II.

Even if pivot-shift (PS) test has been clinically used to specifically detect anterior cruciate ligament (ACL) injury, the main problem in using this combined test has been yet associated with the difficulty of clearly quantifying its outcome. The goal of this study was to describe an original non-invasive methodology used to quantify PS test, highlighting its possible clinical reliability. The method was validated on 66 consecutive unilateral ACL-injured patients. A commercial triaxial accelerometer was non-invasively mounted on patient's tibia, the corresponding 3D acceleration was acquired during PS test execution and a set of specific parameters were automatically identified on the signal to quantify the test. PS test was repeated three times on both injured and controlateral limbs. Reliability of the method was found to be good (mean intra-rater intraclass correlation coefficient was 0.79); moreover, we found that ACL-deficient knees presented statistically higher values for the identified parameters--than the controlateral healthy limbs, averagely reporting also large effect size.

We describe an arthroscopic surgical technique for tissue engineered cartilage grafting. A three-dimensional hyaluronic acid support is used for autologous chondrocyte culturing. The technique reduces morbidity of classic autologous implant and avoids open surgery and the use of a periosteal flap. The procedure includes the advantages of arthroscopic osteochondral grafting without donor site morbidity. With this technique is possible to reduce the patient morbidity, time and cost of surgery.

Lachman, drawer, and pivot-shift (PS) tests are important in the assessment of ACL reconstruction. The goal of this work was to analyze the reliability of the PS test using a navigation system, identifying a set of new quantitative parameters and evaluating their clinical relevance. Eighteen patients that underwent anatomic double-bundle ACL reconstruction were included. The new dynamic parameters were: anteroposterior translation of the medial and lateral compartments and the joint center and internal/external and varus/valgus rotations of the joint. For each parameter we measured the peaks and the areas obtained during the test. Intratester repeatability, comparisons of pre-and postoperative laxities, and correlations between the PS peaks and the corresponding peaks obtained with standard static tests were evaluated. Areas, peaks, and static laxity outcomes were compared, grouping patients according to the preoperative International Knee Documentation Committee (IKDC) score. The PS test was reliable in identifying the surgical reconstruction. Correlation analysis showed good coefficients both for pre-and postoperative values. Patients with IKDC grade ''D'' had larger areas during the PS compared to patients with grade ''C''. Our analysis is helpful for characterizing patient-specific laxity and surgical performance, thus highlighting the clinical relevance of the PS test. ß

No abstract

Case series.

The primary aim of this work was to evaluate the neurovascular network of the pes anserinus (PA) at its tibial insertion because the PA is often used for anterior cruciate ligament (ACL) reconstruction. Four fresh cadaver knees were injected with India ink gelatin solution and the arteries that supply blood to the PA were identified; microscopic studies of vessels and nerve fibers were also performed. Superficial and deep branches of the inferior medial genicular artery contribute to an arterial arch that courses deep to the PA insertion. A widespread array of small vessels and nerve fibers penetrate the PA insertion and course along the length of the gracilis and semitendinosus tendons. Computer analysis revealed that the mean diameter of the vessels decreased from 2201 microm at the insertion to 661 microm midway along the length of the tendon (mean tendon length = 17 cm; range = 13-21 cm); the cross-sectional area of the vessels per histologic section decreased from 336.37-137.05 microm(2). This study demonstrates that the PA insertion is well vascularized and richly innervated and that these morphological features continue along the length of the tendons.

The aims of this study were to determine in elite master swimmers of both genders whether, using anthropometric variables and the hand grip strength measure, it was possible to predict freestyle performance time, whether the considered predictors were related similarly to different events (50, 100, 200, 400, 800 m), and whether they were the same in male and female master swimmers. The relationships between performance times and age, body mass, height, arm length, forearm length, forearm muscle volume, and hand grip strength were examined in 135 elite master swimmers. Pearson's simple correlation coefficients were calculated and then prediction equations were developed. Age, height, and hand grip strength were the best predictors in short-distance events, whereas only age and height were predictors in middle- and long-distance events. The corresponding coefficient of determination (R) of performance times were 0.84 in the 50-m event, 0.73 in the 100-m event, 0.75 in the 200-m event, 0.66 in the 400-m event, and 0.63 in the 800-m event. These regression equations were then cross-validated in a control group of 126 nonelite, age-matched swimmers, obtaining significant and good correlations for all distances (range, r = 0.67 and 0.83; p < 0.01), indicating that predictors are valid in an extended sample of master swimmers. Differences between sexes were not found in 50-m event, but were present in all other events. These models might be useful to determine individual performance times by contributing to improving the individual's training program and the selection of master swimmers. Coaches could have better accuracy in determining whether an athlete needs a strength training program in order to optimize performance time.