Comparison of the knee joint reaction force between individuals with and without acute anterior cruciate ligament rupture during walking.

BACKGROUND: Anterior cruciate ligament plays a significant role in knee joint stability. It is claimed that the incidence of knee osteoarthritis increases in individuals with anterior cruciate ligament (ACL) rupture. The aim of this study was to evaluate the knee joints reaction force in ACL rupture group compared to normal subjects. METHOD: Fifteen patients with acute ACL rupture and 15 healthy subjects participated in this study. The ground reaction force (GRF) and kinematic data were collected at a sampling rate of 120 Hz during level-ground walking. Spatiotemporal parameters, joint angles, muscle forces and moments, and joint reaction force (JRF) of lower extremity were analyzed by OpenSIM software. RESULTS: The hip, knee and ankle joints reaction force at loading response and push-off intervals of the stance phase during walking was significantly higher in individuals with ACL rupture compared to healthy controls (p value < 0.05). Walking velocity (p value < 0.001), knee (p value = 0.065) and ankle (p value = 0.001) range of motion in the sagittal plane were significantly lower in the patients with ACL rupture compared to healthy subjects. The mean value of vertical GRF in the mid-stance, the peak of the hip adduction moment in loading response and push-off phases, the hip abductor, knee flexor and vastus intermedius part of quadriceps muscle forces were significantly higher compared to healthy subjects (p < 0.05) while vastus medialis and vastus lateralis produced significantly lower force (p < 0.001). CONCLUSIONS: Based on results of this study, lower limb JRF was higher in those with ACL rupture compared to healthy subjects may be due to the compensatory mechanisms used by this group of subjects. An increase in knee JRF in patients with ACL rupture may be the reason for the high incidence of knee OA.

Evaluation of the Stability of the Subjects with Anterior Cruciate Injuries Reconstruction.

Anterior cruciate ligament (ACL) is the most frequently injured ligament in the knee and is often injured during sport-related activities. ACL injuries influence the abilities of the subjects during standing and walking. Although early surgical intervention is preferred treatment for the majority of knee surgeons, the effect of this approach on postural stability of patients is not fully understood. Therefore, the aim of this study was to determine the difference between stability of ACL-reconstructed subjects before and after surgery. A group of 15 consecutive ACL injured patients participated in this study. Postural stability of the patients was evaluated 1 week before and 6 months after surgery (ACL reconstruction with hamstring autograft). A Kistler force plate was used to evaluate center of pressure (COP) sway during quiet standing. The mean values of the COP parameters were obtained in pre and postsurgery conditions. Paired sample t-test was used to evaluate the difference between the stability parameters of the two conditions. The significant point was set at 0.05. The mean value of path length of COP velocity in mediolateral (ML) direction was 1,485.57 ± 479.42 mm and 2,641.33 ± 996.26 mm before and after surgery, respectively (p-value = 0.01). Although the mean value of COP velocity in anteroposterior and ML directions increased after surgery, the difference was only significant for velocity in ML direction (p-value = 0.049). The results of this study showed that the standing stability of those with ACL reconstruction decreased significantly after ACL reconstruction, which may be due to the effects of the surgery on sensory mechanism of ACL and inability of patients to return to their previous deep sense perception and knee proprioception.

Injury to the Infrapatellar Branch of the Saphenous Nerve during ACL Reconstruction with Hamstring Tendon Autograft: A Comparison between Oblique and Vertical Incisions.

BACKGROUND: Injury to the infrapatellar branch of the saphenous nerve (IPBSN) is common after arthroscopic ACL reconstruction with hamstring tendon autograft, as reported in up to 88% of the cases. Due to close relationship between the IPBSN with pes anserine tendons insertion skin incision may sever IPBSN while harvesting gracillis and semitendinous tendons. As the IPBSN course at the anterior of knee is oblique, we hypothesized a parallel skin incision with nerve passage may decrease nerve injury. METHODS: Vertical and oblique incisions were compared in 79 patients in this clinical trial. The sensory loss area and patients' complain of numbness were measured at 2 and 8 weeks as well as 6 months after surgery. RESULTS: Both the sensory loss area and patients' complain of numbness decreased significantly in the oblique incision group (P<0001). CONCLUSION: According to our findings, oblique incision is suggested instead of traditional vertical incision when hamstring tendons are being harvested in arthroscopic ACL reconstruction with hamstring tendon autograft.Level of evidence: IV.

Relationship between Bone Mineral Density and Serum Vitamin D with Low Energy Hip and Distal Radius Fractures: A Case-Control Study.

BACKGROUND: The main purpose of this study was to determine the relationship between serum vitamin D and the status of bone mineral density in patients with low-energy hip and distal radius fracture. METHODS: This retrospective case-control study was performed between January 2013 and January 2014. Participants aged 55 years or older were divided to case group including 85 patients with low-energy hip fracture and 83 patients with low-energy distal radius fractures, and 82 subjects as a matched control group. Bone mineral density was measured with dual energy X-ray absorptiometry and serum sample was obtained to check vitamin D, calcium, phosphorus, alkaline phosphatase, and protein. RESULTS: Study subjects for final evaluation consisted of 78 in hip and distal radius fracture groups and 80 in control group. There were no significant differences in the mean serum levels of calcium, phosphorus and alkaline phosphatase between the three groups. The overall mean serum level of vitamin D3 was significantly different among the three groups. Similar results were observed with hip and spine t-score between the groups. CONCLUSION: There is not only a direct relation between serum vitamin D and the risk of low energy hip and distal radius fractures, but also a significant relation between low bone density in hip and spine area with low serum calcium was observed.

Comparison of trans patellar approach and medial parapatellar tendon approach in tibial intramedullary nailing for treatment of tibial fractures.

OBJECTIVES: To evaluate the post-operative complications of intramedullary nailing technique by transpatellar approach compared to medial parapatellar approach. METHODS: Fifty patients with tibial fractures treated by intramedullary nailing through two transpatellar (t-group) and medial parapatellar (p-group) approaches were studied. Knee pain was assessed with visual analogue scale (VAS) for 2 weeks, 1, 3 and 6 months and range of motion (ROM) in 2 weeks and 3 months after surgery. RESULTS: There were 23 males and 2 females with a mean age of 28.68 +/- 5.78 years in t-group and 21 males and 4 females with a mean age of 28.80 +/- 5.82 in p-group. There was significant difference in knee pain score after 3 months (p = 0.013) and 6 months (p = 0.009) between the two study groups (p-group had less pain than t-group). But there was not significant difference between the two study groups in range of motion after 2 weeks and 3 months of surgery. CONCLUSION: Our study recommends medial parapatellar tendon approach, although both approaches are safe.