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PubMed1987

[Primary reconstruction of injuries of the capsular ligament of the knee joint].

Whether operative or conservative treatment is indicated for acute knee ligament injuries depends on the lesions of the cruciate ligaments: complex instability with rupture of one or both cruciate ligaments and injuries to the lateral or medial ligamentous structures should be treated by operation. Surgical treatment of an isolated rupture of the anterior cruciate ligament is recommended only for the young active patient. Surgery is performed by way of a single anterolateral incision with standard medial and if necessary, lateral arthrotomies. Ruptures of the cruciate ligaments are reconstructed with absorbable sutures, which are passed through bone channels. Augmentation with an absorbable allograft is used in most reconstructions of the cruciate ligaments. A knee brace with limited range of motion is used for postoperative rehabilitation. Our long-term results after operative reconstruction of acute instabilities of the knee joint show that ligamentous stability was achieved in most cases, but the functional results were impaired by pain and limited range of motion.

Adult↗
PubMed1985

Reconstruction of the anterior cruciate ligament: historical overview.

The first reported surgical repair of anterior cruciate ligament-deficient knees was done by Mayo Robson in 1895. The earliest anterior cruciate ligament reconstructions were done by Hey Groves in 1917 and by Alwyn Smith in 1918. Both used an intra-articular strip of iliotibial band. At this same time, the first attempt to make an artificial anterior cruciate ligament was done. Corner used wire, while Alwyn Smith used multiple silk sutures. Both methods failed. The first extra-articular procedures to correct instability in anterior cruciate ligament-deficient knees were reported by Bennett in 1926 and Cotton and Morrison and Bosworth and Bosworth in the mid 1930s. All of these surgeons reconstructed the medial side of the knee with free strips of fascia. In 1936, Campbell described the intra-articular use of patellar tendon and stressed the need for anterior cruciate ligament reconstruction in young, athletic individuals with unstable knees. In the 1950s, O'Donoghue also emphasized the early repair of an injuried anterior cruciate ligament and did much to improve the care of the college athlete. The procedures described by Jones, Slocum, Larson, and Nicholas dominated the 1960s and early 1970s. Various rotatory knee instabilities were defined, and the Lachman and pivot shift tests were born. Descriptions of various tendon transfers and intra-articular graft techniques have been published over the last 10 years. Most of these are variations of procedures described decades ago. In 1918, Alwyn Smith used electrical stimulation to decrease postoperative quadriceps atrophy. In 1936, Mauck advised the use of a hinged knee cast after surgery for better rehabilitation. Finally, in 1938, Palmer described a drill guide for more anatomic placement of an anterior cruciate ligament graft in the femur. Although prosthetic materials may have a greater place in the 1980s, the foundation for such research was laid long ago by innovative surgeons such as Hey Groves and Alwyn Smith, the great-grandfathers of anterior cruciate ligament reconstructions.

Humans↗
PubMed1985

Ligament replacement with an absorbable copolymer carbon fiber scaffold--early clinical experience.

Eighty-two patients, average age 29 years, were surgically treated (during the period from April 1981 to July 1983) for both acute (8%) and chronic (92%) knee ligament instabilities. An absorbable copolymer-carbon fiber ligament prosthesis was used as a tissue scaffold. Seventy-five percent had anterior cruciate ligament reconstructions, 6% had anterior cruciate and posterior cruciate ligament reconstructions, 6% had just posterior cruciate ligament reconstructions, and 9% had other combinations of anterior cruciate ligament, medical collateral ligament, and lateral collateral ligament reconstructions. Preoperative and postoperative evaluation, consisting of questionnaires, physical examinations, and isoskinetic testing, revealed significant improvements in categories of stability, pain, function, and strength persisting to the end of the study at 24 months. Arthroscopic examination and histologic studies of retrieved specimens demonstrated well-vascularized reconstructions with collagenous tissue ingrowth into the carbon-copolymer implants.

Adolescent↗
PubMed1985

[Sonographic imaging of the posterior cruciate ligament].

At present, cruciate ligaments can only be demonstrated by invasive examination methods (computerized tomography, arthroscopy). In roughly 50% of all cruciate ligament ruptures, the typical clinical symptoms of torn ligaments (abnormally increased motility of the tibia against the femur) cannot be elicited. In the case of older cruciate ligament ruptures especially, uncharacteristic complaints such as recurrent water on the knee, pain in the knee, and a feeling of instability are prominent. In experiments (knee ligament system), the posterior cruciate ligament (p.c.l) can be demonstrated clearly. In longitudinal scans the ligament can be located easily both in specimens as well as in patients. In contrast, the p.c.l. can usually only be identified in transverse scans by the typical shift of the ligament cross-section at various levels.

Adult↗
PubMed1983

[Replacement of the anterior cruciate ligament by carbon fibers. An experimental study].

The authors have excised the anterior cruciate ligament in 14 sheep and replaced it by carbon fibres. The animals were sacrificed after 12 to 18 months. Eight had a satisfactory new ligament without any evidence of arthrosis and with stability of the knee. In 2 cases, there was moderate instability and arthrosis associated with a lax ligament and in 3 cases the new ligament had ruptured with severe instability and arthrosis. Microscopic examination shows a satisfactory acceptance of the carbon filament both inside the bone as well as in the joint. There was no difference between cases repaired immediately or 6 months after excision of the ligament. A study of aortic lymph nodes showed the presence of carbon particles. The rupturing strength of the new ligaments and of normal ligaments were similar. The visco-elasticity of the new ligaments was also studied and was found to be satisfactory. It was considered that the use of carbon fibre may be valuable but more studies should be done to improve the elasticity and to decrease the migration of carbon material.

Animals↗
PubMed1984

Early mobilization of rabbit medial collateral ligament repairs: biomechanic and histologic study.

The postoperative management of repaired medial collateral ligaments is controversial. There are proponents for either early mobilization or immobilization. To contribute to an understanding of the issues, 24 adult Dutch rabbits were divided into four groups and a comparative study was made of their incised medial collateral ligaments, contrasting early immobilization with mobilization at three and six weeks. The ligaments were studied histologically and biomechanically. At three weeks, the immobilized ligaments were twice as strong as mobilized ligaments. Histologically, the immobilized ligaments demonstrated more fibroblastic reaction while the mobilized ligaments showed more mature tissue development at the repair site. There were no statistically significant differences between knees mobilized for six weeks and knees immobilized for three weeks and then subsequently mobilized for three weeks. In view of these results, the authors conclude that the deleterious effects of immobilization should be considered when planning postoperative or postinjury treatment of torn medial collateral ligaments.

Animals↗
PubMed1984

Arthrotomography of the wrist. The palmar radiocarpal ligaments.

Twenty-one fresh cadaver wrists were studied by arthrography and arthrotomography. Arthrography was unreliable in accurately delineating the palmar radiocarpal ligaments. However, lateral arthrotomograms predictively and precisely outlined the radiolucent radiocapitate and radiotriquetral ligaments. The radial and more distant radiolucent area was the radiocapitate ligament, and the ulnar and more proximal area was the radiotriquetral ligament. A constant radiopaque invagination between the outlines of contrast material demonstrated the sulcus anatomically separating these two ligaments. When the ligaments were transected contrast material entered the substance of the ligaments, rendering them radiopaque and, thus, visible on the radiographs. The authors believe that arthrotomography may be a useful clinical tool in the evaluation of post-traumatic injuries to the palmar radiocarpal ligaments of the wrist.

Adult↗
PubMedDate not supplied

Patterns of injury to carpal ligaments. A spectrum.

The concept of a spectrum of progressive ligamentous injury of the wrist, supported by anatomical and biomechanical data, indicates that a pattern of ligamentous injury begins on the radial side of the wrist. The mechanism of carpal injury associated with this ligamentous damage is a three-dimensional or spatial mechanism including extension, ulnar deviation, and intercarpal supination. Perilunar instability (PLI) begins at the scapholunate joint (Stage I PLI) and may be associated with partial interosseous ligament tears, interosseous ligament elongation, or complete disruption. Radiocapitate ligament failure leads to Stage II (PLI) with opening of the space of Poirier. This proceeds to Stage III (PLI) with radiotriquetral ligament failure. Stage IV (PLI) exhibits dorsal radiocarpal ligament disruption.

Adult↗
PubMed1981

The role of incompetence of the anterior cruciate and lateral ligaments in anterolateral and anteromedial instability. A biomechanical study of cadaver knees.

UNLABELLED: The anterolateral and anteromedial stability of seventeen fresh frozen cadaver knees was studied in a test apparatus designed to simulate physiological conditions. Statistically significant increases in internal rotation occurred in seven knees when only the anterior cruciate ligament was sectioned, and these increases were enhanced by subsequent sectioning of the posterolateral complex and the lateral collateral ligament, singly or in combination. On the other hand, sectioning of the posterolateral complex and of the lateral collateral ligament, leaving the anterior cruciate intact, did not produce significant increases in internal rotation until the anterior cruciate ligament was sectioned in seven knees. When the entire anterolateral capsule was sectioned as far posterior as the lateral collateral ligament in three knees, no changes in internal or external rotation occurred. Only when the posterolateral complex was sectioned was there a significant increase in external rotation in any of the ligament-sectioning sequences. Thus, it appears that for pathological internal rotation of the tibia on the femur to occur, the anterior cruciate ligament must be incompetent. CLINICAL RELEVANCE: The test apparatus and the results are useful in assessing which ligament structures contribute to clinically noted rotational knee instabilities.

Biomechanical Phenomena↗
PubMed1994

Posterior cruciate ligament strain biomechanics in total knee arthroplasty.

To evaluate the role of the posterior cruciate ligament in total knee arthroplasty, 8 normal whole-leg cadaveric legs were studied. Strain patterns of the posterior cruciate ligament were measured during active and passive knee flexion extension. Total knee arthroplasty was performed, and posterior cruciate ligament strain was measured again. The standard tibial insert was removed, and 3 additional tibial trays were used: flat, 10 degrees sloped, and 15 degrees sloped. The posterior cruciate ligament strain was recorded for each tibial insert. Total knee arthroplasty with a standard insert produced a large range of posterior cruciate ligament strain values (+/- 6%). Of the 8 specimens, 3 produced excessively taut posterior cruciate ligament strain, 3 were slack, and 2 returned strain to the baseline strain value. Changing the surface contour and slope of the tibial inserts did not produce any consistent change in the posterior cruciate ligament strain pattern. The ability of total knee arthroplasty to reproduce normal posterior cruciate ligament strain behavior has not been demonstrated.

Biomechanical Phenomena↗
PubMed1993

Factors affecting knee motion after total knee arthroplasty: a cadaveric study of the collateral ligament.

Many of the factors affecting postoperative knee motion are related to collateral ligament imbalance. In a cadaveric knee model, the center of origin of either the medial or lateral collateral ligament was found to be located at the center of the quarter circle of the posterior femoral condyle. Two distances were identified: OD (from the center of origin of the collateral ligament to the distal tibiofemoral articulation) and OP (from the center of origin of the collateral ligament to the posterior tibiofemoral articulation). The effect of the collateral ligaments on knee motion was demonstrated by stimulating joint line elevation and ligamentous stretching in a cadaveric knee model. In the knee with an elevated joint line without concomitant anterior displacement (OD reduced, OP unchanged), the flexion limit was reduced. When the collateral ligaments were stretched in a knee with constant OD and OP, both the flexion and extension limits were reduced. A correct joint level can be achieved by measuring the OD, OP and the tension of the collateral ligaments during total knee arthroplasty.

Arthroplasty↗
PubMed1993

[Morphological study of the innervation of spinal ligaments in scoliotic patients].

The purpose of this study was to investigate the morphology of nerve endings in spinal ligaments of scoliotic and normal patients. Nervous elements were investigated by means of gold chloride (AuCl2) impregnation and an indirect avidine-biotine peroxydase immunohistochemical method. Antiserum to a neurofilament protein (NFP) and S-100 protein were used as specific markers of nervous elements. In scoliotic and normal patients, immunohistochemical staining demonstrated a rich innervation of inter- and supra-spinous ligaments as compared to the yellow ligament. The immunohistochemical staining is however the most convenient and specific mean for studying the innervation in the ligaments. These two staining methods did not show any morphological difference in nervous elements of scoliotics ligaments as compared to the normal ligaments. These findings confront the role of the posterior ligamentous system in proprioception essential both in static and dynamic function of the sepine. However, the degeneration of neural elements in spinal ligaments could be involved in the etiology of the idiopathic scoliosis.

Adult↗
PubMed1996

[Diagnostic value of magnetic resonance tomography of the upper ankle joint--imaging of ligaments and tendons in standard slice orientation].

PURPOSE: Evaluation of the capability of high field strength MRI in depicting clinically important tendons and ligaments of the ankle joint using slice orientations parallel to the standard space directions without angulation. MATERIALS AND METHODS: 65 patients whose ankle joint complaints were not sufficiently clarified by conventional radiology sphere underwent MRI using plain T1-weighted spin echo sequences. Tendons and ligaments were classified by three independent radiologists with regard to their perceptibility on images of the different slice orientations. RESULTS: Good perceptibility of at least two-thirds of each structure with the possibility for a decision regarding continuity or rupture of the remaining part was given most frequently in the following slice orientations: Axially for the tendons of peroneus longus, peroneus brevis, tibialis posterior, flexor digitorum longus, flexor hallucis longus, tibialis anterior, extensor digitorum longus, and extensor hallucis longus muscles, and for the calcanear tendon (each over 94% of cases), anterior (68%) talofibular ligament, deltoid (77%), anterior (63%), and posterior (72%) tibiofibular ligaments and coronally for the calcaneofibular (39%) and posterior talofibular ligaments (70%). The sagittal orientation was never the favoured one. CONCLUSIONS: All tendons and ligaments of the ankle joint, except for the calcaneofibular and anterior tibiofibular ligaments, can be sufficiently visualized in the majority of cases by non-angulated spin echo sequences in standard slice orientations if the examination is performed in at least two slice directions. Thus, the minimal examination program should be: one T2-weighted sequence, T1-weighted sequences axially and in a further orientation, i.e. slightly angulated coronally for depicting the calcaneofibular ligament.

Achilles Tendon↗
PubMed1996

A global verification study of a quasi-static knee model with multi-bundle ligaments.

The ligaments of the knee consist of fiber bundles with variable orientations, lengths and mechanical properties. In concept, however, these structures were too often seen as homogeneous structures, which are either stretched or slack during knee motions. In previous studies, we proposed a new structural concept of the ligaments of the knee. In this concept, the ligaments were considered as multi-bundle structures, with nonuniform mechanical properties and zero force lengths. The purpose of the present study was to verify this new concept. For this purpose, laxity characteristics of a human knee joint were compared as measured in an experiment and predicted in a model simulation study. In the experiment, the varus-valgus and anterior-posterior laxities of a knee-joint specimen containing the ligaments and the articular surfaces only, were determined. From this knee-joint, geometric and mechanical parameters were derived to supply the parameters for a three-dimensional quasi-static knee-joint model. These parameters included (i) the three-dimensional insertion points of bundles, defined in the four major knee ligaments, (ii) the mechanical properties of these ligament, as functions of their relative insertion orientations and (iii) three-dimensional representations of the articular surfaces. With this model the experiments were simulated. If knee-model predictions and experimental results agree, then the multi-bundle ligament models are validated, at least with respect to their functional role in anterior-posterior and varus-valgus loading of the joint. The model described the laxity characteristics in AP-translation and VV-rotation of the cadaveric knee-joint specimen reasonably well. Both display the same patterns of laxity changes during knee flexion. Only if a varus moment of 8 N m was applied and if the tibia was posteriorly loaded, did the model predict a slightly higher laxity than that measured experimentally. From the model-experiment comparisons it was concluded that the proposed structural representations of the ligaments and their mechanical property distributions seem to be valid for studying the anterior-posterior and varus-valgus laxity characteristics of the human knee-joint.

Biomechanical Phenomena↗
PubMed1977

The cruciate ligaments of the canine stifle: an anatomical and functional analysis.

Fifty canine stifles were used to study the anatomy and function of the cruciate ligaments. The morphology of the ligaments and the shape of their bony attachments were determined by dissection. The relative tension of the ligaments in flexion and extension was determined by identifying the points of attachment of ligament fibers with small pins and making multiple radiographs as the stifle was taken through a range of motion. The distance between these points was then measured and the linear changes in the ligaments were defined. Measurements of rotation, craniocaudal displacement, extension, and flexion were made before and after cutting of one or both ligaments. It was found that both cruciate ligaments were composed of 2 component parts and that the geometry of their femoral attachments was responsible for a reciprocal loosening and tightening of these components through a range of motion. It was also found that transection of one or both cruciate ligaments resulted in marked joint instability.

Animals↗
PubMed1998

[Anatomical study of Cooper's ligament. Value in the surgical cure of urinary incontinence in women].

The objective of the study was to measure Cooper's ligament thickness in the middle and at 1, 2, 3, 4 cm and to find the best place to fix the stitches of colposuspension. This study was performed on fresh cadavers. Sixteen Cooper's ligaments were studied (8 women, mean age 78 +/- 6 years). The length, the width and thickness of Cooper's ligament at 0, 1, 2, 3, 4 cm from the middle were measured. The limits of Cooper's ligament are indefinite. This ligament is significantly thicker (p < 0.01) in the middle and at 4 cm from the middle (2.2 +/- 0.4 mm) than 1 cm (1.4 +/- 0.5), 2 cm (1.4 +/- 0.5 mm) and at 3 cm (1.9 +/- 0.3 mm) from the middle. Cooper's ligament is used to fix the stitches for colposuspension derived from Burch colposuspension (non-incision percutaneous colposuspension to Cooper's ligament, laparoscopic colposuspension...) and sometime help to fix meshes in frondes procedures and the vagina in the Bologna procedure. This study showed the best point to fix the stitches (by its thickness) for colposuspension on this ligament at 4 cm from the middle (the fixation at the origin exposing to periostitis).

Aged↗
PubMed1998

[Resistance of the the coraco-clavicular ligaments to traction: clinical application].

One method for treating chronic incapacitating acromioclavicular dislocation is to resect the external extremity of the clavicle and to stabilise the stump by ligamentoplastic procedures, using the coracoclavicular ligament. The purpose of this work was to evaluate the mechanical quality of the ligamentoplastic approach. Twelve fresh cadavers, average age 80 years, were studied. The samples taken were 24 coracoclavicular ligaments, 24 coraco-acromial ligaments, 9 tendons from the palmaris longus muscle and 9 iliotibial tracts. The ligaments removed were tested in a Instron traction machine at a speed of 10 cm/mn. The mechanical properties of the coracoclavicular and coraco-acromial ligaments were studied. For comparison, those of the tendon of the palmaris longus muscle and the iliotibial tract were also studied. The results show the pre-rupture resistance of the coraco-acromial ligament to be 50% lower than that of the trapezoid and conoid parts of the coracoclavicular ligaments taken together. These results suggest the validity of ligamentoplastic treatment using the coraco-acromial ligament, but that reinforcement, using a tendon from the palmaris longus muscle or a piece of the iliotibial tract, may also be necessary, especially for subjects taking part in sports or with well-developed musculature.

Acromioclavicular Joint↗
PubMed1996

Changes in the distribution of fibrillar collagens in the collateral and cruciate ligaments of the rabbit knee joint during fetal and postnatal development.

The collateral ligaments can be clearly distinguished in the 25-day fetal rabbit knee joint. Type I and V collagens are present in the extracellular matrix between the cells of the lateral and medial collateral ligaments and this distribution persists until the rabbit is skeletally mature. From 8 months onwards type III collagen is also present, particularly around the cells. Type I collagen mRNA is expressed by the cells from the 25-day fetal to 8-month-old adult ligament. The ligament sheath is composed of types III and V collagens. The cruciate ligaments are present between the femur and tibia in the 20-day fetus. The matrix is composed of types I and V collagens from the 25-day fetus until at 12- to 14-weeks postnatal, type III collagen appears in the pericellular regions together with type V. At 8 months and 2 years the amount of type III collagen has increased. All the cells express the mRNA for type I collagen at 12- to 14-weeks, but only isolated cells express this mRNA at 8 months. Thus, both the collateral and cruciate ligaments undergo changes in their complement of collagens during postnatal development and ageing. The implications of these complex interactions of different types of collagen are discussed in relation to healing and the surgical replacement of torn ligaments by tendons.

Animals↗