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Anterolateral Extraarticular Stabilisation of the Knee: Modified Lemaire Procedure. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:226-227. [PMID: 35354209 DOI: 10.1055/a-1749-6615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The anterolateral aspect of the knee is prone to laxity or symptomatic instability, if the anterior cruciate ligament (ACL) is torn. It is necessary to address this issue in patients with general joint hyperlaxity, overextension of the knee, massive anterolateral instability, or re-tear of the ACL with chronic instability. In these cases, and in addition to a preoperative bony workup and revision ACL reconstruction, anterolateral stabilisation should be considered to avoid persistent anterolateral rotation instability and failure of the ACL reconstruction.To stabilise the anterolateral corner of the knee, the modified Lemaire procedure as presented and illustrated here is a straight forward surgical technique that can be performed right after standard ACL reconstruction surgery, if indicated. It is independent from the graft choice for the ACL reconstruction, and the surgical setting in the operating room remains unchanged.
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Chen Z, Xu J, Shen Y, Zhao T, Dong J. Application of CT Medical Imaging Combined with Deep Learning 3D Reconstruction in the Diagnosis and Rehabilitation of Anterior Cruciate Ligament Injury in Table Tennis Players. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:1152368. [PMID: 34956554 PMCID: PMC8709755 DOI: 10.1155/2021/1152368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022]
Abstract
Because of the intense competition, table tennis requires players to bear a strong physiological load, which increases the risk of sports injury. Anterior cruciate ligament (ACL) is an important structure of the knee joint to maintain forward stability and rotational stability and is also a common sports injury in table tennis players. ACL has poor self-repair ability after injury. Therefore, the purpose of this study is to provide a more comprehensive, reliable, and representative theoretical basis for the diagnosis and rehabilitation of anterior cruciate ligament injury in table tennis players, and three-dimensional reconstruction of ACL using dual-source computed tomography (DSCT) combined with deep learning was conducted. For this purpose, a number of table tennis players with ACL injuries were collected, and each patient underwent arthroscopic anterior cruciate ligament reconstruction. DSCT scanning was performed on several knee joints, the 3D model of the knee joint was reconstructed using a CT image postprocessing workstation, and the medial wall of the femoral lateral condyle was reconstructed, as well as the reconstructed single tract of bony canal, tibial plateau, and bony canal. Then, the Lysholm score was used to score the cases, with scores greater than 75 as the excellent group and below 75 as the poor group. The relative positions of the central points of the femoral and tibial canals were marked and measured. The results were as follows: 3D-CT reconstruction could clearly reflect the situation after anterior cruciate ligament reconstruction. In clinic, it is used to evaluate the relationship between bone tunnel location and graft shape so as to guide the surgeon to improve the operation.
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Affiliation(s)
- Zhenlei Chen
- School of Physical Education, Hubei University of Education, Wuhan, Hubei, China
| | - Jilai Xu
- Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Youqing Shen
- School of Physical Education, Hubei University of Education, Wuhan, Hubei, China
| | - Tianshu Zhao
- School of Sports Medicine and Physical Therapy, Beijing Sport University, Beijing, China
| | - Jiayi Dong
- School of Sports Medicine and Physical Therapy, Beijing Sport University, Beijing, China
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Yumashev AV, Baltina TV, Babaskin DV. Outcomes after arthroscopic revision surgery for anterior cruciate ligament injuries. Acta Orthop 2021; 92:443-447. [PMID: 33739222 PMCID: PMC8381895 DOI: 10.1080/17453674.2021.1897744] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The frequency of primary anterior cruciate ligament (ACL) reconstruction is increasing resulting in more ACL revision surgeries. Therefore, we assessed survival rates of 2 different grafts for ACL revision surgery at 1- and 5-year follow-ups, as well as physical activity levels of patients after revision surgery.Patients and methods - This is a retrospective cohort study involving 218 patients (176 males) who had revision surgery for anterior cruciate ligament injuries between 2008 and 2017 at the Clinic of Traumatology, Orthopedics and Joint Pathology Clinic (I.M. Sechenov First Moscow State Medical University). A comparison group involved 189 patients with only primary surgery. Surgical interventions were performed according to the standard procedure using bone-patellar tendon-bone (BTB) and semitendinosus/gracilis (ST/G) autografts. The results of revision surgery were assessed at 1- and 5-year follow-ups by using the Lysholm and International Knee Documentation Committee scores.Results - Malpositioned bone tunnels were found in 87/218 patients (40%). At 1 and 5 years postoperatively, the revision BTB group had significantly better results in terms of IKDC and Lysholm scores than the revision ST/G group (p = 0.03, Mann-Whitney U-test), and these results were comparable to those in the comparison group. Graft survival after revision was lower than after the primary operation. However, the survival rate of 80% is quite high and is consistent with previous findings. There were no statistically reliable differences in survival between ST/G and BTB autografts.Interpretation - The graft choice for revision ACL surgery should be decided upon before surgery based on, among other things, the state of bone tunnels, in particular their position and degree of bone resorption. Tunnel widening that exceeds 14 mm (osteolysis) would require 2-stage surgery using a BTB autograft with bone plugs because it is larger than the ST/G autograft.
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Affiliation(s)
- Alexei V Yumashev
- Department of Prosthetic Dentistry, Sechenov First Moscow State Medical University (Sechenov University), Moscow; ,Correspondence:
| | - Tatyana V Baltina
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan;
| | - Dmitrii V Babaskin
- Department of Pharmacy, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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Gao KT, Pedoia V, Young KA, Kogan F, Koff MF, Gold GE, Potter HG, Majumdar S. Multiparametric MRI characterization of knee articular cartilage and subchondral bone shape in collegiate basketball players. J Orthop Res 2021; 39:1512-1522. [PMID: 32910520 PMCID: PMC8359246 DOI: 10.1002/jor.24851] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/31/2020] [Accepted: 09/02/2020] [Indexed: 02/04/2023]
Abstract
Magnetic resonance imaging (MRI) is commonly used to evaluate the morphology of the knee in athletes with high-knee impact; however, complex repeated loading of the joint can lead to biochemical and structural degeneration that occurs before visible morphological changes. In this study, we utilized multiparametric quantitative MRI to compare morphology and composition of articular cartilage and subchondral bone shape between young athletes with high-knee impact (basketball players; n = 40) and non-knee impact (swimmers; n = 25). We implemented voxel-based relaxometry to register all cases to a single reference space and performed a localized compositional analysis of T 1ρ - and T 2 -relaxation times on a voxel-by-voxel basis. Additionally, statistical shape modeling was employed to extract differences in subchondral bone shape between the two groups. Evaluation of cartilage composition demonstrated a significant prolongation of relaxation times in the medial femoral and tibial compartments and in the posterolateral femur of basketball players in comparison to relaxation times in the same cartilage compartments of swimmers. The compositional analysis also showed depth-dependent differences with prolongation of the superficial layer in basketball players. For subchondral bone shape, three total modes were found to be significantly different between groups and related to the relative sizes of the tibial plateaus, intercondylar eminences, and the curvature and concavity of the patellar lateral facet. In summary, this study identified several characteristics associated with a high-knee impact which may expand our understanding of local degenerative patterns in this population.
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Affiliation(s)
- Kenneth T. Gao
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Valentina Pedoia
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Feliks Kogan
- Department of RadiologyStanford UniversityStanfordCaliforniaUSA
| | - Matthew F. Koff
- Department of Radiology and ImagingHospital for Special SurgeryNew York CityNew YorkUSA
| | - Garry E. Gold
- Department of RadiologyStanford UniversityStanfordCaliforniaUSA
| | - Hollis G. Potter
- Department of Radiology and ImagingHospital for Special SurgeryNew York CityNew YorkUSA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
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Experimental and clinical analysis of the use of asymmetric vs symmetric polyethylene inserts in a mobile bearing total knee arthroplasty. J Orthop 2020; 23:25-30. [PMID: 33424187 DOI: 10.1016/j.jor.2020.12.031] [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: 10/20/2020] [Accepted: 12/23/2020] [Indexed: 01/17/2023] Open
Abstract
Purpose This study compared the effects of symmetric and asymmetric designs for mobile bearing polyethylene insert for total knee arthroplasty (TKA), both clinically and biomechanically through experimental cadaver tests. Methods 303 patients implanted with a mobile bearing TKA were retrospectively analyzed up to 2-year follow-up with relative scores. The same femoral and tibial components were used for all the patients; 151 patients received a Symmetric Design (SD) insert and 152 an Asymmetric Design (AD). A biomechanical experimental test was performed to improve the comprehension of the clinical results, analyzing passive squat on 5 cadaveric knee specimens: internal-external rotations of femur and tibial insert respect to the tibia tray were analyzed in native and implanted configurations (with both symmetrical and asymmetrical inserts for each specimen). Results After surgery, patients' average flexion improved from 105° (with preoperative extension deficit of 5°), to 115° (SD-group) and 120° (AD-group) at the 2-year follow-up. There was no postoperative extension deficit. AD-group presented better ability to perform certain routines and wasn't affected by any pain, while antero-lateral pain was reported in some SD-group patients. The experimental tests returned no statistically relevant difference in tibio-femoral flexion-extension and internal-external rotations among all the three configurations tested; a statistically significant difference is found for insert-tray internal-external rotations between SD and AD configurations; in details, the AD insert showed insert-tray angles comparable to the ones found for femoral component-tibial tray, while the SD insert returned lower angular values. Conclusion Clinically and biomechanically, an asymmetric mobile bearing insert could represent a valid alternative to symmetric mobile bearing insert. Level of evidence III, Case-control study Retrospective comparative study.
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Triaxial accelerometer evaluation is correlated with IKDC grade of pivot shift. Knee Surg Sports Traumatol Arthrosc 2020; 28:381-388. [PMID: 31201443 DOI: 10.1007/s00167-019-05563-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/07/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the correlation between tibial acceleration parameters measured by the KiRA device and the clinical grade of pivot shift. The secondary objective was to report the risk factors for pre-operative high-grade pivot shift. METHODS Two-hundred and ninety-five ACL deficient patients were examined under anesthesia. The pivot shift tests were performed twice by an expert surgeon. Clinical grading was performed using the International Knee Documentation Committee (IKDC) scale and tibial acceleration data was recorded using a triaxial accelerometer system (KiRA). The difference in the tibial acceleration range between injured and contralateral limbs was used in the analysis. Correlation coefficients were calculated using linear regression. Multivariate logistic regression was used to identify risk factors for high grade pivot shift. RESULTS The clinical grade of pivot shift and the side-to-side difference in delta tibial acceleration determined by KiRA were significantly correlated (r = 0.57; 95% CI 0.513-0.658, p < 0.0001). The only risk factor identified to have a significant association with high grade pivot shift was an antero-posterior side to side laxity difference > 6 mm (OR = 2.070; 95% CI (1.259-3.405), p = 0.0042). CONCLUSION Side-to-side difference in tibial acceleration range, as measured by KiRA, is correlated with the IKDC pivot shift grade in anaesthetized patients. Side-to-side A-P laxity difference greater than 6 mm is reported as a newly defined risk factor for high grade pivot shift in the ACL injured knee. DIAGNOSTIC STUDY Level II.
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Lagae KC, Robberecht J, Athwal KK, Verdonk PCM, Amis AA. ACL reconstruction combined with lateral monoloop tenodesis can restore intact knee laxity. Knee Surg Sports Traumatol Arthrosc 2020; 28:1159-1168. [PMID: 31980844 PMCID: PMC7148266 DOI: 10.1007/s00167-019-05839-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/16/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE An anterior cruciate ligament (ACL) injury is often combined with injury to the lateral extra-articular structures, which may cause a combined anterior and rotational laxity. It was hypothesised that addition of a 'monoloop' lateral extra-articular tenodesis (mLET) to an ACL reconstruction would restore anteroposterior, internal rotation and pivot-shift laxities better than isolated ACL reconstruction in combined injuries. METHOD Twelve cadaveric knees were tested, using an optical tracking system to record the kinematics through 0°-100° of knee flexion with no load, anterior and posterior translational forces (90 N), internal and external rotational torques (5 Nm), and a combination of an anterior translational (90 N) plus internal rotational load (5 Nm). They were tested intact, after sectioning the ACL, sectioning anterolateral ligament (ALL), iliotibial band (ITB) graft harvest, releasing deep ITB fibres, hamstrings tendon ACL reconstruction, mLET combined with ACL reconstruction, and isolated mLET. Two-way repeated-measures ANOVA compared laxity data across knee states and flexion angles. When differences were found, paired t tests with Bonferroni correction were performed. RESULTS In the ACL-deficient knee, cutting the ALL significantly increased anterior laxity only at 20°-30°, and only significantly increased internal rotation at 50°. Additional deep ITB release significantly increased anterior laxity at 40°-90° and caused a large increase of internal rotation at 20°-100°. Isolated ACL reconstruction restored anterior drawer, but significant differences remained in internal rotation at 30°-100°. After adding an mLET there were no remaining differences with anterior translation or internal rotation compared to the intact knee. With the combined injury, isolated mLET allowed abnormal anterior translation and rotation to persist. CONCLUSIONS Cutting the deep fibres of the ITB caused large increases in tibial internal rotation laxity across the range of knee flexion, while cutting the ALL alone did not. With ACL deficiency combined with anterolateral deficiency, ACL reconstruction alone was insufficient to restore native knee rotational laxity. However, combining a 'monoloop' lateral extra-articular tenodesis with ACL reconstruction did restore native knee laxity.
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Affiliation(s)
- Koen C. Lagae
- Antwerp Orthopaedic Centre Monica Hospitals, Antwerp, Belgium ,Galeazzi Orthopaedic Institute, Milan, Italy
| | - Joris Robberecht
- Department of Orthopaedic Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Kiron K. Athwal
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, SW7 2AZ UK
| | - Peter C. M. Verdonk
- Antwerp Orthopaedic Centre Monica Hospitals, Antwerp, Belgium ,Department of Orthopaedic Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Andrew A. Amis
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, SW7 2AZ UK ,Musculoskeletal Surgery Group, Imperial College London School of Medicine, Charing Cross Hospital, London, W6 8RF UK
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Hughes JD, Rauer T, Gibbs CM, Musahl V. Diagnosis and treatment of rotatory knee instability. J Exp Orthop 2019; 6:48. [PMID: 31865518 PMCID: PMC6925612 DOI: 10.1186/s40634-019-0217-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/13/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Rotatory knee instability is an abnormal, complex three-dimensional motion that can involve pathology of the anteromedial, anterolateral, posteromedial, and posterolateral ligaments, bony alignment, and menisci. To understand the abnormal joint kinematics in rotatory knee instability, a review of the anatomical structures and their graded role in maintaining rotational stability, the importance of concomitant pathologies, as well as the different components of the knee rotation motion will be presented. MAIN BODY The most common instability pattern, anterolateral rotatory knee instability in an anterior cruciate ligament (ACL)-deficient patient, will be discussed in detail. Although intra-articular ACL reconstruction is the gold standard treatment for ACL injury in physically active patients, in some cases current techniques may fail to restore native knee rotatory stability. The wide range of diagnostic options for rotatory knee instability including manual testing, different imaging modalities, static and dynamic measurement, and navigation is outlined. As numerous techniques of extra-articular tenodesis procedures have been described, performed in conjunction with ACL reconstruction, to restore anterolateral knee rotatory stability, a few of these techniques will be described in detail, and discuss the literature concerning their outcome. CONCLUSION In summary, the essence of reducing anterolateral rotatory knee instability begins and ends with a well-done, anatomic ACL reconstruction, which may be performed with consideration of extra-articular tenodesis in a select group of patients.
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Affiliation(s)
- Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA
| | - Thomas Rauer
- Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Christopher M Gibbs
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA.
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Colbrunn RW, Dumpe JE, Nagle TF, Kolmodin JD, Barsoum WK, Saluan PM. Robotically Simulated Pivot Shift That Represents the Clinical Exam. J Orthop Res 2019; 37:2601-2608. [PMID: 31410883 DOI: 10.1002/jor.24439] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 07/24/2019] [Indexed: 02/04/2023]
Abstract
A thorough understanding of anterior cruciate ligament (ACL) function and the effects of surgical interventions on knee biomechanics requires robust technologies and simulation paradigms that align with clinical insight. In vitro orthopedic biomechanical testing for the elucidation of ACL integrity doesn't have an established testing paradigm to simulate the clinical pivot shift exam on cadaveric specimens. The study aim was to develop a robotically simulated pivot shift that represents the clinical exam. An orthopedic surgeon performed a pivot shift on an instrumented ACL-deficient cadaver leg to capture 6 degree-of-freedom motion/loads. The same knee was mounted to the robot and the sensitivity of the motion/loading profiles quantified. Three loading profile candidates that generated positive pivot shifts on the instrumented knee were selected and applied to 7 ACL-intact/deficient specimens and resulted in the identification of a profile that was able to induce a positive pivot shift in all ACL-deficient specimens ( p < 0.001). The simulated shifts began at 22 ± 8° and ended at 33 ± 6° of flexion with the average magnitude of the shifts being 12.8 ± 3.2 mm in anterior tibial translation and 17.6 ± 4.3° in external tibial rotation. The establishment and replication of a robotically simulated clinical pivot shift across multiple specimens show the robustness of the loading profile to accommodate anatomical and experimental variability. Further evaluation and refinement should be undertaken to create a useful tool in evaluating ACL function and reconstruction techniques. Statement of clinical significance: Creation and successful demonstration of the simulated clinical pivot shift validates a profile for robotic musculoskeletal simulators to analyze ACL related clinical questions. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2601-2608, 2019.
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Affiliation(s)
- Robb W Colbrunn
- Department of Biomedical Engineering, Lerner Research Institute, and Orthopaedic and Rheumatologic Research Center, Cleveland Clinic, 9500 Euclid Ave., Cleveland, Ohio, 44195
| | - Jarrod E Dumpe
- Orthopaedic Trauma Institute, Navicent Health Physician Group, Macon, Georgia
| | - Tara F Nagle
- Department of Biomedical Engineering, Lerner Research Institute, and Orthopaedic and Rheumatologic Research Center, Cleveland Clinic, 9500 Euclid Ave., Cleveland, Ohio, 44195
| | | | - Wael K Barsoum
- Department of Orthopaedic Surgery, Cleveland Clinic Florida-Weston, and Orthopaedic and Rheumatologic Research Center, Cleveland Clinic, Cleveland, Ohio
| | - Paul M Saluan
- Department of Orthopaedic Surgery, and Orthopaedic and Rheumatologic Research Center, Cleveland Clinic, Cleveland, Ohio
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Distal femur morphology affects rotatory knee instability in patients with anterior cruciate ligament ruptures. Knee Surg Sports Traumatol Arthrosc 2019; 27:1514-1519. [PMID: 30374573 DOI: 10.1007/s00167-018-5269-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 10/23/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Distal femur morphology has been shown to influence knee joint kinematics and may affect rotatory knee laxity. The purpose of this study was to determine the relationship between rotatory knee laxity and distal femoral morphology in patients with complete anterior cruciate ligament (ACL) rupture. It was hypothesized that increased posterior femoral condylar depth on standard lateral radiographs, quantified as the "lateral femoral condyle ratio" would correlate with increased rotatory knee laxity, measured by a quantitative pivot shift test. METHODS Consecutive patients who underwent ACL reconstruction from 2014 to 2016 were retrospectively reviewed. A standardized pivot shift test was performed preoperatively on both knees and quantified using tablet technology. Using standard lateral radiographs of the knee, the ratio of posterior condylar distance over total condylar distance was defined as the lateral femoral condyle ratio. RESULTS Data sets were obtained for 57 patients. The mean anterior translation of the lateral knee compartment during a quantitative pivot shift test was found to be 4.0 ± 2.4 mm and 1.3 ± 0.9 mm for the injured and uninjured knees, respectively. The mean lateral femoral condyle ratio on X-ray was 63.2 ± 4.5%. There were significant correlations between the lateral femoral condyle ratio and the absolute quantitative (ρ = 0.370, p < 0.05) and side-to-side differences in anterior translation of the lateral knee compartment (ρ = 0.419, p < 0.05). CONCLUSION The most important finding from this study is that increased posterior femoral condylar depth, quantified as a lateral femoral condyle ratio, is associated with increased rotatory knee laxity in ACL-deficient patients. This suggests that distal femur morphology may influence rotatory knee laxity. This study may assist clinicians in evaluating ACL injuries and identifying patients at greater risk for persistent increased rotatory knee laxity after ACL reconstruction. LEVEL OF EVIDENCE III.
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Naendrup JH, Zlotnicki JP, Murphy CI, Patel NK, Debski RE, Musahl V. Influence of knee position and examiner-induced motion on the kinematics of the pivot shift. J Exp Orthop 2019; 6:11. [PMID: 30888526 PMCID: PMC6424983 DOI: 10.1186/s40634-019-0183-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background Grading of the pivot shift test varies significantly depending on the examiner’s technique. Thus, the purpose of this study was to determine the influence of knee starting position and the magnitude of motion during the reduction event on the magnitude of the pivot shift test. Methods Twenty-five clinical providers each performed a total of twenty pivot shift tests on one of two fresh-frozen cadaveric full lower extremity specimens with different grades of rotatory knee laxity. By means of ACL transection and lateral meniscectomy, one specimen was prepared to have a high-grade pivot shift and one to have a low-grade pivot shift. Six-degree-of-freedom kinematics were recorded during each pivot shift test using an electromagnetic-tracking-system. Successful pivot shift tests were defined and selected using an automated, mathematical algorithm based on the exceeding of a threshold value of anterior translation of the lateral knee compartment. The kinematics were correlated with the magnitude of anterior translation of the lateral knee compartment based on varying degrees of rotatory knee laxity using the Pearson correlation coefficient. Results Only mild correlations between anterior translation of the lateral knee compartment and internal tibial rotation at the start of the reduction event were observed in both specimens. The ability to generate a successful reduction event was significantly dependent on the rotatory knee laxity, with a 54% success rate on the high-laxity specimen compared to a 30% success rate on the low-laxity specimen (p < 0.001). Nearly 80% of the variability of the anterior translation of the lateral knee compartment in both specimens was accounted for by external rotation during the reduction event (r = 0.847; p < 0.001). Varus rotation during the reduction event also showed a strong correlation with the anterior translation of the lateral knee compartment in the low-laxity specimen (r = 0.835; p < 0.001). Conclusion Magnitude of motion during the reduction event affected the magnitude of anterior translation of the lateral knee compartment more than the starting position. External rotation during the reduction event accounted for most of the variability in the pivot shift test. More uniform maneuvers and improved teaching are essential to generate repeatable quantitative results of the pivot shift test.
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Affiliation(s)
- Jan-Hendrik Naendrup
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany.,Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, Center for Bioengineering - CNBIO, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Jason P Zlotnicki
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, Center for Bioengineering - CNBIO, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Conor I Murphy
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, Center for Bioengineering - CNBIO, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Neel K Patel
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, Center for Bioengineering - CNBIO, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, Center for Bioengineering - CNBIO, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, Department of Bioengineering and Department of Orthopaedic Surgery, University of Pittsburgh, Center for Bioengineering - CNBIO, 300 Technology Drive, Pittsburgh, PA, 15219, USA.
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Blache Y, Dumas R, de Guise J, Saithna A, Sonnery-Cottet B, Thaunat M. Technical considerations in lateral extra-articular reconstruction coupled with anterior cruciate ligament reconstruction: A simulation study evaluating the influence of surgical parameters on control of knee stability. Clin Biomech (Bristol, Avon) 2019; 61:136-143. [PMID: 30562692 DOI: 10.1016/j.clinbiomech.2018.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 12/05/2018] [Accepted: 12/10/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical parameters such as the selection of tibial and femoral attachment site, graft tension, and knee flexion angle at the time of fixation may influence the control of knee stability after lateral extra-articular reconstruction. This study aimed to determine how sensitive is the control of knee rotation and translation, during simulated pivot-shift scenarios, to these four surgery settings. METHODS A computer model was used to simulate 625 lateral extra-articular reconstructions based upon five different variations of each of the following parameters: femoral and tibial attachment sites, knee flexion angle and graft tension at the time of fixation. For each simulated surgery, the lateral extra-articular reconstruction external rotation moment at the knee joint center was computed during simulated pivot-shift scenarios. The sensitivity of the control of knee rotation and translation to a given surgery setting was assessed by calculating the coefficient of variation of the lateral extra-articular reconstruction external rotation moment. FINDINGS Graft tension had minimal influence on the control of knee rotation and translation with less than 2.4% of variation across the scenarios tested. Control of knee rotation and translation was the least affected by the femoral attachment site if the knee was close to full extension at the time of graft fixation. The choice of the tibial attachment site was crucial when the femoral fixation was proximal and posterior to the femoral epicondyle since 15 to 67% of variation was observed in the control of knee rotation and translation. INTERPRETATION Femoral and tibial attachment sites as well as knee flexion angle at the time of fixation should be considered by surgeons when performing lateral extra-articular reconstruction. Variation in graft tension between the ranges 20-40 N has minimal influence on the control of knee rotation and translation.
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Affiliation(s)
- Y Blache
- Univ Lyon, Université Claude Bernard Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité - EA 7424, France.
| | - R Dumas
- Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, F69622 Lyon, France
| | - J de Guise
- Laboratoire de recherche en imagerie et orthopédie (LIO), Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), et École de technologie supérieure, Montréal, Canada
| | - A Saithna
- Advanced Orthopedics and Sports Medicine, Kansas City, USA; School of Science and Technology, Nottingham Trent University, United Kingdom
| | - B Sonnery-Cottet
- Centre Orthopédique Santy-Group Ramsay-Générale de Santé - Hôpital privé Jean Mermoz, Lyon, France
| | - M Thaunat
- Centre Orthopédique Santy-Group Ramsay-Générale de Santé - Hôpital privé Jean Mermoz, Lyon, France
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13
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Zaffagnini S, Signorelli C, Grassi A, Hoshino Y, Kuroda R, de Sa D, Sundemo D, Samuelsson K, Musahl V, Karlsson J, Sheean A, Burnham JM, Lian J, Smith C, Popchak A, Herbst E, Pfeiffer T, Araujo P, Oostdyk A, Guenther D, Ohashi B, Irrgang JJ, Fu FH, Nagamune K, Kurosaka M, Marcheggiani Muccioli GM, Lopomo N, Raggi F, Svantesson E, Hamrin Senorski E, Bjoernsson H, Ahlden M, Desai N. Anatomic Anterior Cruciate Ligament Reconstruction Using Hamstring Tendons Restores Quantitative Pivot Shift. Orthop J Sports Med 2018; 6:2325967118812364. [PMID: 30574514 PMCID: PMC6299314 DOI: 10.1177/2325967118812364] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: It is still uncertain how surgical reconstruction of the anterior cruciate
ligament (ACL) is able to restore rotatory laxity of the involved joint. The
desired amount of restraint applied by the ACL graft, as compared with the
healthy knee, has not been fully clarified. Purpose: To quantify the ability of single-bundle anatomic ACL reconstruction using
hamstring tendons in reducing the pivot-shift phenomenon immediately after
surgery under anesthesia. Study Design: Case series; Level of evidence, 4. Methods: An inertial sensor and image analysis were used at 4 international centers to
measure tibial acceleration and lateral compartment translation of the knee,
respectively. The standardized pivot-shift test was quantified in terms of
the side-to-side difference in laxity both preoperatively and
postoperatively with the patient under anesthesia. The reduction in both
tibial acceleration and lateral compartment translation after surgery and
the side-to-side difference were evaluated using the Wilcoxon signed-rank
test. Alpha was set at P < .05. Results: A total of 107 patients were recruited for the study, and data were available
for 89 patients. There was a statistically significant reduction in
quantitative rotatory knee laxity between preoperatively (inertial sensor,
2.55 ± 4.00 m/s2; image analysis, 2.04 ± 2.02 mm) and
postoperatively (inertial sensor, –0.54 ± 1.25 m/s2; image
analysis, –0.10 ± 1.04 mm) between the involved and healthy joints, as
measured by the 2 devices (P < .001 for both).
Postoperatively, both devices detected a lower rotatory laxity value in the
involved joint compared with the healthy joint (inertial sensor, 2.45 ± 0.89
vs 2.99 ± 1.10 m/s2, respectively [P < .001];
image analysis, 0.99 ± 0.83 vs 1.09 ± 0.92 mm, respectively
[P = .38]). Conclusion: The data from this study indicated a significant reduction in the pivot shift
when compared side to side. Both the inertial sensor and image analysis used
for the quantitative assessment of the pivot-shift test could successfully
detect restoration of the pivot shift after anatomic single-bundle ACL
reconstruction. Future research will examine how pivot-shift control is
maintained over time and correlation of the pivot shift with return to full
activity in patients with an ACL injury.
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Affiliation(s)
- Stefano Zaffagnini
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cecilia Signorelli
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Yuichi Hoshino
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ryosuke Kuroda
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Darren de Sa
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - David Sundemo
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Kristian Samuelsson
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Volker Musahl
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Jon Karlsson
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrew Sheean
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Jeremy M Burnham
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Jayson Lian
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Clair Smith
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Adam Popchak
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elmar Herbst
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Thomas Pfeiffer
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paulo Araujo
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alicia Oostdyk
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Daniel Guenther
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Bruno Ohashi
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - James J Irrgang
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Freddie H Fu
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Kouki Nagamune
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Masahiro Kurosaka
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Nicola Lopomo
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federico Raggi
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eleonor Svantesson
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Haukur Bjoernsson
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mattias Ahlden
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Neel Desai
- Investigation performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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14
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Inderhaug E, Stephen JM, Williams A, Amis AA. Effect of Anterolateral Complex Sectioning and Tenodesis on Patellar Kinematics and Patellofemoral Joint Contact Pressures. Am J Sports Med 2018; 46:2922-2928. [PMID: 30125124 DOI: 10.1177/0363546518790248] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterolateral complex injuries are becoming more recognized. While these are known to affect tibiofemoral mechanics, it is not known how they affect patellofemoral joint behavior. PURPOSE To determine the effect of (1) sectioning the anterolateral complex and (2) performing a MacIntosh tenodesis under various conditions on patellofemoral contact mechanics and kinematics. STUDY DESIGN Controlled laboratory study. METHODS Eight fresh-frozen cadaveric knees were tested in a customized rig, with the femur fixed and tibia free to move, with optical tracking to record patellar kinematics and with thin pressure sensors to record patellofemoral contact pressures at 0°, 30°, 60°, and 90° of knee flexion. The quadriceps and iliotibial tract were loaded with 205 N throughout testing. Intact and anterolateral complex-sectioned states were tested, followed by 4 randomized tenodeses applying 20- and 80-N graft tension, each with the tibia in its neutral intact alignment or left free to rotate. Statistical analyses were undertaken with repeated measures analysis of variance, Bonferroni post hoc analysis, and paired samples t tests. RESULTS Patellar kinematics and contact pressures were not significantly altered after sectioning of the anterolateral complex (all: P > .05). Similarly, they were not significantly different from the intact knee in tenodeses performed when fixed tibial rotation was combined with 20- or 80-N graft tension (all: P > .05). However, grafts tensioned with 20 N and 80 N while the tibia was free hanging resulted in significant increases in lateral patellar tilt ( P < .05), and significantly elevated lateral peak patellofemoral pressures ( P < .05) were observed for 80 N. CONCLUSION This work did not find that an anterolateral injury altered patellofemoral mechanics or kinematics, but adding a lateral tenodesis can elevate lateral contact pressures and induce lateral patellar tilting if the tibia is pulled into external rotation by the tenodesis. Although these in vitro changes were small and might not be relevant in a fully loaded knee, controlling the position of the tibia at graft fixation is effective in avoiding overconstraint at time zero in a lateral tenodesis. CLINICAL RELEVANCE Small changes in lateral patellar tilt and patellofemoral contact pressures were found at time zero with a MacIntosh tenodesis. These changes were eliminated when the tibia was held in neutral rotation at the time of graft fixation. The risk of overconstraint after a lateral tenodesis therefore seems low and in accordance with recent published reports.
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Affiliation(s)
| | | | | | - Andrew A Amis
- Biomechanics Group, Department of Mechanical Engineering, Faculty of Engineering, Imperial College London, London, UK.,Musculoskeletal Surgery Group, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
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15
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Herbst E, Beitzel K, Imhoff AB, Forkel P. Laterale extraartikuläre Rotationsstabilisierung des Kniegelenks nach Lemaire. ARTHROSKOPIE 2018. [DOI: 10.1007/s00142-018-0205-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Anatomic double bundle ACL reconstruction outperforms any types of single bundle ACL reconstructions in controlling dynamic rotational laxity. Knee Surg Sports Traumatol Arthrosc 2018; 26:1414-1419. [PMID: 29138915 DOI: 10.1007/s00167-017-4781-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare the different types of ACL reconstructions in terms of knee dynamic laxity evaluated by acceleration. METHODS Sixteen fresh frozen cadaveric knees were used. Pivot shift test was manually performed while monitoring the tibial acceleration by use of a triaxial accelerometer. The test was repeated before and after the ACL resection and reconstruction. Three types of ACL reconstruction were tested: (1) Anatomic Single-Bundle reconstruction (n = 8), the graft was placed at the center of the ACL footprint for the both femoral and tibial sides (tunnel diameter: 8mm); (2) Conventional Single-Bundle reconstruction (n = 8), the graft was placed from the tibial PL footprint to femoral high AM position (tunnel diameter: 8mm) and (3) Anatomic Double-Bundle reconstruction (n = 8). The acceleration in each of three x-y-z directions and the overall magnitude of acceleration was calculated to evaluate dynamic rotational laxity and compared between different ACL reconstructions. RESULTS The overall magnitude of acceleration was significantly different between ACL intact and deficient knees (p < 0.0001). The acceleration was reduced by the DB ACL reconstruction to the intact level (n.s.), but the two SB ACL reconstruction failed to achieve the intact level of the acceleration (p = 0.0002non-anatomic SB, p < 0.0001 anatomic SB). CONCLUSION The anatomic DB reconstruction better restores dynamic rotational laxity when compared to the SB ACL reconstructions no matter if the tunnel placement was anatomic. The anatomic DB reconstruction better restores dynamic rotational laxity when compared to both anatomic and non-anatomic SB ACL reconstruction. For this reason anatomic DB ACL reconstruction is recommended for cases where rotational laxity is an issue.
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17
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Williams A. Editorial Commentary: The Anterolateral Ligament: The Emperor's New Clothes? Arthroscopy 2018; 34:1015-1021. [PMID: 29622242 DOI: 10.1016/j.arthro.2017.12.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 02/02/2023]
Abstract
In the following editorial commentary, the lateral soft tissues responsible for resisting the pivot shift phenomenon with the anterior cruciate ligament (ACL) are considered. The recent history of the anterolateral ligament (ALL) has led to rapid adoption of surgical techniques that have often not been investigated with scientific due process. A step-by-step approach starts with biomechanical testing to establish the anatomy and biomechanical characteristics of soft tissue structures and questions the importance of the ALL and proposes a more important role for the iliotibial band (ITB) passing between attachments to the distal lateral femur and tibia. Subsequent laboratory testing of various operative options shows superiority of lateral extra-articular tenodeses (LETs) as compared with ALL reconstruction.
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18
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Herbst E, Arilla FV, Guenther D, Yacuzzi C, Rahnemai-Azar AA, Fu FH, Debski RE, Musahl V. Lateral Extra-articular Tenodesis Has No Effect in Knees With Isolated Anterior Cruciate Ligament Injury. Arthroscopy 2018; 34:251-260. [PMID: 29079261 DOI: 10.1016/j.arthro.2017.08.258] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 08/11/2017] [Accepted: 08/11/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate knee kinematics in response to physical examinations to determine the effect of anterolateral capsular injury and lateral extra-articular tenodesis (LET) in anterior cruciate ligament (ACL)-deficient and -reconstructed knees. METHODS Seven human lower limb cadavers were used in this study (mean age, 60 years; age range, 56-63 years). Physical examinations were performed, including the pivot-shift test, Lachman test, anterior drawer at 90°, and internal and external tibial rotation at 30°, 60°, and 90° of knee flexion. ACL injury and reconstruction and LET, all with and without an injured anterolateral capsule, were investigated. Tibial translation and rotation relative to the femur were measured by an electromagnetic tracking system during the physical examination. RESULTS Anterior translation of the lateral knee compartment and internal tibial rotation during the pivot-shift test were highest in combined ACL-deficient and anterolateral capsule-deficient knees (12.3 ± 7.4 mm and 16.3° ± 8.5°, respectively). With the presence of an anterolateral capsular injury, a combined ACL reconstruction and LET reduced the anterior translation of the lateral knee compartment during the pivot-shift test significantly (P = .042), whereas anatomic ACL reconstruction did not. Internal tibial rotation displayed overconstraint when a LET was performed, especially when the anterolateral capsule was intact. CONCLUSIONS ACL reconstruction in combination with a LET was able to reduce anterior tibial translation and internal tibial rotation in response to different physical examinations. However, combined ACL reconstruction and LET led to overconstraint of internal tibial rotation when the anterolateral capsule was intact. CLINICAL RELEVANCE: On the basis of our results, LET with ACL reconstruction restores stability in a combined ACL-injured and anterolateral capsule-injured knee. However, LET with ACL reconstruction overconstrains the knee in an isolated ACL injury.
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Affiliation(s)
- Elmar Herbst
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.; Department of Orthopaedic Sports Medicine, Technical University Munich, Munich, Germany
| | - Fabio V Arilla
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.; Department of Orthopaedic Surgery, Hospital Universitário, Canoas, Brazil
| | - Daniel Guenther
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.; Trauma Department, Hannover Medical School, Hannover, Germany
| | - Carlos Yacuzzi
- Orthopaedic Robotics Laboratory, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Ata A Rahnemai-Azar
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Richard E Debski
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A..
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19
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Abstract
Background: Significant controversy exists regarding the anterolateral structures of the knee. Purpose: To determine the layer-by-layer anatomic structure of the anterolateral complex of the knee. Study Design: Descriptive laboratory study. Methods: Twenty fresh-frozen cadaveric knees (age range, 38-56 years) underwent a layer-by-layer dissection to systematically expose and identify the various structures of the anterolateral complex. Quantitative measurements were performed, and each layer was documented with high-resolution digital imaging. Results: The anterolateral complex of the knee consisted of different distinct layers, with the superficial and deep iliotibial band (ITB) representing layer 1. The superficial ITB had a distinct connection to the distal femoral metaphysis and femoral condyle (Kaplan fibers), and the deep layers of the ITB were identified originating at the level of the Kaplan fibers proximally. This functional unit, consisting of the superficial and deep ITB, was reinforced by the capsulo-osseous layer of the ITB, which was continuous with the fascia of the lateral gastrocnemius and biceps femoris muscles. These 3 components of the ITB became confluent distally, and the insertion spanned from the Gerdy tubercle anteriorly to the lateral tibia posteriorly on a small tubercle (lateral tibial tuberosity). Layer 3 consisted of the anterolateral capsule, in which 35% (7/20) of specimens had a discreet mid-third capsular ligament. Conclusion: The anterolateral complex consists of the superficial and deep ITB, the capsulo-osseous layer of the ITB, and the anterolateral capsule. The anterolateral complex is defined by the part of the ITB between the Kaplan fibers proximally and its tibial insertion, which forms a functional unit. A discrete anterolateral ligament was not observed; however, the anterolateral ligament described in recent studies likely refers to the capsulo-osseous layer or the mid-third capsular ligament. Clinical Relevance: The anterolateral knee structures form a complex functional unit. Surgeons should use caution when attempting to restore this intricate structure with extra-articular procedures designed to re-create a single discreet ligament.
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Affiliation(s)
- Elmar Herbst
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Marcio Albers
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jeremy M Burnham
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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20
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Lansdown D, Ma CB. The Influence of Tibial and Femoral Bone Morphology on Knee Kinematics in the Anterior Cruciate Ligament Injured Knee. Clin Sports Med 2017; 37:127-136. [PMID: 29173552 DOI: 10.1016/j.csm.2017.07.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Bone morphology is one feature that contributes to knee kinematics. The geometry of the tibia and femur vary across individuals, and these differences can influence the risk of anterior cruciate ligament (ACL) injury and of failure after isolated ACL reconstruction. There has been renewed interest in lateral extra-articular stabilization procedures to supplement an ACL reconstruction, although which patients benefit most from these procedures remains unclear. This article reviews the impact of bone morphology on knee kinematics, including tibial slope, depth of the medial tibial plateau, intercondylar notch shape, tibial eminence volume, and sphericity of the femoral condyles.
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Affiliation(s)
- Drew Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, 1500 Owens Street, Suite 186, San Francisco, CA 94158, USA
| | - Chunbong Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, 1500 Owens Street, Suite 186, San Francisco, CA 94158, USA.
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21
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Herbst E, Albers M, Burnham JM, Shaikh HS, Naendrup JH, Fu FH, Musahl V. The anterolateral complex of the knee: a pictorial essay. Knee Surg Sports Traumatol Arthrosc 2017; 25:1009-1014. [PMID: 28233023 DOI: 10.1007/s00167-017-4449-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/20/2017] [Indexed: 01/26/2023]
Abstract
Injuries to the anterolateral complex of the knee can result in increased rotatory knee instability. However, to diagnose and treat patients with persistent instability properly, surgeons need to understand the multifactorial genesis as well as the complex anatomy of the anterolateral aspect of the knee in its entirety. While recent research focused primarily on one structure (anterolateral ligament-ALL), the purpose of this pictorial essay is to provide a detailed layer-by-layer description of the anterolateral complex of the knee, consisting of the iliotibial band with its superficial, middle, deep, and capsulo-osseous layer as well as the anterolateral joint capsule. This may help surgeons to not only understand the anatomy of this particular part of the knee, but may also provide guidance when performing extra-articular procedures in patients with rotatory knee instability. Level of evidence V.
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Affiliation(s)
- Elmar Herbst
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Marcio Albers
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Jeremy M Burnham
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Humza S Shaikh
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Jan-Hendrik Naendrup
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
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22
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Abstract
This article reviews the evidence for the roles of the anterolateral soft-tissue structures in rotatory stability of the knee, including their structural properties, isometry, and contributions to resisting tibial internal rotation. These data then lead to a biomechanical demonstration that the ilio-tibial band is the most important structure for the restraint of anterolateral rotatory instability. Level of evidence V.
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Affiliation(s)
- Andrew A Amis
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, SW7 2AZ, UK.
- Musculoskeletal Surgery Group, Department of Surgery and Cancer, Imperial College London School of Medicine, London, W6 8RF, UK.
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23
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Gatti G. Conceptual design and implantation of an external fixator with improved mobility for knee rehabilitation. Comput Methods Biomech Biomed Engin 2017; 20:884-892. [PMID: 28332404 DOI: 10.1080/10255842.2017.1307342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A hinged external fixator is used to allow early knee rehabilitation in case of injury or trauma, as an alternative approach to immobilization. It is mainly adopted for the treatment of dislocations, which involve tearing of the ligaments, and it basically consists of two links connected to each other by a revolute joint. Each link is fixed to the femur and tibia via pin fixation, and the revolute joint is approximately aligned to the knee flexion-extension (FE) axis. The advantage in its implantation is to protect ligament reconstruction, while allowing for an aggressive rehabilitation. Traditional fixators only accommodate the functional flexion movement in a limited range, i.e. where the anatomical movement is closer to a planar circular trajectory. This paper presents the conceptual design and implantation procedure of a double-axis fixator, which accommodates both FE and longitudinal internal-external rotation. The procedure is based on accurate knee kinematics measurements and on computer-aided multibody simulations to assist clinicians in the implantation. An experimental test is presented using an artificial knee, and guidelines are given for in vitro studies. The proposed technique may allow for a better understanding of knee kinematics and have the potential advantage to increase the range of motion in postoperative rehabilitation.
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Affiliation(s)
- Gianluca Gatti
- a Department of Mechanical, Energy and Management Engineering , University of Calabria , Arcavacata di Rende (CS) , Italy
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24
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Correlation between a 2D simple image analysis method and 3D bony motion during the pivot shift test. Knee 2016; 23:1059-1063. [PMID: 27810428 DOI: 10.1016/j.knee.2016.06.003] [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: 10/14/2015] [Revised: 04/16/2016] [Accepted: 06/12/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The pivot shift test is the most specific clinical test to detect anterior cruciate ligament injury. The purpose of this study was to determine the correlation between the 2D simple image analysis method and the 3D bony motion of the knee during the pivot shift test and assess the intra- and inter-examiner agreements. METHODS Three orthopedic surgeons performed three trials of the standardized pivot shift test in seven knees. Two devices were used to measure motion of the lateral knee compartment simultaneously: 1) 2D simple image analysis method: translation was determined using a tablet computer with custom motion tracking software that quantified movement of three markers attached to skin over bony landmarks; 2) 3D bony motion: electromagnetic tracking system was used to measure movement of the same bony landmarks. RESULTS The 2D simple image analysis method demonstrated a good correlation with the 3D bony motion (Pearson correlation: 0.75, 0.76 and 0.79). The 3D bony translation increased by 2.7 to 3.5 times for every unit increase measured by the 2D simple image analysis method. The mean intra-class correlation coefficients for the three examiners were 0.6 and 0.75, respectively for 3D bony motion and 2D image analyses, while the inter-examiner agreement was 0.65 and 0.73, respectively. CONCLUSIONS The 2D simple image analysis method results are related to 3D bony motion of the lateral knee compartment, even with skin artifact present. This technique is a non-invasive and repeatable tool to quantify the motion of the lateral knee compartment during the pivot shift test.
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25
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Herbst E, Naendrup JH, Pfeiffer T, Debski RE, Musahl V. Neue App zur Quantifizierung des Pivot-shift-Tests. ARTHROSKOPIE 2016. [DOI: 10.1007/s00142-016-0096-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Musahl V, Karlsson J, Zaffagnini S, Fu FH. Authors' Reply. Arthroscopy 2016; 32:1741-4. [PMID: 27594325 DOI: 10.1016/j.arthro.2016.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 02/02/2023]
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Moewis P, Duda GN, Jung T, Heller MO, Boeth H, Kaptein B, Taylor WR. The Restoration of Passive Rotational Tibio-Femoral Laxity after Anterior Cruciate Ligament Reconstruction. PLoS One 2016; 11:e0159600. [PMID: 27467744 PMCID: PMC4965218 DOI: 10.1371/journal.pone.0159600] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/01/2016] [Indexed: 01/15/2023] Open
Abstract
While the anterior cruciate ligament (ACL) is considered one of the most important ligaments for providing knee joint stability, its influence on rotational laxity is not fully understood and its role in resisting rotation at different flexion angles in vivo remains unknown. In this prospective study, we investigated the relationship between in vivo passive axial rotational laxity and knee flexion angle, as well as how they were altered with ACL injury and reconstruction. A rotometer device was developed to assess knee joint rotational laxity under controlled passive testing. An axial torque of ±2.5Nm was applied to the knee while synchronised fluoroscopic images of the tibia and femur allowed axial rotation of the bones to be accurately determined. Passive rotational laxity tests were completed in 9 patients with an untreated ACL injury and compared to measurements at 3 and 12 months after anatomical single bundle ACL reconstruction, as well as to the contralateral controls. Significant differences in rotational laxity were found between the injured and the healthy contralateral knees with internal rotation values of 8.7°±4.0° and 3.7°±1.4° (p = 0.003) at 30° of flexion and 9.3°±2.6° and 4.0°±2.0° (p = 0.001) at 90° respectively. After 3 months, the rotational laxity remained similar to the injured condition, and significantly different to the healthy knees. However, after 12 months, a considerable reduction of rotational laxity was observed towards the levels of the contralateral controls. The significantly greater laxity observed at both knee flexion angles after 3 months (but not at 12 months), suggests an initial lack of post-operative rotational stability, possibly due to reduced mechanical properties or fixation stability of the graft tissue. After 12 months, reduced levels of rotational laxity compared with the injured and 3 month conditions, both internally and externally, suggests progressive rotational stability of the reconstruction with time.
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Affiliation(s)
- Philippe Moewis
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Georg N. Duda
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Jung
- Knee Surgery and Sports Traumatology, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Markus O. Heller
- Bioengineering Research Group, University of Southhampton, Southhampton, United Kingdom
| | - Heide Boeth
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bart Kaptein
- Department of Orthopaedic Surgery, Biomechanics and Imaging Group, Leiden University Medical Center, Leiden, Netherlands
| | - William R. Taylor
- Department of Health Sciences and Technology, Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
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Sundemo D, Alentorn-Geli E, Hoshino Y, Musahl V, Karlsson J, Samuelsson K. Objective measures on knee instability: dynamic tests: a review of devices for assessment of dynamic knee laxity through utilization of the pivot shift test. Curr Rev Musculoskelet Med 2016; 9:148-59. [PMID: 26984465 DOI: 10.1007/s12178-016-9338-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Current reconstructive methods used after anterior cruciate ligament (ACL) injury do not entirely restore native knee kinematics. Evaluation of dynamic knee laxity is important to accurately diagnose ACL deficiency, to evaluate reconstructive techniques, and to construct treatment algorithms for patients with ACL injury. The purpose of this study is to present recent progress in evaluation of dynamic knee laxity through utilization of the pivot shift test. A thorough electronic search was performed and relevant studies were assessed. Certain dynamic knee laxity measurement methods have been present for over 10 years (Navigation system, Electromagnetic sensor system) while other methods (Inertial sensor, Image analysis system) have been introduced recently. Methods to evaluate dynamic knee laxity through the pivot shift test are already potent. However, further refinement is warranted. In addition, to correctly quantify the pivot shift test, the involved forces need to be controlled through either standardization or mechanization of the pivot shift test.
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Affiliation(s)
- David Sundemo
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
| | | | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jón Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
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Abstract
The pivot-shift test is an important examination to assess the rotational laxity in the anterior cruciate ligament (ACL) injured and reconstructed knees. Because this examination is related to subjective knee function, we may still see cases that have residual rotational laxity after ACL reconstruction. Quantitative evaluation of the pivot-shift test is preferable to the clinical pivot-shift test but is difficult to attain mainly due to complicated movements of the pivot-shift. The electromagnetic tracking system was developed to evaluate knee kinematics during the pivot-shift, providing information related to 6-degree-of-freedom knee kinematics with a high sampling rate. Through this device, the abnormal movement of the pivot-shift is characterized in two phases: an increased anterior tibial translation and a boosted acceleration of tibial posterior reduction. Since its invention, this system has been utilized to assess rotational laxity for clinical follow-up and research after the ACL reconstruction.
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Rahnemai-Azar AA, Naendrup JH, Soni A, Olsen A, Zlotnicki J, Musahl V. Knee instability scores for ACL reconstruction. Curr Rev Musculoskelet Med 2016; 9:170-7. [PMID: 26980119 PMCID: PMC4896882 DOI: 10.1007/s12178-016-9339-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Despite abundant biological, biomechanical, and clinical research, return to sport after anterior cruciate ligament (ACL) injury remains a significant challenge. Residual rotatory knee laxity has been identified as one of the factors responsible for poor functional outcome. To improve and standardize the assessment of knee instability, a variety of instability scoring systems is available. Recently, devices to objectively quantify static and dynamic clinical exams have been developed to complement traditional subjective grading systems. These devices enable an improved evaluation of knee instability and possible associated injuries. This additional information may promote the development of new treatment algorithms and allow for individualized treatment. In this review, the different subjective laxity scores as well as complementary objective measuring systems are discussed, along with an introduction of injury to an individualized treatment algorithm.
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Affiliation(s)
- Ata A Rahnemai-Azar
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
- Orthopaedic Robotics Laboratory, Center for Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Jan-Hendrik Naendrup
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
- Orthopaedic Robotics Laboratory, Center for Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Ashish Soni
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Adam Olsen
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Jason Zlotnicki
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
- Orthopaedic Robotics Laboratory, Center for Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
- Orthopaedic Robotics Laboratory, Center for Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA, 15219, USA.
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Signorelli C, Bonanzinga T, Grassi A, Lopomo N, Zaffagnini S, Marcacci M. Predictive mathematical modeling of knee static laxity after ACL reconstruction: in vivo analysis. Comput Methods Biomech Biomed Engin 2016; 19:1610-7. [PMID: 27123692 DOI: 10.1080/10255842.2016.1176152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Previous studies did not take into consideration such large variety of surgery variables which describe the performed anterior cruciate ligament (ACL) reconstruction and the interaction among them in the definition of postoperative outcome. Seventeen patients who underwent navigated Single Bundle plus Lateral Plasty ACL reconstruction were enrolled in the study. Static laxity was evaluated as the value of anterior/posterior displacement at 30° and at 90° of flexion, internal/external rotation at 30° and 90° of knee flexion, varus/valgus test at 0° and 30° of flexion. The evaluated surgical variables were analyzed through a multivariate analysis defining the following models: AP30estimate, AP90estimate, IE30estimate, IE90estimate, VV0estimate, VV30estimate. Surgical variables has been defined as the angles between the tibial tunnel and the three planes, the lengths of the tunnel and the relationship between native footprints and tunnels. An analogous characterization was performed for the femoral side. Performance and significance of the defined models have been quantified by the correlation ratio (η(2)) and the corresponding p-value (*p < 0.050). The analyzed models resulted to be statistically significant (p < 0.05) for prediction of postoperative static laxity values. The only exception was the AP90estimate model. The η(2) ranged from 0.568 (IE90estimate) to 0.995 (IE30estimate). The orientation of the tibial tunnel resulted to be the most important surgical variable for the performed laxity estimation. Mathematical models for postoperative knee laxity is a useful tool to evaluate the effects of different surgical variables on the postoperative outcome.
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Affiliation(s)
- C Signorelli
- a Istituto Ortopedico Rizzoli , Laboratorio di Biomeccanica e Innovazione Tecnologica , Bologna , Italy
| | - T Bonanzinga
- a Istituto Ortopedico Rizzoli , Laboratorio di Biomeccanica e Innovazione Tecnologica , Bologna , Italy.,b Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica II , Bologna , Italy
| | - A Grassi
- a Istituto Ortopedico Rizzoli , Laboratorio di Biomeccanica e Innovazione Tecnologica , Bologna , Italy.,b Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica II , Bologna , Italy
| | - N Lopomo
- a Istituto Ortopedico Rizzoli , Laboratorio di Biomeccanica e Innovazione Tecnologica , Bologna , Italy.,c Dipartimento di Ingegneria dell'Informazione, Università degli Studi di Brescia , Brescia , Italy
| | - S Zaffagnini
- a Istituto Ortopedico Rizzoli , Laboratorio di Biomeccanica e Innovazione Tecnologica , Bologna , Italy.,b Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica II , Bologna , Italy
| | - M Marcacci
- a Istituto Ortopedico Rizzoli , Laboratorio di Biomeccanica e Innovazione Tecnologica , Bologna , Italy.,b Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica II , Bologna , Italy
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Vertullo CJ, Wijenayake L, Grayson JE. A Technique of Improved Medial Meniscus Visualization by Anterior Cruciate Ligament Graft Placement in Chronic Anterior Cruciate Deficient Knees. Arthrosc Tech 2016; 5:e297-302. [PMID: 27354950 PMCID: PMC4912608 DOI: 10.1016/j.eats.2016.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/04/2016] [Indexed: 02/03/2023] Open
Abstract
It is customary to perform medial meniscus repair before anterior cruciate ligament (ACL) graft placement when undertaken as a combined procedure. However, in chronic ACL-deficient knees, intraoperative anterior tibiofemoral translation can cause the medial meniscus repair to be more technically challenging. Intraoperative anterior tibiofemoral translation can both reduce the visualization of the medial meniscus and make its reduction unstable. An operative sequence alteration of ACL graft placement and tensioning before medial meniscal repair improves medial meniscus visualization in chronically ACL-deficient knees by using the ACL graft's ability to prevent anterior tibiofemoral translation. The technique sequence is as follows: (a) the medial meniscus is reduced, (b) ACL reconstruction is undertaken using a hamstring graft without final tibia fixation,
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Affiliation(s)
- Christopher J. Vertullo
- Knee Research Australia, Gold Coast, Australia,Centre for Musculoskeletal Research, Menzies Health Institute, Griffith University, Gold Coast, Australia,Address correspondence to Christopher J. Vertullo, M.B.B.S., F.R.A.C.S., F.A.OrthoA., Orthopaedic Surgery Sports Medicine Center, 8-10 Carrara Street, Benowa, Gold Coast, Queensland 4217, Australia.Orthopaedic Surgery Sports Medicine Center8-10 Carrara StreetBenowaGold CoastQueensland 4217Australia
| | | | - Jane E. Grayson
- Department of Kinesiology and Health Science, Stephen F. Austin State University, Nacogdoches, Texas, U.S.A
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Different roles of the medial and lateral hamstrings in unloading the anterior cruciate ligament. Knee 2016; 23:97-101. [PMID: 26256427 DOI: 10.1016/j.knee.2015.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 06/17/2015] [Accepted: 07/16/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Anterior cruciate ligament injuries are closely associated with excessive loading and motion about the off axes of the knee, i.e. tibial rotation and knee varus/valgus. However, it is not clear about the 3-D mechanical actions of the lateral and medial hamstring muscles and their differences in loading the ACL. The purpose of this study was to investigate the change in anterior cruciate ligament strain induced by loading the lateral and medial hamstrings individually. METHODS Seven cadaveric knees were investigated using a custom testing apparatus allowing for six degree-of-freedom tibiofemoral motion induced by individual muscle loading. With major muscles crossing the knee loaded moderately, the medial and lateral hamstrings were loaded independently to 200N along their lines of actions at 0°, 30°, 60° and 90° of knee flexion. The induced strain of the anterior cruciate ligament was measured using a differential variable reluctance transducer. Tibiofemoral kinematics was monitored using a six degrees-of-freedom knee goniometer. RESULTS Loading the lateral hamstrings induced significantly more anterior cruciate ligament strain reduction (mean 0.764 [SD 0.63] %) than loading the medial hamstrings (mean 0.007 [0.2] %), (P=0.001 and effect size=0.837) across the knee flexion angles. CONCLUSION The lateral and medial hamstrings have significantly different effects on anterior cruciate ligament loadings. More effective rehabilitation and training strategies may be developed to strengthen the lateral and medial hamstrings selectively and differentially to reduce anterior cruciate ligament injury and improve post-injury rehabilitation. CLINICAL RELEVANCE The lateral and medial hamstrings can potentially be strengthened selectively and differentially as a more focused rehabilitation approach to reduce ACL injury and improve post-injury rehabilitation. Different ACL reconstruction procedures with some of them involving the medial hamstrings can be compared to each other for their effect on ACL loading.
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34
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Quantitative comparison of the pivot shift test results before and after anterior cruciate ligament reconstruction by using the three-dimensional electromagnetic measurement system. Knee Surg Sports Traumatol Arthrosc 2015; 23:2876-81. [PMID: 26342695 DOI: 10.1007/s00167-015-3776-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/28/2015] [Indexed: 01/30/2023]
Abstract
PURPOSE Tibial acceleration during the pivot shift test is a potential quantitative parameter to evaluate rotational laxity of anterior cruciate ligament (ACL) insufficiency. However, clinical application of this measurement has not been fully examined. This study aimed to measure and compare tibial acceleration before and after ACL reconstruction (ACLR) in ACL-injured patients. We hypothesized tibial acceleration would be reduced by ACLR and tibial acceleration would be consistent in the same knee at different time points. METHODS Seventy ACL-injured patients who underwent ACLR were enrolled. Tibial acceleration during the pivot shift test was measured using an electromagnetic measurement system before ALCR and at the second-look arthroscopy 1 year post-operatively. Tibial acceleration was compared to clinical grading and between ACL-injured/ACL-reconstructed and contralateral knees. RESULTS Pre-operative tibial acceleration was increased stepwise with the increase in clinical grading (P < 0.01). Tibial acceleration in ACL-injured knee (1.9 ± 1.2 m/s(2)) was larger than that in the contralateral knee (0.8 ± 0.3 m/s(2), P < 0.01), and reduced to 0.9 ± 0.3 m/s(2) post-operatively (P < 0.01). There was no difference between ACL-reconstructed and contralateral knee (n.s.). Tibial acceleration in contralateral knees was consistent pre- and post-operatively (n.s.). CONCLUSION Tibial acceleration measurement demonstrated increased rotational laxity in ACL-injured knees and its reduction by ALCR. Additionally, consistent measurements were obtained in ACL-intact knees at different time points. Therefore, tibial acceleration during the pivot shift test could provide quantitative evaluation of rotational stability before and after ACL reconstruction. LEVEL OF EVIDENCE III.
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Clinically relevant biomechanics of the knee capsule and ligaments. Knee Surg Sports Traumatol Arthrosc 2015; 23:2789-96. [PMID: 25894747 DOI: 10.1007/s00167-015-3594-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 03/31/2015] [Indexed: 01/16/2023]
Abstract
The paper describes the concepts of primary and secondary restraints to knee joint stability and explains systematically how the tibia is stabilised against translational forces and rotational torques in different directions and axes, and how those vary across the arc of flexion-extension. It also shows how the menisci act to stabilise the knee, in addition to load carrying across the joint. It compares the properties of the natural stabilising structures with the strength and stiffness of autogenous tissue grafts and relates those strengths to the strength of graft fixation devices. A good understanding of the biomechanical behaviour of these various structures in the knee will help the surgeon in the assessment and treatment of single and multi-ligament injuries.
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36
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Sena MP, DellaMaggioria R, Lotz JC, Feeley BT. A mechanical pivot-shift device for continuously applying defined loads to cadaveric knees. Knee Surg Sports Traumatol Arthrosc 2015; 23:2900-8. [PMID: 26359176 DOI: 10.1007/s00167-015-3775-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 08/25/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Current techniques to study the biomechanics of the pivot-shift utilize either static or poorly defined loading conditions. Here, a novel mechanical pivot-shift device that continuously applies well-defined loads to cadaveric knees is characterized and validated against the manual pivot-shift. METHODS Six fresh-frozen human lower limb specimens were potted at the femur, mounted on a hinged testing base, and fitted with the mechanical device. Five mechanical and manual pivot-shift tests were performed on each knee by two examiners before and after transecting the ACL. Three-dimensional kinematics (anterior and internal-rotary displacements, and posterior and external-rotary velocities) and kinetics (forces and moments applied to the tibia by the device) were recorded using an optical navigation system and 6-axis load cell. Analysis of variance and Bland-Altman statistics were used to gauge repeatability within knees, reproducibility between knees, agreement between the mechanical and manual test methods, and agreement between examiners. RESULTS The forces and moments applied by the device were continuous and repeatable/reproducible to within 4/10 % of maximum recorded values. Kinematic variables (excluding external-rotary velocity) were qualitatively and quantitatively similar to manual pivot-shift kinematics, and were more repeatable and reproducible. CONCLUSION The presented device induces pivot-shift-like kinematics by applying highly repeatable three-dimensional loads to cadaver knees. It is based on a simple mechanical principle and designed using easily obtainable components. Consequently, the device enables orthopaedic biomechanists to easily and reliably quantify the effect of ACL injury and reconstruction on pivot-shift kinematics.
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Affiliation(s)
- Mark P Sena
- Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, University of California, San Francisco 1500 Owens Ave, San Francisco, CA, 94158, USA
| | - Ryan DellaMaggioria
- Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, University of California, San Francisco 1500 Owens Ave, San Francisco, CA, 94158, USA
- Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jeffrey C Lotz
- Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, University of California, San Francisco 1500 Owens Ave, San Francisco, CA, 94158, USA
| | - Brian T Feeley
- Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, University of California, San Francisco 1500 Owens Ave, San Francisco, CA, 94158, USA.
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37
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Labbé DR, Li D, Grimard G, de Guise JA, Hagemeister N. Quantitative pivot shift assessment using combined inertial and magnetic sensing. Knee Surg Sports Traumatol Arthrosc 2015; 23:2330-2338. [PMID: 24832695 DOI: 10.1007/s00167-014-3056-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 05/02/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of the study was to demonstrate the feasibility of a new measurement system using micro-electromechanical systems (MEMS)-based sensors for quantifying the pivot shift phenomenon. METHODS The pivot shift test was performed on 13 consecutive anterior cruciate ligament-deficient subjects by an experienced examiner while femur and tibia kinematics were recorded using two inertial sensors each composed of an accelerometer, gyroscope and magnetometer. The gravitational component of the acquired data was removed using a novel method for estimating sensor orientations. Correlation between the clinical pivot shift grade and acceleration and velocity parameters was measured using Spearman's rank correlation coefficients. RESULTS The pivot shift phenomenon was best characterized as a drop in femoral acceleration observed at the time of reduction. The correlation between the femoral acceleration drop and the clinical grade was shown to be very strong (r = 0.84, p < 0.0001). CONCLUSIONS The present study demonstrates the feasibility of quantifying the pivot shift using MEMS-based sensors and removing the gravitational component of acceleration using an estimation of sensor orientation for improved correlation to the clinical grade.
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Affiliation(s)
- David R Labbé
- Laboratoire de recherche en imagerie et orthopédie (LIO), Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM), Tour Viger, 900, rue Saint-Denis, Local R11.326, Montreal, QC, H2X 0A9, Canada. .,École de technologie supérieure, Montreal, Canada.
| | - Di Li
- Laboratoire de recherche en imagerie et orthopédie (LIO), Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM), Tour Viger, 900, rue Saint-Denis, Local R11.326, Montreal, QC, H2X 0A9, Canada.,École de technologie supérieure, Montreal, Canada
| | - Guy Grimard
- Centre hospitalier universitaire Ste-Justine, Montreal, Canada
| | - Jacques A de Guise
- Laboratoire de recherche en imagerie et orthopédie (LIO), Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM), Tour Viger, 900, rue Saint-Denis, Local R11.326, Montreal, QC, H2X 0A9, Canada.,École de technologie supérieure, Montreal, Canada
| | - Nicola Hagemeister
- Laboratoire de recherche en imagerie et orthopédie (LIO), Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM), Tour Viger, 900, rue Saint-Denis, Local R11.326, Montreal, QC, H2X 0A9, Canada.,École de technologie supérieure, Montreal, Canada
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Muller B, Hofbauer M, Rahnemai-Azar AA, Wolf M, Araki D, Hoshino Y, Araujo P, Debski RE, Irrgang JJ, Fu FH, Musahl V. Development of computer tablet software for clinical quantification of lateral knee compartment translation during the pivot shift test. Comput Methods Biomech Biomed Engin 2015; 19:217-28. [DOI: 10.1080/10255842.2015.1006210] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Araujo PH, Kfuri Junior M, Ohashi B, Hoshino Y, Zaffagnini S, Samuelsson K, Karlsson J, Fu F, Musahl V. Individualized ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2014; 22:1966-75. [PMID: 24623186 DOI: 10.1007/s00167-014-2928-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 02/25/2014] [Indexed: 01/13/2023]
Abstract
UNLABELLED The pivot shift test is the only physical examination test capable of predicting knee function and osteoarthritis development after an ACL injury. However, because interpretation and performance of the pivot shift are subjective in nature, the validity of the pivot shift is criticized for not providing objective information for a complete surgical planning for the treatment of rotatory knee laxity. The aim of ACL reconstruction was eliminating the pivot shift sign. Many structures and anatomical characteristics can influence the grading of the pivot shift test and are involved in the genesis and magnitude of rotatory instability after an ACL injury. The objective quantification of the pivot shift may be able to categorize knee laxity and provide adequate information on which structures are affected besides the ACL. A new algorithm for rotational instability treatment is presented, accounting for patients' unique anatomical characteristics and objective measurement of the pivot shift sign allowing for an individualized surgical treatment. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Paulo H Araujo
- Department of Biomechanics, Medicine and Rehabilitation of Locomotor System - Ribeirao Preto Medical School, São Paulo University, Av. Bandeirantes, 3900 - Monte Alegre, Ribeirão Prêto, CEP 14049-900, SP, Brazil,
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Fernandes TL, Ribeiro DB, da Rocha DC, Albuquerque C, Pereira CAM, Pedrinelli A, Hernandez AJ. Descrição de sistema de avaliação da cinemática do joelho em lesões ligamentares a partir de rastreamento óptico e tomografia 3D. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2013.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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41
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Fernandes TL, Ribeiro DB, da Rocha DC, Albuquerque C, Pereira CAM, Pedrinelli A, Hernandez AJ. Description of an evaluation system for knee kinematics in ligament lesions, by means of optical tracking and 3D tomography. REVISTA BRASILEIRA DE ORTOPEDIA (ENGLISH EDITION) 2014; 49:513-9. [PMID: 26229854 PMCID: PMC4487496 DOI: 10.1016/j.rboe.2014.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 10/03/2013] [Indexed: 11/25/2022]
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42
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Asai S, Maeyama A, Hoshino Y, Goto B, Celentano U, Moriyama S, Smolinski P, Fu FH. A comparison of dynamic rotational knee instability between anatomic single-bundle and over-the-top anterior cruciate ligament reconstruction using triaxial accelerometry. Knee Surg Sports Traumatol Arthrosc 2014; 22:972-8. [PMID: 23568389 DOI: 10.1007/s00167-013-2499-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 04/02/2013] [Indexed: 12/18/2022]
Abstract
PURPOSE Recently, single-bundle (SB) anterior cruciate ligament (ACL) reconstruction has been advanced by the anatomic concept, but the biomechanical outcome of the anatomic method has not been fully investigated, especially for rotational instability. Anatomic SB and the single over-the-top procedures are the treatment of choice for primary cases and revision or skeletally immature cases, respectively. The purpose of this study was to investigate the dynamic rotational instability of anatomic SB and over-the-top reconstruction during a pivot shift test using triaxial accelerometry. METHODS Eight fresh frozen human cadaveric knees were used in this study. Rotational instability measurement was conducted during a pivot shift test by the use of a triaxial accelerometer attached to the tibia. The tests were performed in the ACL-intact, ACL-deficient and ACL-reconstructed knees with two different procedures (anatomic SB and over-the-top). The acceleration in three directions and the magnitude of acceleration were measured to evaluate rotational instability and compare between four different knee states. RESULTS The overall magnitude of acceleration was significantly different (P < 0.01) between the ACL-intact knees and the ACL-deficient knees. Both anatomic SB and over-the-top ACL reconstruction significantly reduced the overall magnitude of acceleration compared to the ACL-deficient knees, but still had larger accelerations compared to the ACL-intact knees. There was no significant difference for the overall magnitude of acceleration between anatomic SB and over-the-top reconstruction procedure. CONCLUSION Over-the-top reconstruction provides comparable result to anatomic SB reconstruction in terms of controlling the dynamic rotational stability. Over-the-top reconstruction might be one of the options for revision cases and in skeletally immature patients.
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Affiliation(s)
- Shigehiro Asai
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Tardy N, Marchand P, Kouyoumdjian P, Blin D, Demattei C, Asencio G. A Preliminary In Vivo Assessment of Anterior Cruciate Ligament-Deficient Knee Kinematics With the KneeM Device: A New Method to Assess Rotatory Laxity Using Open MRI. Orthop J Sports Med 2014; 2:2325967114525583. [PMID: 26535309 PMCID: PMC4555568 DOI: 10.1177/2325967114525583] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Methods of objectively measuring rotational knee laxity are either experimental or difficult to use in daily practice. A new method has been developed to quantitatively assess rotatory laxity using an open MRI system and new tool, the KneeM device. PURPOSE/HYPOTHESIS To perform a preliminary evaluation of a novel knee rotation measurement device to assess knee kinematics during flexion in an MRI field, in both anterior cruciate ligament (ACL)-deficient and healthy contralateral knees. The hypothesis was that the KneeM device would allow in vivo reproduction and analysis of knee kinematics during flexion in healthy and ACL-deficient knees. STUDY DESIGN Controlled laboratory study. METHODS Ten subjects (7 men and 3 women; mean age ± standard deviation, 32.3 ± 9.4 years) with ACL-deficient knees and contralateral uninjured knees participated in the study. An open MRI was performed with the KneeM device at a mean 4.9 months (range, 3.0-7 months) after ACL injury. The device exerted on the knee an anterior drawer force of 100 N, with an internal rotation of 20°, through the range of flexion (0°, 20°, 40°, and 60°). Both ACL-deficient and healthy contralateral knees were analyzed using the Iwaki method. RESULTS There was no statistical difference of anterior translation in the medial compartment between intact and ACL-deficient knees at all degrees of flexion. However, significant differences in the anterior translation of the lateral compartment were observed between ACL-deficient and intact contralateral knees at 0° and 20° of flexion (P = .005 and P = .002, respectively). Between 20° and 40°, the lateral plateau of ACL-deficient knees translated 7.7 mm posteriorly, whereas the medial compartment remained stable, reflecting a sudden external rotation of the lateral plateau under the femoral condyle. CONCLUSION This preliminary study suggests that measurement of tibiofemoral movements in both compartments during flexion using the KneeM device was useful for quantifying rotatory laxity in ACL-deficient knees. Moreover, this device seemed to allow a "mechanized pivot shift" and allowed reproduction of the "pivot" phase in the MRI field between 20° and 40° of flexion. CLINICAL RELEVANCE This device could be used for diagnostic purposes or to investigate the outcomes of ACL reconstructions.
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Affiliation(s)
| | | | | | | | - Christophe Demattei
- Department of Biostatistics, Epidemiology, Public Health and Medical Information, CHU de Nîmes, Nîmes, France
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Fong DTP, Lam MH, Lai PK, Yung PSH, Fung KY, Chan KM. Effect of anticipation on knee kinematics during a stop-jump task. Gait Posture 2014; 39:75-9. [PMID: 23810337 DOI: 10.1016/j.gaitpost.2013.05.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 03/04/2013] [Accepted: 05/31/2013] [Indexed: 02/02/2023]
Abstract
Knee stability during a functional assessment of the stop-jump task is a key factor to determine if an athlete is adequately rehabilitated after knee ligamentous injury. This study aimed to investigate knee stability due to the effect of anticipation on landing maneuvers during planned and unplanned stop-jump tasks. Knee kinematics of ten healthy male participants were collected using an optical motion analysis system during stop-jump tasks. Stop jumps were performed in four different landing positions either in planned movement or in an unplanned movement on a signal triggered as participants passed through a photocell gate. Kinematic data at the time of foot strike at landing in the stop-jump considered for investigating the anticipation effect during the stop-jump tasks. Two-way multivariate analysis of variance (MANOVA) with repeated measures and stratified paired t-tests were conducted to compare the knee kinematics data between planned and unplanned tasks. Statistical significance was set at the p<0.05 level. External rotational angle showed a significant decrease in unplanned stop-jump tasks during forward (p<0.05) and right (p<0.05) jumps when compared to that of planned tasks. Flexion angle and abduction angle during forward, vertical and right jumps were significantly decreased in the unplanned tasks. Anticipation significantly influenced the landing maneuvers of stop-jump task. The results indicated that both planned and unplanned stop-jump tasks should be considered when monitoring the rehabilitation progress after a ligamentous injury.
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Affiliation(s)
- Daniel Tik-Pui Fong
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; The Hong Kong Jockey Club Sports Medicine and Health Sciences Centre, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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Suero EM, Njoku IU, Voigt MR, Lin J, Koenig D, Pearle AD. The role of the iliotibial band during the pivot shift test. Knee Surg Sports Traumatol Arthrosc 2013; 21:2096-100. [PMID: 23104167 DOI: 10.1007/s00167-012-2257-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 10/16/2012] [Indexed: 01/13/2023]
Abstract
PURPOSE Several studies have suggested that the iliotibial (IT) band plays a role in knee laxity and that it may affect the magnitude of the pivot shift observed. However, the extent of the role played by the IT band, as well as its mechanism of action, is not currently known. This cadaveric study aimed to quantify the effect of the IT band and the hip abduction angle on the magnitude of anterior tibial translation (ATT) during the pivot shift. METHODS Six fresh-frozen hip-to-toes specimens were used. Serial sectioning of the anterior cruciate ligament (ACL) and the IT band was performed. Lachman and mechanized pivot shift manoeuvres were employed at each stage, and ATT of the lateral and medial compartments was measured using navigation. Three hip abduction angles were tested for each condition: 0°, 15° and 30°. RESULTS Sequential sectioning of the ACL and the IT band resulted in a significant increase in ATT in both the lateral (Intact = 0 ± 0.5 mm; ACL deficient = 8.1 ± 0.2 mm; ACL + IT deficient = 10.8 ± 0.3 mm) and medial (Intact = 6.7 ± 0.4 mm; ACL deficient = 8.4 ± 0.3 mm; ACL + IT deficient = 9.9 ± 0.3 mm) compartments. No significant increase in ATT was observed after changing the hip abduction angle at each stage. CONCLUSIONS An increase in the magnitude of the pivot shift and the Lachman was observed as the constraint of the IT band was removed. Additionally, it was shown that the hip abduction angle at which the pivot shift test was performed did not significantly affect the magnitude of ATT in this cadaveric model.
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Affiliation(s)
- Eduardo M Suero
- Computer Assisted Surgery Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St., New York, NY 10021, USA
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Affiliation(s)
- P Christel
- Institut de l'Appareil Locomoteur Nollet, 23, rue Brochant, 75017 Paris
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Quantitative evaluation of the pivot shift by image analysis using the iPad. Knee Surg Sports Traumatol Arthrosc 2013; 21:975-80. [PMID: 23340837 DOI: 10.1007/s00167-013-2396-0] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 01/11/2013] [Indexed: 01/15/2023]
Abstract
PURPOSE To enable comparison of test results, a widely available measurement system for the pivot shift test is needed. Simple image analysis of lateral knee joint translation is one such system that can be installed on a prevalent computer tablet (e.g. iPad). The purpose of this study was to test a novel iPad application to detect the pivot shift. It was hypothesized that the abnormal lateral translation in ACL deficient knees would be detected by the iPad application. METHODS Thirty-four consecutive ACL deficient patients were tested. Three skin markers were attached on the following bony landmarks: (1) Gerdy's tubercle, (2) fibular head and (3) lateral epicondyle. A standardized pivot shift test was performed under anaesthesia, while the lateral side of the knee joint was monitored. The recorded movie was processed by the iPad application to measure the lateral translation of the knee joint. Lateral translation was compared between knees with different pivot shift grades. RESULTS Valid data sets were obtained in 20 (59 %) ACL deficient knees. The remaining 14 data sets were invalid because of failure to detect translation or detection of excessive translation. ACL deficient knees had larger lateral translation than the contra-lateral knees (p < 0.01). In the 20 valid data sets, which were graded as either grade 1 (n = 10) or grade 2 (n = 10), lateral translation was significantly larger in the grade 2 pivot shift (3.6 ± 1.2 mm) than the grade 1 pivot shift (2.7 ± 0.6 mm, p < 0.05). CONCLUSION Although some technical corrections, such as testing manoeuvre and recording procedure, are needed to improve the image data sampling using the iPad application, the potential of the iPad application to classify the pivot shift was demonstrated.
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Lopomo N, Zaffagnini S, Amis AA. Quantifying the pivot shift test: a systematic review. Knee Surg Sports Traumatol Arthrosc 2013; 21:767-83. [PMID: 23455384 DOI: 10.1007/s00167-013-2435-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 01/23/2013] [Indexed: 01/13/2023]
Abstract
PURPOSE This study aims to identify and summarize the evidence on the biomechanical parameters and the corresponding technologies which have been used to quantify the pivot shift test during the clinical and functional assessment of anterior cruciate ligament (ACL) injury and surgical reconstruction. METHODS Search strategy Internet search of indexed scientific articles on the PubMed database, Web of Science and references on published manuscripts. No year restriction was used. Selection criteria Articles included were written only in English and related to search terms: "pivot shift" AND (OR "ACL"). The reviewers independently selected only those studies that included at least one quantitative parameter for the analysis of the pivot shift test, including both in vitro and in vivo analyses performed on human joint. Those studies that analysed only clinical grading were excluded from the analysis. Analysis After evaluating the methodological quality of the articles, the parameters found were summarized. RESULTS Six hundred and eight studies met the inclusion criteria, and finally, 68 unique studies were available for the systematic review. Quantitative results were heterogeneous. The pivot shift test has been quantified by means of 25 parameters, but most of the studies focused on anterior-posterior translations, internal-external rotation and acceleration in anterior-posterior direction. CONCLUSION Several methodologies have been identified and developed to quantify pivot shift test. However, clinical professionals are still lacking a 'gold standard' method for the quantification of knee joint dynamic laxity. A widespread adoption of a standardized pivot shift manoeuvre and measurement method to allow objective comparison of the results of ACL reconstructions is therefore desirable. Further development of measurement methods is indeed required to achieve this goal in a routine clinical scenario.
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Affiliation(s)
- Nicola Lopomo
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy.
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Abstract
Evaluation of injured-knee laxity is essential for treatment selection, clinical follow-up, and research. Interest in rotatory knee laxity increased with implementation of anatomic anterior cruciate ligament reconstruction. The pivot shift test represents a link between static testing with 1° of freedom and dynamic testing during functional activity. Difficulties lie in standardizing the performance of the pivot shift test and extracting measurable and relevant kinematic data. Noninvasive methodologies based on electromagnetic or acceleration sensors can evaluate the pivot shift in a quantitative and reliable manner. Further validation and reliability testing of devices for examination of rotatory laxity is warranted.
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Affiliation(s)
- Mattias Ahldén
- Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital/Mölndal, Sweden.
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Alam M, Bull AMJ, Thomas RD, Amis AA. A clinical device for measuring internal-external rotational laxity of the knee. Am J Sports Med 2013; 41:87-94. [PMID: 23277467 DOI: 10.1177/0363546512469874] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The dial test can be improved by providing reproducible, accurate measurements to improve diagnosis and treatment comparisons. PURPOSE Validation of a rotational measurement device (RMD) for measuring knee internal-external rotational laxity. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS The RMD consisted of 3 components: a femoral clamp and a tibial splint using paired inclinometers to measure rotations, and a boot to apply tibial internal-external rotation torque. A separate boot inclinometer allowed for foot rotations to be measured independently. The measurements were simultaneously compared with electromagnetic "nest of birds" (NOB) sensors. Sequential paired knee measurements were taken at 4, 6, and 8 N·m of torque at 30° and 90° of flexion in 46 volunteers. RESULTS The correlation coefficient was 0.92 (95% CI, 0.89 to 0.94) and 0.63 (95% CI, 0.54 to 0.70) between the NOB and RMD and between the NOB and boot inclinometer, respectively. Bland-Altman analysis revealed that the RMD was on average within 2° (95% CI, 1° to -4°) of NOB readings, whereas the boot overestimated by 34° (95% CI, -9° to -58°). Maximum side-to-side differences measured by the NOB, RMD, and boot were 1°, 3°, and 21°, respectively. The mean +2× standard deviation data gave a range of side-to-side differences of less than 5° for the RMD. The intraobserver intraclass correlation was 0.9 (95% CI, 0.78 to 0.97) at both 30° and 90° of flexion, and the 95% CI of the differences between readings taken on 2 occasions, the interobserver repeatability, was 1° or less. CONCLUSION The novel clinical RMD for measuring rotational laxity of the knee was portable, easy, and comfortable to use in the clinical setting. The RMD showed significant correlation and accuracy compared with sensors of known high accuracy. Side-to-side differences of less than 5° were found in 95% of normal knees, compared with differences of 13° or more for clinical diagnosis of pathological rotational laxity. Measuring knee rotation at the foot showed poor correlation and accuracy.
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Affiliation(s)
- Mahbub Alam
- Department of Mechanical Engineering, Imperial College London, United Kingdom
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