Motion Loss after Ligament Injuries to the Knee

Millett, Peter J.; Wickiewicz, Thomas L.; Warren, Russell F.

doi:10.1177/03635465010290062701

Cited by 61 publications

(39 citation statements)

References 27 publications

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“…Although abnormal patellar mobility potentially contributes to several knee disorders, such as anterior knee pain, patellofemoral pain, and arthrofibrosis, there is no strong evidence to support its importance, partially due to the lack of a standard measurement method [1, 3, 4, 10]. Considering the patient tolerability, low cost, and lower time commitment of our simple method, clinicians can easily evaluate patellar mobility before and after treatment.…”

Section: Discussionmentioning

confidence: 99%

Patellar mobility can be reproducibly measured using ultrasound

Kanamoto

Tanaka

Yonetani

et al. 2014

J Orthopaed Traumatol

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The present study was performed to examine the reliability of ultrasound in evaluating patellar mobility in the superior–inferior direction. Twelve healthy men volunteered for the study. Patellar mobility in the superior–inferior direction during isometric knee extension contraction with the knee immobilized in a semi-flexed knee brace was measured using ultrasound. Both intra-observer and inter-observer reliability were assessed by intra-class correlation coefficients (ICCs). Bland–Altman analysis was used for assessing agreement between measurements. ICC values were excellent for both intra-observer and inter-observer reliability at 0.97 and 0.93, respectively. In 95 % of measurements, the same observer measured within −0.55 to 0.61 mm, while different observers measured within −0.82 to 0.85 mm. In conclusion, patellar mobility in the superior–inferior direction during an isometric knee extension exercise can be reproducibly measured using ultrasound.The level of evidenceVI (basic study of a novel evaluation method).

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Section: Discussionmentioning

confidence: 99%

Patellar mobility can be reproducibly measured using ultrasound

Kanamoto

Tanaka

Yonetani

et al. 2014

J Orthopaed Traumatol

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“…For example, the medial mass does not fit easily into a simple category of ligament or joint injury (like scar, fibrosis, or sprain). Even though the medial mass is an "abnormal" and "excessive" scar-like tissue that mimics intraarticular adhesions and arthrofibrosis, two pathological processes of the human knee, these clinical conditions form unpredictably and are potentially debilitating [10]. In contrast, the medial mass forms reproducibly in time and location and has only a limited effect on joint function in this model system [3,28].…”

Section: Discussionmentioning

confidence: 99%

“…Two clinical complications of joint injury and surgery, intraarticular adhesions and arthrofibrosis [10], are characterized by a reactive fibrosis of the joint, which also is a fitting description of medial mass formation. Furthermore, the macroscopic and microscopic organization of the medial mass resembles the scar tissue that forms between the cut or torn ends of the MCL [11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Indirect Injury Stimulates Scar Formation–Adaptation or Pathology?

Matthews¹,

Chung²,

Matyas³

2004

Connective Tissue Research

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In several animal models of osteoarthritis induced by cruciate ligament transection, a dense, scar-like tissue mass forms rapidly on the medial side of the knee joint. This mass mimics clinical fibrosis that sometimes occurs after joint surgery. It is unknown exactly why this medial tissue mass forms and what cells are involved in its formation. This study characterizes this medial mass by histology, biochemistry, and the expression of types I and III collagen mRNA. The medial mass is compared with the medial collateral ligament (MCL) and the MCL epiligament in anterior cruciate-transected and unoperated joints, and to normal skin and skin scar. The morphology of the medial mass resembled the epiligament and skin scar more than the MCL. The concentration of DNA and RNA and the RNA-DNA ratio were elevated dramatically in the medial mass compared with all other tissues including skin scar. However, the mRNA copy number and ratio of collagen types I and III mRNAs did not differ significantly among the medial mass, MCL, epiligament, and skin in either the control or the operated joints. The response of the medial mass, MCL, and MCL epiligament to cruciate transaction involves both hyperplasia and hypertrophy, but without a dramatic shift in cell phenotype. The medial mass may be a useful mimic or model of intraarticular adhesions, hypertrophic scars, ligament sprains, and arthrofibrosis.

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“…After ACL reconstruction, adhesions can form in the suprapatellar pouch, the medial and lateral gutters, the infrapatellar fat pad, and the posterior capsule. 33 These adhesions can restrict extension, flexion, or both, and may present as a localized or diffuse process. It is important to look for, and treat these adhesions when surgical intervention for knee stiffness after ACL reconstruction is undertaken.…”

Section: Adhesionsmentioning

confidence: 99%

Knee Stiffness After ACL Reconstruction

Nauth¹,

Gilbart²

2012

Techniques in Knee Surgery

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Postoperative knee stiffness after anterior cruciate ligament reconstruction surgery is a significant clinical problem. Clinical deficits of knee flexion more than 10 degrees can limit function and athletic performance, and extension deficits of more than 5 degrees can cause gait changes and altered knee kinematics. The incidence reported in the literature varies significantly. Risk factors for the development of this condition include technical factors, graft selection issues, the timing of surgery relative to the traumatic injury, the presence of associated injuries, and postoperative rehabilitation. This chapter will review the incidence, risk factors, pathology, prevention, treatment options, and the clinical results of management of this condition.Key Words: anterior cruciate ligament reconstruction, single-bundle anatomic ACL reconstruction, knee stiffness, arthrofibrosis of the knee, physical therapy (Tech Knee Surg 2012;11: 26-33) K nee stiffness continues to represent one of the most common complications after anterior cruciate ligament (ACL) reconstruction surgery. This complication is of particular importance as stiffness after ACL reconstruction results in inferior functional outcomes and a higher incidence of radiographic evidence of arthritis. Knee stiffness presents as loss of motion and can include loss of extension, loss of flexion, or both. Normal knee range of motion (ROM) is from 5 degrees of hyperextension to 140 degrees of flexion. Deficits of > 10 degrees of flexion can limit athletic performance. Extension loss is poorly tolerated, with deficits of 5 degrees or greater producing gait changes, altering quadriceps function, and leading to patellofemoral arthritis. Prevention of knee stiffness after ACL surgery remains essential and requires a thorough understanding of the potential causes of loss of motion in ACL reconstruction. The treatment of loss of motion after ACL reconstruction requires an understanding of these causes and the pathoanatomy of the stiff knee. In addition, a systematic approach toward treatment of specific anatomic structures associated with the different types of motion loss is required for effective management. This article reviews the incidence, classification, risk factors, pathoanatomy, prevention, and treatment of knee stiffness after ACL reconstruction. EPIDEMIOLOGYThe true incidence of knee stiffness after ACL reconstruction is difficult to estimate as different studies have used different criteria for loss of motion and estimates have ranged from 2% 1 to 35%. 2 In a recent publication, Paxton et al 3 reported on one of the largest series of ACL reconstructions to date. In their prospective series of 4025 primary ACL reconstructions, the authors reported an overall reoperation rate of 4.4%. Knee stiffness was the second most common cause for reoperation (18.9% of reoperations) after meniscal/chondral injury (34.3% of reoperations), confirming that stiffness is one of the most common complications after ACL reconstruction.Stiffness of the knee after ACL recons...

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Motion Loss after Ligament Injuries to the Knee

Cited by 61 publications

References 27 publications

Patellar mobility can be reproducibly measured using ultrasound

Patellar mobility can be reproducibly measured using ultrasound

Indirect Injury Stimulates Scar Formation–Adaptation or Pathology?

Knee Stiffness After ACL Reconstruction

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