scholarly journals Acute primary repair of extraarticular ligaments and staged surgery in multiple ligament knee injuries

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Yasuyuki Ishibashi ◽  
Yuka Kimura ◽  
Eiji Sasaki ◽  
Shizuka Sasaki ◽  
Yuji Yamamoto ◽  
...  
Keyword(s):  
Knee Joint ◽  
Primary Repair ◽  
Cruciate Ligament ◽  
Stress Test ◽  
Knee Injuries ◽  
Joint Stability ◽  
Posterior Drawer ◽  
Staged Surgery ◽  
Significant Difference ◽  
Repair Group

Abstract Background The purpose of this study is to compare the outcomes of acute primary repair of extraarticular ligaments with staged surgery for acute knee dislocations (KDs) and multiligament knee injuries (MLKIs). Materials and methods Between January 2005 and May 2018, 61 consecutive patients diagnosed with MLKI or KD were referred to or visited our institution. Of these, 31 patients who underwent acute repair of extraarticular ligaments within 3 weeks of injury were included in this study. These patients were retrospectively classified into two groups: those who underwent only primary repair (repair group) and those who underwent staged reconstructive surgery (staged group). Follow-up examination included range of motion (ROM), knee joint stability (Lachman test, posterior drawer test, and varus and valgus stress test), Lysholm knee score, Tegner activity scale, and Knee Injury and Osteoarthritis and Outcome Score (KOOS). Results Twelve of the 31 patients did not need or desire further surgery and were included in the repair group. No significant difference was observed in demographic data between the repair and staged groups. Although staged surgery decreased positive posterior drawer test results, no significant difference was observed between the two groups regarding ROM, other knee joint stability tests, Lysholm scores, Tegner scale, or KOOS. Conclusions In this series, all patients returned to their activities of daily living and preinjury occupation levels. Acute primary repair of extraarticular ligaments provides essential knee stability without varus/valgus instability and may reduce the need for subsequent cruciate ligament reconstruction. Level of evidence Level IV, retrospective observational study.

DETERMINATION OF THE STRESS OF ANTERIOR CRUCIATE LIGAMENT IN VARIOUS DEGREES OF KNEE FLEXION, COMPARISON OF NORMAL AND RECONSTRUCTED LIGAMENT

2021 ◽  
pp. 2150022
Author(s):  
MOHAMMAD TAGHI KARIMI ◽  
SAYED IMAN HOSSEINI ◽  
YOUSEF BAZARGAN LARI
Keyword(s):  
Knee Joint ◽  
Normal Condition ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Joint Stability ◽  
Acl Injuries ◽  
Lateral Collateral Ligaments ◽  
Joint Flexion ◽  
Anterior Cruciate

Background: Knee joint stability is enhanced by ligamentus structures such as anterior cruciate (ACL), posterior cruciate (PCL), medial collateral (MCL) and lateral collateral ligaments (LCL). Rupture of ACL is the most common knee injuries, especially in sport related activities. The aim of this study is to evaluate the stress developed in knee joint structures in various degrees of knee flexion in ACL ruptured compared to normal condition. Method: CT scan images of knee joint were used to create 3d model of knee joint by use of Mimics software. Abaqus software was used to evaluate the stress developed in knee joint in normal and in ACL reconstructed conditions in various degrees of knee flexion. Results: The stress developed in ACL and other knee joint structures increased significantly by increase in knee joint flexion. The stress of knee joint structures (especially in ACL) in ACL reconstructed condition was more than that of normal condition. Conclusion: It is recommended to immobilize the knee joint in extension up to [Formula: see text] of knee flexion in those with ACL injuries. The stress of ACL increased due to an increase in tibia translation associated with knee flexion.

scholarly journals Seeing Beyond Morphology-Standardized Stress MRI to Assess Human Knee Joint Instability

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1035
Author(s):  
Eva-Maria Winkelmeyer ◽  
Justus Schock ◽  
Lena Marie Wollschläger ◽  
Philipp Schad ◽  
Marc Sebastian Huppertz ◽  
...  
Keyword(s):  
Knee Joint ◽  
Imaging Modality ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Anterior Tibial Translation ◽  
Joint Stability ◽  
Anatomic Landmarks ◽  
Human Knee Joint ◽  
Custom Made ◽  
Tibial Translation

While providing the reference imaging modality for joint pathologies, MRI is focused on morphology and static configurations, thereby not fully exploiting the modality’s diagnostic capabilities. This study aimed to assess the diagnostic value of stress MRI combining imaging and loading in differentiating partial versus complete anterior cruciate ligament (ACL)-injury. Ten human cadaveric knee joint specimens were subjected to serial imaging using a 3.0T MRI scanner and a custom-made pressure-controlled loading device. Emulating the anterior-drawer test, joints were imaged before and after arthroscopic partial and complete ACL transection in the unloaded and loaded configurations using morphologic sequences. Following manual segmentations and registration of anatomic landmarks, two 3D vectors were computed between anatomic landmarks and registered coordinates. Loading-induced changes were quantified as vector lengths, angles, and projections on the x-, y-, and z-axis, related to the intact unloaded configuration, and referenced to manual measurements. Vector lengths and projections significantly increased with loading and increasing ACL injury and indicated multidimensional changes. Manual measurements confirmed gradually increasing anterior tibial translation. Beyond imaging of ligament structure and functionality, stress MRI techniques can quantify joint stability to differentiate partial and complete ACL injury and, possibly, compare surgical procedures and monitor treatment outcomes.

Dynamic Postural Control Two Years Following Anterior Cruciate Ligament Reconstruction in a Female Collegiate Soccer Player

2015 ◽  
Vol 20 (2) ◽  
pp. 24-29 ◽  
Author(s):  
Michael A. Samaan ◽  
Eric K. Greska ◽  
Matthew C. Hoch ◽  
Joshua T. Weinhandl ◽  
Sebastian Y. Bawab ◽  
...  
Keyword(s):  
Knee Joint ◽  
Postural Control ◽  
Acl Reconstruction ◽  
Outcome Measure ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Minimal Detectable Change ◽  
Joint Stability ◽  
Compensatory Mechanisms ◽  
Main Outcome Measure

Context:ACL injury may cause a lack of knee joint proprioception and motor control due to knee joint instability. ACL reconstruction restores knee joint stability, yet dynamic postural control may still be affected while performing dynamic tasks.Objective:To examine the effects of ACL injury and reconstruction on dynamic postural control using the Star Excursion Balance Test (SEBT) and single leg hop (SLH).Participant:One Division I female athlete.Main Outcome Measure:The athlete’s dynamic postural control, both pre- and postreconstruction, was compared with preinjury data using the method of minimal detectable change using reach distances obtained from the SEBT and hop distances from the SLH.Results:ACL injury and reconstruction affected the anterior, posteromedial, and posterolateral reach distances of the SEBT. Despite restoration of joint stability, anterior reach distance in the SEBT did not return to preinjury levels 27 months after ACL reconstruction. SLH distances decreased following injury but returned to preinjury levels 27 months after ACL reconstruction.Conclusion:Dynamic postural control and performance during the SEBT and SLH were affected by ACL injury and for extended periods of time after ACL reconstruction. Quadriceps inhibition and muscle strength of the involved limb may affect dynamic postural control both after ACL injury and reconstruction while performing the SEBT. Compensatory mechanisms at the hip and ankle may aid in performance of the SLH after reconstruction. Using baseline measurements, where possible, may help researchers better understand the effects of ACL injury and reconstruction on dynamic postural control.

scholarly journals The anterolateral ligament is a secondary stabilizer in the knee joint

2019 ◽  
Vol 8 (11) ◽  
pp. 509-517 ◽  
Author(s):  
Kyoung-Tak Kang ◽  
Yong-Gon Koh ◽  
Kyoung-Mi Park ◽  
Chong-Hyuck Choi ◽  
Min Jung ◽  
...  
Keyword(s):  
Knee Joint ◽  
Muscle Activation ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Anterolateral Ligament ◽  
Loading Conditions ◽  
Joint Stability ◽  
Musculoskeletal Models ◽  
Subject Specific ◽  
Cycle Loading

Objectives The aim of this study was to investigate the biomechanical effect of the anterolateral ligament (ALL), anterior cruciate ligament (ACL), or both ALL and ACL on kinematics under dynamic loading conditions using dynamic simulation subject-specific knee models. Methods Five subject-specific musculoskeletal models were validated with computationally predicted muscle activation, electromyography data, and previous experimental data to analyze effects of the ALL and ACL on knee kinematics under gait and squat loading conditions. Results Anterior translation (AT) significantly increased with deficiency of the ACL, ALL, or both structures under gait cycle loading. Internal rotation (IR) significantly increased with deficiency of both the ACL and ALL under gait and squat loading conditions. However, the deficiency of ALL was not significant in the increase of AT, but it was significant in the increase of IR under the squat loading condition. Conclusion The results of this study confirm that the ALL is an important lateral knee structure for knee joint stability. The ALL is a secondary stabilizer relative to the ACL under simulated gait and squat loading conditions. Cite this article: Bone Joint Res 2019;8:509–517.

scholarly journals Simulation Analysis of Knee Ligaments in the Landing Phase of Freestyle Skiing Aerial

2019 ◽  
Vol 9 (18) ◽  
pp. 3713 ◽  
Author(s):  
Yanming Fu ◽  
Xin Wang ◽  
Tianbiao Yu
Keyword(s):  
Knee Joint ◽  
Mechanical Response ◽  
Simulation Analysis ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Element Model ◽  
Knee Joints ◽  
Internal Stresses ◽  
Risk Of Injury ◽  
Medium Risk

The risk of knee injuries in freestyle skiing athletes that perform aerials is high. The internal stresses in the knee joints of these athletes cannot easily be directly measured. In order to ascertain the mechanical response of knee joints during the landing phase, and to explore the mechanism of damage to the cartilage and ligaments, a finite element model of the knee joint was established. Three successful landing conditions (neutral, backward, or forward landing) from a triple kicker were analyzed. The results demonstrate that the risk of cruciate ligament damage during a neutral landing was lowest. A forward landing carried medium risk, while backward landing was of highest risk. Backward and forward landing carried risk of injury to the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), respectively. The magnitude of stress on the meniscus and cartilage varied for all three landing scenarios. Stress was largest during neutral landing and least in backward landing, while forward landing resulted in a medium level of stress. The results also provide the basis for training that is scientifically robust so as to reduce the risk of injury and assist in the development of a professional knee joint protector.

scholarly journals MR Imaging of Intra- and Periarticular Cyst-Like Lesions of the Knee Joint in Workers with Occupational Kneeling

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Søren Rytter ◽  
Lilli Kirkeskov Jensen ◽  
Jens Peter Bonde ◽  
Niels Egund
Keyword(s):  
Knee Joint ◽  
Regression Models ◽  
Anterior Part ◽  
Knee Injuries ◽  
Posterior Part ◽  
Popliteus Tendon ◽  
Cystic Lesions ◽  
Logistic Regression Models ◽  
Significant Difference ◽  
Fluid Collections

Objective. To determine the risk of intra- and periarticular cyst-like lesions of the knee joint in occupational kneeling.Methods. Magnetic resonance imaging of both knees (n=282) was conducted in 92 male floor layers and 49 male graphic designers (referents), with a mean age of 55.6 years (range 42–70 years). The prevalence of cyst-like lesions was computed among floor layers and graphic designers, respectively, and associations with occupation summarized by odds ratio (OR) with 95% confidence intervals (CIs). Using logistic regression, models were adjusted for age, body mass index, knee injuries, and knee-straining sports.Results. Floor layers had a significantly higher prevalence of cyst-like lesions in the posterior part of the knee joint compared to graphic designers (OR 2.70, 95% CI 1.50–4.84). Floor layers also had a higher prevalence of fluid collections in the popliteus tendon recess (OR 2.17, 95% CI 0.99–4.77) and large cystic lesions of the popliteus muscle (OR 3.83, 95% CI 0.78–18.89). The prevalence of cystic lesions in the anterior part of the knee joint was low among floor layers (8.7%) and there was no significant difference between the two trade groups (P=0.34).Conclusions. Occupational kneeling increases the risk of cyst-like lesions in the posterior part of the knee joint.

scholarly journals RETURN TO PLAY AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

2020 ◽  
Vol 26 (6) ◽  
pp. 478-486
Author(s):  
Rodrigo A. Goes ◽  
Victor R. A. Cossich ◽  
Bráulio R. França ◽  
André Siqueira Campos ◽  
Gabriel Garcez A. Souza ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Best Practice ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Return To Play ◽  
Joint Stability ◽  
Level Of Evidence ◽  
Strength Assessment ◽  
Anterior Cruciate

ABSTRACT The anterior cruciate ligament (ACL) tear represents more than half of all knee injuries in sports that involve body rotations and sudden changes of direction. Discharging the athlete for return to play (RTP) post-ACL reconstruction (ACLR) is a difficult task with multidisciplinary responsibility. For many years, a six-month period post-ACLR was adopted as the only criterion for RTP. However, it is now suggested that RTP should not be exclusively time-based, but to clinical data and systematic assessments. Despite the importance of post-ACLR factors for RTP, pre- and peri-ACLR factors must also be considered. Historically, ACLR is performed with the hamstring or autologous patellar tendons, although the choice of graft is still an open and constantly evolving theme. Anterolateral ligament reconstruction and repair of meniscal ramp tear associated with ACLR have recently been suggested as strategies for improving knee joint stability. Subjective questionnaires are easy to apply, and help identify physical or psychological factors that can hamper RTP. Functional tests, such as hop tests and strength assessment by means of isokinetic dynamometers, are fundamental tools for decision making when associated with clinical evaluation and magnetic resonance imaging. Recently, the capacity to generate force explosively has been incorporated into the muscle strength assessment. This is quantified through the rate of torque development (RTD). Due to characteristics inherent to the practice of sport, there is an extremely short time available for produce strength. Thus, RTD seems to better represent athletic demands than the maximum strength assessment alone. This review investigates the pre-, peri- and post-ACLR factors established in the literature, and shares our clinical practice, which we consider to be best practice for RTP. Level of evidence V; Specialist opinion.

All-Inside PCL Reconstruction

2021 ◽  
Author(s):  
Erik Therrien ◽  
Ayoosh Pareek ◽  
Bryant M. Song ◽  
Ryan R. Wilbur ◽  
Michael J. Stuart ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Posterior Cruciate Ligament ◽  
Patient Population ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Double Bundle ◽  
Pcl Reconstruction ◽  
Significant Difference ◽  
Single Versus ◽  
The Ideal

AbstractMany different techniques with multiple graft types have been described for the reconstruction of the injured posterior cruciate ligament (PCL); autograft versus allograft, single- versus double-bundle, open inlay versus arthroscopic inlay versus arthroscopic transtibial, and recently described the arthroscopic “all-inside” socket technique. Reported clinical outcomes have demonstrated no significant difference in any of these PCL reconstruction techniques, likely because of the heterogeneity in injury characteristics and patient population. The ideal surgical technique should be safe, simple, and reproducible while allowing treatment of concomitant knee injuries resulting and return to function.

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