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PubMed1990

Nonoperative treatment of acute knee ligament injuries. A review with special reference to indications and methods.

Nonoperative treatment has received little attention in the numerous scientific reports on knee ligament injuries. Great controversy still exists concerning the proper treatment of a knee with a ruptured ligament, especially the anterior cruciate ligament. However, according to the studies of the authors and an extensive review of the literature the indications for conservative management can be established to be all grade I and II sprains (partial tears) of knee ligaments as well as an isolated grade III sprain (complete tear) of the posterior cruciate ligament. In addition, an isolated complete rupture of an anterior cruciate, or medial or lateral collateral ligament may be treated nonoperatively in an older sedentary person. Other injuries obviously call for an operative approach at the acute stage. Nonoperative therapy protocols must be based on the knowledge of the biological phenomenon occurring during connective tissue healing process. In the first phase of ligament healing the injured knee needs 2 to 3 weeks immobilisation for undisturbed fibroblast invasion and proliferation of collagen fibres. This is achieved by immobilising the knee in a rehabilitative knee brace locked in 40 to 45 degrees of flexion. Thereafter, a gradually increasing controlled mobilisation is allowed in the brace to avoid the deleterious effects of immobilisation to cartilage, bone, muscles, tendons and ligaments, and to enhance the orientation of collagen fibres to the stress lines of the healing ligament. After 4 to 8 weeks the goal for rehabilitation is rapid and full recovery to work and sports. A functional knee brace may be used at this phase to give extra protection before final strengthening of the injured ligament. During the mobilisation and muscle training of the therapy protocol various specific techniques can be used for strengthening of the hamstring and quadriceps muscles, including isometric, isotonic, isokinetic and eccentric exercises with or without resistive equipments. In addition, electrical stimulation may help prevent muscle wasting due to immobilisation, and continuous passive motion may be used to correct persistent extension or flexion deficit. Normally, jogging is allowed approximately 3 to 6 months after the injury, and an athlete is generally able to return to full activity and competitive sports after 6 to 12 months. Quite frequently the whole question of successful rehabilitation after a knee ligamentous injury is more motivational rather than methodological and is thus often independent of attending physician's or physiotherapist's skill or will. Therefore, one of the most important things during rehabilitation is to motivate and encourage the patient for longstanding, intensive work.

Biomechanical Phenomena↗
PubMed1988

Knee ligament reconstruction: plain film analysis.

New concepts in knee ligament reconstruction have recently emerged, significantly improving the success of surgical reconstruction of anterior and posterior cruciate ligaments, using high-strength bone-patellar tendon-bone grafts, as well as medial and lateral collateral soft-tissue ligament reconstructions. We reviewed plain radiographs of 50 patients with a total of 72 ligament reconstructions to determine radiographic signs of complications. A major early complication relates to reconstructed ligament positioning. Isometric positioning of the reconstruction is important for all ligaments, but it is most crucial for the femoral portion of the anterior cruciate ligament. Three cases of nonisometric ligament positioning were identified, two anterior cruciate ligaments and one medial collateral ligament. Another early complication is graft fracture, identified in two cases of anterior cruciate ligament reconstruction. Hardware failure did not occur in this series. Late complications include motion of the graft (none in this series) and patellar fracture (one case in this series). Effusions resolved by 4 weeks in 92% of the cases. However, prolonged effusions are usually sterile and should not be mistakenly diagnosed as representing a septic joint if they are an isolated finding. Nonunion of the graft within its osseous tunnel is unusual. Union occurred in 79% of cases by 6 weeks and in 95% of cases by 5 months. Osseous tunnel sclerosis alone is not considered a complication. We conclude that postoperative plain film radiography is important for assessment of graft and hardware position as well as for the detection of early and late surgical complications.

Adolescent↗
PubMed1995

Posterior intermalleolar ligament of the ankle: normal anatomy and MR imaging features.

OBJECTIVE: The purposes of this study were to delineate the normal anatomy and MR imaging features of the posterior intermalleolar ligament--a normal ligamentous variant of the posterior portion of the ankle--and to identify normal anatomic characteristics that may account for the role of the ligament in the development of posterior impingement syndrome. MATERIALS AND METHODS: The prevalence, size, and shape of the posterior intermalleolar ligament were documented in 36 cadaveric ankles and in 97 MR studies of the ankle in patients with and without symptoms. RESULTS: The posterior intermalleolar ligament was identified in 20 (56%) of the 36 cadaveric feet. It was 1-8 mm wide, and its diameter (anterior to posterior) was 5-8 mm. The ligament often resembled a meniscus, and in one case its anterior lip herniated into the ankle joint. The posterior intermalleolar ligament was detected in 18 (19%) of the 97 MR studies of the ankle. It was visualized on coronal T1- or T2-weighted images as a distinct, hypointense band traversing between the posterior talofibular ligament and the inferior transverse ligament. CONCLUSION: The posterior intermalleolar ligament is a normal variant of the posterior ligaments of the ankle and is present in a significant number of persons. It is best seen on coronal T1- and T2-weighted MR images. Its meniscuslike shape and occasional extension into the ankle joint may account for the development of posterior impingement syndrome in susceptible persons.

Adolescent↗
PubMed1997

Injury of the posterior ligament complex in patients with acute spinal trauma: evaluation by MR imaging.

OBJECTIVE: We undertook this study to use MR imaging to determine the frequency of injury to the posterior ligament complex of the thoracolumbar spine in patients who have undergone acute thoracolumbar trauma. SUBJECTS AND METHODS: Sixty-eight patients with varying severity of thoracolumbar trauma were examined prospectively. The majority of injuries were related to motor vehicle accidents. The second most common cause was falls. Patients were examined with plain radiography and MR imaging. In addition to conventional MR imaging sequences consisting of T1-weighted and fast spin-echo T2-weighted sagittal and axial images, a fat-suppressed T2-weighted sagittal sequence was performed. The findings were correlated with surgery in six cases and with follow-up clinical examination that included physical examination and conventional anteroposterior and lateral radiographs. RESULTS: Posterior ligament complex injury was detected in 53% (n = 36) of all patients. Such injury was most common in patients with flexion-distraction (n = 15) and patients with dislocation fracture (n = 4). Of the patients with dislocation fracture, all had posterior ligament complex injury. Of the 24 patients with burst fractures, posterior ligament complex tear occurred in 42% (n = 10). Of the 23 patients with compression fractures, 26% (n = 6) had posterior ligament complex tear. Injury to the interspinous ligaments occurred with decreasing frequency in patients with injury to the supraspinous ligament, flaval ligaments, posterior longitudinal ligament, and anterior longitudinal ligament. Surgical findings correlated with MR imaging in all six patients who underwent surgery. CONCLUSION: Injury to the posterior ligament complex, which is often encountered in patients with burst and compression fractures, can be reliably revealed by MR imaging.

Adult↗
PubMed1989

A study of the mechanisms influencing ligament growth.

This study investigated the effects of tension and/or exogenous growth hormone on the growth (elongation) of ligaments. In the first experiment, tension was applied to the lateral collateral ligaments of immature rabbits. In the second experiment, a group of skeletally mature rabbits was given exogenous growth hormone while tension was applied to their lateral collateral ligaments. The results revealed that immature rabbit ligaments elongated 140 +/- 18% when tension was applied, while "control" ligaments elongated 79 +/- 5% (P less than .01). In mature rabbits receiving exogenous growth hormone, no significant change was found in the ligament's length with or without the application of tension when compared with controls. Tension applied to ligaments in immature rabbits can increase ligament growth, indicating that physical forces (tension) may be important in the regulation of ligament growth. The same tension applied to mature rabbit ligaments in combination with exogenous growth hormone did not cause a resumption of growth, indicating that tension and the presence of growth hormone are not the only factors necessary for ligament growth.

Aging↗
PubMed1996

Medial collateral ligament injuries of the knee: ultrasonographic findings.

The aims of our study were (1) to describe the ultrasonographic findings of the injured medial collateral ligament of the knee and (2) to assess the usefulness of ultrasonography in both evaluating the presence and location of the medial collateral ligament injuries and predicting the prognoses for the patients. The study group consisted of 16 patients with the clinical diagnosis of medial collateral ligament injury. We also examined 20 knee joints in 10 volunteers who had no history of injury to the knee. To predict prognoses, we divided the patients into two groups on the basis of the location of medial collateral ligament injuries. A thickened and heterogeneously hypoechoic appearance of the medial collateral ligament was considered abnormal. The normal medial collateral ligament was a thin and moderately homogeneous hypoechoic band with an average thickness of 4.3 mm (range, 3.3 to 5.6 mm) at the femoral attachment and of 2.3 mm (range, 1.3 to 3.2 mm) at the tibial attachment. All injured medial collateral ligament structures were thickened and heterogeneously hypoechoic. According to the criteria for grading of medial collateral ligament injury with stress view, 10 patients had grade III medial collateral ligament tears, three had grade II tears, and none had grade I injuries. In 15 (94%) of 19 knees, a correct diagnosis could be made with ultrasonography. Ultrasonography is useful in evaluating isolated medial collateral ligament injuries and in predicting patient outcome on the basis of the location of the medial collateral ligament injuries.

Adult↗
PubMed2000

A role for calcitonin gene-related peptide in rabbit knee joint ligament healing.

Knee joint ligament healing has been shown to be improved when the torn ligament ends remain in contact, however, the rationale for these effects is unknown. The sensory neuropeptide calcitonin gene related peptide (CGRP) has potent trophic and vasodilatatory properties and as such is thought to be advantageous in wound repair. In ascertaining a role for CGRP in rabbit medial collateral ligament healing, the present study examined changes in CGRP-like immunoreactivity (CGRP-LI) and CGRP-mediated vasomotor responses in gap injured (non-contact), Z-plasty apposed (contact), and sham operated control medial collateral ligaments. At 6 weeks post-trauma, CGRP-LI decreased in the healing zone of gap injured and Z-plasty apposed medial collateral ligaments compared with controls, and non-contact ligament nerve fibres exhibited an abnormal morphology. Topical administration of CGRP (10(-13) to 10(-9) mol) caused a dose-dependent increase in ligament perfusion in each experimental group of knees. The CGRP-mediated vasodilatation associated with gap injured ligaments was not significantly different from controls (P = 0.06), whereas apposed medial collateral ligaments showed an augmented response to the peptide (P < 0.0005). These findings indicate that the beneficial effects of ligament interposition post-trauma may be related to an enhanced responsiveness to CGRP in conjunction with a more typical re-innervation profile. Conversely, the aberrant characteristics of CGRP-LI nerves occurring in gap injured tissue is suggestive of impaired CGRP release which may explain the poor functional recovery associated with these ligaments.

Animals↗
PubMed1992

[Experimental carpal displacement induced by ligamental lesions].

Ligamentous lesions were created experimentally in 40 fresh cadaver wrists. The precise localization of traumatic rupture of the ligaments and the subsequent carpal imbalance were defined by the comparison between the experimental results and the clinical displacements. The displacements may be permanent, sequential or induced by external forces. Lesions of capsular ligaments cause the displacement. There are 3 functional units; the distal scaphoid complex; the palmar ligaments which form a "belt", consisting of the lateral external ligament, the radiocarpal ligaments an the radiate ligament; the medial ligaments, which also form a "belt" consisting of the palmar triquetral ligaments on each side of the triquetrum. The sprains are caused by a lesion of a functional unit. The lateral sprain is characterized by a lesion of the distal scaphoid complex. The scaphoid moves into a horizontal position, causing a dorsal deviation of the lunate and a scapholunate diastasis. The central sprain is induced by a rupture of the palmar "belt", causing an anteroposterior radiocarpal or mediocarpal drawer movement. The medial sprain is induced by the rupture, of different extents, of the medial ligaments. On examination, there is either a click or a palmar deviation of the lunate, sometimes with a lunotriquetral diastasis. The dislocations of the wrist are caused by lesion of several ligamentous units.

Biomechanical Phenomena↗
PubMed2005

Anatomical dimensions of anterior bundle of ulnar collateral ligament and its role in elbow stability.

OBJECTIVE: To study the anatomical dimensions of the anterior bundle of ulnar collateral ligament and its role in elbow instability. METHODS: We studied 20 elbows of 10 cadavers. Anterior bundle of ulnar collateral ligament was dissected in all elbows and its anatomical length and width were measured. After measuring it, we assessed the role of the anterior bundle of ulnar collateral ligament in the medial elbow joint stability, with the capsule, the radial head and anterior bundle of ulnar collateral ligament being cut. RESULTS: The mean right length of the anterior bundle of ulnar collateral ligament was 21.10 +/- 6.29 mm and the mean left length was 21.70 +/- 5.31 mm. The mean right width of the anterior bundle of ulnar collateral ligament was 12.70 +/- 2.79 mm and the mean left width was 13.90 +/- 2.37 mm. Anterior bundle of ulnar collateral ligament was found to be the main stabilizer of the valgus stress. The anterior capsule and the radial head also make contributions to this stability. However, when anterior bundle of ulnar collateral ligament is cut, the radial head and the anterior capsule fails to maintain the stability against valgus stress. CONCLUSIONS: The anatomical dimensions of the anterior bundle of ulnar collateral ligament are important for a surgeon when graft is used in reconstructing this ligament. Our study is an initiator of this topic and we believe that with larger series, more reliable anatomical measurements can be obtained. We also showed that the anterior bundle of ulnar collateral ligament is the main medial stabilizer of the elbow joint.

Biomechanical Phenomena↗
PubMed2006

A study of the discomalleolar ligament in the adult human.

The discomalleolar ligament (Pinto's ligament) is not described in the anatomy textbooks but was demonstrated by Pinto and others. This is a ligamentous structure connecting the malleus in the tympanic cavity and the articular disc and capsule of the temporomandibular joint. This anatomical relationship between the middle ear and the temporomandibular joint is supposed to be one of the explanations for the aural symptoms associated with temporomandibular joint dysfunction. The objectives of our study were to determine: (1) the frequency of occurrence and morphology of the discomalleolar ligament, (2) its attachments, (3) the morphology of Pinto's ligament in endoscopic visualisation, and (4) whether tension applied to the discomalleolar ligament could elicit movement of the malleus. Fourteen adult human temporomandibular joint and tympanic cavity specimens were examined with the use of an endoscope and then by gross dissection with the superior approach and with the use of the operating microscope. Endoscopic visualisation showed in four cases a band of tissue in the upper temporomandibular joint compartment, known as Pinto's ligament. The dissections exposed a discomalleolar ligament in 11 specimens. We were able to identify two main types of this ligament on the basis of its shape. The discomalleolar ligament was either triangular in shape, as in the first group of seven specimens, or longitudinal in shape, as in the second group of four specimens. We observed that tension applied to the discomalleolar ligament resulted in movement of the malleus in three specimens.

Adult↗
PubMed1991

Biomechanical study of ligaments around the elbow joint.

The ligamentous contribution to elbow joint stability is a product of morphology and biologic parameters of each of the collateral ligaments. Better understanding of these characteristics is of paramount importance for successful ligament reconstruction in the surgery for joint replacement and traumatic injury. Two experiments were performed. In the first, the arc of elbow flexion where the individual ligament was either taut or slack was measured; in the second, the structural properties of each collateral ligament were determined by using bone-ligament-bone preparations. The anterior medial collateral ligament (AMCL) and radial collateral ligament (RCL) were taut throughout most of the entire arc of flexion. The posterior medial collateral ligament (PMCL) was taut only when the elbow was in a flexed position. Among the collateral ligaments, the AMCL was the strongest and stiffest with an average failure load of 260 N. The palmaris longus tendon, the most frequently used graft for elbow ligament reconstruction, was similar in strength (357 N).

Biomechanical Phenomena↗
PubMed1989

[The value of ultrasound in the diagnosis of capsule ligament injuries of the upper ankle joint].

Ankle ligament injuries are usually diagnosed by clinical and radiological examination. In this study we tried to determine the accuracy of dynamic sonography in the diagnosis of ankle ligament injuries. From 1 April 1987 to 1 July 1988, 72 patients with ligamentous injuries of the ankle were examined sonographically. The dynamic stability of the anterior talofibular ligament was determined by measuring the length of the ligaments under normal and stressed conditions. The anatomical course of the ligaments was used as the plane of section. Clinical and radiological examinations were used to determine whether an operation was indicated, and the results of these examinations were compared after the operation with the sonographic and intraoperative findings. Dynamic examination of the stability of the anterior talofibular ligament yielded findings compatible with the intraoperative findings in 64 of the 72 cases (88.8%). The mean difference in length between normal and stressed conditions was 7.4 mm, with a range of 6-12 mm in the case of rupture of the ligament. A high level of agreement between sonographic and intraoperative findings was also found for the calcaneofibular ligament. In 62 of the 72 cases (86.1%) a correct diagnosis was possible. The mean difference in length in this plane of section was 10.6 mm, with a range of 7-17 mm. The sensitivity and specificity of ultrasound in the diagnosis of rupture of the ligaments were between 80% and 90%, respectively, and the positive predictive value was about 95%. Sonography with a high-resolution scanner allows a correct diagnosis of ligamentous lesions at the ankle joint in 80-90% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

In vivo and in vitro investigation of the long-term behavior and fatigue strength of carbon fiber ligament replacement.

The long-term behavior of carbon fiber ligament replacements was evaluated in sheep. In vitro assessments of both isolated carbon fiber prostheses and resected animal ligaments were performed. The right knee in 45 sheep was reconstructed. In 30 animals, only the medical collateral ligaments were replaced, but with different systems of anchorage to bone. In 15 animals, a combined replacement of medial collateral ligament and anterior cruciate ligament was performed. In the first group the animals were sacrificed three months postoperation, while in the latter group evaluation was performed one year after surgery. After one year the strength of the medial collateral ligament complex was higher than that of the normal sheep ligaments. The elasticity and extensibility were similar to those of the normal ligaments. No case of partial rupture or rupture of the medial collateral ligament replacements was seen, but four of 12 anterior cruciate replacements showed signs of partial rupture. In vitro testing showed that rupture is more likely to occur where movement occurs around a small radius of bending, and this may be a factor in these cases where the anterior cruciate ligament enters a bony tunnel at an acute angle. Histologic assessment showed good biocompatibility, similar to that reported by other authors. With an operative technique designed to increase the radius of bending where the carbon fiber enters bone, these ligament replacements have a fatigue strength and elasticity adequate for long-term survival.

Animals↗
PubMed1981

Collateral ligaments of the canine stifle joint: anatomic and functional analysis.

The anatomic features and functions of the collateral ligaments of the canine stifle joint were investigated, using cadaver specimens. The structure of the collateral ligaments was examined by dissection, with attention given to the spatial relationships existing between the collateral ligaments and their neighboring structures, such as the menisci and joint capsule. The relative tension of the ligaments was determined by identifying the points of attachment with lead markers and taking a series of radiographs of the joint throughout its range of motion. The distance between the points was measured, and the change in length was determined as a function of joint position. Measurements of internal and external rotation, varus angulation, and valgus angulation were made before and after severance of one or both ligaments. The medial collateral ligament was taut in extension, with only the caudal portion of the ligament becoming lax in flexion. The lateral collateral ligament was also taut in extension; however, its entire bulk because lax as the joint was flexed. In extension, the ligaments were primary restraints preventing varus and valgus angulation, and they functioned to limit internal and external rotation of the tibia. In flexion, the cranial portion of the medial collateral ligament remained taut and prevented external rotation of the tibia, whereas the relaxation of the lateral collateral ligament allowed the tibia to rotate internally, with further rotation limited by the cruciate ligaments.U

Animals↗
PubMed1995

[Anatomical study of the ligaments in the occipito-atlantoaxial complex].

To investigate the role of the ligamentous complex in the stability of the atlanto-axial joint, the macroscopic anatomy of the occipito-atlanto-axial complex was studied in 44 cadavers involving the cruciate ligament of atlas, alar ligament, and the anterior atlanto-axial ligament (AADL). The transverse ligament (TL) had two layers, one was membranous tissue and the other was ligamentous. The mean length of the TL was 19.7 mm (range 14-25 mm). The TL was significantly longer in males than in females. The diameter of the TL was thinnest at the centre (mean 2.0 mm, range 1-5 mm). The thicker ligaments were significantly larger in diameter. The alar ligament (AL) was dissected and examined in all cadavers. The direction of the AL ran postero-laterally. This ligament was divided into five types according to the fiber orientation. Type 1 was separated type in its origin at the dens. Type 2 was partially connected type. Type 3 was totally connected with a covered dens tip. Type 4 was totally connected but did not cover the dens tip. Type 5 was a combined type of Type 3 covering Type 1. The fiber direction of the AL was divided into three types; caudocranial type, horizontal type, and craniocaudal type. The AADL was examined in 24 specimens (60%). This ligament existed bilaterally in 18 specimens (45%) and hemilaterally in 6 (15%). The right side only was examined in 2 specimens (5%) and the left side only in 4 specimens (10%). In 6 specimens, the orientations of this ligament was identified and the shape was found to be thin. From these results, it was considered that not only TL, but also the AL and AADLs played an important role in stabilizing the atlanto-axial complex.

Adult↗
PubMed1996

[Lesions of the collateral ligaments of the ankle: diagnosis and follow-up with magnetic resonance and ultrasonography].

Acute sprains are one of the most frequent ankle conditions; the lateral collateral ligaments are often involved. Currently, plain radiography and clinical examination are the methods of choice in the management of these injuries. This study was aimed at describing the MR findings of acute ankle sprains, to assess which ligaments are involved, to study the repair process during conservative treatment and, finally, to compare MR and US findings in acute and chronic injuries. We divided our study into a prospective and a retrospective parts. In the prospective study, MRI was performed in 20 consecutive patients with acute ankle sprain diagnosed at the emergency care unit of our institute and treated conservatively with braces. The patients with fractures were excluded. Follow-up was based on a series of MR exams performed every 30 days for 6 months. We diagnosed 18 injuries of the lateral collateral ligaments, 5 of the anterior talofibular ligament (ATFL) (2 partial and 3 complete tears) and 13 of both the ATFL and the calcaneofibular (CFL) (6 partial and 7 complete tears). The follow-up showed complete edema resorption at 30 days in 2 patients with no ligament injuries; the persistence of a medium-large amount of fluid in partial tears at 30 days and its complete resorption at 60 days; and, finally, the persistence of a medium-large amount of fluid at 180 days in 2 complete tears. No scar could be identified in all the patients with ligament injuries. The retrospective study was based on the comparison of MR (gold standard) and US findings in 78 patients with ankle sprain, 28 in the acute and 50 in the chronic phase. In the first group we found 9 ATFL injuries (6 partial and 3 complete tears), 5 ATFL and CFL injuries (3 partial and 2 complete tears), 2 complete tears of lateral collateral ligaments, 3 deltoid ligament (DL) injuries, 2 ATFL and DL injuries and 2 injuries of both lateral and medial collateral ligaments. US was in agreement with MRI in 85% of ATFL, 67% of CFL and 28% of DL injuries; US also yielded 2 false positives in PAA. In the second group of 50 patients, MRI showed 11 ATFL and 8 ATFL and CFL injuries, 3 injuries of lateral collateral ligaments, 6 DL and 8 ATFL, CFL and DL injuries and 5 complete tears of both internal and external collateral ligaments; 10 exams were negative. US had 58% agreement with MRI in ATFL, 46% in CFL and 21% in DL injuries. In this series, US yielded 3 false positives in PAA injuries.

Adolescent↗
PubMed1997

Structural, material, and anatomic characteristics of the collateral ligaments of the canine cubital joint.

OBJECTIVE: To document gross and microscopic anatomic features of the collateral ligaments of the canine cubital joint and to determine their structural and material properties. ANIMALS: 37 canine cadavers. PROCEDURE: After measurement of ligament dimensions, the bone-collateral ligament-bone specimens were loaded in tension until failure, using a materials testing machine. Data from the load-displacement curves were used to determine the structural and material properties of the ligaments. Gross anatomic features were studied during dissection of the specimens from the medial collateral ligament (MCL) and lateral collateral ligament (LCL), which then were saved for microscopic examination. RESULTS: Failure load and stiffness values for the LCL were significantly (P < 0.05) greater than those for the MCL. The LCL had obvious cranial and caudal components that attached to the radius and ulna, respectively. The MCL also had cranial and caudal components; however, the cranial component was indistinct, appearing only as a slight thickening of the joint capsule. The caudal component was more prominent; as it extended distad, it had minor attachments to the interosseous and annular ligaments and attached principally on the caudolateral surface of the proximal portion of the radius. The caudal component did not have substantial attachment to the ulna in any of the specimens studied. Both ligaments were composed of closely packed, parallel fascicles of dense collagen, with scant amounts of fibrocartilage and no detectable elastin. CONCLUSIONS: Gross anatomic features of the collateral ligaments of the canine cubital joint indicate that they provide principal structural support to the joint; microscopic anatomic features are typical of other ligaments. The LCL is stronger and stiffer than the MCL; however, their material properties are similar. CLINICAL RELEVANCE: Knowledge of the sites of attachment of collateral ligament components is essential for surgeons undertaking repair or reconstruction of these structures.

Animals↗
PubMed2005

Treatment of anterior cruciate ligament injuries, part I.

Anterior cruciate ligament injuries are common among athletes. Although the true natural history remains unclear, anterior cruciate ligament injuries are functionally disabling; they predispose the knee to subsequent injuries and the early onset of osteoarthritis. This article, the first in a 2-part series, was initiated with the use of the PubMed database and a comprehensive search of articles that appeared between January 1994 to the present, using the keywords anterior cruciate ligament. A total of 3810 citations were identified and reviewed to determine the current state of knowledge about the treatment of these injuries. Articles pertaining to the biomechanical behavior of the anterior cruciate ligament, the prevalence of anterior cruciate ligament injury, the natural history of the anterior cruciate ligament-deficient knee, injuries associated with anterior cruciate ligament disruption, risk factors for anterior cruciate ligament injury, indications for treatment of anterior cruciate ligament injuries, and nonoperative and operative treatments were obtained, reviewed, and served as the basis for part I. Part II, to be presented in another issue of this journal, includes technical aspects of anterior cruciate ligament surgery, bone tunnel widening, graft healing, rehabilitation after reconstruction, and the effect of sex, age, and activity level on the outcome of surgery. Our approach was to build on prior reviews and to provide an overview of the literature for each of the before-mentioned areas of study by summarizing the highest level of scientific evidence available. For the areas that required a descriptive approach to research, we focused on the prospective studies that were available; for the areas that required an experimental approach, we focused on the prospective, randomized controlled trials and, when necessary, the highest level of evidence available. We were surprised to learn that considerable advances have been made during the past decade regarding the treatment of this devastating injury.

Anterior Cruciate Ligament↗