The anterior cruciate ligament problem.
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Anterior Cruciate Ligament↗
Biomedical subjects
A Lindstrand
Publications and source records attributed to A Lindstrand.
Soccer after anterior cruciate ligament injury--an incompatible combination? A national survey of incidence and risk factors and a 7-year follow-up of 310 players.
All players in Swedish soccer teams are required to have insurance in the same company. From the archives of the insurance company, all 3,735 injuries reported in 1986 in 188,152 Swedish soccer players were reviewed. Of these, 937 were knee injuries. All players were asked by mail to fill in a questionnaire and 83 percent replied. The patient records from the different hospitals were requested. The anterior cruciate injuries represented one third of the reported knee injuries. The relative risk of sustaining an anterior cruciate ligament injury was increased in female players, in elite players, and in players in the forward position. The odds ratios were 1.6 (1.3-2.1), 3.3 (1.7-6.1) and 1.8 (1.4-2.5), respectively. The injuries occurred at a younger age in females than in males. 50 percent of the injured players were treated with anterior cruciate ligament surgery, predominantly as a reconstructive procedure, with use of a patellar tendon transplant. 30 (20) percent of the players with anterior cruciate ligament injury were active in soccer after 3 (7) years, compared to 80 (50) percent of an injured control population of soccer players. None of the elite players was active at the same level after 7 years. A comparison of anterior cruciate ligament-injured players, whether treated by surgical reconstruction or not, revealed no difference with regard to the proportion of players still playing soccer after 7 years.
Adult↗
Severe instability despite a constrained knee prosthesis with central stabilizer. A case report.
We report on the clinical failure of a constrained total condylar knee with a central stabilizer in a revision case. The knee was very unstable, with a valgus deviation of more than 45. At surgery, the instability was normalized, but the valgus deviation recurred during the first year.
Female↗
Roentgen stereophotogrammetric analysis as a predictor of mechanical loosening of knee prostheses.
The tibial components in 143 patients with total knee replacements performed before 1988 were assessed for micromotion using roentgen stereophotogrammetric analysis (RSA) over a period of 13 years. The fixation of the prostheses remained clinically sound in all cases, although revision had been required for other reasons in seven. In a second group taken from all cases with RSA available on our full database to 1990, 15 tibial components had been followed by RSA from the insertion until, 1 to 11 years after the initial arthroplasty, they were revised for mechanical loosening of the tibial component; 12 of these comprised all the loosenings in the base group, thus making a total of 155 consecutive cases, while an additional three were inserted after the base material had been compiled. The mean migration in the first group was about 1 mm at one year, but subsequent migration was slower, reaching a mean of about 1.5 mm after ten years. About one-third migrated continuously throughout follow-up, while two-thirds ceased to migrate after one to two years. In the revision group, 14 components had migrated continuously and at one year significantly more than those in the first group. One revision case lacked the crucial one-year follow-up and could not be classified. These findings suggest that mechanical loosening begins early in the postoperative period. Clinical symptoms which necessitate revision, seen at this stage in 20% of abnormally migrating tibial components, may not appear until up to ten years after the operation.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Effect of a cooled saw blade on prosthesis fixation. Randomized radiostereometry of 33 knee cases.
Tibial migration in 33 cementless total knee replacements, which were performed with a cooled saw blade vs. a conventional blade, was studied in a randomized prospective study using roentgen stereophotogrammetric analysis (radiostereometry). All cases were clinically successful after 2 years and inducible displacement was smaller in the group operated with the cooled saw blade. This group also had a tendency towards less continuous migration.
Aged↗
Radiographic assessment of sagittal knee instability in weight bearing. A study on anterior cruciate-deficient knees.
In 16 patients with chronic, symptomatic anterior cruciate ligament-deficient knees, sagittal displacement was studied in the standing position using fluoroscopic control and a simple device to support the knee. In slight weight bearing all knees but one had normal femorotibial alignment in the lateral view. During full weight bearing sagittal displacements between 2 mm and 17 mm were recorded in 14 patients. The largest displacements were obtained at different angles of inclination of the leg and flexion of the knee joint and were independent of the point of support of the knee joint. The reproducibility of this new standing technique was within 2 mm. A high correlation with previous methods of radiographic measurements of sagittal laxity was found. By the use of the normal relationship between the tibial eminence and the femoral condyles it is possible to record and measure sagittal displacements on a single lateral radiograph of the standing knee joint.
Adolescent↗
Prevalence of syphilis infection in Mozambican women with second trimester miscarriage and women attending antenatal care in second trimester.
OBJECTIVES: To elucidate whether recent syphilis infection is significantly more prevalent among women with mid-trimester miscarriage than among antenatal care attenders in midtrimester pregnancy. DESIGN: Two categories of pregnant women were compared regarding serological signs of syphilis. Rapid Plasma Reagin (RPR) analyses were done in Mozambique and Veneral Disease Research Laboratory (VDRL) tests in Sweden. In case of RPR and/or VDRL positivity, Treponema pallidum haemagglutination (TPHA) and Captia Syphilis-M were performed. SETTING: A suburban antenatal care clinic and the emergency ward at the Department of Obstetrics and Gynecology at the Central Hospital in Maputo, Mozambique, were studied June-August 1991. SUBJECTS: Randomly selected women seeking antenatal care in midtrimester pregnancy (N = 202) were compared with 114 women consecutively entering with clinical signs of midtrimester miscarriage. RESULTS: Among antenatal care attenders, 37/202 (18.3%), and among women with midtrimester miscarriage, 37/114 (32.5%), had syphilis confirmed with the Treponema pallidum haemagglutination test (p < 0.01). Significant titres of IgM antibodies tended to be more prevalent among women with miscarriage (7.0%) than among women attending antenatal care (4.5%), though the difference only approached statistical significance. CONCLUSION: The findings suggest a potential association between syphilis seropositivity and midtrimester miscarriage. Present findings justify more extensive studies to establish whether or not recent syphilis infection is a risk factor for midtrimester miscarriage.
Abortion, Spontaneous↗
Effect of femoral condyle configuration on disability after an anterior cruciate ligament rupture. 100 patients followed for 5 years.
We measured the configuration of the femoral condyles on lateral radiographs in 100 consecutive, prospectively-studied patients with a complete rupture of the anterior cruciate ligament, with or without associated lesions of the menisci and collateral ligaments. The patients had mainly low-to-moderate activity demands, and in all the patients the cruciate tear was primarily treated non-operatively. A quotient was calculated from the measurements of sagittal depth and axial height in order to describe the geometry of the femoral condyles. Measurements were reproducible with an intra- and interobserver coefficient of correlation of 0.89-0.98. At follow-up, after 5 (3-6) years, 16 patients had developed disability leading to reconstructive surgery. The remaining 84 patients did not have any major functional limitations, but some had reduced their activity level. Individual variations in the articular geometry were found with a more spherical shape of the femoral condyles in the patients where non-operative treatment had failed. Our findings indicate that articular geometry is of importance for function after an anterior ligament lesion.
Anterior Cruciate Ligament↗
99mTc-diphosphonate scintigraphy in successful knee arthroplasty and its relation to micromotion.
Nineteen tibial components after successful knee arthroplasty were studied with technetium 99m scintigraphy. All cases were also followed from the operation with roentgen stereophotogrammetric analysis (RSA). All but three cases became stable after an initial period of migration. Scintigraphic uptake was found in all cases, with a ratio as high as seven in the medial compartment and three in the lateral compartment. A group of cases with proven mechanical loosening showed an uptake ratio as high as 6.9 in the medial compartment and 5.5 in the lateral compartment. No correlation was found between scintigraphic uptake and alignment, whether cement was used, or the presence/absence of migration. Technetium 99m scintigraphy is not a useful method for assessing loosening in individual symptomatic cases of knee arthroplasty.
Aged↗
Size of osteonecrosis of the knee.
In the Swedish Multicenter Study of Knee Arthroplasty, 115 knees in 110 patients with knee osteonecrosis represented all reported cases treated with knee arthroplasty in the period from 1975 to 1986. Primary medial femoral condyle osteonecrosis was the most common osteonecrosis reported (89%). Preoperative roentgenograms were staged according to the type of osteonecrosis and classified according to the grade of arthrosis. Detailed measurements of the size of the lesion were also performed. For primary medial femoral osteonecrosis, the width of the lesion averaged 45% of the condyle. The mean width of the lesion (anteroposterior size) was 21 mm and the mean length (lateral size) was 34 mm. The mean depth on lateral roentgenograms was 6 mm. There was a high correlation of results among the various methods of measurement. Using regression analysis, it was possible to approximate the volume of the lesion even from a single measurement of the width on anteroposterior view. The size of osteonecrosis of the knee can be used to plan resection and select the implant design.
Adult↗
The influence of metal backing in unicompartmental tibial component fixation. An in vivo roentgen stereophotogrammetric analysis of micromotion.
The fixation of the tibial component in 36 patients with conventionally cemented unicompartmental knee arthroplasties for femorotibial gonarthrosis was studied using roentgen stereophotogrammetric analysis (RSA). Twenty-four tibial components were all-polyethylene while 12 were metal-backed. The follow-up was for 6 years. Significant migration was detected for all cases but two and ranged from 0.3 mm to 5.4 mm. The greater part of the migration occurred during the first 1-2 years, after which two-thirds of the prostheses remained stable. Seven all-polyethylene components were subjected to a stress examination after 1-2 years and displacement, induced by external forces, was found in all seven. A strong correlation was found between the extension of the radiolucent line and the migration. Otherwise, neither demographic, clinical, nor radiographic data correlated with the RSA results. In this study metal backing did not have any influence on prosthetic fixation as measured by RSA.
Aged↗
Temperature influence in different orthopaedic saw blades.
Laboratory tests were carried out on ox bone to evaluate the thermal effect of eight different saw blades while cutting cortical bone. These saw blades represented the usual clinical blades as well as saw blades specially manufactured in an attempt to decrease the temperature. Temperatures between 34 degrees C and 450 degrees C were registered in the saw blades. Only three measurements (of 219 tests) were below 44 degrees-47 degrees C, which is a critical limit for heat-induced bone necrosis. This test indicates that alternating saw blade design is not a way to control the temperature elevation during cutting of bone in orthopaedic procedures.
Bone and Bones↗
Instability after anterior cruciate ligament rupture. Measurements of sagittal laxity compared in 11 cases.
Manual tests and 2 external devices were used together with roentgen stereophotogrammetry (RSA) and an active weight-bearing radiographic method to measure the sagittal laxity in 11 knees with anterior-cruciate-ligament rupture. In 5 knees no ligament surgery had been performed (unstable knees) and in 6 knees a reconstruction had been performed one year before the examination (stable knees). There were positive correlations between all methods, including the manual tests when all knees, both stable and unstable, were analyzed together. However, the mean values of the total displacement differed between the methods, especially when comparing the weight-bearing radiographs with the three other methods. Some knees with substantial displacement during passive loading did not show any displacement when weight bearing; the measurements thus depended on both the ligamentous laxity and the patient's neuromuscular control of the joint. When the stable knees were analyzed separately, higher mean values were recorded with the external devices than with RSA using 180 N load. This could be explained by an error from soft tissue deformation which added to the skeletal displacement when the external devices were used.
Adolescent↗
Multicenter study of unicompartmental knee revision. PCA, Marmor, and St Georg compared in 3,777 cases of arthrosis.
The prospective Swedish Knee Arthroplasty Project contained 772 PCA, 1564 Marmor and 1441 St Georg unicompartment prostheses, implanted for gonarthrosis during the period December 1983-July 1990. Follow-up was performed in September 1991. There was a significant difference in the cumulative revision rate after only 2 years, increasing to 15 percent for the PCA, compared with 5-7 percent for the two other types. The difference between PCA and Marmor/St Georg was loosening of the femoral component. Major polyethylene wear was noted in a quarter of the revised PCA tibial components. The wear pattern of Marmor/St Georg was not analyzed in this study.
Actuarial Analysis↗
Polyethylene wear of the PCA unicompartmental knee. Prospective 5 (4-8) year study of 120 arthrosis knees.
In Lund, 120 arthrosis knees had the PCA unicompartmental endoprosthesis during 1983-1987 and were followed prospectively for 5 (4-8) years. 17 knees were excluded from the final clinical follow-up because of the development of rheumatoid arthritis (2), severe neurologic disease (3), or death (12). Subjectively, 68 knees were much improved, 26 improved and 9 had failed. First-steps problems were only present in the uncemented group of 49 knees. Of the 9 failures (7 cemented and 2 uncemented) 6 were revised. The main reason for revision was loosening of the femoral component (2), tibial component (2), or both components (1), and polyethylene wear (1). However, all revised tibial components showed polyethylene wear, in 4 quite pronounced. Weight-bearing radiographs (61 knees) revealed major polyethylene wear in an additional 14 knees; not only in thin tibial components. There may be an increasing clinical problem due to polyethylene wear. With the presented findings the PCA unicompartmental knee endoprosthesis cannot be recommended.
Aged↗
Laxity and graft fixation after reconstruction of the anterior cruciate ligament. A roentgen stereophotogrammetric analysis of 11 patients.
The sagittal laxity of the knee was measured in 11 consecutive patients with chronic anterior cruciate ligament deficiency before and 1 year after ligament reconstruction with a free bone-tendon-bone graft from the patellar tendon (modified Clancy technique). Tantalum markers were implanted in the femur, in the tibia, and in the graft for roentgen stereophotogrammetric analysis (RSA) of the sagittal laxity and the migration of the bony ends of the graft. The precision in measurements of total anterior-posterior displacement (+/- 2 SD of the differences between repeated measurements) was 2.2 mm. A decrease in total anterior-posterior displacement from 12 mm before reconstruction of 5 mm 1 year postoperatively using a stress load of 150 N was found. The bony ends of the free graft migrated maximally 0.7 mm, implying adequate fixation.
Adolescent↗
Cartilage regeneration after proximal tibial osteotomy for medial gonarthrosis. An arthroscopic, roentgenographic, and histologic study.
High tibial osteotomy for medial gonarthrosis was performed in 28 patients (28 knees). At the time of surgery, arthroscopy was also performed and a cartilage-bone biopsy was obtained. Postoperatively, 15 patients were randomized to a cylinder plaster cast, whereas 13 patients had a hinged cast brace for early knee mobilization. At follow-up examination, two years after surgery, 16 patients accepted an arthroscopic examination with a cartilage-bone biopsy. In overcorrected knees, cartilage regeneration was found in eight of 14 patients on the medial tibial condyle and in nine of 14 on the medial femoral condyle. The main repair feature was proliferation of fibrocartilage, which covered bone and areas of fibrillated cartilage and filled vertical clefts in hyaline cartilage. The hyaline cartilage showed an increased cellularity with numerous nests of proliferating chondrocytes. No correlation was found between clinical outcome and the degree of cartilage regeneration as observed by arthroscopy, biopsy, or roentgenography. Knees with a brace postoperatively had better knee flexion two years after surgery. No difference in cartilage regeneration was recorded between knees with a plaster cast or a cast brace postoperatively.
Adult↗
Muscle training in chronic anterior cruciate ligament insufficiency--a comparative study.
The aim of the investigation was to study and compare the effect of two basically different training methods on muscle strength and knee function on a consecutive and prospective series of 26 conservatively treated patients with chronic anterior cruciate ligament injury. The two training models were: model Q directed towards specific training of knee extensor muscle strength and model F aiming at training of the lower extremity and trunk muscles in functional weightbearing patterns. The parameters evaluated were: isometric and isokinetic muscle strength, a performance test (one-leg hop test), and a functional score. The results after a three-month training period showed in both groups a significant increase of muscle strength in both knee extensors and knee flexors. No significant difference of isokinetic strength values between the two groups was observed. The isometric gain of knee extension was significantly higher in the Q group. The one-leg hop test value and the functional score were also significantly increased in both groups. However, the hop test indicated a more favourable result in the group who were trained functionally.
Adult↗