Dissertations / Theses on the topic 'Anterior cruciate ligament reconstruction'
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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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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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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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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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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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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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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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San, Jose Argell. "Lower limb strength and biomechanics after anterior cruciate ligament reconstruction." Phd thesis, Australian Catholic University, 2023. https://acuresearchbank.acu.edu.au/download/82e0fbbc487e02a52500840e69eec7ab7fc67914f0b86756d6bb80ddddad355e/4465164/San_Jose_2023_Lower_limb_strength_and_biomechanics_after.pdf.
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Rupture of the anterior cruciate ligament (ACL) is one of the most significant injuries to the knee joint, with the frequency of injury increasing over the last 10 years. Of these injuries, the increase in incidence among young female athletes (<18 years) has been especially significant. Direct and indirect management of ACL injuries range from $100 million in countries like Australia, to as much as $2 billion in the United States. The increasing rates of ALC injury and significant associated costs places significant pressure on the healthcare system.
The high economic cost of ACL injuries is typically associated with ACL reconstruction (ACLR) and the subsequent rehabilitation period. Restoration of lower limb muscle strength, function, and coordination, as well as a gradual return to activities like running, jumping, landing, and agility tasks are all components of a structured rehabilitation program and criteria for return to sports (RTS). Following the completion of rehabilitation, up to 80% of people are able to RTS of some level. Despite the high rate of RTS, a significant number of ACLR individuals will report poor subjective knee function (e.g., knee pain during activity), be subjected to a high risk of reinjury and be prone to early onset of knee osteoarthritis. There is evidence that these poor outcomes are worse in females than in males.
Lower limb strength (e.g., hamstrings and quadriceps) and biomechanical asymmetries are common after ACLR. These asymmetries have been associated with the poor outcomes previously mentioned. As a result, restoration of maximal hamstrings and quadriceps strength symmetry is a focus of rehabilitation and criteria for RTS clearance following ACLR. However, there is evidence that explosive quadriceps strength does not recover at the same rate as maximal quadriceps strength during the first year following ACLR. Whether this is also true in the hamstrings is still unknown and previous studies have only explored concurrent recovery of explosive and maximal strength in males.
Given their function in providing dynamic stability and loading on the knee joint, the hamstrings and quadriceps have received much attention during assessment, rehabilitation, and criteria for RTS following ACLR. However, dynamic tasks (e.g., sidestep cutting) commonly performed in team sports require complex activity and coordination of the different lower limb muscles. This has been previously investigated in healthy individuals but to date, it is still unknown how ACLR affects the function of the different lower limb muscles during sidestep cutting. Additionally, reductions in knee joint loading (e.g., contact force) have been reported from 3-9 months and up to 2 years following ACLR. Quadriceps strength deficits have been proposed to be a major factor influencing the reduced knee joint contact forces after ACLR. However, it is still unknown whether knee joint contact forces are reduced after the restoration of quadriceps strength at RTS.
The purpose of this doctoral thesis was two-part. Firstly, to investigate restoration of both explosive and maximal hamstrings and quadriceps strength during early and late rehabilitation following ACLR in males and females. Second, to explore lower limb biomechanics following the restoration of strength following rehabilitation. The knowledge derived from this program of research is aimed at identifying factors that are modifiable during the rehabilitation period after ACLR, information that should help to guide future clinical and research effort.
The first study of this program of research (Chapter 2) was a systematic review and meta-analysis that explored the time-course of hamstrings and quadriceps strength asymmetries during the preoperative period up to six and 12 months following ACLR between males and females. Initial database search retrieved 6,046 articles. After screening for eligibility, 31 studies were included in the systematic review while 13 articles had enough data for meta-analysis. The findings showed that limb symmetry in maximal hamstrings and quadriceps strength are the most commonly used measure of strength following ACLR. Strength asymmetries in the hamstrings and quadriceps were present from preoperative to six and 12 months after ACLR. Despite the proposed importance of explosive strength following ACLR, studies looking at its time-course of recovery are limited. Furthermore, while sex differences in patient outcomes have been previously reported, majority of the data collected were either not stratified and/or dominated by male participants (males = 62%; females = 30%, sex not reported = 8%).
To address gaps in the literature identified in Chapter 2, an observational cohort study was conducted for the second study of this thesis (Chapter 4). This study investigated the maximal and explosive strength recovery of the quadriceps and hamstrings following ACLR. In this study, participants were assessed during the early (3-6 months) and late (7-12 months) stage of rehabilitation following an ACLR with hamstring tendon (HT) autografts. There was a significant influence of time after ACLR on the limb-symmetry index (LSI) for maximal hamstrings (Early: 86 ± 14; Late 92 ± 13; p = 0.005) and quadriceps (Early, 73 ± 15; Late 91 ± 12; p <0.001) strength. Additionally, explosive quadriceps strength LSI showed significant improvements over time (Early: 82 ± 30; Late: 92 ± 25; p = 0.03). However, despite the recovery of maximal hamstring strength there were still significant deficits in explosive hamstring measures later in rehabilitation (Early: 86 ± 46; Late: 83 ± 22; p = 0.75). Additionally, Chapter 4 also investigated whether there were differences in strength recovery between males and females following ACLR. While no differences were found in the rate of explosive and maximal strength recovery between sexes, females had greater quadriceps strength asymmetries (maximal and explosive) compared to males across ACLR rehabilitation.
The ability to perform dynamic tasks (e.g., sidestep cutting) is one of the major determinants of an ACLR individual’s readiness to RTS. Sidestep cutting tasks, in particular, are common in change-of-direction sports. It is also during these tasks that ACL injuries frequently occur. Previous studies found kinematic and kinetic impairments during sidestep cutting performance in ACLR individuals. However, these studies have been joint level analysis of lower limb biomechanics. Given the complex coordination of the different lower limb muscles during the performance of a sidestep cut, the third study of this thesis (Chapter 5) explored the lower limb muscle contributions to ground reaction forces during vertical support, deceleration, propulsion, and redirection of forces during a sidestep cut in ACLR limbs (who had a quadriceps strength LSI ≥ 90%) and compared them to healthy limbs. Chapter 5 found that muscle function during a sidestep cut is significantly different in the ACLR limb when compared to the contralateral and control limbs. There were less contributions to vertical support (contralateral mean difference = -0.040 BW.s, 95%CI = -0.049 to -0.031, p < 0.001; control mean difference = -0.042 BW.s, 95%CI = -0.061 to -0.022, p < 0.001), braking (contralateral mean difference = 0.020 BW.s, 95%CI = 0.014 to 0.027, p < 0.001; control mean difference = 0.029 BW.s, 95%CI = 0.017 to 0.041), and medial redirection (contralateral mean difference = -0.006 BW.s, 95%CI = -0.01 to -0.001, p = 0.011) GRFs from the quadriceps of the ACLR limb when compared to the contralateral uninjured limb. Alterations in gluteus maximus, gastrocnemius, soleus, hamstrings, and dorsiflexors muscle function were also found when comparing the ACLR and contralateral uninjured limbs. Despite resolution of quadriceps strength asymmetry following ACLR rehabilitation, the quadriceps’ role in contributing forces for the execution of a sidestep cut is significantly impaired. Furthermore, muscle contributions from other major lower limb muscles are also altered following RTS.
Given the alterations in the ability of the quadriceps to modulate GRFs despite restoration of isokinetic strength symmetry, the final study of this thesis (Chapter 6) was conducted with the aims of investigating patellofemoral (PFJ) contact forces in the ACLR limb when compared to healthy limbs at time of RTS. Chapter 6 demonstrated that ACLR limbs have lower PFJ contact forces compared to the contralateral (mean difference = 5.89 BW, 95%CI = 4.7 to 7.1, p < 0.001) and control limbs (mean difference = 4.44 BW, SE = 2.1 to 6.8, p = < 0.001). Additionally, the ACLR limb possessed smaller knee flexion angles (contralateral mean difference = 4.88°, 95%CI = 3.0 to 6.7, p < 0.001; control mean difference = 6.01°, 95%CI = 2.0 to 10.0, p < 0.002) as well as lower knee extension moment and quadriceps force (contralateral mean difference = 4.14 BW, 95%CI = 3.4 to 4.9, p < 0.001; control mean difference = 2.83 BW, 95%CI = 1.4 to 4.3, p < 0.001). These findings suggest that PFJ loading can still be impaired despite the restoration of quadriceps strength symmetry which could have potential implications for PFJ osteoarthritis.
In conclusion, this program of research showed that explosive and maximal quadriceps strength asymmetries resolve during ACLR rehabilitation. Hamstrings maximal strength also restores during the same time; however, explosive hamstrings strength did not. While it was also found that sex does not influence strength recovery, females did have larger maximal and explosive quadriceps strength asymmetries compared to males following ACLR. Finally, impairments in lower limb biomechanics (less quadriceps muscle contributions to vertical support, deceleration, and medial redirection, lower PFJ contact force and quadriceps force, and smaller knee flexion angle) are still present in the ACLR limb compared to the healthy limbs during the performance of a sidestep cut. These deficits still exist, despite the recovery of maximal quadriceps strength following ACLR and provides evidence for the assessment of lower limb muscle function during dynamic movements as part of the RTS criteria.
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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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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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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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Debieux, Pedro [UNIFESP]. "Parafuso de interferência metálico versus bioabsorvível para fixação do enxerto na reconstrução do ligamento cruzado anterior: Revisão sistemática." Universidade Federal de São Paulo (UNIFESP), 2015. http://repositorio.unifesp.br/handle/11600/39312.
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Introdução: Esta revisão avalia se os parafusos de interferência bioabsorvíveis podem apresentar melhores resultados do que os parafusos de interferência metálicos quando utilizados para a fixação do enxerto na reconstrução do LCA. Objetivo: Comparar a efetividade dos parafusos de interferência bioabsorvíveis e metálicos para a fixação do enxerto na reconstrução do ligamento cruzado anterior, através de meta-análise. Métodos: Foram pesquisadas as bases de dados: Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, The Cochrane Library, MEDLINE, EMBASE, LILACS, Current Controlled Trials e the World Health Organization Clinical Trials Registry Platform. Ensaios clínicos randomizados e quasi-randomizado comparando parafusos de interferência bioabsorvíveis com metálicos foram incluídos na pesquisa. Os desfechos primários foram função, qualidade de vida, falhas de tratamento e nível de atividade. Ao menos dois autores selecionaram estudos elegíveis e avaliaram de forma independente o risco de viés. Os dados relevantes foram agrupados. Resultados: Onze ensaios envolvendo 981 participantes foram incluídos na revisão. Em relação à função (avaliada pelo Lysholm), quatro ensaios clínicos (220 participantes) não mostraram diferenças entre os dois métodos de fixação com 12 ou 24 meses de seguimento: MD -026, IC 95%, -1,63 a 1,11 e MD 1,10, IC 95% -1,44 a 1,64, respectivamente. Quando realizada a análise de subgrupos do Lysholm, entretanto, foi observada diferença estatística favorável ao parafuso metálico, quando o parafuso bioabsorvível era constituído por Ácido-L-Polilático (PLLA): RR -4,00, 95% CI -7,59 a -0,41. Três estudos com 24 meses (RR 1,00, 95% CI 0,81-1,24) e dois estudos com 12 meses de seguimento (RR 1,01, 95% CI 0,94-1,08) não mostraram diferenças no IKDC. Em relação ao nível de atividade (analisado pelo Tegner), dois estudos (117 participantes) com 12 meses, e três estudos com 24 meses de seguimento não evidenciaram diferenças entre o grupo bioabsorvível e o grupo que usou parafuso de metal: MD 0.08, 95% CI -0,39 a 0,55 e MD 0,41, IC 95% -0,23 a 1,05, respectivamente. Na análise de subgrupos, houve diferença estatística favorável ao parafuso de PLLA: RR 1,27, 95% CI 0,49 a 3,30. Apesar da diferença estatística, em nenhum dos desfechos supracitados observou-se relevância clínica. Em relação às falhas de tratamento, foi demonstrada uma diferença significativa entre os dois métodos de fixação, quando considerada a quebra de implante (RR 7,06, 95% CI 1,31-2,75) e quanto ao risco global de falha do tratamento (RR 1,89, 95% CI 1,31-2,75), tendo o parafuso bioabsorvível mais falhas nestes aspectos. Em oposição, não houve diferença significativa para estabilidade, testes funcionais, derrame articular, re-lesões, infecção, reação de corpo estranho, dor ou limitação de movimento. Conclusão: Não há evidência que demonstre diferença de efetividade entre parafusos de interferência metálicos com relação aos bioabsorvíveis para fixação do enxerto na reconstrução do ligamento cruzado anterior quanto a função, qualidade de vida e o nível de atividade; entretanto, há evidências de que parafusos bioabsorvíveis estão associados a mais falhas de tratamento global e quebra do implante. Os ensaios clínicos randomizados presentes na literatura fornecem evidências de moderada/baixa qualidade.
Introduction: This review assesses whether bioabsorbable interference screws may show better results than metal ones when used for fixing the graft in the reconstruction of the anterior cruciate ligament (ACL). Objective: To compare the effects of bioabsorbable and metal interference screws for fixing the graft in the reconstruction of the anterior cruciate ligament, by metaanalysis. Methods: The following databases were searched: Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, The Cochrane Library, MEDLINE, EMBASE, LILACS, Current Controlled Trials and the World Health Organization International Clinical Trials Registry Platform. Randomized controlled trials and quasi-randomized trials comparing bioabsorbable with metal interference screws were included in the survey. Primary outcome measures were function, quality of life, treatment failures and activity level. At least two authors selected eligible studies and independently assessed the risk of bias. The relevant data were pooled. Results: Eleven trials involving 981 participants were included in the review. Regarding the function (assessed by Lysholm), four trials (220 participants) showed no differences between the two fixation methods with 12 or 24 months of follow-up: MD -026, CI 95% -1.63 - 1.11 and MD 1.10, CI 95% - 1.44 to 1.64, respectively. However, when subgroup analysis using Lysholm score was performed, statistical difference was observed favoring the metal screw when the bioabsorbable screw was comprised of L-polylactic acid (PLLA): RR -4.00, CI 95%, -7.59 - -0.41. Three studies at 24 months (RR 1.00, 95% CI 0.81 to 1.24) and two studies at 12 months follow-up (RR 1.01, 95% CI 0.94 to 1.08) showed no differences the in the IKDC. Regarding the level of activity (analyzed by Tegner activity level scale), two studies (117 participants) at 12 months and three studies at 24 months follow-up showed no differences between the bioabsorbable group and the group using metal screws: MD 0.08, 95 % CI -0.39 to 0.55 and MD 0.41, 95% CI -0,23-1,05 respectively. In the subgroup analysis, a statiscally favorable difference was found for the PLLA screw: RR 1.27, 95% CI 0.49 to 3.30. Despite the statistical differences, none of the above outcomes has presented clinical relevance. With regard to treatment failures, a significant difference was found between the two methods of attachment, when considering the implant breaks (RR 7.06, 95% CI 1.31 to 2.75) and the overall risk of failure (RR 1.89, CI 95% 1.31 to 2.75), with the bioabsorbable screw having more failures in these respects. In contrast, there was no significant difference in stability, functional testing, joint effusion, re-injury, infection, foreign body reaction, pain or limitation of movement. Conclusion: There is no evidence that demonstrates an effective difference between metal and bioabsorbable interference screws for graft fixation in the reconstruction of the anterior cruciate ligament when considering function, quality of life and level of activity. However, there is evidence that bioabsorbable screws are associatewith more failures in the global treatment as well as breaks of the implant. Clinical trials in the literature provide moderate / low quality evidence.
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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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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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D\'Elia, Caio Oliveira. "Estudo comparativo da avaliação da rotação dos joelhos submetidos à reconstrução do ligamento cruzado anterior: feixe duplo x feixe simples." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/5/5140/tde-16032015-151434/.
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Em uma tentativa de melhor restabelecer a função normal do ligamento cruzado anterior (LCA), foi proposta a técnica de reconstrução do LCA com feixe duplo (FD). Entretanto, a superioridade desta técnica frente à técnica com feixe simples (FS) ainda não está claramente demonstrada no cenário clínico. O propósito do presente estudo foi avaliar e comparar a amplitude de rotação tibial, o máximo de rotação interna e externa, e a força de reação ao solo de joelhos submetidos à reconstrução anatômica com feixe duplo, a joelhos submetidos à reconstrução com feixe simples, durante a realização de tarefas dinâmicas. Para isso, um total de 75 (setenta e cinco) indivíduos foram avaliados (26 reconstruções feixe duplo, 22 reconstruções feixe simples, 27 indivíduos sem lesão do LCA que formaram um grupo controle). Utilizando um sistema de análise do movimento humano, constituído por 4 câmeras para a análise do movimento, os indivíduos foram avaliados em três tarefas de demandas distintas. Utilizou-se a técnica TSACCAST para o cálculo da rotação interna e externa da tíbia. A média da amplitude de rotação tibial, máximo de rotação interna e externa, foi avaliada para cada joelho em cada um dos três grupos. A avaliação clínica destes pacientes foi realizada utilizando-se questionários subjetivo e objetivo (IKDC), assim como artrometria manual. Estas avaliações revelaram que ambos os grupos operados eram semelhantes no que se refere ao resultado clínico pós-operatório. A avaliação da amplitude de rotação tibial, máximo de rotação interna e externa, demonstrou que o joelho operado era semelhante ao joelho não operado e aos joelhos do grupo controle. Também não se verificou diferença significativa nos valores de amplitude de rotação tibial, máximo de rotação interna e externa, quando se comparou o grupo FS ao grupo FD. Desta forma, concluímos que a reconstrução do LCA com a técnica de FS e com a técnica de FD são similares no que se refere ao restabelecimento do controle da rotação da tíbiaIn an attempt to better restore the normal function of the two ACL bundles, the ACL reconstruction with two bundles has been proposed. However, the superiority of the double-bundle technique has not been clearly demonstrated in the clinical setting. The purpose of this study was to compare the tibial rotational range, maximal internal and external rotation and ground reaction force of anatomical double-bundle anterior cruciate ligament reconstructed knees with single-bundle anterior cruciate ligament reconstructed knees during three different demanding tasks. A total of 75 subjects, (26 with double-bundle anterior cruciate ligament reconstruction, 22 with single-bundle anterior cruciate ligament reconstruction, and 27 healthy control individuals) were evaluated in this study. Using a 4-camera motion analysis system, motion subjects were recorded performing during three different tasks. Using the CAST technique, the internal-external tibial rotation of both knees was calculated. The mean tibial rotational range, maximum internal and external rotation, for each knee, was evaluated for the 3 groups (double-bundle group, single-bundle group, and control group). Clinical assessment, including objective and subjective IKDC scores, and knee arthrometric measurement, revealed restoration of the reconstructed knee stability with no differences between the two anterior cruciate ligament reconstruction groups. The results demonstrated that both groups resulted in tibial rotation range values that were similar to those in the non-injured knees and those in the healthy controls. There were also no significant differences in tibial rotational range, maximal internal and external rotation and ground reaction force between the DB group and the SB group. Therefore, anatomical double-bundle and single-bundle reconstruction are able to restore normal tibial rotation
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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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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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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.
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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
Unrestricted
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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.
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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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Eriksson, Karl O. "On the semitendinosus tendon in anterior cruciate ligament reconstructive surgery /." Stockholm, 2001. http://diss.kib.ki.se/2001/91-628-4595-0/.
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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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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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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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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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Júnior, José Carlos Alves Fabricio. "Um estudo comparativo entre dois protocolos fisioterapêuticos: convencional x acelerado nos pacientes submetidos à reconstrução do ligamento cruzado anterior." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/5/5140/tde-14092015-091749/.
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INTRODUÇÃO: Anualmente nos E.U. A, estima-se mais de 250.000 mil casos de lesão do ligamento cruzado anterior, o que torna a reconstrução cirúrgica um procedimento comum na pratica da medicina esportiva. Ainda não existe consenso sobre o quanto de atividade promove uma reabilitação adequada sem prejudicar o enxerto ou produzir uma frouxidão anterior anormal, com consequente dano ao menisco e a cartilagem articular. OBJETIVO: Analisar e comparar o efeito de um protocolo de fisioterapia acelerado na estabilidade anterior e evolução clínica dos indivíduos submetidos à reconstrução do ligamento cruzado anterior. MÉTODOS: Foram incluídos 29 indivíduos no estudo que apresentaram ruptura total do LCA confirmada por RM e submetidos à reconstrução ligamentar com Tendão patelar. Aleatoriamente foram alocados em dois grupos com intervalos de reabilitação diferentes: Grupo Acelerado (4 meses) ou Grupo Convencional (6 meses). No pré-operatório, sexto e no quarto mês de pós-operatório um avaliador cego registrou: a lassidão anterior através do KT1000, Força muscular (CYBEX) e a função do joelho acometido através do IKDC (2000) e o Hop Test. RESULTADOS: os grupos foram semelhantes em relação aos dados demográficos. Não foi encontrada diferença estatística na lassidão anterior no quarto mês 0,92mm versus 1,33mm e no sexto mês 0,50mm versus 1,67mm sendo Grupo Convencional versus Grupo Acelerado respectivamente. No quarto mês o Grupo Acelerado apresentou uma melhora significativa (P< 0,001) na evolução clínica do IKDC (2000) 79,50 versus 60,61 do Grupo Convencional, essa diferença não se repetiu no sexto mês. A força muscular e o Hop Test, o Grupo Acelerado apresentou maiores valores, mas não de forma significativa nos dois momentos de avaliação (P> 0.05). CONCLUSÃO: Com base nos resultados obtidos, o protocolo acelerado quando comparado ao Convencional, não se diferiu quanto à estabilidade anterior do joelho e foi suficiente para demonstrar uma melhora significativa precoce na evolução clínica do joelhoBACKGROUND: Each year in the US, it is estimated more than 250 million cases of anterior cruciate ligament injury, which makes surgical reconstruction a common procedure in the practice of sports medicine. There is still no consensus on how much activity to promote adequate rehabilitation without damaging the graft or produce an abnormal anterior laxity, with consequent damage to the meniscus and articular cartilage. PURPOSE: To analyze and compare the effect of an accelerated physiotherapy protocol in the anterior-stability and clinical outcome of patients undergoing reconstruction of the anterior cruciate ligament. METHODS: We included 29 subjects in the study who had total ACL rupture confirmed by MRI and underwent ligament reconstruction with patellar tendon. Patients were randomly allocated in two groups with different rehabilitation intervals: Accelerated Group (4 months) or Conventional Group (6 months). Preoperatively, six and four months postoperatively a blind evaluator recorded: anterior laxity by KT1000, Brawn (CYBEX) and knee function affected by IKDC (2000) and the Hop Test. RESULTS: the groups were similar relative to demographic data. There was no statistical difference in anterior laxity in the fourth month 0,92mm versus 1.33mm and 0.50mm in the sixth month versus 1,67mm being conventional group versus accelerated group respectively. In the fourth month the accelerated group showed a significant improvement (P <0.001) in the clinical evolution of the IKDC (2000) 79.50 versus 60.61 in the conventional group, this difference was not repeated in the sixth month. Muscle strength and the Hop Test, the fast group had higher values, but not significantly in both time points (P> 0.05). CONCLUSION: Based on these results, the Accelerated protocol when compared to conventional, do not differ as the anterior knee stability and was sufficient to establish an early significant improvement in the clinical outcome of the knee
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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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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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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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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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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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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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Crawford, Richard Lee. "Protocols for preconditioning of patellar tendon for anterior cruciate ligament reconstruction stress relaxation vs. creep /." Master's thesis, Mississippi State : Mississippi State University, 2008. http://library.msstate.edu/etd/show.asp?etd=etd-07232008-132346.
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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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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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Saxby, David John. "The Tibiofemoral Contact Forces in Human Anterior Cruciate Ligament Reconstructed and Healthy Knees and their Association with Articular Tissue Degeneration." Thesis, Griffith University, 2016. http://hdl.handle.net/10072/367609.
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Osteoarthritis is a prevalent and debilitating joint disease. The global prevalence of osteoarthritis is estimated to be 3.6-4.1% of the global population, making it the 11th highest contributor to global disability. Osteoarthritis most commonly occurs in the medial tibiofemoral compartment of the knee. Inappropriate knee loading, during daily activities, is believed to be a principle cause of knee osteoarthritis. Moreover, individuals who have sustained anterior cruciate ligament (ACL) rupture and reconstruction (ACLR) are at particularly high risk of onset of knee OA in the near future. Within 12 years following ACL injury approximately 50% of people will develop knee OA. Worse still, many individuals who have sustained an ACL injury show signs of early knee degeneration as little as 4-5 years post- surgery. The question arises, what is it about ACL injury that results in such high risk of future OA onset?
Individuals with ACLR have abnormal gait biomechanics and muscle activation patterns, which may influence the knee contact forces. As well, the autograft donor muscles are often impaired following harvesting. This muscle impairment also likely influences the knee contact forces. However, what links exist between the altered knee contact forces and degeneration of the articular tissues have not been established. To date, there are no literature reports of the knee contact forces during both daily gait tasks and sporting movements. Likewise, an investigation of the differences in the knee contact forces between ACLR and healthy individuals during different movement tasks has not been performed. Finally, the literature lacks an assessment of the relationships between the tibiofemoral contact forces that arise during daily activity and the structural health of the articular tissues in the knees of ACLR individuals.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Allied Health
Griffith Health
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Suggs, Jeremy F. (Jeremy Floyd) 1976. "Simulation of anterior cruciate ligament injury and reconstruction using a 3D finite element knee joint model." Thesis, Massachusetts Institute of Technology, 2002. http://hdl.handle.net/1721.1/89369.
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Favero, Marta. "Synovial inflammation and associated intra-articular pathology in a cohort of patients undergoing anterior cruciate ligament reconstruction for traumatic rupture." Doctoral thesis, Università degli studi di Padova, 2010. http://hdl.handle.net/11577/3422129.
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Purpose:
Previous epidemiologic studies have established that there is a strong relationship between anterior cruciate ligament (ACL) disruption and the risk for subsequent development of osteoarthritis (OA). Though not normally considered a classical inflammatory arthropathy, OA is often associated with low-grade synovitis. In patients with OA, synovial inflammation is one factor associated with risk of progression of structural joint deterioration and symptoms. The aims of the study were to characterize the histopathological features and chemokine profile of the synovium in patients undergoing ACL reconstruction after traumatic ACL rupture and to determine the relationship between the synovial characteristics and meniscal and/or cartilage abnormalities.
Materials and Methods:
The study was conducted in the context of the ACL registry at the Hospital for Special Surgery (HSS), New York, USA, which maintains extensive records of preclinical, intraoperative and post-operative data for 1200 patients who have undergone ACL reconstruction for traumatic ACL rupture. Synovial biopsies were collected from 40 patients during arthroscopic surgery and processed for histology and RNA extraction. Synovial features of inflammation and degeneration were assessed using a combination histological synovial scoring system developed at HSS in which the following six features were graded: perivascular mononuclear cell infiltration, detritus, mucoid change, fibrosis, increased vascularity and hyperplasia of the synovial lining layer, leading to a total combined maximal score of 15. The following clinical data were also collected: age, sex, body mass index (BMI), date of injury, time to surgery and the intraoperative presence or absence of meniscal and/or cartilage abnormalities. Total RNA extracts were prepared from the suprapatellar synovial samples and the levels of mRNA for four chemokines (IL-8, CCL19, CCL21, and CCL5) and one chemokine receptor (CCR7), shown previously to be associated with synovial inflammation in patients undergoing meniscectomy by microarray pathway analysis (C Scanzello, Arthritis Rheum 2011) [1], were measured by real-time qPCR.
Results:
Of the 40 patients undergoing synovial biopsy and analysis, 19 were female and 21 male, with median ages of 20 and 36, respectively. 85% of the patients exhibited histological evidence of synovial inflammation or degeneration in the suprapatellar area: 44.1% of patients scored 1 or 2, 44.1% scored 3 or 4, 5.8% scored 5 or 6, and 5.8% scored 7 or 8. Arthroscopically, meniscal abnormalities (mostly tears) were observed in 19/40 patients (47%), and cartilage defects were observed in 16/40 patients (40%). No association was observed between the body mass index (BMI), date of injury, time to surgery, and frequency of cartilage defects or meniscal pathology. The patients were divided in two groups based on age: 19 of patients older than 30 years and 21 patients younger than 30 years. Meniscal tears were associated with synovial inflammation in patients older than 30 years. We selected 16 synovial suprapatellar biopsies from patients > 30 years for qPCR analysis, 8 from patients without synovial inflammation (grade 0-2) and 8 with synovial inflammation (grade 3-8). The levels of CCL5 and CCL19 mRNA were significantly upregulated in biopsy specimens exhibiting inflammation with associated fold-changes of 2.7 (P=0.0426) and 4.7 (P=0.0289), respectively.
Conclusions:
In our study, we observed a high percentage of low-grade synovitis (85%), meniscal tear (47%), and/or cartilage defects (40%) in patients undergoing ACL reconstruction for traumatic ACL rupture. In a cohort of patients > 30-years-old, the presence of synovitis correlated with evidence of a meniscal tear, suggesting a relationship between these two pathologic processes. Preliminary analysis of mRNA expression patterns in this group of patients confirmed the upregulation of CCL5 and CCL19. This is in agreement with previously published data [1]. These two chemokines may play an important contributory role in the pathophysiology of OA particularly in those patients having synovial inflammationScopo dello studio: I dati riportati in lettura evidenziano una stretta correlazione tra la rottura del legamento crociato anteriore (LCA) e il rischio di sviluppare osteoartrosi (OA). Benché non sia considerata una classica artropatia infiammatoria, l’OA è spesso associata alla presenza di sinovite di basso grado. Nei pazienti affetti da OA, l’infiammazione sinoviale viene considerata un fattore di rischio correlato con l’attività di malattia e con la progressione del danno articolare. Lo scopo dello studio consiste nel caratterizzare la sinovite dei pazienti sottoposti a ricostruzione del LCA post rottura traumatica e nell’identificare la correlazione tra la presenza d’infiammazione sinoviale e la coesistenza di lesioni meniscali e cartilaginee. Materiali e Metodi: Lo studio è stato condotto presso l’Hospital for Special Surgery (HSS) di New York, USA, utilizzando il registro per il LCA, che raccoglie i dati clinici, preoperatori ed intraoperatori, di 1200 pazienti sottoposti a ricostruzione del LCA in seguito a rottura traumatica. Su 40 pazienti sono state eseguite biopsie sinoviali in corso di artroscopia ed i campioni raccolti sono stati sottoposti ad istologia e ad estrazione di RNA. La presenza d’infiammazione sinoviale è stata valutata mediante l’utilizzo di uno score istologico composito messo a punto all’HSS. Tale score prende in considerazione la presenza dei seguenti parametri istologici per un punteggio complessivo massimo di 15: infiltrazione perivascolare di cellule mononucleate, detriti, cambiamenti mucoidi, fibrosi, incremento della vascolarizzazione ed iperplasia della membrana sinoviale. Sono stati inoltre raccolti i seguenti dati clinici: età, sesso, indice di massa corporea (BMI), data del trauma, data dell’intervento chirurgico e riscontro intraoperatorio di lesioni meniscali e/o cartilaginee. I livelli di mRNA di 4 chemochine (IL-8, CCL19, CCL21, and CCL5) e di un recettore per le chemochine (CCR7) sono stati misurati sulla sinovia sovrapatellare, tramite real time qPCR. Tali chemochine sono risultate precedentemente associate all’infiammazione sinoviale nei pazienti sottoposti a meniscectomia in uno studio condotto tramite microarray analisi (C Scanzello, Arthritis Rheum 2011) [1]. Risultati: Dei 40 pazienti sottoposti a biopsia sinoviale, 19 sono femmine e 21 maschi, con un’età mediana rispettivamente di 20 e 36 anni. L’85% dei pazienti analizzati presenta segni istologici d’infiammazione sinoviale a livello sovrapatellare: il 44.1% dei pazienti ha uno score tra 1 e 2, il 44.1% uno score tra 3 e 4, il 5.8% score tra 5 e 6, e il 5.8% uno score tra 7 e 8. Durante l’artroscopia si sono riscontrate lesioni meniscali in19/40 pazienti (47%) e cartilaginee in 16/40 pazienti (40%). Non si sono identificate correlazioni tra grado d’infiammazione sinoviale e BMI, data del trauma, data dell’intervento e frequenza delle lesioni meniscali e cartilaginee. A seconda dell’età si è suddiviso i pazienti in due gruppi: 19 pazienti hanno un’età superiore a 30 anni e 21 un’età inferiore ai 30 anni. La presenza di lesioni meniscali è associata all’infiammazione sinoviale nei pazienti con età > 30 anni. Tra le biopsie sinoviali sovrapatellari eseguite su pazienti con età > 30 anni, se ne sono selezionate 16 da sottoporre a qPCR analisi: 8 biopsie provenienti da pazienti senza segni d’infiammazione sinoviale (grado 0-2) e 8 provenienti da pazienti con infiammazione sinoviale (grado 3-8). I livelli di mRNA di CCL5 e CCL19 risultano significativamente più elevati nei pazienti con infiammazione sinoviale di 2.7 (p = 0.0426) e di 4.7 volte (p =0.0289) rispettivamente. Conclusioni: Nel nostro studio, i pazienti sottoposti a ricostruzione del LCA per rottura traumatica presentano un’alta percentuale di sinovite di basso grado (85%), lesioni meniscali (47%) e difetti cartilaginei (40%). Nel gruppo di pazienti con età > 30 anni, la presenza di sinovite si correla con il riscontro di lesioni meniscali suggerendo una possibile relazione tra i due processi patologici. L’analisi dell’espressione dell’mRNA in questo gruppo di pazienti, ha confermato un incremento di CCL5 and CCL19, in accordo con quanto riportato in letteratura [1]. Queste due chemochine potrebbero avere un ruolo chiave nella patofisiologia dell’OA, in particolar modo nei pazienti con infiammazione sinoviale
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Swirtun, Linda R. "Anterior cruciate ligament injury : factors affecting selection of treatment and intermediate outcome /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7357-027-3/.
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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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Milandri, Giovanni. "Eccentric cycling rehabilitation after anterior cruciate ligament reconstruction: a randomised controlled trial of strength and biomechanical outcomes." Doctoral thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25452.
Full textAbstract:
After anterior cruciate ligament reconstruction (ACL-R), persistent strength and biomechanical deviations remain. Reducing these by training may reduce risk of re-injury or osteoarthritis for these patients. A cross-sectional study investigated biomechanics of ACL-R male patients long-term (~5 years) post surgery. Fifteen ACL-R and fifteen healthy controls were tested in walking and running using motion capture. Devi- ations were found, primarily between-limbs, and also between groups. Largest deviations were lower knee angles and moments in the affected limb during running. However, these were not found during walking; thus, differences were highlighted by the higher-intensity task. During running, knee abduction moment was lower (more valgus) for the affected compared to unaffected and control limbs. The larger effects in moment show greater clinical potential than knee valgus angle. The ACL-R patients had lower impact foot strike during running than controls. The above results indicate chronic, clinical changes in joint loading. A randomised controlled intervention trial evaluated progressive eccentric cycling for ACL-R males, compared to concentric controls. This is one of the first trials of eccentric vs. concentric training for ACL-R, matched by rating of perceived exertion. Twenty-six adult males, 12 weeks post hamstring-graft ACL-R trained three times/week for 8 weeks under supervision. During training the eccentric group limb powers absorbed were higher than those produced by the concentric group, with a lower heart rate. For both groups, pain scores were low, and one of the patient-reported outcomes (IKDC) improved. Hamstring strength increased in the eccentric group by 15%, but this was not seen in the concentric group. For both groups, 60°/s quadriceps strength increased by a similar amount, approximately 28%. Biomechanically, eccentric training was more effective than matched concen- tric training at resolving knee (P=0.022, walk) and hip (P =0.010, run) flexion angle deviations in the affected limb. In both groups, knee extension moments increased, reducing asymmetries. Large knee abduction moment deviations at baseline were not reduced by either programme (P >0.05). At follow-up (~6 months), both groups showed similar return-to-sports progress; several patients passed using one criterion (IKDC), and none passed using a stricter four-criteria method (Univ. Delaware). Thus it can be concluded that for adult ACL-R males, eccentric cycle training is clinically acceptable, with similar or in some cases better outcomes than concentric cycle training. It improves patient-reported outcomes, strength recovery, biomechanical deviations, and return-to-sports measures.