scholarly journals Numerical Analysis of the ACL, with Sprains of Different Degrees after Trauma

2021 ◽  
Vol 2021 ◽  
pp. 1-19
Author(s):  
Rodrigo Arturo Marquet-Rivera ◽  
Guillermo Urriolagoitia-Sosa ◽  
Beatriz Romero-Ángeles ◽  
Rosa Alicia Hernández-Vázquez ◽  
Octavio Alejandro Mastache-Miranda ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cruciate Ligament ◽  
Muscle Fibres ◽  
Control Case ◽  
Human Knee ◽  
Compressive Stresses ◽  
Healthy State ◽  
Therapeutic Procedures ◽  
Anterior Cruciate ◽  
Von Mises

Nowadays, cruciate ligament injuries have increased in incidence, since practicing a sport or physical activity has become a trend in current societies. Although this lifestyle generates multiple benefits, as a consequence, injury has also increased. Due to its nature and complexity, the ligaments of the knee are those that are most frequently affected, mainly the ACL (anterior cruciate ligament). This tissue reacts to overexertion or movements out of range, either caused by the exercise itself or caused by trauma caused by the practice of physical activity, causing various degrees of sprain. Whatever the etiology of these injuries, they will require a therapy indicated for each degree of injury. This therapy initially entails immobilization of the affected area and later; physical therapy will be required to a lesser or greater degree. Commonly, in the physiotherapy of these injuries, rehabilitation exercises are prescribed, where the physiotherapist asks a patient to use equipment with an estimated weight. However, the effectiveness of a generalized therapy in this way does not always give the expected results. This is related to the fact that these therapies are standardized and do not consider some factors such as the remaining muscle fibres that are not directly affected by the sprain, which does not mean that they should not be considered. Therefore, in the present work, a biomodel of a human knee has been developed and used to evaluate numerically how the ACL acts under an external load, when there are different degrees of injuries, caused by trauma. Four case studies were considered: Case 1 (control case) where the ACL is healthy, Case 2 where the ACL presents a 1st-degree sprain, Case 3 where the ACL presents a 2nd-degree sprain, and finally Case 4 where the ACL presents a 3rd-sprain grade. After performing the analyses, in the control case, it was found that it presents a balance between tensile and compressive stresses. While in the 4th case, the most critical tensile stress decreases while compression stresses increase. This shows that the ligament, having considerable damage, no longer works as it should and can eventually damage the collateral structures. It was found that, when there was a sprain, where the continuity of the ligament is compromised, a second torsional moment occurs in the ACL which causes the tissue fibres not to act according to their normal physiology or in a healthy state. The results obtained from the present study provide the possibility of predicting where the following injuries will occur by considering the von Mises failure criterion. Likewise, they will allow to improve the therapeutic procedures considering not only the injured structure but also the system as a whole.

Assessing Physical Activity After ACL Injury: Moving Beyond Return to Sport

2021 ◽  
pp. 194173812110253
Author(s):  
Christopher Kuenze ◽  
Katherine Collins ◽  
Karin Allor Pfeiffer ◽  
Caroline Lisee
Keyword(s):  
Physical Activity ◽  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Young Patients ◽  
Return To Sport ◽  
Acl Injury ◽  
Noncommunicable Diseases ◽  
Successful Recovery ◽  
Patient Reported ◽  
Anterior Cruciate

Context: Return to sport is widely utilized by sports medicine researchers and clinicians as a primary outcome of interest for successful recovery when working with young patients who have undergone anterior cruciate ligament (ACL) reconstruction (ACLR). While return-to-sport outcomes are effective at tracking progress post-ACLR, they are limited because they do not necessarily capture physical activity (PA) engagement, which is important to maintain knee joint health and reduce the risk of noncommunicable diseases. Therefore, there is a critical need (1) to describe current PA participation and measurement recommendations; (2) to appraise common PA measurement approaches, including patient-reported outcomes and device-based methodologies; and (3) to provide clinical recommendations for future evaluation. Evidence Acquisition: Reports of patient-reported or device-based PA in patients with ACL injury were acquired and summarized based on a PubMed search (2000 through July 2020). Search terms included physical activity OR activity AND anterior cruciate ligament OR ACL. Study Design: Clinical review. Level of Evidence: Level 5. Results: We highlight that (1) individuals with ACLR are 2.36 times less likely to meet the US Department of Health and Human Services PA recommendations even when reporting successful return to sport, (2) common patient-reported PA assessments have significant limitations in the data that can be derived, and (3) alternative patient-reported and device-based assessments may provide improved assessment of PA in this patient population. Conclusion: Clinicians and researchers have relied on return to sport status or self-reported PA participation via surveys. These approaches are not consistent with current recommendations for PA assessment and do not allow for comparison with contemporary PA recommendations or guidelines. Return to sport, patient-reported outcome measures, and device-based assessment approaches should be used in complementary manners to comprehensively assess PA participation after ACLR. However, appropriate techniques should be used when assessing PA in adult and adolescent populations.

Studying the Intact, ACL-Deficient and Reconstructed Human Knee Joint Using a Finite Element Model

2013 ◽  
Author(s):  
Achilles Vairis ◽  
Markos Petousis ◽  
George Stefanoudakis ◽  
Nectarios Vidakis ◽  
Betina Kandyla ◽  
...  
Keyword(s):  
Finite Element ◽  
Knee Joint ◽  
Cruciate Ligament ◽  
Three Dimensional ◽  
Element Model ◽  
Human Knee ◽  
Mechanical Responses ◽  
Human Knee Joint ◽  
Calculated Load ◽  
Anterior Cruciate

The human knee joint has a three dimensional geometry with multiple body articulations that produce complex mechanical responses under loads that occur in everyday life and sports activities. Knowledge of the complex mechanical interactions of these load bearing structures is of help when the treatment of relevant diseases is evaluated and assisting devices are designed. The anterior cruciate ligament in the knee connects the femur to the tibia and is often torn during a sudden twisting motion, resulting in knee instability. The objective of this work is to study the mechanical behavior of the human knee joint in typical everyday activities and evaluate the differences in its response for three different states, intact, injured and reconstructed knee. Three equivalent finite element models were developed. For the reconstructed model a novel repair device developed and patented by the authors was employed. For the verification of the developed models, static load cases presented in a previous modeling work were used. Mechanical stresses calculated for the load cases studied, were very close to results presented in previous experimentally verified work, in both load distribution and maximum calculated load values.

scholarly journals Injury Risk Associated With Sports Specialization and Activity Volume in Youth

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711987012 ◽  
Author(s):  
Alison E. Field ◽  
Frances A. Tepolt ◽  
Daniel S. Yang ◽  
Mininder S. Kocher
Keyword(s):  
Physical Activity ◽  
Cohort Study ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
The United States ◽  
Level Of Evidence ◽  
Sports Activity ◽  
Risk Of Injury ◽  
Increased Risk ◽  
Anterior Cruciate

Background: Sports specialization has become increasingly common among youth. Purpose/Hypothesis: To investigate the relative importance of specialization vs volume of activity in increasing risk of injury. Hypotheses were that specialization increases the risk of injury and that risk varies by sport. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective analysis was conducted with data collected from 10,138 youth in the Growing Up Today Study—a prospective cohort study of youth throughout the United States—and their mothers. Activity was assessed via questionnaires in 1997, 1998, 1999, and 2001. Sports specialization was defined as engaging in a single sport in the fall, winter, and spring. Injury history was provided by participants’ mothers via questionnaire in 2004. The outcome was incident stress fracture, tendinitis, chondromalacia patella, anterior cruciate ligament tear, or osteochondritis dissecans or osteochondral defect. Results: Females who engaged in sports specialization were at increased risk of injury (hazard ratio [HR], 1.31; 95% CI, 1.07-1.61), but risk varied by sport. Sports specialization was associated with greater volume of physical activity in both sexes ( P < .0001). Total hours per week of vigorous activity was predictive of developing injury, regardless of what other variables were included in the statistical model (males: HR, 1.04; 95% CI, 1.02-1.06; females: HR, 1.06; 95% CI, 1.05-1.08). Among females, even those engaging in 3 to 3.9 hours per week less than their age were at a significantly increased risk of injury (HR, 1.93; 95% CI, 1.34-2.77). In males, there was no clear pattern of risk. Conclusion: Sports specialization is associated with a greater volume of vigorous sports activity and increased risk of injury. Parents, coaches, and medical providers need to be made aware of the volume threshold above which physical activity is excessive.

scholarly journals The Efficacy of Perturbation Training in Nonoperative Anterior Cruciate Ligament Rehabilitation Programs for Physically Active Individuals

2000 ◽  
Vol 80 (2) ◽  
pp. 128-140 ◽  
Author(s):  
G Kelley Fitzgerald ◽  
Michael J Axe ◽  
Lynn Snyder-Mackler
Keyword(s):  
Physical Activity ◽  
Training Program ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Standard Group ◽  
Global Rating ◽  
Perturbation Training ◽  
Rehabilitation Programs ◽  
Anterior Cruciate ◽  
High Level

AbstractBackground and Purpose. Treatment techniques involving perturbations of support surfaces may induce compensatory muscle activity that could improve knee stability and increase the likelihood of returning patients to high-level physical activity. The purpose of this study was to determine the efficacy of augmenting standard nonoperative anterior cruciate ligament (ACL) rehabilitation programs with a perturbation training program. Subjects. Twenty-six patients with an acute ACL injury or ruptures of ACL grafts participated in the study. Subjects had to have a unilateral ACL injury, be free of concomitant multiple ligament or meniscal damage requiring surgical repair, and pass a screening examination designed to identify patients who had the potential to return to high-level physical activity with nonoperative treatments. Subjects also had to be regular participants in level I activities (eg, soccer, football, basketball) or level II activities (eg, racquet sports, skiing, construction work). Methods. Subjects were randomly assigned to either a group that received a standard rehabilitation program (standard group) or a group that received the standard program augmented with a perturbation training program (perturbation group). Treatment outcome was determined from scores on the Knee Outcome Survey's Activities of Daily Living Scale (ADLS) and Sports Activity Scale, a global rating of knee function, scores on a series of single-limb hop tests, measurements of maximum isometric quadriceps femoris muscle force output, and the group frequency of unsuccessful rehabilitation. Unsuccessful rehabilitation was defined as the occurrence of an episode of giving way of the knee or failure to maintain the functional status of a rehabilitation candidate on retesting. Results. More subjects had unsuccessful rehabilitation in the standard group compared with the perturbation group. There was a within-group × time interaction for the ADLS, global rating of knee function, and crossover hop test scores. These scores decreased from posttraining to the 6-month follow-up for the standard group. Conclusion and Discussion. Although both the standard program and the perturbation training program may allow subjects to return to high-level physical activity, the perturbation training program appears to reduce the risk of continued episodes of giving way of the knee during athletic participation, and it allows subjects to maintain their functional status for longer periods.

scholarly journals Anterior cruciate ligament changes in the human knee joint in aging and osteoarthritis

2012 ◽  
Vol 64 (3) ◽  
pp. 696-704 ◽  
Author(s):  
Akihiko Hasegawa ◽  
Shuhei Otsuki ◽  
Chantal Pauli ◽  
Shigeru Miyaki ◽  
Shantanu Patil ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Cruciate Ligament ◽  
Human Knee ◽  
Human Knee Joint ◽  
Anterior Cruciate

scholarly journals Assessment of Free-Living Cadence Using ActiGraph Accelerometers Between Individuals With and Without Anterior Cruciate Ligament Reconstruction

2020 ◽  
Vol 55 (9) ◽  
pp. 994-1000
Author(s):  
Caroline M. Lisee ◽  
Alexander H.K. Montoye ◽  
Noble F. Lewallen ◽  
Mayrena Hernandez ◽  
David R. Bell ◽  
...  
Keyword(s):  
Physical Activity ◽  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Activity Monitor ◽  
Free Living ◽  
Cruciate Ligament Reconstruction ◽  
Vigorous Intensity ◽  
Anterior Cruciate

Context Anterior cruciate ligament reconstruction (ACLR) and gait speed are risk factors for developing knee osteoarthritis (OA). Measuring minute-level cadence during free-living activities may aid in identifying individuals at elevated risk of developing slow habitual gait speed and, in the long term, OA. Objective To assess differences in peak 1-minute cadence and weekly time in different cadence intensities between individuals with and without ACLR. Design Cross-sectional study. Setting Short-term, free-living conditions. Patients or Other Participants A total of 57 participants with ACLR (34 women, 23 men; age = 20.9 ± 3.2 years, time since surgery = 28.7 ± 17.7 months) and 42 healthy control participants (22 women, 20 men; age = 20.7 ± 1.7 years). Main Outcome Measure(s) Each participant wore a physical activity monitor for 7 days. Data were collected at 30 Hz, processed in 60-second epochs, and included in the analyses if the activity monitor was worn for at least 10 hours per day over 4 days. Mean daily steps, peak 1-minute cadence, and weekly minutes spent at 60 to 79 (slow walking), 80 to 99 (medium walking), 100 to 119 (brisk walking), ≥100 (moderate- to vigorous-intensity ambulation), and ≥130 (vigorous-intensity ambulation) steps per minute were calculated. One-way analyses of covariance were conducted to determine differences between groups, controlling for height and activity-monitor wear time. Results Those with ACLR took fewer daily steps (8422 ± 2663 versus 10 033 ± 3046 steps; P = .005) and spent fewer weekly minutes in moderate- to vigorous-intensity cadence (175.8 ± 116.5 minutes versus 218.5 ± 137.1 minutes; P = .048) than participants without ACLR. We observed no differences in minutes spent at slow (ACLR = 77.4 ± 40.5 minutes versus control = 83.9 ± 34.3 minutes; P = .88), medium (ACLR = 71.6 ± 40.2 minutes versus control = 82.9 ± 46.8 minutes; P = .56), brisk (ACLR = 115.3 ± 70.3 minutes versus control = 138.3 ± 73.3 minutes; P = .18), or vigorous-intensity (ACLR = 24.3 ± 36.5 minutes versus control = 38.1 ± 60.9 minutes; P = .10) cadences per week. Conclusions Participants with ACLR walked approximately 40 fewer minutes per week in moderate- to vigorous-intensity cadence than participants without ACLR. Increasing the time spent at cadence ≥100 steps per minute and overall volume of physical activity may be useful as interventional targets to help reduce the risk of early development of OA after ACLR.

scholarly journals Protracted Cardiovascular Impairments After Anterior Cruciate Ligament Injury: A Critically Appraised Topic

2020 ◽  
Vol 29 (5) ◽  
pp. 680-683
Author(s):  
Cody R. Butler ◽  
Kirsten Allen ◽  
Lindsay J. DiStefano ◽  
Lindsey K. Lepley
Keyword(s):  
Physical Activity ◽  
Anterior Cruciate Ligament ◽  
National Football League ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Cross Sectional ◽  
History Of ◽  
Cross Sectional Studies ◽  
Anterior Cruciate ◽  
Cv Disease

Clinical Scenario: Anterior cruciate ligament (ACL) tear is a devastating knee injury with negative long-term consequences, such as early-onset knee osteoarthritis, biomechanical compensations, and reduced physical activity. Significant reduction in physical activity is a powerful indicator of cardiovascular (CV) disease; therefore, those with a history of ACL injury may be at increased risk for CV disease compared with noninjured individuals. Focused Clinical Question: Do individuals with a history of ACL injury demonstrate negative CV changes compared with those without a history of ACL injury? Summary of Key Findings: Three articles met the inclusion criteria and investigated CV changes after ACL injury. Both cross-sectional studies compared participants with ACL injury with matched controls. Bell et al compared time spent in moderate to vigorous physical activity and step count, whereas Almeida et al compared maximum rate of oxygen consumption, ventilatory thresholds, isokinetic quadriceps strength, and body composition. Collectively, both quantitative studies found that individuals with a history of ACL injury had less efficient CV systems compared with matched controls and/or preoperative data. Finally, a qualitative study of 3506 retired National Football League athletes showed an increased rate of arthritis and knee replacement surgery after an ACL injury when compared with other retired National Football League members, in addition to a >50% increased rate of myocardial infarction. Clinical Bottom Line: A history of ACL injury is a source of impaired physical activity. Preliminary data indicate that these physical activity limitations negatively impair the CV system, and individuals with a history of ACL injury demonstrate lower maximum oxygen consumption, self-reported disability, and daily step count compared with noninjured peers. These complications support the need for greater emphasis on CV wellness. Strength of Recommendation: Consistent findings from 2 cross-sectional studies and 1 survey study suggest level IIB evidence to support that ACL injury is associated with negative CV health.

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