scholarly journals Muscular Force Patterns during Level Walking in ACL-Deficient Patients with a Concomitant Medial Meniscus Tear

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Hongshi Huang ◽  
Wei Yin ◽  
Shuang Ren ◽  
Yuanyuan Yu ◽  
Si Zhang ◽  
...  
Keyword(s):  
Stance Phase ◽  
Medial Meniscus ◽  
Rectus Femoris ◽  
Cartilage Degeneration ◽  
Meniscus Tear ◽  
Muscular Force ◽  
Acl Deficiency ◽  
Level Walking ◽  
Significant Difference ◽  
Acl Deficient

Background. The abnormal knee joint motion patterns caused by anterior cruciate ligament (ACL) deficiency are thought to be associated with articular cartilage degeneration. High rates of meniscus tear combined with ACL rupture are observed, and these knees suffer a higher risk of early cartilage degeneration. Research Question. This study investigated lower limb muscular force patterns of ACL-deficient knees with a concomitant medial meniscus tear. Methods. 12 volunteers and 22 patients were recruited, including 12 patients with isolated ACL deficiency (ACLD) and 10 ACL-deficient patients with a concomitant medial meniscus tear (ACLDM). Level walking data at a self-selected speed were collected before surgery. Then, a musculoskeletal dynamic analysis system, AnyBody, was applied to simulate tibiofemoral flexion moments and muscle forces. Results. Our results indicate that the tibiofemoral peak flexion and extension moments in ACLDM patients are significantly lower than in controls. The rectus femoris force in ACLDM patients was significantly lower than in isolated ACL-deficient patients and the controls during mid and terminal stance phase, while no significant difference was found in hamstring and vastus force. Additionally, the gastrocnemius force in ACL-deficient patients both with and without a medial meniscus tear was lower than in controls during mid-stance phase. Significance. The ACLDM patients had lower peak tibiofemoral flexion moment, lower gastrocnemius force in mid-stance phase, and lower rectus femoris force during the mid and terminal stance phase. These results may help clinicians to better understand the muscle function and gait pattern in ACL-deficient patients with a concomitant medial meniscus tear.

Medial and lateral meniscus have a different role in kinematics of the ACL-deficient knee: a systematic review

2019 ◽  
Vol 4 (5) ◽  
pp. 233-241
Author(s):  
Alberto Grassi ◽  
Giacomo Dal Fabbro ◽  
Stefano Di Paolo ◽  
Federico Stefanelli ◽  
Luca Macchiarola ◽  
...  
Keyword(s):  
Systematic Review ◽  
Medial Meniscus ◽  
Lateral Meniscus ◽  
Meniscus Tear ◽  
Pivot Shift Test ◽  
Anterior Tibial ◽  
Kinematic Evaluation ◽  
Tibial Translation ◽  
Acl Deficient ◽  
Deficient Knee

ImportanceMeniscal tears are frequently associated with anterior cruciate ligament (ACL) injury and the correct management of this kind of lesion during ACL-reconstruction procedure is critical for the restoration of knee kinematics. Although the importance of meniscus in knee biomechanics is generally accepted, the influence of medial and lateral meniscus in stability of ACL-deficient knee is still unclear.ObjectiveThe aim of this study was to review literature, which analysed effects in cadaveric specimens of meniscal tear and meniscectomy of medial and lateral meniscus on laxity in the ACL-deficient knee.Evidence reviewAuthors performed a systematic search for cadaveric studies analysing the effect of medial and lateral meniscus tears or resection on kinematics of ACL-deficient knee. Extracted data included year of publications, number of human cadaver knee specimens, description of apparatus testing and instrumented kinematic evaluation, testing protocol and results.FindingsAuthors identified 18 studies that met inclusion and exclusion criteria of current review. The major finding of the review was that the works included reported a difference role of medial and lateral meniscus in restraining ACL-deficient knee laxity. Medial meniscus tear or resection resulted in a significant increase of anterior tibial displacement. Lateral meniscus lesions or meniscectomy on the other hand significantly increased rotation and translation under a coupled valgus stress and internal-rotation torque/pivot shift test.ConclusionsMedial and lateral meniscus have a different role in stabilising the ACL-deficient knee: while the medial meniscus functions as a critical secondary stabilisers of anterior tibial translation under an anterior/posterior load, lateral meniscus appears to be a more important restraint of rotational and dynamic laxity.Level of evidenceLevel IV, systematic review of level I–IV studies.

Correlation of Meniscal Tear with Timing of Anterior Cruciate Ligament Reconstruction in Patients without Initially Concurrent Meniscal Tear

2018 ◽  
Vol 32 (11) ◽  
pp. 1128-1132
Author(s):  
Kun-Hui Chen ◽  
En-Rung Chiang ◽  
Hsin-Yi Wang ◽  
Hsiao-Li Ma
Keyword(s):  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Acl Injury ◽  
Meniscus Tear ◽  
Meniscal Tears ◽  
Anterior Cruciate ◽  
Late Group ◽  
Acl Deficient

AbstractThe incidence of meniscal tear was reported to increase with the delay of anterior cruciate ligament reconstruction (ACLR). The tear may occur concurrently with the ACL injury or after the ACL injury. Few studies had focused on the patients whose meniscus is intact during ACL injury. We determined the correlation between timing of surgery and incidence of meniscal tears in ACL-deficient knees with initially intact meniscus. We retrospectively reviewed 387 patients who had undergone primary ACLR. Time of initial ACL injury, magnetic resonance imaging (MRI) examination, and surgery was recorded. The MRI was reviewed by experienced radiologic and orthopaedic doctors. Intraoperative arthroscopic images were also obtained and reviewed. The type of tear noted during surgery was classified according to the modification of International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine classification of meniscal tears. Patients were divided into early (surgery within 12 months from injury) and late surgery group (surgery at more than 12 months from injury). There were 216 patients with intact medial meniscus and 257 patients with intact lateral meniscus on the postinjury MRI study. The incidence of medial meniscus tear (MMT) was significantly higher than lateral meniscus tear (LMT) during the ACLR (33.8 vs. 19.8%, p < 0.001). The incidence of MMT is higher in late group than in early group (53.7 vs. 29.1%, p = 0.004, odds ratio= 2.815). The incidence of LMT is mildly higher in late group but without statistics significance (23.8 vs. 18.6%, p = 0.364). In both MMT and LMT, the most common injury pattern observed was a longitudinal tear. The incidence of each type is not different between early and late group. For patients without concurrent meniscal injuries with the ACL tear, the incidence of MMT significantly increased if ACLR was performed more than 12 months after injury. The medial meniscus was more prone to injury than the lateral meniscus in chronic ACL-deficient knee. ACLR should be performed earlier to reduce the risk of meniscal tears for patients without initially concurrent meniscal tear.

COMMON AND DISTINCT MUSCLE SYNERGIES DURING LEVEL AND SLOPE LOCOMOTION IN THE CAT

2021 ◽  
Author(s):  
Alexander N Klishko ◽  
Adil Akyildiz ◽  
Ricky Mehta ◽  
Boris I. Prilutsky
Keyword(s):  
Stance Phase ◽  
Rectus Femoris ◽  
Emg Activity ◽  
Modular Organization ◽  
Muscle Synergies ◽  
Cycle Duration ◽  
Hindlimb Muscles ◽  
Level Walking ◽  
Adult Cats ◽  
Activity Cluster

Although it is well established that the motor control system is modular, the organization of muscle synergies during locomotion and their change with ground slope are not completely understood. For example, typical reciprocal flexor-extensor muscle synergies of level walking in cats break down in downslope: one-joint hip extensors are silent throughout the stride cycle, whereas hindlimb flexors demonstrate an additional stance phase-related EMG burst (Smith et al. 1998a). Here we investigated muscle synergies during Level, Upslope (27o) and Downslope (-27o) walking in adult cats to examine common and distinct features of modular organization of locomotor EMG activity. Cluster analysis of EMG burst onset-offset times of 12 hindlimb muscles revealed 5 flexor and extensor burst groups that were generally shared across slopes. Stance-related bursts of flexor muscles in downslope were placed in a burst group from Level and Upslope walking formed by the rectus femoris. Walking Upslope changed swing/stance phase durations of Level walking but not the cycle duration. Five muscle synergies computed using non-negative matrix factorization accounted for at least 95% of variance in EMG patterns in each slope. Five synergies were shared between Level and Upslope walking, whereas only 3 of those were shared with Downslope synergies; these synergies were active during the swing phase and phase transitions. Two stance-related synergies of downslope walking were distinct; they comprised a mixture of flexors and extensors. We suggest that the modular organization of muscle activity during Level and Slope walking results from interactions between motion-related sensory feedback, CPG, and supraspinal inputs.

scholarly journals Comparison of two simple stitches and modified Mason-Allen suture for medial meniscus posterior root tear based on the progression of meniscal posterior extrusion: A retrospective cohort study

2021 ◽  
Vol 29 (3) ◽  
pp. 230949902110495
Author(s):  
Keisuke Kintaka ◽  
Takayuki Furumatsu ◽  
Yuki Okazaki ◽  
Shin Masuda ◽  
Takaaki Hiranaka ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Medial Meniscus ◽  
Cartilage Degeneration ◽  
Knee Extension ◽  
Posterior Root ◽  
Open Magnetic Resonance Imaging ◽  
Significant Difference ◽  
Pullout Repair ◽  
The Difference ◽  
Repair Techniques

Purpose: Medial meniscus (MM) posterior root (PR) tear leads to severe MM posterior extrusion (PE), resulting in rapid knee cartilage degeneration. MMPR repairs are recommended to reduce MMPE, especially during knee flexion. However, the difference in MMPE between different repair techniques remains unknown. This study aimed to investigate preoperative and postoperative MMPE following several pullout repair techniques. We hypothesized that a technique using two simple stitches (TSS) would be more useful than FasT-Fix-dependent modified Mason-Allen suture (F-MMA) to prevent the progression of MMPE in knee extension. Methods: This retrospective study included 35 patients who underwent MMPR repair. To compare MMPE, patients were divided into two groups according to the use of F-MMA while grasping the posterior capsule and TSS without grasping it. Open magnetic resonance imaging was performed at 10° and 90° knee flexion preoperatively, and at 3 and 12 months postoperatively, and the MMPE of both groups was evaluated. Results: A significant difference was observed between preoperative and 3-month postoperative MMPE at 90° knee flexion in both groups ( p < .01). A significant difference was observed in 3- and 12-month postoperative MMPE at 10° knee flexion between both groups ( p = .04/.02), whereas no significant difference in the preoperative MMPE at 10° knee flexion was observed between them ( p = .45). Conclusions: Both repairs were found to be useful to reduce MMPE in knee flexion. Further, F-MMA repair increased MMPE in knee extension, unlike TSS repair. These findings suggest that TSS might have more advantages for load distribution when standing or walking.

scholarly journals Accuracy of magnetic resonance imaging for meniscal body tear in anterior cruciate ligament-deficient knees compared to anterior cruciate ligament-intact knee

2021 ◽  
Vol 2 ◽  
pp. 18-25
Author(s):  
Amit Joshi ◽  
Nagmani Singh ◽  
Bibek Basukala ◽  
Rohit Bista ◽  
Navin Tripathi ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Meniscus Tear ◽  
Resonance Imaging ◽  
Anterior Cruciate ◽  
Acl Deficient ◽  
Deficient Knee ◽  
Intact Knee

Objectives: This prospective case–control study was conducted with primary aim to compare the value of magnetic resonance imaging (MRI) in terms of accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for the detection of meniscal tear in anterior cruciate ligament (ACL)-deficient and ACL-intact groups. The secondary aim was to identify if the sensitivity and accuracy differ if the MRI is older than 3 months from the time of surgery. Materials and Methods: There were 255 patients enrolled into this study out of which 207 fulfilled the inclusion criteria. Among 207, 138 underwent surgery within 1 month of MRI, 30 had 1–3 months delay, and 39 cases underwent surgery more than 3 months after their MRI. Among 167 patients who underwent surgery within 3 months of MRI, 97 had ACL tear and 71 had intact ACL. Results: The overall sensitivity for lateral meniscus tear (68.2%) is significantly lower than the medial meniscus tear (92.9%). The sensitivity of MRI for medial meniscus tear in ACL-deficient knee is lower than ACL-intact knees (90% vs. 96.2%, P = 0.3). Similarly, the sensitivity is significantly lesser for lateral meniscus tear in ACL-deficient knee compared to ACL-intact knee (50% vs. 83.3%, P = 0.009). The sensitivity of MRI for both the lateral and medial meniscus tear decreased if the MRI performed 3 months before the surgery. Conclusion: Patients with ACL-deficient knee have to be counseled for intraoperative detection of lateral meniscus tear as the sensitivity of MRI for lateral meniscus tear in ACL-deficient group is low. Similarly, if the MRI is more than 3 months old from the time of surgery, we recommend to repeat the MRI as the sensitivity decreases significantly.

scholarly journals TIME FROM INJURY TO SURGERY IMPACT ON RECOVERY RESULTS AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

2017 ◽  
Vol 27 (3) ◽  
pp. 32-37
Author(s):  
Rokas Jurkonis ◽  
Rimtautas Gudas
Keyword(s):  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Meniscus Tear ◽  
Meniscal Tears ◽  
Medial Meniscal Tear ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
Time From Injury ◽  
Delayed Reconstruction

Lithuanian University of Health Sciences, Department of Orthopaedics and Traumatology, Kaunas, Lithuania 12 months (25 (46.3%)), (P &lt; 0.001). The examination of possible risk factors for medial meniscus tear revealed, that BMI (overweight) (OR=2.04; 95% CI=1.091-3.814) and time from injury to surgery (weeks) (OR=1.026; 95% CI=1.012-1.04) significantly increased possibility of medial meniscus tear. We found no significant laxity difference between postoperative testings’ (3, 6 and 12 months after surgery) and the three groups, created by the time to surgery. Conclusion. The study revealed a significant difference in the incidence of meniscal tears between patients treated in the early group and in those underwent ACL-R after 12 months, which lead to significantly higher chance (every delayed week increase chance by 1.026 times and overweight (BMI ≥ 25 kg/ m2) increase chance by 2.04 times) of a medial meniscal tear occurring in patients undergoing delayed reconstruction.

Patient-acceptable symptom state for reporting outcomes following unicompartmental knee arthroplasty

2021 ◽  
Vol 103-B (8) ◽  
pp. 1367-1372
Author(s):  
Kevin D. Plancher ◽  
Jasmine E. Brite ◽  
Karen K. Briggs ◽  
Stephanie C. Petterson
Keyword(s):  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Cruciate Ligament ◽  
Intact Group ◽  
Unicompartmental Knee ◽  
Significant Difference ◽  
Patient Acceptable Symptom State ◽  
Acl Deficient ◽  
Deficient Group

Aims The patient-acceptable symptom state (PASS) is a level of wellbeing, which is measured by the patient. The aim of this study was to determine if the proportion of patients who achieved an acceptable level of function (PASS) after medial unicompartmental knee arthroplasty (UKA) was different based on the status of the anterior cruciate ligament (ACL) at the time of surgery. Methods A total of 114 patients who underwent UKA for isolated medial osteoarthritis (OA) of the knee were included in the study. Their mean age was 65 years (SD 10). No patient underwent a bilateral procedure. Those who had undergone ACL reconstruction during the previous five years were excluded. The Knee injury Osteoarthritis Outcome Score Activities of Daily Living (KOOS ADL) function score was used as the primary outcome measure with a PASS of 87.5, as described for total knee arthroplasty (TKA). Patients completed all other KOOS subscales, Lysholm score, the Western Ontario and McMaster Universities Osteoarthritis Index, and the Veterans Rand 12-item health survey score. Failure was defined as conversion to TKA. Results Survivorship at ten years was 97% in both the ACL-deficient and ACL-intact groups. The mean survival was 16.1 years (95% confidence interval (CI) 15.3 to 16.8) for the ACL-deficient group and 15.6 years (95% CI 14.8 to 16.361) for the ACL-intact group (p = 0.878). At a mean of nine years (SD 3.5) in the ACL-deficient group, 32 patients (87%) reached the PASS for the KOOS ADL. In the ACL-intact group, at a mean of 8.6 years (SD 3) follow-up, 63 patients (85%) reached PASS for the KOOS ADL. There was no significant difference in the percentage of patients who reached PASS for all KOOS subscales and Lysholm between the two groups. Conclusion PASS was achieved in 85% of all UKAs for KOOS ADL, similar to reports for TKA. Fixed-bearing, medial, non-robotically-assisted UKA resulted in 97% survival at ten years in both the ACL-deficient and ACL-intact groups. There was no significant difference in all outcomes between the two groups. Understanding PASS will allow better communication between surgeons and patients to improve the surgical management of patients with single compartment OA of the knee. This study provides mid- to long-term data supporting the use of PASS to document outcomes following UKA. PASS was met in more than 85% of patients with no differences between ACL-deficient and ACL-intact knees at a mean follow-up of nine years. Cite this article: Bone Joint J 2021;103-B(8):1367–1372.

scholarly journals Magnetic Tracking: A Novel Method of Assessing Anterior Cruciate Ligament Deficiency

2006 ◽  
Vol 88 (1) ◽  
pp. 16-17 ◽  
Author(s):  
RK Kundra ◽  
JD Moorehead ◽  
N Barton-Hanson ◽  
SC Montgomery
Keyword(s):  
Anterior Cruciate Ligament ◽  
Tracking System ◽  
Cruciate Ligament ◽  
Magnetic Tracking ◽  
Lachman Test ◽  
Acl Deficiency ◽  
Anterior Tibial ◽  
Anterior Cruciate ◽  
Tracking Device ◽  
Acl Deficient

INTRODUCTION The Lachman test is commonly performed as part of the routine assessment of patients with suspected anterior cruciate ligament (ACL) deficiency. A major drawback is its reliance on the clinician's subjective judgement of movement. The aim of this study was to quantify Lachman movement using a magnetic tracking device thereby providing a more accurate objective measure of movement. PATIENTS AND METHODS Ten patients aged 21–51 years were assessed as having unilateral ACL deficiency with conventional clinical tests. These patients were then re-assessed using a Polhemus Fastrak™ magnetic tracking device. RESULTS The mean anterior tibial displacement was 5.6 mm (SD = 2.5) for the normal knees and 10.2 mm (SD = 4.2) for the ACL-deficient knees. This gave an 82% increase in anterior tibial displacement for the ACL deficient knees. This was shown to be highly significant with P = 0.005. CONCLUSIONS The magnetic tracking system offers an objective quantification of displacements during the Lachman test. It is convenient, non-invasive and comfortable for the patient and is, therefore, ideally suited for use as an investigative tool.

scholarly journals Effects of Anterior Cruciate Ligament Deficiency on Tibiofemoral Cartilage Thickness and Strains in Response to Hopping

2018 ◽  
Vol 47 (1) ◽  
pp. 96-103 ◽  
Author(s):  
E. Grant Sutter ◽  
Betty Liu ◽  
Gangadhar M. Utturkar ◽  
Margaret R. Widmyer ◽  
Charles E. Spritzer ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Acl Injury ◽  
Cartilage Thickness ◽  
Intercondylar Notch ◽  
Dynamic Activity ◽  
Acl Deficiency ◽  
Anterior Cruciate ◽  
Acl Deficient ◽  
Deficient Knee

Background: Changes in knee kinematics after anterior cruciate ligament (ACL) injury may alter loading of the cartilage and thus affect its homeostasis, potentially leading to the development of posttraumatic osteoarthritis. However, there are limited in vivo data to characterize local changes in cartilage thickness and strain in response to dynamic activity among patients with ACL deficiency. Purpose/Hypothesis: The purpose was to compare in vivo tibiofemoral cartilage thickness and cartilage strain resulting from dynamic activity between ACL-deficient and intact contralateral knees. It was hypothesized that ACL-deficient knees would show localized reductions in cartilage thickness and elevated cartilage strains. Study Design: Controlled laboratory study. Methods: Magnetic resonance images were obtained before and after single-legged hopping on injured and uninjured knees among 8 patients with unilateral ACL rupture. Three-dimensional models of the bones and articular surfaces were created from the pre- and postactivity scans. The pre- and postactivity models were registered to each other, and cartilage strain (defined as the normalized difference in cartilage thickness pre- and postactivity) was calculated in regions across the tibial plateau, femoral condyles, and femoral cartilage adjacent to the medial intercondylar notch. These measurements were compared between ACL-deficient and intact knees. Differences in cartilage thickness and strain between knees were tested with multiple analysis of variance models with alpha set at P < .05. Results: Compressive strain in the intercondylar notch was elevated in the ACL-deficient knee relative to the uninjured knee. Furthermore, cartilage in the intercondylar notch and adjacent medial tibia was significantly thinner before activity in the ACL-deficient knee versus the intact knee. In these 2 regions, thinning was significantly influenced by time since injury, with patients with more chronic ACL deficiency (>1 year since injury) experiencing greater thinning. Conclusion: Among patients with ACL deficiency, the medial femoral condyle adjacent to the intercondylar notch in the ACL-deficient knee exhibited elevated cartilage strain and loss of cartilage thickness, particularly with longer time from injury. It is hypothesized that these changes may be related to posttraumatic osteoarthritis development. Clinical Relevance: This study suggests that altered mechanical loading is related to localized cartilage thinning after ACL injury.

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