We studied the biochemical characteristics of human knees with deficient anterior cruciate ligaments (ACL) and analysed their relationship to the time after ligamentous injury. Thirty-two patients with isolated ACLinjured knees and six healthy volunteers were enrolled. Synovial fluid samples were centrifuged after aspiration during arthroscopic examination, and aliquots of supernatant were frozen and stored at −80°C. The samples were analysed for interleukin (IL)-1β, tumour necrosis factor (TNF)-α, IL-6, matrix metalloproteinase (MMP)-3, and tissue inhibitor of metalloproteinase (TIMP)-1 using commercially available sandwich enzyme-linked immunosorbent assay. In fluid from ACL-injured knees, the average concentrations of IL-6, MMP-3 and TIMP-1 were highly elevated in comparison with normal controls. There was a statistically significant correlation between the concentrations of MMP-3 and IL-6. The IL-6 and TIMP-1 concentrations were interrelated. The concentration of MMP-3 remained high, independent of the duration since the injury, whereas the TIMP-1 and IL-6 levels decreased. The results suggest that the timing of the treatment of an ACL-injured knee might be of importance.Résumé Nous avons étudié les caractéristiques biochimiques des genoux humains avec un ligament croisé antérieur défectueux (LCA) et avons analysé leur rapport au temps après la lésion ligamentaire. Trente-deux malades avec une lésion isolée du LCA et six volontaires sains ont été enrôlés.
We measured muscle strength in 36 patients after anterior cruciate ligament (ACL) reconstruction with autogenous bone-patellar tendon-bone graft. Quadriceps and hamstring isokinetic strength was assessed during concentric contraction at 60 and 180°/s and was measured at 1, 6, 12 and 24 months postoperatively. At 24 months quadriceps muscle strength had recovered to approximately 90% of the level of the uninvolved side, both at 60 and 180°/s. In contrast, hamstring muscle strength had already recovered to approximately 90% at 6 months. Age, gender, activity level, and anterior tibial laxity did not affect the muscle performance. However, the recovery of muscle strength was delayed in patients with anterior knee pain.Résumé Nous avons mesuré la force musculaire chez 36 malades après reconstruction du LCA avec autogreffe "os-tendon rotulien-os". La force isokinétique du quadriceps et des ischio-jambiers a été étudiée pendant la contraction concentrique à 60 et 180 degré/sec et a été mesurée à 1, 6,12 et 24 mois postopératoires. À 24 mois la force musculaire du Quadriceps avait retrouvé approximativement 90% de la force du côté opposé, à 60 et 180 degré/sec. Par contraste, la force musculaire des ischio-jambiers avait déjà retrouvé 90% de sa valeur à 6 mois. L'âge, le sexe, le niveau d'activité, et la laxité tibiale antérieure n'ont pas affecté la performance musculaire. Cependant la récupération de force musculaire a été différée chez les malades avec douleur antérieure du genou.
The aim of this study was to investigate the characteristics of proprioception in patients with an anaterior-cruciate-ligament (ACL)-injured knee and to determine whether there is a correlation between proprioception and performance. We studied 32 patients with unilateral isolated ACL ruptures. Proprioception of the knee was evaluated by examining the joint position sense. Functional performance was evaluated with the one-leg hop (OLH) and one-leg vertical jump (OLV) tests. The mean error angle of the joint position sense was 3.6±1.5°o n the intact side and 5.2±1.9°on the injured side. The joint position sense was thus clearly reduced on the injured side (p<0.05). The distance of jumping in the OLH test and the height of jumping in the OLV test was also clearly reduced on the injured side compared with that on the intact side (p<0.01) both with and without visual control. Moreover, we found a significant correlation between proprioception and performance in the ACL-injured knees, and this correlation was more distinct with visual deprivation. In conclusion, decreased proprioception in patients with ACL deficiency reduced their functional ability.Résumé Le but de cette étude était d'étudier les caractéristiques de proprioception chez les malades avec une lésion du LCA, et déterminer s'il y avait une corrélation entre proprioception et performance. Nous avons étudié 32 malades avec une rupture isolée unilatérale du LCA. La proprioception du genou a été évalué en examinant le sens des positions de l'articulation. La fonction a été évaluée avec le saut à cloche-pied (OLH) et saut vertical unipodal (OLV). L'angle moyen d'erreur de position était 3,6±1,5°sur le côté intact et 5,2±1,9°sur le côté blessé. Le sens de position était donc notablement réduit du côté blessé (p<0.05). La distance de saut dans l'épreuve OLH et la hauteur du saut dans l'épreuve OLV ont aussi été réduite du côté blessé comparé avec le côté intact (p<0.01) les deux avec et sans contrôle visuel. De plus, nous avons trouvé une corrélation certaine entre proprioception et performance dans les genoux avec lésion du LCA, et cette corrélation était encore plus nette avec privation visuelle. En conclusion, la diminution de la proprioception chez les malades avec une insuffisance du LCA à réduit leur capacité fonctionnelle.
There were 2 types of large femoral plateau angles: one had its origin in an increasing tibial posterior slope; the other resulted from hyperextension of the knee. Large posterior tibial slope and hyperextension are both correlated with noncontact ACL injury in women.
Background: Although the biomechanical importance of the ramp lesion in the anterior cruciate ligament (ACL)–deficient knee has been demonstrated, there is no clear consensus on the appropriate treatment for ramp lesions during ACL reconstruction. Purpose: To compare the postoperative outcomes for ramp lesions between patients treated with all-inside repair through the posteromedial portal and those whose ramp lesions were left in situ without repair during ACL reconstruction. We also determined whether ramp lesion healing status affected postoperative knee stability. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 57 patients who underwent anatomic double-bundle ACL reconstruction between August 2011 and December 2017 had attendant ramp lesions. Of these, 25 ramp lesions that were considered stable were left in situ without repair (Nonrepaired group), and 25 ramp lesions, including 21 stable and 4 unstable lesions, were treated using all-inside repair through the posteromedial portal (Repaired group). We evaluated the side-to-side difference (SSD) in anterior tibial translation on stress radiographs and rotational stability by using the pivot-shift test 2 years after surgery, and healing status of the ramp lesions was evaluated on 3.0-T magnetic resonance imaging (MRI) scans 1 year after surgery. Results: The mean SSDs in anterior translation were 2.4 ± 1.6 mm for the Nonrepaired group and 1.9 ± 1.6 mm for the Repaired group, with no significant differences. The positive ratios on the pivot-shift test were not significantly different between groups. Healing rates of ramp lesions on MRI scans showed a significant difference between the Nonrepaired group (60%) and the Repaired group (100%) ( P = .001). The mean SSDs for knees in which the ramp lesion had healed as shown on MRI scans and those in which it had not healed were 1.9 ± 1.6 mm and 3.2 ± 1.1 mm, respectively, which was a significant difference ( P = .02). Conclusion: Healing rates of ramp lesions were significantly better in the Repaired group than in the Nonrepaired group, although postoperative knee stability was not significantly different between groups. Anterior laxity in the knees in which the ramp lesion was unhealed was significantly greater compared with the knees in which the ramp lesion healed. All-inside repair through the posteromedial portal was a reliable surgical procedure to heal ramp lesions.
We have analysed retrospectively the relationship between the axial parameters of alignment of the lower limb and the recurrence of varus deformity after high tibial osteotomy. We studied 29 patients (37 knees) with a mean age at surgery of 66 years. The mean follow-up was for 7.4 years (5 to 10.5). Recurrence of varus deformity was defined as an increase in the femorotibial angle of 3° or more, compared with that obtained six months after the operation. There were four patients (four knees) with recurrence of varus deformity. They had a greater varus inclination of the distal femur than those without varus recurrence. An association between varus inclination of the distal femur and horizontal obliquity of the joint surface was observed. Excessive obliquity prevents the shift of weight-bearing to the lateral compartment, and may cause a recurrence of varus deformity after high tibial osteotomy.
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