were excluded.   The following key characteristics of each study were extracted: type of study (prospective or retrospective); ACL surgical procedure (eg, open or arthroscopic bone-patellar tendon-bone graft); time frame of surgery; mean follow-up (in years) post-ACL reconstruction; total number of participants with radiographs; total number of participants with radiographic OA at follow-up; and number of participants with meniscectomy before, during, or after ACL reconstruction. Although the OA diagnosis was based on radiographic criteria, the included studies used 4 OA classifications and grading scales: Ahlbäck, Fairbanks, Kellgren and Lawrence, and International Knee Documentation Committee. Regardless of classification or grading scale, OA was defined as the presence of joint-space narrowing: Ahlbäck grades 1 through 5, modified Fairbanks grades 2 and 3, Kellgren and Lawrence ≥2, and International Knee Documentation Committee grades C and D. Tibiofemoral and patellofemoral OA data were collapsed due to the lack of reporting specificity among the studies. Participants were categorized into a meniscectomy or nonmeniscectomy group if this information was reported. Partial or total meniscectomies before, during, or after ACL reconstruction were collapsed regardless of location (medial or lateral compartment), and those patients who underwent a meniscal repair were grouped into the nonmeniscectomy group. Data were analyzed using odds ratios, the Cochran χ 2 test, and a random-effects meta-regression analysis. The DerSimonian and Laird approach was used to assess study heterogeneity. P values below .05 were considered statistically significant.   The initial computerized database search resulted in 211 possible studies. However, after the authors applied the inclusionary and exclusionary criteria, only 16 studies were relevant. A total of 1554 participants were available at the follow-up period. Mean follow-up ranged from 10 to 24.5 years; 11 of the 16 articles had a mean follow-up between 10 and 12 years. Heterogeneity was large (I 2 = 96%), which indicated that the included studies generated a wide range of knee OA prevalence (2%-79%). Almost 28% (95% confidence interval [CI] = 16.3%, 43.5%) of participants had radiographic knee OA. A total of 1264 participants were involved in studies that evaluated meniscectomies (n = 11). Among the 614 participants with either partial or total meniscectomies, 50.4% had radiographic knee OA (95% CI = 27.4%, 73.1%). In contrast, only 16.4% (95% CI = 7.0%, 33.9%) of those without a meniscectomy had radiographic knee OA.   The findings of Claes et al reflected a radiographic knee OA prevalence at a minimum average of 10 years' postautologous ACL reconstruction that was lower than commonly perceived (up to 79%). In addition, meniscectomy was an important risk factor (3.54-fold increase) for developing OA after ACL reconstruction.

  17. 50 CFR 648.64 - Yellowtail flounder sub-ACLs and AMs for the scallop fishery.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... framework adjustment process specified in § 648.90, the scallop fishery shall be allocated a sub-ACL for the... multispecies regulations, if the Georges Bank yellowtail flounder sub-ACL for the scallop fishery is exceeded... overage of the Georges Bank yellowtail flounder sub-ACL, as follows: (i) For years when the Closed Area II...

  18. 50 CFR 648.22 - Atlantic mackerel, squid, and butterfish specifications.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... squid, which, subject to annual review, may be specified for a period of up to 3 years; (2) ACL; ACT... years; (3) ACL; commercial ACT, including RSA, DAH, Tier 3 allocation (up to 7 percent of the DAH), DAP... scientific uncertainty; the stock-wide ABC must be less than or equal to the OFL. (ii) ACL. The ACL or...

  19. 50 CFR 648.64 - Yellowtail flounder sub-ACLs and AMs for the scallop fishery.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... framework adjustment process specified in § 648.90, the scallop fishery shall be allocated a sub-ACL for the... multispecies regulations, if the Georges Bank yellowtail flounder sub-ACL for the scallop fishery is exceeded... flounder sub-ACL, as follows: (i) For years when the Closed Area II Sea Scallop Access Area is open, the...

  20. 50 CFR 648.64 - Yellowtail flounder sub-ACLs and AMs for the scallop fishery.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... framework adjustment process specified in § 648.90, the scallop fishery shall be allocated a sub-ACL for the Georges Bank and Southern New England/Mid-Atlantic stocks of yellowtail flounder. The sub-ACL for the 2011... measure. (1) If the Georges Bank yellowtail flounder sub-ACL for the scallop fishery is exceeded, the area...

  1. 50 CFR 648.22 - Atlantic mackerel, squid, and butterfish specifications.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... squid, which, subject to annual review, may be specified for a period of up to 3 years; (2) ACL; ACT... years; (3) ACL; commercial ACT, including RSA, DAH, Tier 3 allocation (up to 7 percent of the DAH), DAP... scientific uncertainty; the stock-wide ABC must be less than or equal to the OFL. (ii) ACL. The ACL or...

  2. 78 FR 13284 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; 2013 Accountability Measures for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-27

    ... (ACL) to 410,157 lb (186,044 kg), based on the 2012 commercial ACL overage. These actions are necessary... the ACL if they occur. Section 303(a)(15) of the Magnuson-Stevens Act mandates the establishment of... established the Gulf greater amberjack stock ACL equal to the greater amberjack stock allowable biological...

  3. 50 CFR 648.22 - Atlantic mackerel, squid, and butterfish specifications.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... squid, which, subject to annual review, may be specified for a period of up to 3 years; (2) ACL; ACT... years; (3) ACL; commercial ACT, including RSA, DAH, Tier 3 allocation (up to 7 percent of the DAH), DAP... ABC must be less than or equal to the OFL. (ii) ACL. The ACL or Domestic ABC is calculated using the...

  4. [Effects of posterior tibial slope on non-contact anterior cruciate ligament rupture and stability of anterior cruciate ligament rupture knee].

    PubMed

    Yue, De-bo; E, Sen; Wang, Bai-liang; Wang, Wei-guo; Guo, Wan-shou; Zhang, Qi-dong

    2013-05-07

    To retrospectively explore the correlation between anterior cruciate ligament (ACL)-ruptured knees, stability of ACL-rupture knee and posterior tibial slope (PTS). From January 2008 to October 2012, 150 knees with ACL rupture underwent arthroscopic surgery for ACL reconstruction. A control group was established for subjects undergoing arthroscopic surgery without ACL rupture during the same period. PTS was measured on a digitalized lateral radiograph. Lachman and mechanized pivot shift tests were performed for assessing the stability of knee. There was significant difference (P = 0.007) in PTS angle between the patients with ACL rupture (9.5 ± 2.2 degrees) and the control group (6.6 ± 1.8 degrees). Only among females, increased slope of tibial plateau had effect on the Lachman test. There was a higher positive rate of pivot shift test in patients of increased posterior slope in the ACL rupture group. Increased posterior tibial slope (>6.6) appears to contribute to non-contact ACL injuries in females. And the changes of tibial slope have no effect upon the Lachman test. However, large changes in tibial slope affect pivot shift.

  5. The Effect of Skeletal Maturity on the Regenerative Function of Intrinsic ACL Cells

    PubMed Central

    Mastrangelo, Ashley N.; Magarian, Elise M.; Palmer, Matthew P.; Vavken, Patrick; Murray, Martha M.

    2010-01-01

    Anterior cruciate ligament (ACL) injuries are an important clinical problem, particularly for adolescent patients. The effect of skeletal maturity on the potential for ACL healing is as yet unknown. In this study, we hypothesized that fibroblastic cells from the ACLs of skeletally immature animals would proliferate and migrate more quickly than cells from adolescent and adult animals. ACL tissue from skeletally immature, adolescent, and adult pigs and sheep were obtained and cells obtained using explant culture. Cell proliferation within a collagen–platelet scaffold was measured at days 2, 7, and 14 of culture using AMMTT assay. Cellular migration was measured at 4 and 24 h using a modified Boyden chamber assay, and cell outgrowth from the explants also measured at 1 week. ACL cells from skeletally immature animals had higher proliferation between 7 and 14 days (p < 0.01 for all comparisons) and higher migration potential at all time points in both species (p < 0.01 for all comparisons).ACL cells from skeletally immature animals have greater cellular proliferation and migration potential than cells from adolescent or adult animals. These experiments suggest that skeletal maturity may influence the biologic repair capacity of intrinsic ACL cells. PMID:19890988

  6. Effect of simulation on knowledge of advanced cardiac life support, knowledge retention, and confidence of nursing students in Jordan.

    PubMed

    Tawalbeh, Loai I; Tubaishat, Ahmad

    2014-01-01

    This study examined the effect of simulation on nursing students' knowledge of advanced cardiac life support (ACLS), knowledge retention, and confidence in applying ACLS skills. An experimental, randomized controlled (pretest-posttest) design was used. The experimental group (n = 40) attended an ACLS simulation scenario, a 4-hour PowerPoint presentation, and demonstration on a static manikin, whereas the control group (n = 42) attended the PowerPoint presentation and a demonstration only. A paired t test indicated that posttest mean knowledge of ACLS and confidence was higher in both groups. The experimental group showed higher knowledge of ACLS and higher confidence in applying ACLS, compared with the control group. Traditional training involving PowerPoint presentation and demonstration on a static manikin is an effective teaching strategy; however, simulation is significantly more effective than traditional training in helping to improve nursing students' knowledge acquisition, knowledge retention, and confidence about ACLS. Copyright 2014, SLACK Incorporated.

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

    NASA Astrophysics Data System (ADS)

    Hirokawa, Shunji; Yamamoto, Kouji; Kawada, Takashi

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

  8. The concept of individualized anatomic anterior cruciate ligament (ACL) reconstruction.

    PubMed

    Hofbauer, M; Muller, B; Murawski, C D; van Eck, C F; Fu, F H

    2014-05-01

    To describe the concept of individualized anatomic anterior cruciate ligament (ACL) reconstruction. The PubMed/Medline database was searched using keywords pertaining to ACL reconstruction. Relevant articles were reviewed in order to summarize important concepts of individualized surgery in ACL reconstruction. Surgical experiences with case examples are also highlighted. Individualized ACL surgery allows for the customization of surgery to each individual patient. Accounting for graft selection and other characteristics such as anatomy, lifestyle and activity preferences may provide the patient with the best potential for a successful outcome. The surgeon should be comfortable with a variety of graft harvests and surgical techniques when practicing individualized surgery. Individualized anatomic ACL reconstruction is founded on the objective evaluation of functional anatomy and individual characteristics, thereby restoring the ACL as closely as possible to the native anatomy and function. The adoption and subsequent use of individualized surgery may facilitate improved clinical as well as objective outcomes, particularly in the long term. V.

  9. Three-Dimensional Anatomic Evaluation of the Anterior Cruciate Ligament for Planning Reconstruction

    PubMed Central

    Hoshino, Yuichi; Kim, Donghwi; Fu, Freddie H.

    2012-01-01

    Anatomic study related to the anterior cruciate ligament (ACL) reconstruction surgery has been developed in accordance with the progress of imaging technology. Advances in imaging techniques, especially the move from two-dimensional (2D) to three-dimensional (3D) image analysis, substantially contribute to anatomic understanding and its application to advanced ACL reconstruction surgery. This paper introduces previous research about image analysis of the ACL anatomy and its application to ACL reconstruction surgery. Crucial bony landmarks for the accurate placement of the ACL graft can be identified by 3D imaging technique. Additionally, 3D-CT analysis of the ACL insertion site anatomy provides better and more consistent evaluation than conventional “clock-face” reference and roentgenologic quadrant method. Since the human anatomy has a complex three-dimensional structure, further anatomic research using three-dimensional imaging analysis and its clinical application by navigation system or other technologies is warranted for the improvement of the ACL reconstruction. PMID:22567310

  10. Successful anterior cruciate ligament reconstruction and meniscal repair in osteogenesis imperfecta.

    PubMed

    Park, Jae-Young; Cho, Tae-Joon; Lee, Myung Chul; Han, Hyuk-Soo

    2018-03-20

    A case of anterior cruciate ligament (ACL) reconstruction with meniscal repair in an osteogenesis imperfecta patient is reported. A 24-year-old female with osteogenesis imperfecta type 1a suffered from a valgus extension injury resulting in tear of ACL and medial meniscus. She underwent an arthroscopic-assisted ACL reconstruction and medial meniscus repair. Meniscal tear at the menisco-capsular junction of the posterior horn of medial meniscus was repaired with three absorbable sutures via inside-out technique. ACL reconstruction was then performed with a bone-patellar tendon-bone allograft. The patient was followed up for 1 year with intact ACL grafts and healed medial meniscus. This case report showed that successful ACL reconstruction and meniscal repair is possible in an osteogenesis imperfecta patient.Level of evidence V.

  11. Delayed Anterior Cruciate Ligament Reconstruction in Young Patients With Previous Anterior Tibial Spine Fractures.

    PubMed

    Mitchell, Justin J; Mayo, Meredith H; Axibal, Derek P; Kasch, Anthony R; Fader, Ryan R; Chadayammuri, Vivek; Terhune, E Bailey; Georgopoulos, Gaia; Rhodes, Jason T; Vidal, Armando F

    2016-08-01

    Avulsion fractures of the anterior tibial spine in young athletes are injuries similar to anterior cruciate ligament (ACL) injuries in adults. Sparse data exist on the association between anterior tibial spine fractures (ATSFs) and later ligamentous laxity or injuries leading to ACL reconstruction. To better delineate the incidence of delayed instability or ACL ruptures requiring delayed ACL reconstruction in young patients with prior fractures of the tibial eminence. Case series; Level of evidence, 4. We identified 101 patients between January 1993 and January 2012 who sustained an ATSF and who met inclusion criteria for this study. All patients had been followed for at least 2 years after the initial injury and were included for analysis after completion of a questionnaire via direct contact, mail, and/or telephone. If patients underwent further surgical intervention and/or underwent later ACL reconstruction, clinical records and operative reports pertaining to these secondary interventions were obtained and reviewed. Differences between categorical variables were assessed using the Fisher exact test. The association between time to revision ACL surgery and fracture type was assessed by Kaplan-Meier plots. The association between need for revision ACL surgery and age, sex, and mechanism of surgery was assessed using logistic regression. Nineteen percent of all patients evaluated underwent delayed ACL reconstruction after a previous tibial spine fracture on the ipsilateral side. While there were a higher proportion of ACL reconstructions in type II fractures, there was not a statistically significant difference in the number of patients within each fracture group who went on to undergo later surgery (P = .29). Further, there was not a significant association between fracture type, sex, or mechanism of injury as it related to the progression to later ACL reconstruction. However, there was a significant association between age at the time of injury and progression to later ACL reconstruction (P = .02). For every year increase in age at the time of injury, the odds of going on to undergo delayed ACL reconstruction were greater by a factor of 1.3 (95% CI, 1.1-1.6). Although an ATSF is a relatively rare injury, our cohort of patients suggests that a subset of young patients with all types of tibial spine fractures will require later ACL reconstruction. There is a need to counsel patients that a delayed ACL rupture is a potential risk after an ATSF, especially as children approach skeletal maturity. Further patient follow-up and prospective studies are required. © 2016 The Author(s).

  12. Validation of Noncontact Anterior Cruciate Ligament Tears Produced by a Mechanical Impact Simulator Against the Clinical Presentation of Injury.

    PubMed

    Bates, Nathaniel A; Schilaty, Nathan D; Nagelli, Christopher V; Krych, Aaron J; Hewett, Timothy E

    2018-06-01

    Anterior cruciate ligament (ACL) injuries are catastrophic events that affect athletic careers and lead to long-term degenerative knee changes. As injuries are believed to occur within the first 50 milliseconds after initial contact during a rapid deceleration task, impact simulators that rapidly deliver impulse loads to cadaveric specimens have been developed. However, no impactor has reproducibly and reliably created ACL injures in a distribution that mimics clinical observation. To better understand ACL injury patterns through a cadaveric investigation that applied in vivo-measured external loads to the knee during simulated landings. Controlled laboratory study. A novel mechanical impact simulator reproduced kinetics from in vivo-recorded drop landing tasks on 45 cadaveric knees. Specimens were exposed to a randomized order of variable knee abduction moment, anterior tibial shear, and internal tibial rotation loads before the introduction of an impulse load at the foot. This process was repeated until a hard or soft tissue injury was induced on the joint. Injuries were assessed by an orthopaedic surgeon, and ligament strain was recorded by implanted strain gauges. The mechanical impact simulator induced ACL injuries in 87% of specimens, with medial collateral ligament (MCL) injuries in 31%. ACL tear locations were 71% femoral side, 21% midsubstance, and 9% tibial side. Peak strain before failure for ACL-injured specimens was 15.3% ± 8.7% for the ACL and 5.1% ± 5.6% for the MCL ( P < .001). The ACL injuries induced by the mechanical impact simulator in the present study have provided clinically relevant in vitro representations of in vivo ACL injury patterns as cited in the literature. Additionally, current ligament strains corroborate the literature to support disproportionate loading of the ACL relative to the MCL during athletic tasks. These findings indicate that the mechanical impact simulator is an appropriate model for examining independent mechanical variables, treatment techniques, and preventive interventions during athletic tasks leading up to and including an ACL injury. Accordingly, this system can be utilized to further parse out contributing factors to an ACL injury as well as assess the shortcomings of ACL reconstruction techniques in a dynamic, simulated environment that is better representative of in vivo injury scenarios.

  13. High knee abduction moments are common risk factors for patellofemoral pain (PFP) and anterior cruciate ligament (ACL) injury in girls: Is PFP itself a predictor for subsequent ACL injury?

    PubMed Central

    Myer, Gregory D; Ford, Kevin R; Di Stasi, Stephanie L; Foss, Kim D Barber; Micheli, Lyle J; Hewett, Timothy E

    2014-01-01

    Background Identifying risk factors for knee pain and anterior cruciate ligament (ACL) injury can be an important step in the injury prevention cycle. Objective We evaluated two unique prospective cohorts with similar populations and methodologies to compare the incidence rates and risk factors associated with patellofemoral pain (PFP) and ACL injury. Methods The ‘PFP cohort’ consisted of 240 middle and high school female athletes. They were evaluated by a physician and underwent anthropometric assessment, strength testing and three-dimensional landing biomechanical analyses prior to their basketball season. 145 of these athletes met inclusion for surveillance of incident (new) PFP by certified athletic trainers during their competitive season. The ‘ACL cohort’ included 205 high school female volleyball, soccer and basketball athletes who underwent the same anthropometric, strength and biomechanical assessment prior to their competitive season and were subsequently followed up for incidence of ACL injury. A one-way analysis of variance was used to evaluate potential group (incident PFP vs ACL injured) differences in anthropometrics, strength and landing biomechanics. Knee abduction moment (KAM) cut-scores that provided the maximal sensitivity and specificity for prediction of PFP or ACL injury risk were also compared between the cohorts. Results KAM during landing above 15.4 Nm was associated with a 6.8% risk to develop PFP compared to a 2.9% risk if below the PFP risk threshold in our sample. Likewise, a KAM above 25.3 Nm was associated with a 6.8% risk for subsequent ACL injury compared to a 0.4% risk if below the established ACL risk threshold. The ACL-injured athletes initiated landing with a greater knee abduction angle and a reduced hamstrings-to-quadriceps strength ratio relative to the incident PFP group. Also, when comparing across cohorts, the athletes who suffered ACL injury also had lower hamstring/quadriceps ratio than the players in the PFP sample (p<0.05). Conclusions In adolescent girls aged 13.3 years, >15 Nm of knee abduction load during landing is associated with greater likelihood of developing PFP. Also, in girls aged 16.1 years who land with >25 Nm of knee abduction load during landing are at increased risk for both PFP and ACL injury. PMID:24687011

  14. Similar Outcomes After Osteochondral Allograft Transplantation in Anterior Cruciate Ligament-Intact and -Reconstructed Knees: A Comparative Matched-Group Analysis With Minimum 2-Year Follow-Up.

    PubMed

    Wang, Dean; Eliasberg, Claire D; Wang, Tim; Fader, Ryan R; Coxe, Francesca R; Pais, Mollyann D; Williams, Riley J

    2017-12-01

    To compare failure rates and clinical outcomes of osteochondral allograft transplantation (OCA) in anterior cruciate ligament (ACL)-intact versus ACL-reconstructed knees at midterm follow-up. After a priori power analysis, a prospective registry of patients treated with OCA for focal chondral lesions ≥2 cm 2 in size with minimum 2-year follow-up was used to match ACL-reconstructed knees with ACL-intact knees by age, sex, and primary chondral defect location. Exclusion criteria included meniscus transplantation, realignment osteotomy, or other ligamentous injury. Complications, reoperations, and patient responses to validated outcome measures were reviewed. Failure was defined by any procedure involving allograft removal/revision or conversion to arthroplasty. Kaplan-Meier analysis and multivariate Cox regression were performed to evaluate the association of ACL reconstruction (ACLR) with failure. A total of 50 ACL-intact and 25 ACL-reconstructed (18 prior, 7 concomitant) OCA patients were analyzed. The mean age was 36.2 years (range, 14-62 years). Mean follow-up was 3.9 years (range, 2-14 years). Patient demographics and chondral lesion characteristics were similar between groups. ACL-reconstructed patients averaged 2.2 ± 1.9 prior surgeries on the ipsilateral knee compared with 1.4 ± 1.4 surgeries for ACL-intact patients (P = .014). Grafts used for the last ACLR included bone-patellar tendon-bone autograft, hamstring autograft, Achilles tendon allograft, and tibialis allograft (data available for only 11 of 25 patients). At final follow-up, 22% of ACL-intact and 32% of ACL-reconstructed patients had undergone reoperation. OCA survivorship was 90% and 96% at 2 years and 79% and 85% at 5 years in ACL-intact and ACL-reconstructed patients, respectively (P = .774). ACLR was not independently associated with failure. Both groups demonstrated clinically significant improvements in the Short Form-36 pain and physical functioning, International Knee Documentation Committee subjective, and Knee Outcome Survey-Activities of Daily Living scores at final follow-up (P < .001), with no significant differences in preoperative, postoperative, and change scores between groups. OCA in the setting of prior or concomitant ACLR does not portend higher failure rates or compromise clinical outcomes. Level III, retrospective comparative study. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  15. A Radiographic Assessment of Failed Anterior Cruciate Ligament Reconstruction: Can Magnetic Resonance Imaging Predict Graft Integrity?

    PubMed

    Waltz, Robert A; Solomon, Daniel J; Provencher, Matthew T

    2014-07-01

    Magnetic resonance imaging (MRI) showing an "intact" anterior cruciate ligament (ACL) graft may not correlate well with examination findings. Reasons for an ACL graft dysfunction may be from malpositioned tunnels, deficiency of secondary stabilizers, repeat injuries, or a combination of factors. To evaluate the concordance/discordance of an ACL graft assessment between an arthroscopic evaluation, physical examination, and MRI and secondarily to evaluate the contributing variables to discordance. Case series; Level of evidence, 4. A total of 50 ACL revisions in 48 patients were retrospectively reviewed. The ACL graft status was recorded separately based on Lachman and pivot-shift test data, arthroscopic findings from operative reports, and MRI evaluation and was categorized into 3 groups: intact, partial tear, or complete tear. Two independent evaluators reviewed all of the preoperative radiographs and MRI scans, and interrater and intrarater reliability were evaluated. Concordance and discordance between a physical examination, arthroscopic evaluation, and MRI evaluation of the ACL graft were calculated. Graft position and type, mechanical axis, collateral ligament injuries, chondral and meniscal injuries, and mechanism of injury were evaluated as possible contributing factors using univariate and multivariate analyses. Sensitivity and specificity of MRI to detect a torn ACL graft and meniscal and chondral injuries on arthroscopic evaluation were calculated. The interobserver and intraobserver reliability for the MRI evaluation of the ACL graft were moderate, with combined κ values of .41 and .49, respectively. The femoral tunnel position was vertical in 88% and anterior in 46%. On MRI, the ACL graft was read as intact in 24%; however, no graft was intact on arthroscopic evaluation or physical examination. The greatest discordance was between the physical examination and MRI, with a rate of 52%. An insidious-onset mechanism of injury was significantly associated with discordance between MRI and arthroscopic evaluation of the ACL (P = .0003) and specifically with an intact ACL graft on MRI (P = .0014). The sensitivity and specificity of MRI to detect an ACL graft tear were 60% and 87%, respectively. Caution should be used when evaluating a failed ACL graft with MRI, especially in the absence of an acute mechanism of injury, as it may be unreliable and inconsistent. © 2014 The Author(s).

  16. 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 autologous whole blood, to a simple suture repair of the ligament. Whether the enrichment of whole blood with MSCs would further improve the in vivo results of bio-enhanced ACL repair was investigated. Hypothesis/Purpose The hypothesis was that the addition of MSCs derived from adipose tissue or peripheral blood to the blood-extracellular matrix composite, which is used in bio-enhanced ACL repair to stimulate healing, would improve the biomechanical properties of a bio-enhanced ACL repair after 15 weeks of healing. Study Design Controlled laboratory study. Methods Twenty-four adolescent Yucatan mini-pigs underwent ACL transection followed by: 1) bio-enhanced ACL repair, 2) bio-enhanced ACL repair with the addition of autologous adipose-derived MSCs and 3) bio-enhanced ACL repair with the addition of autologous peripheral blood derived MSCs. After fifteen weeks of healing, structural properties of the ACL (yield & failure load, linear stiffness) were measured. Cell and vascular density were measured in the repaired ACL via histology, and its tissue structure was qualitatively evaluated using the Advanced Ligament Maturity Index. Results After fifteen weeks of healing, there were no significant improvements in the biomechanical or histological properties with the addition of adipose-derived MSCs. The only significant change with the addition of peripheral blood MSCs was an increase in knee anteroposterior (AP) laxity when measured at 30 degrees of flexion. Conclusions These findings suggest that the addition of adipose or peripheral blood MSCs to whole blood prior to saturation of an extracellular matrix carrier with the blood did not improve the functional results of bio-enhanced ACL repair after 15 weeks of healing in the pig model. Clinical Relevance Whole blood represents a practical biologic additive to ligament repair, and any other additive (including stem cells) should be demonstrated to be superior to this baseline before clinical use is considered. PMID:25549633

  17. 50 CFR 648.65 - Windowpane flounder sub-ACL and AM for the scallop fishery.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false Windowpane flounder sub-ACL and AM for...-ACL and AM for the scallop fishery. (a) As specified in § 648.55(d), and pursuant to the biennial framework adjustment process specified in § 648.90, the scallop fishery shall be allocated a sub-ACL for SNE...

  18. DOE Office of Scientific and Technical Information (OSTI.GOV)

    Green, D.W.; Boparai, A.S.; Bowers, D.L.

    The purpose of this report is to summarize the activities of the Analytical Chemistry Laboratory (ACL) at Argonne National Laboratory (ANL) for fiscal year (FY) 1995 (October 1994 through September 1995). This annual report is the twelfth for the ACL and describes work on 54 continuing and new projects and contributions of the ACL staff to various programs at ANL. The ACL has four technical groups -- Chemical Analysis, Instrumental Analysis, Organic Analysis, and Environmental Analysis.

  19. Angiostrongylus cantonensis (Nematode: Metastrongiloidea): in vitro cultivation of infective third-stage larvae to fourth-stage larvae.

    PubMed

    Lin, Rong-Jyh; He, Jie-Wen; Chung, Li-Yu; Lee, June-Der; Wang, Jiun-Jye; Yen, Chuan-Min

    2013-01-01

    The present study to attempt to cultivate Angiostrongylus cantonensis from third-stage larvae (AcL3) to fourth-stage larvae (AcL4) in vitro in defined complete culture medium that contained with Minimum Essential Medium Eagle (MEM), supplemented amino acid (AA), amine (AM), fatty acid (FA), carbohydrate (CA) and 20% fetal calf serum (FCS) was successful. When AcL3 were cultured in the defined complete culture medium at 37°C in a 5% CO2 atmosphere, the larvae began to develop to AcL4 after 30 days of cultivation, and were enclosed within the sheaths of the third molts of the life cycle. Under these conditions, the larvae developed uniformly and reached to the fourth-stage 36 days. The morphology of AcL3 develop to AcL4 were recording and analyzing. Then comparison of A. cantonensis larval morphology and development between in vitro cultivation in defined complete culture medium and in vivo cultivation in infective BALB/c mice. The larvae that had been cultivated in vitro were smaller than AcL4 of infective BALB/c mice. However the AcL3 that were cultured using defined incomplete culture medium (MEM plus 20% FCS with AA+AM, FA, CA, AA+AM+FA, FA+CA, CA+AA+AM or not) did not adequately survive and develop. Accordingly, the inference is made that only the defined complete medium enable AcL3 develop to AcL4 in vitro. Some nematodes have been successfully cultured into mature worms but only a few researches have been made to cultivate A. cantonensis in vitro. The present study is the first to have succeeded in developing AcL3 to AcL4 by in vitro cultivation. Finally, the results of in vitro cultivation studies herein contribute to improving media for the effective development and growth of A. cantonensis. The gap in the A. cantonensis life cycle when the larvae are cultivated in vitro from third-stage larvae to fourth-stage larvae can thus be solved.

  20. Societal and economic impact of anterior cruciate ligament tears.

    PubMed

    Mather, Richard C; Koenig, Lane; Kocher, Mininder S; Dall, Timothy M; Gallo, Paul; Scott, Daniel J; Bach, Bernard R; Spindler, Kurt P

    2013-10-02

    An anterior cruciate ligament (ACL) tear is a common knee injury, particularly among young and active individuals. Little is known, however, about the societal impacts of ACL tears, which could be large given the typical patient age and increased lifetime risk of knee osteoarthritis. This study evaluates the cost-effectiveness of ACL reconstruction compared with structured rehabilitation only. A cost-utility analysis of ACL reconstruction compared with structured rehabilitation only was conducted with use of a Markov decision model over two time horizons: the short to intermediate term (six years), on the basis of Level-I evidence derived from the KANON Study and the Multicenter Orthopaedic Outcomes Network (MOON) database; and the lifetime, on the basis of a comprehensive literature review. Utilities were assessed with use of the SF-6D. Costs (in 2012 U.S. dollars) were estimated from the societal perspective and included the effects of the ACL tear on work status, earnings, and disability. Effectiveness was expressed as quality-adjusted life years (QALYs) gained. In the short to intermediate term, ACL reconstruction was both less costly (a cost reduction of $4503) and more effective (a QALY gain of 0.18) compared with rehabilitation. In the long term, the mean lifetime cost to society for a typical patient undergoing ACL reconstruction was $38,121 compared with $88,538 for rehabilitation. ACL reconstruction resulted in a mean incremental cost savings of $50,417 while providing an incremental QALY gain of 0.72 compared with rehabilitation. Effectiveness gains were driven by the higher probability of an unstable knee and associated lower utility in the rehabilitation group. Results were most sensitive to the rate of knee instability after initial rehabilitation. ACL reconstruction is the preferred cost-effective treatment strategy for ACL tears and yields reduced societal costs relative to rehabilitation once indirect cost factors, such as work status and earnings, are considered. The cost of an ACL tear over the lifetime of a patient is substantial, and resources should be directed to developing innovations for injury prevention and for altering the natural history of an ACL injury.

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