Anatomical ACL Reconstruction can Restore the Natural Knee Kinematics than Isometric ACL Reconstruction During the Stance Phase of Walking

Young-Jun Koo,Yihwan Jung,Jong-Keun Seon,Seungbum Koo 한국정밀공학회 2020 International Journal of Precision Engineering and Vol.21 No.6

The attachment locations of anterior cruciate ligament (ACL) grafts during reconstruction have been reported to infl uence knee joint function. However, there are controversial opinions on femoral ACL attachment locations for restoring normal knee kinematics. The knee stability and ACL force by diff erent ACL attachment locations could be predicted using the musculoskeletal model simulation. The objectives of this study are to develop a detailed musculoskeletal knee model and to quantify the eff ect of ACL graft attachment locations on knee kinematics and graft force. Five normal subjects walked at a self-selected speed, and motion data were captured. A detailed knee model including 14 ligaments was developed for dynamics simulation using cadaveric specimen data, which were previously published and are open to public access. The ACL bundles of the model were removed and replaced with ACL grafts to develop anatomical and isometric ACL-reconstructed knee models; the femoral anatomical footprint and isometric locations were used, respectively. After the knee models were embedded in a full-body template model from the AnyBody Managed Model Repository, the full-body musculoskeletal model was simulated using the measured gait data. The isometric reconstruction model had signifi cantly large anterior translation and internal rotation than the intact and anatomical reconstruction model. The average diff erences between the isometric reconstruction and intact models were 4.5 mm and 3.0° for tibial anterior translation and internal rotation, respectively. The ACL tensional force in the isometric reconstruction model was signifi cantly lower than that in the intact model. Anatomical reconstruction could closely restore the normal knee kinematics.

Functional results of multiple revision anterior cruciate ligament with anterolateral tibial tunnel associated with anterolateral ligament reconstruction

( Camilo Partezani Helito ),( Andre Giardino Moreira Da Silva ),( Tales Mollica Guimarães ),( Marcel Faraco Sobrado ),( José Ricardo Pécora ),( Gilberto Luis Camanho ) 대한슬관절학회 2022 대한슬관절학회지 Vol.34 No.-

Background: Revision anterior cruciate ligament (ACL) reconstructions are usually complex owing to previous tunnels. The objective of this study is to report the results of a revision ACL reconstruction technique with a tibial tunnel performed from the anterolateral plateau associated with an anterolateral ligament (ALL) reconstruction. Methods: Patients with at least two ACL reconstructions that failed and who had significant enlargement and confluence of tunnels in the medial tibial plateau and underwent revision ACL reconstruction associated with ALL reconstruction with the tibial tunnel for the ACL performed from the lateral plateau between 2017 and 2019 were evaluated. All patients were evaluated by physical examination, International Knee Documentation Committee (IKDC), and Lysholm functional scales. Results: Six patients who underwent this surgical procedure were evaluated. All patients were sports practitioners and presented a grade 3 pivot shift. The mean age was 28.5 ± 8.2 years, and the mean follow-up time was 34.1 ± 12.8 months. No patient had a new graft rupture, but three (50%) had grade 1 pivot shift. Four patients had minor complications with no clinical impact on the final result. All except one patient were able to return to pre-injury type of sports, at a mean time of 14.6 ± 2.3 months after surgery. Conclusion: The anterolateral tibial tunnel technique using an Achilles tendon allograft for revision ACL reconstruction after multiple failures associated with an ALL reconstruction showed good results and no major complications. The anterolateral tunnel can be considered a good alternative in cases of medial tibial confluence or significant enlargement of the medial tunnels in re-revision procedures.

전방십자인대 재재건술

이준규 ( Joon Kyu Lee ),이명철 ( Myung Chul Lee ) 대한슬관절학회 2011 대한슬관절학회지 Vol.23 No.2

As the number of primary reconstructions of the anterior cruciate ligament (ACL) increase, so do the number of revision ACL reconstructions due to failure. Revision ACL reconstruction has several challenges compared to primary ACL reconstruction. Literature review regarding revision ACL reconstruction was performed to discuss the cause of the failure, results of revision, and to assist the decision-making process and approaches to the patients. Usually good functional stability could be obtained after revision ACL reconstruction, but increased incidence of meniscal and cartilage lesions played a role in patient dissatisfaction. To solve issues such as tunnel widening, malposition, and inserted hardware after primary ACL reconstruction, various surgical technique issues were reviewed.

이식건 종류에 따른 전방십자인대 재건술 후 재활운동프로그램 참여가 근기능과 균형능력에 미치는 영향

최현식(HyunSikChoi),신윤아(YunAShin) 한국체육학회 2012 한국체육학회지 Vol.51 No.1

본 연구의 목적은 이식건 종류에 따른 전방십자인대 재건술 후 성인남자 18명을 대상으로 8주간의 재활운동프로그램 참여가 등척성 근력 및 균형성의 차이에 미치는 영향을 알아보고, 두 군간의 회복 양상의 차이를 조사하는 것이다. 18명중 동종건군 9명, 자가건군 9명이 8주간 주 3회 재활운동에 참여 한 후 사전, 4주, 8주에 걸쳐 등척성 근력 및 균형성을 측정하여 수집된 자료를 분석하였다. 본 연구의 결과 전방십자인대 재건술 후 실시된 8주간의 재활운동프로그램은 동종건군과 자가건군의 슬관절의 등척성 근력 및 균형성을 향상 시키는데 효과적인 것으로 나타났다. 따라서 전방십자인대 재건술 후 환자는 회복과정에 있어 재활운동을 참여함으로써 슬관절의 근기능과 균형능력에 도움이 된다고 사료된다. 그러나 재건술에 사용되는 자가건과 동종건의 수술방법의 차이는 재활훈련 후 환측의 신전근력과 굴근 근력에 모두 영향을 주지 않는 것으로 나타났다. 이러한 결과는 수술 후 안정화되는 시기와 적응의 차이도 있을 것으로 사료되므로, 추후 원인을 명확히 밝힐 수 있는 장기적인 연구가 실시되어야 할 것으로 생각된다. The purpose of this study was to investigate the changes of muscular strength and balance ability after eight weeks rehabilitation programme allograft and autograft in anterior cruciate ligament reconstruction. The eighteen subjects participated in rehabilitation programme 3 times per week for eight weeks. Isometric strength test and balance ability test were done before rehabilitation programme, in fourth and eighth week during rehabilitation programme. These findings indicate that rehabilitation programme improve knee joint isometric strength and balance ability after ACL reconstruction. Therefore, the rehabilitation programme can help the recovery of knee joint muscular function and balancing ability after ACL reconstruction. However, there were no differences in extensor and flexion strength recovery pattern between the allograft and autograft used for the reconstruction. Recovery pattern may be affected by the difference in stabilization period and adaptation related to graft types in ACL reconstruction. Further study is needed investigation of the difference in muscle strength after long-term rehabilitation programme between the graft types.

전방 십자 인대 재건술후 Bone SPECT - 관절염의 예후 인자 -

이범구(Beom Koo Lee),성인호(In Ho Sung),김종호(Jong Ho Kim),최장석(Jang Seok Choi) 대한슬관절학회 1999 대한슬관절학회지 Vol.11 No.2

Purpose : To evaluate prognostic factors for arthritis and usefulness of bone SPECT in reconstructed joint. Material & method : ACL reconstruction using bone-patellar tendon-bone graft was performed in fourteen patients from March 1996 to March 1997, and follow-up bone SPECT was done. The mean duration from ACL reconstruction to SPECT was 23 months. The knee was defined to be unstable when the difference of displacement measured using KT-2000 arthrometer was greater than 3 ㎜. Lesions were evaluated in sub-divided five compartments ; patello-femoral joint, anteromedial, anterolateral, postero-medial and posterolateral compartment of tibio-femoral joint. Result : Geographic bone bruise was found in 9 cases(15 compartments) of 14 patients and bone SPECT revealed increased uptake in all the compartments. Reticular type bone bruise was found in 6 cases(7 compartments) and no compartment revealed increased uptake. Partial meniscectomy was done in 9 cases(16 compartments), and 8 cases(13 compartments) of them revealed increased uptake. Six cases were unstable and four of them revealed increased uptake in the patello-femoral joint. Activity level was not correlated with hot uptake. Conclusion : Bone SPECT is a useful method to predict osteoarthritis after ACL reconstruction. Geo-graphic bone bruises at injury, meniscectomy and instability are important factors for prognosis after ACL reconstruction.

앞십자인대 재건술 후 엉덩관절 벌림근 강화운동이 근력과 보행에 미치는 영향

박병준,김중휘,Park, Byung-Joon,Kim, Joong-Hwi 대한물리치료학회 2014 대한물리치료학회지 Vol.26 No.5

Purpose: The purpose of this study was to investigate the effect of strengthening exercises of hip abductors on muscle strength and ambulation for patients with ACL reconstruction. Methods: The subjects were randomly assigned to the intervention group (general exercise plus strengthening of hip abductors) or the control group (general exercise without the strengthening of hip abductors). Both groups participated in a six-week exercise protocol after the surgery for ACL reconstruction. The knee strength test (quadriceps, hamstring, hip abductor) and gait analysis were performed in pretest and post-test. Results: Muscle strength was measured using the Biodex system III model (Biodex Medical System, Inc, NY, US). The results showed no significant difference in knee strength (quadriceps, hamstring) between the two groups (p>0.05), however, there was a significant difference in hip abductors (p<0.05). The gait analysis was measured with Gaitrite system (CIR System Inc, US). Results of comparison between groups showed a significant increase in the step length of both groups. (p<0.05), and there was a significant difference in the affected leg of the intervention group(p<0.05). Conclusion: Exercise of hip abductors for patients with ACL reconstruction provides significant benefits with respect to improvement of muscle strength in hip abductors, increasing the stride. This result indicates that a training program designed for ACL reconstruction patients should include strengthening of the hip abductor. We think that further study is needed to determine the relationship of hip muscles and knee joint for patients with ACL reconstruction.

자가 슬개건과 동종 슬개건을 이용한 전십자인대의 재건의 비교

변기용,이광진,신현대,이원석,Byun Ki-Yong,Rhee Kwang-Jin,Shin Hyun-Dae,Lee Won-Sok 대한관절경학회 1997 대한관절경학회지 Vol.1 No.1

We have studied the results of reconstruction by freeze-dried patellar allografts or patellar autografts in ACL-deficient patients prospectively. From January 1995 to December 1995, we performed ACL reconstruction using an arthroscopic-assisted technique with patellar autografts in 21 patients and patellar allografts in 13 patients. Minimum followup time was 1 year(average 26 months). All patients were evaluated by using KT-2000 arthrometer and MRI as well as by physical examination. Final results were rated as satisfactory or unsatisfactory by using a modified Feagin knee scoring scale. Good or excellent were considered to have satisfactory results and fair or poor were considered to have unsatisfactory results. As measured by the KT-2000, 19 cases$(90.5\%)$ had a 5-mm or Jess side-to-side differential, a satisfactory results in autograft group, 2 cases of unsatisfactory results had joint instability. In allograft group, 10 cases$(76.9\%)$ had a 5-mm or less side-to-side differential, a satisfactory results, 3 cases of unsatisfactory results had joint instability including postoperative infection(1 case). In conclusion, the results of ACL reconstruction with autografts were better than those with allografts. The problem of allograft reconstruction were rehydration, aseptic control and improper mechanical tensioning. So, we thought that success of allograft reconstruction was depended on careful implant preparation including pretensioning technique.

대퇴 사두건을 이용한 관절경적 이중 다발 전방 십자 인대 재건술

김성재,정광암,송대흡,Kim, Sung-Jae,Jung, Kwang-Am,Song, Dae-Heup Korean Arthroscopy Society 2005 대한관절경학회지 Vol.9 No.2

Recently, the interest on anatomical ACL reconstruction with double bundle technique is increased to reproduce the original load distribution, and kinematics of the knee. We developed an arthroscopic double bundle ACL reconstruction technique using autogenous quadriceps tendon with 2 splitted graft and patellar bone plug. The anteromedial bundle and posteolateral bundle of the ACL is replicated with each splitted graft of quadriceps tendon and fixed with biodegradable interference screw on the 2 femoral tunnels. The patellar bone plug of quadriceps tendon is fixed with biodegradable interference screw within the 1 tibial tunnel. We suggest that our technique using quadriceps tendon may be an alternative in arthroscopic double bundle ACL reconstruction.

4겹의 반건양근 건을 이용한 전방십자인대 재건술

이광원,Lee, Kwang-Won 대한관절경학회 1997 대한관절경학회지 Vol.1 No.1

Numerous techniques of anterior cruciate ligament (ACL) reconstruction have been described in literature. All have inherent advantages and disadvantages. The central one-third patellar tendon and hamstring tendons are the most commonly used autogenous tissues for replacement of a torn anterior cruciate ligament. Although the central one-third patellar tendon is considered to be 'the gold standard' for replacement of torn ACL. equivalent results have been reported using hamstring tendon grafts. Autogenous hamstring grafts provide adequate strength while avoiding donor site morbidity associated with bone-tendon-bone harvest. $EndoButton^{\circledR}$ femoral fixation allows precise femoral tunnel placement without a second incison. The purpose of this article is to describe surgical techniques using a quadrupled semitendinosus tendon and $EndoButton^{\circledR}$ fixation, and review the results of replacement of ACL.

골 슬개건 골을 이용한 관절경적 전방십자인대 재건술 전방십자인대 단독손상군과 내측부인대 동반손상군의 비교연구

정영복,태석기,진휘재 ( Young Bok Jung,Suk Ki Tae,Whui Jae Jin ) 대한슬관절학회 1994 대한슬관절학회지 Vol.6 No.2

Through bone-patellar tendon-bone autograft kas been sucessfully used for the reconstruction of the anterior cruciate ligament,whereas,conservative treatment has been used for medial collateral ligament.We experienced 40 arthroscopically reconstructions of the anterior cruciate ligament from January 1990 to June 1993 using bone-patellar tendon-bone autograft. Our purpose is to review the results of ACL reconstruction with isolated ACL injurypatients(Group I) and MCL combined injured patients(Group II);We have followed up from 12months to 54months(average 29months).There was 17 cases in Group I and 23 cases in Group II.According to the evaluation format of the Swiss knee group(OAK:Muller's criteria), in Group I,the results were excellent in 9 cases,good in 7 cases,fair in 1 case.In Group 1I,excellerit in 12 cases,good in 9 cases,fair in 2 cases.On instability evaluation by KT-1000 arthrometry,in Group I,the maximal manual displacement below 3mm difference in 13 cases,above 3mm differeoce in 4 cases.In Group II below 3nun difference in 17 cases, above 3mm difference in 6 cases. From the above results,there are no significant difference between the result of isolatedACL,group and MCL.combined group.We concluded that the acute MCL injury need not be surgically repaired in the ACL-MCL injured knee.