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Articles by L. E. DeFrate
Total Records ( 2 ) for L. E. DeFrate
  E. S Abebe , C. T Moorman , T. S Dziedzic , C. E Spritzer , R. L Cothran , D. C Taylor , W. E Garrett and L. E. DeFrate
  Background

Recent studies have questioned the ability of the transtibial technique to place the anterior cruciate ligament graft within the footprint of the anterior cruciate ligament on the femur. There are limited data directly comparing the abilities of transtibial and tibial tunnel—independent techniques to place the graft anatomically at the femoral attachment site of the anterior cruciate ligament in patients.

Hypothesis

Because placement with the tibial tunnel–independent technique is unconstrained by the tibial tunnel, it would allow for more anatomic tunnel placement compared with the transtibial technique.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

High-resolution, multiplanar magnetic resonance imaging and advanced 3-dimensional modeling techniques were used to measure in vivo femoral tunnel placement in 8 patients with the transtibial technique and 8 patients with a tibial tunnel–independent technique. Femoral tunnel placement in 3 dimensions was measured relative to the center of the native anterior cruciate ligament attachment on the intact contralateral knee.

Results

The tibial tunnel–independent technique placed the graft closer to the center of the native anterior cruciate ligament attachment compared with the transtibial technique. The transtibial technique placed the tunnel center an average of 9 mm from the center of the anterior cruciate ligament attachment, compared with 3 mm for the tibial tunnel–independent technique. The transtibial technique resulted in a more anterior and superior placement of the tunnel compared with the tibial tunnel– independent technique.

Conclusion

The tibial tunnel–independent technique allowed for more anatomic femoral tunnel placement compared with the transtibial technique.

  A. M Caputo , J. Y Lee , C. E Spritzer , M. E Easley , J. K DeOrio , J. A Nunley and L. E. DeFrate
  Background

Previous studies have suggested that injury to the anterior talofibular ligament (ATFL) may be linked to altered kinematics and the development of osteoarthritis of the ankle joint. However, the effects of ATFL injury on the in vivo kinematics of the ankle joint are unclear.

Hypothesis

Based on the orientation of the ATFL fibers, ATFL deficiency leads to increased anterior translation and increased internal rotation of the talus relative to the tibia.

Study Design

Descriptive laboratory study.

Methods

The ankles of 9 patients with unilateral ATFL injuries were compared as they stepped onto a level surface. Kinematic measurements were made as a function of increasing load. With use of magnetic resonance imaging and orthogonal fluoroscopy, the in vivo kinematics of the tibiotalar joint were measured in the ATFL-deficient and intact ankles of the same individuals.

Results

A statistically significant increase in internal rotation, anterior translation, and superior translation of the talus was measured in ATFL-deficient ankles, as compared with the intact contralateral controls. For example, at 100% body weight, ATFL-deficient ankles demonstrated an increase of 0.9 ± 0.5 mm in anterior translation (P = .008), an increase of 5.7° ± 3.6° in internal rotation (P = .008), and a slight increase of 0.2 ± 0.2 mm in the superior translation (P = .02) relative to the intact contralateral ankles.

Conclusion

Deficiency of the ATFL increases anterior translation, internal rotation, and superior translation of the talus.

Clinical Relevance

Altered kinematics may contribute to the degenerative changes observed with chronic lateral ankle instability. These findings might help to explain the degenerative changes frequently observed on the medial talus in patients with chronic ATFL insufficiency and so provide a baseline for improving ankle ligament reconstructions aimed at restoring normal joint motion.

 
 
 
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