Finite Element Analysis of the Knee: Development of a Failure Locus for the Anterior Cruciate Ligament

Author(s):  
A. Homyk ◽  
A. Orsi ◽  
S. Wibby ◽  
N. H. Yang ◽  
H. N. Hashemi ◽  
...  

A full or partial tear of the anterior cruciate ligament (ACL) is a common and painful injury that has been estimated to occur approximately 250,000 times annually in the U.S. [1]. Articular cartilage and meniscal injuries are also associated with ACL injuries [2]. ACL injuries can often lead to degenerative osteoarthritis of the articular cartilage [2]. An epidemiology study of athletic injuries by Majewski et al. [3] determined that out of 19,530 sports injuries, 20% were ACL injuries and 8% were medial collateral ligament (MCL) injuries.

Author(s):  
A. Orsi ◽  
N. H. Yang ◽  
H. N. Hashemi ◽  
P. K. Canavan

A full or partial tear of the anterior cruciate ligament (ACL) is a common and painful injury that has been estimated to occur approximately 250,000 times annually in the U.S. [1]. Articular cartilage and meniscal injuries are also associated with ACL injuries [2]. ACL injuries can often lead to degenerative osteoarthritis of the articular cartilage [2]. An epidemiology study of athletic injuries by Majewski et al. [3] determined that out of 19,530 sports injuries, 20% were ACL injuries and 8% were medial collateral ligament (MCL) injuries.


Author(s):  
A. Orsi ◽  
A. Vaziri ◽  
P. K. Canavan ◽  
H. N. Hashemi

A full or partial tear of the anterior cruciate ligament (ACL) is a common and painful injury that has been estimated to occur approximately 250,000 times annually in the U.S. [1]. Articular cartilage and meniscal injuries are also associated with ACL injuries [2]. ACL injuries can often lead to degenerative osteoarthritis of the articular cartilage [2]. An epidemiology study of athletic injuries by Majewski et al. [3] determined that out of 19,530 sports injuries, 20% were ACL injuries and 8% were medial collateral ligament (MCL) injuries.


Author(s):  
A. Orsi ◽  
A. Vaziri ◽  
S. Chakravarthy ◽  
P. K. Canavan ◽  
R. Goebel ◽  
...  

Anterior cruciate ligament (ACL) injury is a common and painful injury that occurs approximately 250,000 times annually in the U.S. [1]. Articular cartilage and meniscal injuries are also associated with ACL injuries [2]. ACL injuries can often lead to degenerative osteoarthritis of the articular cartilage [2]. An epidemiology study of athletic injuries by Majewski et al. [3] determined that out of 19,530 sports injuries, 20% were ACL injuries and 8% were medial collateral ligament (MCL) injuries.


Author(s):  
Andrew Homyk ◽  
Paul K. Canavan ◽  
Alexander Orsi ◽  
Story Wibby ◽  
Nicholas Yang ◽  
...  

Anterior cruciate ligament (ACL) disruption is a common injury that is detrimental to an athlete’s quality of life. Determining the mechanisms that cause ACL injury is important in order to develop proper interventions. This study was conducted to provide insight into the specific knee orientations associated with ACL injuries. A failure locus for the ACL was developed by simulating multiple loading scenarios using a 3-D finite element analysis (FEA) model of the knee. The results indicated varus and valgus were more dominant to the ACL injury compared to femoral rotation. The order of MCL failure, ACL failure, and maximum meniscus stress was also determined with respect to time during loading. The results of this study could be used to develop training programs focused on the avoidance of the described combination of movements, which may lead to ACL injury.


Women in sport – an almost inexhaustible topic that has been neglected for a long time. Female Athletes conquer discipline after discipline – including the associated injuries. Common sports injuries in female athletes include stress fractures, anterior cruciate ligament (ACL) injuries and sport related concussions (SRC). Less commonly recognized are the specific sex differences that lead to these injuries. An understanding of these factors can improve their clinical management including surgical treatment, the rehabilitation phase and return to play.


2020 ◽  
Vol 8 (10) ◽  
pp. 232596712095900
Author(s):  
Michael Khair ◽  
Jonathan Riboh ◽  
Jaicus Solis ◽  
Jim Maurer ◽  
J. Britt Brown ◽  
...  

Background: The first case series to report on return to play (RTP) in National Football League (NFL) players after primary anterior cruciate ligament (ACL) reconstruction (ACLR) published an RTP rate of 63%. Other studies that have attempted to estimate RTP after ACLR in these elite athletes have been largely based on secondary sources. This study is the second to report the authors’ own results in treating ACL injuries in NFL players spanning a study period of 25+ years. Purpose: To report the senior authors’ experience treating ACL injuries in NFL players as well as revisit the concept of RTP as it is currently used to measure successful surgical outcomes in professional athletes. Study Design: Case series; Level of evidence, 4. Methods: A total of 47 NFL players were treated at our institution for knee injuries that included a complete tear of the ACL; of these, 41 were primary ACLR and 6 were revision ACLR. Of the primary ACLRs, 6 were classified as ACL plus additional ligament and 3 were classified as multiligament. Return to game play (RTGP) was defined as returning to play in a regular-season game. Successful return to previous participation (RTPP) was defined as return to a level of participation equal to the level the player had reached before injury. Multivariate analysis was used to assess predictors of successful RTPP. Results: Using the RTGP criteria proposed by prior authors, the RTGP after primary ACLR was 73%. Using our proposed RTPP criteria, 87.8% of players successfully returned to the same level of participation after primary ACLR. RTGP percentage for all NFL players after ACLR (including multiligament injuries) was 67.6%, and the overall RTPP for those patients was 87.8%. In multivariate analysis, age ≤25 years was predictive of successful RTPP. High draft picks and offensive players played more seasons after primary ACLR. ACL graft rupture occurred in 4.3% of this cohort. Contralateral ACL tear occurred in 8.5%. Conclusion: Regardless of which definition is used to measure a successful outcome after ACLR surgery, the findings of this study suggest that successful return after primary ACLR in NFL athletes is higher than previously reported. While concomitant reconstruction of a single collateral ligament did not affect RTPP, revision ACLR or bicruciate plus collateral ligament reconstruction was associated with a lower RTPP rate. Age ≤25 years predicted successful RTPP. The risk of a future ACL tear of either knee after index reconstruction was approximately 13%.


2020 ◽  
Vol 11 (1) ◽  
pp. 130
Author(s):  
Datao Xu ◽  
Xinyan Jiang ◽  
Xuanzhen Cen ◽  
Julien S. Baker ◽  
Yaodong Gu

Volleyball players often land on a single leg following a spike shot due to a shift in the center of gravity and loss of balance. Landing on a single leg following a spike may increase the probability of non-contact anterior cruciate ligament (ACL) injuries. The purpose of this study was to compare and analyze the kinematics and kinetics differences during the landing phase of volleyball players using a single leg (SL) and double-leg landing (DL) following a spike shot. The data for vertical ground reaction forces (VGRF) and sagittal plane were collected. SPM analysis revealed that SL depicted a smaller knee flexion angle (about 13.8°) and hip flexion angle (about 10.8°) during the whole landing phase, a greater knee and hip power during the 16.83–20.45% (p = 0.006) and 13.01–16.26% (p = 0.008) landing phase, a greater ankle plantarflexion angle and moment during the 0–41.07% (p < 0.001) and 2.76–79.45% (p < 0.001) landing phase, a greater VGRF during the 5.87–8.25% (p = 0.029), 19.75–24.14% (p = 0.003) landing phase when compared to DL. Most of these differences fall within the time range of ACL injury (30–50 milliseconds after landing). To reduce non-contact ACL injuries, a landing strategy of consciously increasing the hip and knee flexion, and plantarflexion of the ankle should be considered by volleyball players.


2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0004
Author(s):  
John A. Schlechter ◽  
Tanner Harrah ◽  
Bryn Gornick ◽  
Benjamin Sherman

Introduction: With participation in youth sports anterior cruciate ligament (ACL) injuries are a common occurrence. Nearly 70% of ACL tears in children and adolescents have an associated meniscus tear. Percutaneous medial collateral ligament (MCL) relaxation has been described as utilitarian in accessing the medial meniscus for diagnostic assessment and treatment in the adult population to increase medial compartment working space in arthroscopic surgery. The technique has not been evaluated in the pediatric population. The purpose of this study was to compare the outcomes of children and adolescents that underwent anterior cruciate ligament reconstruction (ACLR) with and without percutaneous relaxation of the medial collateral ligament (MCL) for meniscal tear management. Methods: A retrospective review was performed of patients aged 8 to 19 years old that had undergone knee arthroscopy for an (ACLR) with meniscus pathology. Those that underwent MCL relaxation were grouped together and compared to a matched cohort that did not have MCL relaxation performed. Preoperative, operative and postoperative data was analyzed. The primary measurement was obtained using a validated patient reported outcome score (Pedi-IKDC), secondary outcome measures were defined as superficial or deep infection, saphenous nerve dysesthesias, ACL graft failure and return to the operating room. Statistical analysis of the two cohorts was performed. Results: Fifty-four patients were included in the study (27 in each group) with average age 15 years (range 10-19). Average follow-up for the MCL relaxation group was 22.4 months versus 58 months for the non-MCL relaxation group. The average Pedi-IKDC score was 93.3 for the MCL relaxation group and 91.4 for the non-MCL relaxation group (p=0.34). There was no difference in patient demographics, return to the operating room (p=0.49), saphenous nerve dysesthesia (p=0.49), superficial or deep infection (p=0.32). Conclusion: ACL reconstruction in children and adolescents with MCL relaxation for the management of medial meniscal tears appears to be a safe option. Equivocal patient reported outcome scores as compared to the control group were found with no increase in post-operative complications. In children with ACL tears, appropriate diagnosis and management of medial meniscal pathology is important to maintain secondary restraint to anterior tibial translation and prevent premature graft failure. Pediatric knees can have tight medial compartments, making access difficult, potentially leading to poor visualization and iatrogenic chondral damage. Percutaneous medial collateral ligament (MCL) relaxation has been described in the adult population to increase medial compartment working space without long term sequela. We report similar findings in an all pediatric cohort.


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