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PubMedDate not supplied

Preoperative anterior knee laxity did not influence postoperative stability restored by anterior cruciate ligament reconstruction.

Eighty-six chronic anterior cruciate ligament (ACL)-injured patients were quantitatively measured for anterior knee stability preoperatively and at 2 years or later (mean, 30 months) postoperatively to examine the influence of preoperative knee laxity on the postoperative knee stability restored by the ACL reconstruction using multiplied hamstring tendon graft. The patients were divided into 3 groups according to the preoperative injured minus normal anterior laxity difference (AL-D) (group I [n = 27] <5 mm, group II [n = 48] 5 to 9 mm, group III [n = 11] >10 mm). The 3 groups were comparable in gender, age, meniscal status, graft excursion measured during operation, time from injury to operation, and activity level. The postoperative AL-D in group I was 0.8 +/- 1. 7 mm, that in group II was 1.1 +/- 1.6 mm, and in group III was 1.5 +/- 1.4 mm. There were no significant statistical differences among these 3 groups. With our surgical technique including postoperative rehabilitation, patients with severe instability could be treated successfully without needing any additional procedures such as extra-articular augmentation or specially designed postoperative rehabilitation programs.

Adolescent↗

PubMed1982

Observations on the morphology and the axon conduction velocity of axotomized and regenerating sciatic motoneurons in the kitten.

In 1 week old kittens a 10 mm long segment of the sciatic nerve was removed distal to the hamstring branch point. After 70-85 days sciatic motoneurons were injected intracellularly with horseradish peroxidase (HRP). The cell body diameter, the summed diameter of the 1st order dendrites, the intramedullary axon diameter and the axon conduction velocity proximal to the lesion were determined in individual neurons and related to the conduction velocity of the regenerating segment of the axons. The lesioned neurons were compared with normal sciatic motoneurons in 7-8 and 77-92 days old kittens. In motoneurons which seemed to lack regenerating axons or had regenerating axon segments with a low conduction velocity there was a clear growth retardation of all studied parameters. In those neurons, however, which had regenerating axon segments conducting faster than 10 m/s, all parameters above the lesion, except for the conduction velocity of the axon, had attained normal values. The intramedullary part of the axon seemed to be less affected by the injury than all other studied parts of the neuron proximal to the lesion.

Animals↗

PubMed2006

Anatomic double bundle: a new concept in anterior cruciate ligament reconstruction using the quadriceps tendon.

Surgical procedures for double-bundle anterior cruciate ligament reconstruction, which currently use hamstring graft, have been described, but some concerns remain regarding graft fixation and the ability to obtain adequate bundle size. We report an original double-bundle anterior cruciate ligament reconstruction technique using a quadriceps tendon graft and a simplified outside-in femoral tunnel-drilling process. The graft consists of a patellar bone block with its attached tendon split into superior and inferior portions, which yields 2 bundles. The anteromedial tunnel is drilled from the outside through a small lateral incision by use of a guide. The posterolateral tunnel is made through the same incision with a specific guide engaged in the anteromedial tunnel. A single tibial tunnel is created. The graft is routed from the tibia to the femur with the bone block in the tibial tunnel and the 2 bundles in their respective femoral tunnels. After fixation of the bone block in the tibia, the 2 bundles are tensioned and secured separately in their femoral tunnels.

Anterior Cruciate Ligament↗

PubMed2006

Minimally invasive quadriceps tendon harvest.

Quadriceps tendon (QT) is becoming a popular graft for primary and revision ligament surgery. A subcutaneous technique for graft harvesting a QT is presented. Special closed tendon strippers were designed; these devices have 10- and 11-mm inner diameters and are stronger and sharper than regular hamstrings strippers. In the mid-line of the patellar upper pole, a 2-cm longitudinal incision is made, a 20- x 10-mm bone plug is created with an oscillating saw, and the tendon stripper is positioned and advanced into the thigh, dissecting the QT until the desired length, usually 10 cm, is obtained. The graft can be released by making a stab incision at the device's tip or by ventrally pointing and turning the tendon stripper to amputate the graft's end. The QT graft can be prepared in several fashions for 1- or 2-bundle ligament reconstructions. The technique was tested and refined in 3 cadaver specimens and has been used at our institution since 2003 in 18 primary posterior cruciate ligament reconstructions with no problems. This minimally invasive technique is safe, provides a consistently good-quality graft with excellent cosmetic results, and is simple and easily reproducible.

Equipment Design↗

PubMed1994

Interdevice reliability and validity assessment of the Nicholas Hand-Held Dynamometer.

The Nicholas Hand-Held Dynamometer (HHD) has been shown to have excellent interday and intraday reliability when using the same HHD. Since clinics may have more than one HHD with which to evaluate patients, it would be of value to know if two identical HHDs measure the same variable consistently. The purpose of this investigation was to assess interdevice reliability of the Nicholas HHD as well as to determine its validity. Thirty healthy female subjects between the ages of 20 and 56 years (mean age = 28.4) were tested for hamstring strength. Three measurements of maximum hamstring contractions were obtained using the first HHD (Device A). The average of these three measurements was compared with the average of three measurements obtained after a brief rest using a second HHD (Device B). Measurements from the two HHDs were also compared with measurements obtained from a Kin-Com isokinetic dynamometer. The Kin-Com measurements were used as criteria to determine validity of the HHD. An intraclass correlation coefficient (ICC) calculated to determine reliability between the two HHDs was low (ICC = .58). Pearson product-moment correlation coefficients were calculated between the Kin-Com and each of the two HHDs. These values were .85 and .83 for Device A and B, respectively. Analysis of variance showed no significant difference between the Kin-Com and Device A but a significant difference between the Kin-Com and Device B (p < .001). Measurements obtained from two identical HHDs may be significantly different and should not be compared.

Adult↗

PubMed2001

Early post-operative morbidity following anterior cruciate ligament reconstruction: patellar tendon versus hamstring graft.

This study documented postoperative morbidity during the first 4 months following anterior cruciate ligament (ACL) reconstruction using either patellar tendon or hamstring tendon autograft. Sixty-five patients undergoing primary arthroscopically assisted single-incision ACL reconstruction were randomized to have a central third bone patellar tendon bone autograft (PT) or a doubled semitendinosus/doubled gracilis autograft (HS). Postoperatively patients undertook a standard 'accelerated' rehabilitation protocol. Patients were reviewed after 2 weeks, 8 weeks, and 4 months. At each review the location and severity of general knee pain and the presence and severity of anterior knee pain (AKP) were recorded as were the presence and size of an effusion as well as the active and passive flexion and passive extension deficits compared to the contralateral limb. Pain on kneeling, KT-1000 measured side to side difference in anterior tibial displacement, isokinetic assessment of quadriceps and hamstring peak torque deficits, IKDC score and Cincinnati sports activity level were also recorded after 4 months. After 2 weeks more patients in the PT group complained of AKP and reported that the pain was more severe. After 8 weeks there was no significant difference between the groups for any variable. After 4 months the severity of general pain experienced and the incidence of pain on kneeling were greater in the PT group. The PT group also demonstrated a significantly greater quadriceps peak torque deficit at 240 degrees /s. IKDC scores were higher in the HS group, but Cincinnati sports activity scores were higher in the PT group. Although we observed a lower morbidity in the HS group, primarily related to pain, the severity of pain in both groups was relatively low and, in light of the higher mean sports activity level observed in the PT group at 4 months the clinical impact of the difference may not be significant.

Adolescent↗

PubMed1994

The contribution of GABAA and glycine receptors to central sensitization: disinhibition and touch-evoked allodynia in the spinal cord.

1. Pain hypersensitivity is characterized by an increase in the response to noxious stimuli (hyperalgesia) and a reduction in threshold such that innocuous stimuli begin to elicit pain (allodynia). These sensitivity changes can be produced by an increase in excitability of dorsal horn neurons; the phenomenon of central sensitization. We have now examined whether a reduction in local segmental inhibitory mechanisms produces similar changes. The model system used for studying touch-evoked allodynia has been the recruitment of a low-threshold mechanoreceptor input to the nociceptive flexion withdrawal reflex in the decerebrate-spinal rat. 2. Hamstring flexor alpha motoneurons are characterized by high-threshold cutaneous receptive fields. Mechanical stimuli (pinch or firm pressure) evoke a brisk firing response in these cells, whereas low-intensity stimuli (light touch or brush) produce little or no effect, as expected for the output neurons of the nociceptive flexion withdrawal reflex. 3. Primary afferent C fiber conditioning inputs have previously been shown to produce prolonged increases in the excitability of the flexion reflex, as measured by the augmentation of the response to high-intensity peripheral stimuli. We have now examined whether these conditioning inputs and segmental disinhibition modify the responsiveness of the reflex to low-threshold inputs. 4. Brief (20 s), low-frequency (1 Hz), C fiber conditioning stimuli to the sural nerve increased the response of the hamstring flexor motor neurons to low-intensity cutaneous touch stimuli, reduced the cutaneous mechanical threshold, and increased the response to A beta inputs from the sural nerve. 5. Intrathecal injections of subconvulsant doses of the glycine receptor antagonist, strychnine (7 nmol) or the gamma-aminobutyric acid-A (GABAA) receptor antagonist, bicuculline (8 nmol) produced similar but longer lasting changes. The GABAB antagonist P-(3-aminopropyl)-P-diethoxymethyl-phosphonic acid (CGP 35348) had no significant effects. 6. The nociceptive flexion withdrawal reflex is under the control, therefore, of segmental inhibitory mechanisms mediated by glycine and GABAA receptors. Removal of this inhibition enables the reflex to be activated by low-intensity cutaneous stimuli. Given the similarities between the stimulus-response profiles of the nociceptive flexion reflex and the production of pain in man, these findings indicate that a decrease in the efficacy of spinal inhibitory circuits may contribute to the touch-evoked allodynia that occurs in pain hypersensitivity states, where A beta inputs begin to produce pain.

Afferent Pathways↗

PubMed2006

The reliability of isokinetic and isometric leg strength measures among individuals with symptoms of mild osteoarthritis.

AIM: The aim of the study is to evaluate the test-retest reliability of measures of isokinetic and isometric leg strength and joint function among individuals exhibiting symptoms of mild osteoarthritis. Reliable procedures are needed to assess the effectiveness of an intervention on osteoarthritic symptoms. METHODS: Test-retest reliability of two leg strength protocols was assessed using the intraclass correlation coefficient (R). Testing was completed on two occasions separated by 7 days. Eighteen subjects (9 male and 9 female; 54.1+/-11 years) completed an isokinetic testing trial, which consisted of a set of 5 maximal repetitions of the quadriceps and hamstrings at 60 deg/s followed by a set of 15 maximal contractions at 180 deg/s with a 2-min rest between sets and an isometric testing trial, which consist of 3 maximal contractions of the quadriceps for 6 s with a 30-s rest between contractions at 30, 45, and 80 degrees of knee flexion for a total of 9 isometric contractions. A 90-s rest occurred between angles. RESULTS: Most of the isokinetic variables showed moderate to high intraclass reliability (ICC). Two of the calculated isokinetic variables (work fatigue at 180 degrees /s for extension and for flexion) showed low intraclass reliability (ICC=0.78, resp. ICC=0.6). All calculated ICC values of the isometric variables were moderate to high. CONCLUSIONS: Test-retest reliability of isokinetic and isometric leg strength was high, allowing the intervention protocol to monitor changes in leg strength and joint function among those exhibiting symptoms of mild osteoarthritis.

Biomechanical Phenomena↗

PubMed2003

Dynamic joint loading following hamstring and patellar tendon anterior cruciate ligament reconstruction.

This study compared lower limb dynamic joint loading after hamstring (HS) and patellar tendon (PT) anterior cruciate ligament (ACL) reconstruction. A three-dimensional motion analysis and force plate system were used to determine sagittal plane kinematics and kinetics in 20 subjects who had undergone ACL reconstruction (10 HS, 10 PT) whilst they performed both horizontal and vertical hopping tasks. Results for both activities showed significantly smaller knee flexion angles and external flexion moments in the operated than the non-operated limbs in PT subjects but no difference between limbs in HS subjects. There was no difference in the summated moment (hip plus knee plus ankle) between limbs for either graft type. The peak vertical ground reaction force was greater in the operated than the non-operated limb in PT subjects during the horizontal hop. These data show functional knee kinematic and kinetic differences between the two graft types that point to an earlier or better functional recovery in patients undergoing ACL reconstruction with HS graft than PT graft.

Adult↗

PubMed2006

Lengthening and transfer of hamstrings for a flexion deformity of the knee in children with bilateral cerebral palsy: technique and preliminary results.

Between July 2000 and April 2004, 19 patients with bilateral spastic cerebral palsy who required an assistive device to walk had combined lengthening-transfer of the medial hamstrings as part of multilevel surgery. A standardised physical examination, measurement of the Functional Mobility Scale score and video or instrumented gait analysis were performed pre- and post-operatively. Static parameters (popliteal angle, flexion deformity of the knee) and sagittal knee kinematic parameters (knee flexion at initial contact, minimum knee flexion during stance, mean knee flexion during stance) were recorded. The mean length of follow-up was 25 months (14 to 45). Statistically significant improvements in static and dynamic outcome parameters were found, corresponding to improvements in gait and functional mobility as determined by the Functional Mobility Scale. Mild hyperextension of the knee during gait developed in two patients and was controlled by adjustment of their ankle-foot orthosis. Residual flexion deformity > 10 degrees occurred in both knees of one patient and was treated by anterior distal femoral physeal stapling. Two children also showed an improvement of one level in the Gross Motor Function Classification System.

Adolescent↗

PubMed2005

Strength and power predictors of sports speed.

For many sporting activities, initial speed rather than maximal speed would be considered of greater importance to successful performance. The purpose of this study was to identify the relationship between strength and power and measures of first-step quickness (5-m time), acceleration (10-m time), and maximal speed (30-m time). The maximal strength (3 repetition maximum [3RM]), power (30-kg jump squat, countermovement, and drop jumps), isokinetic strength measures (hamstring and quadriceps peak torques and ratios at 60 degrees .s(-1) and 300 degrees .s(-1)) and 5-m, 10-m, and 30-m sprint times of 26 part-time and full-time professional rugby league players (age 23.2 +/- 3.3 years) were measured. To examine the importance of the strength and power measures on sprint performance, a correlational approach and a comparison between means of the fastest and slowest players was used. The correlations between the 3RM, drop jump, isokinetic strength measures, and the 3 measures of sport speed were nonsignificant. Correlations between the jump squat (height and relative power output) and countermovement jump height and the 3 speed measures were significant (r = -0.43 to -0.66, p < 0.05). The squat and countermovement jump heights as well as squat jump relative power output were the only variables found to be significantly greater in the fast players. It was suggested that improving the power to weight ratio as well as plyometric training involving countermovement and loaded jump-squat training may be more effective for enhancing sport speed in elite players.

Adult↗

PubMed2005

[Rigid-fix pins fixation and LCA reconstruction with semitendinosus/gracilis autograft].

ACL reconstruction techniques highly developed during the decades and biomechanical tests for hamstrings graft showed much in advance loading and stiffness comparing BPTB grafting. We have made joint analysis of 30 patients with semitendinosus / gracilis ACL reconstruction. Choice for proximal fixation was Mitek Rigid-fix Pins technique and bioactive screws for distal fixation; in 18 cases bioactive screws were used for femoral and tibial graft fixation. Lysholm score and knee clinical tests were parameters used for outcome evaluation. Follow up averaged 6 months with assessment after 1, 3, 6 and 12 months. Our results showed excellent postoperative Lysholm score in 85% and very good in 15% of cases. Postoperative Lachman was 1+ in 15% and postoperative pivot shift was 0%. Full rehabilitation achieved 85% and with modifications in everyday activities 15% of patients. Donor localization morbidity was markedly reduced and we have no complications. On the basis of the improved results in graft compression as well as stability with this technique, applied method is highly recommended for the reconstruction in ACL deficient knees.

Adolescent↗

PubMed1997

[Sagittal balance of the spine].

PURPOSE OF THE STUDY: The authors examined the modifications of sagittal shape and muscular functions in different vertebral diseases in order to investigate their correlations and to specify the role of hip extension in standing posture. MATERIALS AND METHODS: We included 57 patients presenting various diseases, among which lumbar kyphosis, spondylosis and spondylolisthesis, backache and lumbar stenosis. We measured joint mobility (hip extension, lumbar flexion), muscular retractions (ilio-psoas, hamstrings, rectus femoris), and muscular strength (spine flexors and extensors, hamstrings, quadriceps femoris). On standing lateral x-rays, measurements were made of various spinal and pelvic parameters, among which the "pelvi-femoral angle", proposed by the authors for hip extension evaluation. RESULTS: There was a significant correlation between pelvi-femoral angle and pelvic backward tilting (r = 0.8037 p < 0.01). This angle can therefore be considered as fundamental for evaluation of sagittal posture. Characteristic abnormalities were found for each pathogenic group, notably for lumbar kyphosis and spondylolisthesis. DISCUSSION: Upright posture is secondary to hip extension and lumbar lordosis, and an optimal and economic standing posture is obtained when balance between these two phenomena is correct. In lumbar kyphosis pelvic modifications such as hip extension, and pelvic backward tilt-up arise compensating the anterior displacement of the center of gravity, while in spondylolisthesis, anterior displacement is secondary to sacral obliquity. CONCLUSION: It is very important to evaluate the pelvis position in sagittal spinal diseases, in order to understand postural deterioration mechanisms. Lumbar kyphosis and spondylolisthesis are two examples of failure of upright posture.

Adolescent↗

PubMed1988

Characteristics and performance of male citizen cross-country ski racers.

Forty-three male citizen or recreational cross-country (X-C) ski racers (aged 31 +/- 4.4 years) were tested to determine their weight (BW) and percent body fat (BF), maximal oxygen uptake (VO2max), quadriceps (Quad), hamstrings (Ham) and upper body (UBS) isokinetic strength (60 degrees, 180 degrees, 240 degrees/s), and Quad endurance. In addition, skiers filled out a questionnaire to determine their skiing experience and to see what other activities they participated in. All these variables were run through a stepwise regression procedure to see which characteristics best predicted performance in a 10 km X-C ski race. The relatively high VO2max of 56.6 ml O2/kg/min and low BF of 10.1% indicate this group to be a very fit subset of the general population. All the skiers were active in other sports on a year-round basis. Of the variables studied, UBS, VO2max, and Quad strength were all significant determinants of 10 km race performance, yielding a multiple R of 0.78. Quad endurance, Ham strength, BW, BF, and experience did not significantly contribute toward the prediction of performance. It is felt that a proper training program for the citizen X-C skier should strive to maximize upper body strength as well as one's aerobic capacity.

Adult↗

PubMed2005

Effect of drain placed in the donor site in the early postoperative period after arthroscopically assisted anterior cruciate ligament reconstruction with quadrupled hamstring tendons.

BACKGROUND: No scientific study has addressed the effects of the routine use of postoperative drains in the donor site after arthroscopic anterior cruciate ligament reconstruction using hamstring tendons. HYPOTHESIS: Patients who have drains placed in their donor sites have less lower extremity edema, more motion, and more comfort in the early postoperative period. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1. METHODS: Thirty-four patients undergoing arthroscopically assisted quadruple hamstring tendon anterior cruciate ligament reconstruction were randomly assigned to either receive a drain for 24 hours placed at the donor site (17 patients) or have no drain at the donor site (17 patients). Data were collected on postoperative days 1, 3, 5, and 7 regarding knee flexion, knee extension, thigh circumference, leg circumference, and visual analog scale (measuring pain). RESULTS: In the study group versus the control group, there were increased knee flexion measurements on postoperative day 7 (84 degrees vs 69 degrees , P < .05); smaller thigh circumference measurements on postoperative day 7 (36.8 vs 40.1 cm, P < .05); smaller leg circumference measurements on postoperative days 3 (33.2 vs 36.4 cm, P < .05), 5 (32.7 vs 36.0 cm, P < .05), and 7 (31.8 vs 35.7 cm, P < .001); and a lower visual analog scale score on postoperative days 3 (40.38 vs 57.50, P = .001), 5 (38.46 vs 60.35, P = .001), and 7 (38.07 vs 61.43, P = .001). CONCLUSION: Drain placement at the donor site after anterior cruciate ligament reconstruction gives more comfort to the patient and provides better flexion within the first week.

Adolescent↗

PubMedDate not supplied

Anterior cruciate ligament injuries in patients with open physes.

From July 1988 to August 1989, six children with open physes and injuries to the anterior cruciate ligament were treated operatively. All injuries involved twisting episodes during sports activities. All six patients had meniscal abnormalities, and, additionally, one patient sustained a Grade III medical ligament tear and had a lateral patellar dislocation. Operative reconstruction used hamstring tendons and place a groove over the front of the tibia and a groove over the top of the femur without violation of the growth plates. The anterior cruciate ligament was primarily repaired (three patients) at the time of reconstruction, if possible. At 3 months, one patient underwent arthroscopic resection of adhesions for arthrofibrosis. There were no other complications. Five patients were evaluated with clinical examination, radiographs, magnetic resonance imaging, and functional testing at an average followup of 33.2 months (range, 25 to 38). Four of the five had returned to their preinjury level of sports participation. Manual maximum KT-1000 arthrometer side-to-side differences averaged 3.6 +/- 1.9 mm. The average Lysholm knee score was 95.2 +/- 2.5; the average Hospital for Special Surgery knee score was 96.6 +/- 2.3. There were no growth plate injuries. Despite the overall clinical stability, magnetic resonance image scans of the five patients consistently demonstrated areas of increased signal in the anterior cruciate ligament grafts.

Adolescent↗

PubMed1999

Hamstring graft motion in the femoral bone tunnel when using titanium button/polyester tape fixation.

The objective of this study was to determine the relative motion of a quadruple hamstring graft within the femoral bone tunnel (graft-tunnel motion) under tensile loading. Six graft constructs were prepared from the semitendinosus and gracilis tendons of human cadavers and were fixed with a titanium button and polyester tape within a bone tunnel in a cadaveric femur. Three different lengths of polyester tape (15, 25, and 35 mm loops) were evaluated. The femur was held stationary and uniaxial tensile loads were applied to the distal end of the graft using a materials testing machine. Each construct was subjected to loading for ten cycles with upper limits of 50 N, 100 N, 200 N and 300 N. Graft-tunnel motion was then determined using the distances between reflective tape markers placed on the hamstring graft and at the entrance to the femoral bone tunnel, which were tracked with a high-resolution video system. Graft-tunnel motion was found to range from 0.7 +/- 0.2 mm to 3.3 +/- 0.2 mm, and significant increases in graft-tunnel motion were observed with increasing tensile loads (P < 0.05). Shorter tape length (15 mm) resulted in significantly less motion when compared to longer tape length (35 mm) (P < 0.05). We conclude that graft-tunnel motion is significant and should be considered when using this fixation technique. Early stress on the graft, as seen in postoperative rehabilitation exercises and athletic activities, may cause large graft-tunnel motion before graft incorporation is complete. A shorter distance between the tendon tissue and the titanium button is recommended to minimize the amount of graft-tunnel motion. Alternative fixation materials to polyester tape, or different fixation techniques, need to be developed such that graft-tunnel motion can be reduced. Further studies are needed to evaluate the effect of graft-tunnel motion on graft incorporation in the bone tunnel.

Biomechanical Phenomena↗

PubMed2006

Does anterior cruciate ligament reconstruction restore normal knee kinematics?: A prospective MRI analysis over two years.

This prospective study used magnetic resonance imaging to record sagittal plane tibiofemoral kinematics before and after anterior cruciate ligament reconstruction using autologous hamstring graft. Twenty patients with anterior cruciate ligament injuries, performed a closed-chain leg-press while relaxed and against a 150 N load. The tibiofemoral contact patterns between 0 degrees to 90 degrees of knee flexion were recorded by magnetic resonance scans. All measurements were performed pre-operatively and repeated at 12 weeks and two years. Following reconstruction there was a mean passive anterior laxity of 2.1 mm (sd 2.3), as measured using a KT 1000 arthrometer, and the mean Cincinnati score was 90 (sd 11) of 100. Pre-operatively, the medial and lateral contact patterns of the injured knees were located posteriorly on the tibial plateau compared with the healthy contralateral knees (p=0.014), but were no longer different at 12 weeks (p=0.117) or two years postoperatively (p=0.909). However, both reconstructed and healthy contralateral knees showed altered kinematics over time. At two years, the contact pattern showed less posterior translation of the lateral femoral condyle during flexion (p<0.01).

Adult↗