Cruciate Ligament Injury Research Articles

Quality of Movement for Athletes Six Months Post ACL Reconstruction

Objectives:Anterior cruciate ligament (ACL) injury prevention programs evaluate quality of movement (QM) to identify and correct high-risk movement patterns. However, return to play (RTP) decisions post-ACL reconstruction (ACLR) are often based on non-sport relatedquantitative measures such as isokinetic tests and/or time from surgery, with six months post-ACLR being a common expectation for RTP. The purpose of this study was to evaluate whether athletes are ready to RTP 6 months post ACLR using a QM assessment (QMA).Methods:A QMA including nine dynamic tasks (squat, single leg [SL] stance, step down, SL squat, jump in place, side to side jump, broad jump, hop to opposite, SL hop) progressing from double- to single-limb vertical and horizontal movements was administered to 136 athletes at five to seven months post-ACLR. Tasks were viewed from the frontal and sagittal planes by a physical therapist and performance specialist. Movements were evaluated live for risk factors associated with ACL injury (strategy, depth, control, symmetry, and alignment). The proportion of patients exhibiting risky movement patterns for each task was calculated. Fisher’s Exact test was used to determine if there were differences in movement patterns between males and females.Results:The proportion of patients demonstrating risky movement patterns for a task ranged from 48% to 100%. All 136 patients exhibited risky movement patterns for at least one task and 60% of patients displayed risky movement patterns in five or more of the nine tasks. Rates of risky movement patterns were not different between males and females for all tasks (P>0.1 for all tasks).Conclusion:Six months has been cited as a probable time for RTP post-ACLR; thus this is the expectation of the athlete. Our data show that athletes demonstrate multiple QM patterns associated with initial ACL injury, as well as 2nd injury at five to seven months post-operatively. Altered movement patterns evident in tasks as simple as a SL stance remained with the athlete through tasks of increasing difficulty. We recommend that therapists integrate QM screening into rehabilitation with a focus on movement retraining to address mechanical risk factors prior to RTP.

Myoelectric Manifestations of Fatigue after ACL Reconstruction: A Cross-Sectional Study after Postoperative Rehabilitation

An increased fatigability associated with anterior cruciate ligament (ACL) injury may persist several months after surgery. The purpose of this study was to investigate the behavior of muscle fiber conduction velocity (CV) as a descriptor of myoelectric fatigue, at different stages after rehabilitation, post-ACL reconstruction. Nineteen subjects acted as control group (CG), 10 patients had undergone surgery within 12 months (R12), and 23 patients were more than 24 months post-surgery (R24+). Surface electromyography (EMG) signals were detected from the quadriceps femoris using bidimensional arrays during isometric contractions at 20% and 60% maximal voluntary contraction (MVC). We observed a lower fatigability in the R24+ group during the 60% MVC contraction, with respect to the other groups. Lower fatigability of quadriceps muscle after ACL reconstruction in the long term may be linked to a recovery from a transitory altered motor unit recruitment strategy due to surgery, observed in the R12 group. Therefore, the findings of this study do not suggest an impaired fatigability of the quadriceps muscle during sustained isometric contractions in active patients in the long term.

Traction Enhancing Products Affect Maximum Torque at the Shoe-Floor Interface: A Potential Increased Risk of ACL Injury

The knee is one of the most frequently injured joints in the body, between 100 000 and 400 000 Anterior Cruciate Ligament (ACL) injuries occur in the United States each year. This investigation explores the impact of wipe- or spray-on sneaker products used to increase traction between shoes and hardwood courts on the loading of the ACL. Specifically, the maximum torque achieved prior to the sneaker slipping on the court surface is measured using a servo-hydraulic bi-axial load frame. A prosthetic foot fitted into a sneaker was fixed to the load cell and a piece of hardwood court was fixed to the actuator of the load frame. Axial loads were applied to simulate an athlete's body weight and torques were applied to simulate an athlete pivoting on a hardwood surface. The maximum torque achieved prior to the sneaker slipping on the hardwood surface was measured. The investigation finds that the application of the wipe- or spray-on sneaker products increases the maximum torque achieved prior to the sneaker slipping by 164%. This increase in torque exceeds prior published levels of torque that resulted in ACL failure in a cadaveric model.

Arthroscopic ACL Reconstruction with Bone Patellar Bone Graft using Anteromedial Technique

There are approximately 200,000 anterior cruciate ligament (ACL) injuries per year in the United States and more than half will be treated with ACL reconstruction. The diagnosis is made by physical exam supplemented by radiographs and MRI scan. Successful ACL reconstruction returns most athletes to pre-injury activity; however, outcome depends on appropriate preoperative evaluation, surgical timing, surgical technique, and an effective postoperative physical therapy program. Specifically, graft choice, graft positioning, and fixation technique have been shown to play important roles in patient outcome. Surgeons must also be aware of concomitant meniscal tears and cartilage injury that may need to be addressed at the time of ACL reconstruction. In this case, we perform an anatomic ACL reconstruction with bone-patellar tendon-bone (BTB) autograft using an anteromedial drilling technique and flexible reamers for a young college athlete. The anteromedial approach offers the advantage of reliably reproducing the native anatomy of the ACL on the femur footprint by drilling the femoral tunnel independently of the tibial tunnel. Furthermore, using a flexible reamer instead of a straight rigid reamer allows for a longer femoral tunnel and lower risk of posterior wall blowout or fracture.

Patellofemoral Joint Instability: A Review of Current Concepts

The patellofemoral joint remains the enigma of orthopedics and sports medicine. Patellar dislocation is a common problem in the younger and athletic population and it is more disabling than cruciate ligament injuries. The pathology is often multifactorial and complex with no one factor being the sole defining etiology. The current management of patella dislocation has been linked with poor patient satisfaction possibly due to a prolonged period of conservative treatment and the general tendency to delay surgical intervention. This review will address the main abnormal anatomical factors contributing to patellar instability, their clinical and radiological diagnoses, and the role of various surgical interventions, including the medial patellofemoral ligament reconstruction in stabilizing the patella.

The role of MRI in the diagnosis of intra articular knee derangement: A prospective study

Background: MRI has several advantages compared with other modalities in evaluating internal derangement of the knee & it has practically replaced conventional arthrography in the evaluation of menisci & cruciate ligaments as it is non invasive, painless and give excellent soft tissue contrast. Objective: To assess the role of MRI in internal derangement of the knee. Methods: Thirty patients with suspected internal derangement of the knee were subjected to a dedicated MR knee study and correlated knee arthroscopy and surgery. MRI of the knee was performed in closed magnet (1.5T, Seimens). Arthroscopy was done within two months of MR examination and was considered gold standard for the internal derangement of the knee. Results: The sensitivity, specificity, diagnostic accuracy of MRI were 94.1%, 84.6% and 90% respectively for medial meniscal tear; 71.4%, 95.6% and 90% respectively for lateral meniscal tear and 85.7%, 91.3% and 90% respectively for anterior cruciate ligament tear. Conclusion: MRI represents the optimal imaging tool in the evaluation of internal knee derangement as it showed high sensitivity, specificity, diagnostic accuracy for meniscal and cruciate ligament injury, in addition to associated derangement like articular cartilage damage and synovial effusion.

No Biomechanical Changes Observed with the Addition of Video Feedback to an ACL Prevention Program in Female Collegiate Athletes

Poor landing biomechanics could put an athlete at risk of anterior cruciate ligament (ACL) injury. ACL intervention programs aim to reduce injury risk by improving strength, flexibility and neuromuscular control. Video feedback interventions have shown success in improving jump-landing biomechanics in a laboratory setting; however, ACL injury prevention programs have yet to incorporate video feedback interventions. Aim: Examine if the addition of video feedback to a modified Sportsmetrics© ACL injury prevention program would produce biomechanical changes in collegiate female soccer athletes during landing. Methods: Hip and knee biomechanics were collected during landing pre- and post-intervention. Participants were allocated into feedback or control groups. All participants completed a 9 week modified Sportsmetrics© ACL intervention program. The feedback group received individualized feedback on their performance of the squat jump task once a week for 6 weeks. Results: No significant differences were observed between groups for any knee or hip biomechanical variables. Discussion: The task chosen for feedback, caliber of athletes,surface on which the athletes completed the jump-landing task and participant’s lack of previous experience with feedback may have contributed to the lack of statistical significance. Conclusion: Six video feedback sessions may not be enough exposure to produce biomechanical changes. Additionally, feedback should be provided on tasks prone to biomechanical errors (e.g., single leg landing) in order to receive the most benefit from the feedback intervention. Future research should continue to investigate adding formalized feedback to ACL intervention programs in an effort to decrease injury risk.

Rearfoot Landing Technique Increases Knee Loading during Sidestep Cutting Maneuvers by Basketball Players

1.1. Objectiveː Many non-contact anterior cruciate ligament (ACL) injuries in female basketball athletes occur during the deceleration phase of sidestep cutting maneuvers. However, few studies have attempted to quantify the kinetic and kinematical parameters related to landing technique during sidestep cutting maneuvers by basketball players. The objective of this study was to evaluate the effects of forefoot and rearfoot landing techniques on trunk and lower extremity kinetic and kinematic parameters during sidestep cutting maneuvers in this population. 1.2. Methodsː Fourteen healthy female collegiate basketball athletes performed forefoot or rearfoot landing technique randomly during sidestep cutting maneuvers. The trunk and lower extremity kinetic and kinematic variables of the non-dominant leg were analyzed during landing. The variables between forefoot and rearfoot landings during these maneuvers were compared. 1.3. Resultsː Rearfoot landings showed increased peak knee flexion angle and extension moment during the deceleration phase of sidestep cutting maneuvers, as compared to forefoot landing (p<0.05), whereas forefoot landing showed increased peak hip flexion angle (p<0.05). 1.4. Conclusionː The rearfoot landing technique increases knee extension moment, which may potentially place increased strain on the ACL. Therefore, forefoot landing techniques should be adopted during the train and completion of basketball for ACL injury prevention.

Surgical treatment of anterior cruciate ligament avulsion injuries in skeletally immature patients by cerclage wire loop technique

Introduction Tibial eminence avulsion fracture is the pediatric equivalent to a midsubstance anterior cruciate ligament (ACL) injury. It is most common between the ages of 8 and 19 years. Patients and methods From June 2009 to December 2012, 26 patients with ACL avulsion fractures were submitted to surgical treatment by means of a cerclage stainless steel wire loop. Seventeen patients were male and nine were female. Their ages ranged from 8 to 15 (mean: 12) years, and they were followed up for 6–22 (mean: 16) months. Results The Meyers & McKeever and Zaricznyj classifications were used for evaluating fractures for surgery. Radiographs in two views are often sufficient to establish a diagnosis. Cases were evaluated clinically by means of the anterior drawer test, which was negative in 21 patients, whereas four patients had residual laxity of about 2–3 mm increased manual anteroposterior tibial translation compared with the contralateral knee, without subjective feeling of instability. According to the Lyslholm scoring system excellent and good results were achieved in 24 (92%) cases, two patients showed fair results, and there were no poor results. Conclusion The use of a stainless steel wire loop cerclage by open technique gives excellent results, with benefits such as capture and control tension on ACL on each side of the avulsed fragment proper and adequate mechanical strength.

Dynamic load indicators for take-off-landing sequence in blocks and attacks of elite female volleyball players.

Dynamic loads during landings determined by the ground reaction forces (GRFs) may elaborate internal loads and increase the risk of overload knee injuries as a result of performing volleyball jumps many times. The study dealt with a biomechanical assessment of dynamic load indicators in female volleyball players for the motion sequence of take-off-landing in blocks and attacks. Twelve professional female volleyball players participated in the study. Blocks and attacks were filmed by two cameras. GRFs vs. time graphs were recorded with the use of a force platform. Values of dynamic load indicators in terms of the relations of peak of vertical component of GRF, build-up index of this force (BIF), and power output (P) during landing to the vGRF, BIF and P during take-off (L/T) were calculated. The statistically significant ( p < 0.05) highest values of L/T indicators were found for back row attack spikes: 2.4 (vGRF), 12.2 (BIF) and 3.1 (P). In the case of blocks, slide attack spikes and attack line spikes, results of these variables were in range: 1.8÷2.1, 5.9÷7.6 and 2.1÷2.9, respectively. The reduction of GRFs during landings contributes to decreasing the level of the load indicators L/T which should minimize the incidence of anterior cruciate ligament and patellar tendon injuries in female volleyball players.

Validation of predicted patellofemoral mechanics in a finite element model of the healthy and cruciate-deficient knee

Healthy patellofemoral (PF) joint mechanics are critical to optimal function of the knee joint. Patellar maltracking may lead to large joint reaction loads and high stresses on the articular cartilage, increasing the risk of cartilage wear and the onset of osteoarthritis. While the mechanical sources of PF joint dysfunction are not well understood, links have been established between PF tracking and abnormal kinematics of the tibiofemoral (TF) joint, specifically following cruciate ligament injury and repair. The objective of this study was to create a validated finite element (FE) representation of the PF joint in order to predict PF kinematics and quadriceps force across healthy and pathological specimens. Measurements from a series of dynamic in-vitro cadaveric experiments were used to develop finite element models of the knee for three specimens. Specimens were loaded under intact, ACL-resected and both ACL and PCL-resected conditions. Finite element models of each specimen were constructed and calibrated to the outputs of the intact knee condition, and subsequently used to predict PF kinematics, contact mechanics, quadriceps force, patellar tendon moment arm and patellar tendon angle of the cruciate resected conditions. Model results for the intact and cruciate resected trials successfully matched experimental kinematics (avg. RMSE 4.0°, 3.1mm) and peak quadriceps forces (avg. difference 5.6%). Cruciate resections demonstrated either increased patellar tendon loads or increased joint reaction forces. The current study advances the standard for evaluation of PF mechanics through direct validation of cruciate-resected conditions including specimen-specific representations of PF anatomy.

Predictive Neuromuscular Fatigue of the Lower Extremity Utilizing Computer Modeling.

This paper studies the modeling of lower extremity muscle forces and their correlation to neuromuscular fatigue. Two analytical fatigue models were combined with a musculoskeletal model to estimate the effects of hamstrings fatigue on lower extremity muscle forces during a side step cut. One of the fatigue models (Tang) used subject-specific knee flexor muscle fatigue and recovery data while the second model (Xia) used previously established fatigue and recovery parameters. Both fatigue models were able to predict hamstrings fatigue within 20% of the experimental data, with the semimembranosus and semitendinosus muscles demonstrating the largest (11%) and smallest (1%) differences, respectively. In addition, various hamstrings fatigue levels (10-90%) on lower extremity muscle force production were assessed using one of the analytical fatigue models. As hamstrings fatigue levels increased, the quadriceps muscle forces decreased by 21% (p < 0.01), while gastrocnemius muscle forces increased by 36% (p < 0.01). The results of this study validate the use of two analytical fatigue models in determining the effects of neuromuscular fatigue during a side step cut, and therefore, this model can be used to assess fatigue effects on risk of lower extremity injury during athletic maneuvers. Understanding the effects of fatigue on muscle force production may provide insight on muscle group compensations that may lead to altered lower extremity motion patterns as seen in noncontact anterior cruciate ligament (ACL) injuries.

Dynamic knee stability estimated from the knee axis position during hops twenty years after injury of the anterior cruciate ligament

Dynamic knee stability estimated from the knee axis position during hops twenty years after injury of the anterior cruciate ligament

Postoperative Knee Bracing After Anterior Cruciate Ligament Reconstruction

Bracing for anterior cruciate ligament (ACL) injury began in the 1970s and is widely used today for both nonoperative treatment and during the postoperative rehabilitation process. ACL braces are designed to shield the reconstructed ligament from increased stress or stabilize an ACL-deficient knee. The evidence to support routine functional ACL bracing for uncomplicated primary ACL injuries is limited. The decision to use a brace in ACL-deficient knees with collateral ligament injury is the individual physician’s choice. There is some evidence to support the use of bracing in ski athletes. Further research looking at functional bracing in high-demand contact athletes should be conducted to establish its role in the future.

Common injuries and ailments of the female athlete; pathophysiology, treatment and prevention

With increasing numbers of women competing in high school and collegiate athletics, it is important that physicians become familiar with injury patterns and medical conditions unique to the female athlete. Observations and clinical data have elucidated unique biomechanical, anatomic and hormonal factors that predispose skeletally mature female athletes to anterior cruciate ligament (ACL) injuries, patellofemoral disorders and lower extremity stress fractures. Additionally, younger female athletes are particularly at risk of developing components of the “Female Athlete Triad” (more recently included under the syndrome of “Relative Energy Deficiency in Sport” [RED-S]): disordered eating, amenorrhea and osteoporosis. An understanding of the pathophysiology of these conditions has led to the development of programs that can treat their underlying causes, decrease susceptibility to injury, and improve the long-term health of the female athlete. This paper is intended to provide physicians with a review of the sex-specific etiology, prevention and treatment of injuries common to the female athlete.

Bilateral ACL Reconstructions with Hamstring Autografts.

Bilateral anterior cruciate ligament (ACL) injuries are rare with incidence between 2 and 4%, and presently no definitive guidelines for proper management exist. Ideal treatment protocol remains controversial between a single-stage and two-stage bilateral ACL reconstruction. The purpose of this study is to evaluate the outcome of single-stage bilateral ACL reconstruction with hamstring tendon autografts in bilateral ACL injuries. A prospective study was undertaken including a total of 14 consecutive patients with bilateral ACL deficient knee who underwent single-stage bilateral ACL reconstruction with hamstring tendon autograft with a mean follow-up duration of 28 months (24-38 months). Functional outcomes were evaluated by range of movements, International Knee Documentation Committee (IKDC), Lysholm and Tegner activity score, and stability tests. The mean age was 30 years (range 18-42 years). Average duration of rehabilitation was 8 weeks. Time to return to full-time work and full sports was 5.6 weeks and 6.2 months, respectively. Clinical examination demonstrated full range of motion; a total of 12 patients (86%) had a negative Lachman test and 13 patients (93%) had a negative pivot shift at the final follow-ups. The mean IKDC evaluation score was 89 points, the mean Tegner activity score was 7 points, and the mean Lysholm knee score was 91 points. A total of 12 patients (86%) returned to their preinjury level of activity and an overall greater than 90% satisfaction rate was achieved. Single-stage bilateral ACL reconstruction using hamstring autografts is clinically safe, effective, and cost-effective with better patient compliance and with comparable functional outcome as opposed to two-stage ACL reconstructions.

A kinematic analysis of one-leg vertical jump on average 23 years after injury of the anterior cruciate ligament

A kinematic analysis of one-leg vertical jump on average 23 years after injury of the anterior cruciate ligament

Clinical and Arthroscopic Evaluation of Posterior Cruciate Ligament and Posterolateral Corner Injuries of the Knee

Posterior cruciate ligament (PCL) and posterolateral corner (PLC) knee injuries are relatively rare but can lead to significant instability, dysfunction, and chronic knee pathologies. Recent trends in the literature suggest that the best clinical outcomes are obtained through the early identification and timely management of PCL and PLC injuries. Appropriate use of physical examination tests and imaging studies is a crucial part of the initial assessment, allowing identification of all associated injuries and accurate preoperative planning. In this article, we present an evidence-based approach for the assessment of PCL and PLC injuries by focusing on the physical examination, relevant imaging studies, and diagnostic arthroscopy.

Social Sources of Research Interest in Women’s Sport Related Injuries: A Case Study of ACL Injuries

This article offers an analysis of the social sources of biomedical interest in women’s sports injuries through a case study of anterior cruciate ligament (ACL) injuries. Although both men and women incur them, there is extensive research interest in women’s ACL injuries. Drawing on interviews with researchers who have contributed to this research, the investigation examines the social sources of this interest. Explanations lie largely in the evolution of the agenda in sport medicine to a concern with injury prevention, which coincides with a movement toward the inclusion of women in health research. The article concludes with a consideration of the political and ideological implications of the interaction of the prevention and inclusion agendas in research on women’s sport injuries.Cet article propose une analyse des sources sociales de l’intérêt biomédical pour les blessures dans les sports féminins à travers l’étude du cas des blessures au ligament croisé antérieur (LCA). Bien que les hommes et les femmes en soient tous deux victimes, il y a énormément d’intérêt en recherche pour les blessures au LCA chez les femmes. S’appuyant sur des entrevues avec des chercheurs qui ont contribué à ce projet, l’étude examine les sources sociales de cet intérêt. Les explications reposent grandement sur l’évolution de l’agenda en médecine du sport vers un souci de prévention des blessures, ce qui coïncide avec un mouvement vers l’inclusion des femmes dans la recherche sur la santé. L’article conclut par une considération des implications politiques et idéologiques de l’interaction des agendas de prévention et d’inclusion en recherche sur les blessures sportives chez les femmes.

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.