Anteroposterior Stability Research Articles

Different intraoperative kinematics, stability, and range of motion between cruciate-substituting ultracongruent and posterior-stabilized total knee arthroplasty.

The aim of this study was the comparison of intraoperative kinematics, stability, and range of motion (ROM) between the native osteoarthritic knee and cruciate-substituting fixed-bearing total knee arthroplasty (TKA) using both an ultracongruent (UC) and a posterior-stabilized (PS) insert design in the same patient. We hypothesized less knee flexion and less antero-posterior stability in the UC TKA. Intraoperative measurements of kinematics, stability, and ROM were performed in 40 patients before soft-tissue release and bone cuts, and after implantation of the final femoral and tibial implants with both a UC insert and a PS insert. All measurements were performed using a navigation system. Kinematics changed significantly from a constant posterior femoral rollback before surgery to a paradoxical anterior translation during initial knee flexion with both inserts, but less pronounced with the PS insert (p < 0.001). There was significantly more posterior femoral rollback with the PS insert compared to the UC insert (p < 0.01). Stability measurements demonstrated no differences at full extension and 30° of knee flexion but significantly increased antero-posterior translation in 60° and 90° of knee flexion with the UC insert compared to the PS insert (p < 0.001). ROM measurements demonstrated improvement of knee flexion from 118° at the beginning of the surgery to 123° with the UC insert and 128° with the PS insert (p < 0.001). The use of a UC insert intraoperatively resulted in less antero-posterior stability and slightly less knee flexion compared to a PS insert. Surgeons should be aware of these differences when deciding for one of these options to substitute the posterior cruciate ligament (PCL). The impact of these findings on clinical outcome needs further investigation. II.

Pre-surgery exercise and post-operative physical function of people undergoing knee replacement surgery: A systematic review and meta-analysis of randomized controlled trials.

To summarize the evidence regarding the effectiveness and dose-response characteristics of pre-operative exercise programmes on post-operative physical function following total knee arthroplasty. CINAHL, Cochrane Library, PubMed, SPORTDiscus and EMBASE. Randomized controlled trials were eligible if they provided full description of physiological stress (i.e. mode, frequency, intensity and duration). Data extraction and evaluation were performed by one reviewer. Methodological quality of the selected studies was assessed using the Physiotherapy Evidence Database scale. Twelve candidate studies were identified, but only 3 papers satisfied all inclusion criteria: 2 studies evaluated the effect of resistance training and 1 trial investigated proprioceptive training. The latter study elicited significantly enhanced post-operative gains in function for indices of standing balance (overall stability index: Hedges' g = -1; anteroposterior stability index: Hedges' g = -1.15; 6 weeks post-surgery). Results of meta-analysis based on the findings of 2 studies showed that, compared with controls, prehabilitative exercise involving resistance training offered no additional gains in isometric quadriceps muscle strength at 6 and 12 weeks post-operatively. Despite a potential for efficacy of exercise-based conditioning, this review highlights the scarcity of robust dose-response evidence to guide the formulation of total knee arthroplasty prehabilitation effectively.

Solving the Mystery of the Antero Lateral Ligament.

The cruciate ligaments are essential for the antero-posterior stability of the knee joint. In Anterior Cruciate Ligament (ACL) rupture, though reconstructive surgery is a widely accepted and proven procedure, there is still an unacceptably high re-injury rate. The fact that the rotational instability persists even after the surgical reconstruction of ACL injury has evoked a new interest in the study of the soft tissue structures on the anterolateral aspect of the knee joint. The stability of the knee joint was found to improve dramatically if ACL reconstruction is accompanied with the reconstruction of the anterolateral soft structures of the knee. To identify the attachment and observe the measurable parameters of Antero Lateral Ligament (ALL) and its relationship with the adjacent bony landmarks. Twenty six cadaveric specimens of knee joints were collected from the Department of Anatomy, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi and were dissected for the anterolateral ligament. Various parameters of ALL in extended knee- the length, width at midpoint and at the femoral-tibial attachments and thickness- were measured. The relationship of femoral attachment of ALL with the lateral femoral epicondyle as well as the tibial attachment with the Gerdy's Tubercle (GT) and head of fibula were also noted. ALL was identified in all the 26 cadaveric knee specimens. It was 39.2±7.2 mm in length, 6.5±2.7 mm in width at femoral attachment and 7.4±3.4 mm at tibial attachment, while the thickness was 1.0±0.5 mm. At the femoral attachment it was 7.1±3.4 mm proximal to and 4.0±2.9 mm posterior to the lateral epicondyle while at the distal attachment it was 20.4±3.1 mm posterior to the GT and 21.33±4.6 mm anterior to the head of the fibula. The ALL was found to be a distinct, supporting anatomical structure on the anterolateral aspect of the human knee. There is a high incidence of ALL lesions in ACL injuries which causes high-grade pivot-shift. The reconstruction of ALL along with that of ACL could lead to a decrease in the re-injury rates. The anatomical descriptions and the morphometry of ALL may be of great value to the orthopaedic surgeons in performing a more effective reconstructive surgery of ACL.

Postoperative Anteroposterior Laxity Influences Subjective Outcome After Total Knee Arthroplasty

BackgroundWe hypothesized that postoperative anteroposterior (AP) stability of the knee correlates with patient-reported clinical outcome and knee function after total knee arthroplasty (TKA). MethodsThis study enrolled 110 knees in 81 patients after TKA. AP laxity was measured with a KS Measure Arthrometer at 30°, 60°, and 90° flexion, which was confirmed with a goniometer. We assessed knee pain and function by using the Knee Society Function Score (KSS) and Knee Injury and Osteoarthritis Outcome Score (KOOS). Correlations among AP translation values and KOOS subscale scores (pain symptom, activities of daily living, and knee-related quality of life), KSS, and range of motion (ROM) were analyzed. ResultsThe mean follow-up period for the assessment of the KOOS was 4.4 ± 2.2 years (range, 1.1-11.5 years). Twenty-five knees had posterior-stabilized fixed-bearing TKA, and 85 knees had posterior-stabilized mobile-bearing TKA. The mean KSS functional score and mean ROM were 96.3 ± 5.7 (range, 75-100) and 121.6° ± 14.4° (range, 90°-145°), respectively. The mean AP laxity was 4.5 ± 2.2 mm, 3.6 ± 1.9 mm, and 3.0 ± 1.9 mm at 30°, 60°, and 90° knee flexion, respectively. A significant inverse association was observed between AP laxity at 60° knee flexion and KOOS pain (P = .02∗, R2 = 0.05), but no significant association was found between AP laxity and other KOOS subscale score, KSS, and ROM. ConclusionWe found that the AP laxity at 60° knee flexion in this study significantly correlated with patient-reported pain. The observed AP laxity can be considered as a register of normal AP translations after arthroplasty.

Unilateral Stability and Visual Feedback Body Control Improves After Three-Month Resistance Training in Overweight Individuals

ABSTRACTThe authors evaluated the effect of 3 months of resistance and aerobic training (3 sessions/week) on body balance in a group of 25 overweight and obese individuals. Prior to and after the training, they performed static and task-oriented balance tests under various conditions. Mean center of pressure (CoP) velocity and mean trace length of the CoP in the y-axis registered during a one-legged stance significantly decreased after the resistance training (19.1%, p = .024; 29.3%, p = .009). Mean trace length of the CoP in the y-axis decreased significantly also during a bipedal stance on a foam surface with eyes open and closed (10.9%, p = .040; 18.2%, p = .027). In addition, mean CoP distance and mean squared CoP distance in the anteroposterior direction during a visually guided center of mass (CoM) tracking task significantly improved (14.7%, p = .033; 28.2%, p = .016). However, only mean trace length of the CoP in the y-axis during a bipedal stance on a foam surface with eyes open and closed significantly decreased after the aerobic training (10.3%, p = .047; 16.5%, p = .029). It may be concluded that resistance training is more efficient for the improvement of the anteroposterior unilateral stability and the accuracy of the regulation of the CoM anteroposterior position than aerobic training in overweight and obese individuals.

Dual-Tasking Effects on Dynamic Postural Stability in Athletes With and Without Anterior Cruciate Ligament Reconstruction.

To compare the effect of dual tasking on postural stability between patients with anterior cruciate ligament reconstruction (ACL-R) and healthy controls. Single-limb postural stability was assessed in 17 athletes with ACL-R and 17 healthy matched athletes while standing on a Biodex Balance System platform in 4 conditions: stability level of 8 (ie, more-stable support surface) with eyes open, stability level of 8 with eyes closed, stability level of 6 (ie, less-stable support surface) with eyes open, and stability level of 6 with eyes closed. Postural-stability tasks were performed with and without auditory Stroop task. The anteroposterior stability index (APSI), mediolateral stability index (MLSI), and overall stability index (OSI) as measures of postural performance, as well as reaction time and error ratio as measures of cognitive performance, were recorded. Dual-tasking effect on postural stability was not significantly different between the groups in 3 postural conditions. Only in level 6 with eyes open, for APSI and OSI, patients with ACL-R showed lower postural stability under the dual-task condition. However, patients showed poorer performance on both reaction time and error ratio in all postural conditions. The patients with ACL-R appeared to sacrifice their cognitive performance to optimize their performance on postural stability. This posture-first strategy was reflected by a more pronounced effect of dual tasking on the auditory Stroop task than the postural-stability task. In situations where maintenance of posture is challenging, giving priority to the postural task at the expense of cognitive performance can ensure safety from balance loss.

Losing touch: age-related changes in plantar skin sensitivity, lower limb cutaneous reflex strength, and postural stability in older adults

Age-related changes in the density, morphology, and physiology of plantar cutaneous receptors negatively impact the quality and quantity of balance-relevant information arising from the foot soles. Plantar perceptual sensitivity declines with age and may predict postural instability; however, alteration in lower limb cutaneous reflex strength may also explain greater instability in older adults and has yet to be investigated. We replicated the age-related decline in sensitivity by assessing monofilament and vibrotactile (30 and 250 Hz) detection thresholds near the first metatarsal head bilaterally in healthy young and older adults. We additionally applied continuous 30- and 250-Hz vibration to drive mechanically evoked reflex responses in the tibialis anterior muscle, measured via surface electromyography. To investigate potential relationships between plantar sensitivity, cutaneous reflex strength, and postural stability, we performed posturography in subjects during quiet standing without vision. Anteroposterior and mediolateral postural stability decreased with age, and increases in postural sway amplitude and frequency were significantly correlated with increases in plantar detection thresholds. With 30-Hz vibration, cutaneous reflexes were observed in 95% of young adults but in only 53% of older adults, and reflex gain, coherence, and cumulant density at 30 Hz were lower in older adults. Reflexes were not observed with 250-Hz vibration, suggesting this high-frequency cutaneous input is filtered out by motoneurons innervating tibialis anterior. Our findings have important implications for assessing the risk of balance impairment in older adults.

Resultados de la satisfacción subjetiva y traslación tibial residual entre 3 técnicas de reconstrucción del ligamento cruzado anterior

PurposeIn this study, we aimed to determine if there is any difference between the subjetive satisfaction and the residual tibial traslation outcomes, of the three most common reconstruction techniques; which are conventional trans-tibial technique, anatomic tunnel technique and all inside technique. Material and methodsObservational, retrospective study of eigthteen patients who underwent ACL reconstruction between 2014 and 2015. Single-bundle reconstruction with an autologous or allograft was performed in all patients. Femoral tunnel was drilled by the conventional TT technique in 6 patients, Anatomic in 6 patients and all inside in 6. Functional evaluation was performed about 6 months postoperatively. Functional evaluation included the International Knee Documentation Committee Scoring Subjetive form (IKDC) and anteroposterior stability was assessed using a arthrometer in lachman test and anterior drawer test. ResultsThe results of IKDC subjetive test and residual ligament laxity, demonstrated statistical diference between Transtibial (IKDC 70.52) vs all inside technique (IKDC 89.63) (P0.05). ConclusionThe all inside preparation technique in the reconstruction of the ACL seems as effective as the conventional techniques in terms of subjetive satisfaction and stability in the midterm of follow up.Level of evidence: IV.

Relationship Between Proprioception and Dynamic Balance in Knee Osteoarthritis

Background/Aim: Knee Osteoarthritis (OA) is a highly recognized cause for chronic disability in elders. Patients with knee OA show impairment of dynamic balance and high risk of falls. Poor proprioception was also identified in knee osteoarthritic population and was related to increased risk of falling. The findings of studies conducted to correlate between dynamic balance and proprioception in these patients are conflicting. The aim of this study was to find if there is a relationship between dynamic balance and proprioception (sense of position and sense of movement) in patients with knee OA. Subjects and Methods: Thirty nine female patients with knee Osteoarthritis grade II and III Kellgren and Lawrence (KL) scale, aged from 40 to 65 years old were included in the study. Biodex Balance System (BBS) was used to evaluate dynamic balance and retrieve three outcome measures: Overall stability Index (OSI), Mediolateral Stability Index (MLSI) and Anteroposterior Stability Index (APSI). Proprioception was measured through Biodex system 3 isokinetic dynamometer in which knee joint reposition task and the threshold to detection of passive motion (TTDPM) were used to assess the sense of position and the sense of movement

Reconstruction of Monteggia-like proximal ulna fractures using different fixation devices: A biomechanical study

BackgroundComminuted proximal ulna fractures are rare and reconstruction of these fractures is discussed controversially. The aim of this study was to test three currently available plate devices in a standardized comminuted four-part fracture model created in proximal ulna sawbones. Material and methodsA standardized four-part fracture of the proximal ulna was created in 80 sawbones. Reconstruction was performed by five experienced test surgeons according to a standardized reconstruction protocol. Each surgeon reconstructed 4 fractures with a 3.5mm eight-hole reconstruction plate, 4 fractures with seven-hole third-tubular double plates and 4 fractures with a 3.5mm anatomical seven-hole locked angle proximal ulna plate. 4 more fractures were reconstructed with simple K-wires as a reference construct for further experiments. Outcome measurements were time for reconstruction, quality of reconstruction and stability of the reconstruction. Stability testing was done in 90° and 30° flexion of the elbow. Testing in 30° flexion was done to test the anteroposterior stability regarding the fixed coronoid process. ResultsTime for reconstruction was significantly less for K-wire fixation than for the plate devices. Time for reconstruction plating and locked angle plating was significantly lower than for double plating (p<0.005). Quality of reduction did not differ between the three plate systems (p<0.05). K-wire fixation showed the best quality of reduction (p<0.005). In 90° of elbow flexion the anatomic locked angle olecranon plate showed a significantly higher stability compared to the other devices. Furthermore the tubular double plating was significantly more stable than reconstruction plating or K-wire fixation (p<0.05). In anteroposterior loading at 30°, the stability did not differ between the 4 different fixation techniques (p>0.05). For all devices the testing in 30° flexion showed a significantly higher rigidity compared to 90° flexion. ConclusionThe locked angle plate system showed the highest stability in 90° of elbow flexion. Each implant was more stable in 30° flexion than in 90° flexion. Testing of the anterior stability of the elbow did not show any differences between the different implants. Because of the superior stability of this device, we conclude that locked angle plating should be preferred for reconstruction of monteggia like complex proximal ulna fractures.

Comparative study of anatomical anterior cruciate ligament reconstruction versus conventional anterior cruciate ligament reconstruction

BackgroundAim of our study was whether anatomical placement of femoral tunnel using central Gillquist portal for visualization improves the rotational and antero-posterior translational stability as compared to conventional two portal technique of placement of femoral tunnel, where anterolateral portal is the visualization portal and anteromedial portal is the working portal. We define this latter method as non-anatomical placement, because we cannot visualize the face of medial surface of lateral femoral condyle and use jig to make the femoral tunnels. Materials and methodsThis study was a retrospective and prospective study conducted in the Department of Orthopaedic Surgery, NSCB Subharti Medical College, Meerut, over a period of 4 years in patients undergoing arthroscopic ACL reconstruction. The follow-up examination included knee joint range of movement assessment, Lachman test, Pivot shift test, IKDC score and Lysholm score at 6 weeks, 3 months, 6 months and 1 year. Results and conclusionsOn final assessment, we concluded that anatomical method of ACL reconstruction gives superior results for antero-posterior stability and although there is not much difference in functional scores when assessed using IKDC scores, but a small statistically significant difference is seen when assessed by using Lysholm scores for functional scoring.

Changes in anteroposterior stability and proprioception after different types of knee arthroplasty

To compare different types of knee arthroplasty, in selected patients with a knee score above 80 points, for their post-operative changes in anteroposterior (AP) laxity and proprioception. Four groups of each ten patients were tested for AP translation after different types of arthroplasty with a KT-1000 device at 30°, 60° and 90° of flexion. Proprioception of the joint was evaluated by joint position sense with three different tests. Clinical outcome of stability and proprioceptive testing was analysed by comparing the results of three (KSS, KOOS and FJS-12) patient-reported outcome measurement scores (PROMS) for each of the different implant types. Anteroposterior laxity was observed at 30° and 90° of flexion for the two PS TKA designs included in this study, but not for the UKA or the medial pivot design. All knee designs, except UKA, had an increased laxity at 60° of flexion. Proprioceptive testing was inconclusive. PROMS were not able to identify differences in clinical outcome among different knee designs in these selected patients, despite observed differences in AP laxity. Increased AP laxity is a result of the surgical procedure in knee arthroplasty. UKA is the only design mimicking native laxity of the knee. A medial pivot design can obtain the same result as UKA at 30° and 90° of flexion, but not at the importantly cited 60° of flexion as tested under non-load-bearing conditions. The clinical relevance of this study is that despite of an important range of AP translations among the different knee designs, good-to-excellent patient-reported outcome was observed within the findings of this study. II.

A systematic review of double-bundle versus single-bundle posterior cruciate ligament reconstruction

BackgroundPosterior Cruciate Ligament (PCL) ruptures are common sports injuries. One of the key controversies in PCL reconstruction is whether double-bundle reconstruction provides biomechanical and clinical outcomes superior to single-bundle reconstruction.MethodsWe performed a comprehensive search in multiple databases to evaluate the advantages of single-bundle or double bundle reconstructions in anteroposterior stability, graft tension, rotational stability, and functional outcome.ResultsBiomechanical comparisons evaluating anteroposterior stability described either no difference or increased stability in double-bundle reconstructions. Comparing these results is complicated by different graft choices, tensioning techniques, and tunnel positions. Biomechanical studies of graft tension demonstrated conflicting results regarding the optimal reconstruction technique. Seven retrospective clinical studies of single- and double-bundle reconstructions with methodological limitations reported no difference in clinical outcome.ConclusionsThe superiority of single-bundle or double-bundle posterior cruciate ligament reconstruction remains uncertain.

Intraoperative Evaluation of Range of Motion and Anteroposterior Stability in Cruciate-Substituting Total Knee Arthroplasty with Posterior Cruciate Ligament Sacrifice

Intraoperative Evaluation of Range of Motion and Anteroposterior Stability in Cruciate-Substituting Total Knee Arthroplasty with Posterior Cruciate Ligament Sacrifice

Intraoperative assessment of range of motion and anteroposterior stability in cruciate-substituting total knee arthroplasty: Comparison between posterior cruciate ligament retained and sacrificed knees

Intraoperative assessment of range of motion and anteroposterior stability in cruciate-substituting total knee arthroplasty: Comparison between posterior cruciate ligament retained and sacrificed knees

Correlation between Postural Stability and Functional Mobility in Patients with Knee Osteoarthritis

Background : Osteoarthritis (OA) is a degenerative joint disorder caused by progressive erosion of articular cartilage. The joint which is commonly affected is theknee joint. Patient with knee OA has increasing pain with decreasing postural stability, and may cause decrease infunctional mobility of the body. The aim of this study was to analyze the correlation between stability and mobility in patients with knee OA. Methods : A cross sectional study was performed to 43 patients from the Rheumatology Clinic of Dr. Hasan Sadikin General Hospital, Bandung, during September−October 2013. The ‘Timed Up and Go’ (TUG) test and stabillometric platform examination were performed to analyze the mobility and stability in subjects. The data were analyzed with Spearman’s Correlation. Results : Four subjects (9.30%) had normal functional mobility, 31 subjects (72.09%) had good mobility and need no help of others in their activities, and 8 subjects (18.60%) had problems and could not stand and walk without help. This study also found 39 subjects (90.69%) had high risk of fall. The p value were 0.005 for correlation between knee OA and lateral static postural stability, 0.138 with anteroposterior static stability, 0.067 with dynamic to position of top right stability, 0.344 with dynamic to position of top left stability, 0.384 with dynamic to position of bottom left stability and 0.357 with dynamic to position of bottom right stability. Conclusions : There is a strong correlation between functional mobility with static postural stability, especially to the lateral position. [ AMJ .2015;2(4):550–4] DOI: 10.15850/amj.v2n4.639

Effect of induced fatigue on dynamic postural balance in healthy young adults

Background Fatigue may impair the proprioceptive and kinesthetic properties of joints and has been shown to have a negative effect on neuromuscular control, thus increasing the risk for injury. Purpose This study aimed to determine the effect of induced whole-body fatigue on dynamic balance control in healthy young adults. Participants and methods Thirty healthy young participants of both sexes were included in this study; their ages ranged between 18 and 22 years. All of the participants were tested on the Biodex Stability System (BSS) at a stability level 4, subjected to induced fatigue on a treadmill, and then retested directly on the BSS again to evaluate dynamic postural balance. Results There was a significant decrease in the overall stability index, anteroposterior stability index, and mediolateral stability index of dynamic balance at stability level 4 of BSS in healthy young adults as P -values were 0.0001, 0.0001, and 0.0001, respectively. Conclusion and implication It was concluded that induced whole-body fatigue decreased the dynamic postural balance (overall stability index, anteroposterior stability index, and mediolateral stability index) in healthy young adults. This implies that muscles of a fatigued individual are at increased risk for musculoskeletal injury, and steps should be taken during conditioning and rehabilitation programs to prevent muscle fatigue through balance training and endurance exercises to avoid disturbed balance related to fatigue among young healthy adults.

Effect of spinal stabilization exercise on dynamic postural control and visual dependency in subjects with chronic non-specific low back pain

Motor control approach towards chronic non-specific low back pain (CNLBP) has gained increasing attention. CNLBP patients have shown to be more visually dependent for the postural control process than control subjects but no study has yet investigated the treatment programs effect on this disorder. Forty CNLBP patients volunteered to participate in this experimental study. The subjects were randomly assigned into either stabilization exercise (SE) or control group both receiving 12 sessions of routine physiotherapy for four weeks. The SE group also received intensive stabilization exercise. Balance (in terms of overall (OSI), anteroposterior (APSI) and mediolateral stability indices (MLSI)) and functional disability were assessed by Biodex Balance System(®) (BBS) and Oswestry Low Back Disability Questionnaire, respectively prior and after the interventions. The balance tests were performed with open and closed eyes. Both interventions significantly decreased all stability indices but the SE group showed a more pronounced improvement in OSI and APSI. In the SE group, vision deprivation had smaller destabilizing effects on OSI and APSI as compared with the control group. The groups were not statistically different prior and after the interventions on all dependent variables. Oswestry index reduction in the SE group was more pronounced but the interaction of time and group variables were not significant on pain intensity. Both interventions effectively enhanced stability indices and functional capabilities and reduced pain intensity in CNLBP patients. The SE protocol made the patients less visual dependent perhaps via better stability. Since pain reduction was not different between the groups, more functional improvement in SE group cannot simply be interpreted via the pain interference and might be related to postural control capabilities of the patients.

Clinical and Functional Outcome of All-Inside Anterior Cruciate Ligament Reconstruction at a Minimum of 2 Years’ Follow-up

To evaluate the clinical and functional outcomes for anatomic anterior cruciate ligament (ACL) reconstruction using the all-inside technique with a minimum follow-up of 24 months. Patients undergoing anatomic ACL reconstruction via the all-inside technique between January 2011 and October 2012 were reviewed for inclusion in this study. Functional outcome measures, including the Lysholm score, International Knee Documentation Committee score, visual analog scale score, and Tegner Activity Scale, were used to evaluate outcomes before surgery and at 3, 6, 12, and > 24 months. At final follow-up, anteroposterior knee stability was assessed with KT-2000 (MEDmetric, San Diego, CA) measurements. Of the 92 patients who underwent primary all-inside ACL reconstruction, 79 patients returned to final follow-up with a minimum of 2 years. There were 53 men and 26 women with a mean age of 29 years (range, 18 to 54 years) and a mean follow-up of 29 months (range, 24 to 45 months). The International Knee Documentation Committee score (44.6 v 89.7, P < .0001), Lysholm score (53.4 v 93.1, P < .001), visual analog scale score (5 v 0.1, P < .001), and Tegner activity score (2 v 6, P < .001) showed a significant improvement between baseline and final clinical follow-up. The mean side-to-side KT-2000 difference at final follow-up was 1.7 mm (range; 0 to 6 mm). Overall 10 patients (12.7%) sustained an ACL graft rerupture after a mean of 17.6 months (range, 6.9 to 28.6 months). The current data support our first hypothesis that primary anatomic ACL reconstruction using the all-inside technique leads to improved functional outcomes between baseline and clinical follow-up at 24 months. Further, there was no difference in knee stability between the ACL reconstructed- and the contralateral normal knee at 24 months, which confirms our second hypothesis.

Isokinetic muscle strength of the knee in knee OA subjects, the general public and professional athletes: Comparative and analytical study

Isokinetic is a reference method for evaluation of muscle strength. The knee joint is still the most valued joint isokinetic. To compare the isokinetic profile 3 populations knee OA, professional athletes and subjects representing the general population. Analytical comparative study including 30 knee OA patients, 20 professional athletes and 15 subjects representing the general population collected in physical medicine and functional rehabilitation of the CHU Ibn Rochd-Casablanca, Morocco. All subjects had an isokinetic evaluation of the knee by a CYBEX brand-HUMAC dynamometer concentric fashion at the following speeds: 60°/s and 180°/s. The distribution of the variables is verified by the normality test of Shapiro-Wilk. The Kruskal Wallis test followed by Bonferroni post hoc test were used to compare different isokinetic variables of the three groups and objectified a significant difference in the following parameters: the peak maximum torque (PCM) of the quadriceps (Q) and IJ, the Labor Q and IJ, the power of Q and IJ between the 3 groups. It is known that knee OA subjects complain of weakness with loss of function. With a normal age and equivalent to healthy subjects, the knee OA patients show a significant decrease in muscle strength. Muscle weakness alters the anteroposterior knee stability this affects the quality of travel. Physical activity appears to be a protective factor in the deterioration of the articular cartilage of the knee, which is well understood in athletes.