Rehab Centers: The Anatomy of the ACL and Its Importance in ACL Reconstruction.

The anatomy of the ACL and its importance in ACL reconstruction.

Filed under: Rehab Centers

Eur J Orthop Surg Traumatol. 2012 Sep 22;
Markatos K, Kaseta MK, Lallos SN, Korres DS, Efstathopoulos N

The anterior cruciate ligament (ACL) anatomy is very significant if a reconstruction is attempted after its rupture. An anatomic study should have to address, its biomechanical properties, its kinematics, its position and anatomic correlation and its functional properties. In this review, an attempt is made to summarize the most recent and authoritative tendencies as far as the anatomy of the ACL, and its surgical application in its reconstruction are concerned. Also, it is significant to take into account the anatomy as far as the rehabilitation protocol is concerned. Separate placement in the femoral side is known to give better results from transtibial approach. The medial tibial eminence and the intermeniscal ligament may be used as landmarks to guide the correct tunnel placement in anatomic ACL reconstruction. The anatomic centrum of the ACL femoral footprint is 43 % of the proximal-to-distal length of lateral, femoral intercondylar notch wall and femoral socket radius plus 2.5 mm anterior to the posterior articular margin. Some important factors affecting the surgical outcome of ACL reconstruction include graft selection, tunnel placement, initial graft tension, graft fixation, graft tunnel motion and healing. The rehabilitation protocol should come in phases in order to increase range of motion, muscle strength and leg balance, it should protect the graft and weightbearing should come in stages. The cornerstones of such a protocol remain bracing, controlling edema, pain and range of motion. This should be useful and valuable information in achieving full range of motion and stability of the knee postoperatively. In the end, all these advancements will contribute to better patient outcome. Recommendations point toward further experimental work with in vivo and in vitro studies, in order to assist in the development of new surgical procedures that could possibly replicate more closely the natural ACL anatomy and prevent future knee pathology.
HubMed – rehab


Closed internal degloving associated with a thoracolumbar burst fracture: a case report.

Filed under: Rehab Centers

Eur J Orthop Surg Traumatol. 2012 Jul 27;
Bijukachhe B, Banskota B, Shrestha BK, Banskota AK

Internal degloving injuries are rare in association with thoracolumbar fractures. A high index of suspicion is warranted to identify and debride such lesions to prevent infection, which can be disastrous in the presence of spinal hardware. Whether such lesions should be routinely repaired is probably dependent on the extent of avulsion.
HubMed – rehab


Functional walking ability of paraplegic patients: comparison of functional electrical stimulation versus mechanical orthoses.

Filed under: Rehab Centers

Eur J Orthop Surg Traumatol. 2012 Jul 22;
Karimi MT

BACKGROUND: Spinal cord injury (SCI) can cause partial or complete paralysis of the lower extremities, impairing the ability of individuals to stand and walk. Various types of mechanical orthoses, functional electrical stimulation (FES) systems and hybrid orthoses that incorporate FES have been designed to restore the ability of individuals with SCI to stand and walk. Standing and ambulation performance of SCI subjects using these different systems have been previously evaluated using energy consumption analysis, stability analysis and by quantitative gait analysis. Though FES-based systems are technologically more complex than passive mechanical systems, it is not apparent whether user performance is substantially improved with FES and hybrid orthoses compared to purely mechanical orthoses. METHOD: An electronic search was performed via the Pubmed, Embase and ISI Web of Knowledge data base from 1960 to 2010. The abstracts, titles and full details of each individual study were assessed by the authors. The findings that were indicative of users’ performance with the FES systems and hybrid systems were compared with that of mechanical orthoses. Moreover, the effects of using these different systems on physiological health were evaluated. RESULTS: Twelve original articles and 5 review articles were selected by the author. However, most of the original articles were case studies. The results of previous investigations indicate that user performance with the mechanical orthoses was generally better than that of the hybrid and FES systems based on subject’s stability and energy consumption while walking. Moreover, subject reportedly experienced a higher incidence of problems with the use of hybrid orthoses and FES systems compared with mechanical orthoses. CONCLUSION: FES and hybrid orthoses offer considerable potential for restoring standing and walking abilities in persons with SCI. However, improvements in their designs and operation with subsequent objective evaluations are required to demonstrate that these systems enable users to improve their performance over that currently possible with passive, mechanical orthoses.
HubMed – rehab


Combined medial open-wedge high tibial osteotomy and modified Maquet procedure for medial compartmental osteoarthritis and patellofemoral arthritis of the knee.

Filed under: Rehab Centers

Eur J Orthop Surg Traumatol. 2012 Jul 13;
Kim JH, Kim JR, Lee DH, Bang JY, Hong IT

PURPOSE: Patellofemoral arthritis comes frequently with medial compartmental osteoarthritis. The combination of closed wedge high tibial osteotomy with tibial tuberosity anteriorization osteotomy has been introduced in several reports, but this technique is a technically demanding procedure and the outcomes of this technique show variable results. This article describes a novel osteotomy technique that combines medial open-wedge high tibial osteotomy (HTO) and tibial tuberosity anteriorization osteotomy (TTAO) for medial compartmental osteoarthritis and patellofemoral arthritis of the knee. METHODS: Twelve knees in 10 patients who were diagnosed with combined medial compartmental osteoarthritis with patellofemoral compartmental arthritis were treated with the combination of medial open-wedge HTO and TTAO and were followed up for more than 1 year. We evaluated the patients with the Lysholm functional questionnaires, the hospital for special surgery score (HSS), and the international knee documentation committee (IKDC) criteria (mean follow-up, 14.8 months). RESULTS: Union was achieved in all cases within 12 weeks. The mean Lysholm score increased from 42 preoperatively to 82.5 postoperatively (p < 0.001), the HSS increased from 57.5 preoperatively to 83 postoperatively (p < 0.001), and the IKDC score increased from 51 preoperatively to 82 postoperatively (p < 0.001). There were no other complications, such as iatrogenic fractures, nonunion, wound problem, collapse or loss of correction, and so on. CONCLUSIONS: The combination of medial open-wedge HTO and modified Maquet procedure (TTAO) is considered to be an effective treatment modality for medial and patellofemoral compartmental osteoarthritis. This technique could, therefore, constantly provide a minimally invasive, precise correction of the deformity and a firm fixation that is enough to allow early rehabilitation. HubMed – rehab


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