Static tensioning promotes hamstring tendons force relaxation more reliably than cycling tensioning

Piedade, Sérgio Rocha; Fabbro, Inácio Maria Dal; Mischan, Martha Maria; Piedade, Cezar; Maffulli, Nicola

doi:10.1016/j.knee.2017.04.017

Cited by 6 publications

(4 citation statements)

References 32 publications

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“…Since the correction strain in each cast is smaller, the required number of casts has to increase in this modification. In ex vivo studies [36, 39–41], the time to plateau (relaxation time) for tendons is within an hour (2 minutes–1 hour). However, these experiments excluded the soft tissue remodeling (adaptation) which will occur in vivo during the treatment.…”

Section: Tendon and Ligament Mechanical Propertiesmentioning

confidence: 99%

An Analysis of the Mechanical Properties of the Ponseti Method in Clubfoot Treatment

Kadhum

Lee

Czernuszka

et al. 2019

Applied Bionics and Biomechanics

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Congenital clubfoot is a complex pediatric foot deformity, occurring in approximately 1 in 1000 live births and resulting in significant disability, deformity, and pain if left untreated. The Ponseti method of manipulation is widely recognized as the gold standard treatment for congenital clubfoot; however, its mechanical aspects have not yet been fully explored. During the multiple manipulation-casting cycles, the tendons and ligaments on the medial and posterior aspect of the foot and ankle, which are identified as the rate-limiting tissues, usually undergo weekly sequential stretches, with a plaster of Paris cast applied after the stretch to maintain the length gained. This triggers extracellular matrix remodeling and tissue growth, but due to the viscoelastic properties of tendons and ligaments, the initial strain size, rate, and loading history will affect the relaxation behavior and mechanical strength of the tissue. To increase the efficiency of the Ponseti treatment, we discuss the theoretical possibilities of decreasing the size of the strain step and interval of casting and/or increasing the overall number of casts. This modification may provide more tensile stimuli, allow more time for remodeling, and preserve the mechanical integrity of the soft tissues.

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Section: Tendon and Ligament Mechanical Propertiesmentioning

confidence: 99%

An Analysis of the Mechanical Properties of the Ponseti Method in Clubfoot Treatment

Kadhum

Lee

Czernuszka

et al. 2019

Applied Bionics and Biomechanics

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“…Z důvodu nižší morbidity dárcovského místa a snížení pooperačních komplikací než tomu je u BTB štěpů, si získaly v posledních letech autologní šlachy HS popularitu jako náhrada přetrženého LCA a byly obhájeny jako alternativní materiál pro jeho rekonstrukci (1,5,11,17,31,32,36).…”

Section: Discussionunclassified

New Technique of Anterior Cruciate Ligament Reconstruction Using Hamstrings - the Surgical Instrumentation Set

Handl¹,

Hanuš²,

Stančák³

et al. 2018

ACHOT

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Funkce předního zkříženého vazu kolenního kloubu (LCA) je velmi důležitá, což je obecně známo (6). Primární funkcí LCA je bránit subluxaci tibie vůči femuru, hraje tak signifikantní roli v normální kinematice kolenního kloubu (13,15,18). Jeho poškození patří k nejtěžším poraněním kolenního kloubu člověka. Následkem poškození tohoto vazu se vyvíjí instabilita kolenního kloubu a dochází k časnému vývoji osteoartrózy (13,14,20,34). ÚVODV letech 2006-2008 probíhala spolupráce ortopedické kliniky 2. LF UK a FN v Motole Praha a firmou Beznoska, s. r. o., zaměřená na vývoj implantátu a instrumentária pro rekonstrukci předního zkříženého vazu kolenního kloubu. Studie je rozdělena na dvě části, v první části prezentujeme konstrukci vlastního instrumentária s implantáty, zkušenosti z klinických zkoušek a s jejich klinickým použitím. V druhé části práce jsou uvedeny výsledky léčby souboru našich pacientů s použitím této techniky.

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“…Biomechanical studies on ACL graft conditioning show progressive increases in graft elongation under a variety of cyclic loading conditions. 2,6,9,10,17,19,23,29 There are problems in applicability of these studies, as the ACL grafts are cycled .500 times 2,6,19 and under high tension loads that would be difficult to perform during surgery. 19,23 For example, Jaglowski et al 19 preconditioned grafts under loads as high as 600 N (135 lb).…”

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confidence: 99%

“…Additionally, studies did not test the grafts in situ but rather at the bench level without implantation into the knee joint to determine the effect of the ACL graft on knee kinematics. 9,10,17,19,23,29 Consequently, no graft conditioning protocol based on objective criteria is currently accepted from a clinical standpoint. z This study was designed to examine 2 protocols of graft conditioning: first, initial tensioning of the ACL graft on a graft board; second, implanting of the graft into the knee joint and subjecting it to flexion-extension cycling under a defined anterior tibial load.…”

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confidence: 99%

Anterior Cruciate Ligament Graft Conditioning Required to Prevent an Abnormal Lachman and Pivot Shift After ACL Reconstruction: A Robotic Study of 3 ACL Graft Constructs

et al. 2019

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Background: Anterior cruciate ligament (ACL) graft conditioning protocols to decrease postoperative increases in anterior tibial translation and pivot-shift instability have not been established. Purpose: To determine what ACL graft conditioning protocols should be performed at surgery to decrease postoperative graft elongation after ACL reconstruction. Study Design: Controlled laboratory study. Methods: A 6 degrees of freedom robotic simulator evaluated 3 ACL graft constructs in 7 cadaver knees for a total of 19 graft specimens. Knees were tested before and after ACL sectioning and after ACL graft conditioning protocols before reconstruction. The ACL grafts consisted of a 6-strand semitendinosus-gracilis TightRope, bone–patellar tendon–bone TightRope, and bone–patellar tendon–bone with interference screws. Two graft conditioning protocols were used: (1) graft board tensioning (20 minutes, 80 N) and (2) cyclic conditioning (5°-120° of flexion, 90-N anterior tibial load) after graft reconstruction to determine the number of cycles needed to obtain a steady state with no graft elongation. After conditioning, the grafts were cycled a second time under anterior-posterior loading (100 N, 25° of flexion) and under pivot-shift loading (100 N anterior, 5-N·m internal rotation, 7 N·m valgus) to verify that the ACL flexion-extension conditioning protocol was effective. Results: Graft board tensioning did not produce a steady-state graft. Major increases in anterior tibial translation occurred in the flexion-extension graft-loading protocol at 25° of flexion (mean ± SD: semitendinosus-gracilis TightRope, 3.4 ± 1.1 mm; bone–patellar tendon–bone TightRope, 3.2 ± 1.0 mm; bone–patellar tendon–bone with interference screws, 2.4 ± 1.5 mm). The second method of graft conditioning (40 cycles, 5°-120° of flexion, 90-N anterior load) produced a stable conditioned state for all grafts, as the anterior translations of the anterior-posterior and pivot-shift cycles were statistically equivalent ( P < .05, 1-20 cycles). Conclusion: ACL graft board conditioning protocols are not effective, leading to deleterious ACL graft elongations after reconstruction. A secondary ACL graft conditioning protocol of 40 flexion-extension cycles under 90-N graft loading was required for a well-conditioned graft, preventing further elongation and restoring normal anterior-posterior and pivot-shift translations. Clinical Relevance: There is a combined need for graft board tensioning and robust cyclic ACL graft loading before final graft fixation to restore knee stability.

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Static tensioning promotes hamstring tendons force relaxation more reliably than cycling tensioning

Cited by 6 publications

References 32 publications

An Analysis of the Mechanical Properties of the Ponseti Method in Clubfoot Treatment

An Analysis of the Mechanical Properties of the Ponseti Method in Clubfoot Treatment

New Technique of Anterior Cruciate Ligament Reconstruction Using Hamstrings - the Surgical Instrumentation Set

Anterior Cruciate Ligament Graft Conditioning Required to Prevent an Abnormal Lachman and Pivot Shift After ACL Reconstruction: A Robotic Study of 3 ACL Graft Constructs

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