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Ligament Reconstruction with Reference to the Anterior Cruciate Ligament of the Knee
Published in Verna Wright, Eric L. Radin, Mechanics of Human Joints, 2020
Various procedures were developed for the use of the semitendinosus and gracilis tendons as substitutes, and a representative sample of the work published in the literature is cited here. Three different basic types of procedures were used: (i) In one such procedure, on harvesting the tendon from the muscle, leaving its tibial attachment intact, the tendon is passed through tunnels in the tibia and femur and then attached to the lateral side of the femur with sutures to other structures, such as the ΓTB, or with a mechanical fixation device through the bone (51–53). (ii) In another procedure on harvesting, the tendon was implanted within bone tunnels both proximally and distally, but instead of using the tendon (in this case semitendinosus) as a single strand, it was doubled to increase the strength of the substitute (54). Bone plugs were also used to secure the implant within the bone tunnels, (iii) A third method, referred to as dynamic transfer is based on the hypothesis that a ligament substitute with intact proprioceptors gives greater awareness of loads acting along it than a denervated free graft. Proximally based gracilis tendon is routed through the posterior capsule and intercondylar notch of the knee and secured to the tibia through another bone tunnel anterior to the normal ACL attachment. It was hoped that reflex muscle tone would preserve tension along the graft and prevent it from stretching (55,56).
Does inside passing contribute to the high incidence of groin injuries in soccer? A biomechanical analysis
Published in Journal of Sports Sciences, 2018
Thomas Dupré, Johannes Funken, Ralf Müller, Kristian R. L. Mortensen, Filip Gertz Lysdal, Markus Braun, Hartmut Krahl, Wolfgang Potthast
High muscle stresses in the adductors cannot only explain muscle injuries, a connection can also be made to the development of adductor tendinopathy and osteitis pubis: The cross-sectional area of muscles gets smaller towards their apophyses, but the forces produced are constant throughout the entire muscle. Therefore, the stress applied to the tendons and apophyses is higher compared to the centre of the muscle. This even higher stress makes the tendons and apophyses prone to overuse and the onset of inflammations. Accordingly, this is relevant for the development of adductor tendinopathy in soccer players. Furthermore, because the gracilis, together with the adductor longus, is attached to the pubic bone via the inferior pubic ligament, the combined force of the two muscles acts on the pubic symphysis (Cunningham et al., 2007). There are two mechanisms associated with groin pain and/or osteitis pubis that might be explained by this combined force: First, Cunningham et al. (2007) found that osteitis pubis is often accompanied by a microtear in the adductor longus attachment. Second, due to the high stresses, the pubic symphysis and parasymphyseal bone might be put under extensive stress repeatedly, leading also to osteitis pubis (Hiti et al., 2011). Both mechanisms can be explained by high muscle stress acting on the apophysis and pubic symphysis.
Kinetics of the lower limb during two typical Tai Chi movements in the elderly
Published in Research in Sports Medicine, 2018
At the knee joint, both TC movements generated significantly larger knee internal rotation moment compared to walking. Particularly, performing RM generated significantly larger knee abduction and adduction moment than walking, which may help to train the knee abductors and adductors and to apply mechanical loading on the passive structure of the knee, such as ligaments and cartilage. In some of sports or weight training activities, lateral forces on the knee joints can change loading pattern of the joint, leading to injury. Practising TC could provide a form of passive training on the knee joint since TC is performed in a semi-squatting posture; in this position, knee joint rotation and abduction/adduction become possible because the knee is in the “unlock” position (Nordin & Frankel, 2001). The abduction, adduction and rotation of the knee rely on the co-contractive activity of the muscles that surround the knee, such as semi-muscles, biceps femoris and gracilis. Strengthening the hip abductors (Brund et al., 2017; Cronström, Mark Creaby, Jenny Nae, & Eva Ageberg, 2016; Powers, 2010; Snyder, Earl, Connor, & Ebersole, 2009) may help to reduce knee abduction angle that cause patellofemoral pain and injuries (Bell, Padua, & Clark, 2008; Kim, Unger, Lanovaz, & Oates, 2016; Kipp, Mclean, & Palmieri-Smith, 2011).
Tri-axial loading response to anti-gravity running highlights movement strategy compensations during knee injury rehabilitation of a professional soccer player
Published in Research in Sports Medicine, 2023
Matt Greig, Liam Mason, Andy Mitchell
The case was a 26-year-old male professional soccer player, typically employed as an attacking midfielder or forward, with >300 appearances, and with no previous history of injuries. The player suffered an ACL rupture to his right (dominant) knee during match-play with surgical intervention to harvest a four-strand autologous hamstring semitendinosus and gracilis graft from the contralateral limb. Eight months into the rehabilitation pathway the player reported pain in the medial aspect of the same knee and underwent a medial meniscectomy. The subsequent rehabilitation was conducted by medical staff from the professional club, and written consent was provided by the player in accordance with the Helsinki Declaration.