Assessing Laxity Characteristics of Hyperextension Knee in Healthy Young Females Using a Knee Ligament Arthrometer

2007 ◽  
Author(s):  
Hsiu-Chen Lin ◽  
Weng-Hang Lai ◽  
Chia-Ming Chang ◽  
Horng-Chaung Hsu
Keyword(s):  
Female Athletes ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Acl Injury ◽  
Male Athletes ◽  
Knee Ligament ◽  
Young Females ◽  
Anterior Knee Laxity ◽  
Anterior Cruciate ◽  
Anterior Knee

Female athletes are more likely to sustain an anterior cruciate ligament (ACL) injury than male athletes. Previous study has showed that female individuals had larger anterior knee laxity than their male counterparts [1]. Researchers have also reported that knee laxity and hyperextension knee were a possible factor contributing to ACL injury [2]. Loudon showed that a person with hyperextension knee, either healthy or ACL-injured, had poorer proprioceptive control. Even more, ACL-injured subjects with hyperextension knee demonstrated a declined function of proprioception feedback loop and the ability to initiate protective reflexes [3].

scholarly journals Clinical Tests Can Be Used to Screen for Second Anterior Cruciate Ligament Injury in Younger Patients Who Return to Sport

2019 ◽  
Vol 7 (8) ◽  
pp. 232596711986300 ◽  
Author(s):  
Kate E. Webster ◽  
Julian A. Feller
Keyword(s):  
Anterior Cruciate Ligament ◽  
Odds Ratio ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Knee Laxity ◽  
Acl Injury ◽  
Anterior Knee Laxity ◽  
Anterior Cruciate ◽  
Clinical Measures ◽  
Anterior Knee

Background: Younger athletes have high rates of second anterior cruciate ligament (ACL) injury. Return-to-sport criteria have been proposed to enable athletes to make a safe return, but they frequently lack validation. It is unclear whether commonly recorded clinical measures can help to identify high-risk athletes. Purpose: To explore the association between commonly recorded clinical outcome measures and second ACL injury in a young, active patient group. Study Design: Cohort study; Level of evidence, 2. Methods: Included in this study were 329 athletes (200 males, 129 females) younger than 20 years at the time of first primary ACL reconstruction surgery who had subsequently returned to sport participation. Clinical examination included range of knee motion (passive flexion and extension deficits), instrumented anterior knee laxity, and single- and triple-crossover hop for distance. Patients also completed the subjective International Knee Documentation Committee form. All measures were collected prospectively at a 12-month postoperative clinical review. Patients were evaluated for a minimum 3 years to determine the incidence of subsequent ACL injury. Results: A total of 95 patients (29%) sustained a second ACL injury following clinical assessment and return to sport. There were 50 graft ruptures and 45 contralateral ACL injuries. Patients with a flexion deficit of 5° had over 2 times the odds of sustaining a graft rupture (odds ratio, 2.3; P < .05), and patients with a side-to-side difference in anterior knee laxity of 3 mm or greater had over 2 times the odds of sustaining a contralateral ACL injury (odds ratio, 2.4; P < .05). Overall, 29% (94 of 329) of patients met the threshold for satisfactory function on all 6 clinical measures; these patients had a 33% reduction in the risk of sustaining a second ACL injury ( P = .05) as compared with those who did not meet all clinical thresholds. Conclusion: Clinical measures of knee flexion and stability may have utility to screen for and identify patients who are at greater risk for a second ACL injury in an already high-risk group (ie, age and activity level).

scholarly journals Association of Anterior Cruciate Ligament Width With Anterior Knee Laxity

2016 ◽  
Vol 51 (6) ◽  
pp. 460-465 ◽  
Author(s):  
Hsin-Min Wang ◽  
Sandra J. Shultz ◽  
Randy J. Schmitz
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Acl Injury ◽  
Resonance Imaging ◽  
Notch Angle ◽  
Anterior Knee Laxity ◽  
Anterior Cruciate ◽  
Anterior Knee ◽  
Femoral Notch

Context: Greater anterior knee laxity (AKL) has been identified as an anterior cruciate ligament (ACL) injury risk factor. The structural factors that contribute to greater AKL are not fully understood but may include the ACL and bone geometry. Objective: To determine the relationship of ACL width and femoral notch angle to AKL. Design: Cross-sectional study. Setting: Controlled laboratory. Patients or Other Participants: Twenty recreationally active females (age = 21.2 ± 3.1 years, height = 1.66.1 ± 7.3 cm, mass = 66.5 ± 12.0 kg). Main Outcome Measure(s): Anterior cruciate ligament width and femoral notch angle were obtained with magnetic resonance imaging of the knee and AKL was assessed. Anterior cruciate ligament width was measured as the width of a line that transected the ACL and was drawn perpendicular to the Blumensaat line. Femoral notch angle was formed by the intersection of the line parallel to the posterior cortex of the femur and the Blumensaat line. Anterior knee laxity was the anterior displacement of the tibia relative to the femur (mm) at 130 N of an applied force. Ten participants' magnetic resonance imaging data were assessed on 2 occasions to establish intratester reliability and precision. Using stepwise backward linear regression, we examined the extent to which ACL width, femoral notch angle, and weight were associated with AKL. Results: Strong measurement consistency and precision (intraclass correlation coefficient [2,1] ± SEM) were established for ACL width (0.98 ± 0.3 mm) and femoral notch angle (0.97° ± 1.1°). The regression demonstrated that ACL width (5.9 ± 1.4 mm) was negatively associated with AKL (7.2 ± 2.0 mm; R2 = 0.22, P = .04). Femoral notch angle and weight were not retained in the final model. Conclusions: A narrower ACL was associated with greater AKL. This finding may inform the development of ACL injury-prevention programs that include components designed to increase ACL size or strength (or both). Future authors should establish which other factors contribute to greater AKL in order to best inform injury-prevention efforts.

scholarly journals Jump-Landing Biomechanics and Knee-Laxity Change Across the Menstrual Cycle in Women With Anterior Cruciate Ligament Reconstruction

2014 ◽  
Vol 49 (2) ◽  
pp. 154-162 ◽  
Author(s):  
David R. Bell ◽  
J. Troy Blackburn ◽  
Anthony C. Hackney ◽  
Stephen W. Marshall ◽  
Anthony I. Beutler ◽  
...  
Keyword(s):  
Menstrual Cycle ◽  
Cruciate Ligament ◽  
Reaction Force ◽  
Knee Laxity ◽  
Acl Injury ◽  
Initial Contact ◽  
Vertical Ground Reaction Force ◽  
Jump Landing ◽  
Anterior Knee Laxity ◽  
Anterior Cruciate

Context: Of the individuals able to return to sport participation after an anterior cruciate ligament(ACL) injury, up to 25% will experience a second ACL injury. This population may be more sensitive to hormonal fluctuations, which may explain this high rate of second injury. Objective: To examine changes in 3-dimensional hip and knee kinematics and kinetics during a jump landing and to examine knee laxity across the menstrual cycle in women with histories of unilateral noncontact ACL injury. Design  Controlled laboratory study. Setting: Laboratory. Patients or Other Participants: A total of 20 women (age = 19.6 ± 1.3 years, height = 168.6 ± 5.3 cm, mass = 66.2 ± 9.1 kg) with unilateral, noncontact ACL injuries. Intervention(s) Participants completed a jump-landing task and knee-laxity assessment 3 to 5 days after the onset of menses and within 3 days of a positive ovulation test. Main Outcome Measure(s): Kinematics in the uninjured limb at initial contact with the ground during a jump landing, peak kinematics and kinetics during the loading phase of landing, anterior knee laxity via the KT-1000, peak vertical ground reaction force, and blood hormone concentrations (estradiol-β-17, progesterone, free testosterone). Results: At ovulation, estradiol-β-17 (t = −2.9, P = .009), progesterone (t = −3.4, P = .003), and anterior knee laxity (t = −2.3, P = .03) increased, and participants presented with greater knee-valgus moment (Z = −2.6, P = .01) and femoral internal rotation (t = −2.1, P = .047). However, during the menses test session, participants landed harder (greater peak vertical ground reaction force; t = 2.2, P = .04), with the tibia internally rotated at initial contact (t = 2.8, P = .01) and greater hip internal-rotation moment (Z = −2.4, P = .02). No other changes were observed across the menstrual cycle. Conclusions Knee and hip mechanics in both phases of the menstrual cycle represented a greater potential risk of ACL loading. Observed changes in landing mechanics may explain why the risk of second ACL injury is elevated in this population.

scholarly journals Sexual Dimorphisms in Anterior Cruciate Ligament Injury: A Current Concepts Review

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110253
Author(s):  
Tayt M. Ellison ◽  
Ilexa Flagstaff ◽  
Anthony E. Johnson
Keyword(s):  
Female Athletes ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Extrinsic Factors ◽  
Male Athletes ◽  
Acl Injuries ◽  
Sexual Dimorphisms ◽  
Increased Risk ◽  
Anterior Cruciate ◽  
Postsurgical Outcomes

Background: Although most anterior cruciate ligament (ACL) injuries occur in male athletes, female athletes are consistently observed to be at a higher risk for sports-specific ACL injury. Purpose: To provide a thorough review of what is known about the sexual dimorphisms in ACL injury to guide treatment and prevention strategies and future research. Study Design: Narrative review. Methods: We conducted a comprehensive literature search for ACL-related studies published between January 1982 and September 2017 to identify pertinent studies regarding ACL injury epidemiology, prevention strategies, treatment outcomes, and dimorphisms. By performing a broad ACL injury search, we initially identified 11,453 articles. After applying additional qualifiers, we retained articles if they were published in English after 1980 and focused on sex-specific differences in any of 8 different topics: sex-specific reporting, difference in sports, selective training, hormonal effects, genetics, neuromuscular and kinematic control, anatomic differences, and outcomes. Results: A total of 122 articles met the inclusion criteria. In sum, the literature review indicated that female athletes are at significantly higher risk for ACL injuries than are their male counterparts, but the exact reasons for this were not clear. Initial studies focused on intrinsic differences between the sexes, whereas recent studies have shifted to focus on extrinsic factors to explain the increased risk. It is likely both intrinsic and extrinsic factors contribute to this increased risk, but further study is needed. In addition to female patients having an increased risk for ACL injuries, they are less likely than are male patients to undergo reconstructive surgery, and they experience worse postsurgical outcomes. Despite this, reconstructive surgery remains the gold standard when knee stability, return to sports, and high functional outcome scores are the goal, but further research is needed to determine why there is disparity in surgical rates and what surgical techniques optimize postsurgical outcomes for female patients. Conclusion: Male athletes often predominated the research concerning ACL injury and treatment, and although sex-specific reporting is progressing, it has historically been deficient. ACL injuries, prevention techniques, and ACL reconstruction require further research to maximize the health potential of at-risk female athletes.

scholarly journals Effect of Age at Menarche on Anterior Cruciate Ligament Injury Incidence and Anterior Knee Laxity in Collegiate Athletes

2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Andrew Froehle ◽  
Joseph Cox ◽  
Jedediah May ◽  
Kimberly Grannis ◽  
Dana Duren
Keyword(s):  
Injury Risk ◽  
Cruciate Ligament ◽  
Collegiate Athletes ◽  
Knee Laxity ◽  
Age At Menarche ◽  
Injury Incidence ◽  
Acl Injuries ◽  
Anterior Knee Laxity ◽  
Anterior Cruciate ◽  
Anterior Knee

Female athletes suffer painful, costly, and career-limiting non-contact anterior cruciate ligament (ACL) injuries more often than males. Previous research suggests that pubertal neuromusculoskeletal development contributes to this sex-bias, but the manner in which variation in pubertal development affects injury risk within females is poorly understood. Age at menarche is a variable, significant pubertal developmental event, signaling the onset of estrogen cycling and affecting musculoskeletal development. Earlier menarche may increase injury risk, possibly by increasing anterior knee laxity through prolonged estrogen exposure. The purpose of this case-control study was to test the primary hypothesis that collegiate athletes with previous ACL injuries have earlier age at menarche than their uninjured peers, and to test the secondary hypothesis that earlier menarche is related to greater anterior knee laxity in injured and uninjured athletes. The study sample consisted of female NCAA Division-I varsity athletes (N=14 injured, N=120 uninjured). Outcome measures included: menstrual history and ACL injury details (injury age, activity at time of injury, contact vs. non-contact), assessed by questionnaire; and anterior knee laxity assessed by KT-1000 arthrometer. Correlation, t-tests, and regression analysis were used to test for associations between age at menarche, injury incidence, and knee laxity. Fourteen athletes reported ≥1 non-contact ACL injury, and had significantly earlier menarche than uninjured athletes (12.6±1.3 y vs. 13.4±1.4 y; P=0.05). Earlier menarche also significantly predicted injury status (Wald c2=7.43; Pb=-1.02±0.37; OR=0.36; 95% CI:0.17-0.75), but was not correlated with anterior knee laxity. Within injured athletes, however, laxity in the unaffected knee was significantly related to time since menarche (r2=0.79, Pr2=0.72, P

scholarly journals Revision ACL Reconstruction - A retrospective failure analysis with a mean follow up of 35 months

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0030
Author(s):  
Lena Alm ◽  
Matthias Krause ◽  
Karl-Heinz Frosch ◽  
Ralph Akoto
Keyword(s):  
Acl Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Knee Instability ◽  
Medial Knee ◽  
Risk Of Failure ◽  
Anterior Knee Laxity ◽  
Anterior Cruciate ◽  
Anterior Knee

Aims and Objectives: While patients following primary anterior cruciate ligament (ACL) surgery show satisfying results, the outcome after revision ACL reconstruction (ACLR) seems to be less favourable. The purpose of this study was to evaluate the outcome of patients after revision ACLR. We hypothesize that peripheral knee instabilities and further concomitant lesions are risk factors for failure of revision ACLR. Furthermore, we hypothesize that peripheral stabilisation will reduce the risk of failure. Materials and Methods: Between 2013 and 2016, 111 patients with revision ACLR (revision surgery after primary ACL reconstruction) were included in the retrospective study. All patients were clinically examined with a minimum of 2 years after revision surgery (mean 35 months) and identified as “failed revision ACLR” (side-to-side difference greater than 5mm and/or pivot-shift grade 2/3) and “stable revision ACLR”. Multiple logistic regression modeling was used to evaluate whether certain predisposing factors were associated with increased odds of failure of the revision ACLR. Results: Failure after revision ACLR occurred in 14.5% (n=16) of the cases. Preoperative medial knee instability (n=36) was associated with failure of revision ACLR, thus patients had a 17 times greater risk of failure when medial knee instability was diagnosed preoperatively. Also, the risk of failure was reduced when patients had peripheral medial (n=24) and/ or antero-lateral stabilisation (n=51). Increased posterior tibial slope (PTS, n=11 greater than 12°) and high-grade anterior knee laxity (side-to-side-difference greater than 5 mm and/or pivot-shift grade 3, n=41) were associated with failed revision ACLR. Furthermore, patients had a 9 times greater risk of failure when they were obese (BMI greater than 30 kg/m2, n=30). Also, postoperative functional scores in comparison to preoperative scores were shown to be significantly higher (Lysholm 85±27 vs. 51±31.9, p=0.024; Tegner 6.5± 1.3 vs. 4± 2.6, p=0.015). Conclusion: Results following revision anterior cruciate ligament reconstruction (ACLR) are less favourable than primary ACLR. Peripheral medial knee instability, high-grade anterior knee laxity, increased PTS and high BMI are risk factors for failure in revision ACLR while additional medial and/or antero-lateral stabilisation reduces the risk of failure.

scholarly journals Slope-Correction Osteotomy with Lateral Extra-articular Tenodesis and Revision Anterior Cruciate Ligament Reconstruction Is Highly Effective in Treating High-Grade Anterior Knee Laxity

2020 ◽  
Vol 48 (14) ◽  
pp. 3478-3485
Author(s):  
Ralph Akoto ◽  
Lena Alm ◽  
Tobias Claus Drenck ◽  
Jannik Frings ◽  
Matthias Krause ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Case Series ◽  
Knee Laxity ◽  
High Grade ◽  
Correction Osteotomy ◽  
Anterior Knee Laxity ◽  
Functional Scores ◽  
Slope Correction ◽  
Anterior Cruciate ◽  
Anterior Knee

Background: Both an elevated posterior tibial slope (PTS) and high-grade anterior knee laxity are often present in patients who undergo revision anterior cruciate ligament (ACL) surgery, and these conditions are independent risk factors for ACL graft failure. Clinical data on slope-correction osteotomy combined with lateral extra-articular tenodesis (LET) do not yet exist. Purpose: To evaluate the outcomes of patients undergoing revision ACL reconstruction (ACLR) and slope-correction osteotomy combined with LET. Study Design: Case series; Level of evidence, 4. Methods: Between 2016 and 2018, we performed a 2-stage procedure: slope-correction osteotomy was performed first, and then revision ACLR in combination with LET was performed in 22 patients with ACLR failure and high-grade anterior knee laxity. Twenty patients (6 women and 14 men; mean age, 27.8 ± 8.6 years; range, 18-49 years) were evaluated, with a mean follow-up of 30.5 ± 9.3 months (range, 24-56 months), in this retrospective case series. Postoperative failure was defined as a side-to-side difference of ≥5 mm in the Rolimeter test and a pivot-shift grade of 2 or 3. Results: The PTS decreased from 15.3° to 8.9°, the side-to-side difference decreased from 7.2 to 1.1 mm, and the pivot shift was no longer evident in any of the patients. No patients exhibited revision ACLR failure and all patients showed good to excellent postoperative functional scores (mean ± SD: visual analog scale, 0.5 ± 0.6; Tegner, 6.1 ± 0.9; Lysholm, 90.9 ± 6.4; Knee injury and Osteoarthritis Outcome Score [KOOS] Symptoms, 95.2 ± 8.4; KOOS Pain, 94.7 ± 5.2; KOOS Activities of Daily Living, 98.5 ± 3.2; KOOS Function in Sport and Recreation, 86.8 ± 12.4; and KOOS Quality of Life, 65.4 ± 14.9). Conclusion: Slope-correction osteotomy in combination with LET is a safe and reliable procedure in patients with high-grade anterior knee laxity and a PTS of ≥12°. Normal knee joint stability was restored and good to excellent functional scores were achieved after a follow-up of at least 2 years.

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