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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This prospective study evaluated the athletes with chronic instability of the knees using the expanded polytetrafluoroethylene (PTFE) prosthetic ligament as a substitute for the ACL and PCL preoperatively and at regular intervals during the post-operative period. Thirty Gore-Tex ACL and four Gore-Tex PCL reconstruction were performed. All patients had chronic instability of the knee joint for a duration of one month to five years (average 15.7 months). There were thirty-one males and three females, most of them were football players (63%). The average follow-up was 23 months postoperation. Ninety-seven per cent of the patients had satisfactory results. Objectively the instability pattern was improved in 97 per cent of the knees and subjectively, no pain persisted post operatively. Rejection occurred in one patient. The results indicated excellent stability of the affected knee joint. However, longevity of the prosthesis under the wide variety of loading conditions in athletes remains to be determined by continuing clinical study.
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PMID:Gore-Tex cruciate ligament reconstruction in athletes. 129 57

We evaluated extensor mechanism function in 10 patients after they had arthroscopically assisted ACL reconstruction using the central third of the patellar tendon. The patients were randomly selected 12 to 24 months after reconstruction. All had rehabilitation where range of motion was initiated within the 1st postoperative week. All patients stated that they were satisfied and considered their knee to be stable. The KT-1000 maximum measurements (30 to 40 pounds) averaged an increase of 1.7 mm when compared with the opposite knee. Subjective complaints, such as anterior knee pain, grating, and weakness, were common and only 3 of 10 patients returned to all of their preinjury sports. Persistent radiographic abnormalities were common. Physical examination and functional testing also revealed persistent dysfunction of the extensor mechanism in patients with radiographic abnormalities. Isokinetic testing at 60 deg/sec showed an average quadriceps deficit of 18% compared to the normal extremity. Axial computed tomography scans revealed significant decrease in quadriceps cross-sectional area. Magnetic resonance imaging and computed tomography confirmed persistent defects at the harvest site; there was significant anterior knee scar formation in these patients. Despite achieving ligamentous stability, patients still experienced permanent weakness, functional deficits, patellar chondrosis, and pain after ACL reconstruction using the central one-third of the patellar tendon.
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PMID:Extensor mechanism function after patellar tendon graft harvest for anterior cruciate ligament reconstruction. 144 18

Eighty-three patients with ACL reconstructions using the quadriceps patellar tendon graft were evaluated in a 10 year (mean, 5.5 years) follow-up study. A five-part analysis, consisting of physical examination, questionnaire, Genucom analysis, operative note review, and radiographs, was performed. Seventy-six percent were categorized as satisfactory. Ninety-two percent were content with their results, while only 4% were unsatisfied. Ninety-three percent of the patients had no significant pain and 95% had no giving way postreconstruction. Ninety-two percent had no more than a mild functional deficit. Eighty-seven percent and 90% of the patients had no significant Lachman or pivot shift by examination, respectively. Our results showed no increase in failure over time (1 to 10 years), although those operated on during the initial 5 years showed more radiographic degenerative changes. Plotting our results in classification systems of other authors yielded success rates as good as or better than those using our own criteria. An objective means by which to quantify laxity did not reliably correlate with the quantifying of laxity made by physical examination. Only the lack of a formal rehabilitation program greater than 4 months postoperatively and repaired tears of the medial or lateral collateral ligaments proved to be significant risk factors for poor recovery.
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PMID:Anterior cruciate ligament reconstruction using quadriceps patellar tendon graft. Part I. Long-term followup. 196 8

In alpine skiing various mechanisms of injury to the anterior cruciate ligament have been described. External rotation-flexion-valgus stress and hyper-extension are considered the classic mechanisms. Rupture of the anterior cruciate ligament without falling has rarely been reported. In ski racers competing in the World Cup downhill races an accumulation of isolated anterior cruciate ruptures following landing after a jump in a more or less backward position without falling has become evident in recent years. We recorded this mechanism for the first time in 1986. A ski racer landing in a bent position on flat ground after a jump documented on video tape felt a sharp pain and immediate instability, though he did not fall. Clinically hemarthrosis and a positive Lachman sign were found, and intraoperatively an isolated rupture of the anterior cruciate ligament was confirmed. Analysis of the video tape and biomechanical considerations showed that even a minimal shift of the center of body mass dorsal to the axis of the lower leg leads to an acceleration of the thigh and body oriented centrifugally, vertically and in a plantar direction against the rotational axis of the knee and to a forward rotational acceleration of the tibia by the dorsal shaft of the ski boot. This acceleration produces a massive compensatory quadriceps contraction to prevent a backward fall, followed by an "anteroposterior shift" of the femur on the tibia in the sense of an anterior drawer, which in association with other factors leads to an ACL rupture. This "anteroposterior shift mechanism" is only possible in excellent skiers with the muscular control and coordination to prevent a backward fall.
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PMID:[A new mechanism of injury of the anterior cruciate ligament]. 203 31

To evaluate the effectiveness of our treatment regimen, we retrospectively studied the surgically treated knees of 155 athletes, aged 15 to 42 years, who had sustained acute ACL tears. All were treated with ligament excision and intraarticular bone-patellar tendon-bone reconstruction followed by early motion with emphasis on full extension. The follow-up period ranged from 2 to 7 years. Of the 155 patients, 140 were available for final followup at a minimum of 2 years after reconstruction. The patients were evaluated by objective measures (KT-1000, Cybex, Lachman test, range of motion, and postoperative competition level) and subjective assessment scores (pain, swelling, stability, activity level, walking, stair climbing, running, jumping, or twisting). The subjective scores were tabulated for stability level, total score, and activity level. After the patients achieved full range of motion, the KT-1000 measurements at a 20 pound force revealed an average difference of 1.3 mm between the injured and noninjured knees. All but 3 of the 140 patients had a firm endpoint on the Lachman test, and the Cybex tests showed a mean hamstring strength of 98% and mean quadriceps strength of 90%. Sixty of the 69 varsity athletes who were eligible to play returned to preinjury competition level the following season. One had reconstruction failure and eight chose not to continue competition for academic reasons. The questionnaire score average was 92.7 (maximum, 100 points, normal athletic knee score 93.5). We concluded that the surgical procedure, with emphasis on early full extension postoperatively, achieved excellent results and provided a stable knee.
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PMID:Anterior cruciate ligament injury: evaluation of intraarticular reconstruction of acute tears without repair. Two to seven year followup of 155 athletes. 203 75

From 1979 to 1986, isolated repair of a peripheral vascular zone meniscal tear was performed in 22 patients (23 menisci) who had ACL insufficiency. For various reasons none of these patients underwent repair or reconstruction of their ACL. The meniscus repair was done by open arthrotomy in 12 cases and by arthroscopic techniques in 11 cases. The purpose of this study was to evaluate the success rate of a meniscal repair in an anterior cruciate deficient knee. The average age of the patients at the time of surgery was 25 years and the average followup was 56 months. Six patients (26%) had mild occasional pain not requiring medication and one patient had moderate pain requiring nonnarcotic pain medication. Eight patients (26%) had occasional giving way episodes and one of them underwent ACL reconstruction 5 years later because of frequent giving way. One patient required a postoperative manipulation for inadequate range of motion, but there were no neurovascular injuries or infections. There were three patients (13%) who had failed repairs or a retear and required subsequent subtotal meniscectomies. None of the other patients had any clinical symptoms or signs of a meniscal tear. There were no significant differences between the results of open or arthroscopic repair. Even though the failure rate of meniscus repair may be greater in an unstable knee, we conclude that meniscus repair is not contraindicated in an anterior cruciate deficient knee.
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PMID:Meniscus repair in the anterior cruciate deficient knee. 228 90

A retrospective review of 72 acute ACL injuries in 70 athletically active patients (50 recreational and 20 competitive athletes) treated with primary repair and semitendinosus tendon augmentation was conducted (mean follow-up time, 38.5 months). All patients had open primary multiple loop depth-varying suture repair and semitendinosus tendon augmentation at a mean injury to surgery interval of 9.1 days. Fifty-one cases (70.8%) were supplemented with an extraarticular procedure consisting in all cases of an iliotibial band lateral sling reinforcement. All patients underwent 6 weeks of postoperative immobilization followed by a graduated rehabilitation regimen lasting a mean 7.2 months. In 22 of the ACL tears, no other associated injury could be defined at arthrotomy, while in 27, significant medial collateral ligament injuries were noted. Lateral meniscal injuries (24) were more commonly noted than medial meniscal injuries (19). Good to excellent subjective results were reported in 82%, while 77.1% returned to preinjury sport level and participation without limitation. One patient developed "giving way" symptoms and overall, only four patients did not return to sports participation. Objective examination revealed 93.1% to have a 1+ or less Lachman test and 86.1% to have a negative pivot shift. Of 60 knees tested, 93.3% had KT-1000 side-to-side difference values (measured at 25 degrees +/- 5 degrees of flexion with an 89 N load) of less than or equal to 3 mm of anterior displacement. A 100 point Hospital for Special Surgery ligament rating score was used with 25 points assigned to subjective, 45 points to objective, and 30 points to functional assessment. The mean score at followup was 93.1. Analysis of results in patients with or without an extraarticular reinforcement revealed no difference in objective outcome. The incidence of patellofemoral pain was 27.8%. Thirty knees had some degree of loss of range of motion. Loss of terminal flexion was noted in 29, while 5 had loss of terminal extension. No correlation could be found between patellofemoral pain and diminished range of motion. Generalized ligamentous laxity was found in 37.1% of the patients; this was not associated with a poor result. This study suggests that primary repair with semitendinosus tendon augmentation of acute ACL injuries with a graduated rehabilitation regimen provides good subjective, and excellent functional and objective, results in active patients that were followed for more than 3 years.
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PMID:Primary repair with semitendinosus tendon augmentation of acute anterior cruciate ligament injuries. 240 22

During the last few years, major advances have been achieved in our understanding and treatment of chronic instability of the knee joint. The central hub (ACL and PCL) is the most important stabilizing element, and its rupture usually results in slipping knee, pain and recurrent hydrarthrosis, which are particularly frequent and severe in athletes. However, in some circumstances the loss of the anterior cruciate ligament can be compensated for by other stabilizing elements or by an excellent musculature. In patients with slipping knee, clinical, radiological and even arthroscopic examinations are necessary to decide on the treatment to be applied. This treatment depends on the importance and type of laxity, on the presence or absence of meniscal and cartilaginous lesions, on the degree of functional impairment and on the patient's life style. Several methods can be used, from rehabilitation alone to the replacement of the deficient ligament(s) by autografts or artificial ligaments. Treatment should not be stereotyped, and only specialist can determine the best method for each individual patient.
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PMID:[Chronic instability of the knee]. 260 78

Numerous postoperative therapies have been advocated for the rehabilitation of patients who have undergone ACL reconstruction. The effectiveness of these various methods, many of which are based on sound scientific principles, has yet to be documented. The purpose of this study was to determine the efficacy of five commonly used rehabilitation programs. Five groups of 20 patients, all of whom underwent the same method of ACL reconstruction, were compared in order to determine the effects of the following treatments (some in combination): transcutaneous electrical nerve stimulation (TENS), immobilization in flexion, immobilization in extension, electrical muscle stimulation (EMS), and continuous passive motion (CPM). Clinical evaluation, volumetric thigh measurements, instrumented varus-valgus stress testing, KT-1000 arthometer (Medmetric, San Diego, CA) measurements, and Cybex II (Cybex, Division of Lumex, Ronkonkoma, NY) muscle evaluation were used to examine the patients. TENS did not reduce the amount of pain medication required, nor was there improvement in any other clinically measurable parameter of performance. There was no clear difference in stability between those treated in extension and those treated in flexion; however, since three patients who were treated in extension required manipulation, there may be some advantage to treating patients with early limited range of motion in flexion. EMS did not reduce atrophy but it did minimize strength decrease during immobilization. EMS also resulted in significantly greater range of motion than those treated with extension or flexion with early limited motion. Compared to all groups, EMS patients had a significant reduction in the incidence of patellofemoral crepitation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Analysis of rehabilitation techniques after anterior cruciate reconstruction. 266 74

This prospective study assessed 54 consecutive arthroscopically assisted ACL reconstructions for the amount of postoperative pain relief provided by cold therapy, using the Hot/Ice Thermal Blanket. Twenty-six randomly selected patients undergoing this procedure were compared to a control group consisting of 28 patients having the identical procedure in which the Hot/Ice unit was not used postoperatively. The initial ACL injury in both groups was sports related with the exception of three patients whose injury occurred while on the job. The Hot/Ice Thermal Blanket consists of two rubber pads (blankets) connected by a hose to the main cooling unit. The pads were applied to either side of the operated knee in the operative suite. The pads received fluid which was circulated from the main unit. The temperature of the fluid was set at 50 degrees in the recovery room and the unit was run continuously until the time of discharge, which was approximately 4 days. Hot/Ice patients required 53% less injectable Demerol and 67% less oral Vistaril than patients in the control group. Hot/Ice patients had made the conversion from injectable to oral pain medication an average of 1.2 days sooner than did their non-Hot/Ice counterparts. There was no appreciable difference in length of hospital stay. Physical therapy and nursing records documented a greater percentage of compliant patients in the Hot/Ice group. According to these records the Hot/Ice patients were more helpful in self-assistance, were out of bed and ambulating in the halls more quickly, and did their range of motion exercises with greater ease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The effects of cold therapy in the postoperative management of pain in patients undergoing anterior cruciate ligament reconstruction. 272 84


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