scholarly journals Biomechanical modeling of knee for specific patients with chronic anterior cruciate ligament injury

2013 ◽  
Vol 10 (1) ◽  
pp. 525-545 ◽  
Author(s):  
Nenad Filipovic ◽  
Velibor Isailovic ◽  
Dalibor Nikolic ◽  
Aleksandar Peulic ◽  
Nikola Mijailovic ◽  
...  
Keyword(s):  
Gait Analysis ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Biomechanical Model ◽  
Element Model ◽  
Gait Pattern ◽  
Von Mises Stress ◽  
Ligament Injury ◽  
Patient Specific ◽  
Reconstruction Technique

In this study we modeled a patient specific 3D knee after anterior cruicate ligament (ACL) reconstruction. The purpose of the ACL reconstruction is to achieve stability in the entire range of motion of the knee and the establishment of the normal gait pattern. We present a new reconstruction technique that generates patient-specific 3D knee models from patient?s magnetic resonant images (MRIs). The motion of the ACL reconstruction patients is measured by OptiTrack system with six infrared cameras. Finite element model of bones, cartilage and meniscus is used for determination stress and strain distribution at different body postures during gait analysis. It was observed that the maximum effective von Mises stress distribution up to 8 MPa occurred during 30% of the gait cycle on the meniscus. The biomechanical model of the knee joint during gait analysis can provide insight into the underlying mechanisms of knee function after ACL reconstruction.

scholarly journals The influence of anterior cruciate ligament reconstruction on accelerometric gait analysis

2017 ◽  
Vol 21 (1) ◽  
pp. 4-11
Author(s):  
Joanna Golec ◽  
Krzysztof Wójcik ◽  
Agnieszka Bar ◽  
Elżbieta Szczygieł ◽  
Dorota Czechowska ◽  
...  
Keyword(s):  
Gait Analysis ◽  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Fast Rate ◽  
Cruciate Ligament ◽  
Gait Pattern ◽  
Acl Injuries ◽  
Normal Gait ◽  
Gait Parameters ◽  
Anterior Cruciate

ACL injuries – next to damage to the collateral ligaments, menisci of the knee – are the most common injuries of the knee joint and very often require surgical treatment. The main aim of the treatment is to restore normal gait pattern. The objective of this study was to determine the influence of reconstructed ACL on selected gait parameters by using an accelerometer system. The study involved 34 people aged 18-54 who were divided in two groups. The first group consisted of 20 people after ACL reconstruction, aged 19-54 years old (mean 29). The second group consisted of 14 healthy people between the age of 18-45 (mean 25.36). Gait analysis in normal and fast rate was performed using the CQMotion Electronik System, MEMS type. Differences in the results were observed in the first group. In 75% of people during normal walking and in 95% during fast walking, a 5% difference between the healthy limb and the limb after ACL reconstruction was observed. The gait rate had influence on acceleration value which was observed in RMS values in both of the groups. The RMS value was different, depending on the gait rate. Accelerometric gait analysis shows that the differences in comparing rate values between limbs are not so great, however, the gait pace has influence on some gait parameters. parameters.

scholarly journals Effects of intracorneal ring segments implementation technique and design on corneal biomechanics and keratometry in a personalized computational analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Niksa Mohammadi Bagheri ◽  
Mahmoud Kadkhodaei ◽  
Shiva Pirhadi ◽  
Peiman Mosaddegh
Keyword(s):  
Clinical Data ◽  
Three Dimensional ◽  
Element Model ◽  
Von Mises Stress ◽  
Patient Specific ◽  
Average Error ◽  
Constant Thickness ◽  
Arc Length ◽  
Implementation Techniques ◽  
Von Mises

AbstractThe implementation of intracorneal ring segments (ICRS) is one of the successfully applied refractive operations for the treatment of keratoconus (kc) progression. The different selection of ICRS types along with the surgical implementation techniques can significantly affect surgical outcomes. Thus, this study aimed to investigate the influence of ICRS implementation techniques and design on the postoperative biomechanical state and keratometry results. The clinical data of three patients with different stages and patterns of keratoconus were assessed to develop a three-dimensional (3D) patient-specific finite-element model (FEM) of the keratoconic cornea. For each patient, the exact surgery procedure definitions were interpreted in the step-by-step FEM. Then, seven surgical scenarios, including different ICRS designs (complete and incomplete segment), with two surgical implementation methods (tunnel incision and lamellar pocket cut), were simulated. The pre- and postoperative predicted results of FEM were validated with the corresponding clinical data. For the pre- and postoperative results, the average error of 0.4% and 3.7% for the mean keratometry value ($$\text {K}_{\text{mean}}$$ K mean ) were predicted. Furthermore, the difference in induced flattening effects was negligible for three ICRS types (KeraRing segment with arc-length of 355, 320, and two separate 160) of equal thickness. In contrast, the single and double progressive thickness of KeraRing 160 caused a significantly lower flattening effect compared to the same type with constant thickness. The observations indicated that the greater the segment thickness and arc-length, the lower the induced mean keratometry values. While the application of the tunnel incision method resulted in a lower $$\text {K}_{\text{mean}}$$ K mean value for moderate and advanced KC, the induced maximum Von Mises stress on the postoperative cornea exceeded the induced maximum stress on the cornea more than two to five times compared to the pocket incision and the preoperative state of the cornea. In particular, an asymmetric regional Von Mises stress on the corneal surface was generated with a progressive ICRS thickness. These findings could be an early biomechanical sign for a later corneal instability and ICRS migration. The developed methodology provided a platform to personalize ICRS refractive surgery with regard to the patient’s keratoconus stage in order to facilitate the efficiency and biomechanical stability of the surgery.

scholarly journals Percutaneous MCL reconstruction technique in acute anterior medial knee instability using cadaveric grafts

2014 ◽  
Vol 2 (12_suppl4) ◽  
pp. 2325967114S0025
Author(s):  
Jorge Batista ◽  
Rodrigo Maestu ◽  
Sebastián Teper ◽  
Manuel Ocampo ◽  
German Antúnez ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Functional Results ◽  
Lysholm Score ◽  
High Rate ◽  
Knee Instability ◽  
Reconstruction Technique ◽  
Medial Knee ◽  
Acute Injuries ◽  
Anterior Cruciate

Purpose: There are several alternatives described for the treatment of acute injuries of the anterior cruciate ligament (ACL ) and the medial collateral ligament (MCL) of the knee. We present the result of the combined ACL reconstruction and MCL in the same surgical procedure using only percutaneous cadaveric graft in the reconstruction of the MCL ligament. Methods: We retrospectively analyzed 30 patients with acute anterior and medial knee instability surgically treated between August 2007 and September 2013. 27 men and 3 women , mean age 30.53 years (range 18-46 ) The level of pre and post surgical activity was determined by the Tegner score , while the function was evaluated using the Lysholm score and IKDC grade Results: The average follow-up was 43 months (range 12-84 months). The mean Lysholm score was 91 (R, 61-100 ) . Only 19 of 30 (63.3 %) patients returned and kept the pre -injury level sports ; 26 patients IKDC : A (normal knee ), 3 patients IKDC : B (slightly abnormal knee ) and 1 patient IKDC C ( Knee abnormal) with limitation of 15 degrees of extension that had to be reoperated. Conclusion: The use of cadaveric tendons for reconstruction of MCL in combination with ACL reconstruction surgeries resulted in less postoperative pain, good functional results, and a high rate of return to competitive sport. The result of this study shows that the percutaneous reconstruction of LCM cadaveric graft is a viable option.

scholarly journals Unusual Iatrogenic Complication of ACL Surgery

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0027
Author(s):  
Serdar Sargın ◽  
Aziz Atik ◽  
Gökhan Meriç ◽  
Ahmet Aslan
Keyword(s):  
Range Of Motion ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Left Knee ◽  
Ligament Injury ◽  
Complication Rates ◽  
Revision Operation ◽  
Iatrogenic Complication ◽  
Normal Limits ◽  
Arthroscopic Removal

Objectives: Anterior cruciate ligament (ACL) ruptures constitute the most common ligament injury of the knee, and ACL reconstruction is a commonly performed procedure in orthopedic sport medicine. We report a case of on-the-cartilage placement of EndoButton for ACL reconstruction and its treatment with arthroscopic removal. The rehabilitation method was successful, resulting in excellent function and range of motion of the knee. The aim of this study was present an unusual case of iatrogenic complication of ACL reconstruction and to highlight to the surgeons about this complication. Methods: A 22-year-old male patient administered to our outpatient clinic with a history of trauma to his left knee in a soccer game 2 years ago. He underwent arthroscopic transtibial ACL reconstruction using hamstring tendons and EB system in another facility 19 months ago. At the time of initial administration he complained about pain and friction on his left knee, especially when he was running. In his physical examination patellar friction, anterior drawer and lachman tests were pathological which reminded us rerupture of ACL. Knee movements were in normal limits, but he felt pain especially during flexion and extension. Results: We used standard anteromedial and anterolateral portals and an accessory portal for excision of EB. When we explored the knee arthroscopically, we observed the EB misplaced on femoral groove. Firstly the loop of EB was cut then the EB was removed from superolateral portal. Loop remnant was cauterized with RF probe. The knee was irrigated and portals were sutured. The operation was finished without complication. The knee was dressed and the patient was kept in an adjustable knee brace. There was no complaint of crepitation and the range of motion (ROM) of knee was in normal limits. We offered revision operation again but the patient didn’t accept this suggestion. Conclusion: EB is a good and a commonly used option in ACL reconstruction surgery. Even the complication rates seem much more acceptable when compared to other fixation methods; misplacement of fixation device can be seen. In such a situation it is believed that, surgeons must not hesitate for arthroscopic removal and revision surgery.

A Novel Graft Fixation Technique for Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Grafts

2017 ◽  
Vol 12 (1) ◽  
Author(s):  
Guoan Li ◽  
Ali Hosseini ◽  
Hemanth Gadikota ◽  
Thomas Gill
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Reconstruction Technique ◽  
Tibial Rotation ◽  
Pullout Strength ◽  
Anterior Tibial ◽  
Anterior Cruciate ◽  
Tibial Translation ◽  
Intact Knee

This study evaluated the biomechanical efficacy of single-tunnel double-bundle anterior cruciate ligament (ACL) reconstruction technique. The graft construct is achieved using a novel fixation device that splits an ACL (SPACL) graft into two bundles, recreating the anteromedial (AM) and posterolateral (PL) bundles for ACL reconstruction. A pullout strength test of the SPACL was performed using a 7-mm bovine digital extensor tendon graft. The capability in restoration of knee kinematics after SPACL reconstruction was investigated using cadaveric human knees on a robotic testing system under an anterior tibial load of 134 N and a simulated quadriceps load of 400 N. The data indicated that the SPACL graft has a pullout strength of 823.7±172.3 N. Under the 134 N anterior tibial load, the anteroposterior joint laxity had increased constraint using the SPACL reconstruction but not significantly (p > 0.05) at all selected flexion angles. Under the 400 N quadriceps load, no significant differences were observed between the anterior tibial translation of intact knee and SPACL conditions at all selected flexion angles, but the SPACL graft induced a significant increase in external tibial rotation compared to the intact knee condition at all selected flexion angles with a maximal external rotation of −3.20 deg ±3.6 deg at 90 deg flexion. These data showed that the SPACL technique is equivalent or superior to existing ACL reconstruction techniques in restoration of knee laxity and kinematics. The new SPACL reconstruction technique could provide a valuable alternation to contemporary ACL reconstruction surgery by more closely recreating native ACL kinematics.

The 50 Most Cited Articles in the Indications, Risk Factors, Techniques, and Outcomes of ACL Revision Surgery

2020 ◽  
Author(s):  
Hayley E. Ennis ◽  
Kevin Bondar ◽  
Johnathon McCormick ◽  
Clark Jia-Long Chen ◽  
Chester J. Donnally ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Risk Factor ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Ligament Injury ◽  
Future Research ◽  
Revision Acl Reconstruction ◽  
Anterior Cruciate ◽  
Number Of Citations

AbstractThe rate of anterior cruciate ligament (ACL) retear remains high and revision ACL reconstruction has worse outcomes compared with primaries. To make advances in this area, a strong understanding of influential research is necessary. One method for systematically evaluating the literature is by citation analysis. This article aims to establish and evaluate “classic” articles. With consideration of these articles, this article also aims to evaluate gaps in the field and determine where future research should be directed. The general approach for data collection and analysis consisted of planning objectives, employing a defined strategy, reviewing search results using a multistep and multiauthor approach with specific screening criteria, and analyzing data. The collective number of citations for all publications within the list was 5,203 with an average of 104 citations per publication. “Biomechanical Measures during Landing and Postural Stability Predict Second Anterior Cruciate Ligament Injury after Anterior Cruciate Ligament Reconstruction and Return to Sport” by Paterno et al contained both the highest number of total citations and the highest number of citations per year, with 403 total citations and 43.9 citations per year. The most recurring level of evidence were level II (n = 18) and level III (n = 17). “Clinical Outcomes” was the most common article type (n = 20) followed by “Risk Factors” (n = 10). The American Journal of Sports Medicine had the highest recorded Cite Factor with over 50% of the articles (n = 27) published. The most productive authors included R.W. Wright (n = 6), S.D. Barber-Westin (n = 5), F.R. Noyes (n = 5), and K.P. Spindler (n = 5). Historically, influential studies have been published in the realms of clinical outcome and risk factor identification. It has been established that revision ACL reconstruction has worse outcomes and more high-level studies are needed. Additionally, prospective studies that apply the knowledge for current known risk factor mitigation are needed to determine if graft tear rates can be lowered.

scholarly journals Gait Analysis and Knee Kinematics in Patients with Anterior Cruciate Ligament Rupture: Before and After Reconstruction

2020 ◽  
Vol 10 (10) ◽  
pp. 3378
Author(s):  
Dmitry Skvortsov ◽  
Sergey Kaurkin ◽  
Alexander Akhpashev ◽  
Aljona Altukhova ◽  
Alexander Troitskiy ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Gait Analysis ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Surgical Reconstruction ◽  
Control Group ◽  
Cycle Duration ◽  
Post Surgery ◽  
Before And After ◽  
Anterior Cruciate

The objective of the study was to evaluate the clinical, functional, and biomechanical symptoms in patients with anterior cruciate ligament (ACL) rupture before and after ACL reconstruction. The study enrolled 20 patients and 20 healthy subjects as controls. Walking biomechanics was assessed at three time points: before surgery and three months and a year or more after surgical reconstruction. Impact loads on both sides differed significantly from the respective values before surgery (p<0.05). Walking cycle duration decreased with time after surgery. On both sides (affected and unaffected), hip movement amplitudes were significantly smaller than in control (p<0.05). They remained so in the follow-up periods after the reconstruction. Before ACL reconstruction, the amplitude of the main flexion of the knee was significantly reduced both on the affected and unaffected sides. The amplitude gradually increased after the reconstruction, and a year post-surgery, it reached, on the operated side, the same values as in the control group. Complete functional recovery of the knee joint was not achieved within a year after the ACL surgical reconstruction. The remaining changes, however, were not clinically pronounced and could only be detected by instrumental gait analysis. The compensatory processes developed bilaterally, in both the hip and knee joints.

scholarly journals Outcomes and Complications After All-Epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients

2017 ◽  
Vol 5 (3) ◽  
pp. 232596711769360 ◽  
Author(s):  
Eric J. Wall ◽  
Paul J. Ghattas ◽  
Emily A. Eismann ◽  
Gregory D. Myer ◽  
Preston Carr
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Case Series ◽  
Reconstruction Technique ◽  
Skeletally Immature ◽  
Patient Reported ◽  
Ikdc Score ◽  
Anterior Cruciate ◽  
Bone Tunnels

Background: The safest and most effective technique for anterior cruciate ligament (ACL) reconstruction in skeletally immature patients is currently unknown. Purpose: To evaluate the functional and patient-reported outcomes of a specific all-epiphyseal ACL reconstruction technique in which the graft, bone tunnels, and fixation do not cross the knee growth plates. Study Design: Case series; Level of evidence, 4. Methods: Twenty-seven patients (23 boys, 4 girls; mean age, 11 years; range, 8-15 years) underwent an all-epiphyseal ACL reconstruction with a single femoral transverse epiphyseal tunnel and primarily split tibial epiphyseal tunnels. Outcomes were evaluated in terms of the manual Lachman test, range of motion, pain, return to activity, angular or leg-length deformity on imaging, and International Knee Documentation Committee (IKDC) or Pedi-IKDC score an average of 3.8 years postoperatively, with a minimum 2-year follow-up. Results: The mean IKDC score was 94 ± 11. There were no growth arrests, but 3 patients had knee overgrowth, and 2 required a subsequent guided growth procedure. The ACL graft failed in 4 patients (15%), and 2 patients had contralateral ACL tears (7%). There were 5 subsequent ipsilateral meniscal tears, 4 of which were retears of a repaired meniscus. Ipsilateral knee reinjury significantly correlated with the number of associated injuries at the time of index surgery ( P = .040) and the number of sports played ( P = .029). Conclusion: All-epiphyseal ACL reconstruction resulted in excellent long-term functional outcomes, despite a high rate of complications (48%) and secondary procedures (37%) in this highly active cohort. The incidence of graft failure was similar to other standard ACL reconstruction techniques for patients younger than 20 years.

scholarly journals Soft tissue allograft for primary anterior cruciate ligament reconstruction

2017 ◽  
Vol 3 (4) ◽  
pp. 718
Author(s):  
Rahul P. ◽  
Suraj H. P. ◽  
Satish Shervegar ◽  
Abhilash Palla
Keyword(s):  
Anterior Cruciate Ligament ◽  
Soft Tissue ◽  
Acl Reconstruction ◽  
Functional Disability ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Ligament Injury ◽  
Tissue Allograft ◽  
Anterior Cruciate ◽  
Primary Acl Reconstruction

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Arthroscopic ACL reconstruction has become one of the most commonly performed arthroscopic surgeries. Inspite of extensive research on available autograft options, controversy still persists regarding the ideal graft. Allograft tendons usage in orthopedic operations has increased because of its advantages. This study was conducted to assess the functional outcome in patients undergoing ACL reconstruction with soft tissue allografts.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">15 patients with Anterior Cruciate Ligament injury presenting from 2012-2014 who underwent Arthroscopic ACL reconstruction with soft tissue allograft were the subjects of this Prospective study. Assessment of the involved knee was performed to obtain subjective measures of the clinical outcomes of the ACL reconstruction. All patients were followed up at regular intervals of 3 weeks, 6 weeks, 12 weeks, 6 months and 2 years</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">At the final follow up, </span><span lang="EN-IN">the patients had an average Lysholm knee score of 85.60, Tegner score of 7.24 and IKDC score of 85.28. Knee flexion of &gt;120<sup>0</sup> was achieved in &gt;80% of patients and minimal laxity in 60% patients but no functional disability in any of them. No graft failures were noted. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Contrary to the fear of graft failure and complications associated with allograft construct for primary ACL reconstruction, allografts yield the same clinical outcome as autografts with the advantages of reduced operative time, no donor site morbidity, preservation of native hamstring tendons, faster and comfortable rehabilitation. Allografts are a good alternative to autografts for primary ACL reconstruction.</span></p>

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