• The Journal of Korean Physical Therapy
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• 제35권3호
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• pp.57-63
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• 2023

Purpose: The aim of this study was to conduct a systematic review of randomized controlled studies from 2012 to present that explore the diagnostic accuracy of clinical tests used for diagnosing anterior cruciate ligament (ACL) injury. Methods: Study design: Systematic review. Literature search of the PubMed and Scholar databases was conducted using keywords related to diagnostic accuracy of clinical tests for ACL injury. The PRISMA Guidelines were followed to conduct this study. The Cochrane Risk of Bias Tool was utilized to assess the quality of each included study. Results: As a result, 8 studies were included, and 6 clinical tests used in ACL tears were evaluated for diagnostic accuracy. The pivot shift test was reported as having the highest +LR (29.5) value with a sensitivity of 59% and a specificity of 98%. However, the test with the lowest -LR value was the lever test, and the values were as follows: -LR (0.08), +LR (4.7), specificity (80%), sensitivity (94%). Conclusion: In this study, it was concluded that a single clinical test is not sufficient to determine the presence of ACL injury. Test combinations have a higher diagnostic accuracy than a single test. In this study, the accuracy of the clinical tests was examined without considering the amount of ACL rupture and acute-chronic condition. Further research is required to examine the impact of these two factors on diagnostic accuracy of clinical test.

• IMMUNE NETWORK
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• 제24권2호
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• pp.17.1-17.16
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• 2024

We have reported that anterior cruciate ligament (ACL) injury leads to the differential dysregulation of the complement system in the synovium as compared to meniscus tear (MT) and proposed this as a mechanism for a greater post-injury prevalence of post traumatic osteoarthritis (PTOA). To explore additional roles of complement proteins and regulators, we determined the presence of decay-accelerating factor (DAF), C5b, and membrane attack complexes (MACs, C5b-9) in discarded surgical synovial tissue (DSST) collected during arthroscopic ACL reconstructive surgery, MT-related meniscectomy, osteoarthritis (OA)-related knee replacement surgery and normal controls. Multiplexed immunohistochemistry was used to detect and quantify complement proteins. To explore the involvement of body mass index (BMI), after these 2 injuries, we examined correlations among DAF, C5b, MAC and BMI. Using these approaches, we found that synovial cells after ACL injury expressed a significantly lower level of DAF as compared to MT (p<0.049). In contrast, C5b staining synovial cells were significantly higher after ACL injury (p<0.0009) and in OA DSST (p<0.039) compared to MT. Interestingly, there were significantly positive correlations between DAF & C5b (r=0.75, p<0.018) and DAF & C5b (r=0.64 p<0.022) after ACL injury and MT, respectively. The data support that DAF, which should normally dampen C5b deposition due to its regulatory activities on C3/C5 convertases, does not appear to exhibit that function in inflamed synovia following either ACL injury or MT. Ineffective DAF regulation may be an additional mechanism by which relatively uncontrolled complement activation damages tissue in these injury states.

• 대한관절경학회지
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• 제16권2호
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• pp.147-152
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• 2012

목적: 전방십자인대 파열과 동반되는 반월상 연골판 손상에 대해 수술 전 자기공명영상(magnetic resonance imaging, MRI) 검사 소견과 수술 후 관절경 소견을 비교하고자 하였다. 대상 및 방법: 2001년 2월부터 2010년 11월까지 전방십자인대 파열로 본원에서 관절경적 전방십자인대 재건술을 시행받은 225명의 환자를 대상으로 하였으며 관절경 소견상 반월상 연골판 파열은 154예였다. 반월상 연골판 파열은 수술 전 자기공명영상 검사 판독 결과와 관절경 소견을 비교하여 위치 및 모양에 따라 분류하였으며 이에 따른 자기공명영상 검사의 민감도를 조사하였다. 결과: 수술 전 자기공명영상 검사상 전방십자인대와 동반된 내측 반월상 연골판 손상 진단의 민감도는 0.88이었고, 전방십자인대와 동반된 외측 반월상 연골판 손상 진단의 민감도는 0.69였다. 또한 전방십자인대 파열과 동반된 외측 반월상 연골판 손상에서는 후각 및 변연부 파열 시 자기공명영상 검사의 민감도가 가장 낮았으며 내측 반월상 연골판 손상에서는 전각 및 판상 파열 시 민감도가 낮았다. 결론: 전방십자인대 파열 시 동반된 반월상 연골판 손상에서 수술 전 자기공명영상 검사상 진단하기 어려운 외측 반월상 연골판 후각 및 변연부 파열에 대해서는 관절경 수술 시 세심한 관찰이 필요하겠다.

• 대한정형외과스포츠의학회지
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• 제1권2호
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• pp.131-137
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• 2002

목적: 전방십자인대부분파열후보존적치료군과완전파열후자가슬개건을이용한재건술군간의기능적평가, 활동도및전방안정성을비교평가하고자하였다.대상및방법: 전방십자인대손상으로진단되고관절경으로진단치료한38명의환자를대상으로2년이상추시하였으며전방십자인대50$\%$이하파열된부분손상군1 2명(평균연령: 38.3세), 완전파열후자가슬개건을이용한재건술군26명(평균연령: 25.3세)을대상으로하였다. 객관적인안정성은KT-2000 Arthrometer를이용하여15lb와20lb전방전위부하로측정하였으며,기능평가는Lysholm score, 활동도는Tegner activity score를이용하여분석하였다.결과: Lysholm의기능평가는부분손상군은88.5, 재건술군은89.3이었고, Tegner의활동도는부분손상군5.3, 재건술군5.1이었다( P<0.05 ) .전방안정성에서평균전방전위는20lb 부하하에부분손상군에서건측에비해1.7$\pm$1.4 mm, 재건술군에서는건측에비해2.3$\pm$1.9 mm였으며(P<0.05), 15lb 부하하에서는부분손상군은건측에비해1.2$\pm$1.0 mm, 재건술군에서는건측에비해1.4$\pm$1.5 mm였다(P<0.05). 합병증으로관절부종, 불안정성, 전방슬관절동통이었다. 불안정성은부분손상군에서흔한합병증이었다.결론: 양군에서임상결과들은비슷하였으며, Lysholm의기능평가는양호하였고, Tegner 활동도상태는양군에서평균적으로신체적인적당한활동(조깅, 규칙적인자전거타기)은유지되어50$\%$이하의부분손상군에대한보존적치료는양호한결과가나타난것으로사료되었다.

• 대한관절경학회지
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• 제1권1호
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• pp.47-51
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• 1997

A torn anterior cruciate ligament(ACL) is the most common serious ligamentous injury to the knee joint. The incidence of ACL tears seems to be increasing, at least partly as a result of the increasing participation of individuals of all ages in high-risk sports. The most commonly used graft source for ACL reconstruction is the autogenous bone-patellar tendon-bone graft unit. Despite a good success record. postoperative complications, such as infection, patellar contracture/patellar baja, patellar fracture, rupture of the patellar tendon, graft failure without reinjury, can occur following ACL surgery. The purpose of this paper is to provide guidelines regarding the key points of the reconstructive procedure in a sequence and how to prevent or minimize the complications that can follow ACL reconstructive surgery. We want this knowledge can help orthopaedic surgeons to understand the reasons for previous and current successes and failures of reconstruction of the ACL, and it can help them to plan the care of patients who have an injury of the ligament.

• 대한정형외과스포츠의학회지
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• 제2권2호
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• pp.92-99
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• 2003

스포츠 활동과 사고로 인하여 전방십자인대 재건술이 많이 증가하고 있으며 여러 종류의 자가 및 동종이식건이 많이 사용되어지고 있다. 자가 골-슬개건-골을 이용한 전방십자인대 재건술이 제일 대표적인 이식건으로 사용되고 있으나 공여부의 합병증과 전방슬관절통 등의 문제가 발생될 수 있으며 환자에 따라서 이러한 문제를 줄일 수 있는 다른 이식건의 사용도 필요할 수 있다. 여러 이식건의 생역학적인 특성, 장점 및 단점, 합병증을 충분히 이해함으로써 환자 개인에 맞는 적절한 이식건을 선택할 수 있으며 수술후 환자의 만족도를 높일 수 있을 것으로 생각된다

• 대한관절경학회지
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• 제1권1호
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• pp.26-30
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• 1997

Recently, the incidence of anterior cruciate ligament injury is rapidly increasing because many young Korean are actively participating in sports activities including basketball, skiing and soccer. Sometimes acute ACL injuries arc misdiagnosed as sprain because of pain and muscle spasm. An accurate physical examination and careful history taking are very important to diagnose the ACL injuries. Therefore author described the skill of history taking and the technique of physical examination to diagnose ACL injuries. The most sensitive test is the Lachman's test, which is performed with the knee in 200 of flexion, the femur stabilized with full flexed examiner's knee placed behind patient's distal thigh and one hand of examiner, and the proximal tibia grasped with the other. The pivot shift test is a passive motion test that attempts to subluxate the tibia anteriorly, then have it reduce rapidly. The pivot shift test is very sensitive test to diagnose the chronic ACL injuries.

• 대한관절경학회지
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• 제1권1호
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• pp.41-46
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• 1997

The natural history of the anterior cruciate ligament(ACL)-deficient knee remains controversial. although numerous investigation have tried to ascertain the course that the knee would follow once the ACL has lost functional integrity. An extensive review of the literature performed according to symptoms. physical examinations, associated surrounding tissue injuries. returns to activity level and radiological changes in the knee joint. An active individual with a non-functioning ACL was susceptible to injury to the menisci and deteriorate the articular cartilage, followed radiographic changes. An activity levels in general also changed after injury. The most common symptom was pain. But instability varied in these individuals. Conclusively we believe that all these factors will eventually, if not initially, result in a symptomatic knee. which will result in significant limitations to the individual's desired level. So we recommend an aggressive approach in person who desired to return to a relatively active life style in young person as well as in middle aged individuals who have significant symptomatic ACL deficient knee.

• 한국운동역학회지
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• 제18권1호
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• pp.31-38
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• 2008

본 연구는 8주간의 전방십자인대 손상예방훈련이 농구 리바운드 점프 후 착지 시 지면반력에 미치는 영향을 규명하는 것이다. 본 연구에 참가한 연구 대상자는 $16{\sim}18$세 사이의 여자 농구선수 16명이다. 8주간의 전방십자인대 손상예방훈련을 수행할 실험집단 8명과 스포츠상해 예방훈련을 수행하지 않을 통제집단 8명을 무작위로 나눈 후 훈련 전후에 농구 리바운드 점프 후 착지 시 초기피크(%BW), 최대피크(%BW), 충격량(%BW.sec) 및 부하율 (N/sec)을 산출하였다. 본 연구 결과 농구 리바운드 점프 후 착지 시에 8주간의 전방십자인대 손상예방훈련을 받은 실험집단에서 초기피크 값이 감소하였다. 또한, 실험집단에서 지면반력의 충격량과 부하율이 유의하게 감소한 것으로 나타났다. 이는 8주간의 전방십자인대 손상예방 프로그램이 점프 동작에 필요한 하지의 근신경 조직에 유의한 긍정적 영향을 미쳐 효율적으로 착지한 것으로 판단된다.

• 한국운동역학회지
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• 제24권4호
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• pp.385-390
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• 2014

The purpose of this study was to investigate the effects of landing tasks on the anterior cruciate ligament (ACL) injury risk factors in female basketball players. Fifteen female basketball players performed a drop landing and a drop landing with a vertical jump on the 40 cm height box. Three-dimensional motion analysis system and ground reaction force system was used for calculate the ACL injury risk factors. Paired samples t-test with Bonfferoni correction were performed. The drop landing with a vertical jump had the higher knee flexion angle, peak knee varus moment, trunk flexion angle than a drop landing. However, the drop landing had the higher trunk rotation angle than a drop landing with a vertical jump. These results indicate that seemingly minor variations between drop landing and drop landing with a vertical jump may influence the ACL injury risk factors. Caution should be used when comparing studies using different landing tasks.