scholarly journals Diagnostic value of the hamstring to quadriceps ratio in monitoring of the effectiveness of supervised 6-month physiotherapy in males after Anterior Cruciate Ligament Reconstruction (ACLR)

2020 ◽  
Vol 22 (4) ◽  
Author(s):  
Katarzyna Krzemińska ◽  
Andrzej Czamara
Keyword(s):  
Diagnostic Tool ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Peak Torque ◽  
Diagnostic Value ◽  
Control Group ◽  
Isokinetic Test ◽  
Graft Rupture ◽  
Isometric Torque ◽  
Anterior Cruciate

Purpose: The aim of the study was to assess the usefulness of isometric torque (IT) and peak torque (PT) of the hamstring to quadriceps muscles ratio (H/Q ratio) in monitoring the effectiveness of physiotherapy (PH) in males after ACLR. Hypothesis: The H/Q ratio is a diagnostic tool for monitoring of the effectiveness of the 6- month PH after ACLR. Methods: Twenty males 6 months after ACLR (ACLR group) and 20 male controls underwent IT and PT (60°/s and 180°/s) bilateral measurements of H and Q muscles. The IT and PT were normalized to body mass, and expressed as relative IT (RIT) and relative PT (RPT). The RIT and RPT H/Q ratios, and Limb Symmetry Index (LSI) were calculated. Results: In the ACLR group, the RIT for the H and Q, the RIT for the H/Q ratio and most of the RPT, as well as the H/Q ratio, ROM and LSI values of the operated knee, were not significantly different (NSD) than those of the non-operated side (NOS) or the control group. The between-group comparison of the H/Q ratio for RIT and RPT weren’t NSD. The isokinetic test at 180°/s showed lower RPT, H/Q ratio and LSI values for the Q muscle than those of the NOS (p = 0.042, p = 0.001). Conclusions: The H/Q ratio, in combination with the RIT, RPT and LSI, is a useful diagnostic tool for monitoring the effectiveness of 6-month PH after ACLR. Restoring the correct H/Q ratio can reduce the risk factor for ACL graft rupture.

scholarly journals STRONGER THAN EVER! ADOLESCENT ATHLETES SHOW STRENGTH GAINS WITHIN THE UNINJURED LEG AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0005
Author(s):  
Elliot Greenberg ◽  
Joshua Bram ◽  
Theodore Ganley
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Cohort Analysis ◽  
Peak Torque ◽  
Quadriceps Strength ◽  
Strength Assessment ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Background: The restoration of quadriceps strength after anterior cruciate ligament reconstruction (ACLR) is critical to restore optimal patient function and reduce the incidence of secondary ACL injury. Strength is typically quantified during return to sport assessments, by comparing the strength in the involved limb to that of the uninvolved limb. A limb symmetry index (LSI) is calculated and used to determine if any residual strength deficits persist. Recent evidence demonstrates that the uninvolved limb may lose strength during ACLR recovery and suggests that pre-operative uninvolved limb strength values may offer a better representation and more stringent indicator of strength recovery after ACLR. However, this body of literature is limited and no studies have specifically evaluated this occurrence within youth athletes. Purpose: To evaluate the change in strength in the uninvolved limb from pre-operative to 6 months post-ACLR, and assess the effect of pre-operative strength comparison on 6-month post-op LSI. Methods: A retrospective cohort analysis of pediatric patients (≤18 years) undergoing primary ACLR from 1/2018-1/2020 without concomitant multi-ligamentous reconstruction was conducted. Isokinetic peak torque values for the uninvolved and involved quadriceps were extracted at pre-operative (uninvolved only) and 6 months post-operative. Strength changes were analyzed using paired-samples t-test. Results: Complete data was available for a total of 17 subjects (mean age 15.1±1.7, 53% female). Pre-operative strength assessment was performed a mean of 11.5 days (range 1-26) prior to surgery. The mean 6-month post-operative assessment occurred at 177 days (range 127-246). The uninvolved limb was significantly stronger (p<0.001) at 6 months compared to preoperatively, with a mean improvement of 12.1ft/lbs (95%CI 18.3 – 7.2) with a change from 82.4ft/lbs to 95.1 ft/lbs. The LSI was calculated using both pre-operative and 6-month post-operative uninvolved limb values and demonstrated substantially lower LSI values when using concurrent 6-month data (LSIpre 91.3% vs LSI6M 76.9%). Conclusions: Among this sample, the uninvolved limb got stronger during post-ACLR recovery and comparison to concurrently assessed strength values led to a more stringent determination of LSI. Differences in rehabilitation programming, adolescent physiology, and pre-injury training patterns may explain why these results differ than those found in older cohorts.

Outcomes More Than 2 Years After Meniscal Repair for Longitudinal Tears of the Lateral Meniscus Combined With Anterior Cruciate Ligament Reconstruction

2021 ◽  
pp. 036354652098197
Author(s):  
Akira Tsujii ◽  
Yasukazu Yonetani ◽  
Kazutaka Kinugasa ◽  
Tomohiko Matsuo ◽  
Kenji Yoneda ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Complete Healing ◽  
Control Group ◽  
Study Group ◽  
Meniscal Extrusion ◽  
Second Look ◽  
Anterior Cruciate

Background: Meniscal function after repair of longitudinal tears of the lateral meniscus (LM) with anterior cruciate ligament reconstruction (ACLR) has not been comprehensively investigated. Purpose: To evaluate not only the clinical outcomes and radiographic findings of patients who underwent repair of longitudinal tears of the LM combined with ACLR but also the healing status of the repaired meniscus and changes in chondral status with second-look arthroscopy. Study Design: Case series; Level of evidence, 4. Methods: Among 548 patients who underwent primary anatomic ACLR at our institution between 2010 and 2017, 39 who had concomitant longitudinal tears of the LM and underwent repair were studied. During follow-up for more than 2 years, all patients were evaluated clinically (pain, range of motion, swelling, and knee instability) and with imaging (plain radiograph and magnetic resonance imaging [MRI]), and compared with a matched control group (based on age, sex, body mass index, and follow-up period) without any concomitant injuries who underwent ACLR. Measurements on MRI were recorded preoperatively, immediately after surgery, and at final follow-up, and the change in the values over time was assessed. Of the 39 patients in each group, 24 were assessed by second-look arthroscopy with hardware removal 2 years postoperatively. Results: The mean follow-up times of the study and control group were at a mean of 42.4 and 45.4 months, respectively. There were no significant differences in clinical findings, lateral joint space narrowing on radiographs, and chondral status at the lateral compartment between groups, whereas lateral and posterior meniscal extrusion on MRI progressed significantly in the study group (0.43 ± 1.0 mm vs -0.29 ± 1.1 mm, P = .003; 1.9 ± 1.9 mm vs 0.14 ± 1.1 mm, P < .0001, respectively). Second-look arthroscopy revealed complete healing in 12 patients (50%), partial healing in 9 (37.5%), and failure in 3 (12.5%) in the study group, and no new tear in the control group. Conclusion: The clinical and imaging outcomes after repair of longitudinal tears of the LM combined with anatomic ACLR were successful and comparable with those after isolated ACLR without any other injuries at 42 months postoperatively, although meniscal extrusion showed progression on coronal/sagittal MRI. Based on the MRI findings and the result that only half of patients achieved complete healing, meniscal function could not be fully restored even after repair. Although degenerative changes were not apparent, longer-term follow-up is needed.

scholarly journals The influence of femoral tunnel length on graft rupture after anterior cruciate ligament reconstruction

2017 ◽  
Vol 18 (3) ◽  
pp. 243-250 ◽  
Author(s):  
Luiz Gabriel Betoni Guglielmetti ◽  
Leandro Girardi Shimba ◽  
Leonardo Cantarelli do Santos ◽  
Fabrício Roberto Severino ◽  
Nilson Roberto Severino ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Tunnel Length ◽  
Cruciate Ligament Reconstruction ◽  
Graft Rupture ◽  
Anterior Cruciate

scholarly journals A complex approach in rehabilitation of the patients after the anterior cruciate ligament reconstruction

2019 ◽  
Vol 5 (3) ◽  
pp. 37
Author(s):  
I.Ya Hrubar ◽  
Yu.O. Hrubar ◽  
N.M. Grabyk
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Postoperative Period ◽  
Ligament Reconstruction ◽  
Clinical Course ◽  
Cruciate Ligament ◽  
Control Group ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate ◽  
Experimental Group

<p><strong>The Purpose</strong> was to improve the treatment outcomes of patients who undergo ACL reconstruction under arthroscopic control through a comprehensive approach to their rehabilitation program.<strong> </strong></p><p><strong>Materials and methods. </strong>We have implemented a system of comprehensive rehabilitation of patients after the ACL reconstruction under arthroscopic control, which relied on the phase of the clinical course of the postoperative period.</p><p><strong>Results. </strong>The study involved 40 patients who underwent anterior cruciate ligament reconstruction under arthroscopic control. Experimental group (20 people) who applied a comprehensive approach in rehabilitation after ACL reconstruction, taking into account the phase of the clinical course of the postoperative period. The second group was the control group (20 patients) in which rehabilitation was carried out under the existing program. The use of cryotherapy with adjustable pulse compression in patients of the experimental group from the first day allowed to reduce twice the use of non-narcotic analgesics. Analyzing the dynamics of flexion in the knee joint, it was found that patients of the experimental group on the 25th day performed flexion by 88.46% of the appropriate maximum. Whereas in the control group just - 69.23%. Positive dynamics were noted in the indicators of myotonometry of the quadriceps muscle and measurement of the perimeter of the knee joint.</p><strong>Conclusions.</strong> The program of physical rehabilitation of patients after the anterior cruciate ligament reconstruction under arthroscopic control, which was built taking into account the phase of the clinical course of the postoperative period, has been developed and offered positive results in clinical practice. The effectiveness of the program was shown by the improvement of such indicators as: decrease in intensity of pain syndrome in the early postoperative period, increase in the range of motion in the knee joint, faster restoration of the tone of the quadriceps muscle of the thighs of patients of the experimental group as opposed to the control group

scholarly journals Effectiveness of platelet-rich plasma in the treatment of anterior cruciate ligament injuries: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Wenfan Gan ◽  
Zheng Xu ◽  
Chunmei Wu ◽  
Junzhi He
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Platelet Rich Plasma ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Control Group ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Abstract Background: Recently, a number of randomized controlled trials (RCTs) have researched the efficacy of anterior cruciate ligament reconstruction (ACLR) combined with platelet-rich plasma (PRP) in the treatment of anterior cruciate ligament (ACL) injuries. Therefore, we updated a systematic review based on these RCTs to evaluate the effects of PRP on knee function and pain with different time.Methods: We searched in PubMed, Embase, Cochrane, Web of Science(WOS), China National Knowledge Infrastructure(CNKI), and WANFANG DATABASE, for human RCTs comparing the efficacy of intraarticular injection with no injection of PRP. Descriptive summaries and quality assessments were performed for all studies included in this meta-analysis. The outcomes of the stydy included the International Knee Documentation Committee (IKDC), Visual Analogue Scale (VAS), and Lysholm score.Results: Finally, we included 6 RCTs stydies, involving 315 patients. The control group consisted of blank group or placebo group. Follow-up periods ranged from 3 to 18 months. The results of bias risk assessment showed that all the 6 stuydies are unclear risk of bias. Compared with the control group, PRP group significantly improved IKDC score at 3, 6 and 12 months after operation (P = 0.00, 0.01, respectively). Lysholm score and VAS score also has significant differences at 3 months after operation (both P = 0.00).Conclusion: Our study has proved that PRP was more effective in the recovery of knee function and early pain relief after the ACLR than the ACLR alone. Review registration: PROSPERO CRD42021224182. Registered 6 April 2021. Keywords:anterior cruciate ligament injury; anterior cruciate ligament reconstruction; platelet rich plasma; system review; META analysisReview registration: PROSPERO CRD42021224182. Registered 6 April 2021.

scholarly journals The Influence of Therapeutic Training on Changes in Selected Biomechanical Variables After an Anterior Cruciate Ligament Reconstruction

2013 ◽  
Vol 20 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Marta Jarocka ◽  
Adam Czaplicki
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Practical Importance ◽  
Average Power ◽  
Peak Torque ◽  
Rehabilitation Process ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

AbstractIntroduction. The number of arthroscopic reconstructions of the anterior cruciate ligament (ACL) has been increasing not only among competitive athletes, but also among recreational athletes. The monitoring of the rehabilitation process in order to determine a safe time to return to the pre-injury activity is thus of great practical importance. The aim of this paper is to analyse the changes in selected biomechanical variables which occur after the therapeutic training following an anterior cruciate ligament reconstruction. Materials and methods. Twenty nine males (age 27.3 ± 5.7 years) after the anterior cruciate ligament reconstruction participated in the study. A quadruple-stranded semitendinosus/gracilis graft was used for the reconstruction. The biomechanical evaluation of the rehabilitation process was provided by an isokinetic dynamometer Biodex System Pro-3 working at speeds of 60 deg/s and 180 deg/s during testing the knee extensor and flexor muscles. In the case of an injured limb, the absolute peak torque, relative peak torque, average power and hamstring/ quadriceps (H/Q) ratio were determined. In addition, the values of flexor and extensor torques for healthy and injured limbs were compared. The study was carried out in four stages: before the surgery, three, six and twelve months after the surgery. Results and analyses. The results showed significant differences in each value between various stages of the biomechanical rehabilitation process of the knee. The applied therapeutic training influenced significantly the changes in the values of the tested variables. The results have confirmed that the biomechanical measurements can be treated as a supplementation to the clinical evaluation of the patient after ACL reconstruction. They may also be used for the optimisation of the therapeutic training.

scholarly journals Neural Excitability Alterations After Anterior Cruciate Ligament Reconstruction

2015 ◽  
Vol 50 (6) ◽  
pp. 665-674 ◽  
Author(s):  
Brian G. Pietrosimone ◽  
Adam S. Lepley ◽  
Hayley M. Ericksen ◽  
Amy Clements ◽  
David H. Sohn ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Spinal Reflex ◽  
Voluntary Activation ◽  
Control Group ◽  
Cruciate Ligament Reconstruction ◽  
Corticomotor Excitability ◽  
Neuromuscular Dysfunction ◽  
Anterior Cruciate

Context Neuromuscular dysfunction is common after anterior cruciate ligament reconstruction (ACL-R). However, little is known about quadriceps spinal-reflex and descending corticomotor excitability after ACL-R. Understanding the effects of ACL-R on spinal-reflex and corticomotor excitability will help elucidate the origins of neuromuscular dysfunction. Objective To determine whether spinal-reflex excitability and corticomotor excitability differed between the injured and uninjured limbs of patients with unilateral ACL-R and between these limbs and the matched limbs of healthy participants. Design Case-control study. Setting Laboratory. Patients or Other Participants A total of 28 patients with unilateral ACL-R (9 men, 19 women; age = 21.28 ± 3.79 years, height = 170.95 ± 10.04 cm, mass = 73.18 ± 18.02 kg, time after surgery = 48.10 ± 36.17 months) and 29 participants serving as healthy controls (9 men, 20 women; age = 21.55 ± 2.70 years, height = 170.59 ± 8.93 cm, mass = 71.89 ± 12.70 kg) volunteered. Main Outcome Measure(s) Active motor thresholds (AMTs) were collected from the vastus medialis (VM) using transcranial magnetic stimulation. We evaluated VM spinal reflexes using the Hoffmann reflex normalized to maximal muscle responses (H : M ratio). Voluntary quadriceps activation was measured with the superimposed-burst technique and calculated using the central activation ratio (CAR). We also evaluated whether ACL-R patients with high or low voluntary activation had different outcomes. Results The AMT was higher in the injured than in the uninjured limb in the ACL-R group (t27 = 3.32, P = .003) and in the matched limb of the control group (t55 = 2.05, P = .04). The H : M ratio was bilaterally higher in the ACL-R than the control group (F1,55 = 5.17, P = .03). The quadriceps CAR was bilaterally lower in the ACL-R compared with the control group (F1,55 = 10.5, P = .002). The ACL-R group with low voluntary activation (CAR &lt; 0.95) had higher AMT than the control group (P = .02), whereas the ACL-R group with high voluntary activation (CAR ≥ 0.95) demonstrated higher H : M ratios than the control group (P = .05). Conclusions The higher VM AMT in the injured limbs of ACL-R patients suggested that corticomotor deficits were present after surgery. Higher bilateral H : M ratios in ACL-R patients may be a strategy to reflexively increase excitability to maintain voluntary activation.

Anterior Cruciate Ligament Reconstruction with and without a Ligament Augmentation Device

2002 ◽  
Vol 30 (6) ◽  
pp. 851-856 ◽  
Author(s):  
Jon Olav Drogset ◽  
Torbjørn Grøntvedt
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Control Group ◽  
Long Term Effects ◽  
Cruciate Ligament Reconstruction ◽  
Ligament Augmentation ◽  
Significant Difference ◽  
Anterior Cruciate

Background Ligament augmentation devices have been used in anterior cruciate ligament reconstruction since the suggestion of Kennedy et al. in 1980 that such devices would allow grafts to heal faster and more safely. Hypothesis Patients who had augmentation will have better outcomes after 8 years. Study Design Prospective randomized case control study. Methods Between 1991 and 1993, 100 patients were randomized to groups undergoing anterior cruciate ligament reconstruction with bone-patellar tendon-bone grafts with (49) or without (51) use of a Kennedy ligament augmentation device. Of these 100 patients, 94 were examined at an average of 8 years after surgery. Fifteen patients were excluded because of rupture in the other knee and 11 because of rerupture in the same knee. Results Of the remaining 68 patients, the mean Lysholm function score was 84 in the augmentation group and 87 in the control group. There was a statistically significant relationship between preoperatively detected cartilage injury and osteoarthritis. Almost half of the patients had developed osteoarthritis. We observed no significant difference between the two groups concerning rerupture rate, Lysholm or Lachman test scores, or KT-1000 arthrometer measurements. Conclusions We found no positive long-term effects supporting the use of augmentation in anterior cruciate ligament reconstruction.

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