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Opoku M, Fang M, Lu W, Li Y, Xiao W. Acute anterior cruciate ligament rupture: can repair become an alternative to reconstruction: a meta-analysis of randomized controlled trials and cohort studies. J Orthop Surg Res 2024; 19:331. [PMID: 38825707 PMCID: PMC11145936 DOI: 10.1186/s13018-024-04812-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/23/2024] [Indexed: 06/04/2024] Open
Abstract
PURPOSE To perform a meta-analysis to compare clinical outcomes of anterior cruciate ligament (ACL) repair and ACL reconstruction for acute ACL rupture. METHOD We searched Pubmed, Embase, the Cochrane Library, and Web of Science databases to seek relevant studies. Clinical outcomes included failure rate, hardware removal rate, anteroposterior (AP) knee laxity, and patient-reported outcomes. In addition, subgroup analysis was carried out according to repair techniques, rupture locations, and study designs. Funnel plots were used to detect publication bias. All statistical analysis was performed using STATA (version 14.2, StataCorp). RESULTS A total of 10 articles were included in this study, comprising 5 randomized controlled trials (RCTs) and 5 cohort studies, involving a total of 549 patients. We found no statistical differences between the ACL repair and ACL reconstruction in the following outcomes: failure rate, AP knee laxity, International Knee Documentation Committee (IKDC) score, Lysholm score, Knee Injury and Osteoarthritis Outcome (KOOS) Score, and Tegner score. However, the ACL repair group had a higher hardware removal rate. Except for AP knee laxity results on different repair techniques, there was no statistical difference in other subgroup analyses. CONCLUSION Compared with ACL reconstruction, ACL repair shows similar results in clinical outcomes, and it is promising to be an effective alternative treatment for acute ACL rupture. Larger samples and higher-quality studies are needed to support our results and further explore the advantages of ACL repair in other aspects. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Michael Opoku
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Mingqing Fang
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, 410083, China
| | - Wenhao Lu
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Yusheng Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
| | - Wenfeng Xiao
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
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Yang G, Liu D, Zhou G, Wang Q, Zhang X. Robot-assisted anterior cruciate ligament reconstruction based on three-dimensional images. J Orthop Surg Res 2024; 19:246. [PMID: 38632565 PMCID: PMC11022485 DOI: 10.1186/s13018-024-04732-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/11/2024] [Indexed: 04/19/2024] Open
Abstract
Background Tunnel placement is a key step in anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to evaluate the accuracy of bone tunnel drilling in arthroscopic ACL reconstruction assisted by a three-dimensional (3D) image-based robot system. Methods Robot-assisted ACL reconstruction was performed on twelve freshly frozen knee specimens. During the operation, three-dimensional images were used for ACL bone tunnel planning, and the robotic arm was used for navigation and drilling. Twelve patients who underwent traditional arthroscopic ACL reconstruction were included. 3D computed tomography was used to measure the actual position of the ACL bone tunnel and to evaluate the accuracy of the robotic and traditional ACL bone tunnel. Results On the femoral side, the positions of robotic and traditional surgery tunnels were 29.3 ± 1.4% and 32.1 ± 3.9% in the deep-to-shallow direction of the lateral femoral condyle (p = 0.032), and 34.6 ± 1.2% and 21.2 ± 9.4% in the high-to-low direction (p < 0.001), respectively. On the tibial side, the positions of the robotic and traditional surgical tunnels were located at 48.4 ± 0.9% and 45.8 ± 2.8% of the medial-to-lateral diameter of the tibial plateau (p = 0.008), 38.1 ± 0.8% and 34.6 ± 6.0% of the anterior-to-posterior diameter (p = 0.071), respectively. Conclusions In this study, ACL reconstruction was completed with the assistance of a robot arm and 3D images, and the robot was able to drill the bone tunnel more accurately than the traditional arthroscopic ACL reconstruction.
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Affiliation(s)
- Gang Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Rd., Haidian District, Beijing, 100191, People's Republic of China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Dingge Liu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Rd., Haidian District, Beijing, 100191, People's Republic of China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Guangjin Zhou
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Qining Wang
- Department of Advanced Manufacturing and Robotics, Peking University, Beijing, China
- Institute for Artificial Intelligence, Peking University, Beijing, China
| | - Xin Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Rd., Haidian District, Beijing, 100191, People's Republic of China.
- Beijing Key Laboratory of Sports Injuries, Beijing, China.
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
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Zhao Y, Chen Z, Li L, Wu X, Li W. Changes in proprioception at different time points following anterior cruciate ligament injury or reconstruction. J Orthop Surg Res 2023; 18:547. [PMID: 37518000 PMCID: PMC10388458 DOI: 10.1186/s13018-023-04044-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023] Open
Abstract
PURPOSE To investigate the changes in 30° and 60° position sense in patients with anterior cruciate ligament (ACL) injury at different time points after injury and reconstruction. METHODS Patients were divided into six groups according to time after ACL injury and reconstruction: group A (ACL injury 1.5-6 months), group B (ACL injury 6-12 months), group C (ACL injury > 12 months), group D (postoperative ACL reconstruction 1-6 months), group E (postoperative ACL reconstruction > 6 months), and group F consisting of 14 healthy adults (control group). The ability of the affected leg to reproduce the same joint position during knee flexion was tested using active joint position sense assays to assess proprioception in both the lower extremities of the patient or between groups. RESULTS Proprioception decreased rapidly during the early stages of ACL injury. Significant difference in the affected side at 30° compared to the healthy side (Group A: 4.70 (4.78, 9.00) vs 4.15 (3.35, 6.13), P = 0.03; Group B: 2.90 (0.48, 4.56) vs 8.30 (4.18, 10.43), P = 0.001; Group E: 6.25 (2.55, 11.60) vs 9.60 (3.90, 12.73), P = 0.009). However, no significant differences were detected for a double lower limb contrast of 60° (Group A: 5.1 (1.00, 8.00) vs 3.00 (0.75, 3.55), P = 0.044). Finally, the affected side of patients in groups C, D and E had significant differences in position perception at 30° compared with healthy subjects (P < 0.01), and the affected side of patients in groups C and E had significant differences in position sense at 60° compared with healthy subjects (P < 0.01). CONCLUSION ACL injury had a greater impact on the patient's 30° position sense, with only a small impact for 60°. Further, the early and middle proprioception recovery stages after ACL injury were the best before surgery. Finally, proprioception recovery training should be performed soon after injury.
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Affiliation(s)
- Yixuan Zhao
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong, China
| | - Ze Chen
- Tianjin Medical University, Tianjin, China
| | - Longfei Li
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong, China
| | - Xipeng Wu
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong, China
| | - Wei Li
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong, China.
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Roach MH, Aderman MJ, Gee SM, Peck KY, Roach SP, Goss DL, Posner MA, Haley CA, Svoboda SJ, Cameron KL. Influence of Graft Type on Lower Extremity Functional Test Performance and Failure Rate After Anterior Cruciate Ligament Reconstruction. Sports Health 2023; 15:606-614. [PMID: 36154541 PMCID: PMC10293572 DOI: 10.1177/19417381221119420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Both autografts and allografts are used to reconstruct the anterior cruciate ligament (ACL) after injury; however, it is unclear whether graft source affects lower extremity functional test performance or failure rate in an active military population. OBJECTIVE To compare lower extremity functional test performance and graft failure rates between ACL grafts [allograft, hamstring, bone-patellar tendon-bone (BTB)]. STUDY DESIGN Cross-sectional. LEVEL OF EVIDENCE Level 2. METHODS Ninety-eight cadets entering a US Service Academy with a history of unilateral ACL reconstruction (ACLR) agreed to participate. Before basic training, participants completed 4 lower extremity functional tests. Active injury surveillance was conducted within the study cohort to identify all subsequent graft failures. RESULTS Cadets with hamstring autografts outperformed the BTB and allograft groups on the Lower Quarter Y-Balance Test-Posteromedial direction and single-leg hop test, respectively. No differences were detected by graft type for the other functional tests. The incidence of subsequent ipsilateral graft failures in patients with autograft was 8.11%. No failures were observed in the allograft group during the follow-up period. After controlling for sex, joint hypermobility, and time since injury and surgery, the risk of graft failure was 9.8 times higher for patients with a hamstring autograft than with a BTB (P = 0.045). CONCLUSION After ACLR, graft type appears to influence some single-limb measures of lower extremity function and the risk of subsequent failure. Hamstring autografts demonstrated better functional performance but increased risk of graft failure. CLINICAL RELEVANCE Surgeons need to weigh the pros and cons of all graft options in relation to the patient's lifestyle. Regardless of graft type, individuals with an ACLR may require additional rehabilitation to regain neuromuscular control during dynamic single-limb tasks and mitigate graft failure.
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Affiliation(s)
- Megan H. Roach
- Megan H. Roach, PhD, ATC, 2817 Reilly Road, Fort Bragg, NC 28310 () (Twitter: @houston_mn & @WPOrthoResearch)
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5
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Zee M, Keizer M, van Raaij J, Hijmans J, van den Akker-Scheek I, Diercks R. High-demand tasks show that ACL reconstruction is not the only factor in controlling range of tibial rotation: a preliminary investigation. J Orthop Surg Res 2023; 18:194. [PMID: 36915116 PMCID: PMC10009984 DOI: 10.1186/s13018-023-03639-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/23/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Excessive range of tibial rotation (rTR) may be a reason why athletes cannot return to sports after ACL reconstruction (ACLR). After ACLR, rTR is smaller in reconstructed knees compared to contralateral knees when measured during low-to-moderate-demand tasks. This may not be representative of the amount of rotational laxity during sports activities. The purpose of this study is to determine whether rTR is increased after ACL injury compared to the contralateral knee and whether it returns to normal after ACLR when assessed during high-demand hoptests, with the contralateral knee as a reference. METHODS Ten ACL injured subjects were tested within three months after injury and one year after reconstruction. Kinematic motion analysis was conducted, analysing both knees. Subjects performed a level-walking task, a single-leg hop for distance and a side jump. A paired t-test was used to detect a difference between mean kinematic variables before and after ACL reconstruction, and between the ACL-affected knees and contralateral knees before and after reconstruction. RESULTS RTR was greater during high-demand tasks compared to low-demand tasks. Pre-operative, rTR was smaller in the ACL-deficient knees compared to the contralateral knees during all tests. After ACLR, a greater rTR was seen in ACL-reconstructed knees compared to pre-operative, but a smaller rTR compared to the contralateral knees, even during high-demand tasks. CONCLUSION The smaller rTR, compared to the contralateral knee, seen after a subacute ACL tear may be attributed to altered landing technique, neuromuscular adaptation and fear of re-injury. The continued reduction in rTR one year after ACLR may be a combination of this neuromuscular adaptation and the biomechanical impact of the reconstruction. TRIAL REGISTRATION The trial was registered in the Dutch Trial Register (NTR: www.trialregister.nl , registration ID NL7686).
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Affiliation(s)
- Mark Zee
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RM, Groningen, The Netherlands.
| | - Michele Keizer
- Department of Human Movement Science, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RM, Groningen, The Netherlands
| | - Jos van Raaij
- Department of Orthopaedic Surgery, Martini Hospital, Van Swietenplein 1, 9728 NT, Groningen, The Netherlands
| | - Juha Hijmans
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RM, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RM, Groningen, The Netherlands
| | - Ron Diercks
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RM, Groningen, The Netherlands
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Kikuchi N, Kanamori A, Kadone H, Kajiwara M, Okuno K, Hyodo K, Yamazaki M. Relationship Between Posterior Tibial Slope and Lower Extremity Biomechanics During a Single-Leg Drop Landing Combined With a Cognitive Task in Athletes After ACL Reconstruction. Orthop J Sports Med 2022; 10:23259671221107931. [PMID: 35837443 PMCID: PMC9274414 DOI: 10.1177/23259671221107931] [Citation(s) in RCA: 1] [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] [Received: 03/27/2022] [Accepted: 04/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background: A steeper posterior tibial slope (PTS) is an important risk factor for
anterior cruciate ligament (ACL) reinjury. The PTS may affect lower
extremity biomechanics under competition-like conditions for athletes with a
reconstructed ACL. Hypothesis: It was hypothesized that the PTS would be associated with lower extremity
biomechanics, which may increase ACL strain. Study Design: Descriptive laboratory study. Methods: Included were 10 athletes (mean age, 20.9 ± 1.8 years) who had undergone ACL
reconstruction. The authors recorded the 3-dimensional lower extremity
biomechanics while participants performed a single-leg drop jump with the
Stroop task (dual task). Kinematic and kinetic data were analyzed and
compared between the involved and contralateral limbs. The medial and
lateral PTSs were measured using magnetic resonance imaging scans of the
involved knee. The correlation between the biomechanical data and the PTS in
each knee was evaluated. Results: The lateral PTS was significantly correlated with the maximum hip adduction
moment (r = 0.64; P < .05) and maximum
internal tibial rotation angle (r = 0.71;
P < .05) in the involved limb. There were no
differences in kinematic and kinetic data between the involved and
contralateral limbs. Conclusion: In athletes after ACL reconstruction, the lateral PTS was directly associated
with the maximum internal tibial rotation angle during single-leg drop
landing with a cognitive task. Clinical Relevance: The findings in this study indicate that a steeper lateral PTS may cause
internal rotation of the tibia during landing, which may be associated with
reinjury in athletes with a reconstructed ACL.
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Affiliation(s)
- Naoya Kikuchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akihiro Kanamori
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideki Kadone
- Center for Cybernics Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masaya Kajiwara
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kosuke Okuno
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kojiro Hyodo
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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7
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Brophy RH, Schafer KA, Knapik DM, Motley J, Haas A, Matava MJ, Wright RW, Smith MV. Changes in Dynamic Postural Stability After ACL Reconstruction: Results Over 2 Years of Follow-up. Orthop J Sports Med 2022; 10:23259671221098989. [PMID: 35722181 PMCID: PMC9201321 DOI: 10.1177/23259671221098989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The anterior cruciate ligament (ACL) is crucial for knee proprioception and
postural stability. While ACL reconstruction (ACLR) and rehabilitation
improve postural stability, the timing in improvement of dynamic postural
stability after ACLR remains relatively unknown. Purpose: To evaluate changes in dynamic postural stability after ACLR out to 24 months
postoperatively. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing ACLR were prospectively enrolled, and dynamic postural
stability was assessed within 2 days before surgery, at 3-month intervals
postoperatively to 18 months, then at 24 months. Measurements were made on a
multidirectional platform tracking the patient’s center of mass based on
pelvic motion. The amount of time the patient was able to stay on the
platform was recorded, and a dynamic motion analysis score, reflecting the
patient’s ability to maintain one’s center of mass, was generated overall
and in 6 independent planes of motion. Results: A total of 44 patients with a mean age of 19.7 ± 6.2 years completed the
study protocol. Overall mean dynamic postural stability improved
significantly at 3, 6, 9, and 12 months after surgery, with continued
improvement out to 24 months. Notable improvements occurred in
medial/lateral and anterior/posterior stability from baseline to 6 months
postoperatively, while internal/external rotation and flexion/extension
stability declined initially after surgery from baseline to 3 months
postoperatively before stabilizing to the end of the study period. Conclusion: Overall dynamic postural stability significantly improved up to 12 months
after ACLR. Improvement in postural stability occurred primarily in the
medial/lateral and anterior/posterior planes of motion, with initial
decreases in the flexion/extension and internal/external rotational planes
of motion.
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Affiliation(s)
- Robert H Brophy
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA.,School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kevin A Schafer
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA.,School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - John Motley
- STAR Sports Therapy and Rehabilitation, Chesterfield, Missouri, USA
| | - Amanda Haas
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Matthew J Matava
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA.,School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Rick W Wright
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA.,Department of Orthopaedic Surgery, Vanderbilt University, Nashville, Tennessee, USA
| | - Matthew V Smith
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA.,School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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Roe C, Jacobs C, Hoch J, Johnson DL, Noehren B. Test Batteries After Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review. Sports Health 2021; 14:205-215. [PMID: 33896240 DOI: 10.1177/19417381211009473] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT There is a lack of consensus regarding test batteries for return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR). OBJECTIVE To report the RTS test batteries for individuals after ACLR and to examine alignment with the American Academy of Orthopaedic Surgeons (AAOS) Appropriate Use Criteria (AUC). Finally, to examine how published RTS batteries prior to the AAOS AUC (2010-2015) compared with those after publication of the AUC (2016-2020). DATA SOURCE A systematic search of PubMed (2010-2020). STUDY SELECTION Studies were included if they were published from 2010 to 2020, patients underwent primary ACLR and were tested between 6 months and 2 years postoperatively and included a minimum of 2 assessments. Studies were excluded if patients were tested outside the designated time; had undergone a revision, contralateral, or multiligament injury; included healthy participants; were level 5 evidence or the study was a systematic review. A total of 1012 articles were reviewed and 63 met the criteria. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Information regarding the RTS batteries and patient demographics were extracted from the included articles. RESULTS A total of 63 studies met the inclusion and exclusion criteria (22 from 2010-2015 and 41 from 2016-2020). The most common RTS batteries included the hop test, quadriceps strength test, and patient-reported outcome measures. No study met all 7 AUC; the most common criteria met were functional skills (98.4%), followed by confidence (22.2%), then range of motion and knee stability (20.6%). CONCLUSION The test batteries in the current literature show high variability and a lack of essential components necessary for RTS. No study met the AUC guidelines, suggesting a disconnect between recommended guidelines and clinical practice. Test battery research has expanded over the past decade; however, standardized, clinically applicable batteries that encompass all criteria are needed.
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Affiliation(s)
- Chelsey Roe
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
| | - Cale Jacobs
- Department of Orthopedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Johanna Hoch
- Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, Kentucky
| | - Darren L Johnson
- Department of Orthopedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Brian Noehren
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
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9
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Liao W, He X, Du Z, Long Y. Is a tourniquet necessary in arthroscopic anterior cruciate ligament reconstruction?: A randomized controlled study protocol. Medicine (Baltimore) 2021; 100:e23724. [PMID: 33592830 PMCID: PMC7870236 DOI: 10.1097/md.0000000000023724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In the past few decades, the number of surgery of anterior cruciate ligament reconstruction (ACLR) implemented in the outpatient centers has dramatically enhanced. There is still a lack of effective randomized controlled trials in the literature to demonstrate the effectiveness of tourniquets. As a kind of prospective clinical trial, this research protocol is conducted to compare the results of ACLR with and without the use of a tourniquet. METHODS All the patients aged 18 or over who underwent the selective primary anterior cruciate ligament reconstruction in our hospital from November 2020 to January 2022 are eligible to take part in our experiment. Exclusion criteria are history of peripheral neuropathy, pregnancy, lumbar radiculopathy, or surgery to the injured or contralateral knee. After the written informed consent is given, the patients participating in the study are randomly assigned to the tourniquet group (group 1) and the tourniquet free group (group 2) on the day of operation, through utilizing the computer-generated random table with 10 members in each group. And the assignments were kept in an opaque and sealed envelope. Any comments on visual difficulties in the process of operative time, arthroscopy, complications, and total bleeding from suction and drainage, as well as the reduction of postoperative hemoglobin are assessed as the parameters. The software of SPSS v. 24 is applied for all the statistical analyses. RESULTS This protocol will provide a reliable theoretical basis for the following research. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry6240).
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Affiliation(s)
- Weifeng Liao
- Department of Spine Surgery, the Orthopedics Hospital of Traditional Chinese Medicine Zhuzhou City
| | - Xinning He
- Department of Spine Surgery, the Orthopedics Hospital of Traditional Chinese Medicine Zhuzhou City
| | - Zhiyong Du
- Department of Spine Surgery, the Orthopedics Hospital of Traditional Chinese Medicine Zhuzhou City
| | - Yi Long
- Department of Joint Surgery, the Affiliated Zhuzhou Hospital Xiangya Medical College CSU, Zhuzhou, Hunan, China
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10
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Park S, Yoon S. Quantifying Coordination and Variability in the Lower Extremities after Anterior Cruciate Ligament Reconstruction. SENSORS 2021; 21:s21020652. [PMID: 33477847 PMCID: PMC7832890 DOI: 10.3390/s21020652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 01/13/2023]
Abstract
Patients experience various biomechanical changes following reconstruction for anterior cruciate ligament (ACL) injury. However, previous studies have focused on lower extremity joints as a single joint rather than simultaneous lower extremity movements. Therefore, this study aimed to determine the movement changes in the lower limb coordination patterns according to movement type following ACL reconstruction. Twenty-one post ACL reconstruction patients (AG) and an equal number of healthy adults (CG) participated in this study. They were asked to perform walking, running, and cutting maneuvers. The continuous relative phase and variability were calculated to examine the coordination pattern. During running and cutting at 30 and 60°, the AG demonstrated a lower in-phase hip–knee coordination pattern in the sagittal plane. The AG demonstrated low hip–knee variability in the sagittal plane during cutting at 60°. The low in-phase coordination pattern can burden the knee by generating unnatural movements following muscle contraction in the opposite direction. Based on the results, it would be useful to identify the problem and provide the fundamental evidence for the optimal timing of return-to-sport after ACL reconstruction (ACLR) rehabilitation, if the coordination variable is measured with various sensors promptly in the sports field to evaluate the coordination of human movement.
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11
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Kakavas G, Malliaropoulos N, Pruna R, Traster D, Bikos G, Maffulli N. Neuroplasticity and Anterior Cruciate Ligament Injury. Indian J Orthop 2020; 54:275-280. [PMID: 32399146 PMCID: PMC7205971 DOI: 10.1007/s43465-020-00045-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/13/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) tears are common, with a seemingly constant increase in their number, and potentially serious consequences for sports participation and long-term general and musculoskeletal health. AREAS OF AGREEMENT Most players are able to return to cutting sport after ACL reconstruction, but some sustain further knee problems needing different approach to their rehabilitation. GROWING POINTS Neurocognitive tasks, measuring reaction time, processing speed, visual memory and verbal memory, allow indirect assessment of cerebral performance. Situational awareness, arousal, and attentional resources may influence neurocognitive function, affecting the complex integration of vestibular, visual, and somatosensory information needed for neuromuscular control. AREAS OF CONTROVERSY The underlying reasons for uncoordinated, high-velocity movements observed during non-contact injuries of the knee producing an ACL tear are not well understood. Fundamental neuropsychological characteristics are responsible for situational awareness, sensory integration, motor planning, and coordination, all of which control joint stiffness. There is a strong link between acquisition of motor skills and neuronal plasticity at cortical and subcortical levels in the central nervous system; these links may evolve over time and engage different spatially distributed interconnected brain regions. A cascade of neurophysiological alterations occurs after ACL injury. AREAS TIMELY FOR DEVELOPING RESEARCH Training can improve function; hence, rehabilitation programmes which include perturbation training, agility training, vision training and sport-specific skill training are essential after ACL injuries and for injury prevention, and to optimize return to play.
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Affiliation(s)
| | - Nikolaos Malliaropoulos
- Thessaloniki MSK Sports Medicine Clinic, Thessaloniki, Greece ,Queen Mary University of London, Centre for Sports and Exercise Medicine, London, UK
| | - Ricard Pruna
- FC Barcelona, FIFA Medical Center of Excellence, St Joan Despi, Barcelona, Spain
| | - David Traster
- Carrick Institute of Neurology, Cape Canaveral, FL USA
| | - Georgios Bikos
- Euromedica Arogi Rehabilitation Center, Thessaloniki, Greece
| | - Nicola Maffulli
- Queen Mary University of London, Centre for Sports and Exercise Medicine, London, UK ,Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy ,School of Pharmacy and Bioengineering, Guy Hilton Research Centre, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB England, UK
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Dan MJ, Lun KK, Dan L, Efird J, Pelletier M, Broe D, Walsh WR. Wearable inertial sensors and pressure MAT detect risk factors associated with ACL graft failure that are not possible with traditional return to sport assessments. BMJ Open Sport Exerc Med 2019; 5:e000557. [PMID: 31354961 PMCID: PMC6615852 DOI: 10.1136/bmjsem-2019-000557] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction Anterior cruciate ligament reconstruction (ACLR) is associated with poor return to sport and high graft re-rupture rates. This study explored the use of a wearable inertial sensor (ViMove) that incorporates an accelerometer and gyroscope, and MatScan pressure sensing mat (TekScan, South Boston, Massachusetts, USA) to provide objective return-to-sport measures. Methods Three cohorts’ ACLR patients, non-athletic controls and elite athletes (Australian seven’s rugby Olympic Gold medallist). Patients performed biometric and functional tests (thigh circumference and triple hop) and the ViMove knee module (consisting of single and double leg squats, hops and box drops) for lower limb alignment assessment, concurrently with force plate. Results Elite athletes had less varus/valgus (VV) movement during ViMove exercises compared with the ACLR cohort, who in turn had less VV malalignment than controls. When analysing side-to-side differences, single leg squats and box drop were asymmetrical in the ACL group, with greater malalignment in the reconstructed leg (p<0.05). Subgroup analysis failed to differentiate who passed or failed current return to sport assessment. TekScan pressure plate detected differences in double leg landing and flight time while hopping not detected with ViMove, suggesting ACL patients compensate by offloading the reconstructed leg to improve coronal alignment during double leg activity. Conclusion The inertial sensor detected differences in motion for patients following ACLR, which are known to be associated with graft rupture and were not detected with functional return to sport testing. Coupling the device with data from a pressure plate provides a powerful assessment tool detecting alignment differences known to be associate with graft failure only previously detected in formal gait analysis.
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Affiliation(s)
- Michael J Dan
- Surgical and Orthopaedic Research Laboratory, UNSW, Randwick, New South Wales, Australia
| | - Kimberly Kai Lun
- Surgical and Orthopaedic Research Laboratory, UNSW, Randwick, New South Wales, Australia
| | - Luke Dan
- Sports Medicine Department, Narrabeen Sports Medicine Faculty, Narrabeen, New South Wales, Australia
| | - Jimmy Efird
- HRMI, University of Newcastle, Callaghan, New South Wales, Australia
| | - Matthew Pelletier
- Surgical and Orthopaedic Research Laboratory, UNSW, Randwick, New South Wales, Australia
| | - David Broe
- Surgical and Orthopaedic Research Laboratory, UNSW, Randwick, New South Wales, Australia
| | - William R Walsh
- Surgical and Orthopaedic Research Laboratory, UNSW, Randwick, New South Wales, Australia
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Head PL, Kasser R, Appling S, Cappaert T, Singhal K, Zucker-Levin A. Anterior cruciate ligament reconstruction and dynamic stability at time of release for return to sport. Phys Ther Sport 2019; 38:80-86. [PMID: 31071659 DOI: 10.1016/j.ptsp.2019.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Examine dynamic stability using Dynamic Postural Stability Index (DPSI) in athletes following anterior cruciate ligament reconstruction (ACLR) at time of release for return-to-sport (RTS), compared to matched controls. DESIGN Cross-sectional case-control study. SETTING Sports medicine clinic. SUBJECTS Fifteen ACLR athletes who had completed post-operative rehabilitation and were within 6 weeks following release to RTS were age-, gender-, and activity-matched to 15 healthy controls. MAIN OUTCOME MEASURES Ground reaction forces (GRFs) were collected using a portable force plate during stabilization from three different single-leg landing tasks. A composite DPSI was calculated using GRFs. RESULTS Compared to matched controls, ACLR athletes within 6 weeks of release for RTS did not significantly differ in dynamic postural stability and there were no significant differences between the involved and uninvolved limbs in the ACLR group. CONCLUSION Current findings indicate that dynamic postural stability, as measured using the DPSI, is not significantly different in ACLR subjects at time of release for RTS compared to matched controls. In addition, the DPSI was not significantly different between the involved and uninvolved limbs in the ACLR subjects. The results suggest that the post-ACLR rehabilitation program utilized may have adequately restored postural stability in this particular sample.
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Affiliation(s)
- Penny L Head
- University of Tennessee Health Science Center, 930 Madison Avenue, Suite 604, Memphis, TN, 38163, USA.
| | - Richard Kasser
- University of Tennessee Health Science Center, 930 Madison Avenue, Suite 604, Memphis, TN, 38163, USA
| | - Susan Appling
- Ohio State University, 516 Atwell Hall, 453 W, 10th Avenue, Columbus, OH, 43210, USA
| | - Thomas Cappaert
- Rocky Mountain University of Health Professions, 122 East 1700 South, Bldg. 3, Provo, UT 84606, USA
| | - Kunal Singhal
- University of Tennessee Health Science Center, 930 Madison Avenue, Suite 604, Memphis, TN, 38163, USA
| | - Audrey Zucker-Levin
- University of Saskatchewan, 104 Clinic Place, Health Sciences E-Wing, Saskatoon, SK, S7N 2Z4, Canada
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Przybylak K, Sibiński M, Domżalski M, Kwapisz A, Momaya AM, Zielińska M. Supervised physiotherapy leads to a better return to physical activity after anterior cruciate ligament reconstruction. J Sports Med Phys Fitness 2018; 59:1551-1557. [PMID: 30543272 DOI: 10.23736/s0022-4707.18.08692-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The main goal of rehabilitation after anterior cruciate ligament reconstruction (ACLR) is to return to functional and sports activity at a preinjury level. The aim of this study was to assess the influence of supervised (SU) versus non-supervised (NS) rehabilitation protocols after ACLR on the return to sports activity and quality of life of amateur athletes. METHODS The study included a total of 50 patients after ACLR, with 25 in the SU group and 25 in the NS group. No significant differences were observed between the two groups with regard to age, sex, or BMI. Two different ACLR techniques were used: hamstring graft and bone patellar tendon bone. The patients were examined preoperatively and 12 months postoperatively. Outcomes were evaluated utilizing the Kujala Scale, Tegner Scale, the Knee injury and Osteoarthritis Outcome Score (KOOS), the Functional Movement Screen (FMS), and range of motion. Patients from the SU group participated in rehabilitation sessions with a physiotherapist with an average of 48 meetings. Those in the NS attended six meetings with the physiotherapist. RESULTS At final follow-up, patients from both groups demonstrated a higher level of functional and sports activity and had a better quality of life 12 months after ACLR. Patients from the supervised group returned to a significantly higher level of sports activity (Tegner Scale: SU=6, NS=5, P=0.003) and reported significantly better quality of life 12 months after ACLR (KOOS QOL: SU=90, NS=74; P<0.001). CONCLUSIONS Supervised, controlled physiotherapy results in higher activity levels and better quality of life in amateur athletes 12 months after ACLR.
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Affiliation(s)
- Katarzyna Przybylak
- Department of Invasive Cardiology and Electrocardiology, Intensive Cardiac Therapy Clinic, Medical University, Lodz, Poland -
| | - Marcin Sibiński
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University, Lodz, Poland
| | - Marcin Domżalski
- Clinic of Orthopedics and Traumatology, Medical University, Lodz, Poland
| | - Adam Kwapisz
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University, Lodz, Poland
| | - Amit M Momaya
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marzenna Zielińska
- Department of Invasive Cardiology and Electrocardiology, Intensive Cardiac Therapy Clinic, Medical University, Lodz, Poland
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Xu J, Zhou X, Guo X, Wang G, Fu S, Zhang L. Effects of Unilateral Electroacupuncture on Bilateral Proprioception in a Unilateral Anterior Cruciate Ligament Injury Model. Med Sci Monit 2018; 24:5473-5479. [PMID: 30082677 PMCID: PMC6094982 DOI: 10.12659/msm.909508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury can cause knee proprioception degeneration, on which the electroacupuncture (EA) treatment has a definite effect. However, it is still not clear whether conducting EA intervention on the injured side can promote bilateral proprioception recovery. MATERIAL AND METHODS We randomly selected 6 of 9 normal cynomolgus monkeys to develop unilateral ACL injury models via arthroscopy. All knees were divided into 5 groups: the normal control (NC) group, injured side of blank model (ISBM) group, contralateral side of blank model (CSBM) group, injured side of EA (ISE) group, and contralateral side of EA (CSE) group. Ten days after modeling, the monkeys in the EA group were treated with EA daily for 6 weeks at the acupoints. At 6 weeks, the 5 groups were examined by electrophysiology (SEPs and MCV). The ACL was separated to conduct the gold chloride staining for morphology observation and count the number of total and variant proprioceptors. RESULTS At 6 weeks, the latent period of the SEPs and MCV and the number of variant proprioceptors in the blank model group and the EA group were increased compared with the NC group, while the amplitude and the number of total proprioceptors were decreased. The changes in the ISBM and CSBM group were more remarkable than in the ISE and CSE group. All differences were statistically significant (P<0.05). CONCLUSIONS Unilateral ACL injury leads to bilateral proprioception degeneration, and the unilateral knee EA intervention can aid bilateral proprioception recovery.
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Affiliation(s)
- Jie Xu
- School of Traditional Chinese Medicine, Southwest Medical University, Luzhou, Sichuan, China (mainland).,Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland)
| | - Xin Zhou
- Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland).,Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Xiaoguang Guo
- Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland).,Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Guoyou Wang
- Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland).,Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Shijie Fu
- Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland).,Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Lei Zhang
- Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland).,Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
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Adravanti P, Budhiparama NC, Berend KR, Thienpont E. ACL-deficient knee and unicompartmental OA: state of the art. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fujii M, Furumatsu T, Miyazawa S, Tanaka T, Inoue H, Kodama Y, Masuda K, Seno N, Ozaki T. Features of human autologous hamstring graft elongation after pre-tensioning in anterior cruciate ligament reconstruction. INTERNATIONAL ORTHOPAEDICS 2016; 40:2553-2558. [DOI: 10.1007/s00264-016-3298-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/16/2016] [Indexed: 01/07/2023]
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de Souza Leao MG, Pampolha AGM, Orlando Junior N. Functional results from reconstruction of the anterior cruciate ligament using the central third of the patellar ligament and flexor tendons. Rev Bras Ortop 2015; 50:705-11. [PMID: 27218084 PMCID: PMC4867917 DOI: 10.1016/j.rboe.2015.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 10/23/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate knee function in patients undergoing reconstruction of the anterior cruciate ligament (ACL) using the central third of the patellar ligament or the medial flexor tendons of the knee, i.e. quadruple ligaments from the semitendinosus and gracilis (ST-G), by means of the Knee Society Score (KSS) and the Lysholm scale. METHODS This was a randomized prospective longitudinal study on 40 patients who underwent arthroscopic ACL reconstruction between September 2013 and August 2014. They comprised 37 males and three females, with ages ranging from 16 to 52 years. The patients were numbered randomly from 1 to 40: the even numbers underwent surgical correction using the ST-G tendons and the odd numbers, using the patellar tendon. Functional evaluations were made using the KSS and Lysholm scale, applied in the evening before the surgical procedure and six months after the operation. RESULTS From the statistical analysis, it could be seen that the patients' functional capacity was significantly greater after the operation than before the operation. There was strong evidence that the two forms of therapy had similar results (p = >0.05), in all the comparisons. CONCLUSIONS The results from the ACL reconstructions were similar with regard to functional recovery of the knee and improvement of quality of life, independent of the type of graft. It was not possible to identify the best method of surgical treatment. The surgeon's clinical and technical experience and the patient are the factors that determine the choice of graft type for use in ACL surgery.
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Resultados funcionais da reconstrução do ligamento cruzado anterior com o terço central do ligamento patelar e os tendões flexores. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2015.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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