Figure 3 - uploaded by Hélder Miguel Duarte Pereira
Content may be subject to copyright.
MRI images of injured knee obtained using the PKTD: medial compartment without (A) and with pressure (B); and lateral compartment without (C) and with pressure (D).
Source publication
Lesiones ligamentosas de la rodilla L as lesiones de los ligamentos de la rodilla, y en concreto las del ligamento cruzado anterior, son algunas de las más habitua-les en traumatología deportiva. En la última década se han produ-cido avances en la reconstrucción de los diferentes ligamentos de la rodilla, en el conocimiento de la biología y de la b...
Similar publications
En este trabajo se exploran los conceptos de los sistemas dinámicos que explican las sinergias en las redes neuronales biológicas modeladas con la ecuación de Morris-Lecar, según se asume que las neuronas o grupos de neuronas sean osciladores, o no, en los niveles celular, sinapsis neuronal o conectividad de la red. Para los subsistemas para tiempo...
Citations
... Nonetheless, the abovementioned procedures fail to provide an objective quantitative measure of the ACL laxity. To overcome this issue, several mechanical testing devices have been used in order to measure tibiofemoral AP translation and rotational laxity (18). However, the reliability and diagnostic accuracy of some of them, such as, the KT-1000™, has been questioned (19,20). ...
The incidence of anterior cruciate ligament (ACL) injuries has been increasing in the last few decades and, along with it, the number of ACL reconstruction failures has also been growing. To overcome the surgical complications and failures, several developments have been made in regard to the ACL treatment. Nowadays, the ACL reconstruction has become more anatomic and individualized, aiming for the closest replication of the native ACL anatomy and biomechanics. As the knowledge regarding the ACL anatomy and biomechanics moves forward, novel surgical techniques and fixation devices have been developed to keep up the patient’s demands and further prevent the early onset of osteoarthritis. Nonetheless, a considerable number of controversies are still under debate. This review will outline the current concepts of ACL treatment, focusing its consensus and controversies.
... Evaluation of angular and linear tibial dislocation from axial views: without load (g) and with load after internal (h) and external foot rotation (i). Evaluation confirmed global ACL insufficiency one single MRI or CT-based examination by means of using the Porto Knee Testing Device (PKTD) (Espregueira-Mendes et al. 2012;Pereira et al. 2012). In this way one might combine the study of morphologic bony parameters with evaluation of anteroposterior and rotational laxity (Fig. 3). ...
Identification of pre-participation risk factors for noncontact anterior cruciate ligament (ACL) injuries has been attracting a great deal of interest in the sports medicine and traumatology communities. Appropriate methods that enable predicting which patients could benefit from preventive strategies are most welcome. This would enable athlete-specific training and conditioning or tailored equipment in order to develop appropriate strategies to reduce incidence of injury. In order to accomplish these goals, the ideal system should be able to assess both anatomic and functional features. Complementarily, the screening method must be cost-effective and suited for widespread application. Anatomic study protocol requiring only standard X rays could answer some of such demands. Dynamic MRI/CT evaluation and electronically assisted pivot-shift evaluation can be powerful tools providing complementary information. These upcoming insights, when validated and properly combined, envision changing pre-participation knee examination in the near future. Herein different methods (validated or under research) aiming to improve the capacity to identify persons/athletes with higher risk for ACL injury are overviewed.
Multiligament knee injuries have low incidence, however are very devastating and require special attention. New approaches in the diagnosis are vital to allows a better assessement of associated lesions, more careful treatment planning and objective follow-up. The Porto-Knee Testing Device (PKTD) shows very promising results in the assessment of knee instability. The goal of the PKTD is to provide both anatomical and functional evaluation of the knee. It is able to carefully assess the knee sagittal and rotational stability. In multiligament injuries, the use of a arthrometric device concomitantly with imaging procedures can provide valuable information for surgical planning and stability restoration procedures. It is also possible in the postoperative follow-up to evaluate residual instability. Herein, we discuss the recent developments related to PKTD in diagnosis of knee ligament lesions and instability assessment.
Knee laxity, by definition, is a dynamic and multifactorial condition. MRI evaluation, due to its known capacity in achieving high soft tissue contrast (e.g., meniscus, synovia, ligaments, cartilage) and multiplanar joint assessment without ionizing radiation, has contributed to its popularity in the last decades. However, “traditional” MRI studies provide static evaluation, thus requiring careful correlation to clinical findings, particularly when dealing with functional ligament stability. This work aims to describe the most important features of current MRI studies when dealing with anterior cruciate ligaments injuries, while also presenting the evolving possibilities of dynamic and objective MRI assessment of knee instability.
The ligament injuries around the knee, represent some of the most frequent lesions in football. Moreover, anterior cruciate ligament (ACL) tear is known to be amongst the most frequent prolonged absence from competition in this subgroup of patients. In the last decade we have been experiencing an important change on the treatment of these tears, focused on the technical development of surgical treatment. Nevertheless, return to play on some level is far from being completely guaranteed after ACL reconstruction and a number of factors might play a role on this major goal of treatment. Herein it will be discussed the current concepts of dealing with ACL ruptures in footballers. The second most relevant injury around the knee in this populations is medial collateral ligament sprain. In this case, most patients are dealt successfully with conservative treatment and only specific cases might require surgery. Posterior cruciate ligament (PCL) and posterolateral corner (PLC) injuries are less frequent then the former in footballers. However, they have the potential to cause important influence on athlete’s performance. Isolated PCL injuries, particularly up to grade 2 are suitable for conservative treatment and return to play. A brief comment on the “state of the art” on PLC lesions is also included.
The high prevalence of anterior cruciate ligament (ACL) reconstruction [1–3] reinforces the importance of developing strategies aiming at prevention, diagnosis, and treatment of possible complications and/or failure of such procedures. Revision of ACL reconstruction always presents a challenge in orthopedic practice. However, in present time it must enter in the “routine” of any knee reconstruction surgeon [4–19]. Revision of ACL repair, regardless of the inherent cause, must be considered a demanding and delicate clinical procedure. Its results have been considered as predictably less satisfactory than those of the primary operation [20]. Somewhat inferior patient-reported outcome scores comparing to previously published results of primary ACL reconstruction have been shown, but clinical relevance of these findings remains to be clarified [21]. Furthermore, higher remaining laxity, higher graft failure rate, and meniscal or cartilage degeneration have also been described [1, 22]. Despite several reports of favorable results and return to sports at the same level after AC revision, clinical failure rates up to 25 % have been reported [17].
