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Guenoun, B., L. Latargez, M. Freslon, G. Defossez, N. Salas, and L. E. Gayet. "Complication des arthroplasties par prothèses totales de genou à pivot rotatoire Endo-Modell (Link®)." Revue de Chirurgie Orthopédique et Traumatologique 95, no. 7 (November 2009): 634–41. http://dx.doi.org/10.1016/j.rcot.2009.09.018.
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Guenoun, B., L. Latargez, M. Freslon, G. Defossez, N. Salas, and L. E. Gayet. "Résultats fonctionnels des prothèses totales du genou à pivot rotatoire Endo-Modell (Link®) à moyen terme et étude de ses facteurs prédictifs." Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur 94, no. 4 (June 2008): 70. http://dx.doi.org/10.1016/j.rco.2008.03.024.
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Houfani, Fayçal, Didier Mainard, Brice Rubens-Duval, Pierre-Emmanuel Papin, Gilles Pasquier, and Matthieu Ehlinger. "Prothèses charnières à pivot rotatoire dans les reprises aseptiques d’arthroplastie de genou : étude rétrospective multicentrique de 127 cas à 5 ans de recul moyen." Revue de Chirurgie Orthopédique et Traumatologique 107, no. 3 (May 2021): 333–40. http://dx.doi.org/10.1016/j.rcot.2021.02.011.
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Matsumoto, H., and B. B. Seedhom. "Rotation of the Tibia in the Normal and Ligament-Deficient Knee. A study Using Biplanar Photography." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 207, no. 3 (September 1993): 175–84. http://dx.doi.org/10.1243/pime_proc_1993_207_290_02.
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The difference between physiological tibial rotation and rotatory instability of the knee, particularly the ‘pivot shift’ phenomenon, was investigated by analysing knee movements under both rotatory and valgus torques using 29 fresh cadaveric knees. The knee movements were measured in three dimensions using biplanar photography, when all ligaments were intact, and then after the ligaments were sequentially sectioned. The axis of the physiological tibial rotation was shown to be located about the centre of the tibial plateaux, while that of the pivot shift is located about the medial collateral ligament (MCL). When the anterior cruciate ligament (ACL) was sectioned, little or no significant change in physiological tibial rotation was observed under rotary torques, while a significant rotatory instability, including the ‘pivot shift’ phenomenon, was observed under a valgus torque. It was thus concluded that the rotatory instability is not simply an increase in the magnitude of the physiological rotation of the tibia, but is an abnormal tibial rotation which occurs with a different mechanism.
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Tashiro, Yasutaka, Ken Okazaki, Hiromasa Miura, Shuichi Matsuda, Takefumi Yasunaga, Makoto Hashizume, Yoshitaka Nakanishi, and Yukihide Iwamoto. "Quantitative Assessment of Rotatory Instability after Anterior Cruciate Ligament Reconstruction." American Journal of Sports Medicine 37, no. 5 (March 4, 2009): 909–16. http://dx.doi.org/10.1177/0363546508330134.
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Background Anterior cruciate ligament reconstruction successfully reduces anterior knee instability, but its effect on rotatory stability is not fully understood. In addition, a definitive method for the quantitative evaluation of rotatory instability remains to be established. Hypothesis Measurement of anterolateral tibial translation by open magnetic resonance imaging could positively correlate with the clinical grading of the pivot-shift test and would clarify residual rotatory abnormalities not shown by conventional methods for measurement of anterior stability. Study Design Controlled laboratory study. Methods An anterior cruciate ligament—reconstructed group (n = 21) and an anterior cruciate ligament—deficient group (n = 20) were examined using a Slocum anterolateral rotatory instability test in open magnetic resonance imaging. Anterior tibial translation was measured at the medial and lateral compartments by evaluating sagittal images. Clinical knee stability was evaluated before the above measurement using the pivot-shift test, KT-2000 arthrometer, and stress radiography. A cutoff value for anterolateral tibial translation relating to pivot-shift was determined using a receiver operating characteristic curve. Results Side-to-side differences of anterolateral tibial translation correlated with clinical grade of the pivot-shift test and stress radiography but not with KT-2000 arthrometry in both groups. The cutoff value was established as 3.0 mm. Although the mean anterolateral translation showed no difference, 9 reconstructed knees revealed greater than 3 mm of anterolateral tibial translation, whereas only 3 uninjured knees did. Conclusion Measurement using an open magnetic resonance imaging successfully quantified the remaining rotatory instability in anterior cruciate ligament—reconstructed knees. Clinical Relevance This method is a useful means for quantifying anterior cruciate ligament function to stabilize tibial rotation.
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Ueki, Hiroko, Hiroki Katagiri, Koji Otabe, Yusuke Nakagawa, Toshiyuki Ohara, Mikio Shioda, Yuji Kohno, Takashi Hoshino, Ichiro Sekiya, and Hideyuki Koga. "Contribution of Additional Anterolateral Structure Augmentation to Controlling Pivot Shift in Anterior Cruciate Ligament Reconstruction." American Journal of Sports Medicine 47, no. 9 (June 18, 2019): 2093–101. http://dx.doi.org/10.1177/0363546519854101.
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Background: Several types of anterolateral structure (ALS) augmentation procedures in anterior cruciate ligament (ACL) reconstruction have been reported. However, information is limited regarding the effect of additional ALS augmentation on rotatory stability in a clinical setting. Purpose/Hypothesis: This study aimed to investigate the contribution of additional ALS augmentation in ACL reconstruction in cases with a high risk of residual pivot shift. The 2 hypotheses were as follows. First, additional ALS augmentation would improve rotatory stability as compared with solely reconstructing the ACL. Second, graft tension changes would be different between the ACL and ALS during knee range of motion and against anterior or rotatory loads. Study Design: Controlled laboratory study. Methods: Fifteen patients who met at least 1 of the following criteria were included: (1) revision ACL reconstruction, (2) preoperative high-grade pivot shift, or (3) hyperextended knee. The pivot-shift test was performed preoperatively and during surgery after ACL reconstruction and after additional ALS augmentation with acceleration measurements from a triaxial accelerometer. The tension changes of the ACL and ALS grafts were also measured during knee range of motion and against manual maximum anterior tibial translation, internal rotation, and external rotation. Results: After ACL reconstruction, the pivot-shift acceleration was still greater than that of the uninjured knee. However, additional ALS augmentation further reduced acceleration when compared with ACL reconstruction alone in both primary and revision cases ( P < .05 vs preoperative, P < .05 vs ACL). During knee flexion-extension, the tension of the ACL increased as the knee was extended, whereas that of the ALS did not change. Graft tension of the ACL and ALS became higher with internal rotation and lower with external rotation as compared with the neutral position. Tension of the ACL was significantly increased against anterior tibial translational loads, whereas that of the ALS was not. Conclusion: Additional ALS augmentation further improved the rotatory stability during ACL reconstruction in patients with a high risk of residual pivot shift at the time of surgery. Significant differences in graft tension changes were also observed between the ACL and ALS against different loads. Additional ALS augmentation may be considered to eliminate the pivot shift in patients with a high risk of residual pivot shift.
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Musahl, Volker, Yuichi Hoshino, Roland Becker, and Jon Karlsson. "Rotatory knee laxity and the pivot shift." Knee Surgery, Sports Traumatology, Arthroscopy 20, no. 4 (December 24, 2011): 601–2. http://dx.doi.org/10.1007/s00167-011-1844-y.
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Zaffagnini, Stefano, Cecilia Signorelli, Alberto Grassi, Yuichi Hoshino, Ryosuke Kuroda, Darren de SA, David Sundemo, et al. "Anatomic Anterior Cruciate Ligament Reconstruction Using Hamstring Tendons Restores Quantitative Pivot Shift." Orthopaedic Journal of Sports Medicine 6, no. 12 (December 1, 2018): 232596711881236. http://dx.doi.org/10.1177/2325967118812364.
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Background: It is still uncertain how surgical reconstruction of the anterior cruciate ligament (ACL) is able to restore rotatory laxity of the involved joint. The desired amount of restraint applied by the ACL graft, as compared with the healthy knee, has not been fully clarified. Purpose: To quantify the ability of single-bundle anatomic ACL reconstruction using hamstring tendons in reducing the pivot-shift phenomenon immediately after surgery under anesthesia. Study Design: Case series; Level of evidence, 4. Methods: An inertial sensor and image analysis were used at 4 international centers to measure tibial acceleration and lateral compartment translation of the knee, respectively. The standardized pivot-shift test was quantified in terms of the side-to-side difference in laxity both preoperatively and postoperatively with the patient under anesthesia. The reduction in both tibial acceleration and lateral compartment translation after surgery and the side-to-side difference were evaluated using the Wilcoxon signed-rank test. Alpha was set at P < .05. Results: A total of 107 patients were recruited for the study, and data were available for 89 patients. There was a statistically significant reduction in quantitative rotatory knee laxity between preoperatively (inertial sensor, 2.55 ± 4.00 m/s2; image analysis, 2.04 ± 2.02 mm) and postoperatively (inertial sensor, –0.54 ± 1.25 m/s2; image analysis, –0.10 ± 1.04 mm) between the involved and healthy joints, as measured by the 2 devices ( P < .001 for both). Postoperatively, both devices detected a lower rotatory laxity value in the involved joint compared with the healthy joint (inertial sensor, 2.45 ± 0.89 vs 2.99 ± 1.10 m/s2, respectively [ P < .001]; image analysis, 0.99 ± 0.83 vs 1.09 ± 0.92 mm, respectively [ P = .38]). Conclusion: The data from this study indicated a significant reduction in the pivot shift when compared side to side. Both the inertial sensor and image analysis used for the quantitative assessment of the pivot-shift test could successfully detect restoration of the pivot shift after anatomic single-bundle ACL reconstruction. Future research will examine how pivot-shift control is maintained over time and correlation of the pivot shift with return to full activity in patients with an ACL injury.
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Sheean, Andrew J., Jayson Lian, Sean J. Meredith, Robert Tisherman, Andrew D. Lynch, Volker Musahl, and Bryson P. Lesniak. "Lateral Extra-Articular Tenodesis Does Not Affect Rotatory Knee Instability in Anatomic ACL Reconstruction." Orthopaedic Journal of Sports Medicine 7, no. 7_suppl5 (July 2019): 2325967119S0029. http://dx.doi.org/10.1177/2325967119s00295.
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Objectives: Single-bundle, anatomic anterior cruciate ligament reconstruction (ACLR) may not fully restore rotatory knee stability, and the addition of a lateral extra-articular tenodesis (LET) has been proposed as means for reducing residual rotatory knee instability. However, the magnitude of the in vivo, time zero effects of these procedures on rotatory knee instability remain poorly defined. The pivot shift test is used to assess for rotatory knee instability; however, it is a subjective grading system with limited generalizability and ability to predict clinical outcomes. Consequently, a quantified pivot shift (QPS) test software application, PIVOT iPad, has been developed and validated to measure the magnitude of rotatory knee laxity. The objective of this study was use intraoperative QPS (iQPS) to assess for differences in residual rotatory knee instability after ACLR versus ACLR augmented with lateral extra-articular tenodesis (ACLR + LET.) Methods: During examination under anesthesia (EUA), QPS was performed on both the operative and non-operative knees prior to ACLR (Figure 1A) Three, yellow ¾ inch markers were attached to skin overlying bony landmarks: lateral epicondyle, Gerdy’s tubercle and 3 cm posterior to Gerdy’s tubercle. The PIVOT software application was used to measure lateral compartment translation (Figure 1B) ACLR were randomly augmented with a LET if the lateral compartment translation measured during QPS was greater than or equal to double the amount of lateral compartment translation measured for the unaffected knee. iQPS measurements were subsequently performed after either ACLR or ACLR + LET with sterile markers (Figure 1C) iQPS data were recorded and compared to both the preoperative QPS measurements of the affected and unaffected knees. Based upon normative QPS data established from a database of >150 previously performed ACLR at our institution, it was determined that 8 patients in each group would be required to achieve 80% power with an effect size of 1.2 mm and an alpha level of 0.05. Post-procedure iQPS data were compared to preoperative QPS measurements with paired samples t-tests. Results: iQPS measurements were performed in 20 ACLR (10 ACLR and 10 ACLR + LET). The mean age in the cohort was 17.3 years old (range: 17-24 years old.). Both ACLR and ACLR + LET resulted in significant decreases in rotatory knee instability when compared to preoperative QPS measurements (pre-ACLR: 4.7 ± 1.9 v. post-ACLR: 1.3 ± 0.70, P < 0.001; pre-ACLR +LET: 3.6 ± 1.8 v. post-ACLR + LET: 0.9 ± 0.5, P < 0.001.) When comparing isolated ACLR to ACLR + LET, no significant differences were observed in the magnitude of change in iQPS between the pre and post-intervention states (ACLR: - 3.5 ± 1.6 mm v. ACLR + LET: -1.5 ± 3.1 mm, P = N.S.) Furthermore, there were no significant differences in lateral compartment translation between the operative knees and non-operative knees (ACLR: -0.1 ± 0.9 mm v. ACLR + LET: -0.5 ± 1.0 mm, P = N.S.), suggesting that neither ACLR nor ACLR + LET led to over-constrained kinematics. Conclusion: In this randomized control study, both ACLR and ACLR + LET resulted in significant decreases in rotatory knee instability. However, there were no significant differences in time-zero, rotatory knee instability detected between isolated ACLR versus ACLR combined with LET in patients. The utility of combining a LET with ACLR remains unclear, and future research is necessary to refine the indications for LET in patients with high-grade rotatory knee instability.
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Sheean, Andrew J., Jayson Lian, Robert Tisherman, Sean J. Meredith, Darren de SA, Andrew Lynch, Bryson P. Lesniak, and Volker Musahl. "Augmentation of Anatomic Anterior Cruciate Ligament Reconstruction With Lateral Extra-articular Tenodesis Does Not Significantly Affect Rotatory Knee Laxity: A Time Zero, In Vivo Kinematic Analysis." American Journal of Sports Medicine 48, no. 14 (November 11, 2020): 3495–502. http://dx.doi.org/10.1177/0363546520966624.
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Background: The pivot-shift test is used to assess for rotatory knee laxity in the anterior cruciate ligament (ACL)-deficient knee and ACL-reconstructed knee; however, the pivot shift uses a subjective grading system that is limited by variability between examiners. Consequently, quantified pivot shift (QPS) test software (PIVOT iPad application) has been developed and validated to measure the magnitude of rotatory knee laxity during the positive pivot-shift test. Purpose: To employ intraoperative QPS (iQPS) to assess for differences in residual rotatory knee laxity after ACL reconstruction (ACLR) versus ACLR augmented with lateral extra-articular tenodesis (ACLR + LET), and to employ iQPS to determine if ACLR and/or ACLR + LET result in overconstrained knee kinematics when compared with the contralateral knee. Study Design: Cohort study; Level of evidence, 2. Methods: iQPS was performed in 20 patients by a single surgeon on both the operative and contralateral knees before ACLR. ACLR was augmented with a LET if the lateral compartment tibial translation measured during QPS was greater than or equal to double the amount of lateral tibial compartment translation measured for the contralateral knee. After each reconstruction (ACLR or ACLR + LET), iQPS measurements were performed. iQPS data were compared with the preoperative QPS measurements of the operative and contralateral knees. Postoperative iQPS data were compared with both the preoperative QPS measurements of the operative and contralateral knees with paired samples t tests. Categorical variables were compared using the Fisher exact test. Results: The mean age in the cohort was 17.3 years (range, 15-24 years). There were no significant differences between the groups in terms of the proportion of male patients (ACLR: 5 male, 5 female vs ACLR + LET: 4 male, 6 female) or age (ACLR: 17.7 ± 3.3 years; 95% CI, 15.4-24.0 vs ACLR + LET: 16.8 ± 2.8 years, 95% CI, 14.8-22.0; P = .999). There were no significant differences between the groups with respect to preoperative QPS performed during examination under anesthesia (ACLR: 4.7 ± 2.0 mm; 95% CI, 3.3-6.1 vs ACLR + LET: 3.6 ± 1.8 mm; 95% CI, 2.3-4.9; P = .2). Both ACLR and ACLR + LET resulted in significant decreases in rotatory knee laxity when compared with preoperative QPS measurements (ACLR: –3.4 ± 1.7 mm; 95% CI, −4.6 to −2.2; P < .001: ACLR + LET: –2.6 ± 1.9 mm; 95% CI, −3.9 to −1.3; P < .002). Moreover, when compared with isolated ACLR, ACLR + LET did not result in a significantly smaller magnitude of change in iQPS between the pre- and postoperative states ( P = .3). Conclusion: Both ACLR and ACLR + LET resulted in significant decreases in rotatory knee laxity. The augmentation of ACLR with LET did not change the constraint of the knee with respect to lateral compartment translation as measured during iQPS.
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STASINOPOULOS, DHMHTRIOS, IOANNIS STASINOPOULOS, and KALIOPPI STASINOPOULOU. "A pilot trial to study the effectiveness of an exercise programme in the treatment of rotator cuff tendinopathy." journal biology of exercise 10, no. 2 (October 22, 2014): 69–77. http://dx.doi.org/10.4127/jbe.2014.0079.
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Lee, Dhong Won, Ji Hwan Lee, Du Han Kim, Jung Ho Park, and Jin Goo Kim. "Quantitative measures of pivot shift on knee rotatory instability." Arthroscopy and Orthopedic Sports Medicine 5, no. 1 (January 1, 2018): 11–18. http://dx.doi.org/10.14517/aosm17011.
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Devitt, Brian M., Ian Al’khafaji, Nicola Blucher, Lachlan M. Batty, Jerome Murgier, Kate E. Webster, and Julian A. Feller. "Association Between Radiological Evidence of Kaplan Fiber Injury, Intraoperative Findings, and Pivot-Shift Grade in the Setting of Acute Anterior Cruciate Ligament Injury." American Journal of Sports Medicine 49, no. 5 (March 15, 2021): 1262–69. http://dx.doi.org/10.1177/0363546521994467.
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Background: Biomechanical studies have suggested that the Kaplan fibers (KFs) of the iliotibial band play a role in controlling anterolateral rotation of the knee. There is a paucity of clinical information on whether injury to the KF in the setting of anterior cruciate ligament (ACL) rupture contributes to increased rotatory laxity of the knee. Purpose/Hypothesis: The purpose was to evaluate the association among radiological evidence of KF injury, intraoperative arthroscopic findings, and grade of pivot shift at the time of ACL reconstruction (ACLR). It was hypothesized that KF injury would be associated with increased injury to the lateral compartment of the knee and a higher grade of pivot shift. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective magnetic resonance imaging (MRI) analysis was conducted on 267 patients with ACL-injured knees who underwent primary ACLR. Patients who had MRI and surgery within 60 days of injury were included (mean age, 23.6 years); there were 158 (59.2%) male patients. MRI was performed using standard knee protocols, and diagnostic criteria were applied to identify KF injury. Associations were made among MRI findings, intraoperative findings, and grade of pivot shift with the patient examined under anesthesia at the time of ACLR. A comparison was made between patients with and without radiological evidence of KF injury. Results: The prevalence of KF injury was 17.6% (47/267 patients). Arthroscopic evidence of lateral meniscal injury was associated with KF injury (KF intact, 31%; KF injured, 55%; P = .010). The majority of patients in the intact and injured KF groups had a grade 2 pivot shift (75% and 70%, respectively). A minority had grade 3 pivot shift: 5% in the intact group versus 6.4% in the injured group. There was no association between radiological evidence of KF injury and pivot-shift grade ( P = .600). Conclusion: In acute ACL injury, KF injuries were not very common (17.6%), and the rate of grade 3 pivot shift was low (5.2%). When present, KF injuries were not associated with a higher-grade pivot shift. However, there was an association between KF injury and lateral meniscal tears identified at the time of ACLR. The role of KFS in controlling anterolateral rotatory laxity in the acute ACL injury in the clinical setting may be less evident when compared with the biomechanical setting.
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Eliya, Yousif, Khaled Nawar, Benjamin B. Rothrauff, Bryson P. Lesniak, Volker Musahl, and Darren de SA. "Anatomical anterior cruciate ligament reconstruction (ACLR) results in fewer rates of atraumatic graft rupture, and higher rates of rotatory knee stability: a meta-analysis." Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine 5, no. 6 (September 16, 2020): 359–70. http://dx.doi.org/10.1136/jisakos-2020-000476.
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ImportanceThis review highlights the differences in outcomes between anatomical and non-anatomical anterior cruciate ligament reconstruction (ACLR) techniques.ObjectiveTo compare clinical and functional outcomes between anatomical and non-anatomical ACLR techniques.Evidence reviewA search of MEDLINE, Embase and PubMed from 1 January 2000 to 24 October 2019 was conducted. Randomised and prospective primary ACLR studies using autograft and a minimum of 2 years of follow-up were included. The Anatomic Anterior Cruciate Ligament Reconstruction Checklist (AARSC) was used to categorise studies as anatomical. Outcomes analysed included failure rate, knee stability and functional outcomes. A meta-analysis using risk ratio and mean differences was conducted using a random effects model.FindingsThirty-six studies were included, representing 3710 patients with a follow-up range of 24–300 months. The overall failure rate was 96/1470 (6.5%) and 131/1952 (6.7%) in the anatomical group and non-anatomical group, respectively. The pooled results of the overall failure rate showed that there was no statistically significant difference between the anatomical and the non-anatomical groups (p=0.96). There were 37/60 (61.7%) and 29/67 (43.3%) traumatic failures in the anatomical and non-anatomical groups, respectively. The number of patients with the negative postoperative pivot-shift test was 995/1252 (79.5%) and 1140/1589 (71.1%) in the anatomical and non-anatomical groups, respectively. The pooled results indicated a statistically significant higher number of patients with a positive pivot shift in the non-anatomical group compared with the anatomical group (p=0.03).Conclusions and relevanceThis study demonstrated that the overall failure rate was similar between the anatomical and non-anatomical approaches. However, the anatomical ACLR demonstrated a significantly superior restoration of rotatory stability, as evidenced by a higher percentage with a negative postoperative pivot-shift test. Non-anatomical ACLR resulted in higher rates of atraumatic graft ruptures and persistent rotatory knee instability. Surgeons should consider anatomical ACLR when treating rotatory knee stability in patients.Level of evidenceII, systematic review and meta-analysis of level I and II studies.
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Getgood, Alan M., Dianne Bryant, Robert B. Litchfield, Robert Gordon McCormack, Mark Heard, Peter B. MacDonald, Tim Spalding, et al. "Lateral Extra-Articular Tenodesis Reduces Failure of Hamstring Tendon Autograft ACL Reconstruction -Two Year Outcomes from the STABILITY Study Randomized Clinical Trial." Orthopaedic Journal of Sports Medicine 7, no. 7_suppl5 (July 2019): 2325967119S0028. http://dx.doi.org/10.1177/2325967119s00280.
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Objectives: Persistent anterolateral rotatory laxity following anterior cruciate ligament reconstruction (ACLR) has been correlated with poor outcome and graft failure. We hypothesized that anterolateral complex reconstruction by way of a Lateral Extra-articular Tenodesis (LET) in combination with single bundle ACLR would reduce the risk of persistent rotatory laxity in young individuals who are deemed as being at high risk of failure. Methods: This is a pragmatic, multicenter, randomized clinical trial comparing standard hamstring tendon ACLR with combined ACLR and LET, utilizing a strip of iliotibial band (Modified Lemaire). Patients aged 25 years or less with an ACL deficient knee were included. They also had to have two of the following three criteria: 1) Grade 2 pivot shift or greater; 2) Returning to high risk/pivoting sports; 3) Generalized ligamentous laxity. The primary outcome was graft failure defined as either the need for revision ACLR or symptomatic instability associated with a positive asymmetric pivot shift, indicating persistent rotational laxity. Secondary outcome measures included the P4 pain scale, KOOS, IKDC. Patients were followed for two years with visits at 3, 6, 12 and 24 months postoperatively. A sample size of 300 per group was calculated based on a relative reduction in graft failure by 40%, with type 1 error of 5%, 80% power and 15% loss to follow-up rate. Results: 624 patients were randomized with a mean age of 18.9 (range: 14-25), 293 male. 436 (87.9%) patients presented pre-operatively with high-grade rotatory laxity (grade 2 pivot or greater) and 215 (42.1%) were diagnosed as having generalized ligamentous laxity (Beighton Score of 4 or greater). 523 of the 624 patients are at least 2 years postoperative; 29 lost to follow-up (˜5%). In the ACLR group 104/252 (41%) of patients suffered the primary outcome compared to 61/242 (25%) of the ACLR+LET patients (RR=0.61, 95%CI 0.47 to 0.79), p<0.0001. 39 patients suffered graft rupture, 28/252 (11%) in the ACLR group compared to 11/242 (4.5%) in the ACL+LET group (RR=0.41, 95%CI 0.21 to 0.80, p<0.001). At 3 months postoperative, patients in the ACLR group had less pain (p=0.004); at 3 and 6 months all KOOS subdomains, the IKDC favored the ACLR alone group (p=0.03). At 12 and 24 months, no important between-group differences were observed in any patient reported outcome. Conclusion: The addition of LET to a hamstring autograft ACLR in young active patients significantly reduces graft failure and persistent anterolateral rotatory laxity at 2 years post operatively.
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Fogarty, L. M. R. "The Kinematic Morphology-Density Relation from the SAMI Pilot Survey." Proceedings of the International Astronomical Union 10, S309 (July 2014): 113–16. http://dx.doi.org/10.1017/s1743921314009429.
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AbstractWe present the kinematic morphology-density relation in three galaxy clusters, Abell 85, 168 and 2399, using data from the SAMI Pilot Survey. We classify the early-type galaxies in our sample as fast or slow rotators (FRs/SRs) according to a measured proxy for their projected specific stellar angular momentum. We find each cluster contains both fast and slow rotators with and average fraction of SRs in the sample of fSR=0.15 ± 0.04. We investigate this fraction within each cluster as a function of local projected galaxy density. For Abell 85 we find that fSR increases at high local density but for Abell 168 and 2399 this trend is not seen. We find SRs not just at the centres of our clusters but also on the outskirts and hypothesise that these SRs may have formed in group environments eventually accreted to the larger cluster.
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Kendal, Joseph K., Damian Clark, David Longino, Travis E. Marion, Richard Buckley, Prism S. Schneider, and Ryan Martin. "VIS-IT: Visualizing the Injured Tibia—A Cadaveric Study of Limb Positioning for Posterolateral Tibial Plateau Fracture Visualization." Journal of Knee Surgery 33, no. 02 (January 24, 2019): 132–37. http://dx.doi.org/10.1055/s-0038-1676799.
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AbstractPosterolateral tibial plateau (PLTP) fractures are often associated with anterior cruciate ligament (ACL) incompetence, such as tibial eminence fractures. Both occur from a pivot shift like mechanism. Malreductions of the tibial plateau most frequently occur in the posterolateral quadrant. Acquiring adequate intraoperative visualization of the PLTP poses a challenge. We hypothesized that visualization of PLTP could be improved by positioning the knee at 110 degrees of flexion with the addition of a varus anterolateral rotatory vector. This position and maneuver take advantage of both the nonisometric nature of the lateral soft tissues and, when present, ACL incompetence. In this cadaveric study, we digitally quantified the percentage of the lateral tibial plateau visualized under different conditions after performing an anterolateral surgical approach with submeniscal arthrotomy. Four conditions were assessed for articular visualization: (1) 30 degrees of knee flexion, (2) 110 degrees of knee flexion, (3) 110-degrees of knee flexion plus varus anterolateral rotatory vector, (4) 110-degrees of knee flexion plus varus anterolateral rotatory vector with ACL sacrifice (ACL incompetence model). In the ACL competent models, maximal lateral tibial plateau exposure was obtained with the knee positioned at 110 degrees of flexion with a varus anterolateral rotatory vector (58.2%, range: 52.9–63.4%). Articular visualization was further improved with the ACL incompetent model (82.4%, range: 77.1–87.7%), modeling a tibial eminence fracture.
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Lian, Jayson, João V. Novaretti, Andrew J. Sheean, Neel K. Patel, Sean Whaley, Adam Popchak, and Volker Musahl. "Static Lateral Tibial Plateau Subluxation Predicts High-Grade Rotatory Knee Laxity in Anterior Cruciate Ligament–Deficient Knees." American Journal of Sports Medicine 47, no. 2 (December 7, 2018): 277–84. http://dx.doi.org/10.1177/0363546518812435.
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Background: In anterior cruciate ligament–deficient (ACL-D) knees, injury pattern and bony morphologic features have been shown to influence both static anterior tibial subluxation relative to the femur and dynamic rotatory knee laxity. Therefore, the relationship between static anterior tibial subluxation and dynamic rotatory knee laxity was investigated. Purpose: To determine whether static tibial subluxation as measured on magnetic resonance imaging (MRI) is associated with the grade of rotatory knee laxity in ACL-D knees. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Two-hundred fifty-eight knees underwent preoperative, image-guided assessment of lateral knee compartment translation during quantitative pivot shift (QPS). Subluxations of the medial and lateral tibial plateaus were measured on preoperative MRI in a subset of primary ACL-D knees meeting criteria for high-grade (QPS > 5.2 mm) and low-grade (QPS < 2.4 mm) rotatory laxity. Tibial subluxations on MRI were compared between patients with high- and low-grade rotatory laxity through use of pairwise t test and were analyzed via univariate and multivariate logistic regression. Significance was set at P < .05. Results: On MRI, greater anterior subluxation of the lateral tibial plateau was observed in patients with high-grade compared with low-grade rotatory knee laxity (4.5 mm vs 2.3 mm; P < .05). No similar relationship was observed for the medial tibial plateau (−0.9 mm vs −0.4 mm; P > .05). Univariate logistic regression demonstrated that static subluxation of the lateral tibial plateau was associated with high-grade rotatory knee laxity (odds ratio [OR], 1.2; P < .05). An optimal cutoff of 2.95 mm of static lateral tibial subluxation was associated with high-grade rotatory knee laxity (sensitivity, 75%; specificity, 63%). Lateral meniscal injury was the first variable entered into a multivariate regression analysis and proved to be most associated with high-grade rotatory knee laxity (OR, 6.8; P < .05). When lateral meniscal injury was excluded from multivariate regression analysis, static anterior subluxation of the lateral tibial plateau alone was associated with high-grade rotatory knee laxity (OR, 1.2; P < .05). Conclusion: Data from this MRI study of two distinct rotatory knee laxity groups showed that static anterior subluxation of the lateral tibial plateau of 2.95 mm or greater was associated with high-grade rotatory knee laxity, and each millimeter increase of lateral tibial plateau subluxation was associated with a 1.2-fold odds of high-grade rotatory knee laxity. Anterior subluxation of the lateral tibial plateau on MRI was not independently associated with high-grade rotatory knee laxity in the presence of concomitant lateral meniscal injury. Static measurements made preoperatively may aid in predicting high-grade rotatory knee laxity and refining the indications for individualized knee surgery.
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Lian, Jayson, João V. Novaretti, Andrew J. Sheean, Neel K. Patel, Adam Popchak, and Volker Musahl. "Static Lateral Tibial Plateau Subluxation Predicts the Grade of Rotatory Knee Laxity in ACL-Deficient Knees." Orthopaedic Journal of Sports Medicine 7, no. 7_suppl5 (July 2019): 2325967119S0029. http://dx.doi.org/10.1177/2325967119s00296.
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Objectives: In anterior cruciate ligament-deficient (ACL-D) knees, injury pattern and bony morphology have been shown to influence both static anterior tibial subluxation relative to the femur and dynamic rotatory knee laxity. Therefore, the relationship between static anterior tibial subluxation and dynamic rotatory knee laxity was investigated. The goal of this study was to determine if static tibial subluxation as measured on magnetic resonance imaging (MRI) was associated with the grade of rotatory knee laxity in ACL-D knees. Methods: Two-hundred and fifty-eight knees underwent preoperative, image-guided assessment of lateral knee compartment translation during quantitative pivot shift (QPS). Subluxations of the medial and lateral tibial plateaus were measured on preoperative MRI in a subset of primary ACL-D knees meeting criteria for high-grade (QPS > 5.2 mm) and low-grade (QPS < 2.4 mm) rotatory laxity. Tibial subluxations on MRI were compared between patients with high- and low-grade rotatory laxity using pairwise t-test, and analyzed using uni- and multivariate logistic regression. Significance was set at p<0.05. Results: On MRI, greater anterior subluxation of the lateral tibial plateau was observed in patients with high-grade compared to low-grade rotatory knee laxity (4.5 mm vs. 2.3 mm; p<0.05). No similar relationship was observed for the medial tibial plateau (-0.9 mm vs. -0.4 mm; p>0.05). Univariate logistic regression demonstrated that static subluxation of the lateral tibial plateau was associated with high-grade rotatory knee laxity (Odds ratio [OR] 1.2; p<0.05). An optimal cut-off of 2.95 mm of static lateral tibial subluxation was associated with high-grade rotatory knee laxity (sensitivity: 75%; specificity: 63%). Lateral meniscus injury was the first variable to enter a multivariate regression analysis and proved to be most associated with high-grade rotatory knee laxity ([OR] 6.8; p < 0.05). When lateral meniscus injury was excluded from multivariate regression analysis, static anterior subluxation of the lateral tibial plateau alone was associated with high-grade rotatory knee laxity ([OR] 1.2; p<0.05). Conclusion: Data from this MRI study of two distinct rotatory knee laxity groups showed that static anterior subluxation of the lateral tibial plateau of 2.95 mm or greater was associated with high-grade rotatory knee laxity, and each millimeter increase of lateral tibial plateau subluxation was associated with a 1.2-fold odds of high-grade rotatory knee laxity. Anterior subluxation of the lateral tibial plateau on MRI was not independently associated with high-grade rotatory knee laxity in the presence of concomitant lateral meniscus injury. Static measurements made pre-operatively may aid in predicting high-grade rotatory knee laxity and refining the indications for individualized knee surgery.
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Pfeiffer, Thomas, Jeremy Burnham, Elmar Herbst, Sven Shafizadeh, and Volker Musahl. "A Tomahawk Shape of the Femur Predicts Greater Rotatory Knee Laxity in Patients with Anterior Cruciate Ligament Ruptures." Orthopaedic Journal of Sports Medicine 6, no. 4_suppl2 (April 1, 2018): 2325967118S0003. http://dx.doi.org/10.1177/2325967118s00030.
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Interindividual variations in knee laxity are poorly understood. Utilizing novel pivot shift arthrometers and patients in our ACL registry the magnitude of the pivot shift was found to vary between 0-14 mm of anterior translation in the lateral compartment. Increased tibial slope was found to influence the magnitude of the pivot shift, however, it is unclear if femur morphology might influence the magnitude of the pivot shift. Therefore, the purpose of this study was to determine the relationship between anterior translation of the lateral compartment during a quantitative pivot shift test and the posterior femoral offset, quantified as the “tomahawk ratio”, in patients with complete ACL rupture. It was hypothesized that the “tomahawk ratio” would correlate with increased anterior translation of the lateral compartment of the knee. Consecutive patients with no history of prior knee surgeries undergoing primary ACL reconstruction were analyzed. A standardized pivot shift test was performed preoperatively under anesthesia on both knees and quantified using tablet technology as previously described. Radiographic measurements were made using standard lateral knee radiographs. The long axis of the femur shaft was determined by a line through the center of two circles centered on the femoral shaft. The axis of the femoral condyle was determined by a line between the most posterior and most anterior points of the lateral condyle. The distance from the intersection of these lines to the posterior end of the condyle was divided by the total anteroposterior length of the condyle. This ratio was defined as “tomahawk ratio”. Pearson correlation coefficient was used to analyze correlations (p- value < 0.05). Data sets were successfully obtained for 32 female and 25 male patients. The mean anterior translation of the lateral compartment during the pivot shift test was found to be 3.96 ±2.38 mm and 1.27±0.89 mm for the involved and uninvolved knees, respectively, with a mean side-to-side difference of 2.70±2.25 mm. The mean length of the lateral femoral condyle on x-ray was 68.36±5.31 mm, and the mean tomahawk ratio was 63.16±4.53%. There was a significant correlation between the tomahawk ratio and the absolute quantitative (r = 0.370 p < 0.05) and side-to-side differences in anterior translation of the lateral compartment (r =0.419 p < 0.05). The main finding from this study is that ACL-deficient patients with larger posterior femoral offsets quantified as the “tomahawk ratio” were found to have higher lateral translations of the knee during the pivot shift test. This suggests that variation in knee instability may be significantly affected by femoral bony morphology characterized by a larger posterior portion of the lateral condyle. This study may assist clinicians in evaluating ACL injuries and identifying patients at greater risk for increased rotational knee instability.
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Raschhofer, Rudolf, Nikos Poulios, Wolfgang Schimetta, Rüdiger Kisling, and Christian Mittermaier. "Early active rehabilitation after arthroscopic rotator cuff repair: a prospective randomized pilot study." Clinical Rehabilitation 31, no. 10 (February 1, 2017): 1332–39. http://dx.doi.org/10.1177/0269215517694931.
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Objective: To compare two different rehabilitation strategies, primary passive motion versus early isometric loading of the rotator cuff. Design: Prospective randomized controlled observer-blinded pilot study. Setting: Institute of Physical Medicine and Rehabilitation. Subjects: Thirty patients after rotator cuff surgery. Intervention: All participants were randomly assigned to one of the two outpatient treatment groups: primary passive motion versus early isometric loading of the rotator cuff. Both groups were treated for 12 weeks and performed additionally a home exercise program. Main measures: The primary outcome measure for functional assessment was the Constant Murley score. The secondary outcome measures were the Disabilities of the Arm, Shoulder and Hand score (DASH), active range of motion, pain level and strength. Patients were assessed before, 6, 12 and 24 weeks after surgery. Results: Repeatedly measured metric variables were compared by the Quade rank analysis of covariance and revealed substantially better Constant Murley scores in the early activated group at all 3 assessments (6 weeks: 41 [31;45] versus 30 [23;37]; 12 weeks: 68 [56;77] versus 59 [53;62]; 24 weeks: 79 [76;81] versus 66 [62;74]; data as median [25%;75%]). Postoperative changes of Constant score were in favour of the active group with the biggest difference at week 12 (28 [38;12] versus 9 [27;-4]). Maximal pain levels showed clear more reduction 6 and 24 weeks after surgery in the early activated group. Conclusions: This pilot study with early isometric loading of the rotator cuff shows better function and less maximal pain. Further research is warranted to confirm our results.
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Akinola, Bola, Ben Quansah, Theodore Gouliouris, and Andrew D. Carrothers. "A Retained Stitch in Time Saves 9 - But Does it Increase the Risk of Deep Prosthetic Infection?" HIP International 27, no. 6 (May 23, 2017): 564–66. http://dx.doi.org/10.5301/hipint.5000501.
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Introduction During the posterior approach to the hip, the short external rotators are detached and secured with stay sutures. At the time of definitive closure, some surgeons incorporate the initial sutures into their repair while others discard for fresh sutures, presumably as an infection prevention measure. We have conducted a pilot study to investigate whether the incorporation of the primary stay sutures may constitute an infection risk to the patient undergoing a total hip replacement through the posterior approach. Materials and methods The pilot study was conducted between August 2014 and June 2015. A pair of suture specimens were sent from 25 patients to microbiology, 1 set of primary stay sutures and 1 set of control sutures. All operations were carried out by the senior author through a posterior approach. Results All specimens were analysed for bacterial and fungal growth, using extended cultures. 1 set of primary sutures had a positive growth, likely from skin contamination; 1 set of control sutures also had a positive growth, likely from environmental contamination. Conclusions Our pilot study suggests that the practice of incorporating the primary stay sutures for definitive soft tissue repair of the short external rotators, rather than exchanging them for new sutures, can be deemed safe.
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Diermeier, Theresa, Sean J. Meredith, James J. Irrgang, Stefano Zaffagnini, Ryosuke Kuroda, Yuichi Hochino, Kristian Samuelsson, et al. "Patient-Reported and Quantitative Outcomes of Anatomic Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autografts." Orthopaedic Journal of Sports Medicine 8, no. 7 (July 1, 2020): 232596712092615. http://dx.doi.org/10.1177/2325967120926159.
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Background: The pivot-shift test has become more consistent and reliable and is a meaningful outcome measurement after anterior cruciate ligament reconstruction (ACLR). Purpose/Hypothesis: The purpose of this investigation was to assess patient-reported outcomes (PROs) and the quantitative pivot shift (QPS) preoperatively, at time zero immediately after anatomic ACLR, and after 24 months as well as the relationship between PROs and the QPS. It was hypothesized that anatomic ACLR would restore rotatory stability measured by the pivot-shift test and that QPS measurements would be positively correlated with PROs. Study Design: Cohort study; Level of evidence, 2. Methods: The ACL-injured and contralateral uninjured knees from 89 of 107 (83.2%) enrolled patients at 4 international centers were evaluated using a standardized pivot-shift test. Tibial acceleration was assessed with an inertial sensor, and lateral compartment translation was measured using an image analysis system preoperatively, at time zero immediately postoperatively, and at follow-up after 2 years. PROs were assessed at 12 and 24 months postoperatively with the International Knee Documentation Committee (IKDC) subjective knee form, Cincinnati Knee Rating System (CKRS), Marx activity rating scale, and activity of daily living score (ADLS). Results: The mean patient age at surgery was 27 years (range, 15-45 years). A positive pivot shift preoperatively (side-to-side difference in tibial acceleration, 2.6 ± 4.0 m/s2; side-to-side difference in anterior tibial translation, 2.0 ± 2.0 mm) was reduced at time zero postoperatively (side-to-side difference in tibial acceleration, –0.5 ± 1.3 m/s2; side-to-side difference in anterior tibial translation, –0.1 ± 1.0 mm). All PROs improved from preoperatively to final follow-up at 24 months: from 56.5 to 85.5 points for the IKDC ( P = .0001), from 28.8 to 32.4 points for the CKRS ( P = .04), from 11.2 to 7.9 points for the Marx ( P < .0001), and from 75.7 to 91.6 points for the ADLS ( P < .0001). Neither preoperative nor time zero postoperative rotatory laxity assessed by the pivot-shift test correlated with PROs at 24-month follow-up. A graft retear was observed in 4 patients (4.5%) within 2 years of follow-up. Conclusion: Anatomic ACLR resulted in significantly improved and acceptable PROs at 2-year follow-up and a low failure rate. Anatomic ACLR restored QPS measurements of anterior tibial translation and tibial acceleration to those of the contralateral knee immediately after surgery while still under anesthesia, but there was no correlation between the QPS preoperatively or at time zero after ACLR and PROs at 2-year follow-up.
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Witke-Woźniak, Agnieszka, Michał Wychowański, Tomasz Dąmbski, Karina Szymfel, and Tomasz Kochański. "Hip muscle strength and static balance in patients with snapping hip syndrome – a pilot study." Advances in Rehabilitation 30, no. 3 (September 1, 2016): 55–68. http://dx.doi.org/10.1515/rehab-2015-0049.
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Abstract Introduction: Snapping hip syndrome (SHS) occurs in 5-10% of the global population. A back and forth skip of the tendon of the dysfunctional muscle across the osseous prominence is the most common symptom of this condition. Mainly young generation suffers from SHS. Depending on the structures that cause an audible snap, snapping hip syndrome may be classified into intra-articular and extra-articular types. The main aim of the research was to assess the strength of the major hip muscles and static balance in patients with snapping hip syndrome. Material and methods: The research was carried out on 10 untrained females and 10 untrained males with extra-articular snapping hip syndrome. An average age was approximately 25 years. The research was conducted with the use of interview questionnaire, clinical examination, balance assessment on the JBA Staniak 4P dynamometric platform and measurements of the hip muscle strength on the JBA Staniak SPB2 set. Results: Patients with SHS manifested an increased tension in iliotibial band, while significant weakening of internal and external rotator muscle strength was noted in women and significant weakening of external rotator muscle strength was observed in men. No correlations between hip muscles strength and stabilographic test results in patients with snapping hip syndrome were found. Conclusions: Individuals with SHS and healthy persons demonstrate similar balance levels. The treatment of snapping hip syndrome should include: 1) restoring internal rotator muscle strength in women, 2) restoring external rotator muscle strength both in women and in men, as well as 3) restoring iliotibial band flexibility.
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Hanson, Blaine R., and Steve B. Orloff. "Rotator nozzles more uniform than spray nozzles on center-pivot sprinklers." California Agriculture 50, no. 1 (January 1996): 32–35. http://dx.doi.org/10.3733/ca.v050n01p32.
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Patiño, Juan M., and Juan M. Torres Moirano. "Engaging Posterior Capitellum Fracture and Elbow Posterolateral Rotatory Instability: Is It Always Necessary to Treat the Bone Defect?" Case Reports in Orthopedics 2020 (March 6, 2020): 1–3. http://dx.doi.org/10.1155/2020/3260106.
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Case. We present a 23-year-old male with 7 episodes of left elbow dislocation during a two-year period. He had a positive pivot shift test with engaging. The original treatment plan included lateral ulnar collateral ligament reconstruction and eventually bone defect grafting and osteosynthesis. However, a bone graft was not performed. After 2 years of follow-up, the DASH score was 3.3. The Mayo Score was 90. Conclusion. Posterolateral instability associated with an engaging bone defect, in every elbow extension and pivot shift test, was not found in the literature. The capitellum defects are associated with PLRI and make it worse. Bone reconstruction may not be indicated.
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Uhl, Timothy L., Thomas Rice, Brianna Papotto, and Timothy A. Butterfield. "Effectiveness of a Home-Based Eccentric-Exercise Program on the Torque-Angle Relationship of the Shoulder External Rotators: A Pilot Study." Journal of Sport Rehabilitation 26, no. 2 (March 2017): 141–50. http://dx.doi.org/10.1123/jsr.2017-0020.
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Context:The role of the rotator cuff is to provide dynamic stability to the glenohumeral joint. Human and animal studies have identified sarcomerogenesis as an outcome of eccentric training indicated by more torque generation with the muscle in a lengthened position.Objective:The authors hypothesized that a home-based eccentric-exercise program could increase the shoulder external rotators’ eccentric strength at terminal internal rotation (IR).Design:Prospective case series.Setting:Clinical laboratory and home exercising.Participants:10 healthy subjects (age 30 ± 10 y).Intervention:All participants performed 2 eccentric exercises targeting the posterior shoulder for 6 wk using a home-based intervention program using side-lying external rotation (ER) and horizontal abduction.Main Outcome Measures:Dynamic eccentric shoulder strength measured at 60°/s through a 100° arc divided into 4 equal 25° arcs (ER 50–25°, ER 25–0°, IR 0–25°, IR 25–50°) to measure angular impulse to represent the work performed. In addition, isometric shoulder ER was measured at 5 points throughout the arc of motion (45° IR, 30° IR, 15° IR, 0°, and 15° ER). Comparison of isometric and dynamic strength from pre- to posttesting was evaluated with a repeated-measure ANOVA using time and arc or positions as within factors.Results:The isometric force measures revealed no significant differences between the 5 positions (P = .56). Analysis of the dynamic eccentric data revealed a significant difference between arcs (P = .02). The percentage-change score of the arc of IR 25–50° was found to be significantly greater than that of the arc of IR 0–25° (P = .007).Conclusion:After eccentric training the only arc of motion that had a positive improvement in the capacity to absorb eccentric loads was the arc of motion that represented eccentric contractions at the longest muscle length.
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Okazaki, Ken, Hiromasa Miura, Shuich Matsuda, Takefumi Yasunaga, Hideaki Nakashima, Kozo Konishi, Yukihide Iwamoto, and Makoto Hashizume. "Assessment of Anterolateral Rotatory Instability in the Anterior Cruciate Ligament—Deficient Knee Using an Open Magnetic Resonance Imaging System." American Journal of Sports Medicine 35, no. 7 (July 2007): 1091–97. http://dx.doi.org/10.1177/0363546507299530.
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Background In the clinical evaluation of the anterior cruciate ligament—deficient knee, anterolateral rotatory instability is assessed by manual tests such as the pivot-shift test, which is subjective and not quantitative. Hypothesis The anterolateral rotatory instability in an anterior cruciate ligament—deficient knee can be quantified by our newly developed method using open magnetic resonance imaging. Study Design Controlled laboratory study. Methods Eighteen subjects with anterior cruciate ligament—deficient knees and 18 with normal knees were recruited. We administered the Slocum anterolateral rotatory instability test in the open magnetic resonance imaging scanner and scanned the sagittal view of the knee. The anterior displacements of the tibia at the medial and lateral compartments were measured. Furthermore, we examined 14 anterior cruciate ligament—deficient knees twice to assess intraobserver and interobserver reproducibility and evaluated the difference and interclass correlation coefficient of 2 measures. Results In the anterior cruciate ligament—deficient knee, displacement was 14.4 ± 5.5 mm at the lateral compartment and 1.6 ± 2.3 mm at the medial compartment; in the normal knee, displacement was 0.7 ± 1.9 mm and —1.1 ± 1.2 mm, respectively. The difference and interclass correlation coefficient between 2 repeated measures at the lateral compartment were 1.0 ± 0.7 mm and .98 for intraobserver reproducibility and 1.1 ± 0.7 mm and .91 for interobserver reproducibility. Conclusion This method is useful to assess the anterolateral rotatory instability of the anterior cruciate ligament—deficient knee. Clinical Relevance This method can be used in the clinical assessment of anterior cruciate ligament stability, such as comparing studies of graft positions or 2-bundle anatomic reconstruction and the conventional 1-bundle technique.
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Napier, Richard J., Julian A. Feller, Brian M. Devitt, Jodie A. McClelland, Kate E. Webster, Ciaran S. J. Thrush, and Timothy S. Whitehead. "Is the KiRA Device Useful in Quantifying the Pivot Shift in Anterior Cruciate Ligament–Deficient Knees?" Orthopaedic Journal of Sports Medicine 9, no. 1 (January 1, 2021): 232596712097786. http://dx.doi.org/10.1177/2325967120977869.
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Background: Various technologies have been developed to quantify the pivot shift, as it is regarded as a key indicator of anterolateral rotatory laxity of the knee. Purpose: To determine the usefulness of a commercially available triaxial accelerometer (Kinematic Rapid Assessment [KiRA]) in numerically quantifying the pivot shift in patients under anesthesia with an anterior cruciate ligament (ACL)–deficient knee. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Both knees of 50 patients (26 male [mean age, 30.4 years], 24 female [mean age, 26.6 years]) under anesthesia were assessed immediately before unilateral ACL reconstruction by an orthopaedic fellow and 1 of 3 experienced knee surgeons. The pivot-shift grade and 2 KiRA outputs (range of acceleration and slope of acceleration change) were compared. Results: The surgeon and fellow recorded the same pivot-shift grade for 45 of 50 patients (90%). Data from the 5 patients with no agreement and 1 patient with extreme outlying data were excluded from subsequent analysis. Using the KiRA range and slope data, the surgeon identified the injured knee in 74% and 76% of patients, respectively, while the fellow’s rate of injured knee identification was 74% and 80%, respectively. A correlation could be found only between pivot-shift grade and surgeon-derived range data ( ρ = 0.40; P < .01) but not slope data or any fellow-derived outputs. Using the surgeon-derived range data, there was a significant difference between a grade 3 pivot (>5 m/s2) and a grade 1 or 2 pivot (<5 m/s2) ( P = .01). Conclusion: Although a correlation between KiRA output data and pivot-shift grade was found when the device was used by an experienced surgeon, there was no correlation when used by a well-trained but less experienced orthopaedic fellow. Furthermore, the KiRA output data identified the ACL-deficient knee correctly in only 74% of patients. Although a threshold acceleration range value could be identified, above which the value was associated with a grade 3 pivot shift, this was dependent on the examiner, and distinction between other grades could not be made.
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Silva, Alyssa Conte, Juliana Falcão Padilha, Jefferson Luiz Brum Marques, and Cláudia Mirian de Godoy Marques. "Spinal manipulation effect on pain and cardiac autonomic modulation in patients with rotator cuff tendinopathy: a pilot study." Manual Therapy, Posturology & Rehabilitation Journal 14 (December 30, 2016): 417. http://dx.doi.org/10.17784/mtprehabjournal.2016.14.417.
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Introduction: there are few studies that propose to identify the relationship of Vertebral Manipulation (MV) on pain and cardiac autonomic modulation, especially in subjects with rotator cuff injury. Objective: To analyze the effect of chest pain and MV on cardiac autonomic modulation in patients with rotator cuff (TMR). Method: quasi-experimental study with a quantitative approach. Sample of 6 subjects divided into two groups: Asymptomatic (GA, n = 3) not presenting shoulder injury and pain complaints and Symptomatic Group (GS, n = 3), with rotator cuff injury. Pain assessment was performed by Visual Analog Scale (VAS) before and after handling, as well as the assessment of Heart Rate Variability (HRV) using an electrocardiogram (ECG) with 8 minutes. Chest MV was held on 4th and 5th thoracic vertebra. The analysis of HRV was relaizada in the Frequency Domain (VLF, LF, HF, LF / HF). The statistical analysis used the Wilcoxon test for comparison in the same group and the Mann Whitney test for comparison between groups, adopting a 5% significance (p <0.05). Results: There was a reduction of post handling pain, but no statistically significant difference in GS (p = 0.317). HRV GA showed a decrease VLF (p = 0.83) and increased LF variables (p = 0.51), HF (p = 0.83) and LF / HF (p = 0.51). In the GS was increased VLF variables (p = 0.83), LF (p = .83), HF (p = 0.51) and decreased variable LF / HF (p = 0.51). Conclusion: A MV upper thoracic no effect on the pain and cardiac autonomic modulation in patients with rotator cuff (TMR).
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Burkhart, Timothy A., Manoj Matthew, W. Scott McGuffin, Alexandra Blokker, David Holdsworth, Ryan M. Degen, and Alan Getgood. "There Are No Kinematic Differences Between Inframeniscal and Suprameniscal Anterolateral Ligament Injury in the Anterior Cruciate Ligament–Deficient Knee." American Journal of Sports Medicine 46, no. 14 (November 2, 2018): 3391–99. http://dx.doi.org/10.1177/0363546518803359.
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Background: Previous research demonstrated that the attachment of the anterolateral ligament (ALL) to the lateral meniscus is stiffer and stronger in its tibial attachment than its femoral attachment. How this relates to anterolateral knee stability and lateral meniscal function is unknown. Hypothesis/Purpose: The hypothesis was that the ALL acts as a peripheral anchor to the lateral meniscus, aiding in anterolateral rotatory stability, and that the inframeniscal fibers of the ALL will provide greater anterolateral rotatory stability because of their greater tensile properties. The purpose was therefore to compare the difference in kinematics of the anterior cruciate ligament (ACL)–deficient knee between the infra- and suprameniscal ALL-sectioned states. Study Design: Controlled laboratory study. Methods: Eight paired fresh-frozen cadaveric knees were tested in a 5–degree of freedom loading jig under the following loading conditions: 5-N·m internal rotation at 15° incremental angles of flexion and combined 5-N·m internal rotation moment, 10-N·m valgus moment, and 88-N anterior translation force representing a pivot shift test at 0°, 15°, and 30° of flexion. The knees were tested under intact, ACL-deficient, and ACL-/ALL-deficient conditions, with the pairs of knees being randomized to either supra- or inframeniscal ALL sectioning. Resultant joint kinematics and tibiofemoral translations were measured and compared with a 2-way mixed repeated measures analysis of variance. Results: Internal rotation increased by 3° after sectioning of the ACL at 0° of knee flexion ( P = .035). At 45° of knee flexion, internal rotation increased significantly by 2° between the ACL-deficient and the ACL-/ALL-deficient conditions ( P = .049). Secondary kinematics of valgus and anterior translation were observed in response to the 5-N·m load after ACL and ALL sectioning. Analysis of the pivot shift showed increases in tibiofemoral translation after sectioning of the ACL, with further translations after sectioning of the ALL. No differences were observed between supra- and inframeniscal ALL sectioning under any of the loading conditions. Conclusion: An injury to the ALL, coexisting with ACL deficiency, results in only minor increases in knee joint patholaxity. No differences in pivot-shift kinematics or tibiofemoral rotations were observed between the supra- and inframeniscal sectioning of the ALL in the ACL-deficient knee Clinical Relevance: Tears of the midbody and/or posterior root attachment of the lateral meniscus are often observed at the time of ACL reconstruction. Increased anterolateral rotatory laxity has been observed in both lateral meniscus– and ALL-deficient states in combination with an ACL injury. While no significant functional relationship was found between the ALL and lateral meniscus, ALL sectioning did result in increased knee joint patholaxity, as demonstrated by composite tibiofemoral rotations.
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Araki, Daisuke, Takehiko Matsushita, Yuichi Hoshino, Kanto Nagai, Kyohei Nishida, Hideyuki Koga, Tomomasa Nakamura, Mai Katakura, Takeshi Muneta, and Ryosuke Kuroda. "The Anterolateral Structure of the Knee Does Not Affect Anterior and Dynamic Rotatory Stability in Anterior Cruciate Ligament Injury: Quantitative Evaluation With the Electromagnetic Measurement System." American Journal of Sports Medicine 47, no. 14 (October 28, 2019): 3381–88. http://dx.doi.org/10.1177/0363546519879692.
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Background: The biomechanical function of the anterolateral structure (ALS), which includes the anterolateral joint capsule and anterolateral ligament (ALL), remains a topic of debate. Hypothesis: The ALS contributes to knee joint stability during the Lachman test and the pivot-shift test in anterior cruciate ligament (ACL)–deficient knees. Study Design: Controlled laboratory study. Methods: Fourteen fresh-frozen hemipelvis lower limbs were used. For 7 specimens, the anterior one-third of the ALS and the residual ALS were cut intra-articularly with a radiofrequency device. Subsequently, the ACL was cut arthroscopically. For the other 7 specimens, the ACL was cut first, followed by the anterior one-third of the ALS and the residual ALS intra-articularly. During the procedures, the iliotibial band (ITB) was kept intact. At each condition, the anterior tibial translation (ATT) during the manual Lachman test and the acceleration of posterior tibial translation (APT) and the posterior tibial translation (PTT) during the manual pivot-shift test were measured quantitatively with an electromagnetic measurement system. The mean values of those parameters were compared among 6 groups (ACL intact, one-third ALS cut, all ALS cut, ACL cut, ACL/one-third ALS cut, and ACL/all ALS cut). Results: The mean ATTs during the Lachman test and the mean APTs and PTTs in the ACL-cut conditions (ACL cut, ACL/one-third ALS cut, and ACL/all ALS cut) were significantly larger than those under the ACL-intact conditions (ACL intact, one-third ALS cut, all ALS cut) ( P < .01). However, no statistically significant differences were observed among the intact, one-third ALS–cut, and all ALS–cut conditions, within the ACL-intact or ACL-cut conditions. Conclusion: Intra-articular dissection of the ALS did not increase the ATT during the Lachman test or the APT and PTT during the pivot-shift test under the intact condition of the ITB, regardless of the integrity of the ACL. When the ITB is intact, the ALS does not have a significant role in either anterior or dynamic rotatory knee stability, while the ACL does. Clinical Relevance: Recent growing interest about ALL reconstruction or ALS augmentation may not have a large role in controlling either anterior or dynamic rotatory knee instability in isolated ACL-deficient knees.
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Wojtowicz, Sebastian, Anna Daniluk, Karolina Wiaderna, Aneta Bugalska, Anna Hadamus, Marta Grabowicz, and Darius Bialoszewski. "ASSESSMENT OF IMPACT OF ACTIVATION OF HIP JOINT ABDUCTORS AND EXTERNAL ROTATORS ON GAIT AND RUNNNING PARAMETERS IN HEALTHY PEOPLE - PILOT STUDY." Acta kinesiologica, N1 2021 (2021): 120–26. http://dx.doi.org/10.51371/issn.1840-2976.2021.15.1.14.
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Many physiotherapists and motor preparation coaches recommend including resistance exercises for the hip joint abductors and external rotators in a warm-up. Muscle activation with resistance band exercises is believed to improve positional control of the pelvis and the lower limbs, thus reducing the risk of musculoskeletal injury during rehabilitation or training proper. The aim of this study was to assess the impact of a single session of activation of hip joint abductors and external rotators on gait and running parameters in healthy people. The study involved 54 healthy individuals aged 19-21 years. An experimental group (Group 1) performed a set of 6 resistance exercises with Thera rubber bands, intended to activate the hip joint abductors and external rotators. A control group (Group 2) performed the same set of exercises but without external resistance. A walking and running gait examination was performed on a Zebris FDM treadmill in both groups before and after the exercises. Both variants of exercises produced changes in selected gait parameters (p<0.05). An examination of running gait in Group 1 revealed an increase in step length in the dominant limb (p<0.05) and stride length (p<0.05) and step time in the dominant limb (p<0.05), stride length (p<0.05) and cadence (p<0.05). Heel pressure also decreased in both limbs, and heel pressure force decreased in the non-dominant limb (p<0.05). A running gait examination in Group 2 revealed increased midfoot pressure force in both limbs (p<0.05). Thus, a single session of exercises with resistance banding to activate the hip joint abductors and external rotators exerted an effect on running parameters, which may improve running economy.
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Batty, Lachlan M., Andrew Firth, Gilbert Moatshe, Dianne M. Bryant, Mark Heard, Robert G. McCormack, Alex Rezansoff, et al. "Association of Ligamentous Laxity, Male Sex, Chronicity, Meniscal Injury, and Posterior Tibial Slope With a High-Grade Preoperative Pivot Shift: A Post Hoc Analysis of the STABILITY Study." Orthopaedic Journal of Sports Medicine 9, no. 4 (April 1, 2021): 232596712110000. http://dx.doi.org/10.1177/23259671211000038.
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Background: A spectrum of anterolateral rotatory laxity exists in anterior cruciate ligament (ACL)–injured knees. Understanding of the factors contributing to a high-grade pivot shift continues to be refined. Purpose: To investigate factors associated with a high-grade preoperative pivot shift and to evaluate the relationship between this condition and baseline patient-reported outcome measures (PROMs). Study Design: Cross-sectional study; Level of evidence, 3. Methods: A post hoc analysis was performed of 618 patients with ACL deficiency deemed high risk for reinjury. A binary logistic regression model was developed, with high-grade pivot shift as the dependent variable. Age, sex, Beighton score, chronicity of the ACL injury, posterior third medial or lateral meniscal injury, and tibial slope were selected as independent variables. The importance of knee hyperextension as a component of the Beighton score was assessed using receiver operator characteristic curves. Baseline PROMs were compared between patients with and without a high-grade pivot. Results: Six factors were associated with a high-grade pivot shift: Beighton score (each additional point; odds ratio [OR], 1.17; 95% CI, 1.06-1.30; P = .002), male sex (OR, 2.30; 95% CI, 1.28-4.13; P = .005), presence of a posterior third medial (OR, 2.55; 95% CI, 1.11-5.84; P = .03) or lateral (OR, 1.76; 95% CI, 1.01-3.08; P = .048) meniscal injury, tibial slope >9° (OR, 2.35; 95% CI, 1.09-5.07; P = .03), and chronicity >6 months (OR, 1.70; 95% CI, 1.00-2.88; P = .049). The presence of knee hyperextension improved the diagnostic utility of the Beighton score as a predictor of a high-grade pivot shift. Tibial slope <9° was associated with only a high-grade pivot in the presence of a posterior third medial meniscal injury. Patients with a high-grade pivot shift had higher baseline 4-Item Pain Intensity Measure scores than did those without a high-grade pivot shift (mean ± SD, 11 ± 13 vs 8 ± 14; P = .04); however, there was no difference between groups in baseline International Knee Documentation Committee, ACL Quality of Life, Knee injury and Osteoarthritis Outcome Score, or Knee injury and Osteoarthritis Outcome Score subscale scores. Conclusion: Ligamentous laxity, male sex, posterior third medial or lateral meniscal injury, increased posterior tibial slope, and chronicity were associated with a high-grade pivot shift in this population deemed high risk for repeat ACL injury. The effect of tibial slope may be accentuated by the presence of meniscal injury, supporting the need for meniscal preservation. Baseline PROMs were similar between patients with and without a high-grade pivot shift.
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Lucidi, Gian Andrea, Alberto Grassi, Stefano Di Paolo, Piero Agostinone, Maria Pia Neri, Luca Macchiarola, Giacomo Dal Fabbro, and Stefano Zaffagnini. "The Lateral Femoral Notch Sign Is Correlated With Increased Rotatory Laxity After Anterior Cruciate Ligament Injury: Pivot Shift Quantification With A Surgical Navigation System." American Journal of Sports Medicine 49, no. 3 (January 15, 2021): 649–55. http://dx.doi.org/10.1177/0363546520982002.
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Background: The lateral femoral notch sign (LNS) is a bony impression on the lateral femoral condyle correlated with anterior cruciate ligament (ACL) injury. Its presence is associated with lateral meniscal injury and higher cartilage degradation on the lateral femoral condyle. Purpose/Hypothesis: The purpose was to investigate the effect of the presence and magnitude of LNS on rotatory instability. The hypothesis was that a positive LNS is correlated with a high-grade pivot shift (PS). Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 90 consecutive patients with complete ACL tears between 2013 and 2017 underwent intraoperative kinematic evaluation with the surgical navigation system and were included in the present study. The same surgeon performed a standardized PS under anesthesia. The PS was quantified through the acceleration of the lateral compartment during tibial reduction (PS ACC) and the internal-external rotation (PS IE). Presence and depth of LNS were evaluated on sagittal magnetic resonance images (1.5-T). Results: In 47 patients, the LNS was absent; in 33, the LNS depth was between 1 mm and 2 mm; and in 10 patients, it was deeper than 2 mm. Patients with a notch deeper than 2 mm showed increased PS ACC and PS IE compared with the group without the LNS. However, no significant differences were present between the group with a notch between 1 and 2 mm and the patients without LNS. Receiver operating characteristic curve analysis showed that 2 mm was the most predictive cutoff value to identify the “high-grade rotatory instability” group, with an accuracy of 77.8% and 74.4% and a specificity of 95.5% and 93.9% referred to the PS ACC and PS IE, respectively. Conclusion: The presence of a lateral LNS deeper than 2 mm could be used for the preoperative identification of patients with a high risk of increased rotatory instability.
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Gurney, Jennifer M., Will C. Cole, John C. Graybill, Stacy A. Shackelford, and Darin K. Via. "Maintaining Surgical Readiness While Deployed to Low-Volume Military Treatment Facilities: A Pilot Program for Clinical and Operational Sustainment Training in the Deployed Environment." Military Medicine 185, Supplement_1 (January 2020): 508–12. http://dx.doi.org/10.1093/milmed/usz263.
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ABSTRACT Introduction Maintaining readiness among Army surgeons is increasingly challenging because of declining operative experience during certain deployments. Novel solutions should be considered. Materials and Methods A pilot program was conducted to rotate surgical teams from a military treatment facility with a low volume of combat casualty care to one with a higher volume. Pre- and postrotation surveys were conducted to measure relative operative experience, trauma experience, and perceived readiness among rotators. Results Operative volumes and trauma volumes were increased and that perceived readiness among rotators, especially those with the fewest previous deployments, was improved. Conclusions Maintaining readiness among Army surgeons is a difficult task, but a combination of increased trauma care while in garrison, as well as increased humanitarian care during deployments, may be helpful. Additionally, rotating providers from facilities caring for few combat casualties to facilities caring for more combat casualties may also be feasible, safe, and helpful.
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Gandara, Luis, David Rabago, Michael Scarpone, Edward Snell, Patrick DeMeo, Kristine Ruppert, Perry Pritchard, Gennie Arbogast, and John Wilson. "Platelet-Rich Plasma Injection for Rotator Cuff Tendinopathy and Partial Rotator Cuff Tears: A Pilot Study." Medicine & Science in Sports & Exercise 43, Suppl 1 (May 2011): 263–64. http://dx.doi.org/10.1249/01.mss.0000400723.08410.b3.
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Getgood, Alan M. J., Dianne M. Bryant, Robert Litchfield, Mark Heard, Robert G. McCormack, Alex Rezansoff, Devin Peterson, et al. "Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From the STABILITY Study Randomized Clinical Trial." American Journal of Sports Medicine 48, no. 2 (January 15, 2020): 285–97. http://dx.doi.org/10.1177/0363546519896333.
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Background: Persistent anterolateral rotatory laxity after anterior cruciate ligament (ACL) reconstruction (ACLR) has been correlated with poor clinical outcomes and graft failure. Hypothesis: We hypothesized that a single-bundle, hamstring ACLR in combination with a lateral extra-articular tenodesis (LET) would reduce the risk of ACLR failure in young, active individuals. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This is a multicenter, prospective, randomized clinical trial comparing a single-bundle, hamstring tendon ACLR with or without LET performed using a strip of iliotibial band. Patients 25 years or younger with an ACL-deficient knee were included and also had to meet at least 2 of the following 3 criteria: (1) grade 2 pivot shift or greater, (2) a desire to return to high-risk/pivoting sports, (3) and generalized ligamentous laxity (GLL). The primary outcome was ACLR clinical failure, a composite measure of rotatory laxity or a graft rupture. Secondary outcome measures included the P4 pain scale, Marx Activity Rating Scale, Knee injury Osteoarthritis and Outcome Score (KOOS), International Knee Documentation Committee score, and ACL Quality of Life Questionnaire. Patients were reviewed at 3, 6, 12, and 24 months postoperatively. Results: A total of 618 patients (297 males; 48%) with a mean age of 18.9 years (range, 14-25 years) were randomized. A total of 436 (87.9%) patients presented preoperatively with high-grade rotatory laxity (grade 2 pivot shift or greater), and 215 (42.1%) were diagnosed as having GLL. There were 18 patients lost to follow-up and 11 who withdrew (~5%). In the ACLR group, 120/298 (40%) patients sustained the primary outcome of clinical failure, compared with 72/291 (25%) in the ACLR+LET group (relative risk reduction [RRR], 0.38; 95% CI, 0.21-0.52; P < .0001). A total of 45 patients experienced graft rupture, 34/298 (11%) in the ACLR group compared with 11/291 (4%) in the ACL+LET group (RRR, 0.67; 95% CI, 0.36-0.83; P < .001). The number needed to treat with LET to prevent 1 patient from graft rupture was 14.3 over the first 2 postoperative years. At 3 months, patients in the ACLR group had less pain as measured by the P4 ( P = .003) and KOOS ( P = .007), with KOOS pain persisting in favor of the ACLR group to 6 months ( P = .02). No clinically important differences in patient-reported outcome measures were found between groups at other time points. The level of sports activity was similar between groups at 2 years after surgery, as measured by the Marx Activity Rating Scale ( P = .11). Conclusion: The addition of LET to a single-bundle hamstring tendon autograft ACLR in young patients at high risk of failure results in a statistically significant, clinically relevant reduction in graft rupture and persistent rotatory laxity at 2 years after surgery. Registration: NCT02018354 ( ClinicalTrials.gov identifier)
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Musahl, Volker, Sebastian Kopf, Stephen Rabuck, Roland Becker, Willem van der Merwe, Stefano Zaffagnini, Freddie H. Fu, and Jon Karlsson. "Rotatory knee laxity tests and the pivot shift as tools for ACL treatment algorithm." Knee Surgery, Sports Traumatology, Arthroscopy 20, no. 4 (December 30, 2011): 793–800. http://dx.doi.org/10.1007/s00167-011-1857-6.
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Alessio-Mazzola, Mattia, Matteo Formica, Antonio Russo, Francesca Sanguineti, Andrea Giorgio Capello, Stefano Lovisolo, and Lamberto Felli. "Outcome after Combined Lateral Extra-articular Tenodesis and Anterior Cruciate Ligament Revision in Professional Soccer Players." Journal of Knee Surgery 32, no. 09 (September 18, 2018): 906–10. http://dx.doi.org/10.1055/s-0038-1672120.
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AbstractWe report the functional outcome after combined anterior cruciate ligament (ACL) reconstruction and lateral extra-articular tenodesis (LET) for ACL re-rupture and high-grade pivot shift in professional soccer players. For this retrospective review, the medical records of 24 professional soccer players were analyzed. The mean age at surgery was 23.8 ± 4.2 years and the mean follow-up was 42.2 ± 16.9 months. Pre- and postoperative assessment included the KT-1000 Lachman test, pivot shift test, International Knee Documentation Committee (IKDC) subjective knee evaluation, Tegner activity scale (TAS), and Lysholm score. The rate of return to sports and the level of play at final follow-up were recorded. ACL revision was performed with an autologous bone–patellar tendon–bone autograft or a hamstring graft. LET was performed using an extra-articular MacIntosh procedure as modified by Arnold–Coker. Anterior–posterior laxity was significantly reduced at the final clinical assessment (p < 0.0001): 22 patients (91.7%) had a negative pivot shift and 2 (8.3%) had residual glide (+), with significant improvement (p < 0.0001). The mean subjective IKDC and Lysholm score improved from 69.5 ± 11.1 (range: 56–90) to 88.4 ± 8.9 (range: 62.1–100) and from 58.1 ± 11.7 (range: 33–72) to 97.4 ± 3.2 (range: 88–100), respectively, with significant improvement (p < 0.0001) over preoperative values. The overall failure rate was 8.3%. There were no differences between mean preinjury and final TAS scores (p > 0.05). The rate of return to sports at the same level was 91.7% and the mean time to return to sports was 9.2 ± 2.2 months. Mid-term functional outcome after combined extra-articular reconstruction and ACL revision surgery was satisfactory, with a reduction in residual postoperative rotatory instability and degree of pivot shift.
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Panczykowski, David, Andrew N. Nemecek, and Nathan R. Selden. "Traumatic Type III odontoid fracture and severe rotatory atlantoaxial subluxation in a 3-year-old child." Journal of Neurosurgery: Pediatrics 5, no. 2 (February 2010): 200–203. http://dx.doi.org/10.3171/2009.9.peds09202.
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In this report, the authors describe the case of a 3-year-old child with a traumatic Type III odontoid fracture. To their knowledge, this is the first reported case of a true Type III odontoid fracture with atlantoaxial rotatory subluxation in a child. The patient presented with pain and had resisted manipulation of the neck following a motor vehicle crash. Plain cervical radiographs revealed an odontoid fracture, which was confirmed by CT imaging. The left lateral mass of C-1 was rotated anterior to that of C-2 with the displaced odontoid process acting as the pivot point of rotation. The C1–2 alignment was normalized, and the C-2 fracture was reduced completely. The regional anatomy and mechanism of injury, radiographic diagnosis, and management of cervical spine injuries in children are discussed.
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Kesikburun, Serdar, Evren Yaşar, Berke Aras, Bayram Kelle, and Bilge Yılmaz. "Rotator manşon tendinopatisine bağlı hemiplejik omuz ağrısında proloterapinin etkinliği: pilot çalışma." Cukurova Medical Journal (Çukurova Üniversitesi Tıp Fakültesi Dergisi) 42, no. 1 (March 31, 2017): 15. http://dx.doi.org/10.17826/cutf.270401.
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Turnbull, J., T. Mackenzie, M. Walton, P. Monga, and L. Funk. "Predictors of outcomes of arthroscopic rotator cuff repair: A pilot study." International Journal of Surgery 23 (November 2015): S88. http://dx.doi.org/10.1016/j.ijsu.2015.07.399.
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Erickson, Jacob L., and Andrew R. Jagim. "Ultrasonic Tenotomy and Debridement for Calcific Tendinopathy of the Shoulder: A Pilot Case Series." Journal of Primary Care & Community Health 11 (January 2020): 215013272096466. http://dx.doi.org/10.1177/2150132720964665.
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Calcific tendinopathy of the rotator cuff is a common cause of shoulder pain and debility. Minimally invasive treatment options have been employed for management; however, ultrasonic tenotomy has not been previously described for management of calcific tendinopathy of the shoulder. The purpose of the current case series was to provide preliminary evidence in support of a novel treatment modality for calcific tendinopathy of the rotator cuff. This descriptive pilot case series included a total of 8 patients with calcific tendinopathy of the supraspinatus that underwent ultrasound-guided ultrasonic debridement in the sports medicine clinic. All procedures were performed by the same physician (JLE). All patients had confirmation of the diagnosis with MRI and ultrasound imaging. Pain was measured pre-procedure and followed until 3-months post-procedure. Very large, statistically significant, reductions (P < .01) in pain scores were observed at 1 (ES = 1.93), 2 (ES = 1.84) and 3 (ES = 2.20) months post-procedure, respectively. All patients experienced a significant reduction in pain scores, regardless of hardness of the calcium deposit, at 1 month post-procedure with pain scores remaining lower than at baseline at 2 and 3 months post-procedure. No adverse events were noted in any patients. Ultrasonic tenotomy and debridement appears to be a safe and effective treatment option for patients with calcific tendinopathy of the supraspinatus.
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Braun, Cordula, Nigel C. Hanchard, Alan M. Batterham, Helen H. Handoll, and Andreas Betthäuser. "Prognostic Models in Adults Undergoing Physical Therapy for Rotator Cuff Disorders: Systematic Review." Physical Therapy 96, no. 7 (July 1, 2016): 961–71. http://dx.doi.org/10.2522/ptj.20150475.
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Abstract Background Rotator cuff–related disorders represent the largest subgroup of shoulder complaints. Despite the availability of various conservative and surgical treatment options, the precise indications for these options remain unclear. Purpose The purpose of this systematic review was to synthesize the available research on prognostic models for predicting outcomes in adults undergoing physical therapy for painful rotator cuff disorders. Data Sources The MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL, and PEDro databases and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) up to October 2015 were searched. Study Selection The review included primary studies exploring prognostic models in adults undergoing physical therapy, with or without other conservative measures, for painful rotator cuff disorders. Primary outcomes were pain, disability, and adverse events. Inclusion was limited to prospective investigations of prognostic factors elicited at the baseline assessment. Study selection was independently performed by 2 reviewers. Data Extraction A pilot-tested form was used to extract data on key aspects of study design, characteristics, analyses, and results. Risk of bias and applicability were independently assessed by 2 reviewers using the Prediction Study Risk of Bias Assessment tool (PROBAST). Data Synthesis Five studies were included in the review. These studies were extremely heterogeneous in many aspects of design, conduct, and analysis. The findings were analyzed narratively. Limitations All included studies were rated as at high risk of bias, and none of the resulting prognostic models was found to be usable in clinical practice. Conclusions There are no prognostic models ready to inform clinical practice in the context of the review question, highlighting the need for further research on prognostic models for predicting outcomes in adults who undergo physical therapy for painful rotator cuff disorders. The design and conduct of future studies should be receptive to developing methods.
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Deprés-Tremblay, Gabrielle, Anik Chevrier, Martyn Snow, Scott Rodeo, and Michael D. Buschmann. "Freeze-dried chitosan-platelet-rich plasma implants improve supraspinatus tendon attachment in a transosseous rotator cuff repair model in the rabbit." Journal of Biomaterials Applications 33, no. 6 (November 14, 2018): 792–807. http://dx.doi.org/10.1177/0885328218811386.
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Rotator cuff tears result in shoulder pain, stiffness, weakness and loss of motion. After surgical repair, high failure rates have been reported based on objective imaging and it is recognized that current surgical treatments need improvement. The aim of the study was to assess whether implants composed of freeze-dried chitosan (CS) solubilized in autologous platelet-rich plasma (PRP) can improve rotator cuff repair in a rabbit model. Complete tears were created bilaterally in the supraspinatus tendon of New Zealand White rabbits ( n = 4 in a pilot feasibility study followed by n = 13 in a larger efficacy study), which were repaired using transosseous suturing. On the treated side, CS-PRP implants were injected into the transosseous tunnels and the tendon itself, and healing was assessed histologically at time points ranging from one day to two months post-surgery. CS-PRP implants were resident within transosseous tunnels and adhered to tendon surfaces at one day post-surgery and induced recruitment of polymorphonuclear cells from 1 to 14 days. CS-PRP implants improved attachment of the supraspinatus tendon to the humeral head through increased bone remodelling at the greater tuberosity and also inhibited heterotopic ossification of the supraspinatus tendon at two months. In addition, the implants did not induce any detectable deleterious effects. This preliminary study provides the first evidence that CS-PRP implants could be effective in improving rotator cuff tendon attachment in a small animal model.
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Randelli, Pietro S., Paolo Arrigoni, Paolo Cabitza, Piero Volpi, and Nicola Maffulli. "Autologous platelet rich plasma for arthroscopic rotator cuff repair. A pilot study." Disability and Rehabilitation 30, no. 20-22 (January 2008): 1584–89. http://dx.doi.org/10.1080/09638280801906081.
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Valette, Arnault, Dany Mouarbes, Vincent Marot, and Etienne Cavaignac. "Combined Anterior Cruciate Ligament Reconstruction Revision and Double-Bundle Medial Collateral Ligament and Posterior Oblique Ligament Reconstruction." Video Journal of Sports Medicine 1, no. 2 (March 2021): 263502542110007. http://dx.doi.org/10.1177/26350254211000751.
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Background: Nonsurgical treatment of concomitant medial collateral ligament (MCL) in the setting of anterior cruciate ligament reconstruction (ACLR) increases the risk of graft failure. Few published cases of medial complex reconstruction combined with ACLR with no clear consensus on the optimal technique to treat these complex injuries. Indications: A female patient aged 41 years, with failure of ACLR in 2009 and 2 revisions in 2013 and 2014, associated with concomitant nontreated MCL and posterior oblique ligament (POL) injury. Physical examination showed valgus test laxity grade III at 30° of knee flexion and at full extension, with Lachman and pivot-shift test grade III. Imaging showed normal long-leg standing axis with 10° posterior tibial slope on radiograph, and associated MCL and POL injury on magnetic resonance imaging. Technique Description: ACLR and anterolateral tenodesis using the fascia lata leaving its distal insertion on the Gerdy tubercle, with double-stranded contralateral gracilis, was completed. A new femoral tunnel was made from outside to inside, with preservation of the previous tibial tunnel. The transplant was fixed with 2 interference screws. Second, the contralateral semitendinous autograft was used for MCL and POL reconstruction. A single strand of the graft was used for femoral fixation created on femoral epicondyle to cover MCL and POL origins, and double strands were used for distal fixation of MCL at the level of hamstring insertion and POL at the posteromedial corner of medial tibial plateau. The graft was secured with 3 interference screws at 30 knee flexion for MCL and full extension for POL. Results: The results include favorable functional and clinical outcome with improvement in the anteroposterior and rotatory knee stability at mid-term follow-up. Lateral extra-articular tenodesis in supplementing ACLR controls internal tibial rotatory knee stability. Double-bundle reconstruction of MCL and POL improved both valgus and anteromedial rotatory instability by restraining external rotation. Discussion/Conclusion: Surgeons should consider the need for surgical treatment of concomitant MCL injury to prevent chronic valgus laxity and increased strain on the anterior cruciate ligament (ACL) graft, potentially increasing the risk of ACLR revision. Our described technique offers a safe method for ACLR and lateral tenodesis with an advantage to avoid tunnel convergence, and medial stabilization to restore native valgus and rotatory stability and prevent increased stress on ACL graft.
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Cornu, C., A. Nordez, and B. Bideau. "Shoulder Rotators Electro-Mechanical Properties Change with Intensive Volleyball Practice: A Pilot Study." International Journal of Sports Medicine 30, no. 12 (December 2009): 857–62. http://dx.doi.org/10.1055/s-0029-1237390.
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Trebinjac, Suad, and Hamda Kitchbi. "Long-term effect of Prolotherapy on symptomatic rotator cuff tendinopathy." Journal of Health Sciences 5, no. 3 (December 15, 2015): 93–98. http://dx.doi.org/10.17532/jhsci.2016.257.
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Introduction: The objective of this study was to assess a long-term clinical effect of Prolotherapy on chronic symptomatic rotator cuff tendinopathy.Methods: We conducted a retrospective, uncontrolled study in the outpatient setting with 12 months follow-up. Adults diagnosed clinically and radiologically with rotator cuff tendinopathy that has been persisting for a minimum of six months were included. Patients received 15% extra-articular and 25% intra-articular hyperosmolar dextrose injections, repeated at weeks 5, 9, 13, 17 and 21. Primary outcome measure was validated Shoulder Pain and Disability Index (SPADI). Secondary outcome measure was validated visual pain analogue scale (VAS 0-10). The third outcome measures were patient’s satisfaction with Prolotherapy and adverse reactions after injections.Results: Twenty-one patients, 14 male and 7 female were treated with 6 sessions of hyperosmolar dextrose Prolotherapy repeated every 4 weeks. Average SPADI before starting the treatment was 73.995 ± 13.6, while 12 months after completed treatment was 20.84 ± 26.03 (P< 0.0001). Average VAS score before starting the treatment was 8.14 ± 1.2, while 12 months after completed treatment was 2.29 ± 2.8 (P<0.0001). Out of 21 patients, 18 (85.71%) would recommend Prolotherapy to other people with the similar condition, and no one participant reported any side effect that was not resolved within one week after the treatment.Conclusion: Hyperosmolar dextrose Prolotherapy may result in significant reduction of pain and disability index in adult patients with chronic rotator cuff tendinopathy, without eliciting long-lasting side effects. Results of this pilot study need to be validated in prospective controlled randomized trials.