ACL reconstruction Research Papers - Academia.edu (original) (raw)

Background. Il ritorno allo sport dopo ricostruzione del Legamento Crociato Anteriore (LCA) rimane un processo decisionale difficile e non strutturato su valutazioni condivise ed omogenee. Obbiettivo. Presentare e sintetizzare le... more

Background. Il ritorno allo sport dopo ricostruzione del Legamento Crociato Anteriore (LCA) rimane un processo decisionale difficile e non strutturato su valutazioni condivise ed omogenee. Obbiettivo. Presentare e sintetizzare le Evidence, presenti nella letteratura, relative alla terminologia e al processo decisionale, (decision-making),concernente il ritorno allo sport, dopo ricostruzione del LCA. Introduzione. Nonostante le continue richieste di un linguaggio comune in termini di terminologie e metodologie da adottare, differenze fondamentali nelle definizioni e nell’implementazione delle strategie terapeutiche, durante il processo di recupero, persistono dopo ricostruzione del LCA. È evidente come diversificazioni nelle definizioni e nelle terminologie possano creare differenze significative nella diagnosi, nel progetto riabilitativo e nei risultati finali influendo sul “Successful Outcome” dopo ricostruzione del LCA. Obiettivi. Abbiamo voluto verificare se in letteratura vi è un “consenso” sulla definizione delle funzioni di alcuni Key Terms. L’omogeneità di queste concorrono ad ottimizzare il ritorno allo sport dell’atleta. Materiali e Metodi. Inserendo la Key word “return to sport” sul database PubMed abbiamo riscontrato 3.245 “scientific and medical abstracts/citations” mentre su PubMed Central 12.059 “full-text journal articles”. Includendo, nella ricerca altre Key words come: a) “ACL terminology” abbiamo riscontrato su PubMed 47 “scientific and medical abstracts/citations” mentre su PubMed Central 570 full-text journal articles b) inserendo “Consensus Return to sport” abbiamo rilevato su PubMed 139 “scientific and medical abstracts/citations” mentre su PubMed Central 2.825 “full-text journal articles”. Da questo volume di articoli, attraverso criteri di inclusione ed esclusione siamo arrivati agli articoli di sintesi per la stesura di questa review. Risultati. Nella letteratura,recente, da noi analizzata, non sono stati riscontrati sufficienti studi scientifici sul “Consensus” sia in termini di terminologia e definizioni delle funzioni che relative al decision-making. Comunque siamo riusciti a sviluppare questo articolo di sintetizzando, e definendo parametri di linguaggio essenziali per la comunicazione ed integrazione delle informazioni clinico/riabilitative tra le varie componenti professionali che seguono l’atleta nel suo ritorno alla piena attività agonistica. Conclusioni. Il ritorno allo sport dopo ricostruzione del LCA rappresenta un momento di decision-making che coinvolge molti professionisti. Alla base del successo finale vi è anche una omogeneità nel linguaggio scientifico oltre che una architettura riabilitativa che coniuga processo di guarigione biologica associato ad un livello di performance pre- injury. Con questo lavoro siamo risusciti ad identificare dei Key terms atti ad esprimere dal punto di vista clinico/riabilitativo linguaggio comune da condividere durante l’attività della pratica scientifica. Study Design. Systematic Review. [D’Onofrio R. Tucciarone A. Godente L, Fabbrini R. ; Ritorno allo sport dopo ricostruzione del LCA : terminologie e definizioni delle funzioni. Ita. J. Sports Reh. Po.; 2019 ; 6 ; 3 ;1348 - 1375 ; ]

Cedera atau injury merupakan sesuatu kerusakan pada struktur atau fungsi tubuh yang dikarenakan suatu paksaan atau tekanan fisik. Injury sering dialami oleh seorang atlet, seperti cedera goresan, robek pada ligamen, atau patah tulang... more

Cedera atau injury merupakan sesuatu kerusakan pada struktur atau fungsi tubuh yang dikarenakan suatu paksaan atau tekanan fisik. Injury sering dialami oleh seorang atlet, seperti cedera goresan, robek pada ligamen, atau patah tulang karena terjatuh. Injury tersebut biasanya memerlukan pertolongan yang profesional dengan segera. Injury olahraga secara umum berupa cedera memar, cedera ligamentum, cedera pada otot dan tendon, pendarahan pada kulit dan pingsan. Risiko terjadinya injury dalam perminan futsal diakibatkan pengaruh dari luar (faktor ekstrinsik) berupa tackling atau tabrakan, pukulan atau benturan, lapangan yang jelek dimana menggunakan semen yang dialas dengan rumput sintetis berbahan kasar dan alat yang digunakan dalam bermain kurang baik seperti sepatu yang rusak dan tidak menggunakan alas pelindung tulang kering (deker). Sedangkan injury akibat pengaruh dari dalam (faktor intrinsik) seperti postur tubuh yang kurang baik, gerakan latihan yang salah, kelemahan otot, fisik yang tidak fit, prosedur keselamatan atlet yang kurang terjamin dan otot atau ligament yang berlebihan. Kejadian cedera pada lutut cenderung menyebabkan atlet futsal absen dalam jangka waktu paling lama, cedera di bagian ini juga paling sering membutuhkan operasi pembedahan untuk mengatasinya salah satunya adalah cidera pada Anterior Cruciate Ligament (ACL) (Sumadi, 2018).

Background: Knee valgus angle seems to be a key factor in both primary– and second–ACL injury risk models. The control of the alignment of the lower limb during dynamic movements depends on the neural activation of the muscles crossing... more

Background: Knee valgus angle seems to be a key factor in both primary– and second–ACL injury risk models. The control of the alignment of the lower limb during dynamic movements depends on the neural activation of the muscles crossing the knee joint prior to the occurrence of stressful events. The current study examined the elationship between the preparatory knee muscle activity and knee valgus angle.
Methods: Twenty-eight ACL reconstructed (ACLR) athletes were asked to perform three trials of a single-leg cross drop landing (SCD). Lower extremity kinematics and surface EMG were recorded. Initial contact knee valgus angle and EMG from 100 ms prior to ground contact were used in the data analyses.
Results: Preparatory activation medial and lateral hamstring muscles were found to be negatively correlated with knee valgus angle at initial contact (P<0.05).
However, the preparatory activity of vastus medialis and vastus lateralis muscles was not associated with initial contact knee valgus angle (P>0.05).
Conclusion: The preparatory activity of the knee muscles is linked to knee valgus angle at initial contact, and it may indicate a potential target of second ACL injury prevention programs.

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... more

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.

There have been numerous treatments developed to address ligament injury, given the functional impact of such injury on lifestyle and participa- tion in physical activities at all levels of recre- ational and competitive endeavors. With... more

There have been numerous treatments developed to address ligament injury, given the functional impact of such injury on lifestyle and participa- tion in physical activities at all levels of recre- ational and competitive endeavors. With regard to commonly diagnosed knee injuries, anterior cru- ciate ligament (ACL) insufficiency is a frequently encountered pathology that often requires surgi- cal treatment to restore the desired level of func- tion. Considering that ligament injuries most commonly affect active individuals who tend to be younger, such injuries can lead to substantial alterations in lifestyle, and therapeutic treatments that restore near-anatomic function of damaged ligaments have the potential to overcome some of the shortcomings associated with current methds of reconstruction, particularly in the case of ACL insufficiency. The incidence of complete injury to the posterior cruciate ligament (PCL) is considerably lower than that of the ACL and is estimated to occur at a rate of 2 per 100,000; however, the prevalence of asymptomatic PCL injury is considered to be not ably higher [1]. Injury to collateral ligaments represents a signifi- cant proportion of knee injuries that present to emergency rooms, and high rates of medial and collateral ligament injuries are associated with collegiate sporting activities, with many of these cases involving noncontact competition [2].
Despite advances in sports medicine, there remains controversy in the treatment of ligament injury, particularly when there is functional insuf- ficiency associated with partial ligament injury. For instance, reconstruction of the ACL is the current gold standard treatment for symptomatic ACL insufficiency, irrespective of injury pattern, and high rates of return to sport are expected [3, 4]. Disadvantages of ACL reconstruction include donor site morbidity, inability to restore normal joint kinematics, and an increased incidence of premature degenerative joint changes [5–8].
There are challenges associated with restoring anatomic function in cases of ligament injury, and biologic therapies have great potential to address some of these concerns. Therapeutic interventions that utilize bioactive growth factors and cellular elements may be used to augment ligament repair processes and can be used inconjunction with surgical treatment modalities. These biologic treatments may be a prominent feature of treatment algorithms as these technolo- gies develop and understanding of reparative pro- cesses at the cellular level advances.

translation during the Lachman test with a Rolimeter and measurement of knee hyperextension with a goniometer for both knees. A standardized pivot shift test was performed in both knees and quantified using image analysis technology.... more

translation during the Lachman test with a Rolimeter and measurement of knee hyperextension with a goniometer for both knees. A standardized pivot shift test was performed in both knees and quantified using image analysis technology. Generalized ligamentous laxity was assessed using the modified Beighton score. Results The average anterior translation of the lateral compartment during the pivot shift test was 1.6 mm (range 0.1– 7.1) with a mean side-to-side difference of 0.6 mm (range 0–2.7). The average anterior translation during the Lachman test was 9.0 (range 2–15). The anterior translation of the lateral compartment during the pivot shift test was significantly higher in females (median, 1.6; range 0.3–4.9) than in males (1.1, 0.1–7.1 mm) (p < 0.05). Anterior translation of the lateral compartment during the pivot shift test was significantly correlated with anterior translation during the Lachman test (r = 0.34; p < 0.05). There was no significant correlation between anterior translation of the lateral compartment during the pivot shift test and knee hyperextension or modified Beighton score (n.s). Conclusion The data from this study show that female sex is associated with increased rotatory knee laxity measured during the pivot shift test and anterior translation during the Lachman test in collegiate athletes. In the future, these data may be helpful in diagnosing and managing ACL injuries in athletes and could be used in the clinic as a baseline by which to compare and identify patients who might exhibit increased rotatory laxity. Level of evidence Diagnostic level II. Keywords Knee · Rotatory knee laxity · Pivot shift · Knee instability Abstract Purpose/hypothesis The purpose of this observational study was to determine which factors, including sex, are associated with increased rotatory knee laxity in collegiate athletes with no history of knee injuries. It was hypothesized that increased rotatory knee laxity, measured by a quantitative pivot shift test, would correlate with female sex, increased anterior translation during the Lachman test, generalized ligamentous laxity, and knee hyperextension. Methods Ninety-eight collegiate athletes with a median age of 20 (range 18–25) years with no history of knee injuries were tested. IKDC and Marx activity scores were obtained and subjects underwent measurement of anterior

RESUMEN. Las lesiones del ligamento cruzado anterior (LCA) hoy en día son tratadas principal-mente con injerto de isquiotibiales y una amplia gama de técnicas y sistemas de fijación del LCA en busca de una menor morbilidad del paciente.... more

RESUMEN. Las lesiones del ligamento cruzado anterior (LCA) hoy en día son tratadas principal-mente con injerto de isquiotibiales y una amplia gama de técnicas y sistemas de fijación del LCA en busca de una menor morbilidad del paciente. Se reporta un caso de una paciente de 42 años que sufrió ruptura de LCA, tratada con reconstrucción de LCA con injerto autólogo de isquiotibiales, fi ja-ción femoral con pines transversos bioabsorbibles y fi jación tibial con tornillo bioabsorbible. La pa-ciente evolucionó con presencia de dolor en región lateral de rodilla, diagnosticado como síndrome de fricción de la banda iliotibial un año posterior a la cirugía. Se realizaron estudios de imagen que incluyeron rayos X y resonancia magnética (RM) donde se observó adecuada fi jación del LCA con presencia de migración y ruptura del pin proximal bioabsorbible. Se decidió extraer el fragmento del pin bioabsrobile en un segundo tiempo quirúrgico y la paciente regresó a sus actividades cotidianas y deportivas sin dolor y con una adecuada estabi-lidad. Palabras clave: Pines bioabsorbibles, ligamento cruzado anterior, isquiotibiales, fi jación transversa. ABSTRACT. Injuries of the anterior cruciate ligament are currently treated primarily with the use of hamstring graft with a wide range of different techniques and fixation systems for anterior cruciate ligament in reducing patient morbidity. We report the case of a female patient aged 42 that suff ered an anterior cruciate ligament rupture and was treated with anterior cruciate ligament reconstruction with hamstring autograft with femoral fi xation with bio-absorbable cross-pin and tibial fi xation with bio-absorbable screw. The patient presented lateral knee pain that was diagnosed one year after the operation as an iliotibial band friction syndrome. Imaging studies were performed. X-rays and magnetic resonance imaging demonstrated adequate fixation of the anterior cruciate ligament with the presence of migration and rupture of the proximal bio-absorbable cross-pin. It was decided to remove the bio-absorbable cross-pin fragment in a second surgical procedure after which the patient went back to her daily activities and sports without pain and with stability stable knee. Este artículo puede ser consultado en versión completa en http:// www.medigraphic.com/actaortopedica

Meniscal tears within the body of the meniscus or at the meniscocapsular junction represent a well-understood and manageable condition encountered in clinical practice. In comparison , however, meniscal root tears (MRTs) often go... more

Meniscal tears within the body of the meniscus or at the meniscocapsular junction represent a well-understood and manageable condition encountered in clinical practice. In comparison , however, meniscal root tears (MRTs) often go unnoticed and represent a unique injury pattern with unique biomechanical consequences. Though first described decades ago, improvements in magnetic resonance imaging and arthroscopy have only recently enhanced our diagnostic and treatment capabilities with regard to MRTs. This review contains an anatomic description of the roots including their significance in meniscal function as well as the consequences of their loss. In addition, how to properly identify MRTs and when it is appropriate to surgically repair them are described. Finally, we review the surgical techniques available in the existing literature and present an illustrative case.

Background: Performance outcomes and return-to-play data have been reported after anterior cruciate ligament (ACL) injuries in professional football and basketball, but they have rarely been reported in professional hockey.

Objectives: Evaluate the relationship of hip and trunk muscle function with the Single Leg Step-Down test (SLSD). Study design: Laboratory study. Setting: Biomechanics Laboratory. Participants: 71 healthy participants with no history of... more

Objectives: Evaluate the relationship of hip and trunk muscle function with the Single Leg Step-Down test (SLSD). Study design: Laboratory study. Setting: Biomechanics Laboratory. Participants: 71 healthy participants with no history of anterior cruciate ligament (ACL) or lower extremity injury in the last 3 months completed this study (38 males, 33 females; mean 25.49 ± 0.62 years). Main outcomes: Hip abduction (HABD), external rotation (HER), and extension (HEXT) peak isometric force were measured. Trunk endurance was measured with plank (PL) and side plank (SPL) tests. SLSD repetitions in 60-s and dynamic knee valgus (VAL) were recorded. Results: PL, SPL, HABD, HER, and HEXT were positively correlated with SLSD repetitions. PL (r ¼ 0.598, p < 0.001) was most correlated with SLSD repetitions, and regression demonstrated that PL (p ¼ 0.001, R 2 ¼ 0.469) was a predictor of SLSD repetitions. VAL trended toward negative correlation with PL and SPL. Sex-specific differences were present, with PL, SPL, HABD, and HER showing stronger relationships with SLSD in females. Conclusion: Hip and trunk muscle function were positively correlated with SLSD performance, and these relationships were strongest in females. PL predicted performance on the SLSD. Further research is needed to investigate the utility of SLSD as a screening or return-to-play test for lower extremity conditions such as ACL injury and patellofemoral pain.

Ligament injury is a frequently cited cause of functional disability and affects people participating in a wide range of physical activities and levels of play. There are numerous potential benefits of ligament repair that include... more

Ligament injury is a frequently cited cause of functional disability and affects people participating in a wide range of physical activities and levels of play. There are numerous potential benefits of ligament repair that include restoration of normal joint kinematics and preservation of proprioception, which may lead to improved long-term preservation of joint anatomy and function. The healing potential for certain ligament injuries is not ideal due to anatomic considerations of vascularity and availability of native reparative growth factors and cellular elements. There are several therapeutic options involving biologic treatments that are becoming more widely used. These therapies include bioactive growth factors and multipotent cellular therapies that can be used in isolation or in combination with surgical treatment to augment ligament repair and regeneration.

Ligament injury is a frequently cited cause of functional disability and affects people participating in a wide range of physical activities and levels of play. There are numerous potential benefits of ligament repair that include... more

Ligament injury is a frequently cited cause of functional disability and affects people participating in a wide range of physical activities and levels of play. There are numerous potential benefits of ligament repair that include restoration of normal joint kinematics and preservation of proprioception, which may lead to improved long-term preservation of joint anatomy and function. The healing potential for certain ligament injuries is not ideal due to anatomic considerations of vascularity and availability of native reparative growth factors and cellular elements. There are several therapeutic options involving biologic treatments that are becoming more widely used. These therapies include bioactive growth factors and multipotent cellular therapies that can be used in isolation or in combination with surgical treatment to augment ligament repair and regeneration.

Though anterior cruciate ligament (ACL) is the most commonly reconstructed ligament all over the world, its arthroscopic reconstruction was relatively less frequent in the West African sub region until recently. The patronage of the... more

Though anterior cruciate ligament (ACL) is the most commonly reconstructed ligament all over the world, its arthroscopic reconstruction was relatively less frequent in the West African sub region until recently. The patronage of the traditional bone setters in the acute phase of closed knee injuries has made Chronic ACL injury the main form of presentation with significant secondary injuries and degenerative changes from sub-optimal initial care. The aim of this study was to determine functional outcome and patient's satisfaction from Arthroscopic chronic ACL injury repair. Diagnoses were made using clinical parameters and MRI. Lysholm scores were determined preoperatively, and repeated with patient's satisfaction assessment (using the Likert scale) at 3, 6, 12, 24 and 48 months postoperatively. Arthroscopic single-bundle ACL repair using a triple-weaved hamstring tendon (s) was done for all the patients. Debridement and meniscectomy were done for various degrees of degenerative changes and irreparable meniscal injuries respectively. No one was dissatisfied and 91.4% of the patients had well to excellent Lysholm scores at 2 years of follow up. It was concluded that arthroscopic chronic ACL rupture reconstruction using single-bundle triple-weaved hamstring autografts with good rehabilitation offers good to excellent knee function and patients' satisfaction with minimal complications.

[Purpose] The purpose of this review was to summarize available methods and equipment which are administered to evaluate the balance in anterior cruciate ligament reconstruction. [Subjects and Methods] A literature search was performed... more

[Purpose] The purpose of this review was to summarize available methods and equipment which are administered to evaluate the balance in anterior cruciate ligament reconstruction. [Subjects and Methods] A literature search was performed and reviewed using the narrative approach. This study reviewed English articles concerning balance assessment methods in anterior cruciate ligament reconstruction subjects from 1985 to 2015 using the following key words: Anterior Cruciate Ligament Injury, Anterior Cruciate Ligament Reconstruction, Postural Control, Equilibrium , Balance and Stability. [Results] This review included 44 studies out of 117 initially retrieved articles. These articles were discussed in balance measurement procedure without comparing the effect of various surgical, medical or rehabilitation approaches. [Conclusion] Biodex and EquiTest, functional dynamic tests are of choice in the evaluation and tracking of anterior cruciate ligament reconstruction subjects. Force plate parameters provide information regarding strategies of static postural control and is not sensitive enough to challenge postural control system in physical activities.

Background: Knee valgus angle seems to be a key factor in both primary– and second–ACL injury risk models. The control of the alignment of the lower limb during dynamic movements depends on the neural activation of the muscles crossing... more

Background: Knee valgus angle seems to be a key factor in both primary– and second–ACL injury risk models. The control of the alignment of the lower limb during dynamic movements depends on the neural activation of the muscles crossing the knee joint prior to the occurrence of stressful events. The current study examined the elationship between the preparatory knee muscle activity and knee valgus angle. Methods: Twenty-eight ACL reconstructed (ACLR) athletes were asked to perform three trials of a single-leg cross drop landing (SCD). Lower extremity kinematics and surface EMG were recorded. Initial contact knee valgus angle and EMG from 100 ms prior to ground contact were used in the data analyses. Results: Preparatory activation medial and lateral hamstring muscles were found to be negatively correlated with knee valgus angle at initial contact (P<0.05). However, the preparatory activity of vastus medialis and vastus lateralis muscles was not associated with initial contact knee...

Bagaimana Anda bisa menyebabkan cedera ACL? Ligamentum cruciatum anterior (ACL) menghubungkan tulang tungkai bawah ke tulang kaki bagian atas. Ligamen adalah pita jaringan fleksibel yang mengikat tulang bersama-sama. ACL, menghubungkan... more

Bagaimana Anda bisa menyebabkan cedera ACL? Ligamentum cruciatum anterior (ACL) menghubungkan tulang tungkai bawah ke tulang kaki bagian atas. Ligamen adalah pita jaringan fleksibel yang mengikat tulang bersama-sama. ACL, menghubungkan tulang paha Anda (tulang paha) ke tibia Anda (tulang kering) dan membantu menjaga sendi lutut Anda tetap stabil. Jika Anda berpartisipasi dalam olahraga seperti bola basket, senam, bola voli, sepak bola dan sepak bola, ACL Anda mungkin lebih berisiko. Jika Anda berolahraga seperti ini, Anda akan banyak stres pada lutut Anda. Ketika Anda berputar, berputar, tiba-tiba mengubah arah, dan melompat ACL Anda bisa merobek. Jika Anda hyperextend lutut Anda (ketika sendi lutut kembali lebih berbulu dari biasanya) itu juga bisa sobek. Cedera ACL terjadi ketika ligamen di lutut Anda robek. Ketika ligamen ini robek lutut Anda mungkin terasa seperti longgar. Mungkin terasa seperti itu mungkin "memberikan." Apa saja gejala cedera ACL? Rasa sakit yang ekstrem tepat setelah Anda mempertahankan cedera. Anda mungkin pernah mendengar suara pop atau retak pada saat cedera. Pembengkakan lutut Anda bisa kecil atau lebih luas atau bahkan tertunda. Anda mungkin merasa seperti Anda tidak bisa meluruskan kaki Anda. Anda mungkin merasakan kelembutan di sekitar area yang terluka. Lutut Anda mungkin terasa tidak stabil. Ketika Anda melukai ACL Anda, Anda mungkin ingin menggunakan penjepit. Mengapa menggunakan penyangga lutut untuk cedera ACL? Ada banyak penopang lutut ACL di pasar dari mana Anda dapat memilih. Pengungkit lutut ACL dapat membantu dengan cedera ringan dan yang lebih serius. Anda dapat memakai banyak jenis kawat gigi saat bermain olahraga kontak. Penguat lutut ACL membantu Anda meningkatkan tingkat aktivitas Anda dengan memberikan dukungan dan perlindungan. Penahan lutut ACL dapat membantu ACL cedera Anda untuk menyembuhkan sementara memungkinkan Anda kebebasan bergerak. Pengungkit lutut ACL dapat membantu mengurangi rasa sakit Anda dengan menjaga lutut tetap stabil. Kawat gigi berikut menyediakan tingkat IV (maksimum) perlindungan. The Townsend Rebel PRO Ligament Brace, Ligament Xig Ligament Brace Breg, dan Ligament Ligament DonJoy FULL adalah semua kawat gigi yang sangat baik untuk digunakan jika Anda telah menyakiti ACL Anda. Setiap penjepit memberi Anda perlindungan dan dukungan tingkat tinggi.Peranjang ini harganya $ 595,00, $ 515,95, dan $ 549,95 masing-masing. The Townsend adalah salah satu alat penguat terbaik untuk cedera ligamen meskipun itu yang paling mahal. Untuk olahraga dengan intensitas tinggi, dianjurkan. Harga ini telah dirujuk dari Braceshop.com. Sumber: https://dokter.my/ortopedi/cedera-acl

Although not life-threatening, rupture of the anterior cruciate ligament (ACL) can severely impair activities of daily living and quality of life. ACL reconstruction is an accepted modality of treatment but failure rates as high as 25%... more

Although not life-threatening, rupture of the anterior cruciate ligament (ACL) can severely impair activities of daily living and quality of life. ACL reconstruction is an accepted modality of treatment but failure rates as high as 25% have beeb reported. In view of this, we reviewed the clinicaloutcome of 33 patients who had undergone arthroscopic-assisted autogenous graft reconstruction using either patella-tendon or hamstring graft following anterior cruciate ligament (ACL) rupture in UMMC between 2000 to 2003. This study was also conducted to compare the outcome of the two different types of autogenous graft used for ACL reconstruction which are the bone-patella tendon-bone (BPB) and hamstring (HS) grafts. Patients between the ages of 17 to 48 years (mean age of 27.8 years) were evaluated at 1 to 3 years post-operatively using various clinical parameters which include functional index, subjective and objecyive scores and an objective measurement using KT 1000 arthrometer. On the overall, patients operated in our centre did well with 6% (n=2) failures reported. Both the BPB and HS groups had good to excellent results post operatively. Ninety seven percent (n=32) of the patients were able to kneel and squat with more than half of them achieving >90% single-legged hop test. Eighty eight percent of patients (n=29) achieved normal to nearly normal subjective IKDC score. The mean Lysholm score was 92.2, with 97% (n=32) scored excellent (80 points or more). More than 90% had equal or less than 2 Tegner activity-level drop. The mean KT 1000 side by side differences was 1.71mm, with 94% had less than 4mm difference. Even though the BPB group was observed to have a higher mean Lysholm score (92.6%) compared to the HS group (91.8%), they were statistically significant. The BPB group had a significantly less residual laxity with the KT 1000 side to side different of 1.1mm compared with the HS group of 1.9mm. However no correlation between laxity and any of the outcome scores were noted. In conclusion, ACL reconstruction procedures performed in UMMC have yield good to excellent short term results.

Background: A new device (T-anchor) was developed for ACL reconstruction and is implanted via the outside-in technique using hamstring grafts. The purpose of this study was to compare the T-anchor with the EndoButton Direct. Methods: This... more

Background: A new device (T-anchor) was developed for ACL reconstruction and is implanted via the outside-in technique using hamstring grafts. The purpose of this study was to compare the T-anchor with the EndoButton Direct. Methods: This study was conducted on 30 cadaveric knees (15 matched pairs). There were two groups of 15 each in the T-anchor and EndoButton Direct groups. After the harvest of grafts, fixation site profile and graft length were measured by loading the grafts onto both devices. They were then tested on a universal testing machine to assess elongation after cyclic loading, load to failure, ultimate load, and mode of failure. Results: The fixation site profile was lower in the T-anchor group than in the EndoButton Direct group (2.3 ± 0.4 mm vs. 4.7 ± 1.0 mm, P b 0.001). The length of the graft-device complex of the T-anchor specimens was longer than that of the EndoButton Direct specimens (125.0 ± 8.9 mm vs. 115.0 ± 8.7 mm, P b 0.001). The mean cyclic elongation was lower for the T-anchor group when compared with the EndoButton Direct group (2.4 ± 0.6 mm vs. 3.9 ± 2.6 mm, P = 0.015). There was no statistically significant difference in ultimate load and load to failure between the T-anchor and EndoButton Direct groups. For mode of failure, the T-anchor fared better (P = 0.013) with all failures attributed to specimens. Conclusions: In this cadaveric study, the new device, T-anchor, performed better than the EndoButton Direct with respect to the above-mentioned study parameters except for ultimate load and load to failure.

Anterior cruciate ligament (ACL) is the most frequently torn ligament in the knee, and complete healing is unlikely due to lack of vascularization. Current approaches for the treatment of ACL injuries include surgical interventions and... more

Anterior cruciate ligament (ACL) is the most frequently torn ligament in the knee, and complete healing is unlikely due to lack of vascularization. Current approaches for the treatment of ACL injuries include surgical interventions and grafting, however recent reports show that surgeries have 94% recurrency, and that repaired tissues are biomechanically inferior to the native tissue. These necessitate the need for new strategies for scar-free repair/re-generation of ACL injuries. Polycaprolactone (PCL) is a biodegradable and biocompatible synthetic polymer, which has been widely used in the connective tissue repair/regeneration attempts. Here, we report on the synthesis of PCL via ring opening po-lymerization using ε-caprolactone as the monomer, and ammonium heptamolybdate as a catalyst. The synthesized PCL was characterized using Fourier Transform Infrared Spectroscopy (FTIR) and Nuclear Magnetic Resonance (NMR) spectroscopy. It was then processed using electrospinning to form nanofiber-based scaffolds. These scaffolds were characterized in terms of surface as well as mechanical properties, and compared to the properties of commercially available PCL, and of native ACL tissue harvested from sheep. In addition, scaffolds fabricated with synthesized PCL were evaluated regarding their cell attachment capacity using human bone marrow mesenchymal stem cells (hBMSCs). Our findings demonstrated that the synthesized PCL is similar to its commercially available counterpart in terms of surface morphology and mechanical properties. In addition, fibrous scaffolds generated with electrospinning showed weaker mechanical properties visa vis native ACL tissue in terms of ultimate stress, and elastic modulus. Also, the synthesized PCL can accommodate cell attachment when tested with hBMSCs. Putting together, these observations reveal that the PCL synthesized in this study could be a good candidate as a biomaterial for ligament repair or regeneration.

PDF HTML Your Comments Download Download

Persistent rotatory instability is often described in association with ACL reconstruction. Recent studies have drawn attention to the lateral sided knee structures as possible contributors to this instability. However, varying terminology... more

Persistent rotatory instability is often described in association with ACL reconstruction. Recent studies have drawn attention to the lateral sided knee structures as possible contributors to this instability. However, varying terminology and research methodology has made the results of these recent studies difficult to interpret. It is crucial that surgeons have a thorough understanding of anterolateral knee anatomy and function prior to proposing extra-articular treatment options. The most important factor in restoring rotatory knee stability is to perform an individualized, anatomic ACL reconstruction that recreates the native anatomy of the torn ACL. This will restore native knee stability in the vast majority of cases. However, a subset of patients will have some degree of anterolateral knee injury that may need to be addressed. At this time, the proper indications for surgery and the best extra-articular procedure are not known. Therefore, it is paramount that future research establishes consistent terminology and research methodology so that scientific understanding of this incredibly intricate anatomic complex can progress.