Abstract Anterior Cruciate Ligament Reconstruction Research Articles

Evaluation of anterior cruciate ligament surgical reconstruction through finite element analysis

Anterior cruciate ligament (ACL) tear is one of the most common knee injuries. The ACL reconstruction surgery aims to restore healthy knee function by replacing the injured ligament with a graft. Proper selection of the optimal surgery parameters is a complex task. To this end, we developed an automated modeling framework that accepts subject-specific geometries and produces finite element knee models incorporating different surgical techniques. Initially, we developed a reference model of the intact knee, validated with data provided by the Open Knee(s) project. This helped us evaluate the effectiveness of estimating ligament stiffness directly from MRI. Next, we performed a plethora of “what-if” simulations, comparing responses with the reference model. We found that (a) increasing graft pretension and radius reduces relative knee displacement, (b) the correlation of graft radius and tension should not be neglected, (c) graft fixation angle of 20^{circ } can reduce knee laxity, and (d) single-versus double-bundle techniques demonstrate comparable performance in restraining knee translation. In most cases, these findings confirm reported values from comparative clinical studies. The numerical models are made publicly available, allowing for experimental reuse and lowering the barriers for meta-studies. The modeling approach proposed here can complement orthopedic surgeons in their decision-making.

The efficacy of platelet rich plasma on anterior cruciate ligament reconstruction: a systematic review and meta-analysis

Anterior cruciate ligament (ACL) rupture is a common musculoskeletal injury, most frequently affecting young and physically active patients. Platelet-rich plasma (PRP) has been widely used in ACL reconstruction to augment the graft healing. However, high-level studies addressing its clinical efficacy could not reach a consensus. In this study, we assess the efficacy of PRP on pain relief, functional improvement along with radiological changes in patients who underwent ACL reconstruction. We performed comprehensive literature search and included 17 RCTs containing 970 participants who underwent ACL reconstruction. The combined data showed significant difference between PRP and control with regard to VAS score (MD: −1.12, 95% CI −1.92, −0.31; P = .007), subjective IKDC score (MD: 6.08, 95% CI 4.39, 7.77; P < .00001) and Lysholm score (MD: 8.49, 95% CI 1.63, 15.36; P = .02) by postoperative 6 months, but only pain reduction was deemed clinically important. At the end of one year’s follow-up, no clinically meaningful improvement in VAS (MD: −0.47, P = .04), subjective IKDC score (MD: 3.99, P = .03), Lysholm score (MD: 2.30, P = .32), objective IKDC score (RR: 1.03, P = .09) and knee joint laxity (MD: 0.17, P = .28) was seen. In terms of radiological findings, about one-third of the studies favored PRP to facilitate the graft healing, improve the harvest site morbidity and prevent tunnel widening. In summary, moderate quality of evidence suggested that PRP could provide short-term but not long-term clinically important pain reduction.

Evaluation of the Stability of the Subjects with Anterior Cruciate Injuries Reconstruction.

Anterior cruciate ligament (ACL) is the most frequently injured ligament in the knee and is often injured during sport-related activities. ACL injuries influence the abilities of the subjects during standing and walking. Although early surgical intervention is preferred treatment for the majority of knee surgeons, the effect of this approach on postural stability of patients is not fully understood. Therefore, the aim of this study was to determine the difference between stability of ACL-reconstructed subjects before and after surgery. A group of 15 consecutive ACL injured patients participated in this study. Postural stability of the patients was evaluated 1 week before and 6 months after surgery (ACL reconstruction with hamstring autograft). A Kistler force plate was used to evaluate center of pressure (COP) sway during quiet standing. The mean values of the COP parameters were obtained in pre and postsurgery conditions. Paired sample t-test was used to evaluate the difference between the stability parameters of the two conditions. The significant point was set at 0.05. The mean value of path length of COP velocity in mediolateral (ML) direction was 1,485.57 ± 479.42 mm and 2,641.33 ± 996.26 mm before and after surgery, respectively (p-value = 0.01). Although the mean value of COP velocity in anteroposterior and ML directions increased after surgery, the difference was only significant for velocity in ML direction (p-value = 0.049). The results of this study showed that the standing stability of those with ACL reconstruction decreased significantly after ACL reconstruction, which may be due to the effects of the surgery on sensory mechanism of ACL and inability of patients to return to their previous deep sense perception and knee proprioception.

Biomechanical and Histopathological Analysis on Different Approaches for Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) injury is one of the common injuries in sports and vehicle accidents. ACL decreases joint stability, leading to increased incidence of osteoarthritis. Although there are various approaches for the reconstruction of ACL, no consensus has been reached on the safest and most effective method to achieve joint stability. Here we have compared the biomechanical and histopathological outcomes of three different approaches: intra-articular ACL reconstruction, remnant-preserving and re-tensioning and non-remnant-preservation technique, using finite element analysis, histopathologic observation as well as qPCR and western blot analysis. Results of the current study showed no significant differences among the three methods concerning biomechanical, histopathological analysis and mRNA and protein levels of chondrocyte apoptotic markers such as JNK, MMP-1 and SIRT1 (P &gt; 0 05). Those results indicated that remnant preservation techniques such as intra-articular ACL reconstruction and remnant-preserving and re-tensioning are similar in their ability to achieve joint stabilization and prevent chondrocyte regeneration to non-remnantpreservation technique.

1. Investigating the Link Between Kinematic, Kinetic and Muscular Symmetry in Young Adults 12 or More Months post-ACL Reconstruction

Anterior cruciate ligament (ACL) injury after primary reconstruction and return-to-sport clearance is common. Since research indicates asymmetry as a valid predictor of injury, it is proposed that inter-limb asymmetry following ACL reconstruction contributes to the elevated incidence of re-injury in this population. Current return-to-sport protocol include objective tests such as joint laxity and strength tests, as well as single leg hop and drop landing tests. Since these assessments are based on visual observation, or simple kinematics measurements, it is unclear how visual asymmetry reflects the underlying joint forces and muscular effort responsible for the performance in these tasks. This study aims to assess the asymmetry present at the kinematic, kinetic, and motor control levels to clarify the after-effects of ACL reconstruction. This pilot study will help us appreciate if additional work exploring screening measures as effective tools for predicting ACL injury following primary reconstruction is warranted. Standard techniques will be used to measure the kinematics, joint kinetics and muscle activation during this 25-repetition squat protocol. Correlations will compare the left and right lower limbs for joint angular displacement, joint angular velocity, joint power, vertical ground reaction forces, and muscle activation amplitude.

Study of isokinetic strength training's rehabilitating effects on elite athletes after knee joint ACL reconstruction surgery

Anterior cruciate ligament (ACL) injury is one of the most common knee injuries for most athletes and sports-active people. Arthroscopic reconstruction is the preferred treatment. Rebuilding ACL for the rapid return to pre-injury level movement and function is an important goal for athletes. In this paper, the use of isokinetic strength training methods for athletes after ACL injury rehabilitation effect is reported. Thirty-one knee anterior cruciate ligament reconstruction athletes were divided into two groups and were respectively subjected to 12 weeks' traditional rehabilitation training and isokinetic strength training. It was found that constant strength training of the knee joint could improve the muscle strength of the athletes more quickly which provides better rehabilitation training for the postoperative recovery of athletes to return to the track.

Autograft Options for ACL Reconstruction. Which is Best?

Abstract Anterior cruciate ligament (ACL) tears are commonly seen in orthopedic practice, and usually restoration is recommended to re-establish normal knee function. Autografts and allografts are viable options. Among autografts the main sources are the patellar tendon, the hamstrings and the quadriceps tendon, each having advantages and drawbacks. Many factors should be taken into consideration when deciding on a graft source for ACL restoration; however, clinical data may aid the surgeon in choosing the right graft for every specific patient in an individualized manner. This short review is intended to highlight the main characteristics and clinical data for each type of autograft.

Primary Anterior Cruciate Ligament Reconstruction. How Do We Do It?

Abstract Anterior cruciate ligament (ACL) tears are frequently seen in current practice mostly affecting the young, active subjects, and usually require ligament reconstruction in order to restore normal knee kinematics. As worldwide interest in anatomic reconstruction grew over the last decade, we have also refined our technique in order to restore the anatomical function as near to the normal as possible. This anatomical restoration concept is believed to prevent the onset of osteoarthritis, which the non-anatomic reconstructions fail to attain. The knowledge gained from the ACL anatomy, function and kinematics has helped in developing the current anatomic methods of reconstruction, which take into account patient anatomy, the rupture pattern, as well as the comorbidities. We present our approach to anatomical single- and double-bundle ACL reconstruction.

Pretibial Cyst Formation in ACL Reconstruction - A Case Report

Anterior cruciate ligament (ACL) reconstruction technique was under tremendous improvement during last 10 years; anatomical versus transtibial technique gradually increased, with soft tissue graft overcoming bone-tendon-bone, and biodegradable exceeding metallic implants. Still, complications related to ACL reconstruction are reported; one of it is pretibial cyst formation. Pretibial cyst formation is reported to develop between 2 and 5 years post-operation. We report a case in which the cyst was developed at 2 years after surgery; a biocomposite screw was used for fixation on tibial site, in an ACL reconstruction done with soft tissue autograft. The MRI examination suggested the diagnostic, which was confirmed by histological examination of the cyst. The screw suffered multiple fragmentation; the remnants were retrieved and analyzed. The knee stability was not affected by the cyst development. After retrieval of the screw and appropriate rehabilitation, the patient recovery was complete. The presented case confirms that even biocomposite screw may be related to these sorts of complications, mainly related to plain biodegradable screws. The case offers a point of start for analysis of the literature. A precise ethology of this kind of complications is still unknown; a lot of theories have been developed, two of them seem to be related to our case. Technical improvement together with long time surveillance of cases in which biocomposite implants were used may improve our knowledge concerning the fate of these implants.

Evaluation of Knee Joint after Double-Bundle ACL Reconstruction with Three-Dimensional Isotropic MRI

Anterior cruciate ligament (ACL) reconstruction is one of the most common surgical procedures conducted in sports medicine and can be performed using a variety of techniques (1). Traditional ACL reconstruction is performed using the single anteromedial bundle This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Received: June 17, 2016 Revised: July 1, 2016 Accepted: July 1, 2016

Arthroscopic-Assisted Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft Augmented with a Dehydrated Human Amnion/Chorion Membrane Allograft: A Retrospective Case Report

Anterior Cruciate Ligament (ACL) rupture is a very common sports related knee injury. Surgical reconstruction using either autograft or allograft is the gold-standard treatment for a ruptured ACL. Presented is a case of a 23-year old female skier with a Magnetic Resonance Imaging (MRI) confirmed primary ACL tear that underwent an arthroscopic-assisted ACL reconstruction using a quadruple-stranded hamstring autograft augmented with a Dehydrated Human Amnion/Chorion Membrane (dHACM) allograft patch. Post-operative follow-up MRI scans at three and six months show early vascularization and maturation of the hamstring graft. Additionally, the patient’s rehabilitation progressed at an accelerated timeline with regards to strength and proprioception with subsequent clearance to return to play at 8 months post-op.

A Comparison of Ligament Tensions Between Intra- and Extra-Articular Measurement in Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) reconstruction is one of the treatments of ACL injuries. In the surgery, the reconstructed ligament should be properly tensioned to provide a normal ligament behavior. However, the ligament tension has been measured with an extra-articular technique in past studies, while the intra-articular ligament tension is still unknown. The purpose of this study is to compare the ligament tensions between intra- and extra-articular measurements in the ACL reconstruction. Intra-articular measurement employs a micro-force sensor designed with a width and thickness same as those of the reconstructed ligament. This study performed two experiments (i.e., sensor accuracy and cadaveric study). In the sensor accuracy experiment, the accuracy of the sensor was about 3% until an applied force of 100 N. In the cadaveric study, the results of the intra- and extra-articular measurement tensions were 13.6±3.9 N and 18.7±1.3 N (n= 6), respectively. The significant difference in student t-test (p-value was 0.026) between the intra- and extra- articular measurements was observed. The bending angle and friction between the graft and bone tunnel, and the shape of the intra-articular edge of tibial bone tunnel affected the intra-articular measurement in ACL reconstruction.

Risk of Reinjury or Subsequent Injury After Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) tears are one of the most common injuries seen by orthopaedic surgeons. The standard of care following an ACL tear in a physiologically young, active patient is an ACL reconstruction. This can be accomplished with one of a variety of grafts through a multitude of techniques. With the growing number of ACL tears that are treated with reconstruction, the number of failures, including both graft rerupture and functional instability, is increasing. Reinjury following an ACL reconstruction places a significant physical and physiological burden on the patient, but also creates a societal burden with lost time at work as well as use of health care resources. To better educate patients and to prevent subsequent ACL injuries, it is imperative that orthopaedic surgeons understand the risk factors for reinjury or an injury to the contralateral knee. These include patient-related factors such as age, gender, and activity level, as well as technical considerations such as graft type, size, and position. Furthermore, treating physicians must be able to council patients on ways to avoid a reinjury through rehabilitation, functional sports assessments, and others.

The Role of Deep Venous Thrombosis Prophylaxis After Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) reconstruction is one of the most commonly performed orthopaedic procedures. Venous thromboembolism is a rare, but potentially serious complication of ACL reconstructions and having a thorough understanding of the potential risk factors could help to minimize the incidence of postoperative deep vein thrombosis or pulmonary embolism. We review some of the literature on the risk factors, diagnosis and treatment of deep vein thrombosis or pulmonary embolism. Although current data does not support the routine use of thromboprophylaxis in all patients undergoing ACL reconstruction, it is important for the clinician to be aware that some consideration should be given for initiating pharmacological prophylaxis in some patients who may be at increased risk for thromboembolic disease.

Managing Perioperative Extensor Mechanism Injuries and the Patellar Defect After Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) tears are a common and potentially devastating injury for an athlete. ACL reconstruction is a safe, highly effective procedure that has been shown to result in excellent clinical and functional outcomes, but complications still do arise. Although extremely unusual, perioperative extensor mechanism injuries after ACL reconstruction are a serious and potentially complex complication. An overview of some of the technical aspects of managing the extensor mechanism in ACL reconstructions, types of injuries and their management, as well as a comprehensive review of the literature on the management of the patellar defect following ACL reconstruction with bone-patellar-tendon-bone autograft is explored.

Isokinetic profile in female athletes with and without patellofemoral pain syndrome after anterior cruciate ligament reconstruction

Anterior Cruciate Ligament (ACL) injury is one of the most frequent injury type in individuals who participate in pivoting sports, with an annual incidence of more than 200,000 cases according to the American Academy of Orthopaedic Surgeons (2007).This has motivated numerous studies on risk factors and prevention strategies (see Griffin et al., 2000 for review), as well as on ACL reconstructiontechnics (see Spindler et al., 2004 as an example). The most prevalent complications after ACL reconstruction are quadriceps weakness, flexion contracture, and patellofemoral pain (Sachs et al., 1989).Patellofemoral Pain Syndrome (PFPS) is characterised by pain around the patella mainly at activities that load the patellofemoral joint like bending knees, walking stairs or kneeling. The origin of the complaints is not fully understood although weakness and/or tightness of the extensor muscles, changes in medial and lateral quadriceps muscle reflex time, patellar laxity and increased navicular drop are suggested to be associated with PFPS (Boling et al., 2009; Witvrouw et al., 2000). This study therefore aimed at comparing the isokinetic profile in female athletes with and without PFPSto gain further understanding in characteristics and prognosis of PFPS after ACL reconstruction.

What is the role of the conservative intervention in the treatment of a torn anterior cruciate ligament?

Anterior cruciate ligament (ACL) injuries are common and the economic burden of these injuries is high. However, the optimal management of a torn ACL of the knee is still controversial. Anterior cruciate ligament surgery is not suitable for all patients; there are some indications for non-surgical treatment with a strict neuromuscular rehabilitation program in selected patients. Neuromuscular rehabilitation is also necessary prior to ACL reconstruction. This is crucial for the primary and secondary prevention, too.

Radiological Study of Anterior Cruciate Ligament of the Knee Joint in Adult Human and its Surgical Implication

Anterior cruciate ligament (ACL) is considered as an intra-capsular extra-synovial ligament, primarily responsible for resisting anterior displacement of the tibia on flexion and extension. Magnetic resonance imagining (MRI) has been applied to musculoskeletal patho-anatomy and has been shown to be an effective tool for definition and characterization of knee pathology, regarding the knees subjected to MRI examination, measurement was done for length from femoral to tibial attachment site and thickness at the mid-portion. Comparison between the data obtained in the present study with data obtained from Kowen results there is variable length and thickness. Concluded that for the anterior cruciate ligament the length and thickness of the native ACL played an important role for choosing the type of graft and for the preparation of the graft and dimensions of the native ACL have to be considered in graft selection for anatomic ACL reconstruction.

Dynamic quantification of tibio-femoral rotation in postero-lateral bundle insufficiency of the anterior cruciate ligament: a cadaver study.

Anterior cruciate ligament (ACL) injury represents one of the most common diagnoses in orthopaedic sports medicine. In the past, anatomic knowledge about the different bundles within the cruciate ligaments triggered new treatment concepts, such as double-bundle ACL reconstruction. Recently, besides complete tearing, partial ACL ruptures and bundle augmentation became a focus. However, only little is known regarding rotational stability of the knee with an isolated torn postero-lateral (PL) bundle. Therefore, the aim of the present study was the torsiometric analysis of tibio-femoral restraint patterns of the PL-insufficient knee joint. Fresh human whole body cadavers were enrolled. After diagnostic arthroscopy to ensure the structural integrity of the cruciate ligaments, knee joints underwent torsiometry at 0°, 30°, and 90° degree flexion. Then stepwise the PL bundle and the anteromedial (AM) bundle were arthroscopically resected, while torsiometry of the PL- as well as of the ACL-deficient knee joints was repeated. An area under the curve (AUC) was calculated. All statistical analyses were conducted using a p-value of 0.05 as level of significance. The comparison of charged and equilibrated curves during internal rotation revealed significant results at low flexion (30° flexion) angles between the ACL intact versus PL absent conditions (p = 0.04). In addition, charged and equilibrated curves during external rotation at 90° flexion, thus high angles, resulted in a significant difference when comparing the ACL-intact with the PL-deficient condition (p = 0.01). In the present cadaver study using the Torsiometer tool we found a distinct destabilization of the rotational restraints in full knee extension only after total ACL resection. In contrast, no significant findings resulted after an isolated dissection of the PL bundle during internal deflection. Nevertheless, a significant loss of stability was found during unstressed external deflection after isolated PL bundle dissection. Therefore patients, undergoing PL augmentation might benefit regarding rotational instability patterns.

Revision surgery for failed anterior cruciate ligament reconstruction in the knee

Abstract Anterior cruciate ligament (ACL) reconstruction is a commonly performed surgical procedure in the knee. Revision following failed ACL reconstruction surgery is an increasingly common procedure. Revision surgery can be complicated due to the large variability of methods of primary ACL reconstruction, and the presence of bony defects and hardware. The cause of failure of the original ACL graft must be identified. The surgeon must have a strategy to deal with various problems and be flexible when operating on these patients. Outcomes following revision ACL surgery should not be expected to be as good as following primary ACL surgery, and patients should be counselled regarding this. Even if a stable knee is achieved objectively, subjective patient related outcomes are not as good as following primary ACL reconstruction. There is also a higher rate of re-rupture after revision ACL surgery, and thus return to sport is less likely. Damage to the chondral surfaces has a significant effect on the outcome following revision ACL surgery. An unstable ACL-deficient knee has a higher incidence of chondral damage and there may be a role for revision ACL surgery for its protective effect against further chondral damage, even if subjective outcomes are not as good.