Effects of Corrective Exercises on Lumbar Lordotic Angle Correction: A Systematic Review and Meta-Analysis.

Lumbar lordosis is one of the most important parts of the spine, which is of special importance due to its unique position and direct contact with the pelvis. The aim of this study was to combine the results of several studies and to evaluate the magnitude of the effect of different Lumbar lordotic angle correction programs through meta-analysis. This study has been developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Four databases were searched for articles collection: PubMed, Cochrane Library, Web of Science, and Google Scholar. The key search terms were: "Lumbar Lordotic angle", "Lordosis", "Hyperlordosis", "Corrective exercise", and "Low back pain. "The articles included in our study were limited to original articles written only in English that met the following inclusion criteria: (1) participants with lumbar lordosis or hyperlordosis or low back pain; (2) different programs of corrective exercises were applied; (3) Lumbar lordotic angle used as outcome measures. Ten studies are included in our systematic review and meta-analysis. The effect size for the Lumbar lordotic angle outcome was (SMD = 0.550, p ˂ 0.001, moderate effect size). Subgroup analysis for Lumbar lordotic angle: Subgroup Younger group (SMD = 0.640, p ˂ 0.001), Subgroup Older group, (SMD = 0.520, p ˂ 0.001). Subgroup Treatment (SMD = 0.527, p ˂ 0.001), Subgroup No treatment (SMD = 0.577, p = 0.002). This was the only outcome assessed in our analysis. The current meta-analysis indicates that different correction methods have a positive effect on subjects with lumbar lordosis or hyperlordosis. In the following research, we should try to determine which corrective methods have the best effects.

Femoral Footprint Visualization Using a Transtibial Portal in Anterior Cruciate Ligament Reconstruction.

In traditional endoscopic anterior cruciate ligament (ACL) reconstruction, inadequate visualization of the femoral footprint through a lateral portal frequently causes surgical errors. Although various portal locations have been reported, no study has identified ideal locations for specific portals in relation to ACL reconstruction. This article presents the new transtibial portal technique (ie, the use of an existing tibial tunnel). This technique provides excellent direct visualization of the femoral ACL footprint without the need to create additional portals. It allows dynamic visualization of the relationship of the future graft with posterior cruciate ligament and bone structures. [Orthopedics. 2021;44(5):e691-e693.].

THE TIBIAL APERTURE SURFACE ANALYSIS IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION PROCESS.

INTRODUCTION: The tibial tunnel aperture in the anterior cruciate ligament reconstruction is usually analyzed as an ellipse, generated as an intersection between a tibial plateau and a tibial bone tunnel. The aim of this study is to show that the tibial tunnel aperture, which utilizes 3D tibial surface bone model, differs significantly from common computations which present the tibial tunnel anterior cruciate ligament aperture surface as an ellipse. MATERIAL AND METHODS: An interactive program system was developed for the tibial tunnel aperture analysis which included the real tibia 3D surface bone model generated from a series of computed tomography images of ten male patients, their mean age being 25 years. In aperture calculation, the transverse drill angle of 10 degrees was used, whereas sagittal drill angles of 40 degrees, 50 degrees and 60 degrees were used with the drill-bit diameter set to 10 mm. The real 3D and 2D tibial tunnel aperture surface projection was calculated and compared with an ellipse. RESULTS: According to the calculations, generated 3D aperture surfaces were different for every patient even though the same drill parameters were used. For the sagittal drill angles of 40 degrees, 50 degrees and 60 degrees, the mean difference between the projected 3D and 2D area on the tibial plateau was 19.6 +/- 5.4%, 21.1 +/- 8.0% and 21.3 +/- 9.6%, respectively. The difference between the projected 3D area on the tibial plateau and ellipse surface was 54.8 +/- 16.3%, 39.6 +/- 10.4% and 25.0 +/- 8.0% for sagittal drill angles of 40 degrees, 50 degrees and 60 degrees, respectively. CONCLUSION: The tibial tunnel aperture surface area differs significantly from the ellipse surface area, which is commonly used in the anterior cruciate ligament reconstruction analysis. Inclusion of the 3D shape of the tibial attachment site in the preoperative anterior cruciate ligament reconstruction planning process can lead to a more precise individual anatomic anterior cruciate ligament reconstruction on the tibial bone. Both tibial aperture area generated in 3D and its projection on a tibial plateau are larger than the ellipse surface; therefore, individual characteristics of each patient have to be taken into consideration.

THE RELATIONSHIP BETWEEN THE RANGE OF MOTON OF THE HIP JOINT WITH RUPTURED ANTERIOR CRUCIATE LIGAMENT.

INTRODUCTION: A knee injury, especially anterior cruciate ligament. has recently become more common significantly affecting the life standard. There are many factors that cause an injury of the anterior eruciate ligament, ~nd one of them is limited range of motion in the hip joint. This studyhas been aimed at finding a relationship between the range of motion in the hip joint and the anterior eriiciate ligament injury. Matcrial and Methods. Of88 male athletes included in the study sample in 2014, 60 (68%) had ruptured knee anterior cruciate ligament and 28 (32%) were without an injury. There was no sianificant difference in sex, height, weight, age and time of injury between the two groups. RESULTS: Significant differences were found in the range ofmotion between the lefi and right leg in both groups. The athletes with a ruptured anterior cruciate ligament had an abduction limit of the hip joint (p0.007) and a wider rang of motion of the knee joint (p0.O02) than thc athletes without the inj Liry. CONCLUSION: Data obtained in this study suggest a possible relationship between a limited hip abduction of range of motion in athletes and an increased risk of anterior cruciate ligament injury.

INFLUENCE OF DIFFERENT LEVELS OF SPORTS ACTIVITIES ON THE QUALITY OF LIFE AFTER THE RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT.

INTRODUCTION: The goal of this study was to examine the nature and presence of influence of different levels of sports activity on the life quality of the patients a year after the reconstruction of anterior cruciate ligament. MATERIAL AND METHODS: The study included 185 patients operated at the Department of Orthopedic Surgery and Traumatology of the Clinical Centre of Vojvodina, who were followed for twelve months. Data were collected using the modified Knee Injury and Osteoarthritis Outcome Score questionnaire which included the Lysholm scale. RESULTS: This study included 146 male and 39 female subjects. The reconstruction of anterior cruciate ligament was equally successful in both gender groups. In relation to different types of sports activity, there were no differences in the overall life quality measured by the questionnaire and its subscales, regardless of the level (professional or recreational). However, regarding the level of sports activities, there were differences among the subjects engaged in sports activities at the national level as compared with those going in for sports activities at the recreational level, and particularly in comparison with physically inactive population. A significant correlation was not found by examining the aforementioned relationship between sports activities. CONCLUSIONS: This study has shown that the overall life quality a year after the reconstruction of the anterior cruciate ligament does not differ in relation to either the gender of the subjects or the type of sports activity, while the level of sports activity does have some influence on the quality of life. Professional athletes have proved to train significantly more intensively after this reconstruction than those going in for sports recreationally.

ASSESSMENT OF QUALITY OF LIFE IN PATIENTS AFTER LOWER LIMB AMPUTATION.

INTRODUCTION: Lower extremity amputation is a surgical procedure resulting in important anatomical, functional, psychological, and social consequences that can influence the quality of life of these patients. The aim of this research was to compare the quality of life of patients with lower extremity amputation and people without amputation taking into account gender differences as well as the amputation level. MATERIAL AND METHODS: The study was designed as a cross-sectional study which included 56 subjects. The patients from the experimental group underwent prosthetic rehabilitation treatment at the Department of Medical Rehabilitation, Clinical Centre of Vojvodina. The experimental group included 28 patients (21 male, 7 female) with lower extremity amputation, their average age being 65.36±13.64. The control group consisted of 28 age and gender matching subjects without amputation. Research ANd Development (RAND) 36--Item Health Survey 1.0 (SF-36) was used to measure the quality of life. RESULTS: The results showed that patients with lower extremity amputation scored lower than the control group on all SF-36 variables (p<0.05). None of the SF-36 variables differed between the genders (p>0.05). Seventeen (61%) patients were with transfemoral, and 11 (39%) with transtibial level of amputation. The patients with transtibial amputations scored higher on physical functioning and general health status variables (p<0.05). CONCLUSION: The patients with lower extremity amputations have numerous limitations compared to the control group, regardless of gender, while the patients with lower level of amputation have a higher level of physical functioning.

Patellar tendon rupture--treatment results.

INTRODUCTION: Patellar tendon rupture is a rare injury which, if missed, leads to delayed surgical treatment and may result in the loss of the knee joint function. The aim of this study was to report our results of operative treatment of the patellar tendon rupture and point out the significance of timely diagnosis and surgical procedure. MATERIAL AND METHODS: This retrospective ten-year study included 20 patients, 15 males and 5 females, their mean age being 42 (20-84) years. Seven participants had an injury on the right side and 13 had an injury on the left side. Thirteen participants had the diagnosis set in the first seven days after the injury. The applied techniques were surgical suture of the tendon, bone-tendon-bone ligamentoplasty using allograft from a bone bank and bone-tendon-bone ligamentoplasty using contralateral autograft, and they were performed in 12, 5 and 3 patients, respectively. The treatment results were assessed by using the Lysholm score, measuring the range of movement in the knee joint and measuring the girth of the thigh 10 cm above the patella. RESULTS: The follow-up period after the surgery was 4 years on average (1-10 years) and the average value of the Lysholm score was 83 (27-100). The result was found to be excellent in 11 cases, satisfactory in 5 cases and unsatisfactory in 4. A statistically significant difference (p=0.0197 p<0.05) was found in the average values of the Lysholm score between the group of patients with risk factors (71.78) and the subjects without risk factors (92.18). A statistically significant difference (p=0.008 p<0.01) was found in the Lysholm score between the patients with timely diagnosis (91.62) and cases of chronic tendon tear (67). CONCLUSION: Timely diagnosis and early surgical reparation are the basic imperatives in the treatment of this injury. Comorbidity and risk factors are related to a poorer postoperative Lysholm score. The method of choice is early surgical treatment.

BONE-PATELLAR TENDON-BONE GRAFT PREPARATION TECHNIQUE TO INCREASE CROSS-SECTIONAL AREA OF THE GRAFT IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION.

INTRODUCTION: Not much has changed in the way the bone-patellar tendon-bone graft is prepared before implantation. We present a modified bone-patellar tendon-bone graft preparation technique by implying the increased cross-sectional area. MATERIAL AND METHODS: Measurements of bone-patellar tendon-bone graft were made during the reconstruction of the anterior cruciate ligament in 93 male patients. The bone part of bone-patellar tendon-bone graft 10 mm wide and the tendon part 12-14 mm wide was placed on the holder with a handle in a way which allowed sewing the edges of the patellar tendon in a shape of a tube. The circumference of the central part of the graft was measured using a suture tightened around the graft. The diameters of the circle and cross-sectional areas were then calculated using geometrical calculation. RESULTS: After preparation of the bone-patellar tendon-bone graft, the fol- lowing measures were recorded: the circumference of 30 mm, the diameter of 9.55 mm, and the cross-sectional area of 72 mm2 in 9 patients; the circumference of 31mm, the diameter of 9.87 mm, and the cross-sectional area of 76 mm2 in 15 patients, and the circumference of 32 mm, the diameter of 10.19 mm, and the cross-sectional area of 82 mm2 in 69 patients. CONCLUSION: For the average thickness (3-5 mm) and width (10 mm) of the patellar tendon graft, the cross-sectional area will be 30-50 mm2. The modified bone-patellar tendon-bone graft preparation technique made it possible to increase its cross-sectional area to 71-81 mm2.

Magnetic resonance imaging comparison of lateral collateral ligament and patellar tendon length.

INTRODUCTION: The problem of using patellar tendon auto or allografts for lateral collateral ligament reconstruction results in the occurrence of ligaments mismatch. The length of patellar tendon does not match the lateral collateral ligament. MATERIAL AND METHODS: Out of 151 patients, who formed the study, 102 were men with the mean age of 30 years (18-54) and 49 women, with the mean age of 34 (18-55), and they all underwent magnetic resonance imaging of the knee. Both patellar tendon and lateral collateral ligament were measured using a three-dimensional isovoxel true-fast-imaging with steady-state precession sequence with water excitation and secondary multiplanar reformations. In order to visualize the lateral collateral ligament insertions precisely, sagittal images were reformatted according to the anatomical, oblique ligament position, in anteriorly tilted, paracoronal plane. The length of the patellar tendon was measured from the patellar apex to the tibial tuberosity insertion site. RESULTS: The mean patellar tendon length was 52.88 +/- 7.56 mm (37-75) with a significant difference between men and women. The mean lateral collateral ligament length was 61.21 +/- 5.77 mm (46-80) with a significant difference between genders. The average differences between lateral collateral ligament and patellar tendon length was 8.38 +/- 7.23 mm (-9 to 26) without a significant difference between the genders. In 18 (11.92%) patients, the patellar tendon was longer than the lateral collateral ligament; in 7 patients (4.63%) they were equal; and in 126 patients (83.44%) the patellar tendon was shorter than the lateral collateral ligament. CONCLUSION: The length of patellar tendon does not match the length of lateral collateral ligament. If patellar tendon auto or allograft is used for lateral collateral ligament reconstruction, the lengths of both ligaments must be determined preoperatively in order to avoid intraoperative complications.

The relationship between posterior tibial slope and anterior cruciate ligament injury.

INTRODUCTION: The aim of this study was to identify an increased posterior tibial slope as a possible risk factor for anterior cruciate ligament injury. MATERIAL AND METHODS: Sixty patients were divided into two groups (with and without anterior cruciate ligament rupture). The posterior tibial slope on the lateral and medial condyles was measured by sagittal magnetic resonance imaging slices by means of computerized method using circles to determine tibial axis. RESULTS: The patients with anterior cruciate ligament rupture had a statistically significantly (p = 0.06) greater posterior tibial slope on the lateral tibial condyle than the control group (6.68 degrees:5.64 degrees), and a greater slope on the medial condyle (5.49 degrees:4.67 degrees) in comparison to the patients with the intact anterior cruciate ligament. No significant difference in the average values of angles was observed between males and females with anterior cruciate ligament rupture, the average value being 6.23 degrees in men and 5.84 degrees in women on the lateral condyle, and 4.53 degrees in men and 4.53 degrees in women on the medial condyle. DISCUSSION AND CONCLUSION: A statistically significant difference between the values of posterior tibial slope was observed between the groups with and without anterior cruciate ligament rupture, the sex having no affect on the value of the posterior tibial slope. The method of measuring angles should be unique.

Infections after reconstructions of anterior cruciate ligament.

INTRODUCTION: Infections after anterior cruciate ligament reconstructions are rare, but, on the other hand, they are difficult to be treated. The aim of this study was to analyze causes of infections, risk factors, diagnostics, and possibilities of their prevention. MATERIAL AND METHODS: Seventeen deep infections (1.2%) were found in 1425 patients who had undergone anterior cruciate ligament reconstructions. Fifteen patients were males and two were females. Out of 475 professional athletes nine (1.9%) had this postoperative complication. Eleven patients with septic arthritis were allergic to penicillin. Three of them had immunosuppressive diseases. RESULTS: Staphylococcus aureus was isolated in eleven cases (65%), other Staphylococcus and Streptococcus groups were found in four and three patients, respectively; while one patient had infection although the punctate was negative. Out of 965 patients with the patellar tendon grafts, ten (1.03%) had this complication, while the incidence was 1.52% (7/460) in those with the hamstring grafts. Fifteen infections were acute with obvious symptoms within 14 days after surgery. Severe pain, limited range of motion, swelling of the knee joint and fever were the most common symptoms, while rubor and pus developed rarely. The infection was three times more frequent in the patients who had undergone surgery lasting more than 1.5 hour. DISCUSSION AND CONCLUSION: The following population groups are at risk of developing septic arthritis after anterior cruciate ligament reconstructions: professional athletes, those who are allergic to penicillin, and those with immunosuppressive diseases. Staphyllococus aureus is the most common cause of infection. The patients with the hamstring autografts have a higher risk than those with the patellar tendon grafts. Preventive measures that should be performed include aseptic conditions in operative rooms, irrigation of the graft before its placement into the bone tunnels, experience of surgeon and proper antibiotics.

Influence of different methods of internal bone fixation on characteristics of bone callus in experimental animals.

INTRODUCTION: Correct choice of osteosynthesis method is a very important factor in providing the optimal conditions for appropriate healing of the fracture. There are still disagreements about the method of stabilization of some long bone fractures. Critically observed, no method of fracture fixation is ideal. Each osteosynthesis method has both advantages and weaknesses. OBJECTIVE: The objective of this study was to compare the results of the experimental application of three different internal fixation methods: plate fixation, intramedullary nail fixation and self-dynamisable internal fixator (SIF). METHODS: A series of 30 animals were used (Lepus cuniculus) as experimental animals, divided into three groups of ten animals each. Femoral diaphysis of each animal was osteotomized and fixed with one of three implants. Ten weeks later all animals were sacrificed and each specimen underwent histological and biomechanical testing. RESULTS: Histology showed that the healing process with SIF was more complete and bone callus was more mature in comparison to other two methods. During biomechanical investigation (computerized bending stress test), it was documented with high statistical significance that using SIF led to stronger healing ten weeks after the operation. CONCLUSION: According to the results obtained in this study, it can be concluded that SIF is a suitable method for fracture treatment.

Disruption of the knee extensor apparatus complicating anterior cruciate ligament reconstruction.

Disruption of the knee extensor apparatus, after harvesting the central third of the patellar tendon for a bone-tendon-bone autograft, is a rare complication. We made 2215 reconstructions of the anterior cruciate ligament of the knee using bone-patellar tendon-bone technique, and 10 patients had fracture of the patella (0.45%), and fore patients had rupture of the patellar tendon (0.18%). The fracture of the patella in two patients was treated nonoperatively and 8 patients was treated with operative reduction and osteosynthesis. Reconstruction of the patellar ligament in four patients with a rupture of patellar tendon (0.18%) was performed by a technique previously published with BTB allograft taken from the local bone bank. The mean Lysholm score was 90 (85-100), and all of them have continued to engage in sporting activities. In all patients the Lachman test was with the firm stop compared to the other leg. X-ray changes in the patella were found in 2 patients, who had multifragmentary fractures of the patella. Disruption of the knee extensor apparatus, after harvesting the central third of the patellar tendon for a bone-tendon-bone autograft, can be prevented by avoiding to take too much bone graft, by using the most precise tools for cutting, while rehabilitation must be carefully planned. The optimal treatment disruption of the knee extensor apparatus after the reconstruction of the anterior cruciate ligament is a operative reconstruction, which allows continuation of the rehabilitation program.

[Comparative analysis of the position of the graft in the femur after anterior cruciate ligament reconstruction done through the front inner portal and through the shin bone].

Anterior cruciate ligament (ACL) is the most common surgically treated knee ligament. If we take into account the fact that incidence of ACL injuries is growing, it is clearly that the interest of orthopedic surgeons for this pathology is also growing. Increasing number of this operations leads to increasing of complications, which requires its analysis. One of the most common failure of ACL reconstruction is a bad position of the graft in the femoral condyle. This study aimed to analyze the positioning of the graft in to the femur by two generally accepted techniques--transtibial technique and technique through the antero-medial portal. The analysis included postoperative radiographs in 60 patients, of whom 30 were operated by transtibial technique and 30 by technique through anteromedial portal. Radiographic analysis involved the measurement of the AP digital imaging, the tunnel projection X ray measurements and measurements of the computed tomography (CT), which was here a control method. The accuracy of measurement was set at 0.5 degrees or 1 min. All radiographs were made in the same way according to the literature. The results showed that the neoligaments were placed lower in the femoral condyle by technique through anteromedial portal than by transtibial technique, and the difference was statistically significant (on tunnel X ray by anteromedial portal screws were average placed at 50.0 degrees and 10:20 am, and by transtibial technique at 37.5 degrees or 10:45 am). Based on the results, it was concluded that the neoligaments were positioned closer to its anatomical position by technique through anteromedial portal.

Dislocation of the proximal tibiofibular joint.

INTRODUCTION: Dislocation of the proximal tibiofibular joint is a rare injury. It occurs during a sports activity that includes rough twisting movements of the bent knee. The role of the proximal tibiofibular joint is to reduce torsional loads to the ankle, to distribute the bending moment of the outer side of tibia, and transfer the vertical load while standing. In the literature there is no larger series; only several cases of the proximal tibiofibular joint dislocation treated by different methods have been published so far. CASE REPORT: A 23-year-old male soccer player sustained an injury after he had joined the game without previous warming-up. He fell on his right side because of a sudden change of direction while his foot was fixed to the base. He felt a severe pain and had a sensation as if something had snapped in his right knee. Pain and swelling at the head of fibula were found by physical examination, which, however, did not reveal any pain, swelling and instability of the ankle or peroneal nerve palsy. The x-ray showed anterolateral dislocation of the proximal tibiofibular joint, Ogden type II. Since manual reposition in general anesthesia failed, open reduction internal fixation was performed and proximal tibiofibular joint was transfixed with a screw After the wound closure, the above-the-knee plaster cast was applied. The screw was extracted six weeks later, full weight bearing was allowed and he started with physical therapy. Four months after the injury he returned to sports activities. On the follow-up one year after the injury he had the full range of motion of the knee, no complains, and continued with active soccer playing. X-ray showed no signs of arthrosis of the proximal tibiofibular joint. CONCLUSION: The proximal tibiofibular joint dislocation may be the cause of the chronic pain of the knee so it has to be taken into account when making differential diagnosis in case of the pain at the lateral side of the knee. The key for making the accurate diagnosis is the technically correct X-ray of the injured knee compared with the opposite one, showing the displacement of fibular head. If manual reposition fails, open reduction internal fixation and screw transfixation of the proximal tibiofibular joint allow good results and fast return to sport activities.

[Injuries in elite athletes in the olympic period from 2008 to 2012]. / Povrede vrhunskih atleticara u olimpijskom periodu 2008-2012. godine.

INTRODUCTION: Research related to injuries of elite athletes is very demanding in comparison to research on injuries in team sports, and therefore, there are a lot fewer resources and data on injuries in track and field sports than in other sports. MATERIAL AND METHODS. The research included 78 athletes who were the members of junior and senior national track and field team of Serbia (34 women and 44 men), aged 15 to 32 years. The research was conducted in the official training camp for the national selection in Bar (Montenegro) by using a non-standardized survey research technique, an anonymous questionnaire. Out of the total number, 59 athletes reported incidence of injury and 19 athletes were without injury over the four-year cycle. RESULTS: The majority of injuries were reported on the lower extremities, i.e. in 90.8% (n=158), the upper leg and the hamstring muscle having been injured in 99 cases (56.9%) and 61 cases (35.05%), respectively. The most common type of injuries were strains (n=74; 42.5%), followed by partial ruptures (n=30, 16.3%) and distortion (n=25; 14.4%). The most frequent diagnosis was hamstring strain (n=37; 21.3%). DISCUSSION AND CONCLUSION: Inadequate procedures related to the extent and intensity of training, without prevention of injury, often lead to injuries in athletes. It is necessary to carry out continuous educational training, especially for coaches, whose effects should be reflected in the introduction of new knowledge and scientific achievements in the field of biomechanics, training technology, prevention and cure in the field of sports medicine. It is also very important to achieve adequate and constant cooperation between sports physicians and athletic clubs.

Fracture of the patella after the anterior cruciate ligament reconstruction.

INTRODUCTION: Fracture of the patella, after harvesting the central third of the patellar tendon for a bone-tendon-bone autograft, is a rare complication. MATERIAL AND METHODS: We made 1714 reconstructions of the anterior cruciate ligament of the knee using bone-patellar tendon-bone technique, and 7 patients had fracture of the patella (0.42%). The fracture was immediately recognized in the patients with vertical non-displaced patellar fracture and the broken screw osteosynthesis was carried out without changes in the rehabilitation period. One patient was treated non-operatively and patellar fracture in four patients was treated with operative reduction and osteosynthesis. RESULTS: The patients were invited for the check-up 5 years (2-8 years) after surgery on average. The mean Lysholm score was 92 (85-100). All of them continued to engage in sporting activities at the same or greater level after 9 months on average (6-12 months). In all patients the Lachman test was with the firm stop compared to the other leg. X-ray changes in the patella were found in 2 patients who had multifragmentary fractures. DISCUSSION AND CONCLUSION: The fracture of patella can be prevented by avoiding to take too much bone graft, by using the most precise tools for cutting, while rehabilitation must be carefully planned. The optimal treatment of the fracture of the patella after the reconstruction of the anterior cruciate ligament is a firm osteosynthesis, which allows healing of the bone and continuation of the rehabilitation program.