scholarly journals Femur-tibia Angle and Patella-tibia Angle: New Indicators for Diagnosing Anterior Cruciate Ligament Tears in Magnetic Resonance Imaging

2021 ◽  
Author(s):  
Zeng Li ◽  
Mengyuan Li ◽  
Yan Du ◽  
Hai Jiang ◽  
Yuanchen Ma ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Cruciate Ligament ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Youden Index ◽  
Control Group ◽  
Acl Tear ◽  
Anterior Cruciate ◽  
Arthroscopic Knee

Abstract Background: Torn anterior cruciate ligament (ACL) contributes to internal rotation of tibia. However, there is no indicator in MRI to reflect the rotation of knee joint. So the purpose of this study is to introduce two new measurements in MRI, femur-tibia angle (FTA) and patella-tibia angle (PTA), which reflect the rotation of knee joint and assess their role in diagnosing ACL tears.Methods: Present study retrospectively reviewed the cases of primary arthroscopic knee surgery from January 2018 to December 2019 from the Arthroscopy Database at Guangdong Provincial People's Hospital. Firstly, comparisons of different measurements were conducted between the ACL tears group and isolated meniscus injury group. Then, the measurements were tested in diagnosing complete or partial ACL tears. Diagnostic performance of different measurements was assessed by area under the curve (AUC) of receiver operating characteristic (ROC) curve and cutoff values were determined by Youden index. Results: FTA and PTA in ACL tears group had 4.79 and 7.36 degrees more than that of control group (p = 0.022 and < 0.001, respectively). Besides, ACL angle and distance of anterior tibial subluxation (D) also showed significant differences (p<0.05). In distinguishing complete ACL tear with intact ACL, the ROC curves indicated that ACL angle had the highest AUC of 0.906 (95% CI: 0.833-0.978) while AUC of PTA was 0.849 (95% CI: 0.763-0.936) and AUC of FTA was 0.809 (95% CI: 0.710-0.908). In distinguishing partial ACL tear with intact ACL, the ROC curves showed that FTA and PTA had the highest AUCs of 0.847 and 0.813 with 95% CI of 0.737-0.957 and 0.680-0.947, respectively. In contrast, the AUCs of ACL angle and D were only 0.519 and 0.387 with 95% CI of 0.292-0.745 and 0.227-0.546.Conclusion: Present study introduced two new quantitative parameters, FTA and PTA, to assess the rotation of knee joint. FTA and PTA increased when ACL tears and they might be valuable in diagnosing ACL tears, especially in distinguishing partial ACL tear with intact ACL which was poorly diagnosed in MRI.

scholarly journals The underlying mechanism of partial anterior cruciate ligament injuries to the meniscus degeneration of knee joint in rabbit models

2020 ◽  
Author(s):  
Dalin Wang ◽  
Zhe Wang ◽  
Mingcheng Li ◽  
Songbao Xu
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Cruciate Ligament ◽  
Underlying Mechanism ◽  
Joint Fluid ◽  
Control Group ◽  
Rabbit Knee ◽  
Meniscus Degeneration ◽  
Anterior Cruciate ◽  
Experimental Group

Abstract Background: The diagnosis, treatment and efficacy evaluation of anterior cruciate ligament (ACL) partial rupture remains controversial. This research aims to investigate the underlying mechanism of partial ACL injuries to the meniscus degeneration in the rabbit knee.Methods: Sixty New Zealand, white rabbits were randomly divided into three groups including an experimental group, a sham group (n=6) and and a blank control group (n=6). The experimental group is composed of an anteromedial bundle (AMB) rupture group (n=24), a posterolateral bundle (PLB) rupture group (n=24). Rabbits in the experimental group were subjected to right hind limbs knee surgery to induce ACL part injury under the arthroscopy. Finally, eight rabbits including 6 in the model group and 2 in the control group were sampled randomly on the second, fourth and eighth weeks respectively. We observed the typical form of the meniscus through HE staining. Expressions of inflammatory factors including interleukin-1β (IL-1β) and IL-17 in the knee joint fluid were determined by means of an ELISA. Analysis of the mRNA expressions of matrix metalloproteinases-13(MMP-13) was performed to evaluate the inflammatory mediators in the pathogenesis of the meniscus.Results: HE staining results showed that the surface was rough and the tissues were loose displaying collagen fibers of varying thickness. Both IL-1β and IL-17 in the synovial fluid, and the positive rate of MMP-13 in addition to MMP-13 mRNA showed a demonstrable increase treads from the 2nd to the 8th week. The significant difference was found (P<0.05) compared to the control group.Conclusion: We conclude that the elevated levels of IL-1β and IL-17, along with increased MMP13 expression, resulted in meniscus degradation in the rabbit knee joint model with partial ACL injury.

scholarly journals The underlying mechanism of partial anterior cruciate ligament injuries to the meniscus degeneration of knee joint in rabbit models

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Dalin Wang ◽  
Zhe Wang ◽  
Mingcheng Li ◽  
Songbao Xu
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Cruciate Ligament ◽  
Underlying Mechanism ◽  
Joint Fluid ◽  
Control Group ◽  
Rabbit Knee ◽  
Meniscus Degeneration ◽  
Anterior Cruciate ◽  
Experimental Group

Abstract Background The diagnosis, treatment, and efficacy evaluation of anterior cruciate ligament (ACL) partial rupture remains controversial. This research aims to investigate the underlying mechanism of partial ACL injuries to the meniscus degeneration in the rabbit knee. Methods Sixty New Zealand white rabbits were randomly divided into three groups including an experimental group, a sham group (n = 6), and a blank control group (n = 6). The experimental group is composed of an anteromedial bundle (AMB) rupture group (n = 24) and a posterolateral bundle (PLB) rupture group (n = 24). Rabbits in the experimental group were subjected to right hind limbs knee surgery to induce ACL part injury under the arthroscopy. Finally, eight rabbits including 6 in the model group and 2 in the control group were sampled randomly on the 2nd, 4th, and 8th weeks respectively. We observed the typical form of the meniscus through HE staining. Expressions of inflammatory factors including interleukin-1β (IL-1β) and IL-17 in the knee joint fluid were determined by means of an ELISA. Analysis of the mRNA expressions of matrix metalloproteinases-13(MMP-13) was performed to evaluate the inflammatory mediators in the pathogenesis of the meniscus. Results HE staining results showed that the surface was rough and the tissues were loose displaying collagen fibers of varying thickness. Both IL-1β and IL-17 in the synovial fluid and the positive rate of MMP-13 in addition to MMP-13 mRNA showed a demonstrable increase treads from the 2nd to the 8th week. The significant difference was found (P < 0.05) compared to the control group. Conclusion We conclude that the elevated levels of IL-1β and IL-17, along with increased MMP13 expression, resulted in meniscus degradation in the rabbit knee joint model with partial ACL injury.

scholarly journals Texture Analysis to Differentiate Anterior Cruciate Ligament in Patients After Surgery With Platelet-Rich Plasma

2020 ◽  
Author(s):  
Allan Felipe Fattori Alves ◽  
José Ricardo de Arruda Miranda ◽  
Sérgio Augusto Santana de Souza ◽  
Ricardo Violante Pereira ◽  
Paulo Roberto de Almeida Silvares ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Texture Analysis ◽  
Platelet Rich Plasma ◽  
Cruciate Ligament ◽  
Area Under The Curve ◽  
Stochastic Gradient Descent ◽  
Control Group ◽  
Gray Level ◽  
Significant Difference ◽  
Anterior Cruciate

Abstract BackgroundPlatelet-Rich Plasma (PRP) has been used to favor Anterior Cruciate Ligament (ACL) healing after reconstruction surgeries. However, clinical data are still inconclusive and subjective about PRP. Thus, we propose a quantitative method to demonstrate that PRP produced morphological structures changes.MethodsThirty-four patients undergoing ACL reconstruction surgery were evaluated and divided into Control Group (sixteen patients) without PRP application and Experiment Group (eighteen patients) with intraoperative application of PRP. Magnetic Resonance Imaging (MRI) scans were performed three months after surgery. We used Matlab® and Machine Learning (ML) in Orange Canvas® to Texture Analysis (TA) features extraction. Experienced radiologists delimited the regions of interest (RoIs) in the T2-weighted images. 62 texture parameters were extracted, including Gray-Level Co-occurrence Matrix and Gray Level Run Length. We used the algorithms Logistic Regression (LR), Naive Bayes (NB) and Stochastic Gradient Descent (SGD).ResultsThe accuracy of the classification with NB, LR, and SGD was 83.3%, 75%, 75%, respectively. For the area under the curve: NB, LR, and SGD presented values of 91.7%, 94.4%, 75%, respectively. In clinical evaluations, the groups show similar responses in terms of improvement in pain and increase in the IKDC index (International Knee Documentation Committee) and Lysholm Score indices differing only in the assessment of flexion, which presents a significant difference for the group treated with PRP.ConclusionsHere, we demonstrated quantitatively that patients who received PRP presented texture changes when compared to the control group. Thus, our findings suggest that PRP interferes with morphological parameters of the ACL.Trial RegistrationProtocol no. CAAE 56164316.6.0000.5411.

scholarly journals Improved Deep Convolutional Neural Network to Classify Osteoarthritis from Anterior Cruciate Ligament Tear Using Magnetic Resonance Imaging

2021 ◽  
Vol 11 (11) ◽  
pp. 1163
Author(s):  
Mazhar Javed Awan ◽  
Mohd Shafry Mohd Rahim ◽  
Naomie Salim ◽  
Amjad Rehman ◽  
Haitham Nobanee ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Cruciate Ligament ◽  
Area Under The Curve ◽  
Magnetic Resonance Images ◽  
Learning Rate ◽  
Receiver Operating Curve ◽  
Acl Tear ◽  
Anterior Cruciate ◽  
Sensitivity Specificity

Anterior cruciate ligament (ACL) tear is caused by partially or completely torn ACL ligament in the knee, especially in sportsmen. There is a need to classify the ACL tear before it fully ruptures to avoid osteoarthritis. This research aims to identify ACL tears automatically and efficiently with a deep learning approach. A dataset was gathered, consisting of 917 knee magnetic resonance images (MRI) from Clinical Hospital Centre Rijeka, Croatia. The dataset we used consists of three classes: non-injured, partial tears, and fully ruptured knee MRI. The study compares and evaluates two variants of convolutional neural networks (CNN). We first tested the standard CNN model of five layers and then a customized CNN model of eleven layers. Eight different hyper-parameters were adjusted and tested on both variants. Our customized CNN model showed good results after a 25% random split using RMSprop and a learning rate of 0.001. The average evaluations are measured by accuracy, precision, sensitivity, specificity, and F1-score in the case of the standard CNN using the Adam optimizer with a learning rate of 0.001, i.e., 96.3%, 95%, 96%, 96.9%, and 95.6%, respectively. In the case of the customized CNN model, using the same evaluation measures, the model performed at 98.6%, 98%, 98%, 98.5%, and 98%, respectively, using an RMSprop optimizer with a learning rate of 0.001. Moreover, we also present our results on the receiver operating curve and area under the curve (ROC AUC). The customized CNN model with the Adam optimizer and a learning rate of 0.001 achieved 0.99 over three classes was highest among all. The model showed good results overall, and in the future, we can improve it to apply other CNN architectures to detect and segment other ligament parts like meniscus and cartilages.

scholarly journals Impact of Physiotherapy rehabilitation program on postoperative ACL tear patient on prognosis leading to maintain consistency in sport

2020 ◽  
Vol 11 (3) ◽  
pp. 4821-4825
Author(s):  
Prasad Risaldar ◽  
Akshata Raut ◽  
Dushyant Bawiskar ◽  
Waqar M. Naqvi
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Cruciate Ligament ◽  
Rehabilitation Program ◽  
Clinical Findings ◽  
Acl Tear ◽  
Anterior Cruciate ◽  
Typical Treatment ◽  
Joint Integrity ◽  
Loss Of Strength

Anterior cruciate ligament (ACL) injury is a devastating injury that occurs at high frequency during involvement in competitive sporting activity. Typical treatment of ACL damage is a reconstruction of the anterior cruciate ligament (ACLR). It is projected that between 50 percent and 60 percent of ACL injured athletes will return to competitive sport. Athletes undergoing ACLR surgery are recommended for comprehensive rehab and preparedness to rebuild knee joint integrity and specific functional criteria to direct the comeback to sport to protect against secondary ACL damage.Patient main concerns were pain, with loss of strength and stability at the knee joint, the clinical findings found that there was a marked decrease in range of motion (ROM), and decreased strength of the quadriceps and the hamstrings.Diagnosis of case was grade 2 ACL tear which was confirmed by the MRI reports.The patient showed a great co-operation during the intervention period and now the subject is able to maintain his consistency in his sport. The outcome measures of physical therapy intervention progressed him in an enhanced athlete with return to his sport.

scholarly journals Early Quadriceps Wasting after Anterior Cruciate Ligament Reconstruction in Young Adults: A Prospective Study

2021 ◽  
Author(s):  
Shubham Agarwal ◽  
Hemant Jain ◽  
Kishore Raichandani ◽  
Jagdish Godara ◽  
Sunil Choudhary
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Cruciate Ligament ◽  
Quadriceps Muscle ◽  
Thigh Circumference ◽  
Femur Length ◽  
Acl Tear ◽  
Measuring Tape ◽  
Anterior Cruciate ◽  
Prospective Longitudinal

Introduction: Anterior Cruciate Ligament (ACL) is the most commonly injured ligament in the knee that requires surgical intervention. The weakness of quadriceps muscle is a sequele of ACL tear that can persist even after reconstruction. Muscle wasting if identified in early postoperative period can help to formulate structured protocols for rehabilitation that can help patient to recover. Best available method for scan of the same includes Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scan, but it is neither accessible nor affordable to masses of population. Aim: To evaluate the quadriceps thickness using an easily available modality i.e., Ultrasonography (USG) and thigh circumference to detect early wasting. Materials and Methods: This prospective longitudinal study was done on 48 patients between the ages of 18-45 years with ACL tear operated arthroscopically. After six months of surgery, all patients were evaluated for quadriceps thickness using USG and thigh circumference using traditional measuring tape at the same points. Paired t-test was used for evaluation of the results. Results: This study quantifies quadriceps thickness using USG at two distinct levels of the thigh and found a significant deficit of 13.05% in the involved extremity at 1/3rd of femur length from knee joint and a deficit of 11.72% in involved extremity at 2/3rd of femur length from knee joint. This study established that the quadriceps of the involved extremity definitely goes under atrophy despite early rehabilitation. Also, there was a deficit of 5.04% in thigh circumference at 1/3rd of femur length from knee joint and 4.43% at 2/3rd of femur length from knee joint in the operated limb. There was no positive correlation between both the methods. Conclusion: This study concluded that USG is an easily available and affordable method to determine quadriceps thickness and it’s wasting early in the postoperative rehabilitation phase. It can assist in establishing early vigorous rehabilitation protocols. The traditional method of measuring thigh circumference using measuring tape to quantify quadriceps muscle bulk can be misleading as its underestimates the atrophy due to various factors.

scholarly journals The underlying mechanism of partial anterior cruciate ligament injuries to the meniscus degeneration of knee joint in rabbit models

2020 ◽  
Author(s):  
Dalin Wang ◽  
Zhe Wang ◽  
Mingcheng Li ◽  
Songbao Xu
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Cruciate Ligament ◽  
Underlying Mechanism ◽  
Joint Fluid ◽  
Control Group ◽  
Rabbit Knee ◽  
Meniscus Degeneration ◽  
Anterior Cruciate ◽  
Experimental Group

Abstract Background: The diagnosis, treatment and efficacy evaluation of anterior cruciate ligament (ACL) partial rupture remains controversial. This research aims to investigate the underlying mechanism of partial ACL injuries to the meniscus degeneration in the rabbit knee. Methods: Sixty New Zealand, white rabbits were randomly divided into three groups including an experimental group, a sham group (n=6) and and a blank control group (n=6). The experimental group is composed of an anteromedial bundle (AMB) rupture group (n=24), a posterolateral bundle (PLB) rupture group (n=24). Rabbits in the experimental group were subjected to right hind limbs knee surgery to induce ACL part injury under the arthroscopy. Finally, eight rabbits including 6 in the model group and 2 in the control group were sampled randomly on the second, fourth and eighth weeks respectively. We observed the typical form of the meniscus through HE staining. Expressions of inflammatory factors including interleukin-1β (IL-1β) and IL-17 in the knee joint fluid were determined by means of an ELISA. Analysis of the mRNA expressions of matrix metalloproteinases-13(MMP-13) was performed to evaluate the inflammatory mediators in the pathogenesis of the meniscus. Results: HE staining results showed that the surface was rough and the tissues were loose displaying collagen fibers of varying thickness. Both IL-1β and IL-17 in the synovial fluid, and the positive rate of MMP-13 in addition to MMP-13 mRNA showed a demonstrable increase treads from the 2nd to the 8th week. The significant difference was found (P<0.05) compared to the control group. Conclusion: We conclude that the elevated levels of IL-1β and IL-17, along with increased MMP13 expression, resulted in meniscus degradation in the rabbit knee joint model with partial ACL injury.

scholarly journals SPORTS MECHANICS REHABILITATION EFFECTS ON KNEE AND MUSCLE

2021 ◽  
Vol 27 (8) ◽  
pp. 807-809
Author(s):  
Aona Chen ◽  
Shuhua Qu ◽  
Xuejun Ma ◽  
Wenjiang Zhao ◽  
Chenggen Guo
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Human Body ◽  
Cruciate Ligament ◽  
Weight Ratio ◽  
Peak Torque ◽  
Ligament Injury ◽  
Control Group ◽  
Level Of Evidence ◽  
Anterior Cruciate

ABSTRACT Introduction: The knee joint is a complex and important joint in the human body. It plays an active role in maintaining posture balance of the human body in sports, allowing one to bear a larger load and complete various complex technical movements. Objective: To investigate the stability and influence of kinemechanics in knee joint rehabilitation training. Methods: A total of 80 patients with anterior cruciate ligament injury who received treatment in Henan Provincial People's Hospital were selected and divided into control group and observation group according to the random number table method, with 40 cases in each group. Results: Six months after surgery, the peak torque (PT), peak torque to body weight ratio (PT/BWT), total work (TWT), Lysholm score and Tegner score, and knee circumference of the two groups were significantly improved compared with those before surgery (P <0.01). The degree of improvement was greater in the observation group:compared with the control group, the difference was highly statistically significant (P<0.01). Conclusions: Professional exercise rehabilitation has a definite effect on patients after anterior cruciate ligament reconstruction. It can significantly improve the muscle strength of quadriceps and hamstring, improve the function of knee joint and promote its recovery. Level of evidence II; Therapeutic studies - investigation of treatment results.

scholarly journals The underlying mechanism of partial anterior cruciate ligament injuries to the meniscus of knee joint in rabbit models

2020 ◽  
Author(s):  
Dalin Wang ◽  
Zhe Wang ◽  
Mingcheng Li ◽  
Songbao Xu
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Underlying Mechanism ◽  
Joint Fluid ◽  
Control Group ◽  
Rabbit Knee ◽  
Significant Difference ◽  
Anterior Cruciate

Abstract Background The diagnosis, treatment and efficacy evaluation of anterior cruciate ligament (ACL) remains controversial. This research aims to investigate the underlying mechanism of partial ACL injuries to the meniscus degeneration in rabbit knee. Methods Sixty New Zealand, white rabbits were randomly divided into three groups: the anteromedial bundle (AMB) splitting, the posterolateral bundle (PLB) splitting and a control group. Finally, eight rabbits were sampled randomly on the second, fourth and eighth weeks respectively. We observed the typical form of the meniscus through HE staining. Expressions of inflammatory factors including interleukin-1β (IL-1β) and IL-17 in the knee joint fluid were determined by means of an ELISA. Analysis of the mRNA expressions of MMP-13 was performed to evaluate the inflammatory mediators in the pathogenesis of the meniscus. Results HE staining results showed that the surface was rough and the tissues were loose displaying collagen fibers of varying thickness. Both IL-1β and IL-17 in the synovial fluid, and the positive rate of MMP-13 in addition to MMP-13 mRNA showed a demonstrable increase treads from the 2nd to the 8th week. The significant difference was found ( P <0.05) compared to the control group. Conclusion Our findings illustrated that the elevated levels of IL-1β and IL-17, along with increased MMP13 expression, resulting in meniscus degradation in the rabbit knee joint model with partial ACL injury. When the partial ACL injury on the different bundles occurred, the reconstruction of the reserved AMB or PLB must be operated on time due to uncertainty of conservative treatment.

Orthopedic Anterior Cruciate Ligament Evaluator (OR.A.C.L.E): A Preliminary Design

2015 ◽  
Author(s):  
Davide Piovesan ◽  
David Church ◽  
Sean Herron ◽  
Calvin Oldham ◽  
Mollie Sebald ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Physical Examination ◽  
Physical Therapist ◽  
Cruciate Ligament ◽  
Rapid Prototype ◽  
Cost Effective ◽  
Acl Tear ◽  
Anterior Cruciate ◽  
Injured Knee

An anterior cruciate ligament (ACL) tear is one of the most prominent, and debilitating injuries currently to athletes. Physical therapist students need to be able to practice common physical examination techniques regularly and repeatedly in order to gain the skills necessary to accurately diagnose an ACL tear. A cost effective, adjustable knee apparatus that could mimic the behavior of both a healthy and an injured knee joint may mitigate this problem. We built an apparatus mimicking the geometry and function of a knee joint, including the effect of forces and stiffness proper of knee ligaments. SimWise 4D was used to dynamically simulate an anatomically approximated model of the knee joint during physical examination conditions. The numerical simulation tested the displacement between the femur and the tibia with and without an ACL ligament. The SimWise 4D simulation gave an increase in displacement of 1.58 mm or 30% after removing the ACL, which is comparable with known displacements in human test subjects. Finally, a design for a 3D rapid prototype is proposed and fabricated with fusion deposition modeling (FDM).

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