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

Degenerative suspensory ligament desmitis (DSLD) is a debilitating disease of connective tissues seen in many breeds but has become prevalent in the Peruvian Pasohorse. DSLD is believed to be a genetic disorder caused by one primary founder and most likely has a recessive mode of inheritance although a dominant or co-dominant mode of inheritance has not been ruled out. A genome scan using 259 microsatellite markers was used to test for linkage disequilibrium between one or more markers and DSLD. Two groups of Peruvian Pasohorses were selected from one population including the US and Canada. The only difference between the two groups of horses besides the size of the two groups was the presence of DSLD in the affected group and the absence of DSLD in the unaffected group. It was assumed that differences seen between the two groups in homozygosity and or common allele frequency could be an indication of linkage to DSLD. As a connective tissue disorder, there were a large number of candidate genes forDSLD to consider, yet no identical human or animal model exists. The genome scan identified five chromosomal regions where statistically significant differences were seen between affected and unaffected sample populations that could be indications of linkage to DSLD. Those chromosomes were: ECA 6, 7, 11, 14, and 26. Sequencing of a portion of the G domain in the Chondroitin Sulfate Proteoglycan2 (CSPG2) gene has mostly ruled out that segment of chromosome 14 as having linkage to DSLD. Further research needs to be conducted in the regions of ECA 6,7,11 and 26 where statistically significant differences were seen between the affected and unaffected groups, especially on ECA 6 and 11 since possible candidate genes are located in those regions based on the human comparative map.

Reflex effects evoked by graded electrical stimulation of the posterior articular nerves (PAN) of the ipsi- and contralateral knee joints were investigated using both micro-electrode recordings from 7 - motoneurones and recordings from single muscle muscle spindle afferents. Spindle afferent responses were also recorded using natural stimulation of different types of receptors, to elucidate if the articular reflexes onto the y -motoneurones were potent enough to significantly alter the muscle spindle afferent activity. Stretches of the ipsilateral posterior (PCL) and anterior (ACL) cruciate ligaments, pressure on the ipsi- and contralateral knee and ankle joint capsules, and passive flexion/extension movements of the joints in the contralateral hind limb were performed. The occurrance of different sensory endings in the ACL and PCL was examined using gold chloride staining for neuronal elements. All experiments were performed on chloralose anaesthetized cats. More than 90% of the static and dynamic y -motoneurones were responsive to electrical stimulation of the PAN. Most 7-cells responded to low intensity electrical stimulation. Excitatoiy reflex effects predominated on both static and dynamic posterior biceps-semitendinosus (PBSt) 7 -cells, while excitatory and inhibitory effects occurred with an about equal frequency on triceps-plantaris (GS) 7-cells. The fastest segmental route for excitatory PAN effects on hind limb 7-motoneurones seems to be di- or trisynaptic, while the path for inhibitory effects seems to be at least one synaps longer. Physiological stimulations of ipsi- and contralateral joint capsules and of ipsilateral cruciate ligaments were all found to evoke frequent and potent changes in spindle afferent responses from the GS and PBSt muscles. It was shown that these effects were due to reflexes onto dynamic and static fusimotor neurones caused by physiological activation of articular sensory endings. Both ipsi- and contralateral joint receptor stimulation evoked excitatory as well as inhibitory fusimotor effects. The highest responsiveness was found during stimula­tion of the cruciate ligaments, i.e. 58% for GS and 47% for PBSt primary spindle afferents to PCL stimula­tion, and 73% for GS and 55% for PBSt primary spindle afferents to ACL stimulation. Significant altera­tions in spindle afferent activity was encountered at very low traction forces applied to the cruciate ligaments (5-10 N). The low thresholds, the tonic character of the stimuli, and the fact that different types of sensory endings were demonstrated in the cruciate ligaments (i.e. Ruffini endings, Pacinian corpuscles, Golgi ten­don organ like endings and free nerve endings), indicate that the fusimotor effects observed were caused by activation of slowly adapting mechanoreceptors, most likely Ruffini endings and/or Golgi tendon organ like endings. The potent reflex effects on the muscle spindle afferents elicited by increased tension in the cruciate ligaments indicate that these ligaments may play a more important sensory role that hitherto believed, and it is suggested that they may be important in the regulation of the stiffness of muscles around the knee joint, and thereby for the joint stability. The possible clinical relevance and the mechanisms by which joint receptor afferents, via adjustment of the muscle stiffness, may control joint stability are discussed. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1989, härtill 7 uppsatser.</p> / digitalisering@umu

Chronic lateral instability of the ankle (CLI), defined as frequent sprains and recurrent giving way, difficulty in walking and running on uneven surface, is often connected with pain and swollen ankles. It occurs in 10 to 20 percent after acute ankle injuries. Mechanical instability of the talocrural and subtalar joint, peroneal weakness and impaired proprioception has been suggested as etiological factors. Aim. To investigate the natural course in conservatively treated patients with CLI. To assess the mechanical stability in patients with CLI by measuring the three dimensional motions in the talus, the fibula and the calcaneus in relation to the tibia during different testing procedures pre- and postoperatively. To determine if CLI is associated with proprioceptive deficiency. Patients and Methods. This Thesis includes 127 ankles in 78 patients (30 women, 48 men) with CLI. Thirty-seven patients were followed up 20 years after their first contact with the orthopaedic department because of CLI. Forty-six ankles were evaluated radiographically and the result was compared with a gender- and age - matched control-material. The neuromuscular response to a sudden angular displacement of the ankles was studied in 15 ankles in 13 patients using EMG. Thirty-six patients entered a prospective study using roentgen stereophotogrammetric analysis (RSA) in which the ankles were tested at manual adduction, adduction with predetermined torque, with and without external support and at drawer tests (40 N and 160N). Twenty-seven patients were followed five years postoperatively. Result. After 20 years 22 patients, conservatively treated still suffered from instability of the ankle and ten had recurrent giving way symptoms even on plane surface. Six ankles in the patient group and four in the control group displayed osteoarthritic changes Prolonged ipsilateral reaction time (m. per. long, and m. tib. ant.) was found in patients with CLI indicating proprioceptive insufficiency. Increased talar adduction and a tendency toward increased total translation of the talar center was found in ankles with CLI. Concomitant fibular rotations and translations were found but with no conclusive deviation in the ankles with symptoms. The talo-calcaneal adduction reached the same level in the patient and control groups regardless of symptoms. External support (ankle brace) increased the talar stability. The use of predetermined torque and constrained testing procedure did not add information compared with the manual test Twenty-five patients graded the result as excellent or good five years after lateral ligament reconstruction. Talar stability (decreased adduction and translation) was increased two years postoperatively and was improved or remained the same at five years without comprising the range of motion. Conclusion. In more than half the cases symptoms of CLI did not resolve spontaneously. Minor degenerative changes was found after twenty years, but not to a greater extent than in a control group. CLI was associated with proprioceptive insufficiency and talocrural but not subtalar instability. Increased ankle stability can be obtained by the use of an ankle brace and by an anatomical ligament reconstruction. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1994</p> / digitalisering@umu

The use of knee braces prophylactically is still considered as an approach for injury mitigation for those in high-risk sporting activities, though their use is not fully supported. The purpose of this thesis was to examine biomechanical and neuromuscular effects of prophylactic brace wear following standardized repetitive exercise. Twelve participants participated and acted as their own control. The participants were required to participate in two sessions, one control session with no brace and one intervention session with the application of a off-the-shelf prophylactic knee brace. Pre-and post-exercise intervention single leg drop landings were recorded to examine the effects of an acute exercise stimulus on the neuromuscular and biomechanical effects of brace wear. Additionally, trials were collected at 30-minutes post-exercise to examine residual effects of the brace wear on landing kinematics and kinetics. Difference tests using analysis of variance (ANOVA) showed that there was a minimal effect of the prophylactic knee brace on biomechanical and neuromuscular variables following exercise as well as 30-minutes following knee brace removal. Further research may be required to identify if braces can be worn prophylactically to reduce the risk of injury during activity.

Abstract Aim: The main objective of this study was to compare electro mechanical delay (EMD) and rate of torque development (RTD) of the knee extensors 6 weeks after rehabilitation of anterior cruciate ligament reconstruction (ACLR) with or without neuromuscular electrical stimulation (NMES). Further the feasibility of the study was examined. Method: 10 participants were randomized into two groups, one neuromuscular electrical stimulation group (NMESG) and one training group (TG). The NMESG used a NMES-device as a complement to the ordinary rehabilitation protocol. Regular meetings with a physiotherapist were scheduled during the rehabilitation. Measurements of RTD and EMD during knee extension were made in an isokinetic dynamometer with electromyography recordings (EMG) from the knee extensors 6 weeks after surgery. Results: All participants completed the study. The NMESG went to see the physiotherapist 6.7 ± 2.5 times and the TG 6.8 ± 1.8 times. The participants in the NMESG used the NMES-apparatus 28 ± 1.7 times. Total number of training days for the NMESG was 25 ± 4 and for the TG 35 ± 1. RTD did not significantly differ between the groups. For the TG, RDT was 901.1, 941.2 and 531.0 Nm/s, over the first 50, 100 and 200 ms, respectively. For NMESG: RTD was 824.3, 966.2 and 529.0 Nm/s, over the first 50, 100 and 200 ms, respectively. No significant difference between the groups or interaction between group and muscle was found in EMD. For both groups EMD was significantly larger for vastus medialis as compared to the vastus lateralis and rectus femoris. Conclusions: The study was feasible to perform, and despite fewer training days for the NMESG, no significant group differences were found in RTD or EMD. A larger study population is needed to evaluate the efficacy of the intervention. / Abstrakt Syfte: Huvudsyftet med denna studie var att jämföra elektromekaniska fördröjning (EMD) och vridmoment utveckling (RTD) för knäextensorerna 6 veckor efter rehabilitering av främre korsbandsrekonstruktion (ACLR) med eller utan neuromuskulär elektrisk stimulering (NMES). Vidare undersöktes genomförbarheten av studien. Metod: 10 deltagare randomiseras in i två grupper, en neuromuskulär elektrisk stimulerings grupp (NMESG) och en träningsgrupp (TG). NMESG använde en NMES - enhet som ett komplement till ordinarie rehabiliteringsprotokoll. Regelbundna möten med sjukgymnast var inplanerad under rehabiliteringen. Mätningar av RTD och EMD under knäets extension gjordes i en isokinetisk dynamometer med elektromyografi inspelningar (EMG) från knäextensorerna 6 veckor efter operationen. Resultat: Alla deltagare fullföljde studien. NMESG träffade sjukgymnasten 6,7 ± 2,5 gånger och TG 6,8 ± 1,8 gånger. Deltagarna i NMESG använde NMES - apparaten 28 ± 1,7 gånger. Totalt antal träningsdagar för NMESG var 25 ± 4 och för TG 35 ± 1. RTD skiljde sig inte signifikant mellan grupperna. För TG var RDT 901,1, 941,2 och 531,0 Nm/s, under de respektive första 50, 100 och 200 ms. För NMESG var RTD 824,3, 966,2 och 529,0 Nm/s, under de respektive första 50, 100 och 200 ms. Inga signifikanta skillnader mellan grupperna eller samspel mellan grupp och muskler hittades i EMD. För båda grupperna var EMD signifikant större för vastus medialis jämfört vastus lateralis och rectus femoris. Slutsats: Studien var möjligt att utföra, och trots färre träningsdagar för NMESG sågs inga signifikanta skillnader mellan grupperna i RTD eller EMD. Det behövs en större studiepopulation för att utvärdera effekten av interventionen.

Introduction: Acellular scaffolds are increasingly used for the surgical repair of tendon injury and ligament tears. Despite this increased use, very little data exist directly comparing acellular scaffolds and their native counterparts. Such a comparison would help establish the effectiveness of the acellularization procedure of human tissues. Furthermore, such a comparison would help estimate the influence of cells in ligament and tendon stability and give insight into the effects of acellularization on collagen. Material and Methods: Eighteen human iliotibial tract samples were obtained from nine body donors. Nine samples were acellularized with sodium dodecyl sulphate (SDS), while nine counterparts from the same donors remained in the native condition. The ends of all samples were plastinated to minimize material slippage. Their water content was adjusted to 69%, using the osmotic stress technique to exclude water content-related alterations of the mechanical properties. Uniaxial tensile testing was performed to obtain the elastic modulus, ultimate stress and maximum strain. The effectiveness of the acellularization procedure was histologically verified by means of a DNA assay. Results: The histology samples showed a complete removal of the cells, an extensive, yet incomplete removal of the DNA content and alterations to the extracellular collagen. Tensile properties of the tract samples such as elastic modulus and ultimate stress were unaffected by acellularization with the exception of maximum strain. Discussion: The data indicate that cells influence the mechanical properties of ligaments and tendons in vitro to a negligible extent. Moreover, acellularization with SDS alters material properties to a minor extent, indicating that this method provides a biomechanical match in ligament and tendon reconstruction. However, the given protocol insufficiently removes DNA. This may increase the potential for transplant rejection when acellular tract scaffolds are used in soft tissue repair. Further research will help optimize the SDS-protocol for clinical application.

Po priekinio kryžminio raiščio (PKR) rekonstrukcijos fizinio aktyvumo atgavimas trunka nuo 3 iki 12 mėnesių. Siekiant greitesnio kelio sąnario funkcijos atkūrimo, šiame darbe vertinamas dviejų skirtingų metodikų efektyvumas. Darbo tikslas – palyginti raumenų elektrostimuliacijos (RES), taikomos kineziterapijos metu ir prieš kineziterapijos procedūrą, poveikį kelio sąnario funkcijos atkūrimui po priekinio kryžminio raiščio rekonstrukcinės operacijos. Apžvelgus mokslinę literatūrą numatytą mokslinio darbo tikslą pasiekti buvo iškelti 3 uždaviniai. Pirmuoju uždaviniu siekiama įvertinti kelio sąnario funkcijos kitimą po priekinio kryžminio raiščio rekonstrukcinės operacijos taikant raumenų elektrostimuliaciją prieš kineziterapijos procedūras. Antrasis uždavinys skirtas įvertinti kelio sąnario funkcijos kitimą po priekinio kryžminio raiščio rekonstrukcinės operacijos taikant raumenų elektrostimuliaciją kineziterapijos procedūros metu. Trečiuoju uždaviniu siekiama palyginti kelio sąnario funkcijos atkūrimo pokytį po priekinio kryžminio raiščio rekonstrukcinės operacijos taikant raumenų elektrostimuliaciją kineziterapijos metu ir prieš kineziterapijos procedūrą. Tyrimo metodai: 1. Judesių amplitudė per kelio sąnarį vertinta goniometrijos metodu. 2. Blauzdą lenkiančių ir tiesiančių raumenų jėga vertinta Medicininių tyrimų tarnybos skale. 3. Skausmo intensyvumui vertinti naudota Skaičių analoginė skausmo skalė. 4. Kelio sąnario funkcinė būklė vertinta Lysholm klausimynu. 5. Operuotos... [toliau žr. visą tekstą] / After anterior cruciate ligament (ACL) reconstruction physical activity recovery lasts from 3 to 12 months. Seeking more rapid knee joint function recovery the effectiveness of two different methods are estimated in this research. The aim of the research is to compare the effectiveness of neuromuscular electrical stimulation (NMES) applied before and during physiotherapy procedure, as well as the effect of the knee joint function recovery after anterior cruciate ligament reconstruction. After review of scholarly literature there were 3 tasks set to reach the aim of the research. The first task is to estimate the changes in the knee joint function after anterior cruciate ligament reconstruction applying neuromuscular electrical stimulation before physiotherapy procedures. The second task is to estimate the changes in the knee joint function after anterior cruciate ligament reconstruction applying neuromuscular electrical stimulation during physiotherapy procedures. The third task is to compare the changes in the knee joint function applying neuromuscular electrical stimulation during physiotherapy and before physiotherapy procedure. The methods of the research: 1. The amplitude of the knee joint movements is estimated by goniometry method. 2. The force of the calf flexor and extensor muscles is estimated by Medical Research Council scale. 3. The intensity of the pain is estimated by Numeric Rating Scale. 4. The knee joint function is assessed by Lysholm knee questionnaire. 5... [to full text]

Darbo tikslas: įvertinti jauno amžiaus, fiziškai aktyvių asmenų, patyrusių kelio sąnario priekinių kryžminių raiščių plyšimą apatinių galūnių funkcinius rodiklius. Uždaviniai: 1) įvertinti vyrų ir moterų apatinių galūnių funkcijos rodiklius po PKR rekonstrukcijos uždaroje kinetinėje grandyje atliekant horizontalius šuolių testus; 2) Nustatyti vyrų ir moterų po PKR rekonstrukcijos judesio stereotipo ypatybes uždaroje kinetinėje grandyje atliekant vertikalius šuolių testus; 3) įvertinti vyrų ir moterų dinaminės pusiausvyros rodiklius po PKR rekonstrukcijos; 4) palyginti vyrų ir moterų operuotos kojos funkcijos rodiklius su sveikosios kojos rodikliais po PKR rekonstrukcijos. Tiriamieji ir metodika: tyrime ištirti 38 jauno amžiaus asmenys iš kurių 30 – vyrai (28,77 ± 7,9 metai) ir 8 moterys (26,50 ± 7,1 metai). Tiriamieji buvo padalinti į dvi grupes: 30 vyrų bei 8 moterys ir atliktas vienkartinis testavimas (tiriamiesiems buvo vertinama tiek operuota, tiek sveika koja). Siekiant įvertinti jauno amžiaus fiziškai aktyvių asmenų kelio sąnario funkcinę būklę buvo naudojami šie funkciniai testai: nužengimo nuo pakylos ir maksimalaus šuolio testas, dinaminio stabilumo “Y” testas bei šuolių viena koja testas. Tyrimo rezultatai ir išvados: 1. Įvertinus vyrų, patyrusių priekinių kryžminių raiščių traumą funkcinę apatinių galūnių būklę šuolių viena koja testais nustatyta, jog operuotosios kojos rodikliai buvo mažesni nei sveikosios tik trijų maksimalių šuolių viena koja testo metu. Moterų... [toliau žr. visą tekstą] / Aim: to assess the lower limbs’ function indexes of young active people, who suffered a tear of anterior cruciate ligament. Objectives: 1) to assess the lower limbs’ function indexes of females and males after the ACL reconstruction in a close kinetic chain with horizontal hop tests; 2) to identify peculiarities of movement stereotype of females and males after the ACL reconstruction in a close kinetic chain with vertical hop tests; 3) to assess the dynamic balance indexes of females and males after the ACL reconstruction; 4) to compare indexes of the leg after the ACL reconstruction surgery of females and males with ones of a healthy leg. Respondents and methodology: 38 young people, inc. 30 males (28,77 ± 7,9 y. o. ) and 8 females (26,50 ± 7,1 y. o. ). The respondents were divided into two groups: 30 males and 8 females and have underwent a single test (for a leg after surgery and a healthy one). In order to assess the lower limbs’ function indexes of young active people, the following tests have been used: drop vertical jump test, dynamic stability “Y” test and single leg hop test. Results and conclusions: 1. After assessment of the lower limbs’ function of males, who suffered a tear of anterior cruciate ligament with single leg hop tests, it has been identified that indexes of a leg after surgery were lower, compared to a healthy one only during the test of three maximum single leg hop test. Functional indexes of lower limbs for females were the same. 2. According to the... [to full text]

No description available.