Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “LIGAMENTS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,279 records · Page 71Linked to original sources
PubMedDate not supplied

Clinical outcomes after combined meniscal allograft transplantation and anterior cruciate ligament reconstruction.

BACKGROUND: Concomitant meniscal transplantation performed at the time of ligament surgery may help to protect the anterior cruciate ligament graft. PURPOSE: To determine the objective and subjective clinical outcomes after combined anterior cruciate ligament reconstruction and meniscal allograft transplantation. STUDY DESIGN: Uncontrolled retrospective review. METHODS: Twenty-eight patients who underwent anterior cruciate ligament reconstruction along with meniscal transplantation were retrospectively evaluated postoperatively at an average of 2.8 years (range, 1.8 to 5.6). RESULTS: On the International Knee Documentation Committee overall subjective assessment, 86% had normal or nearly normal scores. The SF-36 physical and mental component summary scores were at higher levels than those of the patients' age- and sex-matched populations. Objectively, nearly 90% had normal or nearly normal Lachman and pivot shift test scores. The KT-1000 arthrometer testing at 30 pounds and maximum manual both demonstrated an average increased anterior translation of 1.5 mm compared with the contralateral knee. Joint space narrowing of the transplanted compartments was not significantly different from that of the contralateral knee. CONCLUSIONS: Meniscal transplantation with anterior cruciate ligament reconstruction can be a beneficial procedure in properly selected patients with either chronic anterior cruciate ligament insufficiency or failed anterior cruciate ligament surgery. Restoration of meniscal function may provide protection for the articular cartilage and improve joint stability.

Adolescent↗
PubMed2005

Revision anterior cruciate ligament reconstruction using a 2-stage technique with bone grafting of the tibial tunnel.

BACKGROUND: Revision anterior cruciate ligament surgery is often considered a salvage procedure with limited goals. However, this limitation need not be the case. Similar to primary reconstruction, the goal should be to choose an appropriate graft and place it in an anatomical position in a good quality bone. The issue of good quality bone seems to have been ignored. HYPOTHESIS: A 2-stage anterior cruciate ligament revision reconstruction with bone grafting of the tibial tunnel and the use of a different femoral tunnel will produce measured knee laxity and International Knee Documentation Committee scores similar to a primary anterior cruciate ligament reconstruction. STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: This prospective study involved 49 consecutive 2-stage anterior cruciate ligament revisions (group R) performed by a single surgeon from 1993 to 2000. Two-stage revision surgery was performed if the tibial tunnel from a previous reconstruction surgery would overlap (either partially or fully) the correctly placed revision tunnel. The first stage consisted of removal of the old graft and interfering metalwork, together with bone grafting of the tibial tunnel. After ensuring adequate bone graft incorporation using computed tomography scan, the second stage revision was undertaken. This stage comprised harvesting the autograft, its anatomical placement, and its adequate fixation. The results were compared with the results of a matched group of patients with primary anterior cruciate ligament reconstruction (group P). RESULTS: In group R, as meniscal and chondral lesions were more common, the International Knee Documentation Committee scores were lower than those of group P (61.2 for group R and 72.8 for group P; P = .006). Objective laxity measurement was similar in both groups (1.36 mm for group R and 1.2 mm for group P; P = .25). CONCLUSION: This study establishes that the laxity measurements achieved with a 2-stage revision anterior cruciate ligament reconstruction can be similar to those achieved after primary anterior cruciate ligament reconstruction, although the International Knee Documentation Committee rating is lower.

Adult↗
PubMed2005

Gender differences in outcome after anterior cruciate ligament reconstruction with hamstring tendon autograft.

BACKGROUND: It is now well documented that women are more likely to suffer anterior cruciate ligament injuries than are men. A few studies have examined gender differences in the outcome of anterior cruciate ligament reconstruction with patellar tendon graft and hamstring tendon with EndoButton fixation, but no well-controlled studies have specifically compared men and women after anterior cruciate ligament reconstruction with hamstring tendon graft and interference screw fixation. HYPOTHESIS: There is no difference in outcome between men and women after anterior cruciate ligament reconstruction with hamstring tendon autograft and interference screw fixation. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: There were 100 men and 100 women who underwent isolated anterior cruciate ligament reconstruction by a single surgeon. Patients were assessed preoperatively and at 1, 2, and 7 years after surgery. Variables were compared between female and male patients. RESULTS: Laxity on physical evaluation was greater in women than in men on Lachman (P = .04), pivot-shift (P = .05), and mean manual maximum testing (P = .05) at 7 years. However, the magnitude of this difference was small. No patient had a greater than grade 1 Lachman or pivot-shift test result, and the mean difference between men and women was 0.6 mm on instrumented testing. Anterior cruciate ligament graft rupture occurred in 11 men and 10 women. There was no difference between male and female patients for self-reported knee function or symptoms of instability or radiologic examination. CONCLUSION: Anterior cruciate ligament reconstruction using hamstring tendon autograft affords excellent self-reported and objective results in both men and women after 7 years. Although significantly greater laxity on physical examination was present in female patients than in male patients, the magnitude of this difference was small and had no effect on activity level, graft failure, or subjective or functional assessment.

Adult↗
PubMed2006

Outcomes of anterior cruciate ligament injuries to running backs and wide receivers in the National Football League.

BACKGROUND: Anterior cruciate ligament injuries are common in professional football players, and their career impact is unclear. PURPOSE: To quantify the affect of anterior cruciate ligament injuries on professional football player performance. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: Anterior cruciate ligament injury data from the National Football League were collected during a 5-year period (1998-2002) for running backs and wide receivers. Recorded variables included player age, experience, position, time to return to competition, and yearly total yards and touchdowns. Power ratings (total yards divided by 10 plus touchdowns multiplied by 6) were calculated for the injury season as well as for the 3 seasons before and after injury. A control group consisted of all running backs and wide receivers without an identified anterior cruciate ligament injury who competed in the 2000 season. RESULTS: Data were analyzed for 31 running backs and wide receivers with 33 anterior cruciate ligament injuries. More than one fifth of players never returned to a National Football League game. Returning players first competed in a game 55.8 +/- 5.4 weeks (mean +/- standard error) after injury. For the 24 anterior cruciate ligament-injured players with a minimum total power rating (sum of all 7 seasons) of 200 points, power rating per game played decreased from 9.9 +/- 1.1 preinjury to 6.5 +/- 0.9 postinjury. This decline in power rating per game played was statistically significant (P = .002) when compared with the change for the 146 control players. CONCLUSION: Nearly four fifths of National Football League running backs and wide receivers who sustain an anterior cruciate ligament injury return to play in a game. On return to competition, player performance of injured players is reduced by one third.

Adult↗
PubMed2006

In vivo kinematics of the knee after anterior cruciate ligament reconstruction: a clinical and functional evaluation.

BACKGROUND: Recent follow-up studies have reported a high incidence of joint degeneration in patients with anterior cruciate ligament reconstruction. Abnormal kinematics after anterior cruciate ligament reconstruction have been thought to contribute to the degeneration. HYPOTHESIS: Anterior cruciate ligament reconstruction, which was designed to restore anterior knee laxity under anterior tibial loads, does not reproduce knee kinematics under in vivo physiological loading conditions. STUDY DESIGN: Controlled laboratory study. METHODS: Both knees of 7 patients with complete unilateral rupture of the anterior cruciate ligament were magnetic resonance imaged, and 3D models were constructed from these images. The anterior cruciate ligament of the injured knee was arthroscopically reconstructed using a bone-patellar tendon-bone autograft. Three months after surgery, the kinematics of the intact contralateral and reconstructed knees were measured using a dual-orthogonal fluoroscopic system while the subjects performed a single-legged weightbearing lunge. The anterior laxity of both knees was measured using a KT-1000 arthrometer. RESULTS: The anterior laxity of the reconstructed knee as measured with the arthrometer was similar to that of the intact contralateral knee. However, under weightbearing conditions, there was a statistically significant increase in anterior translation of the reconstructed knee compared with the intact knee at full extension (approximately 2.9 mm) and 15 degrees (approximately 2.2 mm) of flexion. In addition, there was a mean increase in external tibial rotation of the anterior cruciate ligament-reconstructed knee beyond 30 degrees of flexion (approximately 2 degrees at 30 degrees of flexion), although no statistical significance was detected. CONCLUSION: The data demonstrate that although anterior laxity was restored during KT-1000 arthrometer testing, anterior cruciate ligament reconstruction did not restore normal knee kinematics under weightbearing loading conditions. CLINICAL RELEVANCE: Future reconstruction techniques should aim to restore function of the knee under physiological loading conditions.

Adult↗
PubMedDate not supplied

The accuracy of the clinical examination in the setting of posterior cruciate ligament injuries.

Thirty-nine subjects volunteered for this blinded, randomized, and controlled study to assess the clinical examination skills of orthopaedic surgeons with fellowship training in sports medicine. Eighteen of the patients had 19 chronic isolated posterior cruciate ligament tears. The controls were 9 patients with 9 anterior cruciate ligament-deficient knees, 12 subjects with normal knees, and the contralateral normal knees of the ligament-deficient patients. To eliminate preexamination bias, all examiners were blinded from the examinee's history, identity, and diagnosis. The overall clinical examination accuracy for all orthopaedic surgeons was 96%. The accuracy for detecting a posterior cruciate ligament tear was 96%, with a 90% sensitivity and a 99% specificity. The examination accuracy was higher for grade II and III posterior laxity than for grade I laxity. Eighty-one percent of the time, the examiners agreed on the grade of the posterior cruciate ligament tear for any given patient. The posterior drawer test, which included palpation of the tibia-femur step-off, was the most sensitive and specific clinical test. A thorough and precise physical examination, coupled with a patient history, can be considered diagnostic in the majority of isolated posterior cruciate ligament injuries. With this accuracy level known, the natural history of isolated posterior cruciate ligament tears can be reliably documented and studied.

Adolescent↗
PubMedDate not supplied

The role of the popliteofibular ligament in stability of the human knee. A biomechanical study.

The popliteal tendon has a significant attachment to the fibula, the popliteofibular ligament. The role of this ligament in knee stability has not been determined. In this study we used selective cutting techniques to measure the static contribution of the popliteal tendon attachments to the tibia and the popliteofibular ligament for stability of the knee. Sectioning of all the posterolateral structures except the popliteal tendon attachments to the tibia or the popliteofibular ligament resulted in increased primary posterior translation, varus rotation, external rotation, and coupled external rotation. Although statistically significant, these increases were small. Sectioning of all the posterolateral structures resulted in larger increases in primary posterior translation, varus rotation, external rotation, and coupled external rotation. Our data indicate that the popliteal tendon attachments to the tibia and the popliteofibular ligament are important in resisting posterior translation and varus and external rotation. If an isolated injury to the posterolateral structures occurs, anatomic reconstruction of the major ligaments that restrain posterior translation and varus and external rotation may provide the best functional result. Reconstruction for isolated posterolateral instability should include anatomic attachment of the popliteal tendon to the tibia and the popliteofibular ligament.

Aged↗
PubMedDate not supplied

Anterior cruciate ligament graft rotation. Reproduction of normal graft rotation.

The purpose of this study was to determine normal rotation of the anterior cruciate ligament and to provide a technique for reproduction of this rotation. Ten fresh-frozen knees were dissected of all soft tissue except for the anterior cruciate ligament. Specimens were secured in a vise in 60 degrees of flexion. Each tibia was allowed to spin freely on the femur, and rotation was recorded. Anterior cruciate ligament reconstructions, using bone-patellar tendon-bone grafts, were then performed on all specimens using four graft rotations. Each specimen was then tested to assess how the graft twist affected tibial rotation. The average tibial rotation of the normal anterior cruciate ligaments was 55 degrees internally. Previous descriptions of anterior cruciate ligament reconstructions have advocated medial or internal rotation of the graft to reproduce normal anatomic rotation of the anterior cruciate ligament. Our cadaveric dissections have demonstrated that the anterior cruciate ligament normally produces internal rotation of the tibia in relation to the femur. Reproduction of this anatomic rotation is accomplished with 90 degrees of lateral rotation of the tibial plug toward the fibula.

Aged↗
PubMedDate not supplied

Analysis of skiing accidents involving combined injuries to the medial collateral and anterior cruciate ligaments.

Two types of ligament injuries common in skiing are the isolated ruptures of the anterior cruciate and ruptures of the medial collateral, either with or without rupture of the anterior cruciate. Based on research related to ligament injury mechanics and two-mode release binding function, the purpose of this paper was to critically assess the ability of two-mode release bindings to prevent combined medial collateral and anterior cruciate ligament injuries. Making this assessment entailed several steps. First, I determined the loads typically transmitted by the knee during falls in which combined injuries occurred. Because more than one load was transmitted, the next step was to discern which of the loads was more damaging. Finally, heel-toe type bindings were evaluated for their potential to release in response to damaging loads. I concluded that combined medial collateral and anterior cruciate ligament injuries typically occur in forward, twisting-type falls in which the primary loads are external axial and valgus moments. An external axial moment is more damaging than a valgus moment, both to the medial collateral ligament when the joint is intact and to the anterior cruciate ligament when the medial collateral ligament is damaged. Because heel-toe type bindings offer release sensitivity to this moment, the release level of the toepiece in twist is an important factor in the prevention of these injuries.

Accidents↗
PubMed2006

Kinematic MRI of the normal ankle ligaments using a specially designed passive positioning device.

BACKGROUND: Knowledge of the normal MRI appearances of the ankle ligaments and tendons is particularly important in the diagnosis of ankle sprains. In most clinical practices, the ankle is imaged in a neutral position with standard imaging planes and sequences. The purpose of our study was to investigate whether passive positioning influences the MRI appearances of the ligaments of the ankle. METHODS: The axial and coronal T1-weighted MR images obtained from 10 subjects were reviewed by two musculoskeletal radiologists. The following imaging planes were used: dorsiflexion with inversion, dorsiflexion with neutral, dorsiflexion with eversion, neutral with inversion, neutral, neutral with eversion, plantarflexion with inversion, plantarflexion with neutral, and plantarflexion with eversion. A subjective rating system was used to determine the optimal imaging plane and position for individual ligaments in each volunteer. Each ligament was rated on a scale (of 1 to 6). RESULTS: There were significant differences in the appearances of the anterior talofibular (p = 0.0002), calcaneofibular (p < 0.0001), and posterior talofibular (p < 0.0001) ligaments between the optimal and least optimal ankle positions in the axial plane, and in those of the (plantar calcaneonavicular) spring (p < 0.0001), tibiocalcaneal (p < 0.0001), posterior tibiotalar (p = 0.0087) and posterior talofibular (p = 0.0213) ligaments in the coronal plane. CONCLUSIONS: Kinematic MRI of the ankle is feasible and appears to improve visualization of ankle ligaments compared to MRI.

Adult↗
PubMed1999

Total knee arthroplasty with retention of both cruciate ligaments. A nine to eleven-year follow-up study.

BACKGROUND: Although many early designs of total knee arthroplasty allowed the retention of both cruciate ligaments, in most current designs of knee replacement systems, either both cruciate ligaments are removed or the posterior cruciate ligament alone is retained. This report is a review of a series of total knee arthroplasties in which both cruciate ligaments were retained. METHODS: The results of 163 total knee arthroplasties (130 patients) in which both cruciate ligaments were retained were assessed prospectively. One hundred and seven knees (eighty-nine patients) were followed for an average of ten years. There were thirty-four men and ninety-six women, and the average age at the time of the index arthroplasty was sixty-seven years (range, forty-two to eighty-four years). The diagnosis was osteoarthritis in 122 (75 percent) of the knees and rheumatoid arthritis in forty-one (25 percent). Twenty-six knees had a valgus deformity, 109 had a varus deformity, and twenty-eight had a normal alignment of 5 to 10 degrees of valgus. The anterior cruciate ligament was relatively normal in ninety-six knees and was partly degenerated in sixty-seven knees. With use of the rating system of the Knee Society, all 163 knees were prospectively evaluated at yearly intervals; fifty-six of these knees (in forty-one patients) were followed in this manner until the patient died or was lost to follow-up. RESULTS: One hundred and four (97 percent) of the 107 knees available for study at an average of ten years had an excellent or good result. At the time of the latest follow-up, pain was adequately relieved in ninety-seven knees (91 percent) and the average range of flexion was 107+/-12.6 degrees (range, 65 to 135 degrees). Ninety-five knees (89 percent) had normal anteroposterior stability (less than five millimeters of movement in this plane), and twelve knees (11 percent) had five to ten millimeters of movement as demonstrated by the drawer sign. Ninety-six knees (90 percent) had normal mediolateral stability, and eleven (10 percent) had 5 to 10 degrees of laxity. Ninety-four knees (88 percent) had valgus alignment of 5 to 10 degrees. The average knee score was 91+/-8.4 points (range, 54 to 100 points), and the average functional score was 82+/-21 (range, 10 to 100 points). The survival rate at ten years, with revision as the end point, was 95+/-2.0 percent. Seven (4 percent) of the 163 knees in this series were revised. There were no revisions for patellar problems or aseptic loosening of the tibial component. CONCLUSIONS: The good anteroposterior stability in this series after an average follow-up period of ten years indicates that both the anterior and the posterior cruciate ligaments, even when partly degenerated, remain functional when they are preserved in a total knee arthroplasty.

Aged↗
PubMed2003

Occupational disability after hospitalization for the treatment of an injury of the anterior cruciate ligament.

BACKGROUND: To date, no large population-based studies have focused on permanent occupational disability after injury of the anterior cruciate ligament as far as we know. The purpose of our study was to determine the risk factors for occupational disability after an injury of the anterior cruciate ligament. METHODS: We identified a cohort of 2192 active-duty personnel in the Army who had been hospitalized between 1989 and 1997 because of an injury of the anterior cruciate ligament and had completed a health risk-assessment survey. With use of the Total Army Injury and Health Outcomes Database, we retrospectively followed these individuals for up to nine years and collected clinical, demographic, occupational, and psychosocial data. These data were then evaluated with bivariate and proportional-hazards regression analyses to identify risk factors for receiving a disability discharge related to an injury of the anterior cruciate ligament. RESULTS: Overall, 209 (9.5%) of 2192 initial anterior cruciate ligament injuries resulted in a permanent disability discharge. In bivariate analyses, the following factors were related to a disability discharge: lower job satisfaction (p < 0.0001), lower education level (p < 0.0001), shorter length of service (p < 0.0001), lower pay grade or rank (p < 0.0001), occupational classification (p < 0.0001), older age (p < 0.01), cigarette-smoking (p = 0.01), and greater mental stress at work (p = 0.02). Associated cartilage injury (p = 0.07) and occupational physical demands (p = 0.08) approached significance; however, with the numbers available, other variables that were hypothesized to contribute to the development of disability, such as gender (p = 0.85), reconstruction of the anterior cruciate ligament (p = 0.52), and other secondary comorbidities of the knee, demonstrated no significant association. Proportional-hazards regression analysis confirmed that pay grade or rank, occupational classification, job satisfaction, age, and length of service were independent predictors of disability discharge. CONCLUSIONS: In keeping with risk profiles of several other musculoskeletal disorders, such as low-back pain and carpal tunnel syndrome, the results revealed a multifactorial risk profile in which psychosocial factors were strongly associated with disability discharge from active military duty after injury of the anterior cruciate ligament.

Adolescent↗
PubMed1993

MR evaluation of the anterior cruciate ligament: value of supplementing sagittal images with coronal and axial images.

OBJECTIVE: Most studies evaluating the anterior cruciate ligament have focused on sagittal MR images for the diagnosis of injury. Limitations of sagittal images have been reported, however, including nonvisualization and incomplete visualization of the ligament. This study was undertaken to assess the value of adding coronal and axial MR images to sagittal images in the evaluation of the anterior cruciate ligament. MATERIALS AND METHODS: We reviewed oblique sagittal T1-weighted, coronal T2-weighted, and axial T2-weighted images to determine the status of the anterior cruciate ligament in 325 patients. All patients had arthroscopy. Sagittal images were initially interpreted alone and then in combination with coronal and axial images. RESULTS: Sagittal T1-weighted images alone had a 94% sensitivity and an 84% specificity for determining the status of the anterior cruciate ligament. A multiplanar evaluation of the anterior cruciate ligament resulted in a change in MR interpretation in 21 patients (6%), which led to an improved sensitivity of 98% and a specificity of 93%. Diagnostic confidence was improved in an additional 14 patients (4%). CONCLUSION: Our results show that the efficacy of MR imaging for the detection of anterior cruciate ligament tears is greater when axial and coronal images are used in combination with sagittal images than when sagittal images are used alone.

Adult↗
PubMedDate not supplied

[Patellar fracture after reconstruction of the anterior cruciate ligament--case report].

INTRODUCTION: The most frequent procedure in treatment of acute or chronic anterior cruciate ligament (ACL) rupture is the so called bone-tendon-bone reconstruction. A transverse dislocated patella fracture is a rare complication of this procedure with an incidence of 0.23%-2.3%. In a five year period, (1998-2002), 407 arthroscopic reconstructions of the anterior cruciate ligaments were done at our Clinic, and there was only one case of patella fracture. CASE REPORT: An 18-year-old female patient, a handball player, suffered an acute rupture of anterior cruciate ligament of the left knee, so arthroscopic bone-tendon-bone reconstruction of the anterior cruciate ligament was performed. After adequate skin incision, a bone graft was taken from the patella and upper part of trapezoid tibia, which was 25 mm long, 10 mm wide and 5 mm thick, together with a part of patellar ligament. After the remains of the anterior cruciate ligament had been arthroscopically removed, tunnels were made in tibia and femur and a graft was inserted and fixed with two metal interference screws. Knee stability was tested, and drainage was put in the knee joint. The wound was closed by layers. The quadriceps exercises and passive knee movements started immediately. Full range of movements was accomplished six weeks later when the patient started to walk with full weight-bearing on her operated leg. Three weeks later, (nine weeks after the operation), the patient has accidentally lost her balance and fell. A transverse, dislocated fracture of the left patella was diagnosed and osteosynthesis of the fractured patella with two Kirschner wires and a metallic loop was performed. Postoperatively, full range of movement was allowed. Six months later, the patient felt no pain, there was no swelling, full range of knee movement was achieved, while the Lachman Test was identical in both knees and the pivot shift test was negative. DISCUSSION: Fracture of patella after ACL reconstruction is due to several reasons: size and shape of the graft, technique of its taking, disturbed patellar blood supply, incomplete filling of patella defect after graft taking, and inappropriate postoperative rehabilitation. If a patellar fracture occurs after anterior cruciate ligament reconstruction, the best treatment is firm osteosynthesis, which enables bone healing and immediate continuation of the previously resumed rehabilitation program. However, this complication prolongs the rehabilitation period and slows down return to sports.

Adolescent↗
PubMed2005

Intraoperative arthrometry in anterior cruciate ligament reconstruction.

Arthrometry has an established role in the measurement of knee laxity in anterior cruciate ligament injury and following reconstruction. The role of routine intraoperative arthrometry in anterior cruciate ligament reconstruction is poorly defined, and this study was designed to test the hypothesis that intraoperative arthrometry provides an objective method of documenting successful knee stabilisation following anterior cruciate ligament reconstruction. A consecutive cohort of 100 patients with unilateral isolated anterior cruciate ligament disruption were prospectively evaluated using a Rolimeter arthrometer. A maximal manual force method was utilised by a single examiner. This allowed for side-to-side comparisons with the uninjured contralateral knee. Analysis of tibial translation was recorded preoperatively with patients both awake and asleep, intraoperatively following anterior cruciate ligament reconstruction, and postoperatively at 2 weeks and 3 months. Statistical analysis was performed using Spearman's correlation coefficients. Intraoperative arthrometry of anterior cruciate ligament reconstructed knees revealed statistically significant correlation with measurements of uninjured knees (p < 0.0001). These findings were reproducible at 2 weeks (p < 0.0001) and at 3 months (p = 0.0002). Based on our findings, we conclude that intraoperative arthrometry can be simple and provide reproducible results. It is a useful method of immediately and objectively documenting successful anterior cruciate ligament reconstruction.

Adolescent↗
PubMed2006

Multiple-ligament injured knee.

OBJECTIVE: To explore the clinical characteristic of the multiple-ligament injured knee and evaluate the protocol, technique and outcome of treatment for the multiple-ligament injured knee. METHODS: From October 2001 to March 2005, 9 knees with combined anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears in 9 patients were identified with clinical and arthroscopic examinations. Of them, 5 knees were combined with ruptures of posteromedial corner (PMC) and medial collateral ligament (MCL), 4 with disruptions of posterolateral corner (PLC), 2 with popliteal vascular injuries and 1 with peroneal nerve injuries. Six patients were hospitalized in acute phase of trauma, 2 received repairs of popliteal artery and 4 had repairs of PMC and MCL. Reconstructions of ACL and PCL with autografts under arthroscope were performed in all patients at 4 to 10 weeks after trauma, including reconstruction of PLC with the posterior half of biceps femoris tendon tenodesis in 4 patients and reconstructions of PMC and MCL with femoral fascia in 1 patient. RESULTS: No severe complications occurred at early stage after operation in the 9 patients. All of them were followed-up for 10-39 months with an average of 23.00 months+/-9.46 months. Lysholm score was 70-95 with an average of 85.00+/-8.29. International Knee Documentation Committee (IKDC) score was from severely abnormal (Grade D) in 9 knees at initial examination to normal (Grade A) in 2 knees, nearly normal (Grade B) in 6 knees and abnormal in 1 knee at the last follow-up. Of the 9 patients, 7 returned to the same activity level before injury and 2 were under the level. CONCLUSIONS: The multiple-ligament injured knee with severe instability is usually combined with other important structure damages. Therefore, careful assessment and treatment of the combined injuries are essential. Reconstructions of ACL and PCL under arthroscope, combined with repairs or reconstructions of the extraarticular ligaments simultaneously or in stages, have advantage of minimal trauma in surgery and satisfactory outcome.

Adult↗
PubMed1991

A sensory role for the cruciate ligaments.

Morphologic, physiologic, and clinical evidence for the sensory role of the cruciate ligaments is reviewed. The cruciate ligaments accommodate morphologically different sensory nerve endings (Ruffini endings, Pacinian corpuscles, Golgi tendon organlike endings, and free nerve endings) with different capabilities of providing the central nervous system with information not only about noxious and chemical events but also about characteristics of movements and position-related stretches of these ligaments. A survey of available data reveals that low threshold joint-ligament receptor (i.e., mechanoreceptor) afferents evoke only weak and rare effects in skeletomotor neurons (alpha-motor neurons), while they frequently and powerfully influence fusimotor neurons (gamma-motor neurons). The effects on the gamma-muscle-spindle system in the muscles around the knee are so potent that even stretches of the cruciate ligaments at relatively moderate loads (not noxious) may induce major changes in responses of the muscle spindle afferents. As the activity in the primary muscle spindle afferents modifies the stiffness in the muscles, the cruciate ligament receptors, via the gamma-muscle-spindle system, may participate in the regulation and preprogramming of the muscular stiffness around the knee joint and thereby of the knee joint stiffness. Thus, the sensory system of the cruciate ligaments is able to significantly contribute to the functional stability of the knee joint.

Anterior Cruciate Ligament↗
PubMed1995

[MR imaging features of chronically torn anterior cruciate ligament].

Magnetic resonance (MR) images of 40 knee joints with arthroscopically proved chronic anterior cruciate ligament (ACL) tears were retrospectively evaluated. MRI demonstrated various features of chronic ACL tears: 19 knees revealed with no identifiable ligamentous structure, and 21 had residual ligamentous structures. These pseudoligaments, 14 discontinuous bands and seven continuous bands with elongation, were residual torn ligamentous fibers and/or synovial tissues. All the discontinuous bands were disrupted from the femoral attachment and were likely to traverse the lower intercondylar space. Six disrupted ligaments were attached to the lateral aspect of the posterior cruciate ligament (PCL). Coronal T2-weighted gradient echo images showed better delineation of the disrupted femoral attachment and adhesion to the PCL. A chronic ACL tear with minimal elongation or with PCL attachment at a higher position may occasionally be difficult to distinguish from an intact ligament.

Adolescent↗