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Simultaneous quantitation of knee ligament forces.

An apparatus and experimental technique have been developed which allow the simultaneous quantitation of human cadaver knee ligament forces with the knee in various positions and subjected to various loads. The methodology permits all the major ligaments of the knee to be kept intact, thus preserving much of their normal relative load-bearing function. A novel measurement technique was employed for ligament force measurement. Strain gauges were placed at the ligamentous insertions and origins either on cortical bone or the cancellous/cortical transition. Gauge output was subsequently calibrated quantitatively by cutting the ligaments and subjecting them to known loads. The gauging technique was thermally stable, and the method as a whole yielded reproducible relative ligament force data when knee positions and loads were repeated for a given knee specimen. Three fresh human cadaver knee specimens have been subjected to testing thus far with gauges at six ligamentous sites. Initial evaluation of the data indicate that ligamentous loading patterns were quite different from those reported in the literature as determined by other methods.

Humans↗

Cruciate ligament rupture in young adult broiler knee joints.

Derangement of the caudal cruciate ligament was identified in 11 broiler fowls aged between 18 and 38 weeks. In some cases, the caudal cruciate ligament alone was ruptured, whereas, in others, the caudal meniscofemoral and meniscotibial ligaments and medial meniscus were also deranged. In some birds, ligaments were only partially ruptured but, in 5 cases, complete rupture had occurred in both knee joints. All birds showed severe lameness which, in 2 cases, could only be ascribed to caudal cruciate derangement. Degenerative changes were present in many of the ligaments which suggested that rupture may be a consequence of primary ligamentous change. Proximal tibiotarsal osteochondrosis was a frequent concomitant finding which may affect the integrity of the ligament attachment. A number of other factors including postural abnormality, obesity, and relative inactivity may predispose broilers to caudal cruciate ligament rupture.

Aging↗

Origin of the medial ulnar collateral ligament.

The anatomic features of the origin of the anterior medial collateral ligament of the elbow were studied in 10 cadaver elbows to determine the percentage of the medial epicondyle that can be removed without violating the ligament, and whether or not this ligament attaches to the condyle as well as to the epicondyle. In all specimens the anterior medial collateral ligament originated exclusively from the anteroinferior surface of medial epicondyle and had no attachment to the condyle. Only 20% of the width of the medial epicondyle in the coronal plane can be removed without violating a portion of the origin of the anterior medial collateral ligament, an essential stabilizer of the elbow. Excision of the entire epicondyle for ulnar neuropathy would completely detach this ligament from its origin and might therefore potentiate instability. Since the ligament originates on the anteroinferior surface of the epicondyle, more bone can be removed with less violation of the anterior medial collateral ligament origin if the plane of the osteotomy lies between the sagittal and coronal planes.

Cadaver↗

Changes in the extracellular matrix of the autogenous patellar tendon graft after posterior cruciate ligament reconstruction: a biochemical study in sheep.

The left knee joints of female German sheep were operated, replacing the posterior cruciate ligament by the central third of the patellar tendon. After 2, 6, 16, 26 and 52 weeks the graft of the operated leg as well as the contralateral central third of the patellar tendon and the posterior cruciate ligament were dissected and used for biochemical analysis. The total glycosaminoglycan content in grafts increases within the first year up to 5 fold and is higher than that of the patellar tendon, but is lower than that of the cruciate ligament. The distribution pattern of glycosaminoglycans differ in the posterior cruciate ligament and the patellar tendon. In cruciate ligament the main components are chondroitin sulfate (76%) and hyaluronan (15%). In the patellar tendon a higher portion of dermatan sulfate (approx. 16%) was found, next to 52% chondroitin sulfate and 22% hyaluronan. During the examination time the grafts show changes in the concentration and the distribution pattern of glycosaminoglycans. The chondroitin sulfate content increases during the experimental period from 1.4 +/- 1.2 mumol/g dry weight (d.w.) to 8.7 +/- 2.9 mumol/g d.w. After 1 year the chondroitin sulfate content in the graft does not differ significantly from that of the cruciate ligament. In the grafts the concentration of chondroitin (non sulfated) increases after 6 weeks up to 1.3 +/- 0.6 mumol/g d.w. in comparison to the value after 2 weeks (0.2 +/- 0.1 mumol/g d.w.) and also in the other groups (16, 26 and 52 weeks) it remains significantly increased. After 1 year the dermatan sulfate content in the graft has increased up to the fifth-fold compared to the value after 2 weeks and is higher than in the patellar tendon and in the cruciate ligament. In graft the hyaluronan content (1.0 +/- 0.4 mumol/g d.w. does not differ significantly in the groups 2, 6, 16, 26 and 52 weeks after operation, but in all five groups it is lower than in the cruciate ligament (2.4 +/- 1.0 mumol/g d.w.). Dermatan and heparan sulfate are not or only little detected in all three tissues. The distribution pattern of glycosaminoglycans in graft shows chondroitin sulfate and dermatan sulfate being the major parts of glycosaminoglycans with a slight increase of these components in the different groups during the experimental period. Hyaluronan makes up to 24 +/- 5% of the whole content of glycosaminoglycans after 2 weeks and decrease to 8 +/- 1% after 52 weeks.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

Three-dimensional regular arrangement of the annular ligament of the rat stapediovestibular joint.

The stapes footplate articulates with the vestibular window through the annular ligament. This articulation is known as the stapediovestibular joint (SVJ). We investigated the ultrastructure of adult rat SVJ and report here on the characteristic ultrastructure of the corresponding annular ligament. Transmission electron microscopy showed that this annular ligament comprises thick ligament fibers consisting of a peripheral mantle of microfibrils and an electron-lucent central amorphous substance that is regularly arranged in a linear fashion, forming laminated structures parallel to the horizontal plane of the SVJ. Scanning electron microscopy revealed that transverse microfibrils cross the thick ligament fibers, showing a lattice-like structure. The annular ligament was vividly stained with elastica van Gieson's stain and the Verhoeff's iron hematoxylin method. Staining of the electron-lucent central amorphous substance of the thick ligament fibers by the tannate-metal salt method revealed an intense electron density. These results indicate that the annular ligament of the SVJ is mainly composed of mature elastic fibers.

Animals↗

Influence of ligament stiffness on the mechanical behavior of a functional spinal unit.

Data on the stiffnesses of spinal ligaments are required for analytical studies on the mechanical behavior of spinal segments. Values obtained experimentally vary widely in the literature. A finite element model of an L3/L4 functional spinal unit was used to determine the influence of ligament stiffness on intersegmental rotation and forces in the ligaments. The lowest values for ligament stiffness selected from the literature were used in one set of calculations, and the highest values were simulated in a second set. The nonlinear model was loaded with pure moments of 7.5 and 15 Nm in the three main anatomical planes. The mechanical behavior of the functional spinal unit was strongly influenced by ligament stiffness. In some cases, a ligament with low stiffness does not carry any load, while the same ligament with high stiffness has to carry a high load. This indicates that finite element models of spinal segments have to be validated and that a realistic quantitative prediction of ligament forces is extremely difficult.

Biomechanical Phenomena↗

The appearance of the lateral ulnar collateral ligament on magnetic resonance imaging.

The lateral ulnar collateral ligament is an important element of the elbow's lateral capsuloligamentous complex, and loss of integrity contributes to posterolateral rotatory instability. However, the normal appearance on magnetic resonance imaging is poorly defined. The purpose of this study was to assess the appearance of the lateral ulnar collateral ligament of asymptomatic elbows on magnetic resonance imaging. We performed magnetic resonance imaging on 20 asymptomatic elbows. The lateral ulnar collateral ligament was identified as a hypointense structure originating from the lateral epicondyle and inserting on the proximal ulna in 10 cases (50%) and was ambiguous in the other 10 elbows. The identified lateral ulnar collateral ligament images included areas of high signal intensity, which was confusing because it suggested ligamentous disruption within the ligament. These results indicate that magnetic resonance imaging is not reliable for diagnosing lateral ulnar collateral ligament injuries at the present time. Further progress in magnetic resonance imaging will be clinically useful for diagnosing abnormalities of the lateral ulnar collateral ligament.

Adult↗

Mechanical properties of the scapholunate ligament correlate with bone mineral density measurements of the hand.

The mechanical properties of the scapholunate ligament have been previously examined in small sample sizes, with ultimate load and occasionally stiffness reported. The present study examined 16 scapholunate ligaments in uniaxial extension at two rates and determined stiffness, ultimate load, and stress relaxation properties. Mean stiffness values of 66.4+/-28.6 N/mm at an elongation rate of 50 mm/min and 94.5+/-44.4 N/mm at an elongation rate of 100 mm/min were found. Relaxation behavior, determined by the percent load remaining after 100 s, was found to be 68.1+/-12%. Mean ligament ultimate loads were 357+/-110 N (n = 8). In eight specimens, failure occurred in bone. Positive correlations were observed between bone mineral density of the hand and ligament stiffness, ligament ultimate load, and bone ultimate load. No correlation was observed between bone mineral density and ligament load relaxation behavior. The results provide a comprehensive understanding of scapholunate ligament biomechanics and demonstrate a relationship between bone and ligament properties.

Absorptiometry, Photon↗

Differences in the presence of mechanoreceptors and nerve structures between wrist ligaments may imply differential roles in wrist stabilization.

The purpose of this study was to analyze human wrist ligaments with regard to presence of general innervation and mechanoreceptors. The ligaments studied were: dorsal radiocarpal (DRC), dorsal intercarpal (DIC), long radiolunate (LRL), radioscaphocapitate (RSC), ulnocarpal (UC), scapholunate interosseous (SLI) and lunotriquetral interosseous (LTI) ligaments. Specific immunohistochemical markers were used to target neural/perineurial structures. Both Ruffini and Pacini-like mechanoreceptors (sensory corpuscles) as well as nerve fascicles/free nerve fibers were identified. Ruffini corpuscles were primarily identified via their dendritic intracapsular nerve endings, whereas the Pacini-like corpuscles were identified through their thick perineurial capsules with marked p75 immunoreaction. The wrist ligaments were found to vary in innervation, the DIC, DRC and SLI being richly innervated, whereas the LRL being almost without innervation. The difference in innervation between the ligaments might reflect differential function. Ligaments without innervation might act as structures of passive restraint, whereas ligaments with rich innervation are proposed to also provide proprioceptive information. Wrist ligament injuries should, therefore, be regarded as a disturbance not only of the intrinsic carpal kinematics, but also of the coordination and proprioception of the entire wrist joint.

Adult↗

Outcome of arthroscopic single bundle reconstruction for complete posterior cruciate ligament tear.

PURPOSE: To evaluate the clinical outcome and correlate the results and degenerative change of the affected knees with the duration of injury, ligament laxity and follow-up time in 30 patients with 31 knees undergoing arthroscopic single bundle reconstruction for complete posterior cruciate ligament (PCL) tear with 2-9-year follow-up. MATERIALS AND METHODS: This series included 22 men and 8 women with an average age of 32 years. High-energy trauma accounts for 93.5% of PCL injury, while only 6.5% are sports related. Arthroscopic single bundle PCL reconstruction was performed in all knees. The average follow-up time was 40 (range: 24-108) months. The methods of evaluation included functional assessment, ligament laxity and radiograph of the knee. RESULTS: The overall clinical results showed 77.4% satisfactory (61.3% excellent and 16.1% good) and 22.6% unsatisfactory (16.1% fair and 6.5% poor). Complete restoration of ligament stability was noted in 52% of the knees with one third showing mild (0-5 mm) and 9.7% moderate (5-10 mm) ligament laxity. The incidence of radiographic degenerative changes was 52% (16/31), and it correlated with the duration of injury, severity of ligament laxity and length of follow-up time. CONCLUSION: Arthroscopic single bundle reconstruction produced 77.4% satisfactory clinical results in medium term follow-up. Despite good clinical results, complete restoration of ligament stability was achieved in only 52% of the knees. The incidence of degenerative changes of the affected knees was 52% that correlated with the duration of injury, ligament laxity and follow-up time.

Adult↗

The puboprostatic ligament and the male urethral suspensory mechanism: an anatomic study.

OBJECTIVES: To perform a detailed anatomic study of the puboprostatic ligament and male urethral suspensory mechanism with comparisons to homologous female anatomy. METHODS: Anatomic dissections were performed on hemipelves of normal fresh male and female cadavers. RESULTS: The puboprostatic ligament was not a discrete "band" of fascia that simply fixes the prostate to the public symphysis, but a pyramid-shaped structure that is part of a larger urethral suspensory mechanism that attaches the membraneous urethra to the pubic bone. As in the female, the male urethral suspensory mechanism was composed of three continuous structures: the anterior pubourethral ligament (suspensory ligament of the penis and fascial reflection of the perineal membrane), the intermediate pubourethral ligament (arcuate and transverse ligaments), and the posterior pubourethral ligament (the puboprostatic ligament). The attachments of the urethral suspensory mechanism bilaterally inserted along the lateral border of the urethra to form a sling of support from the pubic arch. CONCLUSIONS: The male and female urethral suspensory mechanism are comparable. Understanding the relationship of the male urethral suspensory mechanism to the urethra, striated urethral sphincter, and dorsal vein may help in performing the apical dissection of the prostate during radical retropubic prostatectomy and in preserving urinary continence following radical pelvic surgery.

Adult↗

The capitohamate ligaments. A comparison of biomechanical properties.

The physical attributes of the three capitohamate interosseous ligaments were tested in a computer-controlled multi-axis testing machine using 12 human cadaver specimens. After an intact test run, selected ligaments were cut in random sequence and the test repeated. The remaining ligaments were tested to failure with servohydrolic stress at 5 mm/second. In the intact joint complex, the average dorsopalmar rotational displacement was approximately 9 degrees in each direction. Under the load limit, the dorsopalmar translational displacement averaged 0.9 mm and 0.5 mm respectively, proximal-distal translational displacement averaged 0.8 mm and 0.4 mm respectively, and distractional displacement averaged 0.3 mm. Based on the sequential sectioning it was found that the dorsal ligament provided 76% (SD 14) of the rotational resistance with palmar rotation of the capitate and 44% (SD 19) of translational constraint with palmar translation of the capitate. The deep ligament provided 51% (SD 15) of the rotational resistance with dorsal rotation of the capitate and 63% (SD 24) of translational resistance with dorsal translation of the capitate. With proximal-distal translation, the dorsal ligament was the most important constraint in each direction. In resisting distraction, each of the three ligaments was equally effective. Failure testing showed the deep ligament was strongest at 289 N, followed by the palmar at 171 N and the dorsal at 133 N.

Adult↗

Coincident rupture of the scapholunate and lunotriquetral ligaments without perilunate dislocation: pathomechanics and management.

Wrist injuries causing coincident disruptions of the scapholunate and lunotriquetral ligaments commonly result in perilunate dislocations. This article (1) describes our management of eight patients with wrist pain after coincident scapholunate and lunotriquetral ligament disruptions in the absence of perilunate dislocation; and (2) reports the results of biomechanical testing of some of the extrinsic and intrinsic wrist ligament and interprets these data to explain the injury seen clinically. The diagnosis of ligament failure was made on the basis of history, physical examination, arthrography and surgical exploration. Surgical treatment of seven patients consisted of concomitant scapho-trapezio-trapezoid fusion and lunotriquetral fusion. Three of seven patients were free of pain, two had pain only at the extremes of motion, and two required additional surgery. Biomechanical analysis of the scapholunate and lunotriquetral ligaments and two extrinsic wrist ligaments, the radiolunotriquetral and the radioscaphocapitate, confirmed the clinical suspicion that the intrinsic ligaments could be completely disrupted while the extrinsics are only partially injured. Such a scenario could account for the residual stability that prevents the development of perilunate dislocations. Coincident disruption of the scapholunate and lunotriquetral ligaments in the absence of perilunate dislocation is an unusual injury. Treatment with lunotriquetral fusion and scapho-trapezio-trapezoid fusion restored functional use in five of seven wrists while maintaining wrist motion.

Adult↗

The ligaments of the wrist.

The ligaments of the wrist were studied by dissecting ten fixed and seven fresh frozen wrists. In three other specimens multiple cross-sections were prepared. These studies show that the wrist ligaments can be classified into two groups: extrinsic and intrinsic. In the extrinsic group, the deep volar radiocarpal ligaments are three strong and very important structures connecting the radius to the capitate, the radius to the lunate, and, in a deeper layer, the radius to both the scaphoid and the lunate. A ligamentous deficiency was noted frequently between the capitate and the lunate. There also are very strong volar connections between the radius and the medial or ulnar carpus. These studies suggest that certain patients with a generalized ligamentous laxity and weakness will develop a pathological disruption of the volar ligaments with trauma. These torn volar ligaments should be repaired or reconstructed, for repair of only the dorsal ligaments seldom will provide good stability to such wrists.

Humans↗

Type I and type III procollagen gene expressions in the early phase of ligament healing in rabbits: an in situ hybridization study.

The purpose of this study is to observe type I and type III procollagen gene expressions in the healing ligament using in situ hybridization histochemistry. The rabbit medial collateral ligaments were incised and harvested at 3, 7, 14, and 28 days postoperatively. The healing ligament showed increased expression of both procollagen genes through this period compared with the unoperated ligament. The peak expression level was observed at 7 or 14 days for type I and at 7 days for type III, respectively. The strongest expression of both genes was detected in the scar tissue created between the ends of the old ligament. Although type III procollagen gene expression was observed almost only in the newly created scar tissue, type I procollagen gene was expressed not only in the scar tissue, but also at the ends of the previously normal ligament. These results suggest that type I collagen synthesis begins shortly after ligament injury and occurs at the ends of the injured ligament as well as in the scar tissue, and that type III collagen is largely synthesized in the scar tissue around one week after injury but continues being synthesized for at least four weeks after injury.

Animals↗

Ligamentous anatomy of the distal clavicle.

We describe the insertional variations of supporting ligaments of the acromioclavicular joint, especially with respect to gender. We analyzed 41 cadaveric clavicles (22 female and 19 male) with attached ligaments. The distance between the insertion of the trapezoid ligament and the distal end of the clavicle was not significantly different between sexes, although that of the conoid ligament and the mean anteroposterior width of the distal clavicle was significantly greater in men. Although there are significant sex-related differences in the insertional distances of the CC ligaments, resection of less than 11.0 mm should not violate the trapezoid ligament and less than 24.0 mm should not violate the conoid ligament in either sex in 98% of the general population. Resection of more than 7.6 mm of the distal clavicle in men and 5.2 mm in women, performed by an arthroscopic approach, may violate the superior acromioclavicular ligament.

Aged↗

Hyper-elastic model analysis of anterior cruciate ligament.

The objectives of this study were to theoretically analyze changes in shape and stress distribution which occur over the entire surface of the anterior cruciate ligament (ACL). While many studies on the cruciate ligaments' tensile characteristics have been conducted, the length patterns and the differential function of the ACL are still controversial issues for two reasons. Highly variable deformations of the ligaments (which are not uniaxial structures such as a bundle of separate fibres) cannot be adequately quantified by one-dimensional and/or localized measurements. Furthermore, it is impossible to directly measure in situ, non-uniform distribution of biaxial strain over the entire surface of the intra-articular ligaments. We employed an alternative approach which may have the potential to solve some of these difficulties. Using the finite element method, in which the ligament was treated as an incompressive hyper-elastic membrane, the finite deformation of the ligament was theoretically analyzed. Boundary conditions were applied by prescribing the displacements at the boundary nodes corresponding to the insertions. Special attention was paid to the distribution of longitudinal strain. The following values were obtained as a function of knee flexion: three-dimensional change in shape and strain distribution, length change of each fibre, length changes in positions along a fibre, resultant pull force on the tibial insertion, and change of strain pattern by anterior-posterior displacement of the tibia. The results demonstrated that strain distribution varied, even along the fibre run, and large strain gradients were observed in the regions near the insertions. It was found that distance between insertions introduced noticeable discrepancies from the length along a curved fibre. The net resultant force at the tibial insertion of the ligament was maximum at 0 degree of flexion, decreased until 50 degrees of flexion, then slightly increased up to 120 degrees of flexion. Predominantly, the anterior and the posterior displacements of the tibia, respectively, increased and decreased strain in the ligament, however, some portions were even more stretched by the posterior displacement.

Anterior Cruciate Ligament↗

Aging of the elastic and collagen fibers in the human cervical interspinous ligaments.

BACKGROUND CONTEXT: The ligaments consist of collagen bands intermingled with elastic fibers that support hundreds of pounds of stress per square inch. In the spine the basic functional unit comprises vertebrae, intervertebral disc and ligament tissues. The interspinous ligaments with the function of limiting the spine flexion are exposed to a traumatic and degenerative process that promotes pain or instability. It has been shown that aging induces structural changes to capsular, fascial and ligamentous structures, mainly to the elastic and collagen fibers. However, the relative changes with age in elastic and collagen fibers have not been quantified. PURPOSE: Examine the changes in the arrangement and amount of the elastic and collagen fibers of the human cervical interspinous ligament and attempt to correlate them with age. STUDY DESIGN/SETTING: Histomorphometric analysis of ligament samples harvested during surgery. PATIENT SAMPLE: We studied the dorsal portion of this ligament from 17 patients aged 16 to 69 years. OUTCOME MEASURES: Fraction of collagen and elastic fibers with linear regression analysis correlating fraction versus age. METHODS: The elastic and collagen fibers were identified by selective staining methods, and a blinded investigator using an image analysis system performed the histomorphometry. RESULTS: There is an age-related progressive increase in collagen and mature and elaunin elastic fibers responsible to elasticity. However, these elastic fibers showed structural degenerative changes with aging. Furthermore, there is an age-related decrease of oxytalan elastic fibers responsible to resistance. CONCLUSIONS: The aged interspinous ligament showed loss of elasticity that could alter the flexion limiting of the vertebral column.

Adolescent↗