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Thesis--Auburn University, 2009. / Abstract. Includes bibliographic references (p.115-

Anterior cruciate ligament (ACL) rupture is a major clinical problem in sports medicine. The current mainstay of treatment is arthroscopic-assisted ACL reconstruction with a soft tissue tendon graft. However, the affected patients are required to abstain from any pivoting activity for at least six to nine months after the operation to protect the graft-host bone interface in order to allow the graft to heal. In this study, a method to accelerate the graft healing within the bone tunnel is proposed by using a local application of an osteoconductive bone cement (Strontium enriched calcium phosphate cement, Sr-CPC) at the graft-host bone interface. It is postulated that Sr-CPC can induce earlier new bone formation in the gap between the graft and host bone tunnel and hence can result in an accelerated healing of the graft within the bone tunnel in ACL reconstruction. Preparation of Sr-CPCs using the conventional setting method (a dissolution/precipitation process) leads to a delay in setting. This study adopted a new setting reaction, a chelate reaction, to manufacture a Sr-CPC system. The Sr-CPC system was fast-setting, injectable and cohesive, and it was suitable for use in minimally invasive orthopaedics surgeries (e.g. arthroscopic-assisted ACL reconstruction). In order to investigate the biocompatibility and osteoconductivity of the Sr-CPC, in vitro cell experiments and an in vivo animal study were carried out. The in vitro experiments showed that the Sr-CPC was biocompatible with no local toxicity. In addition, a higher proliferation rate of osteoblastic-like MG-63 cells, accompanying higher alkaline phosphatase activity, was found in the Sr-CPC group. The in vivo study using a rat femur metaphyseal bone defect model showed evidence of earlier endochondral ossification which was noted at 2 weeks post operation. Moreover, a higher peri-cement bone formation rate, accompanied by a higher cement resorption rate, was found in the Sr-CPC group at 32 weeks after the operation compared with the convention calcium phosphate cement group. To study the effect of the Sr-CPC on the graft healing within the bone tunnel, a one-stage bilateral ACL reconstruction using an Achilles tendon allograft was performed in 30 rabbits. One study (15 rabbits) was to investigate the effect of the Sr-CPC on the healing of a soft tissue tendon graft within the bone tunnel, and the other study (15 rabbits) was to study the difference between the Sr-CPC and the conventional CPC in the healing of a soft tissue tendon graft within the bone tunnel. The Sr-CPC treated graft showed an accelerated healing at all of the time points when compared with the non-treated graft; and at time points of 3 to 12 weeks when compared with the CPC treated graft. In conclusion, a strontium enriched calcium phosphate cement, which is suitable for the arthroscopic use, was manufactured. It is biocompatible, osteoconductive and degradable. It accelerates the graft healing within the bone tunnels in a rabbit ACL reconstruction model using an Achilles tendon allograft when compared with both of the non-treated group and the conventional CPC-treated group. / published_or_final_version / Orthopaedics and Traumatology / Doctoral / Doctor of Philosophy

published_or_final_version / Orthopaedic Surgery / Master / Master of Philosophy

Die Ruptur des vorderen Kreuzbandes ist die häufigste Verletzung des Kniegelenkes. Ziel dieser prospektiven klinischen Studie ist es, Kriterien wie Operationsmethode- und zeitpunkt, subjektive Patientenzufriedenheit, Alltagsfähigkeit und betriebene Sportarten nach der Kreuzbandersatzplastik in verschiedenen Abhängigkeiten voneinander zu diskutieren. Um eine möglichst allgemeingültige Aussage treffen zu können, umfasst die Studie ein nicht-selektives Patientenkollektiv, das Männer und Frauen, Sportler und Nicht-Sportler, Schüler, Studenten und Berufstätige beinhaltet. Außerdem handelt es sich um eine Multicenterstudie, bei der Operationen und Untersuchungen von verschiedenen Personen durchgeführt werden und die Studie so eine höhere wissenschaftliche Aussagekraft bekommt. Der standardisierte Fragebogen, mit dem die Untersuchungen an allen drei Zentren durchgeführt wurden, ermöglicht dennoch eine gute Vergleichbarkeit aller Ergebnisse. Es wird ein Patientenkollektiv von 160 Patienten untersucht und nach dem standardisierten Fragebogen befragt. Kriterien der Sportfähigkeit (sportliches Leistungsniveau, Aktivitätsniveau und Zeitpunkt der vollen Sportfähigkeit), prä- und postoperativ betriebene Sportarten und Lysholm-Score, Operationsmethode und –zeitpunkt sowie die subjektive Patientenzufriedenheit werden miteinander in Verbindung gesetzt. Nach einem Zeitraum von durchschnittlich etwa 17 Monaten nehmen 90 Patienten an den Nachuntersuchungen teil. Etwa ein Jahr nach der Operation kann ca. die Hälfte der Patienten von einer komplett wieder erreichten Sportfähigkeit berichten. Auch bei der Befragung nach dem sportlichen Leistungsniveau in Wochenstunden berichtet ca. die Hälfte der nachuntersuchten Patienten von einer unveränderten sportlichen Leistungsfähigkeit im Vergleich zum Leistungsniveau vor der Operation. Hinsichtlich des Bezuges zwischen Sportfähigkeit und Operationsmethode ergibt sich, dass Patienten, die ein Double-Bundle-Transplantat erhielten, ihr sportliches Leistungsniveau am schnellsten und mit den geringsten Einschränkungen wieder erreichen. Patienten aus der Bone-Tendon-Bone-Gruppe erzielen die schlechtesten Ergebnisse hinsichtlich des Zeitpunktes und des Niveaus der Sportfähigkeit. Betrachtet man das gesamte Patientenkollektiv unabhängig von der Operationsmethode in Bezug auf den Lysholm-Score, ist der postoperativ erhobene Wert signifikant höher als der präoperative. Aufgeschlüsselt nach Operationsmethoden zeigt sich diese Signifikanz bei der Bone-Tendon-Bone- sowie bei der Semitendinosusgruppe. Nach der Operation mit einem Double-Bundle-Transplantat findet sich kein signifikant erhöhter Lysholm-Score. Der Operationszeitpunkt in Zusammenhang gesetzt mit dem in dieser Arbeit erhobenen postoperativen Lysholm-Score ergibt keine statistisch signifikante Korrelation. Auch die subjektive Patientenzufriedenheit korreliert nicht mit dem Zeitpunkt der Operation. Unabhängig vom Operationszeitpunkt ist eine große subjektive Patientenzufriedenheit zu finden. Mehr als 80 % der operierten Patienten bewerten ihr behandeltes Kniegelenk gut oder sehr gut. Hier findet sich eine Korrelation zwischen positiver Bewertung und einer möglichst vollständigen und zeitnahen Rückkehr zur ursprünglichen Sportfähigkeit. Durch diese Korrelationen bestätigt sich die These dieser Arbeit, dass die Wiedererlangung der Sportfähigkeit für den Patienten mit einer Ruptur des vorderen Kreuzbandes im Mittelpunkt steht.

Determining if an athlete, who has had Anterior Cruciate Ligament (ACL) surgery, is ready to return to sport is a difficult clinical decision, partially due to the lack of standardized evaluation protocols. Since there is a risk of re-injury post-surgery, medical teams need to be cautious. However, athletes who are perceived to be ready to return to sport do not necessarily do so. Some leave sport altogether while others return to a lower competition level. As psychological thoughts and emotions are relevant to athletes’ injury experiences, a psychological component, such as sport confidence, needs to be thoughtfully considered during the return to sport process. Our objectives were to develop the relationship between drop vertical jump (DVJ) performance and physical attributes in young healthy adults and to then apply this relationship to ACL participants. Another objective was to see if the relationship is improved by including confidence (determined from a survey). It was hypothesized that including confidence will predict the ACL participants’ DVJ performance more precisely. Thirty-five participants were in the control group with thirteen participants in the ACL group. All were recreationally active and all had the following anthropometric and performance measurements recorded: height, weight, calf and thigh girth, knee angle, leg dominance, percent body fat, skeletal muscle mass, anaerobic power, balance, and drop vertical jump height. The ACL group also completed a confidence survey. Regression analyses were performed. The results showed that anaerobic power and relative skeletal muscle mass were significant predictors of DVJ performance; however, DVJ performance could not be predicted precisely. The analysis was also carried out by gender. No significant predictors for male’s DVJ performance were found while the significant predictors for female’s DVJ performance were weight, power and knee extension angle. Once again, DVJ performance could not be precisely predicted. On the other hand, results showed that power could be more precisely predicted by body weight than could DVJ performance. / Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2009-08-19 16:08:52.13

The purpose of this investigation was to evaluate and compare the efficacy of three functional knee braces in stabilizing anterior cruciate ligament (ACL) deficient knees. The subject sample consisted of eighteen males and females with a unilateral ACL deficiency. / The criterion variables consisted of the ability of each brace in controlling internal rotation and knee extension during active movement and knee extension during a high velocity activity (dynamic task). Total displacement of the knee brace during a running test was also evaluated. / The results of this study demonstrated significant differences between the efficacy of the three braces for control of knee extension during active movement, knee extension during a dynamic task and brace migration during a running task. There was no significant difference between the efficacy of the three braces in controlling internal rotation during active movement.

Det finns idag ingen konsensus om den optimala rehabiliteringen efter en främre korsbandsrekonstruktion, vi vet heller inte idag huruvida rehabiliteringen ska specificeras efter parametrar som kön och ålder. Studien var en korrelerande tvärsnittsstudie med syfte att ta reda på om det förelåg någon skillnad i postoperativ lårmuskelstyrka 4-7 månader efter en korsbandsrekonstruktion med avseende på kön, ålder, skada och typ av operativt ingrepp. Av de 330 aktuella försökspersonerna var det endast 74 personer som godkänt deltagande och uppfyllde kraven för inklusionskriterierna. Försökspersonerna testades i en isokinetisk dynamometer(Biodex) för maximal styrka(60gr/s) och uthållig styrka(180gr/s). Resultaten presenterades genom ett Limb Symmetry Index. Studien fann inga signifikanta skillnader i de undersökta parametrarna mellan försökspersonerna i uppmätt lårmuskelstyrka mellan opererade och icke opererade benet. Detta tyder på att ålder och kön inte är avgörande vid initial rehabilitering avseende post operativ lårmuskelstyrka.

The purpose of this investigation was to objectively evaluate whether three functional de-rotational knee braces stabilize an anterior cruciate ligament (ACL) deficiency. The subject sample consisted of fifteen males and females with a unilateral ACL deficiency. The data for each subject was obtained using the Genucom Knee Analyzer. A right knee-left knee anterior laxity difference of 3mm or greater served as a subject inclusion parameter for protocol completion. The inclusion criteria reduced the subject sample to a total of eleven. / The study consisted of a randomized block design. The experimental design consisted of three parts: (1) an investigation of translational stability, (2) an investigation of rotatory stability, and (3) a comparison between the three braces. / The analysis involved a one way ANOVA of the criterion variables; anterior laxity (ALAX), anterior midrange stiffness (AMRS), anterior endrange stiffness (AERS), internal laxity (ILAX), and translation of the lateral tibial plateau (TLTP). / The AMRS characteristics differed significantly (alpha = 0.05) at 20$ sp circ$ flexion. The results were the following: $-$10.00 $ pm$ 9.78 N/mm for brace 1, $-$2.86 $ pm$ 7.2 N/mm for brace 2 and $-$41.02 $ pm$ 14.79 N/mm for brace 3. The values evaluated for ALAX, AERS, ILAX, and TLTP profiles did not differ significantly between knee braces.

Thesis (MAppSc in Physiotherapy)--University of South Australia, 1996