Annotated Bibliography: Anterior Cruciate Ligament

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Arnold, T., & Shelbourne, K. (2000). A perioperative rehabilitation program for anterior cruciate ligament surgery. The Physician and Sportsmedicine, 28, 1-16

Rehabilitation is crucial for postoperative knee injury. Describing their somewhat innovative preoperative program that had been conducted at their clinic during the last 10 years, the researchers detailed the 4-phase structure that they used to restore patients to activity quickly and safely and to reduce post-operative swelling. Methods included mental preparation for cure, aggressive swelling reduction, hyperextension exercise, and gait training, and program started instantly after injury occurred. Post-operative goals were to control swelling whilst endeavoring to attain full kneecap motion. The program's goals were to shift to sport-specific exercises once quadriceps-strengthening goals had been accomplished.

Bandi, M., & Volpi, P. (2006). Comparative evaluation of knee stability following reconstruction of the anterior cruciate ligament with the bone-patellar tendon-bone and the double semitendinosus-gracilis methods: 1- and 2-year prospective study. Knee Surgery, Sports Traumatology, Arthroscopy, 14, 637-640.

Two mismatched groups were studied for an account of the anterior cruciate ligament (ACL) reconstructions. Both groups - bone -- patellar tendon -- bone autograft (BPTB) (n=39) and the doubled semitendinosus -- gracilis autograft (ST -- GR)(n=22), although mismatched in gender and age, revealed no significant differences in clinical and instrumental evaluations after 1 and 2 years. Both groups demonstrated satisfactory anterior knee stability.

Bonci, C.M. (1999). Assessment and evaluation of predisposing factors to anterior cruciate ligament injury. Journal of Athletic Training, 34(2), 155-164.

Accompanied with clear diagrams, Bonci (1999) conducted a literature review in order to assess the most common variables existing in possible injury to the knee in regards to women athletes. The intention, here, was to identify possible risk factors and appropriate measurement indices of the predictive power of these variables, and, by doing so, to draw up a standardized screening protocol whereby clinicians and trainers could predict and prevent possible sources of injury.

Three variables emerged, but data regarding their predictive value was ambiguous and contradictory.

Bonci recommends the benefit of using her research as important baseline information for maximizing structural and functional outcomes when deficiencies are observed in groups of female athletes, and calls for further research regarding predictive value of variables.

Dick, R., Ferrara, M., Agel, J., Courson, R., Marshall, S., Hanley, M., & Reifsteck, F. (2007). Descriptive epidemiology of collegiate men's football injuries: National Collegiate Athletic Association Injury Surveillance System. Journal of Athletic Training, 42(2), 221-233.

The objective of this research was to review 16 years of National Collegiate Athletic Association (NCAA) with the intention of pinpointing repeated injury patterns in order to provide clinicians and athletic trainers with certain pointers whereby they could establish standard protocol and identify particular risk factors. Results showed that the greatest amounts of injuries were accumulated during the game rather than during the fall practices and were greatest for upper leg contusions, acromioclavicular joint sprains, knee internal derangements, ankle ligament sprains, and concussions.

The authors recommended that injury prevention measures should focus on specific positions in order to reduce the injury rate; that injury patterns and trends should be consistently monitored; and that surveillance of protection offered by new sports equipment should be monitored too.

Evans, N.A., Chew, H.F., & Stanish, W.D. (2006). The natural history and tailored treatment of ACL injury. The Physician and Sportsmedicin, 29(9)

Treatment of ACL injury should be individualized and may at times need to be aggressive. Predicting the outcome after various injuries is, however, difficult. To that end, authors recommend that physicians should work towards understanding the bodily responses that can occur in response to ACL injury. Injury can range from minor to significant, but understanding these factors can better help physicians design individualized programs where sometimes more aggressive approaches are needed in order to return patient to former active level.

Fitzgerald, G. (1997). Open vs. closed kinetic chain exercises: issues in rehabilitation after anterior cruciate ligament reconstructive surgery. Physical Therapy, 77(12), 1747-1754.

Clinicians have recently preferred 'closed kinetic chain' exercise to that of 'open kinetic chain exercise' as postoperative rehabilitative manner in which to restore former muscle strength and ability. Fitzgerald (1997) tested and compared the strength of both forms of exercises and found little difference between them. Whilst clinicians prefer closed kinetic chain due to the alleged functionality and enhanced safety potential, Fitzgerald demonstrated that both types of exercises provide similar benefits in minimizing risk of strain on the ACL graft as well as minimizing patellofemoral joint stress. Both forms of exercise are advantageous in simulating functional activities, and, therefore, both should be integrated and combined rather than one used in preferance to the other.

Gorschewsky, O., Klakow, a., Putz, a, Mahn, H., & Neumann, W. (2007). Clinical comparison of the autologous quadriceps tendon (bqt) and the autologous patella tendon (bptb) for the reconstruction of the anterior cruciate ligament. Knee Surgery, Sports Traumatology, Arthroscopy, 15(11), 1284-1292.

BTB autograft is the most common method for ACL reconstruction but to prevent donor-site-morbidity a transplant of quadriceps tendon, with an attached bone block (BQT) has been recently preferred. In order to compare and assess both methods, Gorschewsky et al. (2007) assessed the knee stability after a 2-year follow up of 2 groups of patients, one who had received BTB autograft (n=124) and the other who had received a transplant of quadriceps tendon (n=136) with an attached bone block. Both objective and subjective methods were used. Whislt the BQT groups showed slightly better results as regards donor-site morbidity, there were no overall significant differences as regards functional outcome. The BTB transplant, however, does show slighly better patient outcome and satisfaction, but for patients who often engage in kneeling activities or in activities that involve prolonged flexing of the knee joint, BQT transplants are recommended as a better alternative.

Hewett, T. (2009). Prevention of non-contact acl injuries in women: use of the core of evidence to clip the wings of a black swan. Current Sports Medicine Reports, 8(5), 219-221.

Using Taleb's treatise "The Black swan: The Impact of the Highly Improbable" as theme, Hewett (2009) agrees that although non-contact ACVL injuries can be unpredictable and random, prophylactic interventions that target underlying mechanisms of ACL risk factors can prevent injury from occurring. Certain factors can be controlled such as knowing times when injury is most apt to occur, as well as knowing neuromuscular control differences between the genders.

Previous reports to study possible risk factors have been grounded on interviews with athletes and Hewett (2009) states that his clinic differs in that it uses a system of computer modeling and "prospective, longitudinal, coupled biomechanical-epidemiologic studies" that are geographically based in order to detect and identify possible risk factors. Their program also helps identify neuromuscular imbalances.

Neuromuscular imbalances can be used to identify athletes that are at risk and to then address these imbalances so that ACL injuries may be prevented. Whilst not all random ACL injuries can be predicted, potential for injury can and neuromuscular interventions can be designed in order to better prevent injuries from occurring.

Hootman, J., Dick, R, & Agel, J. (2007). Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. Journal of Athletic Training, 42(2), 311-319.

The objective of this research was to study 16 years of National Collegiate Athletic Association (NCAA) as played across 15 sports to determine the sports in which injuries were most likely to occur, and the most common areas of these injuries in order to implement injury prevention programs and to help clinicians and sports trainers reduce risk of injury.

Researchers discovered that injury was more often accrued through actual games than in practice and that preseason practice injuries were significantly higher than in-season and post-season practice injuries combined. Ankle ligament sprains were the most common, and more than 50% of injuries happened to the lower extremities. Football showed the highest rates of injury, with male baseball and female softball demonstrating the lowest rates.

Using this data, researchers recommended, would result in potentially alleviating injuries endured through collegiate sports.

Mahirogullari, M., Oguz, Y., & Ozkan, H. (2006). Reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone graft with double biodegradable femoral pin fixation. Knee Surgery, Sports Traumatology, Arthroscopy, 14(7), 646-653.

The purpose of this study was to assess bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction (using biodegradable cross pin fixation) as comparative technique to patellar tendon fixation in ACL reconstruction.

In a nonrandomized clinical study, thirty-five patients were assessed after a 2-year follows up to determine results. Thirty BPTB autografts and five BPTB allografts were clinicaly evaluated using International Knee Documentation Committee (IKDC), Lysholm and Tegner activity score, and Telos stress device measurements. Most of the patients reported excellent results whilst all had returned to their preinjury level of activity and former athletic participation. Results concluded that BTB anterior cruciate ligament reconstruction could serve as reliable alternative for patellar tendon fixation in ACL reconstruction.

Maletis, G., Cameron, S., Tengan, J., & Burchette, R. (2007). A prospective randomized study of anterior cruciate ligament reconstruction: a comparison of patellar tendon and quadruple-strand semitendinosus/gracilis tendons fixed with… [END OF PREVIEW]

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Anterior Cruciate Ligament.  (2011, March 3).  Retrieved August 17, 2019, from

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"Anterior Cruciate Ligament."  March 3, 2011.  Accessed August 17, 2019.