Teses / dissertações sobre o tema "Knee Reconstruction"
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1
Paton, Bruce Murray. "Knee swelling and anterior cruciate ligament reconstruction". Thesis, King's College London (University of London), 2017. https://kclpure.kcl.ac.uk/portal/en/theses/knee-swelling-and-anterior-cruciate-ligament-reconstruction(1dbd0b68-0e8b-42a9-bc5a-c6bf2cf22edd).html.
Resumo:
Swelling is universal after Anterior Cruciate Ligament Reconstruction (ACLR). Cooling compressive devices aim to treat swelling after surgery, but research has focussed more on pain than swelling. The aims of this work were to measure knee swelling in ACLR with a perometer (an optoelectric volumeter) and to evaluate an intervention for knee swelling in ACLR which uses a cold compressive device. The main outcome for the studies was knee volume measured using the perometer. Reliability was established and a randomised controlled trial was undertaken The study aimed to compare the use of Cryocuff, and elevation, with standard treatment used post ACLR (compression bandage alone). Secondary outcomes were also measured to assess the correlates of knee swelling in ACLR. The patients were randomised into a standard treatment group or into a Cryocuff and elevation group. Knee volume in both knees was measured pre-operatively and at two weeks post-operatively using the perometer. Secondary variables measured included: - range of movement, pain, knee laxity and function, medication use, tourniquet and discharge times, and operative factors. There was with no significant difference between the groups (p=0.977). This study did not find Cryocuff and elevation to be more effective for minimising swelling at 2 weeks post-operatively, than a compression bandage alone. The perometer was reliable with Intra class correlation coefficient of 0.996. Significant correlates of swelling post-ACLR were: blood pressure; knee joint laxity and extension loss, with daily elevation time and Intravenous fluid given intra operatively close to significance. Further investigation outlined the level and profile of compression applied to the knee by the Cryocuff found that this device may have inherent features that could be provocative of swelling.
2
Wasielewski, Noah Jon. "Predictors of functional outcome following anterior cruciate ligament reconstruction /". view abstract or download file of text, 2002. http://wwwlib.umi.com/cr/uoregon/fullcit?p3061971.
Resumo:
Thesis (Ph. D.)--University of Oregon, 2002.Typescript. Includes vita and abstract. Includes bibliographical references (leaves 212-238). Also available for download via the World Wide Web; free to University of Oregon users.
3
Nesbitt, Rebecca J. "Establishing Design Criteria for Anterior Cruciate Ligament Reconstruction". University of Cincinnati / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1428048607.
4
Jayashekar, Sundareswar. "Three dimensional image reconstruction of skeletal tissue from computed tomography". Morgantown, W. Va. : [West Virginia University Libraries], 2000. http://etd.wvu.edu/templates/showETD.cfm?recnum=1745.
Resumo:
Thesis (M.S.)--West Virginia University, 2000.Title from document title page. Document formatted into pages; contains vii, 57 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 50-51).
5
An, Vincent Vinh Gia. "Predictive models in knee surgery". Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/20063.
Resumo:
Reconstructive knee surgery is the definitive option for patients with knee pathology which causes irreconcilable functional deficit, or which is otherwise unacceptable without direct intervention. There are many factors which affect patient outcomes post-operatively, whether they are patient-specific factors, or intraoperative decision making. This thesis aimed to frame and generate predictive models which could guide clinical and intraoperative decision making with regards to two reconstructive procedures in knee surgery: total knee arthroplasty (TKA) and anterior cruciate ligament reconstruction (ACLR).
6
Stanley, Christopher J. Yu Bing. "Effects of knee extension constraint on knee flexion angle and ground reaction forces after ACL reconstruction". Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2006. http://dc.lib.unc.edu/u?/etd,532.
Resumo:
Thesis (M.S.)--University of North Carolina at Chapel Hill, 2006.Title from electronic title page (viewed Oct. 10, 2007). "... in partial fulfillment of the requirements for the degree of Master of Science in the Department of Human Movement Science." Discipline: Human Movement Science; Department/School: Medicine.
7
Sambatakakis, A. "Biomechanics of imbalance in the reconstruction of the arthritic knee". Thesis, University of Strathclyde, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.312145.
8
Beard, David John. "Hamstring contraction latency following anterior cruciate ligament rupture, reconstruction and rehabilitation". Thesis, University of Oxford, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.308448.
9
Smale, Kenneth. "Relating Subjective and Objective Knee Function After Anterior Cruciate Ligament Injury Through Biomechanical and Neuromusculoskeletal Modelling Approaches". Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/37947.
Resumo:
Background: Knee injuries have a considerable impact on both the person’s psychological and physical health. We currently have tools to address each of these aspects but they are often considered independent of each other. Little work has been done to consolidate the subjective and objective functional ability of anterior cruciate ligament (ACL) injured individuals, which can be detrimental when implementing a return-to-play decision-making scheme. The lack of understanding concerning the relationship of these two measures may account for the high incidence of re-injury rates and lower quality of life exhibited by so many of these patients.
Purpose: The purpose of this doctoral thesis is to investigate the relationship between subjective and objective measures of functional ability in ACL deficient and ACL reconstructed conditions through biomechanical and neuromusculoskeletal modelling approaches.
Methods: This thesis is comprised of five studies based on a single in vivo data collection protocol, medical imaging and in silico data analyses. The in vivo data collection was of test-retest design where ACL deficient patients participated prior to their operation and approximately ten months post-reconstruction. This experimental group was matched to a healthy, uninjured control group, which was tested a single time.
The first study of this thesis involved a descriptive analysis of spatiotemporal, neuromuscular, and biomechanical patterns during hopping and side cut tasks in addition to subjective functional ability questionnaires. Then, two novel measures of dynamic knee joint control were developed and applied along with a third measure to determine if changes in joint control exist between the three groups (Study 2). The relationships of these objective measures of functional ability to subjective measures were then examined through correlation and regression models (Study 3). Following this, a method of including magnetic resonance imaging to construct patient-specific models was developed and implemented to determine realistic kinematic and ligament lengthening profiles (Study 4). These patient-specific models were then applied to quantify knee joint loading in the form of contact and ligament forces, which were correlated to subjective measures of functional ability (Study 5).
Results: Even though no major differences in neuromuscular patterns were observed between all three groups, it was found that subjective patient-reported outcome measures scores and biomechanical measures in the form of knee flexion angles and extensor moments were lower in the ACL deficient group compared to healthy controls. These differences continued to exist 10 months post-operation as the ACL reconstructed group had not fully recovered to patterns observed in the healthy controls. The current findings also suggest a possible hierarchy in the relationships between objective and subjective measures of functional ability. Basic kinematic objective measures such as knee flexion angle show small to moderate correlations, while more comprehensive measures such as stiffness and joint compressive force show moderate to strong correlations to subjective questionnaires. Finally, this thesis developed patient-specific OpenSim models that were used to produce appropriate kinematics and ligament lengthening with the reduction in soft tissue artefact.
Conclusion:
This thesis demonstrated that patients who are high-functioning in the ACL deficient state show greater improvements in subjective outcome scores after ACL reconstruction compared to objective measures. Biomechanical and neuromusculoskeletal modelling approaches identified important differences between the healthy and ACL deficient groups that were not resolved post-operatively. Our results also demonstrate that certain subjective and objective measures of functional ability are strongly correlated. The knowledge gained from this test-retest design and novel patient-specific in silico models aids clinicians in managing their expectations regarding the effectiveness of reconstruction and the respective long-term sequelae.
10
Mikkelsen, Christina. "Rehabilitation following bone-patellar tendon-bone graft ACL reconstruction /". Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-913-0/.
11
Hartigan, Erin. "Knee function after ACL rupture and reconstruction effects of neuromuscular training". Access to citation, abstract and download form provided by ProQuest Information and Learning Company; downloadable PDF file, 203 p, 2009. http://proquest.umi.com/pqdweb?did=1896910991&sid=7&Fmt=2&clientId=8331&RQT=309&VName=PQD.
12
Alinejad, Mona. "Artificial anterior cruciate ligament reconstruction". Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:9cace6f9-2147-481e-b19f-502c38cc6b98.
Resumo:
Conventional anterior cruciate ligament (ACL) reconstruction grafts have not been able to replicate the mechanical behaviour of the native ACL, reproduce normal knee mechanics and kinematics, or prevent degenerative disease progression of the knee. The aim of this thesis was to investigate a novel ACL design to more closely mimic the normal mechanical behaviour of the ACL, reconstruct the isometric ACL fibre and potentially reproduce the normal kinematics and mechanics of the knee. The designed artificial ACL reconstruction (ACLR) system could be used as a stand-alone device or in conjunction with a total knee replacement (TKR). The nominated design option for the ACLR system consisted of a connecting cord made of ultra-high molecular weight polyethylene (UHMWPE) fibres and an elastic system made of cobalt-chrome-molybdenum (CoCrMo) alloy with similar load-elongation characteristics to the native ACL. The design requirements were defined based on the mechanical properties of the native ACL, size constraints from the bony geometry and TKR components, and the location of the isometric fibres of the native ACL. The in vitro mechanical tests performed in this project on the designed cord showed a 2-3 times greater ultimate tensile load compared to the ACL in young human cadavers. The decreasing creep modulus of the UHMWPE cord under fatigue loading in simulated body conditions (3118 MPa at 6.5×106 cycle) indicated nominal creep and stabilised mechanical properties by the 3000th loading cycle. To replicate the non-linear stiffness of the ACL with ~38 N mm-1 toe and ~100 N mm-1 linear regions, the artificial ACLR device consisted of a femoral spring (~60 N mm-1) in series with a tibial spring (~100 N mm-1) and a connecting cord (~2000 N mm-1). Two helical springs in series were used for the stand-alone ACLR, whereas a helical spring in series with a spiral spring was designed for the ACLR-TKR. As both the helical and spiral springs had a constant stiffness, stop mechanisms were added to the springs to create a non-linear stiffness and control the maximum safe deformation limit of each spring. To understand the mechanical behaviour of the reconstructed isometric fibre of the ACL, passive and loaded motions were simulated in 18 sets of segmented MRI models of healthy human knees. Constant load and elongation was observed throughout flexion during the passive movements, whereas maximal load and elongation in the reconstructed ACL was identified at 50 º of flexion during loaded motion. An ACL attachment placement sensitivity study, conducted in this project to assess the effect of surgical implantation error on the behaviour of the reconstructed ACL, revealed that misplacement of the femoral attachment would significantly influence the load-elongation of the reconstructed ACL. Finite element (FE) models of the designed ACLR devices enabled their behaviour under simulated axial loading, squatting and the Lachman test to be assessed. Both ACLR devices successfully reproduced stiffness of the native ACL with a multi-linear stiffness curve, however, elongation greater than 3.1 mm could not be achieved. It can be concluded that the designed artificial ACLR devices were able to mimic the mechanical behaviour of the ACL provided it was positioned at the isometric attachment points; potentially enabling achievement of more natural kinematics and mechanics of the reconstructed knee. However, ACL placement was shown to have a significant impact on the behaviour of the reconstructed ACL, therefore, placement error may over-constrain the joint. For this reason, a more forgiving design with a lower stiffness and a larger deformation limit would be advised.
13
Elmqvist, Lars-Gunnar. "Chronic anterior cruciate ligament tear : knee function and knee extensor muscle size, morphology and function before and after surgical reconstruction". Doctoral thesis, Umeå universitet, Ortopedi, 1988. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-102562.
Resumo:
Knee function was evaluated by knee score, activity level, clinical findings and performance tests, muscle size by computerized tomography (CT), morphology by light (LM) and electron microscopy (EM), muscle function by electromyography (EMG) and isokinetic performance in 29 patients with chronic anterior cruciate ligament (ACL) tear. Preoperatively CT disclosed a significant mean atrophy of the quadriceps and nonsignificant changes of the other muscle areas of the injured leg. Morphology of m vastus lateralis of the injured leg was normal in more than half of the biopsies preoperatively, the rest showed signs of nonoptimal activation. Significant decreases in all isokinetic parameters were noticed together with significantly decreased EMG of the quadriceps muscle of the injured leg. Âfter surgical reconstruction the knees were immobilized in a cast for 6 weeks at either 30° or 70° of knee flexion. After cast removal CT showed significant decreases of all areas which also remained after training. The 30° group showed larger fibres (intracellular oedema) and more frequent morphological abnormalities than the 70° group. Fourteen weeks postoperatively the patients were allocated to either a combination of isometric and progressive resistance training or isokinetic training for 6 weeks. CT showed slightly larger areas at 20 weeks postoperatively than at 6 weeks. Morphological abnormalities were still prominent at 20 weeks postoperatively. Maximum isokinetic knee extensor mechanical output and endurance were markedly decreased at 14 weeks postoperatively but both improved progressively during the one year rehabilitation, mostly during the intensive 6 week training period but irrespective of training programme used. Fatiguability/endurance level improved over the preoperative level. Muscular work/integrated EMG was stable while EMG/t increased indicating neuromuscular relearning. The clinical result at 28 months foliowup was excellent or good in 93% of the patients and clinical stability improved in 66%. Independent upon primary knee immobilization angle or training programmes no differences could be demonstrated with respect to stability, range of motion, function or isokinetic mechanical output. Isokinetic performance was still significantly lower in the injured compared to the noninjured leg and not significantly different from the preoperative values. Morphology, only 6 cases, showed abnormalities similar to preoperative findings. In conclusion, the reason for the decreased maximum and total knee extensor performance in these patients with ACL tears is suggested to be nonoptimal activation of normal functioning muscle fibres depending on changes in knee joint receptor afferent inflow. No differences concerning the markedly improved postoperative clinical result could be seen between the different treatment modalities used. A nonoptimal muscular activation might explain the still decreased isokinetic performance present at followup.S. 1-40: sammanfattning, s. 43-137: 5 uppsatser
digitalisering@umu.se
14
Ithurburn, Matthew P. "Associations among Knee Impairments, Patient-Reported Function, Landing Mechanics, and Knee Cartilage Integrity over Time after Anterior Cruciate Ligament Reconstruction". The Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu1503059931724191.
15
Boguszewski, Daniel V. "Characterizing the Porcine Knee as a Biomechanical Surrogate Model of the Human Knee to Study the Anterior Cruciate Ligament". University of Cincinnati / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1337715685.
16
Mayson, Scott A. "Design of an orthopaedic instrument for image guided anterior cruciate ligament reconstruction". Australian Digital Thesis Program, 2006. http://adt.lib.swin.edu.au/public/adt-VSWT20061006.130922/index.html.
Resumo:
Thesis (PhD) - Swinburne University of Technology, Industrial Research Institute Swinburne - 2006. Thesis (PhD) - National School of Design, Swinburne University of Technology, 2006.A thesis submitted to the Industrial Research Institute Swinburne (IRIS) and the National Institute of Design in fulfilment of the requirements for the degree of Doctor of Philosophy, - 2006. Typescript. Includes bibliographical references (p. 192-199).
17
Konrath, Jason Matthew. "A Morphological and Biomechanical Evaluation of the Semitendinosus and Gracilis After the Use of Hamstring Tendon for Anterior Cruciate Ligament Reconstruction". Thesis, Griffith University, 2017. http://hdl.handle.net/10072/368183.
Resumo:
Injuries to the anterior cruciate ligament (ACL) are one of the most common knee injuries, with the majority occurring during non-contact manoeuvers such as side-stepping and single leg landing. Surgical intervention is generally required to restore stability to the tibiofemoral joint, unfortunately no perfect graft choice exists for reconstruction of the ACL, with all graft choices having potential advantages and disadvantages. The quadrupled hamstring autograft taken from the semitendinosus (ST) and gracilis (GR) muscles is a common choice for orthopaedic surgeons. However, harvest of the ST and GR tendons leads to post-operative donor muscle atrophy, as well as proximal retraction of the musculotendinous junction. This could in turn, have implications for tibiofemoral joint function, stability and loading. Thus, the overarching purpose of this thesis was to explore the morphological changes that occur to the donor muscles following tendon harvest and their biomechanical consequences.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Allied Health
Griffith Health
Full Text
18
Aronhalt, Taylor W. "Effects of Patellar Reconstruction Procedures on Extensor Torque Output of the Human Knee Joint". University of Cincinnati / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1205158977.
19
Lee, Anna Glyn. "A Novel Device and Method to Quantify Knee Stability during Anterior Cruciate Ligament Reconstruction". The Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu159535872238711.
20
Saweeres, Emad Samuel Boles. "Interference fixation of anterior cruciate ligament reconstruction grafts : biomechanical and radiological assessment of a ß tri-calcium phosphate/poly-L-lactic acid composite screw". Thesis, Keele University, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.269185.
21
Plochocki, Jeffrey H. "Mechanical regulation of limb joint growth : computational analysis of chondral modeling and implications for the reconstruction of behavior from articular form /". free to MU campus, to others for purchase, 2003. http://wwwlib.umi.com/cr/mo/fullcit?p3091958.
22
Bailey, Andrea Kay. "Enhancing rehabilitation following anterior cruciate ligament reconstruction". Thesis, University of Exeter, 2015. http://hdl.handle.net/10871/17475.
Resumo:
Thesis Title: Enhancing rehabilitation following anterior cruciate ligament reconstruction. Context: Physical training with a neuromuscular focus has been shown to reduce anterior cruciate ligament (ACL) injury. However, ACL injury remains prevalent and often leads to joint instability, which requires surgical reconstruction. Following reconstructive surgery, a minimum of 6 months supervised rehabilitation is recommended with associated with financial cost implications to the National Health Service (NHS), the patient and society. Traditionally rehabilitation is offered in a concurrent format, whereby strength and cardio-vascular endurance exercises are performed in the same session. However, accumulating evidence from healthy populations, suggests that the development of strength might be attenuated by cardio-vascular endurance conditioning performed in close temporal proximity. This thesis comprises an entirely novel investigation of potential attenuation of strength gains in rehabilitating clinical populations that is associated with temporal incompatibility of physiological conditioning stimuli. No study has previously investigated this phenomenon, whether it might compromise the efficacy of treatment or recovery, or its potential influence on objectively-measured and patients’ perception of functional, musculoskeletal and neuromuscular performance capabilities. Objectives: The purpose of this thesis was to assess the effects of reconstruction surgery and 24 weeks of non-concurrent strength and endurance rehabilitation (with 48 week post-operative follow-up) on (a) subjective (IKDC; KOOS; PP [Chapter 4]) and objective measures of function (HOP [Chapter 5]) (primary outcome measures for this thesis), and (b) objective measures of musculoskeletal (ATFD) and neuromuscular performance (PF, EMD, RFD, SMP [Chapter 5]) (secondary outcome measures), in patients with anterior cruciate ligament deficiency. The secondary aim was to evaluate the relationships amongst a subjective outcome of function (IKDC), an objective outcome of function (HOP), and the secondary objective outcomes of musculoskeletal (ATFD) and neuromuscular (PF, RFD, EMD, SMP) performance at pre-surgery and at 24 weeks post-surgery (Chapter 6). Setting: Orthopaedic Hospital NHS Foundation Trust. Design: Prospective random-allocation to group trial involving iso-volume rehabilitative intervention versus contemporary practice, using contralateral limb assessment and clinico-social approbation controls. The design compared the effects of experimental post-surgical rehabilitation comprising non-concurrent strength and endurance conditioning with two conditions of control reflecting contemporary clinical practice (matched versus minimal assessment interaction). Participants: Eighty two patients (69♂, 13♀, age: 35.4 ± 8.6 yr; time from injury to surgery 9.4 ± 6.9 months [mean ± SD]) electing to undergo unilateral ACL reconstructive surgery (semitendinosus and gracilis graft [n = 57]; central third, bone-patella tendon-bone graft [n = 25]); were allocated to groups (2:2:1 purposive sampling ratio, respectively). Nineteen patients were lost to follow-up. Intervention: A standardised traditional concurrent (CON) ACL rehabilitation programme acted as the control versus an experimental non-concurrent (NCON) ACL rehabilitation programme that involved separation of strength and cardio-vascular endurance conditioning. An additional control group (Limited testing CON) matched the CON group rehabilitation applied within contemporary clinical practice. Outcome Measures: Chapter 4: The self-perceived primary outcome measures of function IKDC, KOOS and PP were assessed on five separate occasions (pre-surgery, and at 6, 12, 24 and 48 weeks post-surgery). However, assessment occasions were purposefully reduced to pre-operative and 48 weeks post-operative for the Limited testing CON group. Chapter 5: The primary objective outcome of function was HOP; the secondary outcomes were ATFD, PF, RFD, EMD and SMP associated with the knee extensors and flexors of the injured and non-injured legs. These objective outcomes were assessed on five separate occasions (pre-surgery, and at 6, 12, 24 and 48 weeks post-surgery). However, assessment occasions were purposefully reduced to pre-operative and at 48 weeks post-operative only for the Limited testing CON group. Chapter 6 Self-perceived (IKDC) subjective knee evaluation and the objective outcome of function (HOP), and selected objective outcomes of musculoskeletal and neuromuscular performance including ATFD, PF, RFD, EMD and SMP of the knee extensors and flexors of the injured and non-injured legs where applicable; measured at pre-surgery and at 24 weeks post-surgery were analysed for association, using Pearson product-moment correlation coefficients. A priori alpha levels were set at p<0.05. Results: Chapter 4: Factorial analyses of variance (ANOVAs) with repeated-measures investigating the primary aim showed significant group (NCON; CON) by test occasion (pre-surgery, 6, 12. 24 and 48 weeks post-surgery) interactions for self-perceived outcomes of function IKDC, KOOS and PP confirmed increased clinical effectiveness of NCON conditioning (F(2.0, 82.9)GG = 4.0 p<0.05, F(2.2, 134.7)GG = 5.5 p<0.001, F(1.9, 121.4)GG = 14.6 p<0.001, respectively) and the group mean peak relative difference in improvement for NCON was ~5.9% - 12.7% superior to CON. The greatest interaction effect was found to occur between pre-surgery and the 12 weeks post-operative test occasion for IKDC and KOOS, and between pre-surgery and the 24 week test occasion for PP. Patterns of improvements in self-perceived fitness over time were represented by a relative effect size range of 0.71 to 1.92. Improvement patterns were not significantly different between control groups offering matched or minimised assessor-patient interaction (CON vs. Limited testing CON; pre-surgery vs. 48 weeks post-surgery) indicating that clinical approbation by patients had not contributed to the outcome. Chapter 5: Factorial analyses of variance (ANOVAs) with repeated-measures showed significant group (NCON; CON) by leg (injured/non-injured) by test occasion (pre-surgery, 6, 12, 24 and 48 weeks post-surgery) interactions of the objective measure of function (HOP) together with the secondary outcomes of ATFD, PF, RFD, EMD and SMP. Similar responses were noted for the knee extensors and flexors of the injured and non-injured legs (F(2.1, 248) GG = 4.5 to 6.6; p<0.01) and confirmed increased clinical effectiveness of NCON conditioning (range ~4.7% - 15.3% [10.8%]) better than CON between 12 and 48 weeks. Patterns of improvements in physical fitness capabilities over time were represented by a relative effect size range of 1.92 to 2.89. Improvement patterns were not significantly different between control groups offering matched or minimised assessor-patient interaction (CON vs. Limited testing CON; pre-surgery versus 48 weeks post-surgery) indicating that clinical approbation by patients had not contributed to the outcome. Chapter 6: Two-tailed probabilities were used due to the exploratory nature of this study. A limited number of weak to moderate statistically significant correlations were confirmed (ranging from r = 0.262 – 0.404; p<0.05; n=48 [amalgamated NCON and CON groups] ) between IKDC and most notably, the neuromuscular performance outcome of EMD. Conclusion: Overall, the patterning and extent of changes amongst self-perceived, functional, musculoskeletal and neuromuscular performance scores offer support for the efficacy of using non-concurrent strength and endurance conditioning to enhance post-surgery rehabilitation. The limited robustness of relationships amongst the validated and frequently-used self-perceived outcome of function [IKDC], and objectively-measured outcomes of function and musculoskeletal and neuromuscular performance suggested that each might properly reflect an important but separate aspect of clinical response and should be deployed to detect change.
23
Rankin, Anne E. "A survey of functional knee brace usage following anterior cruciate ligament reconstruction, a pilot study". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/MQ28646.pdf.
24
Shabani, Bujar. "Gait knee kinematics of patients with ACL rupture : a 3D assessment before and after the reconstruction". Thesis, Lyon 1, 2015. http://www.theses.fr/2015LYO10021/document.
Resumo:
La rupture du ligament croisé antérieure (LCA) conduit à une instabilité et à des modifications biomécaniques du genou. Actuellement, les patients présentant une lésion du LCA bénéficient généralement une reconstruction du LCA. L'analyse cinématique quantitative est un outil important pour acquérir une compréhension approfondie de la fonction articulaire du genou normal et pathologique au cours de la locomotion humaine. Ce travail est axé sur l'évaluation in vivo de la cinématique du genou chez les patients avec rupture du LCA, avant et après la reconstruction du LCA au cours de toutes les phases de la marche, en utilisant un nouvel outil d'évaluation 3D, quasi-rigide, en temps réel (KneeKGTM). Dans la première étude, des modifications cinématiques significatives ont été identifiées dans les genoux avec une rupture du LCA. Ces changements cinématiques pourraient mener à des contacts fémoro-tibiaux anormaux du cartilage pendant les activités quotidiennes, représentant potentiellement un mécanisme biomécanique de l'usure des articulations après une lésion du LCA. Dans la seconde étude, l'analyse 3D in vivo du mouvement a révélé que les genoux avec LCA reconstruits améliorent significativement leur extension par rapport aux genoux avec LCA déficient, mais il y avait encore une différence par rapport au groupe témoin sain. Dans le plan axial, le tibia reste en position interne significative par rapport à un groupe témoin, tandis qu'il n'y avait pas de différences significatives en translation antéro-postérieur et dans le plan coronal. Ces changements cinématiques pourraient conduire à une charge anormale dans l'articulation du genou et initier le processus d'atteinte dégénérative cartilagineuse à venir. Toutefois, les données cinématiques post-opératoires ont été collectées 10 mois après la chirurgie, ainsi un suivi plus long serait nécessaire pour évaluer si ces changements cinématiques persistent dans le temps, et leurs effets sur l'articulationBecause of the role of the ACL in knee joint’s biomechanics, it is essential to quantify the kinematics of ACL deficient and ACL reconstructed knee. In-vitro models bare the handicap of limited muscle simulation, while static, one-dimensional testing cannot predict the behavior of these groups of patients under realistic loading conditions. Currently, the most widely accepted method for assessing joint movement patterns is gait analysis. Respectively, 3D motion analysis is necessary to provide high reliability movement analysis. The purpose of the study was in-vivo evaluation of the behavior of the anterior cruciate ligament deficient (ACLD) and anterior cruciate ligament reconstructed (ACLR) knees during walking, using 3D, real-time assessment tool. Significant alterations of joint kinematics in the ACLD knee were revealed in this study by manifesting a higher flexion gait strategy and excessive internal tibial rotation during walking that could result in a more rapid cartilage thinning throughout the knee. In the other hand, even though ACLR knees showed some improvements in sagittal plane compared to ACLD knees, in axial plane there still exists difference compared to healthy control knees. These kinematic changes could lead to abnormal loading in knee joint and initiate the process for future chondral degeneration. However, the post-operative kinematic data were collected 10 months after surgery, so a longer follow-up is needed to evaluate if these kinematic changes persist in time, and their effects in joint degeneration
25
Grasso, Salvatore Samuel. "Optimised Structural Assessment of ACL Reconstruction: Development, Reliability, Validation and Clinical Application". Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/17845.
Resumo:
Rupture of the Anterior Cruciate Ligament (ACL) is a common sports knee injury and is managed with reconstruction of the ligament. Despite the increase in the number of ACL reconstructions being performed and with improvements of ACL reconstruction technique, postoperative outcomes are variable and ACL revision reconstruction is rising, presenting a challenge for the surgeon. The causes of ACL reconstruction failure can be related to recurrent instability, postoperative complications or patient comorbidities. Recurrent instability is the most common cause for revision surgery and categorised as traumatic or atraumatic failure. Technical errors which are related to variables associated with the surgical procedure are the most common cause of atraumatic failure amongst other factors such as, missed concomitant injuries, biological factors and infection. Careful preoperative evaluation, planning and optimisation of technical variables including individualised graft selection, anatomical tunnel placement and secure fixation are all essential for successful ACL reconstruction surgery. However, despite this, there are no objective and universally standardised methodologies to evaluate the technical variables of ACL reconstruction on an individualised, patient specific basis both in the clinical and research setting. To this end, novel MRI-based methodologies and techniques were developed and validated to accurately and objectively evaluate technical factors critical for successful ACL reconstruction using computational modelling methodologies. Optimised structural assessment of ACL reconstruction has utility in clinical and research applications, and inclusion of these evaluation techniques should be considered in routine postoperative assessment, pre-surgical planning for revision surgery, and also in any study attempting to analyse outcomes of ACLR in a meaningful manner.
26
Suggs, Jeremy F. (Jeremy Floyd) 1976. "Simulation of anterior cruciate ligament injury and reconstruction using a 3D finite element knee joint model". Thesis, Massachusetts Institute of Technology, 2002. http://hdl.handle.net/1721.1/89369.
27
Tagesson, (Sonesson) Sofi. "Dynamic knee stability after anterior cruciate ligament injury : Emphasis on rehabilitation". Doctoral thesis, Linköpings universitet, Sjukgymnastik, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-10498.
Resumo:
Anterior cruciate ligament injury leads to increased sagittal tibial translation, and perceptions of instability and low confidence in the knee joint are common. Many patients have remaining problems despite treatment and are forced to lower their activity level and prematurely end their career in sports. The effect of ACL reconstruction and/or rehabilitation on dynamic knee stability is not completely understood. The overall aim of this thesis was to study the dynamic knee stability during and after rehabilitation in individuals with ACL injury. More specific aims were 1) to elaborate an evaluation method for muscle strength, 2) to evaluate the effect of exercises in closed and open kinetic chain, and 3) to evaluate dynamic knee stability in patients with ACL deficiency or ACL reconstruction. Sagittal tibial translation and knee flexion angle were measured using the CA‐4000 computerised goniometer linkage. Muscle activation was registered with electromyography. The intra‐ and inter‐rater reliability of 1 repetition maximum (RM) of seated knee extension was clinically acceptable. The inter‐rater reliability of 1RM of squat was also acceptable, but the intra‐rater reliability was lower. The systematic procedure for the establishment of 1RM that was developed can be recommended for use in the clinic. One specific exercise session including cycling and a maximum number of knee extensions and heel raises did not influence static or dynamic sagittal tibial translation in uninjured individuals. A comprehensive rehabilitation program with isolated quadriceps training in OKC led to significantly greater isokinetic quadriceps strength compared to CKC rehabilitation in patients with ACL deficiency. Hamstring strength, static and dynamic translation, and functional outcome were similar between groups. Five weeks after ACL reconstruction, seated knee extension produced more anterior tibial translation compared to the straight leg raise and standing on one leg. All exercises produced less or equal amount of anterior tibial translation as the 90N Lachman test. Five weeks after the ACL reconstruction the static and dynamic tibial translation in the ACL reconstructed knee did not differ from the tibial translation on the uninjured leg. Patients in the early phase after ACL injury or ACL reconstruction used a joint stiffening strategy including a reduced peak knee extension angle during gait and increased hamstring activation during activity, which reduces the dynamic tibial translation. Patients with ACL deficiency that completed a four months rehabilitation program used a movement pattern that was more close to normal.
28
DeFrate, Louis E. 1977. "The biomechanics of the knee following injury and reconstruction of the posterior cruciate ligament c Louis DeFrate". Thesis, Massachusetts Institute of Technology, 2005. http://hdl.handle.net/1721.1/32394.
Resumo:
Thesis (Sc. D.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 2005."June 2005."
Includes bibliographical references (leaves 199-216).
Very little is known regarding the function of the posterior cruciate ligament in response to physiological loading conditions. A limited understanding of posterior cruciate ligament function might contribute to the poor clinical outcomes that are observed after reconstruction. Therefore, the objectives of this thesis were to quantify the biomechanical function of the posterior cruciate ligament both in-vitro and in-vivo and to investigate the effects of injury and reconstruction of the posterior cruciate ligament on knee joint biomechanics. First, muscle loading conditions were simulated in cadavers to measure the effects of posterior cruciate ligament injury and reconstruction on knee joint kinematics and contact pressures. Next, the structural properties of the grafts used in posterior cruciate ligament reconstructions were optimized using a theoretical model. In order to verify these results using an experimental model, an imaging system was developed to measure the strain distributions around the graft surface during tensile testing. Finally, the deformation of the posterior cruciate ligament was studied in living subjects using imaging and solid modeling techniques. Three-dimensional models of the knee joint, including the insertion sites of the posterior cruciate ligament were created from magnetic resonance images. The subjects then flexed their knees as they were imaged using fluoroscopy from two orthogonal directions. The models and orthogonal images were imported into a solid modeling software and used to reproduce the kinematics of the knee as a function of flexion. From these models, the three- dimensional deformation of the posterior cruciate ligament insertion sites was measured.
(cont.) These data illustrated that the in-vivo function of the posterior cruciate ligament is different from that observed in in-vitro studies. Current surgical treatments of posterior cruciate ligament injuries do not account for the in-vivo function observed in this study. In summary, this thesis quantified the biomechanical role of the posterior cruciate ligament in response to physiological loading conditions. In addition, grafts used to reconstruct the posterior cruciate ligament were optimized. These data provide valuable information for developing surgical treatments that recreate the in-vivo biomechanics of the posterior cruciate ligament.
Sc.D.
29
Lindbäck, Kristoffer. "ACL reconstruction with a hamstring graft, can a forced foot dorsiflexion alter isokinetic knee flexion performance - a pilot study". Thesis, Luleå tekniska universitet, Hälsa och rehabilitering, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-74642.
Resumo:
Abstract Introduction: The prevalence of anterior cruciate ligament tear is around 7000 every year within the swedish population and 95% of reconstructive surgery was with a hamstring tendon graft. Six months post surgery a 13% decrease in knee flexion strength compared to non injured side. The need for a study that determine the role of gastrocnemius and foot position in knee flexion is lacking in the litterature and could benefit Physiotheraphy ACL rehabilitation. Purpose: of his study was to investigate M gastrocnemius medialis (MGM) activation in the ipsilateral knee after removal of hamstring tendon for ACLR, and se if ankle position alter knee flexion outcomes. Method: 3 women, mean age 24 years who underwent ACL reconstruction with hamstring graft on one leg was tested. The time since injury was 3, 6 and 7 years respectively with an mean ,5 years wait until surgery. Isokinetic knee flexion and extension testing was done in the Biodex system 3 pro. EMG electrodes measured medial gastrocnemius activation with and without ankle in dorsiflexion. Results: Knee flexion peak strength was higher by a mean of 3 Nm (3,5%) with dorsiflexed foot. Mean (MGM) activation remained the same with or without dorsiflexion. Overall knee flexion strength was higher by a mean of 5 Nm compared to the injured side. Conclusion: Knee flexion in the biodex with foot in dorsiflexion could allow for isometric plantarflexion and increas power output. Certain changes in inclusion criteria and methodology as well more studies is needed to come to a given conclusion.nej
30
Hemmerich, Andrea. "Rotational laxity of the knee following reconstruction of the anterior cruciate ligament using single vs double-bundle surgery". Doctoral thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/3243.
31
Muren, Olle. "Anterior cruciate ligament reconstruction : patellar tendon, gore-tex, Kennedy LAD and tibia tunnel ingrowth /". Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-523-9/.
32
Crawford, Richard Lee. "Protocols for preconditioning of patellar tendon for anterior cruciate ligament reconstruction stress relaxation vs. creep /". Master's thesis, Mississippi State : Mississippi State University, 2008. http://library.msstate.edu/etd/show.asp?etd=etd-07232008-132346.
33
Koya, Bharath. "A Finite Element Study on Medial Patellofemoral Ligament Reconstruction". University of Akron / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=akron1386780806.
34
Švedienė, Saulė. "Evaluating the efficacy of intra-articular and perineural analgesia methods for the arthroscopic reconstruction of anterior cruciate ligament of the knee". Doctoral thesis, Lithuanian Academic Libraries Network (LABT), 2013. http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2013~D_20130930_092340-97167.
Resumo:
Choice of optimal postoperative analgesia technique after anterior crutiate ligament repair remains challenging. Aiming to evaluate and compare the efficacy of intra-articular injection of morphine and neostigmine our prospective randomized clinical study compared pain intensity, consumption of adjunct analgesics and patient satisfaction during 48 postoperative hours in patients who, in addition to spinal block, received a single-shot femoral nerve block followed by the end-of-surgery intra-articular injection of morphine, neostigmine or placebo. Additionally, the former two were compared with continuous femoral nerve block with postoperative patient controlled analgesia infusion pump containing 0.1 % bupivacaine preset in 2 different regimens: with or without basal infusion. Our results show that there was only a single difference among intra-articular groups found on the 2nd postoperative day: a significantly better pain control at motion in neostigmine group than in the placebo group. There was no additive analgesic effect of i/a morphine. Also, we observed a significantly better pain control and patient satisfaction in continuous femoral perineural block PCA groups during the whole trial. There was a significant prevalence of the PCA analgesia regimen which implies the preset basal rate of 0.1% bupivacaine: a 5 ml bolus with a lockout period 30 min and basal infusion 5 ml/h.Artroskopinė priekinio kryžminio raiščio rekonstrukcija – viena iš dažniausiai atliekamų ortopedinių operacijų. Adekvati skausmo kontrolė yra svarbi siekiant efektyvios ankstyvos reabilitacijos ir gerų funkcinių rezultatų, sutrumpinant gydymo ligoninėje trukmę. Atlikome randomizuotą perspektyvųjį dvigubai aklą placebu kontroliuojamą tyrimą panaudodami intrasąnarinius vaistus (morfiną ir neostigminą), derindami su vienkartine šlauninio nervo blokada. Taip pat tyrėme tęstinį skausmo malšinimą šlaunies perineuriniu kateteriu, taikydami du skirtingus paciento kontroliuojamos analgezijos režimus. Taikėme mažesnę vietinio anestetiko koncentraciją, siekdami selektyvesnės sensorinės blokados, mažesnės paros dozės, mažiau toksinių reakcijų. Tikrinome, ar tęstinis skausmo malšinimas yra veiksmingesnis nei vienkartinė nervo blokada su intrasąnarinėmis analgetikų injekcijomis. Intrasąnarinis morfinas turėjo panašų analgezinį poveikį kaip ir neostigminas paciento krūvio metu per visą tyrimo laiką (48 val.); tačiau neostigminas buvo patikimai efektyvesnis už placebą antrą pooperacinę dieną. Skausmo kontrolė ramybėje ir krūvio metu bei pacientų pasitenkinimas per visą tyrimą buvo geresni perineurinio skausmo malšinimo grupėse negu intrasąnarinėse. Intrasąnarinių grupių pacientų analgezijos efektyvumui priartėjus prie kateterinių grupių, nustatydavome didesnį papildomų analgetikų suvartojimą pirmosiose. Skausmo malšinimas 0,1% bupivakaino infuzija šlaunies perineuriniu kateteriu, taikant... [toliau žr. visą tekstą]
35
Ringer, Geoffrey Wadsworth. "Evaluation of Graft Pretension Effects in Anterior Cruciate Ligament Reconstruction: A Series of In Vitro and In Vivo Experiments". Diss., Virginia Tech, 1998. http://hdl.handle.net/10919/40494.
Resumo:
The purpose of this dissertation was to study the effects of graft pretension in anterior cruciate ligament (ACL) reconstruction through a series of experiments. First, an in vitro study of 5 human knees was conducted to determine if intact joint kinematics could be restored when using the ideal graft - the intrinsic ACL. The ACL tibial insertion site was freed, and pretensions of 0, 10, 20, 30, and 40 N were applied to the ligament using a custom designed load cell connection. Kinematics during a simulated active extension were compared to those of the intact knee. Intact knee kinematics were not restored. Pretensions that best restored tibial anterior/posterior translation and internal/external rotation ranged from 0-40 N. Furthermore, the pretensions that best restored these kinematic variables were widely disparate in two specimens. Second, the in vitro kinematics during a simulated active extension of human and porcine knees were compared and contrasted both prior to and following transection of the ACL. The ACL limited: (1) tibial anterior translation in both species, (2) tibial internal rotation in humans, and (3) tibial external rotation in pigs. Differences in kinematic patterns for tibial internal/external rotation and abduction/adduction between the species was explained by requirements for biped and quadruped stances. Third, the mechanical characteristics of porcine patellar tendon (PT) were investigated by uniaxial tensile testing at two strain rates. Patella-PT-tibia complexes from freshly sacrificed skeletally immature and mature animals were loaded to failure at elongation rates of 20 and 200 mm/min. Both strain rate and skeletal maturity significantly affected failure mode, tangent modulus, and ultimate stress of the tendons, and hence are important considerations in the mechanical evaluation of porcine PT. Fourth, ACL reconstructions were performed using pretensions of 10 or 20 N in an in vivo porcine model with a specially designed load cell/telemetry system to monitor graft load. Graft pretension was seen to increase during fixation with interference screws. Following sacrifice at 4 weeks, tissues were mechanically, histologically, and biochemically analyzed. A pretension of 20 N resulted in a tissue more similar to the intrinsic ACL.Ph. D.
36
Néri, Thomas. "Etude anatomique et biomécanique du ligament antérolatéral ; implication dans sa reconstruction chirurgicale". Thesis, Lyon, 2017. http://www.theses.fr/2017LYSES033/document.
Resumo:
Il a été démontré que les reconstructions du ligament croisé antérieur (ACL) ne permettaient pas un contrôle parfait de l’instabilité rotatoire antérolatérale (ALRI). Ce postulat a conduit à la redécouverte du ligament antérolatéral (ALL). Toutefois de nombreuses questions persistent, rendant sa reconstruction chirurgicale approximative.Après avoir établi un protocole de dissection non extensif, les principales caractéristiques anatomiques du ALL ont été définies. Puis, une description histologique du ALL a été réalisé afin de confirmer sa nature ligamentaire.Deuxièmement, grâce à la mise au point et à la validation d’un protocole d’analyse cinématique par système optoélectronique tridimensionnel, nous avons pu étudier le rôle du ALL sur la stabilité du genou. A travers une analyse des variations de sa longueur au cours du mouvement, et des conséquences de sa section, nous avons déterminé son rôle sur le contrôle de la l’ALRI.Troisièmement, une technique de reconstruction physiologique du ALL, modifiée selon nos résultats, a été proposée. Afin de l’évaluer, nous avons analysé les cinématiques du genou après cette reconstruction en les comparant avec celles obtenues après une ténodèse latérale extra-articulaire.Enfin, afin de préciser ses indications de reconstruction, différents outils cliniques (laximétrie, accéléromètre triaxial), et morphologiques (IRM, échographie) ont été analysés afin d’évaluer leurs pertinences dans le diagnostic de rupture du ALL.En conclusion, ce travail donne une vue d’ensemble globale du ALL, de sa description anatomique et histologique, en passant par sa fonction biomécanique, jusqu’à à sa reconstruction chirurgicaleMany clinical studies have shown that anterior cruciate ligament (ACL) anatomical reconstruction do not allow a perfect control of anterolateral rotational instability (ALRI). This clinical postulate led to rediscovery of the anterolateral ligament (ALL). However ALL surgical reconstruction are still approximate, due to a lack of knowledge.Initially, we have studied cadaveric knees, using our own non-extensive and reproducible dissection protocol. With tis approach, we were able to define the anatomical parameters relevant to obtaining an effective ALL reconstruction. Then, we performed an histological study in order to confirm ALL ligamentary structure.In a second part, we have developed and validated a kinematic analysis protocol using a three-dimensional optoelectronic system to study the ALL role on the knee stability. Through an analysis of ALL length variations during motion and ALL section consequences, we determined the ALL capacity on ALRI control.In a third part, we were able to define, regarding our previous results, biomechanical and anatomical imperatives to perform an anatomic ALL reconstruction. In order to evaluate this technique, we analyzed and compared knee kinematics after ALL reconstruction and after lateral extra-articular tenodesis on cadaveric knees.Lastly, various clinical (laximeter, triaxial accelerometer) and morphological (MRI, ultrasound) systems were analyzed to evaluate their relevance in ALL tear diagnosis, in order to improve ALL reconstruction indications.In conclusion, this work gives a global view of ALL, from anatomical description and biomechanical function to surgical reconstruction
37
Bier, Bastian [Verfasser], Andreas [Akademischer Betreuer] Maier e Andreas [Gutachter] Maier. "C-arm Cone-Beam Computed Tomography Reconstruction for Knee Imaging under Weight-Bearing Conditions / Bastian Bier ; Gutachter: Andreas Maier ; Betreuer: Andreas Maier". Erlangen : Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 2020. http://d-nb.info/1210705761/34.
38
Möller, Eva. "Anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft : postoperative intervention and influential factors for patient-relevant long-term outcome /". Stockholm : Karolinska institutet, 2007. http://diss.kib.ki.se/2007/978-91-7357-198-2/.
39
Braun, Kaitlyn Nicole. "Single-leg power generation in adolescent & young adult athletes returning to sport following anterior cruciate ligament reconstruction". Oxford, Ohio : Miami University, 2010. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=miami1272044091.
40
Wordeman, Samuel Clayton. "Effects of Neuromuscular Training in Anterior Cruciate Ligament-Reconstructed Subjects". The Ohio State University, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=osu1410446293.
41
Alzaabi, Hana. "Development and validation of an evidence based educational program for adults undergoing anterior cruciate ligament reconstruction surgery in the United Arab Emirates". Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/4223.
Resumo:
Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2010.Patients’ knowledge about the effectiveness of interventions is now recognized as an important facilitator of the implementation of evidence in practice. Evidence-based, patient education programs aim to impart knowledge about the efficacy and effectiveness about interventions to individuals. However, there is currently a lack of structured evidence-based educational programs to educate patients about the evidence-base for interventions prescribed by the health professionals in the field of orthopaedics. OBJECTIVE: The main objective of this study was to develop and validate an Arabic version of an evidence-based educational program for patients who are scheduled to undergo ACL reconstruction surgery in UAE, based on available evidence collated through a systematic review process. METHODS: A systematic review was conducted to generate clinical recommendations which were used to develop the evidence-based educational program. The evidence-based information was derived from secondary research to determine which rehabilitation strategies were most effective in improving outcome measurements following ACL reconstruction surgery. A pre-final draft of the evidence-based educational program was prepared and forward and back translated from English into the Arabic language. Feedback groups of ACL patients and physiotherapists were used to determine the content and face validity of the program. The final draft was validated in a group of 40 ACL patients waiting to undergo ACL reconstruction surgery at Zayed Military hospital and Abu Dhabi Knee and Sports Medicine Centre in the UAE, using checklists. RESULTS: A total of 40 patients undergoing ACL reconstruction surgery consented to participate in this study. All the subjects were male. The age range was between 18 to 38 years old with mean age of 28.5 years (SD 5.75). Most of the patients (65%) underwent ACL reconstruction surgery to the right knee. Of the total sample (n=40), the majority of the subjects who participated in this study (90 %), had ACL surgery for the first time. Most of the responses to the evidence-based educational program checklist were positive. iv CONCLUSION: It can be recommended that the newly-developed evidence-based educational program is a valid tool which can be given to ACL patients prior to ACL reconstruction to prepare them for the rehabilitation postoperatively. By informing patients of their condition, the expected outcomes of their condition and the effect of doing exercises to improve their condition, the patients will be more encouraged to partake in rehabilitation, as they know it is for their own good. This will ultimately improve overall patient care and improve management of ACL patients.
42
Krafft, Frieder Cornelius [Verfasser], e W. [Akademischer Betreuer] Potthast. "Comprehensive Assessment and Investigation of Knee Joint Functionality in ACL Reconstructed Subjects - Course of performance capacities from Pre- to Six Months Post-ACL Reconstruction / Frieder Cornelius Krafft ; Betreuer: W. Potthast". Karlsruhe : KIT-Bibliothek, 2019. http://d-nb.info/1178527980/34.
43
Krafft, Frieder [Verfasser], e W. [Akademischer Betreuer] Potthast. "Comprehensive Assessment and Investigation of Knee Joint Functionality in ACL Reconstructed Subjects - Course of performance capacities from Pre- to Six Months Post-ACL Reconstruction / Frieder Cornelius Krafft ; Betreuer: W. Potthast". Karlsruhe : KIT-Bibliothek, 2019. http://nbn-resolving.de/urn:nbn:de:swb:90-906020.
44
Nagelli, Christopher. "Sensorimotor Contribution to Joint Dysfunction following Anterior Cruciate Ligament Injury and Neuromuscular Training as a Clinical Tool to Recover Sensorimotor Control". The Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu1500287443874928.
45
Zimmermann, Júnior José Mauro. "Comparação de técnicas de reconstrução do ligamento cruzado anterior em pacientes com restrição da mobilidade do quadril : dupla banda versus banda simples associado a tenodese extraarticular". reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2014. http://hdl.handle.net/10183/99170.
Resumo:
Introdução: Estudos têm mostrado que, pelo menos em jogadores de futebol, a diminuição da amplitude de movimento do quadril homolateral tem uma influência significativa na ocorrência de lesão do LCA, com alta incidência de rerrupturas especialmente após reconstrução em banda simples. Esse estudo objetiva comparar a capacidade de duas técnicas cirúrgicas de prevenir a rerruptura do LCA em jogadores de futebol com a articulação do quadril homolateral limitada (soma de rotação interna e externa <60°). Materiais e Métodos: Esse estudo foi um ensaio clínico randomizado prospectivo. Trinta atletas de futebol do sexo masculino (idade média de 22 anos, variando de 18 a 28 anos), com rupturas por não contato do LCA, foram alocados aleatoriamente em dois grupos. Os critérios de inclusão foram lesão ligamentar isolada do LCA, soma das rotações do quadril homolateral abaixo de 60° e ser jogador de futebol profissional ou semi-profissional. Os critérios de exclusão englobaram dor persistente no quadril ou história de fratura ou cirurgia prévia em qualquer segmento do membro inferior. Um grupo foi submetido à reconstrução combinada intra e extra-articular (GIE), enquanto o outro foi tratado com reconstrução dupla banda com enxertos do semitendinoso e grácil (GDB). Resultados: Nos dois anos de acompanhamento de cada paciente, ocorreram três rerrupturas no GDB contra nenhuma no GIE. Nos 27 atletas com reconstruções intactas, a quantidade de instabilidade residual no exame físico e no Rolimeter® foram os mesmos. Conclusão: Nossos achados mostram que, em dois anos de acompanhamento, a incidência de rerruptura, embora não tenha sido a mesma, não apresentou diferença significativa entre as técnicas de reconstrução intra + extraarticular e dupla banda do LCA em pacientes atletas com articulação do quadril homolateral restrita.Introduction: Studies have shown that, at least in soccer players, decreased ipsilateral hip range of motion has a significant influence on the occurrence of anterior cruciate ligament (ACL) injury, with a high incidence of re-ruptures especially after single-bundle reconstruction. This study aimed to compare the ability of two surgical techniques to prevent re-rupture of the ACL in soccer players with ipsilateral restricted hip joints (sum of internal and external rotation < 60°). Materials and Methods: The study was a prospective randomized clinical trial. Thirty male soccer players (mean age, 22 years; range, 18-28) with noncontact ACL ruptures were allocated to two groups. Inclusion criteria were isolated ACL injury, ipsilateral hip range of rotation below 60°, and being a professional or semi-professional soccer player. Exclusion criteria were persistent hip pain or history of any fracture or previous surgery of the lower limb. One group underwent a combined intra- plus extra-articular reconstruction (IEG), while the other was treated with double-bundle reconstruction (DBG) with semitendinosus and gracilis grafts. All patients were followed up for two years after surgery. Results: At two-year follow-up of each patient, there were three re-ruptures in the DBG vs. none in the IEG. In the 27 athletes with intact reconstructions, the amount of residual instability in the physical examination and Lachman test was about the same. Conclusion: Our findings demonstrate that, in two years of follow-up, the incidence of rerupture, although not the same, showed no significant difference between intra- plus extraarticular and double-bundle ACL reconstruction techniques in patients with ipsilateral restrained hip joints.
46
Júnior, José Carlos Alves Fabricio. "Um estudo comparativo entre dois protocolos fisioterapêuticos: convencional x acelerado nos pacientes submetidos à reconstrução do ligamento cruzado anterior". Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/5/5140/tde-14092015-091749/.
Resumo:
INTRODUÇÃO: Anualmente nos E.U. A, estima-se mais de 250.000 mil casos de lesão do ligamento cruzado anterior, o que torna a reconstrução cirúrgica um procedimento comum na pratica da medicina esportiva. Ainda não existe consenso sobre o quanto de atividade promove uma reabilitação adequada sem prejudicar o enxerto ou produzir uma frouxidão anterior anormal, com consequente dano ao menisco e a cartilagem articular. OBJETIVO: Analisar e comparar o efeito de um protocolo de fisioterapia acelerado na estabilidade anterior e evolução clínica dos indivíduos submetidos à reconstrução do ligamento cruzado anterior. MÉTODOS: Foram incluídos 29 indivíduos no estudo que apresentaram ruptura total do LCA confirmada por RM e submetidos à reconstrução ligamentar com Tendão patelar. Aleatoriamente foram alocados em dois grupos com intervalos de reabilitação diferentes: Grupo Acelerado (4 meses) ou Grupo Convencional (6 meses). No pré-operatório, sexto e no quarto mês de pós-operatório um avaliador cego registrou: a lassidão anterior através do KT1000, Força muscular (CYBEX) e a função do joelho acometido através do IKDC (2000) e o Hop Test. RESULTADOS: os grupos foram semelhantes em relação aos dados demográficos. Não foi encontrada diferença estatística na lassidão anterior no quarto mês 0,92mm versus 1,33mm e no sexto mês 0,50mm versus 1,67mm sendo Grupo Convencional versus Grupo Acelerado respectivamente. No quarto mês o Grupo Acelerado apresentou uma melhora significativa (P< 0,001) na evolução clínica do IKDC (2000) 79,50 versus 60,61 do Grupo Convencional, essa diferença não se repetiu no sexto mês. A força muscular e o Hop Test, o Grupo Acelerado apresentou maiores valores, mas não de forma significativa nos dois momentos de avaliação (P> 0.05). CONCLUSÃO: Com base nos resultados obtidos, o protocolo acelerado quando comparado ao Convencional, não se diferiu quanto à estabilidade anterior do joelho e foi suficiente para demonstrar uma melhora significativa precoce na evolução clínica do joelhoBACKGROUND: Each year in the US, it is estimated more than 250 million cases of anterior cruciate ligament injury, which makes surgical reconstruction a common procedure in the practice of sports medicine. There is still no consensus on how much activity to promote adequate rehabilitation without damaging the graft or produce an abnormal anterior laxity, with consequent damage to the meniscus and articular cartilage. PURPOSE: To analyze and compare the effect of an accelerated physiotherapy protocol in the anterior-stability and clinical outcome of patients undergoing reconstruction of the anterior cruciate ligament. METHODS: We included 29 subjects in the study who had total ACL rupture confirmed by MRI and underwent ligament reconstruction with patellar tendon. Patients were randomly allocated in two groups with different rehabilitation intervals: Accelerated Group (4 months) or Conventional Group (6 months). Preoperatively, six and four months postoperatively a blind evaluator recorded: anterior laxity by KT1000, Brawn (CYBEX) and knee function affected by IKDC (2000) and the Hop Test. RESULTS: the groups were similar relative to demographic data. There was no statistical difference in anterior laxity in the fourth month 0,92mm versus 1.33mm and 0.50mm in the sixth month versus 1,67mm being conventional group versus accelerated group respectively. In the fourth month the accelerated group showed a significant improvement (P <0.001) in the clinical evolution of the IKDC (2000) 79.50 versus 60.61 in the conventional group, this difference was not repeated in the sixth month. Muscle strength and the Hop Test, the fast group had higher values, but not significantly in both time points (P> 0.05). CONCLUSION: Based on these results, the Accelerated protocol when compared to conventional, do not differ as the anterior knee stability and was sufficient to establish an early significant improvement in the clinical outcome of the knee
47
Pereira, Paulo Paes. "Integração do tendão do músculo semitendíneo na reconstrução do ligamento cruzado anterior: estudo biomecânico, histológico e ressonância magnética em coelhos". Universidade de São Paulo, 2006. http://www.teses.usp.br/teses/disponiveis/5/5140/tde-29012007-143512/.
Resumo:
O estudo analisa experimentalmente a integração tendinosa no túnel ósseo femoral na reconstrução do ligamento cruzado anterior do joelho esquerdo com o tendão do músculo semitendíneo autólogo, utilizando imagens de ressonância magnética, teste biomecânico e análise histológica em 15 coelhos da raça Nova Zelândia. Após os períodos de quatro, oito e doze semanas do procedimento cirúrgico, os animais foram submetidos ao exame de ressonância magnética para avaliar o túnel femoral dos joelhos. A seguir os animais foram eutanasiados e os joelhos foram submetidos a testes de tração em uma máquina de ensaios mecânicos Kratos para verificar a integração do enxerto nos túneis e a exame histológico do túnel femoral. A análise dos resultados demonstrou integração mecânica do tendão no túnel femoral a partir da 4ª semana em todos os animais estudados e observou-se na histologia e nas imagens da ressonância magnética alterações do enxerto e da área ao redor de forma heterogênea, sugerindo um processo de cicatrização do tendão-osso, porém não se pode afirmar que ocorria a integração até a 12 semanas.The purpose was to verify the incorporation (healing) of the graft of the semitendinous tendon into the femoral bone tunnel after an anterior cruciate ligament reconstruction, and verify the post operative evolution of the biomechanical histology and magnetic resonance image analysis of the graft into the femoral bone tunnel. Fifteen New Zealand white rabbits were submitted to an intra-articular anterior cruciate ligament reconstruction in the left knee, using semitendinous tendon autograft. The rabbits were submitted to an magnetic resonance image at 4, 8 and 12 weeks after surgery, after which they were euthanized. The left knee of each rabbit was disarticulated and the anterior cruciate ligament reconstruction was tested for the biomechanical properties and histological analysis of the femoral tunnel. Every rabbit knee showed incorporation of the tendon at the femoral tunnel as of the fourth week in all of the knees studied. After the fourth week signs of integration occurred in the histological analysis and heterogeneous alterations in the magnetic resonance image of the graft and the surrounding areas, which suggests a healing process. Despite the biomechanical incorporation of the graft in the femoral bone tunnel after the fourth week it was not possible to affirm that there occurred incorporation of the graft until the completion of 12 weeks in histological and magnetic resonance image analysis.
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Nemanja, Kovačev. "Poređenje rezultata primarne i ponovne rekonstrukcije prednje ukrštene veze kolena". Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2016. http://www.cris.uns.ac.rs/record.jsf?recordId=100460&source=NDLTD&language=en.
Resumo:
Studija se sastojala od dva dela – eksperimentalnog i kliničkog. Eksperimentalni deo je sproveden na Fakultetu tehničkih nauka u Novom Sadu na Departmanu za mehanizaciju i konstrukciono mašinstvo. Trideset dve zglobne površine gornjeg okrajka golenjače sa pripojem prednje ukrštene veze je uzeto tokom totalne aloartroplastike kolena kod trideset dva pacijenta kod kojih je preoperativno načinjena AP i profilna radiografija sa standardnim uvećanjem u cilju merenja veličine kolena a uz prethodno potpisanu saglasnost pacijenata. Zatim je načinjeno trodimenzionalno skeniranje prostorne površine pripoja prednje ukrštene veze na golenjači u odnosu na ravan zglobne površine golenjače heptičkim uređajem „Phantom Omni®“ radi utvrđivanja korelacije između površine pripoja prednje ukrštene veze na golenjači i veličine platoa golenjače. U eksperimentalni deo su bili uključeni pacijenti oba pola metodom slučajnog izbora kod kojih je ugrađivana totalna proteza kolena a koji su prethodno potpisali informisani pristanak pacijenta na operativni zahvat na Klinici za ortopedsku hirurgiju i traumatologiju Kliničkog centra Vojvodine. Klinički deo studije je bio retrospektivno-prospektivnog karaktera i obuhvatio je ukupno 60 pacijenata izabranih metodom slučajnog izbora od kojih je ispitivanu grupu činilo 30 pacijenata u kojih je došlo do ponovne rupture prednje ukrštene veze levog ili desnog kolena nakon urađene primarne rekonstrukcije te je načinjena ponovna rekonstrukcija veze, i kontrolnu grupu koju je činilo 30 pacijenata u kojih je zbog rupture prednje ukrštene veze načinjena primarna rekonstrukcija nakon koje nije došlo do ponovne rupture. Kod svih pacijenata je rekonstrukcija prednje ukrštene veze kolena rađena kalemom kost-tetiva-kost. Ishod rekonstrukcije je procenjivan na osnovu Tegner bodovne skale, Lysholm i IKDC bodovne skale za koleno, artrometrijskog merenja Lachman testa, Pivot shift testa, poloţaja kalema i urađeno je poređenje dobijenih rezultata u ispitivanoj (revizionoj) i kontrolnoj grupi. U klinički deo istraţivanja su bili uključeni pacijenti oba pola, ţivotne dobi od 18 do 40 godina koji su operisani na Klinici za ortopedsku hirurgiju i traumatologiju Kliničkog centra Vojvodine u Novom Sadu a koji su dali informisani pristanak za uključivanje. Kriterijumi za isključivanje pacijenata iz kliničkog dela istraživanja su bili životna dob manja od 18 i veća od 40 godina, pojava težih opšte-hirurških komplikacija i prestanak želje pacijenta da dalje učestvuje u ovom istraživanju. Nakon sveobuhvatne analize dobijenih rezultata istraţivanja, zaključeno je da postoji korelacija između površine pripoja prednje ukrštene veze na golenjači i veličine platoa golenjače. Formula, načinjena matematičko-statističkim metodama za ovo istraživanje, adekvatna je i praktično primenljiva za predikciju površine pripoja prednje ukrštene veze na golenjači u velikom procentu slučajeva a na osnovu samo dva radiografska parametra izmerenih preoperativno – prednje-zadnjeg i unutrašnje-spoljašnjeg dijametra platoa golenjače. Korišćenje ove formule može da doprinese poboljšanju rezultata hirurškog lečenja pacijenata sa pokidanom prednjom ukrštenom vezom kolena. Takođe, zaključeno je da je uzrok neuspeha primarne rekonstrukcije multifaktorijalan kao i da nema statistički značajne razlike u ishodu između ispitanika sa dobrom i ispitanika sa lošom pozicijom kalema. Potvrđena je pretpostavka da je ishod ponovne rekonstrukcije prednje ukrštene veze kolena slabiji u odnosu na ishod primarne.This study consisted of two parts – experimental and clinical. Experimental part was conducted at the Department of Mechanization and Design Engineering of The Faculty of Technical Sciences, University of Novi Sad. Thirty two proximal tibial articular surfaces together with the anterior cruciate ligament insertion of thirty two patients were harvested during total knee arthroplasty. All patients had standard preoperative AP and profile radiographs with standard magnification in order to acquire the knee measurements. All patients previously signed the informed consent. The harvested proximal tibial articular surfaces were 3D scanned by a haptic device called „Phantom Omni®“ in order to determine the correlation between the size of the anterior cruciate ligament insertion site and the size of the tibial plateau. Thirty two randomly chosen patients of both sexes which had a knee arthroplasty were included in the experimental part of this study. All of the patients signed the informed consent at The Clinic for Orthopedic Surgery and Traumatology of The Clinical Centre of Vojvodina. The clinical part was a retrospective-prospective study. This part included 60 randomly chosen patients divided into two groups. The test group consisted of 30 patients who had undergone a revision anterior cruciate ligament reconstruction. The control group consisted of 30 patients who had undergone only primary anterior cruciate ligament reconstruction. A bone-tendon-bone graft was used for the reconstruction in all cases. The outcome was assessed by using Tegner activity scale, Lysholm knee scoring scale, IKDC score, arthrometric evaluation, Pivot shift test and the position of the graft. The results were compared between the test group and the control group. The clinical part of the study included 60 patients of both sexes, age 18-40 which were operated at The Clinic for Orthopedic Surgery and Traumatology of The Clinical Centre of Vojvodina. All of the patients signed the informed consent for participation in this study. The exclusion criteria were age under 18 and above 40, occurrence of severe general surgical complications and a patient wish to be excluded from further investigation. After a thorough analysis of the results, we concluded that the correlation between the size of the anterior cruciate ligament tibial insertion site and the size of the tibial plateau exists. Formula which was created for this study by using mathematical and statistical methods, is adequate and practically applicable for the prediction of size of the anterior cruciate ligament tibial insertion site in the majority of cases based on just two preoperative radiographic parameters – AP and profile diameter of the tibial plateau. The use of this formula may improve the outcome of the anterior cruciate ligament reconstruction. We also concluded that the cause of the primary anterior cruciate ligament reconstruction failure is multifactorial as well as that there is no statistically significant difference between the patients with good and the patients with poor graft position. We confirmed the assumption that the outcome of the revision anterior cruciate ligament reconstruction is poorer than the outcome of the primary anterior cruciate ligament reconstruction.
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Oliveira, Danilo Ricardo Okiishi de. "Avaliação de equilíbrio em esportistas após a reconstrução anatômica do ligamento cruzado anterior nas posições anteromedial e central: estudo clínico randomizado". Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/5/5140/tde-05112018-105705/.
Resumo:
Introdução: Na reconstrução anatômica do ligamento cruzado anterior (LCA) com banda simples, o diâmetro dos túneis não preenche totalmente sua área de origem e inserção. Estudos recentes sugerem que a banda anteromedial teria um papel dominante na função estabilizadora do LCA em qualquer grau de flexão, o que favoreceria o posicionamento dos túneis nessa região. No entanto, ao se buscar reproduzir a função das duas bandas com um enxerto simples, a escolha mais intuitiva é posicioná-lo na região central. O posicionamento inadequado do enxerto poderá resultar em uma instabilidade residual, mais evidente em indivíduos com alta demanda funcional, como é o caso de esportistas. Retomar a prática esportiva no mesmo nível não depende somente da estabilidade isolada do joelho, é preciso que o equilíbrio postural seja reestabelecido. O objetivo deste estudo foi comparar o posicionamento do enxerto na região anteromedial ou central na origem e inserção do LCA. Métodos: Trata-se de um estudo clínico prospectivo e randomizado, incluindo 42 esportistas (Tegner > 5) com lesão do LCA alocados para serem submetidos àreconstrução anatômica na posição anteromedial (22 pacientes - Grupo AM) ou central (20 pacientes - Grupo C). O desfecho primário foi obtido pelo valor médio da oscilação do centro de pressão (CP) de cada indivíudo no plano mediolateral (Xavg) avaliado na plataforma de força com apoio monopodálico simulando a posição de chute aos 6 meses de pós-operatório, enquanto os demais parâmetros de posturografia, escalas de Tegner, Lysholm, IKDC subjetivo, hop test e avaliação isocinética foram considerados desfechos secundários. Todos os resultados foram avaliados aos 6 e 12 meses, com exceção da escala de Tegner, avaliada somente aos 12 meses. Resultados: Na avaliação dos dados de posturografia fornecidos pela plataforma de força, o grupo C apresentou melhores resultados quando comparados ao grupo AM em três parâmetros de oscilação mediolateral do CP: valor médio (Xavg) na posição de chute aos 6 meses (-0,43 ± 0,15cm vs. -0,87 ± 0,18cm respectivamente, p < 0,05), deslocamento máximo (Xmax) na posição de apoio monopodálico simples aos 12 meses (1,05 ± 0,18cm vs. 1,28 ± 0,31 cm respectivamente, p < 0,05) e valor médio na posição de flexão do joelho aos 6 meses (0,31 + 1,35cm vs. -1,03 + 1,18cm respectivamente, p < 0,05). O grupo C também apresentou melhores resultados quando comparado ao grupo AM nas seguintes avaliações: índice de simetria do hop test aos 6 meses (93 ± 7% vs. 84 ± 17% respectivamente, p < 0,05) e aos 12 meses (100 ± 7% vs. 92 ± 7% respectivamente, p < 0,05) e deficit do pico de torque na velocidade angular de 60o/s aos 6 meses (12,55 ± 9,77 Nm vs. 22,9 ± 17,89 Nm respectivamente, p < 0,05). Conclusões: A reconstrução anatômica do LCA na posição central apresentou melhores resultados em três parâmetro de posturografia relacionados a oscilação no plano mediolateral (incluindo o desfecho primário), melhor índice de simetria no hop test e menor deficit do pico de torque na velocidade angular de 60o/s aos 6 meses, quando comparados à reconstrução na posição anteromedial. Não houve diferença significante quanto ao número de complicaçõesIntroduction: Bone tunnel diameters in anatomical single-bundle anterior cruciate reconstruction cannot fulfill the footprint area. The latest studies have suggested that the anteromedial bundle might play a dominant role in ACL function at any flexion degree. This fact could support placing the bone tunnel on the anteromedial bundle footprint. However, positioning the graft at the center of the footprint could be a more efficient way to mimic part of the two-bundle function. Improper graft positioning may result in residual instability, particularly in individuals with higher functional demand, such as sport practitioners. Returning to their sport at the same level as before their injury could not be defined by knee stability alone; a global evaluation provided by more comprehensive parameters, such as postural balance, should also be included. The main purpose of this study is to compare grafts on anteromedial or central area positions in an ACL footprint. Methods: A prospective, randomized clinical study included 42 sports practitioners (Tegner > 5) with ACL injury undergoing anatomic ACL reconstruction on the anteromedial footprint (22 patients - AM group) or at the central footprint area (20 patients - Group C). The primary outcome was based on a mean center pressure (CP) mediolateral oscillation parameter analysis of each individual simulating a kicking motion on a force plate. Other posturography parameters, Tegner, Lysholm and IKDC subjective scales, a hop test and an isokinetic evaluation were considered as secondary outcomes. All results were evaluated at 6 and 12 months, with the exception of the Tegner scale, which was evaluated only at 12 months. Results; Group C presented better results in three posturography parameters when compared with Group AM: mean mediolateral plane oscillation with kicking position at 6 months (-0,43 ± 0,15cm vs. -0,87 ± 0,18cm respectively, p < 0.05), maximum CP lateral displacement with the one leg standing position at 12 months (1,05 ± 0,18cm vs. 1,28 ± 0,31 cm respectively, p < 0.05) and mean mediolateral plane oscillation with knee flexed position (0.31 ± 1.35 cm vs. -1.03 ± 1.18 cm respectively, p < 0.05) and). Group C also presented better results in the following evaluations: symmetry index in the hop test at 6 months (93 ± 7% vs. 84 ± 17% respectively, p < 0.05) and at 12 months (100 ± 7% vs. 92 ± 7%, respectively, p < 0.05) and torque peak deficit on angular velocity of 60 o/s at 6 months (12.55 ± 9.77 Nm vs. 22.9 ± 17, 89 Nm respectively, p < 0.05). CONCLUSION: Anatomic single bundle ACL reconstruction in the center of the ACL footprint shows better results compared with the anteromedial ACL footprint area in three posturography parameters related to coronal plane balance, index of symmetry in the hop test and the peak of torque deficit on an angular velocity of 60 o/s at 6 months. Surgical complications were similar in both groups
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Peer, Maria. "Peri-surgical changes in functional capabilities associated with reconstructive knee surgery". Thesis, Queen Margaret University, 2017. https://eresearch.qmu.ac.uk/handle/20.500.12289/8974.
Resumo:
This thesis, using a meta-analytical review of the literature and a controlled longitudinal cohort trial, addresses a knowledge gap regarding peri-surgical changes in self-reported and objective measures of physical function, neuromuscular and sensorimotor performance capabilities of patients undergoing total knee arthroplasty (TKA). Responsiveness and patterns of change in perceived exertion (Borg Category-Ratio Scale [CR-10]), perceived task duration (PTD) and neuromuscular performance during an intermittent isometric fatigue task (IIF) were also investigated. Twenty-six individuals (50 % female, 66.8 ± 1.4 years) underwent evaluation at 3 and ~12 weeks pre-surgery, and again at 6 and 12 weeks post-operatively. Patient-reported outcomes including the Knee injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), 36-Item Short Form Health Survey (SF-36), Performance Profile and International Physical Activity Questionnaire demonstrated significant changes in peri-surgical functional status. Significant time related interactions between operated and control legs were observed for range of movement, knee circumference and neuromuscular performance indices of volitional peak force (PFV), rate of force development, rate of force relaxation, electromechanical delay activation and relaxation (vastus medialis). Items of the KOOS (pain and activities of daily living), OKS and SF-36 (role emotional) and PFV demonstrated significant differences at three weeks pre-surgery compared to baseline. Differences in the rate of change of performance at week 6 and week 12 post-surgery contributed most to the overall interactive- and main effect-related changes in the selected outcome measures. In estimating patient perceptions of exercise stress in an environment mimicking aspects of self-managed rehabilitative conditioning, the Borg Category-Ratio Scale and PTD showed a differential pattern of change during a novel IIF, with the latter perceptual tool showing congruency with patterns of objective fatigue-related loss of performance. This thesis provides the most comprehensive evaluation of peri-surgical physical function using patient-reported and objective (physical and physiological performance) outcomes. Further, this study is the first to contribute insight into how people undergoing TKA perceive exercise exertion and task duration. The research presents possible directions of future research to optimise physical function of TKA recipients.