scholarly journals Healing Status of Meniscal Ramp Lesion Affects Anterior Knee Stability After ACL Reconstruction

2020 ◽  
Vol 8 (5) ◽  
pp. 232596712091767 ◽  
Author(s):  
Kazuhisa Hatayama ◽  
Masanori Terauchi ◽  
Kenichi Saito ◽  
Ryota Takase ◽  
Hiroshi Higuchi
Keyword(s):  
Acl Reconstruction ◽  
Pivot Shift ◽  
Pivot Shift Test ◽  
Knee Stability ◽  
Ramp Lesion ◽  
Significant Difference ◽  
Mri Scans ◽  
The Mean ◽  
Postoperative Knee

Background: Although the biomechanical importance of the ramp lesion in the anterior cruciate ligament (ACL)–deficient knee has been demonstrated, there is no clear consensus on the appropriate treatment for ramp lesions during ACL reconstruction. Purpose: To compare the postoperative outcomes for ramp lesions between patients treated with all-inside repair through the posteromedial portal and those whose ramp lesions were left in situ without repair during ACL reconstruction. We also determined whether ramp lesion healing status affected postoperative knee stability. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 57 patients who underwent anatomic double-bundle ACL reconstruction between August 2011 and December 2017 had attendant ramp lesions. Of these, 25 ramp lesions that were considered stable were left in situ without repair (Nonrepaired group), and 25 ramp lesions, including 21 stable and 4 unstable lesions, were treated using all-inside repair through the posteromedial portal (Repaired group). We evaluated the side-to-side difference (SSD) in anterior tibial translation on stress radiographs and rotational stability by using the pivot-shift test 2 years after surgery, and healing status of the ramp lesions was evaluated on 3.0-T magnetic resonance imaging (MRI) scans 1 year after surgery. Results: The mean SSDs in anterior translation were 2.4 ± 1.6 mm for the Nonrepaired group and 1.9 ± 1.6 mm for the Repaired group, with no significant differences. The positive ratios on the pivot-shift test were not significantly different between groups. Healing rates of ramp lesions on MRI scans showed a significant difference between the Nonrepaired group (60%) and the Repaired group (100%) ( P = .001). The mean SSDs for knees in which the ramp lesion had healed as shown on MRI scans and those in which it had not healed were 1.9 ± 1.6 mm and 3.2 ± 1.1 mm, respectively, which was a significant difference ( P = .02). Conclusion: Healing rates of ramp lesions were significantly better in the Repaired group than in the Nonrepaired group, although postoperative knee stability was not significantly different between groups. Anterior laxity in the knees in which the ramp lesion was unhealed was significantly greater compared with the knees in which the ramp lesion healed. All-inside repair through the posteromedial portal was a reliable surgical procedure to heal ramp lesions.

Is an Anterolateral Ligament Reconstruction Required in ACL-Reconstructed Knees With Associated Injury to the Anterolateral Structures? A Robotic Analysis of Rotational Knee Stability

2017 ◽  
Vol 45 (5) ◽  
pp. 1018-1027 ◽  
Author(s):  
Frank R. Noyes ◽  
Lauren E. Huser ◽  
Darin Jurgensmeier ◽  
James Walsh ◽  
Martin S. Levy
Keyword(s):  
Internal Rotation ◽  
Acl Reconstruction ◽  
Pivot Shift ◽  
Anterolateral Ligament ◽  
Rotational Stability ◽  
Iliotibial Band ◽  
Pivot Shift Test ◽  
Knee Stability ◽  
Acl Graft ◽  
Tibial Translation

Background: The effect of an anterolateral ligament (ALL) reconstruction on rotational knee stability and corresponding anterior cruciate ligament (ACL) graft forces using multiple knee loading conditions including the pivot-shift phenomenon has not been determined. Purpose: First, to determine the rotational stability and ACL graft forces provided by an anatomic bone–patellar tendon–bone ACL reconstruction in the ACL-deficient knee alone and with an associated ALL/iliotibial band (ITB) injury. Second, to determine the added rotational stabilizing effect and reduction in ACL graft forces provided by an ALL reconstruction. Study Design: Controlled laboratory study. Methods: A 6 degrees of freedom robotic simulator was used to test 7 fresh-frozen cadaveric specimens during 5 testing conditions: intact, ACL-sectioned, ACL-reconstructed, ALL/ITB-sectioned, and ALL-reconstructed. Lateral and medial tibiofemoral compartment translations and internal tibial rotations were measured under Lachman test conditions, 5-N·m internal rotation, and 2 pivot-shift simulations. Statistical equivalence within 2 mm and 2° was defined as P < .05. Results: Single-graft ACL reconstruction restored central tibial translation under Lachman testing and internal rotation under 5-N·m internal rotation torque ( P < .05). A modest increase in internal rotation under 5-N·m internal rotation torque occurred after ALL/ITB sectioning of 5.1° (95% CI, 3.6° to 6.7°) and 6.7° (95% CI, 4.3° to 9.1°) at 60° and 90° of flexion, respectively ( P = .99). Lateral compartment translation increases in the pivot-shift tests were <2 mm. ALL reconstruction restored internal rotation within 0.5° (95% CI, –1.9° to 2.9°) and 0.7° (95% CI, –2.0° to 3.4°) of the ACL-reconstructed state at 60° and 90° of flexion, respectively ( P < .05). The ALL procedure reduced ACL graft forces, at most, 75 N in the pivot-shift tests and 81 N in the internal rotation tests. Conclusion: Although the ALL reconstruction corrected the small abnormal changes in the internal rotation limit at high flexion angles, the procedure had no effect in limiting tibiofemoral compartment translations in the pivot-shift test and produced only modest decreases in ACL graft forces. Accordingly, the recommendation to perform an ALL reconstruction to correct pivot-shift abnormalities is questioned. Clinical Relevance: The small changes in rotational stability after ALL/ITB sectioning would not seem to warrant the routine addition of an ALL reconstruction in primary ACL injuries. Clinical exceptions may exist, as in grossly unstable grade 3 pivot-shift knees and revision knees. However, the concern exists of overconstraining normal tibial rotations.

scholarly journals Bone–Patellar Tendon–Bone Autografts Versus Hamstring Autografts Using the Same Suspensory Fixations in ACL Reconstruction: A Systematic Review and Meta-analysis

2019 ◽  
Vol 7 (11) ◽  
pp. 232596711988531 ◽  
Author(s):  
Wenbo Chen ◽  
Hong Li ◽  
Yuzhou Chen ◽  
Fangyi Jiang ◽  
Yang Wu ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Graft Failure ◽  
Pivot Shift ◽  
Meta Analysis ◽  
Pivot Shift Test ◽  
Knee Stability ◽  
Lachman Test ◽  
Significant Difference ◽  
Suspensory Fixation ◽  
Bone Patellar Tendon

Background: Bone–patellar tendon–bone (BPB) autografts and hamstring tendon (HT) autografts are 2 popular choices for anterior cruciate ligament reconstruction (ACLR). Although existing meta-analyses have explored the clinical outcomes between BPB and HT autografts, none have based their analysis on studies with just femoral suspensory fixation methods. Purpose: To evaluate and compare clinical outcomes, particularly graft failure and knee stability, of ACLR with BPB or HT autografts with suspensory femoral fixation. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was conducted of studies reporting single-bundle ACLR with BPB autografts and HT autografts with suspensory fixation with a minimum 24-month follow-up. Graft failure rate, knee stability, and clinical outcomes were compared for BPB versus HT autografts. Knee stability was measured with the Lachman test, pivot-shift test, and KT-1000/2000 arthrometer side-to-side difference (SSD). Clinical outcomes were measured with Lysholm scores and the Tegner activity scale, as well as rate of return to preinjury sports. Donor site morbidity among included studies was reviewed. A random-effects model was used for calculations of summary estimates. Subgroup, sensitivity, and trial sequential analyses were conducted. Results: Five studies were included. Graft failure was seen more often in the HT group than the BPB group, and this was statistically significant ( P = .03). However, the trial sequential analysis outcome indicated that the included sample size was not large enough to support a solid positive finding. The analysis showed no significant difference in SSD, Lachman test, pivot-shift test, rate of return to sports, Lysholm score, or Tegner score between groups. Subgroup analyses found no significant difference between groups. Conclusion: This meta-analysis demonstrated no significant differences in knee stability and knee functional outcomes between BPB and HT autografts with suspensory fixation. More evidence is needed to prove the lower risk of failure with use of BTB autograft with suspensory fixation.

In-vivo pivot-shift test measured with inertial sensors correlates with the IKDC grade

2018 ◽  
Vol 3 (2) ◽  
pp. 89-93 ◽  
Author(s):  
Giulio Maria Marcheggiani Muccioli ◽  
Cecilia Signorelli ◽  
Alberto Grassi ◽  
Tommaso Roberti di Sarsina ◽  
Federico Raggi ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Pivot Shift ◽  
Case Series ◽  
Pivot Shift Test ◽  
Female Ratio ◽  
The Mean ◽  
Over The Top ◽  
Clinical Grading

ObjectivesKinematic Rapid Assessment (KiRA) is a wireless, non-invasive, inertial system with a single tibial sensor developed to measure the pivot-shift (PS) test. The purpose of this study was to in-vivo compare acceleration values acquired by KiRA to the objective International Knee Documentation Committee (IKDC) clinical grading of PS. The comparison was performed in non-anaesthetised patients before and after anterior cruciate ligament (ACL) reconstruction. We hypothesised the existence of a correlation between the side-to-side difference in the measured acceleration range by KiRA and the objective IKDC clinical grading of the PS.MethodsBetween 2010 and 2014, 60 non-professional football players (male/female ratio: 42/18; mean age 34±15.4 years, range 14–51 years) with ACL lesion were enrolled. They underwent over-the-top ACL reconstruction plus lateral extra-articular plasty with autologous hamstrings. All the patients were evaluated before the reconstruction and re-evaluated at 12-month follow-up. Each patient underwent a clinical examination and then was subjected to the instrumental PS examination by KiRA. The difference in the acceleration range between injured/reconstructed and contralateral limb (Δarange) was used in the analysis. Correlations between Δarange values and objective IKDC clinical grades of PS were calculated using Spearman correlation analysis.ResultsAll subjective scores improved from preoperative to follow-up (P≤0.01). Objective IKDC clinical grading of the PS improved from 4B, 40C and 16D to 50A, 8B and 2C (P<0.0001). The mean Δarange measured by KiRA improved from 2.0±1.0 to 0.2±0.4 m/s2(P<0.0001). A very strong correlation was displayed between the overall Δarange measured by KiRA and overall objective IKDC clinical grading of the PS (r=0.86, P<0.0001); correlation was strong for preoperative data (r=0.71, P<0.0001) and moderate for postoperative data (r=0.53, P<0.0001). The mean Δarange resulted 0.3±0.3 m/s2for the IKDC A subgroup, 0.8±0.3 m/s2for the IKDC B subgroup, 1.7±0.8 m/s2for the IKDC C subgroup and 2.9±0.9 m/s2for the IKDC D subgroup.ConclusionThe side-to-side difference in the measured acceleration range by KiRA shows a correlation with objective IKDC clinical grading of PS.Study designCase series; level of evidence: 4.

scholarly journals Comparing Knee Laxity After Anatomic Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon Versus Semitendinosus Tendon Graft

2021 ◽  
Vol 9 (7) ◽  
pp. 232596712110148
Author(s):  
Katrin Karpinski ◽  
Martin Häner ◽  
Sebastian Bierke ◽  
Theresa Diermeier ◽  
Wolf Petersen
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Tendon ◽  
Pivot Shift Test ◽  
Significant Difference ◽  
Kt 1000 ◽  
The Mean ◽  
Anterior Cruciate ◽  
Primary Acl Reconstruction

Background: The choice of graft in anterior cruciate ligament (ACL) reconstruction is still under discussion. The hamstrings are currently the most used grafts for primary ACL reconstruction in Europe. However, increased interest has arisen in the quadriceps tendon (QT) as an alternative autologous graft option for primary ACL reconstruction. Purpose: To evaluate knee stability and the subjective outcome after ACL reconstruction using either autologous QT graft in implant-free femoral press-fit fixation technique or semitendinosus tendon (ST) graft. Study Design: Cohort study; Level of evidence, 2. Methods: We evaluated 50 patients who underwent ACL reconstruction, including 25 patients who received autologous ipsilateral QT graft (QT group) and 25 patients who received the ipsilateral ST graft (ST group). The follow-up for this prospective comparative study was at least 2 years after surgery, comprising KT-1000 arthrometer testing, pivot-shift test, Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, and rerupture rate. Results: The mean patient age was 31.72 years (9 women, 16 men) in the QT group and 32.08 years (13 women, 12 men) in the ST group. The mean ± standard deviation postoperative side-to-side difference assessed using KT-1000 arthrometer was 1.56 ± 1.56 mm for the QT group and 1.64 ± 1.41 mm for the ST group, with no significant difference. No significant difference was found on any of the KOOS subscale scores ( P = .694) or the Lysholm score ( P = .682). No rerupture or positive pivot-shift test occurred during follow-up. No difference was found in donor-site morbidity between the study groups. Conclusion: Clinical outcomes were not significantly different between QT and ST grafts in the current study. Thus, the QT may serve as a good alternative graft for primary ACL reconstruction.

The Effect of Intraoperative Graft Coverage With Preserved Remnant Tissue on the Results of the Pivot-Shift Test After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction: Quantitative Evaluations With an Electromagnetic Sensor System

2017 ◽  
Vol 45 (10) ◽  
pp. 2217-2225 ◽  
Author(s):  
Nobuto Kitamura ◽  
Kazunori Yasuda ◽  
Masashi Yokota ◽  
Keiko Goto ◽  
Susumu Wada ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Pivot Shift Test ◽  
Tissue Preservation ◽  
Electromagnetic Sensor ◽  
The Mean ◽  
Anterior Cruciate ◽  
Double Bundle Acl Reconstruction

Background: Remnant tissue preservation may be important in improving graft healing after anterior cruciate ligament (ACL) reconstruction, but it has yet to be established whether remnant tissue preservation improves the control of pivot-shift laxity. Hypothesis: The amount of ACL graft coverage with preserved remnant tissue improves the control of pivot-shift laxity, as qualitatively determined with an electromagnetic device. Study Design: Cohort study; Level of evidence, 3. Methods: The 3-dimensional kinematics were evaluated intraoperatively using an electromagnetic sensor system in 38 patients at the time of anatomic double-bundle ACL reconstruction with remnant tissue preservation and again at a minimum of 12 months postoperatively. The magnitude of the peak coupled anterior tibial translation (pCAT) and the maximal acceleration of posterior translation (APT) during the pivot-shift test were evaluated. The degree of graft coverage by remnant tissue was determined arthroscopically at the end of surgery, which was evaluated quantitatively using a scoring system (0-9 points). The relationship between the values during the pivot-shift test and preoperative and intraoperative factors were assessed. Results: The mean (±SD) side-to-side difference of the pCAT (ΔpCAT) was significantly ( P < .0001) improved from 14.0 ± 5.0 mm to 2.6 ± 1.1 mm. Also, the mean side-to-side difference of the APT (ΔAPT) was significantly ( P < .0001) improved from 525.6 ± 99.7 mm/s2 to 32.9 ± 23.6 mm/s2. The mean initial graft coverage score was 5.3 ± 2.6. The correlation analysis demonstrated that the degree of initial graft coverage was significantly correlated with the ΔpCAT ( r = −0.517, P = .0007) and ΔAPT ( r = −0.532, P = .0005). The status of the reconstructed graft at second-look arthroscopic surgery showed no significant correlations with the degree of initial graft coverage or the results of the pivot-shift test. Conclusion: The present study demonstrated that the preservation of ACL remnant tissue in anatomic double-bundle ACL reconstruction appears to improve the control of pivot-shift laxity at a minimum of 12 months postoperatively, as measured by an electromagnetic device. This improvement was significantly affected by the degree of intraoperative graft coverage with preserved remnant tissue.

scholarly journals Clinical Outcome of Lateral Extraarticular Augmentation Procedure for Anterior Cruciate Ligament Reconstruction: Systematic Review of Recent 5-year Studies

2019 ◽  
Vol 7 (11_suppl6) ◽  
pp. 2325967119S0047
Author(s):  
Maria Florencia Deslivia ◽  
I Gusti Ngurah Wien Aryana
Keyword(s):  
Systematic Review ◽  
Functional Outcome ◽  
Acl Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Pivot Shift Test ◽  
Acl Injuries ◽  
Significant Difference ◽  
Anterior Cruciate

Objectives: Anterolateral rotational instability contributes to the persistent significant failure rate after anterior cruciate ligament reconstruction (ACLR) and suggests an inability of the intra-articular graft to normalize knee kinematics. Therefore, there has been a renewed interest in lateral-based soft tissue reconstructive techniques as augmentation of ACLR. Previous reviews regarding this topic have been published, yet the emergence of new findings should be considered to decide the best treatment. The aim of this study is to systematically review evidence of lateral extraarticular augmentation procedure (LEAP) for ACLR in the past 5 years. Methods: Literature research was performed using the PubMed/MEDLINE database for English-language studies pertaining anterolateral or lateral extraarticular procedure for ACLR. This systematic review was conducted based on PRISMA guideline. Inclusion criteria were patients who underwent ACL reconstruction with a combination of intraarticular and extraarticular procedure as augmentation. We excluded studies using isolated extraarticular procedure and studies on cadavers. The primary outcome assessed was subjective and objective clinical outcome. Results: After assessing full text and applying inclusion and exclusion criteria, six articles from 2015-2018 were found to be eligible, with 360 patients undergoing ACLR and LEAP. Level of evidence for the articles were II (n=2), III (n=2), and IV (n=2). The basic data of the studies were as follows: patients age was 16-48 years old; weight was 48-95 kg. Time from injury to surgery is more than 3 months, with one study included only patients with more than 12 months of injury. The procedure is in general indicated for strenuous sporting activities, while excluding collateral ligaments injury. Grafts were taken from gracilis tendon with only 1 study used semitendinosus. After a follow-up ranging from 2-24 years, both subjective (IKDC, Lysholm, Tegner, KOOS, and VAS) and objective (pivot shift test, KT-1000 arthrometer, and laxity tests) functional outcome was found to be satisfying. Two studies found no statistically significant difference with isolated ACLR, while one study favoured the use of LEAP. Most studies agreed that less ACL graft failure was found with LEAP. The complication was minimal, consisting of superficial wound infection. Discussion: Compared to acute ACL injuries, chronic injuries have higher anterolateral laxity. This instability is due to an anterior asymmetrical translation of the lateral tibial plateau. When there is injury or insufficiency of anterolateral structures, either by acute injury that does not heal properly or by the loosening resulting from an untreated ACL injury, it is more complicated to restore normal knee kinematics. It was found that by adding lateral extra-articular procedure to ACL reconstruction, internal rotation of the tibia at 30° of knee flexion can be reduced more significantly compared with either single-bundle or anatomic double-bundle reconstruction. However, three studies with less than 12 months period from injury to surgery concluded that LEAP did not give statistically significant difference in terms of functional outcome. Only one comparison study with more than 12 months of injury favored LEAP, indicating that more chronic injuries might benefit more from this procedure. Despite the differing results of functional outcome among studies, there is a common understanding that LEAP gives significantly better results in terms of pivot-shift test. Two previous systematic reviews agreed that combined procedure of ACLR and LEAP resulted in improvement of pivot-shift, without any statistically significant difference in terms of subjective outcome measures with ACLR alone. An ACL reconstruction alone did not restore stability with the pivot-shift as well as an ACL reconstruction and an extra-articular procedure. Nonetheless, to avoid potential overconstraint, it is best not to perform an extra-articular procedure at the time of ACL reconstruction if there is no evidence of ALL injury. Conclusion: This systematic review presents the update from the last 5-year literature of LEAP for ACLR with sufficient quality of evidence. The different results in terms of functional outcome might be influenced by, among many others, the duration between injury to surgery. More chronic ACL injuries might benefit more from LEAP. The quality of evidence in studies presented herein can still be improved in terms of methodology, number of samples, and duration of follow-up period. This study is expected to provide a platform for future studies in this field.

Tear Rates of the Ipsilateral ACL Graft and the Contralateral Native ACL Are Similar following ACL Reconstruction

2020 ◽  
Author(s):  
Nadia Nastassia Ifran ◽  
Ying Ren Mok ◽  
Lingaraj Krishna
Keyword(s):  
Acl Reconstruction ◽  
Medical Records ◽  
Cruciate Ligament ◽  
Acl Graft ◽  
Increased Risk ◽  
Significant Difference ◽  
The Mean ◽  
Anterior Cruciate ◽  
Mean Time

AbstractThe aim of the study is to compare the tear rates of ipsilateral anterior cruciate ligament (ACL) grafts and the contralateral native ACL as well as to investigate the correlation of gender, age at time of surgery, and body mass index (BMI) with the occurrence of these injuries. The medical records of 751 patients who underwent ACL reconstruction surgery with follow-up periods of 2 to 7 years were retrospectively analyzed. Survival analyses of ipsilateral ACL grafts and contralateral native ACL were performed. Univariate and multivariate logistic regression analyses were performed to identify risk factors that were associated with these injuries. The tear rates of the ipsilateral ACL graft and contralateral ACL were 5.86 and 6.66%, respectively with no significant difference between groups (p = 0.998). The mean time of tears of the ipsilateral ACL and contralateral ACL was also similar (p = 0.977) at 2.64 and 2.78 years, respectively after surgery. Both the odds of sustaining an ipsilateral ACL graft and contralateral ACL tear were also significantly decreased by 0.10 (p = 0.003) and 0.14 (p = 0.000), respectively, for every 1-year increase in age at which the reconstruction was performed. However, graft type, gender, and BMI were not associated with an increased risk of these injuries. There was no difference between tear rates of ipsilateral ACL graft and contralateral ACL following ACL reconstruction. Patients who undergo ACL reconstruction at a young age are at an increased risk of both ipsilateral graft and contralateral ACL rupture after an ACL reconstruction. Patients who are young and more likely to return to competitive sports should be counselled of the risks and advised to not neglect the rehabilitation of the contralateral knee during the immediate and back to sports period of recovery. This is a Level III, retrospective cohort study.

scholarly journals The Anterolateral Structure of the Knee Does Not Affect Anterior and Dynamic Rotatory Stability in Anterior Cruciate Ligament Injury: Quantitative Evaluation With the Electromagnetic Measurement System

2019 ◽  
Vol 47 (14) ◽  
pp. 3381-3388 ◽  
Author(s):  
Daisuke Araki ◽  
Takehiko Matsushita ◽  
Yuichi Hoshino ◽  
Kanto Nagai ◽  
Kyohei Nishida ◽  
...  
Keyword(s):  
Pivot Shift ◽  
Cruciate Ligament ◽  
Pivot Shift Test ◽  
Lachman Test ◽  
Electromagnetic Measurement System ◽  
The Mean ◽  
Anterior Cruciate ◽  
Electromagnetic Measurement ◽  
Tibial Translation ◽  
Acl Deficient

Background: The biomechanical function of the anterolateral structure (ALS), which includes the anterolateral joint capsule and anterolateral ligament (ALL), remains a topic of debate. Hypothesis: The ALS contributes to knee joint stability during the Lachman test and the pivot-shift test in anterior cruciate ligament (ACL)–deficient knees. Study Design: Controlled laboratory study. Methods: Fourteen fresh-frozen hemipelvis lower limbs were used. For 7 specimens, the anterior one-third of the ALS and the residual ALS were cut intra-articularly with a radiofrequency device. Subsequently, the ACL was cut arthroscopically. For the other 7 specimens, the ACL was cut first, followed by the anterior one-third of the ALS and the residual ALS intra-articularly. During the procedures, the iliotibial band (ITB) was kept intact. At each condition, the anterior tibial translation (ATT) during the manual Lachman test and the acceleration of posterior tibial translation (APT) and the posterior tibial translation (PTT) during the manual pivot-shift test were measured quantitatively with an electromagnetic measurement system. The mean values of those parameters were compared among 6 groups (ACL intact, one-third ALS cut, all ALS cut, ACL cut, ACL/one-third ALS cut, and ACL/all ALS cut). Results: The mean ATTs during the Lachman test and the mean APTs and PTTs in the ACL-cut conditions (ACL cut, ACL/one-third ALS cut, and ACL/all ALS cut) were significantly larger than those under the ACL-intact conditions (ACL intact, one-third ALS cut, all ALS cut) ( P < .01). However, no statistically significant differences were observed among the intact, one-third ALS–cut, and all ALS–cut conditions, within the ACL-intact or ACL-cut conditions. Conclusion: Intra-articular dissection of the ALS did not increase the ATT during the Lachman test or the APT and PTT during the pivot-shift test under the intact condition of the ITB, regardless of the integrity of the ACL. When the ITB is intact, the ALS does not have a significant role in either anterior or dynamic rotatory knee stability, while the ACL does. Clinical Relevance: Recent growing interest about ALL reconstruction or ALS augmentation may not have a large role in controlling either anterior or dynamic rotatory knee instability in isolated ACL-deficient knees.

scholarly journals Influence of toothbrushing on enamel softening and abrasive wear of eroded bovine enamel: an in situ study

2006 ◽  
Vol 20 (2) ◽  
pp. 148-154 ◽  
Author(s):  
Daniela Rios ◽  
Heitor Marques Honório ◽  
Ana Carolina Magalhães ◽  
Marília Afonso Rabelo Buzalaf ◽  
Regina Guenka Palma-Dibb ◽  
...  
Keyword(s):  
Abrasive Wear ◽  
The Other ◽  
In Situ Study ◽  
Significant Difference ◽  
The Mean ◽  
Student’S T ◽  
Bovine Enamel ◽  
Enamel Layer ◽  
Student’S T Test

This study assessed the surface softening and abrasive wear of eroded bovine enamel with or without the influence of toothbrushing. Five volunteers took part in this in situ study of 5 days. They wore acrylic palatal appliances containing 6 bovine enamel blocks divided in two rows with 3 blocks, which corresponded to the studied groups: erosion without toothbrushing (GI) and erosion with toothbrushing (GII). The blocks were subjected to erosion by immersion of the appliances in a cola drink for 10 minutes, 4 times a day. After that, no treatment was performed in one row (GI), whereas the other row was brushed (GII). The appliance was then replaced into the mouth. Enamel alterations were determined using profilometry and microhardness tests. Data were tested using paired Student’s t test (p < 0.05). The mean wear values (µm) and percentage of superficial microhardness change (%SMHC) were respectively: GI - 2.77 ± 1.21/91.61 ± 3.68 and GII - 3.80 ± 0.91/58.77 ± 11.47. There was a significant difference in wear (p = 0.001) and %SMHC (p = 0.001) between the groups. It was concluded that the wear was more pronounced when associated to toothbrushing abrasion. However, toothbrushing promoted less %SMHC due to the removal of the altered superficial enamel layer.

The Forced Active Buckling Sign: A New Clinical Test for the Diagnosis of ACL Insufficiency

2018 ◽  
Vol 33 (01) ◽  
pp. 042-047
Author(s):  
Fabian Blanke ◽  
Maximilian Haenle ◽  
Andreas Feitenhansl ◽  
Stephan Vogt ◽  
Carlo Camathias
Keyword(s):  
Predictive Value ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Sign Test ◽  
Pivot Shift Test ◽  
Clinical Test ◽  
Diagnostic Study ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Significant Difference

AbstractAlthough insufficiency of the anterior cruciate ligament (ACL) is a frequent result of an injury, validated tests are associated with unsatisfying validity. Moreover, some of these tests are not easy to perform and patient's muscular resistance often limits their reliability. Therefore, with this study, we want to design an accurate test to diagnose an ACL insufficiency, which is independent of the assessor's skills and overcome any muscular resistance. Fifty patients with an isolated ACL rupture (group A; age 26.4 years ± 14.9 standard deviation [SD]; female, n = 15) and additional 50 patients with an intact ACL but meniscal lesions (group B; age 45.4 years ± 12.9 SD; female, n = 23) were consecutively included in this study. The integrity of the ACL and the menisci were evaluated by magnetic resonance imaging and verified arthroscopically. Two orthopaedic surgeons performed a pivot shift test, a Lachman's test, and our new “forced active buckling” (FAB)-sign test in all patients. The surgeons were blinded for the pathology of the knee and we randomized the tests for each patient and examiner. The sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratios with confidence intervals were calculated and compared. With a prevalence of 0.5, the FAB-sign test revealed the best overall sensitivity of 0.78 compared with the Lachman's and pivot shift tests of 0.74 and 0.46, respectively. Also, the overall specificity of the FAB-sign test of 0.95 was higher than the Lachman's test of 0.83, however, comparable to the pivot shift test of 0.96. The FAB-sign test demonstrated the best positive and negative predictive values of 0.94 and 0.81. There was no significant difference between the two examiners concerning the accuracy of results in each test (p = 0.83). This study shows that the introduced FAB-sign test can detect an ACL insufficiency more sensitive and more specific compared to the pivot shift and Lachman's tests in the subacute phase. This is a randomized controlled diagnostic study, level 1b.

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