Evaluation of Local Cryotherapy after Anterior Cruciate Ligament Reconstruction. Critical Review of the Literature

2019 ◽  
Vol 21 (5) ◽  
pp. 319-328 ◽  
Author(s):  
Piotr Bednarski ◽  
Jerzy Kiwerski
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Early Period ◽  
Scientific Publications ◽  
Cruciate Ligament Reconstruction ◽  
Analgesic Effects ◽  
Anterior Cruciate

Background. At a time of innovative medical technologies development, it is paramount that medical services be evaluated with regard to their effectiveness. Research in physical medicine and rehabilitation, as well as the specialty itself, is relatively young; however, the number of publications in the field has recently been increasing. The main aim of this article is to evaluate the effectiveness of cryotherapy, including local cryostimulation, after anterior cruciate ligament reconstruction. Material and methods. The present paper reviews scientific publications extracted from the Medline Embase, Cochra­ne Library, and PEDro databases according to a pre-designed search strategy. The review analysed publications where the authors indicated cryotherapy as an intervention in patients after ACL reconstruction and the study endpoints referred to analgesic or anti-oedema effects. Results. As a result of selection, 16 publications were chosen for the analysis, including 1 meta-analysis, 2 systematic reviews and 13 RCTs. Only the results of randomised studies are presented. Endpoints referring to analgesic effects were present in all of the studies in the analysis, while endpoints referring to anti-oedema effects were present in five studies. Statistically significant results constituted 62% of the results for analgesic effects and 60% for anti-oedema effects. Conclusions. 1. The currently limited evidence from randomised studies is not sufficient to draw final conclusions on the effectiveness of cryotherapy in patients after anterior cruciate ligament reconstruction. 2. It seems that cryotherapy can serve as an adjunct analgesic treatment in the early period after arthroscopic ACL reconstruction, while there is no notable improvement in patients after this procedure in reducing oedema.

Perioperative Opioid Use in Anterior Cruciate Ligament Reconstruction Patients

2021 ◽  
Author(s):  
Ali Aneizi ◽  
Elizabeth Friedmann ◽  
Leah E. Henry ◽  
Gregory Perraut ◽  
Patrick M. J. Sajak ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

AbstractAnterior cruciate ligament reconstruction (ACLR) is one of the most commonly performed outpatient orthopaedic procedures, yet there is little data about perioperative opioid prescribing practices. The purposes of this study were to quantify the perioperative opioid prescriptions filled by patients who underwent ACLR and to identify factors associated with greater postoperative opioid use. Patients who underwent ACLR at a single institution between June 2015 and May 2017 were studied using a regional prescription monitoring database to identify all preoperative and postoperative outpatient opioid prescriptions up to 2 years postoperatively. The number of morphine milligram equivalents of each opioid was calculated to determine total morphine milligram equivalents (TMEs) filled preoperatively, at discharge, and refilled postoperatively. Patients who refilled an opioid prescription postoperatively were compared with those who did not. Ninety-nine of 269 (36.8%) total patients refilled an opioid prescription postoperatively. Thirty-three patients (12.3%) required a refill after 2 weeks postoperatively, and no patients refilled after 21 months postoperatively. Fifty-seven patients (21%) received an opioid prescription in the 2 years following surgery that was unrelated to their ACL reconstruction. Increased age, higher body mass index (BMI), government insurance, current or prior tobacco use history, preoperative opioid use, and greater number of medical comorbidities were significantly associated with refilling a prescription opioid. Higher BMI and government insurance were independent predictors of refilling. Higher preoperative TMEs and surgeon were independent predictor of greater refill TMEs. In the opioid-naïve subgroup of 177 patients, only higher BMI was a predictor of refilling, and only greater comorbidities was a predictor of greater refill TMEs. The results demonstrate that preoperative opioid use was associated with postoperative opioid refills and higher refill TMEs in a dose-dependent fashion. A higher percentage of patients received an opioid prescription for reasons unrelated to the ACL reconstruction than refilled a prescription after the first 2 weeks postoperatively.

scholarly journals The effect of femoral bone tunnel configuration on tendon-bone healing in an anterior cruciate ligament reconstruction

2018 ◽  
Vol 7 (5) ◽  
pp. 327-335 ◽  
Author(s):  
Y. Sato ◽  
R. Akagi ◽  
Y. Akatsu ◽  
Y. Matsuura ◽  
S. Takahashi ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Acl Reconstruction ◽  
Bone Healing ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Bone Tunnel ◽  
Femoral Bone ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Objectives To compare the effect of femoral bone tunnel configuration on tendon-bone healing in an anterior cruciate ligament (ACL) reconstruction animal model. Methods Anterior cruciate ligament reconstruction using the plantaris tendon as graft material was performed on both knees of 24 rabbits (48 knees) to mimic ACL reconstruction by two different suspensory fixation devices for graft fixation. For the adjustable fixation device model (Socket group; group S), a 5 mm deep socket was created in the lateral femoral condyle (LFC) of the right knee. For the fixed-loop model (Tunnel group; group T), a femoral tunnel penetrating the LFC was created in the left knee. Animals were sacrificed at four and eight weeks after surgery for histological evaluation and biomechanical testing. Results Histologically, both groups showed a mixture of direct and indirect healing patterns at four weeks, whereas only indirect healing patterns were observed in both groups at eight weeks. No significant histological differences were seen between the two groups at four and eight weeks in the roof zone (four weeks, S: mean 4.8 sd 1.7, T: mean 4.5 sd 0.5, p = 0.14; eight weeks, S: mean 5.8 sd 0.8, T: mean 4.8 sd 1.8, p = 0.88, Mann-Whitney U test) or side zone (four weeks, S: mean 5.0 sd 1.2, T: mean 4.8 sd 0.4, p = 0.43; eight weeks, S: mean 5.3 sd 0.8,T: mean 5.5 sd 0.8, p = 0.61, Mann-Whitney U test) . Similarly, no significant difference was seen in the maximum failure load between group S and group T at four (15.6 sd 9.0N and 13.1 sd 5.6N) or eight weeks (12.6 sd 3.6N and 17.1 sd 6.4N, respectively). Conclusion Regardless of bone tunnel configuration, tendon-bone healing after ACL reconstruction primarily occurred through indirect healing. No significant histological or mechanical differences were observed between adjustable and fixed-loop femoral cortical suspension methods. Cite this article: Y. Sato, R. Akagi, Y. Akatsu, Y. Matsuura, S. Takahashi, S. Yamaguchi, T. Enomoto, R. Nakagawa, H. Hoshi, T. Sasaki, S. Kimura, Y. Ogawa, A. Sadamasu, S. Ohtori, T. Sasho. The effect of femoral bone tunnel configuration on tendon-bone healing in an anterior cruciate ligament reconstruction: An animal study. Bone Joint Res 2018;7:327–335. DOI: 10.1302/2046-3758.75.BJR-2017-0238.R2.

scholarly journals Lower Limb Asymmetry After Anterior Cruciate Ligament Reconstruction in Adolescent Athletes: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 55 (8) ◽  
pp. 811-825 ◽  
Author(s):  
Gerwyn Hughes ◽  
Perry Musco ◽  
Samuel Caine ◽  
Lauren Howe
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Reaction Force ◽  
Knee Extension ◽  
Cruciate Ligament Reconstruction ◽  
Peak Knee ◽  
Anterior Cruciate

Objectives To identify reported (1) common biomechanical asymmetries in the literature after anterior cruciate ligament (ACL) reconstruction in adolescents during landing and (2) timescales for asymmetry to persist postsurgery. Data Sources We identified sources by searching the CINAHL, PubMed, Scopus, and SPORTDiscus electronic databases using the following search terms: asymmetry OR symmetry AND landing AND biomechanics OR kinematics OR kinetics. Study Selection We screened the titles and abstracts of 85 articles using our inclusion criteria. A total of 13 articles were selected for further analysis. Data Extraction Three reviewers independently assessed the methodologic quality of each study. We extracted the effect sizes directly from studies or calculated them for biomechanical variables assessing asymmetry between limbs of participants with ACL reconstruction. We conducted meta-analyses on variables that were assessed in multiple studies for both double- and single-limb landings. Data Synthesis Asymmetry was more commonly identified in kinetic than kinematic variables. Anterior cruciate ligament reconstruction appeared to have a large effect on asymmetry between limbs for peak vertical ground reaction force, peak knee-extension moment, and loading rate during double-limb landings, as well as mean knee-extension moment and knee energy absorption during both double- and single-limb landings. Conclusions Our findings suggested that return-to-sport criteria after ACL reconstruction should incorporate analysis of the asymmetry in loading experienced by each limb rather than movement patterns alone.

Surgical techniques of anterior cruciate ligament reconstruction

2011 ◽  
Author(s):  
Julian Feller
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Cruciate Ligament Reconstruction ◽  
Tunnel Position ◽  
Anterior Cruciate

♦ The principal indication for ACL reconstruction is instability, either existent or predicted♦ In general, it is crucial that the knee has settled and motion has been restored prior to surgery♦ Accurate tunnel position is the most important aspect of surgery

Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction Knee Joint Using Hamstring Autograft

2021 ◽  
Vol 15 (12) ◽  
pp. 3345-3347
Author(s):  
Muhammad Bilal ◽  
Muhammad Ijaz Bhatti ◽  
Muhammad Shakeel Basit ◽  
Qasim Raza Naqvi ◽  
Gull Mahnoor Hashmi ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Surgical Technique ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Hamstring Autograft ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

One of the most common injuries during sports is anterior cruciate ligament (ACL) injury. A number of surgical and rehabilitation techniques have been developed. ACL reconstruction is mainstay of treatment. Objective: In this study we are evaluating the outcome of ACL surgery. Design & Setting: Retrospective study Methodology: Data collection of all cases that underwent primary arthroscopic anterior cruciate ligament reconstruction performed. All patients were operated with same surgical technique using quadrupled hamstring autograft. Results: There was an overall male predominance (95.3%). Medical meniscal injury was found in 05 (24%) patients. Lateral Meniscus injury was found in 04(19%) patients. Adjustable length CSF device was used in 12 (57%) patients and fixed-loop CSF device in 9 (43%) patients. Conclusion: At two years, outcome of ACL reconstruction performed by one surgeon using same surgical technique with adjustable CSF device and absorbable tibial screw granted satisfactory clinical results in all patients. Rehabilitation played an important role in return to activities of daily living in all patients at final follow up. Keywords: Anterior Cruciate Ligament, Arthroscopy, Rehabilitation

scholarly journals Reducing Intra-Articular Haemarthrosis After Arthroscopic Anterior Cruciate Ligament Reconstruction

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0013
Author(s):  
Fatih Karaaslan ◽  
Sinan Karaoğlu ◽  
Musa Uğur Mermerkaya
Keyword(s):  
Anterior Cruciate Ligament ◽  
Blood Loss ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Control Group ◽  
Double Blind Study ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Objectives: A significant proportion of surgeons use intra-articular drains after arthroscopic anterior cruciate ligament (ACL) reconstruction. Haemarthrosis and pain adversely affects the functional outcome of ACL reconstruction. The purpose of the study was to evaluate the effect of tranexamic acid (TXA) administration to minimize pain and stiffness of knee joint by reducing haemarthrosis. Methods: The study enrolled 123 patients who underwent arthroscopic anterior cruciate ligament reconstruction in a prospective, randomized, double-blind study. The patients who were randomized into the TXA group (71 patients) received both intravenous and intra-articular TXA. The control group (52 patients) did not receive TXA. The anesthetist, surgeon, and observer were blinded to the study group (double-blinded). TXA was administered as a bolus dose of 15 mg/kg 10 minutes before the inflation of the tourniquet on the first side. This was followed by continued intra-articular administration of 3 g at 10 minutes before the deflation of the tourniquet. Intravenous infusion of 10 mg/kg/h was continued for the next 3 hours. Equal volumes of placebo were administered at the same rate and by the same route. We measured volume of drained blood 48 hours postoperatively. Results: The mean (± SD) postoperative volume of blood loss from the drain in the TXA and control groups was 100.6 ± 72mL and 164.3 ± 75mL ml, respectively. The difference between the two groups was significant (p < 0.005). Conclusion: This prospective randomized study showed that during arthroscopic anterior cruciate ligament reconstruction, TXA reduced blood loss and helped to reduce haemarthrosis amount and frequency with negligible side effects. With regard to the administration route, combined intravenous–intra-articular administration of TXA significantly reduces blood loss and the need for puncturing associated with arthroscopic anterior cruciate ligament reconstruction without enhancing the risk of deepssssssahrombosis.

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