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Estimates of voluntary activation in individuals with anterior cruciate ligament reconstruction:Effects of type of stimulator,number of stimuli,and quantification technique

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Journal of Sport and Health Science 2022年第1期11卷 85-93页

作者： Steven A.Garcia Kazandra M.Rodriguez Scott R.Brown Riann M.Palmieri-Smith Chandramouli Krishnan School of Kinesiology University of MichiganAnn ArborMI 48109USA Neuromuscular and Rehabilitation Robotics Laboratory(NeuRRo Lab) Department of Physical Medicine and RehabilitationUniversity of MichiganAnn ArborMI 48108USA Department of Orthopaedic Surgery Michigan MedicineUniversity of MichiganAnn ArborMI 48109USA Robotics Institute University of MichiganAnn ArborMI 48109USA

Background:Accurate quantification of voluntary activation is important for understanding the extent of quadriceps dysfunction in individuals with anterior cruciate ligament reconstruction(ACLR).Voluntary activation has been quantified using both percent activation derived from the interpolated twitch technique and central activation ratio(CAR)derived from the burst superimposition technique,as well as by using different types of electrical stimulators and pulse train conditions.However,it is unclear how these parameters affect voluntary activation estimates in individuals with ACLR.This study was performed to fill this important knowledge gap in the anterior cruciate ligament literature.Methods:Quadriceps strength and voluntary activation were examined in 18 ACLR participants(12 quadriceps/patellartendon graft,6 hamstring tendon graft;time since ACLR:1.06±0.82 years,mean±SD)at 90°of knee flexion using 2 stimulators(Digitimer and Grass)and pulse train conditions(3-pulse and 10-pulse).Voluntary activation was quantified by calculating both CAR and percent activation.Results:Results indicated that voluntary activation was significantly overestimated by CAR when compared with percent activation(p0.05);however,the Digitimer evoked greater torque at rest than the Grass(p<0.001).Conclusion:These results indicate that percent activation derived from the interpolated twitch technique provides superior estimates of voluntary activation than CAR derived from burst superimposition and is less affected by pulse train conditions or stimulators in individuals with ACLR.

关键词： anterior cruciate ligament Central activation Inhibition Knee strength Triplet Twitch interpolation

Therapeutic effect of two methods on avulsion fracture of tibial insertion of anterior cruciate ligament

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World Journal of Clinical Cases 2022年第27期10卷 9641-9649页

作者： Hai-Ming Niu Qing-Chun Wang Rui-Zhao Sun Department of Orthopedics Guanyun People's HospitalLianyungang 222200Jiangsu ProvinceChina

BACKGROUND The tibial stop of anterior cruciate ligament(ACL) is fan-shaped and attached to the medial groove in front of the intercondylar spine,which is located between the anterior horn of the medial and lateral meniscus.The incidence of this fracture is low previously reported,which is common in children and adolescents.With the increase of sports injury and traffic injury and the deepening of understanding,it is found that the incidence of the disease is high at present.AIM To explore the difference between open reduction and internal fixation with small incision and high-intensity non-absorbable suture under arthroscopy in the treatment of tibial avulsion fracture of ACL.METHODS Seventy-six patients with tibial avulsion fracture of anterior cruciate ligament diagnosed and treated in Guanyun County People’s Hospital from April 2018 to June 2020 were retrospectively analyzed.According to the surgical methods,they were divided into group A(40 cases) and group B(36 cases).Patients in group A were treated with arthroscopic high-strength non-absorbable suture,and patients in group B were treated with small incision open reduction and internal fixation.The operation time,fracture healing time,knee joint activity and functional score before and after operation,and surgical complications of the two groups were compared.RESULTS The operation time of group A was higher than that of group B,and the difference was statistically significant(P 0.05);The knee joint function activity was compared between two groups before operation,3 mo and 6 mo after operation,and the difference was not statistically significant(P > 0.05);the knee joint function activity of group A and group B at 3 mo and 6 mo after operation was significantly higher than that before operation(P < 0.05);the limp,support,lock,instability,swelling,upstairs,squatting,pain and Lysholm score were compared between the two groups

关键词： Small incision anterior cruciate ligament Open reduction and internal fixation Arthroscopy Non-absorbable sutures anterior cruciate ligament tibial avulsion fracture

Patient reported outcome measures in anterior cruciate ligament rupture and reconstruction:The significance of outcome score prediction

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World Journal of Clinical Cases 2022年第30期10卷 10939-10955页

作者： Oday Al-Dadah Lee Shepstone Simon T Donell Translational and Clinical Research Institute Faculty of Medical SciencesNewcastle UniversityNewcastle-upon-Tyne NE24HHTyne and WearUnited Kingdom Department of Trauma and Orthopaedic Surgery South Tyneside District HospitalSouth Shields NE340PLTyne and WearUnited Kingdom Department of Medical Statistics Norwich Medical SchoolUniversity of East AngliaNorwich NR47TJNorfolkUnited Kingdom Norwich Medical School University of East AngliaNorwich NR47TJNorfolkUnited Kingdom

BACKGROUND Numerous anterior cruciate ligament(ACL) clinical outcome measures exist.However,the result of one score does not equate to the findings of another even when evaluating the same patient group.AIM To investigate if statistically derived formulae can be used to predict the outcome of one knee scoring system when the result of another is known in patients with ACL rupture before and after reconstruction.METHODS Fifty patients with ACL rupture were evaluated using nine clinical outcome measures.These included Tegner Activity Score,Lysholm Knee Score,Cincinnati Knee Score,International Knee Documentation Committee(IKDC) Objective Knee Score,Tapper and Hoover Meniscal Grading Score,IKDC Subjective Knee Score,Knee Outcome Survey-Activities of Daily Living Scale(KOS-ADLS),Short Form-12 Item Health Survey and Knee Injury and Osteoarthritis Outcome Score.Thirtyfour patients underwent an ACL reconstruction and were reassessed post-operatively.RESULTS The mean total of each of the nine outcome scores appreciably differed from each other.Significant correlations and regressions were found between most of the outcome scores and were stronger post-operatively.The strongest correlation was found between Cincinnati and KOS-ADLS (r=0.91,P<0.001).The strongest regression formula was also found between Cincinnati and KOS-ADLS (R~2=0.84,P<0.001).CONCLUSION The formulae produced from this study can be used to predict the outcome of one knee score when the results of the other are known.These formulae could facilitate the conduct of systematic reviews and meta-analysis in studies relating to ACL injuries by allowing the pooling of substantially more data.

关键词： anterior cruciate ligament Prediction Regression Correlation Patient reported outcome measures Reconstruction Rupture

Surgical treatment for a combined anterior cruciate ligament and posterior cruciate ligament avulsion fracture: A case report

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World Journal of Clinical Cases 2022年第12期10卷 3879-3885页

作者： Katsuhiro Yoshida Michiyuki Hakozaki Hideo Kobayashi Masashi Kimura Shinichi Konno Department of Orthopaedic Surgery Fukushima Medical University School of MedicineFukushima 960-1295Japan Higashi-Shirakawa Orthopaedic Academy Fukushima Medical University School of MedicineFukushima 960-1295Japan Department of Orthopaedic Surgery Sukagawa HospitalFukushima 962-0022Japan Gunma Sports Medicine Research Center Zenshukai HospitalGunma 379-2115Japan

BACKGROUND Independent avulsion fractures with anterior cruciate ligament(ACL)or posterior cruciate ligament(PCL)attachment are relatively common among tibial intercondylar eminence fractures,and their postoperative outcomes are generally favorable.Conversely,huge avulsion fractures of the intercondylar eminence containing the attachment site of both the ACL and the PCL are extremely rare,and the reported clinical outcomes are poor.CASE SUMMARY We describe a 30-year-old Japanese male's huge avulsion fracture of the intercondylar eminence of a tibia containing the attachment site of both the ACL and PCL,together with a complete tear of the medial collateral ligament and a partial tear of both the medial and lateral menisci caused by a fall from a high place.All of these injuries were treated surgically,with anatomical reduction and stable fixation.The limb function at 1 year post-surgery was excellent(Lysholm score:100 points).CONCLUSION Although this patient's complete surgical repair was complex,it should be performed in similar cases for an excellent final clinical outcome.

关键词： Avulsion fracture Intercondylar eminence Tibia anterior cruciate ligament Posterior cruciate ligament Meniscal tear

Consensus Delphi study on guidelines for the assessment of anterior cruciate ligament injuries in children

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World Journal of Orthopedics 2022年第9期13卷 777-790页

作者： Angélica Campón Chekroun Jorge Velázquez-Saornil Isabel Guillén Vicente Zacarías Sánchez Milá David Rodríguez-Sanz Carlos Romero-Morales Tomas Fernandez-Jaén JoséIgnacio Garrido González MiguelÁngel Sánchez-Garrido Pedro Guillén García Campus San Jerónimo Guadalupe Universidad Católica de MurciaMurcia 30107MurciaSpain Department of Physiotherapy Universidad Católica deÁvilaÁvila 05005ÁvilaSpain Department of Orthopaedic and Trauma Surgery Clínica CemtroMadrid 28035MadridSpain Nursing Physiotherapy and PodiatryUniversidad Complutense de MadridMadrid 28040MadridSpain Department of Physical Therapy Universidad Europea de MadridMadrid 28023MadridSpain Department of Orthopaedic and Trauma Surgery Gabinete Médico GarridoSalamanca 37003SalamancaSpain

Background:Knee examination guidelines in minors are intended to aid decisionmaking in the management of knee instability.Clinical question:A Delphi study was conducted with a formal consensus process using a validated methodology with sufficient scientific evidence.A group consensus meeting was held to develop recommendations and practical guidelines for use in the assessment of instability injuries in children.Key findings:there is a lack of evidence to analyse anterior cruciate ligament injuries in children and their subsequent surgical management if necessary.Diagnostic guidelines and clinical assessment of the patient based on a thorough examination of the knee are performed and a guide to anterior cruciate ligament exploration in children is developed.Clinical application:In the absence of a strong evidence base,these established guidelines are intended to assist in that decision-making process to help the clinician decide on the most optimal treatment with the aim of benefiting the patient as much as possible.Following this expert consensus,surgical treatment is advised when the patient has a subjective sensation of instability accompanied by a pivot shift test++,and may include an anterior drawer test+and a Lachman test+.If these conditions are not present,the conservative approach should be chosen,as the anatomical and functional development of children,together with a physiotherapy programme,may improve the evolution of the injury.

关键词： anterior cruciate ligament Diagnoses and examinations Sports injuries Knee Injury to minors

Demographic characteristics of patients who underwent anterior cruciate ligament reconstruction at a tertiary care hospital in India

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World Journal of Clinical Cases 2023年第15期11卷 3464-3470页

作者： Sai Krishna Mlv Asjad Mahmood Pulak Vatsya Siva Srivastava Garika Ravi Mittal Manoj Nagar Department of Orthopaedics All India Institute of Medical SciencesNew Delhi 110029India Department of Orthopaedics All India Institute of Medical SciencesBhopal 462020India

BACKGROUND anterior cruciate ligament(ACL)tears are common sports-related injuries.Their incidence is not the same either for all the sports or for the same sport across various nations.This information is maintained by many sports leagues in their registries.However,very few nationwide registries exist for such injuries.This study is carried out to know the demographic characteristics of patients who underwent ACL reconstruction at our hospital in India.AIM To know the demographic characteristics of patients who underwent ACL reconstruction at a tertiary care hospital in India.METHODS All the patients who underwent ACL reconstruction from January 2020 to December 2021 were retrospectively studied.Patients with multi-ligament injuries or a history of previous knee surgery were excluded.The patients’history was obtained from the hospital records,they were interviewed telephonically,and online questionnaires were given.Their demographic data was analyzed and compared to the existing literature.RESULTS A total of 124 patients were operated on for ACL reconstruction during this period.The mean age of the patients was 27.97 years.One hundred and thirteen patients(91.1%)were male and 11(8.9%)were female.The majority of the patients(47.6%)sustained this injury by road traffic accidents(RTA)followed by sportsrelated injuries(39.5%).The commonest presenting complaint was giving way of the knee in 118 patients(95.2%).The mean duration from the injury to the first hospital visit among the patients was 290.1 d.The mean duration from the injury to surgery was 421.8 d.CONCLUSION ACL patients’demography is different in developing nations as compared to the developed world.RTA are the leading cause of ACL injuries and are followed by recreational sports as a cause.There is delayed access to healthcare leading to delayed diagnosis as well as even greater time to surgery.This,in turn,leads to poorer prognosis and longer rehabilitation.National registries for developing nations are the need of the hour due to the different demograp

关键词： anterior cruciate ligament Sports injury Demography Epidemiology Knee

anterior cruciate ligament remnants nodule： potential factor causing extension loss

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Chinese Medical Journal 2013年第6期126卷 1108-1111页

作者： WANG Jian AO Ying-fang Institute of Sports Medicine Peking University Third Hospital Beijing 100191 China

Background Extension loss caused by anterior cruciate ligament （ACL） remnants nodule was usually reported by case reports. There is no systematic report analyzing ACL remnants nodule. The purpose of this study was to investigate the characteristics of extension loss caused by remnants of ACL after injury. Methods From June 2008 to December 2011, ACL remnants were observed by arthroscopy in 1012 cases with ACL injuries at the time of primary reconstruction. ACL remnants nodules were recorded. The time of extension loss occurrence caused by ACL remnants nodule, associated symptom and sign, magnetic resonance imaging （MRI）, and arthroscopic findings were observed. Histological examination was performed on the lesion resected. Results Twenty-four cases with ACL remnants nodules were found by arthroscopy. Among them extension loss caused by remnants of ACL happened in 19 cases （male 13; female 6）. The average extension loss were 9.1° （range, 5°-20°）. The average time from injury to operation was 8.9 weeks （range, 3-26 weeks）. The remnants of ACL depressed in the inter-condylar notch were found on MRI in 15 cases with extension loss. The rupture locations of ACL were all close to the upper insertion of ACL. The microscopic examination of the resected remnants of ACL revealed disorganized fibrous connective tissue and tissue of ACL ligament. Conclusions Among 1012 ACL injury cases, 24 ACL remnants nodules were found with arthroscopy and 19 nodules could cause knee extension loss. ACL remnants nodule should be paid attention to as a potential cause of extension loss.

关键词： anterior cruciate ligament extension loss remnants

Hamstring autograft utilization in reconstructing anterior cruciate ligament:Review of harvesting techniques,graft preparation,and different fixation methods

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World Journal of Orthopedics 2022年第10期13卷 876-890页

作者： Waleed Albishi Baraa Baltow Nora Albusayes Ameer A Sayed Hamza M Alrabai Department of Orthopedic Surgery College of MedicineKing Saud UniversityRiyadh 11362Saudi Arabia Department of Orthopedic Surgery AlHada Armed Forces HospitalMinistry of DefenseAlHada 26792Saudi Arabia Department of Orthopedic Surgery King Fahad Armed Forces HospitalMinistry of DefenseJeddah 23311Saudi Arabia

Rupture of the anterior cruciate ligament(ACL)is a common orthopedic injury.Various graft options are available for the reconstruction of ruptured ACL.Using the hamstring muscle as an autograft was first described in 1934,and it remains a commonly harvested graft for ACL reconstruction.Hamstring autografts can be harvested using the traditional anteromedial approach or the newer posteromedial technique.An isolated semitendinosus tendon can be used or combined with the gracilis tendon.There are numerous methods for graft fixation,such as intra-tunnel or extra-tunnel fixation.This comprehensive review discusses the different hamstring muscle harvesting techniques and graft preparation options and fixation methods.It provides a comprehensive overview for choosing the optimal surgical technique when treating patients.

关键词： anterior cruciate ligament anterior cruciate ligament reconstruction Graft fixation Hamstring autograft Infrapatellar nerve injury Patient reported outcomes

Clinical and mechanical outcomes in isolated anterior cruciate ligament reconstruction vs additional lateral extra-articular tenodesis or anterolateral ligament reconstruction

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World Journal of Orthopedics 2022年第7期13卷 662-675页

作者： Nikhil Agarwal Jaibaji Monketh Andrea Volpin Department of Trauma and Orthopaedics University of AberdeenAberdeen AB243FXUnited Kingdom Health Education England North East Newcastle Upon Tyne NE158NYUnited Kingdom Department of Trauma and Orthopaedics NHS GrampianElgin IV301SNUnited Kingdom

BACKGROUND anterior cruciate ligament(ACL) reconstruction has been a successful treatment for ACL rupture.However ongoing rotational instability can be an issue.Several surgical techniques have been recommended to overcome this including lateral extra-articular tenodesis(LET) and more recently anterolateral ligament reconstruction(ALLR).AIM To compare the clinical outcomes following ACL reconstruction(ACLR) alone or ACLR with either LET or ALLR.METHODS A systematic review was conducted by means of four databases(MEDLINE,EMBASE,Cochrane and Clinical.Trials.Gov),and the Reference Citaion Analysis(https://***/) to identify all studies investigating either or both of LET and ALLR.The Critical Appraisal Skills Programme checklist for cohort studies was employed for critical appraisal and evaluation of all twenty-four studies which met the inclusion criteria.RESULTS Pooled meta-analyses illustrated that ACLR with additional LET or ALLR results in improved pivot shift test scores,compared to isolated ACLR.There was no statistically significant difference in International Knee Documentation Committee(IKDC) clinical scores with addition of either LET or ALLR.ACL re-rupture rates were compared between LET and ALLR techniques.There was a statistically significant difference between techniques,with a 1.14% rupture rate in ACLR +ALLR,and 4.03% rupture rate in ACLR + LET.Isolated ACLR re-rupture rates were 12.59%,significantly higher than when augmented with either ALLR or LET(P < 0.0001 for both groups).There were no statistical differences in pivot shift test or IKDC scores between LET and ALLR techniques.CONCLUSION This meta-analysis has found that use of either LET or ALLR in addition to ACLR results in improved mechanical outcomes suggesting surgeons should consider augmenting ACLR with an extra-articular procedure in patients with rotatory instability.Furthermore,both anterolateral extra articular procedures in addition to ACLR lead to reduced ACL re-rupture rates compared to isolated ACLR.Moreover,ALLR results in reduce

关键词： anterior cruciate ligament Knee Systematic review Lateral extra tenodesis Anterolateral ligament Knee surgery