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1.
Knee Surg Sports Traumatol Arthrosc ; 32(2): 223-234, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38293720

RESUMEN

PURPOSE: The aim of this consensus project was to give recommendations regarding surgical treatment of the anterior cruciate ligament (ACL) injured patient. METHODS: For this consensus process, an expert, steering and rating group was formed. In an initial online meeting, the steering group, together with the expert group, formed various key topic complexes for which multiple questions were formulated. For each key topic, a structured literature search was performed by the steering group. The results of the literature review were sent to the rating group with the option to give anonymous comments until a final consensus voting was performed. Sufficient consensus was defined as 80% agreement. RESULTS: During this consensus process, 30 topics regarding the surgical management and technique of ACL reconstruction were identified. The literature search for each key question resulted in 30 final statements. Of these 30 final statements, all achieved consensus. CONCLUSIONS: This consensus process has shown that surgical treatment of ACL injury is a complex process. Various surgical factors influence patient outcomes. The proposed treatment algorithm can be used as a decision aid for the surgeon. LEVEL OF EVIDENCE: Level V.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Humanos , Algoritmos , Ligamento Cruzado Anterior/cirugía , Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior/métodos , Consenso
2.
Sportverletz Sportschaden ; 37(3): 126-132, 2023 08.
Artículo en Inglés | MEDLINE | ID: mdl-37348534

RESUMEN

BACKGROUND: Injuries to the elbow are frequent in judo combat, but studies on down-time and effect on performance after conservative treatments are rare. This issue is particularly relevant for elbow dislocations in high-performance patients such as elite athletes. The purpose of this study was to evaluate (1) time-loss and (2) the regained level of performance in judoka after conservative treatment of simple elbow dislocation. METHODS: In cooperation with the European Judo Union, judoka were asked to complete a 139-item survey regarding elbow injuries they suffered during their career. Besides demographics, injury data, diagnosis and treatment options, the athletes were asked about down-time and reductions in performance level. This study enrolled 108 judoka with conservative treatment of elbow dislocation out of a population of 5426 volunteers. RESULTS: 69% (n=74) reported a time-loss of less than three months; 6% reported a time-loss of more than six months. The majority (68%, n=73) reported that they had returned to their previous performance level, while 22% (n=24) suffered from a slightly reduced level of performance. In the subgroup of international and national athletes (n=54), 63% returned to judo after less than three months, with 72% achieving the same level and 15% reporting a slightly reduced performance level. Level of performance and time lost after conservative treatment for elbow dislocations were comparable for male and female judoka. CONCLUSION: Approximately two out of three judoka returned to the same level of performance after three months of down-time after undergoing conservative therapy for simple elbow dislocations. Despite the high performance level of the study population, conservative treatment of simple elbow dislocation resulted in satisfactory outcomes. The presented data can guide medical professionals and competitive-level contact-sport athletes with respect to expectations in the process of returning to sport.


Asunto(s)
Luxaciones Articulares , Inestabilidad de la Articulación , Artes Marciales , Humanos , Masculino , Femenino , Tratamiento Conservador , Codo , Volver al Deporte , Luxaciones Articulares/diagnóstico , Luxaciones Articulares/terapia
3.
PLOS Digit Health ; 2(2): e0000175, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36812639

RESUMEN

OBJECTIVES: Implementing evidence-based recommendations with the option of patient-individualised and situation-specific adaptations in telerehabilitation may increase adherence with improved clinical outcome. METHODS: As part of a registry-embedded hybrid design (part 1), digital medical device (DMD)-usage in a home-based setting was analysed in a multinational registry. The DMD combines an inertial motion-sensor system with instructions for exercises and functional tests on smartphones. A prospective, single-blinded, patient-controlled, multicentre intervention study (DRKS00023857) compared implementation capacity of the DMD to standard physiotherapy (part 2). Usage patterns by health care providers (HCP) were assessed (part 3). RESULTS AND CONCLUSION: Registry raw data (10,311 measurements) were analysed from 604 DMD-users, demonstrating clinically expected rehabilitation progression post knee injuries. DMD-users performed tests for range-of-motion, coordination and strength/speed enabling insight to stage-specific rehabilitation (χ2 = 44.9, p<0.001). Intention-to-treat-analysis (part 2) revealed DMD-users to have significantly higher adherence to the rehabilitation intervention compared to the matched patient-control-group (86% [77-91] vs. 74% [68-82], p<0.05). DMD-users performed recommended exercises at home with higher intensity (p<0.05). HCP used DMD for clinical decision making. No adverse events related to the DMD were reported. Adherence to standard therapy recommendations can be increased using novel high quality DMD with high potential to improve clinical rehabilitation outcome, enabling evidence-based telerehabilitation.

4.
Knee Surg Sports Traumatol Arthrosc ; 31(5): 1675-1689, 2023 May.
Artículo en Inglés | MEDLINE | ID: mdl-36471029

RESUMEN

PURPOSE: The aim of this consensus project was to create a treatment algorithm for the management of the ACL-injured patient which can serve as an aid in a shared decision-making process. METHODS: For this consensus process, a steering and a rating group were formed. In an initial face-to-face meeting, the steering group, together with the expert group, formed various key topic complexes for which various questions were formulated. For each key topic, a structured literature search was performed by the steering group. The results of the literature review were sent to the rating group with the option to give anonymous comments until a final consensus voting was performed. Sufficient consensus was defined as 80% agreement. RESULTS: During this consensus process, 15 key questions were identified. The literature search for each key question resulted in 24 final statements. Of these 24 final statements, all achieved consensus. CONCLUSIONS: This consensus process has shown that ACL rupture is a complex injury, and the outcome depends to a large extent on the frequently concomitant injuries (meniscus and/or cartilage damage). These additional injuries as well as various patient-specific factors should play a role in the treatment decision. The present treatment algorithm represents a decision aid within the framework of a shared decision-making process for the ACL-injured patient. LEVEL OF EVIDENCE: Level V.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Traumatismos de la Rodilla , Menisco , Humanos , Ligamento Cruzado Anterior
5.
Knee Surg Sports Traumatol Arthrosc ; 31(5): 1665-1674, 2023 May.
Artículo en Inglés | MEDLINE | ID: mdl-35445329

RESUMEN

PURPOSE: The aim of this consensus project was to validate which endogenous and exogenous factors contribute to the development of post-traumatic osteoarthritis and to what extent ACL (anterior cruciate ligament) reconstruction can prevent secondary damage to the knee joint. Based on these findings, an algorithm for the management after ACL rupture should be established. METHODS: The consensus project was initiated by the Ligament Injuries Committee of the German Knee Society (Deutsche Kniegesellschaft, DKG). A modified Delphi process was used to answer scientific questions. This process was based on key topic complexes previously formed during an initial face-to-face meeting of the steering group with the expert group. For each key topic, a comprehensive review of available literature was performed by the steering group. The results of the literature review were sent to the rating group with the option to give anonymous comments until a final consensus voting was performed. Consensus was defined a-priori as eighty percent agreement. RESULTS: Of the 17 final statements, 15 achieved consensus, and 2 have not reached consensus. Results of the consensus were summarized in an algorithm for the management after ACL rupture (infographic/Fig. 2). CONCLUSION: This consensus process has shown that the development of post-traumatic osteoarthritis is a complex multifactorial process. Exogenous (primary and secondary meniscus lesions) and endogenous factors (varus deformity) play a decisive role. Due to the complex interplay of these factors, an ACL reconstruction cannot always halt post-traumatic osteoarthritis of the knee. However, there is evidence that ACL reconstruction can prevent secondary joint damage such as meniscus lesions and that the success of meniscus repair is higher with simultaneous ACL reconstruction. Therefore, we recommend ACL reconstruction in case of a combined injury of the ACL and a meniscus lesion which is suitable for repair. LEVEL OF EVIDENCE: Level V.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Menisco , Osteoartritis , Humanos , Ligamento Cruzado Anterior/cirugía , Lesiones del Ligamento Cruzado Anterior/cirugía , Articulación de la Rodilla/cirugía , Menisco/cirugía , Osteoartritis/complicaciones , Rotura/complicaciones
6.
Orthop J Sports Med ; 9(11): 23259671211050929, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34888389

RESUMEN

BACKGROUND: Different indications and treatment options for combined injuries to the anterior cruciate ligament (ACL) and medial collateral ligament complex (MCL) are not clearly defined. PURPOSE: To perform a modified Delphi process with the Committee for Ligament Injuries of the German Knee Society (DKG) in order to structure and optimize the process of treating a combined injury to the ACL and MCL. STUDY DESIGN: Consensus statement. METHODS: Scientific questions and answers were created based on a comprehensive literature review using the central registers for controlled studies of Medline, Scopus, and Cochrane including the terms medial collateral ligament, anterior cruciate ligament, MCL, ACL, and outcome used in various combinations. The obtained statements passed 3 cycles of a modified Delphi process during which each was readjusted and rated according to the available evidence (grades A-E) by the members of the DKG Ligament Injuries Committee and its registered guests. RESULTS: The majority of answers, including several questions with >1 graded answer, were evaluated as grade E (n = 16) or C (n = 10), indicating that a low level of scientific evidence was available for most of the answers. Only 5 answers were graded better than C: 3 answers with a grade of A and 2 answers with a grade of B. Only 1 answer was evaluated as grade D. An agreement of >80% (range, 83%-100%) among committee members was achieved for all statements. CONCLUSION: The results of this modified Delphi process offer a guideline for standardized patient care in cases of combined injuries to the ACL and MCL.

7.
Orthop J Sports Med ; 9(8): 23259671211022681, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34471645

RESUMEN

BACKGROUND: Stand-up paddleboarding (SUP) is a water sport that has gained in popularity. Still, very little is known about its injury profile. PURPOSE: To analyze the incidence, mechanisms, and risk factors for SUP-related injuries in mainly calm waters and the use of safety equipment. STUDY DESIGN: Descriptive epidemiology study. METHODS: The authors distributed an online survey that gathered information on characteristics, injury history over the past 12 months, use of (safety) equipment, and health issues of SUP riders in German-speaking countries. RESULTS: A total of 438 participants completed the survey. The mean participant age was 45 years (range, 8-82 years), 48% were female athletes, and 19.6% took part in competitions. Over the past 12 months, 72 (17%) of 431 respondents experienced a SUP-related injury, resulting in an overall incidence rate (IR) of 1.95 injuries per 1000 hours of activity. Male competitive athletes using a hardboard had the highest risk of injury. The IR for competitive riders was higher (3.21 injuries per 1000 hours) than that for recreational riders (1.41 injuries per 1000 hours). Mechanisms of injury were overuse (n = 29) and contact with the board (n = 18) or ground (n = 12). Injuries affected mainly muscles/tendons and joints of the upper arm/shoulder (n = 20), followed by wrist/hand (n = 18), knee (n = 16), elbow/forearm (n = 12), and foot (n = 11). The highest risk of injury occurred when paddling in wild water (33.3%), followed by SUP surfing (29.4%), and the lowest risk occurred while paddling on a lake (16.1%). A life vest was always used by 27, depending on the situation by 201, and never by 202 participants; a leash was always used by 161, depending on the situation by 244, and never by 26 participants. Of the 272 participants who paddled in winter, 253 wore a drysuit or wetsuit, whereas 19 paddled without any special clothing. CONCLUSION: SUP-related injuries predominantly happened in wild water or while SUP surfing, and male competitive athletes using a hardboard had the highest risk of injury. The main mechanisms of injury were overuse and hitting the board or ground. The upper extremity was more prone to injury, followed by the knee and foot. More effort should be made to educate paddlers on the necessity and correct use of the life vest, leash, and specialized outfits.

8.
Trials ; 20(1): 495, 2019 Aug 13.
Artículo en Inglés | MEDLINE | ID: mdl-31409425

RESUMEN

BACKGROUND: Although anterior cruciate ligament (ACL) tear-prevention programs may be effective in the (secondary) prevention of a subsequent ACL injury, little is known, yet, on their effectiveness and feasibility. This study assesses the effects and implementation capacity of a secondary preventive motor-control training (the Stop-X program) after ACL reconstruction. METHODS AND DESIGN: A multicenter, single-blind, randomized controlled, prospective, superiority, two-arm design is adopted. Subsequent patients (18-35 years) with primary arthroscopic unilateral ACL reconstruction with autologous hamstring graft are enrolled. Postoperative guideline rehabilitation plus Classic follow-up treatment and guideline rehabilitation plus the Stop-X intervention will be compared. The onset of the Stop-X program as part of the postoperative follow-up treatment is individualized and function based. The participants must be released for the training components. The endpoint is the unrestricted return to sport (RTS) decision. Before (where applicable) reconstruction and after the clearance for the intervention (aimed at 4-8 months post surgery) until the unrestricted RTS decision (but at least until 12 months post surgery), all outcomes will be assessed once a month. Each participant is consequently measured at least five times to a maximum of 12 times. Twelve, 18 and 24 months after the surgery, follow-up-measurements and recurrence monitoring will follow. The primary outcome assessement (normalized knee-separation distance at the Drop Jump Screening Test (DJST)) is followed by the functional secondary outcomes assessements. The latter consist of quality assessments during simple (combined) balance side, balance front and single-leg hops for distance. All hop/jump tests are self-administered and filmed from the frontal view (3-m distance). All videos are transferred using safe big content transfer and subsequently (and blinded) expertly video-rated. Secondary outcomes are questionnaires on patient-reported knee function, kinesiophobia, RTS after ACL injury and training/therapy volume (frequency - intensity - type and time). All questionnaires are completed online using the participants' pseudonym only. Group allocation is executed randomly. The training intervention (Stop-X arm) consists of self-administered home-based exercises. The exercises are step-wise graduated and follow wound healing and functional restoration criteria. The training frequency for both arms is scheduled to be three times per week, each time for a 30 min duration. The program follows current (secondary) prevention guidelines. Repeated measurements gain-score analyses using analyses of (co-)variance are performed for all outcomes. TRIAL REGISTRATION: German Clinical Trials Register, identification number DRKS00015313 . Registered on 1 October 2018.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirugía , Servicios de Atención a Domicilio Provisto por Hospital , Actividad Motora , Volver al Deporte , Prevención Secundaria/métodos , Adolescente , Adulto , Ligamento Cruzado Anterior/diagnóstico por imagen , Ligamento Cruzado Anterior/fisiopatología , Lesiones del Ligamento Cruzado Anterior/diagnóstico por imagen , Lesiones del Ligamento Cruzado Anterior/fisiopatología , Reconstrucción del Ligamento Cruzado Anterior/efectos adversos , Femenino , Alemania , Humanos , Masculino , Estudios Multicéntricos como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Recuperación de la Función , Recurrencia , Método Simple Ciego , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
9.
BMC Musculoskelet Disord ; 20(1): 109, 2019 Mar 14.
Artículo en Inglés | MEDLINE | ID: mdl-30871508

RESUMEN

BACKGROUND: The objective of the study was to compare the results of a primary anterior cruciate ligament reconstruction (ACLR) using the press-fit fixation technique for a quadriceps tendon (QT) graft to a standard quadrupled hamstring (HT) graft with interference screw fixation. METHODS: A retrospective cohort study with a 12-month follow up provided data for 92 patients. Exclusion criteria were accompanying ligament injuries and contralateral ACL injury. Patients who suffered a graft failure, which was defined as a side-to-side difference of > 3 mm, or infection were rated 'D' according to the IKDC and excluded from further evaluation. Forty-six patients underwent primary ACLR using the press-fit fixation technique for autologous bone QT graft. These patients were matched in terms of age, gender, accompanying meniscus tear and cartilage injury to 46 patients who underwent standard HT graft with interference screw fixation. Patients were evaluated according to the Lachman test, Pivot-Shift test, IKDC score, Tegner score, Rolimeter measurements, one-leg hop test, thigh circumference and donor side morbidity. RESULTS: No significant differences in Tegner score (p = 0.9), subjective or objective IKDC score (p = 0.9;p = 0.6), knee stability (Lachman Test p = 0.6; Pivot-Shift Test p = 0.4; Side-to-Side Difference p = 0.4), functioning testing (One-Leg Hop Test p = 0.6; Thigh Circumference p = 0.4) or donor side morbidity (p = 0.4) were observed at the follow up. The Lachman test was negative for 85% of the QT group and 83% of the HT group. The Pivot Shift Test was negative for 80% of the QT group and 85% of the HT group. The mean side-to-side difference was 1.6 ± 0 .2mm in both groups. The one-leg hop test revealed a collateral-side jumping distance of 96.2 ± 8.5% for the QT group and 95.5 ± 8.5% for the HT group. The thigh circumference of the injured leg was 98.3 ± 3.0% on the uninjured side in the QT group and 99.7 ± 3.0% in the HT group. A knee walking test resulted in no discomfort for 90% of the QT group and 85% of the HT group. The graft failure rate was 7.3% in the QT group and 9.8% in the HT group. CONCLUSION: QT grafts fixated using the press-fit technique are a reliable alternative for primary ACL surgery.


Asunto(s)
Reconstrucción del Ligamento Cruzado Anterior/métodos , Tornillos Óseos , Músculos Isquiosurales/trasplante , Fijadores Internos , Músculo Cuádriceps/trasplante , Tendones/trasplante , Adulto , Lesiones del Ligamento Cruzado Anterior/diagnóstico , Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior/instrumentación , Reconstrucción del Ligamento Cruzado Anterior/tendencias , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Masculino , Análisis por Apareamiento , Estudios Retrospectivos , Factores de Tiempo , Donantes de Tejidos , Trasplante de Tejidos/métodos , Adulto Joven
10.
Knee Surg Sports Traumatol Arthrosc ; 27(9): 3014-3021, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30666370

RESUMEN

PURPOSE: To investigate whether pre-soaking the graft in vancomycin during anterior cruciate ligament reconstruction (ACLR) reduces the postoperative infection rate and if this technique is associated with an increased rate of complications, including graft failure or arthrofibrosis. METHODS: A retrospective review of a prospective database was performed in 1779 patients who underwent ACLR over a period of 5 years, analysing the rate of postoperative deep knee infection. Group 1 and 2 both received perioperative IV antibiotics, while only group 2 underwent ACLR with grafts pre-soaked in a 5 mg/ml vancomycin solution. To analyse possible side effects associated with vancomycin use, 500 patients out of the overall study population (100 patients per year) were randomly selected and retrospectively interviewed for further postoperative complications including graft failure and arthrofibrosis as well as subjective evaluation of their knee by completing the IKDC form with a minimum mean follow-up of 37 months. RESULTS: In group 1, 22 out of 926 (2%) patients suffered a postoperative deep knee infection. In contrast, there were no postoperative infections in the second group of 853 patients (0%). 16 of 22 infections (73%) were caused by coagulase-negative Staphylococcus. Statistical analysis revealed a significantly reduced postoperative infection rate when bathing the autograft in vancomycin (p < 0.01). Analysis of the random sample revealed a significant decrease of graft failure with 8 reruptures in 257 patients (3%) in the vancomycin group compared to 16 cases of graft failure in 167 patients (10%) in the control group (p < 0.05). No differences were found in the rate of postoperative arthrofibrosis, Tegner or subjective outcome scores. CONCLUSION: Prophylactic vancomycin pre-soaking of autografts during ACLR appears to be a viable, cost-effective and safe option to reduce the rate of deep infection compared to systemic antibiotics alone. LEVEL OF EVIDENCE: III.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior/métodos , Articulación de la Rodilla/cirugía , Infección de la Herida Quirúrgica/prevención & control , Vancomicina/uso terapéutico , Adulto , Antibacterianos/uso terapéutico , Autoinjertos , Femenino , Rechazo de Injerto , Humanos , Artropatías/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/cirugía , Estudios Prospectivos , Estudios Retrospectivos , Trasplante Autólogo , Trasplantes/cirugía , Adulto Joven
11.
Am J Sports Med ; 46(11): 2646-2652, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-30059247

RESUMEN

BACKGROUND: Recent literature correlated anterior cruciate ligament (ACL) reconstruction failure to smaller diameter of the harvested hamstring (HS) autograft. However, this approach may be a simplification, as relation of graft size to native ACL size is not typically assessed and oversized grafts may impart their own complications. PURPOSE: To evaluate in vivo data to determine if the commonly used autografts reliably restore native ACL size. STUDY DESIGN: Descriptive laboratory study. METHODS: Intraoperative data of the tibial insertion area and HS graft diameter were collected and retrospectively evaluated for 46 patients who underwent ACL reconstruction with HS autografts. Magnetic resonance imaging measurements of the cross-sectional area (CSA) of the possible patellar tendon (PT) and quadriceps tendon (QT) autografts were also done for each patient. The percentages of tibial insertion site area restored by the 3 possible grafts were then calculated and compared for each individual. RESULTS: The mean ACL tibial insertion area was 107.2 mm2 (60.5-155.5 mm2). The mean CSAs of PT, HS, and QT were 33.2, 55.3, and 71.4 mm2, respectively. When all grafts were evaluated, the percentage reconstruction of the insertion area varied from 16.2% to 123.1% on the tibial site and from 25.5% to 176.7% on the femoral site, differing significantly for each graft type ( P < .05). On average, 32.8% of the tibial insertion area would have been filled with PT, 53.6% by HS, and 69.5% by QT. Based on previous cadaveric studies indicating that graft size goal should be 50.2% ± 15% of the tibial insertion area, 82.7% of patients in the HS group were within this range (36.9%, QT; 30.5%, PT), while 65.2% in the PT group were below it and 60.9% in the QT group were above it. CONCLUSION: ACL insertion size and the CSAs of 3 commonly used grafts vary greatly for each patient and are not correlated with one another. Thus, if the reconstructed ACL size is determined by the harvested autograft size alone, native ACL size may not be adequately restored. PT grafts tended to undersize the native ACL, while QT might oversize it. CLINICAL RELEVANCE: These results may help surgeons in preoperative planning, as magnetic resonance imaging measurements can be helpful in determining individualized graft choice to adequately restore the native ACL.


Asunto(s)
Reconstrucción del Ligamento Cruzado Anterior/estadística & datos numéricos , Músculos Isquiosurales/cirugía , Ligamento Rotuliano/trasplante , Músculo Cuádriceps/cirugía , Trasplantes/anatomía & histología , Adolescente , Adulto , Ligamento Cruzado Anterior/cirugía , Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior/métodos , Autoinjertos/cirugía , Femenino , Fémur/cirugía , Músculos Isquiosurales/anatomía & histología , Músculos Isquiosurales/diagnóstico por imagen , Humanos , Masculino , Ligamento Rotuliano/anatomía & histología , Ligamento Rotuliano/diagnóstico por imagen , Músculo Cuádriceps/anatomía & histología , Músculo Cuádriceps/diagnóstico por imagen , Estudios Retrospectivos , Tendones/trasplante , Tibia/cirugía , Trasplante Autólogo , Trasplantes/diagnóstico por imagen , Adulto Joven
12.
Arthrosc Tech ; 7(5): e547-e551, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-29868433

RESUMEN

The posterior oblique ligament (POL) is the main component of the posteromedial corner (PMC) of the knee and plays a crucial role in acting as a secondary restraint against translation, rotation, and valgus forces. Injuries to the PMC often occur in association with acute or chronic deficiency of the anterior cruciate ligament and may result in anteromedial rotatory instability. A surgical technique for treatment of acute and chronic injuries of the posteromedial structures was first established by Hughston in 1973. This procedure involves an advancement and reefing of the POL and adherent posterior capsule to the stout tissue of the intact medial collateral ligament, potentially using suture anchors if the POL tissue is detached from bone. Additionally, in cases of residual laxity, the semimembranosus tendon may be advanced anteriorly to improve dynamic stabilization. This procedure appears to be useful in cases of moderate posteromedial insufficiency and avoids retrieval of a medial tendon graft from the region of the medially stabilizing hamstrings or from the healthy contralateral side.

13.
Br J Sports Med ; 52(17): 1109-1115, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28446454

RESUMEN

BACKGROUND: Sport injury severity can be detected by duration of time loss and reduction of sporting performance. AIM: To detect injury type-specific time loss duration and sporting performance reduction in judo. METHODS: An online survey of active and former judo athletes was conducted (exclusion criterion: incomplete questionnaire). Only injuries causing more than 3 weeks' time loss were recorded. Athletes classified themselves into performance classes. Injury type-specific frequencies were recorded according to gender, age and performance level. Injury severity was assessed by time loss duration and performance reduction. RESULTS: The study included 4659 athletes (65% male, 38% competitive sports). The most commonly injured body regions were the upper extremity (41%) and the lower extremity (39%). Anterior cruciate ligament (ACL) ruptures were the most severe injury type (time loss: 4% of cases 3-6 weeks, 6% 6-12 weeks, 26% 3-6 months, 32% 6-9 months, 18% 9-12 months, 14%>12 months; performance reduction: 32% same level, 39% slightly reduced, 24% strongly reduced, 5% stopped judo). The second most severe type of injury was a vertebral disc prolapse (time loss: 26% 3-6 weeks, 31% 6-12 weeks, 20% 3-6 months, 7% 6-9 months, 3% 9-12 months 13%>12 months; reduction of sporting performance: 39% same level, 34% slightly reduced, 20% strongly reduced, 8% stopped judo). CONCLUSION: Across genders and performance levels, ACL ruptures and vertebral disc prolapses were the most severe injuries with respect to time loss and sporting performance reduction.


Asunto(s)
Traumatismos en Atletas/epidemiología , Artes Marciales/lesiones , Adolescente , Adulto , Lesiones del Ligamento Cruzado Anterior/epidemiología , Atletas , Rendimiento Atlético , Estudios Transversales , Femenino , Humanos , Desplazamiento del Disco Intervertebral/epidemiología , Traumatismos de la Rodilla/epidemiología , Masculino , Volver al Deporte , Lesiones del Hombro/epidemiología , Encuestas y Cuestionarios , Factores de Tiempo , Adulto Joven
14.
BMC Musculoskelet Disord ; 16: 200, 2015 Aug 19.
Artículo en Inglés | MEDLINE | ID: mdl-26285568

RESUMEN

BACKGROUND: Bone tunnel enlargement is a phenomenon present in all anterior cruciate ligament (ACL)- reconstruction techniques. It was hypothesized that press-fit fixation using a free autograft bone plug reduces the overall tunnel size in the tibial tunnel. METHODS: In a prospective cohort study twelve patients who underwent primary ACL reconstruction using an autologous quadriceps tendon graft and adding a free bone block for press-fit fixation (PF) in the tibial tunnel were matched to twelve patients who underwent ACL reconstruction with a hamstring graft and interference screw fixation (IF). The diameters of the bone tunnels were analysed by a multiplanar reconstruction technique (MPR) in a CT scan three months postoperatively. Manual and instrumental laxity (Lachman test, Pivot-shift test, Rolimeter) and functional outcome scores (International Knee Documentation Committee sore, Tegner activity level) were measured after one year follow up. RESULTS: In the PF group the mean bone tunnel diameter at the level of the joint entrance was not significantly enlarged. One and two centimeter distal to the bone tunnel diameter was reduced by 15% (p = .001). In the IF group the bone tunnel at the level of the joint entrance was enlarged by 14% (p = .001). One and two centimeter distal to the joint line the IF group showed a widening of the bone tunnel by 21% (p < .001) One and two centimeter below the joint line the bone tunnel was smaller in the PF group when compared to the IF group (p < .001). No significant difference for laxity test and functional outcome scores could be shown. CONCLUSION: This study demonstrates that press-fit fixation with free autologous bone plugs in the tibial tunnel results in significantly smaller diameter of the tibial tunnel compared to interference screw fixation.


Asunto(s)
Reconstrucción del Ligamento Cruzado Anterior/métodos , Ligamento Cruzado Anterior/diagnóstico por imagen , Trasplante Óseo/métodos , Fijadores Internos , Cuidados Posoperatorios/métodos , Tibia/trasplante , Adolescente , Adulto , Reconstrucción del Ligamento Cruzado Anterior/tendencias , Trasplante Óseo/tendencias , Estudios de Cohortes , Femenino , Humanos , Fijadores Internos/tendencias , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios/tendencias , Estudios Prospectivos , Factores de Tiempo , Tomografía Computarizada por Rayos X/tendencias , Trasplante Autólogo/métodos , Trasplante Autólogo/tendencias , Adulto Joven
15.
Knee Surg Sports Traumatol Arthrosc ; 23(4): 1107-12, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24562696

RESUMEN

PURPOSE: The quantification of posterior knee laxity is crucial in the evaluation of injuries to the posterior cruciate ligament (PCL) as it has important implications to the treatment for these injuries. The objective of this study was to compare the test results of stress radiography and instrumented drawer testing (Rolimeter) for the assessment of posterior knee laxity in patients with PCL injury. METHODS: In 45 patients with an injury to the PCL, lateral radiographs of both knees were obtained under anterior and posterior tibial load (150 N) using a standardized approach. Patients with injury of the ACL to either knee were excluded from the study. During the same clinic visit, an instrumented measurement of anterior-posterior knee laxity was performed at 90° of knee flexion by an experienced examiner using the Rolimeter device. The mean side-to-side differences (SSD) of both (radiographic and instrumented) measurements were compared to each other, and the correlation was calculated using the Pearson coefficient. RESULTS: The SSD (affected/healthy side) of posterior translation determined from the radiographs was 8.2 ± 3.2 mm, and the SSD of the instrumented measurement testing was 7.6 ± 3.2 mm. The mean difference between radiographic and Rolimeter test results was 1.8 ± 1.5 mm. The Pearson's correlation coefficient revealed a good correlation between both measurements of 0.74. CONCLUSIONS: It may be suggested by the results of this study that under the absence of an ACL injury and a fixed posterior drawer sign, the Rolimeter is a suitable tool to assess the posterior laxity of the knee in the clinical setting. Its advantages are the absence of radiation to the patient, its availability, and the low cost. Therefore, the Rolimeter device may serve as a valuable alternative to stress radiography in the evaluation of PCL-injured patients. LEVEL OF EVIDENCE: II.


Asunto(s)
Inestabilidad de la Articulación/diagnóstico por imagen , Traumatismos de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/diagnóstico por imagen , Ligamento Cruzado Posterior/lesiones , Rango del Movimiento Articular/fisiología , Estrés Mecánico , Adulto , Femenino , Humanos , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/fisiopatología , Traumatismos de la Rodilla/complicaciones , Traumatismos de la Rodilla/fisiopatología , Articulación de la Rodilla/fisiopatología , Masculino , Radiografía
16.
Clin Biomech (Bristol, Avon) ; 29(5): 512-7, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24815055

RESUMEN

BACKGROUND: Patients with a history of anterior cruciate ligament rupture are at elevated risk of developing knee osteoarthritis. Altered knee kinematics and kinetics during functional activities have been viewed as risk factors for cartilage breakdown and, therefore, one of the primary goals of anterior cruciate ligament reconstruction is to restore knee joint function. METHODS: Patients' (n=18) knee mechanics while performing a single leg hop for distance were calculated for both legs using a soft-tissue artifact optimized rigid lower-body model at the pre-reconstruction state and six and twelve months after anterior cruciate ligament reconstruction. FINDINGS: Independent of the analyzed time point the involved leg showed a lower external flexion and adduction moment at the knee, and an increased anterior translation and external rotational offset of the shank with respect to the thigh compared to the uninvolved leg. There were no differences for any of the analyzed knee kinematic and kinetic parameters within the control subject group. INTERPRETATION: The identified kinematic changes can cause a shift in the normal load-bearing regions of the knee and may support the view that the risk of developing knee osteoarthritis in an anterior cruciate ligament ruptured joint while performing activities involving frequent landing and stopping actions is less likely to be associated with the knee adduction moment and is rather due to kinematic changes. Anterior cruciate ligament reconstruction surgery failed to restore normal knee kinematics during landing, potentially explaining the persistent risk for the development of knee osteoarthritis in patients who have returned to sports following reconstruction surgery.


Asunto(s)
Reconstrucción del Ligamento Cruzado Anterior/rehabilitación , Ligamento Cruzado Anterior/fisiopatología , Articulación de la Rodilla/fisiopatología , Adulto , Fenómenos Biomecánicos/fisiología , Estudios de Casos y Controles , Femenino , Humanos , Rodilla/fisiopatología , Traumatismos de la Rodilla/fisiopatología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Movimiento , Rango del Movimiento Articular , Rotación , Rotura/fisiopatología , Muslo/fisiopatología , Soporte de Peso
17.
BMC Musculoskelet Disord ; 15: 100, 2014 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-24666711

RESUMEN

BACKGROUND: The purpose of this article was to evaluate the risks and benefits of non-operative treatment versus surgical excision of a fabella causing posterolateral knee pain. We performed a systematic review of literature and also present two case reports.Twelve publications were found in a PubMed literature review searching the word "fabella syndrome". Non-operative treatment and surgical excision of the fabella has been described. CASE PRESENTATION: Two patients presented to our outpatient clinic with persisting posterolateral knee pain. In both cases the presence of a fabella was identified, located in close proximity to the posterolateral femoral condyle. All other common causes of intra- and extra articular pathologies possibly causing the posterolateral knee pain were excluded.Following failure to respond to physiotherapy both patients underwent arthroscopy which excluded other possible causes for posterolateral knee pain. The decision was made to undertake surgical excision of the fabella in both cases without complication.Both patients were examined 6 month and one year after surgery with the Tegner activity score, the Visual Analogue Scale (VAS), and International Knee Documentation Committee Score (IKDC). CONCLUSION: Consistent posterolateral pain during exercise might indicate the presence of a fabella syndrome. Resecting the fabella can be indicated and is a minor surgical procedure with minimal risk. Despite good results in the literature posterolateral knee pain can persist and prevent return to a high level of sports. LEVEL OF EVIDENCE: IV, case reports and analysis of literature.


Asunto(s)
Artralgia/etiología , Rodilla/patología , Músculo Esquelético/patología , Huesos Sesamoideos/patología , Adolescente , Adulto , Anciano , Artralgia/cirugía , Artroscopía , Ejercicio Físico , Humanos , Rodilla/diagnóstico por imagen , Masculino , Músculo Esquelético/cirugía , Manejo del Dolor , Neuropatías Peroneas/etiología , Radiografía , Recuperación de la Función , Huesos Sesamoideos/diagnóstico por imagen , Huesos Sesamoideos/cirugía , Deportes , Síndrome
18.
Arch Orthop Trauma Surg ; 133(9): 1309-14, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-23836318

RESUMEN

INTRODUCTION: Interference screw fixation of soft tissue grafts has been a widely used fixation technique for cruciate ligament reconstruction. Suturing of the graft construct prior to graft fixation has been proposed to increase fixation strength; however, the effect on mechanical properties has not been well characterized. The goal of this study was to determine whether uniform suturing of the tendon graft affects (1) ultimate fixation strength of the hamstring tendon graft and (2) motion of the tendon in the bone tunnel during cyclic loading when comparing sutured grafts vs. unsutured grafts. METHOD: Eight pairs of matched mature porcine tibias (age <2 years) and eight paired fresh-frozen human quadrupled hamstring tendon grafts were used. One quadrupled graft from each pair was placed into one of two groups. In the group A a single cerclage suture 3 cm from the doubled end of the graft was placed to join the four tendon strands. In group B a heavy suture was used to tightly unite the four strands of tendon graft to provide a better grip for the interference screw during fixation. The grafts were placed in tibial bone tunnels that matched the graft's diameter and fixed with an interference screw. The looped end of the graft and the attached tibia were rigidly fixed in a material testing machine. The graft constructs were subjected to 100 cycles of 20-250 N load, followed by a load-to-failure test. In addition, a motion analysis system was used during cyclic testing to better determine the amount of elongation at the graft-tunnel interface. Statistical analysis of the failure load and stiffness and the overall elongation following cyclical loading was performed using the Wilcoxon rank sum test. Level of significance was set at p < 0.05. RESULTS: Elongation at the tendon-bone interface during sub-maximal cyclic loading was 2.4 ± 1.4 mm (unsutured) vs. 2.0 ± 0.7 mm (sutured) (p > 0.05). Failure load of the grafts without sutures (634 ± 86 N) was significantly lower than with the sutures (837 ± 183 N). Ultimate stiffness of group A (283 ± 34 N/mm) was lower than that of group B (331 ± 51 N/mm); however, this was not statistically significant (p = 0.051). CONCLUSION: This study confirms that suturing of the graft construct before interference screw fixation may increase ultimate failure load. However, an improvement of structural properties in response to cyclic loading with sub-maximal loads could not be confirmed. Clinicians using interference screw fixation may suture the graft to improve fixation strength; however, suturing does not appear to allow a more aggressive rehabilitation after surgery.


Asunto(s)
Suturas , Tendones/trasplante , Animales , Fenómenos Biomecánicos , Humanos , Técnicas In Vitro , Porcinos , Tendones/cirugía , Tibia
19.
Med Sci Sports Exerc ; 45(3): 506-13, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23034645

RESUMEN

PURPOSE: This longitudinal study aimed to examine whether patients with anterior cruciate ligament (ACL) reconstruction show a similar landing strategy during the single-leg hop test (SLHT) postsurgery analog to that previously identified when ACL deficient. It is hypothesized that ACL-reconstructed patients demonstrate greater trunk flexion to reduce knee joint moments at the cost of postural dynamic stability at their involved leg compared to their uninvolved leg. METHODS: Ten ACL-reconstructed patients performed a bilateral SLHT 6 and 12 months after surgery. Landing mechanics were determined by means of a soft tissue artifact optimized, rigid, full-body model, and the margin of stability was quantified using an inverted pendulum approach. Knee extensor muscular strength (KS) was assessed during isometric maximal voluntary knee extension contractions. RESULTS: ACL-reconstructed patients showed similar landing strategies as previously reported in their ACL-deficient state. By flexing their trunk, patients repositioned the ground reaction force vector more anteriorly in relation to the joints of the lower extremity (P < 0.05) and, in doing so, were able to transfer joint moments from the knee to the adjacent joints (P < 0.05). This upper body strategy reduced the margin of stability in the ACL-reconstructed leg during landing (P < 0.05). Twelve months after surgery, the ACL-reconstructed leg showed lower KS compared to the uninvolved leg (P < 0.05), and knee joint moment output during landing was significantly correlated to KS. CONCLUSIONS: The results highlight the important role of KS on the interaction between trunk angle, joint kinetics, and postural dynamic stability during landing and show that ACL-reconstructed patients use an analogous feedforward strategy (e.g., more flexed trunk) to that used in their ACL-deficient state, aiming to compensate for KS deficits and thereby sacrificing postural dynamic stability and increasing the risk of loss of balance during landing maneuvers.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Traumatismos de la Rodilla/fisiopatología , Rodilla/fisiopatología , Movimiento , Fuerza Muscular , Adulto , Reconstrucción del Ligamento Cruzado Anterior , Fenómenos Biomecánicos , Humanos , Traumatismos de la Rodilla/cirugía , Estudios Longitudinales , Músculo Esquelético/fisiología , Torso/fisiología , Soporte de Peso , Adulto Joven
20.
J Biomech ; 45(8): 1387-92, 2012 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-22440611

RESUMEN

The current study aimed to examine the effect of anterior cruciate ligament deficiency (ACLd) on joint kinetics and dynamic stability control after a single leg hop test (SLHT). Twelve unilateral ACLd patients and a control subject group (n=13) performed a SLHT over a given distance with both legs. The calculation of joint kinetics was done by means of a soft-tissue artifact optimized rigid full-body model. Margin of stability (MoS) was quantified by the difference between the base of support and the extrapolated center of mass. During landing, the ACLd leg showed lower external knee flexion moments but demonstrated higher moments at the ankle and hip compared to controls (p<0.05). The main reason for the joint moment redistribution in the ACLd leg was a more anterior position of the ground reaction force (GRF) vector, which affected the moment arms of the GRF acting about the joints (p<0.05). For the ACLd leg, trunk angle was more flexed over the entire landing phase compared to controls (p<0.05) and we found a significant correlation between moment arms at the knee joint and trunk angle (r² = 0.48;p<0.01). The consequence of this altered landing strategy in ACLd legs was a more anterior position of the center of mass reducing the MoS (p<0.05). The results illustrate the interaction between trunk angle, joint kinetics and dynamic stability during landing maneuvers and provide evidence of a feedforward adaptive adjustment in ACLd patients (i.e. more flexed trunk angle) aimed at reducing knee joint moments at the cost of dynamic stability control.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/fisiopatología , Marcha , Traumatismos de la Rodilla/fisiopatología , Articulación de la Rodilla/fisiopatología , Locomoción , Rango del Movimiento Articular , Adulto , Femenino , Humanos , Masculino , Análisis y Desempeño de Tareas , Torque
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