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  • 11
    Electronic Resource
    Electronic Resource
    Bone tunnel enlargement after anterior cruciate ligament reconstruction: fact or fiction? (1998)
    Springer
    Knee surgery, sports traumatology, arthroscopy 6 (1998), S. 231-240 
    Details
    ISSN: 1433-7347
    Keywords: Key words Bone tunnel ; enlargement ; ACL reconstruction ; Inflammation ; Graft-tunnel motion ; Radiographic evaluation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract Radiographic enlargement of bone tunnels following anterior cruciate ligament (ACL) reconstruction has been recently introduced in the literature; however, the etiology and clinical relevance of this phenomenon remain unclear. While early reports suggested that bone tunnel enlargement is mainly the result of an immune response to allograft tissue, more recent studies imply that other biological as well as mechanical factors play a more important role. Biological factors associated with tunnel enlargement include foreign-body immune response (against allografts), non-specific inflammatory response (as in osteolysis around total joint implants), cell necrosis due to toxic products in the tunnel (ethylene oxide, metal), and heat necrosis as a response to drilling (natural course). Mechanical factors contributing to tunnel enlargement include stress deprivation of bone within the tunnel wall, graft-tunnel motion, improper tunnel placement, and aggressive rehabilitation. Graft-tunnel motion refers to longitudinal and transverse motion of the graft within the bone tunnel and can occur with various graft types and fixation techniques. Aggressive rehabilitation programmes may contribute to tunnel enlargement as the graft-bone interface is subjected to early stress before biological incorporation is complete. Further basic research is required to verify the effect of the various proposed factors on the etiology of bone tunnel enlargement. We recommend that routine follow-up examinations after ACL reconstruction should include the measurement of bone tunnel size in order to contribute to a better understanding of the incidence, time course, and clinical relevance of this phenomenon. Improved and more anatomical surgical fixation techniques may be useful for the prevention of bone tunnel enlargement.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001670050105
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  • 12
    Electronic Resource
    Electronic Resource
    Proprioception in the posterior cruciate ligament deficient knee (1999)
    Springer
    Knee surgery, sports traumatology, arthroscopy 7 (1999), S. 310-317 
    Details
    ISSN: 1433-7347
    Keywords: Key words Posterior cruciate ; ligament ; Proprioception ; Ligament ; Knee
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract This study was undertaken to evaluate knee proprioception in patients with isolated unilateral posterior cruciate ligament (PCL) injuries. Eighteen subjects with isolated PCL tears were studied 1–234 months after injury. The threshold to detect passive motion (TTDPM) was used to evaluate kinesthesia and the ability to passively reproduce passive positioning (RPP) to test joint position sense. Two starting positions were tested in all knees: 45 ° (middle range) and 110 ° (end range) to evaluate knee proprioception when the PCL is under different amounts of tension. TTDPM and RPP were tested as the knee moved into flexion and extension from both starting positions. A statistically significant reduction in TTDPM was identified in PCL-injured knees tested from the 45 ° starting position, moving into flexion and extension. RPP was statistically better in the PCL-deficient knee as tested from 110 ° moving into flexion and extension. No difference was identified in the TTDPM starting at 110 ° or in RPP with the presented angle at 45 ° moving into flexion or extension. These subtle but statistically significant findings suggest that proprioceptive mechanoreceptors may play a clinical role in PCL-intact and PCL-deficient patients. Further, it appears that kinesthesia and joint position sense may function through different mechanisms.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001670050169
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  • 13
    Electronic Resource
    Electronic Resource
    Effect of knee flexion on the in situ force distribution in the human anterior cruciate ligament (1995)
    Springer
    Knee surgery, sports traumatology, arthroscopy 3 (1995), S. 9-13 
    Details
    ISSN: 1433-7347
    Keywords: Anterior cruciate ligament ; Knee joint ; Biomechanics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract This study was conducted to evaluate the effect of applied load on the magnitude, direction, and point of tibial intersection of the in situ forces of the anteromedial (AM) and posterolateral (PL) bands of the human anterior cruciate ligament (ACL) at 30° and 90° of knee flexion. An Instron was used to apply a 100 N anterior shear force to 11 human cadaver knees, 6 at 30° of knee flexion and 5 at 90° of knee flexion. A Universal Force Sensor (UFS) recorded the resultant 6 degree-of freedom (DOF) forces/moments. Each specimen then underwent serial removal of the AM and PL bands. With the knee limited to 1 DOF (anteroposterior), tests were performed before and after each structure was removed. Because the path was identical in each test, the principle of superposition was applied. Thus, the difference between the resultant forces could be attributed to the force carried by the structure just removed. The magnitudes of force in the ACL at 30° and 90° of knee flexion were 114.1±7.4 N and 90.8±8.3 N, respectively (P〈0.05). At 30°, the AM and PL bundles carried 95% and 4% of the total ACL force, respectively. At 90°, the AM and PL bands carried 85% and 13%, respectively (P〈0.05). The direction of the in situ force in the whole ACL as well as its two bands correlated with the anatomic orientation of the ligament. The resultant total ACL force intersected the tibial plateau at the posterolateral aspect of the AM band's insertion at 30° of knee flexion, while at 90°, the force intersection moved posteriorly to the AM/PL border. This research provides new insight into the fundamental force relationships of the ACL and its bundles. In response to an anterior tibial shear force, the AM band of the ACL was the predominant load carrier at both 30° and 90° of knee flexion. However, contrary to carlier reports, the in situ force carried in the PL band increased as knee flexion increased. Further, the tibial intersection of the resultant ACL force moved laterally with knee flexion. These findings confirm the dynamic structure of the ACL that in itself has no isometricity and may also indicate that there is no ideal location in which to position a replacement graft. The use of this methodology with more physiologically unconstrained motion should lead to more definitive clinical conclusions.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01553518
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  • 14
    Electronic Resource
    Electronic Resource
    The Bankart lesion of the shoulder: A biomechanical analysis following repair (1995)
    Springer
    Knee surgery, sports traumatology, arthroscopy 3 (1995), S. 117-120 
    Details
    ISSN: 1433-7347
    Keywords: Bankart lesion ; Shoulder biomechanics ; Shoulder instability
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract The Bankart lesion of the shoulder has long been associated with anterior instability. Our laboratory has developed a biomechanical model of the human shoulder which was used to determine the effects of creating a Bankart lesion on cadaveric specimens and then to compare the effects of two repair techniques. The model simulates the abducted, externally rotated position of the glenohumeral joint and uses pneumatic cylinders to simulate the rotator cuff forces. Specimens were tested intact following a partial Bankart lesion, following a complete Bankart lesion, and after performing a Bankart repair using three Mitek suture anchors. Finally, both the traditional and Mitek repairs were tested until failure. Strain in the inferior glenohumeral ligament (IGHL) and torque resistance was measured as an indication of instability of the joint. Strain was noted to decrease with increasing depth of lesion of the IGHL. Torsional rigidity of the shoulder decreased with increasing depth of lesion as well. Repairing the shoulder restores the strain and rigidity to control conditions. The mean load until failure was greater with the traditional repair than with the suture anchor technique. This study quantitates the effects of a Bankart lesion of the shoulder, and demonstrates that repairing the lesion with a suture anchor technique restores the biomechanics of the shoulder.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01552387
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  • 15
    Electronic Resource
    Electronic Resource
    Peroneal nerve palsy following knee dislocation: pathoanatomy and implications for treatment (2000)
    Springer
    Knee surgery, sports traumatology, arthroscopy 8 (2000), S. 163-165 
    Details
    ISSN: 1433-7347
    Keywords: Keywords Peroneal nerve palsy ; Knee dislocation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract Peroneal nerve palsy following knee dislocation is a serious problem, and neurolysis at the time of knee reconstruction does not always result in return of peroneal nerve function. We describe peroneal nerve pathoanatomy in three patients in whom late exploration of the peroneal nerve was performed because of ongoing absence of ankle dorsiflexion. We identified frank nerve rupture in two patients and a lengthy neuroma in continuity in one which extended far proximal to the fibular head and well above the previous surgical incision used for peroneal nerve neurolysis at the time of knee reconstruction. In light of the current state of microneural surgery and the potential to reconstruct nerve defects, we discuss how our findings impact on treatment, and provide recommendations which may improve recovery of peroneal nerve function in future cases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001670050208
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