scholarly journals Effect of Fatigue on Functional Stability of the Knee: Particularities of Female Handball Players

2019 ◽  
Vol 40 (07) ◽  
pp. 468-476 ◽  
Author(s):  
Timothée Gillot ◽  
Maxime L'Hermette ◽  
Typhanie Garnier ◽  
Claire Tourny-Chollet
Keyword(s):  
Cruciate Ligament ◽  
Joint Laxity ◽  
Ligament Injury ◽  
Anterior Tibial Translation ◽  
Knee Stability ◽  
Load Curve ◽  
Fatigue Protocol ◽  
Flexion Extension ◽  
Anterior Tibial ◽  
Tibial Translation

AbstractThe risk of anterior cruciate ligament injury in female handball players is high. Fatigue of active stabilizers and increases in joint laxity are often mentioned in the literature as causal factors. However, no studies have been carried out on this population. Our objective is to determine the effect of muscle fatigue on active and passive knee stability in female handball players. This prospective study assessed tibiofemoral joint laxity, as well as hamstring and quadriceps strength, before (Tinitial), during and 3 min after (Tfinal) an isokinetic fatigue protocol (25 repetitions of knee flexion / extension at 180°.s−1). Laxity values (slope of the displacement-load curve and anterior tibial translation) were measured using a GNRB-Rotab® arthrometer; torque values were measured at specific joint angles and peak muscle torque using an isokinetic dynamometer. Nineteen women (20.9±2.4 years, 62.0±4.9 kg, 166±5 cm) were included. Normalized peak torque decreased significantly between the first three and last three repetitions of the fatigue protocol (p<0.0001, ES=3.2 and 3.2). Slope of the displacement-load curve and anterior tibial translation, functional and conventional ratios did not change significantly between Tinitial and Tfinal. Active and passive markers of knee stability were not altered by a fatigue protocol in female handball players, suggesting these players have a large capacity for recovery. These results suggest that muscle strengthening to prevent ACL injury in female handball players may be inappropriate.Level of evidence: Level 2b, Prospective Cohort.

Anterior Cruciate Ligament Graft Conditioning Required to Prevent an Abnormal Lachman and Pivot Shift After ACL Reconstruction: A Robotic Study of 3 ACL Graft Constructs

2019 ◽  
Vol 47 (6) ◽  
pp. 1376-1384 ◽  
Author(s):  
Frank R. Noyes ◽  
Lauren E. Huser ◽  
Brad Ashman ◽  
Michael Palmer
Keyword(s):  
Patellar Tendon ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Anterior Tibial Translation ◽  
Acl Graft ◽  
Flexion Extension ◽  
Anterior Tibial ◽  
Tibial Translation ◽  
Bone Patellar Tendon ◽  
Anterior Posterior

Background: Anterior cruciate ligament (ACL) graft conditioning protocols to decrease postoperative increases in anterior tibial translation and pivot-shift instability have not been established. Purpose: To determine what ACL graft conditioning protocols should be performed at surgery to decrease postoperative graft elongation after ACL reconstruction. Study Design: Controlled laboratory study. Methods: A 6 degrees of freedom robotic simulator evaluated 3 ACL graft constructs in 7 cadaver knees for a total of 19 graft specimens. Knees were tested before and after ACL sectioning and after ACL graft conditioning protocols before reconstruction. The ACL grafts consisted of a 6-strand semitendinosus-gracilis TightRope, bone–patellar tendon–bone TightRope, and bone–patellar tendon–bone with interference screws. Two graft conditioning protocols were used: (1) graft board tensioning (20 minutes, 80 N) and (2) cyclic conditioning (5°-120° of flexion, 90-N anterior tibial load) after graft reconstruction to determine the number of cycles needed to obtain a steady state with no graft elongation. After conditioning, the grafts were cycled a second time under anterior-posterior loading (100 N, 25° of flexion) and under pivot-shift loading (100 N anterior, 5-N·m internal rotation, 7 N·m valgus) to verify that the ACL flexion-extension conditioning protocol was effective. Results: Graft board tensioning did not produce a steady-state graft. Major increases in anterior tibial translation occurred in the flexion-extension graft-loading protocol at 25° of flexion (mean ± SD: semitendinosus-gracilis TightRope, 3.4 ± 1.1 mm; bone–patellar tendon–bone TightRope, 3.2 ± 1.0 mm; bone–patellar tendon–bone with interference screws, 2.4 ± 1.5 mm). The second method of graft conditioning (40 cycles, 5°-120° of flexion, 90-N anterior load) produced a stable conditioned state for all grafts, as the anterior translations of the anterior-posterior and pivot-shift cycles were statistically equivalent ( P < .05, 1-20 cycles). Conclusion: ACL graft board conditioning protocols are not effective, leading to deleterious ACL graft elongations after reconstruction. A secondary ACL graft conditioning protocol of 40 flexion-extension cycles under 90-N graft loading was required for a well-conditioned graft, preventing further elongation and restoring normal anterior-posterior and pivot-shift translations. Clinical Relevance: There is a combined need for graft board tensioning and robust cyclic ACL graft loading before final graft fixation to restore knee stability.

Postoperative physical therapy rehabilitation of patients with anterior cruciate ligament injury - A Bibliographic Review

2020 ◽  
pp. 35098-35102
Author(s):  
Keyword(s):  
Knee Joint ◽  
Cruciate Ligament ◽  
Complex Structure ◽  
Ligament Injury ◽  
Anterior Tibial Translation ◽  
Acl Injuries ◽  
Anterior Tibial ◽  
Postoperative Physical Therapy ◽  
Anterior Cruciate ◽  
Tibial Translation

The knee joint is considered a complex structure, which provides stability and mobility, which is composed of bone, muscle and ligament structures. ACL rupture causes knee joint instability with excessive internal rotation and anterior tibial translation, especially when reaching the last degrees of extension, causing limitations in activities of daily living. This work aims to show the effectiveness of physiotherapy in the treatment of ACL injuries. The method started from a bibliographic review, through books, personal files, websites of medicine and physiotherapy available on the internet, magazines and scientific articles in the health area, aiming to illustrate and theoretically base the work. Articles were selected for the present study, in Portuguese and English. The bibliographic survey was carried out with references to publications between the years 2000 to 2017. The present study revealed the importance of Physiotherapy in the process of rehabilitation of ACL injuries. It demonstrated that most patients respond satisfactorily, and resistance levels can be noticed in a few cases.

scholarly journals Anterior Cruciate Ligament: Anatomy and Biomechanics

2019 ◽  
Vol 21 (2) ◽  
pp. 166 ◽  
Author(s):  
Maristela Prado e Silva Nazario ◽  
Juliana Santi Sagin Pinto Bergamim ◽  
Mara Lilian Soares Nasrala ◽  
Elias Nasrala Neto ◽  
Lilian Assunção Felippe ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Anterior Tibial Translation ◽  
Knee Stability ◽  
Anterior Tibial ◽  
Anterior Cruciate ◽  
The Stability ◽  
Tibial Translation ◽  
Keywords Anterior Cruciate ◽  
Flexion And Extension

Abstract The Anterior cruciate ligament (ACL) is a unique structure and one of the most important ligaments for knee stability, serving as primary restriction for the anterior tibial translation on the femur and secondary restriction  to the knee external and internal rotation  that is not sustaining weight. The objective of this study was to demonstrate the anatomy and biomechanics of anterior cruciate ligament as well as demonstrate the importance of the anterior cruciate ligament in the stability of the tibial-femoral joint. Literature review was performed using the data bases Scielo, Pubmed and  Lilacs  having as descriptors: "Anterior Cruciate Ligament", "LCA", "Anatomy" and "biomechanics" from the year 2008 to 2018. The LCA stability for the femorotibial joint and realization of the movement amplitude  are in the ability of the  anteromedial and posterolateral bands of the same in absorbing  the entire load and traction of the joint when in antagonistic movements of the knee flexion and extension, favoring the stability of the tibial-femoral joint. Keywords: Anterior Cruciate Ligament. Anatomy. Knee. Resumo O Ligamento Cruzado Anterior (LCA) é uma estrutura única e um dos mais importantes ligamentos para a estabilidade do joelho, servindo como restrição primária para a translação anterior da tíbia relativa ao fêmur e restrição secundária à rotação externa e interna do joelho que não está sustentando peso. Este estudo teve como objetivo demonstrar a anatomia e a biomecânica do ligamento cruzado anterior bem como demonstrar a importância do ligamento cruzado anterior na estabilidade da articulação tíbio-femoral. Foi realizado revisão da literatura usando as bases de dados Scielo, Lilacs e Pubmed tendo como descritores: “Ligamento Cruzado Anterior”, “LCA”, “Anatomia” e “biomecânica” a partir do ano de 2008 a 2018. A estabilidade do LCA para a articulação femorotibial e realização da amplitude de movimento estão na capacidade das bandas ântero-medial e póstero-lateral do mesmo em absorver toda a carga e tração da articulação quando em movimentos antagônicos de extensão e flexão do joelho, favorecendo na estabilidade da articulação tíbio-femoral. Palavras-chave: Ligamento Cruzado Anterior. Anatomia. Joelho. 

A Comparison of Central Anatomic Single-Bundle Reconstruction and Anatomic Double-Bundle Reconstruction in Anteroposterior and Rotational Knee Stability: Intraoperative Biomechanical Evaluation

2020 ◽  
Author(s):  
Yasunari Ikuta ◽  
Atsuo Nakamae ◽  
Ryo Shimizu ◽  
Masakazu Ishikawa ◽  
Tomoyuki Nakasa ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Knee Flexion ◽  
Double Bundle ◽  
Anterior Tibial Translation ◽  
Single Bundle ◽  
Tibial Rotation ◽  
Knee Stability ◽  
Flexion Extension ◽  
Anterior Tibial ◽  
Tibial Translation

AbstractPostoperative anterior and rotational stability are still controversial when compared with single-bundle (SB) and double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. This study aimed to compare the central anatomical SB and anatomical DB ACL reconstruction in intraoperative knee kinematics during continuous knee flexion-extension. A total of 34 patients who underwent ACL reconstruction using the hamstring tendon were evaluated intraoperatively before and immediately after ACL reconstruction using OrthoPilot ACL Navigation System Version 3.0. The patients were prospectively randomized into the central anatomical SB (17 knees) and the anatomical DB reconstruction (17 knees) groups. The tibial translation and rotation were continuously measured during knee flexion-extension under conventional knee motion, anterior tibial load (100N), and internal-external torque (3 N·m). The anterior tibial translation and total range of tibial rotation were calculated from the measurement values from 20 to 50 degrees at each 5-degree point. The anterior tibial translation (p = 0.59; two-factor repeated measures analysis of variance; η 2G = 0.0077) and total range of tibial rotation (p = 0.95; η 2G = 0.0001) at each knee flexion angle showed no significant difference between the central anatomical SB and anatomical DB reconstruction groups. It is suggested that the central anatomical SB reconstruction is comparable with the anatomical DB reconstruction in biomechanical anteroposterior and rotational knee stability at time 0.

scholarly journals Copers and Noncopers Use Different Landing Techniques to Limit Anterior Tibial Translation After Anterior Cruciate Ligament Reconstruction

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712199806
Author(s):  
Michèle N.J. Keizer ◽  
Egbert Otten ◽  
Chantal M.I. Beijersbergen ◽  
Reinoud W. Brouwer ◽  
Juha M. Hijmans
Keyword(s):  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Anterior Tibial Translation ◽  
Return To Sports ◽  
Beighton Score ◽  
Positive Correlation ◽  
Anterior Tibial ◽  
Flexion Moment ◽  
Anterior Cruciate ◽  
Tibial Translation

Background: At 1 year after anterior cruciate ligament reconstruction (ACLR), two-thirds of patients manage to return to sports (copers), whereas one-third of patients do not return to sports (noncopers). Copers and noncopers have different muscle activation patterns, and noncopers may not be able to control dynamic anterior tibial translation (ATTd) as well as copers. Purpose/Hypothesis: To investigate whether (1) there is a positive correlation between passive ATT (ATTp; ie, general joint laxity) and ATTd during jump landing, (2) whether ATTd is moderated by muscle activating patterns, and (3) whether there is a difference in moderating ATTd between copers and noncopers. We hypothesized that patients who have undergone ACLR compensate for ATTd by developing muscle strategies that are more effective in copers compared with noncopers. Study Design: Controlled laboratory study. Methods: A total of 40 patients who underwent unilateral ACLR performed 10 single-leg hops for distance with both legs. Lower body kinematic and kinetic data were measured using a motion-capture system, and ATTd was determined with an embedded method. Muscle activity was measured using electromyographic signals. Bilateral ATTp was measured using a KT-1000 arthrometer. In addition, the Beighton score was obtained. Results: There was no significant correlation between ATTp and ATTd in copers; however, there was a positive correlation between ATTp and ATTd in the operated knee of noncopers. There was a positive correlation between the Beighton score and ATTp as well as between the Beighton score and ATTd in both copers and noncopers in the operated knee. Copers showed a negative correlation between ATTd and gastrocnemius activity in their operated leg during landing. Noncopers showed a positive correlation between ATTd and knee flexion moment in their operated knee during landing. Conclusion: Copers used increased gastrocnemius activity to reduce ATTd, whereas noncopers moderated ATTd by generating a smaller knee flexion moment. Clinical Relevance: This study showed that copers used different landing techniques than noncopers. Patients who returned to sports after ACLR had sufficient plantar flexor activation to limit ATTd.

scholarly journals Computer-Assisted System in Stress Radiography for Anterior Cruciate Ligament Injury with Correspondent Evaluation of Relevant Diagnostic Factors

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 419
Author(s):  
Chien-Kuo Wang ◽  
Liang-Ching Lin ◽  
Yung-Nien Sun ◽  
Cheng-Shih Lai ◽  
Chia-Hui Chen ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Cruciate Ligament ◽  
Anterior Tibial Translation ◽  
Computer Assisted ◽  
Time Interval ◽  
Stress Radiography ◽  
Factors Affecting ◽  
Anterior Tibial ◽  
Anterior Cruciate ◽  
Tibial Translation

We sought to design a computer-assisted system measuring the anterior tibial translation in stress radiography, evaluate its diagnostic performance for an anterior cruciate ligament (ACL) tear, and assess factors affecting the diagnostic accuracy. Retrospective research for patients with both knee stress radiography and magnetic resonance imaging (MRI) at our institution was performed. A complete ACL rupture was confirmed on an MRI. The anterior tibial translations with four different methods were measured in 249 patients by the designed algorithm. The diagnostic accuracy of each method in patients with all successful measurements was evaluated. Univariate logistic regression analysis for factors affecting diagnostic accuracy of method four was performed. In the inclusive 249 patients, 177 patients (129 with completely torn ACLs) were available for analysis. Mean anterior tibial translations were significantly increased in the patients with a completely torn ACL by all four methods, with diagnostic accuracies ranging from 66.7% to 75.1%. The diagnostic accuracy of method four was negatively associated with the time interval between stress radiography and MRI as well as force-joint distance on stress view, and not significantly associated with age, gender, flexion angle, intercondylar distance, and force-joint angle. A computer-assisted system measuring the anterior tibial translation in stress radiography showed acceptable diagnostic performance of complete ACL injury. A shorter time interval between stress radiography and MRI as well as shorter force-joint distance were associated with higher diagnostic accuracy.

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