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At least 235 records · Page 13Linked to original sources
PubMed2003

Comparative study of the covered area of Leeds-Keio (LK) artificial ligament and radio frequency generated glow discharge treated Leeds-Keio (Bio-LK) ligament with synovial cells.

The Leeds-Keio artificial ligament (LK), which was developed not only as a ligament substitute but also as a scaffold for tissue induction in knee ligament reconstruction, has been in clinical use since 1982 in Europe and Japan. Recently, we have developed radio frequency generated glow discharge (RFGD)-treated LK ligament (Bio-LK) to expedite the process of tissue induction and its maturation. In this study of cell adhesion to the scaffold, we report the difference in the covered area with synovial cells when using scaffolds made from treated and untreated materials. Plasma clot methods were used in this study. The covered area on LK and Bio-LK by cells was stained by 0.1% toluidine blue and analyzed using NIH image. The covered area of Bio-LK was about three times higher than that of LK (untreated) at 3 weeks. In scanning electron microscopy, more cells were observed on fibers of Bio-LK, and these filled the space among the fibers more extensively. The spreading of covered area means that cell attachment, cell proliferation, and cell migration on the fibers are likely to be improved. Our experimental study indicates that Bio-LK will possibly speed up the process of induction of autogenous tissue from synovium.

Cell Culture Techniques↗
PubMed1976

Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments.

Based on the clinical and operative findings in sixty-eight knees with acute tears of the medial compartment and cruciate ligaments, a standardized terminology and classification of knee ligament instability is presented. With an intact posterior cruciate ligament, anteromedial, anterolateral, or posterolateral rotatory instability may occur, but not true posteromedial rotatory instability. With the posterior cruciate ligament ruptured, straight anterior, posterior, medial, or lateral instability may be found.

Humans↗
PubMed1992

Semitendinosus Kennedy ligament augmentation device anterior cruciate ligament reconstruction.

This is a prospective study of 78 chronic unilateral isolated anterior cruciate ligament (ACL) patients who were treated with an arthroscopically-assisted reconstruction technique using the semitendinosus tendon, occasionally associated with the gracilis, augmented with the Kennedy-ligament augmentation device (LAD). There was a minimum two-year follow-up period (mean, 34.3 months; range, 24-50 months). Ligamentous surgery was always restricted to the ACL intraarticular reconstruction. Preoperative, intraoperative, and postoperative examinations at three, six, 12, 18, and 24 months, and every year thereafter, including subjective and objective evaluation with KT 1000 arthrometer laxity measurements, were completed. Two-year examination data were available on 77 (98.7%) of the 78 patients compared with preoperative data. The pivot shift (side-to-side difference) improved from 49.3% with Grade 0-1 to 92.2% with Grade 0-1. KT 1000 20-pound anterior drawer (greater than 5 mm side-to-side difference) improved from 49.3% (mean, 6 mm) to 91.1% (mean, 0.55 mm). KT 1000 maximum manual anterior drawer (greater than 5 mm side-to-side difference) improved from 21.9% (mean, 7.8 mm) to 97.4% (mean, 0.55 mm). After ACL reconstruction, 89.6% of patients had a full range of motion and only 10.3% had flexion contractures of less than 5 degrees; 5.2% of patients had mild effusion. Functional Lysholm knee scoring of 100 points improved from 7.7% scoring over 85 points preoperatively (mean, 66.5) to 92.1% postoperatively (mean, 95.6). Instability was controlled in 89.4% of the patients, and 71.4% have been involved in sports after injury. Anterior cruciate ligament reconstruction reduces pathologic laxity, improves lower-leg function, and minimizes flexion contracture and effusion.

Adolescent↗
PubMed1989

[Clinical study on anterior cruciate ligament reconstruction with the scaffold type artificial ligament (Leeds-Keio)].

Over 400 cruciate ligaments were reconstructed with the newly developed scaffold type Leeds-Keio artificial ligament made of polyester. In this survey, 146 ACL cases with over 36 months postoperative history were clinically and in some cases arthroscopically and histologically reviewed. In the first series of 80 cases, ACL was reconstructed intra-articularly alone, and in the second series of 66, extra-articular lateral stabilization was added to the intra-articular procedure. In the first series, the Lachman test was improved in 88%, anterior drawer sign in 80% and jerk test in 75%. In the second, these were improved to a much greater degree, so that the corresponding figures were 95%, 86% and in 91% respectively. There were no complications such as joint effusion, chronic synovitis and infection. Revision due to implant rupture was done in 8 cases. Postoperative arthroscopy showed coverage of the implant by new tissue and development into a biologically sound ligament by 12 months postoperatively. Histological examination of the biopsy specimen obtained in arthroscopy showed abundant collagenous fibres running longitudinally. These results indicate that the Leeds-Keio artificial ligament yields satisfactory clinical results.

Adolescent↗
PubMed1987

Fractures of the distal part of the fibula with associated disruption of the deltoid ligament. Treatment without repair of the deltoid ligament.

The results in twenty-four patients who were treated for a distal fibular fracture and disruption of the deltoid ligament were studied, using subjective, objective, and radiographic criteria, over a period of at least two years. Nineteen (90 per cent) of the twenty-one patients who were treated without repair of the deltoid ligament had a good or excellent result. All but two of these patients were unrestricted in the ability to walk and run and had no pain during the activities of daily living. No patient had instability of the ankle. At follow-up, the range of motion of the ankle was within 15 degrees of that of the uninjured ankle in 90 per cent of the patients. Only one ankle had radiographic evidence of narrowing of the joint space. The three patients in whom the deltoid ligament was repaired did not have as good a result as the twenty-one patients in whom it was not, but this group was too small to permit valid comparisons. We concluded that exploration of the medial side of the ankle and repair of the deltoid ligament are not necessary unless reduction of the lateral malleolus fails to reduce the talus within the ankle mortise.

Activities of Daily Living↗
PubMed1986

[Assessing the strength of the anterior cruciate ligaments and transplants from the central third of the patellar ligament].

Tensile strength and elongation tests were applied to bone-ligament-bone specimens of anterior cruciate ligaments and grafts from the central third of patellar tendons of 16 autopsy knee joints. A comparison of all strength values thus recorded has revealed that a graft from the central third of the patellar tendon is a fully effective substitute for anterior cruciate ligaments. No significant difference was found to exist between both variants with regard to percentual elongation and stiffness. Tensile strength of patellar tendon grafts was higher by almost one third as compared to tensile strength recorded from anterior cruciate ligaments.

Adult↗
PubMed1983

[Carbon fiber ligament replacement in the treatment of chronic instability of the external ankle joint ligament].

Ligament repair should be considered when a patient has disabling pain with giving way and chronic instability of the ankle from old ruptures of the lateral ligaments. Because of some incontestable disadvantages using Watson-Jones-or similar techniques we prefer the alloplastic with carbon fibres to reconstruct the anterior talofibular and calcaneofibular ligaments. Imitating the physiological course and insertions of the ligaments we managed to achieve a permanent lateral stability in 51 cases out of an operated group of 54 patients.

Ankle Injuries↗
PubMed1982

Anterior cruciate ligament reconstruction using one-third of the patellar ligament, augmented by extra-articular tendon transfers.

Eighty patients with persistent clinical and functional instability of the knee due to anterior cruciate ligament insufficiency underwent the operation reported, in which one-third of the patellar ligament substitutes for the cruciate ligament and extraarticular tendon transfers, medial and lateral, augment the substitution. The patients were followed for a minimum of two years, and fifty returned for personal evaluation. The average follow-up was thirty-three months, with a range of two to five years. There were thirty-five male and fifteen female patients. The average age was twenty-three years. The average interval from initial injury to the index operation was two years. Meniscal tears and articular changes were noted in most of the patients. Forty-three (86 per cent) of the fifty patients had at least one torn meniscus, twenty-seven patients (54 per cent) had significant degenerative articular changes, and fourteen (28 per cent) had patellar articular changes. In the procedure described, eccentric placement of the tibial and femoral tunnels for more accurate placement of the patellar ligament substitute is essential. The over-all results were graded as excellent in thirty knees, good in seventeen, fair in one, and a failure in two. One knee that was classified as a failure showed excellent stability, but the patient had significant pain from chondromalacia of the patella, while significant pain and hyperesthesia from a neuroma was the reason for failure in the second patient.

Adolescent↗
PubMed1982

A computerized study of knee-ligament injuries: repair versus removal of the torn anterior cruciate ligament.

A retrospective review of 202 patients with acute injury to knee ligaments was carried out by chart review, scored questionnaire and scored physical examination. Of 62 patients with complete midsubstance injury to the anterior cruciate ligament, repair was attempted in 46, while 16 had complete excision of the ligament without replacement or augmentation. Computer analysis revealed that these groups were similar with respect to mean age of the patients, sex distribution, incidence of meniscectomy and distribution of associated injuries. At 4-year follow-up, there was no advantage of primary repair over excision for these injuries. In fact, repair seemed to be subjectively and objectively worse than excision, being associated with increased pain and decreased range of motion. The high rate of signs and symptoms of deterioration in both groups suggests a need for better alternatives in the acute phase of anterior cruciate ligament injury.

Adolescent↗
PubMed1996

Normal and healing ligament vascularity: a quantitative histological assessment in the adult rabbit medial collateral ligament.

Normal and healing adult rabbit medial collateral ligaments (MCL) have been assessed for microvascular anatomy using a quantitative image analysis methodology. MCL preparation by ink-gelatin perfusion enabled acceptable visualisation of microvascular channels within the tissue. Fifteen adult rabbits were studied; 3 normal rabbits formed an external time-zero control group; 12 animals received a standardised gap injury to the right MCL. The ligament injury was permitted to heal for 3, 6, 17 or 40 wk (3 animals in each healing group). Results confirmed that the normal MCL is hypovascular (about 1.46% vascularity by area) and that microvascular channels are highly organised and oriented longitudinally deep within the tissue. Healing MCL scar becomes twice as vascular as normal ligament early on, but returns to near normal values by 40 wk. Microvascular channels appear less organised in scar than in contralateral controls, but remodel with time. The directional scatter and spatial extent of ligament microvascular channels is quantifiable in normal and healing tissues.

Animals↗
PubMedDate not supplied

Effect of joint position and ligament tension on the MR signal intensity of the cruciate ligaments of the knee.

Six cadaveric lower extremities were imaged with T1-weighted spin-echo pulse sequences with the knees extended and flexed to 90 degrees. Magnetic resonance signal intensities of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) were compared. Changing from extension to flexion resulted in decreased signal intensity in six of six ACLs and five of six PCLs. Two of the knees were then imaged with and without tension applied to the ACL. Both specimens showed a decrease in signal intensity with tension, followed by an increase in signal intensity with release of the tension. Finally, in three of the limbs the ACL was surgically reconstructed and then imaged with and without tension applied to the tendon graft. Signal intensity decreased with tension and increased with release of the tension in all three specimens. Thus, joint position and changes in ligament tension affect the signal intensity of the ACL and PCL, generally resulting in a signal intensity decrease with tension.

Aged↗
PubMed1998

[Morbidity after contralateral transplantation of the patellar ligament for cruciate ligament replacement].

After cruciate ligament reconstruction using an autogenous central bone-patellar tendon-bone graft persistent complaints are described in the literature. There is the difficulty to distinguish the morbidity associated with the graft harvest and the morbidity caused by the injury and the reconstruction procedure. In order to clarify the morbidity resulting from the graft harvest alone, we evaluated those patients who had transplantat harvest from the opposite knee. Between 1990 and 1995 a central bone-tendon-bone graft has been taken from the contralateral uninjured knee in 37 patients, in 22 cases for anterior and in 15 cases for posterior cruciate ligament reconstruction. 27 patients were clinically (IKDC Score), isokinetically and radiologically followed up in an average of 25.3 months after the operation (range: 9-73 months). 21 patients were classified into IKDC group A. Except of one patient with an extension deficit of 5 degrees all others showed normal range of motion. Only 5 of 27 patients expressed minimal knee pain during vigorous activities. Three of them reported about weather sensitivity in addition. These 6 patients were ranked in group B. No patient was classified into IKDC group C or D. The isokinetic examination showed a normal level of quadriceps strength. At final followup, the technique of Blackburne and Peel was used to assess patellar height. There was no radiographic evidence of patella contracture or baja. According to our results taking the autogenous CBTB graft used for cruciate ligament reconstruction leads to no serious morbidity.

Adult↗
PubMed2002

[Axis deviation, cartilage damage and cruciate ligament rupture--concomitant interventions in replacement of the anterior cruciate ligament].

BACKGROUND: Osteochondral lesions and osteoarthritis in young patients are often caused by chronic knee instability and varus malalignment. We present the indications, operative technique, and results for the combined operation of high tibial osteotomy and cruciate ligament reconstruction. MATERIALS AND METHODS: From April 1996 until December 2000, 58 patients (average age: 33 years) underwent simultaneous osteotomy (57 correcting valgus, 1 valgus malalignment) and cruciate ligament reconstruction (49 ACL, 7 PCL, 2 ACL & PCL) which was routinely performed with an arthroscopic technique after completion of the osteotomy (closed wedge technique). Average correction angle of the osteotomy was 7 degrees (4-10 degrees) with a mean malalignment of 5 degrees (0-10 degrees). Thirteen patients underwent additional cartilage surgery (osteochondral autograft transplantation, autologous chondrocyte transplantation, microfracturing), and two patients were implanted with a collagen meniscus (CMI) at the same time. RESULTS: Preoperatively the Lysholm score was 66 (35-81) points and increased to 81 (74-95), 87 (79-99), and 93 (88-99) points 3, 6, and 12 months after surgery, respectively. Subjectively all patients reported an improvement of preoperative swelling, pain, and instability. Additional cartilage surgery or meniscus implantation did not significantly alter the clinical score values. Complications were noted in four patients. CONCLUSIONS: Unstable knees with varus malalignment can be sufficiently treated by osteotomy and cruciate ligament reconstruction at the same time, suggesting that unicompartimental decompression and treatment of instability is a causal and cost-effective therapy delaying the progression of osteoarthritis and minimizing clinical symptoms. Performing both operations in one procedure facilitates early rehabilitation and the return of these patients to the activities of daily living and sports.

Adult↗
PubMed2002

Lateral thrust of anterior cruciate ligament-insufficient knees and posterior cruciate ligament-insufficient knees.

Leaving anterior cruciate ligament (ACL) insufficiency and posterior cruciate ligament (PCL) insufficiency untreated frequently leads to osteoarthritis (OA). The purpose of this study was to evaluate dynamically the lateral thrust of ACL-insufficient knees and PCL-insufficient knees, and from the findings investigate the relationship between cruciate ligament insufficiency and OA occurrence. An acceleration sensor was attached to the affected and control anterior tibial tubercles, acting in medial-lateral and perpendicular directions. The lateral thrust immediately after heel strike was measured continuously by a telemeter under stabilised walking conditions. When compared to the contralateral healthy knee, the peak value of lateral acceleration immediately after heel strike was significantly larger in the ACL-insufficient knee; and lateral thrust was increased, but not significantly, in the PCL-insufficient knee. Given that lateral thrust of the knee during walking increases due to ACL or PCL injury, it may be a principal contributor to OA progression.

Adolescent↗
PubMed2006

One-stage posterior cruciate ligament inlay reconstruction combining anterior cruciate ligament reconstruction following knee dislocation.

Knee dislocation is a rare but severe injury that involves damage to the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), lateral or medial ligamentous structures, and other soft tissues or bony structures surrounding the knee joint. No consensus exists regarding the best treatment method. This work presents a method of 1-stage ACL and PCL reconstruction in which a contralateral quadriceps tendon-bone autograft with tibial inlay technique is used for the PCL and contralateral hamstring tendon autograft with suspension fixation is used for the ACL. After harvesting grafts, the patient is put in the lateral decubitus position. Under arthroscopy, the femoral tunnel for the anterolateral bundle of the PCL is created using an 8-mm reamer via a prepositioned guide pin. Next, the tibial tunnel of the ACL is created with an appropriate diameter cannulated reamer. Directed by the femoral guide instrument with a 7-mm offset, a guide pin is positioned retrograde through the tibial tunnel. A reamer is then used to create a 35-mm long closed-ended femoral tunnel for the ACL. A posterior arthrotomy for the PCL inlay technique is performed. After capsulotomy, a unicortical window is created at the footprint of the PCL and the inlay graft is fixed using a 3.5mm-cancellous screw and washer. The PCL graft is then passed into the femoral tunnel. The ACL graft is passed in a retrograde fashion using the Beath pin. The ACL graft is fixed by tying with a washer on the femoral side and by tying with a screw on the tibial side. The PCL graft is then fixed on the femoral side.

Anterior Cruciate Ligament↗
PubMed1995

Indirect forces and patella fracture after anterior cruciate ligament reconstruction with the patellar ligament. Case report.

Patella fracture is either an infrequent or underreported complication after anterior cruciate ligament (ACL) reconstruction using a portion of the patellar ligament. Patella fracture pattern has been related to the mechanism of injury. Direct fractures resulting from impaction forces delivered to the patella are typically stellate or comminuted. Indirect fractures resulting from tensile stresses applied across the extensor mechanism typically are displaced transverse disruptions. After ACL reconstruction using a portion of the patellar ligament, Y-shaped stellate fractures can occur. Fracture pattern seems related to the time elapsed since the harvest; stellate fractures occur following stumbles or slips without direct injury early in the postoperative period while transverse fractures occur late. This article describes two cases of patella stellate fractures that occurred in patients who underwent ACL reconstruction using patellar graft.

Adult↗
PubMed1996

[Injuries of the medial collateral ligament and anterior cruciate ligament of the knee joint and Lemaire surgical functional treatment. Long-term outcome].

The present paper reports the results of 112 extraarticular ligamento-plasties performed on the knee with the procedure proposed by Lemaire. The series includes isolated tears of the anterior cruciate and medical collateral ligament as well as combined tears of both ligaments. The clinical and radiological results with a mean follow-up time of 11.5 years are compared with the results obtained in a first assessment 8 years ago. Good clinical results are in contrast with increasing osteoarthrosis in 1/3 of the knees radiologically assessed. The operation for a torn anterior cruciate ligament should be performed as soon as possible to avoid secondary meniscal lesions with subsequent severe osteoarthrosis. Presence or absence of arthrotic signs in the X-rays mainly determine the long-term result after ligamento-plasties of the knee. The Lemaire plasties are well tolerated even by elderly still active people and need little postoperative care.

Adult↗