A Novel Joint Loading System to Investigate the Effect of Daily Mechanical Load on a Healing Anterior Cruciate Ligament (ACL) Reconstruction

2009 ◽  
Author(s):  
Mark Stasiak ◽  
Peter Torzilli ◽  
Carl Imhauser ◽  
Jonathan Packer ◽  
Asheesh Bedi ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Acl Reconstruction ◽  
Rat Model ◽  
Mechanical Load ◽  
Cruciate Ligament ◽  
Joint Distraction ◽  
The Us ◽  
Loading System ◽  
Anterior Cruciate

A novel system was developed to investigate the effect of mechanical load on tendon to bone healing, using a rat model of ACL reconstruction. A greater understanding of the effects of mechanical load may improve rehabilitation practices for the more than 100,000 ACL reconstructions each year in the US alone.[1] The purpose of this study was to assess: the accuracy of knee joint distraction, variability in fixator compliance, and ability of animals to tolerate the fixator over a typical loading protocol.

scholarly journals Effective Graft Preservation by Following a Standard Protocol for the Treatment of Knee Joint Infection after Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 32 (11) ◽  
pp. 1111-1120
Author(s):  
Robin Otchwemah ◽  
Jan-Hendrik Naendrup ◽  
Frauke Mattner ◽  
Thorsten Tjardes ◽  
Holger Bäthis ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Joint Infection ◽  
Standard Protocol ◽  
Standardized Protocol ◽  
Graft Preservation ◽  
Knee Joint Infection ◽  
Anterior Cruciate

AbstractKnee joint infections constitute a rare but devastating complication after anterior cruciate ligament (ACL) reconstruction. We hypothesized that effective infection therapy and graft preservation is possible following a standard treatment protocol. We retrospectively analyzed all patients admitted to our center with suspected infection of the knee after ACL reconstruction between 2010 and 2012. Following a standardized protocol, blood samples were drawn and synovial fluid was analyzed. Furthermore, the protocol consisted of arthroscopic lavages and debridements of the anterior and posterior joint compartments over three incisions, and targeted antibiotic therapy over a period of 6 weeks. Surgeries were repeated every 2 days until clinical signs of infections resolved, but at least two times. Mean observation period was 10 months. Forty-one patients aged 31 ( ±  9.9) years and admitted 14 ( ±  7.5) days after ACL reconstruction were included. Pathogens were found in 34 patients and coagulase-negative staphylococci were isolated most commonly (31 isolates in 28 patients). Quinolones were the most commonly used antibiotic agents. Mean number of operations was 3.8 ( ± 1.4). Following the standard protocol, primary successful infection treatment with graft preservation was possible in 37 of the included 41 patients. Graft preservation was achieved in 100% of the included patients with Gaechter stage 1 and 2 infections. Knee joint infection after ACL reconstruction was successfully treated following a standardized protocol, and graft preservation was reliably achieved especially in cases with infections at an early stage.

Result of anterior cruciate ligament reconstruction with all-inside technique using button system tightrope in Viet Duc University Hospital

2021 ◽  
Vol 11 (2) ◽  
Author(s):  
Trường Thịnh Vũ ◽  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
University Hospital ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Abstract Background: Evaluating the treatment results of Anterior Cruciate Ligament (ACL) reconstruction with the all-inside technique using the TightRope system. Patients and methods: It was a longitudinal descriptive study to investigate 56 patients who underwent ACL reconstruction with an all-inside technique using the Tight-Rope system in Viet Duc University Hospital between June 2019 and March 2020. Result: 82% of patients were men, and mainly of working age. The primary cause of ACL injury was a sports injury. Six months after surgery, the outcomes were excellent. The patient's knee joint range of motion and stability (evaluated by the Lachman and Pivot-Shift test) has improved significantly. Conclusions: Arthrosopic ACL reconstruction with all-inside technique using TightRope system leads to significant improvement in range of motion of patient's knee joint. The result of this study helps surgeons choose more options for management of ACL injury. Key word: Knee arthroscopy, anterior cruciate ligament reconstruction, all-inside. Tóm tắt Mục tiêu: Nghiên cứu đánh giá kết quả điều trị của phẫu thuật tái tạo dây chằng chéo trước (DCCT) theo kĩ thuât tái tạo "all inside" (tất cả bên trong) sử dụng Tightrope (TGR) hai đầu. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả tiến cứu trên 56 người bệnh (NB) phẫu thuật nội soi tái tạo DCCT với kỹ thuật tất cả bên trong sử dụng Tightrope hai đầu tại bệnh viện Hữu Nghị Việt Đức từ tháng 6 năm 2019 đến tháng 3 năm 2020. Kết quả: NB chủ yếu là nam giới (82%), trong độ tuổi lao động, nguyên nhân chủ yếu do tai nạn thể thao. Kết quả sau mổ 6 tháng rất tốt, NB cải thiện biên độ vận động và độ vững của khớp gối rõ rệt qua đánh giá bằng dấu hiệu Lachman và nghiệm pháp Pivot-shift. Kết luận: Nội soi tái tạo DCCT bằng kỹ thuật "tất cả bên trong" sử dụng TGR hai đầu đạt kết quả cao về sự phục hồi biên độ vận động khớp gối của NB sau mổ, giúp cho phẫu thuật viên có thêm lựa chọn về phương pháp phẫu thuật trong điều trị tái tạo DCCT. Từ khóa: Nội soi khớp gối, tái tạo dây chằng chéo trước, tất cả bên trong.

17-Year Results following Transepiphyseal Anterior Cruciate Ligament Reconstruction in Children and Adolescents

2021 ◽  
Author(s):  
Alexander Zimmerer ◽  
Marco M. Schneider ◽  
Carina Semann ◽  
Wolfgang Schopf ◽  
Christian Sobau ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Lysholm Score ◽  
Long Term Results ◽  
Childhood And Adolescence ◽  
The Mean ◽  
Anterior Cruciate

Abstract Objective Rupture of the anterior cruciate ligament (ACL) in childhood and adolescence is a serious injury. It is now known that conservative therapy of an unstable knee joint in childhood or adolescence under can lead to poor subjective and objective results. The aim of this study is to record long-term results after transepiphyseal ACL reconstruction using autologous hamstring tendons and extracortical fixation in childhood and adolescence with open physes – at least 15 years after surgery. Methods Our internal registry was used to identify all patients who received surgical treatment of an acl tear during childhood and adolescence by transepiphyseal acl reconstruction more than 15 years previously. In these patients, the International Knee Documentation Committee for Subjective Knee Form (IKDCsubj.), Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Score (TAS) and Lysholm Score were collected, and clinical and magnetic resonance imaging (MRI) examinations were performed. Results A total of 22 patients were identified, 5 of whom could not be contacted. The mean age at the time of surgery was 13.1 years, and the mean follow-up time was 17.4 years. In 3 patients, a traumatic tear was observed with subsequent reconstruction of the ACL. None of the included patients showed a growth disorder during the course of the study. The IKDCsubj. was 92.4 ± 14.7 (48 – 100), the Lysholm score was 87.9 ± 16.9 (34 – 100), the TAS was 5.7 ± 2.3 (3 – 9) and the pain level based on VAS was 3.5 ± 2.6 (1 – 8) points. The values showed subjective and objective deterioration compared to the 10-year results, with no statistical significance. The following subscores were reported for the KOOS: KOOSpain 90.9 ± 17.6 (28 – 100); KOOSsymptom 82.9 ± 22.6 (11 – 100); KOOOSADL 94.3 ± 13.7 (44 – 100); KOOSSport 80.3 ± 26.4 (15 – 100); KOOSQOL 80.9 ± 25.8 (0 – 100). 13 of the 17 patients could also be clinically and radiologically examined. In 92% of patients, an intact acl reconstruction was found without evidence of cartilage or meniscus damage. The mean lateral difference in the KT-1000 measurement was 1.5 mm. Conclusion ACL reconstruction in childhood and adolescence provides good functionality and stability of the knee joint over the long term. Secondary signs of osteoarthritis can only be detected in isolated cases by MRI. ACL reconstruction using the transepiphyseal technique can be considered the method of choice for open growth plate knee joints.

Force-Measuring Robot for Evaluation of Anterior Cruciate Ligament Reconstruction

2012 ◽  
Vol 466-467 ◽  
pp. 1418-1423
Author(s):  
Yan Hu ◽  
Jun Wei ◽  
Lei Li ◽  
Shi Li ◽  
Xi Ju Zong
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Lateral Force ◽  
Mathematics Model ◽  
Lateral Direction ◽  
Post Operation ◽  
Anterior Cruciate ◽  
And Control

Aiming at the problems of the anterior cruciate ligament (ACL) reconstruction in knee joint, such as deficiency in effective effect evaluation and insufficiency in operation safety, a zero gravity based force-measuring robot is developed to measure the pre- and post-operative tension of the knee joint ACL. The requirements for the robot's configuration and control are analyzed with regard to the ACL operation environment. Then the mathematical model of the ACL lateral force is deduced. The mechanical configuration and the control system design of the force-measuring robot for knee joint ACL are presented in detail. Lastly, experiments on measuring precision of the displacement and force of the mandrel, and the post-operation evaluation on the ovine bone, are implemented. The results show that the robot is effective for ACL reconstruction evaluation and the mathematics model of ACL forced in lateral direction is valid.

scholarly journals A Novel In Vivo Joint Loading System to Investigate the Effect of Daily Mechanical Load on a Healing Anterior Cruciate Ligament Reconstruction

2010 ◽  
Vol 4 (1) ◽  
Author(s):  
Mark Stasiak M. Eng ◽  
Carl Imhauser ◽  
Jonathan Packer ◽  
Asheesh Bedi ◽  
Robert Brophy ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Bone Healing ◽  
Structural Changes ◽  
Mechanical Load ◽  
Tracking System ◽  
Cruciate Ligament ◽  
Healing Process ◽  
Anterior Cruciate

We designed and validated a novel knee joint fixation/distraction system to study tendon–to-bone healing in an in vivo rat model of anterior cruciate ligament (ACL) reconstruction. The system uses an external fixator to apply a cyclic distraction of the knee joint while monitoring the resultant force developed across the joint, thus providing a temporal indication of structural changes during the healing process of the bone-tendon-bone reconstruction. The validation was performed using an optical kinematic tracking system to determine the local displacement of the knee. The average system compliance was determined to be 42.4±8.8 μm/N with a coefficient of variation of 20.7%. The compliance was used to obtain a best fit correction factor which brought the total root mean square error of knee joint distraction to within 179 μm (16.1%) of the applied distraction. We performed a pilot study using 15 rats that had ACL reconstructions using a flexor digitorum longus tendon autograft and found that the animals tolerated the indwelling fixator and daily anesthesia over a 10 day loading protocol. Our knee joint fixation/distraction system provides a valuable tool to study how mechanical stimuli affect in vivo bone-tendon-bone healing.

scholarly journals Influence of Bundle Diameter and Attachment Point on Kinematic Behavior in Double Bundle Anterior Cruciate Ligament Reconstruction Using Computational Model

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Oh Soo Kwon ◽  
Tserenchimed Purevsuren ◽  
Kyungsoo Kim ◽  
Won Man Park ◽  
Tae-Kyu Kwon ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Pivot Shift Test ◽  
Tibial Rotation ◽  
Attachment Point ◽  
Anterior Cruciate ◽  
Double Bundle Acl Reconstruction

A protocol to choose the graft diameter attachment point of each bundle has not yet been determined since they are usually dependent on a surgeon’s preference. Therefore, the influence of bundle diameters and attachment points on the kinematics of the knee joint needs to be quantitatively analyzed. A three-dimensional knee model was reconstructed with computed tomography images of a 26-year-old man. Based on the model, models of double bundle anterior cruciate ligament (ACL) reconstruction were developed. The anterior tibial translations for the anterior drawer test and the internal tibial rotation for the pivot shift test were investigated according to variation of bundle diameters and attachment points. For the model in this study, the knee kinematics after the double bundle ACL reconstruction were dependent on the attachment point and not much influenced by the bundle diameter although larger sized anterior-medial bundles provided increased stability in the knee joint. Therefore, in the clinical setting, the bundle attachment point needs to be considered prior to the bundle diameter, and the current selection method of graft diameters for both bundles appears justified.

scholarly journals Analysis of Motor Coordination Alteration after Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 2 (85) ◽  
Author(s):  
Vilma Jurevičienė ◽  
Dovilė Kielė ◽  
Ričardas Jurevičius ◽  
Tadas Česnaitis
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Acl Reconstruction ◽  
Motor Coordination ◽  
Cruciate Ligament ◽  
Movement Coordination ◽  
Coordination Test ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
Injured Knee

Research background and hypothesis. The Anterior cruciate ligament (ACL) is the most commonly injured ligament of the knee and its injuries result in significant functional impairment. Injury to the ACL is associated with altered knee joint loading and impaired neuromuscular control, which defined as the ability to produce well controlled movements and dynamic balance.Research aim. The aim of this study was to evaluate motor  coordination  and functional capacity of patients who received rehabilitation program following ACL reconstruction.Research methods. The study included 15 males aged 33.7 ± 2.49 years who had undergone unilateral ACL reconstruction  with  a  semitendinosus/gracilis  (STG)  graft  in  Kaunas  Clinical  hospital.  For  objective  functional testing, we used figure-of-eight movement coordination test. The Lysholm questionnaire was included as a disability outcome measure following ACL injury and reconstruction.  The patients were assessed preoperatively and after 5 and 21weeks postoperatively.Research  results.  The  results  of  this  study  indicated  that  motor  coordination  timescale  showed  significant differences (p < 0.05) between the injured and the healthy legs before surgery and after 5 and 21 weeks. The movement coordination test data showed that there the timescale significantly  longer on the injured knee compared with the noninjured knee. After 21 weeks of rehabilitation we found significantly lower (p  < 0.05) values in injured knees compared with the preoperative data. In injured knee the timescale after 21 weeks of rehabilitation was significantly (p < 0.05) longer compared with noninjured knee.The Lysholm questionnaire scale indicated that there was a significant difference in the results for values (p  < 0.05) before surgery and after 21 weeks of rehabilitation. The questionnaire scale data showed that after 21 weeks of rehabilitation results for values was significantly (p < 0.05) highest compared with before surgery and after 5 weeks.Discussion and conclusions. There was improvement in the injured leg in mean motor coordination timescale 21 weeks after ACL reconstruction, but the timescale was higher than in the uninjured leg. After 21 weeks of ACL reconstruction knee functional status in most patients was good or excellent.Keywords: knee joint, the Lysholm questionnaire, movement coordination test.

The Effectiveness of a Functional Knee Brace on Joint-Position Sense in Anterior Cruciate Ligament–Reconstructed Individuals

2016 ◽  
Vol 25 (2) ◽  
pp. 190-194 ◽  
Author(s):  
Dai Sugimoto ◽  
Jessica C. LeBlanc ◽  
Sarah E. Wooley ◽  
Lyle J. Micheli ◽  
Dennis E. Kramer
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Position Sense ◽  
Joint Position Sense ◽  
Joint Position ◽  
Knee Brace ◽  
Reconstruction Surgery ◽  
Anterior Cruciate

It is estimated that approximately 350,000 individuals undergo anterior cruciate ligament (ACL) reconstruction surgery in each year in the US. Although ACL-reconstruction surgery and postoperative rehabilitation are successfully completed, deficits in postural control remain prevalent in ACL-reconstructed individuals. In order to assist the lack of balance ability and reduce the risk of retear of the reconstructed ACL, physicians often provide a functional knee brace on the patients’ return to physical activity. However, it is not known whether use of the functional knee brace enhances knee-joint position sense in individuals with ACL reconstruction. Thus, the effect of a functional knee brace on knee-joint position sense in an ACL-reconstructed population needs be critically appraised. After systematically review of previously published literature, 3 studies that investigated the effect of a functional knee brace in ACL-reconstructed individuals using joint-position-sense measures were found. They were rated as level 2b evidence in the Centre of Evidence Based Medicine Level of Evidence chart. Synthesis of the reviewed studies indicated inconsistent evidence of a functional knee brace on joint-position improvement after ACL reconstruction. More research is needed to provide sufficient evidence on the effect of a functional knee brace on joint-position sense after ACL reconstruction. Future studies need to measure joint-position sense in closed-kinetic-chain fashion since ACL injury usually occurs under weight-bearing conditions.

Influence of the Injury-to-Surgery Interval on the Healing Potential of Human Anterior Cruciate Ligament–Derived Cells

2017 ◽  
Vol 45 (6) ◽  
pp. 1359-1369 ◽  
Author(s):  
Takao Inokuchi ◽  
Tomoyuki Matsumoto ◽  
Koji Takayama ◽  
Naoki Nakano ◽  
Shurong Zhang ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Bone Healing ◽  
Rat Model ◽  
Early Phase ◽  
Cruciate Ligament ◽  
Chronic Phase ◽  
Early Group ◽  
Chronic Group ◽  
Anterior Cruciate

Background: Vascular CD34+ cells in anterior cruciate ligament (ACL) tissue have the potential for high proliferation and multilineage differentiation that can accelerate tendon-bone healing. While patient characteristics, such as age, can affect tendon-bone healing, the influence of elapsed time after injury on the healing process is unclear. Hypothesis: Cells obtained during the early phase after injury will exhibit a greater tendon-bone healing potential compared with chronic phase counterparts when applied to an immunodeficient rat model of ACL reconstruction. Study Design: Controlled laboratory study. Methods: Adult human ACL-ruptured tissue was harvested from patients undergoing arthroscopic primary ACL reconstruction and classified into 2 groups based on the time elapsed between injury and surgery: (1) early group (≤3 months from injury) and (2) chronic group (>3 months from injury). In addition, 76 ten-week-old female immunodeficient rats underwent ACL reconstruction, followed by intracapsular administration of one of the following: (1) ACL-derived cells from the early group (n = 5), (2) ACL-derived cells from the chronic group (n = 5), or (3) phosphate-buffered saline (PBS) only (n = 5). During the 8 weeks after surgery, histological (weeks 2, 4, 8), immunohistochemical (week 2), radiographic (weeks 0, 2, 4, 8), and biomechanical (week 8) analyses were performed to evaluate tendon-bone healing. Results: In the early group, the histological evaluation showed early healing, induction of endochondral ossification–like integration, and mature bone ingrowth. Micro–computed tomography showed that the tibial bone tunnels at week 4 and week 8 were significantly reduced in the early group compared with those in the chronic group and PBS group ( P < .05). Moreover, biomechanical tensile strength was significantly greater in the early group than in the other groups ( P < .05). An accelerated healing potential in the early group was further demonstrated by the enhancement of intrinsic angiogenesis/osteogenesis and human-derived vasculogenesis/osteogenesis. Conclusion: Compared with human ACL-derived cells obtained during the chronic phase, cells obtained during the early phase after injury have a greater tendon-bone healing potential when used in an immunodeficient rat model of ACL reconstruction. Clinical Relevance: During ACL reconstruction surgery, transplanting ACL remnant tissue in the early phase after injury could accelerate and enhance tendon-bone healing.

Effects of Remnant Tissue Preservation on the Tendon Graft in Anterior Cruciate Ligament Reconstruction

2016 ◽  
Vol 44 (7) ◽  
pp. 1708-1716 ◽  
Author(s):  
Tsuneari Takahashi ◽  
Eiji Kondo ◽  
Kazunori Yasuda ◽  
Shin Miyatake ◽  
Yasuyuki Kawaguchi ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Structural Properties ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Joint Stiffness ◽  
Tissue Preservation ◽  
Anterior Translation ◽  
Remnant Preservation ◽  
Anterior Cruciate

Background: There is controversy regarding the efficacy of remnant tissue preservation on graft healing in anterior cruciate ligament (ACL) reconstruction. Hypothesis: The preserved remnant tissue will (1) adhere to the graft surface and undergo a remodeling process, (2) accelerate graft revascularization, (3) increase the number of graft mechanoreceptors by 4 weeks, and (4) improve anteroposterior knee laxity and structural properties of the graft by 12 weeks. Study Design: Controlled laboratory study. Methods: Forty-two sheep were randomly divided into 2 groups of 21 animals. In group I, the ACL was completely removed. In group II, the ACL was transected at the midsubstance but not debrided. ACL reconstruction was performed using a semitendinosus tendon autograft in both groups. Histological changes of the grafted tendon and the remnant tissue were evaluated at 4 and 12 weeks after surgery. Biomechanically, anterior translation and knee joint stiffness under an anterior drawer force and the structural properties of the femur-graft-tibia complex were evaluated. Results: The preserved remnant tissue was histologically distinct from the graft at 4 weeks, while the tissue partially adhered to the graft surface at 12 weeks. The ACL remnant tissue significantly accelerated revascularization in the grafted tendon at 4 weeks and significantly increased the number of mechanoreceptors at 4 and 12 weeks. In addition, remnant preservation significantly improved anterior translation (9.3 ± 2.1 mm and 5.4 ± 1.7 mm at 60° of knee flexion in groups I and II, respectively) and knee joint stiffness at 12 weeks. However, there were no significant differences in the structural properties between the 2 groups at 4 and 12 weeks after surgery. Conclusion: Preservation of the ACL remnant tissue in ACL reconstruction enhanced cell proliferation, revascularization, and regeneration of proprioceptive organs in the reconstructed ACL and reduced anterior translation. However, remnant preservation did not improve the structural properties of the graft. Clinical Relevance: These results imply that preservation of the ACL remnant tissue may improve graft healing after ACL reconstruction.

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