scholarly journals Using a self-rehabilitation application alone can effectively combat post-ACL ligament reconstruction flexion contracture during the COVID-19 lockdown

2021 ◽  
Vol 9 (2_suppl) ◽  
pp. 2325967121S0001
Author(s):  
Jean Marie Fayard ◽  
Maxime Tatar ◽  
Mathieu Thaunat ◽  
Bertrand Sonnery-Cottet ◽  
Benjamin Freychet ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Physical Therapist ◽  
Weight Bearing ◽  
Group Versus ◽  
Flexion Contracture ◽  
Rehabilitation Protocol ◽  
Flexion Contractures ◽  
Acl Surgery ◽  
Significant Difference

Objectives: The lockdown during the COVID-19 crisis deprived the majority of patients who had undergone ACL surgery of access to their physical therapist. The objective of the study was to analyze the benefit of using a self-rehabilitation application to combat post-ligament reconstruction flexion contracture in the absence of rehabilitation during the lockdown. Methods: We conducted a retrospective study that compared 2 groups of patients who had undergone ACL reconstruction: the "App" group that underwent surgery between 10 February and 15 March 2020 were partially or totally deprived of access to a physiotherapist due to the COVID-19 lockdown and had completed rehabilitation using a self-rehabilitation application, and the "Physio" group that underwent surgery between 16 May and 23 December 2019 and had completed rehabilitation with a physiotherapist. Results: 148 patients were included in the study: 47 in the "App" group and 101 in the "Physio" group. Mean flexion contracture 3 weeks postoperatively was 1.3° +/- 3.8 in the "App" group versus 3.3° +/- 4 in the "Physio" group (p=0.002). The rate of flexion contractures was 45% in the “App” group and 65% in the “Physio” group (p=0.025). 71.4% of the patients acquired knee locking on weight-bearing with crutches in the "App" group, compared to 40.6% in the "Physio" group (p<0.01). No significant difference was noted between the two groups concerning the degree and rate of flexion contractures 6 weeks postoperatively and quadriceps recovery at 3 and 6 weeks postoperatively. Conclusion: Our study showed that the use of a self-rehabilitation application that targets flexion contracture control and quadriceps recovery in the first 6 weeks after ACL reconstruction provides similar results to a rehabilitation protocol by an independent physiotherapist.

scholarly journals Outcome Differences of Remnant- Preserving versus Non-Preserving Methods in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Meta-analysis with Subgroup analysis

2020 ◽  
Vol 32 (1) ◽  
Author(s):  
Sung Hun Won ◽  
Byung-Il Lee ◽  
Su Yeon Park ◽  
Kyung-Dae Min ◽  
Jun-Bum Kim ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Acl Reconstruction ◽  
Subgroup Analysis ◽  
Observational Studies ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Lachman Test ◽  
Significant Difference ◽  
Anterior Cruciate

Abstract Purpose To analyze differences in clinical outcomes of arthroscopic anterior cruciate ligament reconstruction between remnant-preserving and non-preserving methods. Methods International electronical databases PubMed, Embase, and the Cochrane central database from January 1966 to December 2017 were searched for randomized controlled trials (RCTs) and observational studies that compared differences of clinical outcomes of ACL reconstruction with and without remnant preservation. A meta-analysis of these studies was performed to compare clinical outcomes. Subgroup analyses were conducted to evaluate the role of methodological quality in primary meta-analysis estimates. Results Five RCTs and six observational studies were included in this meta-analysis and subgroup analysis. The remnant-preserving method in arthroscopic ACL reconstruction showed a statistically significant difference compared to the non-preserving method regarding arthrometric evaluation (side-to-side difference). Lachman test, Lysholm scores, and IKDC subjective scores showed statistically minor difference in meta-analysis, but showed no significant difference in subgroup analysis. Remained parameters including pivot shift test, IKDC grades, incidence of cyclops lesion showed no statistically differences in meta-analysis or subgroup analysis. Conclusions This meta-analysis with subgroup analysis showed that arthroscopic remnant-preserving ACL reconstruction provided statistically significant but limited clinical relevance in terms of arthrometric evaluation. Results of Lachman test, Lysholm scores, and IKDC subjective scores demonstrated statistically minor differences.

Clinical Outcome of Fixed Versus Adjustable Loop Cortical Suspension Devices in Arthroscopic Anterior Cruciate Ligament Reconstruction

2020 ◽  
Vol 22 (3) ◽  
pp. 181-185
Author(s):  
Ramy Said Assaad Ahmed Mohamed ◽  
Mohamed Hossam El-Din El-Shafie ◽  
Mohamed Ahmed El-Sheikh
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Loop Group ◽  
Lysholm Score ◽  
Graft Fixation ◽  
Cruciate Ligament Reconstruction ◽  
Significant Difference ◽  
Anterior Cruciate

Background. Anterior cruciate ligament (ACL) reconstruction has remained the gold standard for ACL injuries, especially for young individuals and athletes exposed to high level sporting activities aiming to return to their preinjury level of activity. Cortical suspensory femoral fixation is commonly performed for graft fixation to the femur in anterior cruciate ligament reconstruction using hamstring tendons. The aim of this study was to compare the clinical results of using fixed and adjustable loop cortical suspension devices in arthroscopic ACL reconstruction using the Lysholm Knee Scoring Scale after 12 months postoperatively. Material and methods. This study included a total of sixty patients who underwent transportal arthroscopic ACL reconstruction using a hamstring tendon autograft from November 2016 to December 2017. For femoral graft fixation, a fixed-length loop device was used in 30 patients (fixed-loop group) and an adjustable-length loop device was used in 30 patients (adjustable-loop group) randomly.For tibial graft fixation, interference screw was used for all patients. Results. The present study shows that there was no statistically significant difference between the two groups regarding the Lysholm score with highly statistically significant difference between preoperative and postoperative Lysholm score in each group separately. Conclusion. Both fixed loop and adjustable loop devices in ACL reconstruction provided good clinical outcomes but without significant statistical difference between both groups from the clinical point of view postoperatively using the Lysholm score.

scholarly journals Anterolateral ligament reconstruction associated with hamstring ACL reconstruction reduces the rate of repeat graft ruptures in a population of young athletes at follow-up in 2 years

2021 ◽  
Vol 9 (2_suppl) ◽  
pp. 2325967121S0001
Author(s):  
Pierre Laboudie ◽  
Adil Douiri ◽  
Nicolas Graveleau ◽  
Nicolas Bouguennec ◽  
Alexandre Biset
Keyword(s):  
Acl Reconstruction ◽  
Survival Data ◽  
Ligament Reconstruction ◽  
Group Versus ◽  
Anterolateral Ligament ◽  
Return To Sports ◽  
Young Athletes ◽  
Anterolateral Ligament Reconstruction ◽  
Semitendinosus Graft

Objectives: The rate of repeat graft ruptures in young athletes is a major concern after ACL reconstruction. Our objective was to evaluate the association between two reconstruction techniques and repeat ruptures, repeat surgery, return to sports and complications in center playing sportspersons younger than 20 years of age. Methods: A prospective study was conducted in patients under 20 years of age who were center players and who had primary ACL reconstruction with a semitendinosus graft (ST4) by a suspension technique, or a semitendinosus graft with suspension technique combined with independent anterolateral ligament reconstruction (ST4+ALL). Patients were followed up in a minimum of 2 years. Survival data from the Kaplan-Meier analysis were used as well as multivariate logistic regression to identify risk factors for repeat rupture. 203 patients (mean age, 16.3±2 years) with a mean follow-up of 40.6±11 months (24-63 months) were included. There were 101 patients in the ST4 group, and 102 patients in the ST4+ALL group. Results: There was a 9.9% repeat in ruptures in the ST4 group versus 5.8% in the ST4+ALL group (p=0.288). The rate of repeat ruptures in the ST4+ALL group was 5 times lower than in the ST4 group in multivariate analysis (odds ratio [OR], 0.201; 95% CI, 0.044-0.922). There was a 6.9% rate of secondary meniscal procedures in the ST4 group versus 1.9% in the ST4+ALL group (p=0.101). Differential laxity was 1.3±1.3 (-2 - 5) in the ST4 group versus 0.9±1.3 (-6 - 4.8) in the ST4+ALL group (p=0.008). There was a 42.2% return to the same sports level in the ST4 group versus 52% in the ST4+ALL group (p=0.178). The mean postoperative scores at the last follow-up were: IKDC: 83.3±14.3 and 82±14.4; ACL-RSI: 69.8±23.5 and 67.4±22.4; Tegner: 6.6±1.8 and 6.9±1.8 and Lysholm: 86.4±15.2 and 86±16.8; for ST4 and ST4+ALL groups, respectively. Conclusion: Anterolateral ligament reconstruction reduces the rate of repeat ruptures in athletes younger than 20 years of age after a semitendinosus graft. It is also associated with fewer secondary meniscal procedures, better control of laxity and a better rate of return to the same level of sports without further complications.

Do Outcomes or Subsequent Injuries Differ After Ulnar Collateral Ligament Reconstruction With Palmaris Versus Hamstring Autograft?

2019 ◽  
Vol 47 (6) ◽  
pp. 1473-1479 ◽  
Author(s):  
Brandon J. Erickson ◽  
Peter N. Chalmers ◽  
John D’Angelo ◽  
Kevin Ma ◽  
Joshua S. Dines ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Performance Metrics ◽  
Group Versus ◽  
Ulnar Collateral Ligament ◽  
Professional Baseball ◽  
Hamstring Autograft ◽  
Collateral Ligament ◽  
Baseball Players ◽  
Injury Rates ◽  
Significant Difference

Background: Ulnar collateral ligament reconstruction (UCLR) is a successful procedure in professional baseball players. It is unclear whether graft choice affects results. Purpose: Determine performance and rate of return to sport (RTS) in professional baseball players after UCLR and compare performance and RTS rate, as well as injury rates, between players who underwent UCLR with hamstring versus palmaris autograft. Hypothesis: A high RTS rate exists in professional baseball players after UCLR, with no significant difference in injury rates, RTS rates, or performance specifically related to primary outcome performance variables—WHIP ([walks + hits]/innings pitched), fielding independent pitching (FIP), and wins above replacement (WAR)—between those who undergo UCLR with palmaris versus hamstring autograft. Study Design: Cohort study; Level of evidence, 3. Methods: All professional baseball players who underwent UCLR with hamstring autograft between 2010 and 2015 were included. Surgical details were gathered from operative reports. Players with hamstring UCLR were compared with a matched control group of players who underwent UCLR with palmaris autograft. Results: Overall, 195 players underwent UCLR with hamstring autograft. No differences in RTS rates or timing to RTS were found between the hamstring and palmaris groups. Significantly more subsequent injuries to the contralateral lower extremity were seen in the hamstring group versus the palmaris group (25 vs 13, respectively) ( P = .040). More subsequent injuries to the upper extremity were found in the palmaris group versus the hamstring group (73 vs 55, respectively), although this difference was not significant ( P = .052). No consistent differences in performance metrics upon RTS existed between hamstring and palmaris groups, although both groups significantly declined in many performance metrics after surgery. Both hamstring and palmaris groups showed a decline postoperatively in WAR (0.86 vs 0.35 and 1.23 vs 0.34, respectively) and WHIP (1.33 vs 1.44 and 1.36 vs 1.51, respectively); FIP did not decline (4.56 vs 5.27 and 4.51 vs 4.53, respectively). No significant difference in WAR, WHIP, or FIP existed between groups postoperatively. Conclusion: Baseball players who underwent UCLR with hamstring autograft were more likely to sustain a subsequent lower extremity injury, whereas those who underwent UCLR with palmaris autograft had a trend toward sustaining more upper extremity injuries. No difference in performance or RTS rates existed between groups. Both groups significantly declined in WAR and WHIP after UCLR.

scholarly journals Is Immediate Weight Bearing Safe for Lateral Malleolus Fracture after Surgery?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0016
Author(s):  
Young Rak Choi ◽  
Sang-June Lee ◽  
Jaehyung Lee ◽  
Seung-Hwan Park
Keyword(s):  
Return To Work ◽  
Weight Bearing ◽  
Lateral Malleolus ◽  
Initiation Point ◽  
Rehabilitation Protocol ◽  
Ankle Motion ◽  
Significant Difference ◽  
Rehabilitation Protocols ◽  
Motion Exercise ◽  
Hospital Stays

Category: Trauma; Ankle Introduction/Purpose: Isolated lateral malleolus fracture is one of the most common fractures. However, there is controversy regarding the rehabilitation protocols used after surgery. In particular, the initiation point for the weight bearing has not been standardized. In the present study, we investigated the prognostic difference between the immediate and delayed weight bearing on isolated lateral malleolus fractures. Methods: Retrospectively, the medical records of matched 50 and 41patients in the immediate and delayed weight-bearing groups were reviewed. All patients were treated with open reduction and internal fixation using an anatomical locking compression plate. In the immediate weight-bearing group (IWB), tolerable weight bearing (i.e., that can be endured immediately after surgery with crutches) was permitted. In the delayed weight-bearing group (DWB), weight bearing was completely restricted for 4 weeks after surgery. Ankle motion exercise were permitted in both groups since postoperative day. Radiographic assessment data and the clinical outcomes were reviewed. Results: There were no significant differences noted in the radiographic assessments and complications between the two groups. Significant differences of shortening the return to work and hospital stays of IWB rehabilitation protocol were confirmed(5.7 vs. 8.0 days, 6.0 vs. 8.0 days in the IBW and DWB groups, respectively). In FAOS, there was a significant difference in the sport factor evaluated at postoperative 3 months(75.5 vs 68.5, respectively). Conclusion: There were no significant differences between the two groups in the postoperative radiological outcome and complications. And benefits of shortening the return to work and hospital stays of IWB rehabilitation protocol were confirmed. Conclusively, immediate weight bearing is recommended in patients with isolated lateral malleolus fracture, following anatomical reduction and firm fixation through surgery.

scholarly journals Anterolateral ligament reconstruction in addition to primary double-bundle anterior cruciate ligament reconstruction for grade 3 pivot shift improves residual knee instability during surgery

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Yusuke Kawanishi ◽  
Makoto Kobayashi ◽  
Sanshiro Yasuma ◽  
Hiroaki Fukushima ◽  
Jiro Kato ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Acl Injuries ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
Grade 3 ◽  
Double Bundle Acl Reconstruction

Abstract Purpose High-grade pivot shift in the anterior cruciate ligament (ACL) injured knee is a risk factor for postoperative residual pivot shift. Procedures in addition to ACL reconstruction such as anterolateral ligament (ALL) reconstruction have been performed for patients with a high-risk of residual pivot shift. The aim of this study was to investigate the effect of the addition of ALL reconstruction to primary double-bundle ACL reconstruction in patients with preoperative high-grade pivot shift to improve stability as evaluated by quantitative measurement. Methods Patients with ACL injuries who showed preoperative grade 3 subjective pivot shift and who underwent primary double-bundle ACL reconstruction combined with ALL reconstructions were retrospectively enrolled. Anterior tibial translation (ATT) in the Lachman test, and acceleration and external rotational angular velocity (ERAV) in the pivot shift were measured as quantitative values. Quantitative values before surgical intervention for ACL-injured knees (ACLD) and uninjured contralateral knees (intact), after temporary fixation of the isolated ACL grafts (ACLR), and subsequently after temporary fixation of both ACL and ALL grafts (ACLR + ALLR) were measured with the patient under general anaesthesia. Results In total, 18 patients were included. The ATT was lower in ACLR and ACLR + ALLR than in intact (P = .008 and .005), while there was no significant difference between ACLR and ACLR + ALLR (P > .05). The acceleration of ACLR + ALLR was lower than that for ACLR (P = .008), while there was no significant difference between intact and ACLR or ACLR + ALLR (P > .05). The ERAV of ACLR was higher than that of intact (P < .001), while that of ACLR + ALLR was lower than that of ACLR (P < 0.001), and there was no significant difference in ERAV between intact and ACLR + ALLR (P > 0.05). Conclusion According to quantitative assessment of the pivot shift, the addition of ALL reconstruction to primary double-bundle ACL reconstruction improved residual knee instability and restored knee stability during surgery. Combination of ALL reconstruction with primary double-bundle ACL reconstruction was effective for patients with ACL injuries exhibiting a preoperative grade 3 subjective pivot shift. Level of evidence IV

scholarly journals Anterior Cruciate Ligament Reconstruction with Hybrid Graft versus Autograft: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Ning Li ◽  
Xiali Xue ◽  
Huan Tu ◽  
Ming Zhang ◽  
Chengqi He
Keyword(s):  
Systematic Review ◽  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Forest Plot ◽  
Funnel Plot ◽  
Cruciate Ligament Reconstruction ◽  
Significant Difference ◽  
Anterior Cruciate

Background. The standard surgical treatment for ACL tear is ACL reconstruction. There is a debate of a choice between autograft or hybrid graft for treating ACL reconstruction. The purpose of this paper is to compare both case scenarios. Methods. A lot of libraries were searched like PubMed, Cochrane, and EMBASE Library for clinical trials which were then compared and analyzed via meta-analysis. The systematic review and meta-analysis were performed as per PRISMA guidelines, and RevMan software was used to perform the meta-analysis. Results. We analyzed 6 studies where patients of both autograft and hybrid graft were studied. The study outcomes, graft failures, graft diameters, reoperations, and so on were compared via forest plot and funnel plot. No significant difference was noted in both cases. Conclusions. In this meta-analysis, the performance of both autograft and hybrid graft was similar. Though the diameters were larger in hybrid, other factors also had an influence like graft failures, reoperations, and age at reconstruction which must be further investigated in detail.

scholarly journals Is immediate weight bearing safe for lateral malleolus fracture after surgery?

2020 ◽  
Author(s):  
Sang-June Lee ◽  
Young Rak Choi ◽  
SeongJu Choi ◽  
Ho Seong Lee ◽  
Seung-Hwan Park
Keyword(s):  
Return To Work ◽  
Hospital Stay ◽  
Weight Bearing ◽  
Length Of Hospital Stay ◽  
Lateral Malleolus ◽  
Initiation Point ◽  
Rehabilitation Protocol ◽  
Ankle Motion ◽  
Significant Difference ◽  
Motion Exercise

Abstract Introduction Lateral malleolus fracture is one of the most common fractures. However, there is controversy regarding the rehabilitation protocols used after surgery. In particular, the initiation point for weight bearing has not been standardized. In the present study, we investigated the prognostic difference between immediate and delayed weight bearing on lateral malleolus fractures. Materials and Methods The medical records of matched 50 and 41 patients in the immediate and delayed weight-bearing groups were reviewed retrospectively. All patients were treated with open reduction and internal fixation using an anatomical locking compression plate. In the immediate weight-bearing group (IWB), tolerable weight bearing (i.e., can be endured immediately after surgery with crutches) was permitted. In the delayed weight-bearing group (DWB), weight bearing was completely restricted for 4 weeks after surgery. Ankle motion exercise was permitted in both groups starting from the day after surgery. Radiographic assessment data and clinical outcomes were reviewed. Results No significant differences in the radiographic assessments and complications were found between the two groups. Significant differences in shortened length of hospital stay and time to return to work with the IWB rehabilitation protocol were confirmed (IWB group vs. DWB group: 5.7 vs. 8.0 days and 6.0 vs. 8.0 months, respectively). A significant difference in sport factor was observed in the Foot and Ankle Outcome Score at 3 months postoperatively (75.5 vs 68.5). Conclusions We found no significant differences between the two groups with respect to postoperative radiological outcome and complications. The benefits of shortening the time to return to work and length of hospital stay associated with the IWB rehabilitation protocol were confirmed. In conclusion, immediate weight bearing is recommended in patients with lateral malleolus fracture after anatomical reduction and firm fixation by surgery.

scholarly journals Comparative Study on the Effectiveness of Early or Delayed Weight-Bearing After Anterior Cruciate Ligament Reconstruction

2016 ◽  
Vol 62 (2) ◽  
pp. 234-238 ◽  
Author(s):  
Margit Hidi ◽  
Istvan Gergely ◽  
Tudor Sorin Pop ◽  
Octav Russu ◽  
Sandor Zuh ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Weight Bearing ◽  
Joint Stability ◽  
Cruciate Ligament Reconstruction ◽  
Significant Difference ◽  
Group Ii ◽  
Anterior Cruciate

AbstractObjectives. The aim of this study is to evaluate the efficacy of immediate weight-bearing versus two weeks delayed weight-bearing following anterior cruciate reconstruction.Methods. We conducted a prospective observational study on the efficiency of immediate or delayed weight-bearing following anterior cruciate reconstruction. 30 patients undergoing anterior cruciate ligament reconstruction were included in the study. The patients in the first group were allowed the maximum endurance level of weight-bearing on the operated leg from the first postoperative day, resuming normal walking as soon as possible. Patients in group II were barely allowed the loading of the affected limb after 2 weeks postoperatively. Patient assessment was performed preoperatively, immediately after the procedure and postoperatively at 6 weeks, 3 and 6 months.Results. The average pre- and postoperative values of the arthometric assessment show a statistically significant improvement of joint stability in both groups of patients. There were no significant differences in the development of joint mobility averages between the two groups. Following the evolution of functional test average values, there is a gradual function improvement in both groups of patients. The assessment results at 6 weeks and three months postoperatively shows that patients in the first group are significantly better in comparison with the results of patients in group II. The final evaluation showed no significant differences between the two groups of patients.Conclusions. The final assessment revealed no statistically significant difference in reported or objectively measured function. We believe that the weight-bearing exercises and the non–weight-bearing exercises are equally effective and safe in the post-ligamentoplasty recovery.

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