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Piyush Mahapatra, Saman Horriat, Bobby S Anand
BACKGROUND: This article provides a detailed narrative review on the history and current concepts surrounding ligamentous repair techniques in athletic patients. In particular, we will focus on the anterior cruciate ligament (ACL) as a case study in ligament injury and ligamentous repair techniques. PubMed (MEDLINE), EMBASE and Cochrane Library databases for papers relating to primary anterior cruciate ligament reconstruction were searched by all participating authors. All relevant historical papers were included for analysis...
June 15, 2018: Journal of Experimental Orthopaedics
José F Vega, Kurt P Spindler
This article highlights the Multicenter Orthopedic Outcomes Network (MOON) study of anterior cruciate ligament reconstruction, from its inception in 1991 to the follow-on studies in progress currently. Lessons learned throughout the process are emphasized.
July 2018: Clinics in Sports Medicine
Malou E Slichter, Nienke Wolterbeek, K Gie Auw Yang, Jacco A C Zijl, Tom M Piscaer
BACKGROUND: Posterolateral rotatory instability (PLRI) of the knee can easily be missed, because attention is paid to injury of the cruciate ligaments. If left untreated this clinical instability may persist after reconstruction of the cruciate ligaments and may put the graft at risk of failure. Even though the dial test is widely used to diagnose PLRI, no validity and reliability studies of the manual dial test are yet performed in patients. This study focuses on the reliability of the manual dial test by determining the rater agreement...
June 14, 2018: Journal of Experimental Orthopaedics
Krishn Khanna, Abhinav Janghala, Nirav K Pandya
Background: Posterior hamstring harvest has been described in the adult population in a limited fashion, but no study is available describing the use of posterior hamstring harvest in an active pediatric and adolescent cohort. At times, surgeons may be faced with a challenging anterior harvest due to patient anatomic characteristics, particularly the anatomic features and size of the pes tendons. Clinicians need to have multiple harvest approaches at their disposal. Complications with hamstring harvest such as premature graft transection are more problematic in this population due to higher failure rates with allograft tissue...
June 2018: Orthopaedic Journal of Sports Medicine
Kåre Amtoft Nissen, Niclas Højgaard Eysturoy, Torsten Grønbech Nielsen, Martin Lind
Background: The literature on revision anterior cruciate ligament (ACL) reconstruction (ACLR) outcomes is generally sparse, but previous studies have demonstrated that autograft use results in improved sports function and patient-reported outcome measures compared with allograft. However, knowledge is still lacking regarding the impact of graft type on rates of re-revision. Purpose: To investigate the clinical outcomes and failure rates of revision ACLRs performed with either allograft or autograft...
June 2018: Orthopaedic Journal of Sports Medicine
Tsuneari Takahashi, Masashi Kimura, Keiichi Hagiwara, Takashi Ohsawa, Katsushi Takeshita
Several investigators have developed anterior cruciate ligament reconstructions (ACLR) with remnant tissue preservation (RTP) and have reported better clinical outcomes. However, the effects of RTP remain controversial. To date, no reports have compared both clinical and radiological outcomes of anatomic double-bundle ACLR using the hamstring tendon and outside-in technique with/without RTP. This article evaluates the effectiveness of RTP in ACLR on knee stability and graft maturation. In total, 75 patients with unilateral ACL injury who had undergone anatomic double-bundle ACLR using autografted hamstring tendon either with RTP (Group P, n  = 43) or without (Group N, n  = 32) were enrolled...
June 13, 2018: Journal of Knee Surgery
Anupam Das, C S Yadav, Shivanand Gamanagatti, R M Pandey, Ravi Mittal
The outcome of single-bundle anterior cruciate ligament (ACL) reconstruction depends largely on the anatomic placement of bone tunnel. The lateral intercondylar ridge (LIR) and bifurcate ridge (BR) are useful bony landmarks for femoral tunnel placement. The purpose of our study was to compare the bony landmarks of ACL footprint on femur by three-dimensional computed tomography (3D CT) scan and arthroscopy in chronic ACL-deficient knees. Fifty patients above 18 years of age who were diagnosed of having ACL tear were selected for the study...
June 13, 2018: Journal of Knee Surgery
David A Boyce, Chantal Prewitt
CASE DESCRIPTION: A 17-year-old male post anterior cruciate ligament reconstruction complained of the inability to extend his great toe immediately following surgery. BACKGROUND: Neurological injuries following knee arthroscopy have been reported to occur between 0.6%-2.5%. The most commonly injured nerves are the saphenous and common fibular nerve (CFN). Great toe-drop secondary to isolated denervation of the extensor hallucis longus (EHL), has only been reported one time in the literature...
June 13, 2018: Physiotherapy Theory and Practice
Abhinav Bhardwaj, Narender Singh Solanki, Hemant Jain, Kishore Raichandani, Surbhi Raichandani, Vistasp Daruwalla
Background: The knee joint is frequently involved in sports and other injuries with Anterior cruciate ligament being a very common ligament to be injured. The Lachman test, pivot-shift test, and instrumented knee laxity examination are frequently used and reported for evaluation of ACL reconstruction. The aim of this study is to examine and evaluate the relationships between the clinical assessment of ligament stability and subjective assessment of symptoms and function after ACL reconstruction...
April 2018: Journal of Clinical Orthopaedics and Trauma
Rajeev Raj Manandhar, Karthik Chandrashekhar, Vinay Kumaraswamy, Santosh Sahanand, David Rajan
Background: Surgical techniques of ACL reconstruction (ACLR) have evolved over the past three decades along with debate regarding timing of reconstruction. It was a widespread belief that the timing of surgery was an important factor in determining the resulting stiffness after ACLR. Delayed rather than early reconstruction of the ACL is the current recommended treatment since it is thought to give a better functional outcome. However, there is no consensus in the literature regarding the optimal time of surgical intervention...
April 2018: Journal of Clinical Orthopaedics and Trauma
Thomas Matthai, Vinu M George, Anbu S Rao, Anil T Oommen, Ravi J Korula, Suresh Devasahayam, Pradeep M Poonnoose
Introduction: The Anterior cruciate ligament (ACL) is the most commonly injured ligament around the knee and is best reconstructed with a biological graft. For ideal graft fixation, there should be sufficient initial strength to avoid failure of fixation and sufficient stiffness to restore the stability of the knee and to avoid gradual loosening in the post-operative period.When considering fixation of Bone Patellar Tendon Bone (BPTB) grafts to the tibia, the interference screw is considered to be the gold standard...
April 2018: Journal of Clinical Orthopaedics and Trauma
A Biazzo, A Manzotti, K Motavalli, N Confalonieri
Introduction: The aim of this paper is to present our experience with femoral press-fit fixation in anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft. Methods: The patient population was randomly placed in two groups: group A (58 patients), who underwent femoral screw fixation; group B (62 patients), who underwent femoral press-fit fixation. Results: At last follow-up 9.2% of patients were lost; 28% of patients in group A and 64% of patients in group B had excellent International Knee Documentation Committee score (grade A); 66% of patients in group A and 32% of patients in group B had good International Knee Documentation Committee scores (grade B)...
April 2018: Journal of Clinical Orthopaedics and Trauma
Adam Meierbachtol, William Yungtum, Eric Paur, John Bottoms, Terese L Chmielewski
Study Design Retrospective cohort study. Background Decreased psychological readiness for sport contributes to poor return to sport rates after anterior cruciate ligament reconstruction (ACLR). Advanced ACLR rehabilitation is used to improve functional readiness for sport, but the effect on psychological readiness is unknown. Objective To examine changes in psychological and functional measures, and readiness for sport based on these measures, in patients with ACLR following advanced group training. Methods Patients with primary ACLR enrolled in a 5-week group training program after completing traditional physical therapy...
June 12, 2018: Journal of Orthopaedic and Sports Physical Therapy
Susan M Sigward, Ming-Sheng M Chan, Paige E Lin, Sara Y Almansouri, Kristamarie A Pratt
Study Design Controlled laboratory study, longitudinal. Background Decreased extensor moments in the surgical knee during bilateral squats can persist longer than one year following anterior cruciate ligament reconstruction (ACLr). This is accomplished using inter-limb and intra-limb compensations. Objectives Assess loading during squatting longitudinally, 3 and 5 months post-ACLr, and to determine the extent to which inter- and intra-limb compensations contribute to reduced knee extensor moments. Methods 11 individuals (4 males) underwent 3-dimensional motion analysis of a squat at 3 and 5 months post-ACLr...
June 12, 2018: Journal of Orthopaedic and Sports Physical Therapy
Grant E Norte, Jay N Hertel, Susan A Saliba, David R Diduch, Joseph M Hart
CONTEXT:   Central and peripheral neural adaptations have been identified after anterior cruciate ligament (ACL) injury and reconstruction (ACLR) and are hypothesized to contribute to posttraumatic muscle dysfunction. Limited evidence exists about the temporal nature of neuromuscular adaptations during early and late-term phases of recovery after ACLR, and no researchers have studied patients with posttraumatic osteoarthritis. OBJECTIVE:   To compare quadriceps neuromuscular function less than 2 years ( early) and more than 2 years ( late) after ACLR, including in patients who experienced posttraumatic knee osteoarthritis...
June 12, 2018: Journal of Athletic Training
Martin Eichinger, Werner Schmoelz, René Attal, Armin Moroder, Christian Heinz Heinrichs, Vinzenz Smekal, Raul Mayr
BACKGROUND: Ideal diameter for tibial interference screw fixation of the anterior cruciate ligament (ACL) graft remains controversial. Tibial graft fixation with screws matching the tunnel diameter vs. one-millimetre oversized screws were compared. METHODS: In 32 cadaveric porcine tibiae, bovine extensor tendons with a diameter of eight millimetres were fixed in (I) a primary ACL reconstruction scenario with eight-millimetre tibial tunnels (pACL), with eight-millimetre (pACL-8) vs...
June 7, 2018: Knee
Paula Calori Domingues, Felipe de Souza Serenza, Thiago Batista Muniz, Luciano Fonseca Lemos de Oliveira, Rodrigo Salim, Fabricio Fogagnolo, Mauricio Kfuri, Aline Miranda Ferreira
OBJECTIVES: The objective of this study was to evaluate the dynamic balance of the injured and uninjured limb before and after the anterior cruciate ligament (ACL) reconstruction and compare with the control group. STUDY DESIGN: Prospective longitudinal. SETTING: Biomechanics laboratory. PARTICIPANTS: Participants are 24 males (mean age, 27.5 years) with unilateral ACL injury (ACLG) and 24 male healthy volunteers (CG)...
June 6, 2018: Knee
Molly Day, Kyle Hancock, Natalie Glass, Matthew Bollier
Outcome instruments have become an essential part of the evaluation of functional recovery after anterior cruciate ligament (ACL) reconstruction. Although the clinical examination provides important objective information to assess graft integrity, stability, range of motion, and strength, these measurements do not take the patient's perception into account. There are many knee outcome instruments, and it is challenging for surgeons to understand how to interpret clinical research and utilize these measures in a practical way...
May 2018: American Journal of Orthopedics
Daniel E Cooper, Warren R Dunn, Laura J Huston, Amanda K Haas, Kurt P Spindler, Christina R Allen, Allen F Anderson, Thomas M DeBerardino, Brett Brick A Lantz, Barton Mann, Michael J Stuart, John P Albright, Annunziato Ned Amendola, Jack T Andrish, Christopher C Annunziata, Robert A Arciero, Bernard R Bach, Champ L Baker, Arthur R Bartolozzi, Keith M Baumgarten, Jeffery R Bechler, Jeffrey H Berg, Geoffrey A Bernas, Stephen F Brockmeier, Robert H Brophy, Charles A Bush-Joseph, J Brad Butler V, John D Campbell, James L Carey, James E Carpenter, Brian J Cole, Jonathan M Cooper, Charles L Cox, R Alexander Creighton, Diane L Dahm, Tal S David, David C Flanigan, Robert W Frederick, Theodore J Ganley, Elizabeth A Garofoli, Charles J Gatt, Steven R Gecha, James Robert Giffin, Sharon L Hame, Jo A Hannafin, Christopher D Harner, Norman Lindsay Harris, Keith S Hechtman, Elliott B Hershman, Rudolf G Hoellrich, Timothy M Hosea, David C Johnson, Timothy S Johnson, Morgan H Jones, Christopher C Kaeding, Ganesh V Kamath, Thomas E Klootwyk, Bruce A Levy, C Benjamin Ma, G Peter Maiers, Robert G Marx, Matthew J Matava, Gregory M Mathien, David R McAllister, Eric C McCarty, Robert G McCormack, Bruce S Miller, Carl W Nissen, Daniel F O'Neill, Brett D Owens, Richard D Parker, Mark L Purnell, Arun J Ramappa, Michael A Rauh, Arthur C Rettig, Jon K Sekiya, Kevin G Shea, Orrin H Sherman, James R Slauterbeck, Matthew V Smith, Jeffrey T Spang, Steven J Svoboda, Timothy N Taft, Joachim J Tenuta, Edwin M Tingstad, Armando F Vidal, Darius G Viskontas, Richard A White, James S Williams, Michelle L Wolcott, Brian R Wolf, James J York, Rick W Wright
BACKGROUND: The occurrence of physiologic knee hyperextension (HE) in the revision anterior cruciate ligament reconstruction (ACLR) population and its effect on outcomes have yet to be reported. Hypothesis/Purpose: The prevalence of knee HE in revision ACLR and its effect on 2-year outcome were studied with the hypothesis that preoperative physiologic knee HE ≥5° is a risk factor for anterior cruciate ligament (ACL) graft rupture. STUDY DESIGN: Cohort study; Level of evidence, 2...
June 1, 2018: American Journal of Sports Medicine
David John Saxby, Adam L Bryant, Ans Van Ginckel, Yuanyuan Wang, Xinyang Wang, Luca Modenese, Pauline Gerus, Jason M Konrath, Karine Fortin, Tim V Wrigley, Kim L Bennell, Flavia M Cicuttini, Christopher Vertullo, Julian A Feller, Tim Whitehead, Price Gallie, David G Lloyd
PURPOSE: External loading of osteoarthritic and healthy knees correlates with current and future osteochondral tissue state. These relationships have not been examined following anterior cruciate ligament reconstruction. We hypothesised greater magnitude tibiofemoral contact forces were related to increased prevalence of osteochondral pathologies, and these relationships were exacerbated by concomitant meniscal injury. METHODS: This was a cross-sectional study of 100 individuals (29...
June 7, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
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