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PubMed1992

The cruciate ligaments of the knee: correlation between MR appearance and gross and histologic findings in cadaveric specimens.

OBJECTIVE: Using anatomic and histologic correlation, we investigated the reasons for differences in the MR signal intensity between the normal anterior and posterior cruciate ligaments and for the focally increased signal intensity within these ligaments occasionally found in elderly patients. MATERIALS AND METHODS: The MR images of 18 anterior and 20 posterior cruciate ligaments obtained from cadavers (age at death, 56-88 years old; mean, 74 years) were evaluated blindly. Their overall signal intensity and focal regions of increased signal were noted. The findings then were correlated with corresponding anatomic and histologic sections. RESULTS: The anterior cruciate ligament had greater signal intensity than did the posterior cruciate ligament in 15 of 18 knees and had comparable signal intensity in three knees. No histologic basis to explain the different MR appearances of the anterior and posterior cruciate ligaments was found. Rather, differences in macroscopic anatomy appeared to be the best explanation. In the posterior cruciate ligament, the fibers were parallel, whereas they were diverging and twisted in the anterior cruciate ligament, causing volume-averaging artifacts. A focal area of signal increase was found in 29 of the 38 ligaments. In 17 of these 29 ligaments, mucoid and/or eosinophilic degeneration was found that appeared to have caused the focal MR signal change. In nine ligaments without focally increased signal on the MR images, only one had histologic evidence of degeneration. The predictive value of an abnormal finding on MR was 59%, and the predictive value of a normal finding on MR was 89%. The relationship between increased signal on MR and histologic degeneration was statistically significant (chi 2 test, p = .0126). CONCLUSION: The differences in the MR appearances of the anterior and posterior cruciate ligaments probably are due to differences in gross architecture. Increased MR signal within the cruciate ligaments occurring in elderly patients often can be attributed to degenerative changes.

Aged↗
PubMed1996

[Synovial cyst of the cruciate ligament. Findings with magnetic resonance in 8 symptomatic cases].

Intraarticular ganglion cysts are uncommon findings: only 30 cases have been reported since the first paper by Caan in 1924 and they were all associated with cruciate ligaments. Many different cystic or pseudocystic lesions are found in articular knee conditions: the most common cystic lesions are popliteal cysts (Baker's cysts), followed by synovial pseudocysts of the posterior cruciate ligament, meniscal cysts and, finally, ganglion cysts of the cruciate ligaments. In our series of 1600 knee MR exams carried out in our MR department since June, 1994, we have found 8 ganglion cysts of the cruciate ligaments. MR studies are always performed on a dedicated 0.2-T permanent magnet (Artoscan, Esaote Biomedica, Genoa, Italy). Five patients were operated on with arthroscopy. The ganglion cysts affected the anterior cruciate ligaments in 4 cases and the posterior cruciate ligaments in 4 cases. The symptoms were mainly pain radiating to the medial side and worsening in forced flexion or extension. The diagnostic suspicion was meniscal tears in 4 patients, chondral lesions in 3 and a loose intraarticular body in one patient. The shape and structure of ganglion cysts in the cruciate ligaments are clearly depicted with MRI. The ganglion cysts in the anterior cruciate ligaments are usually spindle-shaped and within the ligament, while those in the posterior cruciate ligaments have a well-defined outline, with multilocular appearance, and they are usually localized along the ligament, most often on the dorsal aspect. MR signal studies show intermediate signal intensity on SE T1-weighted images and markedly increased signal intensity on SE T2-weighted images. These typical patterns may change depending on lesion content, for instance in the presence of hemoglobin due to an associated angioma. The origin of ganglion cysts in the cruciate ligaments is still unknown, even though many theories have been suggested, including a synovial herniation in ligament fibers, the ectopic inclusion of synovial tissue, a posttraumatic connectival degeneration and, finally, the proliferation of totipotent mesenchymal cells. From a histologic point of view, "synovial ganglion" is a much better definition than "synovial ganglion cyst", because the typical wall of real synovial cysts is missing. The MR patterns are typical of the morphological features described and of the presence of high protein fluid content.

Adult↗
PubMed1998

A retrospective review of the incidence and rehabilitation outcome of concomitant traumatic brain injury and ligamentous knee injury.

OBJECTIVES: To estimate the incidence of ligamentous knee injuries in patients with traumatic brain injury (TBI) involved in pedestrian versus motor vehicle collisions (PVMVC), to identify associated risk factors, and to compare rehabilitation outcomes and costs in TBI patients with and without ligamentous knee injury. DESIGN: Retrospective, case control. SETTING: An academic rehabilitation hospital with a large metropolitan referral base. PATIENTS: Twenty-three consecutive adolescent and adult subjects admitted for acute inpatient rehabilitation after a PVMVC from January 1, 1994, to January 1, 1996. RESULTS: Five subjects (22%) were found to have a ligamentous knee injury, one with bilateral injuries. Two of these six injuries were diagnosed only after presentation to the rehabilitation setting. The most common injury was an anterior cruciate ligament (ACL) disruption in 5 of 6 knees. A coupled ACL and medial collateral ligament injury was identified in 4 of 6 injured knees. The risk of ligamentous knee injury was most closely associated with the presence of a tibial plateau fracture (n=3) (chi2=12.420, p < .001). There was no statistical difference between groups with and without ligamentous knee injuries with respect to age, gender, inpatient acute or rehabilitation length of stay, admission, discharge, or change in motor Functional Independence Measure (FIM) interval measures, or rehabilitation costs. Four of the 5 patients with ligamentous knee injuries were successfully managed nonoperatively. A case illustrating longitudinal management is presented. CONCLUSIONS: TBI and ligamentous knee injuries, in particular ACL injuries, are common comorbidities after PVMVC. Physicians must maintain a high index of suspicion for ligamentous knee injuries in this population, particularly when a tibial plateau fracture is present. TBI patients with and without ligamentous knee injuries can have comparable functional outcomes when the ligament injuries are identified and appropriately managed, without incurring undue cost or length of inpatient rehabilitation.

Adolescent↗
PubMedDate not supplied

Comparative injury rates of uninjured, anterior cruciate ligament-deficient, and reconstructed knees in a skiing population.

To evaluate the risks of skiing after anterior cruciate ligament injury with or without reconstruction, we performed a 3-year study of 5646 skiers employed by a large ski resort. All skiers underwent knee ligament examinations before entering the study. The participants were divided into three groups based on whether they had never had an anterior cruciate ligament injury (N = 4748), were unilaterally deficient of the ligament (N = 138), or had undergone a unilateral reconstruction of the ligament at least 1 year before (N = 274). The rates of knee injuries requiring evaluation by a physician or time off work were calculated. The results of the reconstructed knees were further evaluated to determine whether ligament repair with semitendinosus/gracilis or patellar tendon autograft had a higher injury rate. Compared with knees with intact anterior cruciate ligaments, ligament-deficient knees had a 6.2-times higher rate of injuries, and knees in which the ligament had been reconstructed had a 3.1-times higher rate. The differences between each of the three groups were significant. Injuries to ligament-intact knees were less severe, with 13% requiring surgery, while 39% of the injuries in the ligament-deficient and 41% of the injuries in the reconstructed-ligament knees required surgery. The rates of injury for the graft types were not significantly different, but skiers with a semitendinosus/gracilis tendon autograft were significantly more likely to rupture their graft than skiers with a patellar tendon autograft.

Absenteeism↗
PubMed1998

MR imaging of knees having isolated and combined ligament injuries.

OBJECTIVE: Although clinical evaluation and MR imaging both accurately reveal injuries in knees with isolated ligament tears, physical examination becomes progressively less reliable when multiple lesions exist. We investigated the accuracy of MR imaging of knees having varying degrees and numbers of ligament injuries. SUBJECTS AND METHODS: We prospectively interpreted the MR images of 340 consecutive injured knees and compared these interpretations with the results of subsequent arthroscopy or open surgery, which served as the gold standard. Our interpretations of MR images focused on five soft-tissue supporting structures (the two cruciate ligaments, the two collateral ligaments, and the patellar tendon) and the two menisci. Patients were divided into three groups: no ligament injuries, single ligament injuries, and multiple ligament injuries. RESULTS: Using MR imaging, we found overall sensitivity and specificity for diagnosing ligament tears to be 94% and 99%, respectively, when no or one ligament was torn and 88% and 84%, respectively, when two or more supporting structures were torn. The difference in specificity was statistically significant (p < .0001). Sensitivity for diagnosing meniscal tears decreased as the number of injured structures increased, but the relationship achieved statistical significance (p = .001) only for the medial meniscus. For all categories of injury, MR imaging was more accurate than clinical evaluation, statistics for which were taken from the orthopedic literature. CONCLUSION: In knees with multiple ligament injuries, the diagnostic specificity of MR imaging for ligament tears decreases, as does the sensitivity for medial meniscal tears.

Adolescent↗
PubMed1984

The radioscapholunate ligament: a gross and histologic description.

The anatomic relationships of the carpal radioscapholunate ligament to its contiguous structures were analyzed by studying 1) 12 grossly dissected fresh adult wrists, and 2) multiple histologic sections from six adult wrists. Observations indicate that the radioscapholunate ligament originates from the prominence between the scaphoid and lunate articular facets on the distal articular surface of the radius, and from the palmar margin of the distal radius, deep and medial to the origin of the radiotriquetral and radiocapitate ligaments. The primary insertion of the radioscapholunate ligament is the medial margin of the proximal pole of the scaphoid. The ligament secondarily inserts into the lateral margin of the lunate and significantly contributes to the proximal portion of the scapholunate interosseous ligament. The radioscapholunate ligament is distinguished morphologically from the other palmar radiocarpal ligaments by its loosely organized collagen fibers and relatively high degree of vascularity. The radiotriquetral and radiocapitate ligaments are composed of densely fasciculated collagen fibers surrounded by perpendicularly oriented perifascicular and epiligamentous fibers. A fibrous capsular layer covers the most superficial aspect of each carpal ligament. On the deep surfaces of these ligaments, a condensation of epiligamentous fibers forms a synovial capsular layer. The palmar radiocarpal ligaments are truly intracapsular structures, as they are interposed between the fibrous and synovial capsular layers. No histologic evidence of elastin is present within the substance of these ligaments.

Aged↗
PubMed1998

In situ calibration of miniature sensors implanted into the anterior cruciate ligament part I: strain measurements.

The goals of this study were to (a) evaluate the differential variable reluctance transducer as an instrument for measuring tissue strain in the anteromedial band of the anterior cruciate ligament, (b) develop a series of calibration curves (for simple states of knee loading) from which resultant force in the ligament could be estimated from measured strain levels in the anteromedial band of the ligament, and (c) study the effects of knee flexion angle and mode of applied loading on output from the transducer. Thirteen fresh-frozen cadaveric knee specimens underwent mechanical isolation of a bone cap containing the tibial insertion of the anterior cruciate ligament and attachment of a load cell to measure resultant force in the ligament. The transducer (with barbed prongs) was inserted into the anteromedial band of the anterior cruciate ligament to record local elongation of the instrumented fibers as resultant force was generated in the ligament. A series of calibration curves (anteromedial bundle strain versus resultant force in the anterior cruciate ligament) were determined at selected knee flexion angles as external loads were applied to the knee. During passive knee extension, strain readings did not always follow the pattern of resultant force in the ligament; erratic strain readings were often measured beyond 20 degrees of flexion, where the anteromedial band was slack. For anterior tibial loading, the anteromedial band was a more active contributor to resultant ligament force beyond 45 degrees of flexion and was less active near full extension; mean resultant forces in the range of 150-200 N produced strain levels on the order of 3-4%. The anteromedial band was also active during application of internal tibial torque; mean resultant forces on the order of 180-220 N produced strains on the order of 2%. Resultant forces generated by varus moment were relatively low, and the anteromedial band was not always strained. Mean coefficients of variation for resultant force in the ligament (five repeated measurements) ranged between 0.038 and 0.111. Mean coefficients of variation for five repeated placements of the strain transducer in the same site ranged from 0.209 to 0.342. Insertion and removal of this transducer at the anteromedial band produced observable damage to the ligament. In our study, repeatable measurements were possible only if both prongs of the transducer were sutured to the ligament fibers.

Aged↗
PubMed1983

An analysis of the function of the posterior talofibular ligament.

The function of the posterior talofibular ligament was studied using an apparatus which subjected the ankle joint to a measured torque and allowed the simultaneous recording of rotatory movements in two planes. Thirty osteoligamentous preparations of ankle joints were examined, half in the sagittal and horizontal planes and the remainder in the sagittal and frontal planes. Successive section of the lateral collateral ligaments was performed, including, in particular, selective division of the short and long fibres of the posterior talofibular ligament. The function of this ligament was investigated in combination with the other two collateral lateral ligaments, with the calcaneofibular ligament alone, and finally as the only remaining intact ligament. The posterior talofibular ligament plays only a supplementary role in ankle stability when the lateral ligament complex is intact. After rupture of the anterior talofibular and the calcaneofibular ligaments, however, the short fibres of the posterior ligament restrict internal and external rotation, talar tilt, and dorsiflexion, while its long fibres inhibit only external rotation, talar tilt, and dorsiflexion. As the posterior talofibular ligament has no independent stabilizing function in the intact ankle joint, an isolated rupture of this ligament is unlikely.

Ankle Injuries↗
PubMed2002

[Anatomy and function of the anterior cruciate ligament].

The anterior cruciate ligament originates at the medial wall of the lateral femoral condyle and inserts into the middle of the intercondylar area. It contributes significantly to the stabilization and kinematics of the knee joint. The femoral origin is oval and is located in the posterior aspect of the lateral femoral condyle. Therefore, it is difficult to visualize the femoral origin arthroscopically. This might be one reason for anterior malpositioning of the femoral bone tunnel during anterior cruciate ligament reconstruction. The position of the femoral origin is behind the center of rotation of the knee joint; therefore, it becomes tense when the knee is extended. The tibial insertion is oval and its center is nearly in the middle of the tibial plateau. Definite landmarks for tibial tunnel placement in anterior cruciate ligament reconstruction are the distance between the central insertion point at the intercondylar floor and the posterior cruciate ligament (7-8 mm) and the anterior horn of the lateral meniscus. The anterior cruciate ligament consists of multiple small fiber bundles. From a functional point of view, one can differentiate the anteromedial and posterolateral fiber bundles. The anteromedial fibers are tense during a greater range of motion than the posterolateral fibers. The main part of the anterior cruciate ligament consists of type I collagen-positive dense connective tissue. The longitudinal fibrils of type I collagen are divided into small bundles by thin type III collagen-positive fibrils. In the distal third, the structure of the tissue varies from the typical structure of a ligament. In this region, the structure of the tissue resembles fibrocartilage. Oval-shaped cells surrounded by a metachromatic extracellular matrix lie between the longitudinal collagen fibrils. The femoral origin and the tibial insertion have the structure of a chondral apophyseal enthesis. Near the anchoring region at the femur and tibia, there should be various mechanoreceptors, which might have an important function for the kinematics of the knee joint. The blood supply of the anterior cruciate ligament arises from the middle geniculate artery. The ligament is covered by a synovial fold where the terminal branches of the middle and the inferior geniculate artery form a periligamentous network. From the synovial sheath, the blood vessels penetrate the ligament in a horizontal direction and anastomose with a longitudinally orientated intraligamentous network. The distribution of blood vessels within the anterior cruciate ligament is not homogeneous. We detected three avascular areas within the ligament: Both fibrocartilaginous entheses of the anterior cruciate ligament are devoid of blood vessels. A third avascular zone is located in the distal zone of fibrocartilage adjacent to the roof of the intercondylar fossa.

Anterior Cruciate Ligament↗
PubMed2006

Sonography of the superomedial part of the spring ligament complex of the foot: a study of cadavers and asymptomatic volunteers.

OBJECTIVE: To evaluate the ability of high-resolution sonography for assessing the thickness and echogenicity of the superomedial part of the normal spring ligament in the foot in cadavers and asymptomatic volunteers. MATERIALS AND METHODS: The superomedial part of the normal spring ligament of four cadaveric feet was imaged with a high-resolution linear array transducer. Upon localization, the ligament was injected with 0.1% methylene blue with sonographic guidance. A posteromedial approach was used to dissect the feet immediately following injection to confirm accurate identification of the ligament. The bilateral ligaments in 40 asymptomatic adult volunteers were subsequently imaged. RESULTS: Surgical dissection confirmed the accurate injection of methylene blue into all four cadaveric ligaments. The superomedial part of the normal spring ligament was identified bilaterally in all of the 40 asymptomatic volunteers, with a mean thickness of 3 mm in longitudinal short axes. The ligament was echogenic relative to surrounding fat, and it was thinner in women. Differences in ligament measurements with respect to age, sex, side (left vs. right) and foot dominance were not significant. The volunteers' height, weight and body mass index had a weakly positive correlation with ligament thickness. CONCLUSION: High-resolution ultrasound can be used to identify and measure the thickness of the superomedial part of the normal spring ligament. The provided baseline measurements for the normal ligament could prove valuable when assessing the abnormal ligament.

Adolescent↗
PubMed1993

Anatomy of trapeziometacarpal ligaments.

The stabilizing ligaments of the thumb trapeziometacarpal joint were identified and studied during anatomic dissections of 30 hand specimens. Five main ligamentous structures were identified: (1) the anterior oblique ligament, (2) the ulnar collateral ligament, (3) the first intermetacarpal ligament, (4) the posterior oblique ligament, and (5) the dorsoradial ligament. It was observed that the anterior oblique ligament is the primary stabilizer of the trapeziometacarpal joint and is taut in abduction, extension, and pronation. The first intermetacarpal, ulnar collateral, and posterior oblique ligaments appear to be secondary stabilizers. In every specimen, the first intermetacarpal, ulnar collateral, and posterior oblique ligaments merged to form a force nucleus at the base of the first metacarpal. The dorsoradial ligament did not play a primary or secondary role in thumb stability. The clinical correlation of this anatomic study suggests that, at the minimum, the reconstruction of a primary thumb trapeziometacarpal ligament (anterior oblique ligament) is essential in the treatment of degenerative arthritis to maintain thumb stability.

Aged↗
PubMed2004

The incidence of wrist interosseous ligament and triangular fibrocartilage articular disc disruptions: a cadaveric study.

PURPOSE: The purpose of this cadaveric wrist study was to determine the incidence and size of defects of the scapholunate interosseous ligament (SLIL), lunotriquetral interosseous ligament (LTIL), and triangular fibrocartilage (TFC) articular disc, and to determine their relationship to wrist arthrosis. METHODS: The status of the SLIL, LTIL, and the TFC articular disc was determined in 96 cadaveric wrists with an average age of 75 years (range, 61-92 y). The location and length of the SLIL and LTIL ligament disruptions and the site of ligament detachment were noted. Ligament disruptions were classified into 1 of 3 grades based on the size of the ligament disruption and the absence (grade 1 and 2 disruptions) or presence (grade 3 disruption) of wrist arthrosis. The location, size, and configuration of the TFC articular disc disruptions also were noted. RESULTS: Disruptions of the SLIL were noted in 34 wrists (35%). There were 20 grade 1, 4 grade 2, and 10 grade 3 ligament disruptions. The average length of ligament disruption was 10.9 mm, or 40% of the length of the ligament. Twenty-four of 34 SLIL disruptions occurred without wrist arthrosis. Disruptions of the LTIL were noted in 47 wrists (49%). There were 23 grade 1, 10 grade 2, and 14 grade 3 ligament disruptions. The average length of ligament disruption was 7.6 mm, or 52% of the ligament length. Thirty-three of 47 LTIL disruptions occurred without wrist arthrosis. Disruptions of the TFC articular disc were noted in 58 wrists (60%). The most common patterns of disruption were either a linear defect at the radial attachment of the articular disc or a centrally located oval defect. Thirty-seven of the 58 TFC articular disc disruptions were noted in wrists without distal radioulnar joint (DRUJ) arthrosis. CONCLUSIONS: There is a high incidence of SLIL, LTIL, and TFC articular disc disruptions in the cadaveric model. Large ligament and TFC articular disc disruptions without wrist arthrosis are very common.

Aged↗
PubMed1995

Autografts from the foot for reconstruction of the scapholunate interosseous ligament.

A cadaveric study was undertaken to identify a potential autograft for use in repairing the ruptured scapholunate interosseous ligament. Three ligament complexes (the dorsal metatarsal ligament of the fourth and fifth metatarsals, a dorsal tarsometatarsal ligament, and the dorsal calcaneocuboid ligament) were chosen as autograft candidates. The scapholunate interosseous ligament and the three autograft candidates were harvested as bone-ligament-bone complexes from matched hands and feet of six fresh-frozen male cadavers (age, 51-68 years). The complexes were elongated using a servohydraulic testing machine at a constant grip-to-grip rate of 0.1 mm/s until failure. Stiffness and strength values were calculated and compared for each ligament complex. Analysis indicated that the stiffness values for the tarsometatarsal ligament and the scapholunate interosseous ligament were not statistically different, while such values for the other two autografts were significantly less. The strength values of all three autografts were significantly less than those of the scapholunate interosseous ligament. This study indicates that of the potential autografts tested, the tarsometatarsal ligament is biomechanically most similar to the intact scapholunate interosseous ligament.

Aged↗
PubMed2006

Comparison of plain MRI and MR arthrography in the evaluation of lateral ligamentous injury of the ankle joint.

BACKGROUND: The purpose of this study was to determine the efficacy of plain magnetic resonance imaging (MRI) and magnetic resonance (MR) arthrography for detecting collateral ligamentous injury of the ankle joint. METHODS: Fifty patients (October 2001 to November 2003) suffering from ankle disability who underwent plain MRI and MR arthrographic studies were enrolled in this study. The diagnostic criteria for ligament disruption on plain MRI included nonvisualization, disruption, waviness of the ligament, or coexistent avulsion fracture. The MR arthrographic findings of ligament disruption were based on leakage of gadolinium contrast medium anterior to the anterior talofibular (ATaF) ligament following ATaF ligament disruption, and the contrast medium filling into the common peroneal tendon sheath after calcaneofibular (CF) ligament disruption. The 2 modalities were interpreted respectively and blindly. RESULTS: Seventeen patients received surgical intervention. There were 14 patients who had a torn ATaF ligament and 6 patients who suffered from CF ligament disruption proved by surgery. Limited detection of preoperative plain MRI survey, which showed 12 patients had torn ATaF and 2 patients had torn CF ligament, was noted. However, most patients with ligamentous injury were correctly diagnosed by MR arthrography preoperatively (only 1 case of CF injury was missed). The plain MRI alone had a higher incidence of false negative and false positive detection. MR arthrography was also valuable for evaluating the coexisting intra-articular pathologies of the ankle joint. CONCLUSION: For evaluating ankle disability, using plain MRI alone is not adequate for correctly detecting lateral collateral ligamentous injury of the ankle joint. MR arthrography improves the sensitivity and the accuracy for ATaF and CF ligament injuries. It also helps in assessing coexisting pathologic lesions of ankle joints, especially impingement syndromes and osteochondral lesions, and provides more information for therapeutic decision making.

Adolescent↗
PubMed2002

Possible role of the long dorsal sacroiliac ligament in women with peripartum pelvic pain.

BACKGROUND: To enhance the understanding of the pathophysiology of women with peripartum pelvic pain, it is necessary to couple anatomical insights with relevant clinical research. In this context, the long dorsal sacroiliac ligament is especially of interest because it was noticed that women diagnosed with peripartum pelvic pain frequently experience pain within the boundaries of this ligament. Njoo (1) found a high intertester reliability and a high specificity for long dorsal sacroiliac ligament pain. The present article focuses on the possible role of the long dorsal sacroiliac ligament in the pain pattern of women with peripartum pelvic pain. The diagnostic and therapeutic consequences are considered. STUDY DESIGN: A cross-sectional analysis was performed in a homogenous group of women meeting strict criteria for posterior pelvic pain since pregnancy, diagnosed as having peripartum pelvic pain and excluded for any history of fracture, neoplasm or previous surgery of the lumbar spine, the pelvic girdle, the hip joint or the femur. The patients were also excluded for signs indicating radiculopathy: asymmetric Achilles tendon reflex and/or (passive) straight leg raising restricted by pain in the lower leg. METHODS: The study group comprised 178 women diagnosed with peripartum pelvic pain, selected from the outpatient clinic of a specialized rehabilitation center. Selection was based on criteria enabling a strict division between lumbar and pelvic complaints. Pain in the long dorsal sacroiliac ligament was detected by standardized palpation of the long dorsal sacroiliac ligament by specifically trained physicians and scored on a modified scale. Comparisons with the posterior pelvic pain provocation test and the active straight leg raise test was carried out. RESULTS: The present study confirms that the long dorsal sacroiliac ligament frequently shows tenderness on palpation in patients with peripartum pelvic pain. Sensitivity was 76%. Sensitivity in a group of 133 women of the study group that scored positive on both active straight leg raise and posterior pelvic pain provocation tests was 86%. When only severe pelvic patients were included, sensitivity increased to 98%. In comparisons between the posterior pelvic pain provocation and the long dorsal sacroiliac ligament tests on the left and right side, Pearson's correlation coefficient was 0.33 and 0.41, respectively. In comparisons between the active straight leg raise and the long dorsal sacroiliac ligament tests on the left and right side, Pearson's correlation coefficient was 0.35 and 0.41, respectively. CONCLUSIONS: The present study, carried out on a group of peripartum pelvic pain patients with strict in- and exclusion criteria, attempts to further elucidate the pathophysiology of patients with peripartum pelvic pain by adding a simple pain provocation test. It is concluded that the combination of the active straight leg raise, the posterior pelvic pain provocation and the long dorsal sacroiliac ligament pain tests combined with the proposed in- and exclusion criteria seems promising in differentiating between mainly lumbar and pelvic complaints. Although the sensitivity of the long dorsal sacroiliac ligament pain test seems promising, further clinical study is necessary in targeting specifically the long dorsal sacroiliac ligament. It is suggested that studies initiated to show the prevalence of sacroiliac joint pain in patients presenting nonspecific lumbopelvic pain, by using intra-articularly double block injection techniques, should include a peripheral injection of at least the long dorsal sacroiliac ligament.

Adult↗
PubMed2005

Pedestrian injuries: viscoelastic properties of human knee ligaments at high loading rates.

OBJECTIVE: Accidents involving pedestrians are very common, and often lead to severe injuries to the lower extremities. In a large portion of pedestrian-automobile collisions, knee ligament injuries are sustained. In this study, the viscoelastic properties of the four major human knee ligaments were investigated at loading rates representative for pedestrian-automobile collisions. METHODS: Bone-ligament-bone specimens were tested in knee distraction loading. The collateral ligaments and the separate functional bundles of the cruciate ligaments were tested in the anatomical position corresponding to a fully extended knee. A series of step-and-hold tests and ramp tests at different rates were conducted to characterize the time-dependent behavior of the knee ligaments for deformation rates associated with the pedestrian impact loading environment. The quasi linear viscoelastic (QLV) theory was used to describe the structural response of the knee ligaments and averaged parameters for this model were determined. RESULTS: The QLV theory was found to be applicable for the time range that is relevant for pedestrian-automobile collisions. The structural behavior of the knee ligaments was found to be particularly rate-sensitive for high elongation rates, as occur during these collisions. The ligament stiffness was found to increase with age for both the collateral ligaments and with weight for the medial collateral ligament. CONCLUSIONS: For the loading conditions that are relevant for pedestrian-automobile collisions, the use of the QLV model for the description of the mechanical behavior of knee ligaments is appropriate. The rate-sensitivity is particularly important for these extreme loading conditions. The relaxation behavior was found to be consistent between different ligament types and samples. Variations due to donor anthropometry were found predominantly for the instantaneous elastic behavior.

Accidents, Traffic↗
PubMedDate not supplied

Anatomy of the iliolumbar ligament: a review of its anatomy and a magnetic resonance study.

Data of the postmortem studies of the iliolumbar ligament are controversial because of the number, complexity, and variability of the structures present in the lumbosacral region. The objective of this work was to study the anatomy of the iliolumbar ligament to resolve some clinical problems: (1) do anatomic bases exist that can explain the lumbar painful syndrome termed "iliolumbar syndrome?" (2) do iliolumbar ligament varieties exist that can influence lumbosacral joint stability? Magnetic resonance was used to analyze the anatomic structure of the iliolumbar ligament of live human beings. Thirty iliolumbar ligaments of 15 volunteers were analyzed with magnetic resonance. The images were acquired along the transversal and coronal planes (respectively, superoinferior and anteroposterior). The portion of the iliolumbar ligament originating from the L-5 transverse process is made up of two bands (anterior and posterior). The anterior band is broad and flat and has two different anatomic varieties. Type 1 originates from the anterior aspect of the inferolateral portion of the L-5 transverse process and fans out widely before inserting on the anterior portion of the iliac tuberosity. Type 2 originates anteriorly, laterally, and posteriorly from inferolateral aspect of the L-5 transverse process and fans out before inserting on the anterior portion of the iliac tuberosity. The posterior band of the iliolumbar ligament originates from the apex of the L-5 transverse process and is fusiform. Just before inserting on the anterior margin and apex of the iliac crest it widens, assuming the aspect of a small cone. On the transaxial plane, the anterior band of the iliolumbar ligament was placed along the horizontal line passing through the transverse processes, whereas the posterior band formed an angle of approximately 45 to 55 degrees opened posterolaterally with this line. On the coronal plane, the spatial disposition of the iliolumbar ligament varies greatly with the size of the L-5 vertebra and its position in the pelvis: (1) when L-5 is situated low in the pelvis, the bands of the iliolumbar ligament are longer and oblique; (2) when L-5 is situated high in the pelvis, the bands of the iliolumbar ligament are shorter and horizontal. The insertion manner of iliolumbar ligament posterior band in the iliac crest allows us to confirm the possibility of existence of the lumbar painful syndrome termed iliolumbar syndrome and confirms the possibility of examining its insertional site manually. Being accessible manually, various drugs can be injected directly into it or deep friction can be applied. This posterior band is thinner than the anterior, with a smaller insertional base on the iliac crest, which explains its lesser resistance to torsional overloading and also explains the frequency of this painful syndrome. It is probable that the spatial disposition of the iliolumbar ligament influences its antitorsional role. Further anatomic and biomechanic studies are needed.

Adult↗
PubMed2002

Histologic evaluation of posterior cruciate ligaments from osteoarthritic knees.

It is controversial whether posterior cruciate ligament-retaining or posterior cruciate ligament-sacrificing (-substituting) implants should be used in total knee arthroplasty. The use of posterior cruciate ligament-retaining implants implies that the residual ligament is functional, and presumably normal, but few studies have been conducted to elucidate the histologic appearance of the posterior cruciate ligament taken from osteoarthritic knees. The purposes of the current study were (1) to evaluate the histologic appearance of posterior cruciate ligaments excised from osteoarthritic knees during primary total knee arthroplasty and to compare their appearance with posterior cruciate ligaments from knees of cadavers that were not operated on; and (2) to determine whether a correlation exists between the histologic appearance of the posterior cruciate ligament and the clinical status of the patients studied. Twenty-six posterior cruciate ligament specimens from patients with osteoarthritis and four specimens from cadavers were evaluated with the use of light and electron microscopy. Posterior cruciate ligaments from osteoarthritic knees showed greater degeneration than those from cadavers by light microscopy. Age greater than 60 years was associated with decreased collagen diameter in posterior cruciate ligaments from osteoarthritic knees as determined by electron microscopy. With the number of specimens available, the authors could not find a significant correlation between tibiofemoral alignment and mean collagen diameter or percentage of collagen occupancy. The extent of tissue degeneration of the posterior cruciate ligament could not be predicted by clinical findings. Additional studies identifying the mechanical competency of the posterior cruciate ligament in osteoarthritis would be valuable.

Adult↗