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Özlem Feyzioğlu, Özgul Öztürk, Bilsen Sirmen and Selim Muğrabi

return to preinjury performance and functional level of professional athletes or injured individuals. 8 ACLR can be performed using a hamstring or patellar tendon autograft. In surgical techniques using hamstring tendon grafts, anterior knee pain, loss of proprioception, decrease of hamstring muscle

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Yoshiko Hasebe, Yoshie Tanabe and Kazunori Yasuda

Context:

Anterior cruciate ligament (ACL) reconstruction with doubled hamstring autograft might not sufficiently improve fundamental sports abilities of patients with ACL-deficient knees.

Objective:

To clarify whether ACL reconstruction using the hamstring graft can improve fundamental sports abilities.

Design:

Patients were examined twice, preoperatively and 2 years postoperatively, using the conventional evaluation scales and performance tests.

Participants:

15 athletic patients with ACL reconstruction using hamstring autograft.

Measurements:

A stairs-run test and figure-8 one-leg hop test. Muscle strength and knee stability were measured with Cybex® II and KT-2000® arthrometers, respectively.

Results:

There were no significant differences between the preoperative and postoperative results in the performance tests. The degree of postoperative recovery in the subjective score, the anterior translation of the tibia, and the isokinetic muscle strength was not significantly correlated with the degree of restoration in each performance test.

Conclusions:

Postoperative restoration as measured by conventional evaluation scales is not correlated with restoration of sports abilities in patients with ACL insufficiency.

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Federico Morelli, Andrea Ferretti, Fabio Conteduca, Francesca Nanni, Lucilla Monteleone and Marco Valente

The purpose of this study was to develop a new device, which represents a modification of the Cryo-Jaw described by Riemersa and Schamhardt and modified by Hamner et al., for in vitro biomechanical testing of tendons which allows the lower clamp to move in every direction and thus simulate a pathological dislocation of the knee. Tendons are fixed to the device by freezing the clamped part with dry ice. After fixation of their free ends, the lower clamp was rotated 45°, translated 1 cm, and angled 40° to simulate a knee sprain. Various configurations of bundles were tested: parallel, twisted, and braided. Tests were performed on 10 paired bovine bifurcated digital extensor tendons and 6 paired human hamstring tendons. Grafts were then tested to failure subjected to impulsive load, using a servohydraulic machine. The highest ultimate load recorded for parallel bundles was 4662 ± 565.71 N for bovine bifurcated digital extensor tendons, and 3057 ± 475.44 N for human hamstring tendons. In any case, the tendons ruptured midway, well clear of the frozen part; in no case was slippage of the tendons observed. Thus the device proposed allows one to test what happens to the graft of an ACL reconstructed knee during physiological and pathological movements because it can be easily displaced in every direction.

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Gulcan Harput, H. Erkan Kilinc, Hamza Ozer, Gul Baltaci and Carl G. Mattacola

Context:

There is lack of information related to quadriceps and hamstring strength recovery during the early period of rehabilitation after anterior cruciate ligament reconstruction (ACLR) using hamstring-tendon graft (HTG).

Objective:

To investigate quadriceps and hamstring isometric strength at 4-, 8-, and 12-wk time points after ACLR and to document the strength changes of these muscles over time.

Design:

Longitudinal study.

Participants:

24 patients (age 28.1 ± 8.1 y) who underwent unilateral single-bundle anatomic ACLR with 4-strand semitendinosus and gracilis tendon graft.

Main Outcome Measures:

The isometric strength of quadriceps and hamstring muscles was measured on an isokinetic dynamometer at a 60° knee-flexion angle 4, 8, and 12 wk after surgery.

Results:

Quadriceps and hamstring strength significantly increased over time for both the involved limb (quadriceps F 2,46 = 58.3, P < .001; hamstring F 2,46 = 35.7, P < .001) and uninvolved limb (quadriceps F 2,46 = 17.9, P < .001; hamstring F 2,46 = 56.9, P = .001). Quadriceps and hamstring indexes significantly changed from 4 wk (QI 57.9, HI 54.4) to 8 wk (QI 78.8, HI 69.9) and from 8 wk to 12 wk (QI 82, HI 75.7) (P < .001); however, there was no difference between indexes at the 12-wk time point (P = .17).

Conclusions:

The results of this study serve as a reference for clinicians while directing a rehabilitation protocol for HTG ACLR patients to better appreciate expected strength changes of the muscles in the early phase of recovery.

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Igor Setuain, Mikel Izquierdo, Fernando Idoate, Eder Bikandi, Esteban M. Gorostiaga, Per Aagaard, Eduardo L. Cadore and Jesús Alfaro-Adrián

Context:

The muscular function restoration related to the type of physical rehabilitation followed after anterior cruciate ligament reconstruction (ACLR) using autologous hamstring tendon graft in terms of strength and cross-sectional area (CSA) remain controversial.

Objective:

To analyze the CSA and force output of quadriceps and hamstring muscles in subjects following either an Objective Criteria-Based Rehabilitation (OCBR) algorithm or the usual care (UCR) for ACL rehabilitation in Spain, before and 1 year after undergoing an ACLR.

Design:

Longitudinal clinical double-blinded randomized controlled trial.

Setting:

Sports-medicine research center.

Patients:

40 recreational athletes (30 male, 10 female [24 ± 6.9 y, 176.55 ± 6.6 cm, 73.58 ± 12.3 kg]).

Intervention:

Both groups conducted differentiated rehabilitation procedures after ACLR. Those belonging to OCBR group were guided in their recovery according to the current evidence-based principles. UCR group followed the national conventional approach for ACL rehabilitation.

Main Outcome Measures:

Concentric isokinetic knee joint flexor-extension torque assessments at 180°/s and Magnetic Resonance Imaging (MRI) evaluations were performed before and 12 months after ACLR. Anatomical muscle CSA (mm2) was assessed, in Quadriceps, Biceps femoris, Semitendinous, Semimembranosus, and Gracilis muscles at 50% and 70% femur length.

Results:

Reduced muscle CSA was observed in both treatment groups for Semitendinosus and Gracilis 1 year after ACLR. At 1-year follow-up, subjects allocated to the OCBR demonstrated greater knee flexor and extensor peak torque values in their reconstructed limbs in comparison with patients treated by UCR.

Conclusions:

Objective atrophy of Semitendinosus and Gracilis muscles related to surgical ACLR was found to persist in both rehabilitation groups. However, OCBR after ACLR lead to substantial gains on maximal knee flexor strength and ensured more symmetrical anterior-posterior laxity levels at the knee joint.

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Erik H. Arve, Emily Madrak and Aric J. Warren

nonreconstructive knee arthroscopy 24 physically active subjects all sustaining injury during sport (18–40 years); all planned for ACL reconstruction using hamstring tendon graft Interventions Both groups performed same rehab exercises for 16 weeks postoperatively. Experimental group : Included BFR tourniquet at

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Lauren Anne Lipker, Caitlyn Rae Persinger, Bradley Steven Michalko and Christopher J. Durall

hamstring tendon graft were followed for 16 d postoperatively. Subjects were randomly assigned to intervention group (n = 12; M = 7, F = 5; traditional rehabilitation with BFR) or to the control group (n = 12; M = 7, F = 5; traditional rehabilitation without BFR). No significant differences between groups

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Jay R. Ebert, Kate E. Webster, Peter K. Edwards, Brendan K. Joss, Peter D’Alessandro, Greg Janes and Peter Annear

anterior cruciate ligament reconstructions in the Kaiser Permanente ACLR registry . Am J Sports Med . 2015 ; 43 ( 3 ): 641 – 647 . PubMed ID: 25548148 doi: 10.1177/0363546514561745 26. Persson A , Fjeldsgaard K , Gjertsen JE , et al . Increased risk of revision with hamstring tendon grafts

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Gulcan Harput, Volga B. Tunay and Matthew P. Ithurburn

hamstring tendon graft . Clin Biomech . 2007 ; 22 ( 5 ): 543 – 550 . doi: 10.1016/j.clinbiomech.2007.01.009 33. Benjaminse A , Holden S , Myer GD . ACL rupture is a single leg injury but a double leg problem: too much focus on ‘symmetry’ alone and that’s not enough! Br J Sports Med . 2018 ; 52

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Haley Bookbinder, Lindsay V. Slater, Austin Simpson, Jay Hertel and Joseph M. Hart

, 11 HT, and 1 Cadaver – Abbreviations: ACLR, anterior cruciate ligament reconstruction; HT, hamstring tendon graft; IKDC, International Knee Documentation Committee Questionnaire; PT, bone-patellar tendon-bone graft. Baseline Measures Participants came to the laboratory wearing athletic clothing and