Lesiones del ligamento cruzado anterior en esquiadores: conceptos actuales / Anterior cruciate ligament injuries in skiers: current concepts

El esquí es un deporte individual con una tasa de lesiones de 1,84 por 1.000 días esquiador en la población general. Las roturas del ligamento cruzado anterior (LCA) son algunas de las más comunes, llegando a una tasa de 5 por cada 100 esquiadores por temporada a nivel competitivo, debido a la gran exigencia a la que se encuentran sometidas las rodillas. Lo anterior presenta un desafío para el traumatólogo a la hora de plantear un manejo. Se realizó una revisión de la literatura respecto de los mecanismos de lesión, tratamiento, prevención, rehabilitación y uso de órtesis en el retorno deportivo. Se describen los mecanismos clásicos de lesión en esquiadores amateurs y competitivos. La mayoría de las lesiones de LCA son de resolución quirúrgica, en que la recomendación de reconstrucción debe ser con injerto autólogo de hueso-tendón patelar-hueso, salvo en los pacientes mayores o en pacientes con fisis abierta, en los que se recomienda el uso de injerto autólogo de semitendinoso-gracilis. La prevención y rehabilitación se basan en mejorar la fuerza y el control neuromuscular de los estabilizadores dinámicos de la rodilla implementándose programas específicos, evaluación del gesto deportivo, y pruebas de control neuromuscular. Se recomienda el uso de órtesis funcionales adecuadas en los pacientes sometidos a reconstrucción del LCA. Las lesiones de LCA en esquiadores de nivel competitivo son habituales, de manejo específico y multidisciplinario. La elección del injerto y del tipo de rehabilitación son fundamentales en el retorno deportivo del esquiador. NIVEL DE EVIDENCIA: V.

Skiing is an individual sport with an injury rate of 1.84 per 1,000 skier days among the general population. Anterior cruciate ligament (ACL) tears are among the most common injuries in skiers, with a rate of 5 per 100 skiers per season at a competitive level, because of the great demand placed on the knees. Their treatment is a challenge for orthopedic surgeons. A review of the literature was carried out regarding injury mechanisms, treatment, prevention, rehabilitation, and the use of bracing in the return to sports. The classic injury mechanisms in amateur and competitive skiers are described. Most ACL injuries require surgical resolution, with reconstruction using autologous bone-patellar tendon-bone graft, except in older patients or those with open physis, who must receive an autologous semitendinosusgracilis graft. Prevention and rehabilitation are based on improving strength and neuromuscular control of the dynamic knee stabilizers, implementing specific programs, evaluating the sport movements, and performing neuromuscular control tests. Suitable functional bracings are recommended in patients undergoing ACL reconstruction. ACL injuries in competitive-level skiers are common, and their management is specific and multidisciplinary. The choice of graft and rehabilitation type is critical to resume skiing. LEVEL OF EVIDENCE: V.

Estudio histopatológico en rotura aguda del ligamento cruzado anterior de rodilla / Histopathological study in acute rupture of the anterior cruciate ligament of the knee

Introducción: la estructura histológica de los ligamentos, inclusive el ligamento cruzado anterior, está compuesta por colágeno y elastina envueltos en una matriz de agua y proteoglicanos. El colágeno es el componente principal de los tendones y ligamentos, representa el 65-75% de su peso en seco. El objetivo de este estudio es realizar una evaluación histopatológica de los fragmentos de ligamento cruzado anterior rotos, tomados en el momento de la cirugía artroscópica.Materiales y Métodos: Estudio prospectivo observacional sobre 50 casos con rotura de ligamento cruzado anterior. Se tomaron muestras de ligamento cruzado anterior en el procedimiento artroscópico y se evaluó la histopatología del ligamento. Resultados: Se mencionan los resultados de la anatomía patológica y la evolución posoperatoria. Conclusión: Se observaron cambios degenerativos en la histopatología; no puede demostrarse si estos cambios son anteriores o posteriores a la rotura ligamentaria.

Introduction: histological structure of ligaments, including the anterior cruciate ligament, is composed of collagen and elastin wrapped in a matrix of water and proteoglycans. Collagen is the main component of tendons and ligaments, accounting for 65-75% of its dry weight. The aim of the present study is to perform a histopathological evaluation of the ruptured anterior cruciate ligament fragments taken at the time of surgical procedure by arthroscopy.Methods: A prospective observational study of 50 cases with anterior cruciate ligament rupture. Anterior cruciate ligament samples were taken in an arthroscopic procedure and histopathology of the ligament was evaluated.Results: Pathology results and post-operative evolution are mentioned.Conclusion: Degenerative changes were observed in the histopathology exam; it cannot be demonstrated if these changes are previous or posterior to ligament rupture.

Influencia de la reconstrucción del ligamento cruzado anterior sobre la calidad de vida, nivel de confianza y retorno al deporte: un seguimiento de 15 años / Influence of anterior cruciate ligament reconstruction on quality of life, level of confidence and return to sports: a follow-up of 15 years

Antecedentes: la articulación de la rodilla es una de las más afectadas y lesionadas, siendo la lesión del ligamento cruzado anterior (ACL) la más frecuente entre ellas, alcanzando aproximadamente el 79% de todas las lesiones de rodilla. Esta lesión, cuando involucra atletas, causa compromisos físicos, fisiológicos y especialmente psicológicos, considerando la alta tasa de incidencia o lesión contralateral después de regresar al deporte. Este compromiso a veces aleja al atleta del deporte, o disminuye su rendimiento. Toda esta limitación o deterioro afecta directamente la calidad de vida de los atletas. Caso clínico: en el presente estudio se realizó seguimiento de una atleta femenina de balonmano durante 15 años, que fue sometida a 3 reconstrucciones del LCA, para evaluar el deterioro físico, funcional y psicológico que estas cirugías causaron a lo largo de los años. Con-clusión: se comprobó que el paciente se alejó por completo de las actividades posteriores a las cirugías, además de haber desarrollado un severo proceso de artrosis como consecuencia de un importante déficit muscular.

Background information: the knee joint is one of the most affected and injured joints in the body, with the Anterior Cruciate Ligament (ACL) injury being the most common (about 79%). Howe-ver, when this injury involves athletes, not only does it cause physical damage, but physiological and, particularly, psychological as well, as it has a high recurrence rate or provokes a contralateral injury after returning to sports. This damage sometimes steers the athlete away from sports al-together, or performance decreases. Hence, these limitations or impairments directly affect the athletesÍ´ quality of life. Case report: in this study, monitoring or a follow up of a female handball athlete who had to undergo three reconstructions of the ACL was carried for 15 years in order to evaluate the physical, functional and psychological impairment that these surgeries caused over the years. Conclusion: it can be verified that the patient completely steered away from sports activities after the surgeries and developed a severe arthrosis process as a consequence of serious muscular deficit.

Evaluation of static and dynamic balance in athletes with anterior cruciate ligament injury – A controlled study

OBJECTIVES: Anterior cruciate ligament injury leads to adaptive responses to maintain postural control. However, there is no consensus regarding whether leg dominance also affects postural control in athletes with anterior cruciate ligament injury. The purpose of this study was to evaluate dynamic and static postural control among athletes with and without anterior cruciate ligament injury to the dominant leg. METHODS: Twenty-eight athletes, twenty-one males and seven females aged 15-45 years, were allocated to one of two groups: the anterior cruciate ligament injury group (26±3 years) or the control group without anterior cruciate ligament injury (25±6.5 years). All subjects performed one legged stance tests under eyes open and eyes closed conditions and squat and kick movement tests using a postural control protocol (AccuSwayPlus force platform, Massachusetts). The center of pressure displacement and speed were measured by the force platform. In addition, the distance traveled on the single-leg hop test was assessed as an objective measure of function. RESULTS: Significantly greater mediolateral sway was found under the eyes closed condition (p=0.04) and during squat movement (p=0.01) in the anterior cruciate ligament injury group than in the control group. Analysis of the single-leg hop test results showed no difference between the groups (p=0.73). CONCLUSION: Athletes with anterior cruciate ligament injury had greater mediolateral displacement of the center of pressure toward the dominant leg under the eyes closed condition and during squat movement compared to control athletes.

A conceptual framework for a sports knee injury performance profile (SKIPP) and return to activity criteria (RTAC)

ABSTRACTInjuries to the knee, including intra-articular fractures, ligamentous ruptures, and meniscal and articular cartilage lesions, are commonplace within sports. Despite advancements in surgical techniques and enhanced rehabilitation, athletes returning to cutting, pivoting, and jumping sports after a knee injury are at greater risk of sustaining a second injury. The clinical utility of objective criteria presents a decision-making challenge to ensure athletes are fully rehabilitated and safe to return to sport. A system centered on specific indicators that can be used to develop a comprehensive profile to monitor rehabilitation progression and to establish return to activity criteria is recommended to clear athletes to begin a progressive and systematic approach to activities and sports. Integration of a sports knee injury performance profile with return to activity criteria can guide clinicians in facilitating an athlete's safe return to sport, prevention of subsequent injury, and life-long knee joint health.