Résumé
ObjectiveTo investigate the difference in bilateral lower limb muscle synergy mode during gait in patients after unilateral anterior cruciate ligament reconstruction. MethodsElectromyography from bilateral lower limb muscles during gait were collected from twelve male and eight female patients after unilateral anterior cruciate ligament reconstruction in Affiliated Hospital of Wuhan Sports University, from April to June, 2023. The data were analyzed using non-negative matrix decomposition algorithm to extract the number of muscle synergies in the affected and unaffected legs, the time to peak activation of muscle synergies and the relative weights of the muscles. ResultsSix types of muscle synergy were identified in the unaffected leg of males during gait, while five types were identified in the affected leg, lacking synergy 2 that mainly from the tibialis anterior muscle. Six types of muscle synergy were identified in both legs in females during gait. There was no significant difference in the time to peak activation of muscle synergies between both legs in males (P > 0.05). However, the time to peak activation of muscle synergies increased in females in the affected leg for synergy 3 and synergy 5 (P < 0.05). The relative weight of the rectus femoris was lower in synergy 1 in the affected leg in males (P < 0.05). For female, the relative weight of the vastus lateralis was higher and the relative weight of the biceps femoris was lower in synergy 2 in the affected leg in females (P < 0.05); while the relative weight of the rectus femoris was lower in synergy 3 (P < 0.05), and the relative weight of the biceps femoris was lower in synergy 6 (P < 0.05). ConclusionMales would freeze the muscle synergy dominating ankle dorsiflexion in affected leg to enhance ankle stability, and reduce the relative weight of rectus femoris during the loading response phase to weaken the knee landing cushioning. However, females would delay the activation of synergies dominating in loading response phase and the mid-stance phase, enhance the relative weight of vastus lateralis during the loading response phase, and reduce the relative weights of rectus femoris in the loading response phase and the relative weight of biceps femoris in the mid-stance phase, to limit knee flexion.
Résumé
OBJECTIVE@#To investigate the efficacy and clinical results of total internal protection technique in anterior cruciate ligament reconstruction.@*METHODS@#A total of 56 patients undergoing anterior cruciate ligament reconstruction treated from January 2018 to December 2019 were selected. According to the different surgical methods, they were divided into total internal reconstruction group and standard bone tunnel group. There were 21 patients in the total internal reconstruction group, including 15 males and 6 females, aged from 20 to 48 with an average of (35.6±6.7) years old, and 35 patients in the standard tibial tunnel group, including 26 males and 9 females, aged 22 to 51 years old with an average of (33.7±9.6) years old. Preoperative examination of Lachman test was positive, magnetic resonance indicated anterior cruciate ligament rupture. There were no significant differences between the two groups in age, sex, body mass index, time from injury to ACL reconstruction, combined meniscus injury and operation method, operation time, ligament diameter, ligament length and other general information. Postoperative evaluation included operation duration, length and diameter of transplanted tendon after braid. International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner score and perioperative complications 2 years after surgery.@*RESULTS@#Both groups were followed up, ranging from 24 to 30 months with an average of (26.9±3.4) months. Postoperative incision healing was good, and no failure or joint infection occurred at the last follow-up. There was no statistically significant difference between the two groups in IKDC score, Lysholm score and Tegner score before, 1 year and 2 years after surgery. However, IKDC score, Lysholm score and Tegner score at 1 year and 2 years after surgery.@*CONCLUSION@#The same postoperative function and stability of knee joint can be obtained by both the residual whole technique and the standardized reconstruction technique. In the residual whole group, only the semitendinosus muscle is taken, and the femoral thin muscle is retained, with greater tibial bone mass preserved, which is safe and effective in clinical practice.
Sujets)
Mâle , Femelle , Humains , Adulte , Jeune adulte , Adulte d'âge moyen , Ligament croisé antérieur/chirurgie , Études rétrospectives , Résultat thérapeutique , Arthroscopie/méthodes , Articulation du genou/chirurgie , Lésions du ligament croisé antérieur/chirurgieRésumé
Abstract Objective To evaluate the incidence of symptomatic cyclops lesions requiring surgical treatment after anterior cruciate ligament (ACL) reconstruction and to establish possible intraoperative risk factors related to it. Methods Three hundred and eighty-nine patients aged between 18 and 50 years who underwent primary ACL reconstruction were retrospectively evaluated. Patients were divided into groups according to the presence or absence of symptomatic cyclops lesions, and their characteristics were compared. Patients with associated lesions that required additional surgical procedures (except anterolateral extra-articular procedures) were not included. The rate of symptomatic cyclops lesions was recorded and the following parameters were evaluated: age, gender, time from injury to surgery, graft type and diameter, femoral tunnel perforation technique, fixation type, presence of knee hyperextension, preservation of the ACL remnant, associated anterolateral extra-articular procedure, associated meniscal injury and participation in sports. Results 389 patients were evaluated and 26 (6.7%) patients developed cyclops. The patients with and without cyclops lesions did not differ in age, time from injury to surgery, graft type or diameter, surgical technique, femoral fixation method, presence of knee hyperextension, remnant preservation and associated meniscal injury. The group with cyclops lesion had a higher proportion of females (10 (38.4%) vs 68 (18.7%); OR = 2.7; p= 0.015), higher proportion of extra-articular reconstruction (18 (11.8%) vs 8 (3.4%); OR = 3.8; p= 0.001) and higher proportion of sports practice (23 (8.6%) vs 3 (2.5%); OR = 3.6; p= 0.026). Conclusion In our series, 6.7% of the patients required arthroscopic removal of cyclops lesions. Female gender, associated extra-articular reconstruction and sports practice were factors related to this lesion. Remnant preservation had no relationship with cyclops lesion formation.
Resumo Objetivo Avaliar a incidência de lesões cyclops sintomáticas que precisam de tratamento cirúrgico após a reconstrução do ligamento cruzado anterior (LCA) e estabelecer os possíveis fatores de risco intraoperatórios relacionados a elas. Métodos Trezentos e oitenta e nove pacientes com idades entre 18 e 50 anos submetidos à reconstrução primária do LCA foram avaliados de forma retrospectiva. Os pacientes foram divididos em grupos de acordo com a presença ou ausência de lesões cyclops sintomáticas e suas características foram comparadas. Não foram incluídos pacientes com lesões associadas que necessitassem de outros procedimentos cirúrgicos (à exceção de procedimentos extra-articulares ântero-laterais). A taxa de lesões cyclops sintomáticas foi registrada e os seguintes parâmetros foram avaliados: idade, sexo, tempo da lesão à cirurgia, tipo e diâmetro do enxerto, técnica de perfuração do túnel femoral, tipo de fixação, presença de hiperextensão do joelho, preservação do LCA remanescente, associação a procedimento extra-articular ântero-lateral, lesão de menisco associada e participação em esportes. Resultados Dos 389 pacientes avaliados, 26 (6,7%) desenvolveram lesão cyclops. Os pacientes com e sem lesão cyclops não diferiram quanto à idade, tempo da lesão à cirurgia, tipo ou diâmetro do enxerto, técnica cirúrgica, método de fixação femoral, presença de hiperextensão do joelho, preservação do LCA remanescente e lesão de menisco associada. O grupo com lesão cyclops apresentou mais mulheres (10 [38,4%] vs. 68 [18,7%]; razão de probabilidades [OR] = 2,7; p= 0,015), maior proporção de reconstrução extra-articular (18 [11,8%] vs. 8 [3,4 %]; OR = 3,8; p= 0,001) e maior proporção de prática esportiva (23 [8,6%] vs. 3 [2,5%]; OR = 3,6; p= 0,026). Conclusão Em nossa série, 6,7% dos pacientes necessitaram de remoção artroscópica das lesões cyclops. O sexo feminino, a reconstrução extra-articular associada e a prática esportiva foram fatores relacionados a essa lesão. A preservação do menisco remanescente não foi associada à formação de lesões cyclops.
Sujets)
Humains , Mâle , Femelle , Ligament croisé antérieur , Amplitude articulaire , Articulation du genou , Ligaments articulaires , MinocyclineRésumé
Abstract Mucoid degeneration of the anterior cruciate ligament (ACL) is an uncommon cause of pain in the posterior region of the knee, of unknown pathophysiology and underdiagnosed. The best treatment modality is still under discussion. Resection of the lesion with partial ACL debridement has shown good results without the occurrence of instability. The authors present a case of mucoid degeneration of the ACL treated with resection of the mucoid degeneration and partial debridement of the ACL by arthroscopy.
Resumo A degeneração mucoide do ligamento cruzado anterior (LCA) é uma causa pouco frequente de dor na região posterior do joelho, de patofisiologia desconhecida e subdiagnosticada. A melhor modalidade de tratamento ainda está em discussão. A ressecção da lesão com desbridamento parcial do LCA tem apresentado bons resultados, sem a ocorrência de instabilidade. Os autores apresentam um caso de degeneração mucoide do LCA tratado com ressecção da degeneração mucoide e desbridamento parcial do LCA por artroscopia.
Sujets)
Humains , Femelle , Sujet âgé de 80 ans ou plus , Malformations artérioveineuses , Arthroplastie prothétique de hanche , Anomalies vasculairesRésumé
La ruptura de ligamento cruzado anterior (LCA) es la lesión de rodilla más común que se trata de una reconstruc- ción quirúrgica. El objetivo principal de esta revisión fue analizar la importancia de la función de los músculos isquiosurales como factor de riesgo de posibles lesiones de LCA. Se llevó a cabo siguiendo las normas Preferred Reported Item for Systematic Reviews and Meta- analyses (PRISMA). La fuente de la recopilación de datos fue la consulta directa de las bases de datos Pubmed, Sportdiscus, Web of Science y Scopus. Para la recuperación documental, se utilizaron varias palabras clave y se evaluó la calidad de los estudios que fueron seleccionados mediante la escala PEDro. Los déficits de la función muscular en los músculos isquiosurales se han relacionado con una mayor translación tibial anterior y, como consecuencia, un incremento del estrés tensional sobre el LCA entre los 10° y 45° de flexión de rodilla. Una co-activación de los músculos isquiosurales con el músculo cuádriceps femoral puede ser de gran ayuda para reducir los factores de riesgo de la lesión LCA.
SUMMARY: Anterior cruciate ligament (ACL) rupture is the most common knee injury to undergo surgery in the sports setting. The main objective of this review was to analyze the importance of hamstring function as a risk factor for potential ACL injury. It was conducted following the Preferred Reported Item for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The source of data collection was direct consultation of the Pubmed, Sportdiscus, Web of Science and Scopus databases. For documentary retrieval, several key words were used and the quality of the studies that were selected was assessed using the PEDro scale. Muscle function deficits in the hamstrings have been related to increased anterior tibial translation and, as a consequence, increased tensional stress on the ACL between 10° and 45° of knee flexion. A co-activation of the hamstrings with the quadriceps may be helpful in reducing the risk factors for ACL injury.
Sujets)
Humains , Contrainte mécanique , Muscles de la loge postérieure de la cuisse/physiopathologie , Lésions du ligament croisé antérieur/étiologie , Facteurs de risque , Sports d'équipesRésumé
Abstract Objective The purpose of this meta-analysis is to compare ligament healing on autograft and allograft in anterior cruciate ligament (ACL) reconstruction. Methods The selection of appropriate studies was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We made a statistical analysis using a review manager. Electronic reports were searched using the PubMed, Medline, and Cochrane Library databases. The inclusion criteria were animal studies and cellular histology of both grafts as an outcome. Results The initial search revealed 412 potential articles. After duplicates were removed, 246 articles remained. Then, 14 articles were obtained and screened for relevance and eligibility. The relevant articles were searched manually, checking for eligibility and details in order not to miss included reports. Subsequently, 5 studies were included, with a total of 232 samples, reporting the biopsied results with quantitative histology of ligament healing between allograft and autograft. The biopsy samples in those studies were examined under light or electron microscope, to analyze the cellular distribution area and ligamentization stages in each group. Meta-analyses found significant difference between autograft and allograft (Heterogeneity, I2 = 89%; Mean Difference, 95% confidence interval [CI] =-34.92, -54.90, -14.93; p = 0.0006). There is also a significant difference on both graft in cellular count at over 24 weeks (Heterogeneity, I2 = 26%; Mean Difference, 95% CI = -14.59, -16.24, -12.94; p < 0.00001). Conclusion In the current meta-analysis, autograft shows a significant difference when compared to allograft, with more cellular accumulation and faster remodeling response on the ligamentization process being noticed in the former. However, a larger clinical trial will be needed to emphasize this literature's result.
Resumo Objetivo O objetivo desta metanálise comparar a cicatrização de ligamentos no autoenxerto e aloenxerto na reconstrução do ligamento cruzado anterior (LCA). Métodos A seleção dos estudos adequados foi realizada de acordo com as diretrizes de Relatórios Preferenciais para Revisões Sistemáticas e Metanálises (Preferred Reporting Items for Systematic Reviews and Meta-Analyses - PRISMA). Uma análise estatística foi feita usando um gerente de revisão. Os relatórios eletrônicos foram pesquisados usando os bancos de dados PubMed, Medline e Cochrane Library. Os critérios de inclusão foram estudos em animais e a histologia celular de ambos os enxertos como desfecho. Resultado A pesquisa inicial revelou 412 artigos potenciais. Após a retirada das duplicatas, restaram 246 artigos. Então, 14 artigos foram obtidos e selecionados pela relevância e elegibilidade. Os artigos relevantes foram pesquisados manualmente, verificando sua elegibilidade e detalhando os estudos para não perder os relatórios incluídos. Posteriormente, foram incluídos 5 estudos, com um total de 232 amostras, relatando os resultados de biópsia com histologia quantitativa de cicatrização de ligamento entre aloenxerto e autoenxerto. As amostras de biópsia nesses estudos foram examinadas sob microscópio leve ou eletrônico, para análise da área de distribuição celular e estágios de ligamentização em cada grupo. As metanálises encontraram diferença significativa entre autoenxerto e aloenxerto (Heterogeneidade, I2 = 89%; Diferença média, 95% intervalo de confiança [IC] =-34,92, -54,90, -14,93; p = 0,0006). Também há uma diferença significativa nosdoisenxertosnacontagem celular de mais de 24 semanas (Heterogeneidade, I2 = 26%; Diferença média, 95% IC = -14,59 , -16,24, -12,94; p < 0,00001). Conclusão Na presente metanálise, o autoenxerto mostra resultados significativos quando comparado ao aloenxerto, com mais acúmulo celular e resposta de remode-lagem mais rápida no processo de ligamentizaçãosendoobservadonoprimeiro.No entanto, será necessário um estudo clínico maior para enfatizar o resultado desta literatura.
Sujets)
Humains , Adolescent , Reconstruction du ligament croisé antérieur , AllogreffesRésumé
Abstract Objective Commonly used methods for measuring proprioception have resulted in conflicting reports regarding knee proprioception with anterior cruciate ligament (ACL) rupture and the influence of ACL reconstruction. Methods One hundred subjects (50 patients with radiologically and arthroscopically confirmed unilateral ACL rupture and 50 normal controls) were assessed with regards to proprioception using dynamic single-leg stance postural stabilometry. Instrumented knee ligament laxity and knee outcome scores were also measured. Of the 50 patients in the ACL group, 34 underwent reconstruction and were reassessed postoperatively. Results There was a significant proprioceptive deficiency in the ACL group compared with their contralateral knee ( p < 0.001) and to the control group ( p = 0.01). There was asignificant improvement in knee proprioception following ACL reconstruction compared to preoperative findings ( p = 0.003). There was no correlation between ligament laxity measurements and outcome scores. A significant correlation was found preoperatively between outcome scores and proprioception measurements. This correlation was not found post-operatively. Pre-operative proprioception testing had asignificant correlation (r = 0.46) with post-operative proprioception ( p = 0.006). Conclusion Patients with an ACL rupture had a proprioceptive deficit which improved following ligament reconstruction. Knee outcome scores had a better correlation with proprioception than ligament laxity. Proprioception may be a superior objective measure than ligament laxity in quantifying functional knee deficits and outcomes in patients with ACL ruptures. Level of Evidence III Therapeutic Study; Prospective Longitudinal Case-Control Study.
Resumo Objetivo Os métodos comumente usados para medir a propriocepção resultaram em relatos conflitantes sobre a propriocepção do joelho com ruptura do ligamento cruzado anterior (LCA) e a influência da reconstrução do LCA. Métodos A propriocepção de 100 indivíduos (50 pacientes com ruptura unilateral do LCA confirmada à radiologia e artroscopia e 50 controles normais) foi avaliada por estabilometria postural dinâmica em apoio unipodal. A lassidão ligamentar do joelho instrumentado e suas pontuações de desfechos também foram medidas. Dos 50 pacientes do grupo LCA, 34 foram submetidos à reconstrução e reavaliados no período pós-operatório. Resultados O grupo LCA apresentou deficiência proprioceptiva significativa em relaçãoaojoelho contralateral ( p < 0,001) e ao grupo controle ( p = 0,01). A propriocepção do joelho melhorou de maneira significativa após a reconstrução do LCA em relação aos achados pré-operatórios ( p = 0,003). Não houve correlação entre as medidas de lassidão ligamentar e as pontuações de desfechos. Além disso, observamos uma correlação significativa entre as pontuações de desfechos e as medidas de propriocepção antes da cirurgia. Essa correlação não foi detectada no período pós-operatório. O teste pré-operatório de propriocepção teve correlação significativa ( r = 0,46) com a propriocepção pós-operatória ( p = 0,006). Conclusão Os pacientes com ruptura do LCA apresentaram déficit proprioceptivo que melhorou após a reconstrução ligamentar. As pontuações de desfecho do joelho tiveram melhor correlação à propriocepção do que a lassidão ligamentar. A proprio-cepção pode ser uma medida objetiva superior à lassidão ligamentar na quantificação de déficits funcionais e desfechos do joelho em pacientes com ruptura do LCA. Nível de Evidência III Estudo Terapêutico; Estudo de Caso-Controle Longitudinal Prospectivo.
Sujets)
Humains , Proprioception , Ligament croisé antérieur , MécanorécepteursRésumé
SUMMARY: The anterior cruciate ligament (ACL) is a ligament that mainly controls the anterior and rotational mobility of the knee joint, and its surface is covered by a synovial membrane with large number of blood vessels. In general, nutritional supply to the ligament is from many capillaries in the adjacent synovium. However, statistical studies of the capillaries distributed to the ACL are insufficient. In this study, we examined cross-sectional histological images of the femoral attachment (femoral level), middle level of the tendon (middle level), and tibial attachment (tibial level) of the ACL and statistically analyzed blood capillary distribution among the three levels. The ACLs of 10 cadavers were divided into 5 equal sections, and 4mm-thick paraffin sections were made at the femoral level, middle level, and tibial level, and then hematoxylin-eosin (HE) staining were performed. The area of each transverse section was measured using Image-J 1.51n (U. S. National Institutes of Health, Bethesda, MD, USA). Fiber bundles of the ACL were relatively small and sparse in cross-sectional area at the femoral level and became larger and denser toward the tibial level. Many blood levels. The synovium at the attachment of ACL covered the surface of the fiber bundle and also penetrated deeply between the fiber bundles. In particular, the blood capillaries were densely distributed in the synovium at the femoral attachment rather than another two levels. Indeed, the number of capillaries were also most abundant in the femoral level. The cross-sectional ACL area at the femoral level is significantly small, however, the blood capillaries were most abundant. Therefore, when the ACL is injured, its reconstruction with preservation of the femoral ligamentous remnant may be clinically useful for remodeling of the grafted tendon.
El ligamento cruzado anterior (LCA) es un ligamento que controla principalmente la movilidad anterior y rotacional de la articulación de la rodilla, y su superficie está cubierta por una membrana sinovial con gran cantidad de vasos sanguíneos. En general, el suministro de nutrientes al ligamento proviene de muchos capilares en la sinovial adyacente. Sin embargo, los estudios estadísticos de los capilares distribuidos en el LCA son insuficientes. En este estudio, examinamos imágenes histológicas trans- versales de la inserción femoral (nivel femoral), el nivel medio del tendón (nivel medio) y la inserción tibial (nivel tibial) del LCA y analizamos estadísticamente la distribución de los capilares sanguíneos entre los tres niveles. Los LCA de 10 cadáveres se dividieron en 5 secciones iguales y se realizaron cortes en parafina de 4 µm de espesor a nivel femoral, medio y tibial, y luego se realizó tinción con hematoxilina-eosina (HE). El área de cada sección transversal se midió utilizando Image-J 1.51n (Institutos Nacionales de Salud de EE. UU., Bethesda, MD, EE. UU.). Los haces de fibras del LCA eran relativamente pequeños y escasos en el área de la sección transversal a nivel femoral y se hicieron más grandes y más densos hacia el nivel tibial. La membrana sinovial en la unión del LCA cubría la superficie del haz de fibras y también penetraba profundamente entre entre los haces de fibras. En particular, los capilares sanguíneos estaban densamente distribuidos en la unión femoral de la sinovial respecto a los otros dos niveles. De hecho, el número de capilares también fue más abundante a nivel femoral. El área transversal del LCA a nivel femoral era significativamente pequeña, sin embargo, los capilares sanguíneos fueron los más abundantes. Por lo tanto, cuando hay una lesión del LCA su reconstrucción con preservación del ligamento femoral remanente puede ser clínicamente útil para remodelar el tendón injertado.
Sujets)
Humains , Mâle , Femelle , Sujet âgé , Sujet âgé de 80 ans ou plus , Vaisseaux capillaires/anatomie et histologie , Ligament croisé antérieur/vascularisation , Fémur/vascularisation , Membrane synoviale/vascularisation , Tibia/vascularisation , CadavreRésumé
Abstract Objective To analyze the dimensions of the posterior cruciate ligament (PCL), anterior cruciate ligament (ACL), the presence of meniscus-femoral ligaments MFLs in human knees, and the correlation with the dimensions of the knee skeleton. Methods Anatomical study on 29 specimens of human knees in which we measured the length and width of the cruciate and meniscus-femoral ligaments and the dimensions of femoral and tibia condyles and the femoral notch. The ACL length was calculated with different degrees of knee flexion. The relationship between the ligaments and bone dimensions were analyzed. Results The length of the ACL and the PCL were similar. Posterior MFL was more frequent and longer than the anterior MFL. We found the posterior MFL in the 72.41% of the knees and anterior MFL in 20.69%. The ACL presented 30% of its maximum length up to 60°, approximately half of its length between 90° and 120°, reaching its maximum length at 170°. We found a strong correlation between the length of the ACL and that of the PCL (p= 0.001). However, the lengths of the ACL and PCL were not related with the bone dimensions. Conclusion We have found no correlations between the cruciate and MFLs and the anatomical dimensions of the intercondylar notch and the proximal tibia and distal femur. The presence of the posterior MFL was more frequent and longer than that of the anterior ligament.
Resumo Objetivo Analisar as dimensões do ligamento cruzado posterior (LCP), do ligamento cruzado anterior (LCA), a presença de ligamentos meniscofemorais (LMFs) em joelhos humanos e a correlação com as dimensões do esqueleto do joelho. Métodos Estudo anatômico em 29 espécimes de joelhos humanos nos quais medimos o comprimento e a largura dos ligamentos cruzado e meniscofemoral e as dimensões dos côndilos femorais e tibiais e do entalhe femoral. O comprimento do LCA foi calculado com diferentes graus de flexão do joelho. Analisou-se a relação entre os ligamentos e as dimensões ósseas. Resultados O comprimento do LCA e do LCP foram semelhantes, LMF posterior foi mais frequente e mais longo do que o LMF anterior. Foram encontradas LMF posterior em 72,41% dos joelhos e LMF anterior em 20,69%. O LCA apresentou 30% de seu comprimento máximo até 60°, aproximadamente metade de seu comprimento entre 90° e 120°, atingindo seu comprimento máximo com flexão de 170°. Encontramos uma forte correlação entre o comprimento do LCA e do LCP (p= 0,001). No entanto, os comprimentos do LCA e do LCP não estavam relacionados com as dimensões ósseas. Conclusão Não encontramos correlações entre os ligamentos cruzado e meniscofemoral e as dimensões anatômicas do entalhe intercondilar e da tíbia proximal e do fêmur distal. A presença do LMF posterior foi mais frequente e maior que a do ligamento anterior.
Sujets)
Humains , Ligament croisé antérieur , Ligament croisé postérieur , Ménisque , GenouRésumé
Abstract Objective To calculate the minimal important clinical difference (MICD) value for the Lysholm and International Knee Documentation Committee (IKDC) scores in a sample of patients submitted to anterior cruciate ligament reconstruction. Methods Primary, observational, retrospective, analytical study of participants submitted to anterior cruciate ligament reconstruction from March 2019 to December 2020 by the same surgeon, with a minimum follow-up of 6 months, analysis of knee function in the pre- and postoperative period by the Lysholm and IKDC scores, and answer to an anchor question at 6 months postoperatively for the calculation of the MICD of each score. Results A total of 59 patients participated in the study, with a mean age of 27.1 ± 5.7 years old. In the comparison between pre- and postoperative scores of all groups, there was an increase in values with statistical significance after intervention. The MICD was 5.5 for the Lysholm score, and the MICD value for the IKDC score could not be determined. Conclusion For the Lysholm score, the calculation of the MICD value by the anchor question method in the sample evaluated was 5.5. It was not possible to determine the value of the MICD for the IKDC score.
Resumo Objetivo Calcular o valor da mínima diferença clinicamente importante (MDCI) para os escores de Lysholm e International Knee Documentation Commitee (IKDC) na amostra de pacientes submetidos a reconstrução de ligamento cruzado anterior. Métodos Estudo primário, observacional, retrospectivo, analítico, de participantes submetidos a reconstrução do ligamento cruzado anterior no período de março de 2019 a dezembro de 2020, pelo mesmo cirurgião, com seguimento mínimo de 6 meses, análise da função do joelho no período pré e pós-operatório pelos escores de Lysholm e IKDC, e resposta a uma pergunta âncora aos 6 meses de seguimento pós-operatório, para o MDCI de cada escore. Resultados Participaram do estudo 59 pacientes, com média de idade de 27,1 ± 5,7 anos. Na comparação dos escores pré- e pós-operatórios de todos os grupos, observa-se aumento dos valores com significância estatística após a intervenção. A MDCI foi de 5,5 para o escore de Lysholm, não tendo sido possível determinar o valor para o IKDC. Conclusão O cálculo do valor da MDCI pelo método da pergunta âncora, na amostra avaliada, foi de 5,5 para o escore de Lysholm. Não foi possível determinar o valor da MDCI para o IKDC.
Sujets)
Humains , Enquêtes et questionnaires , Reproductibilité des résultats , Ligament croisé antérieur , Reconstruction du ligament croisé antérieur , Articulation du genouRésumé
ObjectiveTo explore the effect of core stability training on dynamic balance and surface electromyography (sEMG) after anterior cruciate ligament reconstruction (ACLR), and to analyze the correlation between balance index and sEMG. MethodsFrom March to December, 2022, 32 patients with ACLR in Yantai Affiliated Hospital of Binzhou Medical University were randomly divided into control group (n = 16) and experimental group (n = 16). The control group accepted routine rehabilitation treatment, and the experimental group added core stability training, for six weeks. They were evaluated with American Hospital for Special Surgery Knee Score (HSS) and International Knee Documentation Committee Knee Score (IKDC), and the dynamic balance function and sEMG were measured before and after treatment, and the correlation between dynamic balance index and root mean square (RMS) of sEMG was analyzed. ResultsAfter treatment, the scores of HSS and IKDC increased significantly in both groups (|Z| > 3.526, |t| > 63.544, P < 0.001), and were better in the experimental group than in the control group (Z = -2.392, t = 2.650, P < 0.05); the length of gait line and single support line increased significantly, the medial-lateral displacement displacement decreased (|t| > 2.368, Z = -3.516, P < 0.05), and they were better in the experimental group than in the control group (|t| > 2.497, Z = -3.091, P < 0.05); the RMS of gluteus maximus and gluteus medius increased in the experimental group (t = -5.900, Z = -2.741, P < 0.01), and were better than those in the control group (t = 3.930, Z = -3.260, P < 0.01). After treatment, the RMS of gluteus maximus and gluteus medius in both groups were positively correlated with gait line length and single support line length, and were negatively correlated with medial-lateral displacement (|r| > 0.502, P < 0.01). ConclusionCore stability training could significantly improve knee joint function and dynamic balance, and enhance the activation of gluteus maximus and gluteus medius. Dynamic balance is highly correlated with sEMG.
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ObjectiveTo explore the effect of hip neuromuscular training on reducing the risk of anterior cruciate ligament (ACL) injury in female soccer players. MethodsFrom March to May, 2022, 39 female soccer players from Xi'an Physical Education University were randomly divided into control group (n = 19) and experimental group (n = 20). On the basis of daily training, the control group received sham intervention, and the experimental group received hip neuromuscular training, for six weeks. Before and after training, they were measured dynamic knee valgus (DKV) angle and assessed with Landing Error Score System (LESS); while they were also measured the maximal voluntary isometric contraction (MVIC) and root mean square (RMS) of electromyography as single leg landing of gluteus medius and gluteus maximus. ResultsAll the indexes varied little after training in the control group (|t| < 1.178, P > 0.05), while the indexes improved in the experimental group (|t| > 2.288, P < 0.05), except sagittal score of LESS; and all the indexes improved more in the experimental group than in the control group (|t| > 2.609, P < 0.05), except sagittal score of LESS and MVIC of gluteus maximus. ConclusionHip neuromuscular training can reduce the risk of ACL injury in female soccer players.
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ABSTRACT Objective: To report and compare the results of posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) reconstructions. Methods: In total, 42 patients were retrospectively evaluated, 20 with isolated PCL injuries (group 1) and 22 with isolated ACL ones (group 2) who were subjected to arthroscopic ligament reconstruction with autologous grafts and followed up for at least two years. To evaluate the results in group 1, objective IKDC and Lysholm scores, posterior drawer tests, and evaluations by a KT-1000 arthrometer were used, whereas for group 2, subjective IKDC and Lysholm score and the Lachman test were employed. To compare groups, objective IKDC and Lysholm scores and assessment via a KT-1000 arthrometer were considered. Results: Intragroup analysis showed improved results for all variables (p < 0.001) in both groups. Comparisons between groups showed a significant difference in objective IKDC scores (p < 0.001), but no such disparities for Lysholm ones (p = 0.052), clinical tests (p = 0.058) or evaluation by KT-1000 (p = 0.129). Conclusion: Treatment restored knee stability and function in both groups. Comparisons between groups showed that PCL reconstructions had inferior results than ACL ones according to patients' objective IKDC scores. Level of Evidence II, Retrospective Study.
RESUMO Objetivo: Reportar e comparar os resultados da reconstrução do ligamento cruzado posterior (LCP) e do ligamento cruzado anterior (LCA). Métodos: Foram avaliados retrospectivamente 42 pacientes: 20 com lesão isolada do LCP (grupo 1) e 22 com lesão isolada do LCA (grupo 2), submetidos à reconstrução ligamentar artroscópica com enxertos autólogos e acompanhados por pelo menos dois anos. Para avaliação dos resultados no grupo 1, foram utilizados o escore do International Knee Documentation Committee (IKDC) objetivo, escore de Lysholm, teste da gaveta posterior e avaliação pelo artrômetro KT-1000; e, para o grupo 2, foram utilizados o IKDC subjetivo, escore Lysholm e teste de Lachman. Para comparação entre os grupos, foram considerados o IKDC objetivo, escore Lysholm e avaliação pelo artrômetro KT-1000. Resultados: Ambos os grupos demonstraram melhora dos resultados na análise intragrupo em todas as variáveis (p < 0,001). Na comparação intergrupos, observou-se diferença significativa no IKDC objetivo (p < 0,001), não sendo observada diferença no escore Lysholm (p = 0,052), nos testes clínicos (p = 0,058) ou na avaliação pelo KT-1000 (p = 0,129). Conclusão: A estabilidade e função do joelho foram restauradas em ambos os grupos. Na comparação intergrupos, a reconstrução do LCP apresentou resultados inferiores à reconstrução do LCA no critério IKDC objetivo. Nível de Evidência II, Estudo Retrospectivo.
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ABSTRACT Objective: To evaluate the citation of the ligament in the magnetic resonance imaging (MRI) reports and confirm its presence and injury in the images of exams performed in the acute phase retrospectively. Methods: In total, 103 patients who underwent anterior cruciate ligament (ACL) reconstruction in 2019 were included. The images were reanalyzed by two radiologists. Results: In the first analysis, only one report mentioned the anterolateral ligament (ALL) and its injury (0.97%). On reanalysis, ALL was visualized in almost all cases (95% and 97%). An injury was found in 53 (51.5%) cases by radiologist A and in 56 (54.4%) cases by radiologist B. The injury was diagnosed by both in 39 (37.9%) cases (p < 0.0001). Radiologists disagreed regarding the injury (Kappa = 0.411). Conclusion: The reports failed to describe the ligament and diagnose a significant number of injuries. The analysis of conventional resonance images still presents divergences in the diagnosis of ALL injury associated with the ACL among radiologists. Level of Evidence IV, Case Series.
RESUMO Objetivo: Avaliar, de forma retrospectiva, a citação do ligamento anterolateral (LAL) em laudos de ressonância magnética (RM) e confirmar sua presença e lesão nas imagens de exames feitos na fase aguda. Métodos: Foram incluídos 103 pacientes submetidos à reconstrução do ligamento cruzado anterior (LCA) em 2019, cujas imagens foram reanalisadas por dois radiologistas. Resultados: Em primeira análise, apenas um laudo citava o LAL e sua lesão (0,97%); enquanto na reanálise, o LAL foi visualizado em quase todos os casos (95% pelo radiologista A e 97% pelo radiologista B). Foi encontrada lesão em 53 (51,5%) casos pelo radiologista A e 56 (54,4%) pelo radiologista B. Lesão foi diagnosticada por ambos em 39 (37,9%) casos (p < 0,0001). Houve divergência entre os radiologistas com relação à lesão (KappaL = 0,411). Conclusão: Os laudos deixaram de descrever o ligamento e diagnosticar um número significativo de lesões. A análise das imagens convencionais de ressonância ainda gera divergências no diagnóstico da lesão do LAL associada ao LCA entre os radiologistas. Nível de Evidência IV, Série de Casos.
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ABSTRACT Objective: To determine, by biomechanical analysis, safe patellar cut limits in anterior cruciate ligament (ACL) reconstruction that minimize fracture risks. Methods: From three-dimensional reconstruction, triangular cuts were made in the patella, with a depth of 6.5 mm and variable width and length (10 to 20 mm and 8 to 12 mm, respectively, both with an interval of 1 mm). The combinations of cuts constituted 55 models for tests, with five variations in width and 11 variations in length, tested with the finite element method (FEM). Results: The mean of the localized principal maximum (traction force) values was 4.36 Pa (SD 0.87 ± 0.76) and the localized principal minimum (compression force) was −4.33 Pa (SD 1.05 ± 1.11). Comparing width and length to the tension force of the values of the main maximum, we found statistical significance from 11 mm for width and 13 mm for length. Conclusion: In ACL reconstruction, the removal of the patellar bone fragment is safe for fragments smaller than 11 mm in width and 13 mm in length, which corresponds to 24% of the width and 28% of the length of the patella used. Level of Evidence II, Comparative Prospective Study.
RESUMO Objetivo: Determinar, por meio de análise biomecânica, os limites de corte patelar seguros para a reconstrução do ligamento cruzado anterior (LCA) e que minimizem riscos de fratura. Métodos: A partir de reconstrução tridimensional, foram feitos cortes triangulares na patela, com profundidade de 6,5 mm e largura e comprimento variáveis (8 a 12 mm e 10 a 20 mm), respectivamente, com intervalo de 1 mm). As combinações dos cortes constituíram 55 modelos para ensaios, com 5 variações de largura e 11 variações de comprimento, ensaiados por meio do método dos elementos finitos (MEF). Resultados: A média dos valores da máxima principal localizada (força de tração) foi de 4,36 Pa (DP 0,87 ± 0,76), e a mínima principal localizada (força de compressão) foi de −4,33 Pa (DP 1,05 ± 1,11). Comparando largura e comprimento à força de tensões dos valores da máxima principal, houve significância estatística a partir de 11 mm para largura e 13 mm para comprimento. Conclusão: Na reconstrução do LCA, a retirada do fragmento ósseo patelar mostrou-se segura para fragmentos menores que 11 mm de largura e 13 mm de comprimento, o que corresponde a 24% da largura e 28% do comprimento da patela utilizada. Nível de Evidência II, Estudo Prospectivo Comparativo.
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ABSTRACT Objective: To compare anatomic anterior cruciate ligament (ACL) reconstruction between two tunnel positions in knees with isolated ligament tears. Methods: Anatomic ACL reconstruction was performed, from hip-to-toe, on 15 fresh cadaveric specimens. No associated lesions were created to enhance knee instability. The protocol was conducted in three states: (1) complete isolated ACL deficiency; (2) anatomic femoral and tibial anteromedial ACL reconstruction (AM REC); and (3) anatomic femoral and tibial central ACL reconstruction (Central REC). The reconstruction protocols were randomly assigned. The continuous mechanized pivot-shift test was recorded dynamically with a tracking system. Results: The Central REC group showed a smaller degree of internal rotation (0.6° ± 0.3° vs. 1.8° ± 0.3°, respectively, P < 0.05) and no difference in anterior translation (4.7 mm ± 0.4 mm vs. 4.5 mm ± 0.4 mm, respectively, P > 0.05) in the pivot-shift test, compared with the AM REC group. Conclusion: The central anatomic ACL reconstruction resulted in greater restriction of internal rotation than the anteromedial anatomic ACL reconstruction. Experimental Study on Cadaver.
RESUMO Objetivo: Comparar a reconstrução anatômica do ligamento cruzado anterior (LCA) entre duas posições de túnel em joelhos com lesões isoladas do ligamento. Métodos: A reconstrução anatômica do LCA foi realizada, do quadril aos pés, em 15 peças anatômicas de cadáveres frescos. Não foram criadas lesões associadas para intensificar a instabilidade do joelho. O protocolo foi realizado em três estados: (1) deficiência isolada completa do LCA; (2) reconstrução anatômica femoral e anteromedial tibial do LCA (AM REC); e (3) reconstrução anatômica femoral e central tibial do LCA (Central REC). Os protocolos de reconstrução foram atribuídos aleatoriamente. O teste de pivot-shift mecanizado contínuo foi registrado dinamicamente com um sistema de rastreamento. Resultados: O grupo Central REC apresentou menor grau de rotação interna (0,6° ± 0,3° vs. 1,8° ± 0,3°, respectivamente, p < 0,05) e nenhuma diferença na translação anterior (4,7 mm ± 0,4 mm vs. 4,5 mm ± 0,4 mm, respectivamente, p > 0,05) no teste de pivot-shift, comparado ao grupo AM REC. Conclusão: A reconstrução anatômica central tibial do LCA resultou em maior restrição da rotação interna do que a reconstrução anteromedial tibial do LCA. Estudo em Cadáver Experimental.
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Abstract Introduction Rupture of the anterior cruciate ligament (ACL) is one of the frequent traumatic injuries of the knee joint complex, and the isokinetic dynamometer is essential to assess and measure its joint function. Objective To analyze the volume of physical therapy treatment using the same protocol with different duration in patients undergoing ACL reconstruction. Methods This is a prospective observational cohort study. The sample consisted of 13 adult male individuals who underwent ACL reconstruction surgery. Participants were divided into two groups: accelerated treatment (AC) and non-accelerated treatment (NAC). Participants underwent a standardized protocol of post-reconstruction physio-therapy, starting in the immediate postoperative period. The AC group performed the treatment three times a week, with a duration of 4 hours each session for 6 months, while the NAC performed twice a week with duration of two hours each session for eight months. Results The groups showed the same behavior during the post-reconstruction treatment periods, showing that regardless of time, the results were beneficial at the end of the treatment. However, in the accelerated protocol, the injured limb showed a significant difference for extender peak torque (PTEXT) in the preoperative and 4-month postoperative period (230.5 vs 182.6), 4-month postoperative period and final (182.6 vs 242.1) in the AC group, while in the NAC group there was no significant difference between times in this same limb. Conclusion Greater volumes of weekly training characterized better results, showing that rehabilitation time is not a predictor of discharge, but rehabilitation time obtains good results for the variables.
Resumo Introdução A ruptura do ligamento cruzado anterior (LCA) é uma das lesões traumáticas frequentes do complexo articular do joelho, sendo o dinamômetro isocinético fundamental para avaliar e mensurar sua função articular. Objetivo Analisar o volume de tratamento fisioterapêutico utilizando o mesmo protocolo com diferentes durações em pacientes submetidos à reconstrução do LCA. Métodos Trata-se de um estudo de coorte observacional prospectivo. A amostra foi composta por 13 indivíduos adultos do sexo masculino submetidos à cirurgia de reconstrução do LCA. Os participantes foram divididos em dois grupos: tratamento acelerado (AC) e tratamento não acelerado (NAC). Os participantes foram submetidos a um protocolo padronizado de fisioterapia pós-reconstrução, com início no pós-operatório imediato. O grupo AC realizou o trata-mento três vezes por semana, com duração de 4 horas cada sessão, durante 6 meses, enquanto o grupo NAC realizou duas vezes por semana, com duração de duas horas cada sessão, durante oito meses. Resultados Os grupos apresentaram o mesmo comportamento durante os períodos de tratamento pós-reconstrução, mostrando que independente do tempo, os resultados foram benéficos ao final do tratamento. No protocolo acelerado, porém, o membro lesionado apresentou diferença significativa para pico de torque extensor (PTEXT) no pré-operatório e pós-operatório de 4 meses (230,5 vs 182,6), pós-operatório de 4 meses e final (182,6 vs 242,1) no grupo AC, enquanto no NAC não houve diferença significativa entre os tempos neste mesmo membro. Conclusão Maiores volumes de treinamento semanal caracterizaram melhores resultados, mostrando que o tempo de reabilitação não é preditor de alta, mas o tempo de reabilitação obtém bons resultados para as variáveis.
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Abstract Introduction Return to sport is a desired outcome in individuals submitted to anterior cruciate ligament reconstruction (ACLR). Objective Understand the factors that affect return to pre-injury level sport after ACLR from the patient's perspective. Methods The sample consisted of 29 individuals submitted to ACLR who participated in sport before the ligament injury. This is a narrative analysis with a qualitative approach, using a semi-structured interview as a methodological resource. Standardized instruments were also applied to evaluate psychological readiness to return to sport, via the Anterior Cruciate Ligament - Return to Sport after Injury Scale (ACL-RSI); self-perceived knee function using the International Knee Documentation Committee (IKDC) subjective questionnaire; and the frequency of participation in sports with the Marx scale. Results Analysis of the interviews produced three main themes related to post-ACLR return to sport: self-discipline, fear of reinjury and social support. In qualitative analysis, the average scores obtained were 59.17 (± 23.22) on the ACL-RSI scale, 78.16 (± 19.03) for the IKDC questionnaire and 9.62 (± 4.73) and 7.86 (± 5.44) for the Marx scale before and after surgery, respectively. Conclusion: Psychological factors influence the decision to return to sport post-ACLR. Physiotherapists should therefore be aware of the psychological aspects and expectations of patients, and that other health professionals may be needed to help prepare these individuals to return to their preinjury sports level and achieve more satisfactory outcomes after ACLR.
Resumo Introdução O retorno ao esporte é um desfecho alme-jado pelos indivíduos que se submetem à reconstrução do ligamento cruzado anterior (RLCA). Objetivo Com-preender os fatores que interferem no retorno ao esporte no nível anterior à lesão ligamentar em indivíduos submetidos à RLCA sob o ponto de vista do paciente. Métodos A amostra foi composta por 29 indivíduos que se submeteram à RLCA e praticavam esporte antes da lesão ligamentar. O estudo é caracterizado como uma pesquisa narrativa de abordagem qualitativa, utilizando como recurso metodológico a entrevista semiestrutu-rada. Com o uso de instrumentos padronizados, avaliou-se também a prontidão psicológica para retornar ao esporte, utilizando a escala ACL-RSI; a autopercepção da função do joelho, utilizando o questionário subjetivo do IKDC; e a frequência de participação esportiva antes da lesão e após a cirurgia, utilizando a Escala de Marx. Resultados A análise das entrevistas gerou três unidades temáticas principais relacionadas com o retorno ao esporte pós-RLCA: autodisciplina, medo de uma nova lesão e suporte social. Na análise quantitativa, obteve-se média de 59,17 pontos (± 23,22) na escala ACL-RSI, 78,16 pontos (± 19,03) no IKDC, e 9,62 (± 4,73) e 7,86 pontos (± 5,44) na escala de Marx, antes da lesão e após a cirurgia, respectivamente. Conclusão Fatores psicológicos influenciam a decisão de retorno ao esporte pós-RLCA. Os fisioterapeutas, portanto, devem estar atentos aos aspectos psicológicos e expectativas dos pacientes, considerando a necessidade de outros profissionais da saúde auxiliarem na preparação do indivíduo para retornar ao nível esportivo pré-lesão e alcançar resultados mais satisfatórios pós-RLCA.
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Abstract Objective To evaluate hip and knee muscular function, knee patient-reported outcome measures and hop performance in patients with a clinical indication for combined ACL+ALL reconstruction surgery compared to patients with an isolated ACL reconstruction surgery indication (preoperative phase) and to a control group. Design Cross-sectional study. Methods The sample was composed of male individuals, aged between 18 and 59 years, divided into three groups (ACL, ACL+ALL and Control). Isokinetic dynamometry was performed for the flexor and extensor knee muscles and for the hip abductors and adductors. SLHT, COHT and the Lysholm score were performed. Pain, swelling, and thigh trophism were also measured. Results The study participants were 89 male individuals: 63 in the injury group and 26 in the control group. After applying the criteria for an ALL reconstruction indication, 33 patients were assigned to the ACL Group and 30 patients to the ACL+ALL Group. Regarding knee and hip muscle function, both groups presented worse results when compared to the control group, however, did not show significant differences compared to each other. Regarding the functional variables, the ACL+ALL group showed a significantly shorter distance achieved in the Crossover Hop Test than the other groups, as well as more pain during the tests. Conclusion Knee and hip muscular functions are impaired after an ACL injury and do not seem to be influenced or worsened in individuals with greater rotational instability with clinical indications for combined reconstruction of the anterior cruciate and the anterolateral ligaments of the knee.
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Abstract The posterolateral corner is critical to knee stability. Neglected injuries have a direct impact on the prognosis due to residual instability, chronic pain, deformities, and failure to repair other structures. Several techniques are used to reconstruct the posterolateral corner, often with autologous ischiotibial grafts or homologous grafts. An option little used for knee ligament reconstructions is the peroneus longus tendon graft. Although reported as a good alternative for anterior cruciate ligament reconstruction, we found no case using a peroneus longus tendon graft for posterolateral corner reconstruction. Here, we describe the case of a patient who underwent a non-anatomical reconstruction of the posterolateral corner using a peroneus longus tendon graft. The patient underwent surgical procedures for ligament reconstruction and correction of the deformity caused by a failed graft, but his knee remained unstable. During the preoperative planning, it was decided to reconstruct the posterolateral corner with an ipsilateral peroneus longus tendon graft. Studies have shown that the peroneus longus tendon graft does not increase ankle morbidity, and that its length and diameter favor ligament reconstruction. Thus, the present article highlights the importance of the proper diagnosis of ligament injuries in the acute phase, and describes a new technique for posterolateral corner reconstruction that must be included in the surgeon's body of knowledge, increasing the amount of technical options.
Resumo O canto posterolateral tem grande importância na estabilidade do joelho. Sua lesão pode ser negligenciada, o que tem um impacto direto no prognóstico e resulta em instabilidade residual, dor crônica, deformidades e falha do reparo de outras estruturas. Existem diversas técnicas de reconstrução do canto posterolateral e o uso de enxertos autólogos dos isquiotibiais ou homólogos são as mais comuns. Uma opção pouco utilizada para reconstruções ligamentares no joelho é o enxerto do tendão fibular longo. Apesar de descrito como boa opção na reconstrução do ligamento cruzado anterior, não foi encontrado nenhum caso de uso do enxerto do tendão fibular longo na reconstrução do canto posterolateral. Neste artigo, descrevemos o caso de um paciente submetido a reconstrução não anatômica do canto posterolateral com uso do enxerto do tendão fibular longo. O paciente foi submetido a procedimentos cirúrgicos para reconstrução ligamentar e correção de deformidade ocasionada pela falha do enxerto, mas manteve instabilidade ligamentar. No planejamento pré-operatório, optou-se pela reconstrução do canto posterolateral com enxerto do tendão fibular longo ipsilateral. Estudos evidenciaram que o enxerto do tendão fibular longo não provoca aumento de morbidadeem relação aotornozelo abordado, bem comoseapresenta com comprimento e diâmetro favoráveis à reconstrução ligamentar. Dessa forma, este artigo aponta para a importânciadodiagnóstico correto das lesões ligamentaresnafase aguda,e para uma nova técnica na reconstrução do canto posterolateral, que deve fazer parte do arsenal de conhecimentos do cirurgião, pois aumenta as opções de técnicas.