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

ACL injuries are ubiquitous and the literature surrounding ACL reconstructions is complex and difficult to comprehend. In summary, this paper provides a simple yet coherent overview of ACL injuries. Etiology, prevention, and the consequences of injury are discussed. The paper examines literature surrounding the decision to reconstruct the anterior cruciate ligament. An overwhelming quantity of literature is in favor of an ACL reconstruction in order to maintain an active lifestyle. ACL surgery has advanced exponentially in recent years and there is a multitude of fixation and tunneling methods. Graft choice for an ACL reconstruction is also complicated and multifactorial. In general, three types of grafts exist: autografts, allografts, and synthetic grafts. Autografts usually include the hamstring tendon (HT) and patella tendon (BTB), however, recent studies suggest the quadricep tendon (QT) may be a suitable graft. The BTB is often considered the “gold standard” due to its strength and stability. On the other hand, the HT is often used as it is less invasive and is associated with less antero-patellar knee pain. Common allografts include the patella tendon, Achilles tendon, and tibialis muscle group. Despite a higher cost, allografts are usually used in revision surgeries and leave patients with less donor-site morbidity. Lastly, synthetic grafts are growing in popularity, especially the LARS procedure, however, more research is needed. Lastly, this paper attempts to consolidate literature surrounding the QT graft. Only one meta-analysis focusing on the QT has been published, however, the last meta-analysis is from three years ago and several new studies have been published since. The recent literature suggests the QT is a viable option in terms of stability and functional outcomes. Specifically, when comparing the QT to BTB and HT, the QT grades similarity in KT-1000 scores, a common measure of knee laxity and stability. Additionally, IKDC scores, frequently used to assess functionality, show positive results. More literature is needed to fully understand the QT; however, preliminary research indicates the QT can be an esteemed option in ACL reconstruction surgery.

Medical imaging technologies have allowed for in vivo evaluation of the human musculoskeletal system. With advances in both medical imaging and computing, patient-specific model development of anatomic structures is becoming a reality. Three-dimensional surface models are useful for patient-specific measurements and finite element studies. Orthopaedics is closely tied to engineering in the analysis of injury mechanisms, design of implantable medical devices, and potentially in the prediction of injury. However, a disconnection exists between medical imaging and orthopaedic analysis; whereby, the ability to generate three-dimensional models from an imaging dataset is difficult, which has restricted its application to large patient populations. We have compiled image processing, image segmentation, and surface generation tools in a single software package catered specifically to image-based orthopaedic analysis. We have also optimized an automated segmentation technique to allow for high-throughput bone segmentation and developed algorithms that help to automate the cumbersome process of mesh generation in finite element analysis. We apply these tools to evaluate graft placement in anterior cruciate ligament reconstruction in a multicenter study that aims to improve the patient outcomes of those that undergo this procedure.

Submitted by Diogo Misoguti (diogo.misoguti@gmail.com) on 2016-06-24T19:52:09Z No. of bitstreams: 1 2015-12-doutorado-pedro-debieux-vargas-silva.pdf: 2344545 bytes, checksum: 1ecd3c6040fb5757f7f2df3ba6314152 (MD5) / Approved for entry into archive by Diogo Misoguti (diogo.misoguti@gmail.com) on 2016-06-24T19:52:38Z (GMT) No. of bitstreams: 1 2015-12-doutorado-pedro-debieux-vargas-silva.pdf: 2344545 bytes, checksum: 1ecd3c6040fb5757f7f2df3ba6314152 (MD5) / Made available in DSpace on 2016-06-24T19:52:38Z (GMT). No. of bitstreams: 1 2015-12-doutorado-pedro-debieux-vargas-silva.pdf: 2344545 bytes, checksum: 1ecd3c6040fb5757f7f2df3ba6314152 (MD5) Previous issue date: 2015 / Introdução: Esta revisão avalia se os parafusos de interferência bioabsorvíveis podem apresentar melhores resultados do que os parafusos de interferência metálicos quando utilizados para a fixação do enxerto na reconstrução do LCA. Objetivo: Comparar a efetividade dos parafusos de interferência bioabsorvíveis e metálicos para a fixação do enxerto na reconstrução do ligamento cruzado anterior, através de meta-análise. Métodos: Foram pesquisadas as bases de dados: Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, The Cochrane Library, MEDLINE, EMBASE, LILACS, Current Controlled Trials e the World Health Organization Clinical Trials Registry Platform. Ensaios clínicos randomizados e quasi-randomizado comparando parafusos de interferência bioabsorvíveis com metálicos foram incluídos na pesquisa. Os desfechos primários foram função, qualidade de vida, falhas de tratamento e nível de atividade. Ao menos dois autores selecionaram estudos elegíveis e avaliaram de forma independente o risco de viés. Os dados relevantes foram agrupados. Resultados: Onze ensaios envolvendo 981 participantes foram incluídos na revisão. Em relação à função (avaliada pelo Lysholm), quatro ensaios clínicos (220 participantes) não mostraram diferenças entre os dois métodos de fixação com 12 ou 24 meses de seguimento: MD -026, IC 95%, -1,63 a 1,11 e MD 1,10, IC 95% -1,44 a 1,64, respectivamente. Quando realizada a análise de subgrupos do Lysholm, entretanto, foi observada diferença estatística favorável ao parafuso metálico, quando o parafuso bioabsorvível era constituído por Ácido-L-Polilático (PLLA): RR -4,00, 95% CI -7,59 a -0,41. Três estudos com 24 meses (RR 1,00, 95% CI 0,81-1,24) e dois estudos com 12 meses de seguimento (RR 1,01, 95% CI 0,94-1,08) não mostraram diferenças no IKDC. Em relação ao nível de atividade (analisado pelo Tegner), dois estudos (117 participantes) com 12 meses, e três estudos com 24 meses de seguimento não evidenciaram diferenças entre o grupo bioabsorvível e o grupo que usou parafuso de metal: MD 0.08, 95% CI -0,39 a 0,55 e MD 0,41, IC 95% -0,23 a 1,05, respectivamente. Na análise de subgrupos, houve diferença estatística favorável ao parafuso de PLLA: RR 1,27, 95% CI 0,49 a 3,30. Apesar da diferença estatística, em nenhum dos desfechos supracitados observou-se relevância clínica. Em relação às falhas de tratamento, foi demonstrada uma diferença significativa entre os dois métodos de fixação, quando considerada a quebra de implante (RR 7,06, 95% CI 1,31-2,75) e quanto ao risco global de falha do tratamento (RR 1,89, 95% CI 1,31-2,75), tendo o parafuso bioabsorvível mais falhas nestes aspectos. Em oposição, não houve diferença significativa para estabilidade, testes funcionais, derrame articular, re-lesões, infecção, reação de corpo estranho, dor ou limitação de movimento. Conclusão: Não há evidência que demonstre diferença de efetividade entre parafusos de interferência metálicos com relação aos bioabsorvíveis para fixação do enxerto na reconstrução do ligamento cruzado anterior quanto a função, qualidade de vida e o nível de atividade; entretanto, há evidências de que parafusos bioabsorvíveis estão associados a mais falhas de tratamento global e quebra do implante. Os ensaios clínicos randomizados presentes na literatura fornecem evidências de moderada/baixa qualidade. / Introduction: This review assesses whether bioabsorbable interference screws may show better results than metal ones when used for fixing the graft in the reconstruction of the anterior cruciate ligament (ACL). Objective: To compare the effects of bioabsorbable and metal interference screws for fixing the graft in the reconstruction of the anterior cruciate ligament, by metaanalysis. Methods: The following databases were searched: Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, The Cochrane Library, MEDLINE, EMBASE, LILACS, Current Controlled Trials and the World Health Organization International Clinical Trials Registry Platform. Randomized controlled trials and quasi-randomized trials comparing bioabsorbable with metal interference screws were included in the survey. Primary outcome measures were function, quality of life, treatment failures and activity level. At least two authors selected eligible studies and independently assessed the risk of bias. The relevant data were pooled. Results: Eleven trials involving 981 participants were included in the review. Regarding the function (assessed by Lysholm), four trials (220 participants) showed no differences between the two fixation methods with 12 or 24 months of follow-up: MD -026, CI 95% -1.63 - 1.11 and MD 1.10, CI 95% - 1.44 to 1.64, respectively. However, when subgroup analysis using Lysholm score was performed, statistical difference was observed favoring the metal screw when the bioabsorbable screw was comprised of L-polylactic acid (PLLA): RR -4.00, CI 95%, -7.59 - -0.41. Three studies at 24 months (RR 1.00, 95% CI 0.81 to 1.24) and two studies at 12 months follow-up (RR 1.01, 95% CI 0.94 to 1.08) showed no differences the in the IKDC. Regarding the level of activity (analyzed by Tegner activity level scale), two studies (117 participants) at 12 months and three studies at 24 months follow-up showed no differences between the bioabsorbable group and the group using metal screws: MD 0.08, 95 % CI -0.39 to 0.55 and MD 0.41, 95% CI -0,23-1,05 respectively. In the subgroup analysis, a statiscally favorable difference was found for the PLLA screw: RR 1.27, 95% CI 0.49 to 3.30. Despite the statistical differences, none of the above outcomes has presented clinical relevance. With regard to treatment failures, a significant difference was found between the two methods of attachment, when considering the implant breaks (RR 7.06, 95% CI 1.31 to 2.75) and the overall risk of failure (RR 1.89, CI 95% 1.31 to 2.75), with the bioabsorbable screw having more failures in these respects. In contrast, there was no significant difference in stability, functional testing, joint effusion, re-injury, infection, foreign body reaction, pain or limitation of movement. Conclusion: There is no evidence that demonstrates an effective difference between metal and bioabsorbable interference screws for graft fixation in the reconstruction of the anterior cruciate ligament when considering function, quality of life and level of activity. However, there is evidence that bioabsorbable screws are associatewith more failures in the global treatment as well as breaks of the implant. Clinical trials in the literature provide moderate / low quality evidence.

Introdução: Estudos têm mostrado que, pelo menos em jogadores de futebol, a diminuição da amplitude de movimento do quadril homolateral tem uma influência significativa na ocorrência de lesão do LCA, com alta incidência de rerrupturas especialmente após reconstrução em banda simples. Esse estudo objetiva comparar a capacidade de duas técnicas cirúrgicas de prevenir a rerruptura do LCA em jogadores de futebol com a articulação do quadril homolateral limitada (soma de rotação interna e externa <60°). Materiais e Métodos: Esse estudo foi um ensaio clínico randomizado prospectivo. Trinta atletas de futebol do sexo masculino (idade média de 22 anos, variando de 18 a 28 anos), com rupturas por não contato do LCA, foram alocados aleatoriamente em dois grupos. Os critérios de inclusão foram lesão ligamentar isolada do LCA, soma das rotações do quadril homolateral abaixo de 60° e ser jogador de futebol profissional ou semi-profissional. Os critérios de exclusão englobaram dor persistente no quadril ou história de fratura ou cirurgia prévia em qualquer segmento do membro inferior. Um grupo foi submetido à reconstrução combinada intra e extra-articular (GIE), enquanto o outro foi tratado com reconstrução dupla banda com enxertos do semitendinoso e grácil (GDB). Resultados: Nos dois anos de acompanhamento de cada paciente, ocorreram três rerrupturas no GDB contra nenhuma no GIE. Nos 27 atletas com reconstruções intactas, a quantidade de instabilidade residual no exame físico e no Rolimeter® foram os mesmos. Conclusão: Nossos achados mostram que, em dois anos de acompanhamento, a incidência de rerruptura, embora não tenha sido a mesma, não apresentou diferença significativa entre as técnicas de reconstrução intra + extraarticular e dupla banda do LCA em pacientes atletas com articulação do quadril homolateral restrita. / Introduction: Studies have shown that, at least in soccer players, decreased ipsilateral hip range of motion has a significant influence on the occurrence of anterior cruciate ligament (ACL) injury, with a high incidence of re-ruptures especially after single-bundle reconstruction. This study aimed to compare the ability of two surgical techniques to prevent re-rupture of the ACL in soccer players with ipsilateral restricted hip joints (sum of internal and external rotation < 60°). Materials and Methods: The study was a prospective randomized clinical trial. Thirty male soccer players (mean age, 22 years; range, 18-28) with noncontact ACL ruptures were allocated to two groups. Inclusion criteria were isolated ACL injury, ipsilateral hip range of rotation below 60°, and being a professional or semi-professional soccer player. Exclusion criteria were persistent hip pain or history of any fracture or previous surgery of the lower limb. One group underwent a combined intra- plus extra-articular reconstruction (IEG), while the other was treated with double-bundle reconstruction (DBG) with semitendinosus and gracilis grafts. All patients were followed up for two years after surgery. Results: At two-year follow-up of each patient, there were three re-ruptures in the DBG vs. none in the IEG. In the 27 athletes with intact reconstructions, the amount of residual instability in the physical examination and Lachman test was about the same. Conclusion: Our findings demonstrate that, in two years of follow-up, the incidence of rerupture, although not the same, showed no significant difference between intra- plus extraarticular and double-bundle ACL reconstruction techniques in patients with ipsilateral restrained hip joints.

Introdução: Estudos têm mostrado que, pelo menos em jogadores de futebol, a diminuição da amplitude de movimento do quadril homolateral tem uma influência significativa na ocorrência de lesão do LCA, com alta incidência de rerrupturas especialmente após reconstrução em banda simples. Esse estudo objetiva comparar a capacidade de duas técnicas cirúrgicas de prevenir a rerruptura do LCA em jogadores de futebol com a articulação do quadril homolateral limitada (soma de rotação interna e externa <60°). Materiais e Métodos: Esse estudo foi um ensaio clínico randomizado prospectivo. Trinta atletas de futebol do sexo masculino (idade média de 22 anos, variando de 18 a 28 anos), com rupturas por não contato do LCA, foram alocados aleatoriamente em dois grupos. Os critérios de inclusão foram lesão ligamentar isolada do LCA, soma das rotações do quadril homolateral abaixo de 60° e ser jogador de futebol profissional ou semi-profissional. Os critérios de exclusão englobaram dor persistente no quadril ou história de fratura ou cirurgia prévia em qualquer segmento do membro inferior. Um grupo foi submetido à reconstrução combinada intra e extra-articular (GIE), enquanto o outro foi tratado com reconstrução dupla banda com enxertos do semitendinoso e grácil (GDB). Resultados: Nos dois anos de acompanhamento de cada paciente, ocorreram três rerrupturas no GDB contra nenhuma no GIE. Nos 27 atletas com reconstruções intactas, a quantidade de instabilidade residual no exame físico e no Rolimeter® foram os mesmos. Conclusão: Nossos achados mostram que, em dois anos de acompanhamento, a incidência de rerruptura, embora não tenha sido a mesma, não apresentou diferença significativa entre as técnicas de reconstrução intra + extraarticular e dupla banda do LCA em pacientes atletas com articulação do quadril homolateral restrita. / Introduction: Studies have shown that, at least in soccer players, decreased ipsilateral hip range of motion has a significant influence on the occurrence of anterior cruciate ligament (ACL) injury, with a high incidence of re-ruptures especially after single-bundle reconstruction. This study aimed to compare the ability of two surgical techniques to prevent re-rupture of the ACL in soccer players with ipsilateral restricted hip joints (sum of internal and external rotation < 60°). Materials and Methods: The study was a prospective randomized clinical trial. Thirty male soccer players (mean age, 22 years; range, 18-28) with noncontact ACL ruptures were allocated to two groups. Inclusion criteria were isolated ACL injury, ipsilateral hip range of rotation below 60°, and being a professional or semi-professional soccer player. Exclusion criteria were persistent hip pain or history of any fracture or previous surgery of the lower limb. One group underwent a combined intra- plus extra-articular reconstruction (IEG), while the other was treated with double-bundle reconstruction (DBG) with semitendinosus and gracilis grafts. All patients were followed up for two years after surgery. Results: At two-year follow-up of each patient, there were three re-ruptures in the DBG vs. none in the IEG. In the 27 athletes with intact reconstructions, the amount of residual instability in the physical examination and Lachman test was about the same. Conclusion: Our findings demonstrate that, in two years of follow-up, the incidence of rerupture, although not the same, showed no significant difference between intra- plus extraarticular and double-bundle ACL reconstruction techniques in patients with ipsilateral restrained hip joints.

Introdução: Estudos têm mostrado que, pelo menos em jogadores de futebol, a diminuição da amplitude de movimento do quadril homolateral tem uma influência significativa na ocorrência de lesão do LCA, com alta incidência de rerrupturas especialmente após reconstrução em banda simples. Esse estudo objetiva comparar a capacidade de duas técnicas cirúrgicas de prevenir a rerruptura do LCA em jogadores de futebol com a articulação do quadril homolateral limitada (soma de rotação interna e externa <60°). Materiais e Métodos: Esse estudo foi um ensaio clínico randomizado prospectivo. Trinta atletas de futebol do sexo masculino (idade média de 22 anos, variando de 18 a 28 anos), com rupturas por não contato do LCA, foram alocados aleatoriamente em dois grupos. Os critérios de inclusão foram lesão ligamentar isolada do LCA, soma das rotações do quadril homolateral abaixo de 60° e ser jogador de futebol profissional ou semi-profissional. Os critérios de exclusão englobaram dor persistente no quadril ou história de fratura ou cirurgia prévia em qualquer segmento do membro inferior. Um grupo foi submetido à reconstrução combinada intra e extra-articular (GIE), enquanto o outro foi tratado com reconstrução dupla banda com enxertos do semitendinoso e grácil (GDB). Resultados: Nos dois anos de acompanhamento de cada paciente, ocorreram três rerrupturas no GDB contra nenhuma no GIE. Nos 27 atletas com reconstruções intactas, a quantidade de instabilidade residual no exame físico e no Rolimeter® foram os mesmos. Conclusão: Nossos achados mostram que, em dois anos de acompanhamento, a incidência de rerruptura, embora não tenha sido a mesma, não apresentou diferença significativa entre as técnicas de reconstrução intra + extraarticular e dupla banda do LCA em pacientes atletas com articulação do quadril homolateral restrita. / Introduction: Studies have shown that, at least in soccer players, decreased ipsilateral hip range of motion has a significant influence on the occurrence of anterior cruciate ligament (ACL) injury, with a high incidence of re-ruptures especially after single-bundle reconstruction. This study aimed to compare the ability of two surgical techniques to prevent re-rupture of the ACL in soccer players with ipsilateral restricted hip joints (sum of internal and external rotation < 60°). Materials and Methods: The study was a prospective randomized clinical trial. Thirty male soccer players (mean age, 22 years; range, 18-28) with noncontact ACL ruptures were allocated to two groups. Inclusion criteria were isolated ACL injury, ipsilateral hip range of rotation below 60°, and being a professional or semi-professional soccer player. Exclusion criteria were persistent hip pain or history of any fracture or previous surgery of the lower limb. One group underwent a combined intra- plus extra-articular reconstruction (IEG), while the other was treated with double-bundle reconstruction (DBG) with semitendinosus and gracilis grafts. All patients were followed up for two years after surgery. Results: At two-year follow-up of each patient, there were three re-ruptures in the DBG vs. none in the IEG. In the 27 athletes with intact reconstructions, the amount of residual instability in the physical examination and Lachman test was about the same. Conclusion: Our findings demonstrate that, in two years of follow-up, the incidence of rerupture, although not the same, showed no significant difference between intra- plus extraarticular and double-bundle ACL reconstruction techniques in patients with ipsilateral restrained hip joints.

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

No description available.

Zielstellung: Die Ruptur des vorderen Kreuzbandes (VkB) ist die häufigste Ursache einer Lahmheit beim Hund. Im Gegensatz zu der Humanmedizin, wo die anatomische intraartikuläre Rekonstruktion des vorderen Kreuzbandes als Therapie der Wahl gilt, wird die intraartikuläre Rekonstruktion beim Hund nur selten durchgeführt und hat bis jetzt nicht dauerhaften Erfolg. Die anatomische Platzierung der Bohrkanäle ist bei Menschen für den Erfolg der Operation bei Menschen entscheidend. Erstes Ziel der Studie war die Bestimmung der radiologischen Lage des Zentrums des femoralen vorderen Kreuzbandursprungs beim Hund. Zweites Ziel war die Entwicklung und Erprobung eines Zielgerätes für die arthroskopisch-assistierte, anatomische vordere Kreuzbandrekonstruktion beim Hund. Material und Methode: A. Radiologische Studie: Die kraniale Begrenzung des femoralen Ursprungs des vorderen Kreuzbandes (VK) wurde mit einem röntgendichten Draht bei 49 Femora orthopädisch gesunder Hunde (KM > 20 kg) markiert. Anschließend wurde eine Computertomographie und 3D- Rekonstruktion jedes Femurs angerfertigt, anhand derer der Ursprung manuell segmentiert und das Zentrum berechnet wurde. Schließlich wurden, basierend auf den 3D-Modellen, virtuelle Röntgenbilder in zwei Ebenen berechnet. An diesen wurde die Position des berechneten Zentrums mit drei unterschiedlichen Methoden bestimmt (4x4-Gitterbox-Methode und prozentuale Position für die medio-laterale Projektion; Ziffernblattmethode für die disto-proximale Projektion). B. Zielgerät: Hintergliedmaßen (n = 12) von 6 Hundekadavern (KM ≥20 kg) wurden verwendet. Eine Gliedmaße jedes Kadavers wurde zufällig ausgewählt und die kaudo-kraniale Lage des Zentrums des vorderen Kreuzbandansatzes (vKBA) in medio-lateralen Röntgenbildern berechnet und anschließend auf ein justierbares Zielgerät übertragen. Unter arthroskopischer Kontrolle wurde das Zielgerät hinter der lateralen Kondyle eingehakt und ein Steinmann Pin von extra nach intraartikulär platziert. Die Position der resultierenden Bohrkanäle wurde sowohl röntgenologisch bestimmt als auch dreidimensional mit dem anatomischen Zentrum des vKBA der kontralateralen Hintergliedmaßen verglichen. Ergebnisse: A. Radiologische Studie: In der medio-lateralen Projektion befand sich das Zentrum des femoralen Kreuzbandursprungs im zweiten Rechteck von proximal in der kaudalen Spalte. Die mittlere prozentuale kaudo-kraniale und proximo-distale Position war 20,2 % (± 2,2), beziehungsweise 33,8% (± 3,7). Im disto-proximalen Röntgenbild lag in 97,6 % der Femora das Zentrum des femoralen Kreuzbandursprungs zwischen 14:00 und 15:00 Uhr. B. Zielgerät: In allen postoperativen Röntgenaufnahmen lagen die sechs Bohrkanäle im bzw. nahe dem Zentrum des vKBA. Die 3D- Messungen ergaben eine mediane Abweichung der Bohrkanalposition im Vergleich zum anatomischen Zentrum der kontralateralen Seite von 0,6 mm (Bereich:0,2– 0,9 mm). Schlussfolgerung: Die erarbeiteten Referenzwerte können für die Planung sowie die intra- und postoperative Kontrolle der femoralen Bohrung verwendet werden. Die Verwendung eines justierbaren Zielgerätes ermöglicht die präzise anatomische Platzierung des femoralen Bohrkanals für die intraartikuläre Rekonstruktion des vorderen Kreuzbandes. Die beschriebene Methode wird helfen, eine Fehlplatzierung des femoralen Bohrkanals im Zuge der intraartikulären vorderen Kreuzbandplastik zu reduzieren. In Kombination mit dem bereits beschriebenen tibialen Zielgerät sind nun die technischen Voraussetzungen für die arthroskopisch-assistierte anatomische vordere Kreuzbandplastik in der Tiermedizin gegeben. / Objective: Cranial cruciate ligament (CrCL) pathology is the most frequent cause of lameness in dogs. In contrast to human medicine, where anatomic reconstruction of the ACL is considered the treatment of choice, intra-articular repair in dogs is not commonly performed and until now has not met with enduring success. Accurate tunnel placement has been shown to be crucial in obtaining a successful outcome after anterior cruciate ligament reconstruction in humans. The first aim of our study was to define the radiographic location of the center of the femoral attachment of the CrCL in dogs, for the pre- operative planning as well as post-operative control of anatomical placement of the femoral tunnel. Second aim of the study was to develop and validate an aiming device for arthroscopic femoral tunnel placement. Materials and Methods: A. Radiographic study: Using femora from 49 adult, orthopedically sound dogs (BW ≥ 20 kg), a radiopaque marker was placed on the cranial border of the femoral footprint of the CrCL. Computed tomography and 3D reconstruction of each femur was performed subsequently, followed by manual segmentation of the footprint on the 3D models and calculation of its center. Finally, virtual digital radiographs in two planes were produced and the location of the calculated center of the CrCL was expressed using three different methods (4x4 box grid method and percentage position for the medio-lateral projection; o’clock position for the disto-proximal projection). B. Aiming device: Hindlimbs (n=12) of 6 cadaveric dogs weighing ≥20 kg were used. One hindlimb from each cadaver was randomly chosen and the caudo- cranial position of the CrCL center was calculated, on standard medio-lateral stifle radiographs, and transferred onto to an adjustable aiming device. During stifle arthroscopy the aiming device was inserted and guide pin placed from extra-to-intra-articular. The position of the resulting bone tunnel was evaluated on stifle radiographs and also compared with the anatomic center of each contralateral hindlimb, in the three dimensional (3D) space. Results: A. Radiographic study: In the medio-lateral radiographs the center of the femoral footprint was consistently located in the second rectangle from the top of the most caudal column of the 4x4 grid. The mean percentage caudo- cranial and proximo-distal location was 20.2% (± 2.2) and 33.8% (± 3.7), respectively. In the disto-proximal radiograph, the o’clock position of the CrCL center was between 2 and 3 o’clock in 97.6% of the femora. B. Aiming device: According to the postoperative radiographs, the location of all 6 intra-articular tunnel openings was consistent with the results of the radiographic study. In 3D space, arthroscopic femoral drilling resulted in a median deviation of the drill tunnels of 0.6 mm around the CrCL center. All tunnel openings were located within the CrCL insertion. Conclusions: The reported data can be used to plan and verify the placement of the femoral tunnel opening during intra-articular anatomic CrCL repair. The use of the aiming device suggests that arthroscopic femoral tunnel placement can be achieved with high precision. The measurement for the device can be derived from a standard medio-lateral radiograph of the stifle, which is part of the diagnostic work up of every dog with lameness localized in the stifle. The proposed technique may reduce femoral tunnel misplacement when performing intra-articular CrCL repair in dogs. In combination with the described technique for arthroscopic tibial tunnel drilling, arthroscopic assisted anatomic reconstruction of the CrCL in dogs can be achieved.