scholarly journals The significance of post-operative bracing in preventing knee arthrofibrosis after ACL reconstruction

2021 ◽  
Author(s):  
Valeri Akhalkatsi ◽  
Marine Matiashvili ◽  
Lela Maskhulia ◽  
George Obgaidze ◽  
Levan Chikvatia
Keyword(s):  
Acl Reconstruction ◽  
Sports Medicine ◽  
Quadriceps Muscle ◽  
High Energy ◽  
Knee Extension ◽  
Negative Influence ◽  
Knee Brace ◽  
Extension Deficit ◽  
Reconstruction Surgery ◽  
Post Operative Period

High-energy injuries of the knee joint can cause ligament damage which may have complications in 4-6% of all cases in the form of movement limitation and arthrofibrosis (5,9,14). There are several intra- and extraarticular factors that could be closely connected with formation of arthrofibrosis. One of the most important factors is the utilization of a knee brace as the means of immobilization during the post-operative period (7,8). There are various opinions on the matter of using a knee brace after an ACL reconstruction surgery. For instance, 85% of members of the American Orthopedic Society for Sports Medicine (AOSSM) support and utilize this method (6). Despite the fact that movement limitations in the affected joint are rare after the aforementioned surgical procedure, the issue of preventing and eliminating knee extension deficit during the post-operative period is still relevant. The following research is based on the evaluation of the findings in 22 patients with extension deficits 2 weeks after arthroscopic ACL reconstruction surgery and it studies the effectiveness of knee brace in eliminating extension limitation during a 3-week rehabilitation period. The results of the abovementioned research showed that utilization of knee brace in the rehabilitation process during 3 weeks is significantly effective method (P<0.008) for eliminating knee extension deficit in a way that the negative influence on the function of the quadriceps muscle of the affected limb stays negligible.

Muscle metabolic responses to exercise above and below the “critical power” assessed using 31P-MRS

2008 ◽  
Vol 294 (2) ◽  
pp. R585-R593 ◽  
Author(s):  
Andrew M. Jones ◽  
Daryl P. Wilkerson ◽  
Fred DiMenna ◽  
Jonathan Fulford ◽  
David C. Poole
Keyword(s):  
Critical Power ◽  
Quadriceps Muscle ◽  
High Energy ◽  
Knee Extension ◽  
Work Rate ◽  
Metabolic Responses ◽  
Time To Exhaustion ◽  
Resonance Spectroscopy ◽  
High Energy Phosphates ◽  
Constant Work Rate

We tested the hypothesis that the asymptote of the hyperbolic relationship between work rate and time to exhaustion during muscular exercise, the “critical power” (CP), represents the highest constant work rate that can be sustained without a progressive loss of homeostasis [as assessed using 31P magnetic resonance spectroscopy (MRS) measurements of muscle metabolites]. Six healthy male subjects initially completed single-leg knee-extension exercise at three to four different constant work rates to the limit of tolerance (range 3–18 min) for estimation of the CP (mean ± SD, 20 ± 2 W). Subsequently, the subjects exercised at work rates 10% below CP (<CP) for 20 min and 10% above CP (>CP) for as long as possible, while the metabolic responses in the contracting quadriceps muscle, i.e., phosphorylcreatine concentration ([PCr]), Pi concentration ([Pi]), and pH, were estimated using 31P-MRS. All subjects completed 20 min of <CP exercise without duress, whereas the limit of tolerance during >CP exercise was 14.7 ± 7.1 min. During <CP exercise, stable values for [PCr], [Pi], and pH were attained within 3 min after the onset of exercise, and there were no further significant changes in these variables (end-exercise values = 68 ± 11% of baseline [PCr], 314 ± 216% of baseline [Pi], and pH 7.01 ± 0.03). During >CP exercise, however, [PCr] continued to fall to the point of exhaustion and [Pi] and pH changed precipitously to values that are typically observed at the termination of high-intensity exhaustive exercise (end-exercise values = 26 ± 16% of baseline [PCr], 564 ± 167% of baseline [Pi], and pH 6.87 ± 0.10, all P < 0.05 vs. <CP exercise). These data support the hypothesis that the CP represents the highest constant work rate that can be sustained without a progressive depletion of muscle high-energy phosphates and a rapid accumulation of metabolites (i.e., H+ concentration and [Pi]), which have been associated with the fatigue process.

The Effectiveness of a Functional Knee Brace on Joint-Position Sense in Anterior Cruciate Ligament–Reconstructed Individuals

2016 ◽  
Vol 25 (2) ◽  
pp. 190-194 ◽  
Author(s):  
Dai Sugimoto ◽  
Jessica C. LeBlanc ◽  
Sarah E. Wooley ◽  
Lyle J. Micheli ◽  
Dennis E. Kramer
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Position Sense ◽  
Joint Position Sense ◽  
Joint Position ◽  
Knee Brace ◽  
Reconstruction Surgery ◽  
Anterior Cruciate

It is estimated that approximately 350,000 individuals undergo anterior cruciate ligament (ACL) reconstruction surgery in each year in the US. Although ACL-reconstruction surgery and postoperative rehabilitation are successfully completed, deficits in postural control remain prevalent in ACL-reconstructed individuals. In order to assist the lack of balance ability and reduce the risk of retear of the reconstructed ACL, physicians often provide a functional knee brace on the patients’ return to physical activity. However, it is not known whether use of the functional knee brace enhances knee-joint position sense in individuals with ACL reconstruction. Thus, the effect of a functional knee brace on knee-joint position sense in an ACL-reconstructed population needs be critically appraised. After systematically review of previously published literature, 3 studies that investigated the effect of a functional knee brace in ACL-reconstructed individuals using joint-position-sense measures were found. They were rated as level 2b evidence in the Centre of Evidence Based Medicine Level of Evidence chart. Synthesis of the reviewed studies indicated inconsistent evidence of a functional knee brace on joint-position improvement after ACL reconstruction. More research is needed to provide sufficient evidence on the effect of a functional knee brace on joint-position sense after ACL reconstruction. Future studies need to measure joint-position sense in closed-kinetic-chain fashion since ACL injury usually occurs under weight-bearing conditions.

scholarly journals Quadriceps Neuromuscular Impairments after Arthroscopic Knee Surgery: Comparison between Procedures

2019 ◽  
Vol 8 (11) ◽  
pp. 1881 ◽  
Author(s):  
Casartelli ◽  
Item-Glatthorn ◽  
Friesenbichler ◽  
Bizzini ◽  
Salzmann ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Acl Reconstruction ◽  
Muscle Weakness ◽  
Muscle Activation ◽  
Vastus Lateralis ◽  
Quadriceps Muscle ◽  
Knee Extension ◽  
Patient Reported ◽  
Meniscal Surgery

Quadriceps neuromuscular function remains impaired in the short- and long-term following knee arthroscopy for meniscal surgery and/or anterior cruciate ligament (ACL) reconstruction. The aim of this study was to compare quadriceps neuromuscular impairments in patients following meniscal surgery with and without ACL reconstruction. Thirty patients were tested six months after meniscal surgery with (n = 15) and without (n = 15) ACL reconstruction. We bilaterally assessed knee extension maximal voluntary contraction (MVC) torque using dynamometry, vastus lateralis thickness using ultrasound, quadriceps voluntary activation and evoked knee extension torque with transcutaneous electrical stimulation. Patient-reported outcomes were evaluated with the Knee Injury and Osteoarthritis Outcome Score (KOOS). Compared with meniscus patients, ACL patients demonstrated larger asymmetries in MVC torque (15% vs. 5%, p = 0.049) and vastus lateralis thickness (6% vs. 0%, p = 0.021). In ACL patients, asymmetries in MVC torque correlated with asymmetries in evoked torque (r = 0.622, p = 0.013). In meniscus patients, asymmetries in muscle activation correlated with KOOS quality of life (r = 0.619, p = 0.018). Patients demonstrated persistent quadriceps muscle weakness six months after ACL reconstruction, but not after isolated meniscal surgery. Quantitative and/or qualitative muscular changes likely underlie quadriceps muscle weakness in ACL patients, whereas activation failure is associated with poor quality of life in some meniscus patients.

PHYSIOTHERAPY AFTER SURGICALLY STABILIZED PROXIMAL TIBIA FRACTURE

2020 ◽  
Vol 18 (2) ◽  
pp. 156-160
Author(s):  
R. Tasheva
Keyword(s):  
Proximal Tibia ◽  
Weight Bearing ◽  
Lateral Compartment ◽  
Recovery Phase ◽  
Knee Extension ◽  
Tibia Fracture ◽  
Extension Deficit ◽  
Proximal Tibia Fracture ◽  
Ao Classification ◽  
Correct Function

THE AIM OF THIS STUDY is to present the physiotherapy for overcoming the substitution movements and to restore the correct function in the phase of relative protection after surgical stabilized proximal tibia fracture. Material and method Seven patients after fracture in the proximal lateral compartment of the tibia (type b1 in AO classification) with an average age of 42, 9 years were treated. After surgery, an average of 30 days of the brace was used for relative protection. The aim of the physiotherapy was to overcome muscle imbalance to achieve proper movement in the respective planes. Emphasis on recovery was the proper weight bearing on the operated lower limb. RESULTS The results of the first recovery phase demonstrated very limited knee flexion in range of 22, 7º, and knee extension deficit in the range of -15º. After two weeks the results progressed to 115, 5º flexion and full restoration of the extension. Control of edema and hypotrophy of the thigh were proven by circumference. CONCLUSION The adequate physiotherapy provides overcoming of the substitution movements and to restore the correct knee function in the phase of relative protection after surgical stabilized fracture in the proximal tibia.

Digestibility of nutrients and milk productivity of cows when using the concentrate mixture with the inclusion of rapeseed presscake

2020 ◽  
pp. 48-53
Author(s):  
L. Yarmots ◽  
G. Yarmots ◽  
A. Belenkaya
Keyword(s):  
Protein Digestibility ◽  
High Energy ◽  
Negative Influence ◽  
The Body ◽  
Milk Productivity ◽  
Lactating Cows ◽  
Low Protein ◽  
Concentrate Mixture ◽  
Almost All ◽  
Experimental Group

For ruminants, especially high-yielding animals in addition to the complete supply of animals with protein, its digestibility in the rumen is important. With low protein digestibility in the rumen, the released ammonia will be more effectively used by the rumen microflora, and the undigestible protein in the subsequent sections of the digestive tract can serve as a source of amino acids for the body. The use of concentrate mixtures with the inclusion of local, affordable and cheaper grain feeds, in particular a high-energy and protein ingredient- rapeseed presscake makes it possible to increase the milk productivity of cows throughout lactation. These presscakes are well balanced in their amino acid composition and belong to feeds whose protein has a low degree of digestibility in the rumen. The purpose of the researches was to study the digestibility of nutrients and milk productivity of cows when using the concentrate mixture with the inclusion of rapeseed presscake. In the scientific and economic experiment has been carried out on lactating cows, where the cows of the experimental group in the concentrate mixture of peas has been replaced with rapeseed presscake the digestibility of nutrients in the ration, energy metabolism and milk productivity have been studied. Studies have shown that almost all the nutrients were significantly better digested by the animals of the experimental group. Energy in milk was more allocated by cows of the experimental group by 6,29 MJ. From cows of the experimental group for 100 and 305 days of lactation has been obtained more milk by 6,27 and 7,06 %, respectively, than from control herdmates. The biochemical parameters of blood were within the limits of the physiological norm in animals of both groups. Thus, the replacement of peas with rapeseed presscake in the concentrate mixture did not have a negative influence on the metabolic processes and helped to increase the milk productivity of cows.

scholarly journals Confirming Proper Button Deployment of Suspensory Fixation During ACL Reconstruction

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097434
Author(s):  
Daniel F. O’Brien ◽  
Lilah Fones ◽  
Victoria Stoj ◽  
Cory Edgar ◽  
Katherine Coyner ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Acl Reconstruction ◽  
Sports Medicine ◽  
Cruciate Ligament ◽  
Case Series ◽  
Graft Fixation ◽  
Level Of Evidence ◽  
Lateral Cortex ◽  
Suture Button ◽  
Suspensory Fixation

Background: Suspensory fixation of anterior cruciate ligament (ACL) reconstruction (ACLR) grafts has emerged as a popular device for femoral graft fixation. However, improper deployment of the suspensory fixation can compromise proper graft tensioning, leading to failure and revision. Also, soft tissue interposition between the button and bone has been associated with graft migration and pain, occasionally requiring revision surgery. Many surgeons rely on manual testing and application of distal tension to the graft to confirm proper button deployment on the lateral cortex of the femur for ACL graft fixation. Purpose: To determine the reliability of the manual resistance maneuver when applying distal tension to deploy the suspensory device along the lateral cortex of the femur. Study Design: Case series; Level of evidence, 4. Methods: All patients undergoing ACLR with a suture button suspensory device for femoral fixation were eligible for enrollment in the study. The surgeries were performed by 3 board-certified, sports medicine fellowship–trained orthopaedic surgeons at a single outpatient surgical center between May 2018 and June 2019. All grafts were passed in a retrograde manner into the femoral tunnel, and a vigorous manual tensioning maneuver in a distal direction was placed on the graft to deploy and secure along the lateral cortex of the femur. Intraoperative mini c-arm fluoroscopy was obtained to demonstrate proper suture button positioning. If interposing tissue or an improperly flipped button was identified, rectifying steps were undertaken and recorded. Results: A total of 51 patients with a mean age of 33.3 years were included in the study. Of these patients, 74.5% had normal suture button positioning identified via intraoperative fluoroscopic imaging, while 15.7% had interposed soft tissue and 9.8% had an improperly flipped button. In all cases, the surgeon was able to rectify the malpositioning intraoperatively. Conclusion: Despite the manual sensation of proper suspensory button positioning, intraoperative fluoroscopy identified suture button deployment errors in ACLR 25% of the time. Correcting the malpositioning is not technically demanding. These findings advocate for routine intraoperative surveillance to confirm appropriate suture button seating during ACLR.

Lateral Meniscus Height and ACL Reconstruction Failure: A Nested Case–Control Study

2021 ◽  
Author(s):  
Iskandar Tamimi ◽  
David Bautista Enrique ◽  
Motaz Alaqueel ◽  
Jimmy Tat ◽  
Almudena Pérez Lara ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Tibial Plateau ◽  
Case Control Study ◽  
Lateral Meniscus ◽  
Case Control ◽  
Lateral Tibial Plateau ◽  
Reconstruction Surgery ◽  
Meniscus Height ◽  
Nested Case Control ◽  
Control Study

AbstractPrevious work has shown that the morphology of the knee joint is associated with the risk of primary anterior cruciate ligament (ACL) injury. The objective of this study is to analyze the effect of the meniscal height, anteroposterior distance of the lateral tibial plateau, and other morphological features of the knee joint on risk of ACL reconstruction failure. A nested case–control study was conducted on patients who underwent an ACL reconstruction surgery during the period between 2008 and 2015. Cases were individuals who failed surgery during the study period. Controls were patients who underwent primary ACL reconstruction surgery successfully during the study period. They were matched by age (±2 years), gender, surgeon, and follow-up time (±1 year). A morphological analysis of the knees was then performed using the preoperative magnetic resonance imaging scans. The anteroposterior distance of the medial and lateral tibial plateaus was measured on the T2 axial cuts. The nonweightbearing maximum height of the posterior horn of both menisci was measured on the T1 sagittal scans. Measurements of the medial and lateral tibial slope and meniscal slope were then taken from the sagittal T1 scans passing through the center of the medial and lateral tibial plateau. A binary logistic regression analysis was done to calculate crude and adjusted odds ratios (ORs) estimates. Thirty-four cases who underwent ACL revision surgery were selected and were matched with 68 controls. Cases had a lower lateral meniscal height (6.39 ± 1.2 vs. 7.02 ± 0.9, p = 0.008, power = 84.4%). No differences were found between the two groups regarding the bone slope of the lateral compartment (6.19 ± 4.8 vs. 6.92 ± 5.8, p = 0.552), the lateral meniscal slope (–0.28 ± 5.8 vs. –1.03 ± 4.7, p = 0.509), and the anteroposterior distance of the lateral tibial plateau (37.1 ± 5.4 vs. 35.6 ± 4, p = 0.165). In addition, no differences were found in the medial meniscus height between cases and controls (5.58 ± 1.2 vs. 5.81 ± 1.2, respectively, p = 0.394). There were also no differences between cases and controls involving the medial bone slope, medial meniscal slope, or anterior posterior distance of the medial tibial plateau. Female patients had a higher medial (4.8 degrees ± 3.2 vs. 3.3 ± 4.1, p = 0.047) and lateral (8.1 degrees ± 5.1 vs. 5.6 degrees  ± 5.6, p = 0.031) tibial bone slope, and a lower medial (5.3 mm ± 1.0 vs. 6.1 mm ± 1.2, p = 0.001) and lateral (6.6 ± 1.0 vs. 7.0 ± 1.2, p = 0.035) meniscus height, and medial (4.3 ± 0.4 vs. 4.8 ± 0.4, p =0.000) and lateral (3.3 ± 0.3 vs. 3.9 ± 0.4, p = 0.000) anteroposterior distance than males, respectively.The adjusted OR of suffering an ACL reconstruction failure compared to controls was 5.1 (95% confidence interval [CI]: 1.7–14.9, p = 0.003) for patients who had a lateral meniscus height under 6.0 mm. The adjusted OR of suffering an ACL reconstruction failure was 2.4 (95% CI: 1.0–7.7, p = 0.01) for patients who had an anteroposterior distance above 35.0 mm. Patients with a lateral meniscal height under 6.0 mm have a 5.1-fold risk of suffering an ACL reconstruction failure compared to individuals who have a lateral meniscal height above 6.0 mm. Patients with a higher anteroposterior distance of the lateral tibial plateau also have a higher risk of ACL reconstruction failure.

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