Cruciate Ligament Rupture Research Articles

Genetic risk factors for anterior cruciate ligament ruptures: COL1A1 gene variant

Background:Anterior cruciate ligament (ACL) ruptures are considered the most severe injury sustained in sports. Although various intrinsic and extrinsic risk factors have been identified, the exact aetiology of the injury...

Coverage and accuracy of diagnosis of cruciate ligament injury in the Finnish National Hospital Discharge Register

Routinely collected hospital discharge data are a valuable and widely used source of information when assessing the incidence of sports and other injuries in epidemiological studies. However, in order to ensure the usefulness of a hospital discharge register for scientific purposes, the coverage and accuracy of the database should be evaluated. In this study, cruciate ligament rupture was used to assess the coverage and accuracy of the Finnish National Hospital Discharge Register (NHDR). The coverage of the diagnosis of cruciate ligament injury in the NHDR was examined by comparing patients with a confirmed cruciate ligament injury in the arthroscopy register of the Finnish Central Military Hospital (N=262) to their register data in the NHDR. To assess the accuracy of this diagnosis in the NHDR, the original medical reports including magnetic resonance imaging (MRI) and arthroscopy files were reviewed. Of the above noted 262 conscripts with a confirmed cruciate ligament injury, 241 were found to be correctly coded in the NHDR (register coverage 92%). Concerning register accuracy, of the 217 patients having cruciate ligament injury as the main or secondary diagnosis in the NHDR, 194 were confirmed to have this injury as verified by MRI or arthroscopy of the knee (register accuracy 89%). Our results showed that the coverage and accuracy of diagnosis registration of a cruciate ligament injury of the knee in the Finnish NHDR are very good. Further multi-centre studies are needed to confirm our findings.

A Modified Press-fit Fixation for Reconstruction of Anterior Cruciate Ligament

Abstract Anterior cruciate ligament (ACL) ruptures can lead to recurrent knee instability, meniscal tears, and articular cartilage degeneration. To restore the stability of the knee, the procedure of ACL reconstruction is always needed. Most surgeons prefer an autogenous graft for ACL reconstruction. However, the advantages of different grafts are still under debate. We performed ACL reconstruction with modified press-fit fixation on 101 patients and selected autogenous tendon grafts based on the patients' specific condition. Ninety-eight patients were followed up for a mean of 3.5 years, and the knee functions were significantly improved in 85.7% of the patients according to the knee functional scale.

Traumatic fracture of the patella in 11 cats

Traumatic patellar fracture in cats mainly occurred in male neutered cats with an average age of four years, six months and a mean weight of 4.8 kg. Patellar fractures were concurrent with long bone fractures and cruciate ligament rupture or occurred after gunshot. The patella luxated medially or laterally in four cats. Fracture fragments were usually small, either from the proximal pole (base) or distal pole (apex) or longitudinal fragments. Treatment was by fragment excision when the fragment was small or by reconstruction with pins and wires when fractures were comminuted. The outcome in six cats was reported as 'good' to 'normal' and three cats were 'improving' or had 'mild' intermittent lameness at the last follow up.

Clinical significance of altered gastrocnemius muscle coordination in anterior cruciate ligament-deficient knees

In a study of conservatively treated patients with isolated anterior cruciate ligament (ACL) ruptures, 7 patients with good or excellent results (Lysholm score > 84) and 7 patients with poor results (Lysholm score < 64) were compared considering muscle coordination, which was assessed by means of electromyographic (EMG) recordings from the thigh muscles and the medial head of gastrocnemius and heel contact recordings while the patient walked on a treadmill at different gradients. The results of this study revealed that significant differences were seen only in the medial gastrocnemius. An earlier onset, an earlier peak, a longer activation of EMG and a greater normalized root mean square amplitude, correlating with muscular tension, were seen in the medial gastrocnemius of the patients with good or excellent Lysholm score. This study is the first to investigate and demonstrate EMG differences between ACL-deficient patients with good and poor functional results. Furthermore, it reveals that the strength and coordination of the gastrocnemius might be of importance and should be considered in the search for optimal training programmes.

Frequency and distribution of patellar luxation in dogs

This study investigated the frequency and distribution of patellar luxation in the dogs presented to the Chonbuk National University Animal Medical Centre during January 2000 to September 2005. Patellar luxations were classified as medial or lateral, and unilateral or bilateral, were graded I to IV, and were subdivided according to age, sex and size of the dogs. The incidence of medial patellar luxation (MPL) was greater than the incidence of lateral patellar luxation (LPL) in both small and large dogs. Small-breed dogs were admitted almost exclusively with MPL. LPL was found uncommon; however it was observed more often in larger-breed dogs. Surgical correction was performed primarily in the dogs (165 stifles in 111 dogs) with grade II, III and IV patellar luxations following different surgical techniques. The combination of the surgical techniques was found to be more effective for the management of the disease. The prognosis was found to be favourable, because when the grade was low, the dog was younger, without cruciate ligament rupture, and as the surgical correction was performed with combination of more techniques.

Cruciate ligament assessment in MRI scans: A pilot study of a static drawer technique

Ten subjects with cruciate ligament rupture (five ACL and five PCL), and four normal subjects underwent magnetic resonance imaging (MRI) with a novel splint that stresses the knee. The splint acted as a fulcrum to translate the tibia in an anterior and posterior direction, depending on application. The MRI images showed that translation of the tibial plateaux occurred but not in a simple manner. The resultant images did not show marked anterior tibial translation in the ACL ruptured knee with an anterior drawer, nor posterior tibial translation for the PCL injured knee in posterior drawer. The medial plateau tended to move posteriorly in anterior drawer in the normal knees. The secondary MRI findings of ACL injury and associated meniscal injuries were enhanced.A further study with 50 subjects in each group, and arthroscopic confirmation of the findings, would be required to confirm these results.

Development and efficiency of an acute knee trauma list

Following acute knee trauma some patients will require urgent arthroscopy. Traditionally surgery is undertaken as in-patient on the general trauma list. This system leads to blockage of beds, repeated starving of the patient and out-of-hour's surgery in many cases. We introduced a dedicated Day Surgery knee trauma list (KTL) to reduce in-patient admissions, waiting time and cost. The typical indications for urgent knee arthroscopy are locked knees secondary to meniscal tears, loose bodies or cruciate ligament ruptures; acute osteochondral fractures; and children with acute meniscal tears. This retrospective review compares the study group: patients on the knee trauma list during the first 8 months following introduction, and the control group: patients on the general in-patient trauma list over a similar period immediately prior to implementation of the new list. There were 49 patients in the control group with an average stay in hospital of 2.5 days. Out-of-hour's operations were performed in 13 patients and 3 patients required a repeat arthroscopy. Fifty-three patients were treated in the knee study group. The significant operations were meniscal repair in 7, fixation of osteochondral fragments in 3. None of the patients required overnight stay. Control group patients were more likely to have surgery performed by inexperienced non-specialist knee surgeons, whereas specialist knee surgeons staffed the knee trauma list. Specialist surgeons were available to staff the knee trauma list. As the majority of the control group had spent an average of 2.2 nights in hospital, there has been considerable savings to the hospital. Introduction of the Day Surgical Knee trauma list has reduced unnecessary admissions per week; episodes of prolonged starving, cost and have improved patient satisfaction and management.

Ultrastructural Differences in Cranial Cruciate Ligaments from Dogs of Two Breeds with a Differing Predisposition to Ligament Degeneration and Rupture

Cranial (anterior) cruciate ligament (CCL) samples were obtained from dogs of the Labrador retriever (LR) and greyhound (GH) breeds, of which the former but not the latter is predisposed to CCL rupture. Electron microscopy revealed that the collagen fibril diameters of GHs were larger than those of LRs (P=0.03). Histological examination revealed a "fibrocartilaginous" appearance of CCLs in seven of eight GHs, and, to a lesser extent, in three of eight LRs. The formation of fibrocartilage is clearly not a disadvantage to the healthy racing GH, and cannot be regarded as a pathological degeneration in this breed. It is suggested that fibrocartilage is formed as a beneficial physiological adaptation to the compression of CCLs caused by tensile stress as a result of the tightening of two twisted bands. Fibrocartilage would appear to protect CCLs in the GH, but it may be indicative of a mild degenerative change, which may eventually lead to rupture in the LR.

Acute traumatic extension deficit of the knee.

The purpose of this study was to evaluate the events leading to acute traumatic extension deficit of the knee and the arthroscopic findings in these patients. A total of 78 consecutive patients treated in the Turku university hospital during the years 1994-1996 were included. The mean annual incidence of acute traumatic extension deficits of the knee in our study was 1.1 per 10 000 inhabitants. The single most common (33%) event causing the extension deficit was non-sports related twisting of the knee. Various sports related activities accounted for 42% of the extension deficits, and soccer was the most common sport in this group. In conclusion, acute traumatic extension deficit of the knee is usually a sign of serious intra-articular damage, and the most likely finding (in 82% of the patients in our study) is either a meniscal rupture, an anterior cruciate ligament (ACL) rupture, a patellar dislocation, or a combination of these. The lesions in these knees require prompt evaluation by an orthopaedic surgeon mainly because of the high number of bucket-handle and menisco-capsular insertion ruptures of the menisci, which are possibly suitable for repair.

Proper use of MR imaging in internal derangement of the knee (orthopedic surgeon's view).

MR imaging of the knee is a highly accurate examination in terms of the detection of meniscal tears and cruciate ligament ruptures among internal derangement of the knee. The overall accuracy in more than 2000 published cases reached nearly as high as 90% in meniscal tears, and 94% in anterior cruciate ligament (ACL) and 99% in posterior cruciate ligament (PCL) ruptures. Furthermore, the negative predictive value of the knee MR imaging, the number of true negative examination results divided by the numbers of true negative plus false-negative examination results, reaches almost 100% because of its very low false-negative rate. Therefore, from the orthopedic surgeon's point of view, even though the medical cost becomes a great concern, MR imaging has prime importance in the diagnosis of the internal derangement of the knee.

Viewpoints in Surgery: Cruciate ligament rupture

Viewpoints in Surgery: Cruciate ligament rupture

The assessment of acute knee injuries by Senior House Officers in the Accident and Emergency Department

This study in a large inner city Accident & Emergency (A&E) department investigated the awareness of new Senior House Officers (SHO’s) of the major symptoms and signs of significant trauma to the knee. They were able to identify a knee effusion clinically but were unable to differentiate a haemarthrosis from a reactive effusion. An acute haemarthrosis is suggestive of significant damage such as fracture, cruciate ligament rupture, major meniscal tear, synovial tear or patella dislocation (Maffulli N, Binfield PM, King JB, Good CJ. J Bone Joint Surg [Br] 1993;75(6):945–949 [1]; Noyes FR, Basset RW, Grood ES, Butler DL. J Bone Joint Surg [Am] 1980;62-A:687–695 [2]; Jain AS, Swanson AJG, Murdoch G. Injury 1983;15:178–181.] [3]). In many cases a haemarthrosis may be the only abnormality demonstrable in the acute setting (Dehaven KE. Am J Sports Med 1980;8:9–14 [4]; Visuri T, Koskenvuo M, Dahlstrom S. Milit Med 1993;158(6):378–381 [5]). If this diagnosis is missed then patients may be inappropriately sent home without suitable treatment and follow up. Greater emphasis should be placed on the differentiation between reactive effusion and haemarthrosis in the knee during the teaching of orthopaedics both at medical school and also on arrival at the A&E department.

Replacement of the anterior cruciate ligament

56 patients with anterior cruciate ligament (ACL) rupture underwent an endoscopic procedure to replace the torn ligament with a bone-patellar tendon-bone autograft. Their mean age was 24 (18-35) years and 45 were men. Follow-up was mean 3 (1-5.5) years. The outcome of the endoscopic technique was compared to that of 100 patients, matched for age and activity level, who were operated on during the same period using the mini-open method. Patients operated on with endoscopic technique had considerably less postoperative pain and regained knee motion faster. Function and stability were similar in the two groups.

C1–C2 transarticular screw fixation for treatment of C1–C2 instability

C1–C2 instability has traditionally been treated by C1–C2 posterior wiring and bone grafting. However, this technique has an incidence of non-union which may exceed 10%. Transarticular screw fixation has developed as a technique of providing increased strength of fixation of C1–C2 arthrodesis, while at the same time avoiding the need for postoperative halo bracing and avoiding the risk of neurological injury associated with the passage of sublaminar wires. We present a retrospective review of 12 patients with C1–C2 instability treated by C1–C2 transarticular screw fixation. Eight patients underwent this procedure as primary treatment, and 4 after a failed Gallie fusion. Five patients had a cruciate ligament rupture, 5 had an odontoid process fracture, 1 had os odontoideum, and 1 had rheumatoid instability. There was no surgical morbidity or mortality and, at a mean follow up of 12.1 ± 3 months (range 8–14 months), all patients had achieved solid fusion, and all neurological symptoms referable to the instability had resolved. C1–C2 transarticular screw fixation has been shown to be safe and effective and has a number of advantages when compared to traditional posterior wiring techniques. We recommend that this technique be considered as a primary treatment of C1–C2 instability.

The Relationship between Knee Hyperextension and Articular Pathology in the Anterior Cruciate Ligament Deficient Knee

The purpose of this study was to determine whether there was a relationship between knee hyperextension and intra-articular pathology in 100 consecutive patients whose sole ligament injury was an arthroscopically confirmed anterior cruciate ligament (ACL) rupture. Hyperextension of both knees was measured using a supine heel-height measurement of high reliability. There was more articular damage to the total joint, lateral joint, and lateral meniscus in patients who hyperextended than in those who did not. There was more articular damage to the total joint and medial joint in patients who were chronically ACL deficient than in those who were acutely or subacutely ACL deficient. The results demonstrate that individuals with ACL injuries whose knees hyperextend 3 cm or more sustain significantly more joint damage at the time of injury than in those whose knees hyperextend less than 3 cm. This study further defines the role of knee hyperextension in ACL injuries and offers a useful and reliable means of measuring knee hyperextension.

Changing injury pattern of acute anterior cruciate ligament tears treated at Tampere University Hospital in the 1980s.

During the years 1980-1989, 450 patients with an acute anterior cruciate ligament (ACL) rupture were treated at the University Hospital of Tampere, Finland. ACL ruptures were diagnosed by arthroscopy or open surgery. The data were analyzed in terms of patient age, sex, injury etiology, injury type and sports activity to determine the trends in the 1980s. The number of ACL tears seen in the Hospital increased by 247% over this period. Sixty-three percent of the patients were male (mean age 33 years) and 37% female (mean age 39 years), and there were no changes in the sex and age distribution in 1980s. The most common injury type was the isolated ACL rupture (51%), followed by a combination injury of the ACL and medial collateral ligament (38%). Isolated ACL ruptures in the 1980s increased 6.5 times. Sports accounted for 54% of all injuries without any sign of change in their relative proportion in 1980s. The most common sports causing the rupture were soccer (29%), downhill skiing (20%), cross-country skiing (12%) and volleyball (12%). From 1980 to 1989, there was a decrease (2 times) in ACL injuries sustained in cross-country skiing and a substantial (30 times) increase in ACL injuries sustained in downhill skiing.

An Evaluation of Three Different Cranial Cruciate Ligament Surgical Stabilization Procedures As They Relate to Postoperative Meniscal Injuries

SummaryCranial cruciate ligament (CrCL) rupture is the most commonly diagnosed stifle condition in the dog. Meniscal injury, in conjunction with CrCL rupture is also common in both man and dogs. There is a growing concern regarding meniscal injuries, whether unrecognized at the time of CrCL surgical stabilization or subsequent to stabilization, and the relationship to poor postoperative functional outcome. However, current literature is not specific as to an actual number of dogs subsequently requiring a second arthrotomy/meniscectomy.Three different CrCL stabilization operations in dogs were compared, retrospectively, for the occurrence of post-operative meniscal damage requiring a second arthrotomy and meniscectomy. Additional information concerning: signalment, weight, history of injury, CrCL ruptured, surgeon, type of CrCL rupture and amount of arthritis present was recorded in 665 cases. It was found that 13.8% of the stifles at risk (i. e. those stifles that did not have the meniscus removed at the time of initial surgical stabilization) returned for a second arthrotomy/meniscectomy. A significant difference in outcome was not found between the results when initially performed by different surgeons. The number of dogs which returned for a second arthrotomy/ meniscectomy whose weight were ≤ 15 kg was significant, when compared to the total number of dogs considered at risk for this weight range. There was a significantly lower rate of return, in those dogs at risk, which had received fibular head transposition stabilization.A retrospective study of 665 canine cranial cruciate ligament rupture cases documents the incidence (13.8%) of those dogs requiring a second arthrotomy, and subsequent meniscectomy, after one of three initial surgical stabilization procedures. Of the three procedures, the fibular head transposition technique had a significantly lower return rate requiring subsequent meniscectomy.

Incidence of Canine Appendicular Musculoskeletal Disorders in 16 Veterinary Teaching Hospitals from 1980 through 1989

SummaryThe goal of this study was to determine the incidence of musculoskeletal disorders in a large canine population. Patient information was obtained from clinical cases contributed to the Veterinary Medical Data Base (VMDB) by 16 veterinary teaching hospitals during the ten year period of 1980 through 1989. The relative contribution of bone diseases, joint diseases, and muscle-tendon-unit diseases was determined, and the incidence of each musculoskeletal disease reported.Nearly 24% of all patients in the source population had been affected by a disorder of the musculoskeletal system, and over 70% of those diagnoses involved appendicular structures. Diseases of joints, ligaments, and related structures contributed more cases (47%) to this study than diseases of bones (39%) or muscle-tendon-units (14%). Fractures made up the largest disease category, with pelvic fractures most common, followed by femoral fractures, and fractures of the radius and/or ulna. Joint instability and degenerative joint dis-ease were also common diagnosis categories, affecting primarily the hip and stifle joints. Common specific dis-ease entities included hip dysplasia, cruciate ligament rupture, traumatic hip luxation and patellar luxation.In this study we provided a comprehensive analysis of the canine musculoskeletal system. The relative importance of joint disorders compared to those of bones and muscle-tendon-units was illustrated. The incidence of most of the disorders described in this report had not been well documented previously.Patient information was obtained from the clinical cases of 16 veterinary teaching hospitals during a 10-year period. The number of dogs with musculoskeletal disorders was determined. The absolute and relative contribution of bone diseases, joint diseases, and muscle-tendon-unit diseases is reported as well as the incidence of the specific disease entities affecting the canine appendicular musculoskeletal system.

Prospective Clinical Study of Biodegradable Poly-L-Lactide Implant as an Augmentation Device with Fascia Lata in Cranial Cruciate Ligament Repair in the Dog: Early Results

SummaryTwenty-seven dogs with cranial cruciate ligament (CCL) rupture were treated with intra-articular reconstruction using a biodegradable poly-Llactide (PLLA) implant as an augmentation device, with a fascia lata graft in 12 dogs or with a fascia lata graft alone in 15 dogs. The clinical assessment was performed two, 12, and 24 weeks postoperatively. At 12 weeks the stability of the stifle joints was significantly better (p &lt; 0.05) in the fascia lata-PLLA (FL-PLLA) group, compared to the fascia lata (FL) group, because the PLLA augmentation device gave additional support to the fascia lata graft in the early healing phase. At 24 weeks 11 dogs (92%) of the FL-PLLA group and 13 dogs (87%) of the FL group were free of lameness. Radiographically, degenerative changes defined as osteophyte formation were found preoperatively in 10 dogs in the FLPLLA group and 11 dogs in the FL group. The postoperative degenerative changes increased in four dogs in the FL-PLLA group and five dogs in the FL group at 12 weeks. At 24 weeks in two dogs in both groups the degenerative changes had advanced.A biodegradable poly-L-lactide (PLLA) augmentation device was used to reinforce a fascia lata graft in cranial cruciate ligament repair in 12 dogs and compared clinically and radio-graphically with a fascia lata replacement technique in 15 dogs. Clinically, at 12 weeks the stability of the stifle joints was significantly better (p &lt;0.05) using the PLLA im-plant with the fascia lata. At 24 weeks significant differences were not found in the clinical nor radiographic outcome between the two groups.