Acl Surgery

Cedera atau injury merupakan sesuatu kerusakan pada struktur atau fungsi tubuh yang dikarenakan suatu paksaan atau tekanan fisik. Injury sering dialami oleh seorang atlet, seperti cedera goresan, robek pada ligamen, atau patah tulang karena terjatuh. Injury tersebut biasanya memerlukan pertolongan yang profesional dengan segera. Injury olahraga secara umum berupa cedera memar, cedera ligamentum, cedera pada otot dan tendon, pendarahan pada kulit dan pingsan. Risiko terjadinya injury dalam perminan futsal diakibatkan pengaruh dari luar (faktor ekstrinsik) berupa tackling atau tabrakan, pukulan atau benturan, lapangan yang jelek dimana menggunakan semen yang dialas dengan rumput sintetis berbahan kasar dan alat yang digunakan dalam bermain kurang baik seperti sepatu yang rusak dan tidak menggunakan alas pelindung tulang kering (deker). Sedangkan injury akibat pengaruh dari dalam (faktor intrinsik) seperti postur tubuh yang kurang baik, gerakan latihan yang salah, kelemahan otot, fisik yang tidak fit, prosedur keselamatan atlet yang kurang terjamin dan otot atau ligament yang berlebihan. Kejadian cedera pada lutut cenderung menyebabkan atlet futsal absen dalam jangka waktu paling lama, cedera di bagian ini juga paling sering membutuhkan operasi pembedahan untuk mengatasinya salah satunya adalah cidera pada Anterior Cruciate Ligament (ACL) (Sumadi, 2018).

The purpose of this study was to examine the effects of 8-week retraining programs, with either two or three training sessions per week, on measures of functional performance and muscular power in athletes with anterior cruciate ligament reconstruction (ACLR). Sixteen male athletes were randomly assigned to two groups after ACLR: a functional training group (FTG, n = 8) training 2 intense sessions per week (4hrs/week), and a control group (CG, n = 8) training 3 sessions per week with moderate intensity (6hrs/week). The two groups were assessed at four and six months post-ACLR and the effects of retraining were measured using the following assessments: the functional and the muscular power tests, and the agility T-test. After retraining, the FTG had improved more than the CG in the operated leg in the single leg hop test (+34.64% vs. +10.92%; large effect), the five jump test (+8.87% vs. +5.03%; medium effect), and single leg triple jump (+32.15% vs. +16.05%; medium effect). For the agility T-test, the FTG had larger improvements (+17.26% vs. +13.03%, medium effect) as compared to the CG. For the bilateral power tests, no significant training effects were shown for the two groups in the squat jump (SJ), the counter movement jump (CMJ) and the free arms CMJ (Arm CMJ). On the other hand, the unilateral CMJ test with the injured and the uninjured legs showed a significant increase for the FTG with respect to CG (p < 0.05). The present study introduces a new training modality in rehabilitation after ACLR that results in good recovery of the operated limb along with the contra-lateral leg. This may allow the athletes to reach good functional and strength performance with only two physical training sessions per week, better preparing them for a return to sport activity at 6 months post-ACLR and eventually sparing time for a possible progressive introduction of the sport specific technical training.

Background: Anterior cruciate ligament reconstruction (ACLR) has been established as the gold standard for treatment of complete ruptures of the anterior cruciate ligament (ACL) in active, symptomatic individuals. In contrast, treatment of partial tears of the ACL remains controversial. Biologically augmented ACL-repair techniques are expanding in an attempt to regenerate and improve healing and outcomes of both the native ACL and the reconstructed graft tissue.

There have been numerous treatments developed to address ligament injury, given the functional impact of such injury on lifestyle and participa- tion in physical activities at all levels of recre- ational and competitive endeavors. With regard to commonly diagnosed knee injuries, anterior cru- ciate ligament (ACL) insufficiency is a frequently encountered pathology that often requires surgi- cal treatment to restore the desired level of func- tion. Considering that ligament injuries most commonly affect active individuals who tend to be younger, such injuries can lead to substantial alterations in lifestyle, and therapeutic treatments that restore near-anatomic function of damaged ligaments have the potential to overcome some of the shortcomings associated with current methds of reconstruction, particularly in the case of ACL insufficiency. The incidence of complete injury to the posterior cruciate ligament (PCL) is considerably lower than that of the ACL and is estimated to occur at a rate of 2 per 100,000; however, the prevalence of asymptomatic PCL injury is considered to be not ably higher [1]. Injury to collateral ligaments represents a signifi- cant proportion of knee injuries that present to emergency rooms, and high rates of medial and collateral ligament injuries are associated with collegiate sporting activities, with many of these cases involving noncontact competition [2].
Despite advances in sports medicine, there remains controversy in the treatment of ligament injury, particularly when there is functional insuf- ficiency associated with partial ligament injury. For instance, reconstruction of the ACL is the current gold standard treatment for symptomatic ACL insufficiency, irrespective of injury pattern, and high rates of return to sport are expected [3, 4]. Disadvantages of ACL reconstruction include donor site morbidity, inability to restore normal joint kinematics, and an increased incidence of premature degenerative joint changes [5–8].
There are challenges associated with restoring anatomic function in cases of ligament injury, and biologic therapies have great potential to address some of these concerns. Therapeutic interventions that utilize bioactive growth factors and cellular elements may be used to augment ligament repair processes and can be used inconjunction with surgical treatment modalities. These biologic treatments may be a prominent feature of treatment algorithms as these technolo- gies develop and understanding of reparative pro- cesses at the cellular level advances.

Introducción: La reconstrucción del Ligamento Cruzado Anterior (LCA) se ha establecido como el estándar de oro para el tratamiento de las rupturas completas del Ligamento Cruzado Anterior (LCA) en individuos activos y sintomáticos. Contra-riamente, el tratamiento de las rupturas parciales del LCA continúa siendo controversial. Las técnicas de reparación del LCA con aumentación biológica se encuentran en expansión en un intento de regenerar y mejorar la cicatrización del LCA nativo. Propósito: El propósito de este trabajo es presentar nuestra técnica de aumentación biológica intra-operatoria con infiltra-ción intra-ligamentaria e intra-articular de médula ósea concentrada y factores de crecimiento plaquetario (PRP) bajo visión artroscópica, para el tratamiento de las lesiones parciales del LCA aisladas en una serie de cinco casos y sus resultados. Diseño del estudio: Serie de casos. Material y Métodos: Cinco pacientes (hombres) entre 15 y 30 años con lesión parcial aislada del LCA que cumplieron con los criterios de inclusión y fueron controlados prospectivamente por un periodo de dos años. Todos los pacientes fueron intervenidos y se realizaron las infiltraciónes intra-ligamentaria e intra-articular de médula ósea concentrada y factores de crecimiento plaquetario autólogo bajo visión artroscópica siguiendo el mismo protocolo. Resultados: En nuestra serie de casos todos los pacientes volvieron a su actividad deportiva en un promedio de ocho meses con rodilla estable y sin síntomas, con un seguimiento de dos años, sin re rupturas en ese periodo de tiempo. Discusión: El uso de nuevas técnicas biológicas de reparación del LCA, que incluye factores de crecimiento, PRP y células madre han reportado resultados prometedores en estudios pre-clínicos y clínicos a corto plazo. En nuestra serie, la técnica de aumentación biológica intra-operatoria con médula ósea concentrada y PRP para las rupturas parciales, aisladas y agudas del LCA, fue segura, reproducible y tuvo buenos resultados a los dos años de seguimiento. Sin embargo, son necesarios estudios a largo plazo con un mayor número de pacientes y validación de técnicas para evaluar los efectos reales de estos abordajes. Palabras claves: Lesiones parciales del LCA, Médula Ósea Concentrada, Factores de Crecimiento, PRP, Aumentación Biológica del LCA. Abstract Introduction: Anterior Cruciate Ligament (ACL) reconstruction has been established as the gold standard for the treatment of complete ruptures of the ACL in active and symptomatic individuals. Conversely, treatment of partial ruptures of the ACL remains controversial. ACL repair techniques with biological augmentation are expanding in an attempt to regenerate and improve native ACL healing. Purpose: The purpose of this paper is to present our intraoperative biological augmentation technique with intra-ligamentous and intra-articular infiltration of bone marrow concentrate (BMAC) and platelet rich in growth factors (PRP) under arthrosco-pic vision for the treatment of partial and isolated ACL tears in a series of 5 cases and their results. Study design: Case series. Material and Methods: Five patients (men) between 15 and 30 years with partial and isolated tears of the ACL who met the inclusion criteria and were prospectively controlled for a period of 2 years. All patients were treated with and intra-ligamentous and intra-articular infiltrations of BMAC and PRP under arthroscopic vision following the same protocol. Results: In our cases series, all patients returned to their sport activity in an average of 8 months with stable knee and without symptoms with a follow-up of 2 years, without ruptures in that period of time. Conclusion: The use of new biological techniques of ACL repair, including growth factors, PRP and stem cells have reported promising results in short-term preclinical and clinical studies. Our work showed that this intraoperative biological augmentation technique with BMAC and PRP for partial, isolated and acute ACL ruptures was a safe procedure, reproducible with good results at 2 years of follow-up. However, long-term studies with a greater number of patients and validation of techniques are necessary to evaluate the real effects of these approaches.

Study design: Pretest post-test observational parallel-group design. Objectives: To evaluate the efficacy of passive knee extension mobilization in addition to exercise therapy on extension range of motion (ROM) in patients with osteoarthritis (OA) of the knee. Secondary objectives were to determine changes in pain and functional abilities. Background: Patients with knee OA complain of pain, limited range of motion, and impaired activities. Efficacy of mobilization as a treatment option next to exercises has not been studied rigorously. Methods and measures: Thirty-four participants with persistent knee pain, a positive radiography for knee OA, and a passive extension deficit were included. Seventeen participants (mean age ± SD, 59.8 ± 6.1 years) were treated with an exercise protocol and were additionally given manual mobilizations to improve passive extension ROM. The other group (mean age ± SD, 61.5 ± 7.3 years) with equal characteristics was treated with an identical exercise therapy protocol only. Prior to participation, detailed ROM measurements were recorded next to muscle function tests, pain (VAS), six-minute walking tests (6MWTs), a condition-specific questionnaire, and the patient-specific function scale (PSFS). Participants in both groups completed 16 treatment sessions each. Results: Passive mobilization significantly improved extension ROM in the intervention group (5.2 versus 8.6°, p = .017). The manually mobilized group also had better physical capacities as assessed by 6MWT, less pain, and a lower PSFS score. Conclusion: A combined protocol including exercise therapy and passive mobilization was beneficial for patients with OA of the knee complaining of pain, decreased extension ROM and decreased limited abilities. Level of evidence: Therapy, 2b.

RESUMEN. Las lesiones del ligamento cruzado anterior (LCA) hoy en día son tratadas principal-mente con injerto de isquiotibiales y una amplia gama de técnicas y sistemas de fijación del LCA en busca de una menor morbilidad del paciente. Se reporta un caso de una paciente de 42 años que sufrió ruptura de LCA, tratada con reconstrucción de LCA con injerto autólogo de isquiotibiales, fi ja-ción femoral con pines transversos bioabsorbibles y fi jación tibial con tornillo bioabsorbible. La pa-ciente evolucionó con presencia de dolor en región lateral de rodilla, diagnosticado como síndrome de fricción de la banda iliotibial un año posterior a la cirugía. Se realizaron estudios de imagen que incluyeron rayos X y resonancia magnética (RM) donde se observó adecuada fi jación del LCA con presencia de migración y ruptura del pin proximal bioabsorbible. Se decidió extraer el fragmento del pin bioabsrobile en un segundo tiempo quirúrgico y la paciente regresó a sus actividades cotidianas y deportivas sin dolor y con una adecuada estabi-lidad. Palabras clave: Pines bioabsorbibles, ligamento cruzado anterior, isquiotibiales, fi jación transversa. ABSTRACT. Injuries of the anterior cruciate ligament are currently treated primarily with the use of hamstring graft with a wide range of different techniques and fixation systems for anterior cruciate ligament in reducing patient morbidity. We report the case of a female patient aged 42 that suff ered an anterior cruciate ligament rupture and was treated with anterior cruciate ligament reconstruction with hamstring autograft with femoral fi xation with bio-absorbable cross-pin and tibial fi xation with bio-absorbable screw. The patient presented lateral knee pain that was diagnosed one year after the operation as an iliotibial band friction syndrome. Imaging studies were performed. X-rays and magnetic resonance imaging demonstrated adequate fixation of the anterior cruciate ligament with the presence of migration and rupture of the proximal bio-absorbable cross-pin. It was decided to remove the bio-absorbable cross-pin fragment in a second surgical procedure after which the patient went back to her daily activities and sports without pain and with stability stable knee. Este artículo puede ser consultado en versión completa en http:// www.medigraphic.com/actaortopedica

Ligament injury is a frequently cited cause of functional disability and affects people participating in a wide range of physical activities and levels of play. There are numerous potential benefits of ligament repair that include restoration of normal joint kinematics and preservation of proprioception, which may lead to improved long-term preservation of joint anatomy and function. The healing potential for certain ligament injuries is not ideal due to anatomic considerations of vascularity and availability of native reparative growth factors and cellular elements. There are several therapeutic options involving biologic treatments that are becoming more widely used. These therapies include bioactive growth factors and multipotent cellular therapies that can be used in isolation or in combination with surgical treatment to augment ligament repair and regeneration.

Ligament injury is a frequently cited cause of functional disability and affects people participating in a wide range of physical activities and levels of play. There are numerous potential benefits of ligament repair that include restoration of normal joint kinematics and preservation of proprioception, which may lead to improved long-term preservation of joint anatomy and function. The healing potential for certain ligament injuries is not ideal due to anatomic considerations of vascularity and availability of native reparative growth factors and cellular elements. There are several therapeutic options involving biologic treatments that are becoming more widely used. These therapies include bioactive growth factors and multipotent cellular therapies that can be used in isolation or in combination with surgical treatment to augment ligament repair and regeneration.