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At least 91 records · Page 5Linked to original sources
PubMed1991

[Alloplastic replacement of the anterior cruciate ligament. Comparative studies of ruptured Dacron, Trevira and Ligapro ligaments].

Histological investigations were performed on 24 polyethylene terephthalate ligaments (eight Dacron, eleven Trevira and five Ligapro) which had served as substitute for the human anterior cruciate ligament. Because of rupture or loosening they had been explanted six to 48 months after operation. Only in one Trevira ligament a longitudinal direction of collagenous lamellae could be seen, all other ligaments had only few collagenous fibers, mainly orientated in circular direction. In the fibrous tissue of all three kinds of ligaments there were signs of inflammation. Foreign body giant cells have immigrated--they mainly enclose the graft fibres in Dacron and Ligapro ligaments. In Trevira and Ligapro ligaments the foreign body giant cells phagocyte particles of graft fibers after increasing implantation times. The inflammatory reaction to graft fibers and their particles may also damage host tissue. Regarding these results we conclude that the Polyethylene terephthalate ligaments are not qualified as substitutes for the anterior cruciate ligament.

Adolescent↗
PubMed1993

Arthroscopic and histologic evaluation of anterior cruciate ligaments reconstructed with the Leeds-Keio ligament.

In 62 of the patients who underwent anterior cruciate ligament (ACL) reconstruction with the Leeds-Keio (L-K) artificial ligament, we performed an arthroscopic second look and biopsy of the reconstructed ACL at 8-36 months postoperatively. Arthroscopic findings were classified into two groups according to the tautness of the ligament and the coverage of the implanted L-K ligament with synovial tissue. Histologic results were classified into three groups according to the orientation of the collagen fibers around the L-K ligament, and the arrangement and morphology of the cells. Although our results demonstrated that the implanted L-K ligament had the capacity for tissue induction, no statistically significant correlation was observed between any two results among the arthroscopic, histologic, and clinical data. Therefore, within the time span of our experiment, we could not conclude that the L-K ligament functioned as a scaffold type of artificial ligament. More convincing results must be attained before any firm recommendation can be made for the use of the L-K ligament as a substitute ACL over the autograft or allograft.

Adolescent↗
PubMed2004

A ligament in the lumbar foramina: inverted Y ligament: an anatomic report.

OBJECTIVES: The objective of this study was to investigate the ligaments in the exit zone of lumbar foramen and describe their anatomic relationships with adjacent structures. Few studies have been reported on the ligaments of foramen and the anatomic relationships on the lumbar level. The ligament described in this study is novel since it has not been reported previously. METHODS: Ten male and five female cadavers were used to investigate intraforaminal area and ligaments of the lumbar level. The cadavers were filled with colored latex, and the lumbar foramen were examined under operative microscope. RESULTS: A lumbar foramen branched off into two or three main passages, composed of inverted Y ligament form. The medial lower arm of Y ligament was attached to the upper and anterior surface of the superior articular process of the lower corpus vertebra. Its lateral lower arm was attached to the upper surface of the area where the lower corpus vertebra and its pedicle met, and the upper arm was attached to the lower surface of the pedicle of upper vertebra where it met with transverse process. The anatomic properties of vascular and nervous structures in foramen and the relations among them are described. CONCLUSION: The ligament detected in the study was different from the other reported descriptions of foraminal ligaments. It divided the lumbar foramen into three passages. Because of its relations with adjacent structures, such as nerves and vessels, the inverted Y ligament may be an important structure for lumbar foramen. Thus, it may be an important anatomic landmark.

Adult↗
PubMed2005

Arthroscopic transtibial posterior cruciate ligament reconstruction with preservation of posterior cruciate ligament fibers: clinical results of minimum 2-year follow-up.

BACKGROUND: The transtibial technique for posterior cruciate ligament reconstructions can potentially lead to poor clinical outcomes due to the "killer turn" effect. HYPOTHESIS: Preserving the original posterior cruciate ligament fibers in the reconstruction will contribute significantly to the posterior stability of the knee joint, healing of the graft, and prevention of graft failure. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Sixty-one patients (45 men and 16 women; mean age, 30.4 years) underwent transtibial posterior cruciate ligament reconstruction with preservation of the cruciate ligament fibers; they were reviewed at a mean period of 40.8 months. All patients were assessed with the Lysholm knee score, International Knee Documentation Committee subjective and objective evaluations, and KT-2000 arthrometry. Follow-up magnetic resonance imaging was performed in 40 patients; images were assessed for graft continuity, thickness, and signal intensity. Second-look arthroscopy was performed in 42 patients. RESULTS: The mean Lysholm score improved from 65.8 to 92.9. The final International Knee Documentation Committee subjective evaluation rated all patients as normal or nearly normal, and the objective evaluation showed normal or nearly normal in 59 patients (97%) and abnormal in 2 patients (3%). The mean side-to-side difference on the KT-2000 arthrometer was 2.79 mm. All patients showed well-preserved graft continuity on magnetic resonance images. Mean graft thickness was 9.9 mm in the sagittal plane and 12.3 mm in the coronal oblique plane. Images for all patients revealed homogeneously low signal intensity in the distal portion of the graft, with complete healing of the graft and original posterior cruciate ligament fibers as one ligament. Graft loosening or graft tear by the killer turn effect was not detected in any patients. Second-look arthroscopy revealed complete healing and graft integration, with the original posterior cruciate ligament fibers in all patients. CONCLUSION: In transtibial posterior cruciate ligament reconstructions, poor outcomes from the killer turn effect may be reduced by preserving the original posterior cruciate ligament fibers.

Achilles Tendon↗
PubMed1994

Ulnar collateral ligament of the thumb: MR findings in cadavers, volunteers, and patients with ligamentous injury (gamekeeper's thumb).

OBJECTIVE: The ulnar collateral ligament bridges the ulnar aspect of the first metacarpal and the proximal phalanx and functions as a major stabilizer of the first metacarpophalangeal joint. Acute or chronic injury of this ligament is referred to as gamekeeper's thumb. The objectives of this study were to (1) determine the MR appearance of the ulnar collateral ligament of the thumb in cadavers and volunteers and (2) analyze the MR findings in patients with gamekeeper's thumb, especially with regard to the value of MR in detecting clinically significant displacement of the ligament (Stener lesion). MATERIALS AND METHODS: MR imaging of the first metacarpophalangeal joint was performed in three volunteers, two cadaveric specimens, and 11 patients with acute injury. In the patients, the mechanism of injury was an abrupt abductive force on the thumb resulting in rupture of the ulnar collateral ligament. The diagnosis was confirmed by surgery in five patients and by clinical follow-up in the remaining six. Cryomicrotome sectioning of the cadaveric tissue blocks was performed to correlate pathologic and MR findings. Images were interpreted by one radiologist. RESULTS: MR images showed rupture of the ulnar collateral ligament in all 11 patients. Prospectively, Stener lesions (n = 3) could be differentiated from non-Stener lesions (n = 8) in eight of 11 patients. Retrospectively, the correct diagnosis could be made in all 11 patients once the importance of determining the position of the ulnar collateral ligament relative to the adductor aponeurosis was understood. CONCLUSION: MR imaging of the first metacarpophalangeal joint depicts the ulnar collateral ligament and adductor aponeurosis to good advantage. It can also accurately show tears of the ulnar collateral ligament and thus be used to differentiate a rupture without significant retraction from a Stener lesion. This information is important in determining whether surgical or conservative management is indicated.

Collateral Ligaments↗
PubMed1991

[Recent ruptures of the anterior cruciate ligament. Suture technique on a reinforcement ligament. Results of a 5 years' experience].

225 patients with acute rupture of the anterior cruciate ligament were operated upon with a knitted polyester synthetic ligament (Ligastic) reinforced by a suture of the anterior cruciate ligament remnant. Five technical points must respected during the implantation of the ligament: isometry, direction of the femoral and tibial tunnels, absence of abrasion of the ligament in the notch, tensioning of the synthetic ligament equal to the natural cruciate ligament, careful suture of the remnants of the ruptured anterior cruciate around the synthetic ligament replacement. The functional results, according to the rating system of ARPEGE, demonstrated 8.6 on the stability scale, 8.1 for pain, 8.7 for mobility; 87 per cent of the competitors were able to return to their sport at the same level. There were no cases of acute synovitis. The patients were separated into three groups for evaluation: Group I--More than three years follow-up. Group II--More than two years follow-up. Group III--Less than two years follow-up. An anterior drawer test of less than 5 mm was observed in 85 per cent of Group I, 88 per cent of Group II, and 87 per cent of Group III. A negative jerk test was noted in 92 per cent of Group I, 95 per cent of Group II and 95 per cent of Group III. These differences were not statistically significant. On follow-up, a Lachman test of less than 5 mm was found respectively in 37 per cent, 70 per cent and 79 per cent; this difference was statistically significant. The relatively mediocre results of the Lachman test in Group I led us to follow a more precise isometric method. Postoperative cases were reexamined and demonstrated that the artificial ligament had become covered with an oriented fibrous tissue. The long-term outlook also depended on a successful restoration of proprioception in the repaired remnant of the anterior cruciate.

Adult↗
PubMed1989

[Treatment and rehabilitation of anterior cruciate ligament injuries in Norway. A comparison with the Anterior Cruciate Ligament Study Group].

The method of treatment for ruptures of the anterior cruciate ligament range from nonoperative treatment through direct repair to complicated augmentation. The Anterior Cruciate Ligament (ACL) Study Group, consisting of orthopaedic surgeons from USA, Canada, Australia, Sweden, Austria and Switzerland, summarized its thoughts on treatment and rehabilitation in a recent paper. A survey has been carried out on Norwegian treatment practice and compared with the practice of the Anterior Cruciate Ligament Study Group. This paper describes the difference in treatment between the two groups of surgeons and reviews the methods of rehabilitation used for acute tears of the Anterior Cruciate Ligament Study Group. The majority of Norwegian surgeons in this study use primary repair with no augmentation, while surgeons in the Anterior Cruciate Ligament Study Group use augmentation methods allowing early mobilization and return to preinjury activities. 88% of the Norwegian surgeons prescribed a cast for six weeks after surgery, while only 15% of the surgeons in the Anterior Cruciate Ligament Study Group prescribe immobilization for more than four weeks. In the rehabilitation protocol the Anterior Cruciate Ligament Study Group emphasizes strength training of the hamstring in order to protect the Anterior Cruciate Ligament, at the same time preventing dynamic exercises of the quadriceps for the last 30 degrees of extension so as to prevent strain on the Anterior Cruciate Ligament. This policy was shared by less than 50% of the Norwegian surgeons.

Humans↗
PubMed1985

[Healing of ruptures of the anterior cruciate ligament treated with simple sutures. Possibilities, usefulness, clinical evaluation. Apropos of a series of 51 anterior cruciate ligament sutures using barbed wire with macroscopic verification of the healing].

Fifty-one ruptures of the anterior cruciate ligament were treated by early suture using barbed wires followed by plaster cast for 6 weeks. The state of healing was assessed by a second look during arthrotomy to remove the wire after an average of 6 months. In addition, 45 knees have been examined more than 20 months after the initial repair. Three out of 4 ligaments were found to be healed, but only one out of 3 had adequate tension and was correctly sited. The rate of satisfactory healing was high in cases of clear-cut rupture and when the pre-operative laxity was moderate. Associated lesions of the collateral ligaments healed satisfactorily thanks to the period of 6 weeks treatment in the plaster cast. The cases in which the cruciate ligaments had healed demonstrate subjective and objective stability better than others, even when the ligament had been found to be loose or incorrectly re-implanted and were superior from the functional point of view. There was no parallel between the true state of healing of the ligament and the clinical tests of stability. It is concluded that early suture of the cruciate ligament is worthwhile in cases of clear-cut rupture. In cases of attenuation or when there are severe lesions of the collateral ligaments, suture of the cruciate ligaments should be reinforced by carbon fibres. This management is valuable in active people or amateur sportsmen in whom rehabilitation is somewhat slow. In professional athletes peripheral ligamentoplasties lead to earlier resumption of sporting activities. In older patients, plaster cast immobilisation is sufficient to produce satisfactory results.

Adolescent↗
PubMed1997

Bone morphogenetic protein receptors and activin receptors are highly expressed in ossified ligament tissues of patients with ossification of the posterior longitudinal ligament.

Ossification of the posterior longitudinal ligament (OPLL) is a pathological ossification in the spinal ligament, with formation of ectopic bone mainly through endochondral ossification. Bone morphogenetic proteins (BMPs) and activins are multifunctional proteins that belong to the transforming growth factor-beta superfamily and that have been implicated in the formation of new bone and cartilage. BMPs and activins signal via type I and type II receptors for BMPs (BMPRs) and activins (ActRs), respectively. OP-1/BMP-7 binds to BMPR-II and ActR-II and forms complexes with BMPR-IA and -IB and ActR-I. We studied the expression of BMPR-IA, -IB, and -II, ActR-I, ActR-II, and OP-1/BMP-7 by immunohistochemistry in ossified ligament tissues of patients with OPLL and control ligament tissues from patients with cervical disc herniation. The expression of BMPRs and ActRs was elevated in OPLL compared with controls. Expressions of BMPR-IA, -IB, and -II were observed not only in chondrocytes at the fibrocartilage tissue around the calcified zone but also in fibroblast-like spindle cells at the nonossified ligament. ActR-I and -II were found co-localized in the hypertrophic chondrocytes near the calcified zone and in the ossified tissue. OP-1/BMP-7 was expressed in chondrocytes near the calcified zone. In the control cases, the BMPRs and ActRs were only weakly expressed in the fibrocartilage tissue at the site of ligament attachments to bone and OP-1/BMP-7 was not detected. Enhanced expression of BMPRs at the nonossified ligament in OPLL patients suggests that these cells have a greater potential to differentiate into osteogenic cells than ligament cells from non-OPLL patients. The high expression of BMPRs and ActRs in the ectopic ossified ligament suggests that BMPs and activin may be tightly involved in the pathological ossification process of OPLL.

Activin Receptors↗
PubMed1995

Integrin display increases in the wounded rabbit medial collateral ligament but not the wounded anterior cruciate ligament.

The differential capacities of the anterior cruciate and medial collateral ligaments to heal may be related to differences in cellular function. This study tested the hypothesis that differential expression of integrins occurs in these ligaments after injury. The integrins are a family of cell surface receptors that mediate adhesion, migration, and other cellular functions critical to the healing of a wound. A similar complement and amount of the beta 1 subfamily of integrins are known to be present on the unperturbed anterior cruciate and medial collateral ligaments in humans and rabbits. A partial laceration was surgically created in these two ligaments in 12 anesthetized New Zealand White rabbits. Immunohistochemistry was performed on sections from the ligaments at 1, 3, 7, and 10 days after injury, using monoclonal antibodies directed against the integrin subunits beta 1, alpha 5, alpha 6, and alpha v. Between 3 and 7 days, the wounded medial collateral ligament demonstrated a striking increase in staining for the beta 1, alpha 5, and alpha v subunits on the fibroblasts, within the repair site, and on capillary endothelium. Increased staining was most marked for the beta 1 subunit and less marked for the alpha 5 and alpha v subunits. The alpha 6 subunit stained exclusively vascular structures within the healing medial collateral ligament. In marked contrast, the anterior cruciate ligament, which does not mount an effective repair response, demonstrated no comparable alteration of integrin expression from baseline levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

Isolated sectioning of the medial and posteromedial capsular ligaments in the posterior cruciate ligament-deficient knee. Influence on posterior tibial translation.

This study was undertaken to determine the contribution of various structures in the posterior cruciate ligament-deficient knee in resisting posterior tibial translation. With "isolated" injuries to the posterior cruciate ligament, the amount of posterior translation will decrease with the posterior drawer test as the knee is taken from neutral to internal tibial rotation. The present study was performed to conclusively determine the anatomic structure responsible for this clinical observation. The TestStar device was used to perform single-plane posterior drawer tests in 14 cadaveric knee specimens. The tests were performed with the knee in neutral tibial rotation and in 20 degrees of internal tibial rotation. The intact knee was tested and then the knee was tested after sequential sectioning of the meniscofemoral ligaments, the posterior cruciate ligament, the posteromedial capsule, and the superficial medial collateral ligament. With the knee in neutral rotation, posterior translation continued to increase as each structure was sectioned. With the knee in internal tibial rotation, posterior displacement was significantly less than in neutral rotation for each state until the superficial medial collateral ligament was sectioned; posterior translation was increased after its sectioning. Our data demonstrate that the superficial medial collateral ligament is the structure responsible for a decrease in posterior tibial translation in the posterior cruciate ligament-deficient knee.

Anterior Cruciate Ligament↗
PubMed1993

[Foreign body synovitis--a limiting factor in use of the Trevira ligament in cruciate ligament surgery?].

In a prospective clinical study on 32 patients with Trevira ligament implants arthroscopic and histological findings were used to assess the articular effects of the synthetic ligament. In group 1 of patients with intact Trevira ligament no changes associated with foreign-body reactions were seen. In group 2 with abrased or frayed synthetic ligaments generalised foreign-body reactions in the suprapatellar recess as well as perivascular, round-cell infiltrates were seen in four out of six patients; four of the six cases also showed fibrotic signs indicative of prearthrotic changes. In group 3 with ruptured Trevira ligament no diffuse foreign-body reactions in the suprapatellar recess were seen in any of the 16 cases. In the intercondylar space foreign-body reactions correlating with the age of the implant were identified (p < 0.03). In 18% of cases with ruptured Trevira ligament generalised foreign-body reactions were seen; however, these changes were not accompanied by chronic inflammatory changes. Cases with technical shortcomings associated with a gradual fraying of the synthetic ligament invariably showed diffuse foreign-body reactions as well as chronic inflammatory infiltrates. In patients with spontaneous ligament rupture due to repeated trauma foreign-body reactions were restricted to the intercondylar space. In spite of the histological evidence of foreign-body granuloma no permanent clinical articular effects could be seen in our patients population within the follow-up time of up to 60 months.

Adult↗
PubMedDate not supplied

Correlation of anthropometric measurements, strength, anterior cruciate ligament size, and intercondylar notch characteristics to sex differences in anterior cruciate ligament tear rates.

We performed a prospective study based on the hypothesis that physiologic differences exist between men and women in strength after adjustments for body weight; that the size of the anterior cruciate ligament is proportionate to the strength of its antagonists, the quadriceps muscles; and that women have a relatively small anterior cruciate ligament, thus predisposing them to a disproportionate number of anterior cruciate ligament injuries. One hundred matched high school basketball players, 50 male and 50 female, were evaluated with anthropometric measurements, body fat analysis, muscle strength evaluation, and magnetic resonance imaging measurements of the intercondylar notch and cross-sectional area of the anterior cruciate ligament at the outlet. The male players were taller and heavier than their female counterparts, although they had 11% less body fat. Male players had statistically greater quadriceps and hamstring muscle strength than female players, even when adjustments were made for body weight. With adjustments for body weight, the size of the anterior cruciate ligament in girls was found to be statistically smaller than in boys. There was no statistically significant difference in the notch width index between the sexes. The study data support our hypothesis that sex differences in anterior cruciate ligament tear rates are caused primarily by several interrelated intrinsic factors. Most importantly, stiffness and muscular strength increase stress on the anterior cruciate ligament in female athletes. The anterior cruciate ligament, when adjustments have been made for body weight, is smaller in female athletes, and therefore, probably does not compensate for the lack of stiffness and strength.

Adolescent↗
PubMedDate not supplied

Clinical experience with the Leeds-Keio artificial ligament in anterior cruciate ligament reconstruction. A prospective two-year follow-up study.

In this study, 24 consecutive patients with symptomatic chronic anterior cruciate ligament ruptures who had ligament reconstructions with the Leeds-Keio artificial ligament were observed for a minimum of 2 years or until ligament failure, whichever came first. The evaluation included a clinical examination, Lysholm knee score, and testing with a KT-1000 arthrometer. Within 2 years after surgery three patients underwent reoperation because of a rupture of the artificial ligament leading to instability. Another six patients developed significant subjective instability, even during ordinary activity. Only eight patients had a subjectively stable knee. Eleven patients scored 84 points or less on the Lysholm knee score, and 13 patients scored 85 points or more. The mean difference in anterior translation between the reconstructed knee and the opposite knee tested with the KT-1000 arthrometer was 3.7 mm. The high incidence of unstable knees, 9 of 24, due to insufficiency of the artificial ligament in this 2-year follow-up study strongly suggests that the Leeds-Keio artificial ligament is not an effective device for the reconstruction of the anterior cruciate ligament.

Adolescent↗