Injury to the Anterior Cruciate Ligament during Alpine Skiing

2002 ◽  
Vol 30 (4) ◽  
pp. 537-540 ◽  
Author(s):  
Sharon L. Hame ◽  
Daniel A. Oakes ◽  
Keith L. Markolf
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Alpine Skiing ◽  
Full Extension ◽  
Flexion Extension ◽  
Fresh Frozen ◽  
Full Flexion ◽  
The Mean ◽  
Anterior Cruciate ◽  
Knee Flexion Position

Background The anterior cruciate ligament has been shown to be particularly susceptible to injury during alpine skiing. Tibial torque is an important injury mechanism, especially when applied to a fully extended or fully flexed knee. Purpose We wanted to record the forces generated in the anterior cruciate ligament with application of tibial torque to cadaveric knees in different positions. Study Design Controlled laboratory study. Methods Thirty-seven fresh-frozen cadaveric knees were instrumented with a tibial load cell that measured resultant force in the anterior cruciate ligament while internal and external tibial torques were applied to the tibia at full extension, 90° of flexion, full flexion, and forced hyperflexion. Results At each knee flexion position, mean force generated by 10 N·m of internal tibial torque was significantly higher than the mean generated by 10 N·m of external tibial torque. Mean forces generated by tibial torque at 90° of flexion were relatively low. During flexion-extension without tibial torque applied mean forces were highest (193 N) when the knee was hyperflexed. Conclusions Application of internal tibial torque to a fully extended or fully flexed knee represents the most dangerous loading condition for injury from twisting falls during skiing. Clinical Relevance Understanding of the mechanisms of falls can be used to design better equipment and to better prevent or treat injury.

A Comparative Study of the Length Patterns of Anterior Cruciate Ligament Reconstructions in the Dog and Man

2000 ◽  
Vol 13 (02) ◽  
pp. 73-77 ◽  
Author(s):  
J. T. Andrish ◽  
M. L. Olmstead ◽  
Helen Kambic ◽  
A. Shah ◽  
M. P. Palmisano
Keyword(s):  
Anterior Cruciate Ligament ◽  
Soft Tissues ◽  
Cruciate Ligament ◽  
Statistical Significance ◽  
Full Extension ◽  
Cranial Cruciate Ligament ◽  
Custom Made ◽  
Fresh Frozen ◽  
Anterior Cruciate ◽  
Over The Top

SummaryTo measure the change of length patterns of nine different simulated anterior cruciate ligament (ACL) reconstructions in the canine and human knee.Six fresh-frozen canine cadaver knees and six fresh-frozen human cadaver knees were used in this study. All of the soft tissues were removed from each cadaver knee, leaving the menisci, collateral ligaments and cruciate ligaments intact. After fixation of the femur to a custom-made frame, the ACL was excised. Three tunnels were made each at the ACL origin and insertion, making possible nine reconstruction combinations. A modified intra-articular technique was used to measure change of length, in mm, of each ACL reconstruction through a range of motion of 0 degrees (full extension) to 135 degrees of flexion. A rankorder list of reconstruction combinations was determined. The most isometric combination was determined for the canine and human knees, and trends in length patterns were also evaluated in both species relative to femoral and tibial position. Statistical significance was determined by ANOVA.A combination joining a point caudal to the ACL origin (over-the-top) and anterior on the tibial insertion was found to be the most isometric combination in both the canine and human. The trends in change of length patterns across all reconstruction combinations were similar in the dog and man. Isometry was improved as the reconstruction was placed further posterior on the femur and anterior on the tibia. Conclusions: The canine knee is an appropriate animal model for the study of isometry of the human ACL and its reconstructions.The length patterns of nine simulated Anterior Cruciate Ligament (ACL) reconstructions were determined in the dog and man. In both species, the most isometric reconstruction was one joining points corresponding to a position at the posterior edge of the intercondylar roof of the femur (over-thetop) with a position anterior on the ACL insertion. For the sake of clarity the term anterior cruciate ligament has been used, throughout, for both species, instead of the cranial cruciate ligament (CCL) in the dog. Also knee has been used in place of stifle for the dog.

Effects of Anterolateral Structure Augmentation on the In Vivo Kinematics of Anterior Cruciate Ligament–Reconstructed Knees

2021 ◽  
pp. 036354652098174
Author(s):  
Jiebo Chen ◽  
Cong Wang ◽  
Caiqi Xu ◽  
Jiayu Qiu ◽  
Junjie Xu ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Double Bundle ◽  
Full Extension ◽  
Rotational Kinematics ◽  
The Mean ◽  
Anterior Cruciate

Background: Double-bundle anterior cruciate ligament (ACL) reconstruction (ACLR) is a well-known treatment that restores the stability of ACL-deficient knees. However, some isolated ACL-reconstructed knees ultimately show rotatory laxity and develop osteoarthritis. Whether combined ACLR with anterolateral structure (ALS) augmentation (ALSA) can provide better improvement in the in vivo knee rotational kinematics remains unknown. Hypothesis: When compared with isolated double-bundle ACLR, combined double-bundle ACLR with ALSA can improve knee in vivo rotational kinematics and provide better restoration of knee kinematics. Study Design: Controlled laboratory study. Methods: Sixteen patients with unilateral ACL injury were randomly divided into 2 groups to receive either combined double-bundle ACLR and ALSA (ALSA group) or isolated double-bundle ACLR (ACLR group). All patients performed a single-leg lunge using the operative and nonoperative/contralateral legs under dual-fluoroscopic imaging system surveillance during a hospital visit at a minimum 1 year (12-13 months) of follow-up to assess the 6 degrees of freedom knee kinematics. Functional evaluation using the Lysholm and Marx rating scales and clinical examinations were also performed. Results: From full extension to approximately 90° of knee flexion at 5° intervals, the mean ± SD internal rotation of the reconstructed knees in the ALSA group (1.5°± 0.9°) was significantly smaller than that of the contralateral knees (8.2°± 1.9°; P = .008). The ALSA group knees also showed significantly ( P = .045) more medial translation than the contralateral knees. In the ACLR group, the mean internal rotation of the reconstructed knee (6.0°± 2.1°) was significantly smaller than that of the contralateral knees (8.9°± 0.6°; P < .001). At full extension, the tibia was significantly more externally rotated than that of the contralateral legs (0.5°± 7.4° vs 7.6°± 3.4°, P = .049). Conclusion: When compared with isolated double-bundle ACLR, double-bundle ACLR augmented with ALS reconstruction resulted in anterolateral rotatory overconstraint during the lunge motion. Clinical Relevance: Additional ALSA of double-bundle ACL-reconstructed knees overconstrained rotatory stability. Therefore, the use of ALSA for ACL-reconstructed knees should be considered with caution for patients with ACL deficiency and anterolateral rotatory instability. Longer-term follow-up to evaluate long-term outcomes and altered kinematics over time is recommended.

scholarly journals Autologous conditioned plasma in anterior cruciate ligament reconstruction with hamstrings – short term clinical results

2012 ◽  
Vol 18 (3) ◽  
pp. 111-115
Author(s):  
O.M. Russu ◽  
I. Gergely ◽  
Ancuța Zazgyva ◽  
I. Moldovan ◽  
T.S. Pop
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Clinical Results ◽  
Interference Screw ◽  
Lysholm Score ◽  
Cruciate Ligament Reconstruction ◽  
The Mean ◽  
Anterior Cruciate

Abstract Evaluating the early clinical results of anterior cruciate ligament reconstruction using hamstrings autograft, with interference screw on the tibial side (biocomposite interference screw, ConMed-Linvatec) and continuous closed loop fixation on the femoral side (XO-Button, ConMed-Linvatec), with and without intra-articular injection of autologous conditioned plasma (ACP). Our study included 21 patients with chronic anterior cruciate ligament (ACL) ruptures for whom we performed ACL reconstruction with a hamstrings autograft. The mean age was 34 years (range, 25 to 42), 16 patients were men and 5 were women. In 10 cases we performed an intraarticular infiltration of ACP at the end of the surgical intervention. Final evaluation was performed at the end of the 6th postoperative month using the Lysholm scoring system, Tegner activity scale and objective assessment with the RolimeterTM 50A. The Lysholm score was excellent in all cases at 6 months postoperatively, with a mean Lysholm score of 90 for patients without ACP and 91.09 for patients that received ACP; the mean Tegner activity score was also similar pre- and postoperatively for the two groups (from 3.5 and 3.63 for the group without ACP and the group with ACP to 5.6 and 5.72 respectively). Joint laxity measurement was similar for both groups. We found no graft ruptures. We found similar results after ACL reconstruction with and without intra-articular injection of PRP, but further studies are necessary to determine the exact role of these substances in speeding up the recovery process in these cases.

Twenty-Year Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Prospectively Collected Data

2021 ◽  
pp. 036354652110273
Author(s):  
Joshua S. Everhart ◽  
Sercan Yalcin ◽  
Kurt P. Spindler
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Knee Function ◽  
Increased Risk ◽  
Patient Reported ◽  
The Mean ◽  
Anterior Cruciate

Background: Several long-term (≥20 years) follow-up studies after anterior cruciate ligament (ACL) reconstruction have been published in recent years, allowing for a systematic evaluation of outcomes. Purpose: To summarize outcomes at ≥20 years after ACL reconstruction and identify patient and surgical factors that affect these results. Study Design: Systematic review; Level of evidence, 4. Methods: Prospective studies of primary ACL reconstructions with hamstring or bone–patellar tendon—bone (BTB) autograft via an arthroscopic or a mini-open technique and with a mean follow-up of ≥20 years were identified. When possible, the mean scores for each outcome measure were calculated. Factors identified in individual studies as predictive of outcomes were described. Results: Five studies met the inclusion and exclusion criteria with a total of 2012 patients. The pooled mean follow-up for patient-reported outcome measures was 44.2% (range, 29.6%-92.7%) and in-person evaluation was 33.2% (range, 29.6%-48.9%). Four studies (n = 584) reported graft tears at a mean rate of 11.8% (range, 2%-18.5%) and 4 studies (n = 773) reported a contralateral ACL injury rate of 12.2% (range, 5.8%-30%). Repeat non-ACL arthroscopic surgery (4 studies; n = 177) to the ipsilateral knee occurred in 10.4% (range, 9.5%-18.3%) and knee arthroplasty (1 study; n = 217) in 5%. The pooled mean of the International Knee Documentation Committee subjective knee function (IKDC) score was 79.1 (SD, 21.8 [3 studies; n = 644]). In 2 studies (n?= 221), 57.5% of patients continued to participate in strenuous activities. The IKDC-objective score was normal or nearly normal in 82.3% (n = 496; 3 studies), with low rates of clinically significant residual laxity. Moderate-severe radiographic osteoarthritis (OA) (IKDC grade C or D) was present in 25.9% of patients (n = 605; 3 studies). Medial meniscectomy is associated with increased risk of radiographic OA. Radiographic OA severity is associated with worse patient-reported knee function, but the association with knee pain is unclear. Conclusion: Currently available prospective evidence for ACL reconstruction with hamstring or BTB autograft provides several insights into outcomes at 20 years. The rates of follow-up at 20 years range from 30% to 93%. IKDC-objective scores were normal or nearly normal in 82% and the mean IKDC-subjective score was 79 points.

scholarly journals USE CAUTION WHEN ASSESSING PRE-OPERATIVE LEG LENGTH DISCREPANCY IN PEDIATRIC PATIENTS WITH ANTERIOR CRUCIATE LIGAMENT INJURIES

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0028
Author(s):  
Lindsay M. Schlichte ◽  
Peter D. Fabricant ◽  
Christine Goodbody ◽  
Daniel W. Green
Keyword(s):  
Anterior Cruciate Ligament ◽  
Pediatric Patients ◽  
Cruciate Ligament ◽  
Weight Bearing ◽  
Acl Injury ◽  
Leg Length ◽  
Full Extension ◽  
X Ray ◽  
Length Discrepancy ◽  
Anterior Cruciate

Background: Pre- and post-operative standing hip to ankle radiography is critical for monitoring potential post-operative growth arrest and resultant length and angular deformities after pediatric anterior cruciate ligament (ACL) reconstruction. During acquisition of pre-operative standing alignment radiographs, it is possible that patients are lacking full extension, not weight bearing comfortably, or leaning resulting in inaccurate measurements. Purpose: This study aims to assess both pre- and post-operative radiographic measurements to assess if the standing pre-operative x-ray is a accurate and reliable source for baseline measurements. Methods: We retrospectively reviewed prospectively collected pre-operative and first post-operative full-length hip-to-ankle radiographs in a cohort of skeletally immature athletes who presented with an acute ACL injury and underwent subsequent surgical reconstruction. Initially, leg length discrepancy for 25 patients was measured by 3 orthopedic surgeons (top of femoral head to center of tibial plafond). The intraclass correlation was almost perfect (ICC (2,1) = .996) therefore, 1 surgeon measured the remaining 94 radiographs. Measurements for both the injured and uninjured legs were obtained for comparison and surgeons were blinded to the injured side. Results: A total of 119 pediatric patients (mean age 13.4, range 7-14 years) were included (83 males and 36 females). Patient were categorized as either having ≥5mm, ≥10mm, or ≥15mm LLD on pre-operative standing x-ray. Sixty-two patients (52%) were found to have a pre-operative LLD ≥ 5mm. Forty-one (66%) of these patients tore their ACL on the limb measuring shorter. At 6 month post-operative standing x-ray, 35 patients (56%) resolved to ≤5mm LLD. Eighteen patients had a pre-operative LLD of ≥ 10mm. At 6 month post-operative standing x-ray, 13 (72%) patients resolved to ≤5mm LLD. Five patients had a pre-operative LLD of ≥ 15mm. At 6 month post-operative standing x-ray, 4 (80%) resolved ≤5mm. All patients with a pre-operative LLD of ≥ 13mm had sustained an ACL injury on the limb measuring shorter Conclusion: Of the pediatric ACL patients initially presenting with a pre-operative LLD of ≥ 10mm, 72% demonstrated apparent correction of their LLD on their 6 month standing x-ray. This high rate of LLD pre-operatively but not post operatively calls into question the accuracy of pre-operative standing alignment radiographs for patients after an ACL tear. Surgeons and radiology technicians should be aware of injured patients potentially lacking full extension, leaning, or not weight bearing comfortably, and should consider delaying preoperative radiographic length and alignment analysis until after the patient is able to fully straighten the injured knee and weight bear comfortably.

Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction Using Patellar Tendon Autograft

1998 ◽  
Vol 26 (1) ◽  
pp. 20-29 ◽  
Author(s):  
Bernard R. Bach ◽  
Steven Tradonsky ◽  
John Bojchuk ◽  
Matthew E. Levy ◽  
Charles A. Bush-Joseph ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Physical Examination ◽  
Cruciate Ligament ◽  
Activity Level ◽  
Functional Testing ◽  
Symptomatic Knee ◽  
Kt 1000 ◽  
Arthroscopically Assisted ◽  
The Mean ◽  
Anterior Cruciate

We retrospectively reviewed the results of 97 patients with anterior cruciate ligament reconstructions using an arthroscopically assisted two-incision technique without extraarticular augmentation at an intermediate followup of 5 to 9 years postoperatively. Evaluation included detailed history, physical examination, functional testing, KT-1000 arthrometer measurements, multiple scoring systems, and radiographs. The results were compared with those from a previous study that evaluated a smaller patient cohort using the identical surgical technique at a 2- to 4-year followup. The post-operative physical examination and KT-1000 arthrometer results were statistically improved when compared with preoperative findings. A negative pivot shift result was noted in 83% of patients, and a 1 result in 17% of patients. Seventy percent of patients had 3 mm difference on manual maximum side-to-side testing. Functional testing averaged less than 2% asymmetry for vertical jump, single-legged hop, or timed 6-meter hop. The Tegner activity level was significantly improved from prereconstruction ratings and similar to preinjury ratings. The mean Lysholm score was 87. The modified Hospital for Special Surgery scores resulted in good or excellent results in 82% of the patients (mean, 87 points). The mean Noyes sports function score was 89, and the reoperation rate for a symptomatic knee flexion contracture was 12%. Ninety-seven percent of patients indicated that they would undergo the procedure again. When compared with this same population at 2 to 4 years, we saw no deterioration in scoring scale results.

scholarly journals Preliminary Results in Anatomic All-inside Anterior Cruciate Ligament Reconstruction

2016 ◽  
Vol 1 (s2) ◽  
pp. 23-26
Author(s):  
Octav Russu ◽  
Tiberiu Bățagă ◽  
Andrei-Marian Feier ◽  
Radu Prejbeanu ◽  
Radu Fleaca ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Clinical Results ◽  
Lysholm Score ◽  
X Rays ◽  
The Mean ◽  
Anterior Cruciate

Abstract Introduction: Anterior cruciate ligament (ACL) rupture is one of the most common lesions in knee traumatology; therefore the number of ACL reconstructions is increasing worldwide. Usually, an anteromedial (AM) accessory portal is required in anatomical positioning of the femoral tunnel, which is not absolutely necessary in this technique. Aim: Assessment of all-inside ACL reconstruction preliminary clinical results with adjustable loops and buttons on both femoral and tibial surfaces. Method: Our prospective study included 28 subjects (19 male, 9 female) with chronic ACL ruptures. The mean age of the study population was 27.72 ± 8.23 years. In all cases ACL reconstruction was carried out with the use of quadrupled semitendinosus auto-grafts with adjustable loops and buttons on the femoral and tibial surfaces and anatomic placement of both tunnels, using an outside-in technique, with flipcutters (Arthrex®). Clinical and radiological evaluations were carried out before surgery and at 3 and 6 months postoperatively, with the Lysholm scoring system, the Tegner activity scale and anterior-posterior and latero-lateral X-rays. Anterior knee laxity was measured in 25° of flexion using a portable arthrometer (RolimeterTM, Aircast®) and maximum manual force. Results: During the final follow-up, the Lysholm score was good and excellent in 27 cases, with a mean Lysholm score of 95.55 ± 4.63; all results were classified as good. The mean preoperative Tegner activity score was 3.46 ± 1.71 (range: 1-7), and the post-operative mean score was 5.75 ± 2.24 (range: 2-10). We found no graft ruptures. Preoperative knee laxity measurements showed a mean displacement of 11.5 ± 3.1 mm and side-to-side differences of 5.6 ± 3.5 mm, while the postoperative measurements at the last follow-up were 6.3 ± 1.54 mm and 2.65 ± 1.86 mm, respectively. Conclusion: Short-term clinical outcomes of all-inside ACL restoration with anatomic placement femoral and tibial tunnels seem to recommend this surgical option, with good subjective and objective results. Additional research will have to prove the long-term success.

Primary Anterior Cruciate Ligament Reconstruction Using Fresh-Frozen, Nonirradiated Patellar Tendon Allograft

2005 ◽  
Vol 33 (2) ◽  
pp. 284-292 ◽  
Author(s):  
Bernard R. Bach ◽  
Kirk J. Aadalen ◽  
Michael G. Dennis ◽  
Dominic S. Carreira ◽  
John Bojchuk ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Patellar Tendon ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Radiographic Evaluation ◽  
Cruciate Ligament Reconstruction ◽  
Kt 1000 ◽  
Fresh Frozen ◽  
Anterior Cruciate

Background There are conflicting reports of allograft performance, immune response, tissue incorporation, and rerupture rates when used for anterior cruciate ligament reconstruction. Purpose To evaluate the clinical outcome of a fresh-frozen, nonirradiated, patellar tendon allograft for primary anterior cruciate ligament reconstruction surgery. Study Design Case series; Level of evidence, 4. Methods Patients who underwent endoscopic primary anterior cruciate ligament reconstruction with allograft tissue a minimum of 2 years ago were evaluated with physical examinations, the KT-1000 arthrometer, functional testing, radiographic evaluation, subjective assessment, and outcomes tools. Results Fifty-nine patients (60 knees) were evaluated at an average of 51 months after surgery. Ninety-four percent of patients were mostly or completely satisfied. A negative pivot shift test result was noted in 90% of subjects. The KT-1000 arthrometer side-to-side differences were = 3 mm in 95% of patients, and no patient exceeded 5 mm. The mean International Knee Documentation Committee score was 78 (SD = 19), and the mean Lysholm score was 82 (SD = 17). There were no clinical symptoms consistent with graft rejection or infection. Radiographic evaluation demonstrated infrequent significant tunnel widening. Conclusions Use of a fresh-frozen, nonirradiated allograft for primary reconstruction of the anterior cruciate ligament is a successful procedure both subjectively and functionally for restoring stability in patients selected for allograft reconstruction. In the patients selected for this surgical procedure, clinical, arthrometric stability testing, and subjective satisfaction were comparable to our previously published cohort studies using patellar tendon autograft at similar postoperative follow-up.

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