Increased Rotatory Laxity after Anterolateral Ligament Lesion in Anterior Cruciate Ligament- (ACL-) Deficient Knees: A Cadaveric Study with Noninvasive Inertial Sensors

The anterolateral ligament (ALL) has been suggested as an important secondary knee restrain on the dynamic laxity in anterior cruciate ligament- (ACL-) deficient knees. Nevertheless, its kinematical contribution to the pivot-shift (PS) phenomenon has not been clearly and objectively defined, and noninvasive sensor technology could give a crucial contribution in this direction. The aim of the present study was to quantify in vitro the PS phenomenon in order to investigate the differences between an ACL-deficient knee and an ACL+ALL-deficient knee. Ten fresh-frozen paired human cadaveric knees (n=20) were included in this controlled laboratory study. Intact, ACL-deficient, and ACL+ALL-deficient knees were subjected to a manual PS test quantified by a noninvasive triaxial accelerometer (KiRA, OrthoKey). Kinematic data (i.e., posterior acceleration of the tibial lateral compartment) were recorded and compared among the three statuses. Pairwise Student's t-test was used to compare the single groups (p<0.05). Intact knees, ACL-deficient knees, and ACL+ALL-deficient knees showed an acceleration of 5.3±2.1 m/s2, 6.3±2.3 m/s2, and 7.8±2.1 m/s2, respectively. Combined sectioning of ACL and ALL resulted in a statistically significant acceleration increase compared to both the intact state (p<0.01) and the ACL-deficient state (p<0.01). The acceleration increase determined by isolated ACL resection compared to the intact state was not statistically significant (p>0.05). The ALL sectioning increased the rotatory laxity during the PS after ACL sectioning as measured through a user-friendly, noninvasive triaxial accelerometer

Editorial Commentary: Chronic Anterior Cruciate Ligament Injury Requires Reconstruction Plus Lateral Tenodesis to Control Rotational Instability: Additional Technical Complexity May Result in Complications Without Improved Outcomes

How to restore native knee kinematics following complex knee injuries is still debated and under investigation. To better reproduce the native anterior cruciate ligament (ACL), surgeons have a host of different options, including graft choice, technique, fixation method, and single-, double-, and triple-bundle techniques, etc. Isolated ACL reconstruction alone is not effective in controlling complex instability patterns, especially regarding internal and external rotations. Several techniques have been described to address such instabilities, like single- or double- bundle ACL reconstruction plus lateral extra-articular tenodesis. In truth, chronic ACL injury requires reconstruction plus lateral tenodesis to control rotational instability. Additional technical complexity may result in complications without improved outcomes. Neither single-bundle nor double-bundle techniques are “truly” anatomic. Keep it simple; keep it safe

Videoinsight® art for care

The corporal and psychic dimensions are deeply combined and reciprocally conditioned in the body unit. The improvement of psychological status influences the somatic one. The role that psychology has to play in understanding and improving the recovery after mental or physical stress is really interesting and needs more attention in order to treat the patient as a global unit and not focusing on a single aspect of mental or physical recovery only, in order to promote patient global wellness. The Videoinsight® is a psychological enhancing method that involves the vision of contemporary art videos, selected according to their content and transformative potential, with the intent to catalyze the “insight” psychological experience and to facilitate the process that allows the individual to stimulate sensations, emotions, learning, psycho-aptitude orientation, actions and changes. Insight in psychoanalysis means the capacity to understand the interior psychic pathway and consequently to allow therapeutic transformation. These artistic videos contain a significant psycho-diagnostic and psychotherapeutic meaning that can help treat the psychological and psychosomatic disabilities that are frequently observed after mental or corporal stress, increasing the resistance capacity and improving the cognitive and behavioral power during the recovery process. The Videoinsight® Method has been verified in the clinical, psychological and medical setting: • for the Diagnosis of the Structure and Operation of Personality: the art video reveals similarities with the Projective Rorschach Test; • for the Analysis of Request for Psychological Support and for the Discovery of the Capacity of Trust, Cooperation, and Motivation in the relationship with the Others; • for the Prevention of Psychological Discomfort related to the Crisis of Development (adolescent, post traumatic stress, psychosomatic stress and the one related to physical illness and the aging process); • for the Orientation and Enabling of Attitudes and Functional Talents in support of the healthy personality. They are critical for containment of the weak and dysfunctional parts, supporting a creative and harmonious mental and physical development of the person; • for the Rehabilitation of Psychological Resources following the impairment caused by a physical illness, a trauma, a stress that turns the vulnerability into crisis or into evolutionary stalemate. In particular, in two prospective randomized studies, the Videoinsight® Method was able to accelerate recovery after Anterior Cruciate Ligament reconstruction and also after Total Knee Arthroplasty with improvement of subjective functional score and psychological scales. These results highlight how images are powerful and have a tremendous impact on the personality. Specific images can be very powerful and are able to produce “insight." In this chapter we will describe the Videoinsight® Method and its applications in the psychotherapeutic setting, in distress prevention and in promoting well-being and early recovery during rehabilitation following surgery

Shoulder Biomechanics

The shoulder complex provides greater freedom of motion than any other joint in the body at the expense of reduced stability. Shoulder joint movements include flexion-extension, abduction-addcuction, circumduction and rotation. They result from a complex interplay between static and dynamic stabilizers that require equilibrium and synchronicity. Shoulder instability is a comon problem in active populations, especially young athletes. It can occur in overhead throwing athletes (chronic overuse injuries) but more commonly occurs in contact athletes (acute thraumatic dislocations). The contact sports most commonly associated with shoulder instability include rugby, football, wrestling and hockey. This chapter analyses the clinical functional anatomy and biomechanics of shoulder structures with some insight regarding their patologic changes associated with shoulder instability in the athlete

J\u2011curve design total knee arthroplasty: the posterior stabilized shows wider medial pivot compared to the cruciate retaining during chair raising

Abstract Purpose Which total knee arthroplasty (TKA) design represents the better solution to restore a correct knee biomechanics is still debated. The aim of this study was to compare posterior stabilized (PS) and cruciate retaining (CR) version of the same TKA design (femoral component with an anatomic sagittal radius\u2014J-curve design) by the use of dynamic Roentgen stereophotogrammetric analysis (RSA). The hypothesis was that the two models influence differently in vivo knee kinematic. Methods A cohort of 16 randomly selected patients was evaluated 9 months after surgery: Zimmer PERSONA\uae was implanted, eight with CR design and eight with PS design. The kinematic evaluations were performed using a Dynamic RSA (BI-STAND DRX 2) developed in our Institute, during the execution of the sit-to-stand motor task. The motion parameters were obtained using the Grood and Suntay decomposition and the low-point kinematics methods. Results PS TKA lateral femoral compartment had a wider anterior translation (17 \ub1 2 mm) than the medial one (11 \ub1 2 mm), while the two compartments of CR TKA showed a similar anterior translation (medial: 9 \ub1 2 mm/lateral: 11 \ub1 2 mm). T test for comparison between CR and PS TKA of antero-posterior translation showed a statistically significant difference (p < 0.05) in the flexion range between 15\ub0 and 40\ub0. The CR prosthesis did not anteriorly translate during flexion. The PS design translated anteriorly showing a roll-forward mechanism during extension from 80\ub0 to 18\ub0 of flexion and a posterior translation from 18\ub0 to 0\ub0. The same significant differences (p < 0.05) between the PS and CR groups were found comparing the low-point positions of the femoral condyles in the range of flexion between 25\ub0 and 40\ub0 for the medial compartment and between 15\ub0 and 25\ub0 for the lateral compartment. Conclusions Dynamic RSA was able to investigate for the first time in vivo the kinematic behaviour of PS and CR version of the same TKA J-curve design. PS type showed a medial pivot during sit-to-stand motion task, while the CR type showed a cylindrical movement