A new instrument for measuring self-efficacy in patients with an anterior cruciate ligament injury

It has been suggested that self-efficacy belief is of major importance for rehabilitation outcome after sports-related injuries. No instruments are, however, available to evaluate perceived self-efficacy for prognostic and outcome expectations in patients with an anterior cruciate ligament (ACL) injury. Perceived self-efficacy is defined as a judgment of one's potential ability to carry out a task, rather than a measure of whether or not one actually can or does perform the task. The purpose of this study was to develop a reliable and valid instrument for measuring perceived self-efficacy in patients with an ACL injury. A total of 210 male and female patients with an ACL injury were included in this study. The items were generated by health professionals with long clinical experience of patients with an ACL injury and by discussions with patients. After item analysis and item reduction, based on the results from 88 patients, the final 22-item version of the Knee Self-Efficacy Scale (K-SES) was evaluated in 18 patients for test-retest reliability and in 104 patients for internal consistency and validity. The K-SES was compared with the Multidimensional Health Locus of Control (MHLC), Coping Strategies Questionnaire (CSQ), SF-36 and Knee Injury and Osteoarthritis Outcome Score (KOOS) instruments. A factor analysis was also performed on the K-SES. The test-retest revealed a correlation of r(s)=0.73 between test-days and an intraclass correlation coefficient of 0.75. No significant difference between test-days was found. The internal consistency was 0.94, as calculated with Cronbach's alpha. There were low correlations between the K-SES and MHLC and the K-SES and CSQ, respectively. A strong correlation was found between the K-SES and physical functioning, as measured by the SF-36 (r(s)=0.8). All the sub-scales in the KOOS correlated moderately to strongly (r(s)=0.4-0.7) to the K-SES. The factor analysis produced two factors of importance. Factor one was related to how patients perceived their present physical performance/function, while factor two was related to how patients perceived the future physical performance/prognosis of their knee. Good reliability and good face, content, construct and convergent validity were demonstrated for this new instrument (K-SES) for measuring perceived self-efficacy in patients with an ACL injury. The K-SES is recommended for studies designed to evaluate prognostic and outcome expectations of perceived self-efficacy in patients with an ACL-insufficient knee.     

Factors affecting outcome after anterior cruciate ligament injury: a prospective study with a six-year follow-up

The aim of this study was to investigate whether gender, age, stable personality traits, associated meniscus and/or articular cartilage injuries, treatment (non-operative or reconstructive surgery), additional subsequent trauma to the anterior cruciate ligament (ACL)-injured knee and activity level before injury affect the intermediate outcome after ACL injury. The primary outcome was the Knee injury and Osteoarthritis Outcome Score (KOOS). Fifty-seven patients, 18-50 years old with an acute, unilateral ACL tear were included in the study. At the time of inclusion, the patients completed the Tegner score, regarding activity level before injury, and Swedish universities Scales of Personality (SSP). At follow-up, after 5.6 years they completed the KOOS, the Tegner score and a general questionnaire concerning ACL reconstruction and subsequent knee trauma. The subjects who had sustained additional trauma subsequent to their ACL injury had a significantly worse outcome according to the KOOS than those who had not. Furthermore, low ratings in the embitterment scale in the SSP were correlated to a better outcome in the KOOS. Treatment did not affect the KOOS total score. However, the non-operatively treated subjects had a significantly better outcome according to the knee-related quality-of-life domain in the KOOS.     

Outcome of patients with anterior cruciate ligament injuries selected for conservative treatment

In this retrospective study, 24 patients with acute isolated complete anterior cruciate ligament (ACL) ruptures selected for conservative treatment were re-examined a median of 45 months after injury. Selection for conservative treatment was made after careful patient information, taking into consideration desire for physical activity at work or leisure, interest in sports and muscular fitness. The reference group for the evaluation methods used included 50 students and 22 patients selected for surgical augmentation and reconstruction. In a subjective evaluation, the conservatively treated patients were satisfied, but objectively they had low functional scores and the pivot shift sign was often positive. Arthrometry showed that these patients had an increased anterior displacement of the tibia in relation to the femur in their injured knees. The patients who had a clearly positive pivot shift sign (grades III and IV) had an increased anterior laxity not only in the injured knees but also in the uninjured knees.     

急性膝前交叉韧带损伤的关节镜治疗临床研究

目的探讨利用膝关节镜技术早期重建前交叉韧带的临床效果。方法本组自2010年3月~2012年3月应用关节镜治疗急性前交叉韧带损伤重建69例,男性67例,女性2例;年龄18~42岁,平均27.8岁。术前根据X线及MRI等影像学检查,先行膝关节镜检查、清除关节内积血、处理半月板损伤等关节内结构损伤。对完全断裂的前交叉韧带应用自体肌腱进行重建。术后辅助铰链式膝关节支具外固定进行系统功能康复锻炼。结果本组69例术中镜下证实前交叉韧带股骨侧止点处撕裂47例,体部断裂22例。随访时间12~48个月,平均16.5个月。手术切口均甲级愈合,未出现感染。膝关节功能Lysholm评分术前为(51.5±5.1)分,术后12个月为(91.3±4.3)分,差异比较具有统计学意义(P0.05)。结论关节镜下早期手术重建前交叉韧带损伤可明确关节内合并损伤,缩短治疗过程。     

Five-year outcome of 13 patients with an initially undiagnosed anterior cruciate ligament rupture

We evaluated retrospectively the 5-year outcome of 13 patients with an initially undiagnosed and thus untreated anterior cruciate ligament rupture. At follow-up, these patients experienced decreased knee function and moderate to severe knee instability. They had attempted to reduce their discomfort by decreasing their activity level during the follow-up period. Immediately after the 5-year examination, 6 of the patients decided to have a late reconstruction of the ruptured anterior cruciate ligament. These results agree with previous reports of the natural course of anterior cruciate ligament ruptures.     

军训致膝前交叉韧带损伤的流行病学研究

 目的 分析武警军事训练中前交叉韧带(anterior cruciate ligament,ACL)损伤的流行病学特点,进而指导军事训练,做好预防、诊断、治疗工作.方法 回顾性研究2003-01至2010-06在我科住院治疗的ACL损伤部队患者153例(93膝),对损伤发生率、好发项目、损伤原因及机制、治疗方法等进行统计分析.结果在400 m障碍训练中发生率最高,其次为篮球、擒拿格斗训练;并且反复受伤为特点.结论 为减轻及预防ACL,应提高对本病的认识,避免反复、疲劳训练,ACL重建术应在伤后3个月内进行.     

Postural control — a comparison between patients with chronic anterior cruciate ligament insufficiency and healthy individuals

Postural control in the sagittal plane was evaluated in 22 patients with chronic anterior cruciate ligament (ACL) deficiency and the result was compared to that of a control group of 20 uninjured subjects. Measurement of the body sway was done on a fixed and sway-referenced force plate in both single-limb and two-limb stance, with the eyes open and closed, respectively. Further, an analysis of the postural reactions to perturbations backwards and forwards, respectively, was made in single-limb stance. The results demonstrated statistically significant deficits of the postural control in the patient group compared to the control group, but also within the patient group. There was a significantly higher body sway within the patient group when standing on a stable support surface on the injured limb than standing on the uninjured limb with the eyes open, but no difference with the eyes closed. When standing on a stable support surface, there was a significantly higher body sway in the patient group standing on the injured leg than in the control group, both with eyes open and closed. The patient group also showed a significantly impaired postural control compared to the control group when standing on the uninjured leg with the eyes closed. There was no difference between the groups in the two-limb stance. When standing on the sway-referenced support surface, the patient group had a significantly larger body sway than the control group when the eyes were open, but there was no significant difference between the groups with the eyes closed. The measurement of the postural corrective responses to perturbations backwards and forwards showed that the reaction time measured from the initiation of the force plate translation, and the amplitude of the body sway was significantly greater in the patient group than in the control group. We conclude that patients with a continuing chronic ACL insufficiency several years after injury have an impaired postural control in the anteroposterior direction in single-limb stance on their injured leg. They also show a greater body sway and a prolonged reaction time when subjected to anteroposterior perturbations when standing on their injured leg.     

High risk of new knee injury in elite footballers with previous anterior cruciate ligament injury

Background

Anterior cruciate ligament (ACL) injury is a severe event for a footballer, but it is unclear if the knee injury rate is higher on returning to football after ACL injury.

Objective

To study the risk of knee injury in elite footballers with a history of ACL injury compared with those without.

Method

The Swedish male professional league (310 players) was studied during 2001. Players with a history of ACL injury at the study start were identified. Exposure to football and all time loss injuries during the season were recorded prospectively.

Results

Twenty four players (8%) had a history of 28 ACL injuries in 27 knees (one rerupture). These players had a higher incidence of new knee injury of any type than the players without ACL injury (mean (SD) 4.2 (3.7) v 1.0 (0.7) injuries per 1000 hours, p  =  0.02). The risk of suffering a knee overuse injury was significantly higher regardless of whether the player (relative risk 4.8, 95% confidence interval 2.0 to 11.2) or the knee (relative risk 7.9, 95% confidence interval 3.4 to 18.5) was used as the unit of analysis. No interactive effects of age or any other anthropometric data were seen.

Conclusion

The risk of new knee injury, especially overuse injury, was significantly increased on return to elite football after ACL injury regardless of whether the player or the knee was used as the unit of analysis.     

Simultaneous bilateral anterior cruciate ligament tears in a female beginner skier

We present a case of simultaneous bilateral ACL tears in a woman injured while skiing for the first time. We discuss the role of intercondylar notch stenosis as a high-risk factor for tearing the ACL, the injury mechanism, prevention measures, and the therapeutic strategy. Received: 10 January 2000 Accepted: 10 April 2000     

Changing injury pattern of acute anterior cruciate ligament tears treated at Tampere University Hospital in the 1980s

During the years 1980–1989, 450 patients with an acute anterior cruciate ligament (ACL) rupture were treated at the University Hospital of Tampere, Finland. ACL ruptures were diagnosed by arthroscopy or open surgery. The data were analyzed in terms of patient age, sex, injury etiology, injury type and sports activity to determine the trends in the 1980s. The number of ACL tears seen in the Hospital increased by 247% over this period. Sixty-three percent of the patients were male (mean age 33 years) and 37% female (mean age 39 years), and there were no changes in the sex and age distribution in 1980s. The most common injury type was the isolated ACL rupture (51%), followed by a combination injury of the ACL and medial collateral ligament (38%). Isolated ACL ruptures in the 1980s increased 6.5 times. Sports accounted for 54% of all injuries with out any sign of change in their relative proportion in 1980s. The most common sports causing the rupture were soccer (29%), downhill skiing (20%), cross-country skiing (12%) and volleyball (12%). From 1980 to 1989, there was a decrease (2 times) in ACL injuries sustained in crosscountry skiing and a substantial (30 times) increase in ACL injuries sustained in downhill skiing.     

400m障碍训练致前交叉韧带损伤的原因及预防

目的 调查400 m障碍训练中发生前交叉韧带损伤的位置和原因,并提出预防措施.方法 选择2017-01至2019-12武警广西总队医院收治的前交叉韧带损伤的武警官兵,采集详细的病史,包括受伤科目,若科目为400 m障碍训练则记录受伤的位置和原因.结果 入选92例中,400 m障碍训练发生最多(48例,52.2％).40...     

Knee isokinetic performance following anterior cruciate ligament reconstruction: patellar tendon versus hamstrings graft

Objective: To compare knee isokinetic performance six months after reconstruction of the anterior cruciate ligament using grafts from either the patellar tendon or the hamstrings among patients who underwent the same rehabilitation protocol.

Methods: Thirty-four patients were evaluated (17 with grafts from the patellar tendon and 17 with grafts from the hamstrings). Operated and non-operated knees were compared with regards to the variables of peak torque, work and the hamstring/quadriceps relationship at velocities of 60º/s and 180º/s and power of 180º/s after six months of surgery.

Results: The patients with ACL reconstruction using the patellar tendon (BPTB) showed quadriceps deficits for all variables, but the flexor musculature was balanced. In the hamstring group, both the extensors and the flexors showed deficits for the variables analyzed, except for hamstring power at 180º/s.

Conclusion: Patients in the patellar tendon group had a greater quadriceps deficit compared with those in the hamstrings group. Patients in the hamstrings group had a greater muscular deficit in the flexor mechanism compared with the contralateral knee. An unbalanced H/Q ratio was observed regardless of graft type, but this was more evident in the BPTB group.     

Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective,randomize clinical study

Anatomical observation and biomechanical studies have shown that the anterior cruciate ligament (ACL) mainly consists of two distinct bundles, the anteromedial (AM) bundle and posterolateral (PL) bundle. Conventional single-bundle ACL reconstruction techniques have focused on the restoration of the AM bundle while giving limited attention to the PL bundle. The purpose of this prospective, randomized clinical study is to compare the outcomes of ACL reconstruction when using either double-bundle or single-bundle technique and bioabsorbable interference screw fixation, and similar rehabilitation with both techniques. Sixty-five patients were randomized into either double-bundle (n = 35) or single-bundle (n = 30) ACL reconstruction with hamstring tendons and bioabsorbable screw (Hexalon, Inion Company, Tampere, Finland) fixation in both groups. The evaluation methods were clinical examination, KT-1000 arthrometer measurements, radiographic evaluation, as well as International Knee Documentation Committee and Lysholm knee scores. There were no differences between the study groups preoperatively. For an average of 14 months of follow-up (range 12–20 months), 30 patients of the double-bundle group and 29 patients of the single-bundle group were available (91%). At the follow-up, the rotational stability, as evaluated by pivot shift test, was significantly better in the double-bundle group than in the single-bundle group. However, in anterior stability of the knee, there was no significant difference between the groups. None of the patients in the double-bundle group had graft failure, while four patients in the single-bundle group had. In addition, knee scores were equal at the follow-up, and all the results were significantly better at the follow-up than preoperatively, in both groups.     

Response of hamstring muscles to a perturbation in people with chronic anterior cruciate ligament deficiency

A number of strength parameters were investigated in a group of subjects with chronic anterior cruciate ligament deficiency; The response of subjects' hamstring muscles to a perturbation on an isokinetic dynamometer was fractionated into the premotor and motor times. Rate of force development in the 75 ms following the perturbation was also measured. The functional ability of the subjects was examined using the Noyes knee rating system. The results showed that the motor time was significantly correlated with the rate of force development and functional ability of the subjects. The ratio of hamstring to quadriceps torque recorded at peak and 30° flexion during isokinetic muscle work at 180°/s was also investigated. No significant relationship was observed between these ratios and functional ability. These findings indicate that factors other than peak hamstring muscle torque may be important to the level of functional ability attained by people with chronic anterior cruciate ligament deficiency.     

Revision of failed gore-tex anterior cruciate ligament reconstruction

The Gore-Tex synthetic knee ligament was widely used in the early 1980s because of encouraging early results. However, the long-term failure rate is unfavorable. Gore-Tex failures are divided into four categories: effusion, graft rupture, loosening/ osteolysis, and infection. Revision surgery is challenging and requires a systematic approach to achieve optimal results.     

Knee laxity after complete anterior cruciate ligament tear: a prospective study over 15 years

There is limited knowledge of knee laxity in the long term after a complete anterior cruciate ligament (ACL) tear treated without ACL reconstruction. The aim of this study was (1) to describe the clinical course of knee laxity after a complete ACL tear over 15 years, and (2) to study the association between knee laxity and meniscal injuries and the development of knee osteoarthritis (OA). We studied 100 consecutive subjects [mean (SD) age 26 (8) years] presenting with acute ACL injury prospectively. The initial treatment in all subjects was knee rehabilitation without reconstructive surgery. The subjects were examined with Lachman's and pivot‐shift tests at baseline, 6 weeks, 3 months, 1 year, 3 years and 15 years after the injury. Sagittal knee laxity was also evaluated with the KT‐1000 arthrometer at the 15‐year follow‐up. During follow‐up, 22 subjects were ACL reconstructed due to unacceptable knee instability. There was only a mild remaining knee laxity [median Lachman grade and pivot‐shift test value of 1 on a 4‐grade scale (0–3)] after 15 years in subjects treated without primary ACL reconstruction. Knees with higher anterior sagittal knee laxity 3 months after the injury had a worse long‐term outcome with respect to meniscal injuries and knee OA development.     

关节镜下异体骨-髌腱-骨纤维束重建治疗前交叉韧带部分损伤

目的 探讨异体骨-髌腱-骨纤维束（B-PT-B）重建前交叉韧带（ACL）全部纤维束和部分纤维束的早期疗效。方法在187例采用B-PT-B术式重建ACL的患者中，获得随访的ACL部分束损者共25例，其中采用全部纤维束重建的患者6例，部分纤维束重建19例。术后行X线和KT-1000检查，并按照IKDC、Lysholm、Irgang、Larson评分进行疗效评价。结果 所有患者随访时移植物位置良好，KT-1000检查双侧膝关节前向松弛度差值〈3mm。部分束重建组与全部束重建组各评分系统和分项评分系统无显著性差异。结论 异体B-PT-B重建治疗ACL部分损伤可以取得良好的临床疗效，与ACL全部束重建术相比综合评定无明显差异。     

Early rehabilitation of acute anterior cruciate ligament injury—a randomized clinical trial

The efficacy of a 6-week rehabilitation program was evaluated in 100 consecutive patients, age 15–42 years, with acute anterior cruciate ligament (ACL) injury. Arthroscopy revealed associated lesions in 82% of the patients. Except for resections on menisci with large and unstable lesions, no surgery was performed. The patients were randomly assigned to supervised training or self-monitored training after instruction. Results: At the 6-week follow-up there was no difference between the groups with regard to pain at rest, pain during walking, or experience of giving-way episodes, Tegner activity level or Lysholm knee score. Only 2 of the 100 patients were observed without joint mobility restriction. The only significant difference between the groups was the improvement of muscle function in men in the supervised training group. Conclusion: Six weeks' rehabilitation is too short a time period from original injury to obtain normal mobility and restored knee function.     

Substance P immunoreactive fibers of synovial tissue in patients with anterior cruciate ligament injury

Substance P, a neuropeptide, exerts proinflammatory effects and transmits the sensation of pain. Substance P immunoreactive fibers of the synovial tissue were examined to investigate the significance of Substance P in the traumatic joint. Biopsy specimens from 15 patients (eight female and seven male) with anterior cruciate ligament (ACL) injury were examined immunohistochemically with semi-quantitative counting to correlate Substance P positive fibers of the synovial tissue with clinical data, pain intensity on a visual analog scale, and serous inflammatory indicators. The total (sum of the three compartments) expression of Substance P in females of 571.9±255.1 cm⁻² was significantly greater than that of males of 241.2±126.6 cm⁻². In the female group, the total number of Substance P immunoreactive fibers was significantly correlated with pain intensity (r=0.804); in the male group, there was no significant correlation with pain intensity. The expression of Substance P in the female infrapatellar fat pad was statistically significantly correlated with pre- and postoperative erythrocyte sedimentation rate as inflammation indicators. In the male group, there was no such correlation. Substance P was well- correlated with pain and inflammatory reaction in the female joint. Neural inflammation and neural pain occur more strongly in female joints.     

Rehabilitation after revision anterior cruciate ligament reconstruction: Practice guidelines and procedure-modified, criterion-based progression

Reconstructive surgery has become a more common solution for patients after rupture of the anterior cruciateligament (ACL) as a result of better surgical technique and more efficient and effective rehabilitation. As the incidence of ACL reconstruction surgery increases, the number of reconstructions that ultimately fail also increases. Failure of the primary reconstruction, whether caused by technical error during the surgery or an outside factor such as traumatic rerupture, often necessitates revision of the ACL reconstruction to restore joint integrity and optimize function. We have previously described criterion-based and procedure-modified rehabilitation after primary ACL reconstruction. The same principles that drive rehabilitation after primary reconstruction are factors after revision surgery; however, the progression must be modified. The major difference between the two surgeries lies in the ability of the surgeon to achieve adequate fixation of the new graft within the joint during a revision reconstruction. The second controlled trauma of revision surgery further compromises the bony structures that serve as the foundation for the new graft. Therefore, less rigid fixation after revision ACL reconstruction must be assumed. This necessitates a longer period of controlled weight bearing for every-day activities and slower progression of weight-bearing exercise during rehabilitation to ensure that biological healing can proceed without being compromised by the presence of forces that exceed the strength of the new graft fixation. Other factors such as staging of the revision surgery and concurrent bony procedures will also require modification of the rehabilitation. Understanding these factors and implementing the modifications that they necessitate into rehabilitation should lead to a more predictable return to high functional levels after revision ACL reconstruction.