Aims. Avulsion of the proximal
Aims. The effects of remnant preservation on the anterior cruciate ligament (ACL) and its relationship with the tendon graft remain unclear. We hypothesized that the co-culture of remnant cells and bone marrow stromal cells (BMSCs) decreases apoptosis and enhances the activity of the
Purpose. The Purpose of this study was to evaluate
Injuries to the
Aims. Graft infection following anterior cruciate ligament reconstruction (ACLR) may lead to septic arthritis requiring multiple irrigation and debridement procedures, staged revision operations, and prolonged courses of antibiotics. To our knowledge, there are no previous studies reporting on how gentamicin pre-soaking of
The 2020 London International
Aims. To validate the Sydney
Introduction. Anterior cruciate ligament (ACL) injuries represent a significant burden of disease to the orthopaedic surgeon and often necessitate surgical reconstruction in the presence of instability. The
Proximal
Abstract. Purpose. This study aims to compare the clinical and functional outcomes and donor site morbidity of anterior cruciate ligament reconstruction with hamstring tendon autograft and peroneus longus tendon autograft in patients with complete anterior cruciate ligament rupture. Methods. Patients who underwent ACL reconstruction from February 2018 to July 2019 were randomly allocated into two groups (hamstring and peroneus longus). Functional scores (IKDC and Lysholm scores) and pain intensity by visual analogue score were recorded preoperatively, 3, 6months, 1, and 2 years postoperatively. Donor site morbidities were assessed with thigh circumference measurements in
Most previous studies investigating autograft options (quadriceps,
Purpose: Although
Avulsion of the proximal
Abstract. Purpose. Since arthroscopic reconstruction of the anterior cruciate ligament (ACL) started, the use of peroneus longus grafts for primary ACL reconstruction (ACLR) was never thought of as there is very scant literature on it. So, our study aims to compare the functional outcome and complications in patients with ACL injury managed by ACLR with peroneus longus tendon (PLT) and
Summary:.
The jackaling position within rugby has not been previously described as a mechanism for proximal
Abstract. Objectives. To determine the effectiveness of LIA compared to ACB in providing pain relief and reducing opiates usage in
Abstract. Objectives. To determine the effectiveness of LIA compared to ACB in providing pain relief and reducing opiates usage in
Introduction and Objective. Objectives: To determine the effectiveness of LIA compared to ACB in providing pain relief and reducing opiates usage in
Incomplete avulsion of the proximal hamstrings
can be a severely debilitating injury that causes weakness, pain
while sitting and inability to run. The results of the surgical treatment
of 23 consecutive patients with such injuries at least two years
after surgery are described. The surgery consisted of the repair
of the
Introduction: The piriformis syndrome is known as an entrapment of the sciatic nerve, in which the pain is felt over the upper part of the buttock and radiates down the leg. However, the pain in the buttock may also be located in the area of the ischial tuberosity, accompanied by referred pain to the back of the thigh and this is called the
Abstract. Background. The gold standard treatment for Anterior Cruciate Ligament injury is reconstruction (ACL-R). Graft failure is the concern and ensuring a durable initial graft with rapid integration is crucial. Graft augmentation with implantable devices (internal brace reinforcement) is a technique purported to reduce the risk of rupture and hasten recovery. We aim to compare the short-term outcome of ACL-R using augmented hamstring tendon autografts (internally braced with neoligament) and non-augmented
Abstract. Introduction. MRI has been increasingly used as an outcome measure and proxy for healing and integration after ACL reconstruction (ACLR). Despite this, it has not yet been established what a steady state graft MRI appearance is. Methodology. MRI and clinical outcome measures were prospectively taken at 1 and minimum 2 years after
Given their role in reducing anterior tibial translation, the recruitment patterns and viscoelastic properties of the
The anterior cruciate ligament (ACL) is frequently injured in elite athletes, with females up to eight times more likely to suffer an ACL tear than males. Biomechanical and hormonal factors have been thoroughly investigated; however, there remain unknown factors that need investigation. The mechanism of injury differs between males and females, and anatomical differences contribute significantly to the increased risk in females. Hormonal factors, both endogenous and exogenous, play a role in ACL laxity and may modify the risk of injury. However, data are still limited, and research involving oral contraceptives is potentially associated with methodological and ethical problems. Such characteristics can also influence the outcome after ACL reconstruction, with higher failure rates in females linked to a smaller diameter of the graft, especially in athletes aged < 21 years. The addition of a lateral extra-articular tenodesis can improve the outcomes after ACL reconstruction and reduce the risk of failure, and it should be routinely considered in young elite athletes. Sex-specific environmental differences can also contribute to the increased risk of injury, with more limited access to and availablility of advanced training facilities for female athletes. In addition, football kits are designed for male players, and increased attention should be focused on improving the quality of pitches, as female leagues usually play the day after male leagues. The kit, including boots, the length of studs, and the footballs themselves, should be tailored to the needs and body shapes of female athletes. Specific physiotherapy programmes and training protocols have yielded remarkable results in reducing the risk of injury, and these should be extended to school-age athletes. Finally, psychological factors should not be overlooked, with females’ greater fear of re-injury and lack of confidence in their knee compromising their return to sport after ACL injury. Both intrinsic and extrinsic factors should be recognized and addressed to optimize the training programmes which are designed to prevent injury, and improve our understanding of these injuries. Cite this article:
Purpose: The aim of this study was to see if there is any relationship between a positive
Abstract. Background. The gold standard treatment for Anterior Cruciate Ligament injury is reconstruction (ACL-R). Graft augmentation with suture tape (internal brace) are techniques purported to reduce the risk of rupture and hasten recovery. Our aim was to assess the short-term outcome of ACL-R using fibre tape augmented and non-augmented
1 . A ten-year study of fifty-four operations for transplantation of the
Plantar faciitis is a repetitive microtrauma overload injury of the attachment of the plantar fascia at the inferior aspect of the valvaneus. Several aetiological factors have been implicated in the development of plantar faciitis, however the role of
Objectives. The objective of this study was to determine if the use of fascia lata as a tendon regeneration guide (placed into the tendon canal following harvesting the semitendinosus tendon) would improve the incidence of tissue regeneration and prevent fatty degeneration of the semitendinosus muscle. Materials and Methods. Bilateral semitendinosus tendons were harvested from rabbits using a tendon stripper. On the inducing graft (IG) side, the tendon canal and semitendinosus tibial attachment site were connected by the fascia lata, which was harvested at the same width as the semitendinosus tendon. On the control side, no special procedures were performed. Two groups of six rabbits were killed at post-operative weeks 4 and 8, respectively. In addition, three healthy rabbits were killed to obtain normal tissue. We evaluated the incidence of tendon tissue regeneration, cross-sectional area of the regenerated tendon tissue and proportion of fatty tissue in the semitendinosus muscle. Results. At post-operative week 8, the distal end of the regenerated tissue reached the vicinity of the tibial insertion on the control side in two of six specimens. On the IG side, the regenerated tissue maintained continuity with the tibial insertion in all specimens. The cross-sectional area of the IG side was significantly greater than that of the control side. The proportion of fatty tissue in the semitendinosus muscle on the IG side was comparable with that of the control side, but was significantly greater than that of the normal muscle. Conclusions. Tendon tissue regenerated with the fascia lata graft was thicker than naturally occurring regenerated tissue. However, the proportion of fatty tissue in the semitendinosus muscle was greater than that of normal muscle. Cite this article: K. Tabuchi, T. Soejima, H. Murakami, K. Noguchi, N. Shiba, K. Nagata. Inducement of tissue regeneration of harvested
Aim: To describe a new cosmetic and simple approach to harvest
The purpose of our study is to determine if
Purpose of the study: The hypothesis of this study was that age over 50 years is not a contraindication for
Background & Purpose. The co-ordinated contraction of the kinetic chain is responsible for the dissipation of force. Weakness in the kinetic chain, such as the posterior oblique sling (POS), may increase the demand on additional muscles, such as the
Traction injury to the sciatic nerve can occur during
Tunnel enlargement after AC reconstruction with a
The choice of graft for anterior cruciate ligament reconstruction remains controversial. A systematic review was performed to compare bone-patella tendon-bone and 4-strand
Purpose of the study: The debate continues on the appropriate tendon to use for anterior cruciate ligament (ACL) reconstruction. There are few comparative data on the different types of grafting material. We propose a retrospective analysis of bilateral ACL reconstruction where a patellar tendon (PT) and
Graft fixation in anterior cruciate ligament reconstruction is a basic criterion for the outcome of the surgical procedure. Several solutions have been proposed; each of them had advantages and disadvantages, and the choice of a surgical technique often represents the surgeon’s opinion. The goal of the fixation is stability and incorporation of the graft in the bone tunnels. Bone-patellar tendon-bone graft has the advantage of bone to bone fixation, which is impossible using tendon grafts. Femoral fixation techniques for
The choice of graft for anterior cruciate ligament reconstruction remains controversial. A systematic review was performed to compare bone-patella tendon-bone and 4-strand
Purpose: To investigate sciatic nerve conduction during
Purpose: The purpose of this study was to compare the bone-patellar-tendon-bone (BPTB) and the four-strand
We reviewed Complete Proximal
The level of
Background. Injury to the ACL is a significant problem and can cause further damage to the internal structures of the knee. ACL injury is associated with injuries to other structures in the knee such as the meniscus and chondral cartilage. Such intra articular injuries pre-dispose the knee to develop arthritis. This injury is usually seen in young and active people usually related to sporting injuries. There is a paucity of literature on the influence of anthropometric features on the
AIMS. To review the results of a single surgeon series using the above implants looking at functional outcome and implant survivorship. BACKGROUND. The outcome of ACL reconstruction is multi-factorial. There are many described ways of securing a 4-srandd
Purpose of the study: The issue of which graft to choose for anterior cruciate ligament (ACL) reconstruction is still a matter of debate. An analysis of the literature reveals the difficulty encountered when performing comparative trials. It is also difficult to demonstrate significant differences with results obtained with an insufficient number of patients. We propose here a meta-analysis in order to combine the results obtained with different comparative studies. Material and methods: The literature search (Medline 1990–2005) was based on the following selection criteria: ACL reconstruction, patellar tendon (PT), gracilis and semitendinous (four-strand hamstring) reconstruction and comparative prospective study. Studies were retained with: >
30 patients per group, minimum follow-up 24 months, IKDC score. Evaluation criteria retained were: anterior pain, resumed activity, IKDC score, differential laxity. The relative risk (RR) statistical method with 95% confidence interval (CI) was applied. Means were calculated and the chi-square and z-tests were applied. Results: Thirteen studies satisfied our inclusion criteria. These studies had included more than 1300 transplants. Mean rate of anterior pain was 23.2% with PR and 17.3% with
To investigate whether the harvesting of
Introduction. In order to prepare
The primary purpose of this study was to assess whether patients presenting with clinical graft laxity following primary anatomic anterior cruciate ligament (ACL) reconstruction using
Aims: Patellar instability and painful patellar mal-tracking are common challenging conditions faced by a knee surgeon. Our purpose was to describe an arthroscopy assisted method of medial patellofemoral ligament reconstruction to address these conditions present our results using this modified technique. Materials &
Method: Between April 2001 and December 2003, 22 knees in 20 consecutive patients underwent arthroscopically assisted MPFL reconstruction using an autologous
The potential harm to the growth plate following reconstruction of the anterior cruciate ligament in skeletally-immature patients is well documented, but we are not aware of literature on the subject of the fate of the graft itself. We have reviewed five adolescent males who underwent reconstruction of the ligament with four-strand
There are various methods of measuring proprioception at the knee. Beard et al (1993) have described a delay in reflex
Purpose. The majority (73%) of orthopaedic surgeons in Canada prefer using semitendinosus-gracilis (STG) autograft for ACL reconstruction. However, there is large variation in tendon size between individuals which makes pre-operative estimation of graft size unpredictable. Inadequate graft size may require an alternative source of graft tissue that should be planned prior to surgery. The purpose of this study is to determine if clinical anthropometric data and MRI measurements of STG tendons can be used to predict
Thirty- seven patients were enrolled in a single-blind prospective randomized clinical trial comparing the use of the Endopearl in femoral fixation in otherwise similar anterior cruciate ligament (ACL) reconstructions. Evaluation pre-operatively, three months, six months and eighteen months post-operatively suggested significant difference in the side to side KT-1000 values suggesting improved graft fixation with the EndoPearl by eighteen months post surgery with no differences in the Mohtadi ACL QOL questionnaire. Thus, when bioabsorbable interference screws are used for ACL reconstruction, the use of the EndoPearl improves anterior-posterior stability up to eighteen months post-operatively. The EndoPearl is an adjunct to bioabsorbable interference screw fixation in the femoral tunnel in ACL reconstruction. The purpose of the study was to assess the clinical effectiveness of the EndoPearl using the KT-1000 Knee Arthrometer and the Mohtadi ACL Quality of Life (ACL-QOL) Questionnaire. The application of the EndoPearl in
We evaluated the nerve roots of the cauda equina by CT myelography in 36 patients aged from 11 to 19 years with lumbar disc herniation. On straight-leg-raising tests, six younger patients had isolated
Introduction: Some authors have suggested that the results of ACL reconstruction in females using
Purpose of the study: Free patellar tendon plasty is the most common technique for repairing anterior knee laxity. Functional outcome can be compromised by invalidating knee pain. The purpose of this prospective randomized study was to compare the outcome of plasty procedures using
The purpose of this study was to report the outcome
of ‘isolated’ anterior cruciate ligament (ACL) ruptures treated with
anatomical endoscopic reconstruction using
Introduction: Looking at the controversial discussion about indication, transplant choice and fixation techniques in active ACL-injured patients with open physes we recommend even in childhood an ACL reconstruction using a quadruple
We compared initial fixation strength of two commonly used tibial side
The bead EndoPearl is bioabsorbable material which placed in the ACL graft edge, and augment the stabilization in the femoral tunnel when an interference screw is used. Our aim was to recorded the operative characteristics of this technique and the clinical results after using EndoPearl in ACL reconstruction with
We performed a retrospective study on patients who underwent Arthroscopic ACL reconstruction -The purpose of this study was to evaluate our initial experience with this procedure. Between July 97 and March 2001, 29 patients underwent Arthroscopic ACL reconstruction with 4 Strand
Aim: To determine the short to mid-term outcome differences between patellar tendon (PT) and
Aims: Whether the harvesting of
We report 97 quadruple
There is increasing evidence that patients with ACL reconstruction using ipsilateral graft harvest are at greater risk of rupture (12.5%) on their contralateral compared to their surgical side (7.9%). The purpose of this study is to re-evaluate patients from a previous study comparing ipsi- versus contralateral graft harvest to compare ACL rupture rate at a minimum 10 year follow-up. An attempt to contact all participants from a previously published study was made to invite them to return for a follow-up. The assessment included an International Knee Documentation Committee Knee Clinical Assessment (IKDC), isokinetic concentric knee flexion and extension strength testing, as well as the ACL-Quality of life (ACL-QOL). A chart review was conducted to identify or confirm subsequent ipsi- or contralateral knee surgeries. In patients with ipsilateral graft, 3/34 (8.8%) re-ruptured and 3/34 (8.8%) had contralateral rupture. In the contralateral group, 1/28 (3.6%) re-ruptured and 2/28 (7.1%) had contralateral rupture. The relative risk (RR) of re-rupture with ipsilateral graft was 2.47 compared to using the contralateral site (p=0.42). RR of rupture on the contralateral side when ipsilateral graft was used was 1.23 compared to the alternate approach. Current contact information was unavailable for 21 patients. Of the 47 remaining, 37 were consented (79%). No difference in the ACL-QOL between groups (ipsilateral 68.4±24.4, contralateral 80.1±16.0, p=0.17) was observed. There were no differences in knee flexion strength between groups (peak torque flexion affected leg: ipsilateral 77.8nm/kg±27.4, contralateral: 90.0 nm/kg±35.1; p=0.32; Unaffected leg: ipsilateral: 83.3 nm/kg±30.2 contralateral 81.7 nm/kg±24.4; p= 0.89). This study suggests that using the contralateral
Purpose: This prospective comparative study examined the two-year results of two femoral fixation method for anterior cruciate ligament (ACL) repair using the four-part
Purpose: This study sought to examine return to sports in athletes younger than 25 following ACL reconstruction with either patellar tendon (PT) or
The chioce of the graft and its fixation in LCA reconstruction is basic for the outcome of the surgical procedure. Several solutions have been proposed; each of them had advantages and disavantages. The choice of the graft and the surgical technique is often due to surgeon’s opinion. The goal of the fixation is stability which allowes incorporation of the graft in the bone tunnels. Bone-patellar tendon-bone graf has the advantage of bone to bone fixation which is impossible using tendon grafts. Femoral fixation techniques for
Delayed rather than early reconstruction of the anterior cruciate ligament is the current recommended treatment for injury to this ligament since it is thought to give a better functional outcome. We randomised 105 consecutive patients with injury associated with chondral lesions no more severe than grades 1 and 2 and/or meniscal tears which only required trimming, to early (<
two weeks) or delayed (>
four to six weeks) reconstruction of the anterior cruciate ligament using a quadrupled
Aims: The aims of this study were to evaluate the biomechanical properties and mode of failure of 4 methods of fixation used for
Purpose: Free patellar tendon plasty is classically used for the treatment of chronic anterior instability of the knee. Good functional results may however be compromised by invalidating anterior pain. The purpose of this randomised trial was to obtain a prospective comparison of outcome after
Between July 2000 and April 2004, 19 patients with bilateral spastic cerebral palsy who required an assistive device to walk had combined lengthening-transfer of the medial
Anterior cruciate ligament (ACL) reconstruction is a commonly performed operation. A variety of graft options are used with the most popular being bone-patellar-tendon-bone and
It appears that double bundle anterior cruciate ligament reconstruction can reproduce the original anatomy of the ligament, restoring normal kinematics and rotational control of the tibia. But an anatomical single bundle reconstruction may present very similar results, with minor technical difficulties and lower costs. We compared two groups of 25 patients each, that underwent ACL reconstruction by the same surgeon, with a follow-up of 12–36 months. One group had double bundle reconstruction with
Introduction Transcondylar fixation has recently been offered as an alternative method of femoral fixation in soft tissue ACL reconstructions. It provides the advantages of avoiding intra-articular hardware and of achieving full circumferential contact of soft tissue to bone for graft integration. This paper presents a series of
Aim: MRI examination of tibial tunnel enlargement after
Aim: The aim of our study was to evaluate the results of the Soffix Mark I and Mark II
Background. Recent publications have supported the anatomic placement of anterior cruciate grafts to optimise knee function. However, anatomic placement using the anteromedial portal has been shown to have a higher failure rate than traditional graft placement using the transtibial method. This is possibly due to it being more technically difficult and to the short femoral tunnel compromising fixation methods. It also requires the knee to be in hyper flexion. This position is not feasible during with a tourniquet in situ on the heavily muscled thighs of some athletes. Hypothesis: That navigation can be used to place the femoral tunnel in the anatomic position via a more medial transtibial tunnel. Methods. 25 patients underwent Navigated Anterior Cruciate reconstruction with quadruple
Post traumatic myositisossificans is a benign condition of heterotropic ossification of unknown aetiology which typically is related to trauma from a single blow or repeated episodes of microtrauma. We describe an unusual case of myositis ossificans which developed as a complication at the donor site for
Anterior knee instability associated with rupture of ACL is a disabling clinical problem, especially in the athletic individual. The gracilis and semitendinosus tendon (T4) represent an alternative autograft donor material for reconstruction of the ACL. The aim of our study was to elaborate a CPG to assist physiotherapists in decision making and to improve the efficacy and uniformity of care for patients with ACL reconstruction with T4. The CPG was developed according to international methods of guideline development. To identify “best evidence” a structured search was performed. When no evidence was available, consensus between experts (physiotherapist and orthopaedic surgeons) was achieved to develop the guideline. To identify “best clinical experience” and “physiopathology reasoning” focus group of practicing physiotherapists was used. They reviewed the clinical applicability and feasibility of the guideline, and their comments were used to improve it. CPG include three phases determined from the evidence, physiopathology reasoning and the biological process of autograft (weeks after the surgery: 2. a. –6. a. , 6. a. –10. a. and 10. a. –16. a. ). The recommendations included: In postoperative weeks (2. a. –6. a. ) physiotherapy focused on early range of motion of the knee; manual therapy (passive range of motion (PROM) 0–120° and miofascial techniques), pulsed ultrasound of low intensity with a power of 0.3w/cm2 (1MHz) during 10min/day in tibial tunnel, early active
Introduction and Aims: To describe the arthroscopically assisted technique of medial patello-femoral ligament reconstruction using a
Purpose of the study: The objective was to compare the results of ligamentoplasties with two commonly used grafts,
Purpose: There is increasing evidence that surgical reconstruction of the ACL deficient knee in active patients over the age of 40 is the treatment of choice. The purpose of this study was to compare the objective and subjective outcomes of patients over 40 years old with those of a group of younger patients, all of whom underwent arthroscopic ACL reconstruction with quadruple
The use of platelet-rich plasma (PRP) as an adjuvant
to tissue repair is gaining favour in orthopaedic surgery. Tunnel widening
after anterior cruciate ligament (ACL) reconstruction is a recognised
phenomenon that could compromise revision surgery. The purpose of
this study was to determine whether PRP might prevent tunnel widening
in ACL reconstruction. Patients undergoing ACL reconstruction using a
Introduction: To report the results of quadrupled hamstring tendon autograft anterior cruciate ligament reconstruction with bioabsorbable Rigidfix fixation for both femoral and tibial tunnels. Methods: ninety one patients were retrospectively identified by notes review as having undergone quadrupled
Recurrent patellar instability and anterior knee pain is a common problem after patellar dislocation. The medial patellofemoral ligament (MPFL) which contributes 40–80% of the total restraining forces is either attenuated or ruptured in these patients. Various techniques have been described in reconstructing this MPFL using
MRI has been suggested as an objective method of assessing anterior crucate ligament (ACL) graft “ligamentization” after reconstruction. It has been proposed that the MRI appearances could be used as an indicator of graft maturity and used as part of a return-to-sport assessment. The aim of this study was to evaluate the correlation between MRI graft signal and postoperative functional scores, anterior knee laxity, and patient age at operation. A consecutive cohort of 149 patients who had undergone semitendinosus autograft ACL reconstruction, using femoral and tibial adjustable loop fixations, were evaluated retrospectively postoperatively at two years. All underwent MRI analysis of the ACL graft, performed using signal-to-noise quotient (SNQ) and the Howell score. Functional outcome scores (Lysholm, Tegner, International Knee Documentation Committee (IKDC) subjective, and IKDC objective) were obtained and all patients underwent instrumented side-to-side anterior laxity differential laxity testing.Aims
Methods
Purpose: The hypothesis of this randomized controlled trial is patients undergoing ACL reconstruction using contralateral
Introduction: Mechanical factors are thought to be one of the main reasons in determining tunnel enlargement after ACL reconstruction with
Purpose. To evaluate the results of quadrupled hamstring tendon autograft anterior cruciate ligament reconstruction with four fold
Purpose: We studied early recovery of knee muscles after harvesting the
Background. Anterior Cruciate Ligament Reconstruction is a commonly performed orthopaedic operation. The use of a four-strand semitendinosus and gracilis
Background Female patients undergoing arthroscopic anterior cruciate ligament reconstruction with