This article provides a discussion and commentary around the recent advances in arthroscopic anterior cruciate ligament reconstruction(ACLR),with a focus on the aspects of lateral femoral tunnel preparation and graft ...This article provides a discussion and commentary around the recent advances in arthroscopic anterior cruciate ligament reconstruction(ACLR),with a focus on the aspects of lateral femoral tunnel preparation and graft fixation techniques.The paper explores and comments on a recently published review by Dai et al,titled"Research progress on preparation of lateral femoral tunnel and graft fixation in ACLR",while providing insight into its relevance within the field of ACLR,and recommendations for future research.展开更多
BACKGROUND Cyclops lesions are a known complication of anterior cruciate ligament(ACL)reconstruction,with symptomatic cyclops syndrome occurring in up to 11%of surgeries.Recurrent cyclops lesions have been rarely docu...BACKGROUND Cyclops lesions are a known complication of anterior cruciate ligament(ACL)reconstruction,with symptomatic cyclops syndrome occurring in up to 11%of surgeries.Recurrent cyclops lesions have been rarely documented;this case study documents the successful treatment of a recurrent cyclops lesion.CASE SUMMARY A 28-year-old female presented following a non-contact injury to the right knee.Workup and clinical exam revealed an ACL tear,and arthroscopic reconstruction was performed.Two years later a cyclops lesion was discovered and removed via arthroscopic synovectomy.Seven months postoperatively,the patient presented with pain,stiffness,and difficulty achieving terminal extension.A smaller recurrent cyclops lesion was diagnosed,and a repeat synovectomy was performed.The patient recovered fully.CONCLUSION To the best of our knowledge,this is the first documented case of recurrent cyclops lesion after bone-patellar tendon-bone allograft ACL reconstruction presenting as cyclops syndrome.展开更多
The influences and mechanisms of the physiology,rupture and reconstruction of the anterior cruciate ligament(ACL)on kinematics and clinical outcomes have been investigated in many biomechanical and clinical studies ov...The influences and mechanisms of the physiology,rupture and reconstruction of the anterior cruciate ligament(ACL)on kinematics and clinical outcomes have been investigated in many biomechanical and clinical studies over the last several decades.The knee is a complex joint with shifting contact points,pressures and axes that are affected when a ligament is injured.The ACL,as one of the intra-articular ligaments,has a strong influence on the resulting kinematics.Often,other meniscal or ligamentous injuries accompany ACL ruptures and further deteriorate the resulting kinematics and clinical outcomes.Knowing the surgical options,anatomic relations and current evidence to restore ACL function and considering the influence of concomitant injuries on resulting kinematics to restore full function can together help to achieve an optimal outcome.展开更多
BACKGROUND Suspension training(SET)is a method of neuromuscular training that enables the body to carry out active training under unstable support through a suspension therapy system.However,there have been few report...BACKGROUND Suspension training(SET)is a method of neuromuscular training that enables the body to carry out active training under unstable support through a suspension therapy system.However,there have been few reports in the literature on the application of SET to anterior cruciate ligament reconstruction(ACLR)patients.It is not clear what aspects of the patient's function are improved after SET.AIM To investigate the effect of SET on the neuromuscular function,postural control,and knee kinematics of patients after ACLR surgery.METHODS Forty participants were randomized to an SET group or a control group.The SET group subjects participated in a SET protocol over 6 wk.The control group subjects participated in a traditional training protocol over 6 wk.Isokinetic muscle strength of the quadriceps and hamstrings,static and dynamic posture stability test,and relative translation of the injured knee were assessed before and after training.RESULTS The relative peak torque of the quadriceps and hamstrings in both groups increased significantly(P<0.001),and the SET group increased by a higher percentage than those in the control group(quadriceps:P=0.004;hamstrings:P=0.011).After training,both groups showed significant improvements in static and dynamic posture stability(P<0.01),and the SET group had a greater change than the control group(P<0.05).No significant improvement on the relative translation of the injured knee was observed after training in either group(P>0.05).CONCLUSION Our findings show that SET promotes great responses in quadriceps and hamstring muscle strength and balance function in ACLR patients.展开更多
BACKGROUND Anterior cruciate ligament reconstruction(ACLR)has a high incidence of re-tear in younger patients.Despite comparable functional outcomes,the incidence of retear using single and double bundle ACLR methods ...BACKGROUND Anterior cruciate ligament reconstruction(ACLR)has a high incidence of re-tear in younger patients.Despite comparable functional outcomes,the incidence of retear using single and double bundle ACLR methods has not been well reported.AIM To hypothesize that double bundle hamstring ACLR has a lower graft rupture rate compared with single bundle hamstring ACLR grafts in young patients.METHODS One hundred and twelve patients<30 years of age at the time of primary double bundle ACLR were eligible for study participation.91(81.3%)could be contacted,with a mean age of 20.4 years(range 13-29)and mean post-operative follow-up time of 59 mo(range 25-107).Telephone questionnaires evaluated the incidence(and timing)of subsequent re-tear and contralateral ACL tear,further surgeries,incidence and time to return to sport,and patient satisfaction.RESULTS Of the 91 patients,there were 6(6.6%,95%CI:1.4-11.7)ACL graft re-ruptures,with a mean time to re-rupture of 28 mo(range 12-84).Fourteen patients(15.4%)experienced a contralateral ACL rupture and 14 patients(15.4%)required further surgery to their ipsilateral knee.fifty patients(54.9%)returned to pre-injury level of sport.Of those<20 years(n=45),4 patients(8.9%,95%CI:0.4-17.3)experienced a re-rupture,with mean time to re-injury 15 mo(range 12-24).Comparative analysis with existing literature and revealed a non-significant Chisquared statistic of 2.348(P=0.125).CONCLUSION A trend existed toward lower graft rupture rates in young patients undergoing double bundle ACLR utilizing a hamstring autograft,compared with rates reported after single bundle ACLR.展开更多
The Four-Strand Hamstring Tendon Autograft has been long established as the gold standard for surgical reconstruction of the Anterior Cruciate Ligament. Some studies have suggested wider grafts, such as a Five-Strand ...The Four-Strand Hamstring Tendon Autograft has been long established as the gold standard for surgical reconstruction of the Anterior Cruciate Ligament. Some studies have suggested wider grafts, such as a Five-Strand hamstring graft, may provide greater strength and a larger scaffold for incorporation of the graft into the bone tunnels, leading to greater postoperative anterior stability of the knee. 28 (n = 18 Four-Strand and n = 10 Five-Strand) patients with planned ACL reconstructive surgery by a single surgeon were recruited for this study. The KT-1000 Arthrometer (MED metric, CA, USA) was used to quantify AP translation in the subjects’ knees before (T0) and after surgery at 6 (T1) and 12 (T2) weeks. At 12 weeks there was significantly higher (p = 0.01) mean anterior laxity on Maximum Manual Test in the Five- Strand group (9.1 ± 1.7 mm) than the Four Strand Group (6.9 ± 2.3 mm). Further, there were significantly higher mean side-to-side differences (p = 0.01) on Maximum Manual Test in the Five-Strand cohort (5.1 ± 3.5 mm) compared to the Four-Strand cohort (1.9 ± 2.2 mm). A significantly larger positive mean change in anterior laxity (p = 0.02) from 6 - 12 weeks was evident in the Five-Strand group (1.4 ± 0.9) than the Four-Strand group (-0.3 ± 1.9 mm). No significant correlations were seen between graft widths and measures of anterior stability on KT-1000. This study illustrated that there was no benefit to using a Five-Strand Hamstring Tendon Autograft when compared to the gold standard Four-Strand Repair specifically with regards to anterior stability of the knee.展开更多
AIM: To investigate current preferences and opinions on the diagnosis, treatment and rehabilitation of patients with anterior cruciate ligament(ACL) injury in Croatia. METHODS: The survey was conducted using a questio...AIM: To investigate current preferences and opinions on the diagnosis, treatment and rehabilitation of patients with anterior cruciate ligament(ACL) injury in Croatia. METHODS: The survey was conducted using a questionnaire which was sent by e-mail to all 189 members of the Croatian Orthopaedic and Traumatology Association. Only respondents who had performed at least one ACL reconstruction during 2011 were asked to fill out the questionnaire. RESULTS: Thirty nine surgeons responded to the survey. Nearly all participants(95%) used semitendinosus/gracilis tendon autograft for reconstruction and only 5% used bone-patellar tendon-bone autograft. No other graft type had been used. The accessory anteromedial portal was preferred over the transtibial approach(67% vs 33%). Suspensory fixation was the most common graft fixation method(62%) for the femoral side, followed by the cross-pin(33%) and bioabsorbable interference screw(5%). Almost all respondents(97%) used a bioabsorbable interference screw for tibial side graft fixation. CONCLUSION: The results show that ACL reconstruction surgery in Croatia is in step with the recommendations from latest world literature.展开更多
Despite remarkable improvements in clinical outcomes after anterior cruciate ligament reconstruction,the residual rotational instability of knee joints remains a major concern.The anterolateral ligament(ALL)has recent...Despite remarkable improvements in clinical outcomes after anterior cruciate ligament reconstruction,the residual rotational instability of knee joints remains a major concern.The anterolateral ligament(ALL)has recently gained attention as a distinct ligamentous structure on the anterolateral aspect of the knee joint.Numerous studies investigated the anatomy,function,and biomechanics of ALL to establish its potential role as a stabilizer for anterolateral rotational instability.However,controversies regarding its existence,prevalence,and femoral and tibial insertions need to be addressed.According to a recent consensus,ALL exists as a distinct ligamentous structure on the anterolateral aspect of the knee joint,with some anatomic variations.The aim of this article was to review the updated anatomy of ALL and present the most accepted findings among the existing controversies.Generally,ALL originates slightly proximal and posterior to the lateral epicondyle of the distal femur and has an anteroinferior course toward the tibial insertion between the tip of the fibular head and Gerdy’s tubercle below the lateral tibial plateau.展开更多
文摘This article provides a discussion and commentary around the recent advances in arthroscopic anterior cruciate ligament reconstruction(ACLR),with a focus on the aspects of lateral femoral tunnel preparation and graft fixation techniques.The paper explores and comments on a recently published review by Dai et al,titled"Research progress on preparation of lateral femoral tunnel and graft fixation in ACLR",while providing insight into its relevance within the field of ACLR,and recommendations for future research.
文摘BACKGROUND Cyclops lesions are a known complication of anterior cruciate ligament(ACL)reconstruction,with symptomatic cyclops syndrome occurring in up to 11%of surgeries.Recurrent cyclops lesions have been rarely documented;this case study documents the successful treatment of a recurrent cyclops lesion.CASE SUMMARY A 28-year-old female presented following a non-contact injury to the right knee.Workup and clinical exam revealed an ACL tear,and arthroscopic reconstruction was performed.Two years later a cyclops lesion was discovered and removed via arthroscopic synovectomy.Seven months postoperatively,the patient presented with pain,stiffness,and difficulty achieving terminal extension.A smaller recurrent cyclops lesion was diagnosed,and a repeat synovectomy was performed.The patient recovered fully.CONCLUSION To the best of our knowledge,this is the first documented case of recurrent cyclops lesion after bone-patellar tendon-bone allograft ACL reconstruction presenting as cyclops syndrome.
基金Supported by A Research fellowship from the faculty of Medicine,Westphalian Wilhelms University Muenster to Domnick C
文摘The influences and mechanisms of the physiology,rupture and reconstruction of the anterior cruciate ligament(ACL)on kinematics and clinical outcomes have been investigated in many biomechanical and clinical studies over the last several decades.The knee is a complex joint with shifting contact points,pressures and axes that are affected when a ligament is injured.The ACL,as one of the intra-articular ligaments,has a strong influence on the resulting kinematics.Often,other meniscal or ligamentous injuries accompany ACL ruptures and further deteriorate the resulting kinematics and clinical outcomes.Knowing the surgical options,anatomic relations and current evidence to restore ACL function and considering the influence of concomitant injuries on resulting kinematics to restore full function can together help to achieve an optimal outcome.
文摘BACKGROUND Suspension training(SET)is a method of neuromuscular training that enables the body to carry out active training under unstable support through a suspension therapy system.However,there have been few reports in the literature on the application of SET to anterior cruciate ligament reconstruction(ACLR)patients.It is not clear what aspects of the patient's function are improved after SET.AIM To investigate the effect of SET on the neuromuscular function,postural control,and knee kinematics of patients after ACLR surgery.METHODS Forty participants were randomized to an SET group or a control group.The SET group subjects participated in a SET protocol over 6 wk.The control group subjects participated in a traditional training protocol over 6 wk.Isokinetic muscle strength of the quadriceps and hamstrings,static and dynamic posture stability test,and relative translation of the injured knee were assessed before and after training.RESULTS The relative peak torque of the quadriceps and hamstrings in both groups increased significantly(P<0.001),and the SET group increased by a higher percentage than those in the control group(quadriceps:P=0.004;hamstrings:P=0.011).After training,both groups showed significant improvements in static and dynamic posture stability(P<0.01),and the SET group had a greater change than the control group(P<0.05).No significant improvement on the relative translation of the injured knee was observed after training in either group(P>0.05).CONCLUSION Our findings show that SET promotes great responses in quadriceps and hamstring muscle strength and balance function in ACLR patients.
文摘BACKGROUND Anterior cruciate ligament reconstruction(ACLR)has a high incidence of re-tear in younger patients.Despite comparable functional outcomes,the incidence of retear using single and double bundle ACLR methods has not been well reported.AIM To hypothesize that double bundle hamstring ACLR has a lower graft rupture rate compared with single bundle hamstring ACLR grafts in young patients.METHODS One hundred and twelve patients<30 years of age at the time of primary double bundle ACLR were eligible for study participation.91(81.3%)could be contacted,with a mean age of 20.4 years(range 13-29)and mean post-operative follow-up time of 59 mo(range 25-107).Telephone questionnaires evaluated the incidence(and timing)of subsequent re-tear and contralateral ACL tear,further surgeries,incidence and time to return to sport,and patient satisfaction.RESULTS Of the 91 patients,there were 6(6.6%,95%CI:1.4-11.7)ACL graft re-ruptures,with a mean time to re-rupture of 28 mo(range 12-84).Fourteen patients(15.4%)experienced a contralateral ACL rupture and 14 patients(15.4%)required further surgery to their ipsilateral knee.fifty patients(54.9%)returned to pre-injury level of sport.Of those<20 years(n=45),4 patients(8.9%,95%CI:0.4-17.3)experienced a re-rupture,with mean time to re-injury 15 mo(range 12-24).Comparative analysis with existing literature and revealed a non-significant Chisquared statistic of 2.348(P=0.125).CONCLUSION A trend existed toward lower graft rupture rates in young patients undergoing double bundle ACLR utilizing a hamstring autograft,compared with rates reported after single bundle ACLR.
文摘The Four-Strand Hamstring Tendon Autograft has been long established as the gold standard for surgical reconstruction of the Anterior Cruciate Ligament. Some studies have suggested wider grafts, such as a Five-Strand hamstring graft, may provide greater strength and a larger scaffold for incorporation of the graft into the bone tunnels, leading to greater postoperative anterior stability of the knee. 28 (n = 18 Four-Strand and n = 10 Five-Strand) patients with planned ACL reconstructive surgery by a single surgeon were recruited for this study. The KT-1000 Arthrometer (MED metric, CA, USA) was used to quantify AP translation in the subjects’ knees before (T0) and after surgery at 6 (T1) and 12 (T2) weeks. At 12 weeks there was significantly higher (p = 0.01) mean anterior laxity on Maximum Manual Test in the Five- Strand group (9.1 ± 1.7 mm) than the Four Strand Group (6.9 ± 2.3 mm). Further, there were significantly higher mean side-to-side differences (p = 0.01) on Maximum Manual Test in the Five-Strand cohort (5.1 ± 3.5 mm) compared to the Four-Strand cohort (1.9 ± 2.2 mm). A significantly larger positive mean change in anterior laxity (p = 0.02) from 6 - 12 weeks was evident in the Five-Strand group (1.4 ± 0.9) than the Four-Strand group (-0.3 ± 1.9 mm). No significant correlations were seen between graft widths and measures of anterior stability on KT-1000. This study illustrated that there was no benefit to using a Five-Strand Hamstring Tendon Autograft when compared to the gold standard Four-Strand Repair specifically with regards to anterior stability of the knee.
文摘AIM: To investigate current preferences and opinions on the diagnosis, treatment and rehabilitation of patients with anterior cruciate ligament(ACL) injury in Croatia. METHODS: The survey was conducted using a questionnaire which was sent by e-mail to all 189 members of the Croatian Orthopaedic and Traumatology Association. Only respondents who had performed at least one ACL reconstruction during 2011 were asked to fill out the questionnaire. RESULTS: Thirty nine surgeons responded to the survey. Nearly all participants(95%) used semitendinosus/gracilis tendon autograft for reconstruction and only 5% used bone-patellar tendon-bone autograft. No other graft type had been used. The accessory anteromedial portal was preferred over the transtibial approach(67% vs 33%). Suspensory fixation was the most common graft fixation method(62%) for the femoral side, followed by the cross-pin(33%) and bioabsorbable interference screw(5%). Almost all respondents(97%) used a bioabsorbable interference screw for tibial side graft fixation. CONCLUSION: The results show that ACL reconstruction surgery in Croatia is in step with the recommendations from latest world literature.
基金Supported by a grant of Korea University Anam Hospital,Seoul,Republic of Korea,No.K2209741.
文摘Despite remarkable improvements in clinical outcomes after anterior cruciate ligament reconstruction,the residual rotational instability of knee joints remains a major concern.The anterolateral ligament(ALL)has recently gained attention as a distinct ligamentous structure on the anterolateral aspect of the knee joint.Numerous studies investigated the anatomy,function,and biomechanics of ALL to establish its potential role as a stabilizer for anterolateral rotational instability.However,controversies regarding its existence,prevalence,and femoral and tibial insertions need to be addressed.According to a recent consensus,ALL exists as a distinct ligamentous structure on the anterolateral aspect of the knee joint,with some anatomic variations.The aim of this article was to review the updated anatomy of ALL and present the most accepted findings among the existing controversies.Generally,ALL originates slightly proximal and posterior to the lateral epicondyle of the distal femur and has an anteroinferior course toward the tibial insertion between the tip of the fibular head and Gerdy’s tubercle below the lateral tibial plateau.
