Gait deviations of patients with ruptured anterior cruciate ligament: a cross-sectional gait analysis study on male patients

Background: An evaluation of quadriceps tendon (QT) morphology preoperatively is an important step when selecting an individually appropriate autograft for anterior cruciate ligament (ACL) reconstruction. However, to our knowledge, there are no studies that have assessed the morphology of the entire QT in an ACL-injured knee preoperatively using ultrasound. Purpose: We aimed to investigate the morphological characteristics of the QT using preoperative ultrasound in ACL-injured knees. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 33 patients (mean age, 26.0 ± 11.5 years) with a diagnosed ACL tear undergoing primary ACL reconstruction were prospectively included. Using ultrasound, short-axis images of the QT were acquired in 10-mm increments from 30 to 100 mm proximal to the superior pole of the patella. The length of the QT was determined by 2 contiguous images that did and did not contain the rectus femoris muscle belly. The width of the superficial and narrowest parts of the QT, the thickness of the central and thickest parts of the QT, and the cross-sectional area at the central 10 mm of the superficial QT width were measured at each assessment location. The estimated intraoperative diameter of the QT autograft was calculated using a formula provided in a previous study. Results: There were no significant relationships between QT morphology and any of the demographic data collected. The length of the QT was less than 70 mm in 45.5% of patients (15/33). The width, thickness, cross-sectional area, and estimated intraoperative diameter of the QT autograft were significantly greater at 30 mm than at 70 mm proximal to the superior pole of the patella. Conclusion: Preoperative ultrasound may identify a QT that is too small for an all–soft tissue autograft in ACL reconstruction. Furthermore, harvesting a QT with a fixed width may result in autografts that are smaller proximally than they are distally. Assessing the morphology of the QT preoperatively using ultrasound may help surgeons to adequately reconstruct the native length and diameter of the ACL with a QT autograft.

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Effect of Anterior Cruciate Ligament Reconstruction With an Autologous Semitendinosus-Gracilis Graft on Neuromuscular Function

Advances in Bioengineering ◽

10.1115/imece2003-43031 ◽

2003 ◽

Author(s):

Glenn N. Williams ◽

Peter J. Barrance ◽

Lynn Snyder-Mackler ◽

Thomas S. Buchanan

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Sports Participation ◽

Biceps Femoris ◽

Neuromuscular Function ◽

Magnetic Resonance Images ◽

Cross Sectional ◽

Orthopaedic Surgeons ◽

Lateral Muscle ◽

Anterior Cruciate

The quadrupled semitendinosus-gracilis (ST-G) graft is rapidly becoming the graft of choice for orthopaedic surgeons when reconstructing the anterior cruciate ligament (ACL). During this procedure orthopaedic surgeons harvest the distal semitendinosus and gracilis tendons and use them to replace the ruptured ACL. Although people who undergo this procedure have good functional outcomes over the short-term, we do not know the effect that harvesting these two tendons has on neuromuscular function. The purpose of this study was to examine the effect that ACL reconstruction with an autologous ST-G had on musculotendinous morphology. The methods used in the study included digital reconstruction of knee musculature from magnetic resonance images (MRI). Marked reductions in muscle volume, cross-sectional area, and length were observed in the semitendinosus and gracilis when reassessed approximately 6 months following surgery (after the subjects had returned to sports participation). The subjects appeared to compensate for the diminished medial knee flexor function with the biceps femoris (a lateral muscle) and semimembranosus muscles. These findings may have important implications for joint loading, the long term health of the knee, and surgical decision-making.

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Motor imagery in high-functioning individuals with chronic anterior cruciate ligament deficiency: A cross-sectional study

The Knee ◽

10.1016/j.knee.2019.02.011 ◽

2019 ◽

Vol 26 (3) ◽

pp. 545-554

Author(s):

Shiek Abdullah Ismail ◽

Milena Simic ◽

Tasha R. Stanton ◽

Evangelos Pappas

Keyword(s):

Anterior Cruciate Ligament ◽

Motor Imagery ◽

Cruciate Ligament ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

High Functioning ◽

Anterior Cruciate Ligament Deficiency ◽

Anterior Cruciate

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Predictors of Healing Ligament Size and Magnetic Resonance Signal Intensity at 6 Months After Bridge-Enhanced Anterior Cruciate Ligament Repair

The American Journal of Sports Medicine ◽

10.1177/0363546519836087 ◽

2019 ◽

Vol 47 (6) ◽

pp. 1361-1369 ◽

Cited By ~ 9

Author(s):

Martha M. Murray ◽

Ata M. Kiapour ◽

Leslie A. Kalish ◽

Kirsten Ecklund ◽

Christina Freiberger ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Magnetic Resonance ◽

Signal Intensity ◽

Cruciate Ligament ◽

Quadriceps Strength ◽

Cross Sectional Area ◽

Sectional Area ◽

Acl Repair ◽

Cross Sectional ◽

Anterior Cruciate

Background: Primary repair of the anterior cruciate ligament (ACL) augmented with a tissue engineered scaffold to facilitate ligament healing is a technique under development for patients with ACL injuries. The size (the amount of tissue) and signal intensity (the quality of tissue) of the healing ligament as visualized on magnetic resonance imaging (MRI) have been shown to be related to its strength in large animal models. Hypothesis: Both modifiable and nonmodifiable risk factors could influence the size and signal intensity of the repaired ligament in patients at 6 months after surgery. Study Design: Case series; Level of evidence, 4. Methods: 62 patients (mean age, 19.4 years; range, 14-35 years) underwent MRI of the knee 6 months after ACL repair augmented with an extracellular matrix scaffold. The signal intensity (normalized to cortical bone) and average cross-sectional area of the healing ligament were measured from the MRI stack obtained by use of a gradient echo sequence. Associations between these 2 measures and patient characteristics, which included demographic, clinical, and anatomic features, were determined by use of multivariable regression analysis. Results: A larger cross-sectional area of the repaired ligament at 6 months was associated with male sex, older age, and the performance of a larger notchplasty ( P < .05 for all associations). A lower signal intensity at 6 months, indicating greater similarity to normal ligament, was associated with a smaller tibial slope and greater side-to-side difference in quadriceps strength 3 months after surgery. Other factors, including preoperative body mass index, mechanism of injury, tibial stump length, and Marx activity score, were not significantly associated with either MRI parameter at 6 months. Conclusion: Modifiable factors, including surgical notchplasty and slower recovery of quadriceps strength at 3 months, were associated with a larger cross-sectional area and improved signal intensity of the healing ACL after bridge-enhanced ACL repair in this preliminary study. Further studies to determine the optimal size of the notchplasty and the most effective postoperative rehabilitation strategy after ACL repair augmented by a scaffold are justified. Registration: NCT02664545 (ClinicalTrials.gov identifier).

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Gait Analysis and Knee Kinematics in Patients with Anterior Cruciate Ligament Rupture: Before and After Reconstruction

Applied Sciences ◽

10.3390/app10103378 ◽

2020 ◽

Vol 10 (10) ◽

pp. 3378

Author(s):

Dmitry Skvortsov ◽

Sergey Kaurkin ◽

Alexander Akhpashev ◽

Aljona Altukhova ◽

Alexander Troitskiy ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Gait Analysis ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Surgical Reconstruction ◽

Control Group ◽

Cycle Duration ◽

Post Surgery ◽

Before And After ◽

Anterior Cruciate

The objective of the study was to evaluate the clinical, functional, and biomechanical symptoms in patients with anterior cruciate ligament (ACL) rupture before and after ACL reconstruction. The study enrolled 20 patients and 20 healthy subjects as controls. Walking biomechanics was assessed at three time points: before surgery and three months and a year or more after surgical reconstruction. Impact loads on both sides differed significantly from the respective values before surgery (p<0.05). Walking cycle duration decreased with time after surgery. On both sides (affected and unaffected), hip movement amplitudes were significantly smaller than in control (p<0.05). They remained so in the follow-up periods after the reconstruction. Before ACL reconstruction, the amplitude of the main flexion of the knee was significantly reduced both on the affected and unaffected sides. The amplitude gradually increased after the reconstruction, and a year post-surgery, it reached, on the operated side, the same values as in the control group. Complete functional recovery of the knee joint was not achieved within a year after the ACL surgical reconstruction. The remaining changes, however, were not clinically pronounced and could only be detected by instrumental gait analysis. The compensatory processes developed bilaterally, in both the hip and knee joints.

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