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Gronbeck KR, Tompkins MA. Functional testing following isolated meniscus repair may help to identify patients who need additional physical therapy prior to a return to activity. J ISAKOS 2024; 9:557-561. [PMID: 38616017 DOI: 10.1016/j.jisako.2024.04.007] [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] [Received: 01/12/2024] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES Functional testing (FT), commonly used to evaluate dynamic knee function and provide objective information about how well a patient, has progressed in rehabilitation following an anterior cruciate ligament (ACL) reconstruction. The purpose of the study was to determine whether a functional test could be used as an assessment tool for return to activity following isolated meniscus repair. METHODS The results of FT completed between 80 and 150 days post-operation (representing 4-months post-operative) in isolated meniscal repair patients were analysed for the involved limb, uninvolved limb, and limb symmetry index (LSI). Involved limb performance and LSI on FT were also recorded for a matched cohort of patients who underwent an isolated ACL reconstruction between 151 and 220 days post-operation (representing 6-months post-operative). The meniscus cohort was compared to the ACL cohort. RESULTS The meniscus cohort (n = 26) performed well (LSI of 88% or better) on all functional test exercises, including all hop tests. There were patients in the meniscus cohort who did not achieve 90% LSI on the FT at 4 months. There was no statistically significant difference in any of the tests between the meniscus and ACL (n = 39) cohorts. CONCLUSION A majority of isolated meniscal repair patients perform well on FT by 4 months post-operatively and similar to patients undergoing isolated ACL reconstruction at 6 months post-operatively. Not all patients performed well on FT at 4 months post-operatively; however so, there may be a role for FT in isolated meniscal repair patients, and those patients may need further physical therapy prior to a return to sports. LEVEL OF EVIDENCE III; Retrospective cohort study. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kyle R Gronbeck
- Sanford Health, Department of Emergency Medicine, Fargo, ND 58104, USA
| | - Marc A Tompkins
- TRIA Orthopaedic Center, 8100 Northland Drive, Bloomington, MN 55431, USA; University of Minnesota Department of Orthopedic Surgery, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55455, USA; Gillette Specialty Healthcare, 200 University Av. E, St. Paul, MN 55101, USA.
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2
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Peez C, Grosse-Allermann A, Deichsel A, Raschke MJ, Glasbrenner J, Briese T, Wermers J, Herbst E, Kittl C. Additional Plate Fixation of Hinge Fractures After Varisation Distal Femoral Osteotomies Provides Favorable Torsional Stability: A Biomechanical Study. Am J Sports Med 2023; 51:3732-3741. [PMID: 37936394 PMCID: PMC10691291 DOI: 10.1177/03635465231206947] [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: 02/27/2023] [Accepted: 08/23/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Hinge fractures are considered risk factors for delayed or nonunion of the osteotomy gap in distal femoral osteotomies (DFOs). Limited evidence exists regarding the treatment of hinge fractures after DFO, which could improve stability and thus bone healing. PURPOSE To (1) examine the effect of hinge fractures on the biomechanical properties of the bone-implant construct, (2) evaluate the biomechanical advantages of an additional fixation of a hinge fracture, and (3) test the biomechanical properties of different types of varisation DFOs. STUDY DESIGN Controlled laboratory study. METHODS A total of 32 fresh-frozen human distal femora equally underwent medial closing wedge DFO or lateral opening wedge DFO using a unilateral locking compression plate. The following conditions were serially tested: (1) preserved hinge; (2) hinge fracture along the osteotomy plane; (3) screw fixation of the hinge fracture; and (4) locking T-plate fixation of the hinge fracture. Using a servo-hydraulic materials testing machine, we subjected each construct to 15 cycles of axial compression (400 N; 20 N/s) and internal and external rotational loads (10 N·m; 0.5 N·m/s) to evaluate the stiffness. The axial and torsional hinge displacement was recorded using a 3-dimensional optical measuring system. Repeated-measures 1-way analysis of variance and post hoc Bonferroni correction were used for multiple comparisons. Statistical significance was set at P < .05. RESULTS Independent from the type of osteotomy, a fractured hinge significantly (P < .001) increased rotational displacement and reduced stiffness of the bone-implant construct, resulting in ≥1.92 mm increased displacement and ≥70% reduced stiffness in each rotational direction, while the axial stiffness remained unchanged. For both procedures, neither a screw nor a plate could restore intact rotational stiffness (P < .01), while only the plate was able to restore intact rotational displacement. However, the plate always performed better compared with the screw, with significantly higher and lower values for stiffness (+38% to +53%; P < .05) and displacement (-55% to -72%; P < .01), respectively, in ≥1 rotational direction. At the same time, the type of osteotomy did not significantly affect axial and torsional stability. CONCLUSION Hinge fractures after medial closing wedge DFO and lateral opening wedge DFO caused decreased bone-implant construct rotational stiffness and increased fracture-site displacement. In contrast, the axial stiffness remained unchanged in the cadaveric model. CLINICAL RELEVANCE When considering an osteosynthesis of a hinge fracture in a DFO, an additional plate fixation was the construct with the highest stiffness and least displacement, which could restore intact hinge rotational displacement.
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Affiliation(s)
- Christian Peez
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Arian Grosse-Allermann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Adrian Deichsel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Michael J. Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Johannes Glasbrenner
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Thorben Briese
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Jens Wermers
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
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Forman DA, Alizadeh S, Button DC, Holmes MW. The Use of Elastic Resistance Bands to Reduce Dynamic Knee Valgus in Squat-Based Movements: A Narrative Review. Int J Sports Phys Ther 2023; 18:1206-1217. [PMID: 37795322 PMCID: PMC10547095 DOI: 10.26603/001c.87764] [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: 03/01/2023] [Accepted: 08/17/2023] [Indexed: 10/06/2023] Open
Abstract
An elastic band wrapped around the distal thighs has recently been proposed as a method for reducing dynamic knee valgus (medial movement of the knee joint in the frontal/coronal plane) while performing squats. The rationale behind this technique is that, by using an external force to pull the knees into further knee valgus, the band both exaggerates the pre-existing movement and provides additional local proprioceptive input, cueing individuals to adjust their knee alignment. If these mechanisms are true, then elastic bands might indeed reduce dynamic knee valgus, which could be promising for use in injury prevention as excessive knee valgus may be associated with a greater risk of sustaining an ACL rupture and/or other knee injuries. Due to this possibility, certain athletic populations have already adopted the use of elastic bands for training and/or rehab, despite a limited number of studies showing beneficial findings. The purpose of this narrative review is to examine current literature that has assessed lower limb muscle activity and/or lower limb kinematics performance on squat-based movements with or without an elastic band(s). Importantly, this paper will also discuss the key limitations that exist in this area, propose suggestions for future research directions, and provide recommendations for training implementations. Level of Evidence 5.
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Affiliation(s)
| | - Shahab Alizadeh
- School of Human Kinetics and Recreation Memorial University of Newfoundland
| | - Duane C Button
- School of Human Kinetics and Recreation Memorial University of Newfoundland
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Almansoof HS, Nuhmani S, Muaidi Q. Correlation of ankle dorsiflexion range of motion with lower-limb kinetic chain function and hop test performance in healthy male recreational athletes. PeerJ 2023; 11:e14877. [PMID: 36846443 PMCID: PMC9951801 DOI: 10.7717/peerj.14877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/20/2023] [Indexed: 02/23/2023] Open
Abstract
Background The study aims to identify the correlation of ankle dorsiflexion range-of-motion (ADROM) (with its related gastrocnemius and soleus extensibility) with lower-limb kinetic chain function and hop test performance in young healthy recreational athletes. Methods Twenty-one young male healthy recreational athletes were tested for ADROM, gastrocnemius and soleus extensibility, lower-limb kinetic chain function with the closed kinetic chain lower extremity stability test (CKCLEST) and hop test performance with the single-leg hop for distance test (SHDT) and side hop test (SHT). Results There was a positive significant (rho = 0.514, 95% CI [0.092-0.779], P < 0.01) correlation between the dominant lower-limb weight-bearing/closed-chain ADROM (that represented the soleus extensibility) and the CKCLEST. There were no significant correlations between the study performance-based tests and open-chain ADROM (P > 0.05). Conclusion The CKCLEST is positively and significantly correlated with SHT and weight-bearing ADROM with knee flexion (and its related soleus extensibility) which suggests comparability among them. Open-chain ADROM has a negligible and non-significant correlation with the readings of this study performance-based tests suggesting that it is probably not an essential construct of their execution. To the best of our knowledge, this study is the first to investigate these correlations.
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Affiliation(s)
- Haifa Saleh Almansoof
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
| | - Qassim Muaidi
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
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Butler DL. Evolution of functional tissue engineering for tendon and ligament repair. J Tissue Eng Regen Med 2022; 16:1091-1108. [PMID: 36397198 DOI: 10.1002/term.3360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 11/19/2022]
Abstract
This review paper is motivated by a Back-to-Basics presentation given by the author at the 2022 Orthopaedic Research Society meeting in Tampa, Florida. I was tasked with providing a brief history of research leading up to the introduction of functional tissue engineering (FTE) for tendon and ligament repair. Beginning in the 1970s, this timeline focused on two common orthopedic soft tissue problems, anterior cruciate ligament ruptures in the knee and supraspinatus tendon injuries in the shoulder. Historic changes in the field over the next 5 decades revealed a transformation from a focus more on mechanics (called "bioMECHANICS") on a larger (tissue) scale to a more recent focus on biology (called "mechanoBIOLOGY") on a smaller (cellular and molecular) scale. Early studies by surgeons and engineers revealed the importance of testing conditions for ligaments and tendons (e.g., high strain rates while avoiding subject disuse and immobility) and the need to measure in vivo forces in these tissues. But any true tissue engineering and regeneration in these early decades was limited more to the use of auto-, allo- and xenografts than actual generation of stimulated cell-scaffold constructs in culture. It was only after the discovery of tissue engineering in 1988 and the recognition of frequent rotator cuff injuries in the early 1990s, that biologists joined surgeons and engineers to discover mechanical and biological testing criteria for FTE. This review emphasizes the need for broader and more inclusive collaborations by surgeons, biologists and engineers in the short term with involvement of those in biomaterials, manufacturing, and regulation of new products in the longer term.
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Affiliation(s)
- David L Butler
- College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, Ohio, USA
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Needham L, Evans M, Cosker DP, Wade L, McGuigan PM, Bilzon JL, Colyer SL. The accuracy of several pose estimation methods for 3D joint centre localisation. Sci Rep 2021; 11:20673. [PMID: 34667207 PMCID: PMC8526586 DOI: 10.1038/s41598-021-00212-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/07/2021] [Indexed: 12/14/2022] Open
Abstract
Human movement researchers are often restricted to laboratory environments and data capture techniques that are time and/or resource intensive. Markerless pose estimation algorithms show great potential to facilitate large scale movement studies 'in the wild', i.e., outside of the constraints imposed by marker-based motion capture. However, the accuracy of such algorithms has not yet been fully evaluated. We computed 3D joint centre locations using several pre-trained deep-learning based pose estimation methods (OpenPose, AlphaPose, DeepLabCut) and compared to marker-based motion capture. Participants performed walking, running and jumping activities while marker-based motion capture data and multi-camera high speed images (200 Hz) were captured. The pose estimation algorithms were applied to 2D image data and 3D joint centre locations were reconstructed. Pose estimation derived joint centres demonstrated systematic differences at the hip and knee (~ 30-50 mm), most likely due to mislabeling of ground truth data in the training datasets. Where systematic differences were lower, e.g., the ankle, differences of 1-15 mm were observed depending on the activity. Markerless motion capture represents a highly promising emerging technology that could free movement scientists from laboratory environments but 3D joint centre locations are not yet consistently comparable to marker-based motion capture.
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Affiliation(s)
- Laurie Needham
- Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, UK.
| | - Murray Evans
- Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, UK
| | - Darren P Cosker
- Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, UK
| | - Logan Wade
- Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, UK
| | - Polly M McGuigan
- Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, UK
| | - James L Bilzon
- Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, UK
| | - Steffi L Colyer
- Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, UK
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Dos'Santos T, Thomas C, Jones PA. The effect of angle on change of direction biomechanics: Comparison and inter-task relationships. J Sports Sci 2021; 39:2618-2631. [PMID: 34278968 DOI: 10.1080/02640414.2021.1948258] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of this was study to examine the inter-task relationships and compare change of direction (COD) biomechanics between different angles (45°, 90°, and 180°). Twenty-seven men performed three COD tasks, whereby lower-limb and trunk kinematics and kinetics were assessed via 3D motion and ground reaction force (GRF) analysis. Key mechanical differences (p ≤ 0.025, η2 = 0.024-0.940) in velocity profiles, GRF, sagittal joint angles and moments, multiplanar knee joint moments, and technical parameters existed between CODs. The primary findings were that as COD angle increased, velocity profiles decreased (p < 0.001, d = 1.56-8.96), ground contact times increased (p < 0.001, d = 3.00-5.04), vertical GRF decreased (p < 0.001, d = 0.87-3.48), and sagittal peak knee joint moments decreased (p ≤ 0.040, d = 0.62-2.73). Notably, the greatest peak knee internal rotation (KIRMs) and abduction moments (KAMs) and angles were observed during the 90° COD (p < 0.001, d = 0.88-1.81), indicating that this may be the riskiest COD angle. Small to very large (r = 0.260-0.702) associations in KAMs and KIRMs were observed between tasks, indicating that evaluations at different angles are needed to develop an athlete's biomechanical injury risk profile. The results support the concept that COD biomechanics and potential surrogates of non-contact anterior cruciate ligament injury risk are "angle-dependent"; which have important implications for COD coaching, screening, and physical preparation.
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Affiliation(s)
- Thomas Dos'Santos
- Human Performance Laboratory, Directorate of Sport, Exercise, and Physiotherapy, University of Salford, Greater Manchester, UK.,Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK
| | - Christopher Thomas
- Human Performance Laboratory, Directorate of Sport, Exercise, and Physiotherapy, University of Salford, Greater Manchester, UK
| | - Paul A Jones
- Human Performance Laboratory, Directorate of Sport, Exercise, and Physiotherapy, University of Salford, Greater Manchester, UK
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Schilaty ND, Martin RK, Ueno R, Rigamonti L, Bates NA. Mechanics of cadaveric anterior cruciate ligament reconstructions during simulated jump landing tasks: Lessons learned from a pilot investigation. Clin Biomech (Bristol, Avon) 2021; 86:105372. [PMID: 34052693 PMCID: PMC8278414 DOI: 10.1016/j.clinbiomech.2021.105372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Around half of anterior cruciate ligament (ACL) injuries are treated through reconstruction, but the literature lacks mechanical investigation of reconstructions in a dynamic athletic task and rupture environment. The current objective was to ascertain the feasibility of investigating ACL reconstructions in a rupture environment during simulated landing tasks in a validated mechanical impact simulator. METHODS Four cadaveric lower extremities were subjected to simulated landing in a mechanical impact simulator. External joint loads that mimicked magnitudes recorded from an in vivo population were applied to each joint in a stepwise manner. Simulations were repeated until ACL failure was achieved. Repeated measures design was used to test each specimen in the native ACL and hamstrings, quadriceps, and patellar tendon reconstructed states. FINDINGS ACL injuries were generated in 100% of specimens. Graft substance damage occurred in 58% of ACLRs, and in 75% of bone tendon bone grafts. Bone tendon bone and quadriceps grafts survived greater simulated loading than hamstrings grafts, but smaller simulated loading than the native ACL. Median peak strain prior to failure was 20.3% (11.6, 24.5) for the native ACL and 17.4% (9.5, 23.3) across all graft types. INTERPRETATION The simulator was a viable construct for mechanical examination of ACLR grafts in rupture environments. Post-surgery, ACL reconstruction complexes are weaker than the native ACL when subjected to equivalent loading. Bone tendon bone grafts most closely resembled the native ligament and provided the most consistently relevant rupture results. This model advocated reconstruction graft capacity to sustain forces generated from immediate gait and weightbearing during rehabilitation from an ACL injury.
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Affiliation(s)
- Nathan D Schilaty
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA; Sports Medicine Center, Mayo Clinic, Rochester, MN, USA; Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - R Kyle Martin
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA; Department of Orthopedic Surgery, CentraCare, Saint Cloud, MN, USA
| | - Ryo Ueno
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Luca Rigamonti
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Nathaniel A Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA; Sports Medicine Center, Mayo Clinic, Rochester, MN, USA.
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Ghaderi M, Letafatkar A, Thomas AC, Keyhani S. Effects of a neuromuscular training program using external focus attention cues in male athletes with anterior cruciate ligament reconstruction: a randomized clinical trial. BMC Sports Sci Med Rehabil 2021; 13:49. [PMID: 33964961 PMCID: PMC8106829 DOI: 10.1186/s13102-021-00275-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/27/2021] [Indexed: 11/15/2022]
Abstract
Background Athletes who have undergone anterior cruciate ligament (ACL) reconstruction often exhibit persistent altered biomechanics and impaired function. Neuromuscular training programs appear to be effective for reducing high-risk landing mechanics and preventing primary ACL injuries; however, there have been few attempts to examine their effects in athletes who have undergone ACL reconstruction. The purpose of our study was to examine the effects of a neuromuscular training program that emphasizes external focus of attention cuing on biomechanics, knee proprioception, and patient-reported function in athletes who had undergone ACL reconstruction and completed conventional post-operative rehabilitation. Methods Twenty-four male athletes who had undergone primary, unilateral, hamstring autograft ACL reconstruction and completed conventional post-operative rehabilitation were randomly allocated to an experimental group (n = 12) who took part in an 8-week neuromuscular training program or a control group (n = 12) who continued a placebo program. The neuromuscular training program included lower extremity strengthening and plyometric exercises, balance training, and movement pattern re-training. Biomechanics during single-leg landing, knee proprioception, and patient-reported function were assessed before and after the 8-week training period. Results Athletes in the experimental group demonstrated increased trunk, hip, and knee flexion angles and decreased knee abduction, internal rotation angles and knee valgus during landing following the intervention. Further, the experimental group decreased their peak knee extension and abduction moments and vertical ground reaction force on landing post-intervention. International Knee Documentation Committee questionnaire (IKDC) scores increased in the experimental group following training. The control group demonstrated no changes in any variable over the same time period. Conclusions Neuromuscular training with external focus of attention cueing improved landing biomechanics in patients after ACL reconstruction. Neuromuscular training programs beneficially mitigate second ACL injury risk factors and should be emphasized during and after traditional post-operative rehabilitation. Trial registration Current Controlled Trials using the IRCT website with ID number of, IRCT20180412039278N1 “Prospectively registered” at 21/12/2018.
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Affiliation(s)
- Mohamad Ghaderi
- Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran
| | - Amir Letafatkar
- Sport Injury and Corrective Exercises, Kharazmi University, Tehran, Iran. .,Biomechanics and Corrective Exercise Laboratory, Faculty of Physical Education and Sport sciences, Kharazmi University, Mirdamad Blvd., Hesari St, Tehran, Iran.
| | - Abbey C Thomas
- Department of Kinesiology, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Sohrab Keyhani
- Orthopedic Department Chair, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Bascuñán A, Soula M, Millar KK, Biedrzycki A, Banks SA, Lewis DD, Kim SE. In vivo three-dimensional knee kinematics in goats with unilateral anterior cruciate ligament transection. J Orthop Res 2021; 39:1052-1063. [PMID: 32633844 DOI: 10.1002/jor.24795] [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: 06/09/2019] [Revised: 04/10/2020] [Accepted: 06/25/2020] [Indexed: 02/04/2023]
Abstract
Although the goat is an established animal model in anterior cruciate ligament (ACL) research, in vivo kinematics associated with ACL deficiency have not been previously described in this species. Three-dimensional knee kinematics were determined before and after unilateral ACL transection in eight goats. Fluoroscopic imaging of the knees during treadmill walking and force-platform gait analysis during over-ground walking were performed prior to ACL transection, and 2 weeks, 3 months, and 6 months after ACL transection. Transient lameness of the ACL-transected limb was noted in all goats but resolved by 3 months post-ACL transection. Increased extension of 8.7° to 17.0° was noted throughout the gait cycle in both the ACL-transected and the contralateral unaffected knees by 3 months post-ACL transection, in a bilaterally symmetric pattern. Peak anterior tibial translation increased by 3 to 6 mm after ACL transection and persisted over the 6-month study period. No changes in axial rotation or abduction angle were observed after ACL transection. Unilateral ACL deficiency in goats resulted in persistent kinematic alterations, despite the resolution of lameness by 3 months post-ACL transection.
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Affiliation(s)
- Ana Bascuñán
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Mariajesus Soula
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Kristina K Millar
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Adam Biedrzycki
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Scott A Banks
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, Florida
| | - Daniel D Lewis
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Stanley E Kim
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
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Dos'Santos T, Thomas C, McBurnie A, Comfort P, Jones PA. Biomechanical Determinants of Performance and Injury Risk During Cutting: A Performance-Injury Conflict? Sports Med 2021; 51:1983-1998. [PMID: 33811615 PMCID: PMC8363537 DOI: 10.1007/s40279-021-01448-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Most cutting biomechanical studies investigate performance and knee joint load determinants independently. This is surprising because cutting is an important action linked to performance and non-contact anterior cruciate ligament (ACL) injuries. The aim of this study was to investigate the relationship between cutting biomechanics and cutting performance (completion time, ground contact time [GCT], exit velocity) and surrogates of non-contact ACL injury risk (knee abduction [KAM] and internal rotation [KIRM] moments) during 90° cutting. DESIGN Mixed, cross-sectional study following an associative design. 61 males from multidirectional sports performed six 90° pre-planned cutting trials, whereby lower-limb and trunk kinetics and kinematics were evaluated using three-dimensional (3D) motion and ground reaction force analysis over the penultimate (PFC) and final foot contact (FFC). Pearson's and Spearman's correlations were used to explore the relationships between biomechanical variables and cutting performance and injury risk variables. Stepwise regression analysis was also performed. RESULTS Faster cutting performance was associated (p ≤ 0.05) with greater centre of mass (COM) velocities at key instances of the cut (r or ρ = 0.533-0.752), greater peak and mean propulsive forces (r or ρ = 0.449-0.651), shorter FFC GCTs (r or ρ = 0.569-0.581), greater FFC and PFC braking forces (r = 0.430-0.551), smaller hip and knee flexion range of motion (r or ρ = 0.406-0.670), greater knee flexion moments (KFMs) (r = 0.482), and greater internal foot progression angles (r = - 0.411). Stepwise multiple regression analysis revealed that exit velocity, peak resultant propulsive force, PFC mean horizontal braking force, and initial foot progression angle together could explain 64% (r = 0.801, adjusted 61.6%, p = 0.048) of the variation in completion time. Greater peak KAMs were associated with greater COM velocities at key instances of the cut (r or ρ = - 0.491 to - 0.551), greater peak knee abduction angles (KAA) (r = - 0.468), and greater FFC braking forces (r = 0.434-0.497). Incidentally, faster completion times were associated with greater peak KAMs (r = - 0.412) and KIRMs (r = 0.539). Stepwise multiple regression analysis revealed that FFC mean vertical braking force and peak KAA together could explain 43% (r = 0.652, adjusted 40.6%, p < 0.001) of the variation peak KAM. CONCLUSION Techniques and mechanics associated with faster cutting (i.e. faster COM velocities, greater FFC braking forces in short GCTs, greater KFMs, smaller hip and knee flexion, and greater internal foot progression angles) are in direct conflict with safer cutting mechanics (i.e. reduced knee joint loading, thus ACL injury risk), and support the "performance-injury conflict" concept during cutting. Practitioners should be conscious of this conflict when instructing cutting techniques to optimise performance while minimising knee joint loading, and should, therefore, ensure that their athletes have the physical capacity (i.e. neuromuscular control, co-contraction, and rapid force production) to tolerate and support the knee joint loading during cutting.
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Affiliation(s)
- Thomas Dos'Santos
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, All Saints Building, Manchester Campus John Dalton Building, Manchester Campus, Manchester, M15 6BH, UK. .,Human Performance Laboratory, Directorate of Sport, Exercise, and Physiotherapy, University of Salford, Salford, Greater Manchester, UK.
| | - Christopher Thomas
- Human Performance Laboratory, Directorate of Sport, Exercise, and Physiotherapy, University of Salford, Salford, Greater Manchester, UK
| | | | - Paul Comfort
- Human Performance Laboratory, Directorate of Sport, Exercise, and Physiotherapy, University of Salford, Salford, Greater Manchester, UK
| | - Paul A Jones
- Human Performance Laboratory, Directorate of Sport, Exercise, and Physiotherapy, University of Salford, Salford, Greater Manchester, UK
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12
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Martin RK, Ekås GR, Benth J, Kennedy N, Moatshe G, Krych AJ, Engebretsen L. Change in Posterior Tibial Slope in Skeletally Immature Patients With Anterior Cruciate Ligament Injury: A Case Series With a Mean 9 Years' Follow-up. Am J Sports Med 2021; 49:1244-1250. [PMID: 33683924 DOI: 10.1177/0363546521997097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Increased lateral posterior tibial slope (LPTS) is associated with increased rates of anterior cruciate ligament (ACL) injury and failure of ACL reconstruction. It is unknown if ACL deficiency influences the developing proximal tibial physis and slope in skeletally immature patients through anterior tibial subluxation and abnormal force transmission. PURPOSE To assess the natural history of LPTS in skeletally immature patients with an ACL-injured knee. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 38 participants from a previous study on nonoperative management of ACL injury in skeletally immature patients were included. During the initial study, bilateral knee magnetic resonance imaging (MRI) was performed within 1 year of enrollment and again at final follow-up. All patients were younger than 13 years at the time of enrollment, and final follow-up occurred a mean 10 years after the injury. MRI scans were retrospectively reviewed by 2 reviewers to determine bilateral LPTS for each patient and each time point. Linear mixed models were used to assess LPTS differences between knees, change over time, and association with operational status. Subgroup analyses were performed for patients who remained nonoperated throughout the study. RESULTS A total of 22 patients had ACL reconstruction before final follow-up and 16 remained nonoperated. In the entire study population, the mean LPTS was higher in the injured knee than in the contralateral knee at final follow-up by 2.0° (P < .001; 95% CI, 1.3°-2.6°). The mean LPTS increased significantly in the injured knee by 0.9° (P = .042; 95% CI, 0.03°-1.7°), while the mean LPTS decreased in the contralateral knee by 0.4° (P = .363; 95% CI, -0.8° to 0.4°). A significant difference in LPTS was also observed in the nonoperated subgroup. No significant association was observed between LPTS and operational status. CONCLUSION Lateral posterior tibial slope increased more in the ACL-injured knee than in the contralateral uninjured knee in a group of skeletally immature patients. Lateral posterior tibial slope at baseline was not associated with the need for surgical reconstruction over the study period.
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Affiliation(s)
- R Kyle Martin
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Orthopaedic Surgery, CentraCare, Saint Cloud, Minnesota, USA
| | - Guri R Ekås
- Department of Orthopaedic Surgery, CentraCare, Saint Cloud, Minnesota, USA.,Division of Orthopedic Surgery, Akershus University Hospital, Oslo, Norway.,Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway
| | - JūratėŠaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Blindern, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Nicholas Kennedy
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Gilbert Moatshe
- Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway.,Department of Orthopaedic Surgery, Oslo University Hospital, Norway
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lars Engebretsen
- Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway.,Department of Orthopaedic Surgery, Oslo University Hospital, Norway
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13
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Adouni M, Mbarki R, Al Khatib F, Eilaghi A. Multiscale modeling of knee ligament biomechanics. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3413. [PMID: 33174350 DOI: 10.1002/cnm.3413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 10/02/2020] [Accepted: 11/01/2020] [Indexed: 06/11/2023]
Abstract
Knee connective tissues are mainly responsible for joint stability and play a crucial role in restraining excessive motion during regular activities. The damage mechanism of these tissues is directly linked to the microscale collagen level. However, this mechanical connection is still unclear. During this investigation, a multiscale fibril-reinforced hyper-elastoplastic model was developed and statistically calibrated. The model is accounting for the structural architecture of the soft tissue, starting from the tropocollagen molecule that forms fibrils to the whole soft tissue. Model predictions are in agreement with the results of experimental and numerical studies. Further, damage initiation and propagation in the collagen fiber were computed at knee ligaments and located mainly in the superficial layers. Results indicated higher crosslink density required higher tensile stress to elicit fibril damage. This approach is aligned with a realistic simulation of a damaging process and repair attempt. To the best of our knowledge, this is the first model published in which the connective tissue stiffness is simultaneously predicted by encompassing the mesoscopic scales between the molecular and macroscopic levels.
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Affiliation(s)
- Malek Adouni
- Physical Medicine and Rehabilitation Department, Northwestern University, Chicago, Illinois, USA
- Mechanical Engineering Department, Australian College of Kuwait, Kuwait city, Kuwait
| | - Raouf Mbarki
- Mechanical Engineering Department, Australian College of Kuwait, Kuwait city, Kuwait
| | - Fadi Al Khatib
- Mechanical Engineering Department, Australian College of Kuwait, Kuwait city, Kuwait
| | - Armin Eilaghi
- Mechanical Engineering Department, Australian College of Kuwait, Kuwait city, Kuwait
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14
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Rosario R, Marchi BC, Arruda EM, Coleman RM. The Influence of Anterior Cruciate Ligament Matrix Mechanical Properties on Simulated Whole-Knee Biomechanics. J Biomech Eng 2020; 142:121012. [PMID: 32601691 PMCID: PMC7580848 DOI: 10.1115/1.4047658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 06/20/2020] [Indexed: 11/08/2022]
Abstract
Knee finite element (FE) models are used to study tissue deformation in response to complex loads. Typically, ligaments are modeled using transversely isotropic, hyperelastic material models fitted to tension data along the predominant fiber direction (longitudinal) and, less commonly, to tension data orthogonal to the fiber direction (transverse). Currently, the shear and bulk responses of the anterior cruciate ligament (ACL) are not fitted to experimental data. In this study, a newly proposed material model was fitted to longitudinal tension, transverse tension, and shear experimental data. The matrix transverse tensile, shear, and bulk stiffnesses were then varied independently to determine the impact of each property on knee kinematics and tissue deformation in a whole-knee FE model. The range of values for each parameter was chosen based on published FE studies of the knee. For a knee at full extension under 134 N anterior tibial force (ATF), increasing matrix transverse tensile stiffness, shear stiffness, or bulk stiffness decreased anterior tibial translation (ATT), ACL longitudinal strain, and ACL shear strain. For a knee under 134 N ATF and 1600 N compression, changing the ACL matrix mechanical properties caused variations in ATT and thus changed cartilage deformation contours by changing the point of contact between the femoral and the tibial cartilage. These findings indicate that material models for the ACL must describe matrix material properties to best predict the in vivo response to applied loads.
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Affiliation(s)
- Ryan Rosario
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109
| | - Benjamin C. Marchi
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109
| | - Ellen M. Arruda
- Department of Mechanical Engineering, Program in Macromolecular Science and Engineering, University of Michigan, Ann Arbor, MI 48109; Department of Biomedical Engineering, Program in Macromolecular Science and Engineering, University of Michigan, Ann Arbor, MI 48109
| | - Rhima M. Coleman
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109
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15
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Cronström A, Creaby MW, Ageberg E. Do knee abduction kinematics and kinetics predict future anterior cruciate ligament injury risk? A systematic review and meta-analysis of prospective studies. BMC Musculoskelet Disord 2020; 21:563. [PMID: 32819327 PMCID: PMC7441716 DOI: 10.1186/s12891-020-03552-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 07/31/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND To systematically review the association between knee abduction kinematics and kinetics during weight-bearing activities at baseline and the risk of future anterior cruciate ligament (ACL) injury. METHODS Systematic review and meta-analysis according to PRISMA guidelines. A search in the databases MEDLINE (PubMed), CINAHL, EMBASE and Scopus was performed. Inclusion criteria were prospective studies including people of any age, assessing baseline knee abduction kinematics and/or kinetics during any weight-bearing activity for the lower extremity in individuals sustaining a future ACL injury and in those who did not. RESULTS Nine articles were included in this review. Neither 3D knee abduction angle at initial contact (Mean diff: -1.68, 95%CI: - 4.49 to 1.14, ACL injury n = 66, controls n = 1369), peak 3D knee abduction angle (Mean diff: -2.17, 95%CI: - 7.22 to 2.89, ACL injury n = 25, controls n = 563), 2D peak knee abduction angle (Mean diff: -3.25, 95%CI: - 9.86 to 3.36, ACL injury n = 8, controls n = 302), 2D medial knee displacement (cm; Mean diff:: -0.19, 95%CI: - 0,96 to 0.38, ACL injury n = 72, controls n = 967) or peak knee abduction moment (Mean diff:-10.61, 95%CI: - 26.73 to 5.50, ACL injury n = 54, controls n = 1330) predicted future ACL injury. CONCLUSION Contrary to clinical opinion, our findings indicate that knee abduction kinematics and kinetics during weight-bearing activities may not be risk factors for future ACL injury. Knee abduction of greater magnitude than that observed in the included studies as well as factors other than knee abduction angle or moment, as possible screening measures for knee injury risk should be evaluated in future studies.
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Affiliation(s)
- Anna Cronström
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden. .,Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
| | - Mark W Creaby
- School of Exercise Science, Australian Catholic University, Brisbane, Australia
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden
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16
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Dos'Santos T, Thomas C, Comfort P, Jones PA. The Effect of Training Interventions on Change of Direction Biomechanics Associated with Increased Anterior Cruciate Ligament Loading: A Scoping Review. Sports Med 2020; 49:1837-1859. [PMID: 31493206 PMCID: PMC6851221 DOI: 10.1007/s40279-019-01171-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Change of direction (COD) manoeuvres are associated with anterior cruciate ligament (ACL) injury risk due to the propensity to generate large multiplanar knee joint loads. Given the short- and long-term consequences of ACL injury, practitioners are interested in methods that reduce knee joint loads and subsequent ACL loading. An effective strategy to reduce ACL loading is modifying an athlete’s movement mechanics to reduce knee joint loading. The purpose of this scoping review was to critically appraise and comprehensively synthesise the existing literature related to the effects of training interventions on COD biomechanics associated with increased knee joint loads and subsequent ACL loading, and identify gaps and recommend areas for future research. A review of the literature was conducted using Medline and Sport DISCUS databases. Inclusion criteria consisted of pre-post analysis of a COD task, a minimum 4-week training intervention, and assessments of biomechanical characteristics associated with increased ACL loading. Of the 1,027 articles identified, 22 were included in the scoping review. Based on current literature, balance training and COD technique modification are the most effective training modalities for reducing knee joint loading (small to moderate effect sizes). One study reported dynamic core stability training was effective in reducing knee joint loads, but further research is needed to definitively confirm the efficacy of this method. Perturbation-enhanced plyometric training, the F-MARC 11 + soccer specific warm-up, Oslo Neuromuscular warm-up, and resistance training are ineffective training modalities to reduce COD knee joint loads. Conflicting findings have been observed for the Core-Pac and mixed training programme. Consequently, practitioners should consider incorporating balance and COD technique modification drills into their athletes’ training programmes to reduce potentially hazardous knee joint loads when changing direction. However, training intervention studies can be improved by investigating larger sample sizes (> 20), including a control group, acknowledging measurement error when interpreting their findings, and considering performance implications, to confirm the effectiveness of training interventions and improve adherence.
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Affiliation(s)
- Thomas Dos'Santos
- Human Performance Laboratory, University of Salford, Greater Manchester, UK.
| | - Christopher Thomas
- Human Performance Laboratory, University of Salford, Greater Manchester, UK
| | - Paul Comfort
- Human Performance Laboratory, University of Salford, Greater Manchester, UK
| | - Paul A Jones
- Human Performance Laboratory, University of Salford, Greater Manchester, UK
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17
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Zhou J, Schilaty ND, Hewett TE, Bates NA. ANALYSIS OF TIMING OF SECONDARY ACL INJURY IN PROFESSIONAL ATHLETES DOES NOT SUPPORT GAME TIMING OR SEASON TIMING AS A CONTRIBUTOR TO INJURY RISK. Int J Sports Phys Ther 2020; 15:254-262. [PMID: 32269859 PMCID: PMC7134345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries are a common cause of time loss in sports. Approximately one-third of ACL reconstructed athletes who return to sport suffer secondary injury. The presence of fatigue during athletic performance has been hypothesized to increase susceptibility to ACL injury. However, the relative role of fatigue in secondary ACL failures remains unexplored. PURPOSE To assess how time elapsed within a game and within a season associate with secondary ACL injury occurrence in international professional athletes and American collegiate athletes. STUDY DESIGN Retrospective cohort analysis. METHODS The public domain was searched for secondary ACL injuries that occurred during competitive matches between 2000-2018. Demographics (age, height, weight), side of injury, type of injury (contact, noncontact), and timing of injury within competition and within season were determined for each case. RESULTS Sixty-seven secondary ACL injuries were identified. Within-game, there were no differences in the distribution of ACL injures across each quarter of game time (p = 0.284). This was consistent between sport (p = 0.120-0.448). Within-season, there were no differences in the distribution of secondary ACL injures across each quarter of the season (p = 0.491). This was again consistent between sport (p = 0.151-0.872). Relative risk was not found to be significantly greater for any combination of season and game. CONCLUSION The results of the current study indicate that the occurrences of secondary ACL injuries were equally distributed with respect to in-game and in-season timing. Both in-game and in-season timing were not significantly different across each individual sport examined. These results implicate that overall there is not an association between fatigue and secondary ACL injury occurrence in professional athletes. LEVEL OF EVIDENCE 3.
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18
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Chahla J, Nelson T, Dallo I, Yalamanchili D, Eberlein S, Limpisvasti O, Mandelbaum B, Metzger MF. Anterior cruciate ligament repair versus reconstruction: A kinematic analysis. Knee 2020; 27:334-340. [PMID: 31813701 DOI: 10.1016/j.knee.2019.10.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/10/2019] [Accepted: 10/24/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to compare the biomechanical properties of an anterior cruciate ligament (ACL) anatomic repair of a true femoral avulsion to an anatomic ACL reconstruction. It was hypothesized that the ACL repair and ACL reconstruction would have comparable biomechanical behavior when compared to the native knee. METHODS Ten paired fresh-frozen cadaveric knees (n = 20) were used to investigate knee kinematics when an anterior drawer force, varus, valgus, internal, and external rotational moment were applied at 0, 15, 30, 45, 60, and 90 degrees of flexion. Displacement and rotation were recorded in the following conditions: ACL-intact, ACL-deficient, and ACL-repaired vs reconstructed. RESULTS Sectioning of the ACL significantly increased anterior tibial translation (0°, 15°, 30° and 45°) compared to the intact state. The mean anterior displacement difference from intact was lower in the ACL-repaired knees compared to reconstructed knees at 30° and 90°. There were no significant differences between conditions in varus, valgus, internal, or external rotations. CONCLUSION ACL repair and ACL reconstruction procedures restored knee anterior tibial translation in matched paired specimens. There were no differences in valgus, varus, internal, or external rotation. Although, ACL-repaired knees (avulsion model) demonstrated less anterior tibial translation when compared to ACL-reconstructed knees, this difference was less than one millimeter. Based on the findings of this study, repair and reconstruction procedures both restored anterior tibial translation in matched-pair specimens. This suggests that the initial functionality of both techniques is similar and that further clinical studies are needed to compare the long-term stability.
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Affiliation(s)
- Jorge Chahla
- Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, CA, United States of America
| | - Trevor Nelson
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Ignacio Dallo
- Unit of Regenerative Therapy and Arthroscopy Surgery, Sanatorio Garay, Santa Fe, Argentina
| | - Dheeraj Yalamanchili
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
| | - Sam Eberlein
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Orr Limpisvasti
- Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, CA, United States of America
| | - Bert Mandelbaum
- Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, CA, United States of America
| | - Melodie F Metzger
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
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Wood A, Boren M, Dodgen T, Wagner R, Patterson RM. Muscular architecture of the popliteus muscle and the basic science implications. Knee 2020; 27:308-314. [PMID: 31954610 DOI: 10.1016/j.knee.2019.12.001] [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: 03/13/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The function of the popliteus muscle is largely treated as a static stabilizer and has a lack of basic muscular architectural data to enable study of its dynamic function. A large volume of literature supports its static function and the essential need for reconstruction in the posterolateral knee when injured to restore knee stability. HYPOTHESIS/PURPOSE We hypothesize that the popliteus muscle is more significant as a dynamic presence in the knee. METHODS A collection of popliteus architectural data was collected from 28 cadaver specimens (mean (SD) 76 years (11)). Physiological cross-sectional area of the popliteus and semimembranosus muscles were calculated from muscle volume and fiber length to power future muscle force prediction models. Posterior knee muscle trajectories were measured with respect to the longitudinal axis of the tibia. A 2-tailed T test was performed. RESULTS Significant differences between males and females were found for both the popliteus (p = 1.1E-05) and semimembranosus (p = 2.0E-05) muscle volumes. Significant differences between males and females were also found in PCSA for the popliteus (p = 0.005) and semimembranosus (p = 4.1E-05) muscles. There were no significant differences in fiber length, overall muscle length (with tendon removed), age, and orientation. CONCLUSION Further consideration should be given to include the popliteus muscle as a dynamic entity in the knee given its mechanical properties, trajectory, and prior biomechanical evidence showing when and how it is activated. The present study provides data that may shape future directions of research and treatment with regard to posterolateral corner injuries and ligamentous balancing of the knee.
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Affiliation(s)
- Addison Wood
- Center for Anatomical Sciences, University of North Texas Health Science Center, Fort Worth, TX, United States of America; Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX, United States of America
| | - Morgan Boren
- Center for Anatomical Sciences, University of North Texas Health Science Center, Fort Worth, TX, United States of America.
| | - Taylor Dodgen
- Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX, United States of America
| | - Russell Wagner
- Center for Anatomical Sciences, University of North Texas Health Science Center, Fort Worth, TX, United States of America; Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX, United States of America
| | - Rita M Patterson
- Center for Anatomical Sciences, University of North Texas Health Science Center, Fort Worth, TX, United States of America
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Influence of relative injury risk profiles on anterior cruciate ligament and medial collateral ligament strain during simulated landing leading to a noncontact injury event. Clin Biomech (Bristol, Avon) 2019; 69:44-51. [PMID: 31295670 PMCID: PMC6823138 DOI: 10.1016/j.clinbiomech.2019.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/15/2019] [Accepted: 06/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Athletes have traditionally been subdivided into risk classifications for ACL injury relative to the biomechanical traits they display during landing. This investigation aimed to discern whether these separate risk classifications elicit strain differences on the ACL and MCL during landing. It was hypothesized that the higher risk simulation profiles would exhibit greater ACL strain and that the ACL would exhibit greater strain than the MCL under all conditions. METHOD The mechanical impact simulator was used to simulate landing on a cohort of 46 cadaveric specimens. The simulator applied external joint loads to the knee prior to impulse delivery. These loads were organized into a series of profiles derived from in vivo motion capture previously performed on a cohort of 44 athletes and represented various risk classifications. Strain gauges were implanted on the ACL and MCL and simulations performed until a structural failure was elicited. Differences were assessed with Kruskal-Wallis tests. FINDINGS The highest-risk profiles tended to exhibit greater peak ACL strain and change in ACL strain than the baseline- and moderate-risk profiles. Specimens that failed during lower-risk simulations expressed greater strain at these loads than specimens that completed higher-risk simulations. The ACL recorded greater strain than the MCL throughout all simulation profiles. INTERPRETATION This behavior justifies why neuromuscular interventions have greater impact on higher-risk athletes and supports the continued screening and targeted training of those athletes that express greater injury risk. The loading disparity between ACL and MCL justifies their limited concomitant injury rate.
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Elshafay A, Omran ES, Abdelkhalek M, El-Badry MO, Eisa HG, Fala SY, Dang T, Ghanem MAT, Elbadawy M, Elhady MT, Vuong NL, Hirayama K, Huy NT. Reporting quality in systematic reviews of in vitro studies: a systematic review. Curr Med Res Opin 2019; 35:1631-1641. [PMID: 30977685 DOI: 10.1080/03007995.2019.1607270] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Systematic reviews (SRs) and/or meta-analyses of in vitro research have an important role in establishing the foundation for clinical studies. In this study, we aimed to evaluate the reporting quality of SRs of in vitro studies using the PRISMA checklist.Method: Four databases were searched including PubMed, Virtual Health Library (VHL), Web of Science (ISI) and Scopus. The search was limited from 2006 to 2016 to include all SRs and/or meta-analyses (MAs) of pure in vitro studies. The evaluation of reporting quality was done using the PRISMA checklist.Results: Out of 7702 search results, 65 SRs were included and evaluated with the PRISMA checklist. Overall, the mean overall quality score of reported items of the PRISMA checklist was 68%. We have noticed an increasing pattern in the numbers of published SRs of in vitro studies over the last 10 years. In contrast, the reporting quality was not significantly improved over the same period (p = .363). There was a positive but not significant correlation between the overall quality score and the journal impact factor of the included studies.Conclusions: The adherence of SRs of in vitro studies to the PRISMA guidelines was poor. Therefore, we believe that using reporting guidelines and journals paying attention to this fact will improve the quality of SRs of in vitro studies.
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Affiliation(s)
- Abdelrahman Elshafay
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Online Research Club (http://www.onlineresearchclub.org/)
| | - Esraa Salah Omran
- Online Research Club (http://www.onlineresearchclub.org/)
- Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mariam Abdelkhalek
- Online Research Club (http://www.onlineresearchclub.org/)
- Microbiology and Immunology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Omar El-Badry
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Online Research Club (http://www.onlineresearchclub.org/)
| | - Heba Gamal Eisa
- Online Research Club (http://www.onlineresearchclub.org/)
- Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Salma Y Fala
- Online Research Club (http://www.onlineresearchclub.org/)
- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Thao Dang
- Online Research Club (http://www.onlineresearchclub.org/)
- Surgery Department School of Medicine, Tan Tao University, Tan Duc Ecity, Vietnam
| | - Mohammad A T Ghanem
- Online Research Club (http://www.onlineresearchclub.org/)
- Department of Vascular Surgery, Uniklinik Magdeburg, Magdeburg, Germany
| | - Maha Elbadawy
- Online Research Club (http://www.onlineresearchclub.org/)
- Ministry of Health, Cairo, Egypt
| | - Mohamed Tamer Elhady
- Online Research Club (http://www.onlineresearchclub.org/)
- Department of Pediatrics, Zagazig University Hospitals, Faculty of Medicine, Sharkia, Egypt
| | - Nguyen Lam Vuong
- Online Research Club (http://www.onlineresearchclub.org/)
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Nguyen Tien Huy
- Evidence Based Medicine Research Group & Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam
- Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Dos'Santos T, McBurnie A, Thomas C, Comfort P, Jones PA. Biomechanical Comparison of Cutting Techniques: A Review and Practical Applications. Strength Cond J 2019. [DOI: 10.1519/ssc.0000000000000461] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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23
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Dos’Santos T, McBurnie A, Donelon T, Thomas C, Comfort P, Jones PA. A qualitative screening tool to identify athletes with ‘high-risk’ movement mechanics during cutting: The cutting movement assessment score (CMAS). Phys Ther Sport 2019; 38:152-161. [DOI: 10.1016/j.ptsp.2019.05.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/07/2019] [Accepted: 05/20/2019] [Indexed: 01/14/2023]
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24
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Bates NA, Schilaty ND, Nagelli CV, Krych AJ, Hewett TE. Multiplanar Loading of the Knee and Its Influence on Anterior Cruciate Ligament and Medial Collateral Ligament Strain During Simulated Landings and Noncontact Tears. Am J Sports Med 2019; 47:1844-1853. [PMID: 31150273 PMCID: PMC6988507 DOI: 10.1177/0363546519850165] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tears and concomitant medial collateral ligament (MCL) injuries are known to occur during dynamic athletic tasks that place combinatorial frontal and transverse plane loads on the knee. A mechanical impact simulator that produces clinical presentation of ACL injury allows for the quantification of individual loading contributors leading to ACL failure. PURPOSE/HYPOTHESIS The objective was to delineate the relationship between knee abduction moment, anterior tibial shear, and internal tibial rotation applied at the knee and ACL strain during physiologically defined simulations of impact at a knee flexion angle representative of initial contact landing from a jump. The hypothesis tested was that before ACL failure, abduction moment would induce greater change in ACL strain during landing than either anterior shear or internal rotation. STUDY DESIGN Controlled laboratory study. METHODS Nineteen cadaveric specimens were subjected to simulated landings in the mechanical impact simulator. During simulations, external knee abduction moment, internal tibial rotation moment, and anterior tibial shear loads were derived from a previously analyzed in vivo cohort and applied to the knee in varying magnitudes with respect to injury risk classification. Implanted strain gauges were used to track knee ligament displacement throughout simulation. Kruskal-Wallis tests were used to assess strain differences among loading factors, with Wilcoxon each pair post hoc tests used to assess differences of magnitude within each loading. RESULTS Each loading factor significantly increased ACL strain (P < .005). Within factors, the high-risk magnitude of each factor significantly increased ACL strain relative to the baseline condition (P≤ .002). However, relative to knee abduction moment specifically, ACL strain increased with each increased risk magnitude (P≤ .015). CONCLUSION Increased risk levels of each load factor contributed to increased levels of ACL strain during a simulated jump landing. The behavior of increased strain between levels of increased risk loading was most prevalent for changes in knee abduction moment. This behavior was observed in the ACL and MCL. CLINICAL RELEVANCE Knee abduction moment may be the predominant precursor to ACL injury and concomitant MCL injury. As knee abduction occurs within the frontal plane, primary preventative focus should incorporate reduction of frontal plane knee loading in landing and cutting tasks, but secondary reduction of transverse plane loading could further increase intervention efficacy. Constraint of motion in these planes should restrict peak ACL strain magnitudes during athletic performance.
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Affiliation(s)
- Nathaniel A. Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA.,Address correspondence to Nathaniel A. Bates, Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55902, USA ()
| | - Nathan D. Schilaty
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher V. Nagelli
- Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy E. Hewett
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
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Bulat M, Korkmaz Can N, Arslan YZ, Herzog W. Musculoskeletal Simulation Tools for Understanding Mechanisms of Lower-Limb Sports Injuries. Curr Sports Med Rep 2019; 18:210-216. [DOI: 10.1249/jsr.0000000000000601] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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26
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The effect of limb dominance on change of direction biomechanics: A systematic review of its importance for injury risk. Phys Ther Sport 2019; 37:179-189. [DOI: 10.1016/j.ptsp.2019.04.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 04/06/2019] [Indexed: 01/14/2023]
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Volpi P, Quaglia A, Carimati G, Galli M, Papalia R, Petrillo S. Double bundle anterior cruciate ligament reconstruction: Failure rate and patients-reported outcomes at 4-11 years of follow up. J Orthop 2019; 16:224-229. [PMID: 30906128 DOI: 10.1016/j.jor.2019.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 02/17/2019] [Indexed: 12/31/2022] Open
Abstract
Background Biomechanical studies have demonstrated that single bundle (SB) anterior cruciate ligament (ACL) reconstruction (SB-ACLr), which represents the gold standard for the management of ACL lesions, is not sufficient to completely restore the rotational stability and resistance to valgus stress of the knee. Purpose To evaluate the failure rate and patients reported outcomes at a long-term follow-up of double bundle anterior cruciate ligament reconstruction (DB-ACLr). Study design Retrospective cohort study. Materials and methods The database of arthroscopic DB-ACLr procedures performed from 2006 to 2015 at our Institution was retrospectively reviewed. Patients were screened for eligibility according to the following inclusion criteria: magnetic resonance imaging (MRI) evidence of anterior cruciate ligament (ACL) lesion, positive anterior drawer test and/or Lachman test; age ≤ 45 years at the time of surgery; DB-ACLr with autologous hamstrings, minimum follow up of 24 months. Patients were excluded if they presented associated lesions of the knee preoperatively or at the time of surgery, expect for meniscal lesions, or in case of inability to complete clinical questionnaires. Clinical outcomes were assessed at a mean follow up of 95.4 ± 21.9 months (range 51-129 months; median 98 months) using the Tegner-Lysholm score and the IKDC subjective score. Failures were defined as Tegner-Lysholm score ≤65 points, and were confirmed with MRI. Results 58 (81.7%) male and 13 (18.3%) female patients (mean age 29.7 ± 7.8 years) were included in the study. 2 (2.8%, 95% CI 0.3-9.8%) patients had a failure of DB-ACLr both occurred after a sports trauma. The IKDC subjective score was statically better in patients younger than 30 years. Tegner-Lysholm and IKDC subjective score were statistically better in professional athletes and in patients with isolated medial or lateral meniscus lesion instead of combined medial and lateral meniscus lesion. Conclusion DB-ACLr technique provides excellent clinical results at a long term follow-up. Low failure rate and high percentage of return to sports participation at the same pre-injury level was found in our cohort of patients.
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Affiliation(s)
- Piero Volpi
- Knee Surgery and Sports Traumatology Unit, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Alessandro Quaglia
- Knee Surgery and Sports Traumatology Unit, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giulia Carimati
- Knee Surgery and Sports Traumatology Unit, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Marco Galli
- Centre of Sports Traumatology and Arthroscopic Surgery, Galeazzi Orthopaedics Institution of Milan, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro Del Portillo, 200, 00128, Trigoria, Rome, Italy
| | - Stefano Petrillo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro Del Portillo, 200, 00128, Trigoria, Rome, Italy
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Bates NA, Mejia Jaramillo MC, Vargas M, McPherson AL, Schilaty ND, Nagelli CV, Krych AJ, Hewett TE. External loads associated with anterior cruciate ligament injuries increase the correlation between tibial slope and ligament strain during in vitro simulations of in vivo landings. Clin Biomech (Bristol, Avon) 2019; 61:84-94. [PMID: 30530064 PMCID: PMC6448403 DOI: 10.1016/j.clinbiomech.2018.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 11/07/2018] [Accepted: 11/23/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the present study was to evaluate the relationship between tibial slope angle and ligament strain during in vitro landing simulations that induce ACL failure through the application of variable external loading at the knee. The hypothesis tested was that steeper posterior tibial slope angle would be associated with higher ACL strain during a simulated landing task across all external loading conditions. METHODS Kinetics previously derived from an in vivo cohort performing drop landings were reproduced on 45 cadaveric knees via the mechanical impact simulator. MRIs were taken of each specimen and used to calculate medial compartment posterior tibial slope, lateral compartment posterior tibial slope, and coronal plane tibial slope. Linear regression analyses were performed between these angles and ACL strain to determine whether tibial slope was a predictive factor for ACL strain. FINDINGS Medial and lateral posterior tibial slope were predictive factors for ACL strain during some landings with higher combined loads. Medial posterior slope was more predictive of ACL strain in most landings for male specimens, while lateral posterior and coronal slope were more predictive in female specimens, but primarily when high abduction moments were applied. INTERPRETATION Tibial slope has the potential to influence ACL strain during landing, especially when large abduction moments are present at the knee. Deleterious external loads to the ACL increase the correlation between tibial slope and ACL strain, which indicates that tibial slope angles are an additive factor for athletes apt to generate large out-of-plane knee moments during landing tasks.
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Affiliation(s)
- Nathaniel A Bates
- Mayo Clinic Biomechanics Laboratories, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Sports Medicine Center, Mayo Clinic, Rochester, MN, USA; Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN, USA.
| | | | - Manuela Vargas
- Department of Biomedical Engineering, Universidad EIA, Medellin, Colombia
| | - April L McPherson
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, USA
| | - Nathan D Schilaty
- Mayo Clinic Biomechanics Laboratories, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Sports Medicine Center, Mayo Clinic, Rochester, MN, USA; Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | | | - Aaron J Krych
- Mayo Clinic Biomechanics Laboratories, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Sports Medicine Center, Mayo Clinic, Rochester, MN, USA
| | - Timothy E Hewett
- Mayo Clinic Biomechanics Laboratories, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Sports Medicine Center, Mayo Clinic, Rochester, MN, USA; Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN, USA
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Bates NA, Schilaty ND, Nagelli CV, Krych AJ, Hewett TE. Validation of Noncontact Anterior Cruciate Ligament Tears Produced by a Mechanical Impact Simulator Against the Clinical Presentation of Injury. Am J Sports Med 2018; 46:2113-2121. [PMID: 29864374 PMCID: PMC6405414 DOI: 10.1177/0363546518776621] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries are catastrophic events that affect athletic careers and lead to long-term degenerative knee changes. As injuries are believed to occur within the first 50 milliseconds after initial contact during a rapid deceleration task, impact simulators that rapidly deliver impulse loads to cadaveric specimens have been developed. However, no impactor has reproducibly and reliably created ACL injures in a distribution that mimics clinical observation. PURPOSE To better understand ACL injury patterns through a cadaveric investigation that applied in vivo-measured external loads to the knee during simulated landings. STUDY DESIGN Controlled laboratory study. METHODS A novel mechanical impact simulator reproduced kinetics from in vivo-recorded drop landing tasks on 45 cadaveric knees. Specimens were exposed to a randomized order of variable knee abduction moment, anterior tibial shear, and internal tibial rotation loads before the introduction of an impulse load at the foot. This process was repeated until a hard or soft tissue injury was induced on the joint. Injuries were assessed by an orthopaedic surgeon, and ligament strain was recorded by implanted strain gauges. RESULTS The mechanical impact simulator induced ACL injuries in 87% of specimens, with medial collateral ligament (MCL) injuries in 31%. ACL tear locations were 71% femoral side, 21% midsubstance, and 9% tibial side. Peak strain before failure for ACL-injured specimens was 15.3% ± 8.7% for the ACL and 5.1% ± 5.6% for the MCL ( P < .001). CONCLUSION The ACL injuries induced by the mechanical impact simulator in the present study have provided clinically relevant in vitro representations of in vivo ACL injury patterns as cited in the literature. Additionally, current ligament strains corroborate the literature to support disproportionate loading of the ACL relative to the MCL during athletic tasks. CLINICAL RELEVANCE These findings indicate that the mechanical impact simulator is an appropriate model for examining independent mechanical variables, treatment techniques, and preventive interventions during athletic tasks leading up to and including an ACL injury. Accordingly, this system can be utilized to further parse out contributing factors to an ACL injury as well as assess the shortcomings of ACL reconstruction techniques in a dynamic, simulated environment that is better representative of in vivo injury scenarios.
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Affiliation(s)
- Nathaniel A. Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathan D. Schilaty
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher V. Nagelli
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA
| | - Timothy E. Hewett
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA,Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
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Green JT, Hale RF, Hausselle J, Gonzalez RV. A Reconfigurable Multiplanar In Vitro Simulator for Real-Time Absolute Motion With External and Musculotendon Forces. J Biomech Eng 2018; 139:2653832. [PMID: 28877307 DOI: 10.1115/1.4037853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Indexed: 12/24/2022]
Abstract
Advancements in computational musculoskeletal biomechanics are constrained by a lack of experimental measurement under real-time physiological loading conditions. This paper presents the design, configuration, capabilities, accuracy, and repeatability of The University of Texas at El Paso Joint Load Simulator (UTJLS) by testing four cadaver knee specimens with 47 real-time tests including heel and toe squat maneuvers with and without musculotendon forces. The UTJLS is a musculoskeletal simulator consisting of two robotic manipulators and eight musculotendon actuators. Sensors include eight tension load cells, two force/torque systems, nine absolute encoders, and eight incremental encoders. A custom control system determines command output for position, force, and hybrid control and collects data at 2000 Hz. Controller configuration performed forward-dynamic control for all knee degrees-of-freedom (DOFs) except knee flexion. Actuator placement and specimen potting techniques uniquely replicate muscle paths. Accuracy and repeatability standard deviations across specimen during squat simulations were equal or less than 8 N and 5 N for musculotendon actuators, 30 N and 13 N for ground reaction forces (GRFs), and 4.4 N·m and 1.9 N·m for ground reaction moments. The UTJLS is the first of its design type. Controller flexibility and physical design support axis constraints to match traditional testing rigs, absolute motion, and synchronous real-time simulation of multiplanar kinematics, GRFs, and musculotendon forces. System DOFs, range of motion, and speed support future testing of faster maneuvers, various joints, and kinetic chains of two connected joints.
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Affiliation(s)
- Joshua T Green
- Mem. ASME Department of Metallurgical, Materials and Biomedical Engineering, College of Engineering, The University of Texas at El Paso, 500 West University Avenue, El Paso, TX 79968 e-mail:
| | - Rena F Hale
- Orthopedic Biomechanics Laboratory, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905 e-mail:
| | - Jerome Hausselle
- Mechanical and Aerospace Engineering, College of Engineering, Architecture and Technology, Oklahoma State University, 218 Engineering North, Stillwater, OK 74078 e-mail:
| | - Roger V Gonzalez
- Mem. ASME Department of Engineering Education and Leadership, College of Engineering, The University of Texas at El Paso, 500 West University Avenue, El Paso, TX 79968 e-mail:
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Bez M, Kremen TJ, Tawackoli W, Avalos P, Sheyn D, Shapiro G, Giaconi JC, Ben David S, Snedeker JG, Gazit Z, Ferrara KW, Gazit D, Pelled G. Ultrasound-Mediated Gene Delivery Enhances Tendon Allograft Integration in Mini-Pig Ligament Reconstruction. Mol Ther 2018; 26:1746-1755. [PMID: 29784586 DOI: 10.1016/j.ymthe.2018.04.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 04/18/2018] [Accepted: 04/20/2018] [Indexed: 02/01/2023] Open
Abstract
Ligament injuries occur frequently, substantially hindering routine daily activities and sports participation in patients. Surgical reconstruction using autogenous or allogeneic tissues is the gold standard treatment for ligament injuries. Although surgeons routinely perform ligament reconstructions, the integrity of these reconstructions largely depends on adequate biological healing of the interface between the ligament graft and the bone. We hypothesized that localized ultrasound-mediated, microbubble-enhanced therapeutic gene delivery to endogenous stem cells would lead to significantly improved ligament graft integration. To test this hypothesis, an anterior cruciate ligament reconstruction procedure was performed in Yucatan mini-pigs. A collagen scaffold was implanted in the reconstruction sites to facilitate recruitment of endogenous mesenchymal stem cells. Ultrasound-mediated reporter gene delivery successfully transfected 40% of cells recruited to the reconstruction sites. When BMP-6 encoding DNA was delivered, BMP-6 expression in the reconstruction sites was significantly enhanced. Micro-computed tomography and biomechanical analyses showed that ultrasound-mediated BMP-6 gene delivery led to significantly enhanced osteointegration in all animals 8 weeks after surgery. Collectively, these findings demonstrate that ultrasound-mediated gene delivery to endogenous mesenchymal progenitor cells can effectively improve ligament reconstruction in large animals, thereby addressing a major unmet orthopedic need and offering new possibilities for translation to the clinical setting.
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Affiliation(s)
- Maxim Bez
- Skeletal Biotech Laboratory, The Hebrew University-Hadassah Faculty of Dental Medicine, Ein Kerem, Jerusalem 91120, Israel; Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Thomas J Kremen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Wafa Tawackoli
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Pablo Avalos
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Dmitriy Sheyn
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Galina Shapiro
- Skeletal Biotech Laboratory, The Hebrew University-Hadassah Faculty of Dental Medicine, Ein Kerem, Jerusalem 91120, Israel
| | - Joseph C Giaconi
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Shiran Ben David
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Jess G Snedeker
- Department of Orthopedics, University of Zurich, Zurich 8008, Switzerland
| | - Zulma Gazit
- Skeletal Biotech Laboratory, The Hebrew University-Hadassah Faculty of Dental Medicine, Ein Kerem, Jerusalem 91120, Israel; Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Katherine W Ferrara
- Department of Biomedical Engineering, University of California, Davis, Davis, CA 95616, USA
| | - Dan Gazit
- Skeletal Biotech Laboratory, The Hebrew University-Hadassah Faculty of Dental Medicine, Ein Kerem, Jerusalem 91120, Israel; Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Gadi Pelled
- Skeletal Biotech Laboratory, The Hebrew University-Hadassah Faculty of Dental Medicine, Ein Kerem, Jerusalem 91120, Israel; Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
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Schilaty ND, Bates NA, Nagelli CV, Krych AJ, Hewett TE. Sex-Based Differences of Medial Collateral Ligament and Anterior Cruciate Ligament Strains With Cadaveric Impact Simulations. Orthop J Sports Med 2018; 6:2325967118765215. [PMID: 29687012 PMCID: PMC5900820 DOI: 10.1177/2325967118765215] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Female patients sustain noncontact knee ligament injuries at a greater rate compared with their male counterparts. The cause of these differences in the injury rate and the movements that load the ligaments until failure are still under dispute in the literature. Purpose/Hypotheses: This study was designed to determine differences in anterior cruciate ligament (ACL) and medial collateral ligament (MCL) strains between male and female cadaveric specimens during a simulated athletic task. The primary hypothesis tested was that female limbs would demonstrate significantly greater ACL strain compared with male limbs under similar loading conditions. A secondary hypothesis was that MCL strain would not differ between sexes. Study Design: Controlled laboratory study. Methods: Motion analysis of 67 athletes performing a drop vertical jump was conducted. Kinetic data were used to categorize injury risk according to tertiles, and these values were input into a cadaveric impact simulator to assess ligamentous strain during a simulated landing task. Uniaxial and multiaxial load cells and differential variable reluctance transducer strain sensors were utilized to collect mechanical data for analysis. Conditions of external loads applied to the cadaveric limbs (knee abduction moment, anterior tibial shear, and internal tibial rotation) were varied and randomized. Data were analyzed using 1-way analysis of variance (ANOVA), 2-way repeated-measures ANOVA, and the Fisher exact test. Results: There were no significant differences (P = .184) in maximum ACL strain between male (13.2% ± 8.1%) and female (16.7% ± 8.3%) specimens. Two-way ANOVA demonstrated that across all controlled external load conditions, female specimens consistently attained at least 3.5% increased maximum ACL strain compared with male specimens (F1,100 = 4.188, P = .043); however, when normalized to initial contact, no significant difference was found. There were no significant differences in MCL strain between sexes for similar parameters. Conclusion: When compared with baseline, female specimens exhibited greater values of ACL strain at maximum, initial contact, and after impact (33, 66, and 100 milliseconds, respectively) than male specimens during similar loading conditions, with a maximum strain difference of at least 3.5%. During these same loading conditions, there were no differences in MCL loading between sexes, and only a minimal increase of MCL loading occurred during the impact forces. Our results indicate that female patients are at an increased risk for ACL strain across all similar conditions compared with male patients. Clinical Relevance: These data demonstrate that female specimens, when loaded similarly to male specimens, experience additional strain on the ACL. As the mechanical environment was similar for both sexes with these simulations, the greater ACL strain of female specimens must be attributed to ligament biology, anatomic differences, or muscular stiffness.
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Affiliation(s)
- Nathan D Schilaty
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathaniel A Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher V Nagelli
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy E Hewett
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA.,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
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McPherson AL, Bates NA, Schilaty ND, Nagelli CV, Krych AJ, Hewett TE. Ligament Strain Response Between Lower Extremity Contralateral Pairs During In Vitro Landing Simulation. Orthop J Sports Med 2018; 6:2325967118765978. [PMID: 29662914 PMCID: PMC5894909 DOI: 10.1177/2325967118765978] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Limb asymmetries, as determined through in vivo biomechanical measures, are known risk factors for anterior cruciate ligament (ACL) injury. Previous cadaveric studies have shown a lack of significant differences in ligament strain between contralateral lower extremities when identical kinematics were simulated on specimens. Recent methodological developments have applied in vivo knee kinetics to exert landing forces on cadaveric lower extremities to mimic ACL injury events, but it is unknown whether contralateral limbs fail in a consistent manner during impact simulator testing. Hypothesis: It was hypothesized that contralateral lower extremities would not exhibit side-to-side differences in ligament strains. Furthermore, it was hypothesized that failure loads and failure locations would be independent of limb dominance. Study Design: Controlled laboratory study. Methods: Fourteen pairs of cadaveric lower extremities were obtained from an anatomic donations program (8 female, 6 male; mean ± SD: age, 41.7 ± 8.1 years; mass, 86.8 ± 27.0 kg; body mass index, 29.4 ± 9.0 kg/m2). A mechanical impact simulator was used to re-create the impulse ground-reaction force generated during an in vivo landing task. Ligament strains were recorded by differential variable force transducers implanted on the ACL and medial collateral ligament (MCL). Results: No significant differences were observed in peak ACL or peak MCL strain for 5 loading conditions. Fisher exact tests of independence revealed that limb dominance was independent of both load at failure and failure location. Conclusion: There were no significant differences in ACL and MCL strain values between limb sides during in vitro impact simulation testing. This finding indicates that limb dominance does not influence the failure threshold of the ACL, since there was no significant difference in failure strains. The functional mechanics of the ACL are comparable between contralateral pairs from the same healthy specimen. Clinical Relevance: Injury mechanisms and intra-articular mechanics cannot be ethically studied in an in vivo setting. The current study provides additional insight into limb asymmetry that is observed among athletes in clinical sports medicine settings.
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Affiliation(s)
- April L McPherson
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota, USA.,Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathanial A Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathan D Schilaty
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher V Nagelli
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy E Hewett
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA.,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
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Schilaty ND, Bates NA, Nagelli C, Krych AJ, Hewett TE. Sex-Based Differences in Knee Kinetics With Anterior Cruciate Ligament Strain on Cadaveric Impact Simulations. Orthop J Sports Med 2018; 6:2325967118761037. [PMID: 29568787 PMCID: PMC5858624 DOI: 10.1177/2325967118761037] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Females are at an increased risk of sustaining noncontact knee ligament injuries as compared with their male counterparts. The kinetics that load the anterior cruciate ligament (ACL) are still under dispute in the literature. Purpose/Hypothesis: The purpose of this study was to determine whether there are differences in knee kinetics between the sexes that lead to greater ACL strain in females when similar external loads are applied during a simulated drop vertical jump landing task. It was hypothesized that female limbs would demonstrate significant differences in knee abduction moment that predispose females to ACL injury when compared with males. Study Design: Controlled laboratory study. Methods: Motion analysis data of 67 athletes who performed a drop vertical jump were collected. The kinematic and kinetic data were used to categorize tertiles of relative risk, and these values were input into a cadaveric impact simulator to assess ligamentous loads during the simulated landing task. Uni- and multiaxial load cells and differential variable reluctance transducer strain sensors were utilized to collect kinetic data and maximum ACL strain for analysis. Conditions of external loads applied to the cadaveric limbs were systematically varied and randomized. Data were analyzed with 2-way repeated-measures analysis of variance and the Fisher exact test. Results: Five kinetic parameters were evaluated. Of the 5 kinetic variables, only knee abduction moment (KAM) demonstrated significant differences in females as compared with males (F1,136 = 4.398, P = .038). When normalized to height and weight, this difference between males and females increased in significance (F1,136 = 7.155, P = .008). Compared with males, females exhibited a 10.3-N·m increased knee abduction torque at 66 milliseconds postimpact and a 22.3-N·m increased abduction torque at 100 milliseconds postimpact. For loading condition, the condition of “maximum ACL strain” demonstrated a maximum difference of 54.3-N·m increased abduction torque and 74.5-N·m increased abduction torque at 66 milliseconds postimpact. Conclusion: Under the tested conditions, increased external loads led to increased medial knee translation force, knee abduction moment, and external knee moment. Females exhibited greater forces and moments at the knee, especially at KAM, when loaded in similar conditions. As these KAM loads are associated with increased load and strain on the ACL, the sex-based differences observed in the present study may account for a portion of the underlying mechanics that predispose females to ACL injury as compared with males in a controlled simulated athletic task. Clinical Relevance: KAM increases strain to the ACL under clinically representative loading. Additionally, this work establishes the biomechanical characteristics of knee loading between sexes.
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Affiliation(s)
- Nathan D Schilaty
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathaniel A Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher Nagelli
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy E Hewett
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA.,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
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Bates NA, Nesbitt RJ, Shearn JT, Myer GD, Hewett TE. The influence of internal and external tibial rotation offsets on knee joint and ligament biomechanics during simulated athletic tasks. Clin Biomech (Bristol, Avon) 2018; 52:109-116. [PMID: 29425835 PMCID: PMC5835205 DOI: 10.1016/j.clinbiomech.2018.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 01/16/2018] [Accepted: 01/22/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Following anterior cruciate ligament injury and subsequent reconstruction transverse plane tibiofemoral rotation becomes underconstrained and overconstrained, respectively. Conflicting reports exist on how rotations influence loading at the knee. This investigation aimed to determine the mechanical effects of internal and external tibial rotation offsets on knee kinematics and ligament strains during in vitro simulations of in vivo recorded kinematics. METHOD A 6-degree-of-freedom robotic manipulator arm was used to articulate 11 cadaveric tibiofemoral joint specimens through simulations of four athletic tasks produced from in vivo recorded kinematics. These simulations were then repeated with 4° tibial rotation offsets applied to the baseline joint orientation. FINDINGS Rotational offsets had a significant effect on peak posterior force for female motion simulations (P < 0.01), peak lateral force for most simulated tasks (P < 0.01), and peak anterior force, internal torque, and flexion torque for sidestep cutting tasks (P ≤ 0.01). Rotational offsets did not exhibit statistically significant effects on peak anterior cruciate ligament strain (P > 0.05) or medial collateral ligament strain (P > 0.05) for any task. INTERPRETATION Transverse plane rotational offsets comparable to those observed in anterior cruciate ligament deficient and reconstructed patients alter knee kinetics without significantly altering anterior cruciate ligament strain. As knee degeneration is attributed to abnormal knee loading profiles, altered transverse plane kinematics may contribute to this. However, altered transverse plane rotations likely play a limited role in anterior cruciate ligament injury risk as physiologic offsets failed to significantly influence anterior cruciate ligament strain during athletic tasks.
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Affiliation(s)
- Nathaniel A. Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA
| | - Rebecca J. Nesbitt
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Jason T. Shearn
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Gregory D. Myer
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA,Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Timothy E. Hewett
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA,Sports Medicine Center, Mayo Clinic, Rochester, MN, USA,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
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Nesbitt RJ, Bates NA, Rao MB, Schaffner G, Shearn JT. Effects of Population Variability on Knee Loading During Simulated Human Gait. Ann Biomed Eng 2017; 46:284-297. [PMID: 29159731 DOI: 10.1007/s10439-017-1956-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 11/03/2017] [Indexed: 01/11/2023]
Abstract
Cadaveric simulation models allow researchers to study native tissues in situ. However, as tests are conducted using donor specimens with unmatched kinematics, techniques that impose population average motions are subject to deviation from true physiologic conditions. This study aimed to identify factors which explain the kinetic variability observed during robotic simulations of a single human gait motion using a sample of human cadaver knees. Twelve human cadaver limbs (58 ± 16 years) were subjected to tibiofemoral geometrical analysis and cyclical stiffness testing in each anatomical degree of freedom. A simulated gait motion was then applied to each specimen. Resulting kinetics, specimen geometries, and various representations of tissue stiffness were reduced to functional attributes using principal component analysis and fit to a generalized linear prediction model. The capacity of knee topography to generate force was the largest contributor to kinetic variation in compression. Overall joint size, femoral notch height, translational laxity, and ad/abduction stiffness significantly contributed to kinetic variation in medial/lateral and anterior/posterior forces and associated torques. Future studies will investigate customizing kinematic paths to better simulate native conditions and reduce sampling variation, improving biomechanical test methods and evaluation strategies for future orthopedic techniques.
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Affiliation(s)
- Rebecca J Nesbitt
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Nathaniel A Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Marepalli B Rao
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
- Department of Environmental Health-Genomics, University of Cincinnati, Cincinnati, OH, USA
| | - Grant Schaffner
- Department of Aerospace Engineering & Engineering Mechanics, University of Cincinnati, Cincinnati, OH, USA
| | - Jason T Shearn
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
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Bates NA, Nesbitt RJ, Shearn JT, Myer GD, Hewett TE. Knee Abduction Affects Greater Magnitude of Change in ACL and MCL Strains Than Matched Internal Tibial Rotation In Vitro. Clin Orthop Relat Res 2017; 475:2385-2396. [PMID: 28455730 PMCID: PMC5599390 DOI: 10.1007/s11999-017-5367-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injures incur over USD 2 billion in annual medical costs and prevention has become a topic of interest in biomechanics. However, literature conflicts persist over how knee rotations contribute to ACL strain and ligament injury. To maximize the efficacy of ACL injury prevention, the effects of underlying mechanics need to be better understood. QUESTIONS/PURPOSES We applied robotically controlled, in vivo-derived kinematic stimuli to the knee to assess ligament biomechanics in a cadaver model. We asked: (1) Does the application of abduction rotation increase ACL and medial collateral ligament (MCL) strain relative to the normal condition? (2) Does the application of internal tibial rotation impact ACL strain relative to the neutral condition? (3) Does combined abduction and internal tibial rotation increase ligament strain more than either individual contribution? METHODS A six-degree-of-freedom robotic manipulator was used to position 17 cadaveric specimens free from knee pathology outside of low-grade osteoarthritis (age, 47 ± 8 years; 13 males, four females) into orientations that mimic initial contact recorded from in vivo male and female drop vertical jump and sidestep cutting activities. Four-degree rotational perturbations were applied in both directions from the neutral alignment position (creating an 8° range) for each frontal, transverse, and combined planes while ACL and MCL strains were continuously recorded with DVRT strain gauges implanted directly on each ligament. Analysis of variance models with least significant difference post hoc analysis were used to assess differences in ligament strain and joint loading between sex, ligament condition, or motion task and rotation type. RESULTS For the female drop vertical jump simulation in the intact knee, isolated abduction and combined abduction/internal rotational stimuli produced the greatest change in strain from the neutral position as compared with all other stimuli within the ACL (1.5% ± 1.0%, p ≤ 0.035; 1.8% ± 1.3%, p ≤ 0.005) and MCL (1.8% ± 1.0%, p < 0.001; 1.6% ± 1.3%, p < 0.001) compared with all other applied stimuli. There were no differences in mean peak ACL strain between any rotational stimuli (largest mean difference = 2.0%; 95% confidence interval [CI], -0.9% to 5.0%; p = 0.070). These trends were consistent for all four simulated tasks. Peak ACL strain in the intact knee was larger than peak MCL strain for all applied rotational stimuli in the drop vertical jump simulations (smallest mean difference = 2.1%; 95% CI, -0.4% to 4.5%; p = 0.047). CONCLUSIONS Kinematically constrained cadaveric knee models using peak strain as an outcome variable require greater than 4° rotational perturbations to elicit changes in intraarticular ligaments. CLINICAL RELEVANCE Because combined rotations and isolated abduction produced greater change in strain relative to the neutral position for the ACL and MCL than any other rotational stimuli in this cadaver study, hypotheses for in vivo investigations aimed toward injury prevention that focuses on the reduction of frontal plane knee motion should be considered. Furthermore, reduced strain in the MCL versus the ACL may help explain why only 30% of ACL ruptures exhibit concomitant MCL injuries.
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Affiliation(s)
- Nathaniel A. Bates
- Departments of Orthopedic Surgery and Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN 55902 USA
| | - Rebecca J. Nesbitt
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH USA
| | - Jason T. Shearn
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH USA
| | - Gregory D. Myer
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, USA; and the Departments of Pediatrics and Orthopedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH USA
| | - Timothy E. Hewett
- Departments of Orthopedic Surgery and Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN 55902 USA ,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN USA
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Read CR, Aune KT, Cain EL, Fleisig GS. Return to Play and Decreased Performance After Anterior Cruciate Ligament Reconstruction in National Football League Defensive Players. Am J Sports Med 2017; 45:1815-1821. [PMID: 28467122 DOI: 10.1177/0363546517703361] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries occur commonly in football. Recent work has reported ACL reconstruction (ACLR) as one of several orthopaedic procedures with unfavorable outcomes for professional athletes. The performance impact to defensive players after surgery has not been quantified. PURPOSE To quantify the effect of ACLR on the performance of defensive players by comparing them to a cohort of matched controls as well as to measure the effect of ACLR on athletes' career length in the National Football League (NFL). STUDY DESIGN Case-control and cohort study; Level of evidence, 3. METHODS Thirty-eight NFL defensive players with a history of ACLR from 2006 to 2012 were identified. For each injured player, a matched control player was identified. Demographic and performance statistics were collected from the online NFL player database. Players who returned after ACLR (n = 23) were compared with players who did not return (n = 15) using t tests and chi-squared analyses. Similarly, players who returned after ACLR (n = 23) were compared with their matched controls with t tests and chi-squared analyses. Two-way repeated-measures analysis of variance was utilized to test for significant differences between performance before and after the season of the injury for the players in the ACLR group who returned (n = 23) and for their matched controls. Kaplan-Meier analysis was performed to test for differences in the rate of retirement between the groups. For all analyses, P values <.05 were considered significant. RESULTS Approximately 74% (28/38) of athletes who underwent ACLR returned to play at least 1 NFL game, and 61% (23/38) successfully returned to play at least half a season (ie, 8 games). Athletes in the ACLR group who returned retired from the NFL significantly sooner and more often after surgery than their matched controls. In the seasons leading up to their injury, athletes who successfully returned to play started a greater percentage of their games (81%) and made more solo tackles per game (3.44 ± 1.47) compared with athletes in the ACLR group who did not return to play (54% and 1.82 ± 1.17, respectively) and compared with healthy control players (52% and 1.77 ± 1.19, respectively). After the season of surgery, athletes in the ACLR group who returned to play decreased to 57% games started and 2.38 ± 1.24 solo tackles per game, while their matched controls suffered no significant decreases. CONCLUSION Players who successfully returned were above-average NFL players before their injury but comparatively average after their return.
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Affiliation(s)
- Connor R Read
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Kyle T Aune
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - E Lyle Cain
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Glenn S Fleisig
- American Sports Medicine Institute, Birmingham, Alabama, USA
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Vaienti E, Scita G, Ceccarelli F, Pogliacomi F. Understanding the human knee and its relationship to total knee replacement. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:6-16. [PMID: 28657560 DOI: 10.23750/abm.v88i2 -s.6507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 11/23/2022]
Abstract
The knee is the intermediate joint of the lower limb and it allows the movement between the femur, tibia and patella. Under normal conditions there is a normal distribution of the load forces on these three articular components in both the static load and during ambulation. The understanding of anatomy and knee biomechanics is important for the gait analysis, the diagnosis of joint diseases and the design and development of prosthetic implants. In the last decades comprehension of knee physiology and kinematics has led to the introduction of a wide range of enhanced prosthetic implant designs for a variety of indications. There are a number of types of total knee arthroplasty implant designs, which are intended to offer the surgeon options for individual patients. The various choices imply that each specific problem has a corresponding implant that provides a reliable solution. However, until the current date, it has not been possible to produce a prosthetic design fully restoring the complex kinematics of the normal knee joint.
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40
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Bates NA, Schilaty ND, Nagelli CV, Krych AJ, Hewett TE. Novel mechanical impact simulator designed to generate clinically relevant anterior cruciate ligament ruptures. Clin Biomech (Bristol, Avon) 2017; 44:36-44. [PMID: 28319734 PMCID: PMC5425932 DOI: 10.1016/j.clinbiomech.2017.03.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/09/2017] [Accepted: 03/09/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Over 250,000 anterior cruciate ligament ruptures occur each year; therefore, it is important to understand the underlying mechanisms of these injuries. The objective of the current investigation was to develop and analyze an impact test device that consistently produces anterior cruciate ligament failure in a clinically relevant manner. METHOD A mechanical impact simulator was developed to simulate the ground reaction force impulse generated from landing in a physiologic and clinically relevant manner. External knee abduction moment, anterior shear, and internal tibial rotation loads were applied to the specimen via pneumatic actuators. The magnitudes of applied loads were determined in vivo from a cohort of healthy athletes. Loads were systematically increased until specimen failure was induced. Three cadaveric lower extremity specimens were tested and clinically assessed for failure. Knee specimens were physically and arthroscopically examined at baseline and at post-injury by a board certified orthopedic surgeon. FINDINGS All three specimens experienced failure at either the midsubstance or the femoral insertion site. The mean peak strain prior to failure was 18.8 (6.2)%, while the mean peak medial collateral ligament strain was 7.9 (5.9)%. INTERPRETATION A board certified orthopedic surgeon confirmed observed rupture patterns were representative of clinical cases. Peak strains were consistent with literature. The novel mechanical impact simulator will allow researchers to assess clinically relevant patterns of rupture and the data generated will inform clinician decisions. This novel machine presents the ability to assess healthy specimens as well as differences in the function of deficient and reconstructed knees.
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Affiliation(s)
- Nathaniel A. Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathan D. Schilaty
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA
| | - Timothy E. Hewett
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA,Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA,Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
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Schilaty ND, Bates NA, Krych AJ, Hewett TE. How Anterior Cruciate Ligament Injury was averted during Knee Collapse in a NBA Point Guard. ANNALS OF MUSCULOSKELETAL MEDICINE 2017; 1:008-12. [PMID: 28603786 PMCID: PMC5463573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Non-contact anterior cruciate ligament (ACL) injuries occur with rapid decelerations and pivoting. A recent injury to a high-level National Basketball Association (NBA) player demonstrated neuromuscular control and injury-sparing mechanisms that resulted in only minor ligament injury to the medial collateral ligament. We analyzed biomechanical mechanisms via publically available orthogonal 2-D video to demonstrate how this potential ACL injury was averted. Analysis of the knee injury mechanism demonstrated that the NBA player experienced low ground reaction force, high sagittal plane flexion, and maintenance of frontal plane stability with neuromuscular control. The outcome of these factors inhibited dynamic valgus collapse of the knee throughout the fall, avoiding ACL injury - a potentially career-altering injury. Many athletes, professional and recreational, will be subjected to similar mechanisms of injury and will have improved outcomes if they can successfully utilize preventive strategies of neuromuscular control to limit injury mechanisms.
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Affiliation(s)
- Nathan D Schilaty
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathaniel A Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy E Hewett
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA
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Matsushita T, Nagai K, Araki D, Tanaka T, Matsumoto T, Nishida K, Kurosaka M, Kuroda R. Factors associated with the status of meniscal tears following meniscal repair concomitant with anterior cruciate ligament reconstruction. Connect Tissue Res 2017; 58:386-392. [PMID: 28102713 DOI: 10.1080/03008207.2017.1281257] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Anterior cruciate ligament (ACL) injuries are often accompanied by meniscal tears. Meniscal repair is typically performed during ACL reconstruction. However, retear of the meniscus after repair is frequent. The purpose of this study was to analyze the factors associated with meniscal healing after meniscal repair concomitant with ACL reconstruction. MATERIALS AND METHODS Eighty-seven meniscal repairs in 87 patients who received meniscal repair combined with ACL reconstruction and received second-look arthroscopy at a mean of postoperatively 15.7 months were examined retrospectively. The menisci were divided into three groups (complete heal, incomplete heal, and retear), and factors thought to affect the healing status of repaired menisci were analyzed using multivariate logistic regression analysis. RESULTS Meniscal healing was judged to be complete in 49 knees (56%), incomplete in 19 knees, (22%), and retear in 19 knees (22%). There were no significant differences among the three groups in age, sex, time from injury to operation, mean Tegner activity scale, tear location, or mean postoperative anteroposterior tibial translation on KT-1000. The mean length of the tear was significantly higher in the retear group. Additionally, the proportion patients with complete tear and the proportion with postoperative positive pivot shift test were significantly higher in the retear group than in the other groups. Multivariate logistic regression analysis showed that complete tear and positive pivot shift test were associated with retear. CONCLUSIONS These findings suggest that complete tears and residual instability are associated with retears after meniscal repair concomitant with ACL reconstruction.
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Affiliation(s)
- Takehiko Matsushita
- a Department of Orthopaedic Surgery , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Kanto Nagai
- a Department of Orthopaedic Surgery , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Daisuke Araki
- a Department of Orthopaedic Surgery , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Toshikazu Tanaka
- a Department of Orthopaedic Surgery , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Tomoyuki Matsumoto
- a Department of Orthopaedic Surgery , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Kotaro Nishida
- a Department of Orthopaedic Surgery , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Masahiro Kurosaka
- a Department of Orthopaedic Surgery , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Ryosuke Kuroda
- a Department of Orthopaedic Surgery , Kobe University Graduate School of Medicine , Kobe , Japan
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Vaienti E, Scita G, Ceccarelli F, Pogliacomi F. Understanding the human knee and its relationship to total knee replacement. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88. [PMID: 28657560 PMCID: PMC6178997 DOI: 10.23750/abm.v88i2-s.6507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The knee is the intermediate joint of the lower limb and it allows the movement between the femur, tibia and patella. Under normal conditions there is a normal distribution of the load forces on these three articular components in both the static load and during ambulation. The understanding of anatomy and knee biomechanics is important for the gait analysis, the diagnosis of joint diseases and the design and development of prosthetic implants. In the last decades comprehension of knee physiology and kinematics has led to the introduction of a wide range of enhanced prosthetic implant designs for a variety of indications. There are a number of types of total knee arthroplasty implant designs, which are intended to offer the surgeon options for individual patients. The various choices imply that each specific problem has a corresponding implant that provides a reliable solution. However, until the current date, it has not been possible to produce a prosthetic design fully restoring the complex kinematics of the normal knee joint.
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Affiliation(s)
| | | | | | - Francesco Pogliacomi
- Correspondence: Francesco Pogliacomi, MD Orthopaedics and Traumatology Clinic, Department of Medicine and Surgery, University of Parma, Italy, Via Gramsci, 14 - 43126 Parma (Italy) Tel. 00390521702850 Fax: 00390521290439 E-mail:
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Sonesson S, Kvist J, Ardern C, Österberg A, Silbernagel KG. Psychological factors are important to return to pre-injury sport activity after anterior cruciate ligament reconstruction: expect and motivate to satisfy. Knee Surg Sports Traumatol Arthrosc 2017; 25:1375-1384. [PMID: 27562372 PMCID: PMC5432589 DOI: 10.1007/s00167-016-4294-8] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 08/12/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE To describe individuals' expectations, motivation, and satisfaction before, during, and after rehabilitation for ACL reconstruction and to explore how these factors were associated with return to pre-injury sport activity at 1-year follow-up. METHODS Sixty-five individuals (34 males), median age 22 (15-45) years, scheduled for ACL reconstruction participated. Participants completed the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) and questions about expectations, satisfaction, and motivation pre-operatively and at 16 and 52 weeks after surgery. RESULTS Prior to surgery, 86 % of participants stated that their goal was to return to their pre-injury sport activity. Those who had returned to their pre-injury sport activity at 52 weeks were more motivated during rehabilitation to return to their pre-injury activity level, more satisfied with their activity level and knee function at 52 weeks, and scored significantly higher on the IKDC-SKF [median 92.0 (range 66.7-100.0)] at 52 weeks, compared to those who had not returned [median 77.6 (range 50.6-97.7)]. CONCLUSION Prior to ACL reconstruction, most participants expected to return to their pre-injury activity level. Higher motivation during rehabilitation was associated with returning to the pre-injury sport activity. The participants who had returned to their pre-injury sport activity were more satisfied with their activity level and knee function 1 year after the ACL reconstruction. Facilitating motivation might be important to support individuals in achieving their participation goals after ACL reconstruction. LEVEL OF EVIDENCE Prospective cohort study, Level II.
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Affiliation(s)
- Sofi Sonesson
- Division of Physiotherapy, Linköping University, 581 83, Linköping, Sweden.
| | - Joanna Kvist
- 0000 0001 2162 9922grid.5640.7Division of Physiotherapy, Linköping University, 581 83 Linköping, Sweden
| | - Clare Ardern
- 0000 0001 2162 9922grid.5640.7Division of Physiotherapy, Linköping University, 581 83 Linköping, Sweden ,0000 0001 2342 0938grid.1018.8School of Allied Health, Faculty of Health Sciences, La Trobe University, Melbourne, VIC Australia ,Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Annika Österberg
- 0000 0001 2162 9922grid.5640.7Division of Physiotherapy, Linköping University, 581 83 Linköping, Sweden ,0000 0004 1936 9457grid.8993.bCentre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Karin Grävare Silbernagel
- 0000 0001 0454 4791grid.33489.35Department of Physical Therapy, University of Delaware, Newark, DE USA
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Oberhofer K, Hosseini Nasab SH, Schütz P, Postolka B, Snedeker JG, Taylor WR, List R. The influence of muscle-tendon forces on ACL loading during jump landing: a systematic review. Muscles Ligaments Tendons J 2017; 7:125-135. [PMID: 28717620 PMCID: PMC5505580 DOI: 10.11138/mltj/2017.7.1.125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The goal of this review is to summarise and discuss the reported influence of muscle-tendon forces on anterior cruciate ligament (ACL) loading during the jump-landing task by means of biomechanical analyses of the healthy knee. METHODS A systematic review of the literature was conducted using different combinations of the terms "knee", "ligament", "load", "tension ", "length", "strain", "elongation" and "lengthening". 26 original articles (n=16 in vitro studies; n=10 in situ studies) were identified which complied with all inclusion/exclusion criteria. RESULTS No apparent trend was found between ACL loading and the ratio between hamstrings and quadriceps muscle-tendon forces prior to or during landing. Four in vitro studies reported reduced peak ACL strain if the quadriceps force was increased; while one in vitro study and one in situ study reported reduced ACL loading if the hamstrings force was increased. A meta-analysis of the reported results was not possible because of the heterogeneity of the confounding factors. CONCLUSION The reported results suggest that increased hip flexion during landing may help in reducing ACL strain by lengthening the hamstrings, and thus increasing its passive resistance to stretch. Furthermore, it appears that increased tensile stiffness of the quadriceps may help in stabilising the knee joint during landing, and thus protecting the passive soft-tissue structures from overloading. LEVEL OF EVIDENCE Ib.
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Affiliation(s)
| | | | | | | | - Jess G. Snedeker
- Institute for Biomechanics, ETH Zürich, Switzerland
- University Hospital Balgrist, Zürich, Switzerland
| | | | - Renate List
- Institute for Biomechanics, ETH Zürich, Switzerland
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Postoperative time dependent tibiofemoral articular cartilage contact kinematics during step-up after ACL reconstruction. J Biomech 2016; 49:3509-3515. [PMID: 27720228 DOI: 10.1016/j.jbiomech.2016.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 11/23/2022]
Abstract
This study was to investigate the in vivo tibiofemoral cartilage contact locations before and after anterior cruciate ligament (ACL) reconstruction at 6 and 36 months. Ten patients with unilateral ACL injury were included. A step-up motion was analyzed using a combined magnetic resonance modeling and dual fluoroscopic imaging techniques. The preoperative (i.e. ACL deficient and healthy contralateral) and postoperative cartilage contact locations at 6 and 36 months were analyzed. Similar patterns of the cartilage contact locations during the step-up motion were found for the preoperative and postoperative knee states as compared to the preoperative healthy contralateral side. At the end of step-up motion, the medial contact locations at postoperative 36 months were more anterior when compared to the preoperative healthy contralateral (p=0.02) and 6 months postoperative knee states (p=0.01). The changes of the cartilage contact locations at 36 months after ACL reconstruction compared to the healthy contralateral side were strongly correlated with the changes at 6 months postoperatively. This study showed that the tibiofemoral cartilage contact locations of the knee changes with time after ACL reconstruction, implying an ongoing recovery process within the 36 months after the surgery. There could be an association between the short-term (6 months) and longer-term (36 months) contact kinematics after ACL reconstruction. Future studies need to investigate the intrinsic relationship between knee kinematics at different times after ACL reconstruction.
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Sex-based differences in knee ligament biomechanics during robotically simulated athletic tasks. J Biomech 2016; 49:1429-1436. [PMID: 27083058 DOI: 10.1016/j.jbiomech.2016.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 12/18/2015] [Accepted: 03/02/2016] [Indexed: 01/12/2023]
Abstract
ACL injury rates are greater in female athletes than their male counterparts. As female athletes are at increased risk, it is important to understand the underlying mechanics that contribute to this sex bias. The purpose of this investigation was to employ a robotic manipulator to simulate male and female kinematics from athletic tasks on cadaveric specimens and identify sex-based mechanical differences relative to the ACL loading. It was hypothesized that simulations of female motion would generate the higher loads and ligament strains associated with in vivo ACL injury risk than simulations of male motion. A 6-degree-of-freedom robotic manipulator articulated cadaveric lower extremity specimens from 12 donors through simulations of in vivo kinematics recorded from male and female athletic tasks. Simulation of female kinematics exhibited lower peak lateral joint force during the drop vertical jump and lower peak anterior and lateral joint force and external joint torque during the sidestep cut (P<0.05). Peak ACL strain during a drop vertical jump was 6.27% and 6.61% for the female and male kinematic simulations, respectively (P=0.86). Peak ACL strain during a sidestep cut was 4.33% and 7.57% for female and male kinematic simulations respectively (P=0.21). For the tasks simulated, the sex-based loading and strain differences identified were unlikely to have a significant bearing on the increased rate of ACL injures observed in female athletes. Additional perturbation may be necessary to invoke the mechanisms that lead to higher rates of ACL injury in female populations.
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Abstract
Anterior cruciate ligament (ACL) injuries are common, catastrophic events that incur large expense and lead to degradation of the knee. As such, various motion capture techniques have been applied to identify athletes who are at increased risk for suffering ACL injuries. The objective of this clinical commentary was to synthesize information related to how motion capture analyses contribute to the identification of risk factors that may predict relative injury risk within a population. Individuals employ both active and passive mechanisms to constrain knee joint articulation during motion. There is strong evidence to indicate that athletes who consistently classify as high-risk loaders during landing suffer from combined joint stability deficits in both the active and passive knee restraints. Implementation of prophylactic neuromuscular interventions and biofeedback can effectively compensate for some of the deficiencies that result from poor control of the active knee stabilizers and reduce the incidence of ACL injuries.
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Affiliation(s)
- Nathaniel A. Bates
- The Sports Health and Performance Institute, The Ohio State University, Columbus, OH, USA,Sports Medicine Biodynamics Center, Division of Sports Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Timothy E. Hewett
- The Sports Health and Performance Institute, The Ohio State University, Columbus, OH, USA,Sports Medicine Biodynamics Center, Division of Sports Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA,Departments of Physiology and Cell Biology, Orthopaedic Surgery, Family Medicine, and Biomedical Engineering, The Ohio State University, Columbus, OH, USA
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Bates NA, Nesbitt RJ, Shearn JT, Myer GD, Hewett TE. Relative strain in the anterior cruciate ligament and medial collateral ligament during simulated jump landing and sidestep cutting tasks: implications for injury risk. Am J Sports Med 2015; 43:2259-69. [PMID: 26150588 PMCID: PMC6584634 DOI: 10.1177/0363546515589165] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The medial collateral (MCL) and anterior cruciate ligaments (ACL) are, respectively, the primary and secondary ligamentous restraints against knee abduction, which is a component of the valgus collapse often associated with ACL rupture during athletic tasks. Despite this correlation in function, MCL ruptures occur concomitantly in only 20% to 40% of ACL injuries. HYPOTHESIS/PURPOSE The purpose of this investigation was to determine how athletic tasks load the knee joint in a manner that could lead to ACL failure without concomitant MCL failure. It was hypothesized that (1) the ACL would provide greater overall contribution to intact knee forces than the MCL during simulated motion tasks and (2) the ACL would show greater relative peak strain compared with the MCL during simulated motion tasks. STUDY DESIGN Controlled laboratory study. METHODS A 6-degrees-of-freedom robotic manipulator articulated 18 cadaveric knees through simulations of kinematics recorded from in vivo drop vertical jump and sidestep cutting tasks. Specimens were articulated in the intact-knee and isolated-ligament conditions. After simulation, each ACL and MCL was failed in uniaxial tension along its fiber orientations. RESULTS During a drop vertical jump simulation, the ACL experienced greater peak strain than the MCL (6.1% vs 0.4%; P < .01). The isolated ACL expressed greater peak anterior force (4.8% vs 0.3% body weight; P < .01), medial force (1.6% vs 0.4% body weight; P < .01), flexion torque (8.4 vs 0.4 N·m; P < .01), abduction torque (2.6 vs 0.3 N·m; P < .01), and adduction torque (0.5 vs 0.0 N·m; P = .03) than the isolated MCL. During failure testing, ACL specimens preferentially loaded in the anteromedial bundle failed at 637 N, while MCL failure occurred at 776 N. CONCLUSION During controlled physiologic athletic tasks, the ACL provides greater contributions to knee restraint than the MCL, which is generally unstrained and minimally loaded. CLINICAL RELEVANCE Current findings support that multiplanar loading during athletic tasks preferentially loads the ACL over the MCL, leaving the ACL more susceptible to injury. An enhanced understanding of joint loading during in vivo tasks may provide insight that enhances the efficacy of injury prevention protocols.
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Affiliation(s)
- Nathaniel A. Bates
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,The Sports Health and Performance Institute, The Ohio State University, Columbus, Ohio, USA.,Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA.,Division of Sports Medicine Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rebecca J. Nesbitt
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jason T. Shearn
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA
| | - Gregory D. Myer
- The Sports Health and Performance Institute, The Ohio State University, Columbus, Ohio, USA.,Division of Sports Medicine Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
| | - Timothy E. Hewett
- The Sports Health and Performance Institute, The Ohio State University, Columbus, Ohio, USA.,Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA.,Division of Sports Medicine Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA.,Departments of Physiology and Cell Biology, Orthopaedics, Family Medicine, and Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA.,Address correspondence to Timothy E. Hewett, PhD, The Sports Health and Performance Institute, The Ohio State University, Columbus, Ohio, USA ()
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Bates NA, Nesbitt RJ, Shearn JT, Myer GD, Hewett TE. A Novel Methodology for the Simulation of Athletic Tasks on Cadaveric Knee Joints with Respect to In Vivo Kinematics. Ann Biomed Eng 2015; 43:2456-66. [PMID: 25869454 DOI: 10.1007/s10439-015-1285-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
Abstract
Six degree of freedom (6-DOF) robotic manipulators have simulated clinical tests and gait on cadaveric knees to examine knee biomechanics. However, these activities do not necessarily emulate the kinematics and kinetics that lead to anterior cruciate ligament (ACL) rupture. The purpose of this study was to determine the techniques needed to derive reproducible, in vitro simulations from in vivo skin-marker kinematics recorded during simulated athletic tasks. Input of raw, in vivo, skin-marker-derived motion capture kinematics consistently resulted in specimen failure. The protocol described in this study developed an in-depth methodology to adapt in vivo kinematic recordings into 6-DOF knee motion simulations for drop vertical jumps and sidestep cutting. Our simulation method repeatably produced kinetics consistent with vertical ground reaction patterns while preserving specimen integrity. Athletic task simulation represents an advancement that allows investigators to examine ACL-intact and graft biomechanics during motions that generate greater kinetics, and the athletic tasks are more representative of documented cases of ligament rupture. Establishment of baseline functional mechanics within the knee joint during athletic tasks will serve to advance the prevention, repair and rehabilitation of ACL injuries.
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Affiliation(s)
- Nathaniel A Bates
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA.,Sports Medicine Biodynamics Center, Division of Sports Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,The Sports Health and Performance Institute, The Ohio State University, Columbus, OH, USA
| | - Rebecca J Nesbitt
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Jason T Shearn
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Gregory D Myer
- Sports Medicine Biodynamics Center, Division of Sports Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.,Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.,The Micheli Center for Sports Injury Prevention, Boston, MA
| | - Timothy E Hewett
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA. .,Sports Medicine Biodynamics Center, Division of Sports Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,The Sports Health and Performance Institute, The Ohio State University, Columbus, OH, USA. .,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA. .,Departments of Physiology and Cell Biology, Orthopaedic Surgery, Family Medicine, and Biomedical Engineering, The Ohio State University, Columbus, OH, USA. .,OSU Sports Medicine, 2050 Kenny Road, Suite 3100, Columbus, OH, 43221, USA.
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