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Bailey, Andrea Kay. "Enhancing rehabilitation following anterior cruciate ligament reconstruction." Thesis, University of Exeter, 2015. http://hdl.handle.net/10871/17475.
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Thesis Title: Enhancing rehabilitation following anterior cruciate ligament reconstruction. Context: Physical training with a neuromuscular focus has been shown to reduce anterior cruciate ligament (ACL) injury. However, ACL injury remains prevalent and often leads to joint instability, which requires surgical reconstruction. Following reconstructive surgery, a minimum of 6 months supervised rehabilitation is recommended with associated with financial cost implications to the National Health Service (NHS), the patient and society. Traditionally rehabilitation is offered in a concurrent format, whereby strength and cardio-vascular endurance exercises are performed in the same session. However, accumulating evidence from healthy populations, suggests that the development of strength might be attenuated by cardio-vascular endurance conditioning performed in close temporal proximity. This thesis comprises an entirely novel investigation of potential attenuation of strength gains in rehabilitating clinical populations that is associated with temporal incompatibility of physiological conditioning stimuli. No study has previously investigated this phenomenon, whether it might compromise the efficacy of treatment or recovery, or its potential influence on objectively-measured and patients’ perception of functional, musculoskeletal and neuromuscular performance capabilities. Objectives: The purpose of this thesis was to assess the effects of reconstruction surgery and 24 weeks of non-concurrent strength and endurance rehabilitation (with 48 week post-operative follow-up) on (a) subjective (IKDC; KOOS; PP [Chapter 4]) and objective measures of function (HOP [Chapter 5]) (primary outcome measures for this thesis), and (b) objective measures of musculoskeletal (ATFD) and neuromuscular performance (PF, EMD, RFD, SMP [Chapter 5]) (secondary outcome measures), in patients with anterior cruciate ligament deficiency. The secondary aim was to evaluate the relationships amongst a subjective outcome of function (IKDC), an objective outcome of function (HOP), and the secondary objective outcomes of musculoskeletal (ATFD) and neuromuscular (PF, RFD, EMD, SMP) performance at pre-surgery and at 24 weeks post-surgery (Chapter 6). Setting: Orthopaedic Hospital NHS Foundation Trust. Design: Prospective random-allocation to group trial involving iso-volume rehabilitative intervention versus contemporary practice, using contralateral limb assessment and clinico-social approbation controls. The design compared the effects of experimental post-surgical rehabilitation comprising non-concurrent strength and endurance conditioning with two conditions of control reflecting contemporary clinical practice (matched versus minimal assessment interaction). Participants: Eighty two patients (69♂, 13♀, age: 35.4 ± 8.6 yr; time from injury to surgery 9.4 ± 6.9 months [mean ± SD]) electing to undergo unilateral ACL reconstructive surgery (semitendinosus and gracilis graft [n = 57]; central third, bone-patella tendon-bone graft [n = 25]); were allocated to groups (2:2:1 purposive sampling ratio, respectively). Nineteen patients were lost to follow-up. Intervention: A standardised traditional concurrent (CON) ACL rehabilitation programme acted as the control versus an experimental non-concurrent (NCON) ACL rehabilitation programme that involved separation of strength and cardio-vascular endurance conditioning. An additional control group (Limited testing CON) matched the CON group rehabilitation applied within contemporary clinical practice. Outcome Measures: Chapter 4: The self-perceived primary outcome measures of function IKDC, KOOS and PP were assessed on five separate occasions (pre-surgery, and at 6, 12, 24 and 48 weeks post-surgery). However, assessment occasions were purposefully reduced to pre-operative and 48 weeks post-operative for the Limited testing CON group. Chapter 5: The primary objective outcome of function was HOP; the secondary outcomes were ATFD, PF, RFD, EMD and SMP associated with the knee extensors and flexors of the injured and non-injured legs. These objective outcomes were assessed on five separate occasions (pre-surgery, and at 6, 12, 24 and 48 weeks post-surgery). However, assessment occasions were purposefully reduced to pre-operative and at 48 weeks post-operative only for the Limited testing CON group. Chapter 6 Self-perceived (IKDC) subjective knee evaluation and the objective outcome of function (HOP), and selected objective outcomes of musculoskeletal and neuromuscular performance including ATFD, PF, RFD, EMD and SMP of the knee extensors and flexors of the injured and non-injured legs where applicable; measured at pre-surgery and at 24 weeks post-surgery were analysed for association, using Pearson product-moment correlation coefficients. A priori alpha levels were set at p<0.05. Results: Chapter 4: Factorial analyses of variance (ANOVAs) with repeated-measures investigating the primary aim showed significant group (NCON; CON) by test occasion (pre-surgery, 6, 12. 24 and 48 weeks post-surgery) interactions for self-perceived outcomes of function IKDC, KOOS and PP confirmed increased clinical effectiveness of NCON conditioning (F(2.0, 82.9)GG = 4.0 p<0.05, F(2.2, 134.7)GG = 5.5 p<0.001, F(1.9, 121.4)GG = 14.6 p<0.001, respectively) and the group mean peak relative difference in improvement for NCON was ~5.9% - 12.7% superior to CON. The greatest interaction effect was found to occur between pre-surgery and the 12 weeks post-operative test occasion for IKDC and KOOS, and between pre-surgery and the 24 week test occasion for PP. Patterns of improvements in self-perceived fitness over time were represented by a relative effect size range of 0.71 to 1.92. Improvement patterns were not significantly different between control groups offering matched or minimised assessor-patient interaction (CON vs. Limited testing CON; pre-surgery vs. 48 weeks post-surgery) indicating that clinical approbation by patients had not contributed to the outcome. Chapter 5: Factorial analyses of variance (ANOVAs) with repeated-measures showed significant group (NCON; CON) by leg (injured/non-injured) by test occasion (pre-surgery, 6, 12, 24 and 48 weeks post-surgery) interactions of the objective measure of function (HOP) together with the secondary outcomes of ATFD, PF, RFD, EMD and SMP. Similar responses were noted for the knee extensors and flexors of the injured and non-injured legs (F(2.1, 248) GG = 4.5 to 6.6; p<0.01) and confirmed increased clinical effectiveness of NCON conditioning (range ~4.7% - 15.3% [10.8%]) better than CON between 12 and 48 weeks. Patterns of improvements in physical fitness capabilities over time were represented by a relative effect size range of 1.92 to 2.89. Improvement patterns were not significantly different between control groups offering matched or minimised assessor-patient interaction (CON vs. Limited testing CON; pre-surgery versus 48 weeks post-surgery) indicating that clinical approbation by patients had not contributed to the outcome. Chapter 6: Two-tailed probabilities were used due to the exploratory nature of this study. A limited number of weak to moderate statistically significant correlations were confirmed (ranging from r = 0.262 – 0.404; p<0.05; n=48 [amalgamated NCON and CON groups] ) between IKDC and most notably, the neuromuscular performance outcome of EMD. Conclusion: Overall, the patterning and extent of changes amongst self-perceived, functional, musculoskeletal and neuromuscular performance scores offer support for the efficacy of using non-concurrent strength and endurance conditioning to enhance post-surgery rehabilitation. The limited robustness of relationships amongst the validated and frequently-used self-perceived outcome of function [IKDC], and objectively-measured outcomes of function and musculoskeletal and neuromuscular performance suggested that each might properly reflect an important but separate aspect of clinical response and should be deployed to detect change.
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Verhoff, Kassondra M. Ms. "Lower Extremity Propulsion Biomechanics during a Single Limb Hop for Distance in patients Following Anterior Cruciate Ligament Reconstruction." University of Toledo / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1525454329918514.
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Nesbitt, Rebecca J. "Establishing Design Criteria for Anterior Cruciate Ligament Reconstruction." University of Cincinnati / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1428048607.
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Otzel, Dana M. "Muscle function and quality after anterior cruciate ligament (ACL) reconstruction." [Gainesville, Fla.] : University of Florida, 2005. http://purl.fcla.edu/fcla/etd/UFE0010540.
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Pérez-Prieto, Daniel. "Etiology, prevention and treatment of infections after anterior cruciate ligament reconstruction." Doctoral thesis, Universitat Autònoma de Barcelona, 2018. http://hdl.handle.net/10803/669855.
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Les infeccions després de reconstrucció de lligament encreuat anterior (r-LLEA) són complicacions amb una incidència de entre 0,5% i 1.5% que poden arribar a ser greus si no es tracten de manera adequada. Durant la darrera dècada s’han publicat diversos estudis sobre la eficàcia i els resultats del desbridament artroscòpic d’aquestes infeccions. Malgrat això, la literatura sobre el seu origen i prevenció és més limitada així com el tractament antibiòtic adient de les mateixes.
La present tesi es base en un compendi de tres publicacions sobre la etiologia, la prevenció i el tractament de les infeccions de r-LLEA. Els objectius són: avaluar la contaminació de les plàsties de lligament encreuat anterior (LLEA) com a origen de les infeccions; avaluar la efectivitat de una solució de vancomicina de 5mg/dl com a mètode per eradicar la contaminació i per tant disminuir la taxa d’infecció; i finalment avaluar la combinació de levofloxacino i rifampicina com a tractament antibiòtic òptim per a les infeccions estafilocòcciques.
Durant l’obtenció i preparació de les plàsties de LLEA es va observar una taxa de contaminació d’un 14% la major part de la qual va ser deguda a estafilococs (71%). El remullat en una solució de vancomicina de 5mg/dl aconsegueix eradicar completament la contaminació. En la pràctica clínica, el remullat de les plàsties de LLEA en la solució de 5mg/dl de vancomicina redueix la taxa d’infecció de r-LLEA de 1,8% a 0%. Finalment, la combinació de levofloxacino i rifampicina orals (després de realitzar un desbridament artroscòpic) durant un període de 6 setmanes és un tractament efectiu per les infeccions estafilocòcciques.
Les conclusions que s’han obtingut de la present tesi i el compendi de publicacions que la formen són: 1) Que la obtenció i preparació de les plàsties de LLEA és una font de contaminació bacteriana i podria ser l’origen de les infeccions de r-LLEA. 2) Que el remullat de les plàsties en una solució de 5mg/dl de vancomicina aconsegueix eradicar la contaminació i disminuir a 0% la taxa d’infeccions de r-LLEA. 3) Que el tractament amb levofloxacino i rifampicina associat al desbridament artroscòpic, és el tractament antibiòtic òptim per les infeccions estafilocòcciques després de r-LLEA.Infections after anterior cruciate ligament reconstruction (ACL-R) are complications with an incidence between 0,5% and 1,5% and can cause serious knee joint damage if a correct treatment is not applied. During last decade several studies about arthroscopic debridement efficacy and outcomes have been published. However, literature about the origin and prevention of ACL-R infections is scarce same as its antibiotic treatment. The present thesis is a compendium of three publications about the etiology, the prevention and the treatment of infections after ACL-R. The purposes are: to evaluate the ACL graft contamination as a source of infection; to evaluate the effectiveness of a 5mg/dl vancomycin solution to eradicate contamination and thus reduce infection’s rate; and finally, to evaluate the combination of levofloxacin and rifampicin as the optimal antibiotic treatment for staphylococcal infections. A contamination rate of 14% was observed during ACL graft harvesting and preparation, most of it due to staphylococci (71%). The soaking in a 5mg/dl vancomycin solution completely eradicates contamination. In clinical practice the presoaking of ACL graft in the vancomycin solution reduces infection rate from 1,8% to 0%. Finally the combination of oral levofloxacin and rifampicin (along with arthroscopic debridement) for a period of 6 weeks is an effective treatment for staphylococcal infections. The conclusions of the present thesis and its publications compendium are: 1) The ACL graft harvesting and preparation is a source of contamination that can lead to infection. 2) The vancomycin solution of 5mg/dl completely eradicates the aforementioned contamination and reduces ACL-R infection rate to 0%. 3) The combination of levofloxacin and rifampicin after arthroscopic debridement is the optimal antibiotic schedule for staphylococcal ACL-R infections.
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Mikkelsen, Christina. "Rehabilitation following bone-patellar tendon-bone graft ACL reconstruction /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-913-0/.
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Hartigan, Erin. "Knee function after ACL rupture and reconstruction effects of neuromuscular training." Access to citation, abstract and download form provided by ProQuest Information and Learning Company; downloadable PDF file, 203 p, 2009. http://proquest.umi.com/pqdweb?did=1896910991&sid=7&Fmt=2&clientId=8331&RQT=309&VName=PQD.
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Tagesson, (Sonesson) Sofi. "Dynamic knee stability after anterior cruciate ligament injury : Emphasis on rehabilitation." Doctoral thesis, Linköpings universitet, Sjukgymnastik, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-10498.
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Anterior cruciate ligament injury leads to increased sagittal tibial translation, and perceptions of instability and low confidence in the knee joint are common. Many patients have remaining problems despite treatment and are forced to lower their activity level and prematurely end their career in sports. The effect of ACL reconstruction and/or rehabilitation on dynamic knee stability is not completely understood. The overall aim of this thesis was to study the dynamic knee stability during and after rehabilitation in individuals with ACL injury. More specific aims were 1) to elaborate an evaluation method for muscle strength, 2) to evaluate the effect of exercises in closed and open kinetic chain, and 3) to evaluate dynamic knee stability in patients with ACL deficiency or ACL reconstruction. Sagittal tibial translation and knee flexion angle were measured using the CA‐4000 computerised goniometer linkage. Muscle activation was registered with electromyography. The intra‐ and inter‐rater reliability of 1 repetition maximum (RM) of seated knee extension was clinically acceptable. The inter‐rater reliability of 1RM of squat was also acceptable, but the intra‐rater reliability was lower. The systematic procedure for the establishment of 1RM that was developed can be recommended for use in the clinic. One specific exercise session including cycling and a maximum number of knee extensions and heel raises did not influence static or dynamic sagittal tibial translation in uninjured individuals. A comprehensive rehabilitation program with isolated quadriceps training in OKC led to significantly greater isokinetic quadriceps strength compared to CKC rehabilitation in patients with ACL deficiency. Hamstring strength, static and dynamic translation, and functional outcome were similar between groups. Five weeks after ACL reconstruction, seated knee extension produced more anterior tibial translation compared to the straight leg raise and standing on one leg. All exercises produced less or equal amount of anterior tibial translation as the 90N Lachman test. Five weeks after the ACL reconstruction the static and dynamic tibial translation in the ACL reconstructed knee did not differ from the tibial translation on the uninjured leg. Patients in the early phase after ACL injury or ACL reconstruction used a joint stiffening strategy including a reduced peak knee extension angle during gait and increased hamstring activation during activity, which reduces the dynamic tibial translation. Patients with ACL deficiency that completed a four months rehabilitation program used a movement pattern that was more close to normal.
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Lee, Anna Glyn. "A Novel Device and Method to Quantify Knee Stability during Anterior Cruciate Ligament Reconstruction." The Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu159535872238711.
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Wordeman, Samuel Clayton. "Effects of Neuromuscular Training in Anterior Cruciate Ligament-Reconstructed Subjects." The Ohio State University, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=osu1410446293.
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Smale, Kenneth. "Relating Subjective and Objective Knee Function After Anterior Cruciate Ligament Injury Through Biomechanical and Neuromusculoskeletal Modelling Approaches." Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/37947.
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Background: Knee injuries have a considerable impact on both the person’s psychological and physical health. We currently have tools to address each of these aspects but they are often considered independent of each other. Little work has been done to consolidate the subjective and objective functional ability of anterior cruciate ligament (ACL) injured individuals, which can be detrimental when implementing a return-to-play decision-making scheme. The lack of understanding concerning the relationship of these two measures may account for the high incidence of re-injury rates and lower quality of life exhibited by so many of these patients.
Purpose: The purpose of this doctoral thesis is to investigate the relationship between subjective and objective measures of functional ability in ACL deficient and ACL reconstructed conditions through biomechanical and neuromusculoskeletal modelling approaches.
Methods: This thesis is comprised of five studies based on a single in vivo data collection protocol, medical imaging and in silico data analyses. The in vivo data collection was of test-retest design where ACL deficient patients participated prior to their operation and approximately ten months post-reconstruction. This experimental group was matched to a healthy, uninjured control group, which was tested a single time.
The first study of this thesis involved a descriptive analysis of spatiotemporal, neuromuscular, and biomechanical patterns during hopping and side cut tasks in addition to subjective functional ability questionnaires. Then, two novel measures of dynamic knee joint control were developed and applied along with a third measure to determine if changes in joint control exist between the three groups (Study 2). The relationships of these objective measures of functional ability to subjective measures were then examined through correlation and regression models (Study 3). Following this, a method of including magnetic resonance imaging to construct patient-specific models was developed and implemented to determine realistic kinematic and ligament lengthening profiles (Study 4). These patient-specific models were then applied to quantify knee joint loading in the form of contact and ligament forces, which were correlated to subjective measures of functional ability (Study 5).
Results: Even though no major differences in neuromuscular patterns were observed between all three groups, it was found that subjective patient-reported outcome measures scores and biomechanical measures in the form of knee flexion angles and extensor moments were lower in the ACL deficient group compared to healthy controls. These differences continued to exist 10 months post-operation as the ACL reconstructed group had not fully recovered to patterns observed in the healthy controls. The current findings also suggest a possible hierarchy in the relationships between objective and subjective measures of functional ability. Basic kinematic objective measures such as knee flexion angle show small to moderate correlations, while more comprehensive measures such as stiffness and joint compressive force show moderate to strong correlations to subjective questionnaires. Finally, this thesis developed patient-specific OpenSim models that were used to produce appropriate kinematics and ligament lengthening with the reduction in soft tissue artefact.
Conclusion:
This thesis demonstrated that patients who are high-functioning in the ACL deficient state show greater improvements in subjective outcome scores after ACL reconstruction compared to objective measures. Biomechanical and neuromusculoskeletal modelling approaches identified important differences between the healthy and ACL deficient groups that were not resolved post-operatively. Our results also demonstrate that certain subjective and objective measures of functional ability are strongly correlated. The knowledge gained from this test-retest design and novel patient-specific in silico models aids clinicians in managing their expectations regarding the effectiveness of reconstruction and the respective long-term sequelae.
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Alarifi, S. M. "Functional tasks before and after an anterior cruciate ligament (ACL) reconstruction : are there mechanical differences?" Thesis, University of Salford, 2017. http://usir.salford.ac.uk/43415/.
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Anterior cruciate ligament (ACL) injury is a major cause of significant time loss to sports participation, as well as reportedly leading to an increased risk of osteoarthritis (OA). Knee instability and functional adaptations are likely to occur following injury to the ACL, despite many ACL-deficient (ACLD) patients displaying no, or minimal, visible impairment. ACL reconstruction (ACLR) is the most common form of treatment for physically active individuals following an ACL injury. The aim of most individuals is to return to preinjury levels of physical activity after ACLR. However, most individuals experience persistent changes to lower extremity biomechanics well after completing structured rehabilitation and being cleared to return to activity. Despite this, there is little data available on individuals with an ACLD, or ACL-reconstructed ACLR knee and biomechanical alterations leading to the development of OA. Numerous studies that have investigated walking gait have found significant reductions in peak internal knee extensor moment, and small reductions in peak knee flexion angle, with individuals adopting a quadriceps avoidance gait pattern during walking. One of the most common activities pre- and post- surgery is running, and it is not known whether individuals before and after ACLR knee have different knee kinematic and kinetic patterns to healthy individuals. However, in general clinical practice, the option to ask the individual to run and to assess this is limited, and so a more space-optimised clinical assessment is needed. Therefore, the single leg squat (SLS) has been chosen as the measure to assess these individuals. No previous study has been found on kinematics and kinetics before and after ACLR during running and SLS. Therefore, the research question of this thesis is to determine whether there is an alteration in the kinematics and kinetics of hip and knee joints, along with the related risk factors for patellofemoral pain syndrome and OA, before and after ACLR during running and SLS. This research aimed, in the first study, to establish within-day and between-days reliability for the use of 3D motion analysis to measure the biomechanical variables for running and SLS tasks. This study concludes that for between and within-day sessions, specific variables demonstrated good and excellent levels of consistency (ICC=0.80-0.99), and exhibited standard errors of measurement that have relatively low values. The second study investigated the hip and knee joints’ kinematics and kinetics six to eight months after ACLR, and compared the outcomes between the injured limb and non- injured limb (n=34), and a control group (n=34). This showed that ACLR individuals, despite a return to sport and being deemed medically fit, still have performance issues, which could be related to PF joint pathology and OA. This study found that the injured limb of the ACLR group showed a significant reduction in peak internal knee extensor moment and impulse, knee flexion angle and external knee adduction moment (p=0.01, p=0.01, p=0.01, p=0.04 respectively) compared to the control group during running. On comparing the injured and non-injured limbs in ACLR, an increase in hip internal rotation angle, coupled with a reduction in knee flexion angle, peak internal knee extensor moment and impulse (p=0.01, p=0.01, p=0.01, p=0.01 respectively) was found during running. Comparing the injured and non- injured limbs in SLS, revealed an increase in hip internal rotation angle coupled with knee adduction angle, in addition to a reduction in peak internal knee extensor moment (p=0.01, p=0.01, p=0.04 respectively). The control group compared to the injured limb of the ACLR group during SLS, showed reductions in peak internal knee extensor moment (p=0.01); whereas the non-injured limb of the ACLR group revealed an increase in hip internal rotation moment, and a reduction in peak internal knee extensor moment (p=0.04, p=0.01 respectively). The third study investigated hip and knee joint kinematics and kinetics before, and three and six months after ACLR, during running and a SLS task to compare between the injured limb and non-injured limb (n=6), and the control group (n=6). This was to examine whether these factors develop over time, which could be related to PF joint pathology and OA. The findings show that there was a reduction in the peak internal knee extensor moment and impulse three and six months post ACLR between limbs, and in comparison to the injured limb for the ACLR group and the control group (p=0.01, p=0.01 respectively). In addition, significant differences were noted before, and three and six months after ACLR, during running (p=0.01, p=0.01 respectively), as well as SLS between limbs three months after ACLR. At the same time, within the ACLR group, there was a significant reduction in knee flexion angles during running three and six months after ACLR between limbs. The results of this thesis show that following ACL reconstruction, individuals in this thesis showed some specifically altered knee joint kinematics and kinetics. The reduction in peak internal knee extensor moment and knee flexion angle was in an effort to reduce or avoid the contraction of the quadriceps; namely, quadriceps avoidance. These reductions may contribute towards patellofemoral joint disorders, thereby increasing the risk of degenerate joint disease commonly found post-surgery. The results of this thesis may help to guide the development of new or alternative treatment options for improving long-term joint health after an ACL injury.
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Bennison, John Charles. "Gait Analysis in Anterior Cruciate Ligament Reconstruction & Controls Across Different Levels of Visual Feedback." Ohio University / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1617872112807014.
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Schroeder, Matthew Jason. "Factors Related to the Timing of Anterior Cruciate Ligament Reconstruction Failure Among an Active Population." The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1343664476.
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Criss, Cody R. "Central Nervous System Contributions to Subjective and Objective Measures of Function after Anterior Cruciate Ligament Reconstruction." Ohio University / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1617279837916864.
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Erlandsson, Rasmus. "A retrospective cohort study evaluating the risk of re-arthroscopy two years after Anterior Cruciate Ligament reconstruction." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-86734.
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Introduction: The Anterior Cruciate ligament (ACL) is one of the most important ligaments in the knee providing joint stability. Rupture of ACL is the most common sports injury. About half of the patients undergo surgical reconstruction. The Orthopaedic clinic in Region Örebro county underwent a reorganization in 2016. Aim: The aim of this study was to evaluate the two-year risk of re-arthroscopy in the same knee after primary ACL-reconstruction. Material and Methods: A retrospective cohort study. All patients from 1st January 2005 until 31st December 2017 with primary ACL reconstruction in Region Örebro county were included. Data was collected from medical records and The Swedish National Anterior Cruciate Ligament Register. Results: 431 patients were included. The total risk of re-arthroscopy was 13.0%. Meniscal surgeries and age did not affect the outcome. Fixation method in femur and tibia affected the outcome, as did choice of graft. There was a small numerical difference before (13.4%) vs after (12.1%) the reorganization, but it was not statistically significant either unadjusted or adjusted for age and meniscal surgeries (p=0.721). Conclusions: Our study indicates that choice of graft and fixation method in femur and tibia affect the re-arthroscopy rate. Regarding graft, the semitendinosus tendon alone was the better option, and for fixation both for femur and tibia it seems like Tightrope was the best option and screw the worst. The reorganization did not affect the outcome but might have other benefits.
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Braun, Kaitlyn N. "Single-Leg Power Generation in Adolescent & Young Adult Athletes Returning to Sport Following Anterior Cruciate Ligament Reconstruction." Miami University / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=miami1272044091.
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Braun, Kaitlyn Nicole. "Single-leg power generation in adolescent & young adult athletes returning to sport following anterior cruciate ligament reconstruction." Oxford, Ohio : Miami University, 2010. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=miami1272044091.
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Boguszewski, Daniel V. "Characterizing the Porcine Knee as a Biomechanical Surrogate Model of the Human Knee to Study the Anterior Cruciate Ligament." University of Cincinnati / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1337715685.
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Zelleroth, Ylva. "Progression of psychological readiness to return to sport and the influence of covid-19 on rehabilitation after anterior cruciate ligament reconstruction." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-91062.
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Introduction: A successful return to sport (RTS) after anterior cruciate ligament reconstruction (ACL-R) demands optimal physical and psychological rehabilitation. Aim: Study the change in psychological readiness to RTS between three- and six-months post ACL-R, to associate psychological readiness to patient-reported knee function and identify factors associated to greater psychological readiness to RTS. The secondary aim was to examine how the Covid-19 pandemic has affected the patients’ rehabilitation. Methods: Prospective cohort study including patients with primary ACL-R recruited from the Swedish Knee Ligament register, age 16-40 and physically active on Tegner>3. Demographics including pre-injury sport participation, psychological readiness reported with the Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scale, knee function reported with the subjective International Knee Documentation Committee (IKDC) and the impact on rehabilitation by Covid-19 were analyzed at three- and six-months post-surgery. ACL-RSI scores were compared, correlated to IKDC and univariate analysis was used to determine the association between factors and the psychological readiness to RTS. Results: 141 patients were analyzed (56 men, 85 women; median age 24 years), all were recreational or competitive athletes (median Tegner level 8). The psychological readiness progressed through rehabilitation, was correlated to subjective IKDC. No differences could be detected between ACL-RSI scores and included factors at six months post ACL-R. Covid-19 had an impact on 36% (40/112) of the patients’ rehabilitation. Conclusions: Psychological readiness improved after ACL-R and was significantly associated to self-reported knee function at six months post ACL-R. Covid-19 restrictions affected rehabilitation for one in every three participants.
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Chen, Albert J. "Biomechanical Alterations in Athletes with Anterior Cruciate Ligament Reconstruction and the Implications for Osteoarthritis: A Subject Specific Finite Element Analysis Study." The Ohio State University, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=osu1546185726941703.
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Shabani, Bujar. "Gait knee kinematics of patients with ACL rupture : a 3D assessment before and after the reconstruction." Thesis, Lyon 1, 2015. http://www.theses.fr/2015LYO10021/document.
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La rupture du ligament croisé antérieure (LCA) conduit à une instabilité et à des modifications biomécaniques du genou. Actuellement, les patients présentant une lésion du LCA bénéficient généralement une reconstruction du LCA. L'analyse cinématique quantitative est un outil important pour acquérir une compréhension approfondie de la fonction articulaire du genou normal et pathologique au cours de la locomotion humaine. Ce travail est axé sur l'évaluation in vivo de la cinématique du genou chez les patients avec rupture du LCA, avant et après la reconstruction du LCA au cours de toutes les phases de la marche, en utilisant un nouvel outil d'évaluation 3D, quasi-rigide, en temps réel (KneeKGTM). Dans la première étude, des modifications cinématiques significatives ont été identifiées dans les genoux avec une rupture du LCA. Ces changements cinématiques pourraient mener à des contacts fémoro-tibiaux anormaux du cartilage pendant les activités quotidiennes, représentant potentiellement un mécanisme biomécanique de l'usure des articulations après une lésion du LCA. Dans la seconde étude, l'analyse 3D in vivo du mouvement a révélé que les genoux avec LCA reconstruits améliorent significativement leur extension par rapport aux genoux avec LCA déficient, mais il y avait encore une différence par rapport au groupe témoin sain. Dans le plan axial, le tibia reste en position interne significative par rapport à un groupe témoin, tandis qu'il n'y avait pas de différences significatives en translation antéro-postérieur et dans le plan coronal. Ces changements cinématiques pourraient conduire à une charge anormale dans l'articulation du genou et initier le processus d'atteinte dégénérative cartilagineuse à venir. Toutefois, les données cinématiques post-opératoires ont été collectées 10 mois après la chirurgie, ainsi un suivi plus long serait nécessaire pour évaluer si ces changements cinématiques persistent dans le temps, et leurs effets sur l'articulationBecause of the role of the ACL in knee joint’s biomechanics, it is essential to quantify the kinematics of ACL deficient and ACL reconstructed knee. In-vitro models bare the handicap of limited muscle simulation, while static, one-dimensional testing cannot predict the behavior of these groups of patients under realistic loading conditions. Currently, the most widely accepted method for assessing joint movement patterns is gait analysis. Respectively, 3D motion analysis is necessary to provide high reliability movement analysis. The purpose of the study was in-vivo evaluation of the behavior of the anterior cruciate ligament deficient (ACLD) and anterior cruciate ligament reconstructed (ACLR) knees during walking, using 3D, real-time assessment tool. Significant alterations of joint kinematics in the ACLD knee were revealed in this study by manifesting a higher flexion gait strategy and excessive internal tibial rotation during walking that could result in a more rapid cartilage thinning throughout the knee. In the other hand, even though ACLR knees showed some improvements in sagittal plane compared to ACLD knees, in axial plane there still exists difference compared to healthy control knees. These kinematic changes could lead to abnormal loading in knee joint and initiate the process for future chondral degeneration. However, the post-operative kinematic data were collected 10 months after surgery, so a longer follow-up is needed to evaluate if these kinematic changes persist in time, and their effects in joint degeneration
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Silva, Kevin J. "Validation of the Movement and Activity in Physical Space System as a Functional Outcome Measure Following Anterior Cruciate Ligament Reconstruction Surgery." Ohio University / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1367855684.
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Dahlgren, Joakim. "Incidence of meniscal tears and cartilage lesions at the time of anterior cruciate ligament reconstruction in Region Örebro County – a retrospective cohort study." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-86760.
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Introduction: The anterior cruciate ligament (ACL) is a supporting ligament in the knee. ACL injuries are associated with concomitant meniscal tears and cartilage lesions. Aim: Our aim was to study the incidence of meniscal tears and cartilage lesions in patients with ACL injury and how it varies with time from injury to surgery Methods: This was a cohort study using the Swedish Knee Ligament Registry. We reviewed 479 patients who had ACL reconstruction in Region Örebro County between 2005-01-01 and 2019-03-19. Results: The incidence of meniscal tears was 33 %, cartilage lesions 18 %, both meniscal tears and cartilage lesions 29 %. The incidence of meniscal tears distributed over time from injury to surgery was 8 % for 0-3 months., 38 % for 4-12 months, 53 % for > 12 months. The incidence of cartilage lesions was 8 % for 0-3 months, 45 % for 4-12 months, 47 % for > 12 months. The incidence of both meniscal tears and cartilage lesions was 4 % for 0-3 months, 34 % for 4-12 months, 62 % for > 12 months Conclusions: Patients treated with ACL reconstruction had an increased rate of concomitant damage to menisci and articular cartilage with increased time from injury to surgery, suggesting a benefit of early reconstructive interventions following an ACL injury. Male patients displayed a higher incidence in cartilage lesions than did female. Young age was associated with a higher incidence of meniscal tears, whereas an increasing of age was associated with an increased incidence of cartilage lesions.
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Nagelli, Christopher. "Sensorimotor Contribution to Joint Dysfunction following Anterior Cruciate Ligament Injury and Neuromuscular Training as a Clinical Tool to Recover Sensorimotor Control." The Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu1500287443874928.
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Araujo, Paulo Henrique Mendes de. "Avaliação quantitativa do teste do pivot shift para individualizar o tratamento das lesões do ligamento cruzado anterior." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/17/17142/tde-04082015-133540/.
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O teste do pivot shift é a manobra semiológica mais específica para o diagnóstico da lesão do ligamento cruzado anterior (LCA). É também o único teste que se correlaciona com a probabilidade de desenvolvimento de osteoartrose em joelhos com instabilidade rotacional persistente, após a reconstrução do LCA. Entretanto, há uma grande variabilidade na técnica utilizada para a realização deste teste, comprometendo a sua reprodutibilidade e a sua quantificação objetiva. O teste do pivot shift é influenciado pela associação entre a lesão do LCA e a de outras estruturas anatômicas do joelho. A padronização e a mensuração quantitativa do pivot shift auxiliam na categorização objetiva da frouxidão ligamentar do joelho. O objetivo desta tese foi o de compilar uma série de contribuições do autor, num total de seis publicações, na linha de pesquisa sobre a padronização, quantificação e interpretação do teste do pivot shift. A padronização do teste contribuiu para o aumento da reprodutibilidade da manobra semiológica. Nossos estudos laboratoriais em peças de cadáver demonstraram que a padronização do teste do pivot shift diminuiu de forma significativa a variação da aceleração da redução da tíbia no pivot shift (joelho esquerdo 3,0 ± 1,3 e joelho direito 2,5 ± 0,7 mm/s2) comparada ao teste realizado pela técnica de preferência do cirurgião (joelho esquerdo 4,3 ± 3,3 e joelho direito 3,4 ± 2,3 mm/s2) em cadáver cirurgicamente preparado para apresentar um pivot shift positivo com diferentes gradações em cada joelho. A validação de dispositivos não-invasivos de avaliação da frouxidão ligamentar do joelho, contribuiu para que o teste possa ser medido quantitativamente. Quando comparamos um método invasivo de referência para a mensuração do pivot shift (sensores eletromagnéticos fixados ao osso do fêmur e da tíbia) com três métodos não-invasivos (sensores eletromagnéticos fixados a pele, acelerômetro e um método de análise de imagens), constatamos que todos os métodos não-invasivos apresentaram correlação (r) positiva estatisticamente significante (p <0,01) com o método de referência. Os sensores fixos à pele tiveram r = 0,67 e r = 0,88 para os parâmetros de translação e de aceleração respectivamente. O acelerômetro apresentou r = 0,75 para o parâmetro de aceleração e o método de análise de imagens r = 0,24 para o parâmetro de translação anterior da tíbia. Portanto, neste estudo, métodos não invasivos, adequados para uso em consultório médico, puderam quantificar de forma reprodutível os parâmetros da aceleração e da translação anterior da tíbia no teste do pivot shift. A aplicação clínica destes resultados foi proposta pelo autor por meio de um novo algoritmo para o tratamento individualizado das lesões do LCA, em uma de suas recentes publicações. Embora este algoritmo precise ser validado, a sua proposta abre perspectiva para novos estudos que objetivem melhores resultados no tratamento de pacientes com lesão do ligamento cruzado anterior.The pivot shift test is the most specific semiologic maneuver to diagnose the anterior cruciate ligament (ACL) injuries. It is also the only test capable of predicting the development of osteoarthritis in the presence of persistent rotatory knee laxity after an ACL reconstruction. However, the test has great technique variability among surgeons compromising reliability and objective quantification. The pivot shift test is influenced by the pattern of the ACL tear and associated lesions. The standardization and the quantitative measurement of the pivot shift can aid in the knee rotary laxity categorization and can provide valuable information on possible additional affected structures besides the ACL, thus contributing for an individualized treatment algorithm for this ligament injury. The purpose of this thesis was to compile a series of author\'s contributions, in a total of six publications, in the field of standardization, measurement and interpretation of the pivot shift test. The standardized technique for the pivot shift test improved the maneuver reliability. Our laboratory studies utilizing cadaveric knees demonstrated that the standardized technique significantly reduced the variation of the acceleration of the tibial reduction during the pivot shift test among surgeons (left knee 3.0 ± 1.3 mm/s2; right knee 2.5 ± 0.7 mm/s2) compared to the surgeons\' preferred technique (left knee 4.3 ± 3.3 mm/s2; right knee 3.4 ± 2.3 mm/s2) in a surgically prepared cadaver for a different positive grade pivot shift in each knee. The validation of non-invasive devices for the knee ligament laxity evaluation aided in the quantitative measurement of the pivot shift. The comparison of an invasive reference method for the pivot shift measurement (electromagnetic tracking device fixed to the femur and tibia) with three non-invasive devices (electromagnetic tracking device attached to the skin, accelerometer and image analysis system) showed statistically significant (p > 0.01) positive correlation (r) for all of them. The electromagnetic tracking device attached to the skin had r = 0,67 and r = 0,88 for the anterior translation and acceleration parameters respectively. The accelerometer has r = 0,75 for the acceleration parameter and the image analysis system had r = 0,24 for the anterior tibial translation parameter. Therefore, in this study, non-invasive methods, affordable for a clinical use, could reliably quantify the acceleration and anterior tibial translation parameters during the pivot shift test. The clinical application of these results was proposed by the author by means of a new algorithm for individualized treatment of the ACL injuries in one of his recent publications. Although this algorithm is yet to be validated, its proposal opens perspective for new studies that aim for better treatment results in patients with an anterior cruciate ligament injury.
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Alinejad, Mona. "Artificial anterior cruciate ligament reconstruction." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:9cace6f9-2147-481e-b19f-502c38cc6b98.
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Conventional anterior cruciate ligament (ACL) reconstruction grafts have not been able to replicate the mechanical behaviour of the native ACL, reproduce normal knee mechanics and kinematics, or prevent degenerative disease progression of the knee. The aim of this thesis was to investigate a novel ACL design to more closely mimic the normal mechanical behaviour of the ACL, reconstruct the isometric ACL fibre and potentially reproduce the normal kinematics and mechanics of the knee. The designed artificial ACL reconstruction (ACLR) system could be used as a stand-alone device or in conjunction with a total knee replacement (TKR). The nominated design option for the ACLR system consisted of a connecting cord made of ultra-high molecular weight polyethylene (UHMWPE) fibres and an elastic system made of cobalt-chrome-molybdenum (CoCrMo) alloy with similar load-elongation characteristics to the native ACL. The design requirements were defined based on the mechanical properties of the native ACL, size constraints from the bony geometry and TKR components, and the location of the isometric fibres of the native ACL. The in vitro mechanical tests performed in this project on the designed cord showed a 2-3 times greater ultimate tensile load compared to the ACL in young human cadavers. The decreasing creep modulus of the UHMWPE cord under fatigue loading in simulated body conditions (3118 MPa at 6.5×106 cycle) indicated nominal creep and stabilised mechanical properties by the 3000th loading cycle. To replicate the non-linear stiffness of the ACL with ~38 N mm-1 toe and ~100 N mm-1 linear regions, the artificial ACLR device consisted of a femoral spring (~60 N mm-1) in series with a tibial spring (~100 N mm-1) and a connecting cord (~2000 N mm-1). Two helical springs in series were used for the stand-alone ACLR, whereas a helical spring in series with a spiral spring was designed for the ACLR-TKR. As both the helical and spiral springs had a constant stiffness, stop mechanisms were added to the springs to create a non-linear stiffness and control the maximum safe deformation limit of each spring. To understand the mechanical behaviour of the reconstructed isometric fibre of the ACL, passive and loaded motions were simulated in 18 sets of segmented MRI models of healthy human knees. Constant load and elongation was observed throughout flexion during the passive movements, whereas maximal load and elongation in the reconstructed ACL was identified at 50 º of flexion during loaded motion. An ACL attachment placement sensitivity study, conducted in this project to assess the effect of surgical implantation error on the behaviour of the reconstructed ACL, revealed that misplacement of the femoral attachment would significantly influence the load-elongation of the reconstructed ACL. Finite element (FE) models of the designed ACLR devices enabled their behaviour under simulated axial loading, squatting and the Lachman test to be assessed. Both ACLR devices successfully reproduced stiffness of the native ACL with a multi-linear stiffness curve, however, elongation greater than 3.1 mm could not be achieved. It can be concluded that the designed artificial ACLR devices were able to mimic the mechanical behaviour of the ACL provided it was positioned at the isometric attachment points; potentially enabling achievement of more natural kinematics and mechanics of the reconstructed knee. However, ACL placement was shown to have a significant impact on the behaviour of the reconstructed ACL, therefore, placement error may over-constrain the joint. For this reason, a more forgiving design with a lower stiffness and a larger deformation limit would be advised.
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Paton, Bruce Murray. "Knee swelling and anterior cruciate ligament reconstruction." Thesis, King's College London (University of London), 2017. https://kclpure.kcl.ac.uk/portal/en/theses/knee-swelling-and-anterior-cruciate-ligament-reconstruction(1dbd0b68-0e8b-42a9-bc5a-c6bf2cf22edd).html.
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Swelling is universal after Anterior Cruciate Ligament Reconstruction (ACLR). Cooling compressive devices aim to treat swelling after surgery, but research has focussed more on pain than swelling. The aims of this work were to measure knee swelling in ACLR with a perometer (an optoelectric volumeter) and to evaluate an intervention for knee swelling in ACLR which uses a cold compressive device. The main outcome for the studies was knee volume measured using the perometer. Reliability was established and a randomised controlled trial was undertaken The study aimed to compare the use of Cryocuff, and elevation, with standard treatment used post ACLR (compression bandage alone). Secondary outcomes were also measured to assess the correlates of knee swelling in ACLR. The patients were randomised into a standard treatment group or into a Cryocuff and elevation group. Knee volume in both knees was measured pre-operatively and at two weeks post-operatively using the perometer. Secondary variables measured included: - range of movement, pain, knee laxity and function, medication use, tourniquet and discharge times, and operative factors. There was with no significant difference between the groups (p=0.977). This study did not find Cryocuff and elevation to be more effective for minimising swelling at 2 weeks post-operatively, than a compression bandage alone. The perometer was reliable with Intra class correlation coefficient of 0.996. Significant correlates of swelling post-ACLR were: blood pressure; knee joint laxity and extension loss, with daily elevation time and Intravenous fluid given intra operatively close to significance. Further investigation outlined the level and profile of compression applied to the knee by the Cryocuff found that this device may have inherent features that could be provocative of swelling.
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Clements, Amy E. "Neuromuscular Consequences Following Anterior Cruciate Ligament Reconstruction." University of Toledo / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1364477909.
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Zavras, Tryfon Dionyssios. "Biomechanical studies related to anterior cruciate ligament reconstruction." Thesis, Imperial College London, 2001. http://hdl.handle.net/10044/1/8649.
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Cuomo, Pierluigi. "Biomechanics of double bundle anterior cruciate ligament reconstruction." Thesis, Imperial College London, 2012. http://hdl.handle.net/10044/1/9501.
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The scope of this thesis was to verify whether anatomic reconstruction of the anterior cruciate ligament (ACL) with close replication of its two main bundles ensures better knee kinematics and improved clinical outcomes. The thesis articulates into three parts. In the first part the current anatomic knowledge is reviewed with regard to the double bundle ACL structure and an anatomic study is presented: its results will serve as a basis for the following kinematics and clinical studies. In the second part, a method to investigate cadaveric knee laxities is presented and employed to test intact and ACL deficient knees and to explore the function of the anteromedial and posterolateral ACL bundles. The ACL was found to be a primary restrain to anterior tibial translation mainly because of the action of the anteromedial bundle, with the posterolateral acting as a secondary restrain. Both bundles then were found to equally contribute to control the limit of internal rotation. Finally the reconstruction of both ACL bundles was demonstrated to be superior to traditional single bundle reconstruction in restoring intact knee anterior and rotational laxity. The third part focused on double bundle surgical technique with the development of surgical instruments that were validated on cadaver knees and found to be extremely accurate on the tibial side, less on the femur. Surgical technique was then improved and introduced into clinical practice. Two clinical studies were conducted and demonstrated the superiority of double bundle anatomic reconstruction in improving subjective and objective results as well as instrumented knee laxity measurements. In conclusion the main finding of this thesis was that, after a deep understanding of ACL anatomy and biomechanics, the replication at surgery of its native structure improves knee stability and patients’ satisfaction.
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Wasielewski, Noah Jon. "Predictors of functional outcome following anterior cruciate ligament reconstruction /." view abstract or download file of text, 2002. http://wwwlib.umi.com/cr/uoregon/fullcit?p3061971.
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Thesis (Ph. D.)--University of Oregon, 2002.Typescript. Includes vita and abstract. Includes bibliographical references (leaves 212-238). Also available for download via the World Wide Web; free to University of Oregon users.
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Svensson, Michael. "The clinical, radiographic, histological and ultrastructural results after anterior cruciate ligament reconstruction using autografts /." Göteborg : Dept. of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska Academy at Göteborg University, Göteborg, 2008. http://hdl.handle.net/2077/8437.
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Letchford, Robert. "A study of functional recovery following anterior cruciate ligament reconstruction." Thesis, Cardiff University, 2015. http://orca.cf.ac.uk/91571/.
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Introduction: Anterior cruciate ligament reconstruction (ACLR) and rehabilitation is an accepted intervention for non-coping ACL injured subjects. There is an expectation from ACL injured subjects and the international clinical community that ACLR should enable recovery to pre-injury knee function, activity performance and participation. However, few studies use comprehensive methods to assess this expectation and the reality seems to be a highly variable and often incomplete recovery that is difficult to predict. Improved understanding of recovery of these subjects may identify targets for novel rehabilitation interventions that improve outcomes. Methods: Prospective longitudinal data were collected from 74 ACL injured subjects before surgery and on 5 occasions during the first year following ACLR. Data from a matched healthy group (n=61) were used to define healthy normative values. Outcome measures included; Structure (arthroscopic and MRI findings), Function (IKDC SKF, Lysholm, VAS pain), Activity (2D digital video motion analysis of performance and strategy variables during gait, single leg squat and hop for distance) and Participation (Tegner). Group differences and recovery were assessed with inferential statistics; regression methods identified predictors of recovery. Results: These ACL injured subjects were highly symptomatic non-copers with a prolonged period between injury and surgery. There were statistically and clinically significant deficits from healthy in all outcome measures before surgery, which improved one year following ACLR; however the majority failed to fully recover. Bilateral deficits in activity performance and strategy were identified during all three functional activities. Recovery at one year was not predicted by any of the outcome measures in the pre or post-operative period. However, activity performance at one year was predicted by pre-operative and early post-operative gait velocity and squat depth. Conclusions: Whilst these highly symptomatic non-coping ACLD subjects benefited from ACLR and rehabilitation, expectations of full recovery by one year proved unrealistic for most. Pre-operative deficits appear to be too large for current interventions to overcome. Early diagnostics, classification and intervention should be considered to reduce pre-operative impairments. Bilateral and hierarchical deficits in activities suggest that further development of task oriented rehabilitation strategies should be built on biomechanical and motor control/learning theories to improve outcomes. Utilising technology to facilitate greater engagement in rehabilitation and increasing frequency and intensity of rehabilitation interventions should be considered. Further development of clinically applicable methods to measure and provide real time feedback on both performance and strategy in functional activities are therefore required.
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Baez, Shelby Elyse. "INJURY-RELATED FEAR IN PATIENTS AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION." UKnowledge, 2019. https://uknowledge.uky.edu/rehabsci_etds/53.
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Approximately 200,000 anterior cruciate ligament (ACL) injuries occur each year with about 100,000 of these injuries undergoing reconstruction (ACLR). The impetus of ACLR is to allow previously high functioning, physically active individuals to return to desired levels of sports participation and to engage in recommended levels of physical activity. However, 1 out of 3 patients after ACLR fail to return to competitive levels of sport and meet recommended levels of physical activity. Injury-related fear has been cited as the primary barrier for failure to return to sport. However, the research has been primarily qualitative in nature and limited research has quantitatively examined the impact of injury-related fear on return to sport and physical activity engagement in this population.
In addition to quantifying the impact of injury-related fear, no research has examined the underlying neural substrates associated with injury-related fear after ACLR. Previous research has demonstrated that patients after ACLR undergo neuroplasticity in sensorimotor regions of the brain and exhibit changes in neurocognitive functioning. Despite previous research in other musculoskeletal pathologies demonstrating neuroplasticity in emotional regulation centers of the brain, no research has examined these brain regions in patients after ACLR. Furthermore, previous research in healthy athletes has suggested that psychosocial impairments can lead to changes in neurocognitive functioning, including reaction time. Understanding these neural substrates could provide insight into appropriate intervention strategies to decrease injury-related fear, increase return to sport and physical activity engagement, and potentially improve neurocognitive functioning in patients after ACLR.
The purpose of this dissertation was to further investigate the effects of injury-related fear on patients after ACLR and to determine the efficacy of a cognitive behavioral intervention to decrease injury-related fear in this population. The purposes of these studies were to determine whether patient-based, specifically psychological, and functional outcomes were associated with return to sport and physical activity levels in individuals with a history of ACLR, to determine differences in brain activation patterns when exposed to fear-eliciting stimuli in individuals with a history of ACLR compared healthy matched controls, and to determine the efficacy of in vivo exposure therapy on self-reported fear and reaction times in participants post-ACLR.
The results of these studies indicate that injury-related fear was quantitatively associated with return to sport and physical activity engagement in patients after ACLR. Additionally, individuals with a history of ACLR activated emotional regulation centers of the brain in greater depth when compared to healthy matched controls. Lastly, in vivo exposure therapy decreased self-reported injury-related fear for specific functional tasks but did not improve general fear response or reaction time in post-ACLR participants. The results of these studies objectively elucidate the negative impact of injury-related fear in patients with a history of ACLR.
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Patton, Renita L. "Isokinetic strength status post anterior cruciate ligament reconstruction hamstring vs. patellar tendon autograft." Online version, 2000. http://www.uwstout.edu/lib/thesis/2002/2002pattonr.pdf.
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Beard, David John. "Hamstring contraction latency following anterior cruciate ligament rupture, reconstruction and rehabilitation." Thesis, University of Oxford, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.308448.
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Kim, HoWon. "Identifying Neural Activity Associated with Kinesiophobia after Anterior Cruciate Ligament Reconstruction." Ohio University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1586801043687785.
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Mayson, Scott Anthony, and na. "Design of an orthopaedic instrument for image guided anterior cruciate ligament reconstruction." Swinburne University of Technology, 2006. http://adt.lib.swin.edu.au./public/adt-VSWT20061006.130922.
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This is an interdisciplinary research project in which the methods of Industrial and
Product Design Engineering are focused upon a problem in Orthopaedics.
One of the most controversial areas in Orthopaedics is the reconstruction of the anterior
cruciate ligament (ACL). The current twin-instrument method for locating the ACL is
difficult for surgeons with fewer than 500 surgical experiences. This was clearly
demonstrated by Kohn, Busche and Cans (1995), and confirmed by Sommer,
Friederich and Muller (2000), Sudhahar, Glasgow and Donell (2004), and Kuga,
Yasuda, Hata et al. (2004). The above research indicates that the problem is not only
one of anatomical location, but of how the operation takes place. The aim of the
research was, therefore, to develop a new and improved surgical instrument and
technique for locating the ACL anatomical landmarks.
The research described in this thesis employs a number of design methods that can be
used separately or in combination (hybrid process). They form the theory base that
guides the design process. This allows the designer to engage in a flexible process that is
effective in finding design solutions to the problem. Within this process, iterative case
studies were employed in order to design a new surgical device for ACL reconstruction.
The thesis describes a series of designed devices (case studies) that were iteratively
developed and surgically tested, leading to a penultimate device. This latter device was
tested via a number of surgical operations. The device provides a new method for
externally locating the internal ACL attachment points.
The research has resulted in a commercial association with Smith and Nephew Surgical
Australia and BrainLAB AG Germany for the commercialisation of this technique. At
the time of writing, the next stage of research and development is under way. This is
using a frameless computer-aided image guidance system in the place of X-ray.
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Mayson, Scott A. "Design of an orthopaedic instrument for image guided anterior cruciate ligament reconstruction." Australian Digital Thesis Program, 2006. http://adt.lib.swin.edu.au/public/adt-VSWT20061006.130922/index.html.
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Thesis (PhD) - Swinburne University of Technology, Industrial Research Institute Swinburne - 2006. Thesis (PhD) - National School of Design, Swinburne University of Technology, 2006.A thesis submitted to the Industrial Research Institute Swinburne (IRIS) and the National Institute of Design in fulfilment of the requirements for the degree of Doctor of Philosophy, - 2006. Typescript. Includes bibliographical references (p. 192-199).
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Gabler, Conrad M. "TEMPORAL NEUROMUSCULAR ALTERATIONS OF THE QUADRICEPS AFTER UNILATERAL ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION." UKnowledge, 2016. http://uknowledge.uky.edu/rehabsci_etds/32.
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Objective: The primary aim of this research was to examine the temporal pattern of neuromuscular quadriceps deficits in both the involved and uninvolved limbs of patients assigned to the control group after anterior cruciate ligament reconstruction (ACLr), by assessing quadriceps strength, voluntary activation, and corticomotor excitability prior to surgery (baseline), three months after ACLr, and six months after ACLr. A secondary aim of this research was to determine whether quadriceps strength, voluntary activation, and/or corticomotor excitability assessed in patients prior to ACLr and/or at three months after surgery, is predictive of lower extremity postural control and/or self-reported function at six months after ACLr. Lastly, a tertiary aim of this research was to determine if a 12-week home-based neuromuscular electrical stimulation (Home-NMES) program elicits greater bilateral improvements in quadriceps strength, voluntary activation, and corticomotor excitability of patients at three and six months after ACLr compared to a 12-week standard home-exercise program (control group). Participants: Fifty patients scheduled to undergo unilateral ACLr were randomly allocated to the home-NMES group (19 Female, 6 Male; age: 18.9 ± 5.4 years; height: 170.8 ± 9.7 cm; weight: 74.6 ± 18.5 kg; 28.0±20.0 days-post-injury) or control group (14 Female, 11 Male; age: 19.4 ± 4.5 years; height: 171.1 ± 11.5 cm; weight: 70.7 ± 11.9 kg). Methods: A randomized clinical trial design was used in this study. Prior to ACLr, isometric quadriceps strength and voluntary quadriceps activation were assessed in both limbs of patients, and corticomotor excitability was assessed in the involved limb. Three days after ACLr, both groups were instructed to begin their allocated interventions. The Home-NMES group administered NMES to their involved limb’s quadriceps three sessions a day for 15 minutes, and five days a week for 12 weeks using a portable NMES device. The control group was treated according to the current standard-of-care, but they were also instructed to perform volitional isometric quadriceps contractions for the same duration and frequency as the Home-Based NMES protocol. The outcomes measures were reassessed in both groups at three and six months post-ACLr. Main Outcome Measures: Quadriceps strength and voluntary activation were assessed using maximal voluntary isometric contractions and the superimposed burst technique, respectively. Normalized peak knee extension torque and central activation ratio were used to quantify isometric quadriceps strength and activation, respectively. Corticomotor excitability was evaluated with transcranial magnetic stimulation, and quantified with active motor threshold). The Y-balance test anterior reach (YBT-A) and Knee Injury and Osteoarthritis Outcome Score (KOOS) were used to assess the patients lower extremity knee function at six months post-ACLr. Statistical Analyses: Specific Aim 1: A 2x3 (limb x time) mixed model, ANOVA with repeated measures was performed in the control group to assess differences between the involved limb and the uninvolved limb for isometric quadriceps strength, and voluntary quadriceps activation over time. A one-way mixed model, ANOVA with repeated measures was performed in the control group to assess differences in corticomotor excitability over time. Post-hoc comparisons were performed when appropriate. Specific Aim 2: Separate, mixed model, linear regression analyses were performed in the control group (involved limb) to determine the effect that the neuromuscular quadriceps outcome measures assessed at baseline and 3 months post-ACLr, had on lower extremity knee functional outcome measures assessed at 6 months post-ACLr. Specific Aim 3: A 2x2x3 (group x limb x time) mixed model, ANOVA with repeated measures was performed to assess group differences between the involved limb and the uninvolved limb in isometric quadriceps strength, and voluntary quadriceps activation over time. A 2x3 (group x time) mixed model, ANOVA with repeated measures was performed to assess group differences in corticomotor excitability over time. Post-hoc comparisons were performed when appropriate. Results: Aim 1: Patients demonstrated lower quadriceps strength on their involved limb compared to their uninvolved limb at baseline, three months post-ACLr, and six months post-ACLr. Quadriceps strength progressively decreased in the involved limb of patients from baseline to 3 months post-ACLr, baseline to 6 months post-ACLr, and increased from 3 months to 6 months post-ACLr. Quadriceps strength was also decreased in the uninvolved limb of patients from baseline to 6 months post-ACLr. ). Irrespective of when it was assessed, voluntary quadriceps activation was higher in the involved limb of patients compared to their uninvolved limb. There were no changes in corticomotor excitability of the involved limb over time. Specific Aim 2: The quadriceps strength of patients at three months post-ACLr had a significant positive effect on their 6-month YBT-A performance KOOS score. ). Neither voluntary quadriceps activation or corticomotor excitability or AMT (at baseline or 3-month post-ACLr) had a significant effect on any of the 6-month lower extremity functional outcome measures. Specific Aim 3: Irrespective of limb or when it was assessed, quadriceps strength was higher in the control group compared to the Home-NMES group. Both groups demonstrated lower quadriceps strength on their involved limbs compared to their uninvolved limbs at baseline, three months post-ACLr, and six months post-ACLr. Quadriceps progressively decreased in the involved limbs of both groups from baseline to three months post-ACLr and baseline to six months post-ACLr, and increased from three months to six months post- ACLr. At baseline, voluntary quadriceps activation was higher in the involved limbs of both groups compared to their uninvolved limbs. There were no group differences or changes over time observed in the involved limb of both groups with corticomotor excitability. Conclusion: Although quadriceps weakness is more apparent in the involved limb of patients after ACLr, the quadriceps strength of their uninvolved limb was also affected. Clinicians are encouraged to not rely on a quadriceps strength limb symmetry index when making return-sport-decisions for their patients after recovering from ACLr. The quadriceps in the uninvolved limb of patients demonstrated more inhibition, which may explain the quadriceps strength deficits observed in the uninvolved limb of patients following ACLr. To reduce the risk of subsequent injury upon return-to-sport and protect against the development of knee OA, we recommend that clinicians incorporate bilateral interventions aimed at restoring quadriceps strength and disinhibiting the quadriceps. Intensive quadriceps strengthening should be performed in the early stages of ACLr rehabilitation, so that lower extremity function can be improved in patients later on. Lastly, the effectiveness of home-based NMES as a modality for restoring quadriceps strength and activation in patients after ACLr is inconclusive. Home-based NMES provides patients with the ability to receive higher doses of NMES to the quadriceps; but its effectiveness may be limited by low contraction intensities and poor treatment compliance in patients.
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Simon, Timothy Michael. "Development of a new graft material for use in anterior cruciate ligament reconstruction." Thesis, University of Bristol, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.297976.
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De, Villiers Elsje. "Neuromuscular control and physical performance following anterior cruciate ligament reconstruction using a semitendinosus." Master's thesis, University of Cape Town, 2006. http://hdl.handle.net/11427/3011.
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Ebersohn, Reinette. "Pre-operative determination of the optimum graft length for anterior cruciate ligament reconstruction." Diss., University of Pretoria, 2014. http://hdl.handle.net/2263/45953.
Full textAbstract:
Purpose:
Accurate knowledge of the anatomy of the anterior cruciate ligament (ACL) is crucial
for successful ACL reconstruction. Incorrect graft lengths and/or tunnel
misplacement have to be avoided. If the graft length is incorrect, the patient could
risk knee instability, loss of range of motion or failure of graft fixation. The success of
ACL reconstruction will be enhanced if the correct length of the graft ligament
required, can be predicted in advance. Magnetic resonance imaging (MRI) is
currently used for the evaluation of ACL injuries, but is not available to all patients.
Apart from examining the morphological properties of the ACL at macroscopic and
microscopic levels, this study aimed to determine whether independent factors of an
individual can be used to predict native ACL length which could assist in preoperative
planning.
Methods:
Ninety-one adult cadavers were studied. The patellar ligament (PL) length, ACL
length, ACL width and the maximum femoral epicondylar width (FECW) were
measured. For the radiographic component, 52 patients were sourced to evaluate
and compare ACL length, PL length and FECW, measured on both MRI and
radiograph. Fresh ligaments were harvested (18 ACLs and 10 PLs) to evaluate the
histological composition of the ACL and PL.
Results:
The morphology of the ACL and PL was determined. The morphology of the
ligaments compared well to the descriptions in previous literature. The ligaments
proved to be compatible at histological level. The results revealed that FECW was
the most reliable predictor of ACL length. Linear regression formulas were developed
in order to determine ACL length by measuring maximum FECW. It was also
determined that either an MRI or radiograph can be used to assist in pre-operative
planning.
Conclusion:
ACL and PL morphology compared well with the descriptions found in previous
studies. It was also found that, contrary to previous studies, the maximum FECW is a
more reliable predictor of ACL length than the height of the patient. The results also
showed that both radiographs and MRI scans can be used to determine preoperative
ACL length. These results could improve the pre-operative planning of
ACL reconstruction and minimise the occurrence of graft mismatch.Dissertation (MSc)--University of Pretoria, 2014.
tm2015
Anatomy
MSc
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Messer, Daniel J. "Anterior cruciate ligament reconstruction and the hamstrings: Implications for injury prevention and rehabilitation." Thesis, Queensland University of Technology, 2018. https://eprints.qut.edu.au/118578/2/Daniel_Messer_Thesis.pdf.
Full textAbstract:
Both anterior cruciate ligament and hamstring strain injuries account for a significant amount of lost time in a range of football codes. This program of research has contributed new knowledge relating to the maladaptations which occur after anterior cruciate ligament injury and subsequent reconstruction, while also providing novel data which may be used to form decisions regarding exercise selection in anterior cruciate ligament and hamstring strain injury prevention and rehabilitation programs.
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Muren, Olle. "Anterior cruciate ligament reconstruction : patellar tendon, gore-tex, Kennedy LAD and tibia tunnel ingrowth /." Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-523-9/.
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Möller, Eva. "Anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft : postoperative intervention and influential factors for patient-relevant long-term outcome /." Stockholm : Karolinska institutet, 2007. http://diss.kib.ki.se/2007/978-91-7357-198-2/.
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Rankin, Anne E. "A survey of functional knee brace usage following anterior cruciate ligament reconstruction, a pilot study." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/MQ28646.pdf.
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Lehmann, Tim [Verfasser]. "Exploring cortical contributions to postural control in patients after anterior cruciate ligament reconstruction / Tim Lehmann." Paderborn : Universitätsbibliothek, 2020. http://d-nb.info/1226097529/34.
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Lepley, Adam Scott. "Examining Neural Alterations as the Origins of Disability in Patients Following Anterior Cruciate Ligament Reconstruction." University of Toledo / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1393412488.
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