scholarly journals Application and Surgical Technique of ACL Reconstruction Using Worldwide Registry Datasets: What Can We Extract?

2021 ◽  
Vol 7 (1) ◽  
pp. 2
Author(s):  
Ulrike Wittig ◽  
Georg Hauer ◽  
Ines Vielgut ◽  
Patrick Reinbacher ◽  
Andreas Leithner ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Knee Injuries ◽  
Epidemiological Data ◽  
Surgical Reconstruction ◽  
Acl Injuries ◽  
Knee Ligament ◽  
Graft Choice ◽  
Anterior Cruciate ◽  
The Uk ◽  
Country Specific

Anterior cruciate ligament (ACL) injuries are among the most common knee injuries. The purpose of this study was to compare surgical reconstruction of the ACL between different countries and regions in order to describe differences regarding epidemiological data, reconstruction frequency, and graft choice. A systematic literature search was performed using the ACL study group website in order to identify the relevant knee ligament registers. Four national registries were included, comprising those from Sweden, the UK, New Zealand, and Norway. A large variation was found concerning the total number of primary ACL reconstructions with a reported range from 4.1 to 51.3 per 100,000 inhabitants. The country-specific delay between injury and reconstruction varied between an average of 6.0 months and 17.6 months. The leading sports activities resulting in ACL injury included soccer, alpine skiing, handball, rugby, and netball. Moreover, a strong variability in graft choice for primary reconstruction was found. The comparison of ACL registers revealed large differences, indicating different clinical implications regarding conservative or surgical therapy and choice of the preferable graft. ACL registers offer a real-world clinical perspective with the aim to improve quality and patient safety by investigating factors associated with subsequent surgical outcomes.

scholarly journals Effects of a Prophylactic Knee Sleeve on Anterior Cruciate Ligament Loading During Sport-Specific Movements

2019 ◽  
Vol 28 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Jonathan Sinclair ◽  
Paul J. Taylor
Keyword(s):  
Anterior Cruciate Ligament ◽  
Repeated Measures ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Musculoskeletal Modeling ◽  
Acl Injuries ◽  
Recreational Athletes ◽  
Load Rate ◽  
Anterior Cruciate ◽  
3D Motion Capture

Context: Prophylactic knee bracing is extensively utilized in athletic populations to reduce the high risk from knee injuries, but its role in the attenuation of anterior cruciate ligament (ACL) pathologies is not well understood. Objective: The aim of this investigation was to explore the effects of a prophylactic knee sleeve on ACL loading parameters linked to the etiology of injury in recreational athletes. Setting: Laboratory. Design: Repeated measures. Participants: Thirteen healthy male recreational athletes. Intervention: Participants performed run, cut, and single-leg hop movements under 2 conditions; prophylactic knee sleeve and no sleeve. Main Outcome Measures: Biomechanical data were captured using an 8-camera 3D motion capture system and a force platform. Peak ACL force, average ACL load rate, and instantaneous ACL load rate were quantified using a musculoskeletal modeling approach. Results: The results showed that both average and instantaneous ACL load rates were significantly reduced when wearing the knee sleeve in the hop (sleeve = 612.45/1286.39 N/kg/s and no sleeve = 743.91/1471.42 N/kg/s) and cut (sleeve = 222.55/1058.02 N/kg/s and no sleeve = 377.38/1183.01 N/kg/s) movements. Conclusions: Given the biomechanical association between ACL loading and the etiology of ACL injuries, it is proposed that athletes may be able to attenuate their risk from injury during cut and hop movements through utilization of a prophylactic knee sleeve.

DIAGNOSING ANTERIOR CRUCIATE LIGAMENT INJURIES USING A KNEE ARTHROMETER: DESIGN, FABRICATION, AND CLINICAL EVALUATION

2011 ◽  
Vol 23 (03) ◽  
pp. 181-192
Author(s):  
Damoon Soudbakhsh ◽  
Elham Sahraei ◽  
Mehdi Bostan Shirin ◽  
Farzam Farahmand ◽  
Mohammad Naghi Tahmasebi ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Knee Laxity ◽  
Ligament Injuries ◽  
Acl Injuries ◽  
Anterior Cruciate Ligament Injuries ◽  
Specificity And Sensitivity ◽  
Anterior Cruciate ◽  
The Right

Every year many people suffer from knee injuries. Previous studies on patients with knee injuries have shown that about 40% of knee injuries are Ligament injuries, and about 50% of the ligament injuries are the Anterior Cruciate Ligament (ACL) injuries. Along with other methods, knee arthrometers are widely used to diagnose ACL injuries. In the current research, a knee arthrometer was designed and developed to provide a reliable and repeatable measurement of knee laxity under anterior–posterior applied loads. Test–retest configurations to examine repeatability of the device resulted in less than 1.5-mm difference for more than 97% of tests under applied loads of up to 90 N. These tests included 166 tests on the left knees and 147 tests on the right knees of 37 healthy subjects. Also, this device was tested on 27 confirmed ACL ruptured patients, and the results were analyzed to find a better criterion than standard criteria to diagnose ACL rupture using knee arthrometers by finding specificity and sensitivity of the device using those criteria. Among the 20 criteria evaluated, a combination of side-to-side difference under 150 N of applied load, and CI@90-60 (compliance index calculated between 90 N, and 60 N) resulted in the best sensitivity (96.4%) and specificity (100%).

Evaluating Different Criteria to Diagnose ACL Rupture Using a Knee Arthrometer

2009 ◽  
Author(s):  
Damoon Soudbakhsh ◽  
Mohammad-Naghi Tahmasebi ◽  
Mohamad Parnianpour
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Acl Rupture ◽  
Ligament Injuries ◽  
Acl Injuries ◽  
Anterior Laxity ◽  
Anterior Cruciate

Every year many people suffer from knee injuries. Previous studies on patients with knee injuries has shown that about 40% percent of knee injuries are ligament injuries, and about 50% of the ligament injuries are the Anterior Cruciate Ligament (ACL) injuries [1–2]. Knee arthrometers are widely used to diagnose ACL injuries, along with other methods [3–4]. In the current research, a knee arthrometer which was developed to provide an accurate measurement of AP displacement of the knee [5] was used to measure anterior laxity of the knees of 20 subjects, and the results were analyzed to find better criteria to diagnose ACL rupture using knee arthrometers.

scholarly journals Machine learning algorithm to predict anterior cruciate ligament revision demonstrates external validity

2022 ◽  
Author(s):  
R. Kyle Martin ◽  
Solvejg Wastvedt ◽  
Ayoosh Pareek ◽  
Andreas Persson ◽  
Håvard Visnes ◽  
...  
Keyword(s):  
Machine Learning ◽  
Acl Reconstruction ◽  
External Validity ◽  
Learning Algorithm ◽  
Cruciate Ligament ◽  
External Validation ◽  
Model Performance ◽  
Knee Ligament ◽  
Graft Choice ◽  
Anterior Cruciate

Abstract Purpose External validation of machine learning predictive models is achieved through evaluation of model performance on different groups of patients than were used for algorithm development. This important step is uncommonly performed, inhibiting clinical translation of newly developed models. Machine learning analysis of the Norwegian Knee Ligament Register (NKLR) recently led to the development of a tool capable of estimating the risk of anterior cruciate ligament (ACL) revision (https://swastvedt.shinyapps.io/calculator_rev/). The purpose of this study was to determine the external validity of the NKLR model by assessing algorithm performance when applied to patients from the Danish Knee Ligament Registry (DKLR). Methods The primary outcome measure of the NKLR model was probability of revision ACL reconstruction within 1, 2, and/or 5 years. For external validation, all DKLR patients with complete data for the five variables required for NKLR prediction were included. The five variables included graft choice, femur fixation device, KOOS QOL score at surgery, years from injury to surgery, and age at surgery. Predicted revision probabilities were calculated for all DKLR patients. The model performance was assessed using the same metrics as the NKLR study: concordance and calibration. Results In total, 10,922 DKLR patients were included for analysis. Average follow-up time or time-to-revision was 8.4 (± 4.3) years and overall revision rate was 6.9%. Surgical technique trends (i.e., graft choice and fixation devices) and injury characteristics (i.e., concomitant meniscus and cartilage pathology) were dissimilar between registries. The model produced similar concordance when applied to the DKLR population compared to the original NKLR test data (DKLR: 0.68; NKLR: 0.68–0.69). Calibration was poorer for the DKLR population at one and five years post primary surgery but similar to the NKLR at two years. Conclusion The NKLR machine learning algorithm demonstrated similar performance when applied to patients from the DKLR, suggesting that it is valid for application outside of the initial patient population. This represents the first machine learning model for predicting revision ACL reconstruction that has been externally validated. Clinicians can use this in-clinic calculator to estimate revision risk at a patient specific level when discussing outcome expectations pre-operatively. While encouraging, it should be noted that the performance of the model on patients undergoing ACL reconstruction outside of Scandinavia remains unknown. Level of evidence III.

Biochemical and Structural Alterations in Skeletal Muscle Following ACL Injury: A Narrative Review

2020 ◽  
Vol 8 (1) ◽  
pp. 8
Author(s):  
Trenton Reyes ◽  
Darryn S. Willoughby
Keyword(s):  
Skeletal Muscle ◽  
Physical Environment ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Acl Injury ◽  
Skeletal Muscle Atrophy ◽  
Acl Injuries ◽  
The Us ◽  
Initial Injury ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) injuries are some of the most common knee injuries that occur in the US, accounting for around 200,000 documented cases per year. Varying levels of severity can determine whether surgery is required or if physical therapy will suffice. One of the most common complications for patients is that there is significant atrophy of the impacted limb. Yet, there has not been definitive proof explaining this mechanism. Objective: The primary goal for this review was to examine some of the biochemical differences that tend to occur within and surrounding an ACL injury and the mechanisms involved in skeletal muscle atrophy and regenerative capabilities. Outcome: Multiple studies have found a connection between time spent inactive from the injury and the percentage of retained muscle after exercising again. Among decreases in muscle mass and muscle volume changes, analyses have also revealed alterations in alpha-2 macroglobulin, myostatin, heat shock protein-72, mechano GF-C24E, synovial fluid, and histochemical alterations in collagen and cartilaginous states which all seem to be primary factors in regulating effectiveness and speed of recovery from ACL injury. Conclusion: the influx of various cytokines as a response to the initial injury in relation to inflammation change the chemical and physical environment of the knee, making recovery significantly more difficult and time-consuming. Timing of injury, surgery, and re-initiation of movement after surgery are very important factors that can minimize overall damage and reduce recovery time.

scholarly journals Epidemiology of surgically managed anterior cruciate ligament ruptures in a sports surgery practice

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668428 ◽  
Author(s):  
Andrew Arjun Sayampanathan ◽  
Bryan Koh Thean Howe ◽  
Hamid Rahmatullah Bin Abd Razak ◽  
Chong Hwei Chi ◽  
Andrew Hwee Chye Tan
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Road Traffic ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Knee Injuries ◽  
Treatment Strategies ◽  
Senior Author ◽  
Acl Injuries ◽  
Anterior Cruciate

Introduction: Anterior cruciate ligament (ACL) tears are common knee injuries, especially among sportsmen and sportswomen. The aim of this study is to better understand the epidemiology of surgically managed ACL tears sustained in our institution. Methods: All patients who underwent arthroscopic ACL reconstruction by the senior author of this article in Singapore from 2008 to 2013 were studied. Patients who were diagnosed clinically and/or radiologically to have a complete tear of the ACL and subsequently underwent arthroscopic ACL reconstruction were included. Patients who suffered from traumatic knee dislocation were excluded. Two hundred and ninety-two patients were available for analysis. All patients were operated on by the senior author. Results: 83.9% of patients were male. 60.5, 23.0, 8.46, and 8.11% were of Chinese, Malay, Indian and other origins, respectively. 69.6 and 28.7% were in white-collared and blue-collared jobs, respectively, while 1.69% were unemployed. Mean age at operation was 29.4 years. Mean body mass index was 25.3 kg/m2. 82.4 and 17.6% of ACL tears were sports (contact—27.5%; non-contact—72.5%) and non-sports injuries (activities of daily living—94.2%, road traffic accidents—5.77%), respectively. The top four sporting activities causing ACL tears were soccer, basketball, racquet games and volleyball. 56.2% of ACL tears presented with concomitant knee injuries (medial meniscus—63.4%; lateral meniscus—31.1%; posterior cruciate ligament—5.49%). 84.5% were primary tears. Conclusions: In this epidemiological review of ACL injuries, we found that ACL injuries tend to cluster within certain population subgroups. Patterns of mechanisms of injuries have been observed. These findings may lead to better preventive and treatment strategies in the management of ACL tears.

scholarly journals Outcomes and Predictors of Revision Anterior Cruciate Ligament Reconstruction: An Evaluation of the Norwegian Knee Ligament Registry

2018 ◽  
Vol 6 (3_suppl) ◽  
pp. 2325967118S0000
Author(s):  
Alexander R. Vap ◽  
Robert F. LaPrade ◽  
Lars Engebretsen
Keyword(s):  
Body Mass Index ◽  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Ligament Injury ◽  
Meniscal Injury ◽  
Knee Ligament ◽  
Cruciate Ligament Reconstruction ◽  
Graft Choice ◽  
Anterior Cruciate

Objectives: The Norwegian Ligament Registry (NKLR) provides an opportunity for quality surveillance and research. Intraoperative findings and outcome after revision anterior cruciate ligament reconstruction (RACLR) is not as well studied as after primary ACL reconstruction. There were two objectives of this study. First, to evaluate the Norwegian Knee Ligament Registry (NKLR) for the occurrence, failure rate, graft choice, patient demographic profile (gender, age, body mass index), sport at time of injury and associated pathology (cartilage injuries, meniscal tears, other ligament injuries) for revision anterior cruciate ligament reconstructions (RACLR). Second, to match compare RACLR patients to primary ACL reconstructions in order to define possible predictors for those patients who will require RACLR. Methods: All patients identified in the NKLR from June 2004 until September 2016 that did not undergo cartilage restoration, meniscal transplant nor had a documented fracture at the primary reconstruction were included in the study. Revision rates at 1, 2 and 5 years were estimated with Kaplan-Meier analysis, and the estimated risk of RACLR based upon demographic and associated pathology was estimated with Cox regression analysis. Results: 784 patients with an average age of 25.6 years (25.0-26.3) met the inclusion and exclusion criteria with 53.1% being male. 62.1% of revisions were performed with bone patellar bone (BPTB) autograft while 23% used hamstring autograft. Associated injuries of the menisci, cartilage, and other ligaments and the sport at the time of injury are listed (Table 1). 12.9% of RACLR patients went on to have a Re-revision ACLR at 5 years postop (Figure 1). Match comparisons of primary ACLR patients with RACLR demonstrated no significant difference in occurrence based upon age (<20, 20-30, and >30 years), graft choice (BPTB, Hamstring, Allograft, Bone Quadriceps Tendon (BQT)), cartilage injury (No injury, ICRS 1-2, ICRS 3-4), meniscal Injury, associated ligament injury, sport at time of injury or Body Mass Index (BMI). Conclusion: Based upon review of a large ligament reconstruction registry, one can expect that less than 13% of patients undergo a Re-revision ALCR following failure of a RALCR at 5 years. Match comparison of primary ACLR versus RACLR demonstrated no significant predictor of RACLR based upon age, graft choice, cartilage injury, meniscal injury, associated ligament injury, sport or BMI.

Knee ligament mechanical properties are not influenced by estrogen or its receptors

2006 ◽  
Vol 290 (5) ◽  
pp. E1034-E1040 ◽  
Author(s):  
Stuart J. Warden ◽  
Leanne K. Saxon ◽  
Alesha B. Castillo ◽  
Charles H. Turner
Keyword(s):  
Mechanical Properties ◽  
Cruciate Ligament ◽  
Neuromuscular Control ◽  
High Rate ◽  
Null Mutation ◽  
Sprague Dawley ◽  
Gene Encoding ◽  
Acl Injuries ◽  
Knee Ligament ◽  
Anterior Cruciate

Women are at greater risk of tearing their knee anterior cruciate ligament (ACL) than men participating in similar athletic activities. There is currently no conclusive explanation for this disparity; however, as ACL injuries in women have been linked with estrogen fluctuations during the menstrual cycle, one hypothesis is that estrogen has a direct detrimental effect on knee ligament mechanical properties. This study investigated the influence of estrogen and its receptors (ERα and ERβ) on knee ligament mechanical properties. This was achieved by testing the viscoelastic and tensile mechanical properties of knee medial collateral ligaments (MCL) and ACLs from: 1) male Sprague-Dawley rats treated with either estrogen (17α-ethynylestradiol; 0.03 mg/kg) or an ERα-specific agonist (propyl pyrazole triol; 2 mg/kg), and 2) female mice with a null mutation of the gene encoding for ERβ. Estrogen treatment had no significant effects on the viscoelastic or tensile mechanical properties of the rat MCL or ACL. Similarly, pharmacological stimulation of ERα using a selective agonist in rats and genetic modulation of ERβ by null mutation of its gene in mice did not influence MCL or ACL properties. These data indicate that estrogen does not have a major direct effect on ligament mechanical properties. Energies for the prevention of the disproportionately high rate of knee ligament injuries in women may be better spent focusing on more established and modifiable risk factors, such as abnormalities in neuromuscular control about the knee.

scholarly journals Valoración funcional en pacientes intervenidos mediante plastia de LCA con semitendinoso-recto interno y sistema Togglelock.

2020 ◽  
pp. 108-113
Author(s):  
Patricia DESCALZO-PÉREZ ◽  
DAMIAN MIFSUT-MIEDES ◽  
JUAN RAMON RODRIGUEZ-COLLELL ◽  
ANTONIO LOPEZ-SANCHEZ ◽  
Antonio SILVESTRE-MUÑOZ
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Clinical History ◽  
Functional Results ◽  
Subjective Assessment ◽  
Surgical Reconstruction ◽  
Ligament Injury ◽  
Anterior Cruciate ◽  
Minimal Reduction

Introduction: One of the most frequent knee injuries and one that is on the increase, especially in sports, is the anterior cruciate ligament injury. Surgical reconstruction is essential to recover the biomechanics of the knee, provide correct stability and pain-free function, as well as toavoid early degenerative changes. The objective of the present study was to assess the functional recovery of patients undergoing reconstruction of the anterior cruciate ligament by means of ligamentoplasty with semitendinosus- internal rectus tendon and Toggelock system. Material and methods: A retrospective descriptive observational study was designed, which included 29 patients who underwent a ligamentoplasty with internal semitendinosus-rectum and Togglelock system in our Center, during the years 2017-2018. Variables obtained from the clinical history and the Lysholm scale were studied to assess the patients. Results: In total, a sample of 29 patients was obtained, 26 men and 3 women with a mean age of 31.13 years (range 19-53). The most frequently injured knee was the right knee in 17 patients out of 29, with 65% presenting associated injuries. One patient had suffered a tibial fracture operated with an intramedullary nail that altered the final results. The postsurgical score on the Lysholm subjective assessment scale was 86. The mobility of the operated knee showed a minimal reduction in flexion of 6º compared to the non-operated knee that was statistically significant. Conclusion: The results obtained after ACL reconstruction with this technique, using the semitendinosus- internal rectum plasty and the Togglelock system were good-excellent, with a high degree of patient satisfaction, few complications, and notable functional results.

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.

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