Gait adaptations before and after anterior cruciate ligament reconstruction surgery

Gait analyses of rehabilitated individuals with anterior cruciate ligament (ACL) deficiency and reconstruction have identified the final adaptations of increased hip extensor torque and hamstring electromyography (EMG) and decreased knee extensor torque and quadriceps EMG during stance. The initial adaptations to injury and surgery are, however, unknown as are the factors that influence the development of the adaptations. Identification of the initial response to injury would provide a basis for determining whether the final adaptations are learned automatically or if they are the result of a lengthy training period in which various factors may affect their development. The purpose of the study was to evaluate the initial effects of ACL injury and reconstruction surgery on joint kinematics, kinetics, and energetics, during walking. Injured limbs from nine subjects with ACL injury were tested 2 wk after injury, and 3 and 5 wk after surgery. Ten healthy subjects were tested. Kinematic and ground reaction data were collected and combined with inverse dynamics to calculate the joint torques and powers. A knee extensor torque throughout most of stance was observed in the injured limbs at all test sessions. This result was in conflict with previous observations of reduced extensor torque or a flexor torque in rehabilitated patients with ACL reconstruction and patients with ACL deficiency. This result also differed from the typical midstance extensor then flexor torque in healthy control subjects. Trend analysis showed a significant (P < 0.001) change in average position at the hip and knee, extensor angular impulse at the hip, and positive work done at the hip 3 wk after surgery followed by a partial rehabilitation at 5 wk after surgery. Power and work produced at the knee were reduced fivefold (P < 0.001) after 5 wk of rehabilitation and did not recover to pre-surgical levels. The existence of a long-lasting knee extensor torque 2 wk after injury indicated that the adaptation process to ACL deficiency is lengthy, requiring many gait cycles, and that numerous factors could be involved in learning the adaptations.     

Bone tunnel enlargement after anterior cruciate ligament reconstruction with semitendinosus tendon using Endobutton fixation on the femoral side

We evaluated 29 knees with a minimum follow-up of 2 years after anterior cruciate ligament (ACL) reconstruction using doubled autogenous semitendinosus tendons. On the femoral side, a 5-mm Mersilene tape (Ethicon, Norderstedt, Germany) with an Endobutton (Acufex Microsurgical, Mansfield, MA) was used. The tendon was fixed on the tibial side with two staples. Regarding the IKDC score, 66% of the patients were graded as normal or nearly normal. The anterior laxity side-to-side difference (KT 1000, man-max-drawer) was under 3 mm in 55% and under 5 mm in 90%. Radiographs taken in the lateral and anteroposterior projections of the knee showed sclerotic bone tunnel margins. The diameter of the bone tunnels were measured, corrected for magnification, then compared with the original reamed diameter to determine any change in size. Enlargement of at least 2 mm was identified in 72% of the femoral tunnels and 38% of the tibial tunnels. No correlation was found concerning the enlargement of the tunnel and the IKDC score or the residual joint laxity. We conclude that using an Endobutton-Mersilene construct in ACL reconstruction leads to femoral and tibial bone tunnel enlargement at follow-up of 2 years.     

Psychological factors, rehabilitation adherence, and rehabilitation outcome after anterior cruciate ligament reconstruction.

Objective: To examine prospectively the relationships among psychological factors, rehabilitation adherence, and short-term rehabilitation outcome after knee surgery. Study Design and Participants: Individuals with acute anterior cruciate ligament (ACL) tears (N?=?95) completed measures of self-motivation, social support, athletic identity, and psychological distress before reconstructive surgery. After surgery, 93 participants reported on their completion of home rehabilitation exercises and cryotherapy, and their rehabilitation practitioners indicated the patients' attendance at, and adherence during, rehabilitation sessions. Rehabilitation outcome measures were taken from 69 participants approximately 6 months postsurgery. Main Outcome Measures: Knee laxity, functional ability, and subjective symptoms were the primary outcomes assessed. Results: Self-motivation was significant predictor of home exercise completion; athletic identity and psychological distress were significant predictors of knee laxity; and attendance at rehabilitation sessions and home cryotherapy completion were significant predictors of functional ability. Rehabilitation adherence did not mediate the relationship between psychological factors and rehabilitation outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of arthroscopic and open reconstruction of the anterior cruciate ligament. Early results

The purpose of this study was to determine in a prospective, randomized, blinded design whether arthroscopically assisted anterior cruciate ligament reconstruction offered any significant immediate or short-term advantages over traditional open reconstruction through a limited arthrotomy. Patients with a diagnosis of deficiency of the anterior cruciate ligament were randomly assigned to one of two treatment groups: the open group (limited open reconstruction) or the arthroscopic group (fully arthroscopic reconstruction). Postoperatively, both groups were treated identically. Intra- and postoperative observations included length of surgery, duration of hospitalization, and amount of pain medication. Follow-up evaluations were performed at 1, 6, 12, 16, 20, and 24 weeks to record crepitus, swelling, range of motion, ligament laxity, and thigh atrophy. Lysholm scores were obtained at the 16 and 24 week follow-ups. At 24 weeks, 86% of the open group and 89% of the arthroscopic group had good-to-excellent results. Intraoperative, postoperative, and follow-up findings indicated no statistically significant differences or relationships between the two groups in any of the variables measured, except that operative time was 13 minutes longer in the arthroscopic group (P < 0.001). The results do not substantiate a clinical advantage for either technique.     

Responses of mechanoreceptor neurons in the cat knee joint capsule before and after anterior cruciate ligament transection

It is known that afferent neurons play a protective role in knees made unstable by transection of the anterior cruciate ligament. However, it is not known whether cutting the anterior cruciate ligament has an effect on the response of the sensory neurons that innervate the joint. In this study, the responsiveness (activation threshold and position sensitivity) of single, mechanically sensitive afferent neurons from the cat knee was evaluated by a series of extension, internal, and external rotations. The anterior cruciate ligament then was cut and the same procedure was repeated. Transection of the ligament increased joint laxity for all types of rotation. The responsiveness of the neurons was not changed significantly by cutting the ligament (p > 0.05). Therefore, capsule afferents continue to behave normally in joints in which the anterior cruciate ligament has been transected.     

Effect of femoral condyle configuration on disability after an anterior cruciate ligament rupture. 100 patients followed for 5 years

We measured the configuration of the femoral condyles on lateral radiographs in 100 consecutive, prospectively-studied patients with a complete rupture of the anterior cruciate ligament, with or without associated lesions of the menisci and collateral ligaments. The patients had mainly low-to-moderate activity demands, and in all the patients the cruciate tear was primarily treated non-operatively. A quotient was calculated from the measurements of sagittal depth and axial height in order to describe the geometry of the femoral condyles. Measurements were reproducible with an intra- and interobserver coefficient of correlation of 0.89-0.98. At follow-up, after 5 (3-6) years, 16 patients had developed disability leading to reconstructive surgery. The remaining 84 patients did not have any major functional limitations, but some had reduced their activity level. Individual variations in the articular geometry were found with a more spherical shape of the femoral condyles in the patients where non-operative treatment had failed. Our findings indicate that articular geometry is of importance for function after an anterior ligament lesion.     

Is bracing after anterior cruciate ligament reconstruction necessary? A 2-year follow-up of 78 consecutive patients rehabilitated with or without a brace

OBJECTIVE: To assess the feasibility of using archival oral mucosal tissue to examine gene expression at the ribonucleic acid (RNA) level. MATERIALS AND METHODS: We describe the isolation of RNA from 8 microns sections of formalin-fixed paraffin-embedded oral mucosal tissue. RNA was reverse transcribed and three candidate genes amplified by polymerase chain reaction (PCR). The ribosomal protein S14 gene is a housekeeping gene which has been used as an internal standard in several quantitative PCR protocols. The thymidine kinase (TK) gene is expressed at low levels in most tissues and, with a well-documented genomic organisation, is a useful tool for discrimination between genomic DNA and cDNA. The RI alpha gene is reported to be overexpressed in many cancer cell lines, in malignant tissue and in vitro transformed cells. RESULTS: The S14 gene, the TK gene and the RI alpha gene of the cAMP-dependent protein kinase (PKA) were amplified successfully from formalin-fixed paraffin-embedded tissue sections. The TK primer pair is a useful additional tool in the unambiguous identification of RNA-derived species. CONCLUSION: RNA suitable for reverse transcribed (RT)-PCR was extracted from archival oral mucosal tissue. This should permit rapid sequence analysis of transcribed tumor suppressor genes and oncogenes in this material. Furthermore, the RT-PCR approach described may allow quantification of gene expression in oral mucosal archival material processed in a standard fashion.     

A prospective study of the outcome of anterior laxity of the knee after anterior cruciate ligament reconstruction with procedures using two different patellar tendon grafting methods

Oligonucleotides coding for linear epitopes of the fimbrial colonization factor antigen I (CFA/I) of enterotoxigenic Escherichia coli (ETEC) were cloned and expressed in a deleted form of the Salmonella muenchen flagellin fliC (H1-d) gene. Four synthetic oligonucleotide pairs coding for regions corresponding to amino acids 1 to 15 (region I), amino acids 11 to 25 (region II), amino acids 32 to 45 (region III) and amino acids 88 to 102 (region IV) were synthesized and cloned in the Salmonella flagellin-coding gene. All four hybrid flagellins were exported to the bacterial surface where they produced flagella, but only three constructs were fully motile. Sera recovered from mice immunized with intraperitoneal injections of purified flagella containing region II (FlaII) or region IV (FlaIV) showed high titres against dissociated solid-phase-bound CFA/I subunits. Hybrid flagellins containing region I (FlaI) or region III (FlaIII) elicited a weak immune response as measured in enzyme-linked immunosorbent assay (ELISA) with dissociated CFA/I subunits. None of the sera prepared with purified hybrid flagella were able to agglutinate or inhibit haemagglutination promoted by CFA/I-positive strains. Moreover, inhibition ELISA tests indicated that antisera directed against region I, II, III or IV cloned in flagellin were not able to recognize surface-exposed regions on the intact CFA/I fimbriae.     

The use of cold therapy after anterior cruciate ligament reconstruction. A prospective, randomized study and literature review

We performed a randomized, prospective study to assess the effectiveness of postoperative cold therapy in patients who had anterior cruciate ligament reconstructions. Drain output, length of hospital stay, range of motion, and use of pain medication were all assessed. Patients were randomized into one of four groups after surgery. Group 1 patients had a cooling pad applied to the knee postoperatively and set at a temperature of 40 degrees to 50 degrees F, Group 2 had the cooling pad set at 70 degrees to 80 degrees F, Group 3 received ice packs, and Group 4 received no cold therapy of any kind. The skin temperatures in Groups 1 and 3 were significantly lower than the skin temperatures in Groups 2 and 4 (P < 0.001). The length of hospital stay, range of motion at discharge, use of oral and intramuscular pain medicine, and drain output were not significantly different between groups. No complications related to the type of cold therapy were seen in any group. Thus, both ice packs and cooling pads significantly decreased knee temperature, but we found no objective benefits in the early postoperative course due to this decrease in temperature.     

Proprioceptive capacity of the knee joint area in patients after rupture of the anterior cruciate ligament]

In 30 healthy volunteers with clinically inconspicuous knee joints the proprioception of the knee joint was evaluated by an angle reproduction test. With the same set-up we documented the effect of an elastic knee bandage. We could not document any differences between the left and the right knee joint or between men and women, but at the mid-range of motion, proprioception was worse compared to the end range of motion. The applied elastic knee bandage significantly improved the position sense. Additionally 25 patients with an isolated rupture of the anterior cruciate ligament were evaluated. Fourteen patients were examined preoperatively 11 after operative ACL reconstruction. Preoperatively proprioception was significantly poorer than in the control group. We were able to show a positive influence of a knee bandage on the proprioception of the injured knee as well. Patients after ACL reconstruction showed no significantly better proprioception than the preoperative group.     

A comparison of patellar tendon autograft and allograft used for anterior cruciate ligament reconstruction in the goat model

Similar-sized patellar tendon autografts and fresh-frozen allografts were used to reconstruct the anterior cruciate ligament of one knee in 40 female goats. Evaluations of the reconstructions and contralateral controls at the 6-week and 6-month postoperative periods included anterior-posterior translation, mechanical properties determined during tensile failure tests, measurement of cross-sectional area, histology, collagen fibril size and area distribution, and associated articular cartilage degenerative changes. Six months after anterior cruciate ligament reconstruction, the autografts demonstrated a smaller increase in anterior-posterior displacement, values of maximum force to failure two times greater, a significant increase in cross-sectional area, a more rapid loss of large-diameter collagen fibrils, and an increased density and number of small-diameter collagen fibrils compared to the allografts. Clinical significance. More surgeons are allowing their patients to return to running and sports 6 months after anterior cruciate ligament reconstruction. While the structural and material properties of autografts and allografts at time zero are similar, in the goat model during the first 6 months they differ. The allografts demonstrate a greater decrease in their implantation structural properties, a slower rate of biologic incorporation, and the prolonged presence of an inflammatory response. At 6 months the autograft demonstrates a more robust biologic response, improved stability, and increased strength to failure values.     

Arthroscopic reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone grafts with and without augmentation. A prospective randomised study

In 100 consecutive patients with chronic deficiency of the anterior cruciate ligament we reconstructed the ligament using a bone-patellar tendon-bone autograft either with or without a Kennedy ligament augmentation device. The patients had an aggressive rehabilitation programme supervised by two physiotherapists. They were followed prospectively for at least two years by one surgeon, and assessed after six months and at one and two years. No significant functional or clinical difference was found between the two groups and the stability of the knees did not deteriorate with time in either group. The addition of a Kennedy ligament augmentation device gave no better results than the bone-patellar tendon-bone technique alone.     

Replacement of the anterior cruciate ligament by cold preserved bone-cruciate ligament-bone allotransplants. An experimental study in the sheep

One ACL in each of 17 mature sheep was replaced with a deep-frozen bone-an ACL bone allograft. Allografts were obtained from skeletally mature sheep using a standard aseptic technique and stored deep frozen for at least 6 days (mean 21 days). Macroscopical, biomechanical, and histological changes were evaluated 12, 24, and 52 weeks following implantation. At autopsy all allograft ligaments were present and demonstrated no evidence of infection or immune reaction. We found slight arthrotic changes in 3 knees after 12 weeks, in 4 knees after 24 weeks, and in 3 knees after 52 weeks. Twelve weeks after the operation the maximum load of the allografts was 17.5% of the contralateral controls and increased to 20.9% after 24 weeks and to 32% of controls after 52 weeks. Ligament stiffness in the linear region also increased from 18.9% of control (12 weeks) to 32.5% after 52 weeks, whereas maximum load decreased from 112.2% of controls (12 weeks) to 98% of controls (52 weeks). Histologically, the allografts progressively matured with time, becoming nearly identical to normal ligaments at 52 weeks.     

Levels of chondroitin 4-sulfate, chondroitin 6-sulfate and carboxy-terminal type II procollagen peptide in knee synovial fluid after injury to the anterior cruciate ligament

Changes in the metabolism of articular cartilage associated with injury to the anterior cruciate ligament (ACL) is known to be one of the important factors for the progression to secondary osteoarthritis. To investigate the efficacy of biochemical markers for monitoring the cartilage metabolism after injury to ACL, we measured the levels of chondroitin 4-sulfate (C-4S), chondroitin 6-sulfate (C-6S) and carboxy-terminal type II procollagen peptide (pCOL II-C) in knee synovial fluid (SF) from the patients with ACL rupture and compared with those in knee osteoarthritis (OA). Within 10 days after ACL rupture, levels of C-6S and C-4S in SF were significantly higher than those in early stage of OA. Both levels decreased gradually and became to the same levels as those in early stage of OA at 30 days after the injury. In contrast, pCOL II-C levels in SF just after the injury were observed to be lower than those in early stage of OA. Then they increased gradually to the levels of those in early stage of OA at 30 days after the injury. High levels of C-6S and C-4S in SF just after ACL rupture seemed to reflect the increased release of matrix fragments caused by cartilage destruction associated with the injury. pCOL II-C levels in SF seemed to reflect the repairing process that increased slowly after the cartilage destruction. Measurement of these cartilage derived macromolecules in SF could be useful tools for monitoring the metabolism in articular cartilage after injury.     

Anterior cruciate ligament reconstruction with the patellar tendon augmented by absorbable artificial materials. A histological and molecular biological study in rabbits

An experimental study was performed to investigate the histological and molecular biological properties of reconstructed anterior cruciate ligaments (ACL) using the patellar tendon augmented by absorbable artificial material in rabbits. Thirty rabbits underwent ACL reconstruction with the patellar tendon (non-augmented group), and 30 with the patellar tendon augmented by a polyglactin 910 mesh (augmented group). They were respectively sacrificed at at 1, 2, 3, 4, 6, 8 and 12 weeks after surgery for histological and molecular biological examination. Histologically, the fibrocytes were disappeared in deep portion of transplanted graft at 2 weeks after surgery in both groups. The graft was replaced with granulated tissues at 6 weeks in the augmented group, but it took 8 weeks in the non-augmented group. At 12 weeks, the graft showed hypocellularity with regularly oriented fibers in the augmented group, while it still showed hypercellularity with disoriented fibers in the non-augmented group. Molecular biologically, after the reconstruction at one week, the relative radioactivity in the graft was 1.05 in the non-augmented group, and 2.10 in the augmented group. Additionally the level of the alpha 2 (I) collagen mRNA was also significantly higher in the augmented group than that in the non-augmented group. These results suggested that a polyglactin 910 mesh had an effect on the process of reorganization and remodeling in the transplanted patellar tendon during the post-operative period in rabbit.     

Knee joint proprioception in normal volunteers and patients with anterior cruciate ligament tears, taking special account of the effect of a knee bandage

Proprioception of the knee joint was tested in 30 healthy volunteers with clinically inconspicuous knee joints. To examine proprioception, an angle reproduction test was performed. We could not document any differences between the left and the right knee joint or between men and women. At the mid-range, proprioception was worse compared with the end range of motion. In addition, 25 patients with an isolated rupture of the anterior cruciate ligament were evaluated, 14 before and 11 after operative anterior cruciate ligament (ACL) reconstruction. Preoperatively, there was a significant deterioration of proprioception compared with the control group. We were able to show a positive influence of a knee bandage on the proprioception of the injured knee. Patients after ACL reconstruction showed no significantly better proprioception compared with the preoperative group.     

Learning and generalization deficits in patients with memory impairments due to anterior communicating artery aneurysm rupture or hypoxic brain injury.

[Correction Notice: An erratum for this article was reported in Vol 22(6) of Neuropsychology (see record 2008-15268-012). Author Ramona O. Hopkins's name was misspelled as Romona O. Hopkins.] Human anterograde amnesia can result from a variety of etiologies, including hypoxic brain injury and anterior communicating artery (ACoA) aneurysm rupture. Although each etiology can cause a similarly severe disruption in declarative memory for verbal and visual material, there may be differences in incrementally acquired, feedback-based learning, as well as generalization. Here, 6 individuals who survived hypoxic brain injury, 7 individuals who survived ACoA aneurysm rupture, and 13 matched controls were tested on 2 tasks that included a feedback-based learning phase followed by a transfer phase in which familiar information is presented in new ways. In both tasks, the ACoA group was slow on initial learning, but those patients who completed the learning phase went on to transfer as well as controls. In the hypoxic group, 1 patient failed to complete either task; the remaining hypoxic group did not differ from controls during learning of either task, but was impaired on transfer. These results highlight a difference in feedback-based learning in 2 amnesic etiologies, despite similar levels of declarative memory impairment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology 1984 and six years before: A content analysis of the 86th and 92nd American Psychological Association Annual Conventions in Toronto, Canada.

At the 1978 American Psychological Association Convention, issues of human rights and equal rights for women were pervasive, while Orwellian themes dominated in 1984. 1978 presentations were humanistic, concerned with ethnic and minority issues and broad public policy matters. 1984 presentations focused on the effects of the threat of nuclear war, placed less emphasis on the individual, and were more socially oriented and interactive. While environmental concerns at the 1978 convention focused on pollution, crowding, and conservation, those in 1984 focused on nuclear power. 1978 optimism about community mental health centers was replaced in 1984 by a focus on the failure of deinstitutionalization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)