No abstract

With the abundance of anatomic double bundle ACL reconstruction techniques that currently exist and limited patient outcome data, one has to ask whether or not they should be used and if so, which one, and what is the learning curve for the average knee surgeon to become competent with the technique that they select? The purpose of this literature review is to summarize existing anatomic double bundle ACL reconstruction surgical and rehabilitation techniques and the clinical and biomechanical study evidence that currently exists. In choosing to perform anatomic double bundle ACL reconstruction we suggest that the knee surgeon should look for evidence of: (1) control of the pivot shift phenomenon, (2) improved transverse plane rotatory knee control during the performance of sports type movements, (3) a decreased likelihood of revision procedures either for ACL reconstruction or for treatment of associated primary or recurrent meniscal injuries, (4) improved patient self-reports of perceived function, satisfaction, and quality of life, and (5) radiographic evidence of a lower incidence and/or magnitude of osteoarthritic changes compared to conventional single bundle ACL reconstruction.

Hamstring muscle group dysfunction following anterior cruciate ligament reconstruction (ACL) using a semitendinosus-gracilis autograft is a growing concern. This study compared the mean peak isometric knee flexor torque of the following three groups: subjects 2 years following ACL reconstruction using semitendinosus-gracilis autografts (Group 1), subjects 2 years following ACL reconstruction using tibialis anterior allografts (Group 2), and a non-injured, activity-level-matched control group (Group 3). We hypothesized that Group 1 would have greater mean involved lower extremity peak isometric knee flexor torque deficits than the other groups. Handheld dynamometry with subjects in prone and the test knee at 90 degrees flexion was used to determine bilateral peak isometric knee flexor torque. Group 1 (86.4 +/- 11) and Group 2 (80.5 +/- 13) had similar 2000 IKDC Subjective Knee Evaluation Form scores (P = NS). Group 1 had a mean involved lower extremity peak isometric knee flexor torque deficit of -17.0 +/- 14 Nm. Group 2 had a mean involved lower extremity peak isometric knee flexor torque deficit of -0.8 +/- 9 Nm. Group 3 (control) had a mean left and right lower extremity peak isometric knee flexor torque difference of -0.7 +/- 14 Nm. Group 1 had decreased involved lower extremity peak isometric knee flexor torque compared to Groups 2 and 3 (two-way ANOVA; group x side interaction P < 0.05, Tukey HSD = 0.008). Long-term knee flexor strength deficits exist following hamstring autograft use for ACL reconstruction that does not occur when a tibialis anterior allograft is used. Early identification of impaired knee flexor strength among this group and modified rehabilitation may reduce these deficits. Adding quantitative biomechanical testing of sprinting and sudden directional change movements to the standard physical therapy evaluation will better elucidate the clinical and functional significance of the observed knee flexor strength impairments and aid in determining sport specific activity training readiness.

No abstract

Physical inactivity is a modifiable risk factor (similar to dyslipidemia and hypertension) for a variety of chronic diseases, including cancer and cardiovascular disease. Exercise provides a clear health benefit, which serves in the primary and secondary prevention of these disease processes (the most important being a reduction in cardiovascular disease and premature death). The physiologic mechanisms for such a benefit occur at both a cellular and multisystem level. Prolonged periods of occupational or leisure-time sitting have adverse health effects independent of exercise performed before or after. Almost any form of physical activity (PA) is beneficial, whether part of a regular exercise program or as a series of intermittent, incidental, non-purposeful, lifestyleembedded activity (causing non-exercise activity thermogenesis or NEAT). The health benefits of exercise appear to be dose-dependent. Physicians should recommend near daily exercise which includes at various times strength training, stretching, and aerobic activity in addition to emphasizing adjustments that allow for reduced sitting and increased activity during daily routines. Patients should understand that for optimal health, exercise is no longer optional.