Partial Anterior Cruciate Ligament Research Articles

Functional results and isokinetic muscle strength in patients with Fraser type I floating knee treated with internal fixation

IntroductionAccording to Fraser’s description, ipsilateral femoral and tibial diaphyseal fractures are characterised as type I floating knee and have a better prognosis than fractures with joint involvement (type II). There are few reports of functional and muscle strength in these patients. The objective of this study was to evaluate the functional and isokinetic muscle strength of patients with type I floating knee undergoing femoral and tibial internal fixation. MethodsPatients with type I floating knee undergoing concomitant femoral and tibial internal fixation were invited for clinical evaluation. The parameters evaluated included the following: Karlstrom and Olerud score; Lysholm score; isokinetic thigh and hip muscle evaluation; knee range of motion; pain level; investigation of associated knee injuries by clinical evaluation and MRI; and types of complications. ResultsTwenty-one patients were included in the study; 11 of these were clinically evaluated, with a mean follow-up of 23.9 months. Six patients had an acceptable result according to the Karlstrom criteria, whereas eight patients had a poor result based on the Lysholm scale. The peak torque deficit was 61% for knee extensors, 37% for flexors and -9% for hip abductors. The mean pain level was 5.9. Three patients had a partial anterior cruciate ligament (ACL) injury; one patient had a posterior cruciate ligament (PCL) injury; and three patients had a meniscal injury. There were four cases of tibial or femoral nonunion at one year and two cases of chronic osteomyelitis. ConclusionPatients with type I floating knee had unsatisfactory functional results, significant knee extensor and flexor muscle strength deficits and a significant rate of complications at the two-year follow-up.

Relationship Between Knee Extensor Strength And Dynamic Balance Stability In Partial ACL Injury

PURPOSE: Anterior cruciate ligament (ACL) injury are known to develop muscular weakness in the quadriceps. Also, ligament injures contribute to loss of stability and function. The purpose of this study was to assess the correlations between dynamic balance stability and isokinetic extensor strength measurements in subjects after partial anterior cruciate ligament injury. METHODS: We examined 38 men (mean age, 26.3 ± 7.0 years) with partial ACL tear. The isokinetic strength of extensor and flexor muscles was evaluated by using the CSMI isokinetic testing device. The peak torque was determined at speeds of 60°/s and 180°/s. The value of the highest peak torque for each velocity was compared with the uninjured side, and described as a percent of strength deficit. The balance stability was measured with single-leg by using the Biodex Stability System. Correlations between the ability of single-leg balance and knee extensor muscle strength were determined. RESULTS: The knee extensor strength deficit of 22.5±18.9.% was found in the injured leg that compared to the uninjured leg at 60°/s. and extensor strength deficit was 18.8±17.2% at 180°/s. Single-leg balance stability at 22.1 ±15.8%was required the level of improvement of balance stability. Significant correlations were found between deficient of each extensor muscles in injured knees at 60 and 180°/s and dynamic balance stability (r = 0.61, P = 0.025; and r = 0.58, P = 0.035, respectively). CONCLUSION: The ability of single-leg balance with injured knees appeared to be influenced by knee extensor muscle strength. The results contribute to the evidence indicating the importance of knee strength for dynamic balance stability for partial ACL injury.

Clinical Effectiveness of Single band Augumentation for Parsiel Anterior Crusiat Ligamet Lesions

The aim of this study is demonsrated of single band augumentation for traumatic partial lesions of the anterior cruciate ligament.Method: A restospecific investigation is performed in our medical clinic to 15 patients suffering from partial anterior cruciate ligament tears and other 15 suffering from total anterior cruciate ligament lesion that were operated between 2012-2014. The time between treatment appointment and patients having preoparative trauma, knee extensor group muscular athrophy; treatment duration, knee movement interval and Lysholm score were investigated (Table -1) Table-1.AgeFallowing timeFleksionTrav-application datepreop-Ext AtrofiLYSHOLM SKORETotal ACL27±6.436±8.5(Ay)130±15.76±3.54.5±2.190±8.4Patial ACL22±5.632±11.4(Ay)132±16.89±6.42.4±1.492±4.6Demographic and clinical data Surgical Technique: Total rupture of the ACL reconstruction was also performed by Anatomical medial portal technique with Hamstring auto graft. Parsiel ACL rupture in; maintaining a solid band with auto graft was augument Hamstring single band with a solid band anatomic medial portal technique.Parsiel load and the same physical therapy protocol was applied to all patients by postoperative day 2.Result:Parsiel or total ACL rupture considering the age range of the patients identified as observed weight in younger age groups. The parsiel lesions of clinical symptoms, late treatment applications to a doctor was observed. Independent from the trauma date, when groups were compared in terms of preoperative extensor total ACL rupture of muscle atrophy, it was also found to be more pronounced. Postoperative clinical score and the Lysholm score was seen as similar to each other.Conclusion:Although the total ACL rupture were also significantly more than the preoperative clinical symptoms parsiel ACL rupture, we believe that the Parsiel ACL ruptures single band augumentasyo the total ACL rupture lesions as successful as treatment outcomes.Figüre-1-Antriomedial band rupture and view of the posterolateral bandsFigüre-2-The image of femoral tunnel for anterimedial band

Relationship between Knee Extensor Strength and dynamic balance ability using a Flexible Platform in Partial Anterior Cruciate Ligament Injury

Background/Objectives: Patients with anterior cruciate ligament injury are known to develop muscular weakness in the quadriceps. Also, ligament injures contribute to loss of stability and function. To assess the correlations between single-leg balance ability and isokinetic extensor muscle strength measurements in subjects after partial (ACL) injury. Methods/Statistical analysis: We examined38men (mean age, 26.3 ± 7.0 years) with partial ACL tear. The isokinetic strength of extensor muscles was evaluated by using the CSMI isokinetic testing device. The peak torque was determined at speeds of 60°/s and 180°/s. The balance ability was measured with single-leg by using the Biodex stability system. The correlations between the ability of single-leg balance and knee extensor muscle strength were determined. Findings: The knee extensor strength deficit of 22.5±18.9.% was found in the injured side that compared to the uninjured side at 60°/s. and extensor strength deficit was 18.8±17.2% at 180°/s. Single-leg balance ability at 22.1±15.8%was required the level of improvement of balance stability. Significant correlations were found between deficient of each extensor muscles in injured knees at 60°/s, 180°/s and single-leg balance stability (r=.61and r=.58, respectively). Improvements/Applications: The ability of single-leg balance with injured knees appeared to be influenced by knee extensor muscle strength. The results contribute to the evidence indicating the importance of knee strength for dynamic balance ability for partial ACL injury.

Can MRI Distinguish between a Partial Anterior Cruciate Ligament (ACL) Tear and a Normal ACL?

Objective: The purpose of this study was to determine whether Magnetic resonance imaging (MRI) can distinguish between a partial anterior cruciate ligament (ACL) tear and a normal ACL. Materials and Methods: MR images of 20 patients with an arthroscopically confirmed partial ACL tear were retrospectively interpreted by the author, comparing with normal ACLs. Results and Discussion: All knees with a partial ACL tear had a continuous band of low signal, of which 15 had no increased signal intensity on proton density-weighted images. MRI could not distinguish between a partial ACL tear and a normal ACL. Orthopedic surgeons had better consider an ACL tear when a patient has traumatic hemarthrosis or anxiety provoked by the sensation of the knee ‘going out’ or ‘giving way’ during the pivot shift test, even if the ACL has a continuous band of low signal on the oblique sagittal view on MRI.

Knee Injury – Recreational Runner

HISTORY: Case of a 41 year-old army soldier who had an acute bilateral knee giveaway weakness while jogging. After running for a mile, his left knee gaveway and he fell to the floor. He stood up without difficulties and ambulated for a short distance when he fell again due to right knee weakness. He had difficulty ambulating, although he felt no pain. During his ER visit, he had a third fall resulting in a right lateral malleolus fracture. Orthopedics was consulted and performed bilateral patellar tendon repair and right lateral malleolus ORIF. He was discharged home with bilateral hinged knee braces locked at full extension and weight-bearing precautions. Two months post-op, he was admitted to the acute inpatient rehabilitation ward of the VA Caribbean Healthcare. No past medical history of systemic conditions or regular medications. PHYSICAL EXAMINATION: Examination revealed bilateral knee valgus deformity, mild soft tissue swelling and bilateral pes planus. He had full knee extension and limited knee flexion to 90 degrees. Knee special tests were negative for meniscal, cruciate ligament or collateral ligament injury. Neurovascular exam was unremarkable. DIFFERENTIAL DIAGNOSIS: 1. Patellar tendon rupture 2. Quadriceps tendon rupture 3. Anterior cruciate ligament sprain 4. Meniscal injury 5. Collateral ligament sprain TEST AND RESULTS: 1. Bilateral knee MRI: Bilateral full-thickness tear of proximal patellar tendon with cephalad patellar displacement, medial and lateral patellar retinacula tears, and extensive soft tissue edema. Right high-grade partial versus full-thickness anterior cruciate ligament tear and anterior horn lateral meniscus tear. Left posterior horn medial meniscus tear. 2. Bilateral Knee X-ray: Bilateral patella alta. 3. Labs: Essentially normal except for low vitamin D and positive qualitative ANA test. FINAL/WORKING DIAGNOSIS: Atraumatic bilateral patellar tendon rupture TREATMENT AND OUTCOMES: 1. Outpatient-based physical therapy was provided with emphasis on ROM completion, progression of quadriceps strengthening and neuromuscular retraining. 2. He achieved full ROM in both knees and independence in ADL’s and ambulation. 3. Return to recreational sports recommendations included to avoid high impact activities, such as running, until 9-12 months post-op follow up.

Partial Anterior Cruciate Ligament Knee Reconstruction with Accelerated Anterior Cruciate Ligament Rehabilitation

Objectives:The primary purpose of this study is to determine whether or not a partial Anterior Cruciate Ligament (ACL) reconstruction with accelerated rehabilitation produced similar outcomes to that of the conventional ACL reconstruction with its traditional rehabilitation program timeframe. An improved understanding of these outcomes can change the way partial ACL injuries are treated surgically and return patients back to their chosen activities quicker without compromising their graft.Methods:Level III, therapeutic, retrospective study. Participants who were two years post partial ACL reconstruction with accelerated rehabilitation by were contacted. They filled out IKDC, Modified Cincinatti and Tegner Lysholm knee score questionnaires and were measured using a KT-1000 arthrometer for side-to-side instrumented laxity >2 mm as well as indicating if there partial ACL reconstruction had re-ruptured, requiring further surgical intervention.Results:All three measurements in this study, including re-rupture rates, side – to – side instrumental laxity and satisfaction scores via questionnaires, were statistically significant, thus showing a partial ACL reconstruction with accelerated rehabilitation is a viable choice for the treatment of a patient with a partial ACL tear of his knee.Conclusion:Partial ACL reconstruction with accelerated rehabilitation is a viable choice for the treatment of a patient with a partial ACL tear of his knee.

Compensatory component of PRP-technology and knee-joint osteoarthrosis of dogs

Input: Osteoarthrosis belongs to heterogenous group of diseases with similar morphological and clinical implications that leads to the cartilage and subchondral bone lesion, as well as lesion of other joint components (synovium, ligaments, capsule and periarticular muscles) (patent RU 2117997, 2240602, 2240603, 22464304, 22464305, 2271139, 2271140, 2303436, 2323694, 2323695) . Aim of research – to develop treatment technology of animals with aseptic osteoarthrosis by applying thrombocyte rich plasma. Objectives: The objects of the study were dogs with knee-joint osteoarthrosis of I-III level. Every animal was older than 6 years old, with a live weight ≥30 kg. Methods: clinical, X-ray research, endoscopy. Results: A week later after the autoplasma re-introduction, positive dynamics in all the animals was observed. In particular, lameness decreased, volume of the affected limb muscles recovered a little. At the end of therapy lameness disappeared in all animals virtually, but in some animals it was appeared after loading. Regain mobility joint crepitus disappeared. Joint mobility was recovered, crepitation disappeared. At the end of the treatment, control radiography of affected limbs showed a positive dynamics, consist in unevenness reducing of the articular surface, size of osteophytes reducing, osteosclerosis percent reduction. In the time of re-arthroscopy at the end of treatment some positive dynamics had observed; chondromalacia of I stage was marked, edema and hyperemia of synovial villi reduction, no generalized synovitis, no pulping of partial anterior cruciate ligament in particular. Discussion: Leanness, joint rigidity reduction in all animals by the end of the treatment course proves the presence of anti-inflammatory, regenerative effect of thrombocyte-rich plasma. Chondroprotective effect of platelet-derived growth factor cause reduction of edema of the synovial membrane and cartilage chondromalacia reduction, and reduction in the size of the cartilage defects observed during arthroscopic visualization. Lack of side effects and complications indicate high availability and safety of the method, in comparison with the standard treatment methods of animal osteoarthritis.

The effectiveness of Pilates for partial anterior cruciate ligament injury.

This study explored the effects of Pilates on the muscle strength, function, and instability of patients with partial anterior cruciate ligament (ACL) injuries in situations in which a non-surgical treatment option is preferred. Fifty participants 20-45years of age who were diagnosed with isolated ACL injuries were included in the study. The participants were randomly assigned to either the Pilates exercise group (n=24) or the control group (n=26). The subjects in the Pilates exercise group performed basic mat exercises that focused on the muscle strength and flexibility of the lower limbs and core muscles during each class session, which met three times per week for 12weeks. The control group did not receive any treatment or home exercise programme. All patients were evaluated using the Lysholm Knee Scale, the Cincinnati Knee Rating System, and isokinetic quadriceps and hamstring strength. Patient satisfaction regarding improvement in knee stability was assessed using the Global Rating of Change scale. The Pilates group experienced significant improvement over the control group as measured by the difference in quadriceps strength at 12weeks (p=0.03). Both groups showed some clinical change over time, but the Pilates group improved for all outcome measurements at the 12-week follow-up, and the control group only improved for functional outcomes. Patient satisfaction with the level of knee stability based on the Global Rating of Change scale was higher in the Pilates group than in the control group. Although both groups exhibited improvements in knee strength and functional outcomes, the results suggest that Pilates is a superior management approach over a control treatment for increasing quadriceps strength in participants with partial ACL injury. Pilates may provide clinicians a novel option when choosing a treatment for a partial ACL injury. Further study is needed to determine whether certain subgroups of individuals might achieve an added benefit with this approach. II.

Clinical outcomes and biomechanical analysis of posterolateral bundle augmentation in patients with partial anterior cruciate ligament tears.

To examine the clinical and biomechanical results of posterolateral (PL) augmentation to reconstruct damaged PL bundle while preserving the less-damaged anteromedial bundle for partial anterior cruciate ligament (ACL) tears in comparison with double-bundle ACL reconstruction. Sixteen patients who underwent PL augmentation for partial ACL tears (Group P) and 37 patients who underwent double-bundle ACL reconstructions for complete ACL tears were examined (Group D). Anterior tibial translation (ATT) was evaluated using the KT-1000 arthrometer. ATT during the Lachman test and acceleration of posterior tibial translation (APT) during the pivot shift test were evaluated using an electromagnetic measurement system (EMS). Clinical outcomes were evaluated using the Lysholm score. Second-look arthroscopy was performed 1year after surgery. The mean postoperative Lysholm scores were 91.7±12.2 and 94.6±7.2 in Groups P and D, respectively, and there was no statistically significant difference between the two groups. The mean side-to-side difference of ATT on the KT-1000 was significantly improved in both Groups P and D. In the EMS analysis, the mean side-to-side difference of ATT and the mean APT were significantly improved in both Groups P and D. There was no significant difference in the second-look evaluation between the two groups. The clinical and biomechanical outcomes of PL augmentation were satisfactorily comparable to those of double-bundle ACL reconstruction. PL augmentation could be a useful treatment option for patients with partial ACL tears. IV.

Effect of Anteromedial and Posterolateral Anterior Cruciate Ligament Bundles on Resisting Medial and Lateral Tibiofemoral Compartment Subluxations

This study analyzed the interaction of the anteromedial and posterolateral portions of the anterior cruciate ligament (ACL) in resisting medial and lateral tibiofemoral compartment subluxations under multiple loading conditions. By use of a 6-df robotic simulator, 10 human cadaveric knees were tested in 3 states: intact ACL, partial ACL (loss of either the anteromedial bundle [AMB] or posterolateral bundle [PLB]), and deficient ACL. The testing profile involved anterior-posterior translation and internal-external rotation, as well as 3 pivot-shift loading conditions with varying internal rotation torque (1- or 5-Nm) and coupled anterior force (35- or 100-N). Digitization of anatomic landmarks provided tibiofemoral compartment translations and centers of tibial rotation. During pivot-shift testing (100-N anterior force, 1-Nm internal rotation torque, and 7-Nm valgus), the lateral and medial compartment anterior translation increased by a mean of 2.5 ± 0.8 mm (P= .016) and 3.4 ± 2.0 mm (P= .001), respectively, on AMB sectioning and 1.3 ± 0.9 mm (P= .329) and 0.6 ± 0.7 mm (P= .544), respectively, on PLB sectioning. Higher internal rotation torque (5 Nm v 1 Nm) on pivot-shift testing reduced central and medial anterior translation after ACL sectioning. There was no change in internal rotation on AMB or PLB sectioning. During the Lachman test (100-N), AMB and PLB sectioning increased central translation by 3.6 ± 1.6 mm (P= .001) and 0.7 ± 0.6 mm (P= .498), respectively. Both ACL bundles function synergistically in resisting medial and lateral compartment subluxations on the Lachman and pivot-shift tests. The AMB provided more restraint to anterior tibial translation during both tests as compared with the PLB. PLB sectioning produced no statistically significant change in anterior translation on the Lachman or pivot-shift test. Neither bundle contributed to resisting internal rotation. An ACL graft designed to duplicate the AMB would theoretically resist medial and lateral compartment anterior subluxations under multiple loading conditions. The PLB provides a secondary restraint at low flexion angles. Neither ACL bundle resists internal tibial rotation or allows a positive pivot-shift subluxation.

Routine Examination of Pathology Specimens Following Knee Arthroscopy: A Cost-Effectiveness Analysis.

While the clinical value of routine pathologic examination of tissues removed during orthopaedic procedures has not been determined, limited cost-effectiveness and a low prevalence of findings that alter patient management have been previously demonstrated with arthroscopy. The purpose of this study was to examine the clinical value and cost-effectiveness of routine histological examination of knee arthroscopy specimens. Retrospective chart analysis of 3797 consecutive knee arthroscopies by two surgeons from 2004 to 2013 at three affiliated hospitals within one health-care system was undertaken. Pathology reports regarding tissue removed during partial meniscectomies and anterior cruciate ligament reconstructions were reviewed to determine if the results altered patient care. The total costs of histological examination were estimated in 2012-adjusted U.S. dollars. The cost per health effect was determined by calculating the cost per discrepant and discordant diagnosis. The prevalence of concordant diagnoses was 99.3% (3769 of 3797), the prevalence of discrepant diagnoses was 0.7% (twenty-seven of 3797), and the prevalence of discordant diagnoses was 0.026% (one of 3797). The total cost of histological examinations was estimated to be $371,810. The total cost of the pathology cost per discrepant diagnosis was $13,771, and the cost per discordant diagnosis was $371,810. Routine pathological examination of surgical specimens from patients undergoing knee arthroscopy had limited cost-effectiveness because of the low prevalence of findings that altered patient management. Histological examination of surgical specimens from arthroscopic knee surgery did not alter patient care and increased costs. We suggest that gross and histological examination of tissue removed during knee arthroscopy should be done at the discretion of the orthopaedic surgeon rather than being mandatory.

Bilateral agenesis of the anterior cruciate ligament: MRI evaluation

Bilateral agenesis of the anterior cruciate ligament (ACL) is extremely rare. We describe a 13-year-old girl who presented with bilateral knee pain without history of trauma; she has two family members with knee instability. Magnetic resonance imaging showed bilateral absence of the ACL, and medial posterior horn meniscal tears. Bilateral arthroscopic partial meniscectomy and anterior cruciate ligament reconstruction was performed.

Short-term effects of partial meniscectomy on the clinical results of anterior cruciate ligament reconstruction

This study aims to analyse the short-term effects of partial meniscectomy on the clinical results of anterior cruciate ligament reconstruction surgery. Clinical outcomes of 19 patients who had partial medial meniscectomy and anterior cruciate ligament reconstruction during the same surgery (Group 1) were compared with the outcomes of 25 patients who had also reconstruction but did not have any meniscal lesion (Group 2). Median follow-up time was 29 months (range 12-67 months) in Group 1 and 27 months (range 12-70 months) in Group 2. Feeling of apprehension in sports activities, International Knee Documentation Committee (IKDC) score, KT-2000 Arthrometer(®) measurements and post-operative time to return to sports activity were the criteria for data analysis. Eight patients (42%) in Group 1 and 5 patients (20%) in Group 2 stated feeling of apprehension in sports activities. IKDC score improved to A in 11 patients (58%) from Group 1, and 18 patients (72%) from Group 2. Mean anterior translation according to KT-2000 arthrometer measurements was 5.2 ± 1.3 mm in Group 1, and 4.6 ± 1.3 mm in Group 2. Post-operative time to return to sports activity was 8.5 ± 3.0 months in Group 1, and 6.5 ± 2.2 months in Group 2. Partial meniscectomy for irreparable medial meniscal tears, applied during the same surgery with anterior cruciate ligament reconstruction, negatively affects the clinical outcomes in the short-term follow-up. This study may be a reference for long-term clinical trials and also future investigations of new methods in the treatment of similar cases. IV.

Partial anterior cruciate ligament tears treated with intraligamentary plasma rich in growth factors.

To evaluate the effect of the application of plasma rich in growth factors (PRGF)-Endoret to the remaining intact bundle in partial anterior cruciate ligament (ACL) tears. A retrospective review of the rate of return to play in football players treated with the application of PRGF-Endoret in the remaining intact bundle in partial ACL injuries that underwent surgery for knee instability. Patients with knee instability requiring revision surgery for remnant ACL were selected. PRGF was applied in the wider part of posterolateral bundle and the time it took patients to return to their full sporting activities at the same level before the injury was evaluated. A total of 19 patients were reviewed. Three had a Tegner activity level of 10 and the remaining 16 level 9. The time between the injury and the time of surgery was 5.78 wk (SD 1.57). In total, 81.75% (16/19) returned to the same pre-injury level of sport activity (Tegner 9-10). 17 males and 2 females were treated. The rate of associated injury was 68.42% meniscal lesions and 26.31% cartilage lesions. The KT-1000 values were normalized in all operated cases. One patient was not able to return to sport due to the extent of their cartilage lesions. The 15 patients with Tegner activity level 9 returned to play at an average of 16.20 wk (SD 1.44) while the 3 patients with Tegner activity level 10 did so in 12.33 wk (SD 1.11). With one remaining intact bundle the application of PRGF-Endoret in instability cases due to partial ACL tear showed high return to sport rates at pre- injury level in professional football players.

Surgical treatment of partial anterior cruciate ligament lesions: medium-term results

this study was conducted to evaluate subjective and objective clinical outcomes of partial reconstruction of the anterior cruciate ligament (ACL) in comparison with complete ACL reconstruction. three groups, each comprising 20 patients, were evaluated at a minimum follow-up of 12 months. The group 1 patients underwent partial ACL reconstruction, while those in group 2 and group 3 underwent complete ACL reconstruction, performed using either bone-patellar tendon-bone (BPTB) or quadrupled hamstring tendon (HT) grafts, respectively. The subjective outcome was evaluated using the Lysholm knee scale and the subjective International Knee Documentation Committee (IKDC) scoring system. A visual analog scale (VAS) was used for pain assessment and sporting activity was rated using the Tegner activity scale. Objective evaluation was performed using the IKDC objective form, KT-1000 arthrometer and KiRA triaxial accelerometer. at the follow-up evaluation, the mean subjective IKDC score was 86.1±10.3 in group 1, 85.2±11.1 in group 2, and 82.7±7.8 in group 3. The Lysholm score was 91.3±7.3 in group 1, 91.7±9.6 in group 2, and 89.4±6.1 in group 3. KT-1000 tests showed a mean side-to-side difference of 1.1 mm ± 1.5 mm (range, 0-5 mm) in group 1; 0.79 mm ± 0.8 mm (range, 0-2mm) in group 2; and 1.45 mm ± 1 mm (range, 0-3 mm) in group 3. The differences between groups were not statistically significant. both subjective and objective outcomes of partial ACL reconstruction were comparable to those of complete reconstruction, but partial reconstruction in the presence of a partial lesion of the ACL is considered by the authors to be more respectful of the native vascularization, innervation and anatomy of the ACL, conferring an advantage in terms of recovery of the complete function of the knee. Level III, retrospective comparative study.

Why menisci show higher healing rate when repaired during ACL reconstruction? Growth factors release can be the explanation

Healing rate of meniscus repair is higher when the suture is associated with anterior cruciate ligament reconstruction. A possible explanation can be a different pattern of release of growth factors between anterior cruciate ligament reconstruction and isolated meniscus surgery. Hypothesis of this study is that the concentrations of bFGF, TGF-β and platelet-derived growth factor (PDGF) in joint fluid, immediately after single-bundle anterior cruciate ligament reconstruction and arthroscopic partial meniscectomy, can be different. Twenty consecutive patients underwent partial medial meniscectomy and twenty consecutive patients underwent single-bundle anterior cruciate ligament reconstruction with hamstring grafts were enrolled in the study. Thirty minutes after the end of the surgical procedure, a sample of joint fluid, as well of venous blood, was collected from all the patients. Concentrations of growth factors were determined by enzyme-linked immunosorbent assay. The peripheral blood concentration of TGF-β, bFGF and PDGF was comparable between partial meniscectomy and anterior cruciate ligament reconstruction groups. No differences between the two surgical techniques were also found in term of TGF-β and bFGF joint fluid concentration, whereas joint PDGF concentration of anterior cruciate ligament reconstruction patients was significantly higher than the one found in partial meniscectomy patients. A significant growth factors release was detected in the knee joint during arthroscopic surgery. PDGF concentration was significantly higher in anterior cruciate ligament reconstructed knee than in the meniscectomy group. PDGF can play an important role enhancing the healing response of meniscus suture and can be one of the biological reasons of the higher meniscal healing rate in anterior cruciate ligament reconstructed knee.

The use of conservative treatment in partial anterior cruciate ligament (ACL) tears among male athlete

In this study tried to using conservative treatment in partial anterior cruciate ligament (ACL) tear among male athlete. If an athlete is injured anterior cruciate ligament that he first recommended treatment is surgery. But surgery has complications and athlete will have a lot of problems later. So it is better to replace simple method instead surgical procedures. For this study, 57 patients were selected via magnetic resonance imaging (MRI) scan that should be performed exercises for 10 weeks. The mean time interval between the rupture and the diagnosis by an MRI was 2–14 days and the mean of subjects’ age were 28 years old. Conservative treatment in this study divided into 4 phase included: 1. acute phase, 2. Sub-Acute/Strengthening Phase, 3. Limited Return to Activity Phase, and 4. Return to Activity/Sport Phase. Therapeutic Exercise during 4 phases that mentioned included: Increase and improve the range of motion, Patella mobilization (Medial/Lateral, Superior/Inferior) quadriceps, hamstring strengthening, Flexibility exercises, and Static lunge progressions, daily lower extremity stretching and sports specific drills, speed/agility program. In totally our results indicate that after 10 weeks conservative treatment protocol in partial ACL tear, 39 patients reported good or very good subjective results and 15 patients described a satisfactory result. 31persen had never experienced giving-way symptoms after 10 week, 8 patient had giving-way when participating in heavy exercise and wears an orthosis during sports activities. 26 athletes play sports at the same level as before the treatment. 11 patients were able to perform highrisk pivoting sports. And all patients could participate in low-risk pivoting sports like jogging and mountain hiking. As a general conclusion it can be said conservative treatment in Partial anterior cruciate ligament tear was effective.

Promising Short-Term Results Following Selective Bundle Reconstruction In Partial Anterior Cruciate Ligament Tears

Promising Short-Term Results Following Selective Bundle Reconstruction In Partial Anterior Cruciate Ligament Tears

Partial ACL Tears: Anatomic Reconstruction Versus Nonanatomic Augmentation Surgery

Treatment of partial anterior cruciate ligament (ACL) tears requires ACL remnant preservation. The goal of this study was to compare the outcome of anatomic reconstruction of the torn bundle with nonanatomic augmentation using the over-the-top femoral route. Fifty-two athletes (mean age, 23.3 years) with partial ACL lesions underwent anatomic reconstruction (n=26) or nonanatomic augmentation (n=26). Intraoperative damage of the healthy bundle that required a standard ACL reconstruction occurred in 2 patients in the anatomic reconstruction group. International Knee Documentation Committee (IKDC) score, Tegner score, and arthrometer evaluation were used pre-operatively and at follow-up for up to 5 years postoperatively. One failure occurred in the anatomic reconstruction group. Mean IKDC subjective score at follow-up was 88.2 ± 5.7 in the anatomic reconstruction group and 90.2 ± 4.7 in the nonanatomic augmentation group. According to the IKDC objective score at final follow-up, 96% of knees in the nonanatomic augmentation group were normal vs 87.5% in the anatomic reconstruction group. No significative differences were observed between the 2 groups at final follow-up. Anteromedial bundle reconstruction showed significantly lower IKDC subjective and objective scores and higher residual instability values as evaluated with the arthrometer compared with posterolateral bundle reconstruction (P=.017). The surgical treatment of ACL partial tears is demanding. Adapted portals, perfect control of the tunnel drilling process, and intercondylar space management are required in anatomic reconstruction. The nonanatomic augmentation technique is simpler, providing excellent durable results over time with a lower complication rate. Anteromedial bundle reconstruction is associated with a poorer outcome, especially when performed with anatomic reconstruction.