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Ekinci M, Demir TB, Sahinkaya T, Yakal S, Polat G, Bayraktar B. The Effect of Gracilis Tendon Preservation on Postoperative Knee Joint Stability and Muscle Strength in Arthroscopic Anterior Cruciate Ligament Reconstruction Surgery. J Knee Surg 2024; 37:843-850. [PMID: 38897225 DOI: 10.1055/s-0044-1787829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
The aim of our study is to evaluate preserving gracilis tendon in anterior cruciate ligament reconstruction (ACLR) surgery and its effect to the flexion of the knee joint and tibial internal rotation strength and the stability of the knee. Patients who underwent primary single-bundle arthroscopic ACLR using all-inside technique and using hamstring tendon autograft were evaluated retrospectively. Patients were divided into two groups as gracilis preserved (St) and gracilis harvested (StG) groups. The International Knee Documentation Committee (IKDC) score, Lysholm, Knee Injury and Osteoarthritis Outcome Score-Knee-related quality of life (KOOS-QOL) score, ACL-Return to Sport after Injury scale score were used to evaluate as postoperative functional scores at last follow-up. Anterior tibial translation was evaluated using the KT-1000 device. Knee joint flexion, extension, and internal rotation strength were evaluated using isokinetic dynamometer. Dynamic balance performances were measured using the Biodex Balance System. There were 24 patients in the St group and 23 patients in the StG group. Demographic data and clinical results showed no significant difference. Anteroposterior movement of the tibia was found to be significantly higher in the StG group than in the St group in measurements at 89 and 134 N, respectively (p = 0.01 and <0.001). No statistically significant difference was found between both standard and deep flexor and extensor and internal rotator strength. No statistically significant difference was found in the amount of total, anteroposterior, and mediolateral balance deficit between the two groups. Additional gracilis harvesting does not have a negative effect on both standard and deep knee flexion, and tibial internal rotation strength compared with the St group. Although semitendinosus and StG group showed significantly more anterior tibial translation, there was no significant difference in clinical and dynamic stability measurements.
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Affiliation(s)
- Mehmet Ekinci
- Department of Orthopaedics and Traumatology, Haseki Education and Training Hospital, Istanbul, Turkey
| | - Taha Bedir Demir
- Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Turker Sahinkaya
- Department of Sports Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sertac Yakal
- Department of Sports Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gokhan Polat
- Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bulent Bayraktar
- Department of Sports Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Oronowicz J, Frenzel G, Hörterer H, Moksnes H, Ekas GR, Cabri J, Tischer T, Seil R. Sport-specific differences in ACL injury, treatment and return to sports-Ski jumping. Knee Surg Sports Traumatol Arthrosc 2024; 32:1637-1640. [PMID: 38643402 DOI: 10.1002/ksa.12176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/13/2024] [Accepted: 03/21/2024] [Indexed: 04/22/2024]
Affiliation(s)
- Jakub Oronowicz
- Clinic for Orthopaedics and Trauma Surgery, Malteser St. Mary's Hospital, Erlangen, Germany
- Department of Orthopaedics, University of Rostock, Rostock, Germany
| | | | - Hubert Hörterer
- Chairman Medical Committee FIS, Member Competition Equipment Committee FIS, Rottach-Egern, Germany
| | - Håvard Moksnes
- Norwegian School of Sport Sciences, Oslo Sports Trauma Research Center, Oslo, Norway
| | - Guri Ranum Ekas
- Norwegian School of Sport Sciences, Oslo Sports Trauma Research Center, Oslo, Norway
- Orthopaedic Department, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jan Cabri
- Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science (LIROMS), Luxembourg, Luxembourg
- Dept. GERO, Faculty of Medicine, Vrije Universiteit Brussel, Brussels, Belgium
| | - Thomas Tischer
- Clinic for Orthopaedics and Trauma Surgery, Malteser St. Mary's Hospital, Erlangen, Germany
- Department of Orthopaedics, University of Rostock, Rostock, Germany
| | - Romain Seil
- Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science (LIROMS), Luxembourg, Luxembourg
- Department of Orthopaedic Surgery, Division of Neurosciences and Musculoskeletal Diseases, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg
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Tischer T, Karlsson J, Seil R. Sport-specific differences in ACL injury, treatment and return to sports. Knee Surg Sports Traumatol Arthrosc 2024; 32:1359-1362. [PMID: 38586977 DOI: 10.1002/ksa.12174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/17/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Thomas Tischer
- Department of Orthopaedic and Trauma Surgery, Waldkrankenhaus Erlangen, Erlangen, Germany
- Department of Orthopaedic Surgery, University Medicine Rostock, Rostock, Germany
| | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier-Clinique d'Eich and Luxembourg Institute of Health, Luxembourg
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Nasr A, McPhee J. Scalable musculoskeletal model for dynamic simulations of lower body movement. Comput Methods Biomech Biomed Engin 2024:1-27. [PMID: 38396368 DOI: 10.1080/10255842.2024.2316240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/27/2024] [Indexed: 02/25/2024]
Abstract
A musculoskeletal (MSK) model is an important tool for analysing human motions, calculating joint torques during movement, enhancing sports activity, and developing exoskeletons and prostheses. To enable biomechanical investigation of human motion, this work presents an open-source lower body MSK model. The MSK model of the lower body consists of 7 body segments (pelvis, left/right thigh, left/right leg, and left/right foot). The model has 20 degrees of freedom (DoFs) and 28 muscle torque generators (MTGs), which are developed from experimental data. The model can be modified for different anthropometric measurements and subject body characteristics, including sex, age, body mass, height, physical activity, and skin temperature. The model is validated by simulating the torque within the range of motion (ROM) of isolated movements; all simulation findings exhibit a good level of agreement with the literature.
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Affiliation(s)
- Ali Nasr
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Canada
| | - John McPhee
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Canada
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Nguyen Hoang Q, Nguyen Manh K. Anatomical and Biomechanical Characteristics of Peroneus Longus Tendon: Applications in Knee Cruciate Ligament Reconstruction Surgery. Adv Orthop 2023; 2023:2018363. [PMID: 37409219 PMCID: PMC10319460 DOI: 10.1155/2023/2018363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction The peroneus longus tendon is used in many orthopedic surgeries to regenerate the external ligaments of the knee. This study aims to evaluate some anatomical, biomechanical, and load-bearing properties of the peroneus longus tendon for use in cruciate ligament reconstruction. Materials and Methods The study design is a cross-sectional description. The study subjects were 20 samples of the peroneus longus tendon from fresh carcasses. The leg is still intact, not crushed, is well preserved, and it has never been used in research. Results The average length of the peroneus longus tendon was 29.25 ± 2.1 cm, and the average distance from the peroneus longus tendon to the deep peroneal nerve was 71.1 ± 8.63 mm. The peroneus longus tendon did not have an accessory ligament, the maximum tension of the peroneus longus tendon was 1170.4 ± 203 N, and the maximum length at break was 14.29 ± 3.88 mm. Conclusion Removing the peroneus longus tendon will not affect the surrounding anatomical components. The maximum breaking force and the diameter of the peroneus longus tendon are similar to other graft materials, such as the hamstring tendon and patellar tendon.
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Affiliation(s)
| | - Khanh Nguyen Manh
- Department of Upper Limb Surgery and Sports Medicine, Viet Duc University Hospital, Hanoi 100000, Vietnam
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Goyal T, Paul S, Choudhury AK, Sethy SS. Full-thickness peroneus longus tendon autograft for anterior cruciate reconstruction in multi-ligament injury and revision cases: outcomes and donor site morbidity. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:21-27. [PMID: 34698925 DOI: 10.1007/s00590-021-03145-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 10/03/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Peroneus longus tendon (PLT) autograft has been successfully used for isolated anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) reconstruction cases. Being a powerful evertor and flexor of great toe, there might be associated ankle morbidity with this autograft option. However, there are only a few studies exploring whether the ankle morbidity is significant or not. This study aims to assess the functional outcomes, donor site morbidity, and ankle strength after harvesting ipsilateral peroneus longus autograft for ACL reconstruction in revision ACL and multi-ligament injury cases. METHODS This was a prospective case series. All of the patients were evaluated by clinical examination for knee for laxity, ankle joint stability, and using visual analog scale (VAS) for pain, International Knee Documentation Committee (IKDC) score, and Lysholm score, preoperatively and postoperatively at two-year follow-up. Morbidity of donor ankle was assessed using American Orthopedic Foot and Ankle Society (AOFAS) score, bilateral evertors, and first ray plantarflexion strength measurement using an isometer (Innovative Design Orthopedics) at two-year follow-up. RESULTS Ipsilateral PLT graft was used in ten patients of revision ACL reconstruction and 27 patients of the multi-ligament knee injury. The mean length of PLT harvested (cm) was 26.2 (standard deviation 2.6, range 22-31), and mean diameter of the doubled graft (mm) was 7.9 (standard deviation 0.68, range 7.5-8.5). There was a significant improvement in VAS score for pain, Lysholm, and IKDC scores (p = < 0.001) at two -year follow-up. There were no cases of graft failure, superficial, or deep infection. Ankle dorsiflexion(p = 0.32), ankle plantarflexion (p = 0.19), eversion strength(p = 0.6), first ray plantarflexion strength(p = 0.52), and AOFAS score(p = 0.29) were found to be comparable to the normal side in all patients. CONCLUSIONS Peroneus longus autograft can be considered as a potential autograft option for ACL reconstruction in multi-ligament knee injuries and revision ACL reconstruction. No significant donor site morbidity was noted at follow-up. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Tarun Goyal
- Department of Orthopedics, All India Institute of Medical Sciences Bathinda, Bathinda, Punjab, 151001, India.
| | - Souvik Paul
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | | | - Siddharth S Sethy
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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Bade D, Malayko G, Johnson L, Bradford K, Reddan T, Stockton C, Frawley K, Phillips T, Saxby D, Ware RS, Byrnes J, Carty CP. Single versus double hamstring tendon graft in anterior cruciate ligament reconstruction in the paediatric patient: a single-blind randomised controlled trial study protocol. BMJ Open 2022; 12:e057465. [PMID: 35985784 PMCID: PMC9396117 DOI: 10.1136/bmjopen-2021-057465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION There is currently no clear indication in the literature regarding a single or double hamstring tendon (single bundle) autograft for anterior cruciate ligament (ACL) reconstruction in the paediatric patient. The primary aim of this single blind randomised controlled trial is to determine whether a single or double hamstring tendon graft ACLR leads to superior clinical outcomes postsurgery in paediatric patients with ACL injury. METHODS AND ANALYSIS Single site, prospective, single blind, randomised controlled trial with two parallel treatment arms. 100 patients aged 10-18 years who present with an isolated ACL tear±meniscal injury, verified on MRI, will be randomly allocated to one of the two surgical groups. The primary outcomes will be side-to-side difference in anterior tibial translation and graft failure incidence 12 months postsurgery. Primary and secondary outcomes will also be assessed at 2-year and 5-year postsurgery. ETHICS AND DISSEMINATION Results will be presented in peer-reviewed journals and at international conferences and disseminated to participants and healthcare professionals via newsletters and hospital presentations. This study is approved by the Children's Health Queensland Hospital and Health Service Human Research Ethics committee. TRIAL REGISTRATION NUMBER ACTRN12620001170910p; Australian New Zealand Clinical Trials Registry.
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Affiliation(s)
- David Bade
- Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Garrett Malayko
- Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Liam Johnson
- Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Kylie Bradford
- Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Tristan Reddan
- Department of Medical Imaging and Nuclear Medicine, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Chris Stockton
- Department of Medical Imaging and Nuclear Medicine, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Kieran Frawley
- Department of Medical Imaging and Nuclear Medicine, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Teresa Phillips
- Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - David Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Christopher P Carty
- Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Gracilis and semitendinosus moment arm decreased by fascial tissue release after hamstring harvesting surgery: a key parameter to understand the peak torque obtained to a shallow angle of the knee. Surg Radiol Anat 2021; 43:1647-1657. [PMID: 33755756 DOI: 10.1007/s00276-021-02738-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 03/12/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE Semitendinosus and gracilis muscles whose tendons are used in surgical reconstruction of the anterior cruciate ligament maintain their contractile ability, but the peak torque angle of hamstring muscles shifted to a shallow angle postoperatively. The goal was to quantify the influence of the myofascial structures on instantaneous moment arms of knee muscles to attempt explaining the above-mentioned post-surgical observations. METHODS Hamstring harvesting procedures were performed by a senior orthopaedic surgeon on seven lower limbs from fresh-frozen specimens. Femoro-tibial kinematics and tendons excursion were simultaneously recorded at each step of the surgery. RESULTS No significant difference was demonstrated for instantaneous moment arm of gracilis during anterior cruciate ligament surgery (84% of the maximum intact values; P ≥ 0.05). The first significant semitendinosus moment arm decrease was observed after tendon harvesting (61% of the maximum intact values; p ≤ 0.005). After hamstring harvesting, the maximum and minimum moment arm (both gracilis and semi tendinosus) shifted to a shallow angle and 90°, respectively. CONCLUSION Moment arm modifications by paratenons and the loose connective tissue release are essential to understand the peak torque obtained to a shallow angle. LEVEL OF EVIDENCE Basic science study, biomechanics.
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The function of the popliteus muscle: An in vivo ultrasound shear wave elastography study. Hum Mov Sci 2021; 76:102751. [PMID: 33486378 DOI: 10.1016/j.humov.2020.102751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/28/2020] [Accepted: 12/23/2020] [Indexed: 11/23/2022]
Abstract
The function of the popliteus muscle [PM] is crucial to knee function. However, it remained unclear in vivo. Thus, this study aimed to explore the PM function in the non-weight-bearing and the weight-bearing conditions in vivo. Fourteen healthy subjects participated in this study. The muscle stiffness of the PM was measured using shear wave elastography as an index of muscle force. Muscle stiffness was measured at 30° knee flexion as a reference value. Muscle stiffness was also measured at passive 0°knee flexion and passive 20° external rotation and internal rotation at 30° knee flexion, and during isometric knee extension, flexion, external rotation, and internal rotation at 30° knee flexion. Moreover, muscle stiffness was measured during one-leg standing at 0° and 30° of knee flexion. Muscle stiffness was significantly greater at passive 0° knee flexion and 20° external rotation and during isometric knee flexion and internal rotation than the reference value. Two-way analysis of variance revealed significant main effects of weight bearing and knee angle: Muscle stiffness increased with weight bearing and knee extension. Moreover, muscle stiffness was significantly lower at 30° than at 0° knee flexion during one-leg standing. The PM function is knee flexion and internal rotation, and the PM force increases with weight bearing and decreases with knee flexion during one-leg standing.
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Flies A, Scheibel M, Kraus N, Kruppa P, Provencher MT, Becker R, Kopf S. Isolated gracilis tendon harvesting is not associated with loss of strength and maintains good functional outcome. Knee Surg Sports Traumatol Arthrosc 2020; 28:637-644. [PMID: 31734705 DOI: 10.1007/s00167-019-05790-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 11/05/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE The gracilis tendon is a commonly used autologous graft. Most information on knee function and outcomes after its harvest is related to both semitendinosus- and gracilis tendon harvest. Therefore this study analyzed the effect of isolated gracilis tendon harvest from healthy, uninjured knees on thigh muscle strength and patient reported outcome measures (PROMs). METHODS Stabilization of the acromioclavicular joint because of chronic instability was performed with autologous gracilis tendon in 12 patients. After a mean of 44 ± 25 months after surgery, isokinetic peak-torque measurements of specific functions of the gracilis muscle were performed: knee flexion in a sitting position (flexion angles 0-90°) and in prone position (flexion angles > 70°), internal tibial rotation and hip adduction. The contralateral limb was control. Knee specific PROMs were collected including IKDC-2000 subjective evaluation form, Lysholm score, the Marx Activity Rating Scale and SF-36 health survey. RESULTS No significant side-to-side differences were found regarding torque measurements. Excellent results were shown regarding the PROMs, which even in terms of IKDC-2000 (97 vs. 82 points, p = 0.001) exceeded significantly the age- and gender matched reference-data. CONCLUSION Isolated gracilis tendon harvesting was not associated with loss of strength in knee flexion, internal tibial rotation and thigh adduction. Additionally, good functional outcome as well as excellent knee-specific subjective outcome was found. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anne Flies
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Markus Scheibel
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Natascha Kraus
- Clinic and Outpatient Clinic for Orthopaedics and Orthopaedic Surgery, University Medicine, Greifswald, Germany
| | - Philipp Kruppa
- Department of Plastic, Aesthetic and Reconstructive Microsurgery/Hand Surgery, Hospital Ernst Von Bergmann, Potsdam, Germany
| | | | - Roland Becker
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, Hospital Brandenburg an der Havel, Hochstraße 29, 14770, Brandenburg an der Havel, Germany
| | - Sebastian Kopf
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, Hospital Brandenburg an der Havel, Hochstraße 29, 14770, Brandenburg an der Havel, Germany.
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Beuchat A, Maffiuletti NA. Foot rotation influences the activity of medial and lateral hamstrings during conventional rehabilitation exercises in patients following anterior cruciate ligament reconstruction. Phys Ther Sport 2019; 39:69-75. [DOI: 10.1016/j.ptsp.2019.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 06/11/2019] [Accepted: 06/19/2019] [Indexed: 11/30/2022]
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The significant effect of the medial hamstrings on dynamic knee stability. Knee Surg Sports Traumatol Arthrosc 2019; 27:2608-2616. [PMID: 30421166 DOI: 10.1007/s00167-018-5283-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 11/07/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE While hamstring autograft is a popular option for the general population, BTB autograft is still significantly more popular among professional athletes due to concerns of altering knee kinematics with hamstring harvest. This study seeks to quantify the contribution of the medial hamstrings to knee stability. METHODS Valgus knee laxity, anterior tibial translation, and rotational motion were measured in eight fresh-frozen cadaveric knees after forces were applied on the tibia in each plane (coronal, sagittal, and axial). Four muscle loading conditions were tested: (1) physiologic fully loaded pes anserinus, (2) semitendinosus only loaded, (3) gracilis only loaded, and (4) unloaded pes anserinus. The protocol was then repeated with the ACL transected. RESULTS In the ACL intact knee, the neutral position of the tibia with an unloaded pes anserinus was significantly more externally rotated (p < 0.01) and anteriorly translated (p < 0.05) at all knee flexion angles than a tibia with a physiologic loaded pes anserinus. Applying an external rotation torque significantly increased external rotation for the fully unloaded (p < 0.001), gracilis only loaded (p < 0.001), and semitendinosus only loaded (p < 0.01) conditions at all flexion angles. Applying a valgus torque resulted in a significant increase in laxity for the fully unloaded condition only at 30° of flexion (p < 0.05). Applying an anterior tibial force resulted in significant increase in anterior translation for the fully unloaded condition at all flexion angles (p < 0.01), and for the gracilis only loaded condition in 30° and 60° of flexion (p < 0.05). Similar results were seen in the ACL deficient model. CONCLUSION The medial hamstrings are involved in rotational, translational, and varus/valgus control of the knee. Applying anterior, external rotation, and valgus forces on the hamstring deficient knee significantly increases motion in those planes. Harvesting the gracilis and semitendinosus tendons alters native knee kinematics and stability. This is clinically relevant and should be a consideration when choosing graft source for ACL reconstruction, especially in the elite athlete population.
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Goyal D, Yadav S, Jvs V. Clinical experience with woven and parallel hamstring-tendon anterior cruciate ligament reconstruction. Knee Surg Relat Res 2019; 31:4. [PMID: 32660615 PMCID: PMC7219523 DOI: 10.1186/s43019-019-0002-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 05/23/2019] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The purpose of this study was to determine the effect of the weave technique for hamstring graft preparation on the diameter of the prepared graft, functional outcome, and need for harvesting of semitendinosus and gracilis (ST + G) or semitendinosus alone (ST). MATERIALS AND METHODS This retrospective study evaluated 340 patients who underwent arthroscopic anterior cruciate ligament (ACL) reconstruction from January 2013 to December 2015. Our protocol for graft preparation is that the graft length must be a minimum of 8 cm and the diameter must be between 7 and 10 mm. The parallel-graft preparation technique was used in 189 patient and the weave technique was used in 151 patients. Outcome was measured by using stress radiographs and International Knee Documentation Committee (IKDC) 2000 score. RESULTS In the parallel-graft preparation group, ST + G was used in 99 patients and ST was used in 90 patients. In the weave-graft preparation group, ST + G was used in 38 patients and ST alone was sufficient in 113 patients. The need for G harvest was less in the weave-technique group (p < 0.0001). There was no statistically significant difference at 2 years of follow-up in stress laxiometry, IKDC 2000 scores and rerupture rates between the two groups. CONCLUSION The weave technique helps to reduce the need for G harvest without compromising functional outcome. Level of evidence IV.
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Affiliation(s)
- Divyanshu Goyal
- Fellowship trainees in arthroscopy and sports medicine, B-21, Vaishali nagar, Jaipur, Rajasthan, India.
| | - Sandeep Yadav
- Fellowship trainees in arthroscopy and sports medicine, B-21, Vaishali nagar, Jaipur, Rajasthan, India
| | - Vidyasagar Jvs
- Head of the Department of Orthopaedics and Arthroscopy and Sports Medicine, Hyderabad, India
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Wada O, Gamada K, Aoyama N, Mizuno K, Iwasaki Y. A difference in rotational alignment of the tibio-femoral joint after anterior cruciate ligament reconstruction between the bone-patellar tendon-bone and semitendinosus-gracilis grafts. Clin Biomech (Bristol, Avon) 2019; 65:45-50. [PMID: 30965227 DOI: 10.1016/j.clinbiomech.2019.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/22/2018] [Accepted: 03/20/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND A question as to the effect of the graft choice on rotational kinematics after anterior cruciate ligament reconstruction remains unclear. The purpose of this study was to determine if there were any differences in rotational alignment of the knee after anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BTB) graft compared to that using semitendinosus-gracilis (STG) graft. METHODS Ten patients with BTB graft and 10 patients with STG graft were assessed at 3 months after ACL reconstruction. We compared the 6 degrees-of-freedom alignment of the tibiofemoral joint in the fully extended position between knees reconstructed with BTB graft and STG graft using the uninvolved knee as a control. FINDINGS The BTB graft group showed no difference in knee alignment between the ACL reconstructed knee and uninvolved knee, whereas the STG graft group showed greater external rotation in the ACL reconstructed knee than in the uninvolved knee (median values, 8.4° vs 5.8°; p = 0.022). INTERPRETATION ACL reconstruction with the STG graft leads to increased external tibial rotation. Our findings suggest that clinicians should make an effort to prevent increased external tibial rotation during the rehabilitation process in patients with STG graft.
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Affiliation(s)
- Osamu Wada
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
| | - Kazuyoshi Gamada
- Department of Rehabilitation, Hiroshima International University, 555-36, Kurosegakuendai, Higashihiroshima City, Hiroshima, Japan.
| | - Naoki Aoyama
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
| | - Kiyonori Mizuno
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
| | - Yasunobu Iwasaki
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
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Monaco E, Redler A, Fabbri M, Proietti L, Gaj E, Daggett M, Ferretti A. Isokinetic flexion strength recovery after ACL reconstruction: a comparison between all inside graft-link technique and full tibial tunnel technique. PHYSICIAN SPORTSMED 2019; 47:132-135. [PMID: 30347173 DOI: 10.1080/00913847.2018.1537535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Recently, a new minimally invasive single bundle technique for anatomic ACL reconstruction has been described, called the 'All-Inside graft-link technique'. One of the advantages of this procedure is the reduced morbidity at the donor site as the graft choice is the quadrupled semitendinosus, thus sparing the gracilis tendon. The aim of this study was to evaluate isokinetic flexion strength recovery in patients who underwent a gracilis sparing technique compared to those with a full-tibial tunnel technique using a doubled gracilis and semitendinosus tendons (DGST) graft. METHODS Patients were divided into two groups: Group A (22 patients) who underwent ACL reconstruction performed with an All-Inside graft-link technique; Group B (22 patients) who underwent ACL reconstruction with an Out-In technique and DGST graft. At a mean follow-up of 13 months, quadriceps and hamstring isokinetic peak torque deficits were recorded. RESULTS In group A, the mean side to side peak torque flexion difference between the operated and non-operated limbs was -3% and the mean torque at 30° was -7.5% at high angular velocity (180°/sec); the mean peak flexion torque was 7.2% and the mean torque at 30° was 3.1% at low angular velocity (60°/sec). In group B, the mean side to side peak flexion torque was -3.5% and the mean torque at 30° was -7.6% at high angular velocity (180°/sec); the mean peak flexion torque was -7.2% and the mean torque at 30° was -11% at low angular velocity (60°/sec). A statistically significant difference was found between the two groups at lower angular velocity both for the mean peak flexion torque and the mean torque at 30° (p = 0.009), with better results in the study group. DISCUSSION/CONCLUSION Gracilis sparing technique is a minimally invasive technique for ACL reconstruction and yielded a significantly better flexion strength recovery at lower angular velocity compared to a full tibial tunnel technique with DGST for ACL reconstruction.
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Affiliation(s)
- Edoardo Monaco
- a University of Rome la Sapienza, Sant'Andrea Hospital, Kirk Kilgour Sports Injury Center , Rome , Italy
| | - Andrea Redler
- a University of Rome la Sapienza, Sant'Andrea Hospital, Kirk Kilgour Sports Injury Center , Rome , Italy
| | - Mattia Fabbri
- a University of Rome la Sapienza, Sant'Andrea Hospital, Kirk Kilgour Sports Injury Center , Rome , Italy
| | - Lorenzo Proietti
- a University of Rome la Sapienza, Sant'Andrea Hospital, Kirk Kilgour Sports Injury Center , Rome , Italy
| | - Edoardo Gaj
- a University of Rome la Sapienza, Sant'Andrea Hospital, Kirk Kilgour Sports Injury Center , Rome , Italy
| | - Matthew Daggett
- b Kansas City University of Medicine and Biosciences , Kansas City , MO , USA
| | - Andrea Ferretti
- a University of Rome la Sapienza, Sant'Andrea Hospital, Kirk Kilgour Sports Injury Center , Rome , Italy
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Czamara A, Królikowska A. Two-Plane Assessment of Knee Muscles Isometric and Isokinetic Torques After Anterior Cruciate Ligament Reconstruction. Med Sci Monit 2018; 24:4882-4893. [PMID: 30007063 PMCID: PMC6069442 DOI: 10.12659/msm.908411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background We tested the hypothesis that, in patients participating in 17 weeks of postoperative physiotherapy after anterior cruciate ligament reconstruction (ACLR), maximal isometric torque (IT) and peak torque (PT) generated by the muscles affecting the operated knee joint in the sagittal and transverse planes are not restored. We also present the application of IT and PT measurements of the muscles affecting the knee joint in 2 planes of motion. Material/Methods IT and PT of the knee extensor and flexor muscles and the muscles internally rotating the shin were measured in 30 males who participated in postoperative physiotherapy for 17 weeks after ACLR (ACLR group) and 30 males with no injuries (control group). Results Significantly lower IT and PT values were noted in the operated knee extensors and flexors. The differences were also noted in the PT for the muscles internally rotating the shin and in the IT of those muscles in the position of 25° of internal rotation. Significantly lower relative IT and PT values were noted for studied muscle groups in comparison to the control group. Conclusions Seventeen weeks of postoperative physiotherapy after ACLR did not result in complete restoration of IT and PT of the muscles affecting the operated knee joint, suggesting that even after 17 weeks of physiotherapy following ACLR, athletes may not be ready to return to sports. The results demonstrate the usefulness of biplanar analysis of muscle strength under isometric and isokinetic conditions in the monitoring and assessment of physiotherapeutic procedures.
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Prediction of Pathological Subjects Using Genetic Algorithms. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2018; 2018:6154025. [PMID: 29623101 PMCID: PMC5829316 DOI: 10.1155/2018/6154025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/13/2017] [Accepted: 01/02/2018] [Indexed: 11/17/2022]
Abstract
This paper aims at estimating pathological subjects from a population through various physical information using genetic algorithm (GA). For comparison purposes, K-Means (KM) clustering algorithm has also been used for the estimation. Dataset consisting of some physical factors (age, weight, and height) and tibial rotation values was provided from the literature. Tibial rotation types are four groups as RTER, RTIR, LTER, and LTIR. Each tibial rotation group is divided into three types. Narrow (Type 1) and wide (Type 3) angular values were called pathological and normal (Type 2) angular values were called nonpathological. Physical information was used to examine if the tibial rotations of the subjects were pathological. Since the GA starts randomly and walks all solution space, the GA is seen to produce far better results than the KM for clustering and optimizing the tibial rotation data assessments with large number of subjects even though the KM algorithm has similar effect with the GA in clustering with a small number of subjects. These findings are discovered to be very useful for all health workers such as physiotherapists and orthopedists, in which this consequence is expected to help clinicians in organizing proper treatment programs for patients.
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Sari M, Tuna C, Akogul S. Prediction of Tibial Rotation Pathologies Using Particle Swarm Optimization and K-Means Algorithms. J Clin Med 2018; 7:jcm7040065. [PMID: 29597270 PMCID: PMC5920439 DOI: 10.3390/jcm7040065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 11/18/2022] Open
Abstract
The aim of this article is to investigate pathological subjects from a population through different physical factors. To achieve this, particle swarm optimization (PSO) and K-means (KM) clustering algorithms have been combined (PSO-KM). Datasets provided by the literature were divided into three clusters based on age and weight parameters and each one of right tibial external rotation (RTER), right tibial internal rotation (RTIR), left tibial external rotation (LTER), and left tibial internal rotation (LTIR) values were divided into three types as Type 1, Type 2 and Type 3 (Type 2 is non-pathological (normal) and the other two types are pathological (abnormal)), respectively. The rotation values of every subject in any cluster were noted. Then the algorithm was run and the produced values were also considered. The values of the produced algorithm, the PSO-KM, have been compared with the real values. The hybrid PSO-KM algorithm has been very successful on the optimal clustering of the tibial rotation types through the physical criteria. In this investigation, Type 2 (pathological subjects) is of especially high predictability and the PSO-KM algorithm has been very successful as an operation system for clustering and optimizing the tibial motion data assessments. These research findings are expected to be very useful for health providers, such as physiotherapists, orthopedists, and so on, in which this consequence may help clinicians to appropriately designing proper treatment schedules for patients.
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Affiliation(s)
- Murat Sari
- Department of Mathematics, Yildiz Technical University, Istanbul 34220, Turkey.
| | - Can Tuna
- Department of Mathematics, Yildiz Technical University, Istanbul 34220, Turkey.
| | - Serkan Akogul
- Department of Statistics, Yildiz Technical University, Istanbul 34220, Turkey.
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Saxby DJ, Bryant AL, Wang X, Modenese L, Gerus P, Konrath JM, Bennell KL, Fortin K, Wrigley T, Cicuttini FM, Vertullo CJ, Feller JA, Whitehead T, Gallie P, Lloyd DG. Relationships Between Tibiofemoral Contact Forces and Cartilage Morphology at 2 to 3 Years After Single-Bundle Hamstring Anterior Cruciate Ligament Reconstruction and in Healthy Knees. Orthop J Sports Med 2017; 5:2325967117722506. [PMID: 28894756 PMCID: PMC5582666 DOI: 10.1177/2325967117722506] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Prevention of knee osteoarthritis (OA) following anterior cruciate ligament (ACL) rupture and reconstruction is vital. Risk of postreconstruction knee OA is markedly increased by concurrent meniscal injury. It is unclear whether reconstruction results in normal relationships between tibiofemoral contact forces and cartilage morphology and whether meniscal injury modulates these relationships. HYPOTHESES Since patients with isolated reconstructions (ie, without meniscal injury) are at lower risk for knee OA, we predicted that relationships between tibiofemoral contact forces and cartilage morphology would be similar to those of normal, healthy knees 2 to 3 years postreconstruction. In knees with meniscal injuries, these relationships would be similar to those reported in patients with knee OA, reflecting early degenerative changes. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Three groups were examined: (1) 62 patients who received single-bundle hamstring reconstruction with an intact, uninjured meniscus (mean age, 29.8 ± 6.4 years; mean weight, 74.9 ± 13.3 kg); (2) 38 patients with similar reconstruction with additional meniscal injury (ie, tear, repair) or partial resection (mean age, 30.6 ± 6.6 years; mean weight, 83.3 ± 14.3 kg); and (3) 30 ligament-normal, healthy individuals (mean age, 28.3 ± 5.2 years; mean weight, 74.9 ± 14.9 kg) serving as controls. All patients underwent magnetic resonance imaging to measure the medial and lateral tibial articular cartilage morphology (volumes and thicknesses). An electromyography-driven neuromusculoskeletal model determined medial and lateral tibiofemoral contact forces during walking. General linear models were used to assess relationships between tibiofemoral contact forces and cartilage morphology. RESULTS In control knees, cartilage was thicker compared with that of isolated and meniscal-injured ACL-reconstructed knees, while greater contact forces were related to both greater tibial cartilage volumes (medial: R2 = 0.43, β = 0.62, P = .000; lateral: R2 = 0.19, β = 0.46, P = .03) and medial thicknesses (R2 = 0.24, β = 0.48, P = .01). In the overall group of ACL-reconstructed knees, greater contact forces were related to greater lateral cartilage volumes (R2 = 0.08, β = 0.28, P = .01). In ACL-reconstructed knees with lateral meniscal injury, greater lateral contact forces were related to greater lateral cartilage volumes (R2 = 0.41, β = 0.64, P = .001) and thicknesses (R2 = 0.20, β = 0.46, P = .04). CONCLUSION At 2 to 3 years postsurgery, ACL-reconstructed knees had thinner cartilage compared with healthy knees, and there were no positive relationships between medial contact forces and cartilage morphology. In lateral meniscal-injured reconstructed knees, greater contact forces were related to greater lateral cartilage volumes and thicknesses, although it was unclear whether this was an adaptive response or associated with degeneration. Future clinical studies may seek to establish whether cartilage morphology can be modified through rehabilitation programs targeting contact forces directly in addition to the current rehabilitation foci of restoring passive and dynamic knee range of motion, knee strength, and functional performance.
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Affiliation(s)
| | - David John Saxby
- Investigation performed at School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia; and the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Adam L Bryant
- Investigation performed at School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia; and the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Xinyang Wang
- Investigation performed at School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia; and the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Luca Modenese
- Investigation performed at School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia; and the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Pauline Gerus
- Investigation performed at School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia; and the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jason M Konrath
- Investigation performed at School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia; and the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kim L Bennell
- Investigation performed at School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia; and the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Karine Fortin
- Investigation performed at School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia; and the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tim Wrigley
- Investigation performed at School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia; and the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Flavia M Cicuttini
- Investigation performed at School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia; and the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christopher J Vertullo
- Investigation performed at School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia; and the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Julian A Feller
- Investigation performed at School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia; and the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tim Whitehead
- Investigation performed at School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia; and the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Price Gallie
- Investigation performed at School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia; and the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - David G Lloyd
- Investigation performed at School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia; and the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Konrath JM, Saxby DJ, Killen BA, Pizzolato C, Vertullo CJ, Barrett RS, Lloyd DG. Muscle contributions to medial tibiofemoral compartment contact loading following ACL reconstruction using semitendinosus and gracilis tendon grafts. PLoS One 2017; 12:e0176016. [PMID: 28423061 PMCID: PMC5397063 DOI: 10.1371/journal.pone.0176016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 04/04/2017] [Indexed: 01/28/2023] Open
Abstract
Background The muscle-tendon properties of the semitendinosus (ST) and gracilis (GR) are substantially altered following tendon harvest for the purpose of anterior cruciate ligament reconstruction (ACLR). This study adopted a musculoskeletal modelling approach to determine how the changes to the ST and GR muscle-tendon properties alter their contribution to medial compartment contact loading within the tibiofemoral joint in post ACLR patients, and the extent to which other muscles compensate under the same external loading conditions during walking, running and sidestep cutting. Materials and methods Motion capture and electromyography (EMG) data from 16 lower extremity muscles were acquired during walking, running and cutting in 25 participants that had undergone an ACLR using a quadruple (ST+GR) hamstring auto-graft. An EMG-driven musculoskeletal model was used to estimate the medial compartment contact loads during the stance phase of each gait task. An adjusted model was then created by altering muscle-tendon properties for the ST and GR to reflect their reported changes following ACLR. Parameters for the other muscles in the model were calibrated to match the experimental joint moments. Results The medial compartment contact loads for the standard and adjusted models were similar. The combined contributions of ST and GR to medial compartment contact load in the adjusted model were reduced by 26%, 17% and 17% during walking, running and cutting, respectively. These deficits were balanced by increases in the contribution made by the semimembranosus muscle of 33% and 22% during running and cutting, respectively. Conclusion Alterations to the ST and GR muscle-tendon properties in ACLR patients resulted in reduced contribution to medial compartment contact loads during gait tasks, for which the semimembranosus muscle can compensate.
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Affiliation(s)
- Jason M. Konrath
- School of Allied Health Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- * E-mail:
| | - David J. Saxby
- School of Allied Health Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Bryce A. Killen
- School of Allied Health Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Claudio Pizzolato
- School of Allied Health Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Christopher J. Vertullo
- School of Allied Health Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Knee Research Australia, Gold Coast, Queensland, Australia
| | - Rod S. Barrett
- School of Allied Health Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - David G. Lloyd
- School of Allied Health Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Femoral interference screw fixation of hamstring and quadriceps tendons for ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2017; 25:1241-1248. [PMID: 26818555 DOI: 10.1007/s00167-016-4001-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE This cadaveric study compares the biomechanical properties of femoral graft fixation in ACL reconstruction of either quadriceps or hamstring tendon grafts with four different interference screws. The hypothesis was that quadriceps tendon grafts provide at least equal results concerning gap formation during cyclic loading and ultimate failure load compared to hamstring tendon grafts with four different interference screws. METHODS Eighty porcine femora underwent interference screw fixation of human tendon grafts for ACL reconstruction. Either quadriceps (Q) or hamstring (H) tendon grafts and four different bioabsorbable interference (Wolf (W), Storz (S), Mitek (M), Arthrex (A)) screws were used, resulting in 8 groups with 10 specimens per groups (WQ, WH, SQ, SH, MQ, MH, AQ, AH). Biomechanical analysis included pretensioning the constructs with 60 N for 30 s, then cyclic loading of 500 cycles between 60 and 250 N at 1 Hz in a servohydraulic testing machine, with measurement of elongation and stiffness including video measurements. After this, ultimate failure load and failure mode analysis were performed. RESULTS No statistically significant difference could be noted between the groups regarding gap formation during cyclic loading [Cycles 21-500 (mm): WQ 3.6 ± 0.8, WH 3.9 ± 1.4, SQ 3.6 ± 0.8, SH 3.3 ± 1.5, MQ 4.3 ± 0.8, MH 4.6 ± 1.0, AQ 4.8 ± 0.8, AH 4.3 ± 1.5, n.s.], stiffness during cyclic loading [Cycles 21-500 (N/mm): WQ 72.9 ± 16.9, WH 71.6 ± 20.7, SQ 69.5 ± 23.9, SH 77.4 ± 25.1, MQ 59.6 ± 11.2, MH 48.4 ± 15.4, AQ 48.8 ± 12.7, AH 51.9 ± 22.2, n.s.], and ultimate failure load [(N): WQ 474.4 ± 88.0, WH 579.3 ± 124.2, SQ 493.9 ± 105.2, SH 576.0 ± 90.4, MQ 478.6 ± 59.0, MH 543.9 ± 119.7, AQ 480.2 ± 93.8, AH 497.8 ± 74.2, n.s.]. CONCLUSIONS Quadriceps tendon grafts yield comparable biomechanical results for femoral interference screw fixation in ACL reconstruction compared to hamstring tendon grafts. From a clinical perspective, quadriceps tendon grafts should therefore be considered as a good option in ACL reconstruction in the future.
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Ju SB, Park GD. Effects of the application of ankle functional rehabilitation exercise on the ankle joint functional movement screen and isokinetic muscular function in patients with chronic ankle sprain. J Phys Ther Sci 2017; 29:278-281. [PMID: 28265157 PMCID: PMC5332988 DOI: 10.1589/jpts.29.278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/07/2016] [Indexed: 12/26/2022] Open
Abstract
[Purpose] This study was conducted to investigate the effects of ankle functional
rehabilitation exercise on ankle joint functional movement screen results and isokinetic
muscular function in patients with chronic ankle sprain patients. [Subjects and Methods]
In this study, 16 patients with chronic ankle sprain were randomized to an ankle
functional rehabilitation exercise group (n=8) and a control group (n=8). The ankle
functional rehabilitation exercise centered on a proprioceptive sense exercise program,
which was applied 12 times for 2 weeks. To verify changes after the application, ankle
joint functional movement screen scores and isokinetic muscular function were measured and
analyzed. [Results] The ankle functional rehabilitation exercise group showed significant
improvements in all items of the ankle joint functional movement screen and in isokinetic
muscular function after the exercise, whereas the control group showed no difference after
the application. [Conclusion] The ankle functional rehabilitation exercise program can be
effectively applied in patients with chronic ankle sprain for the improvement of ankle
joint functional movement screen score and isokinetic muscular function.
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Affiliation(s)
- Sung-Bum Ju
- Major in Exercise Therapy, Department of Sport and Health Care, Namseoul University, Republic of Korea
| | - Gi Duck Park
- Department of Leisure and Sports, Kyungpook National University: 386 Gajangdong, Sangju 742-711, Republic of Korea
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Jónasson G, Helgason A, Ingvarsson Þ, Kristjánsson AM, Briem K. The Effect of Tibial Rotation on the Contribution of Medial and Lateral Hamstrings During Isometric Knee Flexion. Sports Health 2016; 8:161-6. [PMID: 26721286 PMCID: PMC4789934 DOI: 10.1177/1941738115625039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Selective atrophy of hamstring components may result from muscle strain or graft harvesting for anterior cruciate ligament reconstruction. Assessment and rehabilitation that specifically targets medial (MH) or lateral (LH) hamstring components may improve patient outcomes. The purpose of this study was to evaluate effects of volitional tibial rotation medially (MR) versus laterally (LR) on activation levels of MH versus LH and strength measures during isometric testing of knee flexors. Hypothesis: Muscle activation of MH and LH during knee flexor strength testing will be augmented when coupled with MR and LR of the tibia, respectively, without affecting knee flexor strength measures. Study Design: Cross-sectional laboratory study. Level of Evidence: Level 3. Methods: Surface electrodes were used to record neuromuscular activity from MH and LH of the right lower limb in 40 healthy young men and women during isometric knee flexor strength testing at 40° of knee flexion, where participants maintained concurrent volitional MR or LR of the tibia. Statistical analyses of variance included general linear models for repeated measures. Results: A significant interaction was found for tibial rotation and hamstring component variables (P < 0.01). When isometric knee flexion was coupled with LR, normalized activation levels were similar for MH and LH. When performed with MR, a significant drop in LH activation led to dissimilar activation levels of the 2 components. Significantly greater strength measures were found when isometric knee flexion was performed with concurrent LR of the tibia (P < 0.01). Both sexes demonstrated the same rotation-dependent differences. Conclusion: Coupling tibial rotation with knee flexor activities primarily affects the LH component. Clinical Relevance: Strategies involving volitional tibial rotation may be considered for specific assessment/rehabilitation of the MH or LH component.
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Affiliation(s)
| | - Andri Helgason
- Department of Physical Therapy, University of Iceland, Reykjavik, Iceland
| | | | | | - Kristín Briem
- Department of Physical Therapy, University of Iceland, Reykjavik, Iceland
- * Kristín Briem, PT, PhD, Research Centre of Movement Science, Department of Physical Therapy, University of Iceland, Saemundargata 2, Reykjavik IS101, Iceland ()
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SAXBY DAVIDJOHN, BRYANT ADAML, MODENESE LUCA, GERUS PAULINE, KILLEN BRYCEA, KONRATH JASON, FORTIN KARINE, WRIGLEY TIMV, BENNELL KIML, CICUTTINI FLAVIAM, VERTULLO CHRISTOPHER, FELLER JULIANA, WHITEHEAD TIM, GALLIE PRICE, LLOYD DAVIDG. Tibiofemoral Contact Forces in the Anterior Cruciate Ligament–Reconstructed Knee. Med Sci Sports Exerc 2016; 48:2195-2206. [DOI: 10.1249/mss.0000000000001021] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Konrath JM, Vertullo CJ, Kennedy BA, Bush HS, Barrett RS, Lloyd DG. Morphologic Characteristics and Strength of the Hamstring Muscles Remain Altered at 2 Years After Use of a Hamstring Tendon Graft in Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2016; 44:2589-2598. [PMID: 27432052 DOI: 10.1177/0363546516651441] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The hamstring tendon graft used in anterior cruciate ligament (ACL) reconstruction has been shown to lead to changes to the semitendinosus and gracilis musculature. HYPOTHESIS We hypothesized that (1) loss of donor muscle size would significantly correlate with knee muscle strength deficits, (2) loss of donor muscle size would be greater for muscles that do not experience tendon regeneration, and (3) morphological adaptations would also be evident in nondonor knee muscles. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Twenty participants (14 men and 6 women, mean age 29 ± 7 years, mean body mass 82 ± 15 kg) who had undergone an ACL reconstruction with a hamstring tendon graft at least 2 years previously underwent bilateral magnetic resonance imaging and subsequent strength testing. Muscle and tendon volumes, peak cross-sectional areas (CSAs), and lengths were determined for 12 muscles and 6 functional muscle groups of the surgical and contralateral limbs. Peak isokinetic concentric strength was measured in knee flexion/extension and internal/external tibial rotation. RESULTS Only 35% of the patients showed regeneration of both the semitendinosus and gracilis tendons. The regenerated tendons were longer with larger volume and CSA compared with the contralateral side. Deficits in semitendinosus and gracilis muscle size were greater for muscles in which tendons did not regenerate. In addition, combined hamstring muscles (semitendinosus, semimembranosus, and biceps femoris) and combined medial knee muscles (semitendinosus, semimembranosus, gracilis, vastus medialis, medial gastrocnemius, and sartorius) on the surgical side were reduced in volume by 12% and 10%, respectively. A 7% larger volume was observed in the surgical limb for the biceps femoris muscle and corresponded with a lower internal/external tibial rotation strength ratio. The difference in volume, peak CSA, and length of the semitendinosus and gracilis correlated significantly with the deficit in knee flexion strength, with Pearson correlations of 0.51, 0.57, and 0.61, respectively. CONCLUSION The muscle-tendon properties of the semitendinosus and gracilis are substantially altered after harvesting, and these alterations may contribute to knee flexor weakness in the surgical limb. These deficits are more pronounced in knees with tendons that do not regenerate and are only partially offset by compensatory hypertrophy of other hamstring muscles.
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Affiliation(s)
- Jason M Konrath
- School of Allied Health Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Christopher J Vertullo
- School of Allied Health Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia Knee Research Australia, Gold Coast, Queensland, Australia
| | | | - Hamish S Bush
- School of Allied Health Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Rod S Barrett
- School of Allied Health Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - David G Lloyd
- School of Allied Health Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Kim K, Jeon K. Development of an efficient rehabilitation exercise program for functional recovery in chronic ankle instability. J Phys Ther Sci 2016; 28:1443-7. [PMID: 27313347 PMCID: PMC4905886 DOI: 10.1589/jpts.28.1443] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 01/19/2016] [Indexed: 12/26/2022] Open
Abstract
[Purpose] The aim of the present study was to construct an integrated rehabilitation
exercise program to prevent chronic pain and improve motor ability in cases of ankle
injury and re-injury. [Subjects and Methods] Twenty-six male soccer players who required
functional strength exercises due to repeated ankle injury were the subjects. A 12-week
rehabilitation exercise program was constructed with the aim of improving muscle strength
in the ankle and dynamic coordination of the lower limb. Muscle strength and dynamic
coordination were evaluated using the Y Balance Test, and isokinetic muscle strength of
ankle dorsiflexion, plantarflexion, inversion, and eversion were measured before and after
the 12-week program. [Results] Following 12 weeks of rehabilitation exercise, there were
statistically significant improvements in the ratios of dorsiflexor strength to
plantarflexor strength, eversion strength, and inversion strength on the left side. The
other variables showed no significant changes. [Conclusion] The rehabilitation exercise
program for chronic ankle instability helped to reduce pain, and to restore normal joint
range of motion, muscle strength and endurance, and functional ability. Active protocols
to improve complex functions need to be developed to complement these results.
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Affiliation(s)
- Kewwan Kim
- Division of Sport Science, Incheon National University, Republic of Korea
| | - Kyoungkyu Jeon
- Sport Science Institute, Incheon National University, Republic of Korea
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Jeon K, Seo BD, Lee SH. Comparative study on isokinetic capacity of knee and ankle joints by functional injury. J Phys Ther Sci 2016; 28:250-6. [PMID: 26957768 PMCID: PMC4756014 DOI: 10.1589/jpts.28.250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 10/16/2015] [Indexed: 12/30/2022] Open
Abstract
[Purpose] To collect basic data for exercise programs designed to enhance functional knee
and ankle joint stability based on isokinetic measurement and muscle strength evaluations
in normal and impaired functional states. [Subjects and Methods] Twenty-four subjects were
randomly assigned to the athlete group and the control group (n = 12 each). Data were
collected of isokinetic knee extensor and flexor strength at 60°/sec, 180°/sec, and
240°/sec and ankle plantar and dorsiflexor strength at 30°/sec and 120°/sec. [Results]
Significant intergroup differences were observed in peak torque of the right extensors at
60°/sec, 180°/sec, and 240°/sec and the right flexors at 240°/sec. Significant differences
were observed in peak torque/body weight in the right extensors at 60°/sec, 180°/sec, and
240°/sec and in the right flexors at 180°/sec and 240°/sec. Significant peak torque
differences were noted in the left ankle joint dorsiflexor at 30°/sec and 120°/sec, right
plantar flexor at 120°/sec, left plantar flexor at 30°/sec, left dorsiflexor at 30°/sec
and 120°/sec, and right dorsiflexor at 120°/sec. [Conclusion] Isokinetic evaluation
stimulates muscle contraction at motion-dependent speeds and may contribute to the
development of intervention programs to improve knee and ankle joint function and correct
lower-extremity instability.
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Affiliation(s)
- Kyoungkyu Jeon
- Sport Science Institute, Incheon National University, Republic of Korea
| | - Byoung-Do Seo
- Department of Physical Therapy, College of Health, Kyungwoon University, Republic of Korea
| | - Sang-Ho Lee
- Department of Physical Education, College of Education, Hankuk University of Foreign Studies, Republic of Korea
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Czamara A, Królikowska A, Szuba Ł, Widuchowski W, Kentel M. Single- vs. double-bundle anterior cruciate ligament reconstruction: a new aspect of knee assessment during activities involving dynamic knee rotation. J Strength Cond Res 2016; 29:489-99. [PMID: 25148470 DOI: 10.1519/jsc.0000000000000638] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Few studies have compared single-bundle (SB) and double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) in the knee joint during activities involving change-of-direction maneuvers and knee rotation. This study examined whether the type of ACLR contributes to postphysiotherapy outcomes, with an emphasis on knee function assessment during activities involving dynamic knee rotation. Fifteen male patients after SB ACLR and 15 male patients after DB ACLR took part in the same physiotherapy program. Twenty-four weeks after ACLR, both groups underwent anterior laxity measurement, pivot shift tests, range of movement and joint circumference measurements, subjective assessment of pain and stability levels in the knee joint, peak torque measurement of the muscles rotating the tibia toward the femur, and a run test with maximal speed and change-of-direction maneuvers. Comparative analysis did not show any differences between the results of anterior tibial translation, pivot shift test, range of movement and joint circumference, and subjective assessment of pain and knee joint stability levels. No differences were noted between the groups in peak torque values obtained from the muscles responsible for internal and external tibial rotation or results of the run test. The data obtained from this study can be used by research teams to monitor and compare the effectiveness of various study protocols involving surgical and physiotherapy treatment. The data are especially useful when combined with the clinical assessment of patients who would like to return to sport.
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Affiliation(s)
- Andrzej Czamara
- 1The Department of Physiotherapy, The College of Physiotherapy in Wroclaw, Wroclaw, Poland; and 2The Department of Physiotherapy, The Center of Rehabilitation and Medical Education, Wroclaw, Poland
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Briem K, Ragnarsdóttir AM, Árnason SI, Sveinsson T. Altered medial versus lateral hamstring muscle activity during hop testing in female athletes 1-6 years after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2016; 24:12-7. [PMID: 25246177 DOI: 10.1007/s00167-014-3333-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 09/15/2014] [Indexed: 01/11/2023]
Abstract
PURPOSE The purpose of this study was to assess activation patterns of medial (MH) versus lateral (LH) hamstrings in female athletes who had undergone ACL reconstruction (ACLR) using a hamstrings-graft during single-limb functional testing. METHODS Eighteen athletes (1-6 years since ACLR) and 18 healthy controls were recruited from the Icelandic women's top divisions in football, handball, and basketball. Activation of the MH and LH was monitored bilaterally using surface electromyography. Peak activation of the normalized signal was identified for two phases of the single-limb crossover (SLC) hop test and performance (distance jumped) registered. Self-reported knee symptoms and function were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS). A repeated measures general linear model was used for main statistical data analyses, comparing variables of interests between limbs (within-subjects factor) and between groups. RESULTS ACLR athletes had worse KOOS-symptoms scores (p < 0.05) than controls, while hop distance was equal. Overall, MH and LH muscle activation levels differed between the two phases of the SLC hop test (p < 0.05). Moreover, inter-limb differences in MH and LH activity were identified between groups (p < 0.05), mainly explained by greater LH than MH activation in the uninjured limb of ACLR athletes. CONCLUSION One to 6 years after ACLR, female athletes performed on par with uninjured controls, but demonstrated inter-limb differences in muscle activation patterns of the hamstrings that were not evident in controls. This may be an important factor to consider during postsurgical rehabilitation in order to lower the risk of a second injury. LEVEL OF EVIDENCE III.
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Affiliation(s)
- K Briem
- Department of Physical Therapy, Research Centre of Movement Science, University of Iceland, Stapi v/Hringbraut, 101, Reykjavik, Iceland.
| | - A M Ragnarsdóttir
- Department of Physical Therapy, Research Centre of Movement Science, University of Iceland, Stapi v/Hringbraut, 101, Reykjavik, Iceland
| | - S I Árnason
- Department of Physical Therapy, Research Centre of Movement Science, University of Iceland, Stapi v/Hringbraut, 101, Reykjavik, Iceland
| | - T Sveinsson
- Department of Physical Therapy, Research Centre of Movement Science, University of Iceland, Stapi v/Hringbraut, 101, Reykjavik, Iceland
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Jeon KK, Kim TY, Lee SH. The effects of a strategic strength resistance exercise program on the isokinetic muscular function of the ankle. J Phys Ther Sci 2015; 27:3295-7. [PMID: 26644696 PMCID: PMC4668187 DOI: 10.1589/jpts.27.3295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/27/2015] [Indexed: 01/22/2023] Open
Abstract
[Purpose] The purpose of this study was to investigate the effects of a strategic strength resistance exercise program on the isokinetic muscular function of the ankle joint. [Subjects] This study included 22 males in their twenties who were diagnosed with functional injury of the ankle joint. [Methods] To strengthen plantar flexion and dorsiflexion of the ankle joint, 8 weeks of weight, resistance band, and plyometric training, and training using props were performed. [Results] A medical examination by interview indicated that pain, swelling, instability, running, and support capacity of the ankle joint significantly improved with the strategic strength resistance exercise program. For the isokinetic peak torque of the ankles, significant differences were observed in right plantar flexion and bilateral dorsiflexion. [Conclusion] The strategic strength resistance exercise program is highly recommended for the functional stability of the ankle joint. Efficient exercise therapy is useful for muscle damage prevention, muscle strengthening, and functional interventions.
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Affiliation(s)
- Kyoung-Kyu Jeon
- Sport Science Institute, Incheon National University, Republic of Korea
| | - Tae-Young Kim
- Department of Physical Education, College of Education, Hankuk University of Foreign Studies, Republic of Korea
| | - Sang-Ho Lee
- Department of Physical Education, College of Education, Hankuk University of Foreign Studies, Republic of Korea
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Królikowska A, Czamara A, Kentel M. Does Gracilis Tendon Harvest During ACL Reconstruction with a Hamstring Autograft Affect Torque of Muscles Responsible for Shin Rotation? Med Sci Monit 2015; 21:2084-93. [PMID: 26190033 PMCID: PMC4514330 DOI: 10.12659/msm.893930] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background A growing body of evidence indicates that in patients after anterior cruciate ligament reconstruction (ACLR) with a combined semitendinosus and gracilis (STGR) graft there are large deficits in the internal rotation strength, which has led some authors to recommend harvest of only ST tendon whenever possible. The purpose of this study was to assess the isometric (IT) and peak torque (PT) of the muscles responsible for shin rotation in patients after ACLR with an ST or with an STGR graft. Material/Methods Twenty patients with an ST graft and 20 patients with a combined STGR graft underwent a 6-month postoperative rehabilitation program after ACLR. At the end of the rehabilitation program, the IT and PT of the muscles responsible for internal (IR) and external rotation (ER) of the shin were measured. The results were compared to the results of a control group. Additionally, to determine the reliability of the dynamometer for clinical research, a test-retest assessment was performed. Results There were no statistically significant differences between the 3 groups of participants. Nevertheless, in the STGR group there was a statistically significant difference between the IT of muscles internally rotating the shin in the involved knee and uninvolved knee at 25° of the internal shin rotation. Conclusions Comparison of IT and PT measurements performed after 24 weeks of postoperative rehabilitation generally showed no differences between patients after ACLR with the use of ST graft and patients who received a combination graft consisting of STGR. Nevertheless, there was an influence of GR harvest on internal shin rotation torque at a deep internal rotation angle.
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Affiliation(s)
| | - Andrzej Czamara
- Department of Physiotherapy, The College of Physiotherapy in Wrocław, Wrocław, Poland
| | - Maciej Kentel
- Department of Physiotherapy, The College of Physiotherapy in Wrocław, Wrocław, Poland
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Krych AJ, Woodcock JA, Morgan JA, Levy BA, Stuart MJ, Dahm DL. Factors associated with excellent 6-month functional and isokinetic test results following ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2015; 23:1053-9. [PMID: 24531355 DOI: 10.1007/s00167-014-2869-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 01/22/2014] [Indexed: 01/11/2023]
Abstract
PURPOSE To identify patient concomitant injury and surgical characteristics associated with 6-month excellent functional and isokinetic testing results following anterior cruciate ligament (ACL) reconstruction. METHODS Patients that underwent ACL reconstruction by a single surgeon had isokinetic and functional testing performed with excellent 6-month outcome defined as greater than 85 % in isokinetic strength and 90 % in functional tests (excellent 6-month group vs. delayed 6-month group). Patient concomitant injury and surgical factors were then analysed in univariate and multivariate statistical models to assess which characteristics predicted the excellent 6-month group. RESULTS The 224 patients included 93 males and 131 females, with median age of 22 (range 12-59) years, body mass index (BMI) of 25.4 (range 17-44), and median Tegner activity score of 6 (range 2-10). Fifty-two patients (23 %) were included in the excellent 6-month group, while 172 patients (77 %) were in the delayed 6-month group. In univariate analysis, favourable factors with the excellent 6-month outcome group were younger age (24 vs. 27; p = 0.01), lower BMI (24.5 vs. 26.2; p = 0.03), and minimal articular cartilage damage (71 vs. 56 %; p = 0.048). In multivariate analysis, a negative effect was observed for patients older than 30 years that had ACL reconstruction with autograft (p = 0.0004). CONCLUSION Factors significantly associated with excellent 6-month functional and isokinetic test results following ACL reconstruction included younger age, lower BMI, and minimal cartilage degeneration. The use of allograft was associated with improved functional and strength testing after ACL reconstruction in patients over 30 years of age. LEVEL OF EVIDENCE Prognostic/therapeutic study, Level III.
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Affiliation(s)
- Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St., SW, Rochester, MN, 55905, USA
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Snoeck O, Beyer B, Feipel V, Salvia P, Sterckx JL, Rooze M, Van Sint Jan S. Tendon and fascial structure contributions to knee muscle excursions and knee joint displacement. Clin Biomech (Bristol, Avon) 2014; 29:1070-6. [PMID: 25168083 DOI: 10.1016/j.clinbiomech.2014.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/07/2014] [Accepted: 08/07/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Semitendinosus and gracilis muscles whose tendons are used in surgical reconstruction of the anterior cruciate ligament maintain their contractile ability, and a limited decrease of hamstring muscles force is observed postoperatively despite important changes. The goal was to quantify the influence of the myofascial structures on excursions and moment arms of knee muscles to attempt explaining the above-mentioned post-surgical observations. METHODS Hamstring harvesting procedures were performed by a senior orthopaedic surgeon on seven lower limbs from fresh-frozen specimens. Femoro-tibial kinematics and tendons excursion were simultaneously recorded at each steps of the surgery. FINDINGS No significant difference was demonstrated for excursions and moment arms after tenotomies and gracilis tendon harvesting (P≥0.05). The first significant semitendinosus excursion (P<1.17×10(-4)) and moment arm (P<6.88×10(-5)) decrease was observed after semitendinosus tendon harvesting (46% of the initial excursion). INTERPRETATION Gracilis and semitendinosus myofascial pathway is crucial for force transmission towards the knee joint.
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Affiliation(s)
- O Snoeck
- Laboratory of Anatomy, Biomechanics and Organogenesis, Université Libre de Bruxelles (ULB), Bruxelles, Belgium.
| | - B Beyer
- Laboratory of Anatomy, Biomechanics and Organogenesis, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - V Feipel
- Laboratory of Anatomy, Biomechanics and Organogenesis, Université Libre de Bruxelles (ULB), Bruxelles, Belgium; Laboratory of Functional Anatomy, Université Libre de Bruxelles, Bruxelles, Belgium
| | - P Salvia
- Laboratory of Anatomy, Biomechanics and Organogenesis, Université Libre de Bruxelles (ULB), Bruxelles, Belgium; Laboratory of Functional Anatomy, Université Libre de Bruxelles, Bruxelles, Belgium
| | - J-L Sterckx
- Laboratory of Functional Anatomy, Université Libre de Bruxelles, Bruxelles, Belgium
| | - M Rooze
- Laboratory of Anatomy, Biomechanics and Organogenesis, Université Libre de Bruxelles (ULB), Bruxelles, Belgium; Laboratory of Functional Anatomy, Université Libre de Bruxelles, Bruxelles, Belgium; Department of Orthopedic Surgery, Erasme Hospital, Université Libre de Bruxelles, Bruxelles, Belgium
| | - S Van Sint Jan
- Laboratory of Anatomy, Biomechanics and Organogenesis, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
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Petersen W, Taheri P, Forkel P, Zantop T. Return to play following ACL reconstruction: a systematic review about strength deficits. Arch Orthop Trauma Surg 2014; 134:1417-28. [PMID: 25091127 DOI: 10.1007/s00402-014-1992-x] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Indexed: 01/09/2023]
Abstract
PURPOSE There is a lack of consensus regarding appropriate criteria attesting patients' unrestricted sports activities after ACL reconstruction. Purpose of this study was to perform a systematic review about strength deficits to find out if a strength test might be a return to play criterion. DATA SOURCE Pubmed central, Google Scholar. STUDY ELIGIBILITY CRITERIA English language articles. INTERVENTIONS Strength tests after ACL reconstruction with autologous tendon grafts. METHODS A systematic search for articles about muscle strength after ACL reconstruction was performed. RESULTS Forty-five articles could be identified. All articles identified reported strength deficits after ACL reconstruction in comparison to control subjects. Some of these deficits persisted up to 5 years after surgery. Knee flexor strength is more impaired after ACL reconstruction with hamstring grafts and quadriceps strength after BPTB ACL reconstruction. CONCLUSION Strength deficits of hip, knee and ankle muscles are reported after ACL reconstruction. Muscular strength test may be an important tool to determine if an athlete can return to competitive sports after ACL reconstruction.
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Affiliation(s)
- Wolf Petersen
- Department of Trauma and Orthopaedic Surgery, Martin Luther Hospital, Caspar Theyss Straße 27-31, 14193, Berlin, Grunewald, Germany,
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Arnason SM, Birnir B, Guðmundsson TE, Guðnason G, Briem K. Medial hamstring muscle activation patterns are affected 1-6 years after ACL reconstruction using hamstring autograft. Knee Surg Sports Traumatol Arthrosc 2014; 22:1024-9. [PMID: 24067994 DOI: 10.1007/s00167-013-2696-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 09/16/2013] [Indexed: 01/11/2023]
Abstract
PURPOSE Although changes in hamstring muscle morphology after anterior cruciate ligament reconstruction (ACLR) using a semitendinosus autograft hamstrings-gracilis (HG) of the ipsilateral limb are recognized, alterations in muscle activation patterns have not been extensively studied. The purpose of this controlled laboratory trial was therefore to monitor muscle activation levels of the medial (MH) and lateral (LH) hamstring muscles in athletes who had undergone ACLR using a HG autograft and to contrast these to activation levels demonstrated by healthy controls. METHODS Surface electromyography (EMG) was sampled from bilateral hamstring muscles of 18 athletes 1-6 years after ACLR and 18 matched controls (CTRL) during the performance of two dissimilar exercises, both involving eccentric knee flexor activity. Peak normalized muscle activation levels were identified for MH and LH of both limbs during the performance of the Nordic Hamstring (NH) exercise and TRX) hamstring curl (TRX) exercise. RESULTS A statistically significant limb by exercise interaction was found for peak activation levels of LH, due to significant interlimb differences in activation during the performance of the TRX exercise compared to more symmetrical activation during the NH (p < 0.001). A three-way interaction was found for peak activation levels of MH, due to group differences in peak muscle activation between limbs and exercise type (p = 0.025). Whereas CTRL group participants consistently favoured one limb over the other during the performance of both exercises, ACLR participants demonstrated dissimilar peak MH activation patterns between limbs during the performance of the NH exercise compared to the TRX. CONCLUSIONS In light of these results and considering the surgical procedure, patients who undergo ACLR using a HG autograft from the ipsilateral limb may benefit from post-operative rehabilitation that involves muscle activation and strengthening specifically targeting the MH component.
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Affiliation(s)
- Stefán Magni Arnason
- Department of Physical Therapy, School of Health Sciences, University of Iceland, Saemundargata 2, 101, Reykjavik, Iceland
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Bencke J, Curtis D, Krogshede C, Jensen LK, Bandholm T, Zebis MK. Biomechanical evaluation of the side-cutting manoeuvre associated with ACL injury in young female handball players. Knee Surg Sports Traumatol Arthrosc 2013; 21:1876-81. [PMID: 22968624 DOI: 10.1007/s00167-012-2199-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 08/30/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of the study was to investigate the biomechanics of the knee and hip joint during handball-specific side-cutting on the dominant and non-dominant leg. Understanding the sports-specific biomechanics may improve prevention measures and post-injury treatment. METHODS Twenty-four young female elite handball players performed 5 handball side-cutting manoeuvres on the dominant and non-dominant legs. The local maxima of the joint moments in each plane, during the initial 100 ms following foot contact, were collected. RESULTS External knee moments of flexion, outward rotation and valgus-along with external hip moments of extension, abduction and internal rotation-were observed, coincidentally 30-40 ms after foot contact. No side-to-side asymmetries were found. The external moments observed support the injury mechanisms previously described in case studies of handball injuries. CONCLUSION The results underline the importance of implementing preventive exercises that increase activity of medial hamstrings, to match the external outward rotating knee moments and knee valgus moments, and increase activity of hip external rotators to match the external hip inward-rotating moment. Furthermore, the results may yield further information to the graft selection decision before ACL surgery. LEVEL OF EVIDENCE Diagnostic studies, Level II.
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Affiliation(s)
- Jesper Bencke
- The Gait Analysis Laboratory, Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegaard Allé 30, 2650, Hvidovre, Denmark.
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Mehran N, Skendzel JG, Lesniak BP, Bedi A. Contemporary Graft Options in Anterior Cruciate Ligament Reconstruction. OPER TECHN SPORT MED 2013. [DOI: 10.1053/j.otsm.2012.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Goddard M, Bowman N, Salmon LJ, Waller A, Roe JP, Pinczewski LA. Endoscopic anterior cruciate ligament reconstruction in children using living donor hamstring tendon allografts. Am J Sports Med 2013; 41:567-74. [PMID: 23371473 DOI: 10.1177/0363546512473576] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The incidence of anterior cruciate ligament (ACL) injuries in children is increasing, but ACL reconstruction with traditional autograft sources is associated with high rates of further ACL injury when compared with adult populations. The outcome of ACL reconstruction using an alternative graft source, the living donor hamstring tendon (HT) allograft, has not been reported. PURPOSE To determine the outcome of endoscopic transphyseal single-tunnel ACL reconstruction using living donor HT allografts. STUDY DESIGN Case series; Level of evidence, 4. METHODS Between 2007 and 2008, 32 children underwent endoscopic transphyseal single-tunnel ACL reconstruction using living donor HT allografts. The HT allograft was harvested from a parent. At a minimum 2 years' follow-up, full International Knee Documentation Committee (IKDC) knee ligament examination was performed on the children including instrumented testing using the KT-1000 arthrometer. Donors underwent subjective review at a minimum 2 years' follow-up. RESULTS Thirty-one children (97%) were able to be contacted for review. Of these, 2 (6%) sustained an ACL graft rupture within 2 years after surgery. Twenty-nine children completed clinical and subjective review. The mean age at ACL reconstruction was 13 years (range, 8-16 years). The mean HT graft size was 7.2 mm (range, 6-8 mm). The mean IKDC subjective score was 97 (range, 84-100). Twenty-eight patients (97%) had a normal or nearly normal IKDC ligament grade. At 2 years after surgery, 27 patients (93%) reported regularly participating in very strenuous or strenuous activities. There were no cases of limb malalignment. Twenty eight (97%) of the donors reported that they would undergo the same procedure again under the same circumstances. CONCLUSION Excellent clinical and subjective outcomes were achieved with high levels of return to desired activities. This technique allows a more predictable size of the HTs compared with an autograft from the child and maintains an intact neuromuscular hamstring structure in the child. Finally, the child's own HTs are reserved for future use. Anterior cruciate ligament reconstruction using living donor allografts should be considered a viable choice in children.
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Affiliation(s)
- Martin Goddard
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
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Janssen RPA, van der Velden MJF, Pasmans HLM, Sala HAGM. Regeneration of hamstring tendons after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2013; 21:898-905. [PMID: 22763570 PMCID: PMC3604585 DOI: 10.1007/s00167-012-2125-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 06/21/2012] [Indexed: 01/09/2023]
Abstract
PURPOSE Primary aim of the study was analysis of hamstring tendon regeneration after anterior cruciate ligament reconstruction (ACLR). Secondary aim was analysis of isokinetic muscle strength in relation to hamstring regeneration. The hypothesis was that regeneration of hamstring tendons after ACLR occurs and that regenerated hamstring tendons contribute to isokinetic hamstring strength with regeneration distal to the knee joint line. METHODS Twenty-two patients scheduled for ACLR underwent prospective MRI analysis of both legs. MRI parameters were tendon regeneration and morphology, muscle retraction and muscle cross-sectional area. A double-blind, prospective analysis of isokinetic quadriceps and hamstrings strength was performed. RESULTS Regeneration of the gracilis tendon after ACLR occurred in all patients. Regeneration of the semitendinosus tendon occurred in 14 patients. At 1 year, the surface area of the semitendinosus and gracilis muscle decreased compared to both preoperatively (P < 0.01) and the contralateral leg (P < 0.01). The cross-sectional area of the semitendinosus muscle decreased in the absence of tendon regeneration (P = 0.05). The cross-sectional area of the gracilis muscle was greater in case of regeneration distal to the joint line (P = 0.01). Muscle retraction of the semitendinosus muscle was increased in case of nonregeneration (P = 0.02). There was no significant relationship between isokinetic flexion strength and tendon regeneration. CONCLUSION Hamstring tendons regenerated after harvest of both semitendinosus and gracilis tendons for ACLR. There was no relation between isokinetic flexion strength and tendon regeneration.
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Affiliation(s)
- Rob P. A. Janssen
- Orthopaedic Center Máxima, Máxima Medical Center, Postbus 90052, 5600 PD Eindhoven, The Netherlands
| | | | - Huub L. M. Pasmans
- Department of Radiology, Máxima Medical Center, Postbus 90052, 5600 PD Eindhoven, The Netherlands
| | - Harm A. G. M. Sala
- Orthopaedic Center Máxima, Máxima Medical Center, Postbus 90052, 5600 PD Eindhoven, The Netherlands
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McCarthy MM, Graziano J, Green DW, Cordasco FA. All-epiphyseal, all-inside anterior cruciate ligament reconstruction technique for skeletally immature patients. Arthrosc Tech 2012; 1:e231-9. [PMID: 23767001 PMCID: PMC3678616 DOI: 10.1016/j.eats.2012.08.005] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 08/27/2012] [Indexed: 02/03/2023] Open
Abstract
Anterior cruciate ligament (ACL) injuries are an increasingly recognized problem in the juvenile population. Unfortunately, outcomes with conservative treatment are extremely poor. Adult reconstruction techniques are inappropriate to treat skeletally immature patients because of the risk of physeal complications, including limb-length discrepancy and angular deformities. "Physeal-sparing" reconstruction techniques exist, but their ability to restore knee stability is not well understood. We describe an all-epiphyseal ACL reconstruction for use in skeletally immature patients. This is an all-inside technique with the femoral tunnel drilled retrograde and the tibial tunnel drilled retrograde; both tunnels are entirely within the epiphysis. Fixation of the hamstring autograft is achieved with soft-tissue buttons on both the femur and tibia. We present case examples for 2 patients who underwent the all-inside, all-epiphyseal reconstruction and our postoperative rehabilitation protocol. We present a novel surgical technique for an all-inside, all-epiphyseal ACL reconstruction in skeletally immature patients.
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Affiliation(s)
- Moira M. McCarthy
- Address correspondence to Moira M. McCarthy, M.D., Hospital for Special Surgery, 535 E 71st St, New York, NY 10021, U.S.A.
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Åhlén M, Lidén M, Bovaller Å, Sernert N, Kartus J. Bilateral magnetic resonance imaging and functional assessment of the semitendinosus and gracilis tendons a minimum of 6 years after ipsilateral harvest for anterior cruciate ligament reconstruction. Am J Sports Med 2012; 40:1735-41. [PMID: 22711582 DOI: 10.1177/0363546512449611] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies are contradictory in terms of the function, regeneration potential, insertion point, and cross-sectional area of the semitendinosus and gracilis tendons after harvest for anterior cruciate ligament (ACL) reconstruction. HYPOTHESES In the long term, the tendons will regenerate in most patients with a more proximal point of insertion, the cross-sectional area of the tendons will be smaller compared with the nonoperated contralateral side, and the patients will be weaker in terms of the internal rotation and deep flexion of the knee. STUDY DESIGN Case series; Level of evidence, 4. METHODS Nineteen patients (9 women and 10 men) who had undergone ACL reconstruction a minimum of 6 years earlier, median 8.5 years (range, 6-11 years), with ipsilateral semitendinosus and gracilis autografts, underwent bilateral magnetic resonance imaging (MRI) of their knees. An experienced, independent musculoskeletal radiologist evaluated all MRI examinations. To evaluate the function, strength measurements in deep knee flexion and internal rotation were performed using an isokinetic strength-testing machine. RESULTS The semitendinosus tendon had regenerated in 17 of 19 (89%) patients and the gracilis tendon in 18 of 19 (95%) patients, as seen on MRI. There were no significant differences between the point of insertion for the tendons on the operated and nonoperated sides. The cross-sectional areas of the regenerated tendons revealed no significant differences compared with the normal tendons on the contralateral side, as measured 4 cm above the joint line. The patients were significantly weaker in terms of deep knee flexion at 60 and 180 deg/sec, but they were stronger in terms of internal rotation of the tibia at 60 deg/sec in the operated leg compared with the nonoperated leg. CONCLUSION The semitendinosus and gracilis tendons regenerated in the majority of patients and regained an almost normal point of insertion on the pes anserinus a minimum of 6 years after harvest. The regenerated tendons had a cross-sectional area similar to that on the nonoperated contralateral side. The patients revealed a strength deficit in deep knee flexion but not in internal rotation.
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Affiliation(s)
- Martina Åhlén
- Department of Orthopedics, NU-Hospital Organization, SE-461 85 Trollhättan, Sweden.
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Musahl V, Scheffler S, Becker R. Klinischer Einsatz von Allografts in der Bandchirurgie am Kniegelenk. ARTHROSKOPIE 2012. [DOI: 10.1007/s00142-011-0674-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Czamara A, Szuba Ł, Krzemińska A, Tomaszewski W, Wilk-Frańczuk M. Effect of physiotherapy on the strength of tibial internal rotator muscles in males after anterior cruciate ligament reconstruction (ACLR). Med Sci Monit 2011; 17:CR523-31. [PMID: 21873950 PMCID: PMC3560515 DOI: 10.12659/msm.881940] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The goal of this study was to evaluate the effect of physiotherapy on the strength of muscles responsible for tibial internal rotation (IR) in male patients after anterior cruciate ligament reconstruction (ACLR) using autografts of the semitendinosus and gracilis muscles (STGR). MATERIAL/METHODS Fifty-nine males were examined. The first group consisted of 19 patients subjected to 4-stage physiotherapy following ACLR. The second group consisted of 20 males without knee injuries. The third group consisted of 20 males who had not undergone systematic physiotherapy within the last 12 months following lower limb injuries. Moments of maximal strength (MMS), isometric torque (IT), and peak torque (PT) were measured under static and isokinetic conditions using the Humac Norm System. In the first group, IT measurements were performed during the 13th and 21st week of physiotherapy, while PT measurements were performed during the 16th and 21st weeks of physiotherapy following ACLR. In the control groups (II and III) the measurements were performed once. RESULTS In the first group, the IT (13 weeks) and PT (16 weeks) values of internal tibial rotator muscles, obtained from the operated extremities were significantly lower than the values obtained from the uninvolved knees and the control group results. During the 21st week of physiotherapy, the results obtained for IT and PT in patients after ACLR were similar to the values obtained from the uninvolved knees and the results of the second group subjects. CONCLUSIONS The 21-week physiotherapy in ACLR patients favorably affected the PT values of tibial rotator muscles of the operated knees. In the third group, the IT values did not indicate a complete improvement after 12 months without systematic physiotherapy.
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Kim JG, Yang SJ, Lee YS, Shim JC, Ra HJ, Choi JY. The effects of hamstring harvesting on outcomes in anterior cruciate ligament-reconstructed patients: a comparative study between hamstring-harvested and -unharvested patients. Arthroscopy 2011; 27:1226-34. [PMID: 21875529 DOI: 10.1016/j.arthro.2011.05.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 03/31/2011] [Accepted: 05/12/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the effects of hamstring harvesting in patients after anterior cruciate ligament (ACL) reconstruction by comparing groups with and without hamstring harvesting. METHODS We evaluated the effect of hamstring harvesting in 73 consecutive patients who underwent ACL reconstruction: 39 patients whose hamstrings were harvested for autografts (group H) were compared with 34 patients who received allografts during the same time period (group C [control]). The cases and controls were compared by analyzing the following variables: age, height, weight, mean follow-up period, type of tissue used, and meniscal surgery. Outcomes were assessed by the Lysholm knee score, Tegner activity score, and KT-2000 side-to-side difference (MEDmetric, San Diego, CA), as well as functional performance tests. The flexor deficit and isokinetic peak torque for knee flexion were measured in the sitting position (0° to 90°), and the flexion torque at 90° was measured in the prone position (60° to 120°). RESULTS Although significant knee flexion weakness after ACL reconstruction was observed, a significantly greater knee flexor deficit was found in autograft patients than in allograft patients (P < .001). No differences were found between groups in terms of clinical and functional results regardless of hamstring harvesting. The performance of both study groups in all 4 functional tests were significantly correlated with flexor deficit in the sitting position (P < .05) but not in hyperflexion. Significant flexor deficits in both normal and hyperflexed positions were noted in both groups when compared with the unaffected knee (group H, P < .001; group C, P = .002). CONCLUSIONS These results indicate significant knee flexion weakness compared with the unaffected knee after ACL reconstruction regardless of hamstring harvesting. Moreover, the greater increase in knee flexor deficit in the hamstring-harvested group compared with the allograft group was statistically significant. However, clinical and functional outcomes were similar between the groups. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Jin Goo Kim
- Department of Orthopedic Surgery, Inje University, Seoul Paik Hospital, Seoul, South Korea
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Colombet P, Dejour D, Panisset JC, Siebold R. Current concept of partial anterior cruciate ligament ruptures. Orthop Traumatol Surg Res 2010; 96:S109-18. [PMID: 21056025 DOI: 10.1016/j.otsr.2010.09.003] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A partial tear of the anterior cruciate ligament is a frequent pattern of ACL injury, observed in 10 to 27% of isolated ACL lesions. There are three reasons to preserve these remnants: biomechanical, vascular and proprioceptive advantages for the patient. Good quality fibers work as graft protection during the healing process. Periligamentous and endoligamentous vessels present into the native ACL tissue may enhance the vascularization of the ACL augmentation. Mechanoreceptors still remaining in the residual ACL fibers may have proprioceptive function. Definition is controversial, based on anatomy, on clinical examination, on instrumental laxity assessment or on MRI findings. Continuous remnant ACL fibers bridging the femur and tibia, from native femoral ACL footprint to native tibial ACL footprint seem to be a good definition. Diagnostic is suspected by accumulation of arguments brought by a thorough clinical examination, precise MRI analysis and examination under anesthesia. But the final diagnostic needs an arthroscopic evaluation to confirm the presence of fibers in good position and to validate its good mechanical properties. The treatment of ACL partial tear is a demanding surgery; difficulties to visualize the graft insertion site, especially on the femoral side, require a perfect knowledge of the normal anatomy of the native ACL footprint. Adapted portals, perfect controls of the tunnel drilling process, intercondylar notch space management are the keys of success. The pivot shift test under anesthesia, a hard stop Lachman test, MRI findings, level and type of sport, arthroscopic aspects of the remnants and its mechanical properties, allow the surgeon decide between non operative treatment, ACL augmentation or standard ACL reconstruction.
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Affiliation(s)
- P Colombet
- Clinique du Sport, 9, rue Jean-Moulin, 33700 Mérignac, France.
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Gao K, Chen S, Wang L, Zhang W, Kang Y, Dong Q, Zhou H, Li L. Anterior cruciate ligament reconstruction with LARS artificial ligament: a multicenter study with 3- to 5-year follow-up. Arthroscopy 2010; 26:515-23. [PMID: 20362832 DOI: 10.1016/j.arthro.2010.02.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 02/05/2010] [Accepted: 02/10/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this multicenter study was to evaluate the clinical outcome of anterior cruciate ligament (ACL) reconstruction by use of the Ligament Advanced Reinforcement System (LARS) artificial ligament (Surgical Implants and Devices, Arc-sur-Tille, France) with 3- to 5-year follow-up. METHODS From August 2004 to July 2006, 159 patients with ACL rupture underwent arthroscopic ACL reconstruction with LARS artificial ligament at 4 orthopaedic sports medicine centers in China. They were retrospectively followed up for 50 +/- 6 months (range, 36 to 62 months). Outcome assessment included physical examination, KT-1000 arthrometer testing (MEDmetric, San Diego, CA), magnetic resonance imaging, radiography, Lysholm score, Tegner score, International Knee Documentation Committee score, and subjective satisfaction rate. Quadriceps and hamstring isokinetic strength was evaluated in 68 patients. RESULTS The side-to-side difference in anterior translation (injured side - uninjured side) measured by KT-1000 arthrometer was 1.5 +/- 1.6 mm (range, -1 to 7 mm) postoperatively, and knee stability was significantly improved compared with preoperative data (P < .0001). Quadriceps and hamstring isokinetic peak torque of the injured limb expressed as a percentage of the contralateral limb was 93.6 +/- 10.7 and 95.8 +/- 12.0, respectively. The Lysholm score improved from 65.1 +/- 12.3 points (range, 30 to 95 points) preoperatively to 94.5 +/- 7.0 points (range, 65 to 100 points) postoperatively (P < .0001). The Tegner score improved from 3.1 +/- 1.6 (range, 0 to 6) preoperatively to 6.1 +/- 1.5 (range, 1 to 9) postoperatively (P < .0001). According to the International Knee Documentation Committee score, 94% of patients were graded A or B at last follow-up. Ninety-three percent of patients were very satisfied or satisfied with their outcome. LARS artificial ligament rupture occurred in 3 patients; knee synovitis developed in 1 of these patients. CONCLUSIONS ACL reconstruction with LARS artificial ligament used in patients with the ACL stump preserved in the acute and chronic phases has a very good outcome at mean of 50 months' follow-up. The overall complication rate for ACL reconstruction with LARS artificial ligament is 5.7%, and knee synovitis developed in only 1 case. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Kai Gao
- Department of Sports Medicine and Arthroscopic Surgery, Huashan Hospital, Sports Medicine Center, Fudan University, Shanghai, China
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Landes S, Nyland J, Elmlinger B, Tillett E, Caborn D. Knee flexor strength after ACL reconstruction: comparison between hamstring autograft, tibialis anterior allograft, and non-injured controls. Knee Surg Sports Traumatol Arthrosc 2010; 18:317-24. [PMID: 19898836 DOI: 10.1007/s00167-009-0931-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 09/08/2009] [Indexed: 01/10/2023]
Abstract
Hamstring muscle group dysfunction following anterior cruciate ligament reconstruction (ACL) using a semitendinosus-gracilis autograft is a growing concern. This study compared the mean peak isometric knee flexor torque of the following three groups: subjects 2 years following ACL reconstruction using semitendinosus-gracilis autografts (Group 1), subjects 2 years following ACL reconstruction using tibialis anterior allografts (Group 2), and a non-injured, activity-level-matched control group (Group 3). We hypothesized that Group 1 would have greater mean involved lower extremity peak isometric knee flexor torque deficits than the other groups. Handheld dynamometry with subjects in prone and the test knee at 90 degrees flexion was used to determine bilateral peak isometric knee flexor torque. Group 1 (86.4 +/- 11) and Group 2 (80.5 +/- 13) had similar 2000 IKDC Subjective Knee Evaluation Form scores (P = NS). Group 1 had a mean involved lower extremity peak isometric knee flexor torque deficit of -17.0 +/- 14 Nm. Group 2 had a mean involved lower extremity peak isometric knee flexor torque deficit of -0.8 +/- 9 Nm. Group 3 (control) had a mean left and right lower extremity peak isometric knee flexor torque difference of -0.7 +/- 14 Nm. Group 1 had decreased involved lower extremity peak isometric knee flexor torque compared to Groups 2 and 3 (two-way ANOVA; group x side interaction P < 0.05, Tukey HSD = 0.008). Long-term knee flexor strength deficits exist following hamstring autograft use for ACL reconstruction that does not occur when a tibialis anterior allograft is used. Early identification of impaired knee flexor strength among this group and modified rehabilitation may reduce these deficits. Adding quantitative biomechanical testing of sprinting and sudden directional change movements to the standard physical therapy evaluation will better elucidate the clinical and functional significance of the observed knee flexor strength impairments and aid in determining sport specific activity training readiness.
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Affiliation(s)
- Sarah Landes
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, 210 East Gray St., Suite 1003, Louisville, KY 40202, USA
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Kiriyama S, Sato H, Takahira N. Gender differences in rotation of the shank during single-legged drop landing and its relation to rotational muscle strength of the knee. Am J Sports Med 2009; 37:168-74. [PMID: 18936276 DOI: 10.1177/0363546508324692] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Increased shank rotation during landing has been considered to be one of the factors for noncontact anterior cruciate ligament injuries in female athletes. There have been no known gender differences in rotational knee muscle strength, which is expected to inhibit exaggerated shank rotation. HYPOTHESIS Women have less knee external rotator strength than do men. Lower external rotator strength is associated with increased internal shank rotation at the time of landing. STUDY DESIGN Controlled laboratory study. METHODS One hundred sixty-nine healthy young subjects (81 female and 88 male; age, 17.0 +/- 1.0 years) volunteered to participate in this study. The subjects performed single-legged drop landings from a 20-cm height. Femoral and shank kinematics were measured using a 3D optoelectronic tracking system during the drop landings, and then the joint angles around the knee (flexion/extension, valgus/varus, and internal/external rotation) were calculated. The maximal isometric rotational muscle strength of the knee was measured at 30 degrees of knee flexion in a supine position using a dynamometer. RESULTS The female subjects had significantly less external shank rotation strength than did the male subjects (P < .001). Female subjects also exhibited significantly greater peak shank internal rotation angles than did males during landing (P < .05). Moderate but significant association was found between the maximum shank external rotation strength and the peak shank internal rotation angle during landing (r = -0.322, P < .01). CONCLUSION Female subjects tended to have poor shank external rotator strength. This may lead to large shank internal rotation movement during the single-legged drop landing. CLINICAL RELEVANCE Improving strength training of the external rotator muscle may help decrease the rates of anterior cruciate ligament injury in female athletes.
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Affiliation(s)
- Shinya Kiriyama
- Clinical Kinesiology Laboratory, Kitasato University Graduate School of Medical Science, Kanagawa, Japan
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Dejour D, Potel JF, Gaudot F, Panisset JC, Condouret J. La rupture du ligament croisé antérieur, de l’analyse préopératoire du type de rupture à l’évaluation finale à deux ans, retentissement selon le transplant choisi sur les résultats subjectifs et objectifs. ACTA ACUST UNITED AC 2008; 94:356-61. [DOI: 10.1016/j.rco.2008.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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