Consequences of Complete ACL Ruptures
This chapter reviews the potential problems caused by ACL tears that are treated conservatively. A general consensus exists among clinicians that a complete ACL rupture causes long-term problems, especially a decrease in activity level and an early onset
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Consequences of Complete ACL Ruptures Sue D. Barber-Westin and Frank R. Noyes
Contents Introduction .............................................................
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Consequences of ACL-Deficiency .......................... Alterations in Knee Kinematics ................................ Bone Loss, Osseous Deficits ..................................... Chronic Quadriceps Weakness.................................. Gait Abnormalities .................................................... Changes in Muscle Activation Strategies During Functional Activities .............. Alterations in Proprioception and Balance ......................................................... Impairment in Single-Leg Hop Functional Testing ..............................................
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Added Problems with Loss of Meniscus Function ........................................ Review of Biomechanics and Function of the Menisci ................................ Incidence of Loss of Meniscus Tissue with ACL Injuries .................................... Effects of Meniscectomy in Chronic ACL-Deficient Knees ........................ Effect of Nonoperative Treatment on Future Activity Levels and Symptoms .......
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Effect of Nonoperative or Delayed Operative Treatment in Skeletally Immature Athletes............................................. Identification of Factors for Initial Conservative Management ...................................................... Muscular and Neuromuscular Differences Between Copers and Non-Copers................................................... References ................................................................
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Introduction
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S.D. Barber-Westin, B.S (*) Cincinnati Sportsmedicine Research and Education Foundation, 10663 Montgomery Road, Cincinnati, Ohio 45242, USA e-mail: [email protected] F.R. Noyes, M.D. Cincinnati Sportsmedicine and Orthopaedic Center, 10663 Montgomery Road, Cincinnati, Ohio 45242, USA Cincinnati Sportsmedicine Research and Education Foundation, 10663 Montgomery Road, Cincinnati, Ohio 45242, USA
There are few long-term prospective studies (with a minimum of 10 years of follow-up) describing the natural history of the anterior cruciate ligament (ACL) deficient knee [3, 47, 87, 108, 116–118]. It is important to define complete from partial ACL-deficiency and to realize that some studies combine patients with these diagnoses into one cohort, making conclusions difficult on the effects of a completely deficient and nonfunctional ligament. For the purpose of this chapter, complete ACL-deficiency is defined as ³5 mm of increased anterior tibial translation on an instrumented or clinical Lachman test (Fig. 2.1) and a fully positive pivot-shift test (grade 2 or 3 on a 0–3 point scale). The International Knee Documentations Committee (IKDC) ligament examination grade of C (abnormal) or D (severely abnormal) also identifies a complete ACL tear. In contrast, patients with 80 % 10 years following the injury. Few studies have used arthroscopy or advan
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