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  1 / 9723 MEDLINE  
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PMID:29279562
Autor:Oshima Y; Iizawa N; Takai S
Endereço:Department of Orthopaedic Surgery, Nippon Medical School.
Título:Midterm Result of Arthroscopic Bicruciate Ligament Sutures for Multiligament Knee Injury in an Adolescent Patient.
Fonte:J Nippon Med Sch; 84(6):301-303, 2017.
ISSN:1347-3409
País de publicação:Japan
Idioma:eng
Resumo:BACKGROUND: Treatment of multiligament knee injuries, especially in adolescent patients, is challenging for orthopedic surgeons. Repair of collateral ligaments and reconstruction of cruciate ligaments are usually performed, however, ligament reconstruction with transphyseal or physeal-sparing techniques may lead to physeal damage and growth disturbances in skeletally immature patients. We present a case report on performing bicruciate ligament sutures arthroscopically in an adolescent patient. PATIENT AND METHODS: The patient was a 14-year-old boy, who was diagnosed with injuries to the anterior cruciate ligament, posterior cruciate ligament, and medial collateral ligament. Single-stage arthroscopic primary suturing of the anterior and posterior cruciate ligaments and open medial collateral ligament suturing were performed 7 days after the injury. RESULTS AND DISCUSSION: The patient returned to routine activities, including high-level competitive sports, at 8 months post-surgery, and currently, 8.5 years after surgery, remains without complications. Suture repair was able to minimize the size of the bone tunnels and to re-establish knee stability with native tissues. Therefore, the application of sutures may be a useful option for repairing multiligament knee injuries, particularly in adolescent patients.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE


  2 / 9723 MEDLINE  
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PMID:28466182
Autor:Domnick C; Garcia P; Raschke MJ; Glasbrenner J; Lodde G; Fink C; Herbort M
Endereço:Department of Trauma-, Hand- and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Waldeyer Strasse 1, 48149, Muenster, Germany.
Título:Trends and incidences of ligament-surgeries and osteotomies of the knee: an analysis of German inpatient records 2005-2013.
Fonte:Arch Orthop Trauma Surg; 137(7):989-995, 2017 Jul.
ISSN:1434-3916
País de publicação:Germany
Idioma:eng
Resumo:INTRODUCTION: In Germany most surgical procedures of the ligaments of the knee and correcting osteotomies of the knees are performed within an inpatient setting. The purpose of this study was to analyze the available data to assess epidemiological trends and incidences in inpatient knee joint surgery. MATERIALS AND METHODS: Approximately 154 million anonymized DRG inpatient records were collected by the German Federal Statistical Office between 2005 and 2013. These data were screened and analyzed for knee joint surgical ligamental procedures and osteotomies. RESULTS: Anterior cruciate ligament reconstruction (ACLR) or repair had a high incidence (46 per 100,000 persons/year). In addition, the most frequent grafts included hamstring tendon (90%) and the patellar tendon (6.3%) autografts (2013). Peak age group for ACLR was 15-20 years (14.5%) for female and 20-25 years (23.6%) for male patients, while there was a second peak in the age group 45-50 years (13.8%) for female patients. Male patients had a higher risk for receiving ACLR (RR 1.96; 95% CI 1.92-2.00) and for receiving valgizing high tibial osteotomy (RR 2.43; 95% CI 2.27-2.61). Females had a higher risk for receiving varizing distal femur osteotomy (RR 1.89; 95% CI 1.58-2.26). CONCLUSION: There are growing trends for joint- and activity-preserving procedure in the middle-aged patients. The knowledge of the trends and incidences related to these procedures may help to validate and discuss the results of clinical and register studies.
Tipo de publicação: JOURNAL ARTICLE


  3 / 9723 MEDLINE  
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PMID:28466554
Autor:Peeler J; Anderson J; Piotrowski S; Stranges G
Endereço:Department of Human Anatomy & Cell Science, University of Manitoba, Winnipeg, Manitoba, Canada.
Título:Motion of the anterior cruciate ligament during internal and external rotation at the knee: A cadaveric study.
Fonte:Clin Anat; 30(7):861-867, 2017 Oct.
ISSN:1098-2353
País de publicação:United States
Idioma:eng
Resumo:Despite advances in our understanding of anterior cruciate ligament (ACL) anatomy and function, the change in position of the ACL during tibial rotation is not well understood. The purpose of this study was to quantify and compare the movements of the anteromedial (AM) and posterolateral (PL) bundles of the ACL during 15° of medial and lateral rotation (with & without a shear force). Cadaveric knees (12 male/12 female) were dissected and mounted at 90° of knee flexion. Anthropometric features of the ACL and distal femur were recorded, and each bundle was marked at: femoral attachment (FA), midpoint of ligament (MP), and tibial attachment (TA). Digital images of ACL motion in the frontal plane were taken as the tibia was rotated about a fixed femur. Using digitizing software, the change in position of the markers was quantified. Measurements suggested the ACL pattern of motion was consistent between sexes, regardless of shear force. The greatest amount of movement of both the AM and PM bundles occurred at the TA marker. The FA marker moved more during medial rotation, and the MP and TA markers moved more with lateral rotation. The 20 lb-shear force affected medial rotation most. This study is the first to quantify movement of the ACL during medial and lateral tibial rotation. Data should assist surgeons to select a graft position that is capable of replicating the rotational movement of the native ACL, and help improve three-dimensional stability of the ACL reconstructed knee. Clin. Anat. 30:861-867, 2017. © 2017 Wiley Periodicals, Inc.
Tipo de publicação: JOURNAL ARTICLE


  4 / 9723 MEDLINE  
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PMID:29249200
Autor:Sadigursky D; Garcia LC; Martins RR; De Queiroz GC; Carneiro RJF; Colavolpe PO
Endereço:Division of Knee Surgery, Clínica Ortopédica Traumatológica - COT, Salvador, Bahia, Brazil. davidsad@gmail.com.
Título:Anatomical variant of the meniscus related to posterior junction: a case report.
Fonte:J Med Case Rep; 11(1):351, 2017 Dec 18.
ISSN:1752-1947
País de publicação:England
Idioma:eng
Resumo:BACKGROUND: There are several reports on anatomical differences of the meniscus. However, there are only a few reports on abnormalities in both menisci and anatomical differences in anterior cruciate ligament insertions. CASE PRESENTATION: This is a case report of a 36-year-old Hispanic man presenting symptoms, including knee pain, locking, and effusion, with an anatomical abnormality of the menisci corresponding to the fusion of the posterior horns of the menisci in tandem with the insertion of the posterior meniscus fibers in the anterior cruciate ligament. CONCLUSIONS: This is the first study describing a meniscus anatomical variant with isolated posterior junction of the posterior horn with an anomalous insertion to the anterior cruciate ligament. The recognition of meniscus variants is important as they can be misinterpreted for more significant pathology on magnetic resonance images.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE


  5 / 9723 MEDLINE  
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PMID:28455730
Autor:Bates NA; Nesbitt RJ; Shearn JT; Myer GD; Hewett TE
Endereço:Departments of Orthopedic Surgery and Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA. batesna@gmail.com.
Título:Knee Abduction Affects Greater Magnitude of Change in ACL and MCL Strains Than Matched Internal Tibial Rotation In Vitro.
Fonte:Clin Orthop Relat Res; 475(10):2385-2396, 2017 Oct.
ISSN:1528-1132
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Anterior cruciate ligament (ACL) injures incur over USD 2 billion in annual medical costs and prevention has become a topic of interest in biomechanics. However, literature conflicts persist over how knee rotations contribute to ACL strain and ligament injury. To maximize the efficacy of ACL injury prevention, the effects of underlying mechanics need to be better understood. QUESTIONS/PURPOSES: We applied robotically controlled, in vivo-derived kinematic stimuli to the knee to assess ligament biomechanics in a cadaver model. We asked: (1) Does the application of abduction rotation increase ACL and medial collateral ligament (MCL) strain relative to the normal condition? (2) Does the application of internal tibial rotation impact ACL strain relative to the neutral condition? (3) Does combined abduction and internal tibial rotation increase ligament strain more than either individual contribution? METHODS: A six-degree-of-freedom robotic manipulator was used to position 17 cadaveric specimens free from knee pathology outside of low-grade osteoarthritis (age, 47 ± 8 years; 13 males, four females) into orientations that mimic initial contact recorded from in vivo male and female drop vertical jump and sidestep cutting activities. Four-degree rotational perturbations were applied in both directions from the neutral alignment position (creating an 8° range) for each frontal, transverse, and combined planes while ACL and MCL strains were continuously recorded with DVRT strain gauges implanted directly on each ligament. Analysis of variance models with least significant difference post hoc analysis were used to assess differences in ligament strain and joint loading between sex, ligament condition, or motion task and rotation type. RESULTS: For the female drop vertical jump simulation in the intact knee, isolated abduction and combined abduction/internal rotational stimuli produced the greatest change in strain from the neutral position as compared with all other stimuli within the ACL (1.5% ± 1.0%, p ≤ 0.035; 1.8% ± 1.3%, p ≤ 0.005) and MCL (1.8% ± 1.0%, p < 0.001; 1.6% ± 1.3%, p < 0.001) compared with all other applied stimuli. There were no differences in mean peak ACL strain between any rotational stimuli (largest mean difference = 2.0%; 95% confidence interval [CI], -0.9% to 5.0%; p = 0.070). These trends were consistent for all four simulated tasks. Peak ACL strain in the intact knee was larger than peak MCL strain for all applied rotational stimuli in the drop vertical jump simulations (smallest mean difference = 2.1%; 95% CI, -0.4% to 4.5%; p = 0.047). CONCLUSIONS: Kinematically constrained cadaveric knee models using peak strain as an outcome variable require greater than 4° rotational perturbations to elicit changes in intraarticular ligaments. CLINICAL RELEVANCE: Because combined rotations and isolated abduction produced greater change in strain relative to the neutral position for the ACL and MCL than any other rotational stimuli in this cadaver study, hypotheses for in vivo investigations aimed toward injury prevention that focuses on the reduction of frontal plane knee motion should be considered. Furthermore, reduced strain in the MCL versus the ACL may help explain why only 30% of ACL ruptures exhibit concomitant MCL injuries.
Tipo de publicação: JOURNAL ARTICLE


  6 / 9723 MEDLINE  
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PMID:28451863
Autor:Lansdown DA; Pedoia V; Zaid M; Amano K; Souza RB; Li X; Ma CB
Endereço:Department of Orthopaedic Surgery, University of California, San Francisco, 1500 Owens Street, San Francisco, CA, 94158, USA. Drew.lansdown@gmail.com.
Título:Variations in Knee Kinematics After ACL Injury and After Reconstruction Are Correlated With Bone Shape Differences.
Fonte:Clin Orthop Relat Res; 475(10):2427-2435, 2017 Oct.
ISSN:1528-1132
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: The factors that contribute to the abnormal knee kinematics after anterior cruciate ligament (ACL) injury and ACL reconstruction remain unclear. Bone shape has been implicated in the development of hip and knee osteoarthritis, although there is little knowledge about the effects of bone shape on knee kinematics after ACL injury and after ACL reconstruction. QUESTIONS/QUESTIONS: (1) What is the relationship between bony morphology with alterations in knee kinematics after ACL injury? (2) Are baseline bone shape features related to abnormal knee kinematics at 12 months after ACL reconstruction? METHODS: Thirty-eight patients (29 ± 8 years, 21 men) were prospectively followed after acute ACL injury and before ligamentous reconstruction. Patients were excluded if there was a history of prior knee ligamentous injury, a history of inflammatory arthritis, associated meniscal tears that would require repair, or any prior knee surgery on either the injured or contralateral side. In total, 54 patients were recruited with 42 (78%) patients completing 1-year followup and four patients excluded as a result of incomplete or unusable imaging data. MR images were obtained for the bilateral knees at two time points 1 year apart for both the injured (after injury but before reconstruction and 1 year after reconstruction) and contralateral uninjured knees. Kinematic MRI was performed with the knee loaded with 25% of total body weight, and static images were obtained in full extension and in 30° of flexion. The side-to-side difference (SSD) between tibial position in the extended and flexed positions was determined for each patient. Twenty shape features, referred to as modes, for the tibia and femur each were extracted independently from presurgery scans with the principal component analysis-based statistical shape modeling algorithm. Spearman rank correlations were used to evaluate the relationship between the SSD in tibial position and bone shape features with significance defined as p < 0.05. Each of the shape features (referred to as the bone and mode number such as Femur 18 for the 18th unique femoral bone shape) associated with differences in tibial position was then investigated by modeling the mean shape ± 3 SDs. RESULTS: Two of the 20 specific femur bone shape features (Femur 10, Femur 18) and two of the 20 specific tibial bone shape features (Tibia 19, Tibia 20) were associated with an increasingly anterior SSD in the tibial position for the patients with ACL injury before surgical treatment. The shape features described by these modes include the superoinferior height of the medial femoral condyle (Femur 18; ρ = 0.33, p = 0.040); the length of the anterior aspect of the lateral tibial plateau (Tibia 20; ρ = -0.35, p = 0.034); the sphericity of the medial femoral condyle (Femur 10; ρ = -0.52, p < 0.001); and tibial slope (Tibia 19; ρ = 0.34; p = 0.036). One year after surgical treatment, there were two of 20 femoral shape features that were associated with SSD in the tibial position in extension (Femur 10, Femur 18), one of 20 femoral shape features associated with SSD in the tibial position in flexion (Femur 10), and three of 20 tibial shape features associated with SSD in the tibial position in flexion (Tibia 2, Tibia 4, Tibia 19). The shape features described by these modes include the sphericity of the medial femoral condyle (Femur 10; ρ = -0.38, p = 0.020); the superoinferior height of the medial femoral condyle (Femur 18; ρ = 0.34, p = 0.035); the height of the medial tibial plateau (Tibia 2; ρ = -0.32, p = 0.048); the AP length of the lateral tibial plateau (Tibia 4; ρ = -0.37, p = 0.021); and tibial slope (Tibia 19; ρ = 0.34, p = 0.038). CONCLUSIONS: We have observed multiple bone shape features in the tibia and the femur that may be associated with abnormal knee kinematics after ACL injury and ACL reconstruction. Future directions of research will include the influence of bony morphology on clinical symptoms of instability in patients with and without ACL reconstruction and the long-term evaluation of these shape factors to better determine specific contributions to posttraumatic arthritis and graft failure. LEVEL OF EVIDENCE: Level II, therapeutic study.
Tipo de publicação: JOURNAL ARTICLE


  7 / 9723 MEDLINE  
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PMID:28457606
Autor:Ali AA; Harris MD; Shalhoub S; Maletsky LP; Rullkoetter PJ; Shelburne KB
Endereço:Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA.
Título:Combined measurement and modeling of specimen-specific knee mechanics for healthy and ACL-deficient conditions.
Fonte:J Biomech; 57:117-124, 2017 05 24.
ISSN:1873-2380
País de publicação:United States
Idioma:eng
Resumo:Quantifying the mechanical environment at the knee is crucial for developing successful rehabilitation and surgical protocols. Computational models have been developed to complement in vitro studies, but are typically created to represent healthy conditions, and may not be useful in modeling pathology and repair. Thus, the objective of this study was to create finite element (FE) models of the natural knee, including specimen-specific tibiofemoral (TF) and patellofemoral (PF) soft tissue structures, and to evaluate joint mechanics in intact and ACL-deficient conditions. Simulated gait in a whole joint knee simulator was performed on two cadaveric specimens in an intact state and subsequently repeated following ACL resection. Simulated gait was performed using motor-actuated quadriceps, and loads at the hip and ankle. Specimen-specific FE models of these experiments were developed in both intact and ACL-deficient states. Model simulations compared kinematics and loading of the experimental TF and PF joints, with average RMS differences [max] of 3.0° [8.2°] and 2.1° [8.4°] in rotations, and 1.7 [3.0] and 2.5 [5.1] mm in translations, for intact and ACL-deficient states, respectively. The timing of peak quadriceps force during stance and swing phase of gait was accurately replicated within 2° of knee flexion and with an average error of 16.7% across specimens and pathology. Ligament recruitment patterns were unique in each specimen; recruitment variability was likely influenced by variations in ligament attachment locations. ACL resections demonstrated contrasting joint mechanics in the two specimens with altered knee motion shown in one specimen (up to 5mm anterior tibial translation) while increased TF joint loading was shown in the other (up to 400N).
Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL


  8 / 9723 MEDLINE  
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PMID:29173557
Autor:Kaplan DJ; Jazrawi LM
Endereço:Department of Orthopaedic Surgery, New York University Langone Medical Center, 301 East 17th Street, New York, NY 10010, USA. Electronic address: danieljameskaplan@gmail.com.
Título:Secondary Stabilizers of Tibial Rotation in the Intact and Anterior Cruciate Ligament Deficient Knee.
Fonte:Clin Sports Med; 37(1):49-59, 2018 Jan.
ISSN:1556-228X
País de publicação:United States
Idioma:eng
Resumo:The controversy regarding the existence and function of the anterolateral ligament or anterolateral complex has reinvigorated interest in rotational stability of the knee joint. This is particularly true of anterolateral rotary instability, as many patients, despite anatomic reconstruction of their anterior cruciate ligament, continue to experience instability. Many experts point toward compromised anterolateral restraints as the underlying culprit, namely, the anterolateral complex, which includes the iliotibial band, anterolateral capsule, lateral meniscus, and lateral collateral ligament. This article provides a breakdown of these structures, their function, biomechanical properties, and clinical importance, based on a thorough review of available literature.
Tipo de publicação: JOURNAL ARTICLE; REVIEW


  9 / 9723 MEDLINE  
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PMID:28745777
Autor:von Freeden N; Duerr F; Fehr M; Diekmann C; Mandel C; Harms O
Endereço:Niklas von Freeden, Klinik für Kleintiere, Stiftung Tierärztliche Hochschule Hannover, Bünteweg 9, 30559 Hannover, Germany, Email: niklas.vonfreeden@gmx.de.
Título:Comparison of two cold compression therapy protocols after tibial plateau leveling osteotomy in dogs.
Fonte:Tierarztl Prax Ausg K Kleintiere Heimtiere; 45(4):226-233, 2017 Aug 10.
ISSN:1434-1239
País de publicação:Germany
Idioma:eng
Resumo:OBJECTIVE: To evaluate two different protocols of cold compression therapy (CCT) for pain management and functional recovery in dogs undergoing tibial plateau leveling osteotomy (TPLO). MATERIAL AND METHODS: A total of 27 adult dogs (n = 30 stifles; staged bilateral procedures: n = 3) undergoing routine TPLO were randomly allocated to three groups (n = 10/group). Dogs of group I received CCT once before and immediately after surgery. In dogs of group II CCT was performed postoperatively four times at 6-hour intervals. Dogs of the control group did not receive CCT. Circumference of the stifle joint and the following pain-related parameters were measured by a single blinded observer before surgery and 1, 10 and 42 days after surgery: stifle joint range of motion (ROM), subjective degree of lameness, and score of a modified Glasgow Pain Scale (GPS). RESULTS: Both CCT groups showed significantly greater ROM and lower GPS scores 24 hours after surgery compared to the control group. Ten days after surgery there was a significantly lower degree of lameness in both CCT groups compared to the control group. Fourty-two days after surgery a significantly greater ROM was observed in both CCT groups compared to the control group. Group II also showed a significant improvement in the degree of lameness and GPS. There were no significant differences in any of the parameters between the two CCT groups at any time point. CONCLUSION: CCT applied preoperatively and immediately postoperatively showed similar short- and long-term beneficial results compared to a previously established protocol of applying CCT four times postoperatively. This protocol may be more suitable for practical use. CLINICAL SIGNIFICANCE: The reported data can be used to establish the new protocol of CCT in a clinical surrounding and to support postoperative rehabilitation of the canine patient.
Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE


  10 / 9723 MEDLINE  
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PMID:29030067
Autor:Mei L; Shen B; Xue J; Liu S; Ma A; Liu F; Shao H; Chen J; Chen Q; Liu F; Ying Y; Ling P
Endereço:School of Pharmaceutical Sciences, Shandong University, Jinan, Shandong Province, People's Republic of China; Post-doctoral Scientific Research Workstation, Shandong Academy of Pharmaceutical Science, Jinan, Shandong Province, People's Republic of China.
Título:Adipose tissue-derived stem cells in combination with xanthan gum attenuate osteoarthritis progression in an experimental rat model.
Fonte:Biochem Biophys Res Commun; 494(1-2):285-291, 2017 Dec 09.
ISSN:1090-2104
País de publicação:United States
Idioma:eng
Resumo:The current study explored the efficacy of an intra-articular (IA) injection of allogeneic adipose tissue-derived stem cells (ADSCs) combined with xanthan gum (XG) in a rat osteoarthritis (OA) model. We confirmed that XG significantly inproved proliferation of ADSCs in a dose dependent manner in vitro. The rat OA model was induced by an anterior cruciate ligament transection (ACLT), and at 4 weeks after surgery, rats were divided into four groups: the XG-ADSCs group, the ADSCs group, the XG group and the phosphate-buffered saline (PBS) group. A single dose of 1 × 10 allogeneic ADSCs suspended in 1% XG, ADSCs suspended in PBS, 1% XG alone or PBS alone was injected into the OA joint of rats in the respective treatment groups. Rats were sacrificed at 8 weeks after surgery. Treatment outcomes were evaluated by weight-bearing control of the hind limbs, gross morphological analysis, histological analysis and specific staining of articular cartilage, and measurement of inflammatory factors in synovial fluid. For the rats in the XG-ADSC-s and ADSCs-treated groups, the weight-bearing percentage of the right hind limb was significantly increased compared to that in the PBS group and was sustained over 4 weeks. However, the positive effect in the XG-ADSCs group was significantly greater than that in the ADSCs group. For the rats in the XG group, the efficacy decreased during the third week after surgery. The articular cartilage was relatively normal in the XG-ADSCs group, and moderate degeneration was observed in the ADSCs and XG groups. ADSCs and XG-ADSC treatments significantly decreased the concentrations of IL-1ß, TNF-α, MMP-3 and MMP-13 in synovial fluid; however, the attenuating effect of the XG-ADSCs treatment was significantly enhanced compared with that of the ADSCs treatment alone. These results indicate that a single IA injection of allogeneic ADSCs combined with XG efficiently attenuated OA progression with a therapeutic effect that was significantly greater than that of either ADSCs or XG alone. IA injection of XG-ADSCs might be an effective treatment for OA in humans.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância:0 (Anti-Inflammatory Agents, Non-Steroidal); 0 (Cytokines); 0 (Polysaccharides, Bacterial); TTV12P4NEE (xanthan gum)



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