Atraumatische Instabilität des vorderen Kreuzbandes durch eine intraligamentäre Zyste

2020 ◽  
Author(s):  
René Burchard ◽  
Jan A. Graw
Keyword(s):  
Pivot Shift ◽  
Klinische Untersuchung ◽  
Pivot Shift Test ◽  
Sich Eine

ZusammenfassungEin 28-jähriger Mann wurde mit einem Instabilitätsgefühl im Knie beim Fußballspielen ohne vorhergehendes Unfallereignis vorstellig. Die klinische Untersuchung ergab sowohl einen pathologischen Lachmann- als auch einen pathologischen Pivot-Shift-Test. Die kernspintomografische Bildgebung zeigte eine intraligamentäre Zyste des vorderen Kreuzbandes (VKB). In der darauffolgenden Arthroskopie zeigte sich eine durch die Zyste verursachte subtotale Zerstörung des VKB. Nach einer VKB-Ersatzplastik mittels Semitendinosustransplantats war das Gelenk wieder stabil. Gelenkzysten sind selten und verursachen häufig unspezifische Schmerzen oder Bewegungseinschränkungen. Bislang wurden keine Zusammenhänge zwischen intraligamentären Zysten und einer Gelenkinstabilität beschrieben. Eine mögliche präventive Resektion auch asymptomatischer und zufällig gefundener Ligament-assoziierter Zysten ist zu diskutieren.

Die Osteoporose des Mannes

2010 ◽  
Vol 19 (02) ◽  
pp. 131-135 ◽  
Author(s):  
C. Hamann ◽  
E. Tsourdi ◽  
L. c. Hofbauer
Keyword(s):  
Rheumatische Erkrankungen ◽  
Klinische Untersuchung ◽  
Sich Eine ◽  
Sekundäre Osteoporose

ZusammenfassungDer männlichen Osteoporose liegt häufig eine sekundäre Osteoporose zugrunde. Die niedrige Knochendichte mit Veränderungen der Mikroarchitektur des Knochens, die zu Fragilitätsfrakturen führt, wird dabei meist durch eine zugrunde liegende Erkrankung oder Medikation verursacht. Das Vorliegen einer männlichen Osteoporose muss insbesondere dann vermutet werden, wenn Fragilitätsfrakturen bei jungen Männern auftreten oder geringe Knochendichtewerte vorliegen. Es sollte zunächst eine ausführliche Krankengeschichte erhoben werden und eine klinische Untersuchung mit Basis-Labordiagnostik erfolgen. Dadurch können klinische Risikofaktoren, osteoporoseinduzierende Medikamente, ursächliche endokrine, gastroenterologische, hämatologische oder rheumatische Erkrankungen erkannt und mit spezifischeren Untersuchungen bestätigt werden. Die Knochendichtemessung mittels DXA-Messung an der Hüfte und der Wirbelsäule ist der entscheidende und wegweisende diagnostische Test. Zum Nachweis bereits eingetretener Wirbelkörperfrakturen empfiehlt sich eine Röntgenuntersuchung der Wirbelsäule (Brustwirbelsäule/Lendenwirbelsäule) in zwei Ebenen. Die Therapie der sekundären Osteoporose beinhaltet neben der spezifischen antiresorptiven Therapie immer die Therapie der zugrunde liegenden Erkrankung,insbesondere aber die Beendigung oder Modifikation osteoporosefördernder Medikamente.

scholarly journals Effect of meniscal root tear on pivot shift test after anterior cruciate ligament-deficient

2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0052
Author(s):  
Ming Zhou
Keyword(s):  
Pivot Shift ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Pivot Shift Test ◽  
High Grade ◽  
Posterior Root ◽  
Meniscal Root Tear ◽  
Tibial Translation ◽  
Acl Deficient ◽  
Deficient Knee

Introduction: A review of the literature demonstrates that injury of the lateral meniscus, anterolateral capsule, and iliotibial(IT ) band or small lateral tibial plateau aggravate the instability of knee and contributes to a high-grade pivot shift in the ACL-deficient knee. Hypotheses: The hypothesis was that disruption of posterior root of the lateral meniscus will further destabilize the ACL-deficient knee and simulated a high-grade pivot shift but posterior root of medial meniscal not. Methods: 6 fresh-frozen cadaveric knees was performed the next test in a custom activity simulator.1.Determine the effect of PRLMT on the stability of ACL-deficient knee.In the pivot shift test, ITB force (50, 75, 100, 125, 150, and 175 N), internal rotation moments (1, 2, and 3 N.m),and valgus moments (5 and 7 N.m). tibial translation of front drawer test were performed by applying a 90-N anterior

Effect of Meniscocapsular and Meniscotibial Lesions in ACL-Deficient and ACL-Reconstructed Knees: A Biomechanical Study

2018 ◽  
Vol 46 (10) ◽  
pp. 2422-2431 ◽  
Author(s):  
Nicholas N. DePhillipo ◽  
Gilbert Moatshe ◽  
Alex Brady ◽  
Jorge Chahla ◽  
Zachary S. Aman ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Medial Meniscus ◽  
Pivot Shift ◽  
External Rotation ◽  
Posterior Horn ◽  
Pivot Shift Test ◽  
Anterior Tibial Translation ◽  
Anterior Tibial ◽  
Tibial Translation ◽  
Acl Deficient

Background: Ramp lesions were initially defined as a tear of the peripheral attachment of the posterior horn of the medial meniscus at the meniscocapsular junction. The separate biomechanical roles of the meniscocapsular and meniscotibial attachments of the posterior medial meniscus have not been fully delineated. Purpose: To evaluate the biomechanical effects of meniscocapsular and meniscotibial lesions of the posterior medial meniscus in anterior cruciate ligament (ACL)–deficient and ACL-reconstructed knees and the effect of repair of ramp lesions. Study Design: Controlled laboratory study. Methods: Twelve matched pairs of human cadaveric knees were evaluated with a 6 degrees of freedom robotic system. All knees were subjected to an 88-N anterior tibial load, internal and external rotation torques of 5 N·m, and a simulated pivot-shift test of 10-N valgus force coupled with 5-N·m internal rotation. The paired knees were randomized to the cutting of either the meniscocapsular or the meniscotibial attachments after ACL reconstruction (ACLR). Eight comparisons of interest were chosen before data analysis was conducted. Data from the intact state were compared with data from the subsequent states. The following states were tested: intact (n = 24), ACL deficient (n = 24), ACL deficient with a meniscocapsular lesion (n = 12), ACL deficient with a meniscotibial lesion (n = 12), ACL deficient with both meniscocapsular and meniscotibial lesions (n = 24), ACLR with both meniscocapsular and meniscotibial lesions (n = 16), and ACLR with repair of both meniscocapsular and meniscotibial lesions (n = 16). All states were compared with the previous states. For the repair and reconstruction states, only the specimens that underwent repair were compared with their intact and sectioned states, thus excluding the specimens that did not undergo repair. Results: Cutting the meniscocapsular and meniscotibial attachments of the posterior horn of the medial meniscus significantly increased anterior tibial translation in ACL-deficient knees at 30° ( P ≤ .020) and 90° ( P < .005). Cutting both the meniscocapsular and meniscotibial attachments increased tibial internal (all P > .004) and external (all P < .001) rotation at all flexion angles in ACL-reconstructed knees. Reconstruction of the ACL in the presence of meniscocapsular and meniscotibial tears restored anterior tibial translation ( P > .053) but did not restore internal rotation ( P < .002), external rotation ( P < .002), and the pivot shift ( P < .05). To restore the pivot shift, an ACLR and a concurrent repair of the meniscocapsular and meniscotibial lesions were both necessary. Repairing the meniscocapsular and meniscotibial lesions after ACLR did not restore internal rotation and external rotation at angles >30°. Conclusion: Meniscocapsular and meniscotibial lesions of the posterior horn of the medial meniscus increased knee anterior tibial translation, internal and external rotation, and the pivot shift in ACL-deficient knees. The pivot shift was not restored with an isolated ACLR but was restored when performed concomitantly with a meniscocapsular and meniscotibial repair. However, the effect of this change was minimal; although statistical significance was found, the overall clinical significance remains unclear. The ramp lesion repair used in this study failed to restore internal rotation and external rotation at higher knee flexion angles. Further studies should examine improved meniscus repair techniques for root tears combined with ACLRs. Clinical Relevance: Meniscal ramp lesions should be repaired at the time of ACLR to avoid continued knee instability (anterior tibial translation) and to eliminate the pivot-shift phenomenon.

scholarly journals The Anterolateral Structure of the Knee Does Not Affect Anterior and Dynamic Rotatory Stability in Anterior Cruciate Ligament Injury: Quantitative Evaluation With the Electromagnetic Measurement System

2019 ◽  
Vol 47 (14) ◽  
pp. 3381-3388 ◽  
Author(s):  
Daisuke Araki ◽  
Takehiko Matsushita ◽  
Yuichi Hoshino ◽  
Kanto Nagai ◽  
Kyohei Nishida ◽  
...  
Keyword(s):  
Pivot Shift ◽  
Cruciate Ligament ◽  
Pivot Shift Test ◽  
Lachman Test ◽  
Electromagnetic Measurement System ◽  
The Mean ◽  
Anterior Cruciate ◽  
Electromagnetic Measurement ◽  
Tibial Translation ◽  
Acl Deficient

Background: The biomechanical function of the anterolateral structure (ALS), which includes the anterolateral joint capsule and anterolateral ligament (ALL), remains a topic of debate. Hypothesis: The ALS contributes to knee joint stability during the Lachman test and the pivot-shift test in anterior cruciate ligament (ACL)–deficient knees. Study Design: Controlled laboratory study. Methods: Fourteen fresh-frozen hemipelvis lower limbs were used. For 7 specimens, the anterior one-third of the ALS and the residual ALS were cut intra-articularly with a radiofrequency device. Subsequently, the ACL was cut arthroscopically. For the other 7 specimens, the ACL was cut first, followed by the anterior one-third of the ALS and the residual ALS intra-articularly. During the procedures, the iliotibial band (ITB) was kept intact. At each condition, the anterior tibial translation (ATT) during the manual Lachman test and the acceleration of posterior tibial translation (APT) and the posterior tibial translation (PTT) during the manual pivot-shift test were measured quantitatively with an electromagnetic measurement system. The mean values of those parameters were compared among 6 groups (ACL intact, one-third ALS cut, all ALS cut, ACL cut, ACL/one-third ALS cut, and ACL/all ALS cut). Results: The mean ATTs during the Lachman test and the mean APTs and PTTs in the ACL-cut conditions (ACL cut, ACL/one-third ALS cut, and ACL/all ALS cut) were significantly larger than those under the ACL-intact conditions (ACL intact, one-third ALS cut, all ALS cut) ( P < .01). However, no statistically significant differences were observed among the intact, one-third ALS–cut, and all ALS–cut conditions, within the ACL-intact or ACL-cut conditions. Conclusion: Intra-articular dissection of the ALS did not increase the ATT during the Lachman test or the APT and PTT during the pivot-shift test under the intact condition of the ITB, regardless of the integrity of the ACL. When the ITB is intact, the ALS does not have a significant role in either anterior or dynamic rotatory knee stability, while the ACL does. Clinical Relevance: Recent growing interest about ALL reconstruction or ALS augmentation may not have a large role in controlling either anterior or dynamic rotatory knee instability in isolated ACL-deficient knees.

Pivot Shift Test: An Evidence-Based Outcome Tool

2016 ◽  
pp. 235-243
Author(s):  
Marie-Claude Leblanc ◽  
Devin C. Peterson ◽  
Olufemi R. Ayeni
Keyword(s):  
Pivot Shift ◽  
Pivot Shift Test ◽  
Evidence Based ◽  
Outcome Tool

Standardized pivot shift test improves measurement accuracy

2011 ◽  
Vol 20 (4) ◽  
pp. 732-736 ◽  
Author(s):  
Yuichi Hoshino ◽  
Paulo Araujo ◽  
Mattias Ahlden ◽  
Charity G. Moore ◽  
Ryosuke Kuroda ◽  
...  
Keyword(s):  
Measurement Accuracy ◽  
Pivot Shift ◽  
Pivot Shift Test

Die Naht der frischen vorderen Kreuzbandruptur mit dynamischer intraligamentärer Stabilisierung – eine Alternative zur vorderen Kreuzbandersatzplastik bei sportlich aktiven jungen Patienten

2018 ◽  
Vol 156 (01) ◽  
pp. 100-102
Author(s):  
Christoph Ihle ◽  
H. Nakayama ◽  
Christoph Gonser ◽  
Ulrich Stöckle ◽  
Stefan Döbele ◽  
...  
Keyword(s):  
Pivot Shift ◽  
Pivot Shift Test ◽  
Operative Verfahren

Zusammenfassung Zielsetzung Der Ersatz des vorderen Kreuzbands (VKB) mit autologem Sehnentransplantat ist derzeit der Goldstandard zur Behandlung der VKB-Ruptur. Gute Ergebnisse wurden berichtet, wobei Langzeitresultate erhöhte Arthroseraten zeigten. Als Ursachen werden verbleibende Instabilitäten und der Propriozeptionsverlust trotz und durch den VKB-Ersatz diskutiert. Eine neue Alternative zur Behandlung frischer VKB-Rupturen stellt die VKB-Naht mit temporärer dynamischer intraligamentärer Stabilisierung (DIS) dar, wobei das readaptierte und heilende VKB durch die DIS über einen Zeitraum von ca. 3 – 5 Monaten biomechanisch geschützt wird. Nach längstens 6 Monaten hat die DIS keine Funktion mehr und das verheilte VKB übernimmt die gesamte Stabilisierung. Dieser Videobeitrag soll das operative Verfahren zum Erhalt des VKB demonstrieren. Indikation Die Indikation zum VKB-Erhalt beinhaltet frische (< 21 Tage) VKB-Rupturen des femurnahen Drittels mit einer sagittalen Translation von > 5 mm im Seitenvergleich bzw. einem positiven Pivot-Shift-Test. Der VKB-Erhalt kann jungen und sportlich aktiven Patienten angeboten werden, wobei die Wachstumsfuge am Tibiakopf weitestgehend verschlossen sein sollte. Methode Ein 22-jähriger Patient mit VKB-Läsion wurde 3 Wochen nach Kniegelenksdistorsion mit VKB-Naht und DIS versorgt. Schlussfolgerung Die VKB-Naht mit DIS ist eine operative Option zum Erhalt des VKB sowie möglicherweise der Propriozeption.

Augmentation of Anatomic Anterior Cruciate Ligament Reconstruction With Lateral Extra-articular Tenodesis Does Not Significantly Affect Rotatory Knee Laxity: A Time Zero, In Vivo Kinematic Analysis

2020 ◽  
Vol 48 (14) ◽  
pp. 3495-3502
Author(s):  
Andrew J. Sheean ◽  
Jayson Lian ◽  
Robert Tisherman ◽  
Sean J. Meredith ◽  
Darren de SA ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Lateral Compartment ◽  
Categorical Variables ◽  
Pivot Shift Test ◽  
Contralateral Knee ◽  
Rotatory Knee Laxity ◽  
Anterior Cruciate

Background: The pivot-shift test is used to assess for rotatory knee laxity in the anterior cruciate ligament (ACL)-deficient knee and ACL-reconstructed knee; however, the pivot shift uses a subjective grading system that is limited by variability between examiners. Consequently, quantified pivot shift (QPS) test software (PIVOT iPad application) has been developed and validated to measure the magnitude of rotatory knee laxity during the positive pivot-shift test. Purpose: To employ intraoperative QPS (iQPS) to assess for differences in residual rotatory knee laxity after ACL reconstruction (ACLR) versus ACLR augmented with lateral extra-articular tenodesis (ACLR + LET), and to employ iQPS to determine if ACLR and/or ACLR + LET result in overconstrained knee kinematics when compared with the contralateral knee. Study Design: Cohort study; Level of evidence, 2. Methods: iQPS was performed in 20 patients by a single surgeon on both the operative and contralateral knees before ACLR. ACLR was augmented with a LET if the lateral compartment tibial translation measured during QPS was greater than or equal to double the amount of lateral tibial compartment translation measured for the contralateral knee. After each reconstruction (ACLR or ACLR + LET), iQPS measurements were performed. iQPS data were compared with the preoperative QPS measurements of the operative and contralateral knees. Postoperative iQPS data were compared with both the preoperative QPS measurements of the operative and contralateral knees with paired samples t tests. Categorical variables were compared using the Fisher exact test. Results: The mean age in the cohort was 17.3 years (range, 15-24 years). There were no significant differences between the groups in terms of the proportion of male patients (ACLR: 5 male, 5 female vs ACLR + LET: 4 male, 6 female) or age (ACLR: 17.7 ± 3.3 years; 95% CI, 15.4-24.0 vs ACLR + LET: 16.8 ± 2.8 years, 95% CI, 14.8-22.0; P = .999). There were no significant differences between the groups with respect to preoperative QPS performed during examination under anesthesia (ACLR: 4.7 ± 2.0 mm; 95% CI, 3.3-6.1 vs ACLR + LET: 3.6 ± 1.8 mm; 95% CI, 2.3-4.9; P = .2). Both ACLR and ACLR + LET resulted in significant decreases in rotatory knee laxity when compared with preoperative QPS measurements (ACLR: –3.4 ± 1.7 mm; 95% CI, −4.6 to −2.2; P < .001: ACLR + LET: –2.6 ± 1.9 mm; 95% CI, −3.9 to −1.3; P < .002). Moreover, when compared with isolated ACLR, ACLR + LET did not result in a significantly smaller magnitude of change in iQPS between the pre- and postoperative states ( P = .3). Conclusion: Both ACLR and ACLR + LET resulted in significant decreases in rotatory knee laxity. The augmentation of ACLR with LET did not change the constraint of the knee with respect to lateral compartment translation as measured during iQPS.

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