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1
Ishibashi, Yasuyuki, Eiichi Tsuda, Akira Fukuda, Harehiko Tsukada e Satoshi Toh. "Intraoperative Biomechanical Evaluation of Anatomic Anterior Cruciate Ligament Reconstruction Using a Navigation System". American Journal of Sports Medicine 36, n. 10 (3 settembre 2008): 1903–12. http://dx.doi.org/10.1177/0363546508323245.
Abstract (sommario):
Background Recently, more anatomic anterior cruciate ligament reconstructions have been developed to improve knee laxity. Purpose The objective of this study is to assess knee kinematics after double-bundle reconstruction with hamstring tendon and after anatomically oriented reconstruction with a patellar tendon using navigation during surgery. Study Design Cross-sectional study; Level of evidence, 3. Methods Eighty knees received double-bundle reconstruction with a hamstring tendon graft, and 45 knees received anatomically oriented reconstruction with a patellar tendon graft. Before reconstruction, knee laxity was measured using a navigation system. After the posterolateral bundle or anteromedial bundle was temporarily fixed during double-bundle reconstruction, knee laxity was measured to assess the function of each bundle. After double-bundle reconstruction or anatomically oriented reconstruction with patellar tendon, knee laxity was measured in the same manner. Results Both double-bundle reconstruction and anatomically oriented reconstruction similarly improved knee laxity compared With before reconstruction in all knee flexion angles. Regarding the function of the anteromedial and posterolateral bundles in double-bundle reconstruction, the 2 grafts showed contrasting behavior. The posterolateral bundle restrained tibial displacement mainly in knee extension, whereas the anteromedial bundle restrained it more in the knee flexion position. The posterolateral bundle has a more important role in controlling rotation of the tibia than the anteromedial bundle. Conclusion Although the posterolateral bundle has an important role in the extension position, the anteromedial bundle is more important in the flexion position. Therefore, both bundles should be reconstructed to improve knee laxity throughout knee range of motion. Even with single-bundle reconstruction using a patellar tendon, anatomic reconstruction might improve knee laxity similar to double-bundle reconstruction.
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Burkhart, Timothy A., Takashi Hoshino, Lachlan M. Batty, Alexandra Blokker, Philip P. Roessler, Rajeshwar Sidhu, Maria Drangova et al. "No Difference in Ligamentous Strain or Knee Kinematics Between Rectangular or Cylindrical Femoral Tunnels During Anatomic ACL Reconstruction With a Bone–Patellar Tendon–Bone Graft". Orthopaedic Journal of Sports Medicine 9, n. 6 (1 giugno 2021): 232596712110095. http://dx.doi.org/10.1177/23259671211009523.
Abstract (sommario):
Background: As our understanding of anterior cruciate ligament (ACL) anatomy has evolved, surgical techniques to better replicate the native anatomy have been developed. It has been proposed that the introduction of a rectangular socket ACL reconstruction to replace a ribbon-shaped ACL has the potential to improve knee kinematics after ACL reconstruction. Purpose: To compare a rectangular femoral tunnel (RFT) with a cylindrical femoral tunnel (CFT) in terms of replicating native ACL strain and knee kinematics in a time-zero biomechanical anatomic ACL reconstruction model using a bone–patellar tendon–bone (BTB) graft. Study Design: Controlled laboratory study. Methods: In total, 16 fresh-frozen, human cadaveric knees were tested in a 5 degrees of freedom, computed tomography–compatible joint motion simulator. Knees were tested with the ACL intact before randomization to RFT or CFT ACL reconstruction using a BTB graft. An anterior translation load and an internal rotation moment were each applied at 0°, 30°, 60°, and 90° of knee flexion. A simulated pivot shift was performed at 0° and 30° of knee flexion. Ligament strain and knee kinematics were assessed using computed tomography facilitated by insertion of zirconium dioxide beads placed within the substance of the native ACL and BTB grafts. Results: For the ACL-intact state, there were no differences between groups in terms of ACL strain or knee kinematics. After ACL reconstruction, there were no differences in ACL graft strain when comparing the RFT and CFT groups. At 60° of knee flexion with anterior translation load, there was significantly reduced strain in the reconstructed state ([mean ±standard deviation] CFT native, 2.82 ± 3.54 vs CFT reconstructed, 0.95 ± 2.69; RFT native, 2.77 ± 1.71 vs RFT reconstructed, 1.40 ± 1.76) independent of the femoral tunnel type. In terms of knee kinematics, there were no differences when comparing the RFT and CFT groups. Both reconstructive techniques were mostly effective in restoring native knee kinematics and ligament strain patterns as compared with the native ACL. Conclusion: In the time-zero biomechanical environment, similar graft strains and knee kinematics were achieved using RFT and CFT BTB ACL reconstructions. Both techniques appeared to be equally effective in restoring kinematics associated with the native ACL state. Clinical Relevance: These data suggest that in terms of knee kinematics and graft strain, there is no benefit in performing the more technically challenging RFT as compared with a CFT BTB ACL reconstruction.
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Chia, Zi-Yang, Jade N. Chee, Hamid Rahmatullah Bin-Abd-Razak, Denny TT Lie e Paul CC Chang. "A comparative study of anterior cruciate ligament reconstruction with double, single, or selective bundle techniques". Journal of Orthopaedic Surgery 26, n. 2 (1 maggio 2018): 230949901877312. http://dx.doi.org/10.1177/2309499018773124.
Abstract (sommario):
Purpose: Reconstruction of the anterior cruciate ligament (ACL) is the most frequently performed reconstructive surgery in the knee. Biomechanical studies have shown that double bundle (DB) reconstruction is better than single bundle (SB) reconstruction with regard to rotational stability. It is postulated that resection of ACL fibres that remain in continuity may be counterproductive for the knee as these fibres have the capacity to produce collagen. In this study, we aimed to evaluate the efficacy among selective bundle, DB and SB ACL reconstructions over a 2-year post-operative follow-up period. Methods: A retrospective comparative study was conducted for comparison between selective bundle, DB and SB reconstructions. Between 2012 and 2014, 291 ACL reconstructions were performed. Of these, 68 patients had selective ACL reconstructions (group SLB), 147 had DB ACL reconstructions (group DB) and 76 had SB ACL reconstructions (group SB). Institutional Review Board approval was obtained, and all patients provided informed consent. Clinical results were assessed with the International Knee Documentation Committee (IKDC), Lysholm and Tegner scores. Stability was measured using Lachman, pivot shift and anterior drawer stress tests using the KT1000 at 30° of knee flexion. Results: There was no significant difference in ligament grade, function grade, IKDC grade, as well as Tegner and Lysholm means among all three groups after a 2-year follow-up period. Conclusion: Selective bundle reconstruction provides comparable results to DB and SB reconstruction techniques. It is a viable alternative for patients with partial tears.
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Yagi, Masayoshi, Eric K. Wong, Akihiro Kanamori, Richard E. Debski, Freddie H. Fu e Savio L.-Y. Woo. "Biomechanical Analysis of an Anatomic Anterior Cruciate Ligament Reconstruction". American Journal of Sports Medicine 30, n. 5 (settembre 2002): 660–66. http://dx.doi.org/10.1177/03635465020300050501.
Abstract (sommario):
Background: The focus of most anterior cruciate ligament reconstructions has been on replacing the anteromedial bundle and not the posterolateral bundle. Hypothesis: Anatomic two-bundle reconstruction restores knee kinematics more closely to normal than does single-bundle reconstruction. Study Design: Controlled laboratory study. Methods: Ten cadaveric knees were subjected to external loading conditions: 1) a 134-N anterior tibial load and 2) a combined rotatory load of 5-N·m internal tibial torque and 10-N·m valgus torque. Resulting knee kinematics and in situ force in the anterior cruciate ligament or replacement graft were determined by using a robotic/universal force-moment sensor testing system for 1) intact, 2) anterior cruciate ligament deficient, 3) single-bundle reconstructed, and 4) anatomically reconstructed knees. Results: Anterior tibial translation for the anatomic reconstruction was significantly closer to that of the intact knee than was the single-bundle reconstruction. The in situ force normalized to the intact anterior cruciate ligament for the anatomic reconstruction was 97% ± 9%, whereas the single-bundle reconstruction was only 89% ± 13%. With a combined rotatory load, the normalized in situ force for the single-bundle and anatomic reconstructions at 30° of flexion was 66% ± 40% and 91% ± 35%, respectively. Conclusions: Anatomic reconstruction may produce a better biomechanical outcome, especially during rotatory loads. Clinical Relevance: Results may lead to the use of a two-bundle technique.
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Chernchujit, Bancha, Arrisna Artha e Panin Anilabol. "Comparative Biomechanical Study Between Minimally Invasive Popliteus and LCL Reconstruction Versus LaPrade Technique". Orthopaedic Journal of Sports Medicine 8, n. 5_suppl5 (1 maggio 2020): 2325967120S0009. http://dx.doi.org/10.1177/2325967120s00091.
Abstract (sommario):
Background: Many aspects of the posterolateral corner (PLC) of the knee have been extensively studied within the past 20 years. Quantitative anatomic and biomechanical studies have demonstrated the importance of the 3 static stabilizers of the lateral side of the knee: the fibular collateral ligament, the popliteus tendon, and the popliteofibular ligament. There are various methods of reconstruction. However, currently, there is no consensus on the preferred reconstruction technique for treating patients with chronic PLC injuries. We have developed a new reconstructive technique for PLC based on tibiofibular-based technique, similar to LaPrade, and this technique is less invasive than the previous techniques. Hypothesis: There is no difference between minimally invasive popliteus and LCL reconstruction and LaPrade’s method in restoring the posterolateral stability of knees Methods: Six paired fresh-frozen cadaveric knees were assessed in the intact state and then dissected to simulate a grade III posterolateral knee injury. By using a “Blocked randomization”, each paired knee was randomized into 2 groups (1) reconstruction via LaPrade’s method, (2) minimally invasive popliteus and LCL reconstruction. Biomechanical testing using varus stress radiographs was performed to compare knee stability between 2 groups. Results: This study included six paired knees, three males and three females. The mean age of the cadaver was 70.8 years (range 57-85 years). No difference was found in the demographic data (sex distribution, lateral opening gap of intact knee and side-to-side difference of lateral opening gap of sectioned knee) between the 2 groups. The side-to-side difference in lateral joint opening on the varus stress radiographs significantly improved after PLC reconstruction in both groups (p <0.001, p <0.001), However, there were no differences between the 2 groups in side-to-side difference of lateral opening gap after reconstruction (Mean difference=-0.05 (95%CI, -0.46 to 0.36); p- value=0.039). Conclusion: Biomechanically, minimally invasive popliteus and LCL reconstruction is equivalent to LaPrade’s technique in restoring the stability of knees in case of grade III PLC injury. Additionally, this technique is less invasive than all traditional open technique of PLC reconstruction. The minimally invasive popliteus and LCL reconstruction technique may be a treatment option for grade III PLC injury. Keywords: posterolateral corner; ligament reconstruction; popliteus tendon; lateral collateral ligament; popliteofibular ligament; knee biomechanics; minimally invasive surgery
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Sasaki, Yusuke, Masataka Fujii, Daisuke Araki, Brandon D. Marshall, Monica A. Linde, Patrick Smolinski e Freddie H. Fu. "Effect of Percentage of Femoral Anterior Cruciate Ligament Insertion Site Reconstructed With Hamstring Tendon on Knee Kinematics and Graft Force". American Journal of Sports Medicine 49, n. 5 (3 marzo 2021): 1279–85. http://dx.doi.org/10.1177/0363546521995199.
Abstract (sommario):
Background: Previous studies have stated that closely matching the size of the anterior cruciate ligament (ACL) insertion site footprint is important for biomechanical function and clinical stability after ACL reconstruction. However, the ACL varies widely regarding the area of femoral insertion, tibial insertion, and midsubstance of ACL, and reconstructing the insertion site area with a uniform diameter graft can result in a cross-sectional area that is greater than that of the midsubstance of the native ACL. Therefore, understanding the effect of relative graft size in ACL reconstruction on knee biomechanics is important for surgical planning. Purpose: To assess how the percentage of femoral insertion site affects knee biomechanics in single- and double-bundle ACL reconstruction. Study Design: Controlled laboratory study. Methods: A total of 14 human cadaveric knees were scanned with magnetic resonance imaging and tested using a robotic system under an anterior tibial load and a combined rotational load. In total, 7 knee states were evaluated: intact ACL; deficient ACL; single-bundle ACL reconstruction with approximate graft sizes 25% (small), 50% (medium), and 75% (large) of the femoral insertion site; and double-bundle reconstruction of approximately 50% (medium) and 75% (large) of the femoral insertion site, based on the ratio of the cross-sectional area of the graft to the area of the femoral ACL insertion site determined by magnetic resonance imaging. Results: Anterior tibial translation was not significantly larger than the intact state in single-bundle and double-bundle medium graft reconstructions ( P > .05) and was significantly greater in the single-bundle small graft reconstruction ( P < .05). Anterior knee translation in single-bundle medium graft and large graft reconstructions was not statistically different ( P > .05). In contrast, the anterior tibial translation for double-bundle large graft reconstruction was significantly smaller than for double-bundle medium graft reconstruction at low flexion angles ( P < .05). The single-bundle small graft force was significantly different from the intact ACL in situ force ( P < .05). The graft force with double-bundle large reconstruction was significantly greater than that with the double-bundle medium reconstruction ( P < .05) but was not significantly different from that of the intact ACL ( P > .05). Conclusion: Knee biomechanics with a single-bundle small graft tended to be significantly different from those of the intact knee. In the kinematic and kinetic data for the single- and double-bundle medium graft reconstruction, only the anterior translation at full extension for the single-bundle reconstruction was significantly different (lower) from that of intact knee. This was a time zero study. Clinical Relevance: This study can provide surgeons with guidance in selecting the graft size for ACL reconstruction.
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Nielsen, Emil Toft, Kasper Stentz-Olesen, Sepp de Raedt, Peter Bo Jørgensen, Ole Gade Sørensen, Bart Kaptein, Michael Skipper Andersen e Maiken Stilling. "Influence of the Anterolateral Ligament on Knee Laxity: A Biomechanical Cadaveric Study Measuring Knee Kinematics in 6 Degrees of Freedom Using Dynamic Radiostereometric Analysis". Orthopaedic Journal of Sports Medicine 6, n. 8 (1 agosto 2018): 232596711878969. http://dx.doi.org/10.1177/2325967118789699.
Abstract (sommario):
Background: An anterior cruciate ligament (ACL) rupture often occurs during rotational trauma to the knee and may be associated with damage to extracapsular knee rotation–stabilizing structures such as the anterolateral ligament (ALL). Purpose: To investigate ex vivo knee laxity in 6 degrees of freedom with and without ALL reconstruction as a supplement to ACL reconstruction. Study Design: Controlled laboratory study. Methods: Cadaveric knees (N = 8) were analyzed using dynamic radiostereometry during a controlled pivotlike dynamic movement simulated by motorized knee flexion (0° to 60°) with 4-N·m internal rotation torque. We tested the cadaveric specimens in 5 successive ligament situations: intact, ACL lesion, ACL + ALL lesion, ACL reconstruction, and ACL + ALL reconstruction. Anatomic single-bundle reconstruction methods were used for both the ACL and the ALL, with a bone-tendon quadriceps autograft and gracilis tendon autograft, respectively. Three-dimensional kinematics and articular surface interactions were used to determine knee laxity. Results: For the entire knee flexion motion, an ACL + ALL lesion increased the mean knee laxity ( P < .005) for internal rotation (2.54°), anterior translation (1.68 mm), and varus rotation (0.53°). Augmented ALL reconstruction reduced knee laxity for anterior translation ( P = .003) and varus rotation ( P = .047) compared with ACL + ALL–deficient knees. Knees with ACL + ALL lesions had more internal rotation ( P < .001) and anterior translation ( P < .045) at knee flexion angles below 40° and 30°, respectively, compared with healthy knees. Combined ACL + ALL reconstruction did not completely restore native kinematics/laxity at flexion angles below 10° for anterior translation and below 20° for internal rotation ( P < .035). ACL + ALL reconstruction was not found to overconstrain the knee joint. Conclusion: Augmented ALL reconstruction with ACL reconstruction in a cadaveric setting reduces internal rotation, varus rotation, and anterior translation knee laxity similar to knee kinematics with intact ligaments, except at knee flexion angles between 0° and 20°. Clinical Relevance: Patients with ACL injuries can potentially achieve better results with augmented ALL reconstruction along with ACL reconstruction than with stand-alone ACL reconstruction. Furthermore, dynamic radiostereometry provides the opportunity to examine clinical patients and compare the recontructed knee with the contralateral knee in 6 degrees of freedom.
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Varelas, Antonios N., Brandon J. Erickson, Gregory L. Cvetanovich e Bernard R. Bach. "Medial Collateral Ligament Reconstruction in Patients With Medial Knee Instability: A Systematic Review". Orthopaedic Journal of Sports Medicine 5, n. 5 (1 maggio 2017): 232596711770392. http://dx.doi.org/10.1177/2325967117703920.
Abstract (sommario):
Background: The medial collateral ligament (MCL) is the most frequently injured ligament of the knee, but it infrequently requires surgical treatment. Current literature on MCL reconstructions is sparse and offers mixed outcome measures. Purpose/Hypothesis: The purpose of this study was to compare the outcomes of isolated MCL reconstruction and multiligamentous MCL reconstruction. Our hypothesis was that in selective patients, MCL reconstruction would significantly improve objective and subjective patient knee performance measures, those being baseline valgus laxity, range of motion, objective and subjective International Knee Documentation Committee (IKDC) scores, Tegner score, and Lysholm knee activity scores. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and utilizing 3 computer-based databases. Studies reporting clinical outcomes of patients undergoing MCL reconstruction due to chronic instability or injury with mean follow-up of at least 2 years and levels of evidence 1 to 4 were eligible for inclusion. All relevant subject demographics and study data were statistically analyzed using 2-sample and 2-proportion z tests. Results: Ten studies involving 275 patients met our inclusion criteria. Of these patients, 46 underwent isolated MCL reconstruction while another 229 underwent reconstruction of the MCL in addition to a variety of concomitant reconstructions. Overall outcomes for all patients were significant for (1) reducing the medial opening of the knee (8.1 ± 1.3 vs 1.4 ± 1.0 mm; P < .001), (2) improving the patient’s objective IKDC score (1.2% vs 88.4%; P < .001), (3) improving the patient’s subjective IKDC score (49.8 ± 6.9 vs 82.4 ± 9.6; P < .001), and (4) improving the Lysholm knee activity score (69.3 ± 5.9 vs 90.5 ± 6.6; P < .001). No differences existed between concomitant reconstruction groupings except that postoperative Lysholm scores were better for MCL/anterior cruciate ligament reconstruction than MCL/posterior cruciate ligament reconstruction (94.3 ± 4.5 vs 84.0 ± 11.7; P < .001). Normal or nearly normal range of motion was obtained by 88% of all patients. Conclusion: The systematic review of 10 studies and 275 knees found that the reported patient outcomes after MCL reconstruction were significantly improved across all measures studied, with no significant difference in outcomes between concomitant reconstructions.
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Stannard, James P., Stephen L. Brown, Rory C. Farris, Gerald McGwin e David A. Volgas. "The Posterolateral Corner of the Knee". American Journal of Sports Medicine 33, n. 6 (giugno 2005): 881–88. http://dx.doi.org/10.1177/0363546504271208.
Abstract (sommario):
Background Injuries to the posterolateral corner of the knee are disabling. Despite improved understanding of this group of tendons and ligaments, the best surgical treatment of an unstable corner is not clear. Hypothesis Surgical repair of acute tears of the posterolateral corner has outcomes that are as good as those from reconstruction combined with an early motion rehabilitation protocol. Study Design Cohort study; Level of evidence, 2. Methods Sixty-three patients with 64 posterolateral corner tears were included in this study, with 39 posterolateral corner repairs and 25 reconstructions using the modified 2-tailed technique. Patients were evaluated with clinical and KT-2000 arthrometer examinations, as well as with Lysholm, International Knee Documentation Committee, and Short Form-36 scores. Results Fifty-six patients with 57 corner tears had minimum clinical follow-up of 24 months (range, 24-59 months). Acute primary repairs were performed on 35 patients, with 22 successful outcomes and 13 (37%) failures. Primary reconstructions were performed on 22 patients, with 20 successful outcomes and 2 (9%) failures. The difference in stability on clinical examination between repairs and reconstructions was significant (P <. 05). Fourteen of 15 patients with failures of the primary posterolateral corner repair or reconstruction underwent successful revision reconstruction. The final patient with failure of the primary repair elected not to have a revision reconstruction. The final mean Lysholm knee score for both repair and reconstruction patients was 88.7 (range, 53-100). Final International Knee Documentation Committee objective scores yielded 14 (26%) normal, 28 (52%) near-normal, 9 (17%) abnormal, and 3 (6%) severely abnormal knees; the mean score was 60 at the most recent clinical evaluation. Conclusion Results with repair followed by early motion rehabilitation have been significantly inferior when compared with results from reconstruction using the modified 2-tailed technique. The authors now use reconstruction rather than repair in the majority of patients who sustain posterolateral corner tears after high-energy injuries.
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Harner, Christopher D., Marsie A. Janaushek, Akihiro Kanamori, Masayoshi Yagi, Tracy M. Vogrin e Savio L.-Y. Woo. "Biomechanical Analysis of a Double-Bundle Posterior Cruciate Ligament Reconstruction". American Journal of Sports Medicine 28, n. 2 (marzo 2000): 144–51. http://dx.doi.org/10.1177/03635465000280020201.
Abstract (sommario):
The objective of this study was to experimentally evaluate a single-bundle versus a double-bundle posterior cruciate ligament reconstruction by comparing the resulting knee biomechanics with those of the intact knee. Ten human cadaveric knees were tested using a robotic/universal force-moment sensor testing system. The knees were subjected to a 134-N posterior tibial load at five flexion angles. Three knee conditions were tested: 1) intact knee, 2) single-bundle reconstruction, and 3) double-bundle reconstruction. Posterior tibial translation of the intact knee ranged from 4.9 2.7 mm at 90° to 7.2 1.5 mm at full extension. After the single-bundle reconstruction, posterior tibial translation increased to 7.3 3.9 mm and 9.2 2.8 mm at 90° and full extension, respectively, while the corresponding in situ forces in the graft were up to 44 19 N lower than those in the intact ligament. Conversely, with double-bundle reconstruction, the posterior tibial translation did not differ significantly from the intact knee at any flexion angle tested. This reconstruction also restored in situ forces more closely than did the single-bundle reconstruction. These data suggest that a double-bundle posterior cruciate ligament reconstruction can more closely restore the biomechanics of the intact knee than can the single-bundle reconstruction throughout the range of knee flexion.
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Inderhaug, Eivind, Joanna M. Stephen, Andy Williams e Andrew A. Amis. "Biomechanical Comparison of Anterolateral Procedures Combined With Anterior Cruciate Ligament Reconstruction". American Journal of Sports Medicine 45, n. 2 (27 dicembre 2016): 347–54. http://dx.doi.org/10.1177/0363546516681555.
Abstract (sommario):
Background: Anterolateral soft tissue structures of the knee have a role in controlling anterolateral rotational laxity, and they may be damaged at the time of anterior cruciate ligament (ACL) ruptures. Purpose: To compare the kinematic effects of anterolateral operative procedures in combination with intra-articular ACL reconstruction for combined ACL plus anterolateral–injured knees. Study Design: Controlled laboratory study. Methods: Twelve cadaveric knees were tested in a 6 degrees of freedom rig using an optical tracking system to record the kinematics through 0° to 90° of knee flexion with no load, anterior drawer, internal rotation, and combined loading. Testing was first performed in ACL-intact, ACL-deficient, and combined ACL plus anterolateral–injured (distal deep insertions of the iliotibial band and the anterolateral ligament [ALL] and capsule cut) states. Thereafter, ACL reconstruction was performed alone and in combination with the following: modified MacIntosh tenodesis, modified Lemaire tenodesis passed both superficial and deep to the lateral collateral ligament, and ALL reconstruction. Anterolateral grafts were fixed at 30° of knee flexion with both 20 and 40 N of tension. Statistical analysis used repeated-measures analyses of variance and paired t tests with Bonferroni adjustments. Results: ACL reconstruction alone failed to restore native knee kinematics in combined ACL plus anterolateral–injured knees ( P < .05 for all). All combined reconstructions with 20 N of tension, except for ALL reconstruction ( P = .002-.01), restored anterior translation. With 40 N of tension, the superficial Lemaire and MacIntosh procedures overconstrained the anterior laxity in deep flexion. Only the deep Lemaire and MacIntosh procedures—with 20 N of tension—restored rotational kinematics to the intact state ( P > .05 for all), while the ALL underconstrained and the superficial Lemaire overconstrained internal rotation. The same procedures with 40 N of tension led to similar findings. Conclusion: In a combined ACL plus anterolateral–injured knee, ACL reconstruction alone failed to restore intact knee kinematics. The addition of either the deep Lemaire or MacIntosh tenodesis tensioned with 20 N, however, restored native knee kinematics. Clinical Relevance: The current study indicates that unaddressed anterolateral injuries, in the presence of an ACL deficiency, result in abnormal knee kinematics that is not restored if only treated with intra-articular ACL reconstruction. Both the modified MacIntosh and modified deep Lemaire tenodeses (with 20 N of tension) restored native knee kinematics at time zero.
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Treme, Gehron P., Christina Salas, Gabriel Ortiz, George Keith Gill, Paul J. Johnson, Heather Menzer, Dustin L. Richter, Fares Qeadan, Daniel C. Wascher e Robert C. Schenck. "A Biomechanical Comparison of the Arciero and LaPrade Reconstruction for Posterolateral Corner Knee Injuries". Orthopaedic Journal of Sports Medicine 7, n. 4 (1 aprile 2019): 232596711983825. http://dx.doi.org/10.1177/2325967119838251.
Abstract (sommario):
Background: Injury to the posterolateral corner (PLC) of the knee requires reconstruction to restore coronal and rotary stability. Two commonly used procedures are the Arciero reconstruction technique (ART) and the LaPrade reconstruction technique (LRT). To the authors’ knowledge, these techniques have not been biomechanically compared against one another. Purpose: To identify if one of these reconstruction techniques better restores stability to a PLC-deficient knee and if concomitant injury to the proximal tibiofibular joint or anterior cruciate ligament affects these results. Study Design: Controlled laboratory study. Methods: Eight matched-paired cadaveric specimens from the midfemur to toes were used. Each specimen was tested in 4 phases: intact PLC (phase 1), PLC sectioned (phase 2), PLC reconstructed (ART or LRT) (phase 3), and tibiofibular (phase 4A) or anterior cruciate ligament (phase 4B) sectioning with PLC reconstructed. Varus angulation and external rotation at 0º, 20º, 30º, 60º, and 90º of knee flexion were quantified at each phase. Results: In phase 3, both reconstructions were effective at restoring laxity back to the intact state. However, in phase 4A, both reconstructions were ineffective at stabilizing the joint owing to tibiofibular instability. In phase 4B, both reconstructions had the potential to restrict varus angulation motion. There were no statistically significant differences found between reconstruction techniques for varus angulation or external rotation at any degree of flexion in phase 3 or 4. Conclusion: The LRT and ART are equally effective at restoring stability to knees with PLC injuries. Neither reconstruction technique fully restores stability to knees with combined PLC and proximal tibiofibular joint injuries. Clinical Relevance: Given these findings, surgeons may select their reconstruction technique based on their experience and training and the specific needs of their patients.
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Coobs, Benjamin R., Robert F. LaPrade, Chad J. Griffith e Bradley J. Nelson. "Biomechanical Analysis of an Isolated Fibular (Lateral) Collateral Ligament Reconstruction Using an Autogenous Semitendinosus Graft". American Journal of Sports Medicine 35, n. 9 (settembre 2007): 1521–27. http://dx.doi.org/10.1177/0363546507302217.
Abstract (sommario):
Background The fibular collateral ligament is the primary stabilizer to varus instability of the knee. Untreated fibular collateral ligament injuries can lead to residual knee instability and can increase the risk of concurrent cruciate ligament reconstruction graft failures. Anatomic reconstructions of the fibular collateral ligament have not been biomechanically validated. Purpose To describe an anatomic fibular collateral ligament reconstruction using an autogenous semitendinosus graft and to test the hypothesis that using this reconstruction technique to treat an isolated fibular collateral ligament injury will restore the knee to near normal stability. Study Design Controlled laboratory study. Methods Ten nonpaired, fresh-frozen cadaveric knees were biomechanically subjected to a 10 N·m varus moment and 5 N·m external and internal rotation torques at 0°, 15°, 30°, 60°, and 90° of knee flexion. Testing was performed with an intact and sectioned fibular collateral ligament, and also after an anatomic reconstruction of the fibular collateral ligament with an autogenous semitendinosus graft. Motion changes were assessed with a 6 degree of freedom electromagnetic motion analysis system. Results After sectioning, we found significant increases in varus rotation at 0°, 15°, 30°, 60°, and 90°, external rotation at 60° and 90°, and internal rotation at 0°, 15°, 30°, 60°, and 90° of knee flexion. After reconstruction, there were significant decreases in motion in varus rotation at 0°, 15°, 30°, 60°, and 90°, external rotation at 60° and 90°, and internal rotation at 0°, 15°, and 30° of knee flexion. In addition, we observed a full recovery of knee stability in varus rotation at 0°, 60°, and 90°, external rotation at 60° and 90°, and internal rotation at 0° and 30° of knee flexion. Conclusion An anatomic fibular collateral ligament reconstruction restores varus, external, and internal rotation to near normal stability in a knee with an isolated fibular collateral ligament injury. Clinical Significance An anatomic reconstruction of the fibular collateral ligament with an autogenous semitendinosus graft is a viable option to treat nonrepairable acute or chronic fibular collateral ligament tears in patients with varus instability.
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Tomar, Lavindra, Rakesh Chandra Arya, Gaurav Govil e Pawan Dhawan. "Neglected bilateral multi-ligament knee injury managed by single-stage limb reconstructive surgery: A very rare case report with literature review". Journal of Bone and Joint Diseases 38, n. 3 (2023): 248–60. http://dx.doi.org/10.4103/jbjd.jbjd_40_23.
Abstract (sommario):
Abstract A multi-ligament knee injury (MLKI) can be a devastating injury. A poorly managed, missed, or neglected injury presenting with a painful arthritic crippling unstable limb needs reconstructive surgery. We present a case report of bilateral MLKI presenting with late neglected knee dislocations (KD) in a 37-year-old male. A rotating hinge arthroplasty for a KD5 right knee MLKI and an arthroscopic reconstruction combined with an open repair of the KD3M left knee MLKI have been presented. The strategy for simultaneous reconstructive procedures has been detailed. The preoperative clinical assessment, imaging, anticipated per-operative technical challenges, and adapting a postoperative guided rehabilitation protocol were important considerations. The advantages of a single-stage MLKI management were multi-fold. The single-stage limb reconstructive surgery gave a good functional outcome. A comprehensive review of case reports and studies for chronic or neglected KD provides an update on the various treatment strategies. The bilateral affection allowed for the utilization of contralateral autografts for the reconstructive surgery of the other knee. The combined arthroplasty and ligament repair for two knees as a single-stage procedure allowed an immediate weight-bearing potential to a wheelchair-bound bedridden adult. The precise decision-making, sound reconstruction principles, and meticulous coordinated surgical skills gave a favorable clinical and functional outcome.
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Sterling, Robert S. "Knee reconstruction". Current Orthopaedic Practice 20, n. 1 (gennaio 2009): 34. http://dx.doi.org/10.1097/bco.0b013e3181954834.
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Sterling, Robert S. "Knee reconstruction". Current Orthopaedic Practice 19, n. 2 (aprile 2008): 139. http://dx.doi.org/10.1097/bco.0b013e3282fa11f8.
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MA, Yong, Ying-fang AO, Jia-kuo YU, Ling-hui DAI e Zhen-xing SHAO. "Failed anterior cruciate ligament reconstruction: analysis of factors leading to instability after primary surgery". Chinese Medical Journal 126, n. 2 (20 gennaio 2013): 280–85. http://dx.doi.org/10.3760/cma.j.issn.0366-6999.20122168.
Abstract (sommario):
Background Revision anterior cruciate ligament (ACL) surgery can be expected to become more common as the number of primary reconstruction keeps increasing. This study aims to investigate the factors causing instability after primary ACL reconstruction, which may provide an essential scientific base to prevent surgical failure. Methods One hundred and ten revision ACL surgeries were performed at our institute between November 2001 and July 2012. There were 74 men and 36 women, and the mean age at the time of revision was 27.6 years (range 16-56 years). The factors leading to instability after primary ACL reconstruction were retrospectively reviewed. Results Fifty-one knees failed because of bone tunnel malposition, with too anterior femoral tunnels (20 knees), posterior wall blowout (1 knee), vertical femoral tunnels (7 knees), too posterior tibial tunnels (12 knees), and too anterior tibial tunnels (10 knees). There was another knee performed with open surgery, where the femoral tunnel was drilled through the medial condyle and the tibial tunnel was too anterior. Five knees were found with malposition of the fixation. One knee with allograft was suspected of rejection and a second surgery had been made to take out the graft. Three knees met recurrent instability after postoperative infection. The other factors included traumatic (48 knees) and unidentified (12 knees). Conclusion Technical errors were the main factors leading to instability after primary ACL reconstructions, while attention should also be paid to the risk factors of re-injury and failure of graft incorporation.
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Nikolic, Dragan, Vlajko Draskovic e Rajko Vulovic. "Reconstruction of the anterior cruciate ligament of the knee". Vojnosanitetski pregled 63, n. 11 (2006): 945–51. http://dx.doi.org/10.2298/vsp0611945n.
Abstract (sommario):
Background/Aim. Numerous papers on reconstruction of the anterior cruciate ligament of the knee (ACL) contribute to the significance of this method. The aim of this study was to analyze the outcome of the use of this surgical treatment method regardless the type of surgical intervention, graft, and the choice of the material for fixing. Methods. The study included 324 patients treated within the period from April 1997 to April 2004. Arthroscopically assisted ACL reconstruction was typically performed using the central one-third of the patellar ligament, as a graft, with bone blocks. Fixing was performed using screws (spongy or interferential, Mitek type). In the cases who required revision of the surgery, we used a graft m. semitendinosus and m. gracilise (STG) or a graft of the patellar ligament (B-Pt-B). Fixation in these cases was performed using absorptive wedges according to the Rigidfix technique or metallic implants. Results. The analysis included the results of the reconstruction of the anterior cruciate ligament of the knee (B-Pt-B or STG graft) in 139 of the knees. Chronic injuries were revealed in 132 (94.9%) of the knees. According to the anamnesis and clinical findings, the feeling of instability prevailed in 132 (94.9%) of the knees, pain in 72 (51.7%), effluents in 24 (17.2%), and blockages in 13 (9.3%). Early and late postoperative complications were noticeable in 3.5% each. Hypotrophy of the upper knee musculature up to 2 cm was present in 53.9% of the operated knees, while minor contractions in 13.6% of them. The final result of the reconstruction graded begusing the Lysholm Scale was 85.2, simultaneous reconstructions of other ligaments 75.3, and revision surgery 68.0. First-grade degenerative postoperative changes according to the K/L Scale were found in 55.0% of the surgically treated knees, while the worst, four-grade one in 2.5%. Conclusion. On the basis of these findings, we can conclude that this method is the method of choice in preventing further "worsening" of the chronically instable knee. The surgical technique of choice is arthroscopically assisted reconstruction using a B-Pt-B or STG graft.
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Spang, Robert, Jonathan Egan, Philip Hanna, Aron Lechtig, Daniel Haber, Joseph P. DeAngelis, Ara Nazarian e Arun J. Ramappa. "Comparison of Patellofemoral Kinematics and Stability After Medial Patellofemoral Ligament and Medial Quadriceps Tendon–Femoral Ligament Reconstruction". American Journal of Sports Medicine 48, n. 9 (18 giugno 2020): 2252–59. http://dx.doi.org/10.1177/0363546520930703.
Abstract (sommario):
Background: There is a lack of evidence regarding the optimum extensor-sided fixation method for medial patellofemoral ligament (MPFL) reconstruction. There is increased interest in avoiding patellar drilling via soft tissue–only fixation to the distal quadriceps, thus reconstructing the medial quadriceps tendon–femoral ligament (MQTFL). The biomechanical implications of differing extensor-sided fixation constructs remain unknown. Hypothesis: The null hypothesis was there would be no differences between traditional MPFL reconstruction and MQTFL reconstruction with respect to resistance to lateral translation, patellar position, or patellofemoral contact pressures. Study Design: Controlled laboratory study. Methods: Nine adult knee specimens were mounted on a jig that applied static, physiologic loads to the quadriceps tendons. Patellar position and orientation, knee flexion angle, and patellofemoral pressure were recorded at 8 different flexion angles between 0° and 110°. Additionally, a lateral patellar excursion test was conducted wherein a load was applied directly to the patella in the lateral direction with the knee at 30° of flexion and subjected to 2-N quadriceps loads. Testing was conducted under 4 conditions: intact, transected MPFL, MQTFL reconstruction, and MPFL reconstruction. For MQTFL reconstruction, the surgical technique established by Fulkerson was employed. For MPFL reconstruction, a traditional technique was utilized. Results: The patellar excursion test showed no significant difference between the MQTFL and intact states with respect to lateral translation. MPFL reconstruction led to significantly less lateral translation ( P < .05) than all other states. There were no significant differences between MPFL and MQTFL reconstructions with respect to peak patellofemoral contact pressure. MPFL and MQTFL reconstructions both resulted in increased internal rotation of the patella with the knee in full extension. Conclusion: Soft tissue-only extensor-sided fixation to the distal quadriceps (MQTFL) during patella stabilization appears to re-create native stability in this time 0 cadaver model. Fixation to the patella (MPFL) was associated with increased resistance to lateral translation. Clinical Relevance: Evolving anatomic knowledge and concern for patellar fracture has led to increased interest in MQTFL reconstruction. Both MQTFL and MPFL reconstructions restored patellofemoral stability to lateral translation without increasing contact pressures under appropriate graft tensioning, with MQTFL more closely restoring native resistance to lateral translation at the time of surgery.
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Harter, Rod A., Louis R. Osternig e Kenneth M. Singer. "Knee Joint Proprioception Following Anterior Cruciate Ligament Reconstruction". Journal of Sport Rehabilitation 1, n. 2 (maggio 1992): 103–10. http://dx.doi.org/10.1123/jsr.1.2.103.
Abstract (sommario):
This study evaluated knee joint position sense in the ACL-reconstructed and contralateral normal knees of 48 male and female subjects (M age 27.6 ± 6.9 yrs). Subjects were blindfolded and tested on their ability to actively reproduce five passively placed knee positions at 5° intervals between 35 and 15° of knee flexion. Mean algebraic target angle error and mean absolute error values were measured in degrees. The grand mean absolute error for the postsurgical knees at all positions was 5.4 ± 3.2°, compared with 5.2 ± 2.7° for the normal contralateral knees. There were no significant differences in knee joint position sense between the postsurgical and normal contralateral limbs at any of the five positions tested. Pivot shift, anterolateral rotatory instability, and Lachman test results were poorly correlated with knee joint position sense. The results suggest that if knee joint position sense was indeed disrupted by ACL injury and reconstructive surgery, related sensory mechanisms compensated for any proprioceptive loss prior to the minimum 2-yr postsurgical follow-up period employed in our study.
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Bergfeld, John A., Scott M. Graham, Richard D. Parker, Antonio D. C. Valdevit e Helen E. Kambic. "A Biomechanical Comparison of Posterior Cruciate Ligament Reconstructions Using Single- and Double-Bundle Tibial Inlay Techniques". American Journal of Sports Medicine 33, n. 7 (luglio 2005): 976–81. http://dx.doi.org/10.1177/0363546504273046.
Abstract (sommario):
Background The efficacy of using a double-bundle versus single-bundle graft for posterior cruciate ligament reconstruction has not been demonstrated. Hypothesis A double-bundle graft restores knee kinematics better than a single-bundle graft does in tibial inlay PCL reconstructions. Study Design Controlled laboratory study. Methods Eight cadaveric knees were subjected to 6 cycles from a 40-N anterior reference point to a 100-N posterior translational force at 10°, 30°, 60°, and 90° of flexion. Testing was performed for the intact and posterior cruciate deficient knee as well as for both reconstructed conditions. Achilles tendons, divided into 2 equal sections, were prepared as both single-bundle and double-bundle grafts. Both grafts were employed in the same knee, and the order of graft reconstruction was randomized. Results There were no statistical differences in translation between the intact state and either of the reconstructions (P >. 05) or between either of the reconstructions at any flexion angle (P >. 05). Conclusion No differences in translation between the 2 graft options were identified. Clinical Relevance The use of a double-bundle graft may not offer any advantages over a single-bundle graft for tibial inlay posterior cruciate reconstructions.
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Tow, BPB, PCC Chang, AK Mitra, BK Tay e MC Wong. "Comparing 2-Year Outcomes of Anterior Cruciate Ligament Reconstruction Using Either Patella-Tendon or Semitendinosus-Tendon Autografts: A Non-Randomised Prospective Study". Journal of Orthopaedic Surgery 13, n. 2 (agosto 2005): 139–46. http://dx.doi.org/10.1177/230949900501300206.
Abstract (sommario):
Purpose. To compare the results of anterior cruciate ligament (ACL) reconstructions using either a patella-tendon autograft or a semitendinosus-tendon autograft. Methods. Based on surgeon experience and preference, 68 patients underwent ACL reconstruction using either a quadruple-strand semitendinosus autograft (n=34) or a central one-third bone-patella tendon-bone autograft (n=34). Each patient was assessed preoperatively and postoperatively at 3, 6, and 24 months using the International Knee Documentation Committee (IKDC) knee score, Biodex muscle strength and endurance testing, and the KT1000 instrumented arthrometer test of knee laxity to anterior translation. All assessments at the 2-year follow-up were performed by the same physician and physiotherapist. Results. While ACL reconstruction improved knee stability and IKDC knee scores significantly, there was no statistically significant difference between semitendinosus- and patella-tendon autograft reconstructions in terms of long-term knee score or laxity to anterior translation. Semitendinosus graft reconstruction was associated with less donor-site morbidity and hamstring weakness. Meniscectomy was associated with poorer long-term knee scores. Conclusion. ACL reconstruction is associated with a significantly better IKDC knee score and laxity measurement at 2-year follow-up. However, we were unable to demonstrate a significantly better long-term outcome in knee score or laxity to anterior translation with either a patella-tendon autograft or a semitendinosus-tendon autograft.
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Sekiya, Jon K., Marcus J. Haemmerle, Kathryne J. Stabile, Tracy M. Vogrin e Christopher D. Harner. "Biomechanical Analysis of a Combined Double-Bundle Posterior Cruciate Ligament and Posterolateral Corner Reconstruction". American Journal of Sports Medicine 33, n. 3 (marzo 2005): 360–69. http://dx.doi.org/10.1177/0363546504268039.
Abstract (sommario):
Background Failure to address both components of a combined posterior cruciate ligament and posterolateral corner injury has been implicated as a reason for abnormal biomechanics and inferior clinical results. Hypothesis Combined double-bundle posterior cruciate ligament and posterolateral corner reconstruction restores the kinematics and in situ forces of the intact knee ligaments. Study Design Controlled laboratory study Methods Ten fresh-frozen human cadaveric knees were tested using a robotic testing system through sequential cutting and reconstructing of the posterior cruciate ligament and posterolateral corner. The knees were subjected to a 134-N posterior tibial load and a 5-N.m external tibial torque at multiple flexion angles. The double-bundle posterior cruciate ligament reconstruction was performed using Achilles and semitendinosus tendons. The posterolateral corner reconstruction consisted of reattaching the popliteus tendon to its femoral origin and reconstructing the popliteofibular ligament with a gracilis tendon. Results Under the posterior load, the combined reconstruction reduced posterior translation to within 1.2 - 1.5 mm of the intact knee. The in situ forces in the posterior cruciate ligament grafts were significantly less than those in the native posterior cruciate ligament at all angles except full extension. Conversely, the forces in the posterolateral corner grafts were significantly higher than those in the native structures at all angles. Under the external torque with the combined reconstruction, external rotation as well as in situ forces in the posterior cruciate ligament and posterolateral corner grafts were not different from the intact knee. Conclusions A combined posterior cruciate ligament and posterolateral corner reconstruction can restore intact knee kinematics at time zero. In situ forces in the intact posterior cruciate ligament and posterolateral corner were not reproduced by the reconstruction; however, the posterolateral corner reconstruction reduced the loads experienced by the posterior cruciate ligament grafts. Clinical Relevance By addressing both structures of this combined injury, this technique restores native kinematics under the applied loads at fixed flexion angles and demonstrates load sharing among the grafts creating a potentially protective effect against early failure of the posterior cruciate ligament grafts but with increased force in the posterolateral corner construct.
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Sim, Jae Ang, Hemanth R. Gadikota, Jing-Sheng Li, Guoan Li e Thomas J. Gill. "Biomechanical Evaluation of Knee Joint Laxities and Graft Forces After Anterior Cruciate Ligament Reconstruction by Anteromedial Portal, Outside-In, and Transtibial Techniques". American Journal of Sports Medicine 39, n. 12 (9 settembre 2011): 2604–10. http://dx.doi.org/10.1177/0363546511420810.
Abstract (sommario):
Background: Recently, anatomic anterior cruciate ligament (ACL) reconstruction is emphasized to improve joint laxity and to potentially avert initiation of cartilage degeneration. There is a paucity of information on the efficacy of ACL reconstructions by currently practiced tunnel creation techniques in restoring normal joint laxity. Study Design: Controlled laboratory study. Hypothesis: Anterior cruciate ligament reconstruction by the anteromedial (AM) portal technique, outside-in (OI) technique, and modified transtibial (TT) technique can equally restore the normal knee joint laxity and ACL forces. Methods: Eight fresh-frozen human cadaveric knee specimens were tested using a robotic testing system under an anterior tibial load (134 N) at 0°, 30°, 60°, and 90° of flexion and combined torques (10-N·m valgus and 5-N·m internal tibial torques) at 0° and 30° of flexion. Knee joint kinematics, ACL, and ACL graft forces were measured in each knee specimen under 5 different conditions (ACL-intact knee, ACL-deficient knee, ACL-reconstructed knee by AM portal technique, ACL-reconstructed knee by OI technique, and ACL-reconstructed knee by TT technique). Results: Under anterior tibial load, no significant difference was observed between the 3 reconstructions in terms of restoring anterior tibial translation ( P > .05). However, none of the 3 ACL reconstruction techniques could completely restore the normal anterior tibial translations ( P < .05). Under combined tibial torques, both AM portal and OI techniques closely restored the normal knee anterior tibial translation ( P > .05) at 0° of flexion but could not do so at 30° of flexion ( P < .05). The ACL reconstruction by the TT technique was unable to restore normal anterior tibial translations at both 0° and 30° of flexion under combined tibial torques ( P < .05). Forces experienced by the ACL grafts in the 3 reconstruction techniques were lower than those experienced by normal ACL under both the loading conditions. Conclusion: Anterior cruciate ligament reconstructions by AM portal, OI, and modified TT techniques are biomechanically comparable with each other in restoring normal knee joint laxity and in situ ACL forces. Clinical Relevance: Anterior cruciate ligament reconstructions by AM portal, OI, and modified TT techniques result in similar knee joint laxities. Technical perils and pearls should be carefully considered before choosing a tunnel creating technique.
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Muaidi, Qassim Ibrahim, Leslie Lorenda Nicholson, Kathryn Margaret Refshauge, Roger David Adams e Justin Phillip Roe. "Effect of Anterior Cruciate Ligament Injury and Reconstruction on Proprioceptive Acuity of Knee Rotation in the Transverse Plane". American Journal of Sports Medicine 37, n. 8 (13 maggio 2009): 1618–26. http://dx.doi.org/10.1177/0363546509332429.
Abstract (sommario):
Background Studies assessing proprioceptive acuity in anterior cruciate ligament (ACL)–deficient knees have only considered proprioception for knee movements in the sagittal plane rather than in the transverse plane (ie, rotation), despite the fact that the ACL plays a critical role in knee rotational stability and that the ACL is injured almost exclusively with a rotation mechanism. Therefore a test of proprioception is needed that involves movements similar to the mechanism of injury, in this case, rotation. Purpose To determine whether proprioceptive acuity in rotation changes after ACL injury and reconstruction, and to examine differences in proprioceptive acuity, range, laxity, and activity level among injured knees, contralateral knees, and healthy controls. Design Cohort study; Level of evidence, 2. Methods Proprioceptive acuity for active knee rotation movements, passive rotation range of motion, anterior knee laxity, and knee function were measured in 20 consecutive participants with unilateral ACL rupture and 20 matched controls. Reconstruction was performed using a single-incision technique with a 4-strand hamstring tendon autograft. Thirty participants (15 control and 15 ACL reconstructed) were retested at 3 months, and 14 with ACL reconstruction were tested at 6 months. Results A deficit was found in preoperative knee rotation proprioception compared with healthy controls (P =. 031). Three months after reconstruction, there was a significant improvement (P =. 049) in proprioceptive acuity, single-plane anterior laxity (P =. 01), and self-reported knee function (P =. 001). At 3 months after reconstruction, proprioceptive acuity of the ACLreconstructed knee was correlated with reported activity level (r =. 63; P =. 021). Conclusion Knee rotation proprioception is reduced in ACL-deficient participants compared with healthy controls. Three to 6 months after reconstruction, rotation proprioceptive acuity, laxity, and function were improved. While these findings are consistent with a return to previous activity level 6 months after reconstruction, the extent of graft maturation and restoration of kinematics should also inform the decision about return to sport.
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Noyes, Frank R., Sue D. Barber-Westin e Timothy E. Hewett. "High Tibial Osteotomy and Ligament Reconstruction for Varus Angulated Anterior Cruciate Ligament-Deficient Knees". American Journal of Sports Medicine 28, n. 3 (maggio 2000): 282–96. http://dx.doi.org/10.1177/03635465000280030201.
Abstract (sommario):
In a consecutive series, we treated 41 young patients who had anterior cruciate ligament deficiency, lower limb varus angulation, and varying amounts of posterolateral ligament deficiency. Seventy-three percent of the patients (N 30) had lost the medial meniscus and 63% (N 26) had marked articular cartilage damage in the medial compartment. All patients were treated with high tibial osteotomy and, in the majority (N 34), anterior cruciate ligament reconstruction a mean of 8 months later. Posterolateral reconstructions were also required in 18 knees. A 100% follow-up was obtained at a mean of 4.5 years after osteotomy. Gait analysis testing was done in 17 knees before and after osteotomy. At follow-up, a reduction in pain was found in 71% (29 knees); elimination of giving way, in 85% (35 knees); and resumption of light recreational activities without symptoms, in 66% (27 knees). The patient rating of the knee condition was normal or very good in 37% (15 knees) and good in 34% (14 knees). The mean Cincinnati Knee Rating Score significantly improved from 63 to 82 points. The mean adduction moment, 35% higher than controls preoperatively, significantly decreased to below normal values postoperatively. Correction of varus alignment was maintained in 33 knees (80%). We recommend osteotomy in addition to ligament reconstructive procedures in these knees with complex injury patterns.
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Brandsson, Sveinbjörn, Jon Karlsson, Leif Swärd, Jüri Kartus, Bengt I. Eriksson e Johan Kärrholm. "Kinematics and Laxity of the Knee Joint after Anterior Cruciate Ligament Reconstruction". American Journal of Sports Medicine 30, n. 3 (maggio 2002): 361–67. http://dx.doi.org/10.1177/03635465020300031001.
Abstract (sommario):
Background Injury of the anterior cruciate ligament changes the kinematics of the knee joint. In studies of cadaveric knees, investigators have examined the effect of anterior cruciate ligament reconstruction on knee kinematics, but the effect on dynamic knee motion is not known. Hypothesis Reconstruction of the anterior cruciate ligament restores knee kinematics to normal. Study Design Prospective cohort study. Methods Nine patients were examined preoperatively and 1 year after reconstruction. Continuous radiostereometric exposures were performed at a speed of two to four exposures per second while the patients ascended an 8-cm high platform. Tibial rotation and tibial and femoral translation were measured with radiostereometric analysis. Results Tibial rotation and tibial and femoral translation were not significantly different after anterior cruciate ligament reconstruction compared with preoperative measurements. A radiostereometric evaluation of anterior knee laxity revealed restoration to within 1 mm of that on the uninjured side. Further evaluation of knee function using the Lysholm score, the Tegner activity level score, the International Knee Documentation Committee evaluation system score, and measurements of laxity using the KT-1000 arthrometer revealed significant improvements after reconstruction. Conclusion Kinematics of the anterior cruciate ligament injured knee did not change significantly after ligament reconstruction, but the functional results were satisfactory and knee laxity was diminished.
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Bartolin, Petra Bonacic, Jobe Shatrov, Simon V. Ball, Sander R. Holthof, Andy Williams e Andrew A. Amis. "COMPARISON OF SIMPLIFIED MCL RECONSTRUCTIONS TO CONTROL VALGUS AND ANTEROMEDIAL ROTATORY INSTABILITY (AMRI): BIOMECHANICAL EVALUATION IN VITRO". Orthopaedic Proceedings 105-B, SUPP_13 (7 agosto 2023): 70. http://dx.doi.org/10.1302/1358-992x.2023.13.070.
Abstract (sommario):
AbstractIntroductionPrevious research has shown that, notwithstanding ligament healing, properly selected MCL reconstruction can restore normal knee stability after MCL rupture. The hypothesis of this work was that it is possible to restore knee stability (particularly valgus and AMRI) with simplified and/or less-invasive MCL reconstruction methods.MethodsNine unpaired human knees were cleaned of skin and fat, then digitization screws and optical trackers were attached to the femur and tibia. A Polaris stereo camera measured knee kinematics across 0o-100o flexion when the knee was unloaded then with 90N anterior-posterior force, 9Nm varus-valgus moment, 5Nm internal-external rotation, and external+anterior (AMRI) loading. The test was conducted for the following knee conditions: intact, injured: transected superficial and deep MCL (sMCL and dMCL), and five reconstructions: (long sMCL, long sMCL+dMCL, dMCL, short sMCL+dMCL, short sMCL), all based on the medial epicondyle isometric point and using 8mm tape as a graft, with long sMCL 60mm below the joint line (anatomical), short sMCL 30mm, dMCL 10mm (anatomical).ResultsNo significant changes were found in anterior or posterior translation, or varus at any stage. MCL deficiency caused increased valgus, external rotation and AMRI instabilities. All reconstructions restored valgus stability. The isolated long sMCL allowed residual external rotation and AMRI instability, while the short sMCL did stabilise AMRI. Both 2-strand reconstructions (dMCL+sMCL) restored stability.ConclusionAll tested techniques, except long sMCL, restored valgus and AMRI stability of the knee. The single femoral tunnel is satisfactory for both the dMCL and sMCL grafts.
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A. Yamani, Al-Muthana M., Naser F. Shari, Mohammad A. Abushahot, Ashraf F. Omor e Nizar A. A. Alannaz. "Knee stiffness post anterior cruciate ligament reconstruction- factors to worry about". International Journal of Research in Orthopaedics 9, n. 5 (28 agosto 2023): 913–17. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20232609.
Abstract (sommario):
Background: Knee stability is affected by integrity of anterior cruciate ligament (ACL). Knee stiffness is a worrying postoperative complication, preventing patients from returning back to pre-injury sport level. In this study, we analyzed incidence of knee stiffness post ACL reconstruction and possible associated risk factors. Methods: This is retrospective study, was held in Royal Medical Services/Jordan–Queen Alia Military hospital/Arthroscopic and Sport injuries division. We analyzed 250 patients’ data using computerized patients record system (CPRS) called Hakeem complaining of knee stiffness post ACL reconstruction between July 2022 and July 2023, whom ACL reconstructive surgeries were performed between March and September 2022. Results: Incidence of knee stiffness post ACL reconstruction is about 1.5% (4 out of 250). All of those 4 patients were males,3 of them had limited flexion (75%), while 1 of them had limited extension (25%). All of the 3 patients having extension contracture had an associated medial meniscus tear, repaired at time of ACL reconstruction, while flexion contracture patient had an isolated ACL tear. Conclusions: Incidence of knee stiffness post ACL reconstruction is about 1.5%. 75% of patients were associated with medial meniscus tear, who underwent meniscus repair and hinged knee brace was applied. We conclude that ACL patients having an associated meniscus tear managed by meniscus repair and hinge knee brace are at higher risk to develop knee stiffness. Therefore, we recommend limiting the usage of knee brace for ACL reconstruction with meniscus repair only.
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Charlton, William P. H., Donald A. Randolph, Stephen Lemos e Clarence L. Shields. "Clinical Outcome of Anterior Cruciate Ligament Reconstruction with Quadrupled Hamstring Tendon Graft and Bioabsorbable Interference Screw Fixation". American Journal of Sports Medicine 31, n. 4 (luglio 2003): 518–21. http://dx.doi.org/10.1177/03635465030310040701.
Abstract (sommario):
Background To date, there has been no publication of clinical follow-up data on patients who have undergone quadrupled hamstring tendon autograft anterior cruciate ligament reconstruction with bioabsorbable screw fixation. Purpose To report the results of quadrupled hamstring tendon autograft anterior cruciate ligament reconstruction with bioabsorbable interference screw fixation. Study Design Retrospective review. Methods Sixty-five patients (66 knees) were retrospectively identified by chart review as having undergone quadrupled hamstring tendon autograft anterior cruciate ligament reconstruction with bioabsorbable interference screw fixation with a minimum 2-year follow-up. Results Data were collected on 48 knees in 47 patients (73%) at an average 30.2 months (range, 24 to 43) after surgery. Thirty-six patients (37 knees) returned for clinical evaluation (56% return) and subjective follow-up only was obtained in 11 patients (17%). The mean Lysolm knee score was 91 (range, 45 to 98), with a mean of 97 for the uninvolved knee. The mean Tegner activity score was 5.7 (range, 3 to 7). The KT-1000 arthrometer mean side-to-side difference for manual maximum displacement was 2.03 mm (range, -1 to 8). The mean International Knee Documentation Committee knee score was 83 (range, 47 to 100). Patients who underwent associated partial meniscectomy or meniscal repair had significantly lower International Knee Documentation Committee scores than patients without associated procedures (P < 0.01). Conclusions Quadrupled hamstring tendon autograft anterior cruciate ligament reconstruction with bioabsorbable interference screw fixation is comparable with other methods of anterior cruciate ligament reconstruction in terms of patient satisfaction, knee stability, and function.
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van der Graaff, Sabine J. A., Duncan E. Meuffels, Sita M. A. Bierma-Zeinstra, Eline M. van Es, Jan A. N. Verhaar, Vincent Eggerding e Max Reijman. "Why, When, and in Which Patients Nonoperative Treatment of Anterior Cruciate Ligament Injury Fails: An Exploratory Analysis of the COMPARE Trial". American Journal of Sports Medicine 50, n. 3 (20 gennaio 2022): 645–51. http://dx.doi.org/10.1177/03635465211068532.
Abstract (sommario):
Background: The optimal treatment strategy for patients with an anterior cruciate ligament (ACL) rupture is still under debate. Different determinants of the need for a reconstruction have not been thoroughly investigated before. Purpose: To investigate why, when, and which patients with an ACL rupture who initially started with rehabilitation therapy required reconstructive surgery. Study Design: Case-control study; Level of evidence, 3. Methods: In the Conservative versus Operative Methods for Patients with ACL Rupture Evaluation (COMPARE) trial, 167 patients with an ACL rupture were randomized to early ACL reconstruction or rehabilitation therapy plus optional delayed ACL reconstruction. We conducted an exploratory analysis of a subgroup of 82 patients from this trial who were randomized to rehabilitation therapy plus optional delayed ACL reconstruction. The reasons for surgery were registered for the patients who underwent a delayed ACL reconstruction. For these patients, we used the International Knee Documentation Committee (IKDC) subjective knee form, Numeric Rating Scale for pain, and instability question from the Lysholm questionnaire before surgery. To determine between-group differences between the nonoperative treatment and delayed ACL reconstruction group, IKDC and pain scores during follow-up were determined using mixed models and adjusted for sex, age, and body mass index. Results: During the 2-year follow-up of the trial, 41 of the 82 patients received a delayed ACL reconstruction after a median time of 6.4 months after inclusion (interquartile range, 3.9-10.3 months). Most reconstructions occurred between 3 and 6 months after inclusion (n = 17; 41.5%). Ninety percent of the patients (n = 37) reported knee instability concerns as a reason for surgery at the moment of planning surgery. Of these patients, 18 had an IKDC score ≤60, 29 had a pain score of ≥3, and 33 patients had knee instability concerns according to the Lysholm questionnaire before surgery. During follow-up, IKDC scores were lower and pain scores were higher in the delayed reconstruction group compared with the nonoperative treatment group. Patients in the delayed reconstruction group had a significantly younger age (27.4 vs 35.3 years; P = .001) and higher preinjury activity level compared with patients in the nonoperative treatment group. Conclusion: Patients who experienced instability concerns, had pain during activity, and had a low perception of their knee function had unsuccessful nonoperative treatment. Most patients received a delayed ACL reconstruction after 3 to 6 months of rehabilitation therapy. At baseline, patients who required reconstructive surgery had a younger age and higher preinjury activity level compared with patients who did not undergo reconstruction.
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Moatshe, Gilbert, Jorge Chahla, Alex W. Brady, Grant J. Dornan, Kyle J. Muckenhirn, Bradley M. Kruckeberg, Mark E. Cinque, Travis Lee Turnbull, Lars Engebretsen e Robert F. LaPrade. "The Influence of Graft Tensioning Sequence on Tibiofemoral Orientation During Bicruciate and Posterolateral Corner Knee Ligament Reconstruction: A Biomechanical Study". American Journal of Sports Medicine 46, n. 8 (28 giugno 2018): 1863–69. http://dx.doi.org/10.1177/0363546517751917.
Abstract (sommario):
Background: During multiple knee ligament reconstructions, the graft tensioning order may influence the final tibiofemoral orientation and corresponding knee kinematics. Nonanatomic tibiofemoral orientation may result in residual knee instability, altered joint loading, and an increased propensity for graft failure. Purpose: To biomechanically evaluate the effect of different graft tensioning sequences on knee tibiofemoral orientation after multiple knee ligament reconstructions in a bicruciate ligament (anterior cruciate ligament [ACL] and posterior cruciate ligament [PCL]) with a posterolateral corner (PLC)–injured knee. Study Design: Controlled laboratory study. Methods: Ten nonpaired, fresh-frozen human cadaveric knees were utilized for this study. After reconstruction of both cruciate ligaments and the PLC and proximal graft fixation, each knee was randomly assigned to each of 4 graft tensioning order groups: (1) PCL → ACL → PLC, (2) PCL → PLC → ACL, (3) PLC → ACL → PCL, and (4) ACL → PCL → PLC. Tibiofemoral orientation after graft tensioning was measured and compared with the intact state. Results: Tensioning the ACL first (tensioning order 4) resulted in posterior displacement of the tibia at 0° by 1.7 ± 1.3 mm compared with the intact state ( P = .002). All tensioning orders resulted in significantly increased tibial anterior translation compared with the intact state at higher flexion angles ranging from 2.7 mm to 3.2 mm at 60° and from 3.1 mm to 3.4 mm at 90° for tensioning orders 1 and 2, respectively (all P < .001). There was no significant difference in tibiofemoral orientation in the sagittal plane between the tensioning orders at higher flexion angles. All tensioning orders resulted in increased tibial internal rotation (all P < .001). Tensioning and fixing the PLC first (tensioning order 3) resulted in the most increases in internal rotation of the tibia: 2.4° ± 1.9°, 2.7° ± 1.8°, and 2.0° ± 2.0° at 0°, 30°, and 60°, respectively. Conclusion: None of the tensioning orders restored intact knee tibiofemoral orientation. Tensioning the PLC first should be avoided in bicruciate knee ligament reconstruction with concurrent PLC reconstruction because it significantly increased tibial internal rotation. We recommend that the PCL be tensioned first, followed by the ACL, to avoid posterior translation of the tibia in extension where the knee is primarily loaded during most activities. The PLC should be tensioned last. Clinical Relevance: This study will help guide surgeons in decision making for the graft tensioning order during multiple knee ligament reconstructions.
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Andrish, J. T., M. L. Olmstead, Helen Kambic, A. Shah e M. P. Palmisano. "A Comparative Study of the Length Patterns of Anterior Cruciate Ligament Reconstructions in the Dog and Man". Veterinary and Comparative Orthopaedics and Traumatology 13, n. 02 (2000): 73–77. http://dx.doi.org/10.1055/s-0038-1632634.
Abstract (sommario):
SummaryTo measure the change of length patterns of nine different simulated anterior cruciate ligament (ACL) reconstructions in the canine and human knee.Six fresh-frozen canine cadaver knees and six fresh-frozen human cadaver knees were used in this study. All of the soft tissues were removed from each cadaver knee, leaving the menisci, collateral ligaments and cruciate ligaments intact. After fixation of the femur to a custom-made frame, the ACL was excised. Three tunnels were made each at the ACL origin and insertion, making possible nine reconstruction combinations. A modified intra-articular technique was used to measure change of length, in mm, of each ACL reconstruction through a range of motion of 0 degrees (full extension) to 135 degrees of flexion. A rankorder list of reconstruction combinations was determined. The most isometric combination was determined for the canine and human knees, and trends in length patterns were also evaluated in both species relative to femoral and tibial position. Statistical significance was determined by ANOVA.A combination joining a point caudal to the ACL origin (over-the-top) and anterior on the tibial insertion was found to be the most isometric combination in both the canine and human. The trends in change of length patterns across all reconstruction combinations were similar in the dog and man. Isometry was improved as the reconstruction was placed further posterior on the femur and anterior on the tibia. Conclusions: The canine knee is an appropriate animal model for the study of isometry of the human ACL and its reconstructions.The length patterns of nine simulated Anterior Cruciate Ligament (ACL) reconstructions were determined in the dog and man. In both species, the most isometric reconstruction was one joining points corresponding to a position at the posterior edge of the intercondylar roof of the femur (over-thetop) with a position anterior on the ACL insertion. For the sake of clarity the term anterior cruciate ligament has been used, throughout, for both species, instead of the cranial cruciate ligament (CCL) in the dog. Also knee has been used in place of stifle for the dog.
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Gill, Thomas J., Louis E. DeFrate, Conrad Wang, Christopher T. Carey, Shay Zayontz, Bertram Zarins e Li Guoan. "The Biomechanical Effect of Posterior Cruciate Ligament Reconstruction on Knee Joint Function". American Journal of Sports Medicine 31, n. 4 (luglio 2003): 530–36. http://dx.doi.org/10.1177/03635465030310040901.
Abstract (sommario):
Background The effectiveness of posterior cruciate ligament reconstruction in restoring normal kinematics under physiologic loading is unknown. Hypothesis Posterior cruciate ligament reconstruction does not restore normal knee kinematics under muscle loading. Study Design In vitro biomechanical study. Methods Kinematics of knees with an intact, resected, and reconstructed posterior cruciate ligament were measured by a robotic testing system under simulated muscle loads. Anteroposterior tibial translation and internal-external tibial rotation were measured at 0°, 30°, 60°, 90°, and 120° of flexion under posterior drawer loading, quadriceps muscle loading, and combined quadriceps and hamstring muscle loading. Results Reconstruction reduced the additional posterior tibial translation caused by ligament deficiency at all flexion angles tested under posterior drawer loading. Ligament deficiency increased external rotation and posterior translation at angles higher than 60° of flexion when simulated muscle loading was applied. Posterior cruciate ligament reconstruction reduced the posterior translation and external rotation observed in posterior cruciate ligament-deficient knees at higher flexion angles, but differences were not significant. Conclusion Under physiologic loading conditions, posterior cruciate ligament reconstruction does not restore six degree of freedom knee kinematics. Clinical Relevance Abnormal knee kinematics may lead to development of long-term knee arthrosis.
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McAllister, David R., Keith L. Markolf, Daniel A. Oakes, Charles R. Young e Justin McWilliams. "A Biomechanical Comparison of Tibial Inlay and Tibial Tunnel Posterior Cruciate Ligament Reconstruction Techniques". American Journal of Sports Medicine 30, n. 3 (maggio 2002): 312–17. http://dx.doi.org/10.1177/03635465020300030201.
Abstract (sommario):
Background Most posterior cruciate ligament reconstruction techniques use a tibial bone tunnel, which results in an acute bend in the graft as it passes over the posterior portion of the tibial plateau. Hypothesis The tibial inlay technique will result in lower graft pretensions, less laxity, and less stretch-out after cyclic loading. Study Design Controlled laboratory study. Methods Graft pretensions necessary to restore normal laxity at 90° of knee flexion (laxity match pretension) and anteroposterior laxities at five knee flexion angles were recorded in 12 fresh-frozen knee specimens with bone-patellar tendon-bone posterior cruciate ligament graft reconstructions using both techniques and two femoral tunnel positions. Results When the graft was placed in a central femoral tunnel, the tibial tunnel reconstruction required an average 15.6 N greater laxity match pretension than the tibial inlay reconstruction. There were no significant differences in mean knee laxities between the tibial tunnel and tibial inlay techniques at any knee flexion angle; both reconstruction techniques restored mean knee laxity to within 1.6 mm of intact knee values over the entire flexion range. Conclusions There was no important advantage of one technique over the other with respect to the biomechanical parameters measured.
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Yoo, Jae Doo, Ramprasad Papannagari, Sang Eun Park, Louis E. DeFrate, Thomas J. Gill e Guoan Li. "The Effect of Anterior Cruciate Ligament Reconstruction on Knee Joint Kinematics under Simulated Muscle Loads". American Journal of Sports Medicine 33, n. 2 (febbraio 2005): 240–46. http://dx.doi.org/10.1177/0363546504267806.
Abstract (sommario):
Background Numerous studies have investigated anterior stability of the knee during the anterior drawer test after anterior cruciate ligament reconstruction. Few studies have evaluated anterior cruciate ligament reconstruction under physiological loads. Purpose To determine whether anterior cruciate ligament reconstruction reproduced knee motion under simulated muscle loads. Study Design Controlled laboratory study. Methods Eight human cadaveric knees were tested with the anterior cruciate ligament intact, transected, and reconstructed (using a bone–patellar tendon–bone graft) on a robotic testing system. Tibial translation and rotation were measured at 0 °, 15 °, 30 °, 60 °, and 90 ° of flexion under anterior drawer loading (130 N), quadriceps muscle loading (400 N), and combined quadriceps and hamstring muscle loading (400 N and 200 N, respectively). Repeated-measures analysis of variance and the Student-Newman-Keuls test were used to detect statistically significant differences between knee states. Results Anterior cruciate ligament reconstruction resulted in a clinically satisfactory anterior tibial translation. The anterior tibial translation of the reconstructed knee was 1.93 mm larger than the intact knee at 30 ° of flexion under anterior load. Anterior cruciate ligament reconstruction overconstrained tibial rotation, causing significantly less internal tibial rotation in the reconstructed knee at low flexion angles (0 °-30 °) under muscle loads (P<. 05). At 30 ° of flexion, under muscle loads, the tibia of the reconstructed knee was 1.9 ° externally rotated compared to the intact knee. Conclusions Anterior cruciate ligament reconstruction may not restore the rotational kinematics of the intact knee under muscle loads, even though anterior tibial translation was restored to a clinically satisfactory level under anterior drawer loads. These data suggest that reproducing anterior stability under anterior tibial loads may not ensure that knee joint kinematics is restored under physiological loading conditions. Clinical Relevance Decreased internal rotation of the knee after anterior cruciate ligament reconstruction may lead to increased patellofemoral joint contact pressures. Future anterior cruciate ligament reconstruction techniques should aim at restoring 3-dimensional knee kinematics under physiological loads.
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Argintar, Evan. "Multiligamentous Knee Reconstruction". Orthopedics 36, n. 7 (1 luglio 2013): 527–28. http://dx.doi.org/10.3928/01477447-20130624-06.
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Calder, David. "Advanced reconstruction: knee". Orthopaedics and Trauma 25, n. 5 (ottobre 2011): 395. http://dx.doi.org/10.1016/j.mporth.2011.07.008.
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Djian, P. "Posterolateral knee reconstruction". Orthopaedics & Traumatology: Surgery & Research 101, n. 1 (febbraio 2015): S159—S170. http://dx.doi.org/10.1016/j.otsr.2014.07.032.
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Hien, Pham The. "Stiff Knee After Ligament Reconstruction". Orthopaedic Journal of Sports Medicine 8, n. 5_suppl5 (1 maggio 2020): 2325967120S0011. http://dx.doi.org/10.1177/2325967120s00111.
Abstract (sommario):
Stiff knee is a difficult complication after surgery and ligament injury. There are many reasons which cause stiff knees and we should undestand them for the best treatment and prevention. Here we present cases of stiff knees after multiligament injury. They were indicated operations by ligament reconstruction or avulsion reattachment. After that, the stiff knees recurred although the patients also had 5 - 6 months of rehabilitation. Via arthroscopy, we found a scar tissue in the suprapatellar compartment, a fiber around the patella, an adhension femur - tibia at the notch, a scar tissue at the notch, and a cyclops lesion. We used the shaver and cautery to cut the fibrous tissue and release the patella and ligaments at the notch. Then, manipulation under anesthesia (MUA) was indicated. After all, the patients had the combined spinal and epidural anaesthesia (CSE) for 5 days. It is a better way to reduce pain and let the patients exercise earlier.
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Smith, Matthew V., Jeffrey J. Nepple, Rick W. Wright, Matthew J. Matava e Robert H. Brophy. "Knee Osteoarthritis Is Associated With Previous Meniscus and Anterior Cruciate Ligament Surgery Among Elite College American Football Athletes". Sports Health: A Multidisciplinary Approach 9, n. 3 (1 dicembre 2016): 247–51. http://dx.doi.org/10.1177/1941738116683146.
Abstract (sommario):
Background: Football puts athletes at risk for knee injuries such meniscus and anterior cruciate ligament (ACL) tears, which are associated with the development of osteoarthritis (OA). Previous knee surgery, player position, and body mass index (BMI) may be associated with knee OA. Hypothesis: In elite football players undergoing knee magnetic resonance imaging at the National Football League’s Invitational Combine, the prevalence of knee OA is associated with previous knee surgery and BMI. Study Design: Retrospective cohort. Level of Evidence: Level 4. Methods: A retrospective review was performed of all participants of the National Football League Combine from 2005 to 2009 who underwent magnetic resonance imaging of the knee because of prior knee injury, surgery, or knee-related symptoms or concerning examination findings. Imaging studies were reviewed for evidence of OA. History of previous knee surgery—including ACL reconstruction, meniscal procedures, and articular cartilage surgery—and position were recorded for each athlete. BMI was calculated based on height and weight. Results: There was a higher prevalence of OA in knees with a history of previous knee surgery (23% vs 4.0%, P < 0.001). The prevalence of knee OA was 4.0% in those without previous knee surgery, 11% in those with a history of meniscus repair, 24% of those with a history of ACL reconstruction, and 27% of those with a history of partial meniscectomy. Among knees with a previous ACL reconstruction, the rate of OA doubled in tibiofemoral compartments in which meniscal surgery was performed. BMI >30 kg/m2 was also associated with a higher risk of OA ( P = 0.007) but player position was not associated with knee OA. Conclusions: Previous knee surgery, particularly ACL reconstruction and partial meniscectomy, and elevated BMI are associated with knee OA in elite football players. Future research should investigate ways to minimize the risk of OA after knee surgery in these athletes. Clinical Relevance: Treatment of knee injuries in football athletes should consider chondroprotection, including meniscal preservation and cartilage repair, when possible.
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Andriacchi, T. P. "Functional Analysis of Pre and Post-Knee Surgery: Total Knee Arthroplasty and ACL Reconstruction". Journal of Biomechanical Engineering 115, n. 4B (1 novembre 1993): 575–81. http://dx.doi.org/10.1115/1.2895543.
Abstract (sommario):
This paper examines the biomechanics of total knee arthroplasty as a treatment for arthritis and anterior cruciate ligament (ACL) reconstruction for repair of torn anterior cruciate ligaments of the knee. These are two of the most frequent reconstructive procedures for the knee joint. Functional testing of patients while performing various activities of daily living was used to study the relationship between the intrinsic biomechanics of the knee and function. The results of the study of patients following total knee replacement demonstrated a dynamic interaction between the posterior cruciate ligament and quadriceps function during stairclimbing. The study of patients with ACL-deficient knees demonstrated that loss of the anterior cruciate ligament can cause the avoidance of quadriceps contraction during activities when the knee is near full extension. Other studies demonstrated a relationship between tibiofemoral joint mechanics and patellofemoral mechanics. In addition, the importance of combined ligamentous laxity with higher than normal adduction moments during gait was examined in relationship to progressive degenerative changes to the medial compartment of the knee. In summary, functional testing such as gait analysis has proven to be an important basic research tool as well as extremely effective for clinical testing of new procedures and devices.
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Noyes, Frank R., e Sue D. Barber-Westin. "Posterior Cruciate Ligament Revision Reconstruction, Part 2". American Journal of Sports Medicine 33, n. 5 (maggio 2005): 655–65. http://dx.doi.org/10.1177/0363546504270456.
Abstract (sommario):
Background Posterior cruciate ligament reconstructions fail for similar reasons as to why anterior cruciate ligament reconstructions fail. Revision surgery is an option after failure. Purpose To prospectively study the results of 15 posterior cruciate ligament revision surgeries using a 2-strand quadriceps tendonpatellar bone autograft. Study Design Case series; Level of evidence, 4. Methods The authors observed 15 knees that received the revision procedure a mean of 44 months (range, 23-84 months) postoperatively. The results were determined by a comprehensive knee examination including stress radiography and several grading scales. A tibial inlay technique was used in 9 knees, and an arthroscopic tibial tunnel technique was done in 6 knees. Six knees required 1 or more concomitant ligament reconstructions. Results Significant improvements occurred in pain, function, and patient perception scores (P <. 05). However, only 53% returned to light sports without problems. Stress radiograph posterior tibial translation values improved from 11.7 ± 3.0 mm preoperatively to 5.1 ± 2.4 mm at follow-up (P <. 001). Two of the 15 revisions failed. Associated knee ligament reconstructive procedures restored anterior, medial, and posterolateral stability. There were no complications from the quadriceps tendon graft harvest site. Abnormal articular cartilage surfaces were found during the revision in 8 (53%) knees. Conclusions The quadriceps tendon 2-strand revision provided reasonable results in this group of complex-injured knees. The tibial inlay approach is advantageous to bypass prior tibial tunnels, and the all-inside arthroscopic technique is advantageous when major concurrent ligament reconstructions are required.
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Mohammed, Riazuddin, Neil Hunt e AJ Gibbon. "Patellar complications in single versus double tunnel medial patellofemoral ligament reconstruction". Journal of Orthopaedic Surgery 25, n. 1 (1 gennaio 2017): 230949901769100. http://dx.doi.org/10.1177/2309499017691007.
Abstract (sommario):
Purpose: Hamstring graft fixation on the patellar side during medial patellofemoral ligament (MPFL) reconstruction is usually with transosseous tunnels and can frequently lead to further problems. The aim of our study was to compare and analyse patellar complications in single patellar tunnel versus double tunnel hamstring graft fixation. Methods: Twenty-nine knees with MPFL reconstructions (group S) in which the hamstring tendon graft was transfixed using a suspensory fixation method in a single tunnel drilled across the patella were analysed in comparison with 29 knees (group D) with interference fixation of the graft through two tunnels drilled up to a predetermined depth in the patella. Primary outcome measured was any patellar complication like anterior knee pain and patella fracture. Secondary outcomes assessed were future functional instability and failure of reconstruction. Results: Anterior knee pain was noted in six patients in group S, of which three patients had removal of the irritating metalwork on the patella. In all, nine surgical interventions were needed in six patients in this group. Three patients in group D complained of knee pain, but no one in this group needed any further surgical interventions ( p value 0.02). Symptomatic instability requiring revision surgery or realignment surgery was required in two patients in the group S and none in group D. No patellar fractures were seen in either group. Conclusion: Our study showed increasing problems with single tunnel patellar fixation, with more reoperation and failure rates compared to double tunnel fixation. The evidence supports the move towards anatomical double bundle MPFL reconstructions.
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Gadikota, Hemanth R., Jong Keun Seon, Michal Kozanek, Luke S. Oh, Thomas J. Gill, Kenneth D. Montgomery e Guoan Li. "Biomechanical Comparison of Single-Tunnel—Double-Bundle and Single-Bundle Anterior Cruciate Ligament Reconstructions". American Journal of Sports Medicine 37, n. 5 (4 marzo 2009): 962–69. http://dx.doi.org/10.1177/0363546508330145.
Abstract (sommario):
Background Anatomic double-bundle reconstruction has been thought to better simulate the anterior cruciate ligament anatomy. It is, however, a technically challenging procedure, associated with longer operation time and higher cost. Hypothesis Double-bundle anterior cruciate ligament reconstruction using a single femoral and tibial tunnel can closely reproduce intact knee kinematics. Study Design Controlled laboratory study. Methods Eight fresh-frozen human cadaveric knee specimens were tested using a robotic testing system to investigate the kinematic response of the knee joint under an anterior tibial load (130 N), simulated quadriceps load (400 N), and combined torques (5 N·m valgus and 5 N·m internal tibial torques) at 0°, 15°, 30°, 60°, and 90° of flexion. Each knee was tested sequentially under 4 conditions: (1) anterior cruciate ligament intact, (2) anterior cruciate ligament deficient, (3) single-bundle anterior cruciate ligament reconstruction using quadrupled hamstring tendon, and (4) single-tunnel—double-bundle anterior cruciate ligament reconstruction using the same tunnels and quadrupled hamstring tendon graft as in the single-bundle anterior cruciate ligament reconstruction. Results Single-tunnel—double-bundle anterior cruciate ligament reconstruction more closely restored the intact knee kinematics than single-bundle anterior cruciate ligament reconstruction at low flexion angles (≤30°) under the anterior tibial load and simulated muscle load (P < .05). However, single-tunnel—double-bundle anterior cruciate ligament reconstruction overconstrained the knee joint at high flexion angles (≥60°) under the anterior tibial load and at 0° and 30° of flexion under combined torques. Conclusion This double-bundle anterior cruciate ligament reconstruction using a single tunnel can better restore anterior tibial translations to the intact level compared with single-bundle anterior cruciate ligament reconstruction at low flexion angles, but it overconstrained the knee joint at high flexion angles. Clinical Relevance This technique could be an alternative for both single-bundle and double-tunnel—double-bundle anterior cruciate ligament reconstructions to reproduce intact knee kinematics and native anterior cruciate ligament anatomy.
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Webster, Kate E., Joanne E. Wittwer, Jason O'Brien e Julian A. Feller. "Gait Patterns after Anterior Cruciate Ligament Reconstruction are Related to Graft Type". American Journal of Sports Medicine 33, n. 2 (febbraio 2005): 247–54. http://dx.doi.org/10.1177/0363546504266483.
Abstract (sommario):
Background Although there is a tendency toward gait normalization after anterior cruciate ligament reconstruction, altered moments about the knee flexion-extension axis have been reported. It is possible that these gait alterations relate to donor site morbidity associated with the graft harvest. Hypothesis There is a relationship between graft type and external knee moments during walking. Study Design Controlled laboratory study. Methods Three groups were compared: 17 patellar tendon anterior cruciate ligament reconstruction patients (mean, 11 months after surgery), 17 hamstring tendon anterior cruciate ligament reconstruction patients (mean, 9.3 months after surgery), and 17 matched controls. A 3-dimensional motion analysis and force plate system was used to determine sagittal plane kinematics and kinetics of the lower limb during comfortable-speed walking. Results There were significant differences in the moments about the knee that related to graft type. The external knee flexion moment at midstance was significantly smaller than that in the control knees in 65% of patients in the patellar tendon group and 29% of patients in the hamstring tendon group. In contrast, the external knee extension moment at terminal stance was significantly smaller than that in the control knees in 53% of subjects in the hamstring tendon group and 23% of subjects in the patellar tendon group. Conclusions There are graft-specific differences in knee biomechanics after anterior cruciate ligament reconstruction that appear to relate to the donor site. Clinical Relevance Considerable debate continues as to whether the patellar tendon or the hamstring tendon graft is preferable for anterior cruciate ligament reconstruction. It is therefore clinically relevant to understand the biomechanical differences in knee function associated with both graft types.
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Rahardja, R., H. Love, M. G. Clatworthy e S. W. Young. "PATELLAR TENDON AUTOGRAFT IS ASSOCIATED WITH DIFFICULTY KNEELING BUT DOES NOT RESULT IN A MORE PAINFUL OR SYMPTOMATIC KNEE COMPARED WITH HAMSTRING TENDON AUTOGRAFT AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION". Orthopaedic Proceedings 105-B, SUPP_3 (febbraio 2023): 61. http://dx.doi.org/10.1302/1358-992x.2023.3.061.
Abstract (sommario):
The bone-patellar tendon-bone (BTB) autograft is associated with difficulty kneeling following anterior cruciate ligament (ACL) reconstruction, however it is unclear whether it results in a more painful or symptomatic knee when compared to the hamstring tendon autograft. This study aimed to identify the rate of significant knee pain and difficulty kneeling following primary ACL reconstruction and clarify whether graft type influences the risk of these complications.Primary ACL reconstructions prospectively recorded in the New Zealand ACL Registry between April 2014 and November 2019 were analyzed. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was analyzed to identify patients who reported significant knee pain, defined as a KOOS Pain subscale score of ≤72 points, and kneeling difficulty, defined as a patient who reported “severe” or “extreme” difficulty when they kneel. The rate of knee pain and kneeling difficulty was compared between graft types via univariate Chi-square test and multivariate binary logistic regression with adjustment for patient demographics.4492 primary ACL reconstructions were analyzed. At 2-year follow-up, 9.3% of patients reported significant knee pain (420/4492) and 12.0% reported difficulty with kneeling (537/4492). Patients with a BTB autograft reported a higher rate of kneeling difficulty compared to patients with a hamstring tendon autograft (21.3% versus 9.4%, adjusted odds ratio = 3.12, p<0.001). There was no difference between graft types in the rate of significant knee pain (9.9% versus 9.2%, p = 0.49) or when comparing absolute values of the KOOS Pain (mean score for BTB = 88.7 versus 89.0, p = 0.37) and KOOS Symptoms subscales (mean score for BTB = 82.5 versus 82.1, p = 0.49).The BTB autograft is a risk factor for post-operative kneeling difficulty, but it does not result in a more painful or symptomatic knee when compared to the hamstring tendon autograft.
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JIAO, Chen, Ying-fang AO, Ping LIU, Xing XIE, Chen LIU e Yong MA. "Anterior cruciate ligament reconstruction using the bone-posterior cruciate ligament-bone allograft". Chinese Medical Journal 126, n. 4 (20 febbraio 2013): 674–78. http://dx.doi.org/10.3760/cma.j.issn.0366-6999.20111738.
Abstract (sommario):
Background Allografts were widely used in anterior cruciate ligament (ACL) reconstruction for patients with ACL rupture of the knee. This study was to approve the feasibility of bone-posterior cruciate ligament-bone (BPCLB) allograft transplantation in ACL reconstruction. Methods Eight patients underwent ACL reconstructions with BPCLB allografts and were followed up for an average period of 32 months after operation. Results Subjective parameters including International Knee Documentation Committee (IKDC), modified Larson knee ligament, Lysholm, and Tegner rating scales were much improved and side to side KT-2000 arthrometer difference was much less postoperatively. Pivot shift test was negative in all patients. The reconstructed ACL had satisfactory shape and tension. Conclusions BPCLB allograft is an optional choice for ACL reconstruction.
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Harris, Kyle, Jeffrey Bradford Driban, Michael R. Sitler, Nicole M. Cattano e Jennifer M. Hootman. "Five-Year Clinical Outcomes of a Randomized Trial of Anterior Cruciate Ligament Treatment Strategies: An Evidence-Based Practice Paper". Journal of Athletic Training 50, n. 1 (1 gennaio 2015): 110–12. http://dx.doi.org/10.4085/1062-6050-49.3.53.
Abstract (sommario):
Reference/Citation: Frobell RB, Roos HP, Roos EM, Roemer FW, Ranstam J, Lohmander LS. Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ. 2013;346:F232. Clinical Question: Does early anterior cruciate ligament (ACL) reconstruction with rehabilitation lead to better patient-reported outcomes and a lower incidence of osteoarthritis at 5 years postinjury compared with delayed ACL reconstruction with rehabilitation? Study Selection: This randomized controlled trial with extended follow-up at 5 years postrandomization was conducted in 2 Swedish orthopaedic departments. Data Extraction: The authors studied a total of 121 moderately active adults (age = 18–35 years) with an acute ACL rupture in a knee with no other history of trauma. Excluded were patients with a collateral ligament rupture, full-thickness cartilage defect, or extensive meniscal fixation. One patient assigned to the early ACL-reconstruction group did not attend the 5-year follow-up visit. Patients were randomly assigned to (1) an early ACL reconstruction plus structured rehabilitation group (n = 62, surgery within 10 weeks of injury) or (2) optional-delayed ACL reconstruction plus structured rehabilitation group (n = 59). The primary outcome measure was change in the average of 4 out of 5 subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS). The authors also assessed crude KOOS (combined 4 subscales), KOOS subscale scores, general physical and mental health (Short-Form 36), activity level (Tegner Activity Scale), mechanical knee stability (Lachman and pivot shift tests), meniscal surgery status, and presence of knee osteoarthritis on radiographs. Main Results: Among patients randomized to the optional-delayed ACL-reconstruction group, 30 (51%) opted for an ACL reconstruction. The treatment groups had comparable 5-year patient-reported outcomes and changes in patient-reported outcomes (eg, knee pain, knee symptoms, activities of daily living, sport and recreational levels, knee-related quality of life, general physical health, and general mental health). Patients in the optional-delayed ACL-reconstruction group had greater mechanical knee instability than patients who received early ACL reconstruction; however, this was primarily among the patients opting for conservative management alone. In the overall sample, 61 knees (51%) required meniscal surgery over 5 years, regardless of treatment group. At 5 years, radiographs were available for 113 patients (93%). Overall, 29 patients (26%) had knee osteoarthritis at 5 years. Specifically, 13 patients (12%) developed tibiofemoral radiographic osteoarthritis (9 patients [16%] in the early ACL-reconstruction group, 4 [7%] in the optional-delayed ACL-reconstruction group) and 22 (19%) developed patellofemoral osteoarthritis (14 patients [24%] in the early ACL-reconstruction group, 8 [15%] in the optional-delayed ACL-reconstruction group). Patients with patellar tendon grafts (n = 40) had a greater incidence of ipsilateral patellofemoral osteoarthritis than patients with hamstrings tendon grafts (n = 51), but the 2 groups had similar incidences of ipsilateral tibiofemoral osteoarthritis. Six knees (5%) had both tibiofemoral and patellofemoral osteoarthritis. Conclusions: Early ACL reconstruction plus rehabilitation did not provide better results at 5 years compared with optional-delayed ACL reconstruction plus rehabilitation. Furthermore, the authors found no radiographic differences among patients with early ACL reconstruction, delayed ACL reconstruction, or no ACL reconstruction (rehabilitation alone).
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Angoules, A. G., K. Balakatounis, E. C. Boutsikari, D. Mastrokalos e P. J. Papagelopoulos. "Anterior-Posterior Instability of the Knee Following ACL Reconstruction with Bone-Patellar Tendon-Bone Ligament in Comparison with Four-Strand Hamstrings Autograft". Rehabilitation Research and Practice 2013 (2013): 1–6. http://dx.doi.org/10.1155/2013/572083.
Abstract (sommario):
Purpose. To evaluate anterior-posterior knee laxity using two different autografts.Material-Methods. 40 patients, (34 males and 6 women), 17–54 years old (mean: 31), were included in the present study. Group A (4SHS = 20) underwent reconstruction using four-strand hamstrings, and group B (BPBT = 20) underwent reconstruction using bone-patellar tendon-bone autograft. Using the KT-1000 arthrometer, knee instability was calculated in both knees of all patients preoperatively and 3, 6, and 12 months after surgery at the ACL-operated knee. The contralateral healthy knee was used as an internal control group.Results. Anterior-posterior instability using the KT1000 Arthrometer was found to be increased after ACL insufficiency. The recorded laxity improved after arthroscopic ACL reconstruction in both groups. However, statistically significant greater values were detected in the bone-patellar tendon-bone group, which revealed reduction of anteroposterior stability values to an extent, where no statistical significance with the normal values even after 3 months after surgery was observed.Conclusions. Anterior-Posterior instability of the knee improved significantly after arthroscopic ACL reconstruction. The bone-patellar tendon-bone graft provided an obvious greater stability.