Objective - To compare preoperative tibial plateau leveling osteotomy planning using the common tangent method to the current conventional method and evaluate the effect on tibial translation and patellar ligament angle following rotation of the tibial plateau. Study Design – Cadaveric study. Seven paired canine pelvic limbs. Methods- Radiographs of the stifle were taken at 135° of extension prior to and following rotation of the tibial plateau under load (0N and 30N). The tibial plateau of each limb was rotated both according to the common tangent and conventional method. Tibial plateau angle (TPA), tibial translation, and the patellar ligament angles (PLA) were measured radiographically following rotation of the tibial plateau. Results- There was no significant difference between planning methods with regards to the amount of rotation of the tibial plateau or position of the tibia relative to the femur following rotation. There was no significant association between the postoperative tibial plateau angle and position of the tibia relative to the femur between groups. There was no significant difference between the patellar ligament angles following rotation based on the common tangent or conventional method preoperative TPLO planning. Conclusion- Both the conventional and common tangent TPLO planning results in adequate proximal tibial rotation to achieve a PLA of approximately 90°, thereby counteracting the compressive shear forces during ambulation. The TPA for both groups following rotation had no significant impact on the amount of cranial or caudal tibial translation relative to the femur. / Master of Science / Cranial cruciate ligament disease is one of the most common diseases of the stifle in dogs, and causes great discomfort. The tibial plateau leveling osteotomy (TPLO) procedure is designed to change the geometry of the tibia's articular surface, such that the femur no longer slides in a caudal direction during weight bearing. Conventional methods of planning do not consider the curved anatomical surface of the tibial condyles, but rather treat the condyles like a flat surface. The goal of this study was to compare the current conventional planning methods with a new technique, the common tangent method, and to evaluate if the common tangent method improves accuracy and tibial translation after surgery. Results of this study show that there was no statistically significant difference in rotation and tibial position between the two planning groups. However, it was found that the common tangent method consistently required less rotation of the tibial articular surface than the conventional method, but still achieved similar postoperative tibial translation. This implies that there may be overcorrection when performing the TPLO under the current conventional method, which could predispose the patients to strain on the caudal cruciate ligament and patellar ligament leading to discomfort. The common tangent method is a feasible way of planning for a TPLO procedure, and shows potential utility in cases where excessive tibial rotation would otherwise cause increased risk for complications or necessitate a more complex procedure.

Objective: To evaluate the effect of two tibial attachment sites for lateral suture stabilization (LSS) on the kinematics of the cranial cruciate ligament-deficient (CrCL-D) canine stifle during early, middle and late stance.<br />Study design: In vitro biomechanical study: 32 hind limbs from 16 canine cadavers.<br />Methods: Limbs were mounted in a testing jig and an electromagnetic tracking system was used to determine 3-D stifle kinematics under 33% body weight load during early, middle and late stance in the following sequence: CrCL intact, CrCL-D and LSS with the distal anchor through the tibial tuberosity (LSSTT) or through the cranial eminence of the extensor groove (LSSEG). The proximal anchor point was the lateral femoro-fabellar ligament.<br />Results: Transection of the CrCL resulted in significant changes in stifle kinematics during early, middle and late stance. Post-LSS stifle kinematics were more comparable to normal than post-transection kinematics for both techniques. Both LSS techniques restored stifle kinematics in CrCL-D stifles to varying amounts but neither technique successfully restored normal 3-D stifle kinematics. LSSEG improved kinematics of the CrCL-D stifle in the medial-lateral direction and axial rotation but performed poorly in restoring stifle kinematics in the cranial-caudal plane as compared to LSSTT.<br />Clinical significance: LSSTT and LSSEG techniques failed to completely restore normal stifle kinematics in CrCL-D stifles in vitro. / Master of Science

The anterior cruciate ligament (ACL) contributes to normal knee function, but it is commonly injured and has poor healing capabilities. Of the current treatments available for ACL reconstruction, none replicate the long-term mechanical properties of the ACL. It was hypothesized that tissue-engineered scaffolds comprised of reconstituted type I collagen fibers would have the potential to yield a more suitable treatment for ACL reconstruction. Ultra-violet (UV) radiation and 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) were investigated as possible crosslinking methods for the scaffolds, and EDC crosslinking was deemed more appropriate given the gains in strength and stiffness afforded to individual collagen fibers. Scaffolds were composed of 54 collagen fibers, which were made using an extrusion process, organized in accordance with a braid-twist design; the addition of a hydrogel (gelatin) to this scaffold was also investigated. The scaffolds were tested mechanically to determine ultimate tensile strength (UTS), Young's modulus, and viscoelastic properties. Scaffolds were also evaluated for the cellular activity of primary rat lateral collateral ligament (LCL) and medial collateral ligament (MCL) fibroblast cells after 7, 14, and 21 days. The crosslinked scaffolds without gelatin exhibited mechanical and viscoelastic properties that were more similar to the human ACL. Cellular activity on the crosslinked scaffolds without gelatin was observed after 7 and 21 days, but no significant increase was observed with time. Although more studies are needed, these results indicate that a braid- twist scaffold (composed of collagen fibers) has the potential to serve as a scaffold for ACL replacement. / Master of Science

Objective-To assess the effect of 9 mm tibial tuberosity advancement (TTA) on cranial tibial translation (CTT) in cranial cruciate ligament (CCL) deficient canine stifles. Study Design-In vitro cadaveric study. Animals-Twelve canine pelvic limbs. Methods-Each stifle was placed in a jig at 135° with a simulated quadriceps force and tibial axial force, and the distance of CTT was measured with the CCL intact (iCCL), transected (tCCL), and after performing a TTA using a 9 mm cage. In addition, a material testing machine was used to assess the force required to elicit CTT in each scenario. Results-The mean CTT for iCCL was 0.42 mm, 1.58 mm after severing the CCL, and 1.06 mm post TTA. The tCCL CTT measured without any quadriceps force was 2.59 mm. Differences between the intact and tCCL (p<0.0001) and tCCL and TTA (p=0.0003) were significant. The difference between the tCCL with and without the quadriceps force was not significant (p=0.0597). The force required to cause CTT was greater in the TTA than the tCCL up to 6mm (p<0.0001). As axial load increased, the force required to advance the tibia increased in both treatment groups (p value for overall weight effect =0.0002). Conclusions- These data confirm that TTA does reduce CTT in tCCL stifles in this model. The addition of a simulated quadriceps force to a CCL deficient stifle prior to a TTA, by itself, may not significantly lessen CTT. Clinical Relevance- While this in vitro model demonstrated that TTA reduced CTT in canine stifles with CCL transected, the modular limitations preclude extrapolation to the effect of TTA on the live dog. / Master of Science

Thèse ou mémoire avec insertion d'articles / Problématique : La réadaptation post reconstruction du ligament croisé antérieur (rLCA) est longue, un résultat positif n'est pas garanti et la réadaptation entre le 3ᵉ et le 6ᵉ mois post rLCA est rarement standardisée. Le programme intensif post rLCA du Rouge & Or de l'Université Laval (PRORO-UL) entraînerait de bons résultats selon les cliniciens l'utilisant, mais il n'a jamais été étudié avec des athlètes amateurs (AA) en comparaison avec le traitement usuel ($Guide d'intervention du CHU de Québec - Université Laval et cliniques privées de Québec$ (CHU-CP)). Méthodes : Lors d'un essai clinique randomisé à simple insu (NCT04137003), 66 AA (3 mois après rLCA) ont été assignés de façon aléatoire au groupe PRORO-UL (n=33; 23,3 ± 3,25 ans) ou au groupe CHU-CP (n=33; 24,9 ± 4,92 ans). Les symptômes et limitations fonctionnelles ont été évalués au 3ᵉ, 6ᵉ, 9ᵉ et 12ᵉ mois post rLCA. La variable principale était le questionnaire $Knee Outcome Survey-Activities of Daily Living Scale et les questionnaires International Knee Documentation Committee, Anterior Cruciate Ligament-Return to Sport after Injury, Brief Pain Inventory$ et les tests de sauts, force musculaire des extenseurs et fléchisseurs du genou et le taux de retour au sport (RAS) à un an étaient les variables secondaires. Des analyses non paramétriques pour données longitudinales ont été réalisées. Résultats : Toutes les variables ont évolué favorablement pour les deux groupes (effet temps : p<0,0001 à 0,042) sans interaction significative groupe x temps (p=0,074 à 0,962) ni d'effets de groupe (p=0,096 à 0,865). Aucune différence n'a été observée pour le RAS (PRORO-UL 39%, 11/28; CHU-CP 37%, 11/30) (p = 0.840)). Conclusions : Structuré, spécifique et exigeant, le PRORO-UL n'entraîne pas de gains supérieurs au CHU-CP chez des AA, mais il demeure une alternative efficace, standardisée et sans effets négatifs 3 mois post rLCA. / Background : Rehabilitation following anterior cruciate ligament reconstruction (ACLr) is long, a positive outcome is not guaranteed, and no standardization exists during the 3-6-month period. The intensive program post ACLr Rouge & Or de l'Université Laval (PRORO-UL) seems to lead to good results according to the clinicians that implemented it but has not been used with amateur athletes nor compared with usual rehabilitation care ($Guide d'intervention du CHU de Québec - Université Laval et cliniques privées de Québec$ (CHU-CP)). Method: For this single-blind (evaluator) randomized controlled trial (NCT04137003), 66 amateur athletes (3 months post ACLr) were randomly assigned to PRORO-UL (n=33; aged 23.3 ± 3.25) or CHU-CP (n=33; aged 24.9 ± 4.92). Symptoms and functional limitations were assessed at baseline (3 months post ACLr), 6-, 9- and 12-months post ACLr. Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) is the primary outcome and the International Knee Documentation Committee questionnaire, Anterior Cruciate Ligament-Return to Sport after Injury scale, Pain Severity subscale of the Brief Pain Inventory, hop-tests, knee flexor and extensor muscle strength and return to sport (RTS) rate were the secondary outcomes. Nonparametric analysis for longitudinal data were used to compare groups. Result: While both groups evolved favourably on all outcomes (Time effect: p<0.0001 to 0.042), there were no significant group x time interactions (p=0.074 to 0.962) nor group effect (p=0.096 to 0.865). There was no significant difference (p = 0.840) in the one-year RTS rate (PRORO-UL = 39%, 11/28, CHU-CP = 37%, 11/30). Conclusions : In amateur athletes post ACLr, an intensive rehabilitation program, although well structured, specific, and physically demanding, PRORO-UL does not seem to provide incremental benefits compared to CHU-CP. The CHU-CP remains a standardized, feasible, secure, and effective alternative without known adverse effect three months post ACLr.

Majoriteten av idrottsskador inklusive skada på främre korsbandet (Anterior Cruciate Ligament, ACL) uppstår i slutet av träning/tävling när personen tenderar att vara trött. Nuvarande funktionstest inför återgång till idrott efter skada utvärderar ofta individens hoppförmåga i ett icke-uttröttat tillstånd. Syfte: Syftet med följande studie var att se huruvida prestationen i två olika enbenshopp kunde skilja sig mellan före och efter 25 minuters löpning, varav 15 minuter på hög-intensiv nivå och om hopprestationen skiljer sig mellan oskadade och ACL-opererade kvinnor. Metod: Totalt deltog 8 friska kvinnor, utan pågående besvär från nedre extremitet samt 6 färdigrehabiliterade ACL-opererade kvinnor som återgått till sin tidigare aktivitetsnivå. Deltagarna genomförde tester vid två olika tillfällen. Ett Pre-test-tillfälle då inträning av distans- och cross-overhopp samt ett max-pulstest (HRmax) på löpband utfördes. Ett Test-tillfälle där respektive hopp utfördes före och efter cirka 25 minuters löpning varav 15 minuter var på hög-intensiv nivå (&gt;RPE 15 eller &gt;85 % av HRmax). Total distans mättes, registrerades och analyserades för två godkända hopp per ben, tillstånd och hopptyp. Antal hopp-försök per ben och hopp registrerades. Ett symmetri index (LSI) beräknades för att bedöma om det förelåg en normal eller onormal sidoskillnad. Resultat: Cross-overhoppet var signifikant kortare efter löpning jämfört med före. Samma resultat syntes inte för distanshoppet. Ingen skillnad fanns mellan grupperna i hopplängd eller LSI-värden, före eller efter löpning. Ingen onormal sidoskillnad syntes före eller efter löpning i något utav hoppen. ACL-skadade behövde signifikant fler hoppförsök på det opererade benet i uttröttat tillstånd jämfört med det icke-opererade och jämfört med oskadade för att uppnå två godkända hopp. Slutsats: Cross-overhoppet försämrades av löpningen och kan därför sägas vara känsligt nog att kunna skilja uttröttat från icke-uttröttat tillstånd hos båda grupperna. Samma resultat syntes inte för distanshoppet. Det uttröttningsprotokoll och de hopptester som utfördes kunde inte frambringa några större förändringar eller olika sidoskillnader mellan färdigrehabiliterade ACL-opererade kvinnor som återgått till sin tidigare aktivitetsnivå och oskadade, generellt fysisk aktiva kvinnor. Viss osäkerhet kan ha funnits kvar hos det tidigare skadade benet eftersom fler hoppförsök krävdes i uttröttat tillstånd på det opererade benet jämfört med det icke-opererade benet eller jämfört med oskadade deltagare för båda hopptyperna. / Most sport injuries including anterior cruciate ligament-injury (ACL) occur at the end of sport events when the person tends to be fatigued. Despite this, the tests commonly used today to assess whether the individual should return to sports are performed in a non-fatigued state. Aim: The aim of this study was to compare effects of 25 minutes treadmill running, including 15 minutes at a level of high-intenisty on the performance of two different single-leg hop tests between un-injured women and women who underwent an ACL-reconstruction. Method: Eight un-injured women without any ongoing symptoms from either leg, and 6 women who had undergone an ACL-reconstruction, finished the rehabilitation program and returned to their pre-injury level of activity performed tests at two different occasions. The first occasion included technique training for each single-leg hop and a maximal heart rate test (HRmax) on a treadmill. On the second occasion subjects performed the single-leg hop for distance and the cross-over hop before and directly after 25 minutes running, including 15 minutes on a high-intensity level (&gt;RPE 15 and/or &gt;85 % HRmax). Total jump-distance was measured, registered and analysed for 2 approved trials per leg, condition and hop. A leg symmetry index (LSI) was calculated to assess side-to-side-differences. Results: The cross-over hop was significantly shorter after running in both groups, whereas no such effect was seen for the single-leg hop for distance. No difference was shown between groups in performed distance, side-to-side difference or LSI-values, before or after running any of the single-leg hops. Subjects in the ACL-group needed significantly more hop-trials on the operated leg compared to the non-operated leg and compared to un-injured subjects to achieve two qualified hops. Conclusions: Subjects jumped shorter in the cross-over hop after running. This hop can therefore be regarded as sensitive enough to tell fatigued state from a non-fatigued state in both groups. The fatigue protocol did not induce any side-to-side differences in subjects who had undergone ACL-reconstruction, finished their rehabilitation and returned to their pre-injury activity level. Some insecurity may still have been present in the previously injured leg since ACL-operated subjects needed more hop-trials for the operated leg compared to the non-operated leg or compared to un-injured subjects when fatigue.

Dernière étape avant l'atomisation d'un volume de liquide, les ligaments sont présents dans de nombreuses applications industrielles, de même que dans le monde qui nous entoure ; leur dynamique demeure mal comprise. L'étirement, qui permet de leur donner naissance, affecte leur évolution et la manière dont ils se fragmentent (ou non). Pour quantifier l'effet de ce dernier, nous avons choisi d'étudier des configurations modèles dans lesquelles plusieurs paramètres peuvent être bien contrôlés. Une configuration de type pont liquide permet notamment de contrôler l'étirement via le déplacement de l'un des supports solides (mors). Lorsque l'étirement imposé est modéré, il est possible de prévoir analytiquement la déviation entre la forme dynamique et la forme d'équilibre correspondante, quelle que soit la loi de déplacement du mors. Cette prédiction montre en particulier qu'un pont liquide étiré peut s'épaissir appréciablement en son centre, suggérant un retardement de la rupture. Elle montre également que l'étirement axial est réparti de manière très inhomogène. Lorsque l'étirement est suffisamment vigoureux, les résultats expérimentaux montrent que le détachement capillaire du ligament peut être significativement hâté. Le temps de rupture est relié à la masse emportée par le mors en mouvement et dépend du protocole d'étirement. Les résultats suggèrent également la possibilité d'obtenir des ligaments démesurément longs et fins sans l'intervention d'effets visqueux. / Liquid ligaments represent the last step before atomization of a liquid volume, and are encountered in a variety of industrial applications, as well as the world around us; yet, there is much to learn about their dynamics and breakup. Stretching is an essential ingredient of ligaments formation, and affect their subsequent dynamics as well as the way they break (or not). In order to quantify its action, we choose model configurations where parameters can be controlled. Liquid bridges, in particular, provide a way to impose stretching by moving one of the solid rod supporting the bridge. When stretching is not too strong, it is possible to predict analytically the shift between the dynamical shape of the bridge and the corresponding static shape, for any given rod displacement. Particularly, this prediction show that the central section of a stretched liquid bridge tend to be thicker, which could delay breakup. It also show that the axial elongation rate is far from being uniform. When stretching is vigorous, experimental results show that the ligament initial breakup can be considerably sped up. Breakup time shows to be linked to the mass taken away by the moving rod and depend on stretching protocol. Finally, results suggest that it is possible to generate infinitely long ligaments without the mediation of viscous effects.

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

Em uma tentativa de melhor restabelecer a função normal do ligamento cruzado anterior (LCA), foi proposta a técnica de reconstrução do LCA com feixe duplo (FD). Entretanto, a superioridade desta técnica frente à técnica com feixe simples (FS) ainda não está claramente demonstrada no cenário clínico. O propósito do presente estudo foi avaliar e comparar a amplitude de rotação tibial, o máximo de rotação interna e externa, e a força de reação ao solo de joelhos submetidos à reconstrução anatômica com feixe duplo, a joelhos submetidos à reconstrução com feixe simples, durante a realização de tarefas dinâmicas. Para isso, um total de 75 (setenta e cinco) indivíduos foram avaliados (26 reconstruções feixe duplo, 22 reconstruções feixe simples, 27 indivíduos sem lesão do LCA que formaram um grupo controle). Utilizando um sistema de análise do movimento humano, constituído por 4 câmeras para a análise do movimento, os indivíduos foram avaliados em três tarefas de demandas distintas. Utilizou-se a técnica TSACCAST para o cálculo da rotação interna e externa da tíbia. A média da amplitude de rotação tibial, máximo de rotação interna e externa, foi avaliada para cada joelho em cada um dos três grupos. A avaliação clínica destes pacientes foi realizada utilizando-se questionários subjetivo e objetivo (IKDC), assim como artrometria manual. Estas avaliações revelaram que ambos os grupos operados eram semelhantes no que se refere ao resultado clínico pós-operatório. A avaliação da amplitude de rotação tibial, máximo de rotação interna e externa, demonstrou que o joelho operado era semelhante ao joelho não operado e aos joelhos do grupo controle. Também não se verificou diferença significativa nos valores de amplitude de rotação tibial, máximo de rotação interna e externa, quando se comparou o grupo FS ao grupo FD. Desta forma, concluímos que a reconstrução do LCA com a técnica de FS e com a técnica de FD são similares no que se refere ao restabelecimento do controle da rotação da tíbia / In an attempt to better restore the normal function of the two ACL bundles, the ACL reconstruction with two bundles has been proposed. However, the superiority of the double-bundle technique has not been clearly demonstrated in the clinical setting. The purpose of this study was to compare the tibial rotational range, maximal internal and external rotation and ground reaction force of anatomical double-bundle anterior cruciate ligament reconstructed knees with single-bundle anterior cruciate ligament reconstructed knees during three different demanding tasks. A total of 75 subjects, (26 with double-bundle anterior cruciate ligament reconstruction, 22 with single-bundle anterior cruciate ligament reconstruction, and 27 healthy control individuals) were evaluated in this study. Using a 4-camera motion analysis system, motion subjects were recorded performing during three different tasks. Using the CAST technique, the internal-external tibial rotation of both knees was calculated. The mean tibial rotational range, maximum internal and external rotation, for each knee, was evaluated for the 3 groups (double-bundle group, single-bundle group, and control group). Clinical assessment, including objective and subjective IKDC scores, and knee arthrometric measurement, revealed restoration of the reconstructed knee stability with no differences between the two anterior cruciate ligament reconstruction groups. The results demonstrated that both groups resulted in tibial rotation range values that were similar to those in the non-injured knees and those in the healthy controls. There were also no significant differences in tibial rotational range, maximal internal and external rotation and ground reaction force between the DB group and the SB group. Therefore, anatomical double-bundle and single-bundle reconstruction are able to restore normal tibial rotation

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