scholarly journals Clinically Reliable Knee Flexion Angle Measured on Stress Radiography for Quantifying Posterior Instability in Posterior Cruciate Ligament Injury

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712198925
Author(s):  
Dong Jin Ryu ◽  
Kyeu Baek Kwon ◽  
Eui Yub Jung ◽  
Sung-Sahn Lee ◽  
Joo Hwan Kim ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Flexion Angle ◽  
Ligament Injury ◽  
Knee Flexion Angle ◽  
Posterior Cruciate Ligament Injury ◽  
Posterior Instability ◽  
Stress Radiography ◽  
Stress Radiographs

Background: After posterior cruciate ligament injury, stress radiography is a common method of quantifying posterior instability, defined as the side-to-side difference in posterior tibial displacement (PTD) between the injured knee and contralateral noninjured knee. However, no study has evaluated the reliability of PTD according to knee flexion angle (KFA) measurements on stress radiographs. Purpose: To evaluate the test-retest reliability of stress radiographic measurements of the KFA in the noninjured knee. In addition, we established a reliable range of KFAs to indicate posterior instability by comparing results with the instability measured at 90° KFA, which is considered the gold standard. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: We evaluated patients who had undergone bilateral stress radiographic examinations at least 5 times for ligament injuries between January 2013 and November 2019. All examinations were performed on a Telos device with a 150-N posterior load. A total of 120 knees and 644 stress radiographs were enrolled. We measured the KFA and PTD on stress radiographs and evaluated the reliability of repeated PTD measurement and the correlation between KFA and PTD. Results: The distribution of the actual noninjured knee KFA ranged from 56.9° to 106.7°. Among the 644 radiographs, 155 (24.1%) showed KFAs between 85° and 95°, and 287 (44.6%) showed KFAs between 80° and 85°. A significant correlation was found between KFA and PTD ( P < .001), and the intrapatient intraclass correlation coefficient (ICC) was 0.788. A KFA range of 85° to 92° satisfied the criteria of high ICC (0.885) and nonsignificant correlation between KFA and PTD ( P = .055) and thus was considered a reliable range of KFAs for quantifying posterior instability. We found no significant risk factors for measurement error, including age ( P = .674), sex ( P = .328), height ( P = .957), weight ( P = .248), or body mass index ( P = .257). Conclusion: We found high reproducibility of posterior displacement measurements on Telos stress radiography at a KFA of 85° to 92° in noninjured knees.

scholarly journals Anterior tibial displacement on preoperative stress radiography of ACL-injured knee depending on knee flexion angle

2019 ◽  
Vol 31 (1) ◽  
Author(s):  
Jung Ho Noh ◽  
Woo Dong Nam ◽  
Young Hak Roh
Keyword(s):  
Knee Flexion ◽  
Cruciate Ligament ◽  
Flexion Angle ◽  
Anterior Tibial Translation ◽  
Knee Flexion Angle ◽  
Stress Radiography ◽  
Cutoff Value ◽  
Stress Radiographs ◽  
Anterior Tibial ◽  
Tibial Translation

Abstract Purpose To compare side-to-side difference (SSD) of anterior tibial translation in instrumented stress radiography for each series of anterior cruciate ligament (ACL)-injured subjects according to knee flexion angle. Methods Forty subjects who were suspected of having significant ACL injury by manual Lachman test and MRI were recruited for this prospective study. These subjects took stress radiographs for both knees with corresponding knee flexion of 10° (series M1) and 30° (series M2) using Telos stress device. Mean SSDs of M1 and M2 were compared. Sensitivities of M1 and M2 were assessed using the SSD ≥ 3 mm or ≥ 5 mm as a cutoff value. Results Mean SSDs in series M1 and M2 were 4.22 ± 3.72 mm and 3.25 ± 3.30 mm, respectively (p < 0.001). When 3 mm of SSD was used as a cutoff value, sensitivities of series M1 and M2 were 47.5% (19/40) and 32.5% (13/40), respectively (p = 0.171). When 5 mm of SSD was used as a cutoff value, sensitivities of series M1 and M2 were 45.0% (18/40) and 22.5% (9/40), respectively (p = 0.033). Conclusions Anterior tibial translation on stress radiographs using a Telos device is more prominent when knee flexion angle is 10° compared to that when knee flexion angle is 30°. However, stress radiography using Telos device, either at 10° or 30° of knee flexion, might not be suitable to make decision on surgical treatment due to relatively low sensitivities.

Determination of the In Situ Forces in the Human Posterior Cruciate Ligament Using Robotic Technology

1998 ◽  
Vol 26 (3) ◽  
pp. 395-401 ◽  
Author(s):  
Ross J. Fox ◽  
Christopher D. Harner ◽  
Masataka Sakane ◽  
Gregory J. Carlin ◽  
Savio L-Y. Woo
Keyword(s):  
Posterior Cruciate Ligament ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Flexion Angle ◽  
Knee Flexion Angle ◽  
Posterior Tibial ◽  
Anterolateral Bundle ◽  
Posteromedial Bundle ◽  
Force Moment

We examined the in situ forces in the posterior cruciate ligament as well as the force distribution between its anterolateral and posteromedial bundles. Using a robotic manipulator in conjunction with a universal force-moment sensor system, we applied posterior tibial loads from 22 to 110 N to the joint at 0° to 90° of knee flexion. The magnitude of the in situ force in the posterior cruciate ligament and its bundles was significantly affected by knee flexion angle and posterior tibial loading. In situ forces in the posterior cruciate ligament ranged from 6.1 6.0 N under a 22-N posterior tibial load at 0° of knee flexion to 112.3 28.5 N under a 110-N load at 90°. The force in the posteromedial bundle reached a maximum of 67.9 31.5 N at 90° of knee flexion, and the force in the anterolateral bundle reached a maximum of 47.8 23.0 N at 60° of knee flexion under a 110-N load. No significant differences existed between the in situ forces in the two bundles at any knee flexion angle. This study provides insight into the knee flexion angle at which each bundle of the posterior cruciate ligament experiences the highest in situ forces under posterior tibial loading. This information can help guide us in more accurate graft placement, fixation, and tensioning, and serve as an assessment of graft performance.

Codominance of the Individual Posterior Cruciate Ligament Bundles: An Analysis of Bundle Lengths and Orientation

2003 ◽  
Vol 31 (2) ◽  
pp. 221-225 ◽  
Author(s):  
Christopher S. Ahmad ◽  
Zohara A. Cohen ◽  
William N. Levine ◽  
Thomas R. Gardner ◽  
Gerard A. Ateshian ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Flexion Angle ◽  
Knee Flexion Angle ◽  
Posterior Tibial ◽  
Anterolateral Bundle ◽  
Posteromedial Bundle ◽  
Flexion And Extension

Background: It is unclear how each bundle of the posterior cruciate ligament contributes to posterior knee stability. Hypothesis: Changes in bundle orientation and length occur such that neither bundle dominates in restraining posterior tibial motion throughout knee flexion and extension. Study Design: Controlled laboratory study. Methods: Six fresh-frozen cadaveric knees were studied in a joint-testing rig with individual quadriceps and hamstring muscle loading. Kinematic data for the tibia and femur were obtained at knee flexion angles from 0° to 120°. The joint was then disarticulated, and the insertions of the two bundles on the tibia and femur were digitized. Results: Length of the anterolateral bundle increased with increasing knee flexion angle from 10° to 120°. Length of the posteromedial bundle decreased with increasing knee flexion angle from 0° to 45° and increased slightly from 60° to 120°. Length of the anteromedial bundle was significantly less than that of the posteromedial at 0°, 10°, and 20° of knee flexion. The anterolateral bundle was significantly more horizontal at flexion angles of 0°, 10°, 20°, 30°, and 45° (P < 0.05). The posteromedial bundle was more horizontal at 120°. Conclusions: Changes in orientation take place such that neither bundle dominates in restraining posterior tibial motion throughout knee flexion and extension. Clinical Relevance: Double-bundle reconstructions achieve more physiologic knee function.

Effects of Knee Flexion Angle and Loading Conditions on the End-to-End Distance of the Posterior Cruciate Ligament

2014 ◽  
Vol 42 (12) ◽  
pp. 2972-2978 ◽  
Author(s):  
Joon Ho Wang ◽  
Yuki Kato ◽  
Sheila J.M. Ingham ◽  
Akira Maeyama ◽  
Monica Linde-Rosen ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Flexion Angle ◽  
Knee Flexion Angle ◽  
Loading Conditions ◽  
End Distance ◽  
End To End

scholarly journals Single-Leg Landings Following a Volleyball Spike May Increase the Risk of Anterior Cruciate Ligament Injury More Than Landing on Both-Legs

2020 ◽  
Vol 11 (1) ◽  
pp. 130
Author(s):  
Datao Xu ◽  
Xinyan Jiang ◽  
Xuanzhen Cen ◽  
Julien S. Baker ◽  
Yaodong Gu
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Flexion ◽  
Sagittal Plane ◽  
Cruciate Ligament ◽  
Flexion Angle ◽  
Ligament Injury ◽  
Time Range ◽  
Acl Injuries ◽  
Volleyball Players ◽  
Anterior Cruciate

Volleyball players often land on a single leg following a spike shot due to a shift in the center of gravity and loss of balance. Landing on a single leg following a spike may increase the probability of non-contact anterior cruciate ligament (ACL) injuries. The purpose of this study was to compare and analyze the kinematics and kinetics differences during the landing phase of volleyball players using a single leg (SL) and double-leg landing (DL) following a spike shot. The data for vertical ground reaction forces (VGRF) and sagittal plane were collected. SPM analysis revealed that SL depicted a smaller knee flexion angle (about 13.8°) and hip flexion angle (about 10.8°) during the whole landing phase, a greater knee and hip power during the 16.83–20.45% (p = 0.006) and 13.01–16.26% (p = 0.008) landing phase, a greater ankle plantarflexion angle and moment during the 0–41.07% (p < 0.001) and 2.76–79.45% (p < 0.001) landing phase, a greater VGRF during the 5.87–8.25% (p = 0.029), 19.75–24.14% (p = 0.003) landing phase when compared to DL. Most of these differences fall within the time range of ACL injury (30–50 milliseconds after landing). To reduce non-contact ACL injuries, a landing strategy of consciously increasing the hip and knee flexion, and plantarflexion of the ankle should be considered by volleyball players.

scholarly journals Quadriceps Strength Symmetry Does Not Modify Gait Mechanics After Anterior Cruciate Ligament Reconstruction, Rehabilitation, and Return-to-Sport Training

2020 ◽  
pp. 036354652098007
Author(s):  
Elanna K. Arhos ◽  
Jacob J. Capin ◽  
Thomas S. Buchanan ◽  
Lynn Snyder-Mackler
Keyword(s):  
Knee Flexion ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Quadriceps Muscle ◽  
Quadriceps Strength ◽  
Flexion Angle ◽  
Knee Flexion Angle ◽  
Sport Training ◽  
Gait Biomechanics ◽  
Peak Knee

Background: After anterior cruciate ligament (ACL) reconstruction (ACLR), biomechanical asymmetries during gait are highly prevalent, persistent, and linked to posttraumatic knee osteoarthritis. Quadriceps strength is an important clinical measure associated with preoperative gait asymmetries and postoperative function and is a primary criterion for return-to-sport clearance. Evidence relating symmetry in quadriceps strength with gait biomechanics is limited to preoperative and early rehabilitation time points before return-to-sport training. Purpose/Hypothesis: The purpose was to determine the relationship between symmetry in isometric quadriceps strength and gait biomechanics after return-to-sport training in athletes after ACLR. We hypothesized that as quadriceps strength symmetry increases, athletes will demonstrate more symmetric knee joint biomechanics, including tibiofemoral joint loading during gait. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Of 79 athletes enrolled in the ACL-SPORTS Trial, 76 were participants in this study after completing postoperative rehabilitation and 10 return-to-sport training sessions (mean ± SD, 7.1 ± 2.0 months after ACLR). All participants completed biomechanical walking gait analysis and isometric quadriceps strength assessment using an electromechanical dynamometer. Quadriceps strength was calculated using a limb symmetry index (involved limb value / uninvolved limb value × 100). The biomechanical variables of interest included peak knee flexion angle, peak knee internal extension moment, sagittal plane knee excursion at weight acceptance and midstance, quadriceps muscle force at peak knee flexion angle, and peak medial compartment contact force. Spearman rank correlation (ρ) coefficients were used to determine the relationship between limb symmetry indexes in quadriceps strength and each biomechanical variable; alpha was set to .05. Results: Of the 76 participants, 27 (35%) demonstrated asymmetries in quadriceps strength, defined by quadriceps strength symmetry <90% (n = 23) or >110% (n = 4) (range, 56.9%-131.7%). For the biomechanical variables of interest, 67% demonstrated asymmetry in peak knee flexion angle; 68% and 83% in knee excursion during weight acceptance and midstance, respectively; 74% in internal peak knee extension moment; 57% in medial compartment contact force; and 74% in quadriceps muscle force. There were no significant correlations between quadriceps strength index and limb symmetry indexes for any biomechanical variable after return-to-sport training ( P > .129). Conclusion: Among those who completed return-to-sport training after ACLR, subsequent quadriceps strength symmetry was not correlated with the persistent asymmetries in gait biomechanics. After a threshold of quadriceps strength is reached, restoring strength alone may not ameliorate gait asymmetries, and current clinical interventions and return-to-sport training may not adequately target gait.

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