Risk factors for contralateral anterior cruciate ligament injury after primary anterior cruciate ligament reconstruction / 中国修复重建外科杂志

OBJECTIVE@#To investigate the risk factors of contralateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction.@*METHODS@#A retrospective review was conducted on the 716 patients with ACL injury who received primary ACL reconstruction surgery and met the selection criteria between January 2012 and September 2018. After a mean follow-up period of 7.6 years (range, 4-10 years), 65 patients (9.1%) experienced contralateral ACL injury (injured group) and 651 patients (90.9%) did not (uninjured group). There was no significant difference in age, body mass index, and preoperative Lachman test degree between groups ( P>0.05). However, the proportion of female in the injured group was significantly higher than that of male ( P<0.05), and the preoperative posterior tibial slope (PTS) was significantly higher than that of the uninjured group ( P<0.05). Using the outcome of contralateral ACL injury as the dependent variable, the clinical data of the patient was first used as the independent variable, and univariate COX regression was used to analyze the prognostic influencing factors. Then, the indicators with differences in univariate COX regression were used as the independent variable, and multivariate COX regression was used to analyze the independent risk factors affecting prognosis. Log-Rank (Mantel-Cox) test was used to test and analyze the occurrence time of contralateral ACL injury in patients of different genders; X-tile software was used to analyze the occurrence time of contralateral ACL injury in patients with different PTS using Log-Rank (Mantel-Cox) test and PTS cut-off values.@*RESULTS@#Univariate COX regression analysis showed that gender and PTS were influence factors for contralateral ACL injury ( P<0.05); further multivariate COX regression analysis showed that female and increased PTS were independent risk factors for contralateral ACL injury ( P<0.05). The Log-Rank (Mantel-Cox) test results showed that the contralateral ACL injury occurred in female at 8.853 (8.600, 9.106) years, which was significantly shorter than that in male [9.661 (9.503, 9.819) years] ( χ 2=20.323, P<0.001). Using X-tile software to analyze the cut-off value of PTS, it was found that the cut-off value of PTS for contralateral ACL injury was 10.92°. According to the Log-Rank (Mantel-Cox) test, it was found that the contralateral ACL injury occurred in 5.762 (4.981, 6.543) years in patients with PTS≥10.92°, which was significantly shorter than patients with PTS<10.92° [9.751 (9.650, 9.853) years]( χ 2 =302.479, P<0.001).@*CONCLUSION@#Female and PTS≥10.92° after primary ACL reconstruction are independent risk factors for contralateral ACL injury.

Study on the diagnostic value of different posterior cruciate ligament index measurement methods for anterior cruciate ligament injury / 中国骨伤

OBJECTIVE@#To compare the posterior cruciate ligament(PCL) index with six different measurement methods, and analyze and verify its clinical diagnostic value in anterior cruciate ligament (ACL) injury.@*METHODS@#The Magnetic resonance imaging (MRI) data of 225 knee joints in our hospital from May 2018 to March 2022 were retrospectively analyzed, aged from 18 to 60 years old, with a median of 32 years old. On the sagittal MRI images of 114 patients with ACL injury and 111 patients with intact ACL, Measure the straight-line distance (A) between the femoral attachment point and the tibial attachment point of the PCL on the MRI sagittal image and the maximum vertical distance (B) between the straight line and the arcuate mark point of the PCL on the sagittal image, calculate the PCL index and evaluate the diagnostic value of the PCL index for ACL injury.@*RESULTS@#The PCL index of the ACL normal group and the ACL injury group were statistically described. There was no significant difference in PCL index 1, 2, 3 and 6 between the two groups(P>0.05). The difference of PCL index 4 and 5 between the two groups was statistically significant (P<0.001). This study only found that the PCL index 2, 6 in the ACL normal group had a negative correlation with the patient's age (correlation coefficient=-0.213, -0.819;P<0.05), and the PCL index 5 in the ACL injury group was significantly correlated with the patient's body mass index(BMI)had a negative correlation (correlation coefficient=-0.277, P<0.05).@*CONCLUSION@#The change of PCL index is helpful for the diagnosis of ACL injury, PCL index 4 and 5 can be used as effective reference indexes for diagnosing ACL injury in clinic.

Research progress on bioactive strategies for promoting tendon graft healing after anterior cruciate ligament reconstruction / 中国修复重建外科杂志

OBJECTIVE@#To review the bioactive strategies that enhance tendon graft healing after anterior cruciate ligament reconstruction (ACLR), and to provide insights for improving the therapeutic outcomes of ACLR.@*METHODS@#The domestic and foreign literature related to the bioactive strategies for promoting the healing of tendon grafts after ACLR was extensively reviewed and summarized.@*RESULTS@#At present, there are several kinds of bioactive materials related to tendon graft healing after ACLR: growth factors, cells, biodegradable implants/tissue derivatives. By constructing a complex interface simulating the matrix, environment, and regulatory factors required for the growth of native anterior cruciate ligament (ACL), the growth of transplanted tendons is regulated at different levels, thus promoting the healing of tendon grafts. Although the effectiveness of ACLR has been significantly improved in most studies, most of them are still limited to the early stage of animal experiments, and there is still a long way to go from the real clinical promotion. In addition, limited by the current preparation technology, the bionics of the interface still stays at the micron and millimeter level, and tends to be morphological bionics, and the research on the signal mechanism pathway is still insufficient.@*CONCLUSION@#With the further study of ACL anatomy, development, and the improvement of preparation technology, the research of bioactive strategies to promote the healing of tendon grafts after ACLR is expected to be further promoted.

Effectiveness of preemptive analgesia with imrecoxib on analgesia after anterior cruciate ligament reconstruction: a randomized controlled study / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of preemptive analgesia with imrecoxib on analgesia after anterior cruciate ligament (ACL) reconstruction.@*METHODS@#A total of 160 patients with ACL injuries who met the selection criteria and were admitted between November 2020 and August 2021 were selected and divided into 4 groups according to the random number table method (n=40). Group A began to take imrecoxib 3 days before operation (100 mg/time, 2 times/day); group B began to take imrecoxib 1 day before operation (100 mg/time, 2 times/day); group C took 200 mg of imrecoxib 2 hours before operation (5 mL of water); and group D did not take any analgesic drugs before operation. There was no significant difference in gender, age, body mass index, constituent ratio of meniscal injuries with preoperative MRI grade 3, constituent ratio of cartilage injury Outerbridge grade 3, and visual analogue scale (VAS) score at the time of injury and at rest among 4 groups (P>0.05). The operation time, hospitalization stay, constituent ratio of perioperative American Society of Anesthesiologists (ASA) grade 1, postoperative opioid dosage, and complications were recorded. The VAS scores were used to evaluate the degree of knee joint pain, including resting VAS scores before operation and at 6, 24, 48 hours, and 1, 3, 6, and 12 months after operation, and walking, knee flexion, and night VAS scores at 1, 3, 6, and 12 months after operation. The knee injury and osteoarthritis score (KOOS) was used to evaluate postoperative quality of life and knee-related symptoms of patients, mainly including pain, symptoms, daily activities, sports and entertainment functions, knee-related quality of life (QOL); and the Lysholm score was used to evaluate knee joint function.@*RESULTS@#All patients were followed up 1 year. There was no significant difference in operation time, hospitalization time, or constituent ratio of perioperative ASA grade 1 among 4 groups (P>0.05); the dosage of opioids in groups A-C was significantly less than that in group D (P<0.05). Except for 1 case of postoperative fever in group B, no complications such as joint infection, deep vein thrombosis of the lower extremities, or knee joint instability occurred in each group. The resting VAS scores of groups A-C at 6 and 24 hours after operation were lower than those of group D, and the score of group A at 6 hours after operation was lower than those of group C, and the differences were significant (P<0.05). At 1 month after operation, the knee flexion VAS scores of groups A-C were lower than those of group D, the walking VAS scores of groups A and B were lower than those of groups C and D, the differences were significant (P<0.05). At 1 month after operation, the KOOS pain scores in groups A-C were higher than those in group D, there was significant difference between groups A, B and group D (P<0.05); the KOOS QOL scores in groups A-C were higher than that in group D, all showing significant differences (P<0.05), but there was no significant difference between groups A-C (P>0.05). There was no significant difference in VAS scores and KOOS scores between the groups at other time points (P>0.05). And there was no significant difference in Lysholm scores between the groups at 1, 3, 6, and 12 months after operation (P>0.05).@*CONCLUSION@#Compared with the traditional analgesic scheme, applying the concept of preemptive analgesia with imrecoxib to manage the perioperative pain of ACL reconstruction can effectively reduce the early postoperative pain, reduce the dosage of opioids, and promote the early recovery of limb function.

Comparison of short-term clinical effects of three fixation methods in anterior cruciate ligament reconstruction / 中国综合临床

Objective:To compare the short-term clinical effects of absorbable cross nail, sheath compression nail and suspension fixation on the femoral side and sheath compression nail on the tibial side in anterior cruciate ligament reconstruction (ACLR) with autologous hamstring tendon.Methods:The clinical data of 373 patients with anterior cruciate ligament injuries treated with surgery in the First Hospital of Qinhuangdao Affiliated to Chengde Medical College from December 2008 to December 2018 were collected for a retrospective case-control study. There were 125 cases of absorbable cross nail (absorbable cross nail group), 112 cases of sheath compression nail (sheath compression nail group) and 136 cases of suspension fixation (suspension fixation group). The mean follow-up time was (13.96±1.42) months. The international knee documentation committee (IKDC) score and Lysholm score were used to score the patients, and the differences were statistically analyzed. The measurement data of normal distribution was represented by xˉ± s, and repeated measurement analysis of variance was used to compare the three groups in different time periods, and the operation time of the three groups of samples was compared by one-way analysis of variance. The counting data were compared by χ 2 test. Results:(1) There were no complications such as infection, adhesion, stiffness and neurovascular injury in the three groups at the last follow-up. (2) Comparison of preoperative and postoperative knee scores: Lysholm score: preoperative absorbable cross nail group (65.98±1.37), sheath compression nail group(66.13±2.13), suspension fixation group (65.76±1.55). Three months after operation, absorbable cross nail group (80.14±2.02), sheath compression nail group (79.70±1.98) and suspension fixation group (79.84±1.86). Twelve months after operation, there were (94.56±2.35) points in the absorbable cross nail group, (94.96±1.34) points in the sheath compression nail group and (94.40±3.15) points in the suspension fixation group.There was significant difference in the scores before and after operation in the same group ( Fintra-group=17 584.14, P<0.001), and there was no significant difference among the three groups ( Finter-group=2.65, P=0.072), There was no statistical significance in the trend of scores before and after operation in the three groups ( Finter-action=1.28, P=0.277). IKDC scores: Preoperative (62.02±1.43) in absorbable cross nail group, preoperative (61.95±0.82) in sheath compression nail group, preoperative (62.25±2.05) in the suspension fixation group. Three months after operation, absorbable cross nail group (77.99±2.18), sheath compression nail group (78.13±2.02) and suspension fixation group (77.97±2.24). Twelve months after operation, the absorbable cross nail group (92.68±3.21), the sheath compression nail group (93.25±2.04) and the suspension fixation group (92.96±3.11). There was significant difference in the scores before and after operation in the same group ( Fintra-group=18 338.15, P<0.001), and there was no significant difference among the three groups ( Finter-group=0.91, P=0.402), and there was no significant trend in the scores before and after operation in the three groups ( Finteraction=0.98, P=0.419). (3) Comparison of operation time: absorbable cross nail group (99.04±18.01) min, sheath compression nail group (112.88±19.79) min and suspension fixation group (83.81±16.69) min. there was significant difference among the three groups ( F=79.74, P<0.001). Further comparison between the three groups, the time of suspension fixation group was the shortest than the other two groups (all P<0.001). Conclusion:There is no significant difference in the short-term efficacy of ACLR with autologous hamstring tendon among the three groups, and there were no complications such as infection, adhesion, stiffness and neurovascular injury in the last follow-up. In terms of operation time, the suspension fixation group has the shortest time and is simple and easy to operate.

Comparison on the establishment of proprioceptive hypoesthesia model of anterior cruciate ligament by open surgery and minimally invasive surgery / 解剖学报

[Abstract] Objective To provide an optimized animal model for basic research by comparing the establishment of proprioceptive hypoesthesia model of anterior cruciate ligament (ACL) by open surgery and minimally invasive surgery. Methods Totally 30 normal cynomolgus monkeys were randomly divided into five groups: minimally invasive surgery group: unilateral ACL injury under arthroscope, n = 6; open surgery group: unilateral ACL injury through direct incision of knee joint, n = 6; minimally invasive sham operation group: unilateral ACL without injury through arthroscopic cleaning only, n = 6; open surgery group: unilateral ACL exploration without injury through direct incision of knee joint, n = 6; positive normal group: no surgical intervention, n = 6. Four weeks later, the neurophysiological examination [somatosensory evoked potentials (SEPs) and motor nerve conduction velocity (MCV)] was carried out. The macaque was killed and its unilateral ACL was stained with gold chloride. The number and variation of ACL proprioceptors were observed and recorded. Results In the aspect of neuroelectrophysiology, except the normal group, the latency of SEPs and MCV were prolonged, and the amplitude decreased. In terms of proprioceptors, the total number of minimally invasive surgery group: 578. 00± 12. 68, amplitude: 36. 33 ± 3. 72; total number of open surgery group: 367. 67 ± 9. 33, amplitude: 77. 00 ± 5. 55; total number of open sham operation group: 969. 00±18. 26, amplitude: 0±0; total number of normal group: 970. 46±16. 34, amplitude: 0± 0, the total number of proprioceptors decreased and the number of variation increased in all four groups except the normal group. At the same time, in the comparison of the two aspects, there were significant differences between the open operation group and the minimally invasive operation group, the open operation group and the open sham operation group, and the minimally invasive operation group and the minimally invasive sham operation group (P0. 05). Conclusion Both the open operation group and the minimally invasive operation group can build ACL proprioceptive hypoesthesia model, but the minimally invasive operation has less damage to the tissues around ACL, more scientific and single model, and less experimental error, which is of great significance in the basic research of ACL injury.

Role and significance of anterior cruciate ligament injury in the development of post-traumatic knee osteoarthritis / 中国组织工程研究

BACKGROUND: Anterior cruciate ligament has the function of stabilizing the knee joint and restricting the tibiofemoral joint in the translation and rotation of the tibia. Most patients with anterior cruciate ligament reconstruction have an increased risk of knee pain and knee instability. Knee osteoarthritis after trauma is a serious complication of anterior cruciate ligament injury. Knee osteoarthritis is a chronic progressive disease, and the mechanism of osteoarthritis after anterior cruciate ligament injury remains unclear. OBJECTIVE: To review the relationship between anterior cruciate ligament injury and the risk factors of post-traumatic knee osteoarthritis, so as to provide guidance for the treatment of post-traumatic knee osteoarthritis. METHODS: The first author searched related articles in PubMed database from the establishment of the database to October 2019. The key words were “ACL injury, traumatic knee osteoarthritis, ACL reconstruction, meniscus status, body mass index, cartilage injury, age, graft selection, time interval between injury and surgery”. A total of 123 articles were retrieved, and 66 articles were eligible for the inclusion criteria. RESULTS AND CONCLUSION: (1) Meniscus status, body mass index, cartilage damage, age, graft selection, and time between injury and surgery may influence the development of post-traumatic knee osteoarthritis. (2) Although anterior cruciate ligament reconstruction is primarily performed to restore stability after anterior cruciate ligament rupture, a long-term goal of the process is to reduce the risk of knee osteoarthritis and maintain long-term joint health. (3) Meniscus resection in patients with anterior cruciate ligament rupture accompanied by meniscus injury is also the cause of knee osteoarthritis, which is likely to be caused by weakened endurance and kinematic changes of the joint.

Difference of Isokinetic Angle-Specific Moment Curves in Anterior Cruciate Ligament-injured Patients with or without Patellofemoral Articular Cartilage Injury / 中国康复理论与实践

Objective:To investigate the difference of isokinetic angle-specific moment curves between anterior cruciate ligament (ACL)-injured patients with and without patellofemoral cartilage injury (PFCI). Methods:A retrospective analysis was performed on patients underwent knee arthroscopy and isokinetic muscle strength testing before surgery from September, 2018 to September, 2019. Seventeen ACL-injured patients with PFCI and 17 ACL-injured patients without PFCI who matched in age, sex and meniscus injury were selected. Before arthroscopy, isometric and isokinetic strength of knee flexion and extension at velocity of 180°/s and 60°/s was tested by isokinetic dynamometer. Normalized torque-angle curves (torque/body mass) were generated in steps of 1° and the differences in angle-specific moment curves between two groups were compared. Results:At 180°/s, there was no significant difference in flexion isokinetic torque both healthy side and affected side between two groups (P >0.05); and no difference in extension torque of the healthy side (P >0.05), however, there was significant difference in extension torque of the affected side at 88° to 90° between two groups (t > 2.102, P <0.05). At 60°/s, there was significant difference in flexion torque of the healthy side at 62° to 82° between two groups (|t| >2.056, P <0.05), and no significant difference was found in flexion torque of the affected side (P >0.05), nor in extension torque of both sides between two groups (P > 0.05). A curve change was found at the beginning of the flexion and extension isokinetic moment curves at the velocity of 180°/s. The isometric knee extension torque was significantly different in the affected side between two groups (t = 2.858, P < 0.01), and no difference was found in isometric knee flexion torque in the affected side as well as both extension and flexion torques in the healthy side between two groups (t < 1.905, P > 0.05). Conclusion:The lower the isokinetic speed, the more significant the difference of strength is between ACL-injury patients with and without PFCI. High speed exercise is recommended for ACL-injured patients with PFCI.

Relative Telomere Length in Blood Leukocytes of Patients with Anterior Cruciate Ligament Injury: A Pilot Study

@#Introduction: Anterior cruciate ligament (ACL) tear is the most common knee ligament injury, especially in athletes. The objective of this study was to investigate relative telomere length (RTL) in blood leukocytes of patients with ACL injury compared with that of controls. Materials and Methods: A total of 187 subjects were invited to participate in this study. Ninety-two patients with clinically diagnosed ACL rupture were enrolled. Ninety-five age and gender-matched healthy controls were also recruited. Blood leukocyte RTL were analysed using quantitative real-time polymerase chain reaction. Results:Patients with ACL rupture had significantly longer relative telomere length than healthy controls (P=0.002). The patients with ACL rupture were classified into two groups according to the sport history of patients which are contact sports and non-contact sports. RTL in patients with non-contact sports was significantly greater than those with contact sports (P=0.006). Moreover, RTL was inversely correlated with body mass index of patients with ACL injury (r=-0.34, P=0.001). Logistic regression analysis indicated that long RTL was associated with a higher risk of ACL rupture. Conclusion: The present study showed that subjects with ACL rupture had significantly greater telomere length compared with their age and gender-matched controls. This finding may result from the increases in physical activity and overexpression of telomerase which acts as a protective mechanism against ACL injury. RTL in blood leukocytes is associated with a risk of ACL rupture.

Anterolateral Ligament Reconstruction in ACL Insufficient Knee with High-grade Pivot Shift——Surgical Technique and Early Follow-up Results / 中国运动医学杂志

Objective To evaluate the effectiveness of anterior cruciate ligament (ACL) reconstruction combined with anterolateral ligament(ALL)reconstruction in ACL injury patients with high-grade pivot shift.Methods From May 2015 to April 2016,156 patients underwent ACL reconstruction by the same surgeon,and 22 of them with grade 2/3 pivot shift were included in this study.Anteroposterior knee stability was evaluated using KT1000 measurement,and the rotatory stability was assessed using the pivot-shift test.The Lysholm score was used to monitor the clinical function.Results There were 14 male subjects and 8 females,with an average age of 29.3 years.The mean follow-up period was 8.6 months.The mean side-to-side difference of anteroposterior knee laxity was 2.1 ± 0.6 mm,significantly improved compared with the preoperative 8.9 ± 3.1 mm.The preoperative pivot-shift indicated 2+ in 20 patients and 3+ in 2 patients,while at the final follow-up,21 patients had negative pivot shift with 1 of 1+ pivot shift.The difference was significant.The average Lysholm score improved significantly from 60.5 ± 12.3 preoperatively to 79.2 ± 7.8 at the final follow-up.Conclusion The rotatory instability can be effectively restored through the ACL reconstruction combined with ALL reconstruction in patients with high-grade pivot shift.The early-stage knee stability and functional outcomes indicate significant improvement postoperatively.

Tratamiento de la lesión del ligamento cruzado anterior en pacientes con fisis abiertas / Treatment of anterior cruciate ligament injury in patients with open physis

Contexto: las roturas del ligamento cruzado anterior (LCA) en pacientes con fisis abiertas representan el 3,3% de las roturas del LCA, En el tratamiento de las roturas intersticiales del LCA en pacientes con fisis abiertas existe controversia en la elección entre tratamiento conservador y tratamiento quirúrgico. Objetivo: analizar la reconstrucción del ligamento cruzado anterior LCA con fisis abierta en el Servicio de Ortopedia y Traumatología del Hospital de Especialidades FFAA No 1. Sujetos y métodos: estudio retrospectivo en pacientes sometidos a cirugía artroscópica para tratamiento de lesión del LCA con fisis abiertas, en el periodo enero 2012 y abril de 2015. En relación al tratamiento, se utilizó la técnica transfisaria completa (monotúnel); el injerto se fija al fémur con un endobotón y a la tibia con un tornillo de interferencia; el injerto fue obtenido del músculo semitendinoso. Resultados: fueron intervenidos 9 pacientes de sexo masculino, con edades entre 13 y 16 años, con lesiones del ligamento cruzado anterior en rodilla derecha (n=7, 78%) e izquierda (n=2, 22%); la ruptura del menisco es la lesión asociada más frecuente. Conclusión: las roturas del LCA con fisis abiertas son cada vez más frecuentes en la actualidad. La reconstrucción del LCA debe ser precoz para evitar lesiones condrales y meniscales. Se recomienda el tratamiento quirúrgico por los óptimos resultados clínicos y funcionales. (AU)

Background: anterior cruciate ligament (ACL) tears in open physis patients represent 3.3% of ACL tears. In the treatment of ACL interstitial tears in patients with open physis, there is controversy in the choice between conservative treatment and surgical treatment. Objective: to analyze the reconstruction of the anterior cruciate ligament ACL with open physis in the Orthopedics and Traumatology Service of the Specialty Hospital FFAA No 1. Subjects and methods: retrospective study in patients undergoing arthroscopic surgery for treatment of ACL injury with open physis, in the period January 2012 and April 2015. In relation to the treatment, the complete transfusion technique (monotunnel) was used; the graft is fixed to the femur with an endobotton and to the tibia with an interference screw; the graft was obtained from the semitendinous muscle. Results: were operated on 9 male patients, with ages between 13 and 16 years, with injuries of the anterior cruciate ligament in the right knee (n = 7, 78%) and left (n = 2, 22%); the rupture of the meniscus is the most common associated lesion. Conclusion: ACL tears with open physis are becoming more frequent today. The reconstruction of the ACL must be early to avoid chondral and meniscal lesions. Surgical treatment is recommended for optimal clinical and functional results. (AU)

Static Anterior Tibial Translation after Anterior Cruciate Ligament Injury: Incidence and Clinical Characteristics / 中国运动医学杂志

Objective To explore the incidence and clinical characteristics of the anterior tibial translation(ATT) after anterior cruciate ligament injury.Methods One hundred and fifty-three patients with the anterior cruciate ligament injury underwent standard magnetic resonance imaging scans with full knee extension.Based on the relative location between the lateral tibial plateau and the lateral femoral condyle,all the patients were divided into an ATT positive group and an ATT negative group.Moreover,the posterior tibial slope angle(PTSA),the continuity of anterolateral ligament(ALL),and the integrity of posterior horn of the lateral meniscus of all the patients were detected so as to find the risking factors for ATT.Results Among the 153 patients,46 patients were finally confirmed to have ATT.Moreover,the average PTSA of the ATT positive group was significantly larger than that of the ATT negative group.However,there were no significant differences between the two groups in the continuity of ALL and the integrity of posterior horn of lateral meniscus.Conclusion In this study,the incidence of ATT was 30.1％,which may be correlated to the increased PTSA.

Anterior Cruciate Ligament Reconstruction Combined with Anterolateral Tenodesis Procedure Treating Patient with High Grade Pivot-shift after ACL Injuries / 中国运动医学杂志

Objective To evaluate the early clinical outcomes of anterior cruciate ligament(ACL)reconstruction combined with anterolateral tenodesis procedure in patient with high grade pivot-shift after ACL injuries.Methods Among the 140 patients diagnosed as ACL injury and undergoing operations in our hospital between June and December 2015,18 presenting high grade pivot-shift 2+ or 3+ under anesthesia were included into this study.During their surgeries,the anterolateral tenodesis procedure using iliotibial tract ITB was applied together with ACL reconstruction.The anteroposterior stability of the knee was examined and pivot-shift test was conducted right after the operation as well as 6 and 12 months after that.The Lysholm score was used to evaluate the clinical function of their knees.Results The mean follow-up period of the 18 patients was 12.7 ± 2.4 months.There were 14 males and 4 females,with an average of 28.3 ± 7.1 years.No patients complained about unstable symptoms during the follow-up.The mean side-to-side difference of anteroposterior knee laxity assessed using KT1000 at 30 degree knee flexion was 2.3 ± 0.7 mm,which was significantly improved compared with preoperative assessment(9.2 ± 2.6 mm)(P＜0.01).For the preoperative examination,the pivot-shift examination indicated 2+ in 13 patients and 3+ in 5 patients.However,all were negative right after the operation.Seventeen patients presented negative pivot-shift at the final follow-up,while 1 had 1+ rotational laxity.Significant differences were found in the Pivot-shift test before and after the operation.The average Lysholm score improved significantly from 67.7 ± 5.9(ranging from 55 to 78)before the operation to 89.0-± 4.6(ranging from 75 to 95)after that.Conclusion The high grade pivot-shift rotational instability could be effectively restored using the anterolateral tenodesis procedure,in addition to ACL reconstruction.The early stage clinical outcomes indicate significant improvement of the knee stability postoperatively.

The Correlation of the Evaluation of Quality of Life Depends on Knee Strength after 1-Year an Anterior Cruciate Ligament Reconstruction / 대한스포츠의학회지

The life situation has been changed in patients who underwent anterior cruciate ligament (ACL) rupture and subsequent reconstruction. The main purpose of this study was to assess the quality of life (QOL) of patients with ACL reconstruction through Short-Form 36 (SF-36) survey. And secondary aim was to investigate a relationship between health-related QOL survey and the correlation of results with other clinical test. 70 patients (age, 32.0+/-11.7 years) with an after 1 year ACL reconstruction participated in this study. As clinical evaluations, the SF-36 Questionnaire was used for the QOL and isokinetic strength test was performed for the knee extensors and flexors. And the anterio tibial translation was measured by KT-2000. Spearman's correlation coefficient showed significant correlations between knee strength (extensor and flexor) deficit and SF-36 score including physical functioning, bodily pain, vitality, social function score (p0.05). In conclusion, the Knee strength is significantly associated with QOL. Therefore after ACL reconstruction, a speedy recovery of muscular strength will help to improve the QOL.

Motor coordination during gait after anterior cruciate ligament injury: a systematic review of the literature / Coordenacao motora durante a marcha apos lesoes no ligamento cruzado anterior: uma revisao sistematica da literatura

To investigate the state of art about motor coordination during gait in patients with anterior cruciate ligament (ACL) injury. Searches were carried out, limited from 1980 to 2010, in various databases with keywords related to motor coordination, gait and ACL injury. From the analysis of titles and applying the inclusion/exclusion criteria 24 studies were initially selected and, after reading the abstract, eight studies remained in the final analysis. ACL deficient patients tend to have a more rigid and less variable gait, while injured patients with ACL reconstruction have less rigid and more variable gait with respect to healthy individuals. The overall results suggest the existence of differences in motor coordination between the segments with intact and those with injured knee, regardless of ligament reconstruction. ACL injured patients present aspects related to the impairment of the capability to adapt the gait pattern to different environmental conditions, possibly leading to premature knee degeneration. However, the techniques used for biomechanical gait data processing are limited with respect to obtaining information that leads to the development of intervention strategies aimed at the rehabilitation of that injury, since it is not possible to identify the location within the gait cycle where the differences could be explained.

Investigar o estado da arte acerca da coordenação motora durante a marcha em pacientes com lesão no ligamento cruzado anterior (LCA). Foram realizadas pesquisas, delimitadas entre 1980 e 2010, em diversas bases de artigos com palavras-chave relacionadas à coordenação motora, marcha e lesão no LCA. A partir da análise de títulos e aplicação dos critérios de inclusão/exclusão, 24 estudos foram selecionados inicialmente e, após a leitura do resumo, oito permaneceram na análise final. Os resultados indicam que pacientes com deficiência no LCA tendem a apresentar uma marcha menos variável, enquanto pacientes com reconstrução do LCA têm uma marcha mais variável, em relação a sujeitos hígidos. Os resultados sugerem a existência de diferenças na coordenação motora entre os segmentos entre sujeitos com e sem lesão no LCA, independentemente da reconstrução ligamentar. Pacientes com lesão no LCA apresentam aspectos relacionados ao comprometimento de adaptar seus padrões de marcha a diferentes condições externas, o que pode levar à degeneração precoce. No entanto, as técnicas usadas pelos estudos para o processamento dos dados biomecânicos foram limitadas no que diz respeito à obtenção de informações que possibilitem o desenvolvimento de estratégias de intervenção voltadas para a reabilitação da lesão. Isso se deve ao fato de as técnicas atuais de estudo da coordenação motora, apesar de possibilitar a identificação de alterações no padrão de marcha saudável, não serem capazes de identificar as principais articulações e fases do ciclo da marcha alteradas.

Spontaneous healing of bucket handle tear of the medial meniscus associated with ACL tear / Resolução espontânea da lesão alça de balde do menisco medial associado com rotura de LCA

We report a case of injury of the medial bucket handle meniscal tears (BH), which resolved spontaneously, in association with anterior cruciate ligament (ACL) injury. The patient twisted his left knee during a fight in martial arts, progressing to pain and joint locking and a sense of distortion. In NMR it could be seen bucket-handle tear of the medial meniscus with displacement of the fragment to the intercondylar region, rupture of the lateral meniscus and ACL tear. After conservative treatment and physiotherapy, in an interval of one year, later examinations showed that there was spontaneous healing of AB.

Neste trabalho é relatado um caso de lesão do menisco medial do tipo em alça de balde (AB), que se resolveu espontaneamente, em associação com lesão de ligamento cruzado anterior (LCA). O paciente torceu o joelho esquerdo durante uma luta em artes maciais, evoluindo com dor e bloqueio articular e sensação de falseamento. Na RMN havia rotura em alça de balde do menisco medial com deslocamento do fragmento para a região intercondilar, rotura do menisco lateral e rotura do LCA. Após tratamento clínico e fisioterápico, em um intervalo de um ano, o exame de controle demonstrou que havia ocorrido resolução espontânea da AB.

Measurement of Knee Morphometrics Using MRI: A Comparative Study between ACL-Injured and Non-Injured Knees

PURPOSE: The purpose of this study is to find out the differences of distal femur morphology between the anterior cruciate ligament (ACL)-injured and the non-ACL injured on an magnetic resonance imaging (MRI), and the difference of bone structure by gender. MATERIALS AND METHODS: MRI Measurements of notch width (NW), bicondylar width (BCW), medial condyle width (MCW), lateral condyle width (LCW), medial-to-lateral condyle ratio (M:L ratio), and notch entrance width (NE) were taken from 120 subjects with ACL injury and the other 106 subjects without ACL injury, by three independent observers, at two different times. The measured values from MRI figures between the ACL-injured and the non-ACL-injured were compared and analyzed, with consideration of the differences by gender. Both intra and inter-observer reliability were calculated. RESULTS: There were significant differences of NW, BCW, MCW, LCW and NE by gender (p<0.001). While NW and MCW in male group were different (p<0.001), NW, MCW, M:L ratio and NW index (NWI) in female group were significantly different (p<0.001) in the bone morphology between the ACL-injured and non-ACL-injured. The intra- and inter-observer reliability was satisfying. CONCLUSIONS: If necessary to take an MRI, female patients with small NWI and NW injury should be carefully treated because of possibility of ACL injuries.

Differences of Femoral Intercondylar Notch on MRI: Between Normal and Anterior Cruciate Ligamen Injured Knee

PURPOSE: The purpose of this study is to evaluate the possible relationship between femoral intercondylar notch stenosis and ACL injury according to gender with retrospective analysis of knee MRI. MATERIALS AND METHODS: The study was based on 260 cases of knee MRI (except the cases of combined colleteral ligaments injury and fracture) between the ages of 18 and 50 years from March 1995 to March 2001. All cases were divided into three groups : group 1 consisted of knees 94 cases that were nor-mal, group 2 consisted of knees from 72 cases that had a contact ACL injury, group 3 consisted of knees from 92 cases that had a non contact ACL injury. We measured the notch height, notch width at the point of 1/3, 2/3 of notch height, notch angle, lateral angle with coronal section. Each measurements of three groups were compared with gender and for statistical significance using the ANOVA test. RESULTS: The mean notch angle was 48.2 +/-6.7 degrees for men and 47.1 +/-1.2 degrees for women in group 1, 48.7 +/- 6.5 degrees for men and 48.7 +/-1.2 degrees for women in group 2, 47.4 +/-6.5 degrees for men and 47.3 +/-1.5 degrees for women in group 3. The mean notch width at the point of 1/3, 2/3of notch height were 18.6 +/-2.4 mm, 15.3 +/-2.4 mm for men and 16.9 +/-2.4 mm, 14.2 +/-2.4 mm for women in group 1, 18.2 +/-2.4 mm, 15.2 +/-2.4 mm for men and 16.7 +/-2.4 mm, 13.9 +/-2.4 mm for women in group 2, 16.8 +/-2.4 mm, 13.9 +/-2.4 mm for men and 15.7 +/-2.4 mm, 13.4 +/-2.4 mm for women in group 3. Statistically significant differences were found between sexes in group 3 in regard to notch width at the point of 1/3, 2/3 of notch height, notch angle(<0.05). CONCLUSION: Stenosis of femoral intercondylar notch may be a factor of ACL injury. So preoperative measurement of femoral intercondylar notch may be necessary to determine the amount of notchplasty degree in ACL reconstruction.

Arthroscopic absorbable interference screw fixation and four-stranded hamstring tendons autograft for anterior cruciate ligament reconstruction / 中国微创外科杂志

Objective To explore surgical techniques and clinical effects of arthroscopic absorbable interference screw fixation and four-stranded hamstring tendon autograft for the reconstruction of anterior cruciate ligament (ACL). Methods Forty-two patients with rupture of the ACL were operated on by arthroscopic four-stranded hamstring tendons autograft reconstruction using SR-PLLA absorbable screw fixation. Results Follow-up for 3～22 months (mean, 11 4 months) in all 42 patients showed normal motion range of knee joint. Postoperative Lachman test revealed ≤1+ in 37 patients, 2+ in 4 patients and 3+ in 1 patient. All patients showed an absent pivot shift. Postoperative Lysholm score was 89 7?9 6 points, which had increased significantly as compared with the preoperative score (49 4?9 1 points; t =2 12, P =0 038). Postoperative Tegner activity grading scale was 5 3?1 1 points, which was significantly higher than the preoperative one (2 3?0 7 points; t =4 13, P =0 008). MRI examination at first postoperative year showed that absorbable interference screws were partly absorbed in 29 patients,and reconstructed ligaments were in good position and normal in shape in 27 patients.The tendon grafts were anchored on the femur a little too more to the front side in 2 patients, and on the tibia a little too more to the front side in 3 patients, with slight impingement phenomena. Conclusions In ACL reconstruction, four-stranded hamstring tendon is an ideal graft material and absorbable interference screw is optimal for internal fixation.

MRI Measurement of the Intercondylar Notch and Correlation to Anterior Cruciate Ligament Injuries / 대한정형외과학회잡지

Notch stenosis had been thought to be related with anterior cruciate ligament (ACL) injury. The purpose of this study is to evaluate the possible relationship between notch stenosis and ACL injury. We measured the notch seen on the axial section in MRI at popliteal groove. We have retrospectively analyzed 116 cases of knee MRI. All cases were divided into three groups ; Group I were fifty six normal knee. Group II were thirty knee with contact ACL injuries. Group III were thirty knee with non contact ACL injuries. The result were as follows; 1. Statistically significant difference was found in the notch width index (NWI) between group I and group III but no significant differences was found in the NWI between group I and group II. 2. Statistically significant correlation to non-contact ACL injuries was found in the NWI at both anterior and posterior outlet of the notch. 3. An unique shape of the notch was found in the majority of group III.There seemed to be an obvious relationship between notch stenosis and non-contact ACL injuries.