Influence of knee flexion and femoral cross-pin insertion angle on posterolateral structures of the knee and lateral fixation lengths during ACL reconstruction

2012 ◽  
Vol 34 (5) ◽  
pp. 421-425
Author(s):  
Jin Goo Kim ◽  
Yong Seuk Lee ◽  
Jeong Ku Ha ◽  
Sung Soo Jun ◽  
Young Jin Chang
Keyword(s):  
Acl Reconstruction ◽  
Knee Flexion ◽  
Insertion Angle ◽  
Posterolateral Structures ◽  
Lateral Fixation

scholarly journals Knee strength, hop performance and self-efficacy at 4 months are associated with symmetrical knee muscle function in young athletes 1 year after an anterior cruciate ligament reconstruction

2019 ◽  
Vol 5 (1) ◽  
pp. e000504 ◽  
Author(s):  
Susanne Beischer ◽  
Eric Hamrin Senorski ◽  
Christoffer Thomeé ◽  
Kristian Samuelsson ◽  
Roland Thomeé
Keyword(s):  
Acl Reconstruction ◽  
Self Efficacy ◽  
Muscle Function ◽  
Knee Flexion ◽  
Early Stage ◽  
Knee Extension ◽  
Young Athletes ◽  
Patient Demographics ◽  
Patient Reported ◽  
Flexion Strength

ObjectivesWe investigated whether patient demographics, 4-month patient-reported outcomes (PRO) and muscle function predicted young athletes regaining symmetrical muscle function in five tests of muscle function 1 year after ACL reconstruction.MethodsWe extracted data on patient demographics, PROs and the results of five tests of muscle function from a rehabilitation-specific register. Athletes were 15–30 years of age, involved in knee-strenuous sport and had undergone a primary ACL reconstruction. The primary outcome was achieving a Limb Symmetry Index of ≥90% for the battery of tests 1 year after ACL reconstruction. Patient demographics, muscle-function data and results for PROs at the 4-month follow-up were analysed.ResultsIn all, 237 athletes (59% female; mean age 22±4 years) were included in the study. One year after ACL reconstruction, 26% (62/237) of the included athletes had achieved symmetrical muscle function. Univariable analysis showed that symmetrical muscle function was associated with present self-efficacy, OR 1.28 (95% CI 1.04 to 1.58, p=0.011), knee-extension strength, OR 1.73 (95% CI 1.28 to 2.34), knee-flexion strength, OR 1.39 (95% CI 1.07 to 1.81), vertical hop, OR 1.77 (95% CI 1.27 to 2.45), single-leg hop for distance, OR 1.98 (95% CI 1.24 to 3.17) and side hop, OR 1.64 (95% CI 1.15 to 2.33).ConclusionSymmetrical knee-extension and knee-flexion strength, a more symmetrical hop performance and higher present self-efficacy at an early stage all increased the odds of achieving symmetrical muscle function in young athletes 1 year after ACL reconstruction.

The Contribution of Partial Meniscectomy to Preoperative Laxity and Laxity After Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction: In Vivo Kinematics With Navigation

2019 ◽  
Vol 47 (13) ◽  
pp. 3203-3211
Author(s):  
Alberto Grassi ◽  
Stefano Di Paolo ◽  
Gian Andrea Lucidi ◽  
Luca Macchiarola ◽  
Federico Raggi ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Single Bundle ◽  
Anatomic Acl Reconstruction ◽  
Medial Meniscectomy ◽  
Lateral Meniscectomy ◽  
Anterior Cruciate

Background: Limited in vivo kinematic information exists on the effect of clinical-based partial medial and lateral meniscectomy in the context of anterior cruciate ligament (ACL) reconstruction. Hypothesis: In patients with ACL deficiency, partial medial meniscus removal increases the anteroposterior (AP) laxity with compared with those with intact menisci, while partial lateral meniscus removal increases dynamic laxity. In addition, greater postoperative laxity would be identified in patients with partial medial meniscectomy. Study design: Cross-sectional study; Level of evidence, 3. Methods: A total of 164 patients with ACL tears were included in the present study and divided into 4 groups according to the meniscus treatment they underwent: patients with partial lateral meniscectomy (LM group), patients with partial medial meniscectomy (MM group), patients with partial medial and lateral meniscectomy (MLM group), and patients with intact menisci who did not undergo any meniscus treatment (IM group). A further division in 2 new homogeneous groups was made based on the surgical technique: 46 had an isolated single-bundle anatomic ACL reconstruction (ACL group), while 13 underwent a combined single-bundle anatomic ACL reconstruction and partial medial meniscectomy (MM-ACL group). Standard clinical laxities (AP translation at 30° of knee flexion, AP translation at 90° of knee flexion) and pivot-shift (PS) tests were quantified before and after surgery by means of a surgical navigation system dedicated to kinematic assessment. The PS test was quantified through 3 different parameters: the anterior displacement of the lateral tibial compartment (lateral AP); the posterior acceleration of the lateral AP during tibial reduction (posterior acceleration); and finally, the area included by the lateral AP translation with respect to the flexion/extension angle (area). Results: In the ACL-deficient status, the MM group showed a significantly greater tibial translation compared with the IM group ( P < .0001 for AP displacement at 30° [AP30] and 90° [AP90] of flexion) and the LM group ( P = .002 for AP30 and P < .0001 for AP90). In the PS test, the area of LM group was significantly larger (57%; P = .0175) than the one of the IM group. After ACL reconstruction, AP translation at 30° was restored, while the AP90 remained significantly greater at 1.3 mm ( P = .0262) in the MM-ACL group compared with those with intact menisci. Conclusion: Before ACL reconstruction, partial medial meniscectomy increased AP laxity at 30° and 90° and lateral meniscectomy increased dynamic PS laxity with respect to intact menisci. Anatomic single-bundle ACL reconstruction decreased laxities, but a residual anterior translation of 1.3 mm at 90° remained in patients with partial medial meniscectomy, with respect to those with intact menisci.

scholarly journals Proprioception following the Anterior Cruciate Ligament Reconstruction with Tibialis Anterior Tendon Allograft

2019 ◽  
Vol 33 (07) ◽  
pp. 722-727 ◽  
Author(s):  
Enes Büyükafşar ◽  
Selda Başar ◽  
Ulunay Kanatli
Keyword(s):  
Acl Reconstruction ◽  
Patient Group ◽  
Knee Flexion ◽  
Tibialis Anterior ◽  
Cruciate Ligament ◽  
Standing Position ◽  
Control Group ◽  
Tibialis Anterior Tendon ◽  
Tendon Allograft ◽  
Anterior Cruciate

AbstractAfter the anterior cruciate ligament (ACL) reconstruction, a loss of proprioception is observed and it can continue years after the operation. The aim of this study is to evaluate proprioception in standing position at different knee flexion angles in patients who underwent ACL reconstruction with tibialis anterior tendon allograft. The study included 34 patients who underwent ACL reconstruction with tibialis anterior tendon allograft and 34 healthy individuals. Proprioception was evaluated in standing position at 15°, 30°, 60° flexion angles with the active joint position sense (AJPS) method using digital inclinometer. Proprioception deviation angle was found to be higher in the operated leg at 30° and 60° flexion angles in the patient group compared with the other leg (p < 0.05), the biggest proprioception difference was between the 15° and 60° flexion angles in both the patient and the control group (p < 0.05) that the difference between 15° and 30° flexion angles is lowest (p < 0.05), and that these differences are higher in the operated leg of the patient group compared with the other leg of the patient group and to the dominant leg of the control group (p < 0.05). As approximately 4 years after ACL reconstruction with tibialis anterior tendon allograft, loss of proprioception at 60° knee flexion continued, ACL injury related to loss of proprioception may occur at angles higher than 30° flexion. Thus, patients may be provided with proprioception-enhancing rehabilitation in the long term, particularly, at flexion angles above medium levels.

scholarly journals Knee Flexion Strength Before and After ACL Reconstruction Using Hamstring Tendon Autografts

2013 ◽  
Vol 18 (3) ◽  
pp. 130-133 ◽  
Author(s):  
Mohammad Kazem Emami Meybodi ◽  
Morteza Jannesari ◽  
Alireza Rahim Nia ◽  
Habib Yaribeygi ◽  
Vahid Sobhani Firoozabad ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Knee Flexion ◽  
Hamstring Tendon ◽  
Before And After ◽  
Flexion Strength

scholarly journals Fibular Collateral Ligament: Varus Stress Radiographic Analysis Using 3 Different Clinical Techniques

2018 ◽  
Vol 6 (5) ◽  
pp. 232596711877017 ◽  
Author(s):  
Patrick W. Kane ◽  
Mark E. Cinque ◽  
Gilbert Moatshe ◽  
Jorge Chahla ◽  
Nicholas N. DePhillipo ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Knee Flexion ◽  
Measurement Techniques ◽  
Lateral Compartment ◽  
Reference Points ◽  
Collateral Ligament ◽  
Fibular Collateral Ligament ◽  
Stress Radiographs ◽  
Varus Stress ◽  
Grade Iii

Background: Fibular collateral ligament (FCL) tears are challenging to diagnose. Left untreated, FCL tears lead to residual ligament instability and increased joint loading on the medial compartment of the knee. Additionally, when a concomitant anterior cruciate ligament (ACL) reconstruction is performed, increased forces on reconstruction grafts occur, which may lead to premature graft failure. Stress radiographs constitute a reliable and validated technique for the objective assessment of a complete grade III FCL tear. Purpose: To evaluate side-to-side difference (SSD) values of lateral compartment gapping on varus stress radiographs in patients with a grade III injury to the FCL. Additionally, to evaluate the reliability and reproducibility of 3 different measurement techniques that used various radiographic reference points. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Inclusion criteria were patients who sustained an FCL with or without a concomitant ACL injury and underwent a combined FCL + ACL reconstruction between 2010 and 2016. Patients were excluded if they had a complete posterolateral corner injury, open physes, intra-articular fracture, meniscal root tear, other ligament injury, or prior surgery on either knee. All FCL tears were diagnosed with a clinical varus stress examination at 0° and 20° of knee flexion and varus stress radiographs at 20° of knee flexion measured in 3 different locations. The SSD for lateral compartment gapping was obtained from the varus stress radiographs and then statistically compared for interrater and intrarater reliability. Results: A total of 98 consecutive patients (50 males, 48 females; 13 isolated FCL injuries, 85 combined ACL + FCL injuries) with mean age 33.6 years (range, 18-69 years) were included. Measurement techniques 1, 2, and 3 had mean ± SD lateral compartment SSDs of 2.4 ± 0.20 mm, 2.2 ± 0.20 mm, and 2.0 ± 0.03 mm, respectively (no significant differences). Interrater reliabilities for the 3 measuring techniques were 0.83, 0.86, and 0.91, respectively, while intrarater reliabilities were 0.99, 0.77, and 0.99, respectively. Conclusion: This study demonstrated a lower SSD value of 2.2 mm to be consistent with a grade III FCL tear on clinician-applied varus stress radiographs in the clinical setting. Although all SSD measurement locations had excellent reliability, the method using the midpoint of the lateral tibial plateau was found to be the most reproducible.

scholarly journals HAMSTRING MORPHOLOGY AND STRENGTH REMAIN ALTERED 2 YEARS FOLLOWING A HAMSTRING GRAFT IN ACL RECONSTRUCTION

2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0018 ◽  
Author(s):  
Christopher J. Vertullo ◽  
Jason M. Konrath ◽  
Benjamin Kennedy ◽  
Hamish Bush ◽  
Rodney S. Barrett ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Acl Reconstruction ◽  
Knee Flexion ◽  
Biceps Femoris ◽  
Muscle Size ◽  
Tibial Rotation ◽  
Hamstring Graft ◽  
Knee Muscle ◽  
Donor Muscle ◽  
Knee Muscle Strength

Background: The hamstring graft used in anterior cruciate ligament (ACL) reconstruction has been shown to lead to changes to the semitendinosus and gracilis musculature. This study further evaluated the effect of the surgery on hamstring muscle morphology and knee muscle strength at 2 years post-surgery. Hypotheses: (1) Loss of donor muscle size would significantly correlate with knee muscle strength deficits (2) Loss of donor muscle size would be greater for muscles that do not experience tendon regeneration, and (3) Morphological adaptations would also be evident in non-donor knee muscles. Study Design: Cross sectional evaluation. Methods: 20 participants (14 male, 6 female, 29 ± 7 years, 82 ± 15 kg) that had undergone a hamstring graft in ACL reconstruction at least two years previously, underwent bilateral MRI and subsequent strength testing. Muscle and tendon volumes, peak CSA’s and lengths were determined for 12 muscles and 6 functional muscle groups of the surgical and contralateral limbs. Peak isokinetic concentric strength was measured in knee flexion/extension and internal/external tibial rotation. Results: Only 50% of the patients regenerated both the semitendinosus and gracilis tendons. The regenerated tendons were longer with larger volume and CSA compared to the contralateral side. Deficits in semitendinosus and gracilis muscle size were greater for tendons that did not regenerate. In addition, combined hamstrings (semitendinosus, semimembranosus, biceps femoris) and combined medial knee muscles (semitendinosus, semimembranosus, gracilis, vastus medialis, medial gastrocnemius, sartorius) on the surgical side were reduced in volume by 12% and 10% respectively. A 7% larger volume was observed in the surgical leg for the biceps femoris and corresponded with a lower internal/external tibial rotation strength ratio. The difference in volume, peak CSA and length of the semitendinosus and gracilis correlated significantly with the deficit in knee flexion strength with Pearson correlations of 0.51, 0.57 and 0.61 respectively. Conclusion: The muscle-tendon properties of the semitendinosus and gracilis are substantially altered following harvesting, and these alterations may contribute to knee flexor weakness in the surgical limb. These deficits are more pronounced in tendons that do not regenerate and are only partially offset by compensatory hypertrophy of other hamstring muscles. Clinical Relevance: Surgeons should consider muscle retraction of the hamstring following tendon harvest in their choice of graft option for ACL reconstruction.

Measuring only hop distance during single leg hop testing is insufficient to detect deficits in knee function after ACL reconstruction: a systematic review and meta-analysis

2019 ◽  
Vol 54 (3) ◽  
pp. 139-153 ◽  
Author(s):  
Argyro Kotsifaki ◽  
Vasileios Korakakis ◽  
Rod Whiteley ◽  
Sam Van Rossom ◽  
Ilse Jonkers
Keyword(s):  
Systematic Review ◽  
Acl Reconstruction ◽  
Knee Flexion ◽  
Meta Analysis ◽  
Grey Literature ◽  
Reaction Force ◽  
Knee Function ◽  
Cochrane Library ◽  
Vertical Ground Reaction Force ◽  
Peak Knee

ObjectiveTo systematically review the biomechanical deficits after ACL reconstruction (ACLR) during single leg hop for distance (SLHD) testing and report these differences compared with the contralateral leg and with healthy controls.DesignSystematic review with meta-analysis.Data sourcesA systematic search in Pubmed (Ovid), EMBASE, CINAHL, Scopus, Web of Science, PEDro, SPORTDiscus, Cochrane Library, grey literature and trial registries, was conducted from inception to 1 April 2018.Eligibility criteria for selecting studiesStudies reporting kinematic, kinetic and/or electromyographic data of the ACLR limb during SLHD with no language limits.ResultsThe literature review yielded 1551 articles and 19 studies met the inclusion criteria. Meta-analysis revealed strong evidence of lower peak knee flexion angle and knee flexion moments during landing compared with the uninjured leg and with controls. Also, moderate evidence (with large effect size) of lower knee power absorption during landing compared with the uninjured leg. No difference was found in peak vertical ground reaction force during landing. Subgroup analyses revealed that some kinematic variables do not restore with time and may even worsen.ConclusionDuring SLHD several kinematic and kinetic deficits were detected between limbs after ACLR, despite adequate SLHD performance. Measuring only hop distance, even using the healthy leg as a reference, is insufficient to fully assess knee function after ACLR.PROSPERO trial registration number CRD42018087779.

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