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At least 307 records · Page 17Linked to original sources
PubMed1986

[Alloplastic treatment of knee ligaments. Experience using artificial support in fresh injuries of the inner ligament].

From November 1983 to July 1985 a plastic reinforcement of the collateral medial ligament was performed in 14 patients. In all cases there was an additional reconstruction of the anterior cruciate ligament and a partial resection respectively refixation of the medial meniscus. In order to confirm the collateral ligament alloplastically in 6 cases a non-resorbable plastic connection (Gore-Tex patch), in 8 cases a resorbable plastic connection (PDS) was used. All the patients could be clinically reinvestigated on an average of 13 months after the operation. The results are presented.

Athletic Injuries↗
PubMed1985

Normal ligament properties and ligament healing.

There is still a long way to go to achieve the goals of ligament replacement through modification of normal, intrinsic ligament healing processes. We are learning about the biology of ligamentous tissues, including the problem of regeneration, and that in itself is an all-important first step toward seeking solutions.

Biomechanical Phenomena↗
PubMed1984

Intra-articular reconstruction of the anterior cruciate ligament. An experimental study of length changes in different ligament reconstructions.

An anatomic model was developed to test different types of intra-articular anterior cruciate ligament reconstructions. Four cadaver knees were tested in an identical fashion. In each knee 12 different positions were tested. The results indicate that over-the-top repair is not suitable for anterior cruciate ligament reconstruction from a mechanical standpoint. It is likely that this type of repair in human knees will lead to excessive stretching and insufficiency of the reconstructed tissue. A posterior approach through the lateral femoral condyle is more desirable. The position of the tibial tunnel is less crucial, but a more anterior tunnel is preferable. When the tunnels are properly drilled, fixation of the reconstructed ligament is advocated with the knee in 45 degrees-90 degrees of flexion. Postoperative immobilization in 45 degrees of flexion is suggested.

Adult↗
PubMed1980

[Importance of damage to the medial fascia of the external lateral ligament (radial collateral ligament) in the mechanisms of luxations of the elbow. Study on the cadaver (author's transl)].

A study of 18 elbows in the cadaver allowed the medial fascia of the radial collateral ligament of the articular capsule to be clearly separated. Section of this ligament associated with that of the anterior fascia, without section of the ulnar collateral ligament always produces luxation of the elbow if it is in flexion. The integrity of the insertion surface of the epicondyles does not stop this luxation. This therefore confirms the arthrographic and operative observations recently published.

Cadaver↗
PubMed1994

Reconstruction of the posterior cruciate ligament with autograft hamstring tendons and the Kennedy ligament augmentation device.

In the 1970s, J. C. Kennedy reported on the use of synthetic augmentation in combination with hamstring tendons in anterior cruciate ligament reconstruction. This article explores the surgical approach, technique, and rationale for reconstruction of the posterior cruciate ligament-deficient knee using autograft hamstring and the Kennedy ligament augmentation device.

Arthroscopy↗
PubMed1992

Fractures associated with patellar ligament grafts in cruciate ligament surgery.

We reviewed retrospectively 490 patellar ligament reconstructions for cruciate ligament injuries performed from 1980 to 1990. There were six cases of patellar splitting and three displaced patellar fractures in donor knees. The fissure fractures all occurred during the removal of the patellar bone block. The displaced fractures were sustained during early rehabilitation, and in two of the three patients, involved the normal contralateral knee. The major reasons for this complication were imprecise saw cuts, spreading osteotomies, and the use of a too large patellar bone block. When a trapezoidal bone block is used to self-lock in the femoral tunnel, this should preferably be taken from the tibia. Special care is needed in rehabilitation when the graft has been taken from the contralateral knee.

Adult↗
PubMed2000

Abnormal bone scans of the tibial tunnel 2 years after patella ligament anterior cruciate ligament reconstruction: correlation with tunnel enlargement and tibial graft length.

Tibial bone tunnels were examined with bone scans 2 years after patella ligament ACL reconstruction in 68 patients. At 2 years, scan uptake at the tibial tunnel was increased in 29% of patients. Marked increase of scintigraphic uptake was associated with tibial tunnel enlargement of more than 35% and a graft length in the tibial tunnel over 14 mm. Scan uptake was correlated to tunnel enlargement (r = 0.64, P < 0.01) and tunnel enlargement was correlated to graft length inside the tibial tunnel (r = 0.59 P < 0.001). No correlation was found between scan uptake or tunnel enlargement and anterior laxity, sagittal tunnel position and subjective outcome. Scintigraphy indicates the enlarged tibial tunnels are filled with remodelling bone. Tibial fixation location influences ligament healing inside the tunnel: Return of osseous homeostasis at the tibial tunnel can take more than 2 years when fixation is more than 14 mm below the joint.

Adolescent↗
PubMed1998

Value of posterior cruciate ligament index in the diagnosis of anterior cruciate ligament injuries.

Assessment of the diagnostic value of the posterior cruciate ligament index (PCL index) for injuries of the anterior cruciate ligament (ACL) was done. Magnetic resonance imaging (MRI) and knee joint arthroscopy of 170 patients were evaluated. The shortest distance between the femoral and tibial attachment of PCL (x) and the distance from that line to the tip of the arc marked by the PCL (y) on the sagittal plane images were measured. The quotient of these two parameters (x/y) defined the PCL index. In 100 patients, for whom arthroscopy ruled out ACL injury, the mean PCL index was 5.01 +/- 0.76. In 30 patients in whom arthroscopy showed total ACL rupture, the mean PCL index was 2.88 +/- 0.74, and in 10 patients with ACL partial rupture, 3.09 +/- 0.23. The conclusion is that injury to the ACL changes the PCL index markedly. In diagnostically unreliable MR images, deterioration of the PCL index could help in the diagnosis of ACL injury.

Adolescent↗
PubMed1999

Combined injuries of the medial collateral ligament and the anterior cruciate ligament. Early ACL reconstruction versus late ACL reconstruction.

Aim of this retrospective study is to evaluate the effect of acute and late anterior cruciate ligament (ACL) reconstruction in patients with a combined injury of the ACL and the medial collateral ligament (MCL). All MCL injuries were treated non-operatively. In 27 patients (group I) we performed early ACL reconstruction (within the first 3 weeks after injury). The postoperative rehabilitation protocol included brace treatment for all patients over a period of 6 weeks. In 37 patients we performed late ACL reconstruction (after a minimum of 10 weeks). In this group initial non-operative MCL treatment (6 weeks brace treatment) was followed by a period of accelerated rehabilitation. Patients with late ACL reconstruction had a lower rate of loss of motion after finishing the postoperative rehabilitation programme and a lower rate of re-arthroscopies for a loss of extension (group I: 4 patients, group II: 1 patient). The difference in the mean quadriceps muscle strength (group I: 83.3%, group II: 86.3%) was not statistically significant. After a mean interval of 22 months, we saw no difference in the frequency of anterior or medial instabilities or in the loss of motion. The Lysholm score was significantly better in the group with late ACL reconstruction (group I: 85.3, group II: 89.9). The position on the Tegner activity scale decreased in both groups, to 5.5 in group I (preoperatively: 6.0) and to 5.6 in group II (preoperatively: 5.9). With regard to the lower rate of motion complications in the early postoperative period, the lower rate of re-arthroscopies, and the significantly better results in the Lysholm score, we prefer late ACL reconstruction in the treatment of combined injuries of the ACL and the MCL.

Adolescent↗
PubMed2005

The arthroscopic appearance of a normal anterior cruciate ligament in a posterior cruciate ligament-deficient knee: the posterolateral bundle (PLB) sign.

Partial anterior cruciate ligament (ACL) tears that result in functional instability are usually the result of a deficiency of the anteromedial bundle (AMB), and are evident arthroscopically by a prominent posterolateral bundle (PLB). As double-bundle ACL reconstructions are being suggested to recreate a more normal anatomy, the roles of each bundle are being more critically questioned. We present a case that describes the appearance of a normal ACL in a posterior cruciate ligament (PCL)-deficient knee in which the PLB of the ACL is prominent, giving the appearance of a complete tear of the AMB of the ACL, and scarring of this bundle to the PCL stump. On further inspection, and when the tibia was reduced, the normal appearance of the ACL returned, with visualization of the AMB obscuring the PLB. We have named this arthroscopic finding the "PLB sign." This finding confirms the individual roles of each bundle of the ACL. It is important to not misinterpret this abnormal appearance of the ACL as a partial ACL tear in a PCL-deficient knee.

Accidents, Traffic↗
PubMed2003

The healing medial collateral ligament following a combined anterior cruciate and medial collateral ligament injury--a biomechanical study in a goat model.

The ideal treatment of a combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injury to the knee is still debated. In particular, the question of whether reconstruction of the ACL can provide the knee with sufficient multidirectional stability to allow for effective MCL healing needs to be better elucidated. Therefore, the first objective of this study was to quantify the changes in the function of goat knees between time-zero and 6 weeks following a combined ACL/MCL injury treated with ACL reconstruction. Using a robotic/universal force-moment sensor testing system, the kinematics of the knee and in situ forces in the ACL/ACL graft as well as in the sham-operated and healing MCL were evaluated in response to (1) a 67 N anterior-posterior (A-P) tibial load and (2) a 5 Nm varus-valgus (V-V) moment. The second objective was to evaluate the structural properties of the healing femur-MCL-tibia complex (FMTC) and the mechanical properties of the healing MCL at 6 weeks under uniaxial tension. In response to the 67 N A-P tibial load, the A-P translations for the experimental knee increased by as much as 4.5 times from time-zero to 6 weeks (p<0.05). Correspondingly, the in situ forces in the ACL graft decreased by as much as 45% (p<0.05). There was no measurable changes of the in situ force in the healing MCL. In response to a 5 Nm V-V moment, V-V rotations were twice as much as controls, but similar for both time periods. From time-zero to 6 weeks, the in situ forces in the ACL graft dropped by over 71% (p<0.05), while the in situ force in the healing MCL was as much as 35+/-19 N. In terms of the structural properties of the healing FMTC, the stiffness and ultimate load values at 6 weeks reached 53% and 29% of sham-operated contralateral controls, respectively (p<0.05). For the mechanical properties of the healing MCL substance, the values for tangent modulus and tensile strength were only 13% and 10% of sham-operated controls, respectively (p<0.05). These results suggest that the ACL graft stabilized the knee initially, but became loose over time. As a result, the healing MCL may have been required to take on excessive loads and was unable to heal sufficiently as compared to an isolated MCL injury.

Animals↗
PubMed2002

Consequences of a ligament injury on neuromuscular function and relevance to rehabilitation - using the anterior cruciate ligament-injured knee as model.

The purpose of this article is to survey current knowledge concerning the consequences of a ligament injury on neuromuscular function and its relevance to rehabilitation, in relation to clinical practice. Although it deals with the ACL-injured knee, these views may also apply to other joints. The effects of a ligament injury on neuromuscular function are first considered - i.e., proprioception, postural control, muscle strength, functional performance, movement and activation pattern, central mechanisms, motor control and learning. The treatment and effects of rehabilitation on neuromuscular function are then discussed. The survey is concluded by discussing the clinical significance.

Anterior Cruciate Ligament↗
PubMed2003

A review of ski injuries resulting in combined injury to the anterior cruciate ligament and medial collateral ligaments.

Alpine skiing is a global winter recreational sport with 15 million participants in the United States alone, and an overall injury rate of 2.5 per 1,000 ski person-days. Isolated injury to the anterior cruciate ligament (ACL) or the medial collateral ligament (MCL) is common among ski injuries; however, combined injury to these structures is rare. Controversy in the management of ACL instability following alpine ski injury is diminishing with improvements in the techniques of intra-articular cruciate reconstruction. However, the management of the combined ACL-MCL injury remains something of an enigma. Evidence exists to support both surgical and nonsurgical management strategies for the medial structures, but little consensus exists for the timing of the repair. This paper highlights the mechanisms of ski injuries that can result in combined injury to the ACL and MCL. The anatomy and biomechanics of the medial complex as it relates both to stability and operative repair are reviewed, and literature on the techniques and indications used for MCL repair in the setting of a combined injury is presented. On the basis of this review, we believe that an injury to the MCL does not need to be repaired if the ACL is reconstructed after a combined injury.

Anterior Cruciate Ligament↗
PubMedDate not supplied

Combined anterior cruciate ligament and medial collateral ligament injuries in adolescents.

Although literature supports bracing of most medial collateral ligament (MCL) injuries followed by arthroscopic repair of anterior cruciate ligament (ACL) tears in adults with combined ACL-MCL injuries, little is published regarding the treatment of these injuries in the pediatric population. The purpose of this study was to present our outcomes after treatment of combined ACL-MCL injuries in a series of adolescents. All 180 patients who underwent ACL reconstruction at our children's hospital from January 1997 to January 2003 were reviewed to identify those patients with concomitant grade II or III MCL injuries. Clinical data were obtained from chart review. All patients were treated with a hinged brace for their MCL injury followed by delayed arthroscopic reconstruction of their ACL using a transphyseal technique with Achilles tendon soft tissue allograft. Patients were contacted by phone to complete Lysholm knee questionnaires and assess return to athletic competition. Data were compared with a control cohort of patients who underwent isolated ACL reconstruction using the same technique. Twelve (6.7%) of 180 patients had combined ACL-MCL injuries. There were 6 boys and 6 girls; the mean age was 15.6 years (range, 14-17 years). Follow-up averaged 5.3 years (range, 2.6-8.2 years), and no patients were lost to follow-up. At last examination, all patients had a stable knee on both Lachman and valgus stress tests; the mean Lysholm knee score was 96 (range, 94-100). All patients were able to return to their preinjury level of athletics. One patient required manipulation for arthrofibrosis. When compared with the control group of 19 isolated ACL reconstructions, there was no significant difference with regards to Lysholm scores or return to athletics. Bracing of grade 2 or 3 MCL injuries followed by ACL reconstruction was an effective means of treating combined ACL-MCL injuries in this small series of adolescent patients.

Achilles Tendon↗
PubMed1991

Ultrastructure of periprosthetic Dacron knee ligament tissue. Two cases of ruptured anterior cruciate ligament reconstruction.

Light- and electron-microscopic investigations were performed on two failed Dacron ligaments that had been removed from 2 patients shortly after failure of the implant 2-3 years after reconstruction of the anterior cruciate ligament. Two different cell populations and matrices were correlated with closeness to the Dacron threads. Fibroblasts surrounded by connective tissue with collagen fibrils were located far from the Dacron threads. Roundish cells, appearing to be myofibroblasts surrounded by a more lax connective tissue and elastic fibers, were found close to the Dacron threads. The presence of myofibroblasts and the matrix differentiation could be attributed to the different mechanical forces acting on the Dacron and on the connective tissue because of their different coefficients of elasticity. The sparse occurrence of inflammatory cells in the synovial membrane and in the connective tissue surrounding the Dacron supports the biologic inertness of this artificial material. However, the repair tissue was not structured to resist tension stresses.

Adult↗
PubMed1993

Prospective preoperative evaluation of anterior cruciate ligament instability of the knee joint and results of reconstruction with patellar ligament.

Of 54 patients with chronic (n = 49) or acute (n = 5) anterior cruciate ligament instability, 52 were evaluated after mean 16 months' follow-up interval after open (n = 18) or arthroscopic assisted (n = 36) bone-tendon-bone patellar ligament reconstruction. Preoperative Knee Signature System side-to-side difference in anterior displacement decreased from 7.9 mm to 3.5 min at follow-up evaluation (p < 0.0001). An objectively satisfactory limit of 5 mm in side-to-side difference was achieved in 73% of the patients. At follow-up evaluation, there was a positive pivot shift sign in eight knees (one definite and seven trace). Average Lysholm knee scores improved from 69 to 83. The only significant difference between the arthroscopic assisted and open groups was smaller side-to-side anterior displacement difference in the arthroscopic group (2.2 mm versus 4.8 mm, p = 0.002). Results suggest that more accurate and isometric placement of the graft is possible with the arthroscopic-assisted technique.

Adolescent↗
PubMed1997

Scarring of the anterior cruciate ligament to the posterior cruciate ligament does not decrease anterior translation.

Frequently, a patient undergoing anterior cruciate ligament (ACL) reconstruction 4 to 6 weeks following the acute injury will be noted to have decreased anterior translation during a Lachman and anterior drawer testing at the time of surgery compared with their examination at the time of their acute injury. Orthopedic surgeons frequently attribute this decreased anterior translation to scarring of the ACL to the posterior cruciate ligament (PCL). We undertook a cadaver study to evaluate this. Four cadaveric lower extremity specimens underwent a midline posterior approach to the knee followed by arthrotomy. The ACL then was cut from its origin on the lateral femoral condyle. Following its release, the ACL was sutured tightly to the PCL. Prior to dissection, the specimens underwent baseline KT-1000 knee arthrometer testing. Following the arthrotomy but prior to ACL release, the KT-1000 test was repeated. KT-1000 testing then was performed after ACL release and repeated after suturing the ACL to the PCL. The results revealed no change in KT-1000 testing following arthrotomy. Anterior translation increased an average of 5 mm following release of the ACL and after suturing to the PCL. No specimen showed a significant decrease in anterior translation following suturing of the ACL to the PCL. These results indicate that while decreased anterior translation from the time of injury to the time of reconstruction may occur, this cannot be explained based on scarring of the ACL stump to the PCL.

Anterior Cruciate Ligament↗