Comparison of Clinical and Radiological Parameters with Two Different Surgical Methods for Anterior Cruciate Ligament Reconstruction

2020 ◽  
Vol 33 (09) ◽  
pp. 938-946
Author(s):  
Osman Çiloğlu ◽  
Hakan Çiçek ◽  
Ahmet Yılmaz ◽  
Metin Özalay ◽  
Gökhan Söker ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Peak Torque ◽  
Tunnel Enlargement ◽  
Clinical Scores ◽  
Significant Difference ◽  
The Mean ◽  
Group 2 ◽  
Anterior Cruciate ◽  
Group 1

AbstractThis study compared the clinical and radiological findings of nonanatomic transtibial (TT) technique with intraspongious fixation and anatomical anteromedial portal (AMP) technique with extracortical button implant in anterior cruciate ligament (ACL) reconstruction. A total of 54 patients with isolated ACL rupture were included in this prospective study. The patients who had the intraspongious fixation by nonanatomical TT technique were allocated to Group 1 (n = 27). The patients with extracortical fixation by anatomical AMP technique were placed in Group 2 (n = 27). The clinical scores of the patients were evaluated with the International Knee Documentation Committee Evaluation Form, Tegner activity score, and Lysholm II Functional Scoring. The tibial and femoral tunnels were evaluated with three-dimensional computed tomography. The kinematic examinations were performed with a Biodex System 3 Pro isokinetic dynamometer. There was no significant difference between the groups in terms of demographic data (p > 0.05). The postoperative clinical scores improved significantly in both the groups compared with the preoperative levels (p = 0.001), but there was no significant difference in the postoperative clinical scores between the groups (p > 0.05). In the extension and flexion of 60 to 180 degrees/s, the peak torque and the peak torque/body weight values of the repaired knee to intact knee ratios showed significant differences in favor of Group 2 (p = 0.001). In both the groups, no significant difference was found between the mean extent of the tunnel enlargement (p > 0.05). The mean tunnel height was significantly greater in Group 1 (45% ± 9.86 vs. 34.11% ± 10.0%) (p = 0.001). When the localization of the tunnel enlargements (proximal-middle-distal) was examined, a significant difference was found between the groups (p = 0.001). Although the AMP technique, which is a more anatomic reconstruction, had an advantage with regard to tunnel enlargement and the isokinetic muscle studies, there was no difference between the two techniques in terms of the clinical results.

The Relationship Between Intercondylar Notch Width of the Femur and the Incidence of Anterior Cruciate Ligament Tears

1998 ◽  
Vol 26 (3) ◽  
pp. 402-408 ◽  
Author(s):  
K. Donald Shelbourne ◽  
Thorp J. Davis ◽  
Thomas E. Klootwyk
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Intercondylar Notch ◽  
Men And Women ◽  
Notch Width ◽  
Significant Difference ◽  
Group 2 ◽  
Anterior Cruciate ◽  
Intercondylar Notch Width ◽  
Group 1

For 714 consecutive patients who underwent autogenous patellar tendon graft anterior cruciate ligament reconstructions we intraoperatively measured intercondylar notch width. We prospectively recorded height, weight, sex, and which patients subsequently tore their contralateral anterior cruciate ligament or the 10-mm autograft. The patients were divided into two groups based on notch width (group 1, 15 mm; group 2, 16 mm). The mean notch width was 13.9 2.2 mm for women and 15.9 2.5 mm for men. There was no statistically significant difference in notch width between height groups for women or men. Analysis showed that, with height and weight as covariates, women had statistically significantly narrower notches than men. Twenty-three of 388 patients in group 1 and 4 of 326 patients in group 2 tore their contralateral anterior cruciate ligaments. Within groups, no statistically significant differences in contralateral tear rates existed between men and women. Once the men and women had reconstructions with equally sized 10-mm autografts, there was no difference in graft tear rate between groups or between men and women. Our results show that patients with narrower notches have a higher incidence of tearing their contralateral anterior cruciate ligament. After reconstruction with a 10-mm autograft, the incidence of graft rupture is the same for men and women.

scholarly journals Comparison of Clinical and Radiological Parameters with Two Different Surgical Methods for Anterior Cruciate Ligament Reconstruction

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0027
Author(s):  
Osman Çiloğlu ◽  
Hakan Çiçek ◽  
Ahmet Yılmaz ◽  
Metin Özalay ◽  
Gökhan Söker ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Muscle Strength ◽  
Surgical Technique ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Tunnel Widening ◽  
Isokinetic Muscle Strength ◽  
Group 2 ◽  
Anterior Cruciate ◽  
Group 1

Objectives: We investigated the effects anatomic or nonanatomic femoral tunnel positions and tunnel fixation methods obtained using two different surgery methods on tunnel widening and clinical results in anterior cruciate ligament (ACL) reconstructions. Methods: Patients with isolated anterior cruciate ligament rupture are included to study who don’t have intra-and extra-articular additional pathology of the knee, without previously a history of operations of both knees. 2 groups were created. Group 1 Aperfix implant were used which can be able to perform non anatomical femoral tunnel and intra tunnel fixation with transtibial technique. In Group 2 Endobutton CL implant were used which can make fixation from outside the cortex with anatomic femoral tunnel in use of anteromedial portal techniques. 27 patients (average age 29,33, range 18 to 55 years) in group 1 and 27 patients (average age 27,51, range 16 to 45 years) in group 2 totally 54 patients were performed surgery. All patients were assessed using the IKDC (International knee documentation committee), Tegner Activity Scala and Lysholm II Functional Scores. Muscle strength measurements in both groups compared to intact knee was measured with an isokinetic dynamometer Biodex System 3 Pro. The location of the femoral tunnel aperture and tunnel widening were imaged with 3D reconstructive computed tomography. All measurements were performed using the same software application by the same radiologist. Results: The two groups were similar with respect to age and sex distribution, operated side, the size of the tunnel created, and follow-up period (p>0.05). After surgery in both groups, the clinical scores showed significant improvement compared to preoperative (p=0,0001). However, postoperative clinical outcomes in the two groups did not show a difference significantly (p>0,005). Isokinetic muscle strength study showed significant differences between the two groups (p=0,0001). Location of femoral tunnel aperture on the medial wall of the lateral femoral condyle showed a significant differences in the two groups (p=0,0001). The expansion of proximal and distal femoral tunnel in two groups showed significant differences (p=0,0001). There was relationship between distal femoral tunnel widening and location of femoral tunnel aperture. Conclusion: Although there is no statistically significant difference between the two groups clinically, difference noticed in terms of isokinetic muscle strength may be due to differences in the degree of shift as a result of multiple loading depending on the biomechanical properties of materials. We thought that the difference seen in the widening of tunnel in the proximal or distal may be due to, the technique of graft fixation, the distance between the fixation point and the joint, and to the location of the femoral tunnel aperture on medial wall of lateral condyle from anatomical or non anatomical region. There is no golden standard in neither surgical technique nor material of fixation. Proper theoretical knowledge and extensive clinical experience are important in the light of an accurate surgical technique applied. We thought that information we have reached in our study should be supported by biomechanical studies

Septic Arthritis After Anterior Cruciate Ligament Reconstruction: How Important Is Graft Salvage?

2018 ◽  
Vol 46 (10) ◽  
pp. 2376-2383 ◽  
Author(s):  
Jonas Pogorzelski ◽  
Alexander Themessl ◽  
Andrea Achtnich ◽  
Erik M. Fritz ◽  
Klaus Wörtler ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Resonance Imaging ◽  
Kt 1000 ◽  
Graft Removal ◽  
Group 2 ◽  
Anterior Cruciate ◽  
Group 1

Background: Septic arthritis (SA) of the knee after anterior cruciate ligament reconstruction (ACLR) is a rare but potentially devastating condition. In certain cases, graft removal becomes necessary. Purpose: To evaluate clinical, subjective, and radiologic outcomes of patients with SA after ACLR and assess whether graft retention has superior clinical results as compared with graft removal. Study Design: Cohort study; Level of evidence, 3. Methods: All patients who were at least 12 months out from arthroscopic treatment of SA after isolated ACLR at our institution were eligible for inclusion. Patients were categorized into 2 groups: group 1, patients with initial graft retention; group 2, patients with initial graft removal. Group 2 was subdivided into 2 groups: group 2a, patients with graft reimplantation; group 2b, patients without graft reimplantation. Objective and subjective assessments were obtained at follow-up, including the International Knee Documentation Committee (IKDC) knee examination form, KT-1000 arthrometer measurements, WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score, Lysholm score, and IKDC subjective evaluation. Radiologic assessment was performed with pre- and postoperative magnetic resonance imaging. Results: Of the 41 patients included, 33 (81%) were available for follow-up at a mean ± SD 54.7 ± 24.4 months at an age of 28.4 ± 9.3 years. When compared with patients from group 2 (n = 12), patients from group 1 (n = 21) obtained significantly better results on the objective IKDC score (normal or nearly normal: group 1, 66.6%; group 2, 36.4%; P = .047) and KT-1000 measurements (group 1, 1.3 ± 1.0 mm; group 2, 2.9 ± 1.5 mm; P = .005). Group 1 also scored better than group 2 on the Lysholm ( P = .007), IKDC subjective ( P = .011), and WOMAC ( P = .069) measures. Between groups 2a (n = 4) and 2b (n = 8), no significant differences in outcomes could be detected ( P values, .307-.705), although patients with anterior cruciate ligament graft reimplantation showed a clear tendency toward better results in objective and not subjective parameters. Magnetic resonance imaging evaluation showed higher rates of cartilage damage and meniscal tears among patients with graft resection versus graft retention. Conclusion: Patients with graft retention showed superior postoperative results when compared with patients who underwent initial graft resection, although subanalysis showed comparable outcomes between graft retention and reimplantation. Thus, while graft-retaining protocols should have the highest priority in the treatment of SA after ACLR, graft reimplantation should be performed in cases where graft resection becomes necessary, to avoid future cartilage and meniscal lesions. Finally, further studies with larger numbers of patients are needed to gain a better understanding of the outcomes of patients with SA after ACLR.

scholarly journals Clinical and radiological outcome after Anterior Cruciate Ligament Reconstruction using the T-Lock Osteotrans resorbable Tendon Anchor: Early Experience and Midterm Follow-up

2020 ◽  
Author(s):  
Yannic Bangert ◽  
Ayham Jaber ◽  
Felix Wünnemann ◽  
Gregor Berrsche ◽  
Nikolaus Streich ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Lysholm Score ◽  
Tunnel Enlargement ◽  
Radiological Outcome ◽  
Clinical And Radiological Outcome ◽  
The Mean ◽  
Anterior Cruciate ◽  
Posterior Anterior

Abstract Purpose Reonstruction of the Anterior cruciate ligament (ACL) using tendon grafting is an established method for restoring knee function and stability. Multiple methods are established for graft fixation. Several involve anchoring the autograft distant to the joint with hardware that remains implanted. This study reports the first early to midterm results in patients who received ACL reconstruction (ACLR) using the T-Lock Osteotrans femoral near joint fixation method with a tibial fixation using the BioactIF Osteotrans interference screw. Methods This consecutive prospective series included 20 Patients (14 Male, 6 Female) with a primary ACL rupture. All patients were treated with an ACLR using the semitendinosus autograft fixated with the T-Lock Osteotrans and were followed-up postoperatively. The following parameters were assessed: Side-to-side difference of the posterior-anterior translation measured using the KT-1000 arthrometer, Tegner activity score, Lysholm score, IKDC subjective knee evaluation form. Magnetic resonance imaging (MRI) was done to assess tunnel enlargement and integrity of the anchoring device. Results The average follow-up duration was 2.15 years (range 1–4.2 years). One patient was lost to follow-up. Two Patients suffered a traumatic ACL re-rupture 2 years postoperatively and received 2-stage revision ACLR. Difference in the posterior-anterior translation was 1.8 mm (range 0–5). The median Tegner score was 6 (range 4–10) and 9 patients (45%) returned to their preinjury level of activity. The mean IKDC subjective knee evaluation form scored 91.2 points (range 77–100). The mean Lysholm score was 86.1 points (74–96). All mentioned scores showed were significantly better compared to preoperative values. No relevant tunnel enlargement was seen on MRI. The anchoring device was evaluated to be intact in all patients. Conclusion ACLR with the aforementioned procedure leads to good clinical and radiological outcome.

scholarly journals ANATOMICAL STUDY OF THE MORPHOMETRY OF THE ANTERIOR CRUCIATE LIGAMENT ATTACHMENT SITES. Estudio anatómico de la morfometría de los sitios de fijación del ligamento cruzado anterior

2016 ◽  
Vol 8 (1) ◽  
pp. 29-37
Author(s):  
Paul I Iyaji ◽  
Abduelmenem Alashkham ◽  
Abdulrahman Alraddadi ◽  
Roger Soames
Keyword(s):  
Anterior Cruciate Ligament ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Acl Rupture ◽  
Attachment Sites ◽  
Significant Difference ◽  
The Mean ◽  
Las Mujeres ◽  
Anterior Cruciate ◽  
Pl Bundle

Incidence of anterior cruciate ligament (ACL) rupture and its consequent reconstruction is on the rise. In contributing to the achievement of anatomic reconstruction this study seek to provide information regarding the position and variability of the tibial attachment sites, dimensions of femoral insertions and compare these measurements in males and females, and in right and left knees. Thirty one cadaveric knees (15 right and 16 left from 9 females and 7 males, mean age 77 years) were dissected. Various ACL footprint dimensions were taken. The mean length and width of the tibial anteromedial (AM) bundle footprint were 8.9 and 9.8 mm while that of the posterolateral (PL) bundle were 9.3 and 8.0 mm respectively. The mean length and width of the tibial AM and PL bundles in males were 8.5 and 9.8 mm, and 9.1 and 8.3 mm while corresponding values in females were and 9.2 and 9.7 mm, and 9.4 and 7.8 mm respectively.  Males had larger femoral footprints (P=0.020) and tibial plateau (P<0.001). No significant difference between the right and left knees were observed. The mean anatomical positions of the AM and PL bundles were 46.0% and 50.0% of the mediolateral diameter of the tibial plateau. The mean length and width of the ACL femoral insertion sites were 8.3 and 7.7 mm for the AM bundle and 7.8 and 6.9 mm for the PL bundle respectively. The smaller ACL attachment parameters in females could be a contributing factor to the higher incidence of ACL rupture in female athletes. La incidencia de la rotura del ligamento cruzado anterior (LCA) y su consiguiente reconstrucción está en aumento. Para contribuir a la actualización de la reconstrucción anatómica del ligamento cruzado anterior, este estudio proporciona información sobre la posición y la variabilidad de los sitios de fijación en la tibia, las dimensiones de las inserciones femorales, así como las relaciones de estas mediciones en hombres y mujeres y en las rodillas derecha e izquierda. Se disecaron treinta y un (15 rodillas de cadáver derecha, 16 izquierda, de 9 mujeres y 7 hombres, con una edad media de 77 años). Se tomaron diversas dimensiones de la huella del LCA. La longitud media y la anchura de la huella del haz tibial anteromedial (AM) eran 8,9 mm y 9,8 mm mientras que la del haz posterolateral (PL) eran 9,3 mm y 8 mm respectivamente. La longitud media y la anchura de la AM tibial y paquetes PL en los varones eran 8,5 y 9,8 mm, y 9,1 y 8,3 mm, mientras que los valores correspondientes en las mujeres eran 9,2 y 9,7 mm, y 9,4 y 7,8 mm, respectivamente. Los varones tenían huellas femorales (P = 0,045 para AM, P = 0,043 para PL) y la meseta tibial (P <0,001) más grandes. No se observó ninguna diferencia significativa entre la rodilla derecha e izquierda. Las posiciones anatómicas medias de los haces de AM y PL fueron 46% y 50% del diámetro mediolateral de la meseta tibial. La longitud media y la anchura de los sitios de inserción femoral del LCA fueron 8,3 y 7,7 mm para el paquete de AM y 7,8 y 6,9 mm para el paquete PL respectivamente. Los parámetros más pequeños de fijación del LCA en las mujeres podría ser un factor que contribuye a la mayor incidencia de rotura del LCA en mujeres atletas.   

scholarly journals Does the Application of Platelet-Rich Fibrin in Anterior Cruciate Ligament Reconstruction Enhance Graft Healing and Maturation? A Comparative MRI Study of 44 Cases

2020 ◽  
Vol 8 (2) ◽  
pp. 232596712090201 ◽  
Author(s):  
Tahsin Beyzadeoglu ◽  
Tuna Pehlivanoglu ◽  
Kerem Yildirim ◽  
Halil Buldu ◽  
Reha Tandogan ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Synovial Fluid ◽  
Acl Reconstruction ◽  
Signal Intensity ◽  
Cruciate Ligament ◽  
Postoperative Blood Loss ◽  
Platelet Rich Fibrin ◽  
Group 2 ◽  
Anterior Cruciate ◽  
Group 1

Background: Anterior cruciate ligament (ACL) reconstruction performed with growth factors and activated platelets has been suggested to accelerate tendon ligamentization, leading to earlier return to daily activities and sports. Hypotheses: Platelet-rich fibrin (PRF) will result in improved graft maturation and healing as evaluated by magnetic resonance imaging (MRI) in patients undergoing hamstring ACL reconstruction. Hemostatic and analgesic properties of PRF will lead to less postoperative blood loss and pain. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 44 patients with isolated ACL injuries who underwent arthroscopic all-inside anatomic single-bundle ACL reconstruction with semitendinosus tendon graft were enrolled. Group 1 included 23 patients who had PRF sprayed to the surface of the graft; group 2 included 21 patients for whom no PRF was used. Patients were discharged after 24 hours and examined for hemarthrosis that needed to be aspirated. MRI was performed at the fifth postoperative month. A blinded radiologist evaluated graft maturation according to its signal intensity and the presence of synovial fluid at the tunnel-graft interface. Results: PRF-treated grafts demonstrated lower MRI signal intensity and less fluid in the graft-tunnel interface as compared with controls for the entire length of the graft. The mean full-length MRI signal intensities were 9.19 versus 16.59 ( P = .047) for groups 1 and 2, respectively. Subgroup analysis of the semitendinosus grafts demonstrated a signal intensity of 11.57 versus 23.98 ( P = .044) for the proximal third, 9.53 versus 13.83 ( P = .237) for the midbody, and 6.48 versus 11.98 ( P = .087) for the distal third. Synovial fluid at the graft-tunnel interface was detected in 1 patient in group 1 (4.3%) and 3 patients in group 2 (14.3%; P < .001). Patients in group 1 had significantly less hemarthrosis that needed to be aspirated ( P = .003), while postoperative analgesia requirements were similar in both groups ( P = .08). No clinical benefit of PRF could be demonstrated in clinical outcomes. Conclusion: Application of PRF led to superior graft integration and maturation in the proximal third of the ACL graft. There was no significant difference in MRI signal intensity in the midbody or distal tibial graft. Application of PRF also resulted in significantly lower rates of postoperative hemarthrosis that needed to be aspirated.

scholarly journals Skeletally immature patient showed lower graft maturity than skeletally mature patient after ACL reconstruction with a rounded rectangular femoral tunnel

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kazuki Asai ◽  
Junsuke Nakase ◽  
Kengo Shimozaki ◽  
Rikuto Yoshimizu ◽  
Mitsuhiro Kimura ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Signal Intensity ◽  
Cruciate Ligament ◽  
Pivot Shift Test ◽  
Control Group ◽  
Skeletally Immature ◽  
Group 2 ◽  
Anterior Cruciate ◽  
Immature Group ◽  
Group 1

AbstractTo compare the clinical results and ligamentization of anterior cruciate ligament reconstruction (ACLR) between skeletally immature and mature patients. Two-hundred-and-two patients who underwent primary ACLR were evaluated retrospectively. The clinical outcomes were compared between skeletally immature (immature group 1, n = 27) and mature (control group 1, n = 175) groups. Graft ligamentization of the reconstructed anterior cruciate ligament (ACL) using magnetic resonance imaging (MRI) signal intensity at 6 months postoperatively was compared between immature group 2 (n = 16), which included participants from immature group 1, and control group 2 (n = 32), created by recruiting data-matched controls from control group 1. Immature group 1 had significantly higher revision (14.8%) and pivot shift test positive (22.2%) rates than control group 1 (2.9% and 4.0%, respectively) (P = 0.020 and 0.003, respectively). The signal intensity in immature group 2 were significantly higher at the mid-substance and distal site of the reconstructed ACL than those in control group 2 (P = 0.003 and 0.034, respectively). Skeletally immature patients had higher graft revision and residual rotational laxity rates. Reconstructed ACL in skeletally immature patients showed higher signal intensity on MRI at 6 months postoperatively.

scholarly journals Does anterolateral ligament injury change the treatment option in patients with partial ACL tears?

2021 ◽  
Vol 87 (2) ◽  
pp. 366-373
Author(s):  
Burak Gunaydin ◽  
Tugba Ilkem Kurtoglu Ozcaglayan ◽  
Mehmet Umit Cetin ◽  
Abdulkadir Sari ◽  
Yasar Mahsut Dincel ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Surgical Planning ◽  
Cruciate Ligament ◽  
Anterolateral Ligament ◽  
Ligament Injury ◽  
Choice Of Treatment ◽  
Group 2 ◽  
Anterior Cruciate ◽  
Group 1

Patients with ACL tears with ALL injury have more clinical complaints (instability, feeling of the pop on the knee or knee sliding). patients have ALL injury with partial ACL tears, It is unclear whether the choice of treatment will be conservative or surgical. This study aimed to determine the effect of anterolateral ligament (ALL) status, whether intact or ruptured, on the choice of conservative or surgical treatment in patients with partial anterior cruciate ligament (ACL) tears. Between 2015 and 2019, patients with suspected partial ACL tears were identified on both physical examination and MR imaging. 122 patients who had partial ACL tears and also status of patient’s ALL could be evaluated by radiologist were included in the study, retrospectively. Sixty-two patients who underwent ACL reconstruction were determined as group 1, and 60 patients who did not undergo ACL reconstruction were defined as group 2. In patients with partial ACL rupture with or without ACL reconstruction, it was evaluated whether a ruptured or non- ruptured ALL was effective in this decision of conservative or surgically. The MRIs of patients with partial ACL tears were evaluated by a radiologist and it was concluded that the ALLs of 50 patients were ruptured, and 72 were intact. The ALLs of 36 patients in group 1 were ruptured, and 26 patients were intact. Fourteen patients in group 2 had ruptured ALLs, 46 patient’s ALLs were intact. Seventy-two percent of the patients with partial ACL tears who had ruptured ALLs in MRI underwent ACL reconstruction. It was found that ACL reconstruction was performed more frequently in patients with partial ACL tears with ALL rupture. Therefore, we believe that preoperative evaluations of ALLs using MRI in patients with partial ACL tears are essential for surgical planning.

scholarly journals Isokinetic assessment of the flexor-extensor balance of the knee in athletes with total rupture of the anterior cruciate ligament

1999 ◽  
Vol 54 (2) ◽  
pp. 35-38 ◽  
Author(s):  
Antonio Sérgio A. P. Terreri ◽  
Marco A. Ambrósio ◽  
André Pedrinelli ◽  
Roberto F.M. Albuquerque ◽  
Felix Andrusaitis ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Peak Torque ◽  
Muscle Group ◽  
Lateral Side ◽  
Flexor Muscle ◽  
Average Value ◽  
Significant Difference ◽  
Angular Velocities ◽  
Anterior Cruciate

The purpose of this study was to assess the flexor-extensor group of muscles of the knee in young athletes diagnosed with a total rupture of the anterior cruciate ligament (ACL). Eighteen knees of 18 athletes (14 men and 4 women) with an average age of 21.6 years (range 16-32 years) were assessed with a Cybex 6000 model isokinetic apparatus. The average interval between occurrence of the injury and assessment was 10.2 months (range 2 - 48 months). There was an associated meniscal injury in eight of the knees. Athletes with any other kind of associated injury, limitation, or blockage of the movement of the joint, significant pain during the exam, or interval between injury and exam of less than two months were excluded from the study. The parameters studied were the peak torque-velocity and flexor-extensor relationships at the constant angular velocities of 60°/sec and 240°/sec. Previous warming-up was done by means of an ergometric bicycle and adaptation with 3 submaximal repetitions. The contra-lateral side, which presented no injury, was used as control. Peak torque (PT) at the constant velocity of 60°/sec was greater than that at 240°/sec for knees with and without injuries. However, there was no significant difference between the injured and uninjured sides at 60°/sec or at 240°/sec. The average value for the flexor-extensor relationship at 60°/sec on the injured was 60% (( 6), compared to 57% (( 10) on the contra-lateral side. At 240°/sec, the average value was 75% ((10) on the injured side, and 65% ((12) on the contra-lateral side. In conclusion, despite the complete rupture of the ACL of one knee, the average values for the flexor-extensor relationship were similar on the injured and uninjured sides at the velocity of 60°/sec. As the velocity increased, an increase in the values for the flexor-extensor relationship of the knee also occurred, indicating a tendency of the performance of the flexor muscle group to approach that of the extensor muscle group, and this tendency was more pronounced on the side of the injury.

scholarly journals Patellar tendon healing after anterior cruciate ligament reconstruction in football players

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0004
Author(s):  
Georgios Nikolaos Tzoanos ◽  
Nikolaos Tsavalas ◽  
Nikolaos Manidakis ◽  
Alkiviadis Kalliakmanis
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Doppler Imaging ◽  
Football Players ◽  
Tendon Defect ◽  
Significant Difference ◽  
The Mean ◽  
Anterior Cruciate

Introduction: To investigate the healing process of the harvested patellar tendon at 12±2 and 24±2 months following Bone-Patellar-Bone (BTB) Anterior Cruciate Ligament (ACL) reconstruction. Methods: 30 football players were enrolled in our study and examined at 12±2 and 24±2 months postoperatively. Donor and contralateral tendons evaluated with a high frequency ultrasound transducer. The maximum anteroposterior (MAP) and maximum transverse (MT) diameters of the patellar tendon and associated defect at the site of the tendon incision measured at its proximal, middle and distal thirds. The presence of vascular flow was examined with Doppler imaging. Echogenicity of the patellar tendon defect was graded as low, mixed or normal compared to the contralateral tendon. Results: There was no statistically significant difference between the mean MAP and MT diameters of the donor tendons at 12±2 and 24±2 months postoperatively (P>0.05). The mean MAP and MT diameters of the patellar tendon defect at 24±2 months were significantly smaller compared to 12±2 months postoperatively (P<0.01). The mean MAP diameter of the harvested tendon was significantly greater at all measured sites in comparison to the contralateral tendon at 12±2 and 24±2 months postoperatively (P<0.01). There was no statistically significant difference between the mean MT diameters of the donor and healthy tendons at 12±2 and 24±2 months postoperatively (P>0.05). At 12±2 months, the mean MAP diameter of the patellar tendon defect was 4.0±2.1 mm, 4.7±2.8 mm and 4.1±2.4 mm at the proximal, middle and distal third of the tendon respectively. The mean MT diameter of the defect was 3.3±2.2 mm (proximal third), 2.9±1.6 mm (middle third) and 2.1±0.9 mm (distal third). 2 of tendon defects showed low echogenicity, 6 mixed echogenicity, 2 patients normal echogenicity. At 24±2 months the mean MAP diameter of the patellar tendon defect was 0.3±0.3 mm, 0.4±0.4 mm and 0.3±0.3 mm at the proximal, middle and distal third of the tendon respectively. The mean MT diameter of the defect was 0.3±0.3 mm (proximal third), 0.2±0.2 mm (middle third) and 0.2±0.2 mm (distal third). 27 of patients demonstrated normal echogenicity, 1 low echogenicity, while 2 mixed echogenicity. No tendon exhibited any signs of neovascularization at 12±2 and 24±2 months postoperatively. Conclusions: Patellar tendons after BTB ACL reconstruction were characterized by increased thickness at 12±2 and 24±2 months postoperatively. Solid healing were evident in 2 patients by 12±2 months and in 27 by 24±2 months. No inflammatory changes were observed at 12±2 and 24±2 months postoperatively. [Figure: see text][Figure: see text]

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