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1.
Six degrees-of-freedom kinematics of ACL deficient knees during locomotion-compensatory mechanism 总被引:2,自引:0,他引:2
The purpose of the study was to investigate six degrees-of-freedom (DOF) kinematic changes in anterior cruciate ligament ACL-deficient knees during locomotion and the possible compensatory mechanism involved. Compared with healthy subjects, ACL-deficient patients walked with increased tibial external rotation throughout most of the stride and increased tibial abduction at the heel contact, and the tibia was more anterior during swing phase (P<0.05). Considering tibial external rotation and abduction unload the ACL, the kinematic changes indicated compensatory mechanism developed by patients to avoid unstable knee positions due to the loss of the ACL or to avoid stretching a partially torn ACL. 相似文献
2.
Rainer Siebold Jeremie Axe James J. Irrgang Kanglai Li Scott Tashman Freddie H. Fu 《Knee surgery, sports traumatology, arthroscopy》2010,18(1):26-31
The bony geometry of the distal femoral condyles may have a significant influence on knee joint kinematics. The aim of this
study was to analyze the relationship between the size of the medial and lateral femoral condyles in different planes. Seventy-four
three-dimensional (3D) CT reconstructions of 37 patients with ACL intact and contralateral ACL reconstructed knees were used
and the data were imported into a graphical software program. The radii of the medial and lateral femoral condyles were analyzed
in the sagittal, coronal, and axial planes by digitally reconstructed circular arcs along the bony condylar profiles marked
with multiple digital surface points. Intra- and interobserver testing was performed. In the intact knees the average sagittal
radius of the distal medial and lateral femoral condyles was similar. There was a significant difference between the radii
of the distal medial femoral condyles compared to lateral femoral condyles in the coronal plane (22.4 vs. 27.8 mm, P < 0.001) as well as between the radii of the medial femoral condyles in the axial plane in 90° knee flexion compared to the
lateral femoral condyles (21.3 vs. 18.3 mm, P < 0.001). The average radius of the medial femoral condyles was significantly smaller in extension compared to 90° of flexion
(21.2 vs. 22.4 mm, P = 0.05) and the average radius of the lateral femoral condyles was significantly larger in extension compared to 90° of flexion
(27.8 vs. 18.3 mm, P < 0.001). The 37 ACL reconstructed knees demonstrated similar radii in all three planes when compared to the intact knees
without any significant difference. The described method of assessing the architecture of the distal femoral condyles is non-invasive,
reproducible, and provides reliable geometric parameters necessary for the 3D reconstruction of the femoral geometry in vivo.
The radii of the FC were similar in the sagittal planes but demonstrate a significant asymmetry in the axial and coronal planes.
The average radius of the lateral femoral condyles was significantly larger in extension whereas the radius of the medial
femoral condyles was significantly larger in flexion. We did not find any significant difference in the shape of the femoral
condyles in ACL intact and contralateral ACL reconstructed knees indicating that the geometry of the femoral condyles might
not influence the injury mechanism of ACL rupture. The asymmetry between the femoral condyles may be considered when designing
new anatomical femoral components in knee arthroplasty. 相似文献
3.
4.
The general consensus is that ACL reconstruction should be undertaken if the patient has functional instability. Functional instability occurring is not just related to the mechanical insufficiency, but also to the neurophysiological role the ACL has in motion control. It may be, possible to enhance control of the abnormal joint motion through neuromuscular training. This case presentation outlines the rehabilitation of two patients with ACL deficient knees, who both presented with functional instability and discusses the role of conservative treatment in the management of this type of patient.The cases reported on indicate that with appropriate rehabilitation, some patients with functional symptomatic instability and a wish to return to high stress sports can be successfully rehabilitated to achieve these goals. The patients achieved these outcomes despite not having a change in joint laxity on passive testing. The significance of joint laxity tests on short term outcome would appear therefore to be not that great, with functional outcome after a period of rehabilitation proving a more sensitive indicator of the need for surgery in the ACL deficient patient. 相似文献
5.
Pierre Imbert Claudio Belvedere Alberto Leardini 《Knee surgery, sports traumatology, arthroscopy》2017,25(9):2725-2735
Purpose
Quantifying the effects of anterior cruciate ligament (ACL) deficiency on knee joint laxity is fundamental for understanding the outcomes of its reconstruction techniques. The general aim of this study was to determine intra-operatively the main modifications in knee laxity before and after standard isolated intra-articular and additional extra-articular anterolateral reinforcement. Our main hypothesis was that laxity abnormalities, particularly axial rotation, can still result from these ACL reconstruction techniques.Methods
Thirty-two patients with primary ACL deficiency were analysed by a navigation system immediately before and after each of the two reconstructions. Laxity measurements in terms of knee translations and rotations were taken during the anteroposterior drawer test, with internal–external rotation at 20° and 90° of flexion, and varus–valgus and pivot-shift tests. All these laxity measures were also taken originally from the contralateral healthy knee.Results
With respect to the contralateral healthy knee, in the ACL-deficient knee significantly increased laxity (expressed in %) was found in the medial compared with that of the lateral compartment, respectively, 115 and 68 % in the drawer test at 20° flexion, and 55 and 46 % at 90° flexion. In the medial compartment, a significant 35 % increment was also observed for the coupled tibial anteroposterior translation during axial knee rotation at 20° of flexion. After isolated intra-articular reconstruction, normal values of anteroposterior laxity were found restored in the pivot-shift and drawer tests in the lateral compartment, but not fully in the medial compartment. After the reinforcement, laxity in the medial compartment was also found restored in the axial rotation test at 20° flexion.Conclusion
In ACL reconstruction, with respect to the contralateral knee, intra-articular plus additional anterolateral reinforcement procedures do not restore normal joint laxity. This combined procedure over-constrained the lateral compartment, while excessive laxity still persists at the medial one.Level of evidence
III.6.
Matthieu Malatray Sebastien Raux Adrien Peltier Clemence Pfirrmann Romain Seil Franck Chotel 《Knee surgery, sports traumatology, arthroscopy》2018,26(4):1074-1079
Purpose
Ramp lesions are common in ACL deficient knees. Their diagnosis is difficult and, therefore, they may be underestimated. So far, no study analyzed their prevalence in a pediatric population. The diagnosis of these Ramp lesions is of major clinical relevance because of a frequent misestimating and technic difficulties. Ramp lesions might be associated with residual knee pain and instability after ACL reconstruction. The aim of this study was to evaluate the prevalence of ramp lesions explored through a systematic intercondylar and posteromedial arthroscopic approach during an ACL reconstruction in a pediatric and adolescent population.Methods
Children and adolescents who underwent an ACL reconstruction were screened prospectively between October 2014 and 2016. The presence or absence of a ramp lesion was evaluated after each of three arthroscopic steps: (1) an anterior approach, (2) an intercondylar inspection, and (3) a posteromedial approach. Ramp lesions were screened at each step and their prevalence was evaluated. Furthermore, their presence was correlated to age, weight, size, sex, and state of the physis (open or closed). Finally, the meniscal status on MRI and arthroscopic findings were compared.Results
Fifty-six patients were analyzed. The median age was 14.0?±?1.3 years (12–17). The median interval between injury and surgery was 11.5 months (1–108). During step 1 (anterior approach), only 1 ramp lesion (2%) was diagnosed. 13 (23%) ramp lesions were found after inspection through the intercondylar notch. No additional lesions were found with a direct view through the posteromedial approach. No correlation between ramp lesions and side, sex, weight, size, or state of physis was found. 10 ramp lesions out of 13 could not be diagnosed on MRI.Conclusions
The prevalence of ACL-associated ramp lesions in children and adolescents is similar to adult populations. A systematic inspection through the intercondylar notch is recommended during ACL reconstruction to make a precise diagnosis. The posteromedial approach is essentially useful for meniscal repairLevel of evidence
Testing, previously developed diagnostic criteria in a consecutive series of patients and a universally applied “gold” standard, Level I.7.
The role of the anterolateral ligament in ACL insufficient and reconstructed knees on rotatory stability: A biomechanical study on human cadavers 下载免费PDF全文
M. Tavlo S. Eljaja J. T. Jensen V. D. Siersma M. R. Krogsgaard 《Scandinavian journal of medicine & science in sports》2016,26(8):960-966
Studies suggest that the anterolateral ligament (ALL) is important for knee stability. The purpose was to clarify ALL's effect on rotatory and anterior‐posterior stability in the anterior cruciate ligament (ACL)‐insufficient and reconstructed knees and the effect of reconstruction of an insufficient ALL. Eighteen cadaveric knees were included. Stability was tested for intact (+ALL), detached (?ALL) and reconstructed (+ reALL) ALL, with ACL removed (?ACL) and reconstructed (+ACL) in six combinations. All were tested in 0, 30, 60, and 90 °C flexion. Anterior‐posterior stability was measured with a rolimeter. Rotation with a torque of 8.85 Nm was measured photographically. The ALL was well defined in 78% of knees. ACL reconstruction had a significant effect on anterior‐posterior stability. Detaching the ALL had a significant effect on internal rotatory stability and on anterior‐posterior stability in ACL‐insufficient knees. Reconstruction of ACL and ALL reestablished knee stability. The appearance of the ALL was not uniform. The ALL was an internal rotational stabilizer. Anatomical ALL reconstruction in combination with ACL reconstruction could reestablish stability. ALL reconstruction might be considered in patients with combined ACL and ALL tears, but the clinical effect should be established in a controlled clinical study. 相似文献
8.
Isokinetic strength of the quadriceps and hamstrings and functional ability of anterior cruciate deficient knees in recreational athletes. 总被引:4,自引:0,他引:4 下载免费PDF全文
OBJECTIVE: To test the hypothesis that increasing the hamstrings and quadriceps (H:Q) isokinetic strength ratio will, in the short term, improve the functional ability of an anterior cruciate ligament (ACL) deficient knee. METHODS: The isokinetic muscular characteristics at a speed of 60 degrees s-1 and 180 degrees s-1 of 46 recreational athletes with an arthroscopically confirmed ACL tear were determined using the Cybex II+ isokinetic dynamometer. The variables tested included peak torque, endurance ratio, total work output, and explosive power. Functional ability was scored with the Cincinnati rating system, measuring the severity of pain and swelling, the degree of giving way, and the overall ability to walk, run, ascent and descent stairs, jump and twist. RESULTS: Among all muscular characteristics, the H:Q ratio at 180 degrees s-1 at 30 degrees of knee flexion was shown to have the highest correlation to the functional score (r = 0.6249, P < 0.001). All variables involving hamstring strength were shown to be significantly correlated to the functional ability score (P < 0.01), while none of the variables involving quadriceps strength showed significant correlation with the functional ability of the injured knee. CONCLUSIONS: The H:Q ratio is strongly correlated to the functional ability of ACL deficient knees in Chinese recreational athletes. It could be used as an additional measure to guide in the decision making process in the management of ACL deficient knees. 相似文献
9.
The relationship between isokinetic quadriceps strength and laxity on gait analysis parameters in anterior cruciate ligament reconstructed knees 总被引:1,自引:1,他引:1
Gait alterations after ACL reconstruction have been reported in the literature. The current study examined a group of 14 patients who all had an ACL reconstruction with a patellar tendon autograft. Kinetic and kinematic data were obtained from the knee during walking. The flexion-extension deficit (FED) calculated from the angular difference between maximal flexion and maximal extension during the stance phase in the ACL-reconstructed and the normal knee was measured. We investigated whether these alterations in gait are related to quadriceps strength and residual laxity of the knee. It may be that patients modify their gait patterns to protect the knee from excessive anterior translation of the tibia by reducing the amount of extension during stance. On the other hand, persistent quadriceps weakness may also cause changes in gait patterns as the quadriceps is functioning as an important dynamic stabilizer of the knee during stance. Results showed that patients had a significantly higher FED value (4.9±4.0) than a healthy control group in a previous study (1.3±0.9). This is caused mainly by an extension deficit during midstance. External extension moments of the knee (TZMAX were significantly lower in the current patients group than in a healthy control group (TZMAX –0.27±0.19 Nm/kg in patients vs. –0.08±0.06 Nm/kg in controls). There were no significant correlations between quadriceps strength and gait analysis parameters. Furthermore no correlation was found between the amount of laxity of the knee and gait. The relevance of this study lies in the fact that apparently the measured gait alterations cannot be explained solely by often used biomechanical indicators such as laxity and strength. The measured gait alterations may be a result of the surgical procedure with subsequent modified motor programming. 相似文献
10.
Exercise may result in increased laxity in the knee. Anterior translation in 40 normal knees, 33 consecutive anterior cruciate ligament-deficient knees, and 30 randomly chosen anterior cruciate ligament-reconstructed knees was measured using the KT-1000 arthrometer before and after the participants ran for 15 minutes on a neutral-incline treadmill. A single observer blinded to the status of each knee tested all participants. There was a significant increase in anterior translation in the normal (mean, 0.75 mm), anterior cruciate ligament-deficient (mean, 0.62 mm), and anterior cruciate ligament-reconstructed knees (mean, 0.25 mm) after exercise. In addition, the amount of anterior translation after exercise was significantly different when these groups were compared with each other. Post hoc analysis using Tukey's procedure indicated that anterior translation in the anterior cruciate ligament-reconstructed knee was significantly less than in the normal and anterior cruciate ligament-deficient knees. Therefore, repetitive loading exercise contributes to an increase in anterior translation in normal, anterior cruciate ligament-deficient, and anterior cruciate ligament-reconstructed knees, and the anterior cruciate ligament-reconstructed knee does not respond to repetitive loading in the same manner as a normal knee. 相似文献
11.
Takanori Iriuchishima Kenji Shirakura Hiroshi Yorifuji Shin Aizawa Freddie H. Fu 《Knee surgery, sports traumatology, arthroscopy》2013,21(4):797-803
Purpose
The purpose of this study was to compare the size of native anterior cruciate ligament (ACL) footprints and the size of commonly used auto grafts. The hypothesis was that the reconstructed graft size with auto grafts might be smaller than the native ACL footprint.Methods
Fourteen non-paired human cadaver knees were used. The semitendinosus tendon (ST) and the gracilis (G) tendon were harvested and prepared for ACL grafts. Simulating an ST graft, the ST was cut in half. The bigger half was regarded as the antero-medial (AM) bundle, and the remaining half was regarded as the postero-lateral (PL) bundle. Simulating an ST–G graft, the bigger half of the ST and G were regarded as the AM bundle, and the smaller half of the ST was regarded as the PL bundle. Each graft diameter was measured, and the graft area was calculated. Simulating a rectangular bone-patella tendon-bone (BPTB) graft, a 10-mm wide BPTB graft was harvested and the area calculated. The ACL was carefully dissected, and the size of the femoral and tibial footprints was measured using Image J software (National Institution of Health).Results
The average areas of the ST, ST–G, and BPTB graft were 52.3 ± 7.3, 64.4 ± 9.2, and 32.7 ± 6.5 mm2, respectively. The sizes of the native femoral and tibial ACL footprints were 85.4 ± 26.3 and 145.4 ± 39.8 mm2, respectively. Only the ST–G graft showed no significant difference in graft size when compared with the femoral ACL footprint.Conclusion
Only the ST–G auto graft was able to reproduce the native size of the ACL footprint on the femoral side. None of the auto grafts could reproduce the size of the tibial ACL footprint. For clinical relevance, ST–G graft is recommended in order to reproduce the native size of the ACL in anatomical ACL reconstruction with auto graft. 相似文献12.
《Gait & posture》2017
Rehabilitation after injury and reconstruction to the anterior cruciate ligament is thought to require a gradual reintroduction of loading, particularly during resumption of running. One strategy to achieve this is via the use of a reduced-gravity treadmill but it is unknown, if and how muscle activity varies in the reduced gravity conditions compared to regular treadmill running. Nineteen healthy participants and 18 male patients at the end of their rehabilitation (8 with a bone-patellar-bone graft, 10 with a hamstring graft) participated in this multi-muscle surface electromyography (sEMG) running study. The hamstrings and triceps surae were evaluated during a 16 km/h running while at 6 different relative bodyweight conditions from 50% (half weight-bearing) to 100% (full weight-bearing). Muscle activation was examined individually as well as normalized to a composite “entire” activation and considered across the entire gait cycle using Statistical Parametric Mapping. The healthy participants showed differences between the 50–100% BW and 60–100% conditions and in the hamstring graft group for 60–100% and 80–100% conditions. No differences were seen comparing all loading conditions in the bone-patellar-bone graft group. For the hamstrings, from 70% BW and above, there appear to be no difference in activation patterns for any of the groups.The activation patterns of the hamstrings was essentially the same from 70% indicated bodyweight through to full weight bearing when running at 16 km/h. Accordingly, when running at this relatively high speed, we do not expect any adverse effects in terms of altered motor patterns during rehabilitation of these muscles. 相似文献
13.
R Glousman C Shields R Kerlan F Jobe S Lombardo L Yocum J Tibone R Gambardella 《The American journal of sports medicine》1988,16(4):321-326
Reconstruction for symptomatic anterior cruciate deficient knees has yielded varying success rates. Prosthetic cruciate replacement has recently become a potentially attractive alternative. The results of the Gore-Tex polytetrafluoroethylene ligament, which is intended as a permanent replacement, are reported. Eighty-two patients were followed prospectively, mean age was 28 years (range, 16 to 51 years) and mean followup was 18 months (range, 12 to 30 months). Subjective scores improved in all categories, including pain, swelling, giving way, locking, and stair climbing. All patients without complications had no episodes of actual giving way, considered themselves improved, and returned to activities of daily living at 3 weeks and athletics at 8 months. Range of motion lacking at 3 months was 2 degrees of extension and 10 degrees of flexion, and at 12 months was 0 degrees of extension and 4 degrees of flexion. All mean objective data, including the anterior drawer, Lachman, and pivot shift, demonstrated improvement at final followup. Cybex testing revealed improvement in relative quadriceps strength from 88% to 99%. The KT-1000 Arthrometer showed improvement in the injured-normal knee difference score throughout the follow-up period. Of importance is that while final objective data was improved over initial data, an early nonprogressive shift toward loosening was indicated by worsening of the drawer, Lachman, pivot shift, and KT-1000 scores. This shift may be attributed to resorption of interposed soft tissue, creep, or loosening of the graft. Subjective scores remained stable after improving. Complications included four ruptures, four chronic sterile effusions with partial attenuation, one infection, and one symptomatic loose body.(ABSTRACT TRUNCATED AT 250 WORDS) 相似文献
14.
Bak K Jørgensen U Ekstrand J Scavenius M 《Scandinavian journal of medicine & science in sports》2001,11(1):16-22
One hundred and thirty-two consecutive soccer players (117 males and 15 females, median age 23, range 16-39 years) underwent primary reconstruction of the anterior cruciate ligament (ACL) with an iliotibial band (ITB) autograft. All patients were followed prospectively for a minimum of 2 years. One hundred and eighteen patients (89%) attended an independent observer follow-up after a median of 47 (24-92) months. The time before participating in soccer was a median of 7 (5-24) months. At a median of 4 years, 80 (68%) were still active soccer players, while 38 had changed activity to a lower level. Twenty-five gave up soccer playing for reasons unrelated to the knee, and 13 (11%) gave up due to problems from the reconstructed knee. The Lysholm score improved from a median of 82 (range 42-99, mean [SD] 80.5 [+/-11.9]) points prior to the operation to a median of 99 (range 57-100, mean [SD] 94.6 [+/-8.5]) at follow-up. The Tegner score improved from a median of 3.5 (0-7) preoperatively to 9 (1-10). Four patients (3%) sustained a rupture of the graft: three ruptures occurred among the 15 females (20%), and one was seen among the 117 males (0.8%) (P=0.01). Eight per cent had predominantly minor cosmetic complaints from the donor-site hernia, while 51% had temporary discomfort from the staples used for graft fixation. Using the ITB autograft for ACL reconstruction, we found excellent and good results in soccer players with ACL deficiency and high demands for optimal knee function. The failure rate in general was comparable with other methods, and the majority was still active in soccer sports at a median of 4 years after surgery. An unacceptably high rerupture rate was registered in female players. 相似文献
15.
Stefano Zaffagnini Tommaso Bonanzinga Alberto Grassi Giulio Maria Marcheggiani Muccioli Costanza Musiani Federico Raggi Francesco Iacono Vittorio Vaccari Maurilio Marcacci 《Knee surgery, sports traumatology, arthroscopy》2013,21(4):934-941
Purpose
To report the medium-term clinical and radiographic outcomes of a group of patients who underwent anterior cruciate ligament (ACL) surgery combined with high tibial osteotomy (HTO) for varus-related early medial osteoarthritis (OA) and ACL deficiency knee.Methods
Thirty-two patients underwent single-bundle over-the-top ACL reconstruction or revision surgery and a concomitant closing-wedge lateral HTO. The mean age at surgery was 40.1 ± 8.1 years. Evaluation at a mean of 6.5 ± 2.7 years of follow-up consisted of subjective and objective IKDC, Tegner Activity Level, EQ-5D, VAS for pain and AP laxity assessment with KT-1000 arthrometer. Limb alignment and OA changes were evaluated on radiographs.Results
All scores significantly improved from pre-operative status to final follow-up. KT-1000 evaluation showed a mean side-to-side difference of 2.2 ± 1.0 mm. Two patients were considered as failures. The mean correction of the limb alignment was 5.6° ± 2.8°. Posterior tibial slope decreased at a mean of 1.2° ± 0.9°. At final follow-up, the mechanical axes crossed the medial–lateral length of tibial plateau at a mean of 56 ± 23 %, with only 1 patient (3 %) presenting severe varus alignment. OA progression was recorded only on the medial compartment (p = 0.0230), with severe medial OA in 22 % of the patients. No patients underwent osteotomy revision, ACL revision, UKA or TKA.Conclusions
The described technique allowed patients with medial OA, varus alignment and chronic ACL deficiency to restore knee laxity, correct alignment and resume a recreational level of activity at 6.5 years of follow-up.Level of evidence
Case series with no comparison group, Level IV. 相似文献16.
M. Ettinger M. Petri D. Guenther C. Liu C. Krusche E. Liodakis U-V Albrecht C. Krettek M. Jagodzinski 《Knee surgery, sports traumatology, arthroscopy》2013,21(9):2057-2062
Purpose
Double-bundle ACL reconstruction has been demonstrated to be at least as effective as single-bundle reconstruction in terms of restoring knee rotational and translational stability. Until now, the influence on knees with hyperextension has not been evaluated. It was the purpose of this study to evaluate whether double-bundle ACL reconstruction restricts extension in hyperextendable knees.Methods
Hamstring tendon reconstructions of 10 human cadaveric knees with the ability of hyperextension (age: 48 ± 14 years) were performed as single bundle (SB) on one side and double bundle (DB) on the other side. A surgical navigation system (BrainLab, Germany) was used to assess the kinematics of each knee at the intact and reconstructed state. A difference with regard to the anterior-to-posterior translation (AP) and rotational stability at 30° of knee flexion, 90° of flexion and the hyperextension capability of each specimen was analysed.Results
The difference in AP translation before and after the reconstruction was not significantly different in 30° and 90° of flexion (n.s). Both single- and double-bundle reconstructions restored the preoperative kinematics at 30° and 90° of knee flexion (n.s). The knee extension was 4° ± 1.8° with the intact ACL and 4° ± 1.7° after reconstruction in the SB group (n.s). The knee extension was 5° of hyperextension ± 1.1° with the intact ACL and 0° ± 0.4° after reconstruction in the DB group; the limitation of the extension was significantly larger in this group (p = 0.013).Conclusion
Both single- and double-bundle ACL reconstruction techniques are capable of restoring knee anteroposterior and rotational stability. Double-bundle reconstructions significantly reduce knee extension in knees with hyperextension capability. Care must be taken when using double-bundle techniques in patients with knee hyperextension as this procedure may limit the knee extension after double-bundle ACL reconstruction. 相似文献17.
The effects of proprioceptive or strength training on the neuromuscular function of the ACL reconstructed knee: a randomized clinical trial 总被引:4,自引:0,他引:4
Liu-Ambrose T Taunton JE MacIntyre D McConkey P Khan KM 《Scandinavian journal of medicine & science in sports》2003,13(2):115-123
OBJECTIVES: The purpose of this study was to determine the effects of a proprioceptive training program (PT) vs. a strength training (ST) program on neuromuscular function after anterior cruciate ligament (ACL) reconstruction. The second purpose was to establish the determinants of functional ability for the operated limb. METHODS: Ten participants with unilateral ACL reconstructions were randomly assigned to one of the following 12-week training protocols: (1) isotonic ST, and (2) PT. The outcome measures were: (1) peak torque time of the hamstring muscles (PeakTT), (2) average concentric and eccentric torques of the quadriceps and hamstring muscles, (3) one-legged single hop for distance (SLHD), (4) one-legged time hop (TH), and (5) subjective scores. RESULTS: : There was a significant group by time interaction effect for PeakTT (P = 0.017). The PT group demonstrated greater percent change in isokinetic torques than the ST group at the end of the 12 weeks (P < or = 0.05). Participants in both groups demonstrated similar significant gains in functional ability and subjective scores (P < or = 0.014). Quadriceps strength is a determinant of functional ability for the operated limb (R2 = 0.72). CONCLUSIONS: : Both training protocols influenced PeakTT. The beneficial effects of ST on PeakTT appear to be load-dependent, while sufficient practice may be crucial in maintaining PeakTT improvements induced by PT. Proprioceptive training alone can induce isokinetic strength gains. Restoring and increasing quadriceps strength is essential to maximize functional ability of the operated knee joint. 相似文献
18.
19.
K. Nawata R. Teshima M. Enokida T. Suzuki T. Yamagata 《Knee surgery, sports traumatology, arthroscopy》1999,7(5):274-277
Signal anomalies observed in magnetic resonance imaging of the intrameniscal tissue adjacent to the tear were compared between stable knees (group 1, 54 menisci) and anterior cruciate ligament (ACL) deficient knees (group 2, 98 menisci). The histological significance of these signal anomalies was also studied (n = 25). The frequency of intrameniscal signal anomalies adjacent to the tear was significantly lower in ACL-deficient knees than in ACL-stable knees (P = 0.0022). There was a close correlation between the imaging anomalies and the presence of histological lesions (fissures, degeneration) within meniscal tissues adjacent to the tear (sensitivity: 0.95, specificity: 0.60). Our results suggest that the severity of intrameniscal degenerative changes adjacent to the tear are lower in ACL-deficient knees than in ACL-stable knees. 相似文献
20.
Functional outcome following reconstruction in chronic multiple ligament deficient knees 总被引:1,自引:0,他引:1
D. Karataglis I. Bisbinas M. A. Green D. J. A. Learmonth 《Knee surgery, sports traumatology, arthroscopy》2006,14(9):843-847
Multiligament knee injuries are rare but potentially limb-threatening conditions. In this study we aim to evaluate the mid- and long-term functional outcome of patients who underwent arthroscopically assisted multiple ligament reconstruction for chronic multiple knee ligament deficiency. Thirty-five patients (27 males and 8 females) with an average age of 35.1 years (range: 17–60) were included in this study. Follow-up ranged from 12 to 124 months (average: 40.3). On final follow-up patients had a mean loss of extension of 3.1°, while flexion ranged from 95° to 135° (average: 118.4°). The functional outcome according to Clancy’s criteria was excellent in 7 patients (20%), good in 14 (40%), fair in 11 (31.4%), while 3 reconstructions resulted in failure (8.6%). Patients scored an average of 4.03 (range: 1–9) in their Tegner Activity Scale, while their score in Activities of Daily Living Scale of the Knee Outcome Survey ranged from 25 to 98 with an average of 72.7. Sixteen patients returned to sporting activities and all but three returned to work. Early operative treatment of multiple ligament injuries is preferable, as it may allow for anatomic repair instead of reconstruction of ligamentous structures. This study demonstrates though, that even if acute reconstruction has not or could not be performed, reconstruction in chronic multiple ligament deficient knees should be attempted. Although this complex and technically demanding procedure rarely results in a “normal” knee, it offers in most cases very satisfactory stability and a significant improvement in knee function. 相似文献