scholarly journals Quantitative Evaluation of Functional Instability Due to Anterior Cruciate Ligament Deficiency

2020 ◽  
Vol 8 (7) ◽  
pp. 232596712093388
Author(s):  
Takayuki Matsuo ◽  
Maki Koyanagi ◽  
Ryo Okimoto ◽  
Toshitaka Moriuchi ◽  
Koji Ikeda ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Muscle Strength ◽  
Cruciate Ligament ◽  
Knee Instability ◽  
Functional Instability ◽  
Independent Variables ◽  
Vas Score ◽  
Uninjured Side ◽  
Anterior Cruciate ◽  
Healthy Participants

Background: A safe and simple procedure to evaluate functional instability due to anterior cruciate ligament (ACL) deficiency (ACLD) has not been established. The angle of trunk backward tilting, which is known as a posture at risk for ACL injuries, could be used as a parameter to evaluate functional instability due to ACLD. Purpose: To measure the backward tilt angle of the trunk with participants standing upright on 1 leg and to investigate its usefulness to quantitatively evaluate functional instability due to ACLD. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Our cohort included 50 participants with unilateral ACLD and 40 participants with bilateral healthy knees. The trunk backward tilt (TBT) test was conducted as follows: the participant was asked to maximally tilt the trunk backward in a single-leg standing position, while forward tilt of the index leg was blocked with a custom-made device. The TBT angle was measured using a side-view photograph. Subjective knee instability during the test was recorded using a visual analog scale (VAS). The relative and absolute reliability of the TBT test were verified in a sample of healthy participants and those with ACLD, and comparisons between indicators were performed. Multiple regression analysis was performed with the injured/uninjured side ratio (I/U ratio) of the TBT angle as the dependent variable and the following independent variables: (1) I/U ratio of knee extension muscle strength, (2) I/U ratio of knee flexion muscle strength, (3) side-to-side difference (SSD) of the KT-1000 arthrometer measurement, (4) sex, and (5) SSD of the VAS score. Results: The TBT test had high reliability among healthy participants and those with ACLD. The TBT angle was significantly smaller and the VAS score was significantly higher on the injured side compared with the uninjured side and with healthy knees ( P < .001 for all). Among the independent variables, the SSD of the VAS score had a negative influence on the I/U ratio of the TBT angle ( R 2 = 0.59; P < .001). Conclusion: The TBT test is a simple, safe, and reliable method for quantitatively evaluating functional instability due to ACLD under weightbearing conditions that reflect subjective knee instability. The test will provide an index of treatment outcomes and return to sports through additional objective measurements before and after ACL reconstruction.

scholarly journals Comparison of Clinical and Radiological Parameters with Two Different Surgical Methods for Anterior Cruciate Ligament Reconstruction

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0027
Author(s):  
Osman Çiloğlu ◽  
Hakan Çiçek ◽  
Ahmet Yılmaz ◽  
Metin Özalay ◽  
Gökhan Söker ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Muscle Strength ◽  
Surgical Technique ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Tunnel Widening ◽  
Isokinetic Muscle Strength ◽  
Group 2 ◽  
Anterior Cruciate ◽  
Group 1

Objectives: We investigated the effects anatomic or nonanatomic femoral tunnel positions and tunnel fixation methods obtained using two different surgery methods on tunnel widening and clinical results in anterior cruciate ligament (ACL) reconstructions. Methods: Patients with isolated anterior cruciate ligament rupture are included to study who don’t have intra-and extra-articular additional pathology of the knee, without previously a history of operations of both knees. 2 groups were created. Group 1 Aperfix implant were used which can be able to perform non anatomical femoral tunnel and intra tunnel fixation with transtibial technique. In Group 2 Endobutton CL implant were used which can make fixation from outside the cortex with anatomic femoral tunnel in use of anteromedial portal techniques. 27 patients (average age 29,33, range 18 to 55 years) in group 1 and 27 patients (average age 27,51, range 16 to 45 years) in group 2 totally 54 patients were performed surgery. All patients were assessed using the IKDC (International knee documentation committee), Tegner Activity Scala and Lysholm II Functional Scores. Muscle strength measurements in both groups compared to intact knee was measured with an isokinetic dynamometer Biodex System 3 Pro. The location of the femoral tunnel aperture and tunnel widening were imaged with 3D reconstructive computed tomography. All measurements were performed using the same software application by the same radiologist. Results: The two groups were similar with respect to age and sex distribution, operated side, the size of the tunnel created, and follow-up period (p>0.05). After surgery in both groups, the clinical scores showed significant improvement compared to preoperative (p=0,0001). However, postoperative clinical outcomes in the two groups did not show a difference significantly (p>0,005). Isokinetic muscle strength study showed significant differences between the two groups (p=0,0001). Location of femoral tunnel aperture on the medial wall of the lateral femoral condyle showed a significant differences in the two groups (p=0,0001). The expansion of proximal and distal femoral tunnel in two groups showed significant differences (p=0,0001). There was relationship between distal femoral tunnel widening and location of femoral tunnel aperture. Conclusion: Although there is no statistically significant difference between the two groups clinically, difference noticed in terms of isokinetic muscle strength may be due to differences in the degree of shift as a result of multiple loading depending on the biomechanical properties of materials. We thought that the difference seen in the widening of tunnel in the proximal or distal may be due to, the technique of graft fixation, the distance between the fixation point and the joint, and to the location of the femoral tunnel aperture on medial wall of lateral condyle from anatomical or non anatomical region. There is no golden standard in neither surgical technique nor material of fixation. Proper theoretical knowledge and extensive clinical experience are important in the light of an accurate surgical technique applied. We thought that information we have reached in our study should be supported by biomechanical studies

scholarly journals Posturography table is a good test to evaluate the anterior cruciate Ligament reconstruction?

2019 ◽  
Vol 7 (5_suppl3) ◽  
pp. 2325967119S0021
Author(s):  
Frank Wein ◽  
Laetitia Peultier ◽  
Didier Mainard ◽  
Philippe Perrin
Keyword(s):  
Anterior Cruciate Ligament ◽  
Muscle Strength ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Strength Measurement ◽  
Cruciate Ligament Reconstruction ◽  
Isokinetic Muscle Strength ◽  
Unstable Support ◽  
Anterior Cruciate ◽  
Muscle Strength Measurement

Introduction: The success of anterior cruciate ligament reconstruction (ACLR) is assessed using subjective and functional scores, as well as measurements of knee laxity. The latter is often quantified using instrumented laximetry devices, which measure ‘static’ anterior tibial translation, though recent studies suggested more comprehensive “dynamic” analyses such as jump tests. To facilitate and improve dynamic stability analyses, a proprioception table was adapted to evaluate knees before and after ACLR, though the accuracy and pertinence of its measurement have not yet been demonstrated. Objectives: To determine whether proprioceptive analysis following ACLR provides meaningful and helpful information to guide surgeons and physiotherapists with postoperative rehabilitation and return to sports. Methods: We conducted a prospective study, on a population of 50 amateur or professional sports patients, who received ACLR by the one surgeon (FW). Preoperative and 6-months assessments included GnRB laxity analysis and proprioceptive dynamic stability analysis, with evaluation of the bearing area under 6 different conditions: open eyes (C1), closed eyes (C2), vision distorted by virtual reality headset (C3), open eyes on unstable support (C4), closed eyes on unstable support (C5) and distorted vison on unstable support (C6); a calculation of the C4/C1 ratio enabled appreciation of visual compensations in the proprioceptive capacity, and dependence on visual inference (low ratios indicate greater recourse to visual afference). A complementary analysis of muscular strength by isokinetic assessment was also performed at 6 months followup. Results: There was a significant improvement in proprioception table stability at 6 months compared to the preoperative condition at the C4 (470 vs 440 mm2), C5 (1710 vs 1315 mm2) and C6 (1330 vs 1210 mm2) assessments. For 32 patients evaluated by GnRB, differential laxity at 6 months was less than 5 mm at 200 N, and isokinetic muscle strength measurement was less than 20% different between the knee healthy and the operated knee, or between quadriceps and hamstrings. Proprioceptive quality was variable, with significant visual offsets in some cases (C4/C1 ratio, 0.5 to 16.2). Conclusion: Patients, who have good results in laximeter tests and isokinetic muscle strength measurement, may have a poor proporioception quality with significant visual offsets. The proprioception analysis at 6 months following ACLR could therefore be important to consider rehabilitation and sports recovery.

scholarly journals Bridge-Enhanced Anterior Cruciate Ligament Repair Is Not Inferior to Autograft Anterior Cruciate Ligament Reconstruction at 2 Years: Results of a Prospective Randomized Clinical Trial

2020 ◽  
Vol 48 (6) ◽  
pp. 1305-1315 ◽  
Author(s):  
Martha M. Murray ◽  
Braden C. Fleming ◽  
Gary J. Badger ◽  
Christina Freiberger ◽  
Rachael Henderson ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Muscle Strength ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Acl Injuries ◽  
Patient Reported ◽  
Subjective Score ◽  
Anterior Cruciate ◽  
Noninferiority Margin

Background: Preclinical studies suggest that for complete midsubstance anterior cruciate ligament (ACL) injuries, a suture repair of the ACL augmented with a protein implant placed in the gap between the torn ends (bridge-enhanced ACL repair [BEAR]) may be a viable alternative to ACL reconstruction (ACLR). Hypothesis: We hypothesized that patients treated with BEAR would have a noninferior patient-reported outcomes (International Knee Documentation Committee [IKDC] Subjective Score; prespecified noninferiority margin, –11.5 points) and instrumented anteroposterior (AP) knee laxity (prespecified noninferiority margin, +2-mm side-to-side difference) and superior muscle strength at 2 years after surgery when compared with patients who underwent ACLR with autograft. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: One hundred patients (median age, 17 years; median preoperative Marx activity score, 16) with complete midsubstance ACL injuries were enrolled and underwent surgery within 45 days of injury. Patients were randomly assigned to receive either BEAR (n = 65) or autograft ACLR (n = 35 [33 with quadrupled semitendinosus-gracilis and 2 with bone–patellar tendon–bone]). Outcomes—including the IKDC Subjective Score, the side-to-side difference in instrumented AP knee laxity, and muscle strength—were assessed at 2 years by an independent examiner blinded to the procedure. Patients were unblinded after their 2-year visit. Results: In total, 96% of the patients returned for 2-year follow-up. Noninferiority criteria were met for both the IKDC Subjective Score (BEAR, 88.9 points; ACLR, 84.8 points; mean difference, 4.1 points [95% CI, –1.5 to 9.7]) and the side-to-side difference in AP knee laxity (BEAR, 1.61 mm; ACLR, 1.77 mm; mean difference, –0.15 mm [95% CI, –1.48 to 1.17]). The BEAR group had a significantly higher mean hamstring muscle strength index than the ACLR group at 2 years (98.2% vs 63.2%; P < .001). In addition, 14% of the BEAR group and 6% of the ACLR group had a reinjury that required a second ipsilateral ACL surgical procedure ( P = .32). Furthermore, the 8 patients who converted from BEAR to ACLR in the study period and returned for the 2-year postoperative visit had similar primary outcomes to patients who had a single ipsilateral ACL procedure. Conclusion: BEAR resulted in noninferior patient-reported outcomes and AP knee laxity and superior hamstring muscle strength when compared with autograft ACLR at 2-year follow-up in a young and active cohort. These promising results suggest that longer-term studies of this technique are justified. Registration: NCT02664545 (ClinicalTrials.gov identifier)

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