The document discusses anterior cruciate ligament (ACL) repair, including a comparison of single bundle versus double bundle ACL reconstruction techniques. It provides details on ACL anatomy, biomechanics, injury mechanisms, treatment options, and surgical procedures. It also reviews findings from journal articles regarding clinical outcomes of single versus double bundle reconstruction.
Pemberton's Osteotomy for Acetabular DysplasiaLibin Thomas
This is a slideshow based on the journal- JBJS- ESSENTIAL SURGICAL TECHNIQUES, INDIAN EDITION, OCTOBER 2015, VOL.4, NO. 3, SPECIAL EDITION by Shier- Chieg, Huang, MD, PhD, Ting- Ming Wang, MD, PhD, Kuan- Wen Wu, MD, Ken N. Kuo, MD
Arthroscopic ACL Reconstruction By Dr Shekhar ShrivastavDelhiArthroscopy
Arthroscopic Acl Reconstruction By Dr Shekhar Shrivastav.
HOW NORMAL KNEE WORKS ?
The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thigh bone(femur), the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur. Four bands of tissue, the anterior and posterior cruciate ligaments, and the medial and lateral collateral ligaments connect the femur and the tibia and provide joint stability. The surfaces where the femur, tibia and patella touch are covered with articular cartilage, a smooth substance that cushions the bones and enables them to glide freely. Semicircular rings of tough fibrous-cartilage tissue called the lateral and medial menisci act as shock absorbers and stabilizers.
WHAT IS THE ROLE OF ACL ?
ACL along with other ligaments of the knee joint and meniscus provides stability to the knee joint.
WHAT IS LIGAMENT RECONSTRUCTION ( ACL ) ?
Ligament reconstruction involves replacing the torn ligament with a tendon (graft) from your knee and fixing the graft in place with screws. This procedure is performed with the use of the arthroscope. The anterior cruciate ligament (ACL) is the most common ligament requiring reconstruction procedures. The torn ligament is excised arthroscopically and new ligament is prepared by ligament grafts taken from your own body. Bony tunnels are prepared in femur and tibia using specialized instruments through which the new ligament is passed and fixed with special screws. This procedure requires relative rest or leave from your work or studies for about 2-3 weeks after which you will be allowed normal day to day activities.
WHEN CAN THE PATIENT BE AMBULATED AFTER SURGERY ?
The patient can walk from the same evening of the surgery. Initially the patient is advised to walk with a brace and a walking cane. Strengthening and range of motion exercises for the knee are started from the next day. The patient is discharged from the hospital 2nd or 3rd day after surgery. The patient can walk without support by 10-14 days depending on muscle strengthening. Slow Jogging and other strenuous activities are permitted after 3 months and the patient can return to active sports only 8-9 months after surgery.
Torn ACL Reconstructed ACL
For Further Queries contact your Orthopedic Surgeon at
+ 91 9971192233
Update on ACL reconstruction, with information on current direction of demineralized bone matrix (DBM) use in bone tunnels and biocartilage on chondral lesions
Pemberton's Osteotomy for Acetabular DysplasiaLibin Thomas
This is a slideshow based on the journal- JBJS- ESSENTIAL SURGICAL TECHNIQUES, INDIAN EDITION, OCTOBER 2015, VOL.4, NO. 3, SPECIAL EDITION by Shier- Chieg, Huang, MD, PhD, Ting- Ming Wang, MD, PhD, Kuan- Wen Wu, MD, Ken N. Kuo, MD
Arthroscopic ACL Reconstruction By Dr Shekhar ShrivastavDelhiArthroscopy
Arthroscopic Acl Reconstruction By Dr Shekhar Shrivastav.
HOW NORMAL KNEE WORKS ?
The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thigh bone(femur), the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur. Four bands of tissue, the anterior and posterior cruciate ligaments, and the medial and lateral collateral ligaments connect the femur and the tibia and provide joint stability. The surfaces where the femur, tibia and patella touch are covered with articular cartilage, a smooth substance that cushions the bones and enables them to glide freely. Semicircular rings of tough fibrous-cartilage tissue called the lateral and medial menisci act as shock absorbers and stabilizers.
WHAT IS THE ROLE OF ACL ?
ACL along with other ligaments of the knee joint and meniscus provides stability to the knee joint.
WHAT IS LIGAMENT RECONSTRUCTION ( ACL ) ?
Ligament reconstruction involves replacing the torn ligament with a tendon (graft) from your knee and fixing the graft in place with screws. This procedure is performed with the use of the arthroscope. The anterior cruciate ligament (ACL) is the most common ligament requiring reconstruction procedures. The torn ligament is excised arthroscopically and new ligament is prepared by ligament grafts taken from your own body. Bony tunnels are prepared in femur and tibia using specialized instruments through which the new ligament is passed and fixed with special screws. This procedure requires relative rest or leave from your work or studies for about 2-3 weeks after which you will be allowed normal day to day activities.
WHEN CAN THE PATIENT BE AMBULATED AFTER SURGERY ?
The patient can walk from the same evening of the surgery. Initially the patient is advised to walk with a brace and a walking cane. Strengthening and range of motion exercises for the knee are started from the next day. The patient is discharged from the hospital 2nd or 3rd day after surgery. The patient can walk without support by 10-14 days depending on muscle strengthening. Slow Jogging and other strenuous activities are permitted after 3 months and the patient can return to active sports only 8-9 months after surgery.
Torn ACL Reconstructed ACL
For Further Queries contact your Orthopedic Surgeon at
+ 91 9971192233
Update on ACL reconstruction, with information on current direction of demineralized bone matrix (DBM) use in bone tunnels and biocartilage on chondral lesions
Evolution of tunnel placement in ACL reconstructionDhananjaya Sabat
One of my talks at Delhi Arthroscopy Club....... this presentation provides a insight regarding the conceptual evolution in tunnel placement during ACL reconstruction.
Access Control Lists are a tool that allows us to map permissions to objects - within Zend_Acl this maps to a hierarchical arrangement of roles and resources.
This talk will follow through the basic use of Zend_Acl and steadily build a series of practical examples to illustrate the different methods of creating and enforcing an ACL for an application. This will include how to implement some of the more complicated hierarchical relationships and advanced conditions through the use of assertions. We will also cover the design considerations of where to attach the ACL, with the differences between applying it to controllers or models. With a functioning ACL in place, we will examine some of the methods for persisting the list and whether that list should be static or dynamic.
Alongside the straight functionality of our code, we will also examine how to effectively unit test it, improving its performance and analysing the level of security that has been created.
Acl Reconstruction Surgery In Delhi Dr. Shekhar Srivastav 09971192233DelhiArthroscopy
ACL Reconstruction Surgery in Delhi by Dr. Shekhar Srivastav - Dr. Shekhar Srivastav is an Orthopedic Surgeon attached to Sant Parmanand Hospital, Delhi with special interest in Knee & Shoulder surgery. After obtaining his M.S. Orthopedics degree he has undergone training in various centers in India and Abroad which has helped him in understanding the Orthopedics problems and their Management. He did his AO/ ASIF fellowship at University Hospital, Salzburg, Austria in 2006 and recieved training in Arthroscopy & Sports Medicine at TUM, Munich (Germany) & Rush Orthopedics Centre, Chicago( USA). He has an experience of more than fifteen years of diagnosing and treating Orthopedics & Trauma patients.
Check Out Details at http://www.delhiarthroscopy.com
General talk about Anterior Cruciate Ligament tear.
it presented during my orthopedic rotation in KFUH.
under supervision of Dr. Balwi "sport injuries consultant"
Can read freely here
https://sethiortho.blogspot.com/
Examination of Knee Joint Ligaments
SethiNet Presentations
Introduction
Proper use of the examination techniques requires
An understanding of the anatomy
Pathophysiology of knee ligament injuries
Advanced imaging - Augment a history and examination when necessary
Imaging should not replace a thorough history and physical examination
History taking
A description of the mechanism of injury
The patient should be queried about previous injuries
The current injury may be the sequela of a previous injury
Common ligament Injuries
Anterior Cruciate Ligament
Anatomy
The ACL originates at posteromedial aspect of the lateral femoral condyle
Wide tibial insertion at the lateral aspect of the anterior tibial spine
The ACL has two fiber bundles
The anteromedial
Posterolateral bundles
Which provide varying tension from flexion through extension
Functions
Primary restraint against anterior tibial translation
Provides rotational stability, especially in extension
ACL - Mechanism of Injury
Injury to the knee ligaments is typically the result of
A non contact change in direction
Twisting injury
Landing from a jump.
The patient often describes a “pop” that is felt or heard at injury
The appearance of swelling (hemarthrosis) within a few hours
ACL -Examinations
Examinations
The Anterior drawer test
The Lachman Test
The Pivot Shift Test
Novel Tests
ACL - Anterior drawer test
Patient with patient supine position
The hip flexed at 45° / knee flexed at 90°
The foot is fixed to the table - often by sitting on it
The clinician applies an anterior force to the proximal tibia, palpating the joint line for anterior translation.
Increased anterior translation indicates ACL insufficiency.
Sensitivity – only 50% with the patient under anesthesia
because the posterior horn of the medial meniscus may act as a so-called doorstop that prevents anterior translation, even in the presence of a torn ACL.
ACL - Lachman Test
It was designed to overcome three identified limitations of the anterior drawer test
Acute effusion that often precludes flexion to 90°
Protective spasm of the hamstring muscles that can prevent anterior translation of the tibia
The articulation of the relatively acute convexity of the posterior medial femoral condyle and the posterior horn of the medial meniscus that buttresses and prevents anterior translation of the tibia.
These limitations can lead to false-negative findings
The Lachman test is typically done with the knee flexed 20° to 30°.
The examiner places one hand laterally on the patient’s thigh to stabilize the femur
while the other hand grasps the proximal and more subcutaneous medial tibia and applies anterior stres
The test is positive
In the presence of anterior translation
A soft or mushy end point.
When the ACL is intact, the end point is hard
ACL - Grading - Lachman test
This is the Presentation on the topic "Pathomechanics of Knee Joint".
The presentation includes images and a clip for proper understanding. The sentences are framed in the way that you can learn it in a easy way.
Similar to acl arthroscopic reconstruction single bundle vs double bundle (20)
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
acl arthroscopic reconstruction single bundle vs double bundle
1. ARTHROSCOPIC ANTERIOR CRUCIATE
LIGAMENT REPAIR
SINGLE BUNDLE VS DOUBLE BUNDLE
Presenter : Dr Abhishek Chaudhary (DNB ortho
resident at SGITO)
Moderator: Dr Madan Ballal (professor and head
of dept of sports medicine)
2. Applied Anatomy
Biomechanics
ACL tear
Available treatment options
Surgical procedures-single and double
bundle
Journals discussion-single bundle vs double
bundle
Final conclusion
3. - length of 38 mm (range 25 -41 mm)
- width of 10 mm (range 7 -12 mm)
- made up of multiple collagen fascicles;
- surrounded by an endotendineum
- microspocially: interlacing fibrils (150 to 250 nm in diameter
- grouped into fibers (1 to 20 um in diameter)
- synovial membrane envelvope
- innervation:
- receives its innervation from tibal nerve;
- infiltrates the capsule posteriorly;
- golgi tendon receptors;
- blood supply:
- major blood supply: from middle genicular artery
- bony attachments do not provide a significant source of
blood to distal or proximal ligaments;
4. Femoral attachment:
ACL arises from the posteromedial corner of medial aspect of
lateral femoral condyle in the intercondylar notch;
attachment is actually an interdigitation of collagen fibers &
rigid bone thru transitional zone of fibrocartilage and
mineralized fibrocartilage;
femoral attachment of ACL is on posterior part of medial surface
of lateral condyle well posterior to longitudinal axis of the
femoral shaft;
Tibial attachment:
tibial attachment is in a fossa in front of & lateral to anterior
spine, a rather wide area from 11 mm in width to 17 mm in AP
direction;
anterior fibers go forward to level of transverse meniscal
ligament;
inserts into the interspinous area of the tibia;
5.
6.
7.
8.
9.
10.
11.
12. Anterior & Posterior Bundles:
ACL is composed of two principal parts: small anteromedial band
and a larger bulky posterolateral portion;
anteromedial bundle is tight in flexion and the posterolateral
bundle is tight in extension;
extension: both bundles are parallel;
flexion:
femoral insertion site of the posterolateral bundle moves
anteriorly
- both bundles are crossed
- anteromedial bundle tightens and
posterolateral bundle loosens
13.
14. - represents posterior directly directed fibers w/ its attachment just lateral
to midline of the intercondylar eminence and slightly lateral to most lateral
attachement of the intermediate bundle;
- unlike the antermedial portion, the bulkier posterolateral bundle is not
isometric.
- interruption of posterolateral bundle of ACL increases external
rotation recurvatum test of posterolateral after anteromedial and intermediate
bundles are divided;
- - w/ knee extended, resistance to the anterior drawer test is by posterolateral
bulky portion;
- it limits anterior translation, hyperextension, and rotation;
- oblique position of the posterolateral bundle provides more
rotational control than is provided by the anteromedial bundle, which is in a
more axial position;
- hyperextension and internal rotation place the posterolateral bundle
at greater risk for injury;
- rupture cause increases in hyperextension, anterior translation
(extended knee), increase in external and internal rotation (knee extended),
and increases in external rotation with the knee in mid flexion;
15. anteromedial bundle:
- femoral insertion of the anteromedial bundle is the center
of rotation of ACL
- anteromedial bundle has isometric behavior;
- is more prone to injury with the knee in flexion
- anteromedial bundle inserts on the medial aspect of the
intercondylar eminence of the tibia and forms the medial corner of
the triangle;
- anteromedial band is primary check against anterior
translation of tibia on femur when anterior drawer test is performed
in usual manner w/ knee flexed;
- cutting this ligament may produce anterolateral
instability;
- limits anterior translation of the tibia on the femur with
the knee in flexion (which requires isometric behavior);
- rupture may cause in an increase in anterior translation in
flexion, minimal increase in hyperextension, and minimal rotational
instability;
- intermediate bundle:
- cutting this ligament produces straight anterior instability;
- when anteromedial band of the ligament is torn,
posterolateral bulk of ligament may remain intact & anterior drawer
sign will be present but surgeon will
have impression that ligament is not torn;
16. accounting for approximately 85% of the
resistance to the anterior drawer test when the
knee is at 90 degrees of flexion and neutral
rotation.
Tension in the anterior cruciate ligament is least
at 30 to 40 degrees of knee flexion. The anterior
cruciate ligament also functions as a secondary
restraint on tibial rotation and varus valgus
angulation at full extension.
proprioceptive function
17. - ultimate tensile load: 2160 ± 157 N
Or simply we can suspend (2160/9.81=220kg) on the strongest
acl before it breaks.
- stiffness:(force to deform it permanenty)- 242 ± 28 N/mm;
- passive knee extension produces forces along ACL only
during last 10 degrees of knee extension;
- hyper-extension:
- the posterolateral bundle of the ACL is tight in
extension;
- at 5 degrees of hyperextension, anterior cruciate
ligament forces range between 50 and 240 newtons;
- hyperextension of the knee develops much higher
forces in ACL than in the PCL;
- flexion:;
- during isometric quadriceps contraction, ACL strain at
30 deg of knee flexion are significantly higher than at 90 deg
where ligament remain unstrained
with isometric quadriceps activity;
- active extension of knee between the limits of 50 and
110 degrees does not strain the anterior cruciate;
- at 90 deg of knee flexion:
- ACL accounts for approx 85% of resistance to anteior
drawer test
18. Sectioning of ACL:
- in unsectioned ACLs in neutral rotation, application of
100 newtons of anterior force produces:
- 2-5 mm of anterior translation at full extension;
- 5-8 mm of translation at 30 deg of flexion;
- as flexion angle increases further, anterior
translation decreases;
- sectioning of ACL results in increased laxity at all flexion
angles;
- 20-30 deg of flexion:
- maximum anterior translation occurs w/ 100-
newton anterior force, 7-9 mm of increased translation is
seen;
- clinically, combined ACL and MCL tears result in large
increases in anterior translation;
- following sectioning of the ACL: anterior restraint derives
from:
- iliotibial band: 24%
- mid medial capsule: 22%
- mid lateral capsule: 20%
- MCL:16%
- LCL: 12%
19. Functional Role:
- ACL is the predominant restraint to anterior tibial
displacement;
- ligament accepts 75 % of anterior force at full extension &
approx 85 % at 30 and 90 degrees of flexion;
- deep MCL is a major secondary restraint to anterior
translation;
role in gait: (gait menu and role of knee in locomotion)
- ACL is taut in full knee extension, and tends to
externally rotate tibia;
- tension in ACL is least at 40 to 50 deg of knee
flexion;
- as knee moves from flexion to extension, shorter,
more highly curved lateral condyle exhausts its articular
surface & is checked by ACL;
- larger and less curved medial condyle continues its
forward roll and skids backward, assisted by tightening of PCL;
- towards full extension there is lateral rotation of tibia
& joint is "screwed home;"
consequences of ACL deficient knee
- absence of the normal internal rotation of the
femur during the terminal swing phase
20. Isometry:
- anterior cruciate ligament does not
remain an isometric, or constant length,
structure as the knee is flexed and extended;
- ligament increases in strain magnitude as
the lower leg is passively extended, with the
femur in a horizontal plane;
- reconstruction of the ACL should not
strive to achieve an isometric placement of
the graft, but rather reproduce strain
behavior of the normal ACL
21. Incidence –unknown but estimates It is estimated that
the annual incidence of ACL injury is about 1 in 3,000
amongst the general population in the USA.
Mechanism of injury: non contact inj such as
noncontact deceleration, jumping, or cutting action
accounts for 70 % of ACL tears.
Contact injury (external forces)-30 % of ACL tears
Immidiate Symptoms:-pain swelling,inabilty to walk
normaly or at all ,a pop sound on hyperextention .
Late symptoms: feeling of instability, joint giving up or
leg falling out of knee joint these symptoms increases
on walking down the stairs and when patient is trying
to run
22. Signs..knee effusion (haemarthrosis)
The Lachman test is the most sensitive test for anterior
tibial displacement (95% sensitivity)
Increased excursion relative to the opposite knee and
absence of a firm end point suggest an injury to the
anterior cruciate ligament.
The pivot shift test requires a relaxed patient and an
intact medial collateral ligament. When the result is
positive, this test reproduces the pathological motion
in an anterior cruciate ligament–deficient knee and is
easier to elicit in a chronic anterior cruciate ligament
disruption or in an anaesthetized patient with an acute
anterior cruciate ligament injury
23. Knee ligament arthrometers such as the KT-1000/2000
can assist in the diagnosis but are more effective in
evaluating patients with chronic anterior cruciate
ligament disruption
when pain and associated muscle guarding are absent.
These devices also are useful for documentation of
surgical results.
both intraoperatively and postoperatively. With a manual
maximal anterior displacement, the right-left difference
is less than 3 mm in 95% of normal knees. The right-left
difference is 3 mm or more in 90% of knees with an
acute anterior cruciate ligament injury
24.
25. incidence of meniscal tears with acute anterior cruciate
ligament injuries to range from 50% to 70%. The lateral
meniscus is more commonly injured with the initial
incident.
As a result of abnormal loading and shear stresses in the
anterior cruciate ligament–deficient knee, the risk of late
meniscal injury is high and appears to increase with time
from the initial injury.
Most late meniscal tears occur in the medial meniscus
because of its firm attachment to the capsule.
Osteochondral damage also influences prognosis. The
reported incidence ranges from 21% to 31% in patients
examined after the initial injury.
26. MRI is the gold standard diagnostic
investigation for ACL injury.
Also gives details of osteochondral damage
and other soft tissue
27. History :-
The first recorded description of rupture of the ACL, was
by Stark in 1850 .
Autologous Fascia Lata and Meniscal Grafts In 1912
The Hamstring Graft In 1934 the Italian orthopaedic
surgeon Riccardo Galeazzidescribeda technique forACL
reconstructionusing the semi-tendinosus tendon.
Patellar Tendon Grafts In 1935, Campbell. Marshall et al.
in 1979 also used the central third of the patellar tendon
By the1990s the technique of using a free bone-patellar
tendon-bone graft harvested from the central one-third
of the patella became the “Gold Standard” of treatment.
28. Synthetic Grafts
Benson suggested the potential biological and
biomechanical Significanceofpurecarbonin1971 carbon
fibre graft.
Allograft
During the 1980s a remarkable interest developed in the
use of allograft tissue for ACL reconstruction . freeze
dried grafts used after upto 18 months of preservation.
inferior results compared to autografts
During the 1980s, techniques for arthroscopic ACL
reconstruction were becoming increasingly popular.
The Double-Bundle graft-In 2003 Marcacci et al.
described a double-bundle gracilis and semitendinosus
graft that they claimed guaranteed a more anatomic ACL
reconstruction and avoided the use of hardware for graft
fixation
83. BACKGROUND:
Surgical technique is essential in anterior
cruciate ligament (ACL) reconstruction.
PURPOSE:
This randomized 5-year study tested the
hypothesis that double bundle ACL
reconstruction with hamstring autografts and
aperture screw fixation has fewer graft
ruptures and rates of osteoarthritis (OA) and
better stability than single bundle
reconstruction.
84. STUDY DESIGN:
Randomized controlled trial; Level of evidence, 1.
METHODS:
Ninety patients
bioabsorbable screw fixation (DB group; n = 30),
bioabsorbable screw fixation (SBB group; n = 30),
metallic screw fixation (SBM group; n = 30).
Evaluation:
clinical examination,
KT-1000 arthrometer measurement, and
International Knee Documentation Committee
(IKDC) and Lysholm knee scores.
radiographic evaluation was made by a
musculoskeletal radiologist who was unaware of the
patients' clinical and surgical data.
A single surgeon.
85. Preoperatively, there were no differences.
Eleven patients (7 in the SBB group, 3 in the SBM group, and
only 1 in the DB group) had a graft failure during the follow-
up and went on to ACL revision surgery (P < .043).
Of the remaining 79 patients, a 5-year follow-up was
performed for 65 patients (20 in the DB group, 21 in the SBB
group, and 24 in the SBM group) who had their grafts intact.
At 5 years, there was no statistically significant difference in
the pivot-shift or KT-1000 arthrometer tests.
In the DB group, 20% of the patients had OA in the medial
femorotibial compartment and 10% in the lateral
compartment, while the corresponding figures were 33% and
18% in the single-bundle groups, again an insignificant
finding.
no significant group differences were found in the knee
scores.
86. The double-bundle surgery resulted in
significantly fewer graft failures and
subsequent revision ACL surgery than the
single-bundle surgeries during the 5-year
follow-up. Knee stability and OA rates were
similar at 5 years.
In view of the size of the groups, some
caution should be exercised when
interpreting the lack of difference in the
secondary outcomes.
87.
88. BACKGROUND:
Arthroscopic reconstruction for anterior cruciate
ligament rupture is a common orthopaedic
procedure. One area of controversy is whether the
method of double-bundle reconstruction, which
represents the 'more anatomical' approach, gives
improved outcomes compared with the more
traditional single-bundle reconstruction.
OBJECTIVES:
To assess the effects of double-bundle versus single-
bundle for anterior cruciate ligament reconstruction
in adults with anterior cruciate ligament deficiency.
89. DATA COLLECTION AND ANALYSIS:
independently selected articles,.
MAIN RESULTS:
Seventeen trials .
1433 cases,
outcomes were available for a maximum of nine trials and 54% of
participants.
There were no statistically or clinically significant differences between
double-bundle and single-bundle reconstruction in the subjective
functional knee score) at short term..
At long term followup, there were statistically significant differences in
favour of doublebundle reconstruction for IKDC knee examination.
There were no significant differences between the two groups in adverse
effects and complications .
There were also statistically significant differences in favour of double-
bundle reconstruction for newly occurring meniscal injury.
There were no statistically significant differences found between the two
groups in range of motion (flexion and extension) deficits.
90. There is insufficient evidence to determine the
relative effectiveness of double-bundle and single-
bundle reconstruction for anterior cruciate ligament
rupture in adults, although there is limited evidence
that double-bundle ACL reconstruction has some
superior results in objective measurements of knee
stability and protection against repeat ACL rupture or
a new meniscal injury.
High quality, large and appropriately reported
randomised controlled trials of double-bundle versus
single-bundle reconstruction for anterior cruciate
ligament rupture in adults appear justified.
91.
92. BACKGROUND:
Double-bundle ACL reconstruction popularity is
increasing with the aim to reproduce native ACL
anatomy and improve ACL reconstruction outcome.
However, to date, only a few randomized clinical
studies have been published.
PURPOSE:
The aim of this study was to prospectively compare
the clinical results of single- and double-bundle ACL
reconstruction.
STUDY DESIGN:
Randomized controlled clinical trial; Level of evidence,
1.
93. METHODS:
Seventy patients
Outcome assessment visual analog scale (VAS) score,
(IKDC) form, the Knee Injury and Osteoarthritis Outcome
Score (KOOS), and KT-1000 arthrometer evaluation.
RESULTS:
minimum follow-up of 2 years.
No differences between the 2 groups were observed in
IKDC subjective score.
A statistically significant difference in favor of the DB
group was found with the VAS (P < .03). The objective
IKDC final scores showed statistically significantly more
"normal knees" in the DB group than in the SB group (P =
.03).
There was 1 stability failure in the DB group and 3 in the
SB group.
The KT-1000 arthrometer data showed a statistically
significant decrease in the average anterior tibial
translation in the DB group (1.2 mm DB vs 2.1 mm SB; P
< .03). The incidence of a residual pivot-shift glide was
14% in DB and 26% in SB (P = .08).
94. CONCLUSION:
In the 2-year minimum follow-up, DB ACL
reconstructions showed better VAS, anterior
knee laxity, and final objective IKDC scores
than SB. However, longer follow-up and
accurate instrumented in vivo rotational
stability assessment are needed
95.
96. BACKGROUND:
No consensus has been reached on the advantages of
double-bundle (DB) anterior cruciate ligament
reconstruction (ACLR) over the single-bundle (SB)
technique, particularly with respect to the prevention
of osteoarthritis (OA) after ACLR.
PURPOSE:
To evaluate whether DB ACLR has any advantages in
the prevention of OA or provides better stability and
function after ACLR compared with the SB technique.
STUDY DESIGN:
Randomized controlled trial; Level of evidence, 2.
97. METHODS:
A total of 130
DB group (n = 65)
SB group (n = 65).
degree of OA based on the Kellgren-Lawrence pre and post
operation.
stability results using the Lachman and pivot-shift tests and
stress radiography.
functional outcomes based on the Lysholm knee score, Tegner
activity score, and International Knee Documentation
Committee (IKDC) subjective scale.
RESULTS:
112 patients were observed for a minimum of 4 years (DB
group, n = 52; SB group, n = 60).
Five patients (9.6%) in the DB group and 6 patients (10%) in the
SB group had more advanced OA at the final follow-up (P = .75)
Six patients (4 in the DB group and 2 in the SB group) suffered
graft failure during the follow-up and had ACL revision surgery
(P = .06).
Other comparisons no difference.
98. CONCLUSION:
The DB technique, compared with SB, was not
more effective in preventing OA and did not
have a more favorable failure rate.
Although the DB ACLR technique produced a
better IKDC subjective scale result than did
the SB ACLR technique, the 2 modalities were
similar in terms of clinical outcomes and
stability after a minimum 4 years of follow-
up.
99.
100. BACKGROUND:
Double-bundle (DB) anterior cruciate ligament
reconstruction (ACLR) has been reported to yield
better joint stability than single-bundle (SB)
reconstruction. Few studies have compared the 2
techniques with regard to postoperative articular
cartilage changes.
HYPOTHESIS:
Less cartilage damage should occur in the short term
after DB ACLR than after SB ACLR.
STUDY DESIGN:
Cohort study; Level of evidence, 2.
101. METHODS:
52 patients (27 in the DB group and 25 in the SB group)
no chondral or meniscus injury at primary ACLR,
Cartilage status at 6 identified regions was evaluated by
second-look arthroscopy .
Other assessments at final follow-up included International
Knee Documentation Committee (IKDC) score, Tegner and
Lysholm scores, side-to-side difference on KT-2000
arthrometer, and range of motion.
RESULTS:
The followup mean time18 months.(short term)
Both groups had cartilage lesions at the patellofemoral joint
(patella, 9 vs 13; trochlea, 5 vs 12) and the medial
compartment (1 vs 2). Significantly less severe lesions were
found in the DB group than in the SB group (mean grade,
0.33 vs 0.96; P < .05).
No significant differences were found between the 2 groups
in terms of cartilage status at other regions, IKDC score,
Lysholm score, Tegner score, KT-2000 arthrometer anterior
laxity, or range of motion.
102. CONCLUSION:
Chondral lesions were found postoperatively
in both DB and SB ACLR groups with
hamstring autograft. The DB ALCR led to less
cartilage damage at the femoral trochlea at
short term followup.
103.
104. PURPOSE:
To prospectively assess the anterior tibial translation and
rotational kinematics of the knee joint as well as the clinical
outcome after singlebundle (SB) and doublebundle (DB)
anterior cruciate ligament (ACL) reconstruction.
METHODS:
Forty two patients randomly underwent singlebundle (Group
SB, n = 21) or double-bundle (Group DB, n = 21) ACL
reconstruction using hamstring tendon autografts.
Anterior tibial translation and rotatory laxity were measured
prior to and after fixation of the graft during reconstruction
under the guidance of a navigation system.
Clinical outcome measurements included the evaluation of
the joint stability and functional status.
105. RESULTS:
Stablity increases significantly in both group compared to
preoperative .
The postoperative total rotation (sum of internal and external
rotation) at 30° and 60° (26.6° vs. 24.0°; 28.7° vs. 25.1°) as well as
postoperative change in external rotation at 60° (-1.4° vs. -4.6°),
and a change in total rotation at 30° and 60° (-7.0° vs. -11.5°; -6.1°
vs. -8.9°) differed between the two groups, with better stability in
the DB group.
At 2 years follow-up, IKDC subjective satisfaction score was
significantly different between two groups (70.9 vs. 79.6),
while manual and instrumented laxity, pivot shift tests, modified
Lysholm score, Tegner activity score, thigh muscle strengths were
not different.
Correlation analysis showed little correlations between anterior
laxity tests at follow-up, and the kinematic variables measured by
navigation during surgery while pivot shift test, IKDC subjective
satisfaction score, modified Lysholm score, and Tegner activity
score were mainly correlated with navigation-measured rotations
in both groups.
106. CONCLUSIONS:
The kinematic tests in this study found
evidence suggesting that the DB ACL
reconstruction improved rotatory laxity better
than the SB ACL reconstruction at 30° and 60°
of flexion, but there was no difference in
functional outcome at 2 years follow-up
between SB and DB groups.
LEVEL OF EVIDENCE:
Prospective comparative study, Level II.
107.
108. BACKGROUND:
Biomechanical differences between anatomical
double-bundle and central single-bundle anterior
cruciate ligament reconstruction using the same graft
tissue have not been defined.
PURPOSE:
The purpose of this study was to compare these
reconstructions in their ability to restore native knee
kinematics during a reproducible Lachman and pivot-
shift examination.
STUDY DESIGN:
Controlled laboratory study.
109. METHODS:
Using a computer-assisted navigation system,
10 paired knees
Lachman and mechanized pivot-shift examination
3D motion path tracking.
RESULTS:
A significant difference in anterior translation was
seen with Lachman examination
The DB construct was significantly better in limiting
anterior translation of the lateral compartment
compared with the SB reconstruction during a pivot
shift maneuver and was not significantly different
than the intact anterior cruciate ligament condition
110. DISCUSSION:
Although DB and SB clinically may be same
functional outcome
but An altered rotational axis resulted in
significantly greater translation of the lateral
compartment in the SB compared with DB
reconstruction.
CLINICAL RELEVANCE:
A DB-ACLR may be a favorable construct for
restoration of knee kinematics in the at risk knee
with associated meniscal injuries and/or
significant pivot shift on preoperative
examination.
111.
112. PURPOSE:
to compare the clinical outcomes of arthroscopic
anatomical double bundle (DB) anterior cruciate ligament
(ACL) reconstruction with either selective anteromedial (AM)
or posterolateral (PL) bundle reconstruction while
preserving a relatively healthy ACL bundle.
MATERIALS AND METHODS:
98 patients
mean follow-up of 2.7 years
34 DB ACL reconstruction (group A),
34 underwent selective AM bundle reconstruction (group B),
and 30 underwent selective PL bundle reconstructions
(group C).
Pre and post op Lysholm and International Knee
Documentation Committee (IKDC) score,
side-to-side differences of anterior laxity measured by KT-
2000 arthrometer at 14 kg, and stress radiography and
Lachman and pivot shift test results.
113. RESULTS:
There were no significant differences between
the three groups in anterior instability
measured by KT-2000 arthrometer, pivot
shift, or functional scores.
CONCLUSION:
Selective bundle reconstruction in partial ACL
tears offers comparable clinical results to DB
reconstruction in complete ACL tears
114. Double bundle repair should be reserved for
high demand patients such as contact sports
persons,athletes considering it provides
better stability,less failures and revisions.
however for general population single bundle
repair is sufficient to get good to excellent
functional outcome in majority of cases.
115.
116. Acta Orthop. Belgium., 2014, 80, 336-347
The Open Sports Medicine Journal,2010, 4, 51-
57 Damien P. Byrne, Kevin J. Mulhall and Joseph
F. Baker Orthopaedic Research and Innovation
Foundation, Sports Surgery Clinic, Santry, Dublin,
Ireland.
Atlas of Human Anatomy, Sixth Edition- Frank H.
Netter, M.D
Apley’s System of Orthopaedics and Fractures
9th Ed
Campbell's Operative Orthopaedics 12th
Pubmed central.