MedWorm: ACL Reconstruction

Anterior Cruciate Ligament Reconstructions - Steep Learning Curve For Surgeons

Health News from Medical News Today — Wed, 08 Feb 2012 18:00:00 +0100

An investigation by researchers at Hospital for Special Surgery reveals that individuals who undergo anterior cruciate ligament (ACL) reconstruction are approximately 4 to 5 times more likely to undergo further ACL reconstruction, if the initial operation was performed by a surgeon who has carried out less than 60 operations. Furthermore, the researchers found that taking part in subspecialty orthopedic fellowship-training program did not enhance the learning curve of young surgeons carrying out ACL reconstructions... (Source: Health News from Medical News Today)

MedWorm Sponsor Message: Find the best January Sales in the UK.

Study identifies steep learning curve for surgeons who perform ACL reconstructions

EurekAlert! - Medicine and Health — Tue, 07 Feb 2012 05:00:00 +0100

(Hospital for Special Surgery) Patients who have their anterior cruciate ligament (ACL) reconstructed by surgeons who have performed less than 60 surgeries are roughly four to five times more likely to undergo a subsequent ACL reconstruction, according to a study by researchers at Hospital for Special Surgery. (Source: EurekAlert! - Medicine and Health)

Breakage of bioabsorbable femoral transfix screw after arthroscopic anterior cruciate ligament repair: a report of two cases

European Journal of Orthopaedic Surgery and Traumatology — Fri, 03 Feb 2012 17:52:41 +0100

We describe the failure of transfix due to breakage in two patients after arthroscopic ACL reconstruction. These patients developed symptoms of screw irritation subcutaneously or skin penetration of the broken, migrated transfix pin. The clinical presentation, diagnosis, the image findings, management and review of literature are presented in this report. To the best of our knowledge, this is the only report from Asia. Content Type Journal ArticleCategory Up-to date Review and Case ReportPages 1-4DOI 10.1007/s00590-012-0954-7Authors A. Raviraj, Department of Orthopedics, Fortis Hospitals, Bangalore, 560076 IndiaAshish Anand, Department of Orthopedics, Fortis Hospitals, Bangalore, 560076 IndiaK. Santosh, Department of Radiology, Fortis Hospitals, Bangalore, 560076 India Jou...

Post injury changes in the properties of mesenchymal stem cells derived from human anterior cruciate ligaments

International Orthopaedics — Thu, 02 Feb 2012 18:10:13 +0100

Conclusions Our results suggest that colony-forming and differentiation potential decrease over time. It is important to consider changes in properties of MSCs and use ACL tissue in the acute phase of rupture when biological manipulation is required. Content Type Journal ArticleCategory Original PaperPages 1-8DOI 10.1007/s00264-012-1484-yAuthors Shuya Nohmi, Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562 JapanYuji Yamamoto, Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562 JapanHiroki Mizukami, Department of Pathology and Molecular Medicine, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562 JapanYasuyuki Ishibash...

A Cost-Effectiveness Analysis Comparing 3 Anterior Cruciate Ligament Graft Types: Bone-Patellar Tendon-Bone Autograft, Hamstring Autograft, and Allograft

The American Journal of Sports Medicine — Thu, 02 Feb 2012 05:00:00 +0100

Conclusions: This model suggests that hamstring autograft ACL reconstruction is the most cost-effective method of surgery for the average patient with ACL deficiency. However, specific clinical scenarios that change postoperative probabilities of the different complications may sway surgeons to choose either allografts or BPTB. Cost-effectiveness analysis is not intended to replace individual clinician judgment but rather is intended to examine both the effectiveness and costs associated with theoretical groups undergoing specific multifactorial decisions. (Source: The American Journal of Sports Medicine)

Biomechanical and Histological Evaluations of the Doubled Semitendinosus Tendon Autograft After Anterior Cruciate Ligament Reconstruction in Sheep

The American Journal of Sports Medicine — Thu, 02 Feb 2012 05:00:00 +0100

Conclusion: The sheep ACL reconstruction model showed predominant intrinsic fibroblast necrosis in the tendon autograft until 12 weeks. Although the structural properties of the femur-graft-tibia complex gradually improved, they were not completely restored to the femur-ACL-tibia complex level even at 52 weeks. Clinical Relevance: Remodeling of the semitendinosus tendon autograft after ACL reconstruction is not different from that of the bone-tendon-bone graft. This study has suggested that vigorous activity should not be permitted for patients in the early periods after ACL reconstruction using semitendinosus tendon autografts, which are necrotized and weakened after surgery. (Source: The American Journal of Sports Medicine)

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Patient and Surgeon Characteristics Associated With Primary Anterior Cruciate Ligament Reconstruction Graft Selection

The American Journal of Sports Medicine — Thu, 02 Feb 2012 05:00:00 +0100

Conclusion: Gender, age, race, as well as facility and surgeon characteristics such as volume and location are associated with ACL graft choices. (Source: The American Journal of Sports Medicine)

Femoral Tunnel Widening After Hamstring Anterior Cruciate Ligament Reconstruction With Bioabsorbable Transfix

The American Journal of Sports Medicine — Thu, 02 Feb 2012 05:00:00 +0100

Conclusion: Broken bio-Transfix implants resulted in significant femoral tunnel widening in the coronal plane, although clinical results were not affected. Surgeons should be aware of this phenomenon when selecting a fixation device for hamstring grafts. (Source: The American Journal of Sports Medicine)

Does Anterior Cruciate Ligament Reconstruction Lead to Degenerative Disease?: Thirteen-Year Results After Bone-Patellar Tendon-Bone Autograft

The American Journal of Sports Medicine — Thu, 02 Feb 2012 05:00:00 +0100

Conclusion: At 13 years, BTB ACL reconstruction provides a good outcome. Chondral and meniscal damage at surgery were associated with a poor radiological outcome, indicating that injuries sustained during ACL rupture may be the main predictors of degenerative bone disease. (Source: The American Journal of Sports Medicine)

Comparison of Inside-Out and All-Inside Techniques for the Repair of Isolated Meniscal Tears: A Systematic Review

The American Journal of Sports Medicine — Thu, 02 Feb 2012 05:00:00 +0100

Conclusion: There are no differences in clinical failure rate or subjective outcome between inside-out and all-inside meniscus repair techniques. Complications are associated with both techniques. More nerve symptoms are associated with the inside-out repair and more implant-related complications are associated with the all-inside technique. Clinical Relevance: Rates of structural healing and complications are comparable for inside-out and all-inside repair techniques for isolated meniscal injury. Differences in observed healing rates after meniscal repair may be more dependent on tear pattern and associated anterior cruciate ligament reconstruction rather than an inside-out versus all-inside surgical approach. (Source: The American Journal of Sports Medicine)

Deterioration of Stress Distribution Due to Tunnel Creation in Single-Bundle and Double-Bundle Anterior Cruciate Ligament Reconstructions.

Annals of Biomedical Engineering — Wed, 01 Feb 2012 05:00:00 +0100

Authors: Yao J, Wen C, Cheung JT, Zhang M, Hu Y, Yan C, Chiu KY, Lu WW, Fan Y Abstract Bone tunnel enlargement is a common effect associated with knee laxity after anterior cruciate ligament (ACL) reconstruction. Nevertheless, its exact pathomechanism remains controversial. One of the possible reasons could be bone remodeling due to tunnel creation, which changes the stress environment in the joint. The present study aims to characterize the deteriorated stress distribution on the articular surface, which is due to tunnel creation after single-bundle or double-bundle ACL reconstruction. The stress distributions in the knee following ACL reconstruction under the compression, rotation, and valgus torques were calculated using a validated three-dimensional finite element (FE) model. T...

MedWorm Sponsor Message: Find the best January Sales in the UK.

Anatomic Landmarks Utilized for Physeal-Sparing, Anatomic Anterior Cruciate Ligament Reconstruction: An MRI-Based Study.

The Journal of Bone and Joint Surgery. American volume — Wed, 01 Feb 2012 05:00:00 +0100

CONCLUSIONS: Drilling from the center of the ACL femoral footprint to the insertion of the popliteus tendon would have resulted in a mean tunnel length of 27 to 30 mm, and it would have allowed the safe placement of a femoral tunnel at least 7 mm in diameter in a patient six to seventeen years old. The center of the ACL femoral footprint and the popliteus insertion are easily identifiable landmarks and will allow safe, reproducible, anatomic ACL reconstruction in the skeletally immature patient. PMID: 22298060 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

The Influence of Posterolateral Rotatory Instability on ACL Reconstruction: Comparison Between Isolated ACL Reconstruction and ACL Reconstruction Combined with Posterolateral Corner Reconstruction.

The Journal of Bone and Joint Surgery. American volume — Wed, 01 Feb 2012 05:00:00 +0100

CONCLUSIONS: On the basis of the evaluation of ligamentous laxity with use of the KT2000 arthrometer, we observed that combined ACL and posterolateral corner reconstruction allows less anterior translation than isolated ACL reconstruction. However, we could not identify significant differences between the two groups in terms of functional outcomes. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. PMID: 22298058 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

An Association of Lateral Knee Sagittal Anatomic Factors with Non-Contact ACL Injury: Sex or Geometry?

The Journal of Bone and Joint Surgery. American volume — Wed, 01 Feb 2012 05:00:00 +0100

CONCLUSIONS: All female patients (both ACL-injured and uninjured) and ACL-injured male patients shared a common lateral knee geometry characterized by a smaller tibial plateau length relative to the femur and by more convex articulating surfaces of the proximal aspect of the tibia and the distal aspect of the femur. Shorter, more highly convex articulating surfaces may be inherently less stable with regard to anterior tibial translation and rotation. These findings may partially explain the greater overall predisposition of women compared with men toward ACL injury as well as why some studies have demonstrated no sex differences in graft reinjury after ACL reconstruction. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evide...

Pre‐operative factors predicting good outcome in terms of health‐related quality of life after ACL reconstruction

Scandinavian Journal of Medicine and Science in Sports — Tue, 31 Jan 2012 05:00:00 +0100

In conclusion, pre‐operative factors, such as pivot shift, knee function, and range of motion, may predict a good post‐operative outcome and explain up to 25% in terms of health‐related quality of life after ACL reconstruction. Furthermore, it appears that the patients’ pre‐injury and pre‐operative Tegner activity levels are important predictors of post‐operative health‐related quality of life. (Source: Scandinavian Journal of Medicine and Science in Sports)

Clinical outcomes of double‐ vs single‐bundle anterior cruciate ligament reconstruction: A systematic review of randomized control trials

Scandinavian Journal of Medicine and Science in Sports — Tue, 31 Jan 2012 05:00:00 +0100

Clinical outcomes of anterior cruciate ligament (ACL) reconstruction with double‐bundle and single‐bundle techniques are still controversial. We therefore performed a systematic review to compare postoperative outcomes between the two techniques. Randomized control trials comparing the outcomes between the two techniques were identified from Medline and EMBASE since inception to April 27, 2011. Data were independently extracted by two reviewers. Thirteen of 318 studies were eligible; 9, 11, 7, and 8 studies were pooled for rotation, translation, function, and complication outcomes, respectively. The double‐bundle technique was approximately four times (95% CI: 2.65, 11.99) and two times (95% CI: 1.16, 5.21) more likely to show a normal pivot shift and normal International Knee Docume...

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Erratum to: Complications in Brief: Anterior Cruciate Ligament Reconstruction.

Clinical Orthopaedics and Related Research — Tue, 31 Jan 2012 05:00:00 +0100

Authors: Tjoumakaris FP, Herz-Brown AL, Bowers AL, Sennett BJ, Bernstein J PMID: 22290135 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)

Bioabsorbable interference screw versus bioabsorbable cross pins: influence of femoral graft fixation on the clinical outcome after ACL reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy — Mon, 30 Jan 2012 16:06:43 +0100

Conclusions In ACL reconstruction with hamstrings graft, similar clinical results are obtained for the use of bioabsorbable cross pins when compared to bioabsorbable interference screws for femoral fixation. Cross pin fixation was superior with regard to the anteroposterior laxity as measured with KT-1000. Content Type Journal ArticleCategory KneePages 1-6DOI 10.1007/s00167-011-1875-4Authors Stephan Frosch, Department of Trauma Surgery, Plastic and Reconstructive Surgery, Medical University of Göttingen, Göttingen, GermanyAnne Rittstieg, Department of Trauma Surgery, Plastic and Reconstructive Surgery, Medical University of Göttingen, Göttingen, GermanyPeter Balcarek, Department of Trauma Surgery, Plastic and Reconstructive Surgery, Medical University of Göttin...

Assessment of rotatory laxity in anterior cruciate ligament-deficient knees using magnetic resonance imaging with Porto-knee testing device

Knee Surgery, Sports Traumatology, Arthroscopy — Mon, 30 Jan 2012 16:06:41 +0100

Conclusion The PKTD proved to be a reliable tool in assessment of antero-posterior translation (comparing with KT-1000) and rotatory laxity (compared with lateral pivot-shift under anesthesia) of the ACL-deficient knee during MRI examination. Level of evidence Therapeutic studies, Level IV. Content Type Journal ArticleCategory KneePages 1-8DOI 10.1007/s00167-012-1914-9Authors João Espregueira-Mendes, Saúde Atlântica Sports Center—F.C. Porto Stadium, Minho University and Porto University, Porto, PortugalHélder Pereira, Saúde Atlântica Sports Center—F.C. Porto Stadium, Minho University and Porto University, Porto, PortugalNuno Sevivas, Saúde Atlântica Sports Center—F.C. Porto Stadium, Minho University and Porto University, Porto, Portuga...

Allograft Anterior Cruciate Ligament Reconstruction: Indications, Techniques, and Outcomes.

Physical Therapy — Wed, 25 Jan 2012 05:00:00 +0100

Authors: Vyas D, Rabuck SJ, Harner CD Abstract Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-...

Knee instruments and rating scales designed to measure outcomes

Journal of Orthopaedics and Traumatology — Tue, 24 Jan 2012 18:09:17 +0100

Abstract In this article, the knee instruments and rating scales that are designed to measure outcomes are revised. Although the International Knee Documentation Committee Subjective Knee Form can be used as a general knee measure, no instrument is currently universally applicable across the spectrum of knee disorders and patient groups. Clinicians and researchers looking to use a patient-based score for measurement of outcomes must consider the specific patient population in which it has been evaluated. The Western Ontario and McMaster Universities Osteoarthritis Index is recommended for the evaluation of treatment effect in persons with osteoarthritis (OA). This is a generic health status questionnaire that contains 36 items, is widely used, and easy to complete. The Kne...

MedWorm Sponsor Message: Find the best January Sales in the UK.

Comparison of anterior and rotatory laxity using navigation between single- and double-bundle ACL reconstruction: prospective randomized trial

Knee Surgery, Sports Traumatology, Arthroscopy — Tue, 24 Jan 2012 12:26:04 +0100

Conclusions The kinematic tests in this study found evidence suggesting that the DB ACL reconstruction improved rotatory laxity better than the SB ACL reconstruction at 30° and 60° of flexion, but there was no difference in functional outcome at 2 years follow-up between SB and DB groups. Level of evidence Prospective comparative study, Level II. Content Type Journal ArticleCategory KneePages 1-10DOI 10.1007/s00167-012-1880-2Authors Sahnghoon Lee, Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110744 KoreaHyoungmin Kim, Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110744 KoreaJak Jang, Department of Orthop...

A Between Sex Comparison of Anterior-Posterior Knee Laxity after Anterior Cruciate Ligament Reconstruction with Patellar Tendon or Hamstrings Autograft: A Systematic Review

Sports Medicine — Tue, 24 Jan 2012 10:49:37 +0100

(Source: Sports Medicine)

Kinematic predictors of subjective outcome after anterior cruciate ligament reconstruction: an in vivo motion analysis study

Knee Surgery, Sports Traumatology, Arthroscopy — Tue, 24 Jan 2012 07:34:46 +0100

Conclusions Restoring rotational kinematics during dynamic pivoting activities after ACLR is predictive of functional outcome. The ability of the athlete after ACLR to control tibial rotation during pivoting activities may be predictive of functional outcome. Level of evidence Case series study. Level IV. Content Type Journal ArticleCategory KneePages 1-8DOI 10.1007/s00167-012-1902-0Authors Franceska Zampeli, Department of Orthopaedic Surgery, Orthopaedic Sports Medicine Center, University of Ioannina, PO Box 1042, 45110 Ioannina, GreeceEvangelos Pappas, Division of Physical Therapy, Long Island University, Brooklyn Campus, Brooklyn, NY 11201, USADimitrios Giotis, Department of Orthopaedic Surgery, Orthopaedic Sports Medicine Center, University of I...

Can the pivot-shift be eliminated by anatomic double-bundle anterior cruciate ligament reconstruction?

Knee Surgery, Sports Traumatology, Arthroscopy — Tue, 24 Jan 2012 07:34:45 +0100

Conclusions The double-bundle reconstruction was shown to over-constrain the knee with respect to the intact value, especially closer to knee extension. This review demonstrated that anatomic double-bundle anterior cruciate ligament reconstruction is able to eliminate pathological translations and rotations during the pivot-shift phenomenon, as identified by quantitative measurement systems. Level of evidence Review of Level III studies, Level III. Content Type Journal ArticleCategory KneePages 1-9DOI 10.1007/s00167-012-1897-6Authors Stefano Zaffagnini, 3rd Orthopaedic and Traumatology Clinic and Biomechanics Laboratory, Codivilla-Putti Research Center, Istituto Ortopedico Rizzoli—University of Bologna, via di Barbiano, 1/10, 40100 Bologna, Ital...

Dermatan sulphate in methoxy polyethylene glycol-polylactide-co-glycolic acid scaffolds upregulates fibronectin gene expression but has no effect on in vivo osteochondral repair

International Orthopaedics — Fri, 20 Jan 2012 07:06:38 +0100

Conclusions Upregulation of fibronectin in vitro indicating early cell-scaffold interaction and attachment did not result in improved cartilage repair in an osteochondral defect model in rabbits. Content Type Journal ArticleCategory Original PaperPages 1-7DOI 10.1007/s00264-011-1479-0Authors Casper Bindzus Foldager, Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, DenmarkCody Bünger, Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, DenmarkAnna Bay Nielsen, Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, DenmarkMichael Ulrich-Vinther, Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, DenmarkSamir Munir, Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, DenmarkHanne Ever...

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

The relationship of anterior and rotatory laxity between surgical navigation and clinical outcome after ACL reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy — Fri, 20 Jan 2012 07:04:49 +0100

Conclusion Although AP and rotational laxities vary largely among the patients, and AP and rotational stabilization are successfully achieved immediately after ACL reconstruction, intraoperative AP and rotational laxity measured by the navigation system did not influence the postoperative AP and rotational laxities after ACL reconstruction. Level of evidence III. Content Type Journal ArticleCategory KneePages 1-7DOI 10.1007/s00167-012-1900-2Authors Shingo Ohkawa, Department of Orthopedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 JapanNobuo Adachi, Department of Orthopedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima...

Knee rotational laxity and proprioceptive function 2 years after partial ACL reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy — Thu, 19 Jan 2012 06:55:58 +0100

Conclusion Our study did not detect any difference in rotational laxity and proprioception between the reconstructed and the healthy knee. Therefore, partial ACL reconstruction appears to restore satisfactory knee laxity and function in case of partial ACL tear. Level of evidence IV. Content Type Journal ArticleCategory KneePages 1-5DOI 10.1007/s00167-012-1879-8Authors J. Chouteau, Service de chirurgie orthopédique, de traumatologie et de médecine du sport, Centre Hospitalier Lyon-Sud, Chemin du Grand Revoyet, 69495 Pierre Bénite, Cedex, FranceR. Testa, Service de chirurgie orthopédique, de traumatologie et de médecine du sport, Centre Hospitalier Lyon-Sud, Chemin du Grand Revoyet, 69495 Pierre Bénite, Cedex, FranceA. Viste, Service de chirur...

Anterior Cruciate Ligament Reconstruction With Bone–Patellar Tendon–Bone Graft: Comparison of Autograft, Fresh-Frozen Allograft, and γ-Irradiated Allograft

Arthroscopy — Wed, 18 Jan 2012 12:06:12 +0100

Conclusions: The study showed a statistically poorer KT-1000 result and higher failure rate in the γ-irradiated allograft group compared with the autograft and fresh-frozen allograft groups. This may suggest that γ-irradiated allograft is not a good candidate graft for ACL reconstruction. Power analysis showed that the study was underpowered, so further research and longer follow-up study are needed to make this point clearer. Level of Evidence: Level III, retrospective comparative study. (Source: Arthroscopy)

Translation and measurement properties of the Swedish version of ACL‐Return to Sports after Injury questionnaire

Scandinavian Journal of Medicine and Science in Sports — Wed, 18 Jan 2012 05:00:00 +0100

Psychological factors may be a hindrance for returning to sport after an anterior cruciate ligament (ACL) reconstruction. The ACL‐Return to Sport after Injury scale (ACL‐RSI) measures athletes' emotions, confidence in performance, and risk appraisal in relation to return to sport. The aim of this study was to translate the ACL‐RSI scale from English to Swedish and to examine some of the measurement properties of the Swedish version. The ACL‐RSI was translated and culturally adapted. A professional expert group and five patients evaluated face validity. One hundred and eighty‐two patients completed the translated ACL‐RSI, a project‐specific questionnaire, the Tampa Scale of Kinesiophobia (TSK), the Knee‐Self‐Efficacy Scale (K‐SES), the Multidimensional Health Locus of Co...

Outcomes for Hamstring Tendon Grafts in ACL Reconstruction Outcomes for Hamstring Tendon Grafts in ACL Reconstruction

Medscape Orthopaedics Headlines — Wed, 18 Jan 2012 03:28:08 +0100

Long-term anterior cruciate ligament (ACL) reconstruction outcomes appear to be better with hamstring tendon grafts than with patellar tendon grafts, researchers from Australia have found. Reuters Health Information (Source: Medscape Orthopaedics Headlines)

MedWorm Sponsor Message: Find the best January Sales in the UK.

Analysis of tunnel widening after double-bundle ACL reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy — Tue, 17 Jan 2012 07:12:23 +0100

Conclusions Tunnel widening after a double-bundle ACL reconstruction using an outside-in technique with press-fitting of the graft was acceptable compared to previously published studies. The tibial PL tunnel showed the most widening among the 4 tunnels examined with the tunnel entrance being most widened area. Level of evidence Therapeutic case series, Level IV. Content Type Journal ArticleCategory KneePages 1-8DOI 10.1007/s00167-011-1874-5Authors Yong Seuk Lee, Department of Orthopedic Surgery, Gil Hospital, Gachon University School of Medicine, Incheon, KoreaSheen-Woo Lee, Department of Radiology, Gil Hospital, Gachon University School of Medicine, Incheon, KoreaShin Woo Nam, Department of Orthopedic Surgery, Gil Hospital, Gachon University Scho...

Recent advances following anterior cruciate ligament reconstruction: rehabilitation perspectives

Current Reviews in Musculoskeletal Medicine — Tue, 17 Jan 2012 07:05:25 +0100

Abstract Injuries to the anterior cruciate ligament are common. Surgical reconstruction is more prevalent than ever. This review article discusses treatment of the patient following surgical reconstruction of the anterior cruciate ligament. Various phases of rehabilitation are discussed with emphasis on early return of passive motion, early weight bearing, bracing, kinetic chain exercises, neuromuscular electrical stimulation and accelerated rehabilitation. Although evidence exists for the treatment of the surgically reconstructed cruciate ligament, more is needed to better define specific timeframes for advancement. Evidence exists that many of these young individuals are not fully returning to unlimited high level activities. This review article presents some of the late...

Applying Simulated In Vivo Motions to Measure Human Knee and ACL Kinetics. - Herfat ST, Boguszewski DV, Shearn JT.

SafetyLit: All (Unduplicated) — Sat, 14 Jan 2012 23:37:58 +0100

Patients frequently experience anterior cruciate ligament (ACL) injuries but current ACL reconstruction strategies do not restore the native biomechanics of the knee, which can contribute to the early onset of osteoarthritis in the long term. To design mor... (Source: SafetyLit: All (Unduplicated))

The role of mechanobiology in tendon healing

Journal of Shoulder and Elbow Surgery — Sat, 14 Jan 2012 14:39:40 +0100

Mechanical cues affect tendon healing, homeostasis, and development in a variety of settings. Alterations in the mechanical environment are known to result in changes in the expression of extracellular matrix proteins, growth factors, transcription factors, and cytokines that can alter tendon structure and cell viability. Loss of muscle force in utero or in the immediate postnatal period delays tendon and enthesis development. The response of healing tendons to mechanical load varies depending on anatomic location. Flexor tendons require motion to prevent adhesion formation, yet excessive force results in gap formation and subsequent weakening of the repair. Excessive motion in the setting of anterior cruciate ligament reconstruction causes accumulation of macrophages, which are detrimenta...

Objective measurement devices to assess static rotational knee laxity: focus on the Rotameter

Knee Surgery, Sports Traumatology, Arthroscopy — Fri, 13 Jan 2012 16:57:45 +0100

Conclusions A non-invasive and objective knee rotational measurement device has been developed, which offers good potential for objective quality control in knee ligament injuries and their treatment. Level of evidence Review article, Level IV. Content Type Journal ArticleCategory KneePages 1-6DOI 10.1007/s00167-011-1876-3Authors Olaf Lorbach, Department of Orthopedic Surgery, Saarland University, Kirrberger Str., 66421 Homburg (Saar), GermanyMatthias Brockmeyer, Department of Orthopedic Surgery, Saarland University, Kirrberger Str., 66421 Homburg (Saar), GermanyMatthias Kieb, Department of Orthopedic Surgery, Saarland University, Kirrberger Str., 66421 Homburg (Saar), GermanyTina Zerbe, Department of Orthopedic Surgery, Saarland University, Kirrber...

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Strategies for patient profiling in articular cartilage repair of the knee: a prospective cohort of patients treated by one experienced cartilage surgeon

Knee Surgery, Sports Traumatology, Arthroscopy — Fri, 13 Jan 2012 16:57:45 +0100

Conclusion This is the first study that provides an assessment of the treatment strategies used by an experienced cartilage surgeon. A treatment algorithm for cartilage repair in a heterogenic population was created that based on the findings of this study could be implemented in a clinical environment. Level of evidence Prospective clinical case series, Level IV Content Type Journal ArticleCategory KneePages 1-8DOI 10.1007/s00167-011-1855-8Authors Tommy S. de Windt, Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, The NetherlandsSebastian Concaro, Department of Orthopaedics, Kungälvs Hospital, Kungälv, SwedenAnders Lindahl, Department of Clinical Chemistry and Transfusion Medicine, Institute of Laboratory Medicine, Sahlgr...

Risk factors of recurrent hamstring injuries: a systematic review

British Journal of Sports Medicine — Thu, 12 Jan 2012 05:00:00 +0100

Conclusions There is limited evidence that athletes with a larger volume size of initial trauma, a Grade 1 hamstring injury and a previous ipsilateral ACL reconstruction are at increased risk for recurrent hamstring injury. Athletes seem to be at lower risk for re-injury when following agility/stabilisation exercises. (Source: British Journal of Sports Medicine)

Influence of knee flexion and femoral cross-pin insertion angle on posterolateral structures of the knee and lateral fixation lengths during ACL reconstruction

Surgical and Radiologic Anatomy — Tue, 10 Jan 2012 17:00:46 +0100

Conclusions The cross-pin was inserted close to the LCL and PT, and a downward 30° angle was the safest insertion angle. Lateral fixation length was sufficient for the cross-pin fixation in the 10:30- or 1:30-positioned femoral tunnel. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s00276-011-0922-7Authors Jin Goo Kim, Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, Seoul, KoreaYong Seuk Lee, Department of Orthopedic Surgery, Gachon University School of Medicine, Gil Hospital, 117, Yong-dong, Jung-gu, Incheon, 400-713 KoreaJeong Ku Ha, Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, Seoul, KoreaSung Soo Jun, Department of Orthopedic Surgery, Gachon University School of Medicine, Gil Hospital,...

Double-bundle bone-patellar tendon-bone and gracilis in ACL reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy — Tue, 10 Jan 2012 17:00:45 +0100

Abstract An original technique for the reconstruction of the anterior cruciate ligament is explained. Two bundles are reconstructed using the central third of the patellar tendon and the gracilis tendon, passed through four tunnels but requiring only two interference screws for fixation. Level of evidence V. Content Type Journal ArticleCategory KneePages 1-4DOI 10.1007/s00167-011-1870-9Authors David Dejour, Lyon-Ortho-Clinic Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009 Lyon, FrancePaolo Ferrua, Lyon-Ortho-Clinic Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009 Lyon, FranceNicolas Bonin, Lyon-Ortho-Clinic Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009 Lyon, FrancePaulo Renato Fernandes Saggin, Instituto de Ortopedia e Traumatologia de Pas...

Applying Simulated In Vivo Motions to Measure Human Knee and ACL Kinetics.

Annals of Biomedical Engineering — Sat, 07 Jan 2012 05:00:00 +0100

This study was designed to apply a simulated human in vivo motion to human knees to measure the kinetics of the human knee and ACL. In pursuit of establishing a viable biomechanical surrogate, a simulated in vivo ovine motion was also applied to human knees to compare the loads produced by the human and ovine motions. The motions from the two species produced similar kinetics in the human knee and ACL. The only significant difference was the intact knee compression force produced by the two input motions. PMID: 22227973 [PubMed - as supplied by publisher] (Source: Annals of Biomedical Engineering)

MedWorm Sponsor Message: Find the best January Sales in the UK.

Objective criteria for return to athletics after anterior cruciate ligament reconstruction and subsequent reinjury rates: a systematic review. - Barber-Westin SD, Noyes FR.

SafetyLit: All (Unduplicated) — Fri, 06 Jan 2012 15:21:09 +0100

Objective: To review anterior cruciate ligament (ACL) clinical studies to assess the objective functional criteria used to determine when patients can return to athletics postoperatively, and to determine the rates of reinjury to either knee when these cri... (Source: SafetyLit: All (Unduplicated))

Quantitative assessment of pivot-shift using inertial sensors

Knee Surgery, Sports Traumatology, Arthroscopy — Thu, 05 Jan 2012 17:06:20 +0100

Conclusion This study showed good reliability of the new device and good correlation with the navigation system results. Therefore, the accelerometer is a valid method to assess dynamic joint laxity. Level of evidence II. Content Type Journal ArticleCategory KneePages 1-5DOI 10.1007/s00167-011-1865-6Authors Nicola Lopomo, Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano, 1/10, 40136 Bologna, ItalyCecilia Signorelli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano, 1/10, 40136 Bologna, ItalyTommaso Bonanzinga, Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano, 1/10, 40136 Bologna, ItalyGiulio Maria ...

What does it take to have a high-grade pivot shift?

Knee Surgery, Sports Traumatology, Arthroscopy — Thu, 05 Jan 2012 17:06:20 +0100

In conclusion, a high-grade pivot shift in the ACL-deficient knee is often associated with incompetence of the lateral soft tissue envelope. Rotatory laxity as assessed by the pivot shift may also be falsely underestimated by concomitant injuries. Level of evidence IV. Content Type Journal ArticleCategory KneePages 1-6DOI 10.1007/s00167-011-1866-5Authors M. Tanaka, Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USAD. Vyas, UPMC Center for Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA 15203, USAG. Moloney, UPMC Center for Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA 15203, USAA. Bedi, Department of Ortho...

Pivot shift as an outcome measure for ACL reconstruction: a systematic review

Knee Surgery, Sports Traumatology, Arthroscopy — Wed, 04 Jan 2012 17:01:38 +0100

Conclusion The pivot shift test is an important test following ACL reconstruction, and it correlates with functional outcomes. Content Type Journal ArticleCategory KneePages 1-11DOI 10.1007/s00167-011-1860-yAuthors Olufemi R. Ayeni, Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, 1200 Main St. West, Room 4E17, Hamilton, ON L8N 3Z5, CanadaManraj Chahal, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, CanadaMichael N. Tran, Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, 1200 Main St. West, Room 4E17, Hamilton, ON L8N 3Z5, CanadaSheila Sprague, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada ...

Effects of graft pretensioning in anterior cruciate ligament reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy — Wed, 04 Jan 2012 17:01:33 +0100

Conclusion Pretensioning ACL grafts resulted in alteration of the collagen fibrillar ultrastructure, detectable using SEM. These results confirm the existence of collagen ultrastructural changes after pretensioning that may be related to its duration. Level of evidence Prospective comparative study, Level II. Content Type Journal ArticleCategory KneePages 1-6DOI 10.1007/s00167-011-1833-1Authors Claude Guillard, Orthopaedic Department, Nantes University Hospital, 44000 Nantes, FranceFrancois Lintz, Orthopaedic Department, Nantes University Hospital, 44000 Nantes, FranceGuillaume Anthony Odri, Orthopaedic Department, Nantes University Hospital, 44000 Nantes, FranceDenis Vogeli, Orthopaedic Department, Nord-Mayenne Hospital, 53100 Mayenne, FranceFabric...

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Analysis of cyclops lesions after different anterior cruciate ligament reconstructions: a comparison of the single-bundle and remnant bundle preservation techniques

Skeletal Radiology — Wed, 04 Jan 2012 16:49:39 +0100

Conclusions The prevalence of a cyclops lesion was similar in both groups. Content Type Journal ArticleCategory Scientific ArticlePages 1-6DOI 10.1007/s00256-011-1347-4Authors Jihoon Cha, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, Korea 135-710Sang-Hee Choi, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, Korea 135-710Jong Won Kwon, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, Korea 135-710Sang-Hak Lee, Department of Orthopedic Surgery, S...

Return-to-Sport Outcomes at 2 to 7 Years After Anterior Cruciate Ligament Reconstruction Surgery

The American Journal of Sports Medicine — Tue, 03 Jan 2012 05:00:00 +0100

Conclusion: Less than 50% of the study sample had returned to playing sport at their preinjury level or returned to participating in competitive sport when surveyed at 2 to 7 years after ACL reconstruction surgery. Return to the preinjury level of sport at 12 months after surgery was not predictive of participation at the preinjury level in the medium term, which suggests that people who return to sport within 12 months may not maintain their sports participation. (Source: The American Journal of Sports Medicine)

Loss of Normal Knee Motion After Anterior Cruciate Ligament Reconstruction Is Associated With Radiographic Arthritic Changes After Surgery

The American Journal of Sports Medicine — Tue, 03 Jan 2012 05:00:00 +0100

Conclusion: The prevalence of osteoarthritis on radiographs in the long term after anterior cruciate ligament reconstruction is lower in patients who achieve and maintain normal knee motion, regardless of the status of the meniscus. (Source: The American Journal of Sports Medicine)

Relationships Among Tendon Regeneration on MRI, Flexor Strength, and Functional Performance After Anterior Cruciate Ligament Reconstruction With Hamstring Autograft

The American Journal of Sports Medicine — Tue, 03 Jan 2012 05:00:00 +0100

Conclusion: Hamstring tendons regenerated after harvest for ACL reconstruction in a high proportion of the patients. The flexor strength with both the standard and prone position isokinetic tests differed in the 3 groups. The number of regenerated hamstring tendons was significantly correlated with performance on the carioca test. Proximal shifting of the musculotendinous junction was significantly correlated with flexor deficit on the hyperflexion isokinetic test. (Source: The American Journal of Sports Medicine)

The pivot shift: a global user guide

Knee Surgery, Sports Traumatology, Arthroscopy — Sat, 31 Dec 2011 16:48:23 +0100

Conclusions Clinical grading, tibial translation, and acceleration vary between examiners performing the pivot shift test. High forces and extremes of rotation are not necessary to produce a clinical detectable pivot shift. In the future, a standardized pivot shift test—which can be performed universally and utilizes only gentle forces allowing motion to occur—may be beneficial when assessing differences in outcome following ACL reconstruction. Content Type Journal ArticleCategory KneePages 1-8DOI 10.1007/s00167-011-1859-4Authors Volker Musahl, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA 15203, USAYuichi Hoshino, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA ...

MedWorm Sponsor Message: Find the best January Sales in the UK.

Quantitative measurement of the pivot shift, reliability, and clinical applications

Knee Surgery, Sports Traumatology, Arthroscopy — Fri, 30 Dec 2011 16:49:55 +0100

Abstract Static load–displacement measurement is unrelated to the dynamic knee function of anterior cruciate ligament (ACL) insufficiency. Performing an accurate, dynamic functional evaluation is necessary not only for the primary ACL injury, but also as an outcome measurement in ACL reconstruction. The pivot shift test is commonly used for assessing dynamic rotatory knee laxity in ACL-insufficient knees and is related to subjective knee function. Residual pivot shift after ACL reconstruction is a crucial factor related to poor clinical outcome. However, the pivot shift test is subjectively determined by the examiners’ hands. Not only 3-dimensional (3D) position displacement but also its 3D acceleration should be measured for quantitative evaluation of the pivot shift ...

Dynamic knee laxity measurement devices

Knee Surgery, Sports Traumatology, Arthroscopy — Fri, 30 Dec 2011 16:49:54 +0100

Conclusion Several devices can be used to evaluate dynamic laxity of the knee. At the present time, the devices are continuously under development. Future implementation should include primary basic research, including validation and reliability testing, as well as part of individualized surgery and clinical follow-up. Level of evidence Diagnostic study, Level V. Content Type Journal ArticleCategory KneePages 1-12DOI 10.1007/s00167-011-1848-7Authors Mattias Ahldén, Department of Orthopaedics, Sahlgrenska University Hospital/Mölndal, 431 80 Mölndal, SwedenYuichi Hoshino, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213, USAKristian Samuelsson, Department of Orthopaedics, Sahlgrenska University H...

Rotatory laxity evaluation of the knee using modified Slocum’s test in open magnetic resonance imaging

Knee Surgery, Sports Traumatology, Arthroscopy — Fri, 30 Dec 2011 16:49:53 +0100

Conclusion The anterior translation in the lateral compartment measured with this method allows objective and quantitative evaluation of the rotatory laxity that causes the pivot-shift phenomenon. The grade of the pivot-shift test is determined by the magnitude of the movement of the lateral compartment when the femoral condyle surmounts the convex tibial articular surface, rather than by the deviation of the rotational angle of the tibia. Level of evidence II. Content Type Journal ArticleCategory KneePages 1-7DOI 10.1007/s00167-011-1861-xAuthors Ken Okazaki, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-0054 JapanYasutaka Tashiro, Department of Orthopaedic Surge...

Transtibial ACL reconstruction technique fails to position drill tunnels anatomically in vivo 3D CT study

Knee Surgery, Sports Traumatology, Arthroscopy — Fri, 30 Dec 2011 16:44:04 +0100

Conclusion ACL reconstruction via traditional transtibial technique fails to accurately position femoral and tibial tunnels within the native ACL insertion site. To achieve anatomical graft placement, other surgical techniques should be considered. Level of evidence IV. Content Type Journal ArticleCategory KneePages 1-8DOI 10.1007/s00167-011-1851-zAuthors Sebastian Kopf, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213, USABrian Forsythe, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213, USAAndrew K. Wong, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213, USAScott Tashman, Department of Orthopaed...

Rotatory knee laxity tests and the pivot shift as tools for ACL treatment algorithm

Knee Surgery, Sports Traumatology, Arthroscopy — Fri, 30 Dec 2011 07:08:02 +0100

This article describes several techniques of laxity assessments. Based on the type and degree of pathologic laxity, a treatment algorithm has been developed. Level of evidence V. Content Type Journal ArticleCategory KneePages 1-8DOI 10.1007/s00167-011-1857-6Authors Volker Musahl, Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA 15203, USASebastian Kopf, Center for Musculoskeletal Surgery, Charité, University Medicine, Berlin, GermanyStephen Rabuck, Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA 15203, USARoland Becker, Department of Orthopaedic and Traumatology, City Hospital Brandenburg, Brandenburg, GermanyWillem van d...

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Don't blame knee arthritis on ACL surgery: study

Modern Medicine — Fri, 30 Dec 2011 05:00:00 +0100

NEW YORK (Reuters Health) - A new study shows the degenerative joint disease that's common years after anterior cruciate ligament (ACL) reconstruction is probably due more to the original injury than to the operation itself. (Source: Modern Medicine)

Evaluation of anterior stability of knee joint following arthroscopic ACL reconstruction with patellar ligament.

Ortopedia, Traumatologia, Rehabilitacja — Fri, 30 Dec 2011 05:00:00 +0100

Conclusions. Arthroscopic ACL reconstruction with the central third of the patellar ligament and stabilization with interference screws fully restored the lost stability of the knee, but the possibility of pain and crepitations in the patello-femoral joint needs to be taken into account. In the course of rehabilitation, it is natural that an ACL graft may extend as a result of remodeling and the impact of rehabilitation being administered. PMID: 22248463 [PubMed - in process] (Source: Ortopedia, Traumatologia, Rehabilitacja)

Authors' Reply

Arthroscopy — Thu, 29 Dec 2011 03:44:12 +0100

We appreciate Dr. Özer for his letter about our article describing anterior cruciate ligament (ACL) reconstruction using remnant preservation and a femoral tensioning technique. He raised 3 questions regarding the surgical technique, results, and the conclusion. (Source: Arthroscopy)

Hypoxia: a critical regulator of early human tendinopathy

Annals of the Rheumatic Diseases — Wed, 28 Dec 2011 05:00:00 +0100

Conclusion Hypoxia promotes the expression of proinflammatory cytokines, key apoptotic mediators and drives matrix component synthesis towards a collagen type III profile by human tenocytes. The authors propose hypoxic cell injury as a critical pathophysiological mechanism in early tendinopathy offering novel therapeutic opportunities in the management of tendon disorders. (Source: Annals of the Rheumatic Diseases)

The knee adduction moment in hamstring and patellar tendon anterior cruciate ligament reconstructed knees

Knee Surgery, Sports Traumatology, Arthroscopy — Fri, 23 Dec 2011 16:53:57 +0100

Conclusions These results indicate that in male patients during the early stages of recovery from ACL reconstruction, the knee adduction moment is not greater than controls for either hamstring or patellar tendon graft types. Although the knee adduction moment was similar between the two graft types, the overall magnitude of the moment was influenced by different biomechanical factors. Level of evidence III. Content Type Journal ArticleCategory KneePages 1-6DOI 10.1007/s00167-011-1835-zAuthors Kate E. Webster, Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University, Melbourne, VIC 3086, AustraliaJulian A. Feller, Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University, Melbourne, VIC 3086, Australia...

MedWorm Sponsor Message: Find the best January Sales in the UK.

Donor-site-related functional problems following anterior cruciate ligament reconstruction: development of a self-administered questionnaire

Knee Surgery, Sports Traumatology, Arthroscopy — Sat, 10 Dec 2011 16:54:41 +0100

Conclusions The questionnaire “Donor-site-Related Functional Problems following Anterior Cruciate Ligament (ACL) Reconstruction” is a patient-reported questionnaire with high content validity and reliability for the evaluation of donor-site-related functional problems after ACL reconstruction, with autograft harvested from the hamstring tendon or patellar tendon. The results of this study support the use of this questionnaire as a standardized outcome measure for both research purposes and in clinical settings. Content Type Journal ArticleCategory KneePages 1-11DOI 10.1007/s00167-011-1812-6Authors Susanna Aufwerber, Department of Physical Therapy, Karolinska University Hospital, 171 76 Stockholm, SwedenMaria Hagströmer, Division of Physiotherapy, Department of...

Prospective evaluation of patients with anterior cruciate ligament reconstruction using a patient-based health-related survey: comparison of single-bundle and anatomical double-bundle techniques

Archives of Orthopaedic and Trauma Surgery — Thu, 08 Dec 2011 18:21:49 +0100

Discussion Although good clinical results have been reported for double-bundle ACL reconstruction, some studies reported no clear difference compared to the conventional single-bundle technique. In the present study, significant improvements were achieved after operation in both groups, confirming the usefulness of both techniques. No clear merit of one method over the other was found, not only from the conventional objective assessments but also from the patient-based subjective evaluation. Content Type Journal ArticleCategory Arthroscopy and Sports MedicinePages 1-6DOI 10.1007/s00402-011-1443-xAuthors Satoshi Ochiai, The Sports Medicine and Knee Center, National Hospital Organization, Kofu National Hospital, 11-35 Tenjin-cho, Kofu, Yamanashi, 400-8533 JapanTetsuo...

A CT-based classification of prior ACL femoral tunnel location for planning revision ACL surgery

Knee Surgery, Sports Traumatology, Arthroscopy — Wed, 07 Dec 2011 10:48:51 +0100

Conclusion Classification of the location of ACL femoral tunnels utilizing 3-D reconstructions of CT data yields moderate to substantial inter- and intra-observer reliability. Level of evidence Diagnostic Level III. Content Type Journal ArticleCategory KneePages 1-9DOI 10.1007/s00167-011-1814-4Authors Robert A. Magnussen, Department of Orthopaedic Surgery, The Ohio State University School of Medicine, 2050 Kenny Road, Columbus, OH 45631, USAPedro Debieux, Department of Orthopaedics and Traumatology, Universidade Federal de São Paulo, São Paulo, BrazilBiju Benjamin, Department of Orthopaedic Surgery, Ministry of Health, Bandar Seri Begawan, BruneiSébastien Lustig, Department of Orthopaedic Surgery, Hôpital de la Croix-Rousse, Centre Albert Trilla...

Human mesenchymal stem cells in synovial fluid increase in the knee with degenerated cartilage and osteoarthritis

Journal of Orthopaedic Research — Tue, 06 Dec 2011 05:00:00 +0100

AbstractWe investigated whether mesenchymal stem cells (MSCs) in synovial fluid (SF) increased in the knee with degenerated cartilage and osteoarthritis. SF was obtained from the knee joints of 22 patients with anterior cruciate ligament (ACL) injury during ACL reconstruction, and cartilage degeneration was evaluated arthroscopically. SF was also obtained from the knee joints of 6 healthy volunteers, 20 patients with mild osteoarthritis, and 26 patients with severe osteoarthritis, in which the grading was evaluated radiographically. The cell component in the SF was cultured for analyses. Synovium (SYN) and bone marrow (BM) were also harvested during total knee arthroplasties. The MSC number in SF was correlated with the cartilage degeneration score evaluated by arthroscopy. The MSC number ...

Accelerated Versus Nonaccelerated Rehabilitation After Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized, Double-Blind Investigation Evaluating Knee Joint Laxity Using Roentgen Stereophotogrammetric Analysis

The American Journal of Sports Medicine — Tue, 06 Dec 2011 05:00:00 +0100

Conclusion: Rehabilitation with the accelerated and nonaccelerated programs administered in this study produced the same increase in the envelope of knee laxity. A majority of the increase in the envelope of knee laxity occurred during healing when exercises were advanced and activity level increased. Patients in both programs had the same clinical assessment, functional performance, proprioception, and thigh muscle strength, which returned to normal levels after healing was complete. For participants in both treatment programs, the Knee Injury and Osteoarthritis Outcome Score (KOOS) assessment of quality of life did not return to preinjury levels. (Source: The American Journal of Sports Medicine)

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Degeneration of the Knee Joint in Skeletally Immature Patients With a Diagnosis of an Anterior Cruciate Ligament Tear: Is There Harm in Delay of Treatment?

The American Journal of Sports Medicine — Tue, 06 Dec 2011 05:00:00 +0100

Conclusion: Young patients who underwent surgical reconstruction of an acute ACL tear >12 weeks after the injury were noted to have a significant increase in irreparable medial meniscal tears and lateral compartment chondral injuries at the time of reconstruction. When a subjective sense of knee instability was present, this association was even stronger. (Source: The American Journal of Sports Medicine)

Predictors of Radiographic Knee Osteoarthritis After Anterior Cruciate Ligament Reconstruction

The American Journal of Sports Medicine — Tue, 06 Dec 2011 05:00:00 +0100

Conclusion: Despite reduced laxity and instability and improved activity and participation, individuals who have undergone ACL reconstruction are still at high risk for developing knee OA compared with the general population. The strongest predictors of knee OA after ACL reconstruction were obesity and grade 2 or greater chondrosis in the medial compartment. These results may aid in identifying patients at risk for OA after ACL reconstruction. (Source: The American Journal of Sports Medicine)

Biomechanical Evaluation of Knee Joint Laxities and Graft Forces After Anterior Cruciate Ligament Reconstruction by Anteromedial Portal, Outside-In, and Transtibial Techniques

The American Journal of Sports Medicine — Tue, 06 Dec 2011 05:00:00 +0100

Conclusion: Anterior cruciate ligament reconstructions by AM portal, OI, and modified TT techniques are biomechanically comparable with each other in restoring normal knee joint laxity and in situ ACL forces. Clinical Relevance: Anterior cruciate ligament reconstructions by AM portal, OI, and modified TT techniques result in similar knee joint laxities. Technical perils and pearls should be carefully considered before choosing a tunnel creating technique. (Source: The American Journal of Sports Medicine)

A Simple Evaluation of Anterior Cruciate Ligament Femoral Tunnel Position: The Inclination Angle and Femoral Tunnel Angle

The American Journal of Sports Medicine — Tue, 06 Dec 2011 05:00:00 +0100

Conclusion: Femoral tunnel angle and inclination angle can be reliably determined from both posterior-to-anterior radiographs and sagittal MRI and provide a useful metric for characterizing femoral tunnel position. (Source: The American Journal of Sports Medicine)

Factors Used to Determine Return to Unrestricted Sports Activities After Anterior Cruciate Ligament Reconstruction

Arthroscopy — Thu, 01 Dec 2011 05:00:00 +0100

Conclusions: The results of this systematic review show noteworthy problems and a lack of objective assessment before release to unrestricted sports activities. General recommendations are made for quantification of muscle strength, stability, neuromuscular control, and function in patients who desire to return to athletics after ACL reconstruction, with acknowledgment of the need for continued research in this area.Level of Evidence: Level IV, systematic review of Level I to IV studies. (Source: Arthroscopy)

MedWorm Sponsor Message: Find the best January Sales in the UK.

Staged arthroscopic reconstructive surgery for multiple ligament injuries of the knee.

Journal of Orthopaedic Surgery — Thu, 01 Dec 2011 05:00:00 +0100

CONCLUSION. Staged management of multiple ligament injuries of the knee enabled satisfactory restoration of function, stability, and range of movement in most of our patients. By staging the procedures, the need for subsequent ACL reconstruction can be better evaluated, as ACL reconstruction is not necessary in patients not undertaking strenuous activities. PMID: 22184158 [PubMed - in process] (Source: Journal of Orthopaedic Surgery)

Displaced tibial intercondylar eminence fractures.

Journal of Orthopaedic Surgery — Thu, 01 Dec 2011 05:00:00 +0100

CONCLUSION. Tibial eminence fractures are as common in adults as in children. Female skiers are at higher risk. Stiffness is a more common complication than laxity. Early range-of-motion exercise may reduce stiffness and extension impingement. PMID: 22184157 [PubMed - in process] (Source: Journal of Orthopaedic Surgery)

Effectiveness of electrical stimulation on rehabilitation after ligament and meniscal injuries: a systematic review.

Sao Paulo Medical Journal — Thu, 01 Dec 2011 05:00:00 +0100

CONCLUSION: There is evidence that ES coupled with conventional rehabilitation exercises may be effective in improving muscle strength and function two months after surgery. PMID: 22249798 [PubMed - in process] (Source: Sao Paulo Medical Journal)

Static and dynamic postural control in competitive athletes after anterior cruciate ligament reconstruction and controls

Knee Surgery, Sports Traumatology, Arthroscopy — Mon, 28 Nov 2011 16:56:36 +0100

Conclusions Static and dynamic postural measures are reliable tests to evaluate functional performance of athletes following ACL reconstruction. Eight months postsurgery, competitive athletes still demonstrated postural asymmetries, compared to matched controls, which might result in their susceptibility to future ACL injury. Level of evidence Prognostic study, case-control, Level III. Content Type Journal ArticleCategory KneePages 1-8DOI 10.1007/s00167-011-1806-4Authors Farshid Mohammadi, Department of Physical Therapy, University of Social Welfare and Rehabilitation Sciences, Koodakyar St, Daneshjou Blvd, Evin, Tehran, IranMahyar Salavati, Department of Physical Therapy, University of Social Welfare and Rehabilitation Sciences, Koodakyar St, Dane...

Treatment of Combined Complete Tears of the Anterior Cruciate and Medial Collateral Ligaments

Arthroscopy — Mon, 28 Nov 2011 05:00:00 +0100

Conclusions: ACL reconstruction should be performed in a subacute time frame once full motion has returned. Valgus instability should be assessed at that time and MCL repair or reconstruction performed in those patients with persistent valgus instability. Level of Evidence: Level IV, systematic review of Level I to IV studies. (Source: Arthroscopy)

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Comparison of femoral graft bending angle and tunnel length between transtibial technique and transportal technique in anterior cruciate ligament reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy — Sat, 26 Nov 2011 16:47:25 +0100

Conclusions The femoral graft bending angle and the femoral tunnel length of the TP technique performed in the maximally flexed knee position was more acute and shorter than those of the TT technique after ACL reconstruction. This might increase the bending stress at the femoral tunnel aperture and shorter graft length in the tunnel after an ACL reconstruction using TP technique compared to the TT technique. Level of evidence III. Content Type Journal ArticleCategory KneePages 1-10DOI 10.1007/s00167-011-1781-9Authors Joon Ho Wang, Department of Orthopaedic Surgery, School of Medicine, Sungkyunkwan University, Samsung Medical Center, Seoul, South KoreaJae Gyoon Kim, Department of Orthopedic Surgery, College of Medicine, Korea University, Guro Hospi...

Prediction of semitendinosus and gracilis autograft sizes for ACL reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy — Thu, 24 Nov 2011 17:52:14 +0100

Conclusion Cross-sectional areas of the hamstring tendons in MR images can be used to estimate the sizes of hamstring grafts prior to anterior cruciate ligament reconstruction surgery which may be very helpful to predict possible graft insufficiencies and take precautions if needed. Level of evidence Level IV. Content Type Journal ArticleCategory KneePages 1-5DOI 10.1007/s00167-011-1770-zAuthors Tahsin Beyzadeoglu, Department of Orthopedics and Traumatology, Yeditepe University School of Medicine, Istanbul, TurkeyUmut Akgun, Department of Orthopedics and Traumatology, Acibadem University School of Medicine, Istanbul, TurkeyNeslihan Tasdelen, Department of Radiology, Yeditepe University School of Medicine, Istanbul, TurkeyMustafa Karahan, Department...

The comparison of intraarticular morphine–bupivacaine and tramadol–bupivacaine in postoperative analgesia after arthroscopic anterior cruciate ligament reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy — Wed, 23 Nov 2011 17:36:33 +0100

Conclusions Intraarticular morphine–bupivacaine provides effective pain relief, longer analgesic duration, less analgesic requirement, shorter unassisted ambulation and discharge time were compared with intraarticular tramadol–bupivacaine after ACL reconstruction arthroscopy. Level of evidence I. Content Type Journal ArticleCategory KneePages 1-6DOI 10.1007/s00167-011-1791-7Authors Habibollah Hosseini, Department of Anesthesiology, Shahid Sadoughi University of Medical Sciences, Yazd, IranSeyyed Mohammad Jalil Abrisham, Department of Orthopedics, Shahid Sadoughi University of Medical Sciences, Shahid Sadoughi Hospital, Ebne Sina Blvd, Shahid Ghandi Blvd, Safaeeie, Yazd, IranHossein Jomeh, Department of Anesthesiology, Shahid Sadoughi University...

Functional and muscle morphometric effects of ACL reconstruction. A prospective CT study with 1 year follow‐up

Scandinavian Journal of Medicine and Science in Sports — Wed, 23 Nov 2011 05:00:00 +0100

Computed tomography (CT) was used to explore if changes in muscle cross‐sectional area and quality after anterior cruciate ligament (ACL) injury and reconstruction would be related to knee function. Fourteen females and 23 males (16–54 years) underwent clinical tests, subjective questionnaires, and CT 1 week before and 1 year after ACL surgery with semitendinosus‐gracilis (STG) graft and rehabilitation. Postoperatively, knee laxity was decreased and functional knee measures and subjective patient scores improved. The most obvious remaining deficit was the quadriceps atrophy, which was significantly larger if the right leg was injured. Right‐leg injury also tended to cause larger compensatory hypertrophy of the combined knee flexor and tibial internal rotator muscles (preopera...

Fast track surgery for anterior cruciate ligament reconstruction in military patients in Scotland.

British Journal of Sports Medicine — Tue, 22 Nov 2011 00:44:27 +0100

Authors: Howes J, Wood AM, Bell DJ, Wrigley S, Angus C Abstract Military patients sustaining an Anterior Cruciate Ligament (ACL) injury are normally listed for "Fast-Track" surgery as the criterion for this is that they are likely to be fully fit for military employment within 12 months. All military patients in Scotland requiring ACL reconstruction should be referred through the Edinburgh Regional Rehabilitation Unit (ERRU) covering a population of 13 772 servicemen. All patients referred to ERRU over a 35 month period requiring ACL reconstruction were retrospectively followed for a minimum of 6 months post referral, with injuries and subsequent employment fitness recorded. 35 patients required "Fast Track" ACL reconstruction giving an incidence of 8.47/10 000/year. 30 patients (8...

MedWorm Sponsor Message: Find the best January Sales in the UK.

Revision ACL reconstruction - causes of failure and graft choices.

British Journal of Sports Medicine — Tue, 22 Nov 2011 00:44:07 +0100

This study looked at the aetiology of primary ACL graft failure and choices of graft used for primary and revision surgery. Prospective data was collected for 98 patients undergoing revision ACL reconstruction between 1996 and 2010 under the care of a single knee surgeon, including demographic details, type of graft used in primary and revision ACL reconstruction and possible cause of failure of the primary ACL reconstruction. The mean age was 31 y (range 13-50 y), with 69 males (70%) and 29 females (30%). 24 patients (27%) were involved in sports and the most common sport played was football (n =10, 42%). The most common graft used for primary ACL reconstruction was hamstring tendon in 39 patients (54%) followed by patella tendon in 20 patients (28%). The commonest reason for graft failur...

Development of a mechanical 'pivot shift' knee stability test.

British Journal of Sports Medicine — Tue, 22 Nov 2011 00:43:26 +0100

Authors: Sena MP, Coughlin D, Dellamaggiora R, Lotz JC, Feeley BT Abstract Anterior cruciate ligament (ACL) injuries are common in sports, with 135 000 ACL tears leading to over 95 000 annual reconstructions in the US. The manual 'pivot shift' test is the most specific clinical examination for diagnosis of ACL injuries. The presence of a 'pivot' (anterior/internal tibial subluxation followed by a rapid reduction or 'clunk') postoperatively correlates with poor patient outcome. Unfortunately, the pivot shift is semi-quantitative and difficult to perform reproducibly. We developed a mechanical pivot shift device (MPSD) that mimics this test through the application of standardised dynamic loads. Manual and mechanised pivot shift tests were performed on right and left cadaveric knees (...

Knee skin strength and hyperlaxity in athletes undergoing ACL reconstruction.

British Journal of Sports Medicine — Tue, 22 Nov 2011 00:42:52 +0100

Authors: Akhtar MA, Keating JF, Muir AY, Simpson H Abstract Anterior cruciate ligament (ACL) injuries are common in athletic population. Hyperlaxity is thought to be a risk factor for ACL injuries and results in stretched scar following surgery. The aim of our study was to investigate the relationship between the strength of the knee skin and hyperlaxity assessed by the Beighton score. Prospective data was collected for 13 patients undergoing primary ACL reconstruction using quadruple hamstring tendon as a graft, including demographic details, mechanism of injury and hyperlaxity. Clinical examination was used to assess hyperlaxity using the Beighton score. Laxity is scored on a 0-9 scale. Scores of 4 or above are indicative of hyperlaxity. We studied 20 specimens of knee skin from ...

Surgery for anterior cruciate ligament deficiency: a historical perspective

Knee Surgery, Sports Traumatology, Arthroscopy — Mon, 21 Nov 2011 18:04:37 +0100

Abstract The anterior cruciate ligament (ACL) has entertained scientific minds since the Weber brothers provided biomechanical insight into the importance of the ACL in maintaining normal knee kinematics. Robert Adams described the first clinical case of ACL rupture in 1837 some 175 years to date, followed by Mayo-Robson of Leeds who performed the first ACL repair in 1895. At that time, most patients presented late and clinicians started to appreciate signs and symptoms and disabilities associated with such injuries. Hey Groves of Bristol provided the initial description of an ACL reconstruction with autologous tissue graft in 1917, almost as we know it today. His knowledge and achievements were, however, not uniformly appreciated during his life time. What followed w...

Variations in the three‐dimensional location and orientation of the ACL in healthy subjects relative to patients after transtibial ACL reconstruction

Journal of Orthopaedic Research — Mon, 21 Nov 2011 05:00:00 +0100

The objective of this study was to address a need for a better understanding of anatomical variations in ACL position and orientation within the joint. Specifically, variations in the ACL anatomy were assessed by testing for side‐to‐side ACL footprint location symmetry in a healthy population relative to the operative and contralateral knee in a patient population after traditional transtibial single‐bundle ACL reconstruction. MRI and three‐dimensional modeling techniques were used to determine the in vivo tibiofemoral ACL footprint centers and the resulting ACL orientations in both knees of 30 healthy subjects and 30 subjects after transtibial ACL reconstruction. While there were substantial inter‐subject variations in ACL anatomy, the side‐to‐side RMS differences in the ACL...

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Revision ACL reconstruction: influence of a lateral tenodesis

Knee Surgery, Sports Traumatology, Arthroscopy — Sat, 19 Nov 2011 16:51:07 +0100

Conclusion This study shows a significant improvement in the IKDC score after revision ACL reconstruction. The association of a lateral extra-articular tenodesis with the intra-articular graft increases knee stability after revision ACL reconstruction; however, this additional procedure does not significantly alter the IKDC score at follow-up. Level of evidence Retrospective case series, Level IV. Content Type Journal ArticleCategory KneePages 1-6DOI 10.1007/s00167-011-1765-9Authors Christophe Trojani, Department of Orthopaedic Surgery and Sports Traumatology, Service de Chirurgie Orthopédique, L’Archet 2 Hospital, 151 route de St Antoine de Ginestière, 06200 Nice, FrancePhilippe Beaufils, Hôpital A. Mignot, 78157 Le Chesnay Cedex, FranceGille...

Reconstruction versus conservative treatment after rupture of the anterior cruciate ligament: cost effectiveness analysis

BMC Health Services Research — Sat, 19 Nov 2011 05:00:00 +0100

Conclusion: ACL reconstruction for reestablishment of knee stability seems cost effective in the Swiss setting based on currently available evidence. This, however, should be reinforced with randomized controlled trials comparing the two treatment strategies. (Source: BMC Health Services Research)

TransLateral ACL reconstruction: a technique for anatomic anterior cruciate ligament reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy — Fri, 18 Nov 2011 06:56:38 +0100

Abstract Anatomic placement of the femoral tunnel in anterior cruciate ligament (ACL) reconstruction confers biomechanical advantages over the traditional tunnel position. The anteromedial portal technique for anatomic ACL reconstruction has many well-described technical challenges. This paper describes the TransLateral technique. The technique produces anatomic femoral tunnel placement using direct measurement of the medial wall of the lateral femoral condyle and out to in drilling. All work is carried out through the lateral portal with all viewing via the medial portal. There is no need for an accessory medial portal or hyperflexion of the knee. Level of evidence Expert opinion, Level V. Content Type Journal ArticleCategory KneePages 1-4DOI 10.1007/s00167-0...

[Treatment costs for anterior cruciate ligament reconstruction : Procedure related cost analysis in an university hospital.]

Der Unfallchirurg — Fri, 18 Nov 2011 05:00:00 +0100

CONCLUSION: Performing the double bundle technique for ACL reconstruction in a university hospital setting, significant cost reductions are needed to achieve the revenue generated by the single bundle technique. Additional changes of the relative weighting in the DRG are also necessary. PMID: 22101778 [PubMed - as supplied by publisher] (Source: Der Unfallchirurg)

Complications In Brief: Anterior Cruciate Ligament Reconstruction.

Clinical Orthopaedics and Related Research — Wed, 16 Nov 2011 05:00:00 +0100

Authors: Tjoumakaris FP, Herz-Brown AL, Legath-Bowers A, Sennett BJ, Bernstein J Abstract When performing reconstruction of the ACL, the major complications that can arise include missed concomitant injuries, tunnel malposition, patellar fracture, knee stiffness, and infection. We review the complications that can occur as a result of errors made before, during, and after surgery. PMID: 22086506 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)

MedWorm Sponsor Message: Find the best January Sales in the UK.

Correlation Between Anterior Cruciate Ligament Graft Obliquity and Tibial Rotation During Dynamic Pivoting Activities in Patients With Anatomic Anterior Cruciate Ligament Reconstruction: An In Vivo Examination

Arthroscopy — Mon, 14 Nov 2011 05:00:00 +0100

Conclusions: After ACL reconstruction with a BPTB graft, patients' knees showed higher TR values than their uninjured knees and the knees of uninjured control volunteers during dynamic pivoting activities. The findings of this study show that TR was better restored in ACL-reconstructed patients with a more oblique graft in the coronal plane. A similar relation was not observed for graft orientation in the sagittal plane. Although these data do not imply a cause-and-effect relation between the 2 variables, they may indicate that a more oblique placement of a single BPTB ACL graft in the coronal plane is correlated with better control of TR. Level of Evidence: Level IV, case series. (Source: Arthroscopy)

Posterior root tear fixation of the lateral meniscus combined with arthroscopic ACL double-bundle reconstruction: technical note of a transosseous fixation using the tibial PL tunnel

Archives of Orthopaedic and Trauma Surgery — Sat, 12 Nov 2011 16:52:30 +0100

This article presents an arthroscopical technique to reattach the posterior meniscus root in combination with ACL double-bundle reconstruction. The procedure uses the tibial PL tunnel to fix the meniscus suture. Content Type Journal ArticleCategory Arthroscopy and Sports MedicinePages 1-5DOI 10.1007/s00402-011-1429-8Authors Philipp Forkel, Clinic for Orthopaedic and Trauma Surgery, Martin Luther Hospital, Caspar-Theyß-Str. 27-31, 14193 Berlin, GermanyWolf Petersen, Clinic for Orthopaedic and Trauma Surgery, Martin Luther Hospital, Caspar-Theyß-Str. 27-31, 14193 Berlin, Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051 (Source: Archives of Orthopaedic and Trauma Surgery)

Treatment of Meniscus Tears During Anterior Cruciate Ligament Reconstruction

Arthroscopy — Fri, 11 Nov 2011 05:00:00 +0100

Conclusions: Meniscectomy is performed 2 to 3 times more frequently than meniscus repair during ACL reconstruction. We were unable to analyze the effect of the location and type of meniscus tear, sex, age, or chronicity of injury on the treatment of meniscus tears. The number of potentially repairable meniscus tears that were treated by resection could not be identified. Clinical Relevance: This study found that meniscectomy was performed in 65% of meniscus tears. This is concerning because studies have shown that, regardless of knee stability obtained after ACL reconstruction, meniscectomy accelerates degenerative joint changes. Level of Evidence: Level IV, systematic review of Level I to IV studies. (Source: Arthroscopy)

Management of anterior cruciate ligament rupture in patients aged 40 years and older

Journal of Orthopaedics and Traumatology — Thu, 10 Nov 2011 16:51:41 +0100

Abstract The aim of anterior cruciate ligament (ACL) reconstruction is essentially to restore functional stability of the knee and to allow patients to return to their desired work and activities. While in the young and active population, surgery is often the best therapeutic option after an ACL tear, ACL reconstruction in middle-aged people is rather more controversial due to concerns about a higher complication rate. The purpose of our article is to establish, through a systematic review of the literature, useful decision-making criteria for the management of anterior cruciate ligament rupture in patients aged 40 years and older, guiding surgeons to the most appropriate therapeutic approach. Various reports have shown excellent results of ACL reconstruction in patie...

Fast track surgery for anterior cruciate ligament reconstruction in military patients in Scotland

British Journal of Sports Medicine — Thu, 10 Nov 2011 05:00:00 +0100

Military patients sustaining an Anterior Cruciate Ligament (ACL) injury are normally listed for "Fast-Track" surgery as the criterion for this is that they are likely to be fully fit for military employment within 12 months. All military patients in Scotland requiring ACL reconstruction should be referred through the Edinburgh Regional Rehabilitation Unit (ERRU) covering a population of 13 772 servicemen. All patients referred to ERRU over a 35 month period requiring ACL reconstruction were retrospectively followed for a minimum of 6 months post referral, with injuries and subsequent employment fitness recorded. 35 patients required "Fast Track" ACL reconstruction giving an incidence of 8.47/10 000/year. 30 patients (86%) had associated ipsilateral knee pathology: 15 (43%) had an associate...

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Revision ACL reconstruction - causes of failure and graft choices

British Journal of Sports Medicine — Thu, 10 Nov 2011 05:00:00 +0100

This study looked at the aetiology of primary ACL graft failure and choices of graft used for primary and revision surgery. Prospective data was collected for 98 patients undergoing revision ACL reconstruction between 1996 and 2010 under the care of a single knee surgeon, including demographic details, type of graft used in primary and revision ACL reconstruction and possible cause of failure of the primary ACL reconstruction. The mean age was 31 y (range 13–50 y), with 69 males (70%) and 29 females (30%). 24 patients (27%) were involved in sports and the most common sport played was football (n =10, 42%). The most common graft used for primary ACL reconstruction was hamstring tendon in 39 patients (54%) followed by patella tendon in 20 patients (28%). The commonest reason for graft ...

Development of a mechanical 'pivot shift' knee stability test

British Journal of Sports Medicine — Thu, 10 Nov 2011 05:00:00 +0100

Anterior cruciate ligament (ACL) injuries are common in sports, with 135 000 ACL tears leading to over 95 000 annual reconstructions in the US. The manual ‘pivot shift' test is the most specific clinical examination for diagnosis of ACL injuries. The presence of a ‘pivot' (anterior/internal tibial subluxation followed by a rapid reduction or ‘clunk') postoperatively correlates with poor patient outcome. Unfortunately, the pivot shift is semi-quantitative and difficult to perform reproducibly. We developed a mechanical pivot shift device (MPSD) that mimics this test through the application of standardised dynamic loads. Manual and mechanised pivot shift tests were performed on right and left cadaveric knees (n=4) in intact and ACL-deficient states. The resultant tibiofemor...

Knee skin strength and hyperlaxity in athletes undergoing ACL reconstruction

British Journal of Sports Medicine — Thu, 10 Nov 2011 05:00:00 +0100

Anterior cruciate ligament (ACL) injuries are common in athletic population. Hyperlaxity is thought to be a risk factor for ACL injuries and results in stretched scar following surgery. The aim of our study was to investigate the relationship between the strength of the knee skin and hyperlaxity assessed by the Beighton score. Prospective data was collected for 13 patients undergoing primary ACL reconstruction using quadruple hamstring tendon as a graft, including demographic details, mechanism of injury and hyperlaxity. Clinical examination was used to assess hyperlaxity using the Beighton score. Laxity is scored on a 0–9 scale. Scores of 4 or above are indicative of hyperlaxity. We studied 20 specimens of knee skin from 13 patients between Nov 2008 and July 2009. These specimens we...

Effect of genu recurvatum on the anterior cruciate ligament-deficient knee during gait

Knee Surgery, Sports Traumatology, Arthroscopy — Wed, 09 Nov 2011 07:03:22 +0100

Conclusions This study provides clinically relevant information regarding the effects of genu recurvatum on gait parameters. The results suggest that in ACL injuries, the presence of genu recurvatum alters gait pattern. Consideration of the presence of genu recurvatum would be useful during rehabilitation following ACL injuries or ACL reconstruction. Level of evidence II. Prospective comparative study. Content Type Journal ArticleCategory KneePages 1-9DOI 10.1007/s00167-011-1701-zAuthors Katsuhiro Kawahara, Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692 JapanTomohisa Sekimoto, Division of Orthopaedic Surgery, Department of Me...

Patients with focal full-thickness cartilage lesions benefit less from ACL reconstruction at 2–5 years follow-up

Knee Surgery, Sports Traumatology, Arthroscopy — Mon, 07 Nov 2011 17:13:48 +0100

Conclusions ACL-injured patients with full-thickness cartilage lesions reported worse outcomes and less improvement after ACL reconstruction than those without cartilage lesions at 2–5 years follow-up. Level of evidence Prognostic; prospective cohort study, Level I. Content Type Journal ArticleCategory KneePages 1-7DOI 10.1007/s00167-011-1739-yAuthors Jan Harald Røtterud, Department of Orthopedic Surgery, Akershus University Hospital and Institute of Clinical Medicine, Akershus University Hospital, University of Oslo, 1478 Lørenskog, NorwayMay Arna Risberg, Norwegian Research Center for Active Rehabilitation (NAR), Norwegian School of Sport Sciences, Hjelp24NIMI and Department of Orthopedics, Oslo University Hospital, Oslo, NorwayLars Engeb...

MedWorm Sponsor Message: Find the best January Sales in the UK.

Over-the-top double-bundle revision ACL reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy — Sat, 05 Nov 2011 17:09:32 +0100

Abstract Revision ACL presents many technical issues that are not seen in the primary ACL reconstruction. A variety of surgical techniques for revising ACL reconstruction have been described in the literature to address these concerns. The purpose of this article is to present a novel technique consisting in a non-anatomic double-bundle ACL revision reconstruction, using a fresh-frozen Achilles tendon allograft with soft tissue fixation. This technique is a valid treatment option when faced with a complex scenario such as ACL revision surgery. Content Type Journal ArticleCategory Technical NotePages 1-5DOI 10.1007/s00167-011-1753-0Authors Maurilio Marcacci, Third Orthopaedic and Traumatology Clinic and Biomechanics Laboratory, Codivilla-Putti Research Center, Istituto...

Anteromedial versus central single-bundle graft position: which anatomic graft position to choose?

Knee Surgery, Sports Traumatology, Arthroscopy — Fri, 04 Nov 2011 16:54:06 +0100

Conclusions It has been shown that there was no difference in the time-zero biomechanical stability between an anatomic anteromedial and anatomic central single-bundle ACL reconstruction. Given the current debate on the best anatomic ACL reconstruction technique, anatomic socket position in either the anteromedial or central locations provides similar time-zero biomechanics. Content Type Journal ArticleCategory KneePages 1-6DOI 10.1007/s00167-011-1737-0Authors Michael B. Cross, Computer Assisted Surgery Laboratory, Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USAVolker Musahl, Department of Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USAAsheesh Bedi, Department of Sports Medicine, University of Michigan, Ann Arbor, ...

Factors affecting anterior knee pain following anatomic double-bundle anterior cruciate ligament reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy — Fri, 04 Nov 2011 16:54:05 +0100

Conclusions Knee extension deficit was an important predisposing factor for postoperative anterior knee pain in the early postoperative period, and anterior knee pain was associated with impaired quadriceps function and inferior subjective results over 2 years postoperatively. Early recovery of full extension may prevent postoperative development of anterior knee pain and achieve successful outcomes for ACL reconstruction. Level of evidence Retrospective comparative study, Level III. Content Type Journal ArticleCategory KneePages 1-7DOI 10.1007/s00167-011-1746-zAuthors Yasuo Niki, Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, JapanAkihiro Hakozaki, Department of Orthopaedic Surgery, Keio Univer...

Femoral tunnel-interference screw divergence in anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft: Additional concerns

Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1) — Fri, 04 Nov 2011 04:00:00 +0100

Dhananjaya Sabat, Sumit AroraIndian Journal of Orthopaedics 2011 45(6):583-584 (Source: Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1))

Femoral tunnel-interference screw divergence in anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft: A comparison of two techniques

Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1) — Fri, 04 Nov 2011 04:00:00 +0100

Dhananjaya Sabat, Sumit AroraIndian Journal of Orthopaedics 2011 45(6):583-584 (Source: Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1))

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Bone-patellar tendon-bone autograft versus hamstring autograft anterior cruciate ligament reconstruction in the young athlete: a retrospective matched analysis with 2–10 year follow-up

Knee Surgery, Sports Traumatology, Arthroscopy — Wed, 02 Nov 2011 16:58:10 +0100

Conclusions Hamstring and bone-patellar tendon-bone autografts allow approximately 70% of young athletes to return to some degree of strenuous or very strenuous sporting activity, while only approximately half of patients were able to return to their pre-injury sporting activity level. Hamstring grafts lead to better preservation of extension, higher patient-reported outcome scores, and less radiographic evidence of osteoarthritis. Level of evidence Therapeutic (case–control study) Level III. Content Type Journal ArticleCategory KneePages 1-8DOI 10.1007/s00167-011-1735-2Authors Randy Mascarenhas, Section of Orthopaedic Surgery, University of Manitoba, AD4-820 Sherbrook Street, Winnipeg, MB R3A 1R9, CanadaMichael J. Tranovich, Lake Erie College o...

Anterior cruciate ligament rupture in gouty arthritis

Knee Surgery, Sports Traumatology, Arthroscopy — Wed, 02 Nov 2011 16:58:07 +0100

Abstract A 34-year-old male presented with right knee instability without any trauma. He had been diagnosed with right knee gouty arthritis 2 years prior. An arthroscopic examination revealed abundant calcific material deposited around the knee joint, including in the ACL tissue, and that the ACL was torn at the femoral attachment site. Treatment involved a synovectomy to remove calcific material, followed by an ACL reconstruction. Histology evaluation revealed gouty arthritis with the presence of tophi in the synovium, soft tissue, and ACL tissue. The case presented here indicates the possibility of pathologic rupture of the ACL associated with gouty tophus infiltration of that ligament. Level of evidence IV. Content Type Journal ArticleCategory KneePage...

Does physiologic posterolateral laxity influence clinical outcomes of anterior cruciate ligament reconstruction?

The Journal of Bone and Joint Surgery. American volume — Wed, 02 Nov 2011 04:00:00 +0100

Conclusions:The stability and functional scores after ACL reconstruction had a negative correlation with the degree of external rotation of the tibia at 90° (physiologic posterolateral rotatory laxity). After ACL reconstruction, patients with ≥50° of tibial external rotation had increased anterior translation and worse functional outcomes in comparison with those who had <50° of tibial external rotation.Level of Evidence:Prognostic Level II. Retrospective comparative study. See Instructions for Authors for a complete description of levels of evidence. PMID: 22048096 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

Low Vitamin D Impairs Strength Recovery After Anterior Cruciate Ligament Surgery

Complementary Health Practice Review — Wed, 02 Nov 2011 04:00:00 +0100

The purpose of this study was to identify strength gains after an anterior cruciate ligament injury and surgery and during inflammatory challenge in participants with disparate vitamin D levels. Plasma samples were obtained from those who had not previously experienced an anterior cruciate ligament injury and from injured patients 2 weeks before and 3 months after anterior cruciate ligament surgery. Plasma 25-hydroxyvitamin D and cytokine concentrations were measured in each blood sample. Single-leg peak isometric forces were measured 2 weeks presurgery and 3 months postsurgery. Compared with noninjured participants, inflammatory cytokines were elevated prior to and following anterior cruciate ligament reconstruction. During this inflammatory challenge, the peak isometric force increases a...

Extra-articular techniques in anterior cruciate ligament reconstruction: a literature review.

The Journal of Bone and Joint Surgery. British volume — Tue, 01 Nov 2011 04:00:00 +0100

Authors: Dodds AL, Gupte CM, Neyret P, Williams AM, Amis AA Abstract This annotation considers the place of extra-articular reconstruction in the treatment of anterior cruciate ligament (ACL) deficiency. Extra-articular reconstruction has been employed over the last century to address ACL deficiency. However, the technique has not gained favour, primarily due to residual instability and the subsequent development of degenerative changes in the lateral compartment of the knee. Thus intra-articular reconstruction has become the technique of choice. However, intra-articular reconstruction does not restore normal knee kinematics. Some authors have recommended extra-articular reconstruction in conjunction with an intra-articular technique. The anatomy and biomechanics of the anterolater...

MedWorm Sponsor Message: Find the best January Sales in the UK.

Mechanical stability of the femoral fixation for single‐ and double‐bundle ACL reconstruction in an in vitro experimental model

Scandinavian Journal of Medicine and Science in Sports — Sun, 30 Oct 2011 04:00:00 +0100

Anterior cruciate ligament ACL reconstruction using the double‐bundle (DB) technique is gaining popularity. A possible weak link in the DB technique could be that two tendon grafts of smaller diameters are used. The purpose of this study was to test different femoral fixation methods and graft diameters representing single‐bundle (SB) and DBACL reconstructions and compare their biomechanical properties. We hypothesized that SB 6‐mm graft constructs had inferior biomechanical properties than SB 9‐mm grafts or DB 2 × 6‐mm grafts. Furthermore, we hypothesized that interference (IF) screw fixation would demonstrate less elongation and a higher stiffness than Endobutton (Smith & Nephew®, Inc., Andover, Massachusetts, USA) fixation (EBF). We performed an in vitro study using ...

Single-Legged Hop Tests as Predictors of Self-Reported Knee Function in Nonoperatively Treated Individuals With Anterior Cruciate Ligament Injury

The American Journal of Sports Medicine — Fri, 28 Oct 2011 04:00:00 +0100

Conclusion: The single hop for distance (LSI) significantly predicted self-reported knee function after 1 year in nonoperatively treated ACL-injured patients. Combinations of 2 single-legged hop tests did not lead to higher discriminative accuracy than the single hop alone. (Source: The American Journal of Sports Medicine)

Prevalence of Septic Arthritis After Anterior Cruciate Ligament Reconstruction Among Professional Athletes

The American Journal of Sports Medicine — Fri, 28 Oct 2011 04:00:00 +0100

Conclusion: Participation in professional sports and having a combined lateral tenodesis are risk factors for the development of infection after ACL reconstruction. We hypothesize that professional athletes may be part of a specific group of patients at higher risk of infection after ACL reconstruction. (Source: The American Journal of Sports Medicine)

The "Ligamentization" Process in Anterior Cruciate Ligament Reconstruction: What Happens to the Human Graft? A Systematic Review of the Literature

The American Journal of Sports Medicine — Fri, 28 Oct 2011 04:00:00 +0100

Conclusion: The key finding of this systematic review is that a free tendon graft replacing a ruptured human anterior cruciate ligament undergoes a series of biologic processes termed "ligamentization." The graft seems to remain viable at any time during this course. Histologically, the mature grafts may resemble the normal human anterior cruciate ligament, but ultrastructural differences regarding collagen fibril distribution do persist. Different stages of the ligamentization process are described, but no agreement exists on their time frame. Problematic direct transmission of animal data to the human situation, the limited number of reports considering the ligamentization process in humans, and the potential biopsy sampling error attributable to superficial graft biopsies necessitate fu...

Biomechanics of the Human Triple-Bundle Anterior Cruciate Ligament

Arthroscopy — Mon, 24 Oct 2011 04:00:00 +0100

Conclusions: The biomechanical role of each of the 3 ACL bundles (AM, IM, and PL) was measured with a robotic/universal force-moment sensor testing system. The AM bundle stabilized the knee against both the anterior and rotatory loads. The PL bundle stabilized the knee especially near full extension. The IM bundle supported the AM and PL bundles through all flexion angles, especially from 30° to 45°, against the rotatory load. Clinical Relevance: Knowledge of functions of the different ACL bundles will help improve ACL reconstruction techniques to enable restoration of normal knee function. (Source: Arthroscopy)

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

The accuracy of bone tunnel position using fluoroscopic-based navigation system in anterior cruciate ligament reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy — Fri, 21 Oct 2011 16:00:26 +0100

Conclusion The fluoroscopic-based navigation system contributed to the more reproducible placement of the bone tunnel during single-bundle ACL reconstruction compared with conventional technique. Additionally, this device was also useful for double-bundle ACL reconstruction. Level of evidence Case–control study, Therapeutic study, Level III. Content Type Journal ArticleCategory KneePages 1-8DOI 10.1007/s00167-011-1726-3Authors Yohei Kawakami, Department of Orthopedic Surgery, Joint Surgery Centre, Takatsuki General Hospital, 1-3-13 Kosobe-cho, Takatsuki, Osaka 569-1192, JapanTakafumi Hiranaka, Department of Orthopedic Surgery, Joint Surgery Centre, Takatsuki General Hospital, 1-3-13 Kosobe-cho, Takatsuki, Osaka 569-1192, JapanTomoyuki Matsumoto, D...

Double-Bundle ACL Reconstruction with Use of a Single Tibial Tunnel: A Technique or an Anatomic Concept?: Commentary on an article by Jin Hwan Ahn, MD, et al.: "Outcomes and Second-Look Arthroscopic Evaluation After Double-Bundle Anterior Cruciate Ligament Reconstruction with Use of a Single Tibial Tunnel".

The Journal of Bone and Joint Surgery. American volume — Wed, 19 Oct 2011 04:00:00 +0100

Double-Bundle ACL Reconstruction with Use of a Single Tibial Tunnel: A Technique or an Anatomic Concept?: Commentary on an article by Jin Hwan Ahn, MD, et al.: "Outcomes and Second-Look Arthroscopic Evaluation After Double-Bundle Anterior Cruciate Ligament Reconstruction with Use of a Single Tibial Tunnel". J Bone Joint Surg Am. 2011 Oct 19;93(20):e1211-2 Authors: Fu FH, Araujo PH, Lin A PMID: 22012538 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

Outcomes and second-look arthroscopic evaluation after double-bundle anterior cruciate ligament reconstruction with use of a single tibial tunnel.

The Journal of Bone and Joint Surgery. American volume — Wed, 19 Oct 2011 04:00:00 +0100

Conclusions:In the present study, we observed that clinical outcomes were as satisfactory with a single tibial tunnel as with two tibial tunnels. However, more tears and poorer synovial coverage were observed for posterolateral than for anteromedial bundles during second-look arthroscopy. No significant correlation was found between graft appearance and clinical outcome.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. PMID: 22012523 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

Hamstring Autografts Can Take More Than Two Years to Remodel Completely After ACL Reconstruction.

The Journal of Bone and Joint Surgery. American volume — Wed, 19 Oct 2011 04:00:00 +0100

Authors: West RV PMID: 22012521 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

Lateral Meniscal Root Tears Left in Situ After ACL Reconstruction Show Good Long-Term Radiographic and Subjective Outcomes.

The Journal of Bone and Joint Surgery. American volume — Wed, 19 Oct 2011 04:00:00 +0100

Authors: West RV PMID: 22012520 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

MedWorm Sponsor Message: Find the best January Sales in the UK.

Risk factors of recurrent hamstring injuries: a systematic review.

British Journal of Sports Medicine — Wed, 19 Oct 2011 04:00:00 +0100

ConclusionsThere is limited evidence that athletes with a larger volume size of initial trauma, a Grade 1 hamstring injury and a previous ipsilateral ACL reconstruction are at increased risk for recurrent hamstring injury. Athletes seem to be at lower risk for re-injury when following agility/stabilisation exercises. PMID: 22011915 [PubMed - as supplied by publisher] (Source: British Journal of Sports Medicine)

Visualization of postoperative anterior cruciate ligament reconstruction bone tunnels.

Acta Orthopaedica — Mon, 17 Oct 2011 04:00:00 +0100

Authors: Meuffels DE, Potters JW, Koning AH, Brown Jr CH, Verhaar JA, Reijman M Abstract Background and purpose Non-anatomic bone tunnel placement is the most common cause of a failed ACL reconstruction. Accurate and reproducible methods to visualize and document bone tunnel placement are therefore important. We evaluated the reliability of standard radiographs, CT scans, and a 3-dimensional (3D) virtual reality (VR) approach in visualizing and measuring ACL reconstruction bone tunnel placement. Methods 50 consecutive patients who underwent single-bundle ACL reconstructions were evaluated postoperatively by standard radiographs, CT scans, and 3D VR images. Tibial and femoral tunnel positions were measured by 2 observers using the traditional methods of Amis, Aglietti, Hoser, Stäu...

Measuring the anterior cruciate ligament’s footprints by three-dimensional magnetic resonance imaging

Knee Surgery, Sports Traumatology, Arthroscopy — Mon, 10 Oct 2011 15:06:26 +0100

Conclusion Measuring the ACL’s footprint by 3D MR imaging or open cadaveric dissection has strong agreement and can be used interchangeably. 3D MR imaging has the potential to allow surgeons to: (1) tailor ACL reconstruction technique or graft choice based on ACL footprint size, (2) plan for selective bundle ACL reconstruction for partial tears, and (3) preoperatively template tunnel position according to the patient’s individual anatomy. Content Type Journal ArticleCategory KneePages 1-10DOI 10.1007/s00167-011-1690-yAuthors Yung Han, Department of Orthopaedic Surgery, McGill University, Montreal, QC, CanadaDavid Kurzencwyg, Department of Radiology, McGill University, Montreal, QC, CanadaAdam Hart, McGill University, Montreal, QC, CanadaTom Powell, Department o...

Identifying individuals with an anterior cruciate ligament-deficient knee as copers and noncopers: a narrative literature review.

Physical Therapy — Sat, 08 Oct 2011 17:45:02 +0100

CONCLUSION: ACL screening examination showed preliminary evidence for detecting potential copers. Objective differences exist between copers and noncopers. Individuals with ACL injury should be informed of the possibility of good knee function following a nonoperative rehabilitation program. J Orthop Sports Phys Ther 2011;41(10):758-766. doi:10.2519/jospt.2011.3384. PMID: 21979555 [PubMed - in process] (Source: Physical Therapy)

Single bundle anterior cruciate reconstruction does not restore normal knee kinematics at 6 months: An upright MRI study

International Journal of Surgery — Thu, 06 Oct 2011 22:52:31 +0100

Introduction: Abnormal knee kinematics following ACL reconstruction may exist despite a resolution of tibial laxity and functional benefit. We performed upright, load bearing, MRI scans of both knees in the sagittal plane throughout different angles of knee flexion to determine the kinematics of patients undergoing unilateral reconstruction (n=12). (Source: International Journal of Surgery)

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Anterior cruciate ligament scoring systems in the UK – Who's using them?

International Journal of Surgery — Thu, 06 Oct 2011 22:52:31 +0100

Method: 134 knee surgeons, performing ACL reconstruction, were asked to complete a posted written questionnaire. Responses were received by post. Results: 81 (60%) surgeons responded by stating their preferred scoring system. 40 (49%) surgeons routinely use ACL scoring systems versus 41 (51%) surgeons who do not. The Lysolm (I and II) knee scoring scale and Tegner activity score were most commonly used (59%) followed by the Knee injury and osteoarthritis outcome score (KOOS) (12%) and International Knee Documentation Committee (IKDC) subjective knee score (9%). (Source: International Journal of Surgery)

Femoral Tunnel Placement in ACL Reconstruction: Letter to the Editor

The American Journal of Sports Medicine — Thu, 06 Oct 2011 04:00:00 +0100

(Source: The American Journal of Sports Medicine)

Quality of Life and Clinical Outcome Comparison of Semitendinosus and Gracilis Tendon Versus Patellar Tendon Autografts for Anterior Cruciate Ligament Reconstruction: An 11-Year Follow-up of a Randomized Controlled Trial

The American Journal of Sports Medicine — Thu, 06 Oct 2011 04:00:00 +0100

Conclusion: Both hamstring and patellar tendon autografts provided good subjective outcomes and objective stability at 11 years. Positive pivot-shift test (1+) was significantly more frequent in the PT group. No significant differences in the rate of graft failure were identified. Patients with patellar tendon graft had a greater prevalence of osteoarthritis at 11 years after surgery. (Source: The American Journal of Sports Medicine)

Longitudinal Tear of the Medial Meniscus Posterior Horn in the Anterior Cruciate Ligament-Deficient Knee Significantly Influences Anterior Stability

The American Journal of Sports Medicine — Thu, 06 Oct 2011 04:00:00 +0100

Conclusion: This study shows that an MMPH longitudinal tear in an ACL-deficient knee alters the knee kinematics, particularly the anterior-posterior tibial translation. MMPH repair significantly improved anterior-posterior tibial translation in ACL-deficient knees. Clinical Relevance: These findings may help improve the treatment of patients with ACL and MMPH longitudinal tear by suggesting that the medial meniscal repairs should be performed for greater longevity when combined with an ACL reconstruction. (Source: The American Journal of Sports Medicine)

Anterior Cruciate Ligament Graft Failure: A Comparison of Graft Type Based on Age and Tegner Activity Level

The American Journal of Sports Medicine — Thu, 06 Oct 2011 04:00:00 +0100

Conclusion: Autograft hamstrings and allografts had a significantly higher failure rate in the age group of patients 25 years and younger compared with the bone–patellar tendon–bone autograft. These data suggest that bone–patellar tendon–bone autografts may be a better graft source for young, active individuals. (Source: The American Journal of Sports Medicine)

MedWorm Sponsor Message: Find the best January Sales in the UK.

Technical note: revision of failed transtibial anterior cruciate ligament reconstruction using anteromedial portal femoral drilling.

The Journal of Bone and Joint Surgery. American volume — Wed, 05 Oct 2011 04:00:00 +0100

Authors: Gamradt SC, Bier A, Van Gelderen J, Petrigliano FA PMID: 22005856 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

Muscle co-contraction after anterior cruciate ligament reconstruction: Influence of functional level

Journal of Electromyography and Kinesiology — Wed, 05 Oct 2011 04:00:00 +0100

Conclusion: Decreased co-contraction in the involved limb before perturbation may be caused by sensorial changes resulting from surgery or injury. Increased co-contraction levels observed in the limited return group after perturbation may be a compensatory mechanism to make up for possible decreased intrinsic stability of the knee joint.Clinical relevance: Increased co-contraction after perturbation does not contribute to knee stability. (Source: Journal of Electromyography and Kinesiology)

Resorption and Remodeling of Hydroxyapatite–Poly-L-Lactic Acid Composite Anterior Cruciate Ligament Interference Screws

Arthroscopy — Wed, 05 Oct 2011 04:00:00 +0100

Conclusions: The HA-PLLA interference screws are slowly resorbed over time, and the majority are completely resorbed between 3 and 4 years after ACL reconstruction with patellar tendon autograft or allograft. Osteoconductivity and remodeling were confirmed by CT scans, and no tunnel widening, sclerosis, cysts, or inflammatory changes were noted.Level of Evidence: Level IV, therapeutic case series. (Source: Arthroscopy)

Functional and morphological changes in the quadriceps muscle induced by eccentric training after ACL reconstruction

Revista Brasileira de Fisioterapia — Tue, 04 Oct 2011 08:53:54 +0100

OBJECTIVES: The purpose of this study was to investigate the contributions of functional and morphological factors in the recovery of the quadriceps muscle after anterior cruciate ligament (ACL) reconstruction. METHODS: Nine subjects (31.3±5.8 years) underwent eccentric exercise sessions twice a week for 12 weeks. Quadriceps muscle function was evaluated using an isokinetic dynamometer (isometric and eccentric peak torque) and electromyography (RMS). Morphological changes were measured using magnetic resonance imaging. RESULTS: The initial evaluation showed a significant deficit in knee extensor torque in the involved limb and significant muscle atrophy along the length of the quadriceps. EMG activity was lower in all tested situations. Eccentric training significantly increased isokineti...

A randomised controlled trial of electrostimulation effects on effussion, swelling and pain recovery after anterior cruciate ligament reconstruction: a pilot study.

Clinical Rehabilitation — Tue, 04 Oct 2011 04:00:00 +0100

Conclusion: Electrostimulation along with exercise therapy appears superior to exercise alone regarding knee effusion, swelling and pain recovery after anterior cruciate ligament reconstruction. Still, there is need for further clinical studies using a radiologic method to demonstrate this effect of electrostimulation. PMID: 21971755 [PubMed - as supplied by publisher] (Source: Clinical Rehabilitation)

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Comparison of Anterior Cruciate Ligament Tunnel Position and Graft Obliquity With Transtibial and Anteromedial Portal Femoral Tunnel Reaming Techniques Using High-Resolution Magnetic Resonance Imaging

Arthroscopy — Mon, 03 Oct 2011 04:00:00 +0100

Conclusions: In this clinical series, AM portal femoral tunnel reaming more accurately restored native ACL anatomy than the TT technique. Although both techniques can capture the native femoral footprint with similar accuracy, the TT technique requires significantly greater posterior placement of the tibial tunnel, resulting in decreased sagittal graft obliquity. When a tibial tunnel is drilled without the need to accommodate subsequent femoral tunnel reaming, more accurate tibial tunnel position and resultant sagittal graft obliquity are achieved.Level of Evidence: Level III, retrospective comparative study. (Source: Arthroscopy)

Osteochondral avulsion fracture of the anterior cruciate ligament femoral origin in a 10-year-old child: a case report.

J Athl Train — Sat, 01 Oct 2011 18:55:09 +0100

CONCLUSIONS: Although they occur infrequently, ACL femoral avulsion fractures in children can result from a low-energy injury mechanism. Identifying the mechanism of injury, performing a thorough physical examination, and obtaining appropriate diagnostic studies will enable the correct treatment to be implemented, with the goal of safely returning the athlete to play. PMID: 21944079 [PubMed - in process] (Source: J Athl Train)

Foreword

Clinics in Sports Medicine — Sat, 01 Oct 2011 04:00:00 +0100

Pediatric ACL injuries. If this subject appeared 20 years ago when I coauthored two articles in a Clinics in Sports Medicine issue on Anterior Cruciate Ligament Injuries guest edited by a very young-looking Freddie Fu (and he still looks young), then it would have only been one article. However, it didn't even get that—and now we have dedicated an entire issue to Pediatric ACL injuries … Wow! Twenty years ago, a midsubstance ACL injury in a child was almost unheard of—now it is commonplace. Is this because we missed something, or is it because athletes are taking on faster and more aggressive sports earlier and earlier? Probably both, but it is true that these injuries, which remain a significant challenge, are becoming increasingly common and demand solutions. This, despite the fact...

Physeal-Sparing Anterior Cruciate Ligament Reconstruction with Iliotibial Band

Clinics in Sports Medicine — Sat, 01 Oct 2011 04:00:00 +0100

This article reviews the indications for IT band reconstruction of the ACL in the skeletally immature athlete, surgical technique, pitfalls, and results of treatment. (Source: Clinics in Sports Medicine)

Anterior Cruciate Ligament Reconstruction Timing in Children with Open Growth Plates: New Surgical Techniques Including All-Epiphyseal

Clinics in Sports Medicine — Sat, 01 Oct 2011 04:00:00 +0100

Over the past decade, there has been a dramatic increase in the total number of participants in organized youth sports, with up to 63% of sports-related injuries in children aged 6 to 12 years reported as joint sprains, and the majority of these sprains occurring at the knee. Tears of the anterior cruciate ligament (ACL) in young patients are becoming increasingly more recognized. In a prospective study of all children with traumatic knee effusions presenting to a pediatric hospital emergency department, 29% of injuries were to the ACL and only 2% were to the tibial eminence. In a consecutive series of children with open growth plates and ACL-type injuries identified on magnetic resonance imaging (MRI), 74% had ACL tears (complete or partial) and 26% had tibial spine fractures. The older c...

MedWorm Sponsor Message: Find the best January Sales in the UK.

Advanced reconstruction: knee

Orthopaedics and Trauma — Sat, 01 Oct 2011 04:00:00 +0100

This book is the result of a collaboration between the American Academy of Orthopaedic Surgeons and the American Knee Society and aims to cover all aspects of knee reconstruction in adults. The authors have produced a text that covers a comprehensive range of current topics relating to knee reconstruction. Approximately half of the book is devoted to arthroplasty-related topics and about half to soft tissue knee surgery. There are arthroplasty sections discussing primary and complex primary knee replacement, complications following arthroplasty and revision arthroplasty. There is also a section on alternative reconstruction procedures. In the soft tissue sections there is coverage of ACL reconstruction, PCL reconstruction, collateral ligament reconstruction, knee dislocation, meniscal inju...

MRI of double-bundle ACL reconstruction: evaluation of graft findings

Skeletal Radiology — Fri, 30 Sep 2011 05:53:57 +0100

Conclusion Both grafts were disrupted in 3% of patients. Also, the frequencies of other complications were low. The use of orthogonal sequences in the evaluation of the PL graft SI seems to cause volume-averaging artefacts. Content Type Journal ArticleCategory Scientific ArticlePages 1-8DOI 10.1007/s00256-011-1285-1Authors Tommi Kiekara, Medical Imaging Centre, Tampere University Hospital, FIN-33521 Tampere, FinlandTimo Järvelä, Sports Clinic and Hospital Mehiläinen, FIN-33210 Tampere, FinlandHeini Huhtala, School of Health Sciences, University of Tampere, FIN-33014 Tampere, FinlandAntti Paakkala, Medical Imaging Centre, Tampere University Hospital, FIN-33521 Tampere, Finland Journal Skeletal RadiologyOnline ISSN 1432-2161Print ISSN 0364-2348 (Source: Skele...

Clinical comparison of two suspensory fixation devices for anatomic double-bundle anterior cruciate ligament reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy — Fri, 30 Sep 2011 05:53:09 +0100

Conclusions This study demonstrated that the usage of the ECL-BTB for graft preparation significantly shortens the total operation time in comparison with the ECL and that there were no significant differences in the 2-year clinical outcome and the intra- and postoperative complications between the 2 graft preparation procedures of the anatomic double-bundle ACL reconstruction. The ECL-BTB can be an alternative device for the hamstring tendon graft in double-bundle ACL reconstruction. Level of evidence Prospective comparative cohort study, Level II. Content Type Journal ArticleCategory KneePages 1-7DOI 10.1007/s00167-011-1687-6Authors Eiji Kondo, The Department of Sports Medicine and Joint Surgery, Hokkaido University Graduate School of Medicine, ...

The use of magnetic resonance imaging to predict ACL graft structural properties

Journal of Biomechanics — Fri, 30 Sep 2011 04:00:00 +0100

Abstract: Magnetic resonance imaging (MRI) could potentially be used to non-invasively predict the strength of an ACL graft after ACL reconstruction. We hypothesized that the volume and T2 relaxation parameters of the ACL graft measured with MRI will predict the graft structural properties and anteroposterior (AP) laxity of the reconstructed knee. Nine goats underwent ACL reconstruction using a patellar tendon autograft augmented with a collagen or collagen–platelet composite. After 6 weeks of healing, the animals were euthanized, and the reconstructed knees were retrieved and imaged on a 3T scanner. AP laxity was measured prior to dissecting out the femur–graft–tibia constructs which were then tested to tensile failure to determine the structural properties. Regression analysis indi...

Pro athletes may have higher risk of septic arthritis after ACL reconstruction

Modern Medicine — Thu, 29 Sep 2011 04:00:00 +0100

NEW YORK (Reuters Health) - Professional athletes appear to have a much higher risk of developing septic arthritis after anterior cruciate ligament (ACL) reconstruction than the general population, a French study suggests. (Source: Modern Medicine)

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Magnetic Resonance Imaging Evaluation of Knee Kinematics After Anterior Cruciate Ligament Reconstruction With Anteromedial and Transtibial Femoral Tunnel Drilling Techniques

Arthroscopy — Thu, 29 Sep 2011 04:00:00 +0100

Conclusions: Using an MR-based approach, we found that knee kinematics were better restored with the AM femoral tunnel drilling ACL reconstruction than with the TT femoral tunnel drilling approach, which resulted in increased knee laxity. Our in vivo results support previous cadaveric and clinical studies that have found AM ACL reconstruction to restore anatomy and stability better than the TT approach. However, the clinical significance of increased contact area in the AM group remains unclear.Level of Evidence: Level III, retrospective comparative study. (Source: Arthroscopy)

Complications Using Bioabsorbable Cross-Pin Femoral Fixation: A Case Report and Review of the Literature

Advances in Pharmacological Sciences — Sun, 25 Sep 2011 18:34:37 +0100

The use of bioabsorbable cross-pin transcondylar fixation has remained a viable option for femoral fixation in anterior cruciate ligament reconstruction. Although numerous biomechanical studies have demonstrated high fixation strength and minimal slippage with use of this method of fixation, there have been increasing reports of a variety of clinical complications associated with these implants. We reviewed the literature for all complications associated with the Bio-TransFix implant and present a case report of a patient status after ACL reconstruction using Bio-TransFix cross-pin femoral fixation with iliotibial band friction syndrome from a broken cross-pin four month post-operatively. (Source: Advances in Pharmacological Sciences)

Expression of chondro-osteogenic BMPs in clinical samples of patellar tendinopathy

Knee Surgery, Sports Traumatology, Arthroscopy — Sat, 24 Sep 2011 15:45:55 +0100

Conclusions Clinical samples of patellar tendinopathy showed ectopic expression of BMP-2/-4/-7. This was not evident in control samples from healthy patellar tendons. Level of evidence Prognostic studies, Level III. Content Type Journal ArticleCategory Sports MedicinePages 1-9DOI 10.1007/s00167-011-1685-8Authors Yun Feng Rui, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, ChinaPauline Po Yee Lui, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, ChinaChrister Gustav Rolf, Department of Orthopaedics, Clintec, Karolinska Institutet, Stockholm, SwedenYin Mei Wong, Department of Orthopaedics and Traumatology, Faculty...

Effects of knee immobilization on morphological changes in the semitendinosus muscle–tendon complex after hamstring harvesting for anterior cruciate ligament reconstruction: evaluation using three-dimensional computed tomography

Journal of Orthopaedic Science — Fri, 23 Sep 2011 05:46:25 +0100

Conclusions This study showed that the structure of regenerated tendons could be clearly identified in 38 of 39 cases (97.4%) after ACL reconstruction. However, prolonged knee immobilization (10–14 days) could not prevent morphological changes in the semitendinosus muscle–tendon complex. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s00776-011-0163-yAuthors Atsuo Nakamae, Department of Orthopaedic Surgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 JapanMasataka Deie, Department of Physical Therapy and Occupational Therapy Sciences, Graduate School of Health Sciences, Hiroshima University, Hiroshima, JapanNobuo Adachi, Department of Orthopaedic Surgery, Graduate Schoo...