Effect of Anterior Cruciate Ligament Reconstruction With an Autologous Semitendinosus-Gracilis Graft on Neuromuscular Function

2003 ◽  
Author(s):  
Glenn N. Williams ◽  
Peter J. Barrance ◽  
Lynn Snyder-Mackler ◽  
Thomas S. Buchanan
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Sports Participation ◽  
Biceps Femoris ◽  
Neuromuscular Function ◽  
Magnetic Resonance Images ◽  
Cross Sectional ◽  
Orthopaedic Surgeons ◽  
Lateral Muscle ◽  
Anterior Cruciate

The quadrupled semitendinosus-gracilis (ST-G) graft is rapidly becoming the graft of choice for orthopaedic surgeons when reconstructing the anterior cruciate ligament (ACL). During this procedure orthopaedic surgeons harvest the distal semitendinosus and gracilis tendons and use them to replace the ruptured ACL. Although people who undergo this procedure have good functional outcomes over the short-term, we do not know the effect that harvesting these two tendons has on neuromuscular function. The purpose of this study was to examine the effect that ACL reconstruction with an autologous ST-G had on musculotendinous morphology. The methods used in the study included digital reconstruction of knee musculature from magnetic resonance images (MRI). Marked reductions in muscle volume, cross-sectional area, and length were observed in the semitendinosus and gracilis when reassessed approximately 6 months following surgery (after the subjects had returned to sports participation). The subjects appeared to compensate for the diminished medial knee flexor function with the biceps femoris (a lateral muscle) and semimembranosus muscles. These findings may have important implications for joint loading, the long term health of the knee, and surgical decision-making.

scholarly journals Posttraumatic Bone Marrow Lesion Volume and Knee Pain Within 4 Weeks After Anterior Cruciate Ligament Injury

2017 ◽  
Vol 52 (6) ◽  
pp. 575-580 ◽  
Author(s):  
Jeffrey B. Driban ◽  
Stefan Lohmander ◽  
Richard B. Frobell
Keyword(s):  
Bone Marrow ◽  
Anterior Cruciate Ligament ◽  
Knee Pain ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Magnetic Resonance Images ◽  
Bone Marrow Lesion ◽  
Bone Bruise ◽  
Cross Sectional ◽  
Anterior Cruciate

Context:  After an anterior cruciate ligament (ACL) injury, a majority of patients have a traumatic bone marrow lesion (BML, or bone bruise). The clinical relevance of posttraumatic lesions remains unclear. Objective:  To explore the cross-sectional associations between traumatic BML volume and self-reported knee pain and symptoms among individuals within 4 weeks of ACL injury. Design:  Cross-sectional exploratory analysis of a randomized clinical trial. Setting:  Orthopaedic departments at 2 hospitals in Sweden. Patients or Other Participants:  As part of a randomized trial (knee anterior cruciate ligament nonoperative versus operative treatment [KANON] study), 121 young active adults (74% men, age = 26 ± 5 years, height = 1.8 ± 0.1 m, weight = 76 ± 13 kg) with an ACL tear were studied. Main Outcome Measure(s):  The BML volume in the proximal tibia and distal femur was segmented using magnetic resonance images obtained within 4 weeks of injury. A radiologist evaluated the presence of depression fractures on the images. Pain and symptoms of the injured knee (Knee Injury and Osteoarthritis Outcome Score [KOOS] pain and symptoms subscales) were obtained the same day as imaging. We used linear regression models to assess the associations. Results:  Most knees had at least 1 BML (96%), and the majority (57%) had a depression fracture. Whole-knee BML volume was not related to knee pain for the entire cohort (β = −0.09, P = .25). Among those without a depression fracture, larger whole-knee BML volume was associated with increased knee pain (β = –0.46, P = .02), whereas no association was found for those with a depression fracture (β = 0.0, P = .96). Larger medial (β = –0.48, P = .02) but not lateral (β = –0.03, P = .77) tibiofemoral BML volume was associated with greater pain. We found no association between BML volume and knee symptoms. Conclusions:  We confirmed the absence of relationships between whole-knee BML volume and pain and symptoms within 4 weeks of ACL injury. Our findings extend previous reports in identifying weak associations between larger BML volume in the medial compartment and greater pain and between BML volume and greater pain among those without a depression fracture.

The Femoral Footprint Position of the Anterior Cruciate Ligament Might Be a Predisposing Factor to a Noncontact Anterior Cruciate Ligament Rupture

2019 ◽  
Vol 47 (14) ◽  
pp. 3365-3372 ◽  
Author(s):  
Dimitris Dimitriou ◽  
Zhongzheng Wang ◽  
Diyang Zou ◽  
Tsung-Yuan Tsai ◽  
Naeder Helmy
Keyword(s):  
Anterior Cruciate Ligament ◽  
Matched Control ◽  
Cruciate Ligament ◽  
Magnetic Resonance Images ◽  
Small Sample ◽  
Transverse Plane ◽  
Acl Rupture ◽  
Coronal Plane ◽  
Predisposing Factor ◽  
Anterior Cruciate

Background: Although the femoral tunnel position is crucial to anatomic single-bundle anterior cruciate ligament (ACL) reconstruction, the recommendations for the ideal femoral footprint position are mostly based on cadaveric studies with small sample sizes, elderly patients with unknown ACL status, and 2-dimensional techniques. Furthermore, a potential difference in the femoral ACL footprint position and ACL orientation between ACL-ruptured and ACL-intact knees has not been reported in the literature. Hypothesis: The femoral ACL footprint position and ACL orientation vary significantly between ACL-ruptured and matched control ACL-intact knees. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Magnetic resonance images of the knees of 90 patients with an ACL rupture and 90 matched control participants who had a noncontact knee injury without an ACL rupture were used to create 3-dimensional models of the femur and tibia. The ACL footprints were outlined on each model, and their positions (normalized to the lateral condyle width) as well as ACL orientations were measured with an anatomic coordinate system. Results: The femoral ACL footprint in patients with an ACL rupture was located at 36.6% posterior and 11.2% distal to the flexion-extension axis (FEA). The ACL orientation was 46.9° in the sagittal plane, 70.3° in the coronal plane, and 20.8° in the transverse plane. The ACL-ruptured group demonstrated a femoral ACL footprint position that was 11.0% more posterior and 7.7% more proximal than that of the control group (all P < .01). The same patients also exhibited 5.7° lower sagittal elevation, 3.1° higher coronal plane elevation, and 7.9° lower transverse plane deviation (all P < .01). The optimal cutoff value of the femoral ACL footprint position to prevent an ACL rupture was at 30% posterior and 12% distal to the FEA. Conclusion: The ACL femoral footprint position might be a predisposing factor to an ACL rupture. Patients with a >30% posterior and <12% distal position of the femoral ACL footprint from the FEA might have a 51.2-times increased risk of an ACL rupture.

Effects of Anterior Cruciate Ligament (ACL) Injury on Muscle Activity of Head, Neck and Trunk Muscles: A Cross-Sectional Evaluation

CRANIO® ◽  
2007 ◽  
Vol 25 (3) ◽  
pp. 177-185 ◽  
Author(s):  
Simona Tecco ◽  
Vincenzo Salini ◽  
Stefano Teté ◽  
Felice Festa ◽  
Christian Colucci
Keyword(s):  
Anterior Cruciate Ligament ◽  
Muscle Activity ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Trunk Muscles ◽  
Cross Sectional ◽  
Anterior Cruciate ◽  
Head Neck

Morphological Evaluation of the Quadriceps Tendon Using Preoperative Ultrasound in Anterior Cruciate Ligament Reconstruction

2021 ◽  
pp. 036354652110540
Author(s):  
Satoshi Takeuchi ◽  
Kevin J. Byrne ◽  
Ryo Kanto ◽  
Kentaro Onishi ◽  
Freddie H. Fu
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Tendon ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
Preoperative Ultrasound ◽  
Anterior Cruciate ◽  
Superior Pole

Background: An evaluation of quadriceps tendon (QT) morphology preoperatively is an important step when selecting an individually appropriate autograft for anterior cruciate ligament (ACL) reconstruction. However, to our knowledge, there are no studies that have assessed the morphology of the entire QT in an ACL-injured knee preoperatively using ultrasound. Purpose: We aimed to investigate the morphological characteristics of the QT using preoperative ultrasound in ACL-injured knees. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 33 patients (mean age, 26.0 ± 11.5 years) with a diagnosed ACL tear undergoing primary ACL reconstruction were prospectively included. Using ultrasound, short-axis images of the QT were acquired in 10-mm increments from 30 to 100 mm proximal to the superior pole of the patella. The length of the QT was determined by 2 contiguous images that did and did not contain the rectus femoris muscle belly. The width of the superficial and narrowest parts of the QT, the thickness of the central and thickest parts of the QT, and the cross-sectional area at the central 10 mm of the superficial QT width were measured at each assessment location. The estimated intraoperative diameter of the QT autograft was calculated using a formula provided in a previous study. Results: There were no significant relationships between QT morphology and any of the demographic data collected. The length of the QT was less than 70 mm in 45.5% of patients (15/33). The width, thickness, cross-sectional area, and estimated intraoperative diameter of the QT autograft were significantly greater at 30 mm than at 70 mm proximal to the superior pole of the patella. Conclusion: Preoperative ultrasound may identify a QT that is too small for an all–soft tissue autograft in ACL reconstruction. Furthermore, harvesting a QT with a fixed width may result in autografts that are smaller proximally than they are distally. Assessing the morphology of the QT preoperatively using ultrasound may help surgeons to adequately reconstruct the native length and diameter of the ACL with a QT autograft.

Return to Play and Long-term Participation in Pivoting Sports After Anterior Cruciate Ligament Reconstruction

2019 ◽  
Vol 47 (14) ◽  
pp. 3339-3346 ◽  
Author(s):  
Line Lindanger ◽  
Torbjørn Strand ◽  
Anders Odd Mølster ◽  
Eirik Solheim ◽  
Eivind Inderhaug
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Replacement ◽  
Revision Surgery ◽  
Cruciate Ligament ◽  
Sports Participation ◽  
Acl Injuries ◽  
Replacement Surgery ◽  
Long Term Consequences ◽  
Anterior Cruciate

Background: Rupture of the anterior cruciate ligament (ACL) is a common and feared injury among athletes because of its potential effect on further sports participation. Reported rates of return to pivoting sports after ACL reconstruction (ACLR) vary in the literature, and the long-term consequences of returning have rarely been studied. Purpose: To examine the rate and level of return to pivoting sports after ACLR, the duration of sports participation, and long-term consequences of returning to pivoting sports. Study Design: Cohort study; Level of evidence, 2. Methods: All primary ACLRs with a bone–patellar tendon–bone autograft between 1987 and 1994 (N = 234) in athletes participating in team handball, basketball, or soccer before injury were selected from a single-center quality database. A long-term evaluation (median, 25 years; range, 22-30 years) was performed using a questionnaire focusing on return to pivoting sports, the duration of sports activity after surgery, later contralateral ACL injuries, revision surgery, and knee replacement surgery. Participants were stratified into 2 groups depending on the time between injury and surgery (early, <24 months; late, ≥24 months). Results: A total of 93% of patients (n = 217) responded to the questionnaire. Although 83% of patients returned to pivoting sports after early ACLR, only 53% returned to preinjury level. Similar return-to-sport rates were observed in males and females ( P > .05), but males had longer sports careers (median, 10 years; range, 1-23 years) than females (median, 4 years; range, 1-25 years; P < .001). The incidence of contralateral ACL injuries was 28% among athletes who returned to sports versus 4% among athletes who did not return ( P = .017) after early ACLR. The pooled reinjury rate after return to preinjury level of sports was 41% (30%, contralateral injuries; 11%, revision surgery). The incidence of contralateral ACL injuries was 32% among females versus 23% among males ( P > .05) and, for revision surgery, was 12% among females versus 7% among males ( P > .05) after returning to sports. Having a late ACLR was associated with an increased risk of knee replacement surgery (9% vs 3%; P = .049) when compared with having an early ACLR. Conclusion: ACLR does not necessarily enable a return to preinjury sports participation. By returning to pivoting sports after ACLR, athletes are also facing a high risk of contralateral ACL injuries. Long-term evaluations in risk assessments after ACLR are important, as a significant number of subsequent ACL injuries occur later than the routine follow-up.

scholarly journals Predictors of Healing Ligament Size and Magnetic Resonance Signal Intensity at 6 Months After Bridge-Enhanced Anterior Cruciate Ligament Repair

2019 ◽  
Vol 47 (6) ◽  
pp. 1361-1369 ◽  
Author(s):  
Martha M. Murray ◽  
Ata M. Kiapour ◽  
Leslie A. Kalish ◽  
Kirsten Ecklund ◽  
Christina Freiberger ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Signal Intensity ◽  
Cruciate Ligament ◽  
Quadriceps Strength ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Acl Repair ◽  
Cross Sectional ◽  
Anterior Cruciate

Background: Primary repair of the anterior cruciate ligament (ACL) augmented with a tissue engineered scaffold to facilitate ligament healing is a technique under development for patients with ACL injuries. The size (the amount of tissue) and signal intensity (the quality of tissue) of the healing ligament as visualized on magnetic resonance imaging (MRI) have been shown to be related to its strength in large animal models. Hypothesis: Both modifiable and nonmodifiable risk factors could influence the size and signal intensity of the repaired ligament in patients at 6 months after surgery. Study Design: Case series; Level of evidence, 4. Methods: 62 patients (mean age, 19.4 years; range, 14-35 years) underwent MRI of the knee 6 months after ACL repair augmented with an extracellular matrix scaffold. The signal intensity (normalized to cortical bone) and average cross-sectional area of the healing ligament were measured from the MRI stack obtained by use of a gradient echo sequence. Associations between these 2 measures and patient characteristics, which included demographic, clinical, and anatomic features, were determined by use of multivariable regression analysis. Results: A larger cross-sectional area of the repaired ligament at 6 months was associated with male sex, older age, and the performance of a larger notchplasty ( P < .05 for all associations). A lower signal intensity at 6 months, indicating greater similarity to normal ligament, was associated with a smaller tibial slope and greater side-to-side difference in quadriceps strength 3 months after surgery. Other factors, including preoperative body mass index, mechanism of injury, tibial stump length, and Marx activity score, were not significantly associated with either MRI parameter at 6 months. Conclusion: Modifiable factors, including surgical notchplasty and slower recovery of quadriceps strength at 3 months, were associated with a larger cross-sectional area and improved signal intensity of the healing ACL after bridge-enhanced ACL repair in this preliminary study. Further studies to determine the optimal size of the notchplasty and the most effective postoperative rehabilitation strategy after ACL repair augmented by a scaffold are justified. Registration: NCT02664545 (ClinicalTrials.gov identifier).

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