Top PDF MRI Evaluation of Anterior Cruciate Ligament Tears with Arthroscopic Correlation.

MRI  Evaluation  of 
Anterior  Cruciate  Ligament  Tears  with  Arthroscopic 
Correlation.

MRI Evaluation of Anterior Cruciate Ligament Tears with Arthroscopic Correlation.

ACL fascicles are organized into functional anteromedial and posterolateral bundles or bands (Girgis et al ) that are named for their location relative to each other at tibial insertion (Resnick, 1995 ). The stronger anteromedial bundle tightens with flexion of the knee and probably resists anterior translation of the tibia in flexion. The posterolateral bundle tightens with knee extension and probably resists hyperextension. The physiologic property where part of the spiraled ACL is taut throughout the normal range of motion of the knee is termed isometry. Graft isometry is one goal of reconstructive surgery.
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EVALUATION OF ARTHROSCOPIC A CRUCIATE LIGAMENT ECONSTRUCTION WITH HAMSTRINGS TENDON GRAFT

EVALUATION OF ARTHROSCOPIC A CRUCIATE LIGAMENT ECONSTRUCTION WITH HAMSTRINGS TENDON GRAFT

Complications of this procedure are an infection, deep vein thrombosis, bleeding, injury to nervous and/vessels, rupture of the graft, swelling, pain and instability, knee stiffness, hamstring-related issues and foreign body reactions due to screws, buttons. Superficial infection was the most common post-operative complication seen in previous studies too [17]. Studies have noted less anterior knee pain with the use of hamstrings compared to bone patella tendon [25,26].

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Original Article A prospective randomized controlled trial to evaluate clinico-radiological outcome of arthroscopic single bundle versus double bundle anterior cruciate ligament reconstruction

Original Article A prospective randomized controlled trial to evaluate clinico-radiological outcome of arthroscopic single bundle versus double bundle anterior cruciate ligament reconstruction

Our study was conducted with a primary aim of comparing the post-operative clinic-radiologi- cal results of SBACLR versus DBACLR. To our knowledge, this is the first clinical prospective trial to compare the clinical outcomes in clinic- radiological perspective. MRI results indicated that the placement of graft of knees showed satisfactory results in both the groups. As men- tioned above, exact positioning of the grafts is essential for optimal clinical outcome [18]. Final radiology results suggest that both gro- ups can reach satisfactory position. Another assessment parameter, GNRB arthrometer showed marginally better results in DBACLR, however statistically significance has not be reached finally. The mean translation in group reconstructed with single bundle was 1.47 mm whereas the mean translation in DB group was found to be 1.07 mm. More collagen in ACL
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Challenges to Use Response Time Standard in Assessing Emergency Medical Services in Iran: A Systematic Review

Challenges to Use Response Time Standard in Assessing Emergency Medical Services in Iran: A Systematic Review

Specificity of clinical examination for ACL tears was less compared to MRI due to the more number of false-positive cases. Out of the 8 false-positive cases, 4 cases were in the age group of 45 - 50 years. There might have been degener- ative changes in the knee leading to false-positive results, as also advocated by Madhusudhan TR et al. (18). In 4 cases of ACL tears we missed the clinical diagnosis, out of these 4 cases 2 cases were of partial tears and 2 cases were of chronic ACL tear. In cases with chronic ACL tear, we found arthroscopically anterior cruciate stumps fibrosis attach- ment with posterior cruciate ligament that might be giv- ing pseudo firm end point on anterior drawer and Lach- mann tests clinically. In the current study, 4 cases of ACL tears were missed on MRI. On MRI, partial tears of ACL may be missed due to the overlying synovial reactions, which have been also suggested by Stanitski CL (19). For ACL and PCL tears, in mass screening and outpatient department basis, clinical examination by experienced hands may be a better or similar tool as compared to MRI (7, 14, 16, 20).
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Diagnostic accuracy of dynamic ultrasound imaging in partial and complete anterior cruciate ligament tears: a retrospective study in 247 patients

Diagnostic accuracy of dynamic ultrasound imaging in partial and complete anterior cruciate ligament tears: a retrospective study in 247 patients

arthroscopic reconstruction. This indicates that it may be hard to differentiate between subtotal ACL tears and complete tears using US. In the case of partial ACL tears, we found that in five out of nine patients who had an actual complete tear in arthroscopy, US exam- ination showed evidence of a subtotal ACL tear rather than a partial tear. This further supports the suggestion of US having difficulties in discriminating subtotal from complete ACL tears. This might be due to the fact that the few remaining fibres do still contract during passive movement used in dynamic US, making these tears appear as partial. These few fibres may be cut through while introducing the scope during arthroscopy, thereby creating a complete ACL tear. As previously described, we considered all subtotal tears as being partial in this study. If we chose to consider subtotal tears as complete tears, this would have improved sensitivity from 79% to 82%, and specificity from 89% to 93%. From a clin- ical perspective, this seems defensible as most patients with a subtotal tear experience knee instability like in a complete tear, requiring an ACL reconstruction.
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A study to evaluate the accuracy of MRI in comparison to knee arthroscopy in diagnosing cruciate ligament tear and meniscal tears in organized sports and physical exercise related knee injuries in armed forces personnel

A study to evaluate the accuracy of MRI in comparison to knee arthroscopy in diagnosing cruciate ligament tear and meniscal tears in organized sports and physical exercise related knee injuries in armed forces personnel

The accuracy of MRI in detection of meniscal and ACL tears is very high. Most of the knee joint pathologies can be detected non-invasively and without causing much discomfort to the patient. Pre-operative MRI in conjunction with adequate history and physical examination can help the clinician to make an accurate diagnosis and can help reduce unnecessary arthroscopic surgeries. The results which we got in present study support the efficacy of MRI in the diagnosis of internal derangements of the knee associated with organized sports and physical training related activities.
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Arthroscopic Reconstruction of Anterior Cruciate Ligament by Hamstring Graft Endobutton vs Rigidfix

Arthroscopic Reconstruction of Anterior Cruciate Ligament by Hamstring Graft Endobutton vs Rigidfix

Demographic and perioperative data were collected from hospital documents. Patients with incomplete medical records, multiligamentous injury or surgery and inaccessibility for final evaluation were excluded. All patients were called to come for final evaluation. We didn’t have knee arthrometer such as KT1000/2000 so knee stability was assessed with clinical examination only. 87 cases (48 endobutton and 39 Rigidfix) were accessible for final evaluation using objective and subjective International Knee Documentation Committee (IKDC) and Lysholm Knee Scores.
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ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION EXPERIENCE AT A TERTIARY CARE HOSPITAL

ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION EXPERIENCE AT A TERTIARY CARE HOSPITAL

This prospective comparative observational study was approved by the ethics committee of the hospital. Informed consent of each patient was obtained. Study related data was collected between January 2018 to June 2019 in Khyber Teaching Hospital Peshawar, Pakisata. Patients with deficient ACL presenting to orthopedic OPD and accident and emergency de- partment underwent arthroscopic ACL reconstruction using hamstring tendon autograft and assessed and monitored for practical result. About 122 patients underwent arthroscopic surgeryof the knee joint. Out of which, 55 patients had their ACL reconstruction surgery done from January 2018 to June 2019. In this prospective, observational study. all the 55 patients were monitored and assessed Patients both the male and female above 18 years of age underwent ACL re- construction surgery were included. Juvenile skeleton, preceding surgery on either of the knee, H/O co-existing fracture and other noteworthy injuries were excluded. The patient’s medical history and assessment findings noted prospectively in a case record form. Detailed medical and radiological assessment was done. The medical evaluation including comprehensive history and clinical assessment including special tests were performed. The patients were asked about duration of symptoms, approach of primary action and restriction of daily life activities. Informed consent taken from the patient. Regular periodic Post op follow up of the pa- tient was done for 6 months. Patient with clinically and radiologically proven torn ACL included in study.In all the patients’ special tests comprising of Lachman test (the most sensitive), pivot test (the most specific) for finding of ACL tear 19 were performed 14-16.
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Large Intra-Articular Anterior Cruciate Ligament Ganglion Cyst, Presenting with Inability to Flex the Knee

Large Intra-Articular Anterior Cruciate Ligament Ganglion Cyst, Presenting with Inability to Flex the Knee

Copyright © 2010 Jake Sloane et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A 41-year-old female presented with a 3-month history of gradually worsening anterior knee pain, swelling and inability to flex the knee. Magnetic resonance imaging (MRI) revealed a large intra-articular cystic swelling anterior to the anterior cruciate ligament (ACL), extending into the Hoffa’s infrapatellar fat pad. Following manipulation under anaesthesia and arthroscopic debridement of the cyst, the patient’s symptoms were relieved with restoration of normal knee motion. ACL ganglion cysts are uncommon intra-articular pathological entities, which are usually asymptomatic and diagnosed incidentally by MRI. This is the first reported case of an ACL cyst being so large as to cause a mechanical block to knee flexion.
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Anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow nucleated cells: a case series

Anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow nucleated cells: a case series

Introduction: This was a prospective case series designed to investigate treatment for anterior cruciate ligament (ACL) tears using an injection of autologous bone marrow concentrate. Methods: Consecutive adult patients presenting to a private outpatient interventional musculo- skeletal and pain practice with knee pain, ACL laxity on exam, and magnetic resonance imaging (MRI) evidence of a grade 1, 2, or 3 ACL tears with less than 1 cm retraction were eligible for this study. Eligible patients were treated with an intraligamentous injection of autologous bone marrow concentrate, using fluoroscopic guidance. Pre- and postprocedural sagittal MRI images of the ACLs were analyzed using ImageJ software to objectively quantify changes between pre- and posttreatment scans. Five different types of measurement of ACL pixel intensity were examined as a proxy for ligament integrity. In addition pain visual analog scale (VAS) and Lower Extremity Functional Scale (LEFS) values were recorded at baseline and at 1 month, 3 months, 6 months, and annually postinjection. Objective outcomes measured were pre- to post-MRI measurement changes, as analyzed by the ImageJ software. Subjective outcomes measured were changes in the VAS and LEFS, and a self-rated percentage improvement.
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Early diagnosis to enable early treatment of pre osteoarthritis

Early diagnosis to enable early treatment of pre osteoarthritis

For the characterization of pre-osteoarthritic clinical cohorts, OCT may complement conventional arthro- scopy and quantitative magnetic resonance imaging (qMRI). A recent review discusses advantages of arthro- scopic OCT for evaluation of subsurface cartilage abnor- malities that may elude conventional arthroscopic surface imaging and MRI [18]. Comparison of OCT with MRI T2 mapping and arthroscopy in human subjects with degenerative meniscal tears revealed that OCT can detect subsurface cartilage degeneration and is a useful translational clinical research tool. While no correlation was found between MRI T2 mapping and arthroscopy, OCT correlated with both techniques [12]. Th is was probably because OCT shared character istics of high resolution with arthroscopy and of cross-sectional quantitative data with MRI T2 mapping. OCT also detected early changes in articular cartilage that otherwise appears normal by gross inspection in bovine osteochondral cores following impact injury [19]. In evaluating the articular cartilage of human subjects following ACL injury, OCT shows microscopic sub- surface changes suggestive of collagen matrix disruption (Figure 2).
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Functional Outcomes for Combined Acute Anterior and Posterior Cruciate Knee Injuries Treated Non Operatively

Functional Outcomes for Combined Acute Anterior and Posterior Cruciate Knee Injuries Treated Non Operatively

Non-operative treatment for combined ACL and PCL tears of the knee was performed on consecutive 13 pa- tients. All patients underwent arthroscopy within 2 weeks after the initial injury. The diagnosis of ligament inju- ries was based upon arthroscopic findings, instability tests under anesthesia, magnetic resonance imaging and stress radiography. Ligament injuries which were complicated with avulsion fracture at the stump-end were ex- cluded. The knees of high energy injuries with neurovascular injuries and/or dislocation which needed reduction procedures were not included [10]. There were no patients of bilateral knee involvement.
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High incidence of subsequent re-operation following treatments for medial meniscus tears combined with anterior cruciate ligament reconstruction: second-look arthroscopic study

High incidence of subsequent re-operation following treatments for medial meniscus tears combined with anterior cruciate ligament reconstruction: second-look arthroscopic study

tear group following ACLR had no obvious symptoms [15]. Tachibana et al. found that 39.5% of patients who were clinically doing well actually had incomplete or un- healed meniscus repairs at 14.3 months after simultaneous meniscus repair and ACLR [16]. Biologic healing status may not be correlated directly with patient-reported out- comes; therefore, it is questionable whether clinically asymptomatic incomplete or unhealed meniscal lesions should be treated or not during the second-look arthros- copy. In the second-look arthroscopic studies to evaluate meniscal healing, subsequent re-operation rates may have depended upon how many asymptomatic incomplete, or asymptomatic failed lesions, are treated surgically. It seems that surgeons are more likely to treat the unhealed meniscal lesions in order to prevent late symptoms, even though the patient may be not symptomatic at the time of the evaluation. These asymptomatic incomplete or un- healed meniscal lesions cannot be detected during clinical assessment; therefore, further surgical management is generally not planned. However, we should bear in mind that asymptomatic incomplete or unhealed lesions can be potential sources of late symptomatic lesions in the mid to long-term follow-up [17]. Considering that subsequent meniscal re-operation occurred with a significantly higher frequency in patients with concomitant meniscal tears at the time of ACL injury compared to patients with ACL in- juries alone, it is important to improve biologic healing of meniscal tears using proper surgical technique, or biologic augmentation, if indicated. In our studies, the rate of re- operation due to failed meniscus repairs was 16%, which is similar to the findings in a recent systematic review reporting clinical failures [3]. All of the failed meniscus re- pairs except one required re-operation, while none of the partially healed lesions underwent re-operation in our studies. Clinical evaluation alone may underestimate asymptomatic meniscal lesions following ACLR. One may argue that second-look arthroscopic evaluation may lead to unnecessary resection of asymptomatic meniscal tears; however, late identification of meniscal tears decreases the chance of meniscus preservation, which leads to ACL graft failures or degenerative arthritis. Therefore, second-look arthroscopic examination had a clinical relevance for early identification of asymptomatic subsequent meniscal tears.
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Anterior arthroscopic-assisted fixation of posterior cruciate ligament avulsion fractures

Anterior arthroscopic-assisted fixation of posterior cruciate ligament avulsion fractures

The diagnosis in all cases was based on history, physical examination and imaging studies. A standard preopera- tive assessment of each case was composed of a clinical examination to define the instability and other associated problems. Routine radiography of the knees showed the fracture. CT scan was also performed to further delineate the bony injury. All the patients were also examined with MRI and arthroscopy to rule out an occult midsubstance injury of the avulsed PCL, ACL injury or injury of the posterior lateral corner. Pre and postoperative posterior instability was determined clinically by performing the posterior drawer test and radiographically by perform- ing posterior drawer stress radiographs. Measurement of the posterior translation with the KT-2000 arthrometer (MEDmetric, San Diego, California) was performed as described by Daniel [13].
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In vivo arthroscopic temperatures: a comparison between 2 types of radiofrequency ablation systems in arthroscopic anterior cruciate ligament reconstruction—a randomized controlled trial

In vivo arthroscopic temperatures: a comparison between 2 types of radiofrequency ablation systems in arthroscopic anterior cruciate ligament reconstruction—a randomized controlled trial

Purpose: To compare a plasma ablation device with a standard ablation device in anterior cruciate ligament (ACL) reconstruction to determine which system is superior in terms of intra-articular heat generation and diathermy ef fi ciency. Methods: This was a prospective, randomized controlled trial. The inclusion criteria were adult patients undergoing primary ACL reconstruction. Patients were randomized preoperatively to the standard ablation group or the plasma ablation group. A thermometer was inserted into the inferior suprapatellar pouch, and the temperature, time, and duration of radiofrequency ablation were measured continually. Results: No significant differences were found between the standard ablation system and the plasma ablation system for maximum temperature (29.77 C and 29.34 C, respec- tively; P ¼ .95), mean temperature (26.16 C and 26.99 C, respectively; P ¼ .44), minimum temperature (22.66 C and 23.94 C, respectively; P ¼ .54), and baseline temperature (26.80 C and 27.93 C, respectively; P ¼ .35). Similarly, no significant differences were found for operative time (82.90 minutes and 80.50 minutes, respectively; P ¼ .72) and mean diathermy activation times (2.6 minutes for both systems; P ¼ .90). The between-system coef fi cient of variation for the measured parameters ranged from 0.12% to 3.69%. No intra-articular readings above the temperature likely to damage chondrocytes were recorded. The mean irrigation fluid temperature had a significant correlation with the maximum temperature reached during the procedure (Spearman rank correlation, r ¼ 0.87; P < .01). Conclusions: No difference in temperature was observed between the standard ablation and plasma ablation probes during ACL reconstruction. Tem- peratures did not exceed critical temperatures associated with chondrocyte death. Level of Evidence: Level I, ran- domized controlled trial.
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Mri study of the “anterolateral ligament of the knee”: appearance, tears  and its association with other internal derangements of the knee

Mri study of the “anterolateral ligament of the knee”: appearance, tears and its association with other internal derangements of the knee

The anatomy of the knee joint is quite complex with numerous structures providing stability. The medial and lateral collateral ligaments, anterior (ACL) and posterior cruciate ligaments, the medial and lateral menisci, medial and lateral patellar retinaculae, along with the shape of femur and tibial condyles play a very important role in keeping the knee joint in its proper alignment. All these ligaments and structures are assessed and routinely reported in every knee MRI study.

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Graft selection in arthroscopic anterior cruciate ligament reconstruction

Graft selection in arthroscopic anterior cruciate ligament reconstruction

Krych et al.’s study showed some heterogeneity between the included studies. The author stated that this was due to the presence of a single study [41] considering the type of preparation and sterilization used for patellar tissue in allograft. These treatments for sterilization with radiation and dehydration with acetone would have, in other words, decreased the efficacy of allograft, producing data against its use, and caused the heterogeneity of results. The evaluation of the outcomes, as defined by the GRADE method, enabled verification that the statistical test used by the author highlighted no significant heterogeneity in relation to the outcomes considered relevant (ex. graft failure). The analysis of sensitivity, based on the inclusion/ exclusion of Gorschewsky et al.’s study, did not substan- tially modify the results, causing only a loss of power that did non allow the results to reach statistical relevance. Results, however, showed a certain superiority of autograft. The panel agreed that the sterilization procedure used in Gorschewsky et al.’s study is to be considered responsible for the lower efficacy of the allograft, but that it is not currently adopted. Therefore, the recommendation defined by the working group did not take into consideration the effects of this procedure on the effectiveness of the intervention.
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Arthroscopic ACL reconstruction with aperture interference fixation: Graft comparison, BPTB versus hamstring tendon- Cohort study with two year follow-up

Arthroscopic ACL reconstruction with aperture interference fixation: Graft comparison, BPTB versus hamstring tendon- Cohort study with two year follow-up

Anterior cruciate ligament (ACL) tear is the most common serious ligamentous injury to the knee joint [1]. Arthroscopic reconstruction of ACL is the worldwide accepted method of treatment with consistently good results. Bone-patellar tendon- bone (BPTB) and the hamstring tendon are the two most commonly used autografts for reconstruction [2-7]. Despite a tremendous amount of research on this topic, choice of graft still remains largely a matter of surgeon’s preference. BPTB autograft has been widely accepted as the gold standard for ACL reconstruction with a high success rate [2]. However hamstring tendon graft has become increasingly popular in last decade [8, 9].
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Anterior cruciate ligament  specialized post operative return to sports (ACL SPORTS) training: a randomized control trial

Anterior cruciate ligament specialized post operative return to sports (ACL SPORTS) training: a randomized control trial

Background: Anterior cruciate ligament reconstruction (ACLR) is standard practice for athletes that wish to return to high-level activities; however functional outcomes after ACLR are poor. Quadriceps strength weakness, abnormal movement patterns and below normal knee function is reported in the months and years after ACLR. Second ACL injuries are common with even worse outcomes than primary ACLR. Modifiable limb-to-limb asymmetries have been identified in individuals who re-injure after primary ACLR, suggesting a neuromuscular training program is needed to improve post-operative outcomes. Pre-operative perturbation training, a neuromuscular training program, has been successful at improving limb symmetry prior to surgery, though benefits are not lasting after surgery. Implementing perturbation training after surgery may be successful in addressing post-operative deficits that contribute to poor functional outcomes and second ACL injury risk.
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ACL graft failure location differs between allografts and autografts

ACL graft failure location differs between allografts and autografts

There are some limitations to this study. Primarily, the retrospective nature of the study limits both the informa- tion available regarding the primary ACL reconstruction (including sterilization technique used for allografts, the surgical technique, and rehabilitation protocol used) as well as the information available at the time of revision re- construction. A prospective study including a careful ana- lysis of graft failure location as well as histologic analysis of remaining graft tissue would be useful in confirming the correlation noted in this study. Additionally, we lacked sufficient data to accurately characterize tunnel locations of the failed ACL reconstructions. It is thus impossible to be certain which patients failed due to a combination of
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