scholarly journals The Effect of Tibial Rotation on the Presence of Instability in the Anterior Cruciate Ligament Deficient Knee

2007 ◽  
Vol 16 (1) ◽  
pp. 2-17 ◽  
Author(s):  
Mina Samukawa ◽  
David Magee ◽  
Masaki Katayose
Keyword(s):  
Outcome Measures ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Normal Subjects ◽  
Group Differences ◽  
Tibial Rotation ◽  
Anterior Cruciate ◽  
The Relationship ◽  
Acl Deficient ◽  
Control Study

Context:The effects of tibial rotation after ACL injury have not yet been well determined.Objective:To show whether clinical outcomes such as the amount of tibial rotation can affect functional outcomes in normal and ACL deficient knees.Design:Case control study.Setting:Research laboratory.Participants:Twenty normal subjects (Control) and 20 subjects with ACL deficient knees (ACL).Main Outcome Measures:Tibial rotation at 30 and 90 degrees of knee flexion was measured using an inclinometer. One-legged hop, crossover hop, figure-of-eight running and 10-m running tests were used and determined the effect(s) of tibial rotation on the outcome of the functional tests.Results:There were significant between-group differences in internal and external rotation. The relationship between external tibial rotation and the figure-of-eight index was significantly negatively correlated.Conclusions:The amount of tibial rotation is greater in ACL ruptured knees than in uninjured knees, and these greater amounts of tibial rotation affected the figure-of-eight running index.

scholarly journals Anterior Cruciate Ligament Rupture and Osteoarthritis Progression

2012 ◽  
Vol 6 (1) ◽  
pp. 295-300 ◽  
Author(s):  
James Min-Leong Wong ◽  
Tanvir Khan ◽  
Chethan S Jayadev ◽  
Wasim Khan ◽  
David Johnstone
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Degenerative Change ◽  
Acl Rupture ◽  
Osteoarthritis Progression ◽  
Anterior Cruciate ◽  
The Relationship ◽  
Meniscal Damage ◽  
Acl Deficient

Anterior Cruciate Ligament (ACL) rupture is a common sporting injury that frequently affects young, athletic patients. Apart from the functional problems of instability, patients with ACL deficient knees also develop osteoarthritis. Although this is frequently cited as an indication for ACL reconstruction, the relationship between ACL rupture, reconstruction and the instigation and progression of articular cartilage degenerative change is controversial. The purpose of this paper is to review the published literature with regards ACL rupture and the multifactorial causes for osteoarthritis progression, and whether or not this is slowed or stopped by ACL reconstruction. There is no evidence in the published literature to support the view that ACL reconstruction prevents osteoarthritis, although it may prevent further meniscal damage. It must be recognised that this conclusion is based on the current literature which has substantial methodological limitations.

The Effect of Hamstring Tendon Autograft Harvest on the Restoration of Knee Stability in the Setting of Concurrent Anterior Cruciate Ligament and Medial Collateral Ligament Injuries

2017 ◽  
Vol 46 (1) ◽  
pp. 163-170 ◽  
Author(s):  
Thomas J. Kremen ◽  
Landon S. Polakof ◽  
Sean S. Rajaee ◽  
Trevor J. Nelson ◽  
Melodie F. Metzger
Keyword(s):  
Anterior Cruciate Ligament ◽  
Medial Collateral Ligament ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Knee Stability ◽  
Hamstring Autograft ◽  
Collateral Ligament ◽  
Intact State ◽  
Anterior Cruciate ◽  
Acl Deficient

Background: A hamstring autograft is commonly used in anterior cruciate ligament (ACL) reconstruction (ACLR); however, there is evidence to suggest that the tendons harvested may contribute to medial knee instability. Hypothesis: We tested the hypothesis that the gracilis (G) and semitendinosus (ST) tendons significantly contribute to sagittal, coronal, and/or rotational knee stability in the setting of ACLR with a concurrent partial medial collateral ligament (MCL) injury. Study Design: Controlled laboratory study. Methods: Twelve human cadaveric knees were subject to static forces applied to the tibia including an anterior-directed force as well as varus, valgus, and internal and external rotation moments to quantify laxity at 0°, 30°, 60°, and 90° of flexion. The following ligament conditions were tested on each specimen: (1) ACL intact/MCL intact, (2) ACL deficient/MCL intact, (3) ACL deficient/partial MCL injury, and (4) ACLR/partial MCL injury. To quantify the effect of muscle loads, the quadriceps, semimembranosus, biceps femoris, sartorius (SR), ST, and G muscles were subjected to static loads. The loads on the G, ST, and SR could be added or removed during various test conditions. For each ligament condition, the responses to loading and unloading the G/ST and SR were determined. Three-dimensional positional data of the tibia relative to the femur were recorded to determine tibiofemoral rotations and translations. Results: ACLR restored anterior stability regardless of whether static muscle loads were applied. There was no significant increase in valgus motion after ACL transection. However, when a partial MCL tear was added to the ACL injury, there was a 30% increase in valgus rotation ( P < .05). ACLR restored valgus stability toward that of the intact state when the G/ST muscles were loaded. A load on the SR muscle without a load on the G/ST muscles restored 19% of valgus rotation; however, it was still significantly less stable than the intact state. Conclusion: After ACLR in knees with a concurrent partial MCL injury, the absence of loading on the G/ST did not significantly alter anterior stability. Simulated G/ST harvest did lead to increased valgus motion. These results may have important clinical implications and warrant further investigation to better outline the role of the medial hamstrings, particularly among patients with a concomitant ACL and MCL injury. Clinical Relevance: A concurrent ACL and MCL injury is a commonly encountered clinical problem. Knowledge regarding the implications of hamstring autograft harvest techniques on joint kinematics may help guide management decisions.

The Effects of Removal and Reconstruction of the Anterior Cruciate Ligament on Patellofemoral Kinematics

1998 ◽  
Vol 26 (2) ◽  
pp. 201-209 ◽  
Author(s):  
Yeou-Fang Hsieh ◽  
Louis F. Draganich ◽  
Sherwin H. Ho ◽  
Bruce Reider
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Flexion ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Anterior Tibial Translation ◽  
Tibial Rotation ◽  
Patellar Tilt ◽  
Anterior Cruciate ◽  
Tibial Translation ◽  
Intact Knee

Patellofemoral pain may be associated with anterior cruciate ligament deficiency or may occur after anterior cruciate ligament reconstruction. We investigated the effects of the removal and reconstruction of the anterior cruciate ligament on the kinematics of the tibiofemoral and patellofemoral joints during physiologic levels of quadriceps muscle loads in seven cadaveric knees. A bone-patellar tendon-bone graft was used for intraarticular reconstruction of the anterior cruciate ligament. The spatial positions of the tibiofemoral and patellofemoral joints were measured between 0° and 90° of knee flexion in 15° increments with a six degree-of-freedom digitizing system. Excision of the anterior cruciate ligament resulted in statistically significant increases in anterior tibial translation between 0° and 90° and valgus tibial rotation between 30° and 90°; intraarticular reconstruction returned these to levels not significantly different from those of the intact knee. Excision of the anterior cruciate ligament resulted in significant increases in lateral patellar tilt, ranging from 6.3° to 9.0° between full extension and 90° of knee flexion, and in lateral patellar shift, ranging from 2.9 mm at 15° of knee flexion to 5.9 mm at 90°; intraarticular reconstruction returned these to levels not significantly different from those of the intact knee. Neither removal nor reconstruction of the anterior cruciate ligament significantly affected tibial internal-external rotation, patellar flexion, patellar mediolateral rotation, patellar anteroposterior translation, or patellar proximodistal translation.

Tibial Rotation in Anterior Cruciate Ligament (ACL)-Deficient and ACL-Reconstructed Knees

2007 ◽  
Vol 37 (7) ◽  
pp. 601-613 ◽  
Author(s):  
Nicholas Stergiou ◽  
Stavros Ristanis ◽  
Constantina Moraiti ◽  
Anastasios D Georgoulis
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Tibial Rotation ◽  
Anterior Cruciate ◽  
Acl Deficient

Sport-Specificity of Knee Scoring Systems to Assess Disability in Anterior Cruciate Ligament-Deficient Athletes

1998 ◽  
Vol 7 (1) ◽  
pp. 44-60 ◽  
Author(s):  
Paul A. Borsa ◽  
Scott M. Lephart ◽  
James J. Irrgang
Keyword(s):  
Anterior Cruciate Ligament ◽  
Activities Of Daily Living ◽  
Outcome Measures ◽  
Scoring System ◽  
Daily Living ◽  
Functional Disability ◽  
Cruciate Ligament ◽  
Scoring Systems ◽  
Anterior Cruciate ◽  
Acl Deficient

We compared the outcome measures of three knee scoring systems currently used to measure disability in anterior cruciate ligament (ACL)–deficient athletes. Twenty-nine ACL-deficient athletes completed three scoring systems (the Lysholm Knee Scoring System, a modified version of the Cincinnati Knee Scoring System, and the Knee Outcome Survey). Results demonstrate statistically significant mean differences and linear relationships between the outcome measures for the three scoring systems. The Knee Outcome Survey appears to provide valid measures of disability and indicates that our subjects functioned well with activities of daily living but became symptomatic and functionally limited with sports. The outcome measures also indicate that the Lysholm system is more specific to activities of daily living, while the modified Cincinnati is more specific to sports. We recommend that standard scoring systems be developed to provide measures of functional disability in athletes who experience knee injuries.

Tibial Rotation Affects Anterior Displacement of the Knee

1994 ◽  
Vol 3 (4) ◽  
pp. 275-281 ◽  
Author(s):  
David E. Martin ◽  
Kevin M. Guskiewicz ◽  
David H. Perrin ◽  
David M. Kahler ◽  
Frank C. McCue
Keyword(s):  
Repeated Measures ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Position Effect ◽  
Tibial Rotation ◽  
Repeated Measures Anova ◽  
Anterior Displacement ◽  
Kt 1000 ◽  
Tibiofemoral Alignment ◽  
Anterior Cruciate

The purpose of this study was to assess anterior translation of the tibia using the Tibial Fixator Device (a mechanical leg stabilizer that controls tibial alignment) with the leg in three positions: neutral (N), internal rotation of 15° (IR), and external rotation of 15° (ER). Displacement was measured using a modified KT-1000 arthrometer. Eleven subjects with anterior cruciate ligament lesions were examined bilaterally in the three positions at 45, 67, and 89 newtons of anterior force. Three-factor repeated-measures ANOVA revealed a significant position effect regardless of force (p < .001). This effect was significant in the injured and noninjured legs. Displacement was greatest in ER and least in IR. These data indicate that the position of the tibia, maintained with an external leg restraint, has a significant effect on anterior displacement of the knee. Control of tibiofemoral alignment and modifications to the KT-1000 provide new potentials for instrumented arthrometry.

scholarly journals The Relationship between Anterior Cruciate Ligament Injury and Osteoarthritis of the Knee

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
David Simon ◽  
Randy Mascarenhas ◽  
Bryan M. Saltzman ◽  
Meaghan Rollins ◽  
Bernard R. Bach ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Surgical Reconstruction ◽  
Ligament Injury ◽  
Tibial Rotation ◽  
Increased Risk ◽  
Anterior Cruciate ◽  
Tibial Translation ◽  
The Relationship

Anterior cruciate ligament (ACL) tears are a common injury, particularly in the athletic and youth populations. The known association between ACL injury and subsequent osteoarthritis (OA) of the knee merits a more in-depth understanding of the relationship between the ACL-injured knee and osteoarthritis. ACL injury, especially with concomitant meniscal or other ligamentous pathology, predisposes the knee to an increased risk of osteoarthritis. ACL insufficiency results in deterioration of the normal physiologic knee bending culminating in increased anterior tibial translation and increased internal tibial rotation. This leads to increased mean contact stresses in the posterior medial and lateral compartments under anterior and rotational loading. However, surgical reconstruction of the ACL has not been shown to reduce the risk of future OA development back to baseline and has variability based on operative factors of graft choice, timing of surgery, presence of meniscal and chondral abnormalities, and surgical technique. Known strategies to prevent OA development are applicable to patients with ACL deficiency or after ACL reconstruction and include weight management, avoidance of excessive musculoskeletal loading, and strength training. Reconstruction of the ACL does not necessarily prevent osteoarthritis in many of these patients and may depend on several external variables.

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