The Diagnostic Value of Clinical Tests, Magnetic Resonance Imaging, and Instrumented Laxity in the Differentiation of Complete Versus Partial Anterior Cruciate Ligament Tears

Dejour, David; Ntagiopoulos, Panagiotis G.; Saggin, Paulo Renato Fernandes; Panisset, Jean-Claude

doi:10.1016/j.arthro.2012.10.013

Cited by 94 publications

(125 citation statements)

References 29 publications

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“…The authors found that the partial tears demonstrated MRI features that are indistinguishable from complete ACL tears, mucoid ACL degeneration, and the normal ACL. Additionally, Dejour et al [4] confirmed these findings by indicating that, in partial tears, there was no correlation between preoperative MRI findings and arthroscopically confirmed type of ACL tear. Partial ACL disruption, compared with complete ACL disruption, is extremely rare.…”

mentioning

confidence: 93%

CORR Insights®: How Useful is MRI in Diagnosing Isolated Bundle ACL Injuries?

Levy

2013

Clinical Orthopaedics &Amp; Related Research

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mentioning

confidence: 93%

CORR Insights®: How Useful is MRI in Diagnosing Isolated Bundle ACL Injuries?

Levy

2013

Clinical Orthopaedics &Amp; Related Research

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“…Previous studies have noted that arthroscopic evaluation and characterization of the remaining fibers as functional or nonfunctional by probe palpation is more important than identifying the injured bundle or determining the percentage of torn ACL fibers [54,56]. Attempts to attenuate or elongate the fibers, sometimes in the "figure of four" position, and evaluating the posterolateral bundle can be difficult and should be conducted by probe palpation [54,56].…”

Section: Remnant-preserving Aclrmentioning

confidence: 99%

“…Regarding the three types of remnant-preserving ACL surgeries, SBA is believed to provide better knee stability results, followed by AG and, lastly, by NFRP [51][52][53][54][55][56]57 Tunnel enlargement is caused by high levels of cytokines and inflammatory agents in the postsurgery synovial fluid bathing the tunnel graft-bone interface and micro-motion in this environment; also, tunnel enlargement is more common in the tibia consequent to gravity. Although a correlation between tunnel enlargement and clinical outcomes has not been conclusively demonstrated, it remains a concern in revision surgery.…”

Section: Remnant-preserving Aclrmentioning

confidence: 99%

“…The definition of remnant-preserving ACLR surgery is controversial because it currently refers to the following three major procedures: selective bundle augmentation (SBA) ACLR in a partial lesion, involving either the posterolateral or anteromedial bundle with functional remaining fibers; augmentation (AG) ACLR in a partial lesion, involving one or both bundles with some remaining functional tissue; and ACLR in a complete lesion, involving both bundles with some remaining nonfunctional tissue (NFRP-nonfunctional remnant preservation) [51][52][53][54][55][56]57 Partial ACL tears are frequent (5 %-38 %) [62•], and the remnant fibers have been given more importance in recent years. ACLR using a remnant-preserving technique also called ACL augmentation supposedly improves the ligamentization process, since the remnant functional fibers may biomechanically protect the graft, the vascularized remnant synovial envelope may enhance vascularization, and the valve mechanism created by the remaining tissue and the tunnel may inhibit the entry of synovial fluid, resulting in less tunnel enlargement; also, histological studies have shown mechanoreceptors in the remaining tissue that may optimize proprioceptive function [52, 54, 55, 57••, 58, 59•, 62•, 63••, 64,65].…”

Section: Remnant-preserving Aclrmentioning

confidence: 99%

“…Attempts to attenuate or elongate the fibers, sometimes in the "figure of four" position, and evaluating the posterolateral bundle can be difficult and should be conducted by probe palpation [54,56].…”

Section: Remnant-preserving Aclrmentioning

confidence: 99%

See 2 more Smart Citations

Updates in biological therapies for knee injuries: anterior cruciate ligament

Franciozi

Ingham

Gracitelli

et al. 2014

Curr Rev Musculoskelet Med

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There have been many advances in anterior cruciate ligament reconstruction (ACLR) techniques incorporating biological treatment. The aim of this review is to discuss the recent contributions that may enlighten our understanding of biological therapies for anterior cruciate ligament (ACL) injuries and improve management decisions involving these enhancement options. Three main biological procedures will be analyzed: bio-enhanced ACL repair, bio-enhanced ACLR scrutinized under the four basic principles of tissue engineering (scaffolds, cell sources, growth factors/cytokines including platelet-rich plasma, and mechanical stimuli), and remnant-preserving ACLR. There is controversial information regarding remnant-preserving ACLR, since different procedures are grouped under the same designation. A new definition for remnant-preserving ACLR surgery is proposed, dividing it into its three major procedures (selective bundle augmentation, augmentation, and nonfunctional remnant preservation); also, an ACL lesion pattern classification and a treatment algorithm, which will hopefully standardize these terms and procedures for future studies, are presented.

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New perspectives on ACL injury: On the role of repetitive sub‐maximal knee loading in causing ACL fatigue failure

Wojtys

Beaulieu

Ashton‐Miller

2016

Journal Orthopaedic Research

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In this paper, we review a series of studies that we initiated to examine mechanisms of anterior cruciate ligament (ACL) injury in the hope that these injuries, and their sequelae, can be better prevented. First, using the earliest in vitro model of a simulated single-leg jump landing or pivot cut with realistic knee loading rates and trans-knee muscle forces, we identified the worst-case dynamic knee loading that causes the greatest peak ACL strain: Combined knee compression, flexion, and internal tibial rotation. We also identified morphologic factors that help explain individual susceptibility to ACL injury. Second, using the above knee loading, we introduced a possible paradigm shift in ACL research by demonstrating that the human ACL can fail by a sudden rupture in response to repeated sub-maximal knee loading. If that load is repeated often enough over a short time interval, the failure tended to occur proximally, as observed clinically. Third, we emphasize the value of a physical exam of the hip by demonstrating how limited internal axial rotation at the hip both increases the susceptibility to ACL injury in professional athletes, and also increases peak ACL strain during simulated pivot landings, thereby further increasing the risk of ACL fatigue failure. When training at-risk athletes, particularly females with their smaller ACL cross-sections, rationing the number and intensity of worst-case knee loading cycles, such that ligament degradation is within the ACL's ability to remodel, should decrease the risk for ACL rupture due to ligament fatigue failure. Keywords: anterior cruciate ligament; fatigue failure; muscle; tibial rotation; repetitive loading DIFFERENT APPROACHES FOR STUDYING ACL INJURY MECHANISMSSuccessful injury prevention efforts usually require a detailed understanding of the mechanism(s) of injury. The fact that anterior cruciate ligament (ACL) injuries continue to occur at a high rate in young athletes means that those mechanisms have remained elusive. Many reports of ACL injury describe a noncontact landing from a jump or a pivot maneuver while changing direction.1,2 The direction of movement and body and lower extremity positions have naturally then become the focus of analyzing injury mechanisms. However, while in vivo experiments might seem preferable, we have been reticent to ask athletes to perform the very maneuvers known to cause these injuries for obvious ethical reasons. Adding to our reticence is the fact that all in vivo field studies involve the use of surface markers or sensors that cannot accurately record the underlying skeletal kinematics.3 While animal studies are an alternative option, the external validity of transferring findings from quadrupeds to humans can be problematic. In silico approaches are another alternative but they require physiological kinematic data. That leaves in vitro studies with cadaver limbs as offering potential for exploring ACL injury mechanisms, as long as the rate and type of loading, the presence of muscle forces, and dynamic load...

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The Diagnostic Value of Clinical Tests, Magnetic Resonance Imaging, and Instrumented Laxity in the Differentiation of Complete Versus Partial Anterior Cruciate Ligament Tears

Cited by 94 publications

References 29 publications

CORR Insights®: How Useful is MRI in Diagnosing Isolated Bundle ACL Injuries?

CORR Insights®: How Useful is MRI in Diagnosing Isolated Bundle ACL Injuries?

Updates in biological therapies for knee injuries: anterior cruciate ligament

New perspectives on ACL injury: On the role of repetitive sub‐maximal knee loading in causing ACL fatigue failure

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