The Experts below are selected from a list of 1308 Experts worldwide ranked by ideXlab platform
Gene R. Barrett - One of the best experts on this subject based on the ideXlab platform.
-
Age, Graft Size, and Tegner Activity Level as Predictors of Failure in Anterior Cruciate Ligament Reconstruction With Hamstring Autograft
American Journal of Sports Medicine, 2013Co-Authors: Przemyslaw M. Kamien, Josie M. Hydrick, Linda T. Go, William H. Replogle, Gene R. BarrettAbstract:Background:Patient age, Tegner activity level, and graft size could be factors that influence the outcome of anterior cruciate ligament reconstruction (ACLR) with hamstring autografts.Hypothesis:Decreased graft size, higher Tegner activity score, and younger age are associated with an increased failure rate of ACLR, represented by continued knee laxity and revision surgery.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 98 patients who had undergone ACLR with hamstring tendon autografts between 2000 and 2007 were identified from a computerized relational database. Inclusion criteria consisted of a minimum of 2 years of follow-up, all age groups, and all activity levels. Exclusion criteria consisted of treatment with other grafts or previous ligament surgery, previous ACL repairs, bilateral ACL injuries, and associated ligament tears. Failure was defined as a 2+ Lachman result, positive pivot shift, and 5-mm difference or more on KT-1000 Arthrometer measurement.Results:Fifteen of the 98 ...
-
anterior cruciate ligament reconstruction in patients older than 40 years allograft versus autograft patellar tendon
American Journal of Sports Medicine, 2005Co-Authors: Gene R. Barrett, David Stokes, Miranda WhiteAbstract:BackgroundAnterior cruciate ligament reconstruction is the recommended treatment for patients of all ages who are involved in sports and have symptoms of knee instability.HypothesisIn patients older than 40 years, allograft reconstruction will have better subjective and objective results than autograft reconstruction, proving allograft to be a better graft source for this patient population.Study DesignCohort study; Level of evidence, 3.MethodsThe authors identified 63 patients meeting the criteria for this study, including 38 patients in the allograft group and 25 patients in the autograft group. All patients were older than 40 years and had at least 2 years’ follow-up. Objective parameters included preinjury and postoperative Tegner activity rating scale and Lysholm scores, range of motion, thigh circumference differences, side-to-side difference at maximum manual force in anterior displacement by KT-1000 Arthrometer, and clinical examination for Lachman and pivot-shift tests. Using a 15-point visual an...
-
reconstruction of the anterior cruciate ligament in females a comparison of hamstring versus patellar tendon autograft
Annual Meeting of the American Academy of Orthopaedic Surgeons, 2002Co-Authors: Gene R. Barrett, Frank K Noojin, Charles W Hartzog, Carrie R NashAbstract:Purpose: To compare the clinical results of anterior cruciate ligament reconstruction in female patients using quadruple-looped hamstring autograft versus patellar tendon autograft at minimum 2-year follow-up. Type of Study: Case series. Methods: A prospective clinical review was performed to compare the results of ACL reconstruction with hamstring versus patellar tendon autograft in a group of female patients. Exclusion criteria included chronic injuries (greater than 3 months), associated collateral ligament injuries, Workers' Compensation or litigation cases, and bilateral anterior cruciate ligament injuries. There were 39 female patients in the hamstring group (average follow-up, 40.9 months) and 37 female patients in the patellar tendon group (average follow-up, 52 months). Both types of grafts were fixed with an EndoButton proximally and with sutures tied over a post or button distally. The postoperative rehabilitation regimen was identical for both groups. Objective parameters evaluated included preinjury and postoperative Tegner and Lysholm scores, side-to-side KT-1000 maximum-manual Arthrometer differences, and clinical examination including Lachman and pivot-shift tests. Graft failure was defined by any one of the following: a KT-1000 difference of greater than 5 mm, a 2+ Lachman, a 1+ or greater pivot shift, or revision surgery. Results: The failure rate in the hamstring group was 23% versus 8% in the patellar tendon group, which was not statistically significant (P >.1). Comparison of preinjury Tegner activity scores to postoperative scores revealed that patients in the hamstring group did not return to their preinjury level of activity (preinjury 6.54 v postoperative 5.17) as well as patients in the patellar tendon group (preinjury 6.20 v postoperative 6.59). Patients in the hamstring group had a significant increase in pain compared with the patellar tendon group (P =.034). Conclusions: Although not statistically significant, the hamstring group had more failures, more laxity on clinical examination, and more patients with larger KT-1000 Arthrometer differences. These results indicate a trend toward increased graft laxity in female patients undergoing reconstruction with hamstring autograft compared with patellar tendon when evaluated by a single surgeon using similar fixation techniques at short- to medium-range follow-up. More studies with larger patient numbers using current fixation techniques are necessary to confirm these findings.
Timothy E Hewett - One of the best experts on this subject based on the ideXlab platform.
-
the effects of generalized joint laxity on risk of anterior cruciate ligament injury in young female athletes
American Journal of Sports Medicine, 2008Co-Authors: Timothy E Hewett, Gregory D Myer, Kevin R Ford, Mark V Paterno, Todd G NickAbstract:BackgroundWomen who participate in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than men.PurposeTo prospectively determine if female athletes with decreased passive knee joint restraint (greater joint laxity) and greater side-to-side differences in knee laxity would be at increased risk of anterior cruciate ligament injury.Study DesignCase control study; Level of evidence, 3.MethodsFrom 1558 female soccer and basketball players who were prospectively screened, 19 went on to tear their anterior cruciate ligaments. Four height- and mass-matched control subjects were selected from the uninjured screened athletes for comparison with each of the 19 injured subjects, making a total of 95 subjects (19 injured; 76 uninjured). Generalized joint-laxity tests and anterior-posterior tibiofemoral translation were quantified using the CompuKT knee Arthrometer. A multivariable logistic regression model was constructed to determine predictors of anterior cruciate ligament injur...
-
diagnosis of complete and partial posterior cruciate ligament ruptures stress radiography compared with kt 1000 Arthrometer and posterior drawer testing
American Journal of Sports Medicine, 1997Co-Authors: Timothy E Hewett, Frank R Noyes, Michael D LeeAbstract:Stress radiography was performed on 21 patients with unilateral posterior cruciate ligament tears: 10 complete and 11 partial. An 89-N posterior load was applied to the proximal tibia and a lateral radiograph was taken of each knee in 70 degrees of flexion. The relative amount of sagittal translation (involved minus noninvolved) was determined at both the medial and lateral tibial plateaus from the radiographic films. Arthrometric (KT-1000 Arthrometer) and posterior drawer tests were also performed. The mean relative posterior translation averaged 12.2 +/- 3.7 mm for knees with complete tears. Arthrometer testing of the same knees showed 7.6 +/- 2.5 mm of increased translation, and posterior drawer testing showed 9.2 +/- 3.3 mm of increased dropback. Stress radiographic results were statistically similar to the electrogoniometric measurements in cadaveric knees. In knees with a partially torn posterior cruciate ligament, mean relative translation measured on stress radiographic was 5.6 +/- 1.5 mm, which was significantly different from that for knees with complete ruptures. The Arthrometer and posterior drawer test data were not significantly different for knees with complete and partial tears. Stress radiography is superior to both the Arthrometer and clinical posterior drawer testing for determining posterior cruciate ligament status. Eight millimeters of more of increased posterior translation on stress radiographs is indicative of complete rupture.
Bernard R Bach - One of the best experts on this subject based on the ideXlab platform.
-
arthroscopic anterior cruciate ligament reconstruction a metaanalysis comparing patellar tendon and hamstring tendon autografts
American Journal of Sports Medicine, 2003Co-Authors: Kevin B Freedman, Michael J Damato, David D Nedeff, Bernard R BachAbstract:BackgroundThe best choice of graft tissue for use in anterior cruciate ligament reconstruction has been the subject of debate. Hypothesis: Anterior cruciate ligament reconstruction with patellar tendon autograft leads to greater knee stability than reconstruction with hamstring tendon autograft.Study DesignMetaanalysis.MethodsA Medline search identified articles published from January 1966 to May 2000 describing arthroscopic anterior cruciate ligament reconstruction with either patellar tendon or hamstring tendon autograft and with a minimum patient follow-up of 24 months.ResultsThere were 1348 patients in the patellar tendon group (21 studies) and 628 patients in the hamstring tendon group (13 studies). The rate of graft failure in the patellar tendon group was significantly lower (1.9% versus 4.9%) and a significantly higher proportion of patients in the patellar tendon group had a side-to-side difference of less than 3 mm on KT-1000 Arthrometer testing than in the hamstring tendon group (79% versus 73....
-
arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft five to nine year follow up evaluation
American Journal of Sports Medicine, 1998Co-Authors: Bernard R Bach, Steven Tradonsky, John Bojchuk, Matthew E Levy, Charles A Bushjoseph, Nazeer H KhanAbstract:We retrospectively reviewed the results of 97 patients with anterior cruciate ligament reconstructions using an arthroscopically assisted two-incision technique without extraarticular augmentation at an intermediate followup of 5 to 9 years postoperatively. Evaluation included detailed history, physical examination, functional testing, KT-1000 Arthrometer measurements, multiple scoring systems, and radiographs. The results were compared with those from a previous study that evaluated a smaller patient cohort using the identical surgical technique at a 2- to 4-year followup. The post-operative physical examination and KT-1000 Arthrometer results were statistically improved when compared with preoperative findings. A negative pivot shift result was noted in 83% of patients, and a 1 result in 17% of patients. Seventy percent of patients had 3 mm difference on manual maximum side-to-side testing. Functional testing averaged less than 2% asymmetry for vertical jump, single-legged hop, or timed 6-meter hop. The...
Andreas Weiler - One of the best experts on this subject based on the ideXlab platform.
-
hamstring tendon versus patellar tendon anterior cruciate ligament reconstruction using biodegradable interference fit fixation a prospective matched group analysis
American Journal of Sports Medicine, 2005Co-Authors: Michael Wagner, Max J Kaab, Jessica Schallock, Norbert Haas, Andreas WeilerAbstract:BackgroundThere are still controversies about graft selection for primary anterior cruciate ligament reconstruction, especially with respect to knee stability and functional outcome.HypothesisBiodegradable interference screw fixation of hamstring tendon grafts provides clinical results similar to those achieved with identical fixation of bone-patellar tendon-bone grafts.Study DesignCohort study; Level of evidence, 2.MethodsIn 1996 and 1997, primary isolated anterior cruciate ligament reconstruction using a bone-patellar tendon-bone autograft was performed in 72 patients. Since 1998, hamstring tendons were used as routine grafts. Matched patients with a hamstring tendon graft were selected from a database (n = 284). All patients were followed prospectively for a minimum of 2 years with KT-1000 Arthrometer testing, International Knee Documentation Committee score, and Lysholm score.ResultsIn the bone-patellar tendon-bone group, 9 patients were excluded because of bilateral rupture of the anterior cruciate l...
Donald K Shelbourne - One of the best experts on this subject based on the ideXlab platform.
-
Arthroscopic Anterior Cruciate Ligament Reconstruction With the Tibial-Remnant Preserving Technique Using a Hamstring Graft. Arthroscopy
2016Co-Authors: Donald K Shelbourne, Tinker GrayAbstract:We sought to determine the long-term results of 1057 consecutive patients who underwent an anterior cruci-ate ligament reconstruction with an autogenous patel-lar tendon graft from 1987 through 1993 and who followed an accelerated rehabilitation program. The patients were followed prospectively and objective physical examination data were obtained on 806 pa-tients at a mean of 4.0 years postoperatively. Subjec-tive follow-up data were obtained on 948 patients at a mean of 4.4 years postoperatively. The mean final range of motion was 5°/0°/140°. The mean manual maximum KT-1000 Arthrometer score was 2.0 ± 1.5 mm. Isokinetic quadriceps muscle strength testing re-vealed a mean of 94 % strength after acute reconstruc
-
Effect on Knee Stability if Full Hyperextension is Restored Immediately After Autogenous Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Reconstruction*
2016Co-Authors: Richard A. Rubinstein, Donald K Shelbourne, Charles D. Vanmeter, John R. Mccarroll, Arthur C. Rettig, Robert L. GloyeskeAbstract:We sought to determine if knee stability after autog-enous bone-patellar tendon-bone anterior cruciate liga-ment reconstruction was adversely affected by obtain-ing immediate full hyperextension. We selected patients based on degree of knee hyperextension. Group 1 (46 men and 51 women), with an average of 10° (range, 8° to 15°) hyperextension, was compared with the ran-domly selected control Group 2 (70 men and 27 women), which had an average of 2° (range, 0° to 5°) hyperextension. The operative knee in both groups, which underwent similar reconstruction of the injured knee, achieved full passive extension equal to the non-involved knee during the immediate postoperative course. The average KT-1000 Arthrometer manual maximum side-to-side differences were 2.4 mm fo
-
knee dislocation with lateral side injury results of an en masse surgical repair technique of the lateral side
American Journal of Sports Medicine, 2007Co-Authors: Donald K Shelbourne, Marc S Haro, Tinker GrayAbstract:Background: Knee dislocations with lateral side injury are rare and disabling if not treated.Hypothesis: An en masse surgical technique to repair the lateral side will provide good stability, and the posterior cruciate ligament will heal when left in situ.Study Design: Case series; Level of evidence, 4.Methods: Twenty-three patients underwent an en masse lateral side repair after knee dislocation injury; all but 1 patient had anterior cruciate ligament reconstruction. Physical examination included the International Knee Documentation Committee score, isokinetic strength testing, KT-2000 Arthrometer testing, radiography (including varus stress), and magnetic resonance imaging scan. Patients were evaluated subjectively with several surveys.Results: Mean objective evaluation occurred for 17 patients at 4.6 years postoperatively, and 21 subjective evaluations occurred for 21 patients at 5.6 years postoperatively. The objective overall grade was normal for 10 patients and nearly normal for 7 patients. Lateral ...
-
ligament stability two to six years after anterior cruciate ligament reconstruction with autogenous patellar tendon graft and participation in accelerated rehabilitation program
American Journal of Sports Medicine, 1995Co-Authors: Donald K Shelbourne, Thomas E Klootwyk, John H. Wilckens, Mark S De CarloAbstract:We studied patients who participated in our accelerated rehabilitation program after anterior cruciate ligament reconstructive surgery to determine if they showed signs of patellar tendon graft stretching. This program initiated in 1987 emphasizes early full hyperextension, early weightbearing as tolerated, and closed-chain functional activities with rapid return to sports when the patient has attained full range of motion, approximately 65% of strength, and has accomplished the running and agility drills prescribed. A total of 209 patients met the criteria of KT-1000 Arthrometer followup at the time full range of motion (5°/0°/135°) was attained and at 2 years or more after surgery. The KT-1000 Arthrometer manual maximum difference between the reconstructed and normal knees was used as the indicator of change in the graft length. All patients completed postoperative sub jective questionnaires. The mean KT-1000 Arthrometer value was 2.06 mm (SD, ±2.2) at full range of motion and 2.10 mm (SD, ±1.9) at more...
-
ligament stability two to six years after anterior cruciate ligament reconstruction with autogenous patellar tendon graft and participation in accelerated rehabilitation program
American Journal of Sports Medicine, 1995Co-Authors: Donald K Shelbourne, Thomas E Klootwyk, John H. Wilckens, Mark S De CarloAbstract:We studied patients who participated in our accelerated rehabilitation program after anterior cruciate ligament reconstructive surgery to determine if they showed signs of patellar tendon graft stretching. This program initiated in 1987 emphasizes early full hyperextension, early weightbearing as tolerated, and closed-chain functional activities with rapid return to sports when the patient has attained full range of motion, approximately 65% of strength, and has accomplished the running and agility drills prescribed. A total of 209 patients met the criteria of KT-1000 Arthrometer followup at the time full range of motion (5 degrees/0 degrees/135 degrees) was attained and at 2 years or more after surgery. The KT-1000 Arthrometer manual maximum difference between the reconstructed and normal knees was used as the indicator of change in the graft length. All patients completed postoperative subjective questionnaires. The mean KT-1000 Arthrometer value was 2.06 mm (SD, +/- 2.2) at full range of motion and 2.10 mm (SD, +/- 1.9) at more than 2 years of followup (P = 0.7961). The patients' subjective stability scores averaged 19.6 with 97% reporting no instability episodes. Based on our findings, we conclude that an accelerated rehabilitation program after this type of reconstruction does not affect long-term stability as measured by the KT-1000 Arthrometer.
