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1.
Arthroscopy ; 37(4): 1192-1193, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33812522

RESUMO

Although most reports in the literature suggest that the knee anterolateral structures contribute to the anterolateral rotational stability of the knee, the extent of its contribution is still controversial. There are many dynamic structures that also affect the stability of the knee joint, including the iliotibial band and quadriceps muscle. Although not all of the dynamic structures surrounding the knee influence stability associated with the anterior cruciate ligament, we recommend that cadaveric, biomechanical analysis of the knee anterolateral ligament and related structures include tensioning of all knee dynamic structures to avoid potential biases.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Instabilidade Articular , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Cadáver , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho/cirurgia , Amplitude de Movimento Articular
2.
Arthroscopy ; 37(4): 1221-1222, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33812525

RESUMO

The timing between anterior cruciate ligament (ACL) injury and surgical treatment may determine secondary injuries and abnormal laxity. Specifically, a knee without a functioning ACL is more at risk of a future episode of instability and the development of injuries to other joint structures. Ultimately, this may result in degenerative joint disease. Associated medial or lateral meniscus, cartilage or multiligamentous lesions indicate earlier ACL reconstruction. In particular, the possibility of an effective meniscus repair is a key indicator for early surgery. Patient selection is the key to success of ACL surgery, and it is deeply linked to surgical timing. Also, in the case of athletic patients, professional or otherwise, surgery must be as performed early to allow a rapid recovery of activity.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Instabilidade Articular , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho/cirurgia , Meniscos Tibiais/cirurgia
3.
Arthroscopy ; 37(4): 1233-1234, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33812526

RESUMO

Despite general agreement that tunnel widening ≥14 mm necessitates a 2-stage approach for revision anterior cruciate ligament (ACL) reconstruction, there is very little literature describing the effect of tunnel overlap between the previous tunnel and new tunnel with 1-stage ACL revisions. Tunnel overlap, particularly at the aperture, should be minimized without compromising anatomic tunnel location(s). This can often be accomplished with a 1-stage revision, but 2-stage revisions are sometimes required. Revision ACL reconstruction can be challenging and it is helpful for the surgeon to carefully plan preoperatively and have several options available to him/her intraoperatively, including the possibility of a 2-stage revision.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Feminino , Humanos , Masculino , Reoperação
4.
Arthroscopy ; 37(4): 1242-1244, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33812527

RESUMO

Preserving the native anterior cruciate ligament (ACL) through primary repair has seen a resurgence over the past few years-rightfully so-given the inherent advantages of repairing the ACL over reconstruction. The issue is how best to repair the ACL and protect it to optimize healing. Suture tape augmentation techniques have shown promising low failure rates, and recent biomechanical studies have demonstrated benefits of the suture tape and optimal fixation methods for ACL repair. So, I believe it is time for orthopaedic surgeons to strongly consider routine suture tape augmentation use for improved outcomes with primary ACL repair.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Seguimentos , Humanos , Suturas
5.
BMJ ; 372: n375, 2021 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-33687926

RESUMO

OBJECTIVE: To assess whether a clinically relevant difference exists in patients' perceptions of symptoms, knee function, and ability to participate in sports over a period of two years after rupture of the anterior cruciate ligament (ACL) between two commonly used treatment regimens. DESIGN: Open labelled, multicentre, parallel randomised controlled trial (COMPARE). SETTING: Six hospitals in the Netherlands, between May 2011 and April 2016. PARTICIPANTS: Patients aged 18 to 65 with an acute rupture of the ACL, recruited from six hospitals. Patients were evaluated at three, six, nine, 12, and 24 months. INTERVENTIONS: 85 patients were randomised to early ACL reconstruction and 82 to rehabilitation followed by optional delayed ACL reconstruction after a three month period (primary non-operative treatment). MAIN OUTCOMES: Patients' perceptions of symptoms, knee function, and ability to participate in sporting activities were assessed with the International Knee Documentation Committee score (optimum score 100) at each time point over 24 months. RESULTS: Between May 2011 and April 2016, 167 patients were enrolled in the study and randomised to one of two treatments (mean age 31.3; 67 (40.%) women), and 163 (98%) completed the trial. In the rehabilitation and optional delayed ACL reconstruction group, 41 (50%) patients underwent reconstruction during follow-up. After 24 months, the early ACL reconstruction group had a significantly better (P=0.026) but not clinically relevant International Knee Documentation Committee score (84.7 v 79.4 (difference between groups 5.3, 95% confidence interval 0.6 to 9.9). After three months of follow-up, the International Knee Documentation Committee score was significantly better (P=0.002) for the rehabilitation and optional delayed ACL reconstruction group (difference between groups -9.3, -14.6 to -4.0). After nine months of follow-up, the difference in the International Knee Documentation Committee score changed in favour of the early ACL reconstruction group. After 12 months, differences between the groups were smaller. In the early ACL reconstruction group, four re-ruptures and three ruptures of the contralateral ACL occurred during follow-up versus two re-ruptures and one rupture of the contralateral ACL in the rehabilitation and optional delayed ACL reconstruction group. CONCLUSIONS: In patients with acute rupture of the ACL, those who underwent early surgical reconstruction, compared with rehabilitation followed by elective surgical reconstruction, had improved perceptions of symptoms, knee function, and ability to participate in sports at the two year follow-up. This finding was significant (P=0.026) but the clinical importance is unclear. Interpretation of the results of the study should consider that 50% of the patients randomised to the rehabilitation group did not need surgical reconstruction. TRIAL REGISTRATION: Netherlands Trial Register NL 2618.


Assuntos
Lesões do Ligamento Cruzado Anterior/reabilitação , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Tratamento Conservador/métodos , Procedimentos Cirúrgicos Eletivos/métodos , Adolescente , Adulto , Idoso , Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Recuperação de Função Fisiológica , Volta ao Esporte , Tempo para o Tratamento , Resultado do Tratamento , Adulto Jovem
6.
Zhongguo Gu Shang ; 34(3): 269-74, 2021 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-33787174

RESUMO

OBJECTIVE: To compare the clinical outcomes of arthroscopic anterior cruciate ligament (ACL) reconstruction (ACLR) with a tibialis anterior allograft (TAA)versus hamstring tendon autograft (HTA) after 10 years follow-up. METHODS: A clinical data of 107 patients who underwent arthroscopic ACLR with a single bundle tendon between March 2007 and March 2010 was retrospectively analyzed. Among the patients, 48 patients were reconstructed with a tibialis anterior allograft (TAA group), including 26 males and 22 females, ranging in age from 16 to 38 years, with a mean of 27.2±6.2 years;59 patients were reconstructed with a hamstring tendon autograft (HTA group), including 31 males and 28 females, ranging in age from 16 to 40 years, with a mean of 28.0±7.6 years. The preoperative tibial anterior displacement and knee joint function, as well as knee joint stability, tibial anterior displacement and knee joint function at 10 years after operation were observed. Lachman test was used to evaluate the forward joint stability and pivot shift test to evaluate the rotational stability of the knee;KT-2000 side-to-side difference (SSD) was used to measure tibial anterior displacement;International Knee Documentation Committee(IKDC) score and Lysholm score were used to evaluate knee function. RESULTS: The incisions of both groups were healed by first intention, and no early complications occurred after operation. All patients were followed-up 10 to 13 years, the mean time was 11.7 years. There was no graft failure were found during the follow up period. The KT-2000 SSD of the TAA group and the HTA group at ten years after operation were 1.9±0.7 and 1.8±0.6 respectively, which were significantly improved than 8.8±0.9 and 8.6±1.0 preoperatively(P<0.05), but there were no significant difference between the two groups(P>0.05). The total Lysholm score of the TAA group and the HTA group at ten years after operation were 90.4±4.4 and 90.7±3.4 respectively, which were significantly improved than 51.4±13.3 and 51.2±14.6 preoperatively(P<0.05), but there were no significant difference between the two groups(P>0.05). The total IKDC score of the TAA group and the HTA group at ten years after operation were 91.5±4.1 and 90.9±3.2 respectively, which were significantly improved than 45.8±12.2 and 47.0±14.5 preoperatively(P<0.05), but there were no significant difference between the two groups(P>0.05). No significant difference were found between the two groups in Lachman test and pivot shift test at 10 years after operation (P>0.05). CONCLUSION: The TAA and HTA have equal long term effect in ACL reconstruction, doctors and patients can choose the graft according to the actual situation.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Tendões dos Músculos Isquiotibiais , Adolescente , Adulto , Aloenxertos , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Artroscopia , Autoenxertos , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
7.
Medicine (Baltimore) ; 100(11): e24846, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725956

RESUMO

ABSTRACT: This research discussed clinical outcomes of anterior cruciate ligament reconstruction accompanied by conservative treatment for grade 2 medial collateral ligament injury, and comparison was performed between double-bundle and single-bundle anterior cruciate ligament reconstruction.Clinical information was retrospectively collected for 41 cases suffering anterior cruciate ligament injuries accompanied by grade 2 medial collateral ligament injuries. Within 14 days after their injuries 22 cases received single-bundle anterior cruciate ligament reconstruction (SB group), while 19 were treated with double-bundle medial collateral ligament reconstruction (DB group). Physical statuses were estimated based on International Knee Documentation Committee (IKDC) and Lysholm scores, Lachman, pivot shift and manual valgus test, and range of motion (ROM), while side-to-side difference was estimated through KT 2000 arthometer.Anterior cruciate ligament reconstruction accompanied by conservative treatment showed significantly improved anteroposterior, rotational and valgus stability, and IKDC and Lysholm scores (in comparison to pre-operative status, P < .05). Incidence of pivot shift was dramatically lower in DB group (2/19) than in SB group (7/22 and 2/22; P = .028). No substantial dissimilarity existed between DB and SB groups either in Lachman and valgus tests, KT 2000, ROM, IKDC, or Lysholm scores.Anterior cruciate ligament reconstruction accompanied by conservative treatment could achieve outstanding stability and functional manifestations for cases facing anterior cruciate ligament injury accompanied by grade 2 medial collateral ligament injury. Moreover, double-bundle anterior cruciate ligament reconstruction is superior to single-bundle operation in treating rotational instability of the knee.Level of evidence: Retrospective comparative study, Level III.


Assuntos
Reconstrução do Ligamento Cruzado Anterior/métodos , Instabilidade Articular/cirurgia , Traumatismos do Joelho/cirurgia , Ligamento Colateral Médio do Joelho/lesões , Adolescente , Adulto , Feminino , Humanos , Instabilidade Articular/etiologia , Traumatismos do Joelho/complicações , Articulação do Joelho/fisiopatologia , Masculino , Ligamento Colateral Médio do Joelho/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
8.
Acta Chir Orthop Traumatol Cech ; 88(1): 39-44, 2021.
Artigo em Tcheco | MEDLINE | ID: mdl-33764866

RESUMO

PURPOSE OF THE STUDY Knee injuries accompanied by anterior cruciate ligament (ACL) tears can also result in rotational instability of the joint. Subsequent insufficient rotational stability after the ACL reconstruction can be a direct consequence also of injuries to lateral knee structures, specifically the anterolateral ligament (ALL). This residual postoperative rotational instability may be prevented by multiple surgical techniques. The purpose of this study was (1) to evaluate the knee stability in internal rotation after the "anatomical" single-bundle (SB) anterior cruciate ligament reconstruction together with ALL reconstruction compared to the double-bundle (DB) ACL reconstruction two years after surgery; (2) to compare the knee joint stability after the ACL and ALL reconstruction with the healthy contralateral knee joint. MATERIAL AND METHODS All the measurements were conducted by the computer navigation system. The study included 20 patients after the single-bundle ACL and ALL reconstruction and 20 patients after the double-bundle ACL reconstruction. The follow-up examination was carried out at 25 months after surgery on average (24 months at least). All measurements were performed in both the healthy and operated knee. Once the data necessary for navigation were determined, the patient remained in standing position with both feet firmly placed on the mat with intermalleolar distance of 20 cm. Then, at 30-degree flexion of the knee joints, the patient first performed the joint internal rotation by trunk torsion, followed by external rotation. Each measurement was repeated 3 times. A non-parametric t-test was used for statistical processing. RESULTS The mean internal rotation in the injured knee joint was 19.1 degrees preoperatively and 8.1 degrees postoperatively, while in the healthy knee it was 8.4 degrees. External rotation was not assessed. The reported internal rotation in the knees after DB ACL reconstruction was 9.2 degrees (p ≥ 0.05). DISCUSSION The double-bundle ACL reconstruction is a complex technique that can lead to many intraoperative and postoperative complications. Grafts harvested from both hamstrings can have an effect on the rotational stability of the joint. In order to restore the knee rotational stability with fewer potential complications, the method of choice can be the ACL reconstruction using the quadriceps femoris muscle graft and the ALL reconstruction using the gracilis muscle graft, leaving the semitendinosus tendon intact. CONCLUSIONS The obtained values reveal that the single-bundle ACL reconstruction in combination with ALL reconstruction results in the same internal rotational stability in the knee joint as the double-bundle ACL reconstruction. Similar joint rotational stability is observed in all the knee joints reconstructed with the use of these techniques and in the contralateral healthy knee joint. Key words: anterolateral ligament, anterior cruciate ligament, internal rotational stability, objective measurement.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Instabilidade Articular , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Cadáver , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Articulação do Joelho/cirurgia , Amplitude de Movimento Articular
9.
Acta Chir Orthop Traumatol Cech ; 88(1): 58-62, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33764869

RESUMO

PURPOSE OF THE STUDY To compare the early clinical results of patients who had anterior cruciate ligament (ACL) reconstruction with peroneus longus allograft versus hamstring tendon autograft. MATERIAL AND METHODS Forty patients who underwent ACL reconstruction were included in the study. Patients were grouped by their graft preference. Lachman and Pivot-shift tests were performed to the patients. Laxity was measured by KT-1000 arthrometer test with 15, 20 and 30 pound power. The maximum force values of nonoperated knee and the operated knee were recorded with Cybex II isokinetic dynamometer (HUMAC) and compared to each other. International Knee Documentation Committee (IKDC) form, modified Lysholm and Cincinnati evaluation forms were compared between two groups. RESULTS Twenty patients included into peroneus longus allograft (Group 1) and 20 patients were included into hamstring autograft group (Group 2). The mean age of patients Group 1 and 2 were 34.25 ± 6.73, and 29.6 ± 4.55, respectively. No significant difference was noted between two groups at modified Lysholm, Cincinati and IKDC scores (p > 0.01). There was no statistically significant difference between the Lachman and Pivot hift levels (p > 0.01). No significant difference was found in KT-1000 device measurements between groups according to the performed techniques (p > 0.01). There was no statistically significant difference between Cybex extension-flexion 60 /sec measurement and extension 240 /sec measurement of the patients (p > 0.01). DISCUSSION Allografts can be preferred because of the advantages, such as lack of donor site morbidity, short operative time, large graft, small incision, minimal scar, good cosmetic appearance, less postoperative pain, less movement restriction, and less arthrofibrosis. However, there are disadvantages, such as disease transmission, low biocompatibility, immune response, long recovery time, and high cost. Although it is difficult to compare the stability and functionality of allografts and autografts because of the differences in graft processing, fixation methods, and surgical techniques in studies, similar clinical results are reported in long-term follow-ups CONCLUSIONS Graft preference is dependent on surgical experience, patient age, activity status, comorbidities, presurgical status, and patient decision. Allograft ACL reconstruction is a good alternative to arthroscopic ACL reconstruction performed with hamstring tendon graft. Key words: anterior cruciate ligament, peroneus longus allograft, hamstring autograft, ACL reconstruction.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Tendões dos Músculos Isquiotibiais , Aloenxertos , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Articulação do Joelho/cirurgia , Transplante Autólogo , Resultado do Tratamento
10.
Arthroscopy ; 37(3): 1053-1054, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33673959

RESUMO

Many different autografts are available for anterior cruciate ligament reconstruction. Although patellar tendon graft and hamstrings are most commonly used, quadriceps tendon with or without a bone plug is gaining popularity. Preliminary evidence suggests that quad tendon without a bone plug performs at least as well as with a plug, although more comparative information is needed. In the meantime, surgeons should strive to gain experience with multiple anterior cruciate ligament grafts.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Autoenxertos , Humanos , Tendões , Transplante Autólogo
13.
Arthroscopy ; 37(3): 961-963, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33673974

RESUMO

An increasing number of surgeons adopt the concept of vancomycin soaking of the graft in anterior cruciate ligament reconstruction and report drastically reduced numbers of postoperative septic knee arthritis. This reduction of incidence is supported by in vitro data, showing no influence of vancomycin on tendon material properties. Although the applied antibiotic concentration has reported to be potent in eradicating graft contamination, no evidence of chondrotoxicity has been shown. Based on the increasing evidence, the call for randomized controlled trials stands in ethical contrast with the medical responsibility not to withhold patients an infection prophylaxis that has already been proven to be safe and effective.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Artrite Infecciosa , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/prevenção & controle , Artrite Infecciosa/cirurgia , Fenômenos Biomecânicos , Humanos , Padrões de Referência , Vancomicina
14.
Arthroscopy ; 37(3): 985-988, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33673976

RESUMO

Magnetic resonance imaging of the torn anterior lateral ligament (ALL) is inconsistent and subject to significant intra- and interobserver variability. Like that of an anterior cruciate ligament (ACL), an ALL tear can vary in degree (first, second, or third) and location (tibial or femoral side). These variations may impact the appropriate surgical intervention. Relevant biomechanical data indicate that the deep iliotibial band fibers are more important than the ALL in controlling pivot shift. Lateral compartment overconstraint after ALL reconstruction does not appear to be a biomechanical or clinical issue. An ALL reconstruction creates a nonisometric construct (tight in extension and lax in flexion), allowing physiologic internal tibial rotation at 90° flexion, whereas lateral extra-articular tenodesis (LET) is more isometric, limiting physiologic internal tibial rotation at 90° flexion. The indications for a combined ACL/ALL reconstruction are evolving, but a Segond fracture and ligamentous hyperlaxity of ≥5 using the modified Beighton system seem reasonable. An ACL/LET reconstruction results in better stability for patients with high-grade pivot shifts.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Instabilidade Articular , Tenodese , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Cadáver , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho/cirurgia , Estudos Retrospectivos , Rotação
15.
Medicine (Baltimore) ; 100(8): e24936, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663131

RESUMO

BACKGROUND: Anterior cruciate ligament reconstruction (ACLR) is the primary treatment for patients with anterior cruciate ligament (ACL) injury. Successful postoperative rehabilitation is imperative for their recovery. This protocol details the methods that will be used to systematically analyze the efficacy of acupuncture and herbal medicine for postoperative care following ACLR. METHODS AND ANALYSIS: Randomized controlled trials will be searched in the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDLINE/PubMed, Chinese National Knowledge Infrastructure, Japan Medical Abstracts Society, and 7 Korean databases (Oriental Medicine Advanced Searching Integrated System, Korean National Assembly Digital Library, Korean Association of Medical Journal Editors, Korean Studies Information Service System, Korean Traditional Knowledge Portal, National Digital Science Library, and Database Periodical Information Academic). The risk of bias will be assessed using the Cochrane assessment tool of risk of bias. The studies that are selected after checking for eligibility will be quantitatively analyzed as a meta-analysis. The primary outcome will be the scores of pain scales, and the secondary outcomes will be the range of motion of the knee, severity of the swelling, and parameters about the knee joint function. ETHICS AND DISSEMINATION: Ethical approval is not required for this protocol because it does not include patient data. The findings of this review will be disseminated through peer-reviewed publications or conference presentations. REGISTRATION NUMBER: DOI 10.17605/OSF.IO/ZY2W8 (https://osf.io/zy2w8).


Assuntos
Terapia por Acupuntura/métodos , Reconstrução do Ligamento Cruzado Anterior/reabilitação , Medicamentos de Ervas Chinesas/uso terapêutico , Humanos , Metanálise como Assunto , Cuidados Pós-Operatórios/métodos , Revisões Sistemáticas como Assunto
16.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(3): 330-336, 2021 Mar 15.
Artigo em Chinês | MEDLINE | ID: mdl-33719242

RESUMO

Objective: To investigate the effectiveness of double-bundle anterior cruciate ligament (ACL) reconstruction combined with anterolateral ligament (ALL) reconstruction in the treatment of revision patients with ACL graft failure. Methods: Between January 2018 and June 2019, 15 patients underwent ACL revision with double-bundle ACL reconstruction combined with ALL reconstruction. There were 12 males and 3 females with an average age of 30.1 years (range, 17-49 years). The technique of primary ACL reconstruction included single-bundle reconstruction in 13 cases and double-bundle reconstruction in 2 cases. These reconstructions applied autografts in 14 cases and allograft in 1 case. The causes of ACL reconstruction failure were identified as traumatic rupture in 9 cases and non-traumatic failure in 6 cases, including 2 cases of graft absorption and 3 cases of graft laxity. The average time from the primary ACL reconstruction to revision was 28.5 months (range, 8-60 months). The subjective and objective indicators of knee joint function were compared before operation and at last follow-up to evaluate the effectiveness. The subjective indicators included International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner score. The objective indicators included anterior tibial translation (dynamic and static) and side-to-side difference (SSD), pivot-shift test, Lachman test, the difference of single-legged hop test, and the loss ratio of extensor muscle strength on the affected side. Results: All incisions healed by first intetion, and no complications such as infection, venous thrombosis of lower extremity, or neurovascular injury occurred. All patients were followed up for an average of 19.1 months (range, 12-30 months). At last follow-up, all patients had returned to pre-injury sports level. The IKDC score, Lysholm score, and Tegner score were significantly improved ( P<0.05); anterior tibial translations (dynamic and static) significantly decreased when compared with preoperative one ( P<0.05) and returned to the physiological range. The SSD, Lachman test, pivot-shift test, the difference of single-legged hop test, and the loss ratio of extensor muscle strength on the affected side were significantly better than those before operation ( P<0.05).During the follow-up, there was no re-rupture of the graft, no stiffness of the knee joint and limitation of mobility; 1 case had a protruding femoral end compression screw, which was removed through the original incision under local anesthesia. Conclusion: Double-bundle ACL reconstruction combined with ALL reconstruction can significantly improve the knee function in revision patients with ACL graft failure. It can reduce the anterior translation of tibia, and effectively prevent postoperative rotational instability of the knee.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Adolescente , Adulto , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Tíbia/cirurgia , Resultado do Tratamento , Adulto Jovem
17.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(3): 337-342, 2021 Mar 15.
Artigo em Chinês | MEDLINE | ID: mdl-33719243

RESUMO

Objective: To investigate the effectiveness of partial anterior cruciate ligament (ACL) suture repair with wide awake local anesthesia no tourniquet (WALANT) technique. Methods: Between July 2017 and July 2019, 18 patients with partial ACL injury were admitted. There were 10 males and 8 females, with an average age of 40.5 years (range, 22-57 years). There were 5 cases on the left knee and 13 cases on the right knee. Forteen cases had a clear history of trauma or sports injury, and 4 cases had no obvious cause. The time from injury to operation was 1-6 months (median, 3 months). Partial ligament was sutured using WALANT technique under arthroscopy. The operation time, total hospital stay, and postoperative hospital stay were recorded. Lachman test and anterior drawer test were performed to evaluate the knee joint stability after treatment, and Lysholm and International Knee Documentation Committee (IKDC) scores were used to evaluate the knee function. Five-point Likert scaling were used to evaluate postoperative patient satisfaction. Results: The operation time was 30-100 minutes (mean, 64.2 minutes). The total hospital stay was 2-12 days (mean, 4.5 days). Postoperative hospital stay was 1-4 days (mean, 1.8 days). All incisions healed by first intention after operation, and no surgery-related complications occurred. All patients were followed up 12-36 months (mean, 19.1 months). Lachman test and anterior drawer test were negative after operation. Lysholm score and IKDC score at 6 and 12 months after operation were significantly higher than those before operation, and at 12 months after operation were higher than those at 6 months after operation, the differences were significant ( P<0.05). At last follow-up, according to five-point Likert scaling of patient satisfaction, 7 cases were very satisfied, 10 cases were relatively satisfied, and 1 case was general. The total patient satisfaction rate was 94.4% (17/18). MRI scan showed the good ligament tension. Conclusion: Using WALANT technique to repair partial ACL injuries under arthroscopy can retain the patient's own ligament tissue to the maximum extent and achieve satisfactory short-term effectiveness.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Adulto , Anestesia Local , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Artroscopia , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Suturas , Resultado do Tratamento , Adulto Jovem
18.
Phys Ther Sport ; 48: 209-218, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33529930

RESUMO

BACKGROUND: Anterior cruciate ligament (ACL) reconstruction has a detrimental impact on athletic performance. Despite rehabilitation guidelines and criterion-based progressions to ensure safe restoration of fundamental physical capacities and maladaptive movement strategies, residual deficits in maximal strength, rate of force development (RFD), power and reactive strength are commonly reported. These combined with associated compensatory inter and intra-limb strategies increase the risk of re-injury. OBJECTIVE: The aim of this article is to examine the relationships between fundamental physical capacities and biomechanical variables during dynamic movement tasks. DESIGN: Narrative review. RESULTS: The available data suggests that quadriceps strength and rate of torque development, explain a moderate portion of the variance in aberrant kinetic and kinematic strategies commonly detected in ACL reconstructed cohorts in the later stages of rehabilitation and RTS CONCLUSION: The available data suggests that quadriceps strength and rate of torque development, explain a moderate portion of the variance in aberrant kinetic and kinematic strategies commonly detected in ACL reconstructed cohorts in the later stages of rehabilitation and RTS.


Assuntos
Lesões do Ligamento Cruzado Anterior/fisiopatologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/reabilitação , Traumatismos em Atletas/fisiopatologia , Traumatismos em Atletas/cirurgia , Força Muscular , Músculo Quadríceps/fisiologia , Fenômenos Biomecânicos , Humanos , Movimento , Volta ao Esporte , Torque
19.
J Rehabil Med ; 53(2): jrm00153, 2021 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-33569607

RESUMO

OBJECTIVE: Recovery of the quadriceps femoris muscle after anterior ligament reconstruction is im-paired. The aim of this study was to investigate satellite cell content and function of the vastus lateralis muscle after anterior ligament reconstruction. METHODS: Biopsies were obtained from the vastus lateralis muscle of 16 recreational athletes immediately before and again 12 weeks after anterior ligament reconstruction. Total satellite cell number (Pax7+), activated (Pax7+/MyoD+), differentiating (Pax7-/MyoD+), and apoptotic (Pax7+/TUNEL+) satellite cells, myofibers expressing myosin heavy chain (MHC) I and II, and neonatal MHC (MHCneo) were determined immunohistochemically. RESULTS: After anterior ligament reconstruction, the number of apoptotic satellite cells was significantly (p = 0.019) increased, concomitant with a significant (p < 0.001) decrease in total satellite cell number, with no change in activated and differentiating satellite cell number. MHCneo+ myofibers tended towards an increase. CONCLUSION: Satellite cell apoptosis and the reduction in the satellite cell pool might provide an explanation for prolonged quadriceps muscle atrophy after anterior ligament reconstruction.


Assuntos
Reconstrução do Ligamento Cruzado Anterior/métodos , Músculo Quadríceps/fisiopatologia , Células Satélites de Músculo Esquelético/fisiologia , Adulto , Apoptose , Feminino , Humanos , Masculino , Atrofia Muscular , Voluntários
20.
Am J Sports Med ; 49(2): 374-383, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33523751

RESUMO

BACKGROUND: Long-term patient-reported outcome measures (PROMs) and predictors of success or failure after anterior cruciate ligament (ACL) reconstruction are not fully understood, especially when combined with a lateral extra-articular reconstruction. PURPOSE: To assess the long-term PROMs, revision rate, and predictors of success or failure after ACL reconstructions using an over-the-top surgical technique with single-bundle hamstring tendon autografts and a lateral extra-articular reconstruction. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The study cohort consisted of 267 consecutive patients (mean age, 30.7 years) who underwent ACL reconstruction with an over-the-top surgical technique with single-bundle hamstring tendon autografts and a lateral extra-articular augmentation between November 2007 and May 2009. The number of subsequent ACL revisions and reoperations were recorded. Subjective clinical status was assessed with PROMs-specifically, the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, Tegner, and visual analog scale for pain-at a minimum follow-up of 10 years. RESULTS: Overall, 3% of patients underwent ACL revision, with a 10-year survival rate of 96.3%. High sport activity (hazard ratio, 6.9; P = .285) and concomitant meniscal lesion (hazard ratio, 2.6; P = .0487) were predictors of ACL revision or new meniscectomy. The mean ± SD Lysholm score was 94.1 ± 10.8, while that for the visual analog scale for pain was 0.2 ± 0.9 at rest and 2.1 ± 2.6 during activity. KOOS subscale scores were as follows: 95.7 ± 8.1 for Pain, 92.5 ± 10.5 for Symptoms, 98.4 ± 7.4 for Activities of Daily Living, 90.7 ± 17.2 for Sport, and 91.2 ± 17.1 for Quality of Life; respectively, 88%, 99%, 81%, 89%, and 91% of patients achieved the Patient Acceptable Symptom State. Female sex and chondropathy with Outerbridge grade ≥2 were predictors of worse KOOS subscales. Overall, 82% of patients returned to sport, and 57% were still participating at the 10-year evaluation. CONCLUSION: ACL reconstruction with an over-the-top surgical technique with single-bundle hamstring autografts and a lateral extra-articular reconstruction provided satisfactory results in terms of function, symptoms, sports, and quality of life in 80% to 90% of patients after 10 years. Long-term survivorship was 96%. Sport participation declined from 82% postoperatively to 57% at long-term follow-up. A concomitant medial meniscal lesion was a predictor of higher risk of ACL failure or new meniscal lesion, while advanced chondropathy and female sex were predictors of higher pain, lower function, and poor quality of life scores.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior/métodos , Tendões dos Músculos Isquiotibiais/transplante , Atividades Cotidianas , Adulto , Lesões do Ligamento Cruzado Anterior/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Medição da Dor , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Sobrevivência
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