Revalidatie na een voorstekruisbandletsel: met of zonder kniebrace?

Revalidatie na een voorstekruisbandherstel dient vroeg en op een intensieve manier te gebeuren. Vooral spierversterkende oefeningen spelen een belangrijke rol in dit proces. De plaats van kniebracing hierbij is echter nog steeds een punt van discussie. Functionele braces hebben wel een mechanisch effect, maar enkel bij een lage belasting (en dus niet bij dagelijkse bewegingen en sport). Bracing heeft een negatief effect op de hamstrings, die, als voorstekruisbandagonisten, een belangrijke rol hebben in het revalidatieproces. Een correcte plaatsing van het transplantaat in een anatomische positie, goede en sterke fixatie, behandeling van bijkomende blessures van de ligamenten en de meniscus en de aanwezigheid van een gecontroleerde revalidatieomgeving zijn dan ook veel belangrijker voor een goed klinisch resultaat in het algemeen en van een goede kniestabiliteit in het bijzonder. Bracing heeft, los van het soort brace (dus ook placebobrace), een positief effect op de proprioceptie. Door de brace ontstaat een subjectief gevoel van veiligheid, wat bij sommige patiënten het revalidatieproces gunstig zal beïnvloeden; dit kan echter ook een te veilig gevoel geven waardoor de patiënt te roekeloos wordt en een grotere kans bestaat op een herval van de blessure

Transplantation of viable meniscal allograft : survivorship analysis and clinical outcome of one hundred cases

Background: Few medium-term or long-term reports on meniscal allograft transplantations are available. In this study, we present the results of a survival analysis of the clinical outcomes of our first 100 procedures involving transplantation of viable medial and lateral meniscal allografts performed in ninety-six patients. Methods: Thirty-nine medial and sixty-one lateral meniscal allografts were evaluated after a mean of 7.2 years. Survival analysis was based on specific clinical end points, with failure of the allograft defined as moderate occasional or persistent pain or as poor function. An additional survival analysis was performed to assess the results of the sixty-nine procedures that involved isolated use of a viable allograft (twenty of the thirty-nine medial allograft procedures and forty-nine of the sixty-one lateral allograft procedures) and of the thirteen viable medial meniscal allografts that were implanted in combination with a high tibial osteotomy in patients with initial varus malalignment of the lower limb. Results: Overall, eleven (28%) of the thirty-nine medial allografts and ten (16%) of the sixty-one lateral allografts failed. The mean cumulative survival time (11.6 years) was identical for the medial and lateral allografts. The cumulative survival rates for the medial and lateral allografts at ten years were 74.2% and 69.8%, respectively. The mean cumulative survival time and the cumulative survival rate for the medial allografts used in combination with a high tibial osteotomy were 13.0 years and 83.3% at ten years, respectively. Conclusions: Transplantation of a viable meniscal allograft can significantly relieve pain and improve function of the knee joint. Survival analysis showed that this beneficial effect remained in approximately 70% of the patients at ten years. This study identified the need for a prospective study comparing patients with similar symptoms and clinical findings treated with and without a meniscal allograft and followed for a longer period with use of clinical evaluation as well as more objective documentation tools regarding the actual fate of the allograft itself and the articular cartilage

ACL Tear and Cartilage Lesions

Articular cartilage injuries are not uncommon finding in patients with anterior cruciate ligament (ACL) tear. There are several ways to address the cartilage injuries when encountered during ACL reconstruction. The favorable treatment of cartilage injuries during ACL reconstruction is controversial. Indeed, the treatment of cartilage injuries depends on multiple factors including patient variables and severity of lesion. It is unclear whether cartilage lesions affect the recovery after ACL reconstruction and vice versa. Whether ACL reconstruction has a preventive effect on further progression of cartilage lesions is also unclear. This chapter gives an overview of current literature related to cartilage injuries with ACL tear in terms of epidemiology, clinical presentation, and management

Patellofemoral contact during squat simulation on cadaveric knees

The Ghent Knee Rig was built in 2006 for studying the biomechanical behavior of post-mortem human knees. To validate this test rig the patellofemoral contact pressures and areas were investigated in 3 post-mortem knees tested under the same circumstances and compared to results in literature. To load the quadriceps, the vastus intermedius and rectus femoris were separated and clamped together. The pulling cable was aligned according to the shaft of the femur to keep the Q-angle at physiological values. A pressure film was inserted in the patellofemoral joint to measure the patellofemoral contact area and pressure. The results follow the general accepted trends of patellofemoral contact during knee flexion and extension; when the patella enters the trochlear groove at approximately 20 degrees of knee flexion, the intra articular contact pressure and area start to build up and the contact area on the patella shifts from distal to proximal. Though working with cadaveric specimens remains a simulation of in vivo situations with well known limitations, the test rig shows a good repeatability and reliability. The next stage of this research project is a comparison of normal with pathological knees

Treatment of skeletal muscle injury: a review

Skeletal muscle injuries are the most common sports-related injuries and present a challenge in primary care and sports medicine. Most types of muscle injuries would follow three stages: the acute inflammatory and degenerative phase, the repair phase and the remodeling phase. Present conservative treatment includes RICE (rest, ice, compression, elevation), nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy. However, if use improper, NSAIDs may suppress an essential inflammatory phase in the healing of injured skeletal muscle. Furthermore, it remains controversial whether or not they have adverse effects on the healing process or on the tensile strength. However, several growth factors might promote the regeneration of injured skeletal muscle, many novel treatments have involved on enhancing complete functional recovery. Exogenous growth factors have been shown to regulate satellite cell proliferation, differentiation and fusion in myotubes in vivo and in vitro, TGF-β1 antagonists behave as inhibitors of TGF-β1. They prevent collagen deposition and block formation of muscle fibrosis, so that a complete functional recovery can be achieved

LifeGene : a large prospective population-based study of global relevance

Studying gene-environment interactions requires that the amount and quality of the lifestyle data is comparable to what is available for the corresponding genomic data. Sweden has several crucial prerequisites for comprehensive longitudinal biomedical research, such as the personal identity number, the universally available national health care system, continuously updated population and health registries and a scientifically motivated population. LifeGene builds on these strengths to bridge the gap between basic research and clinical applications with particular attention to populations, through a unique design in a research-friendly setting. LifeGene is designed both as a prospective cohort study and an infrastructure with repeated contacts of study participants approximately every 5 years. Index persons aged 18-45 years old will be recruited and invited to include their household members (partner and any children). A comprehensive questionnaire addressing cutting-edge research questions will be administered through the web with short follow-ups annually. Biosamples and physical measurements will also be collected at baseline, and re-administered every 5 years thereafter. Event-based sampling will be a key feature of LifeGene. The household-based design will give the opportunity to involve young couples prior to and during pregnancy, allowing for the first study of children born into cohort with complete pre-and perinatal data from both the mother and father. Questions and sampling schemes will be tailored to the participants' age and life events. The target of LifeGene is to enroll 500,000 Swedes and follow them longitudinally for at least 20 years.Stockholm County CouncilVetenskapsrådetKarolinska InstitutetTorsten and Ragnar Söderbergs FoundationAFA FörsäkringarManuscrip

Theorising Global Governance Inside Out: A Response to Professor Ladeur

Professor Ladeur argues that administrative law’s postmodernism (and by extension Global Administrative Law) necessitates that we move beyond relying on ideas of delegation, account- ability and legitimacy. Global Governance, particularly Global Administrative Law and Global Constitutionalism, should try to adapt and experiment with the changing nature of the postmod- ern legality and support the creation of norms that will adapt to the complexities of globalisation. Ladeur’s contestation, similar to GAL’s propositions, can be challenged. By taking the International Criminal Tribunal for Rwanda, a significant contributor to the field of international criminal law, as an example, it is suggested that the creation of networks that Ladeur makes visible may not account for ‘regulatory capture’. This paper will argue that from the outside, the proliferation of networks may suggest that spontaneous accountability is possible. A closer look, however, drawing on anthropological insights from the ICTR, reveals that international institutions are suscepti- ble to capture by special interests. Furthermore, there are two central themes that animate the response to Professor Ladeur: the political nature of international institutions and the history of international law, and the role of institutions in this history