Les traumatismes au genou, tels que les ruptures du ligament croisé antérieur, sont particulièrement fréquentes lors de la pratique d’un sport ou d’une activité physique. La conséquence à moyen ou long terme est l’apparition d’une arthrose précoce. Si l’activité physique peut être indirectement la cause du développement de cette pathologie, elle constitue également une forme de thérapie non pharmacologique. Les effets de l’exercice seront étudiés aussi bien chez l’homme que chez l’animal, à différents stades du développement de l’arthrose sur des paramètres variés. La gonarthrose est une maladie qui se caractérise par de nombreuses modifications des structures de l’articulation du genou. Ainsi, l’os sous chondral est particulièrement implique dans l’initiation ou la progression de l’arthrose. Les méthodes de diagnostic classiquement employées seront complétées par l’analyse de l’organisation des travées osseuses, par l’analyse de la densité minérale osseuse, par l’analyse microscopique de l’ostéocyte et des lacunes dans lesquelles il se trouve. Nos résultats démontrent que l’exercice a des effets positifs sur l’os sous chondral avec un meilleur contrôle de la minéralisation probablement via une augmentation de la viabilité des ostéocytes. / Knee injuries, such as anterior cruciate ligament rupture, occur frequently in sport or exercise. Mid-term or long-term consequence is an early osteoarthritis. If physical activity can be indirectly the cause of development of this disease, it is also a form of non-pharmacological therapy. The effects of exercise will be studied both in humans and animals at different osteoarthritis severity stages on various parameters. Knee osteoarthritis is a disease that is characterized by many changes in the structure of the joint. Thus, the subchondral bone is particularly involved in the initiation or progression of osteoarthritis. Diagnostic methods usually employed, will be complemented by the analysis of trabecular bone organization, analysis of bone mineral density, microscopic analysis of osteocytes and their lacunae in which they are embedded. Our results show that exercise has positive effects on subchondral bone with better control of the mineralization probably through an increase in the viability of osteocytes.

Made available in DSpace on 2014-06-11T19:30:53Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-03-16Bitstream added on 2014-06-13T20:40:41Z : No. of bitstreams: 1 bonfim_tr_dr_rcla.pdf: 758193 bytes, checksum: 4e539179f9c143bb71a697cea610fe9a (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Após a lesão do Ligamento Cruzado Anterior (LCA), a percepção de movimento e o controle postural estão comprometidos, possivelmente pela redução de informação sensorial da perna lesada. Assim, o objetivo desta tese foi investigar o efeito do uso de informação sensorial adicional na propriocepção e no controle postural de indivíduos com lesão do LCA e de indivíduos com joelhos sadios. Foi realizada uma breve revisão teórica e dois conjuntos de análises em um mesmo estudo experimental. O primeiro conjunto de análises investigou o efeito da adição de informação sensorial no limiar para detecção de movimento passivo da articulação do joelho e no controle postural de 28 indivíduos com lesão unilateral do LCA e de 28 indivíduos com joelhos sadios. O limiar para detecção de movimento passivo (LDMP) foi avaliado nas posições de 15 e 45 graus, para as direções de flexão e extensão. O controle postural foi investigado por meio da área de deslocamento, amplitude e velocidade média de oscilação e freqüência mediana de oscilação do centro de pressão (CP). As condições de informação sensorial foram: informação normal, bandagem infra-patelar, faixa infra-patelar e toque suave em uma barra estacionária (força inferior a 1 Newton). Os resultados demonstraram que o LDMP é maior em indivíduos com lesão do LCA, no entanto, há redução do mesmo com a utilização de informação sensorial adicional. A área, a amplitude e a velocidade média de oscilação do CP são maiores após a lesão do LCA e há uma redução com o uso de informação sensorial adicional. Indivíduos com joelhos sadios apresentam uma redução da oscilação corporal apenas na condição de toque suave. / After Anterior Cruciate Ligament (ACL) lesion, perception of movement and postural control are compromised, possibly by reduction of the sensorial information from the injured leg. Therefore, the purpose of this thesis was to examine the effect of the use of additional sensorial information in the proprioception and in the postural control of individuals with ACL lesion and individuals with healthy knees. A short theoretical revision and two groups of specific in a same experimental study were realized. The first group of analyses investigated the effect of the addition of sensorial information in the threshold to detection of passive knee motion and in the control postural of 28 individuals with ACL unilateral lesion and 28 individuals with healthy knees. The threshold to detection of passive motion (TDPM) was evaluated in the positions of 15 and 45 degrees, for flexion and extension directions. Postural control was investigated through the displacement area, mean sway amplitude, mean sway velocity and medium frequency of the center of pressure (CP). The conditions of sensorial information were: normal information, infra-patellar adhesive tape, infra-patelar band and light touch in a stationary bar (applied force below 1 Newton). The results demonstrated that TDPM is larger in individuals with ACL lesion; however, TDPM is reduced with the use of additional sensorial information. The area, mean sway amplitude and mean sway velocity of the CP are larger after ACL lesion and there is a reduction with the use of additional sensorial information. Individuals with healthy knees presented a reduction of the body oscillation only in the condition of light touch.

Exercícios em cadeia cinética aberta e fechada tem sido propostos para a reabilitação no pós operatório de reconstrução do ligamento cruzado anterior. Não há consenso na literatura sobre qual o tipo de exercício é mais apropriado e ao mesmo tempo seguro, não pondo em risco o procedimento cirúrgico. O propósito deste estudo foi verificar os efeitos da utilização de protocolos de reabilitação em cadeia cinética aberta e fechada de indivíduos em pós operatório de reconstrução do ligamento cruzado anterior, através de respostas comportamentais verificadas por indicadores biomecânicos. A amostra experimental foi constituída de trinta indivíduos, divididos em três grupos amostrais independentes: (CON) dez indivíduos normais que não sofreram nenhum tipo de intervenção; (CCF) dez pacientes submetidos ao programa de reabilitação em cadeia cinética fechada e (CCA) dez pacientes submetidos ao programa de reabilitação em cadeia cinética aberta. Os testes para avaliar os parâmetros biomecânicos selecionados foram realizados em duas etapas: avaliação clínica (deslocamento tibial anterior e escore de Lysholm) e avaliação da marcha (análise dinâmica, cinemática e eletromiográfica). O tratamento foi realizados três vezes por semana, durante doze semanas. Os pacientes foram submetidos a três testes; o primeiro no pré-operatório; o segundo após quatro semanas da cirurgia e o terceiro após quatro meses de cirurgia. O grupo controle realizou apenas um teste e não foi submetido a nenhum tipo de tratamento. Para a xx análise do deslocamento tibial anterior foi utilizado o aparelho KT1000. A análise da marcha foi realizada através da esteira rolante Gaitway Kistler, a análise da atividade eletromiográfica através do sistema Bagnoli 8, composta de eletrodos de superfície e a análise da variação angular do joelho através do eletrogoniômetro Elgon-Burns. Os dados foram registrados, armazenados, processados e analisados estatisticamente, levando-se em consideração o nível de significância de 0,05. As variáveis relativas à força de reação do solo foram analisadas através da determinação de componentes principais. O deslocamento tibial anterior diminuiu ao final do tratamento e o escore de Lysholm aumentou em ambos os grupos, sem diferença significativa entre eles. Das variáveis analisadas relativas à marcha o tempo de apoio simples, as taxas de crescimento para os picos da força vertical, a deflexão da força mínima, a força mínima e o segundo pico parecem-nos serem as variáveis mais sensíveis para identificar diferenças na forma de andar em função do protocolo de reabilitação. Ao analisar a amplitude de movimento percebe-se que esta variável é sensível a mudanças expressivas na variação angular do joelho, como ocorreram no teste após quatro semanas de pós-operatório. Pela análise descritiva, diferenças angulares menores devem ser analisadas através dos ângulos em momentos específicos da marcha. Em relação à atividade elétrica muscular o M.bíceps femoral foi o que apresentou maior variação na sua atividade. E os valores de simetria demonstram que o grupo cadeia cinética aberta foi o que apresentou maiores diferenças entre as pernas no teste após quatro semanas de cirurgia, o que demonstra maior instabilidade no andar. O presente estudo permite concluir que as alterações da marcha são mais expressivas um mês após a cirurgia do que no período pré-operatório. O escore de Lysholm, os componentes principais das variáveis relativas a força de reação do solo e a variação angular do joelho indicam que os exercícios em cadeia cinética fechada são mais eficientes para a recuperação da marcha do que os de cadeia cinética aberta. No entanto, os dois tipos de exercícios propiciam melhora dos parâmetros da marcha e parecem ser eficientes na recuperação da marcha dos pacientes submetidos à reconstrução do ligamento cruzado anterior. O período de quatro meses de reabilitação assegura uma marcha sem riscos para o paciente, mas ainda distinta da característica da marcha de indivíduos não acometidos pela lesão / Open kinetic chain and closed kinetic chain exercises have been proposed for rehabilitation protocol in the reconstruction of the anterior cruciate ligament. There is no consensus in the literature regarding which exercise is more appropriate and at the same time safe without putting in risk the surgical procedure. The purpose of this study was to evaluate the results of the open kinetic chain and closed kinetic chain protocols in the rehabilitation of those individuals that were subject to the reconstruction of the anterior cruciate ligament based on biomechanical indicatives. The sample was made of thirty individuals, divided in three independent groups: (CON) ten normal individuals that were not submitted to the surgical intervention; (CCF) ten patients submitted to the closed kinetic chain rehabilitation program, and (CCA) ten patients submitted to the open kinetic chain rehabilitation program. Tests to evaluate the desired biomechanical parameters had been carried out through two stages: clinical evaluation (anterior tibial displacement and Lysholm`s score) as well as gait evaluation (dynamic, kinematic and electromyografic analysis). The treatment was carried out three times per week, during twelve weeks. Each patient had been evaluated in three occasions: before the surgery; four weeks after the surgery; and four months after the surgery. The group control was submitted to only one evaluation test and no treatment at all. KT1000 equipament was used for evaluating the tibial displacement. The gait analysis was carried out through the Gaitway Kistler treadmill; the electromyography analysis was evaluated through xxii the System Bagnoli 8 composed of surface electrodes and the analysis of the angular variation of the knee through Elgon-Burns electrogoniometer. Data had been collected and analyzed considering the 0,05 significance level. The ground reaction force variable had been analyzed through of the determination of main components. The anterior tibial displacement diminished at the end of the treatment and the Lysholm`s score increased in both groups without significant difference between them. From the analyzed variables regarding gait, the time of simple support, the taxes of growth for peaks of the vertical force, the deflection of the minimum force, the minimum force and as the peak, seem to be the most sensible variables to identify gait differences due to the rehabilitation protocol. Upon analyzing the amplitude of movement it was noticed that this variable was sensible to huge changes in the angular variation, as those observed after four weeks from the surgery. By the descriptive analysis, lesser angular differences must be analyzed through the angles at specific moments of the gait. Regarding the muscular activity the femoral biceps femoris (long head) presented greater variation in its activity. And, the symmetry values demonstrate that the open kinetic chain group presented greater differences between both legs in the test four weeks after the surgery, demonstrating greater instability in walking. The current study permit to conclude that the variations in the gait are higher in one month after the surgery than in the pre-surgery period. The Lysholm`s score, the ground reaction force, variable the main components and the angular variation of the knee indicates that the exercises in closed kinetic chain are more efficient than opened kinetic chain for recovering the gait. However, the two exercises improved the parameters of gait and seem to be efficient in recovering the gait pattern of patients submitted to the anterior cruciate ligament reconstruction. Although the four months period of rehabilitation is enough to reinstate a harmless gait pattern to patients, it is still not sufficient to return the patients` gait standards to those of individuals without injury

Approximately 200,000 anterior cruciate ligament (ACL) injuries occur each year with about 100,000 of these injuries undergoing reconstruction (ACLR). The impetus of ACLR is to allow previously high functioning, physically active individuals to return to desired levels of sports participation and to engage in recommended levels of physical activity. However, 1 out of 3 patients after ACLR fail to return to competitive levels of sport and meet recommended levels of physical activity. Injury-related fear has been cited as the primary barrier for failure to return to sport. However, the research has been primarily qualitative in nature and limited research has quantitatively examined the impact of injury-related fear on return to sport and physical activity engagement in this population. In addition to quantifying the impact of injury-related fear, no research has examined the underlying neural substrates associated with injury-related fear after ACLR. Previous research has demonstrated that patients after ACLR undergo neuroplasticity in sensorimotor regions of the brain and exhibit changes in neurocognitive functioning. Despite previous research in other musculoskeletal pathologies demonstrating neuroplasticity in emotional regulation centers of the brain, no research has examined these brain regions in patients after ACLR. Furthermore, previous research in healthy athletes has suggested that psychosocial impairments can lead to changes in neurocognitive functioning, including reaction time. Understanding these neural substrates could provide insight into appropriate intervention strategies to decrease injury-related fear, increase return to sport and physical activity engagement, and potentially improve neurocognitive functioning in patients after ACLR. The purpose of this dissertation was to further investigate the effects of injury-related fear on patients after ACLR and to determine the efficacy of a cognitive behavioral intervention to decrease injury-related fear in this population. The purposes of these studies were to determine whether patient-based, specifically psychological, and functional outcomes were associated with return to sport and physical activity levels in individuals with a history of ACLR, to determine differences in brain activation patterns when exposed to fear-eliciting stimuli in individuals with a history of ACLR compared healthy matched controls, and to determine the efficacy of in vivo exposure therapy on self-reported fear and reaction times in participants post-ACLR. The results of these studies indicate that injury-related fear was quantitatively associated with return to sport and physical activity engagement in patients after ACLR. Additionally, individuals with a history of ACLR activated emotional regulation centers of the brain in greater depth when compared to healthy matched controls. Lastly, in vivo exposure therapy decreased self-reported injury-related fear for specific functional tasks but did not improve general fear response or reaction time in post-ACLR participants. The results of these studies objectively elucidate the negative impact of injury-related fear in patients with a history of ACLR.

This is an interdisciplinary research project in which the methods of Industrial and Product Design Engineering are focused upon a problem in Orthopaedics. One of the most controversial areas in Orthopaedics is the reconstruction of the anterior cruciate ligament (ACL). The current twin-instrument method for locating the ACL is difficult for surgeons with fewer than 500 surgical experiences. This was clearly demonstrated by Kohn, Busche and Cans (1995), and confirmed by Sommer, Friederich and Muller (2000), Sudhahar, Glasgow and Donell (2004), and Kuga, Yasuda, Hata et al. (2004). The above research indicates that the problem is not only one of anatomical location, but of how the operation takes place. The aim of the research was, therefore, to develop a new and improved surgical instrument and technique for locating the ACL anatomical landmarks. The research described in this thesis employs a number of design methods that can be used separately or in combination (hybrid process). They form the theory base that guides the design process. This allows the designer to engage in a flexible process that is effective in finding design solutions to the problem. Within this process, iterative case studies were employed in order to design a new surgical device for ACL reconstruction. The thesis describes a series of designed devices (case studies) that were iteratively developed and surgically tested, leading to a penultimate device. This latter device was tested via a number of surgical operations. The device provides a new method for externally locating the internal ACL attachment points. The research has resulted in a commercial association with Smith and Nephew Surgical Australia and BrainLAB AG Germany for the commercialisation of this technique. At the time of writing, the next stage of research and development is under way. This is using a frameless computer-aided image guidance system in the place of X-ray.

Recorded by Eugene Barsky, Physiotherapy Outreach Librarian, UBC / This is a Systematic Review Presentation titled - "Neuromuscular Training & ACL Injury Prevention: A Systematic Review", created by Master of Physical Therapy Graduating Students, University of British Columbia - 2006, Presented on September 14-15, 2006 , Vancouver, BC, Canada

Study Design: Methodological study. Objectives: To examine the agreement and validity of using observational risk screening guidelines to evaluate ACL injury risk factors. Background: Post-pubescent females have an increased risk of anterior cruciate ligament (ACL) injury compared with their male counterparts partly due to their high-risk landing and cutting strategies. There are currently no scientifically-tested methods to screen for these high risk strategies in the clinic or on the field. Methods and Measures: Three physiotherapists used observational risk screening guidelines to rate the neuromuscular characteristics of 40 adolescent female soccer players. Drop jumps were rated as high risk or low risk based on the degree of knee abduction. Side hops and side cuts were rated on the degree of lower limb 'reaching'. Ratings were evaluated for intrarater and interrater agreement using kappa coefficients. 3D motion analysis was used as a gold standard for determining the validity of ratings. Results: Acceptable intrarater and interrater agreement (k≥0.61) were attained for the drop jump and the side hop, with kappa coefficients ranging from 0.64 to 0.94. Acceptable sensitivity (≥0.80) was attained for the side hop and the side cut, with values ranging from 0.88 to 1.00. Acceptable specificity (≥0.50) was attained for the drop jump, with values ranging from 0.64 to 0.72. Conclusion: Observational risk screening is a practical and cost-effective method of screening for ACL injury risk. Based on levels of agreement and sensitivity, the side hop appears to be a suitable screening task. Agreement was acceptable for the drop jump but its validity needs further investigation.

Key words: knee, anterior cruciate ligament, aquatic physiotherapy, adolescents. There are not so many information about efficiency of aquatic physiotherapy in adolescents after reconstruction of anterior cruciate ligament in the literature. Hypothesis. Because of specific effect of water, aquatic physiotherapy should faster improve range of knee joint motion and muscular strength than physiotherapy in gym. Purpose. The aim of this study was to evaluate efficiency of aquatic physiotherapy in patients who had reconstruction of anterior cruciate ligament. The tasks. 1. To evaluate dinamies of recovery of knee joint functions in patients who had physiotherapy in gym. 2. To evaluate dinamies of knee joint functions in patients who had aquatic physiotherapy and gym. 3. To compare recovery changes of knee joint functions in patients who had physiotherapy in gym with patients who had aquatic physiotherapy and gym. Subjects: 28 adolescents 16-18 years old. Research was accomplished in children’s rehabilitation center “Zibute” in Kacergine. Adolescents were grouped in to two groups for 14 in each group. Control group had physiotherapy in gym and experimental group – in gym and aquatic physiotherapy. Methods: 1. Measurement of knee joint motion. 2. Knee joint stability’s evaluation by Lysholm scale. 3. Knee joint function’s evaluation by Cincinnati scale. 4. Knee joint muscular strength‘s evaluation by Lovett test. 5. Statistic methods. Conclusions: 1. Physiotherapy in gym is... [to full text]

Darbo objektas: skirtingų raumens elektrinės stimuliacijos metodų poveikis kelio sąnario judesių amplitudei, raumenų jėgai ir skausmui po priekinio kryžminio raiščio rekonstrukcinės operacijos. Tyrimo tikslas: nustatyti kineziterapijos ir skirtingų raumens elektrinės stimuliacijos metodų efektyvumą kelio sąnario judesių amplitudei, raumenų jėgai ir skausmui po priekinio kryžminio raiščio rekonstrukcinės operacijos. Tyrimo uždaviniai: 1. Įvertinti kineziterapijos ir pasyvios raumens elektrinės stimuliacijos poveikį kelio sąnario judesių amplitudei, raumenų jėgai ir skausmui. 2. Įvertinti kineziterapijos ir aktyvios raumens elektrinės stimuliacijos poveikį kelio sąnario judesių amplitudei, raumenų jėgai ir skausmui. 3. Palyginti kineziterapijos ir skirtingų raumens elektrinės stimuliacijos metodų poveikį kelio sąnario judesių amplitudei, raumenų jėgai ir skausmui. Tyrimo hipotezė: Manome, kad kineziterapija ir aktyvi raumens elektrinė stimuliacija, labiau padidins šlaunies raumenų jėgą, kelio sąnario judesių amplitudę bei sumažins skausmą kelio sąnaryje vaikštant, lyginant su pasyvios elektrinės stimuliacijos taikymu pacientams po priekinio kryžminio raiščio rekonstrukcinės operacijos. Išvados: 1. Pacientams, kuriems taikyta kineziterapija ir pasyvi raumens elektrinė stimuliacija, statistiškai reikšmingai (p<0,05) padidėjo kelio sąnario lenkimo ir tiesimo amplitudė, blauzdą lenkiančių ir tiesiančių raumenų jėga, o skausmas vaikštant sumažėjo. 2. Pacientams, kuriems... [toliau žr. visą tekstą] / The object: Different muscle electrical stimulation methods for knee joint range of motion, muscle strength and pain after anterior cruciate ligament reconstructive surgery. The aim of the research: to determine the effectiveness of physical therapy and different muscles electrical stimulation methods for knee joint range of motion, muscle strength and pain after anterior cruciate ligament reconstructive surgery. The task of the research: 1. To evaluate the effectiveness of physical therapy and passive muscle electrical stimulation for knee joint range of motion, muscle strength and pain. 2. To evaluate the effectiveness of physical therapy and active muscle electrical stimulation for knee joint range of motion, muscle strength and pain. 3. Compare the effectiveness of physical therapy and different muscle electrical stimulation methods for the range of motion of the knee joint, muscle strength and pain, between control and experimental groups. Hypothesis: we believe that physical therapy and active muscle electrical stimulation will increase thigh muscle strength, the range of motion of the knee and reduce pain in the knee while walking, compared with a passive muscle electrical stimulation in patients after anterior cruciate ligament reconstructive surgery. Conclusions: 1. Patients who apply physical therapy and passive muscle electrical stimulation, statistically significantly increased (p<0,05) the flexion and extention of the knee, strenght of the muscles that bend... [to full text]

Rupture of the anterior cruciate ligament (ACL) increases anterior-posterior (AP) laxity. The treatment aims to reduce or teach the patient to control this instability. Altered kinematics due to absent ligament function may result in knee arthrosis. This study evaluated the clinical and functional results of reconstructive surgery. Roentgen stereophotogrammetry (RSA) was used to analyse the stabilising effect of knee braces, reconstructive surgery and the kinematics of the knee with and without weight-bearing. The stability of the knees were assessed in 86 patients with ACL injuries before and/or after reconstructive surgery with the RSA technique and with the KT-1000 arthrometer The KT- 1000 (89 N) recorded smaller side to side differences than the RSA set-up without any correlation between the methods. The effect of three different braces on the AP and rotatory laxity was studied on patients with ACL injuries. The ECKO and the modified Lenox Hill reduced the instability with about one third. The SKB had no significant effect. None of the braces decreased the internal rotatory laxity but the Lenox Hill reduced the external rotatory laxity. Thirty-two patients with old ACL tears were treated with surgical reconstruction using the over the top technique (OTT) with or without augmentation. A small reduction in AP laxity was observed at the 6 month follow-up, The AP laxity was almost the same two years after as before surgery. No correlation was observed between the stability and knee function. Fifty-four patients with old unilateral anterior cruciate ligament injuries were randomised either to the over the top (OTT) or the isometric femoral tunnel position (ISO) at ACL reconstructive surgery. Seven of 24 (ISO) and 9 of 25 (OTT) had "normal" laxity two years after surgery. The patients operated with the ISO technique did not have better subjective knee function, muscle strength, functional performance or knee stability than patients operated with the OTT technique. The knee kinematics in patients with chronic unilateral ACL ruptures were examined during active extension in the supine position (13 patients) and during extension and weight-bearing (13 patients). The tibia displaced at an average 1.9 mm more anteriorly and 0.8 mm distally in the injured than in the intact knees during active extension. During extension and weightbearing the tibia was about 2 mm more posteriorly positioned than in the intact knee. The ACL rupture did not affect tibial rotations. Conclusions: The RSA recorded larger side to side differences in ACL injured and reconstructed patients than the KT-1000 arthrometer. Some knee braces are able to reduce AP laxity in ACL injured knees. No correlation was observed after surgery between knee laxity and functional scoring or tests. ACL reconstructions with isometric graft position on the femoral side did not offer any advantages compared to the over the top placement. Altered knee kinematics in the ACL injured knees were observed during knee extension with and without weight-bearing. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1993, härtill 6 uppsatser</p> / digitalisering@umu