scholarly journals Twelve Weeks of a Staged Balance and Strength Training Program Improves Muscle Strength, Proprioception, and Clinical Function in Patients with Isolated Posterior Cruciate Ligament Injuries

2021 ◽  
Vol 18 (23) ◽  
pp. 12849
Author(s):  
Cheng-Chang Lu ◽  
Hsin-I Yao ◽  
Tsang-Yu Fan ◽  
Yu-Chuan Lin ◽  
Hwai-Ting Lin ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Strength Training ◽  
Training Program ◽  
Functional Outcome ◽  
Cruciate Ligament ◽  
Study Group ◽  
Pcl Reconstruction ◽  
Isokinetic Muscle Strength ◽  
Pcl Injury ◽  
Reconstruction Group

Ligament reconstruction is indicated in patients with an isolated posterior cruciate ligament (PCL) injury who fail conservative treatment. To eliminate the need for PCL reconstruction, an ideal rehabilitation program is important for patients with an isolated PCL injury. The purpose of this study was to investigate the improvement in functional outcome, proprioception, and muscle strength after a Both Sides Up (BOSU) ball was used in a balance combined with strength training program in patients with an isolated PCL injury. Ten patients with isolated PCL injuries were recruited to receive a 12 week training program as a study group. In the control group (post-PCL reconstruction group), ten subjects who had undergone isolated PCL reconstruction for more than 2 years were enrolled without current rehabilitation. The Lysholm score, IKDC score, proprioception (active and passive), and isokinetic muscle strength tests at 60°/s, 120°/s, and 240°/s, were used before and after training on the injured and normal knees in the study group, and in the post-PCL reconstruction group. The results were analyzed with a paired t-test to compare the change between pre-training, post-training, and the normal leg in the study group, and with an independent t-test for comparisons between the study and post-PCL reconstruction groups. Both the Lysholm and IKDC scores were significantly improved (p < 0.01) after training, and no difference was observed compared to the post-PCL reconstruction group. The active and passive proprioception was improved post-training compared to pre-training, with no difference to that in the post-PCL reconstruction group. Isokinetic knee quadriceps muscle strength was significantly greater post-training than pre-training in PCL injured knees at 60°/s, 120°/s, and 240°/s, and in hamstring muscle strength at 60°/s and 120°/s. Muscle strength in the post-training injured knee group showed no significant difference compared to that in the post-training normal leg and the post-PCL reconstruction group. The post-training improvement of muscle strength was higher in the PCL injured leg compared to the normal leg and there was no difference between the dominant and non-dominant injured leg in the study group. After 12 weeks of BOSU balance with strength training in patients with an isolated PCL injury, the functional outcome, proprioception, and isokinetic muscle strength were significantly improved, and comparable to the contralateral normal leg and the post-PCL reconstruction group. We suggest that programs combining BOSU balance and strength training should be introduced in patients with a PCL injury to promote positive clinical results.

scholarly journals Evaluation of Deep Vein Thrombosis Risk Factors After Arthroscopic Posterior Cruciate Ligament Reconstruction: A Retrospective Observational Study

2021 ◽  
Vol 27 ◽  
pp. 107602962110305
Author(s):  
Pu Ying ◽  
Wenge Ding ◽  
Xiaowei Jiang ◽  
Yue Xu ◽  
Yi Xue ◽  
...  
Keyword(s):  
Risk Factors ◽  
Posterior Cruciate Ligament ◽  
Color Doppler ◽  
Cruciate Ligament ◽  
Color Doppler Ultrasound ◽  
Pcl Reconstruction ◽  
Vein Thrombosis ◽  
Post Surgery ◽  
Pcl Injury ◽  
D Dimer

We evaluated the risk factors of deep venous thrombosis (DVT) after knee arthroscopic posterior cruciate ligament (PCL) reconstruction in patients with only PCL injury. From August 2014 to December 2020, a total of 172 patients who had accepted knee arthroscopic PCL reconstruction underwent the color Doppler ultrasound of bilateral lower-extremities deep veins on 3 days postoperatively. Based on the inspection results, patients were divided into DVT group (18 males and 8 females, mean age 43.62 years) and non-DVT group (108 males and 38 females, mean age 33.96 years). The potential associations of DVT risk and age, gender, body mass index (BMI), diabetes, hypertension, smoking and other factors were analyzed. An old age (OR = 1.090; 95% CI = 1.025-1.158; P = 0.006), a high BMI (OR = 1.509; 95% CI = 1.181-1.929; P = 0.001) and an increased post-surgery D-dimer (OR = 5.034; 95% CI = 2.091-12,117; P ≤ 0.001) value were significantly associated with an elevated DVT risk after knee arthroscopic PCL reconstruction. Increased age, BMI, and postoperative D-dimer were risk factors of DVT following knee arthroscopic PCL reconstruction in patients with only PCL injury.

scholarly journals Implementation of a Strength Training Program for a 5-Year-Old Child With Poor Body Awareness and Developmental Coordination Disorder

2007 ◽  
Vol 87 (4) ◽  
pp. 455-467 ◽  
Author(s):  
Linda B Kaufman ◽  
Denise L Schilling
Keyword(s):  
Physical Therapy ◽  
Muscle Strength ◽  
Strength Training ◽  
Training Program ◽  
Motor Function ◽  
Developmental Coordination Disorder ◽  
Poor Performance ◽  
Body Awareness ◽  
Position Sense ◽  
Coordination Disorder

Background and Purpose This case report describes how a strength (muscle force-generating capacity) training program was associated with changes in muscle strength, motor function, and proprioceptive position sense in a young child with poor body awareness and a diagnosis of developmental coordination disorder. Case Description Assessment of a prekindergarten child referred for physical therapy because of behaviors compatible with poor body awareness revealed muscle weakness, poor performance on the Bruininks-Oseretsky Test of Motor Proficiency, and poor proprioception. Physical therapy testing done when the child was 5 years of age contributed to a pediatrician-assigned diagnosis of developmental coordination disorder. A 12-week strength training program was initiated. Outcomes Improvements were noted in muscle strength, gross motor function, and proprioception. Discussion Research indicates that muscles provide information about joint position. Evidence suggests that muscle strength gains seen in children are the result of neuromuscular learning and neural adaptations; therefore, a structured strength training program may have contributed to proprioceptive changes in this child.

scholarly journals Comparison of Clinical and Radiological Parameters with Two Different Surgical Methods for Anterior Cruciate Ligament Reconstruction

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0027
Author(s):  
Osman Çiloğlu ◽  
Hakan Çiçek ◽  
Ahmet Yılmaz ◽  
Metin Özalay ◽  
Gökhan Söker ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Muscle Strength ◽  
Surgical Technique ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Tunnel Widening ◽  
Isokinetic Muscle Strength ◽  
Group 2 ◽  
Anterior Cruciate ◽  
Group 1

Objectives: We investigated the effects anatomic or nonanatomic femoral tunnel positions and tunnel fixation methods obtained using two different surgery methods on tunnel widening and clinical results in anterior cruciate ligament (ACL) reconstructions. Methods: Patients with isolated anterior cruciate ligament rupture are included to study who don’t have intra-and extra-articular additional pathology of the knee, without previously a history of operations of both knees. 2 groups were created. Group 1 Aperfix implant were used which can be able to perform non anatomical femoral tunnel and intra tunnel fixation with transtibial technique. In Group 2 Endobutton CL implant were used which can make fixation from outside the cortex with anatomic femoral tunnel in use of anteromedial portal techniques. 27 patients (average age 29,33, range 18 to 55 years) in group 1 and 27 patients (average age 27,51, range 16 to 45 years) in group 2 totally 54 patients were performed surgery. All patients were assessed using the IKDC (International knee documentation committee), Tegner Activity Scala and Lysholm II Functional Scores. Muscle strength measurements in both groups compared to intact knee was measured with an isokinetic dynamometer Biodex System 3 Pro. The location of the femoral tunnel aperture and tunnel widening were imaged with 3D reconstructive computed tomography. All measurements were performed using the same software application by the same radiologist. Results: The two groups were similar with respect to age and sex distribution, operated side, the size of the tunnel created, and follow-up period (p>0.05). After surgery in both groups, the clinical scores showed significant improvement compared to preoperative (p=0,0001). However, postoperative clinical outcomes in the two groups did not show a difference significantly (p>0,005). Isokinetic muscle strength study showed significant differences between the two groups (p=0,0001). Location of femoral tunnel aperture on the medial wall of the lateral femoral condyle showed a significant differences in the two groups (p=0,0001). The expansion of proximal and distal femoral tunnel in two groups showed significant differences (p=0,0001). There was relationship between distal femoral tunnel widening and location of femoral tunnel aperture. Conclusion: Although there is no statistically significant difference between the two groups clinically, difference noticed in terms of isokinetic muscle strength may be due to differences in the degree of shift as a result of multiple loading depending on the biomechanical properties of materials. We thought that the difference seen in the widening of tunnel in the proximal or distal may be due to, the technique of graft fixation, the distance between the fixation point and the joint, and to the location of the femoral tunnel aperture on medial wall of lateral condyle from anatomical or non anatomical region. There is no golden standard in neither surgical technique nor material of fixation. Proper theoretical knowledge and extensive clinical experience are important in the light of an accurate surgical technique applied. We thought that information we have reached in our study should be supported by biomechanical studies

scholarly journals Posterior Tibial Slope and Risk of Posterior Cruciate Ligament Injury

2019 ◽  
Vol 47 (2) ◽  
pp. 312-317 ◽  
Author(s):  
Andrew S. Bernhardson ◽  
Nicholas N. DePhillipo ◽  
Blake T. Daney ◽  
Mitchell I. Kennedy ◽  
Zachary S. Aman ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Ligament Injury ◽  
Mechanism Of Injury ◽  
Control Groups ◽  
Pcl Reconstruction ◽  
Posterior Tibial ◽  
Pcl Injury ◽  
Age And Sex

Background: Recent biomechanical studies have identified sagittal plane posterior tibial slope as a potential risk factor for posterior cruciate ligament (PCL) injury because of its effects on the kinematics of the native and surgically treated knee. However, the literature lacks clinical correlation between primary PCL injuries and decreased posterior tibial slope. Purpose/Hypothesis: The purpose of this study was to retrospectively compare the amount of posterior tibial slope between patients with PCL injuries and age/sex-matched controls with intact PCLs. It was hypothesized that patients with PCL injuries would have a significantly decreased amount of posterior tibial slope when compared with patients without PCL injuries. Study Design: Case-control study; Level of evidence, 3. Methods: Patients who underwent primary PCL reconstruction without anterior cruciate ligament injury between 2010 and 2017 by a single surgeon were retrospectively analyzed. Measurements of posterior tibial slope were performed with lateral radiographs of PCL-injured knees and matched controls without clinical or magnetic resonance imaging evidence of ligamentous injury. Mean values of posterior tibial slope were compared between the groups. Inter- and intrarater agreement was assessed for the tibial slope measurement technique via a 2-way random effects model to calculate the intraclass correlation coefficient (ICC). Results: In sum, 104 patients with PCL tears met the inclusion criteria, and 104 controls were matched according to age and sex. There were no significant differences in age ( P = .166), sex ( P = .345), or body mass index ( P = .424) between the PCL-injured and control groups. Of the PCL tear cohort, 91 patients (87.5%) sustained a contact mechanism of injury, while 13 (12.5%) reported a noncontact mechanism of injury. The mean ± SD posterior tibial slopes were 5.7°± 2.1° (95% CI, 5.3°-6.1°) and 8.6°± 2.2° (95% CI, 8.1°-9.0°) for the PCL-injured and matched control groups, respectively ( P < .0001). Subgroup analysis of the PCL-injured knees according to mechanism of injury demonstrated significant differences in posterior tibial slope between noncontact (4.6°± 1.8°) and contact (6.2°± 2.2°) injuries for all patients with PCL tears ( P = .013) and among patients with isolated PCL tears ( P = .003). The tibial slope measurement technique was highly reliable, with an ICC of 0.852 for interrater reliability and an ICC of 0.872 for intrarater reliability. Conclusion: A decreased posterior tibial slope was associated with patients with PCL tears as compared with age- and sex-matched controls with intact PCLs. Decreased tibial slope appears to be a risk factor for primary PCL injury. However, further clinical research is needed to assess if decreased posterior tibial slope affects posterior knee stability and outcomes after PCL reconstruction.

scholarly journals Posturography table is a good test to evaluate the anterior cruciate Ligament reconstruction?

2019 ◽  
Vol 7 (5_suppl3) ◽  
pp. 2325967119S0021
Author(s):  
Frank Wein ◽  
Laetitia Peultier ◽  
Didier Mainard ◽  
Philippe Perrin
Keyword(s):  
Anterior Cruciate Ligament ◽  
Muscle Strength ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Strength Measurement ◽  
Cruciate Ligament Reconstruction ◽  
Isokinetic Muscle Strength ◽  
Unstable Support ◽  
Anterior Cruciate ◽  
Muscle Strength Measurement

Introduction: The success of anterior cruciate ligament reconstruction (ACLR) is assessed using subjective and functional scores, as well as measurements of knee laxity. The latter is often quantified using instrumented laximetry devices, which measure ‘static’ anterior tibial translation, though recent studies suggested more comprehensive “dynamic” analyses such as jump tests. To facilitate and improve dynamic stability analyses, a proprioception table was adapted to evaluate knees before and after ACLR, though the accuracy and pertinence of its measurement have not yet been demonstrated. Objectives: To determine whether proprioceptive analysis following ACLR provides meaningful and helpful information to guide surgeons and physiotherapists with postoperative rehabilitation and return to sports. Methods: We conducted a prospective study, on a population of 50 amateur or professional sports patients, who received ACLR by the one surgeon (FW). Preoperative and 6-months assessments included GnRB laxity analysis and proprioceptive dynamic stability analysis, with evaluation of the bearing area under 6 different conditions: open eyes (C1), closed eyes (C2), vision distorted by virtual reality headset (C3), open eyes on unstable support (C4), closed eyes on unstable support (C5) and distorted vison on unstable support (C6); a calculation of the C4/C1 ratio enabled appreciation of visual compensations in the proprioceptive capacity, and dependence on visual inference (low ratios indicate greater recourse to visual afference). A complementary analysis of muscular strength by isokinetic assessment was also performed at 6 months followup. Results: There was a significant improvement in proprioception table stability at 6 months compared to the preoperative condition at the C4 (470 vs 440 mm2), C5 (1710 vs 1315 mm2) and C6 (1330 vs 1210 mm2) assessments. For 32 patients evaluated by GnRB, differential laxity at 6 months was less than 5 mm at 200 N, and isokinetic muscle strength measurement was less than 20% different between the knee healthy and the operated knee, or between quadriceps and hamstrings. Proprioceptive quality was variable, with significant visual offsets in some cases (C4/C1 ratio, 0.5 to 16.2). Conclusion: Patients, who have good results in laximeter tests and isokinetic muscle strength measurement, may have a poor proporioception quality with significant visual offsets. The proprioception analysis at 6 months following ACLR could therefore be important to consider rehabilitation and sports recovery.

scholarly journals Arthroscopic Standard Anterior and Posteromedial Portal Posterior Cruciate Ligament Reconstruction With Remnant Preservation : 2-Year Follow-up

2020 ◽  
Vol 8 (B) ◽  
pp. 418-422
Author(s):  
Sholahuddin Rhatomy ◽  
Erwin Saspraditya ◽  
Riky Setyawan
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
International Knee Documentation Committee ◽  
Pcl Reconstruction ◽  
Remnant Preservation ◽  
Lysholm Knee Score ◽  
Ikdc Score ◽  
Grade 3 ◽  
Pcl Injury

BACKGROUND: Grade 3 posterior cruciate ligament (PCL) injury needs surgical intervention, but there is no consensus on the optimal technique in PCL reconstruction. The old technique always removes the remnant for good visualization of tunnel replacement. Recently, many studies proposed the concept of preservation of PCL remnant with achieve good visualization. AIM: The aim of the study is to evaluate PCL reconstruction with remnant preservation using the standard anterior and posteromedial portal at 2-year follow-up. METHODS: We conducted a cohort retrospective study between January 2013 and December 2015. In this study, 25 patients underwent PCL reconstruction using the standard anterior and posteromedial portal with remnant preservation. We used quadrupled hamstring autograft. The patients were assessed using the International Knee Documentation Committee (IKDC) score, Lysholm Knee Score, Modified Cincinnati Score, and knee society score (KSS) at pre-operative and 2-year post-operative. Range of motion (ROM) and complications were evaluated postoperatively. RESULTS: The mean diameter of the quadruple hamstring graft was 8 mm. Clinical outcomes enhanced significantly (p < 0.05). The average of Lysholm activity scale improved from 65.12 ± 10.48 to 94.96 ± 4.80. The IKDC score improved from 60.50 ± 15.10 to 95.60 ± 3.44. Modified Cincinnati score improved from 62. 28 ± 13.6 to 96.04 ± 1.62. The KSS also improved from 60.12 ± 18.01 to 94.88 ± 6.36. Twenty-two patients had 0–135° full ROM and three patients had 0–110° ROM. Two patients had surgical site infection but recovered with local debridement. CONCLUSION: PCL reconstruction using the standard anterior and posteromedial portal with remnant preservation at 2-year follow-up resulted in satisfactory clinical and functional outcomes.

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