Anterior Cruciate Ligament

Background: Double hamstring autograft for anterior cruciate ligament (ACL) reconstruction is a well-established graft option; however, a major concern with this method arises when the prepared graft is too small. Resorting to allograft can be a solution to this problem, but some surgeons prefer to use autograft in particular situations and some patients may refuse allograft. We investigate the merits of using autogenous quadriceps tendons to augment the insufficient hamstrings and compare the autograft composite graft to a standard hamstrings graft of equal size. Methods: Semitendinosus, gracilis, and quadriceps tendons were harvested from 10 matched pairs of human cadaver lower extremities. Within each pair, a routine hamstring ACL graft (control) consisting of the semitendinosus and gracilis tendons, and an quadriceps augmented hamstrings graft of equal size comprised of the semitendinosus and quadriceps tendons, were prepared. A freeze-clamp mount was used to biomechanically test each graft construct. Tensile failure load, displacement, energy absorbed, and stiffness were determined and statistically compared within each pair and mode of graft failure was established. Results: No statistically significant differences were found between the quadriceps augmented hamstrings graft versus standard control grafts. Average values for peak failure load and graft displacement at the point of first failure were nearly identical. All ACL graft constructs failed at the mid-substance. Conclusions: This study demonstrates no statistical difference in the biomechanical properties of an isolated hamstring ACL autograft versus a quadriceps augmented ACL autograft of equal size at time zero. Clinical relevance: This is a potentially new and reliable method for quadriceps tendon autograft augmentation of hamstring autograft for ACL reconstruction.

Background: The BPTB graft and quadruple graft of semitendinosus and gracilis are the two most popular options for anterior cruciate ligament reconstruction. Objective: To assess the efficacy of arthroscopic ACL reconstruction with semitendinosus and gracilis tendon grafts and biodegradable screw fixation in ACL injury. Methodology: This prospective interventional study was carried out at Dhaka Medical College Hospital and a private hospital in Dhaka from July 2014 to May 2016. Thirty-one (31) patients with ACL injuries were treated with arthroscopic reconstruction of the ACL using a quadrupled hamstring autograft of semitendinosus and gracilis tendon, as well as a rehabilitation protocol. Patients were routinely followed up on and an outcome evaluation was performed at 24 weeks. Subjective and objective evaluations were performed using the IKDC and Lysholm knee scoring scales to compare preoperative and postoperative outcomes. Results: All patients had either a grade II or a grade ...

Kinesiofobi er en irrationel og invaliderende frygt for fysisk bevaegelse efter en smertefuld skade. Kinesiofobi spiller en stor rolle for, om patienterne kan vende tilbage til sport efter anterior cruciate ligament-rekonstruktion. Kinesiofobi kan begraense patienternes evne til at deltage i genoptraeningen. Ifølge Dansk Korsbåndsregister får omkring 2.000 patienter hvert år foretaget primaer rekonstruktion af forreste korsbånd (anterior cruciate ligament (ACL)) i Danmark. ACLrekonstruktion anbefales til patienter, der ønsker at vende tilbage til pivoterende sportsgrene, samt til patienter, der ikke har haft tilstraekkelig effekt af genoptraening [1]. Desvaerre er det kun 65% af patienterne, der efter ACL-rekonstruktion vender tilbage til sport på samme niveau som før skaden [2]. Dette understreger behovet for at identificere og undersøge faktorer, der kan begraense evnen til at vende tilbage til sport. De seneste år har der vaeret øget opmaerksomhed på, at patienternes opfattelse af knaeets funktion ikke altid matcher den objektive vurdering af knaefunktionen [3, 4]. Objektive mål er således ikke tilstraekkelige, hvis man skal forudsige patienternes mulighed for tilbagevenden til sport. Uoverensstemmelsen mellem fysiske evner og patientens praestation kan forklares ved, at en raekke psykologiske faktorer spiller en betydelig rolle for, om patienten vender tilbage til sport, herunder self-efficacy, psykologisk parathed og kinesiofobi [3]. Isaer kinesiofobi, som er en irrationel og invaliderende frygt for bevaegelse efter en skade, har vist sig at spille en stor rolle efter ACL-rekonstruktion [4]. Omkring halvdelen af de patienter, der aldrig er vendt tilbage til sport, angiver frygt for en ny skade som den primaere årsag [3]. Selvom en vis grad af bekymring er forventelig og naturlig efter en skade, er det påvist, at graden af kinesiofobi er signifikant forbundet med manglende tilbagevenden til sport. Graden af kinesiofobi er uafhaengig af, om UGESKRIFT FOR LAEGER UGESKRIFT FOR LAEGER Open Access under Creative Commons License CC BY-NC-ND 4.0 Side 1 af 7

Triyas Krismantoro: Comparison on the Effectiveness of Combination Therapy of Self
Massage and Active Stretching with the Combination of Deep Tissue Massage and
Passive Stretching Towards the Recovery of Chronic Hip Injury. Thesis. Yogyakarta:
Postgraduate Program of Sports Science, Faculty of Sports and Health Sciences,
Yogyakarta State University, 2023.
This study aims to determine (1) the effectiveness of combination therapy of self
massage and active stretching for the recovery of chronic hip injury, (2) the effectiveness of
deep tissue massage combined with passive stretching for the recovery of chronic hip injury,
(3) a comparison on the effectiveness of combination therapy of self massage and active
stretching with a combination of deep tissue massage and passive stretching on the recovery of
chronic hip injury. Indicators of recovery are the level of pain and function.
This research was a quasi-experimental study with two groups experimental design
with two different sample groups with different treatments. The research sample consisted of
42 non-specific chronic hip injury patients who were randomly divided into two groups of 21
people. Group A used combination therapy of self massage and active stretching and group B
used combination therapy of Deep Tissue Massage and passive stretching (DTMS). The
treatment was conducted three times with a duration of 30 minutes. Measurement of pain scale
was by using the NRS (numeric rating scale) instrument and measuring lower back function
using the Harris Hip Score instrument. Data analysis techniques used different tests Paired ttest, Wilcoxon, independent t-test, and Mann-Whitney.
The results show that both the self massage and active stretching treatment and the Deep
Tissue Massage combination of passive stretching significantly reduce pain and function (p <
0.05). The results of the comparison of pretest and posttest data on self massage and active
stretching and the combination of Deep Tissue Massage and passive stretching on indicators
of pain and function has a p-value > 0.05, so it is concluded that the two types of therapy do
not have a significant difference. Based on the results of the study, it is suggested that the use
of self-massage and active stretching methods of therapy with a combination of Deep Tissue
Massage and passive stretching can be applied to non-specific chronic hip injury according to
situations and conditions by considering the advantages and disadvantages of both types of
therapy.
Keywords: active self massage stretching, passive deep tissue stretching, chronic hip injury

Rupture of the anterior cruciate ligament (ACL) is a common sports injury and is known to be associated with an increased risk of knee osteoarthritis. Several studies have indicated that the risk of additional injuries to the menisci and articular cartilage increases with delays in the treatment of ACL tears. However, no consensus has been reached regarding the ideal timing for ACL reconstruction in terms of preventing secondary lesions. To determine how the time elapsed between an ACL lesion and its reconstruction affects the incidence of meniscal and chondral lesions. Case series; Level of evidence, 4. Medical records of 764 patients who underwent primary ACL reconstruction were reviewed. Data from arthroscopic findings that included information about meniscal lesions and full-thickness articular cartilage lesions at the time of surgery were collected. The association between time elapsed between ACL lesion and reconstruction surgery and incidence of articular cartilage and menisc...

Anterior cruciate ligament (ACL) is one of the regularly reconstructed knee ligaments. Various types of grafts are being used for ACL reconstruction. The Quadrupled hamstring tendon graft is now being most commonly used because of its favorable biomechanical profile and positive clinical outcomes. The aim of this study is to establish the correlation of graft length and diameter with anthropometric parameters in Nepalese people. Methods: Fifty cases (31 males and 19 females) that underwent ACL reconstruction using quadruple hamstring autograft between December 2014 and November 2015 were prospectively evaluated. Anthropometric measurements including age, height, weight, BMI, tibial length, calf girth, thigh girth and waist circumference were recorded pre-operatively. The graft was harvested and length and thickness were intra-operatively determined using standard sizer. Pearson's correlation coefficient was used to determine the relationship between outcome variable (graft length n thickness) and predictor variables (anthropometric measurements). Results: Mean age of the patients was 31.5. There was no statistically significant correlation between any of the anthropometric measurement and graft length and thickness. Conclusion: Pre-operative anthropometric measurements like age, height, weight, BMI, tibial length, calf girth, thigh girth and waist circumference cannot accurately determine the length and thickness of quadruple hamstring tendon graft in ACL reconstruction.

Anterior cruciate ligament (ACL) is one of the regularly reconstructed knee ligaments. Various types of grafts are being used for ACL reconstruction. The Quadrupled hamstring tendon graft is now being most commonly used because of its favorable biomechanical profile and positive clinical outcomes. The aim of this study is to establish the correlation of graft length and diameter with anthropometric parameters in Nepalese people. Methods : Fifty cases (31 males and 19 females) that underwent ACL reconstruction using quadruple hamstring autograft between December 2014 and November 2015 were prospectively evaluated. Anthropometric measurements including age, height, weight, BMI, tibial length, calf girth, thigh girth and waist circumference were recorded pre-operatively. The graft was harvested and length and thickness were intra-operatively determined using standard sizer. Pearson’s correlation coefficient was used to determine the relationship between outcome variable (graft length n...

Introdução: a cabeça é um dos fatores determinantes da posição do corpo durante o desenvolvimento da postura humana, caracterizada pelo equilíbrio entre as estruturas de suporte, envolvendo mínimo esforço e sobrecarga com máxima eficiência. As disfunções temporomandibulares (DTM’s) são condições multifatoriais e, muitas vezes, estão relacionadas à má postura. A atividade alterada da musculatura mastigatória, comum nas DTM’s, interfere nos músculos de contra apoio, levando ao encurtamento dos músculos posteriores cervicais e consequente desequilíbrio postural do crânio. Objetivo: verificar a associação entre flexibilidade da cadeia posterior e severidade das DTM’s. Metodologia: trata-se de um estudo observacional, em corte transversal, em uma amostra não probabilística de universitários entre 18 e 50 anos. Após assinatura do TCLE, os voluntários responderam ao Questionário Anamnésico de Fonseca e, em seguida, foram submetidos ao teste de flexibilidade do Banco de Wells, com e sem cal...

This study investigates the effects of exercises on sand on the frequency content of the lower limb muscles in individuals with anterior cruciate ligament reconstruction and pronated feet during walking. Methods: This was a semi-experimental and laboratory-type study. The study samples included 28 male students with pronated feet and anterior cruciate ligament reconstruction aged 22 to 25 years. The participants were randomly allocated into the following two groups: The experimental and the control group. The electrical activity of the lower limb muscles was recorded using an electromyography system before and after performing the exercises. The statistical analysis was done using a two-way analysis of variance method with a significance level of 0.05. Results: The findings showed that the main effect of time for the frequency content of the tibialis anterior, medial gastrocnemius, vastus medialis muscles during loading and push-off phases, the vastus lateralis muscle during the mid-stance, the rectus femoris at the mid-stance and pushoff phases, semitendinosus muscle during the loading, mid-stance and push-off phases, biceps femoris muscle during the mid-stance and push-off phases, and gluteus medius muscle during the push-off phase (P<0.039; d=0.166-0.606). Conclusion: The group-by-time interaction for the semitendinosus muscle during the loading phase was significant. Exercise on sand can improve walking performance by altering muscular frequency content.

To a ssess electro m yo g ra p h ic (E M G) g a it p a tte rn ch a n g es d u rin g sta ir d e sc e n t in su b jects w ith ch ronic a n te rio r cru cia te lig a m e n t (A C L) deficiency, a n d in su b jects a fte r A C L reconstruction. M eth o d s. T h irteen A C L d e fic ie n t su b je c ts (A C L def), 8 A C L reco n stru cted su b jects (A C Lrec), a n d 1 0 co n tro ls (C O N) p a rtic ip a te d in the study. A ll su b jects w ere a sse sse d f o r fu n c tio n a l a n d lean thigh vo lu m e (LTV) differen ces in th e in ju red a n d u n in ju red lim b. A ll su b jects then step p ed o ff a b e n ch w ith E M G electro d es on the vastu s m edialis, va stus la tera lis a n d h a m strin g s m u scles o f b o th lim bs. R esu lts. S tep d o w n a c tiv ity ca u se d sim ila r E M G responses in the injured a n d su p p o rtin g lim b in the A C L d e f g ro u p co m p a re d to th a t in the control group. In contrast, in the A C L re c group, the o n se t o f E M G activity o cc u rre d e a rlie r d u rin g the step d o w n a c tiv ity in the vastus m ed ia lis a n d va stu s la tera lis o f the su p p o rtin g lim b. There w as sig n ific a n tly g rea te r E M G a c tiv ity in the va stus la tera lis a n d h a m strin g m u scles o f the su p p o rtin g lim b (p < 0.05) in the A C L re c group co m p a red to A C L d e f a n d co n tro l groups. The ch a n g e s in E M G a c tiv ity d id n o t a p p e a r to be related to differen ces in LTV, sin c e g re a te r L T V d e ficits w ere p re se n t in th e A C L d e f co m p a re d to the A C L re c group (p < 0.01). C o n clu sio n s. In A C L reco n stru cted subjects, ch a n g es in m u scle recru itm en t p a tte rn s in the su p p o rtin g lim b du rin g step d o w n a c tiv ity h a ve b een identified. This a ltered a c tiv ity p a tte rn w as n o t p re se n t in the su p p o rtin g lim b o f A C L d e fic ie n t su b jects

An acutely locked knee is a painful and debilitating orthopaedic condition usually caused by a loose body or bucket-handle meniscal tear that requires surgery to remove or repair. We describe 2 cases of acute locking of the knee that occurred during pregnancy. Both patients underwent urgent arthroscopic treatment under spinal anesthesia without complication to the patient or fetus. Concerns regarding surgery during pregnancy revolve around the safety for the mother and fetus. Although local and regional anesthetics are safe with proper management, there is a slightly increased risk of spontaneous abortion when general anesthesia is used, especially in the first trimester. Although purely elective surgery is never recommended during pregnancy, arthroscopic knee surgery can be performed safely in emergency situations with proper planning by a coordinated team including the surgeon, anesthesiologist, and obstetrician.

Recent magnetic resonance imaging (MRI) and three-dimensional (3D) computed tomography (CT) analyses have demonstrated that semitendinosus tendon can regenerate at a high rate following harvesting the tendon for anterior cruciate ligament (ACL) reconstruction. Although it is known that the regeneration of the semitendinosus tendon does not occur in all the patients, the reason for this unsuccessful regeneration of the tendon in certain patients remains unknown. We recently encountered two cases in which regeneration of the semitendinosus tendon was unsuccessful because of apparent reasons. These patients experienced a sudden sharp pain in the posterior aspect of their thighs when their hamstring muscles were subjected to aggressive load at 3 and 4 weeks after surgery. At the follow-up examination conducted after 12 months, 3D CT imaging revealed unsuccessful regeneration of the semitendinosus tendons in both cases. Severe proximal retraction of the semitendinosus muscle belly was also confirmed.

We studied 16 women 21-23 years old with regular menstrual cycles (28±4 days) and no history of knee injury. From their basal body temperatures and the serum concentrations of estradiol and progesterone, the follicular, ovulatory, and luteal phases were delineated. Using a KT-2000 arthrometer, anterior displacement at 89 N and 134 N and anterior terminal stiffness (N/mm) at 134 N were measured two or three times every week over a 4-week period. Eight men 21-23 years old were also measured. In women the anterior displacement at 89 N varied between the follicular and the ovulatory phase and between the follicular and the luteal phase (P<0.05) and at 134 N between the follicular and the luteal phase (P<0.05). There were no statistical differences in the anterior displacement with time in men, nor in anterior terminal stiffness in either sex. We conclude that anterior cruciate ligament laxity in women might be dependent on the concentrations of hormones. Résumé Nous avons étudié seize femmes agées de 21 à 23 ans avec des cycles menstruels réguliers (28±4 jours) et sans antécédents de traumatisme du genou. Les phases folliculaire, ovulatoire et lutéale ont été délimitées à partir des températures corporéales basales et des concentrations sériques d'oestradiol et de progestérone. En utilisant un arthrométre KT-2000 le déplacement antérieur sous 89 N et 134 N et la raideur terminale antérieure (N/mm) à 134 N ont été mesurés 2 ou 3 fois chaque semaine sur un période de 4 semaines. Les mesures ont aussi été faites chez huit hommes agés de 21 à 23 ans. Chez les femmes le déplacement antérieur à 89 N a varié entre la phase folliculaire et ovulatoire, et entre la phase folliculaire et lutéale (p<0,05) et à 134 N entre la phase folliculaire et lutéale (p<0,05). Il n'y avait pas de différences statistiques dans le déplacement antérieur chez les hommes, ni dans la raideur terminale antérieure dans l'un et l'autre sexe. Nous concluons que la laxité du ligament croisé antérieur chez la femme peut être dépendante des concentrations hormonales.

Purpose: To determine whether femoral epicondylar width (FECW) obtained from either magnetic resonance imaging (MRI) or plain radiographs could be used to predict anterior cruciate ligament (ACL) length. A secondary purpose was to develop a formula to use maximum FECW on either MRI or plain radiographs to estimate ACL length preoperatively. Methods: The MRIs and radiographs of 40 patients (mean age 41.0 years), with no apparent knee pathology, surgery, or trauma were included. The ACL length was measured on MRI followed by FECW on both MRI and radiograph of the same patient. This allowed the development of equations able to predict ACL length according to the FECW measured on either an MRI or radiograph. Results: The mean ACL length was 40.6 AE 3.6 mm. FECW measured on both MRIs and radiographs was sufficient to predict ACL length. Pearson's correlations revealed a high positive relationship between ACL length and FECW on MRI (r ¼ 0.89, P < .0001) and ACL length and FECW on radiograph (r ¼ 0.83, P < .0001). The coefficient of determination (R 2) was calculated to be MRI: R 2 ¼ 0.78 and radiograph: R 2 ¼ 0.68 and confirmed that FECW measured on both MRI and radiograph were sufficient to predict ACL length. Based on these models, ACL length can be predicted by FECW using the following formulas: MRI: ACL length ¼ 0.47 (FECW) þ 1.93 and radiograph: ACL length ¼ 0.31 (FECW) þ 11.33. Conclusions: This study demonstrated that FECW measured on either MRI or anteroposterior radiograph could reliably estimate ACL length on a sagittal MRI. There was a high positive relationship between ACL length and FECW on both MRI and radiographs, although MRIs do predict ACL length more reliably. Clinical Relevance: Preoperative ACL length assessment, using FECW on MRI or radiograph, is useful in graft selection and in preventing inadequate graft harvesting for ACL reconstruction, especially if an individualized anatomical approach is pursued.

Cyclops lesions develop in the anterior aspect of the intercondylar notch typically after anterior cruciate ligament (ACL) reconstruction or injury. It is a lesion consisting of fibrous tissue with or without cartilage and bony components. A cyclops lesion is one of the causes for reduced extension and, in the cases reported here, also knee pain or discomfort after ACL reconstruction. We present the MRI features, particularly the features on proton density weighted turbo spin echo (PDW TSE) and proton density weighted turbo spin echo fat saturation (PDW TSE FS) sequences of four cases of cyclops lesions, and distinguish between the MRI findings of large and small lesions. We also describe a cyclops lesion after a posterior cruciate ligament reconstruction, not described in literature before.

Chronic kidney disease (CKD) is a major worldwide health problem, affecting a large proportion of the world's population and leading to higher morbidity and death rates. The early stages of CKD sometimes present without visible symptoms, causing patients to be unaware. Early detection and treatments are critical in reducing complications and improving the overall quality of life for people afflicted. In this work, we investigate the use of an explainable artificial intelligence (XAI)-based strategy, leveraging clinical characteristics, to predict CKD. This study collected clinical data from 491 patients, comprising 56 with CKD and 435 without CKD, encompassing clinical, laboratory, and demographic variables. To develop the predictive model, five machine learning (ML) methods, namely logistic regression (LR), random forest (RF), decision tree (DT), Naïve Bayes (NB), and extreme gradient boosting (XGBoost), were employed. The optimal model was selected based on accuracy and area under the curve (AUC). Additionally, the SHAP (SHapley Additive exPlanations) and LIME (Local Interpretable Model-agnostic Explanations) algorithms were utilized to demonstrate the influence of the features on the optimal model. Among the five models developed, the XGBoost model achieved the best performance with an AUC of 0.9689 and an accuracy of 93.29%. The analysis of feature importance revealed that creatinine, glycosylated hemoglobin type A1C (HgbA1C), and age were the three most influential features in the XGBoost model. The SHAP force analysis further illustrated the model's visualization of individualized CKD predictions. For further insights into individual predictions, we also utilized the LIME algorithm. This study presents an interpretable ML-based approach for the early prediction of CKD. The SHAP and LIME methods enhance the interpretability of ML models and help clinicians better understand the rationale behind the predicted outcomes more effectively.

The aim of this study was to examine performance in hopping tests in male athletes after anterior cruciate ligament reconstruction (ACLR) in the 4-to-6 months post-surgery period. A total of 36 athletes (24 ACLR and 12 controls) participated in this study. The ACLR group consisted of athletes who had undergone an ACLR on their dominant side (ACL DG n=16) or non-dominant side (ACL NDG n=8). Participants completed the following functional tests: a single-leg hop (SLH), single-leg triple hop (SL3H) and single-leg counter movement jump (SLCMJ), then the limb symmetry index (LSI) was calculated. There were no significant differences between the dominant and the non-dominant legs for all functional tests when comparing the ACL DG and the ACL NDG at 6 months after surgery. At 6 months after ACLR, the LSI of the two legs was within acceptable values, whether the athlete had the operation on their dominant or non-dominant leg (except the mean LSI for the ACL DG in the SLCMJ test). Furthermore, the control group showed higher performances as compared to the ACL group for all variables at 6 months after surgery, despite acceptable LSI. We concluded that an early return to "full participation to training" is not recommended in participants who have undergone an ACLR with patellar tendon grafts.

Anterior cruciate ligament (ACL) injury is a common injury encountered by sport medicine clinicians. Surgical reconstruction is the recommended treatment of choice for those athletes wishing to return to full-contact sports participation and for sports requiring multi-directional movement patterns. The aim of ACL reconstruction is to restore knee joint mechanical stability such that the athlete can return to sporting participation. However, knowledge regarding the extent to which lower limb kinematic profiles are restored following ACL reconstruction is limited. In the present study the hip and knee joint kinematic profiles of 13 ACL reconstructed (ACL-R) and 16 non-injured control subjects were investigated during the performance of a diagonal jump landing task. The ACL-R group exhibited significantly less peak knee joint flexion (P = 0.01). Significant between group differences were noted for time averaged hip joint sagittal plane (P < 0.05) and transverse plane (P < 0.05) kinematic profiles, as well as knee joint frontal plane (P < 0.05) and sagittal plane (P < 0.05) kinematic profiles. These results suggest that aberrant hip and knee joint kinematic profiles are present following ACL reconstruction, which could influence future injury risk.

Bracing increased sagittal plane angular velocity for single leg drop jump • Bracing reduced transverse plane motions for pivot turn jump • Participants reported that two tasks were easier to perform with the brace • These effects are clinically relevant in the management of ACL injured patients

Los objetivos de esta revisión fueron analizar las causas y factores de riesgo de la lesión del LCA, realizar una revisión sistemática de los programas de prevención actuales y proponer un protocolo para la prevención de la lesión del LCA. Para ello, se realizó una búsqueda en las bases de datos PuBmed, PeDro y EBSCO, teniendo en cuenta palabras clave en términos DeCS y MeSH, los cuales aportaron 606 y 228 artículos respectivamente. De acuerdo a los criterios de inclusión y exclusión, se seleccionan 18 artículos para ser estudiados. En cuanto a los factores de riesgo de cualquier lesión de rodilla son: lesión previa, fatiga muscular y desequilibrio de fuerza entre isquiosurales y cuádriceps (McCall y col., 2014). Específicamente para la lesión del LCA las causas pueden ser el ángulo Q, el valgo de rodilla, el genu recurvatum, el pie pronador y la torsión externa de la tibia. Además el LCA de la mujer es menor en longitud y en sección transversal que el del hombre (Sutton y col., 2013). Los programas de prevención que han mostrado disminuir la frecuencia lesional inciden en el trabajo del core, la propiocepción, el control motor, el aprendizaje de la técnica de amortiguación, la flexibilidad y el trabajo excéntrico (McCall y col., 2014). En conclusión, se exponen los factores de riesgo específicos a esta lesión en mujeres junto a la eficacia mostrada en los diferentes programas preventivos analizados. Los programas de prevención incluyen el trabajo de la fuerza neuromuscular, estiramientos, pliometría, equilibrio, core y corrección de la técnica de amortiguación del salto y los cambios de dirección. Palabras clave: ligamento cruzado anterior; fútbol femenino; factores de riesgo; programas de prevención. Resumen

The anterior cruciate ligaments (ACL) are the fundamental structures in preserving the common biomechanics of the knees and most frequently damaged knee ligaments. An ACL injury is a tear or sprain of the ACL, one of the fundamental ligaments in the knee. ACL damage most generally happens during sports, for example, soccer, ball, football, and downhill skiing, which include sudden stops or changes in direction, jumping, and landings. Magnetic resonance imaging (MRI) has a major role in the field of diagnosis these days. Specifically, it is effective for diagnosing the cruciate ligaments and any related meniscal tears. The primary objective of this research is to detect the ACL tear from MRI knee images, which can be useful to determine the knee abnormality. In this research, a Deep Convolution Neural Network (DCNN) based Inception-v3 deep transfer learning (DTL) model was proposed for classifying the ACL tear MRI images. Preprocessing, feature extraction, and classification are the ...

The undersigned certify that they have read, and recommend to the Faculty of Graduate Studies for acceptance, a thesis entitled "A Novel Measure of In-Vivo Knee Joint Laxity" submitted by Jessica Küpper in partial fulfilment of the requirements of the degree of Master of Science.

To determine if decreased vascular responsiveness in the medial collateral ligament (MCL) of anterior cruciate ligament transected (ACL-t) rabbit knees is due to pericyte deficiency associated with angiogenesis. Vascular responses to potassium chloride (KCl), phenylephrine, acetylcholine, and sodium nitroprusside (SNP) were evaluated in ACL-t rabbit knees (n = 6) and control knees (n = 5) using laser speckle perfusion imaging. Ligament degeneration was determined by ultrasound imaging. Vascular and pericyte volume were measured using quantitative immunohistochemical volumetric analysis using CD31 and α-smooth muscle actin antibodies with co-localization analysis. Perfusion was increased in the ACL-t rabbits 2.5-fold. Responsiveness to phenylephrine, SNP, and acetylcholine was significantly decreased in the ACL knee while no change in KCl responses was seen. MCL ultrasound imaging revealed decreased collagen organization, increased ligament thickness, and increased water content in t...

We attempted to determine the potential cost savings of prearthroscopic knee MR imaging examinations. SUBJECTS AND METHODS. This prospective study involved 50 consecutive patients. The patients met the surgical-indications-for-monitoring-appropriateness criteria for knee arthroscopy and underwent MR imaging of the knee before arthroscopy. For all patients, we compared MR imaging and arthroscopic findings. On the basis of a cost of $1000 for each MR imaging examination and $4000 for each diagnostic arthroscopy, we decided that costeffective MR imaging would require 25% true negativity. RESULTS.

Purpose Although various kinematic measurements with advanced technology have been used for quantitative evaluation of the pivot shift test, there is no clinically available quantification method of the pivot shift test. The purpose was to describe a novel image analysis technique for quantitative assessment of the pivot shift test using universally available and affordable devices. Methods Five ACL deficient knees were tested during examination under anesthesia. Three skin markers were attached to bony landmarks on the lateral side of the knee joint, (1) Gerdy's tubercle, (2) fibular head, and (3) lateral epicondyle. A standard digital video camera captured motion of the lateral aspect of the knee during the pivot shift test. The image was processed into a 2-dimensional (2-D) coordinate system with Image J software (National Institute of Health, USA) to trace the three landmarks. The anteroposterior (AP) position of the femur was calculated on consecutive still images extracted from the video recording. AP translation over time was reported. Results The reduction phase of the pivot shift could be tracked consistently by a sudden anterior translation of the distal femur. The sudden anterior translation of the lateral epicondyle was on average 3.7 ± 2.1 mm and occurred within 0.2 ± 0.1 s from the start of this anterior translation till the end. Conclusion The sudden shift of the lateral compartment of the knee joint was successfully detected by this newly developed image analysis measurement method. This image analysis technique facilitates a simple and affordable method to evaluate the lateral pivot shift test. Level of evidence Diagnostic studies, Level IV.

The majority of meniscal tears in bucket handles are associated with anterior cruciate ligament (ACL) impairment. Its a rare condition which is rarely encountered when the meniscus has a bucket handle on both sides of the compartment. Here we present the case of a 28-year-old male cricket player with a total ACL rupture, a double Posterior Cruciate ligament (PCL) sign on MRI (Magnetic Resonance Imaging), an uncommon occurrence of a complex bucket handle rupture of the medial meniscus with a double PCL sign. It was a complete ACL tear and displaced bucket handle medial meniscus that was also visible on the magnetic resonance imaging. In this report, double PCL sign was shown on MRI and that was confirmed during the arthroscopic procedure. Keywords: Complete ACL tear, combined medial & lateral bucket handle, meniscus tears.

Purpose The purpose of this in-vitro study was to examine the kinematics of an artificial, free-floating medial meniscus replacement device under dynamic loading situations and different knee joint states. Methods A dynamic knee simulator was used to perform dynamic loading exercises on three neutrally aligned and three 10° valgus aligned (simulating a medial openwedge high tibial osteotomy-MOWHTO) left human cadaveric knee joints. The knee joints were tested in three states (intact, conventional notchplasty, extended notchplasty) while 11 randomised exercises were simulated (jump landing, squatting, tibial rotation and axial ground impacts at 10°, 30° and 60° knee joint flexion) to investigate the knee joint and implant kinematics by means of rigidly attached reflective marker sets and an according motion analysis. Results The maximum implant translation relative to the tibial plateau was < 13 mm and the maximum implant rotation was < 19° for all exercises. Both, the notchplasties and the valgus knee alignment did not affect the device kinematics. Conclusions The results of the present in-vitro study showed that the non-anchored free-floating device remains within the medial knee joint gap under challenging dynamic loading situations without indicating any luxation tendencies. This also provides initial benchtop evidence that the device offers suitable stability and kinematic behaviour to be considered a potential alternative to meniscus allograft transplantation in combination with an MOWHTO, potentially expanding the patient collective in the future.

Background BASHTI is an implant-less anterior cruciate ligament (ACL) reconstruction technique, which resolves the problems caused by implants such as interference screws. This study aims to investigate the effect of the drill bit and tendon's diameter on the Core Bone Engaged Length (CBEL) and the fixation strength. CBEL is the length of core bone which has a full engagement with both tunnel and graft at the same time. Methods 60 in-vitro tests were conducted for 6, 7, 8, and 9 mm tendon sizes with a 10 mm bone tunnel. In this study bovine tendons and dummy bone blocks were used to model the fixation. Drill bits were used to extract the core bone for securing the auto-graft. A three-stage tensile test including a force-controlled cyclical preloading of 10-50 N with a frequency of 0.1 Hz for 10 cycles, followed by the main force-controlled cyclical loading of 50-200 N with a frequency of 0.5 Hz for 150 cycles, and immediately a displacement-controlled single cycle pull-out load with a rate of 20 mm/min were carried out to discover the fixation strength of each sample. Results The 6 mm group had the greatest CBEL. However, all cases in this group failed in loadings below 200 N, which is the minimum required strength after ACL reconstruction. The fixation strength of cases with more than 200 N fixation strength for 7, 8, and 9 mm tendon diameters were 275 ± 42, 330 ± 110, and 348 ± 93 N, respectively, showing insignificant difference between groups (P-value = 0.45). Nevertheless, CBELs for these groups were 16.6 ± 3.4, 9.6 ± 2.4, and 11.7 ± 3.8 mm, respectively, implying a significant increase in CBEL in the 7 mm group than that for 8 and 9 mm groups (P-value = 0.002 and 0.049, respectively). Conclusion Results showed that CBEL could assess the quality of BASHTI technique. However, CBEL was an inverse function of tendon compression, so it was not an independent parameter to determine BASHTI strength. Also, the CBEL of 7 mm group which fulfilled the 200 N threshold was higher than that of 8 and 9 mm groups, so its healing process speed may be higher, which is recommended for a future study in this field.

Background: Bone and Site Hold Tendon Inside (BASHTI) technique is an organic implant-less technique for anterior cruciate ligament (ACL) reconstruction with some clinical advantages, such as speeding up the healing process, over implantable techniques. The study aims to compare the mechanical properties of BASHTI technique with the conventional interference screw technique. Methods: To investigate the mechanical properties, 20 in-vitro experimental tests were conducted. Synthetic dummy bone, along with fresh digital bovine tendons, as a graft, were used for experiments. Three loading steps were applied to all specimens, including a preconditioning, a main cyclic, and a pull-out loading. Results: The mechanical characters of an interference screw technique using an 8 mm tendon diameter, including fixation strength, average cyclic stiffness (ACS), and average pull-out stiffness (APS) were found to be 439 ± 132 N, 10.3 ± 5.3 kN/mm, and 109 ± 40 N/mm, respectively. In the case of an interference screw using a 9 mm tendon, the fixation strength, ACS, and APS were obtained 549 ± 87 N, 10.3 ± 4.7 kN/mm, and 91 ± 13 N/mm, respectively. In parallel, the fixation strength, APS, and ACS of BASHTI technique using an 8 mm tendon were 360 ± 123 N, 3.3 ± 0.6 kN/mm, and 79 ± 27 N/mm, respectively, while, for 9 mm tendon 278 ± 103 N, 2.4 ± 1.2 kN/mm, and 111 ± 40 N/mm, were reported for fixation strength, APS, and ACS respectively when BASHTI technique was used. Conclusion: About 50% of interference screw samples showed superior mechanical properties compared to BASHTI technique, but in another half of the samples, the differences were not significant (N.S.). However, due to organic advantages of BASHTI technique and lower cost, it could be used as a substitute for interference screw technique, especially where fast recovery is expected.

The goal of this study is to investigate the effects of tendon and cannulated drill bit diameter on the strength of the bone and site hold tendon inside (BASHTI) fixation technique for an anterior cruciate ligament (ACL) reconstruction. Bovine digital tendons and Sawbones blocks were used to mimic the ACL reconstruction. Mechanical strength of the specimens was measured using a cyclic loading continued by a single cycle pullout load until failure to simulate the real postsurgical loading conditions. Finally, failure modes of specimens and ultimate failure load were recorded. The maximum possible tendon surface strain (i.e., tendon compression [TC]) for tendon diameters of 6, 7, 8, and 9 mm were 0.73, 0.8, 0.7, and 0.65, respectively. Eighty per cent of the specimens with tendon diameter of 6 mm and 20% of specimens with tendon diameter of 7 mm failed on the torn tendon. All samples with larger tendon diameters (i.e., 8 and 9 mm) failed on the fixation slippage. The maximum fixation ...

Anterior cruciate ligament (ACL) injury is a known risk factor for future development of osteoarthritis (OA). This human clinical study seeks to determine if early changes to cartilage MRI T2 maps between baseline and 6 months following ACL reconstruction (ACLR) are associated with changes to cartilage T2 and cartilage thickness between baseline and 2 years after ACLR. Changes to T2 texture metrics and T2 mean values in medial knee cartilage of 17 human subjects 6 months after ACLR were compared to 2-year changes in T2 and in cartilage thickness of the same areas. T2 texture and mean assessments were also compared to that of 11 uninjured controls. In ACLR subjects, six-month changes in mean T2 correlated to 2-year changes in mean T2 (R = 0.80, p = 0.0001), and 6-month changes to T2 texture metrics, but not T2 mean, correlated with 2-year changes in medial femoral cartilage thickness in 9 of the 20 texture features assessed (R = 0.48-0.72, p ≤ 0.05). Both mean T2 and texture differed...

Lesiones deportivas en baloncesto infantil femenino Introducción: el baloncesto es un deporte que presenta una gran aceptación entre las niñas preadolescentes, si bien poco se sabe sobre la incidencia de lesiones que su práctica tiene sobre esta población. Este trabajo tuvo como objetivo aportar información sobre el patrón de lesión deportiva encontrado en niñas preadolescentes practicantes de baloncesto a nivel federado en España. Material y métodos: durante el Campeonato de España de baloncesto infantil femenino de 2014, se recogió información acerca de ciertas características deportivas individuales de las jugadoras y del club, así como de los entrenamientos y del patrón lesivo, mediante entrevistas personales a los entrenadores y cuestionarios a las jugadoras. Resultados: se recogió información de 348 jugadoras. Un 73,8% reconoció haberse lesionado en la última temporada, mayoritariamente entrenando. El tipo de lesión más frecuentemente fueron los esguinces y la zona corporal el tren inferior, hallándose un 30% de recidivas. El índice lesivo fue de 5,85 lesiones por cada 1000 horas de práctica, y la superficie de juego fue el único factor que mostró tener influencia sobre el riesgo de lesión. El periodo de baja se situó en 2,54 ± 0,97 días, con una ausencia por parte del 25% de las jugadoras de sus actividades académicas. Conclusiones: la práctica de baloncesto por parte de niñas de entre 12 y 13 años presenta un riesgo de lesión que no debe pasar desapercibido, tanto por el promedio de lesiones registrado, como por la posibilidad de que existan recidivas y que la lesión acarree consecuencias a nivel académico. Introduction: basketball is a popular sport among preadolescent girls, although little is known about the incidence of injuries associated with the practice of the sport in this population. The aim of our study was to contribute information on the pattern of injury found in preadolescent girls who play federated basketball in Spain. Materials and methods: during the Spanish Girls' Basketball Championship of 2014, we collected data on certain individual sports-related characteristics of the players and the clubs, as well as on training characteristics and injury patterns, through personal interviews with coaches and administration of a questionnaire to the players. Results: we collected data for 348 female players. Injuries in the past season were reported by 73.8%, most incurred during practice. Sprains were the most frequent type of injury, and the lower extremities the most frequent site; injury recurrence occurred in 30%. The rate of injury was 5.85 injuries per 1000 hours of play, and the court's surface was the sole factor significantly associated with the risk of injury. The time losses due to injuries amounted to 2.54 ± 0.97 days, and 25% of players reported missing school activities. Conclusions: the practice of basketball in girls aged 12 and 13 years carries a risk of injury that cannot be ignored, due to both the number of recorded injuries and to their potential impact on academic performance.

This bilateral squat study tests whether people with anterior cruciate ligament (ACL) reconstruction have symmetric three-dimensional ground reaction forces (GRFs) and symmetric anterior-posterior (AP) translation rates of the femur with respect to the tibia when compared with healthy control subjects. We hypothesized that there would be no long-term asymmetry in knee kinematics and kinetics in ACL reconstructed subjects following surgery and rehabilitation. Position and GRF data were collected on eight ACL reconstructed and eight control subjects during bilateral squat. The rate of relative AP translation was determined for each subject. Principal component models were developed for each of the three GRF waveforms. Principal component scores were used to assess symmetry within the ACL reconstructed group and within the control group. ACL reconstructed knees analyzed in early flexion during squat descent displayed a four-fold greater rate of change in anterior translation in the rec...

Objective: To describe the prevalence of magnetic resonance imaging (MRI) detected structural damage in the patellofemoral joint (PFJ) and tibiofemoral joint (TFJ) in a population-based cohort. A secondary aim was to evaluate the patterns of compartmental involvement in knees with pain, between men and women, and in different age and body mass index (BMI) categories. Methods: We studied 970 knees, one knee per subject, from the Framingham Osteoarthritis Study, a population-based cohort study of persons 51e92 years old. Cartilage damage and bone marrow lesions (BMLs) were assessed using the Whole Organ Magnetic Resonance Imaging Score (WORMS). The prevalence of isolated PFJ, isolated TFJ, and mixed structural damage was determined using the following definitions: any cartilage damage, full thickness cartilage loss, any BML, and the combination of full thickness cartilage loss with any BML. Results: The mean age and BMI was 63.4 years and 28.6 m/kg 2 , respectively; 57% were female. Isolated PFJ damage occurred in 15e20% of knees and isolated TFJ damage occurred in 8e17% of knees depending on the definition used. The prevalence of isolated PFJ damage was greater than isolated TFJ damage using all definitions except the any BML definition. This pattern was similar between genders and among age and BMI categories. In those with knee pain, isolated PFJ was at least as common as TFJ damage depending on the definition used. Conclusion: Using MRI to assess knee joint structural damage, isolated PFJ damage was at least as common as, if not more common than, isolated TFJ damage.

Objectives: It remains difficult to characterize the source of pain in knee joints either using radiographs or magnetic resonance imaging (MRI). We sought to determine if advanced machine learning methods such as deep neural networks could distinguish knees with pain from those without it and identify the structural features that are associated with knee pain. Methods: We constructed a convolutional Siamese network to associate MRI scans obtained on subjects from the Osteoarthritis Initiative (OAI) with frequent unilateral knee pain (n=1,529) comparing the knee with frequent pain to the contralateral knee without pain. The Siamese network architecture enabled pairwise learning of information from two-dimensional (2D) sagittal intermediate-weighted turbo spin echo slices obtained from similar locations on both knees. Class activation mapping (CAM) was utilized to create saliency maps, which highlighted the regions most associated with knee pain. The MRI scans and the CAMs of each subject were reviewed by an expert radiologist to identify the presence of abnormalities within the modelpredicted regions of high association. Results: Using 10-fold cross validation, our model achieved an area under curve (AUC) value of 0.808. When individuals whose knee WOMAC pain scores were not discordant were excluded, model performance increased to 0.853. The radiologist review revealed that about 86% of the cases that were predicted correctly had effusion-synovitis within the regions that were most associated with pain. Conclusions: This study demonstrates a proof of principle that deep learning can be applied to assess knee pain from MRI scans.

Sixteen rabbits were killed 12 weeks after sectioning of the right knee anterior cruciate ligament. The left unoperated knee served as a control. The surface area of fibrillated cartilage from femoral condyles and tibial plateau was evaluated and expressed as a percentage of articular surfaces area. Cartilage from the femoro-patellar surfaces was homogenized for the quantification of several degradative activities, based on the release of digested products. Acid phosphatase, several glycosidases and neutral protease activity from the operated joint cartilage were significantly elevated, while collagenolytic activity was unmodified. The percentage o f fibrillated cartilage correlated positively with arylsulfatase, glucosidase and neutral protease but negatively with mannosidase and fucosidase. The results may be consistent with the hypothesis of a sequential degradative process leading to cartilage destruction.

Background: Increased femoral tunnel widening and weakness of the hamstring muscles postoperatively have been described as potential adverse events after anterior cruciate ligament (ACL) reconstruction (ACLR) with a hamstring graft. Meniscectomy and cartilage lesions are important factors for the development of degenerative osteoarthritis. Purpose: To compare 15-year follow-up data with 5-year follow-up data from the same cohort of patients after ACLR with a hamstring autograft using an outside-in technique. Study Design: Case series; Level of evidence, 4. Methods: A total of 72 patients who underwent anatomic ACLR with a quadruple hamstring graft and an outside-in technique were selected for this prospective study. Patients were reviewed at a minimum follow-up of 15 years. Results were compared with the same series of patients previously reviewed at 5 years after surgery. Lysholm, International Knee Documentation Committee (IKDC), and Tegner scores as well as KT-1000 arthrometer measurements were obtained at final follow-up. Comparative weightbearing radiographs were obtained and analyzed according to the Fairbank, Kellgren-Lawrence, and IKDC classifications and used for the tunnel evaluation. Results: No significant difference was detected on the subjective evaluation. Objectively, patients categorized as A or B according to the IKDC score were not significantly different at 5 and 15 years (P < .01). A KT-1000 arthrometer side-to-side manual maximum difference >5 mm, a pivot shift >2þ, any giving-way episode, and ACL revision surgery were considered as failures, and these were noted in 6 patients at 5 years and 6 patients at 15 years. The radiological evaluation at 15 years showed a higher rate of osteoarthritis in 2 of 3 radiological scales used in the study compared with results at 5-year follow-up (P < .01). At 15-year followup, there was a statistically significant reduction in the mean tibial tunnel diameter (P < .01). Conclusion: Endoscopic single-bundle ACLR using hamstring grafts and an outside-in technique demonstrated good results at 15-year follow-up in terms of subjective, objective, and radiographic evaluations. As compared with 5-year follow-up, clinical results remained stable both subjectively and objectively. However, a progression of osteoarthritis changes was observed, especially in patients in whom meniscectomy had been performed.

The aim of this study was to compare clinical and arthrometrical results of a series of patients older than 40 years with those of younger patients following anterior cruciate ligament (ACL) reconstruction. The hypothesis of this study was that certain biological and biomechanical factors related to middle-aged patients, ACL reconstruction would provide different results compared with younger patients. Methods Thirty-six patients >40 years operated for ACL reconstruction between 2002 and 2010 were selected for this retrospective study, and results were compared with patients in two other age groups (<30 years and 30-40 years). At a minimum follow-up of two years, patients were reviewed and clinically examined subjectively and objectively according to Tegner, International Knee Documentation Committee (IKDC) classification and Lysholm evaluation scales. An arthrometric evaluation with KT-1000 was also performed. Results No statistically significant difference was found among the three different age groups at the subjective and objective evaluations. However, the KT-1000 arthrometric study showed a statistically significant mean side-to-side difference at 30 lb with 1.8 mm [standard deviation (SD) 2.4] for patients >40 years, 2.7 mm (SD 1.8) for patients aged 30-40 years and 2.6 mm (SD 1.8) for patients <30 years. Conclusions Our results seem to show that ACL reconstruction is a safe and valid option for patients of all age groups, even for those >40 years. Moreover, in that group, greater knee stability was found when compared with the younger patient groups.

Background: The anterior cruciate ligament-deficient (ACLD) knee requires appropriate treatment for the patient to return to sports. The purpose of this study was to clarify the kinematics of the anterior cruciate ligament-deficient knee in squatting motion before and after double-bundle anterior cruciate ligament reconstruction (DB-ACLR) using a 2D/3D registration technique. Methods: The subjects of this study were 10 men with confirmed unilateral ACL rupture who underwent DB-ACLR. Computed tomography (CT) of the knee joints was performed before DB-ACLR. Fluoroscopic imaging of the knee motion in squatting before and after DB-ACLR was also performed. The 2D/3D registration technique is a method of calculating positional relationships by projecting the 3D bone model created from the CT data onto the image extracted from the fluoroscopic images. The tibial anteroposterior (AP) and rotational positions were analyzed with reference to the femur. Results: The tibial AP position of the ACLD knees was significantly anterior to the contralateral knees (p = 0.015). The tibial rotational position of the ACLD knees was significantly internally rotated compared to the contralateral knees (p < 0.001). Both tibial AP and rotational positions improved after DB-ACLR (p < 0.001), with no significant differences compared to the contralateral knees. Conclusion: DB-ACLR improved not only tibial AP instability but also tibial rotational instability at knee flexion with weight-bearing. DB-ACLR appears to be a useful technique for normalizing the knee joint kinematics of ACLD knees.

Background: No definitive explanation for the difference in rate of male and female noncontact ACL injury has been found. The hormonal environment, known to be different in men and women has been hypothesized as a possible source for this difference in injury rate. Purpose: To confirm earlier work looking at periodicity of noncontact ACL injury. To increase sample size by adding ankle sprains. To determine the rate of noncontact ACL injury and ankle sprains in collegiate basketball and soccer. To determine if the use of oral contraceptives affects the rate of noncontact ACL injury and ankle sprains. Methods: Data was collected from a sample of NCAA schools over the 2000-2001 basketball and the 2001-2002 basketball and soccer seasons. Results: Recall and prospective data collection of length of menstrual cycle did not produce equivalent results. Periodicity was present only in the recall group of "off pill" users. The rate of noncontact ACL injury and noncontact ankle sprains was twice as high in basketball as in soccer. There was no difference in rate of injuries between those athletes using hormonal therapy and those athletes not using hormonal therapy. Conclusions: Noncontact ACL injuries and ankle sprains occurred at significantly higher rates in basketball than in soccer but this rate difference was not linked to hormonal therapy usage. The overall rate of noncontact ACL injury and ankle sprain to women's collegiate basketball and soccer players is very low.

RESUMEN: INTRODUCCIÓN: La termografía infrarroja (IFT) es una herramienta de análisis que no emite irradiación y no es invasiva por lo que es adecuada para el estudio de las funciones fisiológicas relacionadas con el control de temperatura de la piel. OBJETIVOS: Establecer el comportamiento termográfico de un jugador de baloncesto. MATERIAL Y MÉTO-DOS: En el estudio ha participado un jugador profesional de la ACB. Tras respetar el periodo de aclimatación y cumplir el protocolo de la International Academy of Clinical Thermology (IACT) se han tomado 4 imágenes termográficas, dos de la visión anterior (miembro superior e inferior) y dos de la visión posterior (miembro superior e inferior). RESULTADOS: Se han encontrado diferencias de más de 0.5ºC entre áreas simétricas del cuerpo. CONCLUSIONES: La termografía es una herramienta válida, rápida y segura que nos permite cuantificar el estado térmico del sujeto y controlar su evolución.

Introduccion: La biomecanica de la articulacion de la rodilla es de gran importancia para la prevencion de las diferentes lesiones que se pueden dar a nivel deportivo y en la vida cotidiana. En este sentido la medicion del angulo de proyeccion frontal de la rodilla en 2D, es una tecnica facil y accesible a toda la comunidad academica, que permite por medio de video y la medicion de angulos articulares de manera computarizada, conocer las caracteristicas funcionales de las estructuras articulares, y de manera preventiva saber el riesgo que puede tener un deportista de sufrir lesiones ligamentarias en esta articulacion. Se ha demostrado que las mujeres tienen mayor predisposicion de padecer lesiones de rodilla en deportes que requieran saltar, aterrizar, cortar y realizar maniobras de giro. Estas lesiones ocasionan aproximadamente un tercio de ausencia o perdida de practicas deportivas y competencias (1). La modalidad del voleibol tiene como base de su desarrollo fisico y tecnica depo...

Objectives To evaluate the outcome and complications in dogs with medial patellar luxation (MPL) undergoing tibial tuberosity transposition (TTT) with a locking plate and pin fixation (Plate-Pin). Methods This retrospective multicenter study included 65 consecutive MPL stifle surgeries using tibial tuberosity (TT) fixation with a 5-hole locking plate and a pin. The median weight of the dogs was 6.2 kg. The grade of luxation was 2/4 in 50 stifles and 3/4 in 15 stifles. Outcomes were assessed during follow-up examinations 33 to 648 days after surgery with clinical examination and radiography. Canine Orthopedic Index questionnaires were sent to owners 6 to 39 months after surgery. Results Complications were reported in 14/65 stifles, of which 8/14 were minor and 6/14 were major. After treatment of the major complications, lameness was resolved in all cases and the MPL was resolved in 64/65 stifles. Clinical Significance When the surgery was performed as described in this article, Plate-Pin fixation for TT during MPL surgery is a feasible technique with a lower incidence of luxation recurrence, TT avulsion, and fractures compared with recent retrospective studies with pin and tension band wire TT fixation. Further development of the locking plate TT fixation is indicated to resolve pin-related complications and to determine if fixation including a pin is necessary.

OBJECTIVE. The objective of this study was to evaluate the accuracy of tibial rotation measurement as a secondary sign for diagnosing anterior cruciate ligament (ACL) tears with the use of MRI. MATERIALS AND METHODS. A total of 893 MRI studies were retrospectively reviewed, and 239 patients were identified as having either an intact ACL (group 1; n = 182), an arthroscopically confirmed acutely torn ACL (group 2; n = 22), or a chronically torn ACL (group 3; n = 35). Tibial rotation was estimated by measuring the femorotibial angle (FTA). RESULTS. The mean (± SD) FTA was significantly higher in group 2 (10.7° ± 4.8°) and group 3 (11° ± 5.5°) than in group 1 (3.2° ± 3.3°) (p < 0.001, for all cases). An FTA of 4.9° was the optimal threshold (sensitivity, 93%; specificity, 80%) for separating completely torn ACLs from intact ACLs. An FTA ranging from 4.9° to 5.5° (sensitivity, 95%; specificity, 80%) indicated a complete acute ACL tear, whereas an FTA of 5.6° or greater (sensitivity, 91.4%; specificity, 83.5%) suggested a complete chronic ACL tear. CONCLUSION. An increased FTA indicates alteration in the femorotibial anatomic relationship and could be of value in assessing ACL tears in patients with equivocal signs on MRI.