scholarly journals Posterior oblique ligament of the knee: state of the art

2021 ◽  
Vol 6 (5) ◽  
pp. 364-371
Author(s):  
Riccardo D’Ambrosi ◽  
Katia Corona ◽  
Germano Guerra ◽  
Simone Cerciello ◽  
Chiara Ursino ◽  
...  
Keyword(s):  
External Rotation ◽  
Young Patients ◽  
Clinical Results ◽  
Rotational Instability ◽  
Common Mechanism ◽  
Return To Sports ◽  
Sports Activity ◽  
Posterior Oblique Ligament ◽  
Medial Side ◽  
Ligamentous Reconstruction

The posterior oblique ligament (POL) is the predominant ligamentous structure on the posterior medial corner of the knee joint. A thorough understanding of the anatomy, biomechanics, diagnosis, treatment and rehabilitation of POL injuries will aid orthopaedic surgeons in the management of these injuries. The resulting rotational instability, in addition to valgus laxity, may not be tolerated by athletes participating in pivoting sports. The most common mechanism of injury – accounting for 72% of cases – is related to sports activity, particularly football, basketball and skiing. Moreover, three different injury patterns have been reported: those associated with injury to the capsular arm of the semimembranosus (SM), those involving a complete peripheral meniscal detachment and those involving disruption of the SM and peripheral meniscal detachment. The hallmark of an injury related to POL lesions is the presence of anteromedial rotatory instability (AMRI), which is defined as ‘external rotation with anterior subluxation of the medial tibial plateau relative to the distal femur’. In acute settings, POL lesions can be easily identified using coronal and axial magnetic resonance imaging (MRI) where the medial collateral ligament (MCL) and POL appear as separate structures. However, MRI is not sensitive in chronic cases. Surgical treatment of the medial side leads to satisfactory clinical results in a multi-ligamentous reconstruction scenario, but it is known to be associated with secondary stiffness. In young patients with high functional demands, return to sports is allowed no earlier than 9–12 months after they have undergone a thorough rehabilitation programme. Cite this article: EFORT Open Rev 2021;6:364-371. DOI: 10.1302/2058-5241.6.200127

scholarly journals Sports Activity and Patient-Related Outcomes after Cementless Total Hip Arthroplasty in Patients Younger than 40 Years

2021 ◽  
Vol 10 (20) ◽  
pp. 4644
Author(s):  
Luis Navas ◽  
Jasmin Faller ◽  
Sebastian Schmidt ◽  
Marcus Streit ◽  
Matthias Hauschild ◽  
...  
Keyword(s):  
Los Angeles ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Young Patients ◽  
Activity Level ◽  
Harris Hip Score ◽  
Return To Sports ◽  
Sports Activity ◽  
Total Hip

Background: The management of degenerative hip diseases in young patients remains a challenge. Despite the improvement of hip-preserving procedures, total hip arthroplasty (THA) may be required in some instances. In addition, young patients undergoing THA have high expectations concerning their postoperative level of activity. Purpose: (1) to define the sports activity level and the return to sports after THA, (2) to describe the modification or initiation of new sports disciplines, and (3) to report the clinically meaningful outcomes after THA in patients younger than 40 years. Methods: A total of 36 patients (40 hips) were prospectively analyzed at a midterm follow-up of 3.9 years. The modified Harris Hip Score (mHHS); the Visual Analog Scale (VAS) for pain; the University of California, Los Angeles (UCLA) activity scale; and sports and recreational activity levels were assessed via questionnaire. The minimal clinically important difference (MCID) was determined by calculating half of the standard deviation, and the substantial clinical benefit (SCB) as well as patient acceptable symptomatic state (PASS), were calculated by the anchor method for the mHHS. Results: At the final follow-up, there was a significant improvement in mHHS (34.1 to 92.6; p < 0.0001), UCLA (3.2 to 7.6; p < 0.0001), and VAS for pain (8 to 1; p < 0.0001). More patients were active in sports at follow-up than before surgery (44% to 92%, p < 0.0001). In addition, the duration and frequency of sports activities showed a significant increase (p < 0.0001). The MCID, SCB and PASS for mHHS were 89% and 58%, respectively. No revision surgery had to be performed. Conclusion: This study showed that a large proportion of patients under 40 years of age who underwent THA increased their physical activity. Eighty-six percent of the patients were highly active, with a UCLA score ≥ 7. Furthermore, the reported MCID, SCB, and PASS for mHHS were achieved by more than 80% of patients.

Lesão SLAP Tipo II Isolada em Desportistas – Reparação Labral ou Tenodese da Longa Porção do Bicípite. Análise de Resultados e Taxa de Return to Play

2021 ◽  
Vol 12 (3) ◽  
pp. 27-30
Author(s):  
André Barros ◽  
◽  
Sérgio Gonçalves ◽  
Eduardo Carpinteiro ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Techniques ◽  
Clinical Results ◽  
Return To Play ◽  
Rate Of Return ◽  
Labral Repair ◽  
Return To Sports ◽  
Sports Activity ◽  
Previous Level ◽  
The Mean

Introduction: SLAP injuries are common in young athletes and in the military men. In the failure of conservative treatment, surgical treatment is indicated. Objectives: To compare clinical results in two groups of sportsmen and military men with SLAP type II injuries who underwent two surgical techniques. Material and methods: Retrospective study, in sportsmen and military personnel submitted to surgical treatment between 2010 and 2018. Each group was submitted to the same technique by the same surgical team. Clinical evaluation was performed with a Constant (SC) score, complications were recorded, surgical re-interventions, rate of return to sports activity and rate of return to the previous level of activity. Results: We analyzed 25 patients, 12 who underwent labral repair (RL) and 13 who underwent bicipital tendon tenodesis (TLPB). The mean follow-up was 4.5 years, the mean age was 25.7 years for the RL group and 31 years for the TLPB group. There was an improvement in SC in both groups. In the RL, there were 4 cases of post-operative stiffness with two re-interventions, whereas with the TLPB there was a failure with tenodesis rupture. The rate of return to sports activity was 100% in both groups, but in the RL group the rate of return to the previous level was 42% and in the TLPB group 70%. Conclusions: Both techniques have good clinical results in the medium and long term. In our series, the results are superior for TLPB and without re-interventions. In the RL group, the rate of complications was higher and the rate of return to the previous level of sports activity was lower.

scholarly journals Conservative management of first-time traumatic anterior shoulder dislocation

2021 ◽  
Author(s):  
Benedikt Schliemann ◽  
Marvin Minkus ◽  
Dominik Seybold ◽  
Markus Scheibel
Keyword(s):  
Conservative Management ◽  
Shoulder Dislocation ◽  
External Rotation ◽  
Young Patients ◽  
Clinical Results ◽  
Current Evidence ◽  
Anterior Shoulder Dislocation ◽  
Recurrence Rates ◽  
Traumatic Anterior Shoulder Dislocation ◽  
First Time

AbstractTraumatic anterior shoulder dislocation is a common injury in young and active patients and the proper treatment is still a matter of debate. The recurrence rate after conservative management remains high and, therefore, primary surgical intervention is sometimes recommended in very young patients whose risk of recurrences is highest. Immobilization in external rotation, first described by Itoi, is a promising conservative option as it provides adequate labral reduction and low recurrence rates. Recent meta-analyzes could not unequivocally demonstrate its superiority over internal rotation immobilization. However, biomechanical and early clinical results show a better effect on reduction of the labrum and lower recurrence rates for immobilization in a combination of abduction/external rotation than for external rotation alone. The present article aims to provide an overview of the conservative management of first-time traumatic shoulder dislocation in order to provide the treating physician or surgeon with the best current evidence as a basis for developing the appropriate treatment strategy for the patient.

Dynamic Restraints of the Medial Side of the Knee: The Semimembranosus Corner Revisited

2019 ◽  
Vol 47 (4) ◽  
pp. 863-869 ◽  
Author(s):  
Christoph Kittl ◽  
Deborah K. Becker ◽  
Michael J. Raschke ◽  
Marcus Müller ◽  
Guido Wierer ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Medial Collateral Ligament ◽  
External Rotation ◽  
Optical Tracking ◽  
Anterior Tibial Translation ◽  
Collateral Ligament ◽  
Posterior Oblique Ligament ◽  
Medial Knee ◽  
Medial Side ◽  
Tibial Translation

Background: Little is known about the dynamic restraints of the semimembranosus muscle (SM). Purpose and Hypothesis: The goal of the present study was to elucidate the role of (1) passive and (2) active restraints to medial-side instability and to analyze (3) the corresponding tightening of the posteromedial structures by loading the SM. It was hypothesized that points 1 to 3 will significantly restrain medial knee instability. This will aid in understanding the synergistic effect of the semimembranosus corner. Study Design: Controlled laboratory study. Methods: Nine knees were tested in a 6 degrees of freedom robotic setup and an optical tracking system. External rotation (ER; 4 N·m), internal rotation (4 N·m), anteromedial rotation (4-N·m ER and 89-N anterior tibial translation), and valgus rotation (8 N·m) were applied at 0°, 30°, 60°, and 90°, with and without an SM load of 75 N. Sequential cutting of the medial collateral ligament and posterior oblique ligament was then performed. At the intact state of the knee and after each cut, the aforementioned simulated laxity tests were performed. Results: The medial collateral ligament was found to be the main passive stabilizer to ER and anteromedial rotation, resulting in 9.3° ± 6.8° ( P < .05), 8.1° ± 3.6° ( P < .05), and 7.6° ± 4.2° ( P < .05) at 30°, 60°, and 90°, respectively. Conversely, after the posterior oblique ligament was cut, internal rotation instability increased significantly at early flexion angles (9.3° ± 3.2° at 0° and 5.2° ± 1.1 at 30°). Loading the SM had an overall effect on restraining ER ( P < .001) and anteromedial rotation ( P < .001). This increased with flexion angle and sectioning of the medial structures and resulted in a pooled 2.8° ± 1.7° (not significant), 5.4° ± 2° ( P < .01), 7.5° ± 2.8° ( P < .001), and 8.3° ± 4.4° ( P < .001) at 0°, 30°, 60°, and 90° when compared with the unloaded state. Conclusion: The SM was found to be a main active restraint to ER and anteromedial rotation, especially at higher flexion angles and in absence of the main passive medial restraints. The calculated tensioning effect was small in all flexion angles for all simulated laxity tests. Clinical Relevance: A complete semimembranosus avulsion may indicate severe medial knee injury, and refixation should be considered in multiligament injury.

scholarly journals Return to Sports After Bone Marrow–Derived Cell Transplantation for Osteochondral Lesions of the Talus

Cartilage ◽  
2016 ◽  
Vol 8 (1) ◽  
pp. 80-87 ◽  
Author(s):  
Francesca Vannini ◽  
Marco Cavallo ◽  
Laura Ramponi ◽  
Francesco Castagnini ◽  
Simone Massimi ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Cell Transplantation ◽  
Case Series ◽  
Clinical Results ◽  
Osteochondral Lesions ◽  
Return To Sports ◽  
One Step ◽  
American Orthopaedic ◽  
Return To Activity

Objective Arthroscopic “one-step” technique based on bone marrow–derived cell transplantation (BMDCT) have achieved good results in repairing osteochondral lesions of the talus (OLT), overcoming important drawbacks of older techniques. It may be particularly adequate for the treatment of athletes in order to permit a safe and stable return to sports. The aim of this study was to report the results at 48 months of a series of athletes and the factors influencing the return to sports. Design Case series. A total of 140 athletes underwent a “one-step” BMDCT repair of OLT. All the patients had the cells harvested from the iliac crest, condensed and loaded on a scaffold, and then implanted. Patients were evaluated clinically by the American Orthopaedic Foot and Ankle Society (AOFAS) scores and Halasi score. Results AOFAS score improved from 58.7 ± 13.5 preoperatively to 90.6 ± 8.6 ( P < 0.005) at 24 months, and to 90.9 ± 10.7 at 48 months. Halasi score was 6.88 ± 1.8 preinjury, 4.08 ± 1.7 preoperatively, and 5.56 ± 2.0 at final follow-up. At the final follow-up, all the patients (beside 1 failure and 3 lost) were able to return to activity and 72.8% were able to resume sports at preinjury level. Conclusions “One-step” BMDCT repair of OLT had good clinical results that was durable over time in athletes, permitting a return to sports at preinjury level in the majority of patients. The preoperative presence of impingement and articular degeneration were the main negative prognostic factors.

scholarly journals Arthroscopic Hip Surgery in the Elite Athlete: Comparison of Female and Male Elite Athletes

2017 ◽  
Vol 5 (3_suppl3) ◽  
pp. 2325967117S0010
Author(s):  
Kotaro Shibata ◽  
Marc R. Safran
Keyword(s):  
Hip Arthroscopy ◽  
Elite Athletes ◽  
Hip Surgery ◽  
Return To Sports ◽  
Competitive Sports ◽  
Sports Activity ◽  
Competitive Activity ◽  
Sports Activities ◽  
Athlete Group

Objectives: 1) To compare ability to return to prior competitive sports activity after arthroscopic hip surgery by gender, with an emphasis on the rate of return to the same level of competition. 2) To compare gender differences in type of sports activities, diagnosis and treatment in athletes requiring hip arthroscopy. Methods: Prospectively obtained data on all high-level elite athletes (professional, NCAA collegiate and/or Olympic) treated between 2007 and 2014 were retrospectively reviewed. The clinical and surgical records of 547 hips in 484 consecutive patients who underwent primary hip arthroscopy by the senior author for non-arthritic hip pain during the study period were included. Elite athletes who had a Hip Sports Activity Score (HSAS) of over 6 were identified. Patients completed a pre-operative questionnaire that included medical and sports activity history and level of competition, hip-specific outcome scores (Modified Harris Hip Score [MHHS] and International Hip Outcome Tool-33 [iHOT-33]) at baseline and most recent follow-up. Surgical findings and time to return to competitive sports activity were documented. Results: A total of 98 elite athletes with a mean follow up period of 18.8 months (±12.7) were identified. There were 49 females and 49 males. 27 athletes had bilateral hip arthroscopy, 5 of which had 1 operation elsewhere. All patients were available for follow up. Of the 80 patients desiring to return to their original competitive activity, 38 were female (42 hips) (Female Athlete group [FA]) and 42 were male (54 hips) (Male Athlete group [MA]) their mean ages were 21.5(±3.9) and 20.5(±1.9), duration of pain prior to surgery was 12.1 (±10.3) months and 15.1 (±1.9) months, respectively. 84.2% of FA and 83.3% of MA were able to return to the same level of competition at a mean of 8.3 (±3) and 8.8 (±2.9) months, respectively. Statistically significant improvements between pre- and post-operative mean MHHS and iHOT-33 scores were seen in both groups (p <.0001; p <.0001). FA had significantly higher proportions of hips that were diagnosed with Pincer type FAI (p =.0004), and Instability (p <.0001). Conversely, the MA had significantly higher proportions of hips that were diagnosed with Combined type FAI (p <.0001), had more extensive acetabular cartilage rim damage (p =.0002), and in particularly had more hips that required microfracture treatment (p =.001). When comparing cam lesions (includes Cam and Combined type FAI) the alpha angle was statistically greater in MA (mean 74°±6.7) compared to FA (mean 65.4°±6.8) (p <.0001). The category of sports the FA participated in were more flexibility (11%) and endurance (24%) type sports. MA participated more in cutting (33%), contact (14%) and asymmetric (31%) type sports. Patients who were able to return to same level of competitive activity had a significantly shorter duration of pre-operation symptoms compared to those who could not (p < 0.05). Microfracture treatment did not affect the ability to return to sports. Conclusion: A similar high percentage of both female and male elite athletes were able to return to competitive sports activity after arthroscopic treatment of FAI and/or hip instability. Distinct differences in diagnosis, treatment and participating type of sports activities were seen when comparing female and male athletes. Duration of symptoms negatively correlated with outcomes. Extensive cartilage damage and Microfracture did not affect outcome / return to sports.

FUNCTIONAL OUTCOME OF ARTHROSCOPIC ACL RECONSTRUCTION WITH HAMSTRING GRAFT

2021 ◽  
pp. 36-37
Author(s):  
Sai Bharath Kanugula ◽  
Atchuta Rao Ampolu ◽  
Ashok Kumar Patnala
Keyword(s):  
Anterior Cruciate Ligament ◽  
Functional Outcome ◽  
Cruciate Ligament ◽  
Common Mechanism ◽  
Associated Injuries ◽  
Hamstring Graft ◽  
Sports Activity ◽  
Anterior Drawer Test ◽  
Anterior Cruciate

Background: The most common joint to be injured in our body is knee joint, and the commonest ligament to be injured is anterior cruciate ligament in the knee.Etiology includes road trafc accidents and sport injuries. The ACL, along with other ligaments, the capsule are the stabilizers of the knee and prevents anterior translation, and limits valgus and rotational stress. The articular cartilage injuries in acute ACL tears constitutes from 16 – 46%, and in chronic tears, the incidence increases further2. For prevention of further worsening of the existing lesions and also to prevent formation of new lesions, stablity of the knee should be achieved.The present study is to assess the functional outcome of arthroscopic anterior cruciate ligament reconstruction using hamstring tendon (gracilis and semitendinosus) autograft in patients with ACL tears. Methods: Study design: Hospital Based Observational study. Study period: September 2019 to August 2021. Sample size: 30 30 consecutive patients who underwent arthroscopic ACL reconstructions with hamstring graft were taken for this study. Results: Out of these, 27 patients were male and 3 were female. Right side affected in 18 patients and left side in 12 patients. The most common mechanism of the injury was sports activity in 17 patients, RTA injuries in 10 patients and other job related injuries in 3 patients. Isolated ACL tears in thirteen patients in our study and rest had associated injuries to menisci in same knee.Better postoperative functional scores are seen with patients with isolated ACL injuries compared to those patients with associated injuries of the knee like meniscal tears. Observations include anterior drawer test was negative in 83.33% of patients at 3 months, 86.67% of patients at 6 months and at 1 year 96.15% of patients had a negative anterior drawer test. Full range of motion attained in 86.67% of patients at 3 months, 93.33% of patients at 6 months and at 1 year 96.15% of patients.Pivot shift test was negative postoperatively for all the patients at any follow-up. Postoperatively at 3 months 25 (83.33%) patients had 5/5 quadriceps power (MRC grading) 92.3% of them had 5/5 power at latest follow up. Complications include Supercial infection and Deep infection in our study. Conclusion: Anterior cruciate ligament tears are most common at a mean age of 28 years with preponderance to male gender. The most common mechanism of the injury was sports activity. Isolated ACL injury is more common than along with associated meniscal injuries.Anatomic single bundle reconstruction with quadrupled hamstring graft gives good functional results.Hamstring graft xation with endobutton and interference screw gives better functional outcome.

scholarly journals Ankle Joint Pressure in Supination-External Rotation Injuries: A Dynamic Biomechanic Cadaveric Study

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0030
Author(s):  
Fabian Krause ◽  
Ivan Zderic ◽  
Angela Seidel ◽  
Boyko Gueorguiev ◽  
Marc C. Attinger ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Contact Area ◽  
Peak Pressure ◽  
External Rotation ◽  
Clinical Results ◽  
Deltoid Ligament ◽  
Type Ii ◽  
Type Iv ◽  
Joint Contact ◽  
Supination External Rotation

Category: Ankle; Basic Sciences/Biologics; Trauma Introduction/Purpose: In isolated lateral malleolar fractures of the supination-external rotation (SER) type and competent medial stabilizers (type II and III), non-operative treatment has yielded excellent outcome. With complete rupture of the deltoid ligament (SER type IV) fracture instability increases substantially. The rationale for operative treatment of SER type IV fractures is based upon good clinical results and previous biomechanical studies. A significant reduction of the ankle contact area that however is caused by an artificially forced lateralization of the talus in the ankle mortise has been demonstrated. Presumed resultant elevated joint contact stresses are thought to lead to ankle arthritis in the longterm. Methods: In 12 lower leg specimen SER type injuries were simulated by gradual bony and ligamentous destabilization of the ankle from lateral to medial according to the mechanism of injury as described by Lauge and Hansen. High-resolution pressure sensors placed in the ankle joint recorded tibio-talar pressure changes at physiologic weightbearing (700N) in three positions (plantigrade, 10° dorsiflexion and 20° plantarflexion). Results: With increasing instability changes of the ankle kinematics were seen in SER II and III fractures with the same trend also in SER IV lesions. In the plantigrade position, the medial clear space (MCS) increased significantly from an average of 2.5+-0.4mm (no fracture) to 3.9+-1.1mm (SER type IV fracture). However, the corresponding peak pressure increased only slightly from 2.6+- 0.5 mPa to 3.0+-1.4 mPa on average, and the contact area decreased slightly from 810+-42 mm2 to 735+-27mm2 on average representing a non-significant reduction of only 9% of the contact area (p=0.08) after the deep deltoid ligament was completely dissected.The comparison of the results in plantigrade and plantarflexed position revealed substantial differences for MCS, contact area and center of force. Conclusion: Under physiologic load SER type IV isolated lateral malleolar fracture with completely disrupted deep deltoid ligament led to a significant increase of the MCS, but neither to a significant decrease of the of the joint contact area nor significant increase of peak pressure. Clinical Relevance: The findings of this biomechanical study support the recently reported good clinical results of non-operative treatment of SER type II to IV fractures.

Return to Sports after Anterior Cruciate Ligament Injury: a Matched-Pair Analysis of Repair with Internal Brace and Reconstruction Using Hamstring or Quadriceps Tendons

2020 ◽  
Author(s):  
Reinhold Ortmaier ◽  
Christian Fink ◽  
Wolfgang Schobersberger ◽  
Harald Kindermann ◽  
Iris Leister ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Tendon ◽  
Well Being ◽  
Matched Pair ◽  
Return To Sports ◽  
Acl Repair ◽  
Sports Activity ◽  
Matched Pair Analysis ◽  
Internal Brace

Abstract Purpose The purpose of this study was to evaluate sports activity before anterior cruciate ligament (ACL) injury and after surgical treatment of ACL rupture comparing ACL repair with an Internal Brace to ACL reconstruction using either a hamstring (HT) or quadriceps tendon (QT) autograft. Methods Between 12/2015 and 10/2016, we recruited 69 patients with a mean age of 33.4 years for a matched-pair analysis. Twenty-four patients who underwent Internal Brace reconstruction were matched according to age (± 5 years), gender, Tegner activity scale (± 1), BMI (± 1) and concomitant injuries with 25 patients who had undergone HT reconstruction and 20 patients who had undergone QT reconstruction. The minimum follow-up was 12 months. Results Overall, the return-to-sports rate was 91.3 %. There were no significant differences (p ≥ 0.05) in the number of sports disciplines and the time before return to sports within or among the groups. Overall and within the groups, the level of sports participation did not change significantly (p ≥ 0.05) postoperatively. The patients' sense of well-being was excellent after either ACL repair with an Internal Brace or ACL reconstruction with autologous HT or QT. Conclusion At short-term follow-up, ACL repair using an Internal Brace enables sports activity and provides a sense of well-being similar to that of classic ACL reconstruction using hamstring or quadriceps tendon autografts in a selected patient population. Level of Evidence: Level III Retrospective comparative study.

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