1,721,055 research outputs found
The role of static and dynamic rotatory laxity testing in evaluating ACL injury.
No full textIn this article, we discuss current topics for rotatory knee laxity. All tests for knee laxity have a value. Static knee laxity tests reveal information for each individual patient's laxity status, especially compared to the contralateral side. Static knee laxity tests are simple to do, and some of them are instrumented, therefore quantifiable. Dynamic knee laxity tests are more complex. Dynamic stereo radiography (DSX) is considered the gold standard. Utilizing DSX, information can be gained on 3-D kinematics, functional joint space, and joint contact patterns. The disadvantage is that DSX is expensive and can only be performed in a laboratory environment. The pivot shift test is a unique test, because it is dynamic and easily performed in the office. However, it is subjective and only recently quantifiable. Future endeavors will attempt to improve the value of the pivot shift test by standardizing the test and improving measurement technologies, while keeping the pivot shift test simple and non-invasive
ACL reconstruction in the professional or elite athlete: State of the art
Full text linkAnterior cruciate ligament (ACL) injuries are on the rise at all levels of sport, including elite athletics.ACL injury can have implications on the athlete's sport longevity, as well as other long-term consequences, such as the development of future knee osteoarthritis.In the elite athlete, ACL injury can also have ramifications in terms of contract/scholastic obligations, sponsorships and revenue-generating potential.Although the goal of anterior cruciate ligament reconstruction (ACLR) is to return any athlete to the same preinjury level of sport, management of ACL injuries in the elite athlete come with the additional challenge of returning him or her to an extremely high level of physical performance.Despite outcome studies after ACLR in elite athletes showing a high return-to-sport rate, these studies also show that very few athletes are able to return to sport at the same level of performance.They also show that those athletes who undergo ACLR have careers that are more short-lived in comparison to those without injury.Thus, returning an elite athlete to a near peak' performance may not be good enough for the athletic demands of elite-level sports.A possible explanation for the variability in outcomes is the great diversity seen in the management of ACL injuries in the elite athlete in terms of rehabilitation, graft choices, portal drilling and reconstruction techniques.Recently, the advent of anatomical, individualised ACLR has shown improved results in ACLR outcomes.However, larger-scale studies with long-term follow-ups are needed to better understand the outcomes of modern ACLR techniques-particularly with the rise of quadriceps tendon as an autograft choice and the addition of lateral extra-articular tenodesis procedures.The purpose of this article was thus to provide an up-to-date state-of-the-art review in the management of ACL injuries in the elite athlet
Editorial Commentary: The Importance of Bony Morphology in the Anterior Cruciate Ligament-Injured Patient
No full text: The outcome of anterior cruciate ligament (ACL) surgery depends on many factors. Successful ACL surgery includes evaluating patients' characteristics and addressing all the underlying knee pathologies, including the meniscus tears and ramp lesions. In recent years, there has been a growing interest in ramp lesions as well as the role that bony morphology plays in predisposing patients to ACL injury and failed ACL surgery. Not only pathologic but also physiologic variations in bony morphology like tibial slope and lateral femoral condyle ratio have been correlated with clinical outcomes, failure rates, rotatory instability, and even lesions to the contralateral knee. Evaluating each patient's specific anatomy is recommended when customizing ACL surgery. With further research and increased awareness of relevant bony parameters, we will be able to improve our ability to prevent injury, increase the diagnostic accuracy of associated lesions, and tailor surgery to improve the outcomes and reduce failure rates
The anterolateral aspect of the knee: the state of play.
Full text linkThe anterolateral aspect of the knee: the state of pla
Lateral Closing Wedge High Tibial Osteotomy—Technique and Outcomes
No full textCW-HTO is a powerful surgical procedure used to treat symptomatic varus deformity in the knee, particularly when associated with medial compartment OA, meniscal injuries, or cartilage defects.
In order to realign the mechanical axis of the knee, a wedge of bone is surgically removed from the lateral aspect of the proximal tibia, reestablishing the coronal alignment and the weight-bearing force distribution of the knee.
It is important to take several factors into consideration when determining if LCW-HTO would be a beneficial procedure for each patient, as these factors may greatly influence surgical outcomes and functional improvement. Such factors may include patient-related factors such as chronologic age, BMI, level of sporting activities, and patient expectations, as well as preoperative knee-related factors, such as ligamentous stability, posterior tibial slope, TT-TG, joint line obliquity, and leg length.
With the correct indications and when performed correctly, this joint preserving procedure provides significant improvement in knee pain and function, which has been shown to delay the need for knee arthroplasty and enable patients to return to work and sporting activities, improving patients’ overall quality of life
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
The pivot shift: a global user guide
No full textPURPOSE: The use of several different maneuvers for the pivot shift test has resulted in inconsistent quantitative measurements. The purpose of this study was to describe, analyze, and group several surgeon-specific techniques for the pivot shift test and to propose a standardized pivot shift test. METHODS: Twelve expert surgeons examined a whole lower cadaveric extremity with their preferred technique and assigned a clinical grade, I-III. Anterior tibial translation and acceleration were measured using an electromagnetic system. The test was repeated after watching an instructional video focused on a standardized pivot shift technique. Measurements were repeated and compared with the preferred technique.
RESULTS: The expert surgeons utilized valgus stress unanimously in addition to fixed internal rotation (n = 5), fixed external rotation (n = 1), a motion-allowing technique (n = 3), a dislocation-type maneuver (n = 2), and a fixed anterior drawer type of maneuver in extension (n = 1). Anterior tibial translation measured was on average 15.9 ± 3.7 mm. Average tibial acceleration was 3.3 ± 2.1 mm/s(2). Average clinical grading was 2.3 ± 0.5. There were no differences in average clinical grading when using high stress (2.5 ± 0.6) versus low stress (2.3 ± 0.5, n.s.), or using fixed rotation (2.2 ± 0.5) versus a motion-allowing technique (2.3 ± 0.6; n.s.).CONCLUSIONS: Clinical grading, tibial translation, and acceleration vary between examiners performing the pivot shift test. High forces and extremes of rotation are not necessary to produce a clinical detectable pivot shift. In the future, a standardized pivot shift test-which can be performed universally and utilizes only gentle forces allowing motion to occur-may be beneficial when assessing differences in outcome following ACL reconstruction
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