SciCombinator

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Concept: Hamstring

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Hamstring strain injuries are amongst the most common and problematic injuries in a wide range of sports that involve high speed running. The comparatively high rate of hamstring injury recurrence is arguably the most concerning aspect of these injuries. A number of modifiable and nonmodifiable risk factors are proposed to predispose athletes to hamstring strains. Potentially, the persistence of risk factors and the development of maladaptations following injury may explain injury recurrence. Here, the role of neuromuscular inhibition following injury is discussed as a potential mechanism for several maladaptations associated with hamstring re-injury. These maladaptations include eccentric hamstring weakness, selective hamstring atrophy and shifts in the knee flexor torque-joint angle relationship. Current evidence indicates that athletes return to competition after hamstring injury having developed maladaptations that predispose them to further injury. When rehabilitating athletes to return to competition following hamstring strain injury, the role of neuromuscular inhibition in re-injury should be considered.

Concepts: Strain, Knee, Injuries, Injury, Flexion, Potential, Hamstring, Sprain

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A controversial discussion is held on using stabilizing knee braces after anterior cruciate ligament (ACL) surgery. The current study investigated the influence of a stabilizing knee brace on results after ACL reconstruction using patellar tendon autografts.

Concepts: Knee, Anterior cruciate ligament, Ligament, Anterior cruciate ligament injury, Anterior cruciate ligament reconstruction, Cruciate ligament, Hamstring, Lateral meniscus

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The hamstring tendons, gracilis and semitendinosus are widely used in ligament and reconstructive surgery. Their accessory bands or insertions are technical pitfalls during harvesting.

Concepts: Skeletal system, Harvest, Reconstructive surgery, Ligament, Tendon, Hamstring

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The aim of the present study was to compare primary stability in ACL reconstruction and ultimate load to failure of a mesh augmented hamstring tendon graft fixed with two cross pins to established hamstrings and bone-patellar-tendon-bone (BTB) graft fixation methods.

Concepts: Anterior cruciate ligament, Anterior cruciate ligament reconstruction, Hamstring

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STUDY DESIGN: Within and between subject cross sectional study. OBJECTIVES: To investigate symmetry in hop test performance, strength, and lower extremity kinematics 6-9 months post anterior cruciate ligament reconstruction (ACLR). BACKGROUND: Despite the extensive body of literature in persons following ACLR, no study has comprehensively evaluated measures of strength, lower extremity kinematics and functional performance of hop tests in this population. METHODS: 22 men (age, 28.8± 11.2 years) 6-9 months (7.01±0.93) following ACLR using a bone-patella tendon bone autograft and 22 healthy men (24.8 ± 9.1 years) participated. Participants completed a self-reported questionnaire and underwent isokinetic strength testing and functional and kinematic assessment of the single, triple, and crossover hop tests. Two-way ANOVAs were used to test for differences between the ACLR group and the control group and between the two lower extremities of the ACLR group. RESULTS: Compared to the control group, the ACLR group had greater isokinetic knee extension torque deficits at all speeds (p≤0.001) and greater performance asymmetry for all 3 hop tests (p<0.001). Compared to the intact lower extremity, the involved lower extremity of the ACLR group exhibited less ankle dorsiflexion and knee flexion at propulsion (p≤0.014) and landing phases (p≤0.032). When compared to the control group the involved lower extremity exhibited less ankle dorsiflexion in the propulsion phase (p<0.001) but higher hip flexion in the landing phase (p=0.014). CONCLUSION: Patients following ACLR demonstrate functional hop and isokinetic knee extension deficits as well as kinematic differences during the propulsion and landing phases of the hop tests at 6-9 months after surgery.J Orthop Sports Phys Ther. Epub 14 January 2013. doi:10.2519/jospt.2013.3967.

Concepts: Knee, Anterior cruciate ligament, Extension, Ligament, Anterior cruciate ligament injury, Anterior cruciate ligament reconstruction, Cruciate ligament, Hamstring

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Rehabilitation after anterior cruciate ligament (ACL) reconstruction should consider control of postoperative pain and swelling, protection of the healing graft, restoration of full range of motion symmetric to the contralateral knee, strengthening of the muscles that stabilize the knee, hip, and trunk, enhancing neuromuscular control, and a gradual progression to functional activities that are required for return to sports. The effects of concomitant injuries and surgical procedures must also be considered in planning an individualized rehabilitation program. This article provides an overview, discusses our experience, and makes recommendations for rehabilitation after anatomic ACL reconstruction rehabilitation.

Concepts: Knee, Anterior cruciate ligament, Ligament, Anterior cruciate ligament injury, Anterior cruciate ligament reconstruction, Cruciate ligament, Hamstring, Lateral meniscus

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BACKGROUND:Debate exists on the proper relation of the anterior cruciate ligament (ACL) footprint with the intercondylar notch in anatomic ACL reconstructions. Patient-specific graft placement based on the inclination of the intercondylar roof has been proposed. The relationship between the intercondylar roof and native ACL footprint on the tibia has not previously been quantified. HYPOTHESIS:No statistical relationship exists between the intercondylar roof angle and the location of the native footprint of the ACL on the tibia. STUDY DESIGN:Case series; Level of evidence, 4. METHODS:Knees from 138 patients with both lateral radiographs and MRI, without a history of ligamentous injury or fracture, were reviewed to measure the intercondylar roof angle of the femur. Roof angles were measured on lateral radiographs. The MRI data of the same knees were analyzed to measure the position of the central tibial footprint of the ACL (cACL). The roof angle and tibial footprint were evaluated to determine if statistical relationships existed. RESULTS:Patients had a mean ± SD age of 40 ± 16 years. Average roof angle was 34.7° ± 5.2° (range, 23°-48°; 95% CI, 33.9°-35.5°), and it differed by sex but not by side (right/left). The cACL was 44.1% ± 3.4% (range, 36.1%-51.9%; 95% CI, 43.2%-45.0%) of the anteroposterior length of the tibia. There was only a weak correlation between the intercondylar roof angle and the cACL (R = 0.106). No significant differences arose between subpopulations of sex or side. CONCLUSION:The tibial footprint of the ACL is located in a position on the tibia that is consistent and does not vary according to intercondylar roof angle. The cACL is consistently located between 43.2% and 45.0% of the anteroposterior length of the tibia. Intercondylar roof-based guidance may not predictably place a tibial tunnel in the native ACL footprint. Use of a generic ACL footprint to place a tibial tunnel during ACL reconstruction may be reliable in up to 95% of patients.

Concepts: Knee, Anterior cruciate ligament, Ligament, Anterior cruciate ligament injury, Anterior cruciate ligament reconstruction, Cruciate ligament, Hamstring, Lateral meniscus

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Rates of return to pre-injury sport following anterior cruciate ligament (ACL) reconstruction are less than might be expected from standard outcome measures and there appears to be a rapid decline in sporting participation after two to three years. There are many factors that influence whether an individual will return to sport following this type of surgery. They include not only surgical details and rehabilitation, but also social and psychological factors, as well as demographic characteristics. Age is of particular importance with older patients being less likely to resume their pre-injury sport. It is important that future research clearly identify the pre-injury characteristics of the study cohort when investigating return to sport, and also that there is consistent and precise terminology used to report rates of return to sporting activities. Little is known about how to determine when it is safe to return to sport following ACL reconstruction or how to predict whether an athlete will be able to successfully return to sport. Finally, it needs to be recognised that return to sport following ACL reconstruction is associated with a risk of further injury and the development of osteoarthritis.

Concepts: Knee, Anterior cruciate ligament, Ligament, Anterior cruciate ligament injury, Anterior cruciate ligament reconstruction, Cruciate ligament, Hamstring, Ligaments

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A 22-year-old patient undergoing unilateral surgical reconstruction of the anterior cruciate ligament (ACL) of the right knee volunteered for the research project and followed an established contemporary hospital-based rehabilitation programme. The patient was supervised post-surgically by an experienced and clinically specialized physiotherapist. The clinical outcomes of rehabilitation were assessed by the selected validated patient-reported and objectively-measured outcomes of functional performance capability on four different occasions (pre-surgery, 6^{th}, 12^{th} and 24^{th} weeks post-surgery). The patient scored 30, 56, 60 and 85 on IKDC (maximum score, 100); 46, 53, 90 and 91 on Lysholm (maximum score, 100); 141, 73, 128 and 175 on K-SES (maximum score, 220); 17, 12, 6 and 6 on the symptom subsection of KOOS (maximum score, 28); 7, 7, 5 and 5 on the pain subsection (maximum score, 36); 1, 0, 3 and 1 on the daily function subsection (maximum score, 68); 0, 0, 5 and 5 on the sport and recreation function subsection (maximum score, 20); 13, 11, 15 and 13 on the quality of life subsection (maximum score, 16) of KOOS at pre-surgery and at the 6^{th}, 12^{th} and 24^{th} weeks following ACL reconstruction, respectively. Moreover, the patient scored 1.96 m, 1.92 m and 1.99 m on single-leg hop (injured leg) when assessed at pre-surgery and at the 12^{th} and 24^{th} weeks post-surgery, respectively, following ACL reconstruction. The total time spent in supervised rehabilitation by the patient (675 minutes) was computed as the aggregate patient-reported time spent in exercise during each hospital-based rehabilitation session (verified by physiotherapist evaluation) across the total number of sessions. The patient managed to return to the sport in which he had participated prior to the injury immediately after the completion of the contemporary rehabilitation programme, at 24 weeks post-surgery. A total of fifteen physiotherapy sessions supervised by the physiotherapist, were attended by the patient during the 24 weeks rehabilitation period. The latter number of physiotherapy sessions was substantially less than the average supervised physiotherapy sessions reported in the literature.

Concepts: Knee, Anterior cruciate ligament, Ligament, Anterior cruciate ligament injury, Anterior cruciate ligament reconstruction, Cruciate ligament, Hamstring, Ligaments

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The Royal Dutch Society for Physical Therapy (KNGF) instructed a multidisciplinary group of Dutch anterior cruciate ligament (ACL) experts to develop an evidence statement for rehabilitation after ACL reconstruction.

Concepts: Evidence-based medicine, Knee, Anterior cruciate ligament, Ligament, Anterior cruciate ligament injury, Anterior cruciate ligament reconstruction, Cruciate ligament, Hamstring