Stergiou
N, Ristanis S, Moraiti C, Georgoulis A. Sports Medicine. 2007; 37(7):601-613.
ACL
rupture is one of the most common sports injuries nowadays. It is suggested,
that continuing sports activity with torn ACL will lead to other dysfunctions
including meniscal lesions, chondral defects and early OA. On the other hand,
does ACL reconstruction prevent from experiencing these problems? Research
refutes that notion more frequently. Recent publications show that degeneration
of articular cartilage is present among most of the patients, even within one
year following ACL reconstruction.
Authors
of this paper systematically reviewed available literature and conducted
research analyzing and comparing knee joint kinematics and kinetics in ACL-
deficient, ACL – reconstructed and healthy controls in order to present potential
mechanism underlying causation of early OA in ACL – reconstructed athletes.
Authors found, that during gait, there is excessive tibial rotation seen in ACL – deficient patients. The same was seen in ACL – reconstructed group though, in a more dynamic situation like walking down the stairs or jumping off the box and subsequent pivoting. Graft type and period after reconstruction (1 vs. 2 years) did not make any difference. According to authors, it seems that current reconstruction techniques might not fully restore anatomical complexity of ACL therefore original knee joint kinematics cannot be recovered leading to inappropriate movement patterns within the joint. Excessive tibial rotation may be that kind of pathological movement mechanism resulting in cartilage overload in areas where such loadings do not occur in a healthy people. Subsequently this will effect in articular cartilage degeneration and early onset of OA.
Authors found, that during gait, there is excessive tibial rotation seen in ACL – deficient patients. The same was seen in ACL – reconstructed group though, in a more dynamic situation like walking down the stairs or jumping off the box and subsequent pivoting. Graft type and period after reconstruction (1 vs. 2 years) did not make any difference. According to authors, it seems that current reconstruction techniques might not fully restore anatomical complexity of ACL therefore original knee joint kinematics cannot be recovered leading to inappropriate movement patterns within the joint. Excessive tibial rotation may be that kind of pathological movement mechanism resulting in cartilage overload in areas where such loadings do not occur in a healthy people. Subsequently this will effect in articular cartilage degeneration and early onset of OA.
While
current surgical procedures do prevent from excessive tibial anterior translation
in relation to femur, authors suggest improving and developing new techniques
and graft types in order to prevent tibial excessive rotational range of
motion. Most likely it could be achieved with more horizontally oriented
femoral tunnel or by using double – bundle reconstruction.
This
paper shows the need for rehabilitation programs focused on developing power
and endurance of lower extremity muscles, trunk muscles and sensorimotor
training to improve neuro – muscular control, core stability and in a result,
better knee joint stability.
What
is your experience with ACL – deficient and ACL – reconstructed athletes? Would
you recommend reconstruction or would you try to encourage that patient just to
follow rehabilitation regimen? What factors are the most important in that kind
of rehabilitation?
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All rights reserved to the Sports Medicine.
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