La rupture du ligament croisé antérieur du genou est très fréquente, notamment dans les activités qui impliquent des contraintes en rotation. Une dégénérescence du cartilage articulaire du genou peut par la suite engendrer une arthrose. Le but de cette étude était d’une part dans les pathologies traumatiques et d’autre part dans les pathologies dégénératives, atteignant cette articulation, d’analyser les facteurs prédictifs du contrôle postural et de la récupération fonctionnelle. Les effets d’une rééducation innovante combinant une rééducation conventionnelle réduite avec une rééducation en milieu aquatique ont été comparés à ceux d’une rééducation conventionnelle définie par la Haute Autorité de Santé, sur la cinétique de récupération des compétences proprioceptives et sur l’amélioration fonctionnelle. Le contrôle postural par posturographie et la motricité au moyen de tests cliniques ont été quantifiés chez 67 patients ayant présenté une rupture du ligament croisé antérieur, avant intervention et jusqu’à six mois après intervention chirurgicale. Les effets des paramètres météorologiques sur le contrôle postural et la douleur dans la gonarthrose ont été évalués chez 113 patients, par posturographie et échelle de douleur. Pour une même qualité globale du contrôle postural six mois après ligamentoplastie du genou, les patients ayant suivi le protocole de rééducation innovant utilisaient davantage la somesthésie que ceux ayant suivi une rééducation conventionnelle, qui devaient recourir plus à un mécanisme de compensation. La proprioception était améliorée deux mois après l’intervention chirurgicale par rapport à l’évaluation pré-opératoire chez les patients ayant suivi le protocole innovant. La force musculaire était plus importante chez les patients ayant suivi le protocole de rééducation innovant un mois, deux mois et six mois après intervention. Un mois après l’intervention, la distance de marche parcourue était plus importante chez les patients ayant suivi la rééducation innovante que chez les patients ayant suivi la rééducation conventionnelle. Chez les patients présentant une gonarthrose, une dégradation du contrôle postural était observée lorsque la pression atmosphérique et l’humidité maximale diminuaient au cours de la matinée et lorsque la pression atmosphérique diminuait au cours de la journée. L’augmentation de la douleur était corrélée avec l’augmentation de la température sur la matinée et avec l’augmentation de la température et de l’humidité sur la journée. L’environnement dans lequel évolue le sujet (ex : milieu aquatique, ambiance climatique) a donc une influence sur la performance du contrôle postural. Une meilleure prise en charge en rééducation post-ligamentoplastie du genou permettrait de limiter la nécessité de compensation sur le membre contralatéral par une meilleure utilisation de la somesthésie et ainsi prévenir la survenue de l’arthrose et d’une rupture ligamentaire contralatérale. Ceci permettrait de limiter les coûts socio-professionnels / The knee can suffer damage from either traumatic or degenerative pathology. Anterior cruciate ligament (ACL) injuries frequently occur, especially in activities that including rotational stresses. Degeneration of the articular cartilage of the knee can subsequently result in osteoarthritis. The aim of this study was to analyze the predictive factors of postural control and recovery in traumatic injuries and also in degenerative pathologies of the knee. The effects of an innovative rehabilitation protocol combining reduced conventional rehabilitation with aquatic rehabilitation were compared with conventional rehabilitation defined by the National French Health Authority on the kinetics of recovery of proprioceptive skills and functional improvement. Postural control and motor control using clinical tests were quantified in 67 patients with ACL surgery before and up to six months after surgery. The effects of meteorological parameters on postural control and pain in knee osteoarthritis were evaluated in 113 patients, using posturography and also a pain scale. Six months after knee ligament surgery, both groups attained the same quality of postural control. However, patients who followed the innovative protocol made more used of proprioceptive inputs compared to the group who underwent conventional rehabilitation who made more use of a compensation mechanism. In patients following the innovative protocol proprioception was improved two months after surgery compared to before surgery. Muscle strength was higher in patients who followed the innovative rehabilitation protocol at one, two and six months after surgery. One month after surgery, the walking distance traveled was higher in patients who underwent innovative rehabilitation than in patients who had undergone conventional rehabilitation. In patients with knee osteoarthritis, degradation of postural control was observed when atmospheric pressure and maximum humidity decreased during the morning and when atmospheric pressure decreased during the entire day. Increased pain was correlated with increased temperature in the morning and with increased temperature and humidity during the entire day. The environment in which evolves the subject (aquatic, climatic) thus has an influence on postural control performance. A better management in post-ligamentoplasty rehabilitation of the knee would reduce the need for compensation using the contralateral limb, by better use of somesthesia. This could prevent the occurrence of osteoarthritis and a contralateral ACL injury, which would also reduce costs to the society and health care

INTRODUÇÃO: Estudos têm apontado para a manutenção do déficit do controle postural após a reconstrução do Ligamento Cruzado Anterior (LCA), além de uma eventual instabilidade rotatória. Acredita-se que a lesão do Ligamento Antero Lateral (LAL) possa ter influência na manutenção dessa instabilidade após a reconstrução isolada do LCA. Não há esclarecimento acerca de como indivíduos com indicação da reconstrução combinada desses dois ligamentos se comportam do ponto de vista do controle postural. OBJETIVO: Verificar se há diferença no controle postural de pacientes com indicação cirúrgica de reconstrução combinada desses dois ligamentos (Grupo LCA+LAL), quando comparados aos indivíduos com indicação de reconstrução isolada do LCA (Grupo LCA). O objetivo secundário foi o de realizar uma avaliação clínica e da funcionalidade. MÉTODOS: Foi avaliado o controle postural estático por meio de plataformas de força. Foram realizados testes bipodais e unipodais com olhos abertos e olhos fechados. Para avaliação da funcionalidade foram realizados testes funcionais no aparelho Balance Master, aplicada a escala de Lysholm, além do Single Hop Test e Crossover Hop Test. A avaliação clínica se deu por meio da aplicação da Escala Visual Analógica e a translação anterior da tíbia por meio do artrômetro KT- 1000. Os achados foram comparados ao de um grupo controle. RESULTADOS: Não houve diferença estatística significativa entre os grupos para os testes de controle postural de olhos abertos e fechados. Uma maior porcentagem do Grupo do LCA+LAL (48%) quando comparado ao Grupo LCA (27%) e ao Grupo Controle (0%) não conseguiu realizar o teste unipodal de olhos fechados. O Grupo LCA+LAL apresentou maior translação anterior da tíbia que o Grupo LCA. Quanto aos Hop Tests, mais indivíduos do grupo LCA+LAL (67% versus 33% do Grupo LCA) apresentaram dor no Single Hop Test. CONCLUSÕES: Um número maior de indivíduos do grupo LCA+LAL não conseguiu realizar o teste unipodal com olhos fechados, indicando possivelmente uma instabilidade postural nessa condição. Os indivíduos desse grupo também apresentaram maiores valores de translação anterior da tíbia indicando uma pior instabilidade anteroposterior / INTRODUCTION: Studies have shown a postural control deficit after anterior cruciate ligament (ACL) reconstruction and a persistent rotational instability in some cases. It has been argued that an anterolateral ligament (ALL) injury could be responsible for such instability after an isolated ACL reconstruction. There are no further evidences in order to understand how patients in the preoperative period of a combined surgery of these two ligaments behave regarding postural control. PURPOSE: To verify the postural control of patients in ACL + ALL Group, when compared to the isolated ACL reconstruction indication (ACL Group). As a secondary purpose, the research aims to perform a clinical and functional evaluation. METHODS: An assessment of static postural control was performed using the force plane. Doubleleg and single-leg tests were performed with eyes open and closed. Functionality was assessed by perfoming tests in the Balance Master equipment. The Lysholm scale was applied, and the Single Hop Test and Crossover Hop Test were performed. The clinical evaluation consisted of the Visual Analogue Scale for pain and the anterior tibial translation was measures with a KT-1000 arthrometer. Both groups were compared to a control group. RESULTS: There was no statistical difference between groups regarding postural control in any of the tests. A higher percentage of the ACL + ALL Group (48%), when compared to ACL Group (27%) and Control Group (0%), was not able to perform the single-leg test with eyes closed. The ACL + ALL Group had greater anterior tibial translation than the ACL Group. Regarding the hop tests, a greater number of patients in the ACL + ALL Group (67% versus 33% of the ACL Group) reported pain during the Single Hop test. CONCLUSION: Most patients in the ACL + ALL Group were not able to perform the single-leg test with eyes closed, showing a possible postural instability in this condition. The higher values in anterior tibial translation may also indicate greater anteroposterior instability

OBJETIVO: comparar a técnica de reconstrução convencional do LCA com enxerto patelar e feixe único com a técnica com enxerto patelar bipartido e quatro túneis ósseos, através de um estudo experimental biomecânico em joelhos de cadáveres com testes pareados, sem variação na quantidade de enxerto utilizada em ambas as técnicas. INTRODUÇÃO: As lesões do ligamento cruzado anterior (LCA) do joelho são comuns principalmente na prática esportiva, e o tratamento cirúrgico de reconstrução com o uso de enxertos autólogos, pelos bons resultados alcançados, um consenso na literatura mundial. As controvérsias ficam por conta das variações que podem apresentar a técnica deste procedimento, na busca constante pelo aperfeiçoamento da mesma. Uma delas encontra-se na troca da tradicional reconstrução de feixe único do LCA pela reconstrução dos dois feixes, visando uma maior semelhança com a anatomia do LCA original. Recentemente a tendência nesta técnica é pela passagem dos enxertos por dois túneis femorais e dois túneis tibiais. MÉTODOS: Nosso estudo foi realizado em joelhos de cadáveres (18 joelhos de 9 cadáveres), todos do sexo masculino, com idade variando entre 44 e 63 anos. Estas peças foram divididas aleatóriamente, sempre em pares, nos grupos A, de joelhos operados com a técnica de reconstrução do LCA com único feixe, e grupo B, de joelhos operados com a técnica de reconstrução com duplo feixe e quatro túneis ósseos. Cada espécime foi submetido a testes biomecânicos nas condições LCA íntegro, lesado e operado, com registro de dados de Deslocamento Anterior Máximo (DTAM), Rigidez Média (R) e Rotação Tibial Interna Passiva (RIT), sob força de 100N de deslocamento tibial horizontal, a 30°,60° e 90° de flexão dos joelhos. RESULTADOS: Não houve diferenças significativas, pelo método de Análise de Variância de grupos, entre as duas técnicas tanto para medidas de DTAM em 30°(p=0,47), 60°(p=0,59), 90°(p=0,27); como para R em 30° (p=0,93), 60° (p=0,97), 90° (p=0,45); e RIT em 30° (p= 0,59), 60° (p=0,67) e 90° (p=0,74). CONCLUSÕES: Em nosso estudo, a técnica de reconstrução dos dois feixes do LCA com enxerto patelar e quatro túneis tem comportamento biomecânico semelhante ao da reconstrução do LCA com enxerto patelar de feixe único, sob os aspectos de deslocamento anterior tibial, rigidez e rotação tibial passiva, durante o movimento de deslocamento anterior tibial com força constante / PURPOSES: Test an anatomical double bundle reconstruction technique with a longitudinally split bone-patellar tendon-bone graft through double femoral and tibial tunnels and biomechanically compare it to conventional single bundle reconstruction with the same total amount of bone-patelar tendon-bone graft in a paired experimental cadaver study. INTRODUCTION: Anterior Cruciate Ligament ruptures are frequent especially in sports practice. Surgical reconstruction with autologous grafts widely employed in international literature. Controversies remain in respect to technique variations as continuous research for improvement takes place. One these are the anatomical double bundle techniques instead of conventional single bundle (antero-medial bundle) technique. More recently there is a tendency of positioning of the two bundles through double tunnel technique in the femur and the tibia. METHODS: Nine pairs of male cadaver knees, age ranging from 44 to 63 years were randomized into 2 groups, (A) single bundle reconstruction and (B) anatomical double bundle reconstruction through double femoral and double tibial tunnels. Each knee was biomechanically tested in 3 conditions: intact ACL, sectioned ACL and reconstructed ACL. Maximum anterior dislocation, rigidity and passive internal tibia rotation were recorded with the knee submitted to a 100N horizontal anterior dislocation force applied to the tibia with the knee in 30º, 60º and 90º of flexion. RESULTS: There were no differences between the two techniques for any of the measurements. CONCLUSIONS: The technique of anatomical double bundle reconstruction of the anterior cruciate ligament with bone-patellar tendon-bone graft has a similar biomechanical behavior in regard to anterior tibial dislocation, rigidity and passive internal tibial rotation.

Medical imaging technologies have allowed for in vivo evaluation of the human musculoskeletal system. With advances in both medical imaging and computing, patient-specific model development of anatomic structures is becoming a reality. Three-dimensional surface models are useful for patient-specific measurements and finite element studies. Orthopaedics is closely tied to engineering in the analysis of injury mechanisms, design of implantable medical devices, and potentially in the prediction of injury. However, a disconnection exists between medical imaging and orthopaedic analysis; whereby, the ability to generate three-dimensional models from an imaging dataset is difficult, which has restricted its application to large patient populations. We have compiled image processing, image segmentation, and surface generation tools in a single software package catered specifically to image-based orthopaedic analysis. We have also optimized an automated segmentation technique to allow for high-throughput bone segmentation and developed algorithms that help to automate the cumbersome process of mesh generation in finite element analysis. We apply these tools to evaluate graft placement in anterior cruciate ligament reconstruction in a multicenter study that aims to improve the patient outcomes of those that undergo this procedure.

Background: The incidence of anterior cruciate ligament (ACL) –injury is 3-5 times greater in female athletes compared to male athletes. This may be partially attributed to lower levels of hamstring-quadriceps co-contraction in females with subsequent knee kinematics that increases risk of ACL-injury. Finding training methods that improves co-contraction and increases knee stability is important. Objectives: To evaluate the effects of a new device on hamstring-quadriceps co-contraction and to investigate if training with the device can alter knee kinematics in female athletes. Study design: Controlled experimental study design with repeated measures. Method: Twenty soccer and floor ball athletes were measured with electromyography (EMG) for hamstring-quadriceps co-contraction while performing squats with and without the device. Thirteen athletes also underwent three-dimensional kinematic analyses, measuring knee abduction angles (at initial ground contact and peak angle) during a drop jump, before and after a six week intervention period with the device. Friedman’s test and Wilcoxon signed rank test was used to assess differences and effect sizes (ES) were calculated. Results: Co-contraction was consistently larger on the device (medial side: p<0.001, ES=0.88; lateral side: p<0.001, ES=0.80) and the ratio of medial-to-lateral co-contraction increased (p=0.001, ES=0.79). In the kinematic analysis low adherence rates amongst our subjects meant that the effects of the device on kinematics could not be measured. Conclusion: Performing squats with the new training device stimulates increased hamstring-quadriceps co-contraction and increases the ratio of medial-to-lateral co-contraction. The effects of the device on knee kinematics have yet to be determined.

The purpose of our study was to compare the effectiveness of aggressive and traditional physiotherapy programs for peak torque measurements of knee extensors and flexors at different degrees. 40 patients who had anterior cruciate ligament reconstruction using bone-patellar tendon-bone were examined in this study. Patients were selected in two different groups considering how motivated and physically active they were. Isokinetic dynamometer was used to evaluate the peak torque of knee flexors and extensors. In these latter years isokinetic dynamometer is the most popular and sure method to determine the physiotherapy effectiveness after anterior cruciate ligament reconstruction. Physiotherapy programs were chosen on how patients physically active were. Programs varied with the time period in which goals and exercises were accomplished. Time frame vary from 4 to 9 months, depending on which program is used. Patients were examined 6 months after physiotherapy program was used. The results have shown that the strength of knee flexors and extensors comes back faster using aggressive physiotherapy program right back after anterior cruciate ligament reconstruction. Also time to reach peak torque is less and the angle where the peak torque is reached is smaller. According to our results we can propose, that aggressive physiotherapy must be used at the same day after anterior cruciate ligament reconstruction in order to come back to full activity as soon as possible.

Tyrimo objektas: Kineziterapijos ir kinezioteipavimo momentinis poveikis statinei ir dinaminei pusiausvyrai prieš priekinio kryžminio raiščio operaciją. Tyrimo tikslas: Nustatyti kineziterapijos ir kinezioteipavimo momentinį poveikį statinei bei dinaminei pusiausvyrai prieš priekinio kryžminio raiščio operaciją. Tyrimo uždaviniai: 1. Nustatyti kineziterapijos poveikį statinei ir dinaminei pusiausvyrai prieš priekinio kryžminio raiščio operaciją. 2. Nustatyti kinezioteipavimo momentinį poveikį statinei ir dinaminei pusiausvyrai taikant kineziterapiją prieš priekinio kryžminio raiščio operaciją. Tyrimo hipotezė: Manome, kad tiriamiesiems prieš priekinio kryžminio raiščio operaciją, taikyta kineziterapija pagerins statinę ir dinaminę pusiausvyrą. Be to, pusiausvyra stovint ant pažeistos kojos bus geresnė su kinezioteipu. Tyrimo rezultatai: Nustatėme, kad svyravimai Ax ir Ay ašyse, stovint ant pažeistos kojos, buvo statistiškai reikšmingai mažesni po kineziterapijos. Taip pat, po kineziterapijos pagerėjo pusiausvyra Ax ašyje stovint ant sveikos kojos. Pusiausvyra po šuolio stovint ant sveikos ir pažeistos kojos statistiškai reikšmingai pagerėjo po kineziterapijos Ay ašyje. Stovint ant pažeistos kojos su kinezioteipu, nustatėme statistiškai patikimą skirtumą tarp dinaminės pusiausvyros stovint ant pažeistos kojos be kinezioteipo ir su juo. Pusiausvyra pagerėjo Ax ir Ay ašyse. Išvados: 1. Po kineziterapijos pagerėjo statinė pusiausvyra pirmyn - atgal ir šonine kryptimis stovint ant... [toliau žr. visą tekstą] / Object of the study: The effect of physical therapy and instantaneous kinesio taping for static and dynamic balance before anterior cruciate ligament surgery. Aim of the study: To investigate effect of physical therapy and the instantaneous kinesio taping for static and dynamic balance before anterior cruciate ligament surgery. Goals of the study: 1. To investigate the effect of physical therapy for static and dynamic balance before anterior cruciate ligament surgery. 2. To investigate the instantaneous effect of kinesio taping for static and dynamic balance before anterior cruciate ligament surgery. Hypothesis of the study: We think that, static and dynamic balance will improve after physical therapy before anterior cruciate ligament surgery. Moreover, the balance of the injured limb will improve after instantaneous kinesio taping. Results of the study: We found that variations of standing on injured limb was significantly lower after physical therapy in Ax and Ay axis. Also, balance of healthy limb improved after physical therapy. Moreover, the balance after jump of injured and healthy leg improved in Ay axis after physical therapy. Dynamic balance improved with kinesio tape on injured limb before physical therapy. Conclusions: 1. Static balance forward - backward and side to side improved after physical therapy. Moreover, static balance standing on the injured limb improved side to side. Furthermore, dynamic side to side balance improved in both limbs after physical... [to full text]

Diss. (sammanfattning) Linköping : Linköpings universitet, 2008. / Härtill 4 uppsatser.

Title from first page of PDF document. Includes bibliographical references (p. 31-34).

Introdução: Estudos têm mostrado que, pelo menos em jogadores de futebol, a diminuição da amplitude de movimento do quadril homolateral tem uma influência significativa na ocorrência de lesão do LCA, com alta incidência de rerrupturas especialmente após reconstrução em banda simples. Esse estudo objetiva comparar a capacidade de duas técnicas cirúrgicas de prevenir a rerruptura do LCA em jogadores de futebol com a articulação do quadril homolateral limitada (soma de rotação interna e externa <60°). Materiais e Métodos: Esse estudo foi um ensaio clínico randomizado prospectivo. Trinta atletas de futebol do sexo masculino (idade média de 22 anos, variando de 18 a 28 anos), com rupturas por não contato do LCA, foram alocados aleatoriamente em dois grupos. Os critérios de inclusão foram lesão ligamentar isolada do LCA, soma das rotações do quadril homolateral abaixo de 60° e ser jogador de futebol profissional ou semi-profissional. Os critérios de exclusão englobaram dor persistente no quadril ou história de fratura ou cirurgia prévia em qualquer segmento do membro inferior. Um grupo foi submetido à reconstrução combinada intra e extra-articular (GIE), enquanto o outro foi tratado com reconstrução dupla banda com enxertos do semitendinoso e grácil (GDB). Resultados: Nos dois anos de acompanhamento de cada paciente, ocorreram três rerrupturas no GDB contra nenhuma no GIE. Nos 27 atletas com reconstruções intactas, a quantidade de instabilidade residual no exame físico e no Rolimeter® foram os mesmos. Conclusão: Nossos achados mostram que, em dois anos de acompanhamento, a incidência de rerruptura, embora não tenha sido a mesma, não apresentou diferença significativa entre as técnicas de reconstrução intra + extraarticular e dupla banda do LCA em pacientes atletas com articulação do quadril homolateral restrita. / Introduction: Studies have shown that, at least in soccer players, decreased ipsilateral hip range of motion has a significant influence on the occurrence of anterior cruciate ligament (ACL) injury, with a high incidence of re-ruptures especially after single-bundle reconstruction. This study aimed to compare the ability of two surgical techniques to prevent re-rupture of the ACL in soccer players with ipsilateral restricted hip joints (sum of internal and external rotation < 60°). Materials and Methods: The study was a prospective randomized clinical trial. Thirty male soccer players (mean age, 22 years; range, 18-28) with noncontact ACL ruptures were allocated to two groups. Inclusion criteria were isolated ACL injury, ipsilateral hip range of rotation below 60°, and being a professional or semi-professional soccer player. Exclusion criteria were persistent hip pain or history of any fracture or previous surgery of the lower limb. One group underwent a combined intra- plus extra-articular reconstruction (IEG), while the other was treated with double-bundle reconstruction (DBG) with semitendinosus and gracilis grafts. All patients were followed up for two years after surgery. Results: At two-year follow-up of each patient, there were three re-ruptures in the DBG vs. none in the IEG. In the 27 athletes with intact reconstructions, the amount of residual instability in the physical examination and Lachman test was about the same. Conclusion: Our findings demonstrate that, in two years of follow-up, the incidence of rerupture, although not the same, showed no significant difference between intra- plus extraarticular and double-bundle ACL reconstruction techniques in patients with ipsilateral restrained hip joints.