A lesão do ligamento cruzado anterior (LCA) é incapacitante para vários esportes pela instabilidade e deficiência funcional. O tratamento indicado é a reconstrução cirúrgica do ligamento, no entanto, nem sempre a recuperação funcional após a operação é suficiente para o retorno ao esporte. O objetivo deste estudo foi avaliar o controle postural dinâmico, a força muscular e o parâmetro funcional medido pelo Hop Test de atletas com e sem lesão do LCA. Métodos: Foram incluídos 74 atletas, 60 homens e 14 mulheres, com idades entre 16 e 45 anos, divididos em dois grupos: Grupo-Lesão LCA (GL) com 34 atletas (25,05 anos ± 6,82) e Grupo-Controle (GC) com 40 atletas sem lesão de LCA (27,7 anos ± 8,16). Todos os voluntários realizaram posturografia, dinamometria isocinética e o Hop Test. O GL foi avaliado antes e 12 meses após a reconstrução. O Grupocontrole (GC) foi avaliado num único momento. Resultados: Nas comparações pré e pós-operatórias do GL: a posturografia mostrou maior área de deslocamento no pré-operatório; na dinamometria isocinética, o pico de torque e trabalho total foram maiores no pós-operatório, mas a relação entre músculos flexores e extensores foi menor que a preconizada em ambas as avaliações (pré e pós-operatório); no Hop Test, a distância saltada e a simetria entre os membros foram maiores no pós-operatório. Na comparação com o GC, a posturografia mostrou maior oscilação anteroposterior e menor oscilação mediolateral no GL pré-operatório; na dinamometria isocinética, o pico de torque e trabalho total foram maiores no pré-operatório. No pós-operatório, GL mostrou maior relação entre flexores e extensores que GC. Conclusão: Os atletas submetidos à reconstrução do LCA apresentaram melhor desempenho funcional na avaliação pós-operatória quando comparados com o pré-operatório e com GC. Porém, os parâmetros isocinéticos apresentaram recuperação incompleta / The injury of the anterior cruciate ligament (ACL) is crippling for various sports by instability and functional impairment. The recommended treatment is surgical ligament reconstruction, however, sometimes that functional recovery after operation is not enough to return to the sport. The objective of this study was to evaluate the dynamic postural control, muscle strength, and functional parameter measured by Hop Test of athletes with and without ACL injury. Method: We included 74 athletes, 60 men and 14 women, who are between 16 and 45 years old, divided into two groups: Injury Group (GL) with 34 athletes (25.05 years ± 6.82) and Group Control (GC) with 40 athletes without ACL injury (27.7 years ± 8.16). All volunteers held posturography, isokinetic dynamometry and the Hop Test. The GL was assessed before and 12 months after the reconstruction. The Control Group was evaluated in a single moment. Results: Pre and postoperative comparison of GL: posturography showed greater area of displacement; in isokinetic dynamometry, peak torque and total work were higher in the postoperative period, but the relationship between flexors and extensors muscles was lower than recommended in both evaluation (pre and postoperative); in Hop Test, the distance hopped and the symmetry between the limbs was greater in the postoperative period. In comparison to the GC, posturography showed greater anteroposterior oscillation and lower mediolateral oscillation in preoperative GL; in isokinetic dynamometry, peak torque and total work were higher in GL preoperative. In postoperative period GL showed higher relationship between flexors and extensors than GC. Conclusion: The athletes submitted to ACL reconstruction showed better functional performance in postoperative assessment when surgery was compared to the preoperative period, and to GC. However, isokinetic parameters showed incomplete recovery

Objetivo: Investigar se há associação entre a diminuição da amplitude de movimento da articulação coxofemoral e a lesão por não-contato do ligamento cruzado anterior em jogadores de futebol. Método: Neste estudo de casos e controles, 50 jogadores de futebol, com lesão por nãocontato do ligamento cruzado anterior do joelho, confirmada por cirurgia, tiveram suas articulações coxofemorais examinadas e comparadas com o grupo controle. Os achados foram estatisticamente analisados, de acordo com dois pontos de corte (70° e 80°, na soma total de rotação interna e rotação externa), em ambos os grupos. Resultados: Uma significativa diminuição na amplitude de movimento da articulação coxofemoral foi encontrada em 38% de todos os indivíduos estudados no menor ponto de corte (70°) e 64% no maior ponto de corte (80°). A diminuição da amplitude de movimento do quadril foi maior no grupo com ruptura de LCA do que no grupo controle, com pequena diferença entre os dois pontos de corte (70° e 80°). A diferença entre pacientes e controles foi estatisticamente significativa (p = 0, 001). Conclusão: Houve uma forte associação entre a diminuição da amplitude de movimento da articulação do quadril e a ruptura de LCA em jogadores de futebol, não somente, mas, principalmente, devido à diminuição da rotação interna. Apesar da falta de comparação com outros esportes, o resultado mostrou um maior aumento da diminuição de amplitude de movimento do quadril no grupo de jogadores de futebol, quando comparado com a população em geral. / Purpose: To investigate whether there is an association between decreased hip range of motion and noncontact anterior cruciate ligament (ACL) injuries in soccer players. Methods: In this case-control study, 50 soccer players with noncontact ACL injuries confirmed by surgery had their hips examined and compared with those of a control group. Findings were statistically analyzed according to cutoff points (70 and 80 degrees of total internal-external rotation sum) for both groups. Results: A significant decrease in hip range of motion was found in 38% of all individuals studied at the lower cutoff point (70 degrees) and 64% at the upper cutoff point (80 degrees). The decrease in hip range of motion was greater in the group with ruptured ACL than in controls, with little difference between the two cutoff points (70 and 80 degrees). The difference between patients and controls was statistically significant (p < 0,001). Conclusions: There was strong association between decreased hip range of motion and ACL ruptures in soccer players, not only but mainly due to internal rotation lessening. Despite lacking comparison with other sports, our findings showed a higher decrease of hip range of motion in the group of soccer players when compared with the general population.

The purpose of this project was to review anterior cruciate ligament (ACL) literature and develop a performance evaluation and injury risk assessment (PIER) for female soccer players. A strategy guide for decreasing injury risk and enhancing performance was developed in hopes to bring awareness to the athletic community about ACL injury for female soccer players.

Die klinischen Langzeitergebnisse des vorderen Kreuzbandersatz mit dem Patellarsehnentransplantat nach durchschnittlich 13,8 Jahren waren nicht zufriedenstellend. Hauptursachen hierfür waren operativ-technische Mängel, wie Fehlpositionierung der Bohrkanäle und die Fixierung der Transplantate in einer zu hohen Kniebeugestellung. Diese Abweichungen führten zu signifikant schlechteren Bewegungsausmaßen sowohl in der Streckung als auch in der Beugung. Insbesondere bei zu weit ventral positionierter femoraler Bohrkanalanlage resultierte ein erhebliches Beugedefizit mit Stressbelastung auf das femorotibiale Kompartiment, ähnlich einem Nußknackerphänomen. Bei zu weit ventral positioniertem tibialen Bohrkanal wurde eine signifikante Verringerung der Extension beobachtet. Die Patienten mit gleichzeitiger Meniskusresektion hatten signifikant höhere arthrotische Veränderungen. Sowohl die zum damaligen Zeitpunkt allgemein anerkannte Operationstechnik als auch die postoperative Rehabilitation ist zeitlich überholt und entspricht nicht den gegenwärtigen internationalen Standards. In der experimentellen Untersuchung zum Einwachsverhalten einer autologen vorderen Kreuzbandplastik am Kaninchenmodell konnte der Einfluss und die Wirkung von manipulativ wirkenden Faktoren auf die Ausbildung eines stabilen Bindegewebsregenerates belegt werden. Sowohl der fibrinstabilisierende Faktor XIII als auch die eingesetzte Transplantat-Splitting-Technik zeigten eine positive Wirkung auf den Ein- und Umbau sowie den biomechanischen Ausrissfestigkeiten der Transplantate. Die alleinige Wirkung des Faktor XIII spielt vor allem in der Frühphase eine stimulierende Rolle auf die Initiierung der Umbauvorgänge und der ossären Intergration der Knochenblöcke. Mittel- und langfristig wird die Ausbildung von belastungsstabilen Kollagenfibrillen durch andere weitestgehend unbekannte Einflussfaktoren bestimmt. Die neuartig entwickelte Transplantat-Splitting-Technik erwies sich für den Transplantatumbau ebenfalls als vorteilhaft. Mit dieser Transplantatbearbeitung wurde die Grundlage für eine frühzeitige synoviale Ernährung der Bündel gewährleistet. Durch die artifizielle Gewebsläsion werden reparative Vorgänge beschleunigt. Auf der Grundlage der experimentell gewonnenen Daten kann die Transplantat-Splitting- Technik für die klinische Erprobung und Praxiseinführung empfohlen werden. / The clinical long term results mean 13,8 years after anterior cruciate ligament reconstructions with bone-patellar tendon-bone transplant were not satisfied. Main reasons were technical errors, malpositioning of the bone tunnels and fixation of the transplant in a too high degree of flexion. As a result the patients had significant reductions of motion in extension as well as in flexion. Especially in cases with an anterior femoral bone tunnel position the patients had a loss of flexion and high degree of shear forces in the femoro-tibial compartment similar a nutcracker phenomenon. In ACL reconstructions with an anterior tibial bone tunnel position could be observed a loss of extension. Patients with concomitant meniscal resection showed significant higher rate of osteoarthrotic changes. Both, the former operative technique and the postoperative rehabilitation programme had no clinical relevance today and are replaced by new standards. In an experimental study regarding to the remodeling process of an autologous anterior cruciate ligament plasty in a rabbit model could be examined factors which influencing the maturation process of the graft. The fibrin stabilizing factor XIII as well as the transplant splitting technique showed a positive effect in the remodelling process and the pull-out strength of the transplants. In the early phase the factor XIII activated the initial remodeling and the osseous ingrowth of the bone blocks. In middle and long term period of remodeling there plays unknown factors an important role for building of force restraint collagen fibrils. The new developed splitting technique had some additional advantages. Using these technique the basis of early synovial nutrition could be realized. The artificial tissue lesion leads to an acceleration of the reparative response. On the basis of the experimental data the transplant splitting technique can be recommended and introduce in the clinical trial.

Bakgrund: De senaste åren har intresset för att skapa enkla, validerade, kliniskt orienterade screeningverktyg som mäter biomekaniska parametrar i rörelsemönster växt fram. Bland annat har inriktningen av dessa verktyg varit att förutspå risken att drabbas av skada i det främre korsbandet (ACL) som sitter i knäleden. Det har visat sig att unga kvinnor i idrotter som medför hopp och riktningsförändringar är en högriskgrupp för denna skadetyp och därför har ACL-skadeincidensen ökat sedan allt fler kvinnor engagerar sig i utövning av idrott. Syfte: Att undersöka evidensen för att dessa kliniskt orienterade screeningverktyg förutspår utfallet av främre korsbandsskada hos unga kvinnliga idrottare och se om de kan rekommenderas. Metod: Litteraturstudie med kvalitetsbedömning och grad av evidens i vetenskapliga artiklar enligt validerad checklista och Scottish Intercollegiate Guidelines Network (SIGN). Resultat: Alla evaluerade artiklar fick den högsta evidensgraden som var möjligt för kohortstudier, 2++. Kliniskt orienterade screeningverktyg som mäter biomekaniska parametrar i rörelsemönster fick dock det lägsta rekommendationsvärdet ’D’ då motstridiga resultat visades. Detta innebar att ingen specifik rekommendation gick att göra. Diskussion: Utfallet av en ACL-skada påverkas av många faktorer utöver riskfulla rörelsemönster och därför finns flera viktiga confounders att ta hänsyn till för att hitta de avgörande faktorerna. För att kunna påvisa screeningverktygens förutspående värde och hitta överensstämmande resultat kan det krävas större studier än befintligt gjorda. Slutsats: De biomekaniska screeningverktygen som undersöktes i denna studie visade otillräckliga resultat för att kunna göra ett rekommendationsutlåtande för klinisk användning / Background: Simple tools to predict injuries in high risk sport would be an important development to reduce the amount of injuries and to develop preventative protocols. One such method is biomechanical screening tools where several methods have been developed. One type of injury that has been in focus of predicting is an injury in the anterioer cruciate ligament (ACL) which is located in the kneejoint. Studies have found that young female athletes in sports that involve jumps and cutting maneuvers are at increased risk of suffering this type of injury. Since the number of females engaging in sports is increasing, the incidence of ACL-injurys so do. Aim of the study: To grade the evidence for these clinical oriented screening tools in predicting the outcome of anterior cruciate ligament injury in a population of young female athletes, then state a grade of recommendation. Methods: A literature review of grading quality and evidence in scientific articles according to a validated checklist and Scottish Intercollegiate Guidelines Network (SIGN). Results: All of the evaluated articles scored the highest grade possible for cohort studies, 2++. However, clinical oriented screening tools which measure biomechanical parameters in movement patterns got the lowest possible grade of recommendation, ’D’, since inconsistent results were shown. This meant that no specific recommendation could be done. Discussion: The outcome of an ACL-injury is affected by multiple factors and not only riskful movement patterns. There are many important confounders that could be adjusted for in finding the concluding factors. To be able to demonstrate the predictive value of the screeningtools and find consistent results it could require larger studies than yet available. Conclusion: The reviewed biomechanical screening tools showed insufficient results to state a grade of recommendation for clinical application.

No description available.

Temos aktualumas: Siekiant įvertinti kelio sąnario funkciją po priekinio kryžminio raiščio plyšimo naudojami įvairūs metodai: izokinetinis testavimas dinamometru (Kannus et al., 1992; Risberg et al., 2009), judesio analizė (Risberg et al., 2009), elektromiografija, klinikiniai testai (Irrgang, 2003; Lee et al., 2008) ir klausimynai (Irrgang, 2001; Lee et al., 2008). Ieškodami patikimesnių būdų įvertinti žmogaus nervų- raumenų sistemos valdymo efektyvumą, Kauno technologijos universiteto ir UAB „Katra“ specialistai kartu su Lietuvos kūno kultūros akademija sukūrė naują originalų prietaisą – žmogaus rankų ir kojų judesių dinaminių parametrų analizatorių (DPA–1). Tyrimo objektas: DPA testų patikimumas ir informatyvumas. Tyrimo tikslas: Nustatyti DPA–1 testų patikimumą ir informatyvumą po priekinio kryžminio raiščio rekonstruojamosios operacijos. Tyrimo uždaviniai: 1. Nustatyti DPA–1 testų patikimumą, atliekant standartines ir variabilias užduotis po priekinių kryžminių raiščių rekonstruojamosios operacijos. 2. Nustatyti DPA–1 testų informatyvumą, atliekant standartines ir variabilias užduotis po priekinių kryžminių raiščių rekonstruojamosios operacijos. Tyrimas atliktas Lietuvos kūno kultūros akademijoje „Žmogaus motorikos“ laboratorijoje. Jame dalyvavo 34 tiriamieji, kurie buvo suskirstyti į dvi grupes. Pirmąją grupę sudarė pacientai, patyrę kelio sąnario priekinio kryžminio raiščio rekonstruojamąją operaciją (n=17). Šių tiriamųjų amžiaus vidurkis – 31,3 ± 7,8 metai, ūgis –... [toliau žr. visą tekstą] / Relevancy: Different methods are used to assess capabilities of knee function after ACL injury including isokinetic dynamometry (Kannus et al., 1992, Risberg et al., 2009), motion analysis (Chmielewski et al., 2005, Risberg et al., 2009), electromyography (Chmielewski et al., 2005), clinical testing (Irrgang, 2003, Lee et al., 2008) and questionnaires (Irrgang, 2001, Lee et al., 2008). In order to devise more reliable methods to evaluate the efficiency of human neuromuscular control, the dynamic parameters’ analyzer of human’s hands and legs movements (DPA-1, Patent No. 5251; 2005 08 25) was constructed by Kaunas Technology University and „Katra“ engineers in collaboration with Lithuanian Academy of Physical Education. The object of the study: the reliability and validity of DPA-1 testing procedures. The aim of the study is to establish the reliability and validity of DPA-1 testing procedures after anterior cruciate ligaments reconstructive surgery. The goals of the study are the following: 1. To establish the reliability of DPA-1 testing procedures while performing standard and variable tasks after anterior cruciate ligaments reconstructive surgery. 2. To establish the validity of DPA-1 testing procedures while performing standard and variable tasks after anterior cruciate ligaments reconstructive surgery. The recearch was performed in the Laboratory of Human Motorics at the Lithuanian Academy of Physical Education. 34 participants, who were divided into two groups... [to full text]

Female intercollegiate basketball players experience a three times greater rate of ACL injuries than their male counterparts. This investigation hypothesized that women and men perform the cutting maneuver differently with respect to ground reaction forces and knee range of motion.The subjects performed a ninety degree cut on a force platform while being video taped. The male subjects exhibited a 23.1 percent greater (p=.0167) knee flexion angle than did the female subjects. The female subjects exhibited a 25.5 percent greater (p=.0022) braking force than did the male subjects. The impact maximum was not statistically significant (p=.3290).The performance characteristics exhibited by the female subjects in this study would suggest that the cutting maneuver is more dangerous for female basketball player. Female athletes should be taught correct performance of the cutting maneuver. I addition to technique, strength training should be encouraged to develop a stronger secondary stabilization mechanism for the knee. / School of Physical Education

[Truncated abstract] Anterior cruciate ligament injuries are a major problem in sport. The purpose of this thesis was to investigate the causative factors of ACL injuries and to study the effect of various types of lower-limb training on underlying neuromuscular mechanisms involved in stabilisation and risk of ACL injury. Investigation of the mechanisms was conducted on controlled balance and strength tests as well as in sporting manoeuvres. It was aimed to assess if the neuromuscular changes map over into the performance of sporting manoeuvres and if potential for loading on the ACL and risk of injury was reduced or exacerbated . . . ACL strain can be decreased through reduction in the applied loads and greater knee flexion. Further to this, muscle activation has the ability to reduce loading on the ACL through co-contraction and selective activation patterns. This thesis demonstrated differing neuromuscular adaptations from various training types that map over into the performance of sporting manoeuvres. The research indicated that the Balance-Training was the most favourable in reducing potential for injury risk on the ACL. Alternatively strength training elicited neuromuscular changes that were likely to increase the risk of force on the ACL. The Machine+Balance training resulted in some negative and positive outcomes with the balance training tending to counteract the negative affects of machine weights training resulting in small improvements in muscular support and load reduction. This study provides us with better understanding of the underlying mechanisms from various training types and their potential affect on risk of ACL injury.

Rupture of the anterior cruciate ligament (ACL) of the knee leads to chronic joint instability and reduced range of motion while the long term results are marred by a high prevalence of degenerative joint disease especially osteoarthritis. Bundles of collagen threads have been widely investigated for the repair of torn ACL, but are limited by insufficient tissue ingrowth to repopulate and completely regenerate these grafts. We have developed a novel in vitro method of characterizing fiber-based thread matrices by probing their ability to promote tissue ingrowth from a wound margin as a measure of their ability to promote repopulation and regeneration. This method is useful in the optimization of thread scaffolds, and is sensitive enough to distinguish between subtle variations in biopolymer chemistry and organization. Furthermore, this method was used to characterize the effects of crosslinking on the cell outgrowth and correlated the findings with the mechanical properties of collagen threads. The results suggest that crosslinking is required to achieve sufficient mechanical properties for high stress applications such as ACL replacement, but regardless of technique, crosslinking attenuated the cell outgrowth properties of the threads. To improve the regenerative capacity of these scaffolds, novel fibrin microthread matrices were developed with a similar morphology to collagen threads and sufficient mechanical strength to be incorporated in composite thread scaffold systems. These fibrin microthreads were loaded with FGF-2, a potent mitogen and chemotactic agent that works synergistically with fibrin in regulating cell signaling and gene expression. Increases in fibroblast migration and proliferation in FGF-2-loaded fibrin threads were successfully demonstrated with the concomitant promotion of oriented, aligned, spindle-like fibroblast morphology. These results suggest that fibrin-FGF-2 microthreads have distinct advantages as a biomaterial for the rapid regeneration of injured tissues such as the ACL.