Biomechanics of knee ligaments: injury, healing, and repair

Woo, Savio L‐Y.; Abramowitch, Steven D.; Kilger, Robert; Liang, Rui

doi:10.1016/j.jbiomech.2004.10.025

Cited by 330 publications

(233 citation statements)

References 155 publications

(148 reference statements)

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“…1 The treatment of acute soft-tissue injuries of the knee is guided by knowledge of the phases of healing. [2][3][4][5][6] In order to protect injured tissues and alleviate pain, complete knee joint immobilization (using either a nonhinged knee brace or splint) is used by some physicians as part of the initial management of these injuries. 7 However, the early work has demonstrated the harmful effects of prolonged joint immobilization: motion loss, muscle atrophy, decreased synthesis of proteoglycans in cartilage and decreased bone mass.…”

Section: Discussionmentioning

confidence: 99%

“…21 When managing acute soft-tissue knee injuries, many physicians are influenced by treatment principles that allow motion so long as further injury is avoided, which is evidenced by decreasing levels of pain and inflammation. [1][2][3][4][5][6][22][23][24][25][26][27] Unfortunately, clear guidelines regarding the use of immobilization for specific knee injuries do not currently exist. The purpose of this study was to explore the opinions and reported practice patterns of EPs, SMPs and OS with regards to the use of early immobilization in the management of acute soft-tissue injuries of the knee.…”

Section: Discussionmentioning

confidence: 99%

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The use of early immobilization in the management of acute soft-tissue injuries of the knee: results of a survey of emergency physicians, sports medicine physicians and orthopedic surgeons

Sommerfeldt

Bouliane

Otto

et al. 2015

cjs

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Background: Evidence-based guidelines on the use of immobilization in the management of common acute soft-tissue knee injuries do not exist. Our objective was to explore the practice patterns of emergency physicians (EPs), sports medicine physicians (SMPs) and orthopedic surgeons (OS) regarding the use of early immobilization in the management of these injuries. Methods:We developed a web-based survey and sent it to all EPs, SMPs and OS in a Canadian urban centre. The survey was designed to assess the likelihood of prescribing immobilization and to evaluate factors associated with physicians from these 3 disciplines making this decision. Results:The overall response rate was 44 of 112 (39%): 17 of 58 (29%) EPs, 7 of 15 (47%) SMPs and 20 of 39 (51%) OS. In cases of suspected meniscus injuries, 9 (50%) EPs indicated they would prescribe immobilization, whereas no SMPs and 1 (5%) OS would immobilize (p = 0.002). For suspected anterior cruciate ligament injuries, 13 (77%) EPs, 2 (29%) SMPs and 5 (25%) OS said they would immobilize (p = 0.005). For lateral collateral ligament injuries, 9 (53%) EPs, no SMPs and 6 (32%) OS would immobilize (p = 0.04). All respondents would prescribe immobilization for a grossly unstable knee. Conclusion:We found that EPs were are more likely to prescribe immobilization for certain acute soft-tissue knee injuries than SMPs and OS. The development of an evidenced-based guideline for the use of knee immobilization after acute soft-tissue injury may reduce practice variability.Contexte : Il n'existe pas de lignes directrices factuelles sur le recours à l'immo bilisation pour la prise en charge des traumatismes aigus communs qui affectent les tissus mous du genou. Notre objectif était d'explorer les habitudes de pratique des urgentologues, des médecins du sport et des chirurgiens orthopédistes quant au recours à l'immobilisation pour la prise en charge initiale de ces blessures.Méthodes : Nous avons conçu un sondage Web et l'avons fait parvenir à tous les urgentologues, médecins du sport et chirurgiens orthopédistes d'un centre urbain canadien. Le sondage visait à évaluer la probabilité que l'immobilisation soit prescrite et à dégager les facteurs associés à ce type de décision chez les praticiens de ces 3 disciplines.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The use of early immobilization in the management of acute soft-tissue injuries of the knee: results of a survey of emergency physicians, sports medicine physicians and orthopedic surgeons

Sommerfeldt

Bouliane

Otto

et al. 2015

cjs

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“…Therefore, the load applied by the robot directly affects the ACL. The UFS sensor records the force and torque data in the tibia and through Jacobian operations the magnitudes of these factors that occur in the ACL are determined, such as the in-situ force [1,6,7].…”

Section: Determination Of the Cruciate Ligament Forcesmentioning

confidence: 99%

Relevance of the hyperelastic behavior of cruciate ligaments in the modeling of the human knee joint in sagittal plane

Ponce-Saldias

Martins

Mello-Roesler

et al. 2015

Rev. Fac. Ing. Antioquia

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Relevance of the hyperelastic behavior of cruciate ligaments in the modeling of the human knee joint in sagittal planeABSTRACT: The rupture of the anterior cruciate ligament (ACL) is the most common injury of the human knee. When surgery is required, it is helpful for orthopedic surgeons to scientifi cally defi ne the best position for the graft, which approximates the functionality of an intact ACL. To accomplish that, it is crucial to estimate the force acting on the ligament (or graft) in response to an external load applied to the knee. This force is called the in-situ force. The objective of this research is to evidence the relevance of the hyperelastic behavior of cruciate ligaments in the two-dimensional modeling of the knee. To achieve this, a sequential method of modeling is proposed based on the theory of mechanisms and Davies' method. In a fi rst approach the cruciate ligaments are treated as rigid bodies, and in a second approach, as hyperelastic bodies. These two approaches are then compared. The model provides information to assist the preoperative planning, by simulation of the ACL positions and insitu forces. The proposed methodology consists of four steps and an experimental procedure performed by a robotic manipulator to obtain the in-situ forces. Experimental in-situ forces are used to validate the proposed model. Besides helping the preoperative planning, the model allows verifying two relevant biomechanical hypotheses: 1. During the simulation of the ACL in-situ force, the modeling of the cruciate ligaments as rigid links shows similar results to the modeling, which considers the hyperelastic behavior (more complex). 2. The ACL in-situ force can be well approximated when the knee is modeled as a two-dimensional four bar mechanism. Based on the results it can be concluded that the forces obtained by simulations that consider the hyperelastic behavior of the cruciate ligaments are close to the forces obtained by simulations that consider the cruciate ligaments as rigid bodies. It can also be noted that the simulated results are quite similar to the experimental results, which is important considering that the proposed model is simplifi ed. RESUMEN:La ruptura del ligamento cruzado anterior (LCA) es la lesión más común de la rodilla humana. Cuando se requiere cirugía, es de mucha ayuda para los cirujanos defi nir científi camente el mejor punto de inserción del injerto, para que pueda tener una funcionalidad similar a la de un LCA intacto. Para esto, es crucial la estimación de la fuerza que actúa en el ligamento (o injerto) en respuesta a una carga externa aplicada sobre la rodilla. Esta fuerza es llamada fuerza in-situ. El objetivo de esta investigación es evidenciar la relevancia del comportamiento hiperelástico de los ligamentos cruzados en el modelaje bidimensional de la rodilla. Para ello, se propone una metodología secuencial de modelaje basándose en teoría de mecanismos y el método de Davies. En una primera aproximación, los ligamentos cruzados son considerados como cuerpos rígidos; en u...

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“…Uma forma de contornar este obstáculo seria a normalização dos dados por meio das medidas de área de secção transversa e de comprimento inicial do músculo. A literatura, no entanto, reconhece que a obtenção de tais medidas oferece ainda maiores obstáculos 30 . O caráter destrutivo dos ensaios mecânicos confere grande dificuldade na mensuração adequada da área de secção transversa no local da lesão muscular 19 .…”

Section: Análise Estatísticaunclassified

Efeito do ultrassom terapêutico sobre as propriedades mecânicas do gastrocnêmio em ratos

Barbosa

Filho

Nonato

et al. 2014

Rev Bras Med Esporte

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INTRODUÇÃO: Apesar de algumas controvérsias quanto à sua utilização, o ultrassom terapêutico (UST) é um recurso comumente aplicado na reabilitação desportiva para aceleração do reparo tecidual de lesões musculares. Sabe-se que lesões musculares influenciam negativamente as propriedades mecânicas da musculatura estriada esquelética e algumas evidências demonstram que o UST poderia ter efeitos benéficos sobre o reparo muscular e, consequentemente, sobre suas propriedades mecânicas.OBJETIVO: Analisar o efeito do UST no reparo tecidual por meio das propriedades mecânicas musculares de ratos após trauma por criolesão.MÉTODOS: Foram utilizados no estudo 30 ratos da linhagem Wistar, os quais foram divididos em três grupos: grupo controle intacto (GC), grupo lesionado sem tratamento (GL), e grupo lesionado e estimulado com UST (frequência de 1 MHz; intensidade de 0,5 W/cm2; ciclo de trabalho de 50%; por quatro minutos diários), durante sete dias consecutivos (GLUST). As propriedades mecânicas obtidas através de ensaio mecânico de tração foram avaliadas em uma máquina universal de ensaios.RESULTADOS: Foram analisados estatisticamente, com nível de significância de 95% (P<0,05). Após sete sessões de tratamento, houve melhora estatisticamente significativa nas propriedades mecânicas de carga no limite de proporcionalidade, carga no limite máximo e resiliência para o GLUST em relação ao GL (p<0,05).CONCLUSÃO: O UST foi eficaz no processo de reparo tecidual, conferindo ao tecido muscular maior resistência à tração e absorção de energia.

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Biomechanics of knee ligaments: injury, healing, and repair

Cited by 330 publications

References 155 publications

The use of early immobilization in the management of acute soft-tissue injuries of the knee: results of a survey of emergency physicians, sports medicine physicians and orthopedic surgeons

The use of early immobilization in the management of acute soft-tissue injuries of the knee: results of a survey of emergency physicians, sports medicine physicians and orthopedic surgeons

Relevance of the hyperelastic behavior of cruciate ligaments in the modeling of the human knee joint in sagittal plane

Efeito do ultrassom terapêutico sobre as propriedades mecânicas do gastrocnêmio em ratos

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