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At least 217 records · Page 12Linked to original sources
PubMed2002

A new generation of artificial ligaments in reconstruction of the anterior cruciate ligament. Two-year follow-up of a randomised trial.

We have undertaken a randomised clinical trial comparing two methods of reconstruction of the anterior cruciate ligament in patients with chronic instability. We used an ipsilateral bone-patellar-tendon-bone autograft in 27 patients and the Ligament Advancement Reinforcement System (LARS) artificial ligament in 26. Assessment before and at two, six, 12 and 24 months after surgery, included the history, physical examination, a modified International Knee Documentation Committee (IKDC) score, the Tegner score, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and instrumented laxity testing. There were no cases of reactive synovitis or of infection of the knee, and there was no difference regarding the failure rate between the two groups. The IKDC showed no significant differences between the two groups at any stage of the follow-up. The KOOS evaluation showed consistently better results in all subscales for the LARS group during the first year of follow-up. After 24 months these differences were no longer evident. Instrument-tested laxity was greater in the LARS group at all stages of follow-up, but the differences were not significant at 24 months. Our findings suggest that at follow-up at 24 months the LARS ligament seems to be a satisfactory treatment option, especially when an early return to high levels of activity is demanded.

Activities of Daily Living↗
PubMed2003

Avulsion fracture of the head of the fibula (the "arcuate" sign): MR imaging findings predictive of injuries to the posterolateral ligaments and posterior cruciate ligament.

OBJECTIVE: The purpose of this study was to describe the significance of an avulsion fracture of the head of the fibula ("arcuate" sign) and its association with injuries of the knee on MR imaging. MATERIALS AND METHODS: We conducted a retrospective search of 2318 patients who underwent conventional radiography and MR imaging after an episode of knee trauma. Patients were included in this study if they had an avulsion fracture of the head of the fibula revealed on conventional radiography and underwent arthroscopy. Thirteen patients, all of whom were men, satisfied the inclusion criteria. Ten patients underwent further explorative surgery. The clinical, radiographic, MR imaging, and surgical findings were then reviewed. RESULTS: The avulsion fracture of the styloid process of the fibular head was apparently related to injuries of the arcuate complex in all 13 patients. Radiographically, the bony fragment was horizontally oriented and similar in size in most patients, ranging from 8 to 10 mm in length and from 2 to 5 mm in width. On MR imaging, the fibular avulsion was identified in 11 of the 13 patients. The other two patients had marrow edema in the fibular styloid process, although the avulsion fracture was not evident. All patients had injuries of the posterior cruciate ligament (six tibial avulsions, seven midsubstance tears). No patient had a tear of the anterior cruciate ligament. Disruption of the lateral collateral ligament was evident in seven patients, and one patient had a tear of the popliteal tendon. During surgery, six patients had disruption of the arcuate complex, but this disruption could not be identified on the MR images. CONCLUSION: An avulsion fracture of the fibular head generally involves the styloid process and causes injury of some of the major stabilizers in the posterolateral corner. Avulsion fractures are strongly associated with disruption of the posterior cruciate ligament.

Adolescent↗
PubMed1990

Long-term follow-up of 53 cases of chronic lesion of the anterior cruciate ligament treated with an artificial Dacron Stryker ligament.

Fifty-three cases of chronic lesion of the anterior cruciate ligament were followed up clinically and radiographically, and treated consecutively with an artificial Dacron Stryker ligament. An average of 29 months (range 12-53) after surgery, the authors report a high incidence of residual laxity (70.5%) and a 13% incidence of complications. There were no cases of evident synovitis, even if the authors do report a high percentage (85%) of periligamentous femoral osteolysis. Based on the results obtained, the authors believe that the Dacron Stryker ligamentous prosthesis is only indicated in cases where a biological ligament fails in patients engaged in competitive sports who request immediate activity for a limited period of time.

Adolescent↗
PubMed1990

Bone-patellar ligament-bone and fascia lata allografts for reconstruction of the anterior cruciate ligament.

A prospective study was performed of the first forty-seven consecutive patients who had repair of a ruptured anterior cruciate ligament and replacement with an allograft. Patients who had a rupture of another ligament were excluded, to provide a homogeneous group. Twenty-two patients received a fascia lata allograft and twenty-five patients received a bone-patellar ligament-bone allograft. All patients were enrolled in an exercise program to facilitate motion of the knee immediately after the operation, and all patients returned for postoperative evaluation (mean, forty months; range, twenty-five to sixty-seven months). The results were based on a comprehensive subjective and objective rating system, which assessed twenty factors. On testing with the KT-1000 arthrometer, 69 per cent of the patients had less than three millimeters of increased anterior-posterior displacement of the knee that had been operated on compared with the contralateral knee, 26 per cent had three to five millimeters, and 5 per cent had more than five millimeters. The knees that had a bone-patellar ligament-bone allograft had significantly lower values for anterior-posterior displacement than did those that had a fascia lata allograft (p less than 0.05). Just one patient, the only one in whom the fascia lata graft failed, had giving-way. There were no infections, and there was no evidence of rejection of the allograft or documented transmission of disease at the time of writing. A strict rating system was used. Eighteen patients (38 per cent) had an excellent result, twenty-four (51 per cent) had a good result, and five (11 per cent) had a fair or poor result. Motion of the knee immediately postoperatively was not deleterious to the allograft, and, because limitations of motion were identified and treated in the early postoperative period, full motion (0 to 135 degrees) was restored in all knees.

Activities of Daily Living↗
PubMed1996

[Arthroscopic reconstruction using the Leeds-Keio ligament following anterior cruciate ligament lesions in 200 patients].

OBJECTIVE: To establish the results of arthroscopic reconstruction of the anterior cruciate ligament with the Leeds-Keio ligament after a mean follow-up period of three years. DESIGN: Descriptive follow-up study. SETTING: Medisch Spectrum Twente in Enschede, the Netherlands. METHOD: The arthroscopic reconstruction has been carried out since 1988. Early in 1990 the prospective study was started. The patients were evaluated preoperatively according to a protocol. Postoperatively, follow-up consultations took place 3, 6 and 12 months after surgery and subsequently once every year. The results concerned the first 204 patients (205 knees); 200 patients attended all follow-up consultations. RESULTS: In the early postoperative phase there were few complications (2%). After a short period of hospitalisation (mean 3.5 days), most of the patients were able to handle full weight-bearing quite soon (average 4.8 weeks). A total of 98% returned to their original jobs after a mean of almost 12 weeks, while 94% participated again in sporting activities after a mean of more than 15 weeks. Rupture or elongation of the Leeds-Keio ligament occurred in 9% of the patients, on average 18 months after surgery (6-32), and a partial rupture in three cases (2%). In 62% the rupture or elongation occurred after a new evident trauma. Subjectively 85% of the patients no longer complained of instability, objectively stability was found in 90%. Functionally a marked improvement in comparison with the preoperative situation was achieved: 89% had a good to excellent functional score (Lysholm score). At the last follow-up 92% were satisfied with their knee functioning. CONCLUSION: Arthroscopic reconstruction with the Leeds-Keio ligament leads to promising objective, subjective and functional results after a mean follow-up of three years, with few complications.

Adolescent↗
PubMed2006

Proprioception in the ACL-ruptured knee: the contribution of the medial collateral ligament and patellar ligament. An in vivo experimental study in the cat.

In the absence of anterior cruciate ligament (ACL), secondary restraints such as menisci, ligaments, and tendons restrict anterior knee laxity. Strain detection at these sites could define the contribution of this alternative signalling system to knee proprioception after ACL injury. The hypothesis in this study questions if measurements of anterior tibial translation (ATT) from surface strain gauges on the insertions of the medial collateral ligament (MCL) and the patellar tendon (PT) are sufficiently sensitive and specific to differentiate normal, stable knees from acutely unstable knees due to ACL section. Twelve cats received miniaturized strain gauges on the surface of MCL and PT distal insertions. A purpose-made receiver transformed into measurements any voltage variation obtained during passive knee flexion-extension and anterior tibial translation manoeuvres. Variables under evaluation included first peak latency, normalized amplitude, and slope of voltage along time. Femorotibial displacements were video recorded, digitized, and used as the ATT reference. The proposed system detected significant changes in the slope of the voltage/time signal, with higher specificity and sensitivity during ATT after experimental ACL section. Changes were not significant during flexion or extension. It was found that a pattern of earlier and more intense strain in MCL and PT distal insertions was found during ATT in the ACL deficient knee. Enhanced pattern recognition learning from these structures could be a future target for proprioceptive training after ACL injury.

Animals↗
PubMed1988

Biomechanics of the ligaments of the human knee and of artificial ligaments.

The treatment of serious sprains and chronic laxity of the knee calls for a knowledge of the mechanical properties of the stabilizing structures. The mechanical characteristics indicate an elasticity rate of from 21 to 30% for the cruciate ligaments and average of 11% for the lateral ligaments. Preservation methods markedly influence mechanical properties. In the case of chronic laxity, natural ligaments can be replaced by artificial ones. This comparative biomechanical study of natural and artificial ligaments provides a classification to help the user in his choice.

Biomechanical Phenomena↗
PubMed1997

[Ligamentization as an explanation for the stability of periosteal flap repair in the replacement of the fibular ligament system].

The gold standard in the operative treatment of chronic insufficiency of the lateral ligaments of the ankle joint is replacement with a tendon (tenodesis). The disadvantage of this method is limitation of movement. The results of the replacement of ligaments with a periosteal flap are similar to the results after tenodesis, but the rate of complications is significant lower. We investigated the histological changes in periosteal flaps in patients. We saw an alignment of the collagenous fibers in the periosteal flap 8-12 weeks after the operation. The results are statistically significant. The conclusion is that the periosteal flap in the replacement of ligaments changes into a ligament-like structure.

Biopsy↗
PubMed2003

The discomallear ligament and the anterior ligament of malleus: an anatomic study in human adults and fetuses.

According to some reports, movement of the malleus, resulting from anterior hypertension on the discomallear ligament (DML), could produce aural symptoms related with damage to middle ear structures. The aim of this study was to examine the topographic relationship of the DML and the anterior ligament of malleus (ALM). Four fetuses and 16 adult hemi-sectioned heads were used to determine the anatomic-clinical relevance of DML and ALM in temporomandibular disorder. In fetal specimens, the DML was distinctly interposed between the malleus and the disc of the temporomandibular joint (TMJ), and the ALM had a structure apparently composed of the superior and inferior lamellae, running anteriorly in continuation with the sphenomandibular ligament (SML) through the future petrotympanic fissure (PTF). In all adult specimens, the DML was inserted into the malleus, and it expanded broadly toward the disc and capsular region of the TMJ in a triangular shape and inserted into the disc and capsule of the TMJ. The two-lamellae structure of the ALM was not distinguishable in adult specimens. The overstretched ALM resulted in movement of the malleus in five cases, but similar tension applied to the DML did not cause any movement of the malleus. This result provides an indication of the clinical significance of the ALM, a ligamentous structure continuous with the SML. It is apparent that the ALM has the potential to cause aural symptoms as a result of damage to the middle ear structure.

Adult↗
PubMed2004

Antiresorptive therapy conserves some periarticular bone and ligament mechanical properties after anterior cruciate ligament disruption in the rabbit knee.

The purpose of this study was to assess, in an osteoarthritic (OA) model, whether bisphosphonate (BP) antiresorptive therapy altered periarticular bone and bone-ligament biomechanics and OA progression. We surgically transected the anterior cruciate ligament (ACLX) in two groups of rabbits; the first group was dosed with BP (risedronate, 0.01 mg/kg s.c. daily for 6 wk), the second group remained untreated, and a third group of normal (unoperated) control rabbits was also evaluated. We measured distal femoral bone mineral density (BMD, Dual Energy X-ray Absorptiometry [DEXA]), medial collateral ligament (MCL) laxity, and bone mechanical function (bone cores mechanically tested in compression). These measures were related to cartilage/joint gross morphology, histology, and measures of vascular volume (gelatin-dye perfusion) for evidence of inflammatory angiogenesis and early OA. BMD by DEXA in 6 wk ACLX animals was 18% less than normal controls (p<0.05). In contrast, BP dosing conserved periarticular BMD; risedronate-treated rabbits had distal femoral BMD only 5% less and not significantly different than normal controls. When the same bone cores were compressed to failure, both ACLX and BP-dosed animals were significantly weaker than normal controls (p<0.05). However, the bone energy to failure and elastic modulus of BP-dosed animals was conserved and not significantly different from normal controls 6 wk after ACLX. Blocking bone resorption with BP also resulted in a significantly improved bone-ligament structural complex. MCL-complex laxity was significantly less in BP-dosed animals (1.2 times that of normal controls) compared to untreated ACLX animals (1.7 times that of normal controls; p<0.05). Blocking bone resorption with risedronate did not suppress osteophytosis and inflammatory angiogenesis, which were significantly increased in the periarticular bone of both untreated and BP treated ACLX animals. Thus, administering BP immediately after ACL loss conserved some periarticular bone and MCL-complex properties in an early OA model.

Animals↗
PubMed2005

[Functional ultrasound examination of the posterior cruciate ligament -- a new method of detecting ligament instability in the knee joint].

AIM: Detection of injuries to the posterior cruciate ligament (PCL) is difficult and dismissed in many cases. Here we introduce dynamic ultrasound examination as a safe and reproducible method to detect a PCL-insufficiency with or without fixed posterior tibia position and combined injuries to the cruciate ligament complex. PATIENTS AND METHOD: Dynamic ultrasound examination in a modified technique to Schwarz et al. was performed on 20 patients with a PCL-insufficiency (group 1) and 20 patients with an anterior cruciate ligament (ACL) insufficiency (group 2). Comparing both knee joints, we measured the resting value (RV), ventral translation value (VT) and dorsal translation value (DT). Mean value, standard deviation in mm and t-test for unpaired values were compared with each group and a healthy control population. RESULTS: In group 1 we could distinguish patients with fixed posterior position (PCL (mfix)) who showed a pathological dorsal RV (2.96 mm) from patients without fixation (PCL (ofix),: RV = 0.7 mm). DT was significantly prolonged (PCL (mfix): 6.4 mm; PCL (ofix): 5.6 mm) compared to healthy individuals. Group 2 showed a pathological RV (2,38 mm) and a significant prolonged VT (4.19 mm). 10 patients in this group had a spontaneous ventral tibia translation (RV: 3.7 mm) and 10 patients with ACL insufficiency showed a normal resting value (RV: 0.88 mm). CONCLUSION: Dynamic ultrasound examination allows us to distinguish between isolated ACL- or PCL-insufficiency and combined injuries of the cruciate ligament complex using a standardized flow sheet. PCL-insufficiency therefore can be separated into the entities of fixed posterior and partly reducible instability.

Adult↗
PubMedDate not supplied

[Replacement of the anterior cruciate ligament combined with valgization osteotomy of the tibia in incipient medial gonarthrosis with anterior cruciate ligament insufficiency].

In 7 patients with chronic, primarily anteromedial instability and incipient medial gonarthrosis a procedure combining valgization osteotomy of the tibia with anterior cruciate ligament replacement was employed. Postoperative examinations after observation periods of between 6 months and 5 years revealed that the results were good to very good, both subjectively and objectively. There was either no recurrence or a definite alleviation of knee joint pain present preoperatively. In view of the good results the authors now regard a combination of valgization osteotomy and anterior cruciate ligament replacement as the treatment of choice in cases with clear insufficiency of the anterior cruciate ligament and simultaneous incipient medial gonarthrosis. The combined procedure improves chances of achieving the goal of therapy. A valgization osteotomy or an anterior cruciate ligament replacement alone ought to be regarded as inadequate treatment in such cases, especially in the longer term.

Adult↗
PubMed2006

Dorsal calcaneocuboid ligament versus lateral ankle ligament repair: a case-control study.

OBJECTIVE: Anatomic reconstruction is the treatment of choice for lateral ankle ligament instability. A similar technique has recently been described for stabilisation of a chronic unstable calcaneocuboid joint as an alternative to the previously proposed tenodesis and arthrodesis procedures. METHODS: Five consecutive young females experiencing recurrent giving way of six calcaneocuboid joints were treated operatively during a 4 year period using anatomic ligament repair reinforced by a periosteal flap. Results were compared to five patients who underwent anatomic lateral ankle ligament repair in a case-control design. Outcome was measured using the Foot and Ankle Outcome Score, physical examination, and stress radiographic and MRI (calcaneocuboid group) investigation. Functional neuromuscular performance was evaluated by isokinetic torque measurements, posturometry, single-leg drop jumps, and single-leg long jumps. RESULTS: Outcome scores at follow up (5-61 months after surgery) revealed excellent results for both groups. No relevant difference was found between the affected legs and the non-affected legs or between groups with respect to the outcome measures. MRI exhibited ligament-like structures at the repaired dorsal calcaneocuboid joints in five out of six joints. CONCLUSIONS: Results of anatomic repair of unstable lateral ankle and isolated calcaneocuboid joint instability equally lead to excellent results.

Adolescent↗
PubMedDate not supplied

The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon.

BACKGROUND: Quantitative descriptions of the attachment sites of the main posterolateral knee structures have not been performed. PURPOSE: To qualitatively and quantitatively determine the anatomic attachment sites of these structures and their relationships to pertinent bony landmarks. STUDY TYPE: Cadaveric study. METHODS: Dissections were performed and measurements taken on 10 nonpaired fresh-frozen cadaveric knees. RESULTS: The fibular collateral ligament had an average femoral attachment slightly proximal (1.4 mm) and posterior (3.1 mm) to the lateral epicondyle. Distally, it attached 8.2 mm posterior to the anterior aspect of the fibular head. The popliteus tendon had a constant broad-based femoral attachment at the most proximal and anterior fifth of the popliteal sulcus. The popliteus tendon attachment on the femur was always anterior to the fibular collateral ligament. The average distance between the femoral attachments of the popliteus tendon and fibular collateral ligament was 18.5 mm. The popliteofibular ligament had two divisions-anterior and posterior-in all cases. The average attachment of the posterior division was 1.6 mm distal to the posteromedial aspect of the tip of the fibular styloid process and the anterior division attached 2.8 mm distal to the anteromedial aspect of the tip of the fibular styloid process. CONCLUSIONS: These structures had a consistent attachment pattern. This information will prove useful in the study of anatomic repair and reconstruction of the posterolateral structures of the knee.

Aged↗
PubMedDate not supplied

The functional relationship of the posterior oblique ligament to the medial collateral ligament of the human knee.

Strain in the human knee medial collateral ligament (MCL) was measured in cadavers with a Hall effect strain transducer during normal passive knee flexion, as well as knee flexion accompanied by applied external tibial rotation and valgus torques. In an attempt to determine the contribution of the posterior oblique ligament (POL) to the strain behavior of the MCL, the POL was systematically separated from the MCL and changes in strain in the MCL were observed. These changes in strain were mild and variable, except in the one knee which was later found to be lacking an anterior cruciate ligament. In that particular knee, strain in the MCL increased up to 9.97% under the influence of a valgus torque once the POL fibers had been separated from the MCL. Anatomical dissection and transillumination techniques of the MCL/POL complex demonstrated definite ligament fibers connecting the MCL to the POL. The results demonstrate an intimate anatomical relationship between the POL and MCL. However, the POL and MCL appear to work independently from each other according to our test method.

Biomechanical Phenomena↗
PubMedDate not supplied

Healing of the patellar tendon autograft after posterior cruciate ligament reconstruction--a process of ligamentization? An experimental study in a sheep model.

Forty-eight skeletally mature sheep underwent posterior cruciate ligament reconstruction with free patellar tendon autografts in one knee; the contralateral knee served as a control. Immediate rehabilitation without immobilization followed. Autograft healing was evaluated by histologic, roentgenographic, and biomechanical techniques up to 2 years postoperatively. After implantation, the autograft tissue underwent necrosis and degeneration, followed by a gradual healing process comprising revascularization, cellular migration, and formation of an extracellular matrix. The autograft bone pegs were osseously incorporated by 6 weeks. After an initial loss of strength, the material properties of the operated knee recovered to only about one-third that of the control. Better alignment of the collagen fiber bundles resulted in increased material properties, up to approximately 50% of the control at 52 weeks. After 2 years, the autograft tissue was found to differ structurally and mechanically from a ligament, suggesting that the autograft may never approach normal ligament characteristics. Degenerative alterations, the wide-spread presence of type III collagen, and abnormal accumulations of glycosaminoglycans in the autograft correlated with a maximum stress of 60% and an elastic modulus of 70% of the control. Although ligamentization was not seen, the staging of autograft healing into different phases based on distinct morphologic manifestations (necrosis, revitalization, collagen formation, and remodeling) and correlating with changing mechanical properties may provide a rationale for rehabilitation protocols with a realistic evaluation of the loading capacity of the replacement tissue.

Animals↗
PubMedDate not supplied

High tibial osteotomy and ligament reconstruction in varus angulated, anterior cruciate ligament-deficient knees. A two- to seven-year follow-up study.

We assessed short-term treatment results of younger patients with varus malalignment and chronic anterior cruciate ligament deficiency. Forty-one patients (mean, 32 years; range, 16 to 47) underwent a high tibial osteotomy. Because of giving way symptoms, 14 also had a lateral iliotibial band extraarticular procedure at the time of the osteotomy and 16 had an intraarticular anterior cruciate ligament allograft reconstruction after the osteotomy. All returned for followup (mean, 58 months; range, 23 to 86), which included KT-1000 arthrometer testing and evaluation by our knee rating system. Statistically significant (P < 0.05) improvements were found in the mean overall rating scores for pain, swelling, and giving way. Preoperatively, 30 (73%) had pain with activities of daily living or with any sports activity; 11 (27%) could perform only light sports activities without pain. At followup, 32 patients (78%) had no pain with activities of daily living or light sports. Ten of 15 patients with advanced medial tibiofemoral arthrosis (subchondral bone exposure) had significant improvements in symptoms. Patient satisfaction was high: 88% stated they would undergo the procedure again and 78% felt their knee condition was improved. Patients who had the allograft reconstruction had significantly lower (P < 0.05) anterior-posterior displacements at followup than those who had the extraarticular procedure. We concluded that osteotomy should be performed early in the disease process for younger athletes who experience symptoms with activity. It may be unrealistic, however, to expect continuation of sports beyond light recreational, given the joint arthrosis that is usually present and the high in vivo joint loadings with athletes. Anterior cruciate ligament reconstruction should be considered when giving way previously occurred and the patient plans to resume athletics. However, patients with advanced arthrosis can avoid anterior cruciate ligament surgery by reducing athletic activities.

Adolescent↗
PubMedDate not supplied

The ligament augmentation device in hamstring grafts for reconstruction of the anterior cruciate ligament.

Twenty-eight patients who had reconstructions of the anterior cruciate ligament with a ligament augmentation device in the semitendinosus and gracilis tendons were compared with 32 patients who had reconstructions with semitendinosus and gracilis tendons alone. Preoperatively, there was no significant difference between the 2 groups with respect to age, sex, Tegner activity level, and time from injury to operation. Mean postoperative followup was 31.4 months for the augmentation group and 32.3 months for the nonaugmentation group. At postoperative evaluation, there was no difference in the 2 groups with respect to Lysholm knee scores, return to activity as measured by Tegner levels, KT-1000 arthrometer laxity testing, presence of pivot shift or Lachman sign, range of motion, and the patient's subjective overall rating of the surgery. Twenty-six of the 28 patients (93%) with augmentation rated their results as either "good" or "excellent" compared with 30 of the 32 patients (94%) with no ligament augmentation who rated their results as good or excellent. Four patients with the ligament augmentation devices needed reoperation for recurrent effusions and pain. No patients in the nonaugmentation group had recurrent effusions.

Adult↗