A research report submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Science in Physiotherapy. / The purpose of this retrospective study was to assess the Subjective, objective and functional results of intra-articular anterior cruciate ligament (ACL) reconstructions using the patellar tendon. The subjects of one orthopaedic surgeon were assessed to eliminate surgical variability. Twenty active males, aged 20 - 35 were assessed twelve to fortyeight months post-operatively. Each subject completed a questionnaire and underwent various functional and subjective tests. Eighteen subjects (90 %) were satisfied with the outcome of their operation. Fourteen (70%) complained of intermittent pain or cdscomfort. Six (30%) complained of some form of post-operative giving way. Nineteen (95 %) had returned to sporting activity but most modified their sport or level of participation. Knee stability was restored post-operatively. Nineteen (95%) had a side-to-side difference of three rnillimetres (mm) or less on Lachman testing and eighteen (90 %) a side-to-side difference of 3mm or less on anterior drawer testing. Thirteen (65 %) had a 3mm or less side-to-side difference on KT1000 testing at 20 pounds (lbs) and 14 (70%) a side-to-side difference of 3mm or less on manual maximum testing. Isokinetic muscle testing revealed persistent quadriceps deficits greater than 20 % in seven subjects (35%) and three (15%) had similar hamstring deficits. Various factors may affect post-operative function. These include the length of rehabilitation, pain, residual quadriceps weakness and restoration of stability. / AC 2018

A research report submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Science in Physiotherapy. / The purpose of this retrospective study was to assess the Subjective, objective and functional results of intra-articular anterior cruciate ligament (ACL) reconstructions using the patellar tendon. The subjects of one orthopaedic surgeon were assessed to eliminate surgical variability. Twenty active males, aged 20 - 35 were assessed twelve to forty eight months post-operatively. Each subject completed a questionnaire and underwent various functional and subjective tests. Eighteen subjects (90 %) were satisfied with the outcome of their operation. Fourteen (70%) complained of intermittent pain or discomfort. Six (30%) complained of some form of post-operative giving way. Nineteen (95 %) had returned to sporting activity but most modified their sport or level of participation. Knee stability was restored post-operatively. Nineteen (95%) had a side-to-side difference of three rnillimetres (mm) or less on Lachman testing and eighteen (90 %) a side-to-side difference of 3mm or less on anterior drawer testing. Thirteen (65 %) had a 3mm or less side-to-side difference on KT1000 testing at 20 pounds (lbs) and 14 (70%) a side-to-side difference of 3mm or less on manual maximum testing. Isokinetic muscle testing revealed persistent quadriceps deficits greater than 20 % in seven subjects (35%) and three (15%) had similar hamstring deficits. Various factors may affect post-operative function. These include the length of rehabilitation, pain, residual quadriceps weakness and restoration of stability. / AC2018

Thesis (doctoral)--Ludwig Maximilians-Universität zu München, 1978.

O ligamento cruzado anterior é o ligamento mais lesado dentre os ligamentos do joelho. Apesar de um aprimoramento das técnicas de reconstrução, existe ainda um porcentual de pacientes que apresenta resultado funcional insatisfatório. Possivelmente a causa dessa instabilidade rotatória estaria nas estruturas localizadas na porção anterolateral do joelho, não reconstruídas nas reconstruções intra-articulares isoladas. Uma dessas estruturas seria o ligamento anterolateral, estrutura estudada com detalhes nos últimos anos, ainda com controvérsias em relação a seus parâmetros anatômicos, histológicos e de visualização por ressonância magnética. Neste estudo, foram realizadas dissecções de 112 cadáveres para avaliação dos parâmetros anatômicos e histológicos do ligamento anterolateral, sendo que 13 deles foram submetidos ao exame de ressonância magnética previamente às dissecções. O estudo do ligamento anterolateral por ressonância magnética foi realizado também em 42 pacientes. Como resultados, o ligamento anterolateral foi encontrado com constância na região anterolateral do joelho, com origem próxima ao epicôndilo lateral, trajeto anterodistal em direção à tíbia e inserção na periferia do menisco lateral e na região anterolateral da tíbia, entre o tubérculo de Gerdy e a cabeça da fíbula. Sua análise histológica mostrou a presença de tecido conectivo denso e bem organizado, semelhante a tecido ligamentar. A avaliação por ressonância magnética mostrou parâmetros de origem, inserção e trajeto semelhantes às dissecções anatômicas, embora não sendo possível a visualização completa dessa estrutura em todos os exames. Existiu correlação entre as medidas encontradas nos exames de ressonância magnética e nas dissecções, exceto em relação à espessura do ligamento anterolateral / The anterior cruciate ligament is the most injured ligament of the knee. Despite an improvement in reconstruction techniques, there is still a percentage of patients with poor functional outcome after its reconstruction. Possibly, the cause of this rotational instability would be the structures located in the anterolateral portion of the knee, not addressed in the isolated intra-articular reconstructions. One of such structures would be the anterolateral ligament, a structure studied in detail in recent years, with controversies regarding its anatomical, histological and magnetic resonance imaging parameters. In this study, dissections of 112 cadavers were performed to evaluate anatomical and histological parameters of anterolateral ligament, and 13 of them underwent magnetic resonance imaging examination prior to dissection. The anterolateral ligament study by magnetic resonance imaging was also performed in 42 patients. As a result, the anterolateral ligament was found with constancy in the anterolateral region of the knee, with origin near the lateral epicondyle, antero-distal path towards the tibia and insertion in the periphery of the lateral meniscus and in the anterolateral region of the proximal tibia, between Gerdy\'s tubercle and the fibular head. Its histological analysis showed the presence of dense and well-organized connective tissue, similar to a ligamentous tissue. The magnetic resonance imaging evaluation showed origin, insertion and path parameters similar to the anatomical dissections, although it is not possible to fully visualize this structure in all the magnetic resonance imaging exams. There was a correlation between the measurements found in magnetic resonance imaging scans and dissections, except in relation to the anterolateral ligament thickness

O ligamento cruzado anterior é o ligamento mais lesado dentre os ligamentos do joelho. Apesar de um aprimoramento das técnicas de reconstrução, existe ainda um porcentual de pacientes que apresenta resultado funcional insatisfatório. Possivelmente a causa dessa instabilidade rotatória estaria nas estruturas localizadas na porção anterolateral do joelho, não reconstruídas nas reconstruções intra-articulares isoladas. Uma dessas estruturas seria o ligamento anterolateral, estrutura estudada com detalhes nos últimos anos, ainda com controvérsias em relação a seus parâmetros anatômicos, histológicos e de visualização por ressonância magnética. Neste estudo, foram realizadas dissecções de 112 cadáveres para avaliação dos parâmetros anatômicos e histológicos do ligamento anterolateral, sendo que 13 deles foram submetidos ao exame de ressonância magnética previamente às dissecções. O estudo do ligamento anterolateral por ressonância magnética foi realizado também em 42 pacientes. Como resultados, o ligamento anterolateral foi encontrado com constância na região anterolateral do joelho, com origem próxima ao epicôndilo lateral, trajeto anterodistal em direção à tíbia e inserção na periferia do menisco lateral e na região anterolateral da tíbia, entre o tubérculo de Gerdy e a cabeça da fíbula. Sua análise histológica mostrou a presença de tecido conectivo denso e bem organizado, semelhante a tecido ligamentar. A avaliação por ressonância magnética mostrou parâmetros de origem, inserção e trajeto semelhantes às dissecções anatômicas, embora não sendo possível a visualização completa dessa estrutura em todos os exames. Existiu correlação entre as medidas encontradas nos exames de ressonância magnética e nas dissecções, exceto em relação à espessura do ligamento anterolateral / The anterior cruciate ligament is the most injured ligament of the knee. Despite an improvement in reconstruction techniques, there is still a percentage of patients with poor functional outcome after its reconstruction. Possibly, the cause of this rotational instability would be the structures located in the anterolateral portion of the knee, not addressed in the isolated intra-articular reconstructions. One of such structures would be the anterolateral ligament, a structure studied in detail in recent years, with controversies regarding its anatomical, histological and magnetic resonance imaging parameters. In this study, dissections of 112 cadavers were performed to evaluate anatomical and histological parameters of anterolateral ligament, and 13 of them underwent magnetic resonance imaging examination prior to dissection. The anterolateral ligament study by magnetic resonance imaging was also performed in 42 patients. As a result, the anterolateral ligament was found with constancy in the anterolateral region of the knee, with origin near the lateral epicondyle, antero-distal path towards the tibia and insertion in the periphery of the lateral meniscus and in the anterolateral region of the proximal tibia, between Gerdy\'s tubercle and the fibular head. Its histological analysis showed the presence of dense and well-organized connective tissue, similar to a ligamentous tissue. The magnetic resonance imaging evaluation showed origin, insertion and path parameters similar to the anatomical dissections, although it is not possible to fully visualize this structure in all the magnetic resonance imaging exams. There was a correlation between the measurements found in magnetic resonance imaging scans and dissections, except in relation to the anterolateral ligament thickness