INTRODUCTION. In native knees the anterior cruciate ligament (ACL) plays a major role in joint stability and kinematics. Sacrificing the
Knee joint infection after an ACL reconstruction procedure is infrequently but might be a devastating clinical problem, if not diagnosed promptly and treated wisely. The results of functional outcomes in these patients are not well known because there aren't large patient series in the literature. The objective of this study was to evaluate the prevalence and determine the adequate management of septic arthritis following ACL reconstruction and to assess the patient functional outcomes. The authors conducted a retrospective multicentric analysis of septic arthritis cases occurring after arthroscopically assisted ACL reconstructions (hamstrings and BTB), in patients submitted to surgery between 2010 to 2014. The study reviewed patients submitted do ACL reconstruction, that presented objective clinical suspicion of joint infection, in post-operative acute and sub-acute phases, associated with high inflammatory seric parameters (CRP >=10,0, ESR>=30,0) and synovial effusion laboratory parameters highly suggestive (PMN >=80, leucocytes >=3000). All this patients were treated with antibiotic empiric suppressive therapy and then directed antibiotherapy according to antibiotic sensitivity profile, then the patients were submitted to arthroscopic lavage procedure, without arthropump, but with debris and fibrotic tissue removal preserving always the
Introduction and purpose: To assess the diagnostic usefulness of MRI to diagnose
Anterior cruciate ligament reconstruction has become a standard procedure with a documented good and excellent outcome of 70–90%. It has been demonstrated by previous research that all patients following surgery demonstrate a strength deficit of almost 20%. However it is not known whether these strength deficits have an influence on postoperative functionality. 52 consecutive patients (38 males and 14 females) were selected (mean age 27.9 years). All subjects were tested prior and 12 month following anterior cruciate ligament reconstruction. Muscle strength was assessed using a Biodex dynamometer. Isometric strength was examined at 30 and 60 degrees of flexion. Isokinetic testing was performed at 180 degrees/sec and peak torque and symmetry indices were analysed. No correlations were found between the Cinncinnati Score and isokinetic peak torque for extension. A moderate significant (p=0.001–0.007) correlation (r=0.200.45) was found for peak flexion torque in
The level of hamstring antagonist activation is thought to be related to knee functionality following anterior cruciate ligament (ACL) injury/surgery as pronounced co-activation can control anterior tibial translation (ATT). The purpose of this study was to examine relationships between knee functionality and hamstring antagonist activation during isokinetic knee extension in
The purpose of this study was initially to examine the effect of tibial slope on anterior tibial translation in the
One of the key factors responsible for altered kinematics and joint stability following contemporary total knee arthroplasty (TKA) is resection of the anterior cruciate ligament (ACL). Therefore, retaining the
Summary. This study describes the use of a quasi-static, 6DOF knee loading simulator using cadaveric specimens. Muscle force profiles yield repeatable results. Intra-articular pressure and contact area are dependent on loading condition and
Combined anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) disruptions are uncommon orthopaedic injuries. They are usually caused by high- or low-velocity knee dislocations. Because knee dislocations might spontaneously reduce before initial evaluation, the true incidence is unknown. Dislocation involves injury to multiple ligaments of the knee. Both of the cruciate ligaments are usually disrupted, and they are often combined with a third ligamentous disruption (medial collateral ligament or lateral collateral ligament and/or posterior lateral complex). Associated neurovascular, meniscal, and osteochondral injuries are often present and complicate treatment. Classification Knee dislocations are classified by relating the position of the displaced tibia on the femur; anterior, posterior, medial, lateral, or rotational. Both cruciate ligaments might be disrupted in all these injuries. A rotatory knee dislocation occurs around one of the collateral ligaments (LCL) leading to a combined
Background. Anterior cruciate ligament (ACL) reconstruction with concomitant meniscal injury occurs frequently. Meniscal repair is associated with improved long-term outcomes compared to resection but is also associated with a higher reoperation rate. Knowledge of the risk factors for repair failure may be important in optimizing patient outcomes. Purpose. This study aimed to identify the patient and surgical risk factors for meniscal repair failure, defined as a subsequent meniscectomy, following concurrent primary ACL reconstruction. Methods. Data recorded by the New Zealand
Purpose. Patients with anterior cruciate ligament (ACL) deficiency and symptomatic medial compartment osteoarthritis (OA) present a challenge in management. These are often younger than typical primary OA patients and aspire to remain athletically active beyond simple ADLs. Combined ACL reconstruction and valgus tibial osteotomy (ACLHTO) is a well documented surgical option for patients deemed wither too young or too active for total knee arthroplasty. Unicompartmental knee arthroplasty (UKA) is an established surgical treatment for symptomatic medial osteoarthritis of the knee refractory to conservative management. A commonly cited contraindications is symptomatic
The aim of this study was to assess the value of plain AP and lateral radiographs in determining
Introduction: Anthropometric anatomical factors may influence mechanical and functional stability of joints. An increased posterior tibial slope places the anterior cruciate ligament at a theroretical biomechanical disadvantage. An increased posterior tibial slope can potentially alter forces during landing tasks by either increasing anterior tibial translation and/or
INTRODUCTION. In native knees anterior cruciate ligament (ACL) and asymmetric shape of the tibial articular surface with a convex lateral plateau are responsible for differential medial and lateral femoral rollback. Contemporary
Introduction: The use of the LARS (Ligament Augmentation and Reconstruction System. ®. , Corin) ligament for the surgical treatment of
Anthropometric anatomical factors may influence mechanical and functional stability of joints. An increased posterior tibial slope places the anterior cruciate ligament at a theroretical biomechanical disadvantage. An increased posterior tibial slope can potentially alter forces during landing tasks by either increasing anterior tibial translation and/or
Anteromedial osteoarthritis is a distinct phenotype of osteoarthritis. The arthritic lesion on the tibia is localised to the anteromedial quadrant with an intact
Purpose: Previous research has reported that increasing the posterior tibial slope through an opening wedge osteotomy results in an anterior shift in the position of the tibia relative to the femur. However, the effect of this on anterior cruciate ligament (ACL) strain remains insufficiently understood. The purpose of this study was to examine the relationship between tibial slope and tibial translation, as well as between tibial slope and
Controversies about the management of injuries to the soft tissue structures of the posteromedial corner of the knee and the contribution of such peripheral structures on rotational stability of the knee are of increasing interest and currently remain inadequately characterised. The posterior oblique ligament (POL) is a fibrous extension off the distal aspect of the semimembranosus that blends with and reinforces the posteromedial aspect of the joint capsule. The POL is reported to be a primary restraint to internal rotation and a secondary restraint to valgus translation and external rotation. Although its role as a static stabiliser to the medial knee has been previously described, the effect of the posterior oblique ligament (POL) injuries on tibiofemoral stability during Lachman and pivot shift examination in the setting of ACL injury is unknown. The objective of this study was to quantify the magnitude of tibiofemoral translation during the Lachman and pivot shift tests after serial sectioning of the
Controversies about the management of injuries to the soft tissue structures of the posteromedial corner of the knee and the contribution of such peripheral structures on rotational stability of the knee are of increasing interest and currently remain inadequately characterised. The posterior oblique ligament (POL) is a fibrous extension off the distal aspect of the semimembranosus that blends with and reinforces the posteromedial aspect of the joint capsule. The POL is reported to be a primary restraint to internal rotation and a secondary restraint to valgus translation and external rotation. Although its role as a static stabiliser to the medial knee has been previously described, the effect of the posterior oblique ligament (POL) injuries on tibiofemoral stability during Lachman and pivot shift examination in the setting of ACL injury is unknown. The objective of this study was to quantify the magnitude of tibiofemoral translation during the Lachman and pivot shift tests after serial sectioning of the
Introduction: By characterising
Objective: The treatment of Anterior Cruciate Ligament (ACL) instability resulting from incomplete tears or elongation in continuity has been historically treated either conservatively or by graft replacement. The literature is sparce with regard to alternative reparative surgical treatment of this condition. We report our early experience using a thermal shrinkage treatment on 11 consecutive knees suffering from this condition in patients experiencing continuing instability. Methods: Eleven patients underwent
Purpose: To document healing of the anterior cruciate ligament. Introduction: Conventional wisdom holds that the anterior cruciate ligament (ACL) does not heal. In an athlete the
A group of Athletes with torn
Aim. The aim of this study is to outline the steps and techniques required to create a patient specific 3D printed guide for the accurate placement of the origin of the femoral tunnel for single bundle ACL reconstruction. Introduction. Placements of the femoral tunnels for ACL reconstruction have changed over the years. Most recently there has been a trend towards placing the tunnels in a more anatomic position. There has been subsequent debate as to where this anatomic position should be. The problem with any attempt at consensus over the placement of an anatomic landmark is that each patient has some variation in their positioning and therefore a fixed point for all has compromise for all as it is an average. Our aim was to attempt to make a cost effective and quick custom guide that could allow placement of the center of the patients’ newly created femoral tunnel in the mid position of their contralateral native
Aims:
Despite several anatomical and neurophysiological studies have demonstrated the sensory role of anterior cruciate ligament (ACL), it is still unclear how significant the absence of the
Purpose: Ultrastructural analysis of PT graft for
Purpose: No conventional surgical technique for ligament reconstruction can be used in all cases to achieve ideal position of the transplant. Navigation systems without visualisation of the anterior cruciate ligament should meet the requirements. This is an operative strategy based on one or more computer assisted procedures enabling ligament reconstruction without the need for conventional pre- per, or postoperative imaging. The principle is based at the present time on the use of a station (computer, localisers, display screen, command pedal) used for processing data (spatial measurements and positioning) delivered by markers fixed on rigid bodies and tools (palpation, aiming tools). Material and methods: This study was conducted on ten cadaver knees. Each knee was instrumented with the station. Joint kinetics were recorded with and without the
Previous Anterior Cruciate Ligament (ACL) reconstruction is currently a bar from entry to the Royal Marines and Royal Navy, whilst the British Army allows recruits to join if asymptomatic 18 months post ACL reconstruction. However current Royal Marines policy is to rehabilitate recruits who sustain an
Given their role in reducing anterior tibial translation, the recruitment patterns and viscoelastic properties of the hamstring muscles have been implicated as neuromuscular factors contributing to the
Tibial rotation and translation provide important stability parameters after ACL reconstruction. An accurate tool for a combined pre- intra- and postoperative stability measurement is not in clinical use so far. Navigation of the drill canals for the
Purpose: Gait analysis has become an innovative approach to assess the biomechanical adaptations due to an ACL injury. However, interpreting the large amount of data collected often requires an expert. Therefore, there is a need to develop an automatic method capable to distinguish kinetic pattern of an
Anterior cruciate ligament (ACL) reconstruction allows overall good results, but there is still a significant rate of failure. It is well accepted that the main reason for ACL reconstruction failure is a misplacement of tibial or femoral tunnels. Conventional techniques rely mainly on surgical skill for intra-operative tunnel placement. It has been demonstrated that, even by experienced surgeons, there was a significant variation in the accuracy of tunnel placement with conventional techniques. Navigation systems might enhance the accuracy of ACL replacement. 10 cadaver knees with intact soft-tissue and without any intra-articular abnormalities were studied. We used a non image based navigation system (OrthoPilot ®, Aesculap, Tuttlingen, FRG). Localizers were fixed on bicortical screws on the distal femur and on the proximal tibia. Both kinematic and anatomic registration of the knee joint were performed by moving the knee joint in flexion-extension and palpating relevant intra- and extra-articular landmarks with a navigated stylus. The most anterior, posterior, medial and lateral point of both tibial and femoral attachment of the
Good mid-term results of Oxford UKA (OxUNI) for anteromedial osteoarthritis (OA) were reported. The designers of prosthesis reported a 98% 10-year survival rate for a combined series of phase I and II, and these findings were supported by published results from other series, with 10-year survival ranging from 91% to 98%. In order to obtain good results, the designers of this prosthesis mentioned the importance of adhering to strict indication for OxUNI, especially only for OA cases with intact anterior cruciate ligament (ACL). OxUNI combined with ACL reconstruction (ACLR) is a viable treatment option for only young active patients, in whom the
To evaluate the clinical outcome of arthroscopic treatment of
Separation of the
Meniscal tears commonly co-occur with ACL tears, and many studies address their side, pattern, and distribution. Few studies assess the patient's short-term functional outcome concerning tear radial and circumferential distribution based on the Cooper et al. classification. Meniscal tears require primary adequate treatment to restore knee function. Our hypothesis is to preserve the meniscal rim as much as possible to maintain the load-bearing capacity of the menisci after meniscectomy. The purpose of this study is to document the location and type of meniscal tears that accompany anterior cruciate ligament (ACL) tears and their effect on patient functional outcomes following arthroscopic ACL reconstruction and meniscectomy. This prospective cross-sectional observational study was conducted at AL-BASRA Teaching Hospital in Iraq between July 2018 and January 2020 among patients with combined ipsilateral ACL injury and meniscal tears. A total of 28 active young male patients, aged 18 to 42 years, were included. All patients were subjected to our questionnaire, full history, systemic and regional examination, laboratory investigations, imaging studies, preoperative rehabilitation, and were followed by Lysholm score 6 months postoperatively. All 28 patients were males, with a mean age of 27 ± 0.14 years. The right knee was the most commonly affected in 20/28 patients (71.4%). The medial meniscus was most commonly injured in 11 patients, 7 patients had lateral meniscal tears, and 10 patients had tears in both menisci. The most common tear pattern of the medial meniscus was a bucket handle tear (36.4%), while longitudinal tears were the most frequent in the lateral meniscus (71.4%) (P-value = 0.04). The most common radial tear location was zone E-F (5/28, 17.8%), and the most common circumferential zone affected was the middle and inner third, reported in 50% of tears. Good and excellent outcomes using the Lysholm score after 6 months were obtained in 42.9% and 17.9% of patients, respectively. Better functional scores were associated with lateral meniscal tears, bucket handle tears, tears extending to a more peripheral vascular area, and if no more than one-third of the meniscus was resected (P-value = 0.002). Less favourable outcomes were reported in smokers, posterior horn tears, and when surgery was delayed more than 1 year (P-value = 0.03). We conclude that there is a negative correlation between the amount of meniscus resected and functional outcome. Delayed ACL reconstruction increases the risk of bimeniscal tears. Bucket handle tears are the most common tears, mostly in the medial meniscus, while longitudinal tears are most common in the lateral meniscus. We recommend performing early ACL reconstruction within 12 months to reduce the risk of bimeniscal injuries.
Introduction: Unicompartmental knee arthroplasty (UKA) is an increasingly popular procedure for young osteoarthritic patients whose age and activity levels preclude the use of a total knee arthroplasty (TKA). However, successful reconstruction using an unconstrained mobile bearing implant requires an intact and functioning
We examined the vasoconstrictive actions of neuropeptide Y (NPY) in the intact medial collateral ligament (MCL) of normal and anterior cruciate ligament (ACL) -deficient rabbit knees. Blood flow to the surgically exposed MCL was measured using high-resolution laser speckle imaging (LSI) before and after topical administration of NPY and the α. 1. -adrenoreceptor agonist phenylephrine. In control rabbit knees, dose-dependent vasopressor responses were significantly greater than those in ACL-deficient knees, where there was little or no vasoconstrictor response. We conclude that chronic
Background: Several approaches to the
Introduction. The anterior cruciate ligament (ACL) is one of the most common ligament injuries. Several ACL reconstructions exist and are consequently performed. An accurate and comprehensive description of knee motion is essential for an adequate assessment of these surgeries, in terms of restoring knee motion. Methods. We propose to compare these reconstructions thanks to an index of articular coherence. This index measures the instantaneous state surface configurations during a motion. More specifically, this refers to the position between two articular surfaces facing each other. First of all, the index has to refer to a position known to be physiological. This initial position of the bones, named reference, directly results from the segmentation of CT scans. First we compute all distances between the two surfaces and then we compute the Cumulative Distribution Function (CDF). We process this way for each iteration of the motion. Then we obtain a batch of CDF curves which provide us qualitative information relative to the motion such as potential collisions or dislocations. The graph of all CDF curves is called Figure of Articular Coherence (FoAC). A good articular coherence is characterised by CDF which are close to the reference. This qualitative method is coupled to a quantitative one named Index of Articular Coherence (IoAC) which computes the Haussdorff distance between the temporal distributions and the reference. This distance has to be as low as possible. The tools were tested on cadaveric experiments of ACL reconstruction provided by Hagemeister et al, (1999). They recorded the knee flexion/extension motion in following situations: the intact knee, after
We performed 112 primary total knee replacements in patients under the age of 50, using a unique implant designed to pivot laterally during range of motion. This design more closely approximates the motion of an
Aim. The aim of this study is to outline the steps and techniques required to create a patient specific 3D printed guide for the accurate placement of the origin of the femoral tunnel for single bundle ACL reconstruction. Introduction. Placements of the femoral tunnels for ACL reconstruction have changed over the years 1,2. Most recently there has been a trend towards placing the tunnels in a more anatomic position. There has been subsequent debate as to where this anatomic position should be 3. The problem with any attempt at consensus over the placement of an anatomic landmark is that each patient has some variation in their positioning and therefore a fixed point for all has compromise for all, as it is an average 4. Our aim was to attempt to make a cost effective and quick custom guide that could allow placement of the center of the patients’ newly created femoral tunnel in the mid position of their contralateral native
Arthroscopic controlled retrograde drilling of femoral and tibial sockets and tunnels using a specially designed cannulated drill pin and retrocutter (Arthrex Inc, Naples FL.) provides greater flexibility for anatomical graft placement and in revision cases avoids previous tunnels and intra osseus hardware. Inside out drilling of femoral and tibial sockets minimises incisions and eliminates intra articular cortical bone fragmentation of tunnels rims common to conventional antegrade methods. This technique is also ideal for skeletally immature patients since drilling and graft fixation through growth plates may be avoided. Initial tunnel-referencing cannulated drill guide pin placement is carried out from outside-in. This technique (out-in/in-out) combines the advantages of the two-incision and the one-incision technique. In fact it permits us, as in the two-incision technique, to drill a pin guide from outside to inside in order to obtain the correct anatomical insertion of the
Introduction: The anterior cruciate ligament (ACL) can be anatomically divided into two bundles: the anteromedial (AM) and the posterolateral (PL). These two bundles have unique contributions to load transfer across the knee joint. Material and Methods: We retrospectively reviewed the clinical results of a consecutive series of 25 patients who underwent partial ACL reconstruction. In 22 cases AM bundle reconstruction was performed, and in 3 patients isolated PL bundle reconstruction was performed. The 25 patients included 7 women and 18 men with an average age of 29.2 years at the time of surgery. Preoperative evaluation was conducted using manual Lachman test, pivot-shift tests, KT-1000, magnetic resonance imaging and passive stress radiographs of both knees. In all cases preoperative clinical evaluation was graded C as per the IKDC scoring system. The preoperative side-to-side anterior laxity measured by means of the KT-1000 was 5.8 mm in case of AM bundle rupture and 4.3 mm in case of PL bundle rupture. All the patients underwent single-bundle reconstruction of the
Background The minimum size required for a successful quadrupled hamstring autograft ACL reconstruction remains controversial. The risks of
Summary. Nearly one-third of patients in this series with an ACL rupture requiring reconstruction had evidence of MPFL injury. This should be considered when patients are seen, and when MRI scans are reviewed/reported. Introduction. The Medial Patello-Femoral Ligament (MPFL) is the largest component of the medial parapatellar ligamentous complex. The senior surgeon felt that there was an anecdotally high rate of MPFL injury amongst his patients undergoing Anterior Cruciate Ligament (ACL) repair, but no discussion of this in the present literature. Method. A literature search was performed; although there were both scanty radiographic and anatomical studies of the MPFL, we found no literature looking at