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PubMedDate not supplied

Characterization of cultured cells derived from ossification of the posterior longitudinal ligament of the spine.

Ossification of the posterior longitudinal ligament of the spine (OPLL) is a common cause of spinal canal stenosis and myelopathy in Orientals. OPLL is characterized by heterotopic new bone formation in ligamentous tissue. To investigate the pathogenesis of OPLL, human posterior longitudinal ligament cells were cultured and their in vitro morphological and biochemical characteristics were studied. Cell cultures from control subjects with normal spinal ligaments did not show any osteoblastic properties. In contrast, cell lines (OG1-OG5) obtained from an OPLL patient showed several different phenotypic characteristics for osteoblasts. OG1 cells showed typical osteoblast-like phenotypic characteristics (i.e., in vitro calcification, high alkaline phosphatase [ALP] activity, and elevation of cAMP levels by parathyroid hormone [PTH]). All cell lines (OG1-OG5) responded to PTH and PGE2 by markedly increasing cAMP levels, ALP activities varied among the cell lines. The OG1 and OG2 cells exhibited a high level of ALP activity. Compared with cell lines from the non-ossification group, the activities were higher in the OG3 and OG4 cells, but not significantly in the OG5 cells. Only in the OG3 cells, CT caused an increase in cAMP level and ALP activity, and its stimulatory effects demonstrated that CT had a direct, in vitro action on ligament cells of OPLL patients to stimulate osteoblastic differentiation. It is clear that some cells from ligaments with OPLL had several phenotypes characteristic of osteoblasts, but cells from ligaments without ossification did not show any osteoblastic properties. This observation is considered to be an important clue to understanding the pathophysiology of OPLL.

Acid Phosphatase↗
PubMed2006

Nerve-epithelium association in the periodontal ligament of guinea pig teeth.

Several lines of evidence have suggested that periodontal nerves have other roles besides sensory function. Exploring the distribution pattern of nerves in relation to other structures within the periodontal ligament of various species should be important to understand their roles within the ligament. This study investigated whether any association exists between the nerves and the epithelial cells in the periodontal ligament of continuously erupting guinea pig molars, which show distinct enamel epithelium layers among the cementum pearls. Ten guinea pigs were fixed by vascular perfusion and jaw sections were processed for immunohistochemistry of protein gene product 9.5 (PGP 9.5), growth-associated protein-43 (GAP-43) and glia-specific S-100 protein, and for enzyme histocytochemistry of cholinesterase. Nerves that were immunopositive for the above neuronal markers were located predominantly in the alveolus-related part of the periodontal ligament. Some nerves, immunoreactive for PGP 9.5 and GAP-43, were also found in the tooth-related part (TRP) of the periodontal ligament close to the tooth surface. PGP 9.5-positive nerves in the TRP appeared very thin and terminated by making loops or plexus-like structures in close apposition to the epithelium layers, overlying the enamel surface in between cementum pearls. Such an intimate association between nerves and the enamel epithelium was not found in the labial periodontal tissue of incisors or the apical growing end of the molar, where periodontal fibre attachment was indistinct. The association between nerves and epithelium in the periodontal ligament of guinea pig molar is site specific and is only seen in the presence of cementum, suggesting that this association is related to the attachment function of the ligament.

Animals↗
PubMed2004

Arthroscopic evaluation of scaphoid waist fracture stability and the role of the radioscaphocapitate ligament.

PURPOSE: The purpose of this article is to arthroscopically evaluate the effect of forearm rotation on scaphoid fracture displacement and the impact of intra-articular ligament sectioning. TYPE OF STUDY: Controlled laboratory study. METHODS: Scaphoid fracture stability is studied arthroscopically in 10 cadaveric upper limbs. Displacement of the osteotomized scaphoid with and without forearm rotation is arthroscopically evaluated before and after radioscaphocapitate (RSC) ligament sectioning. RESULTS: No rotation at the fracture site was identified in full pronation and full supination with the wrist immobilized. With the RSC ligament intact, no immobilization, and the wrist fully pronated, 25% of scaphoid fractures rotated less than 1 mm, 62.5% rotated 1 to 2 mm, and 12.5% rotated more than 2 mm. After sectioning the RSC ligament, the fully pronated wrist resulted in rotation of less than 1 mm in 75% and 1 to 2 mm in 25%. No rotation at the fracture site was seen with supination, with or without immobilization. No difference was found between loaded and unloaded trials. CONCLUSIONS: Based on this observational data, it appears safe to use a below-elbow thumb spica cast in the treatment of minimally displaced scaphoid waist fractures. Sectioning of the RSC ligament resulted in reduced amount of rotation at the scaphoid waist fracture; thus the RSC ligament may be a deforming force rather than a stabilizing force in scaphoid waist fractures. Arthroscopy may be a valuable tool in the study of the effect of ligament sectioning on fracture stability.

Arthroscopy↗
PubMed2004

Radiofrequency probe treatment for subfailure ligament injury: a biomechanical study of rabbit ACL.

OBJECTIVE: Utilizing a rabbit anterior cruciate ligament model of ligamentous subfailure injury, biomechanical properties of injured ligament treated with radiofrequency energy were evaluated. It was hypothesized that an injured ligament treated with radiofrequency probe would demonstrate restoration of biomechanical properties lost through injury. BACKGROUND: Radiofrequency probe, thermal treatment has been utilized in the clinical setting to address joint instability caused by ligamentous laxity from injury or repetitive microtrauma. The biomechanical effects of radiofrequency probe thermal treatment on injured ligamentous tissues have not been studied in the laboratory. DESIGN: Three groups of specimens: Control, Sham, and Treatment, 10 each, were tested under identical conditions. METHODS: Viscoelastic behavior was analyzed using a relaxation test (6% strain, up to 180 s) performed before injury, after injury, and after injury plus sham or injury plus radiofrequency probe treatment. RESULTS: After injury the normalized forces in the relaxation test decreased by approximately 50%. The post-treatment relaxation test revealed significant ( P < 0.01 ) restoration of the average relaxation force in the Treatment group to that of the Control group (0.79, SD 0.11 vs. 0.80, SD 0.10). Both of these groups were significantly different from the Sham group (0.44, SD 0.11). Additionally, stretch-to-failure test showed partial restoration of the toe region of the load-deformation curve by the radiofrequency treatment. CONCLUSIONS: The radiofrequency probe treatment is shown to be an effective mechanism for restoring initial ligament tensile stiffness and viscoelastic characteristics lost by the subfailure injury in vitro.

Animals↗
PubMed2005

Distal ligamentous restraints of the first metatarsal. An in vitro biomechanical study.

BACKGROUND: Hypermobility or instability of the first metatarsal is associated with increased hallux valgus deformity and greater risk of recurrence after surgery. The objective of this in vitro study was to determine the ranges of movement, under directional loading, of the normal first metatarsal and the effect of the longitudinal plantar aponeurosis and the transverse tie-bar ligamentous system. METHODS: A model has been developed to quantify the influence of the first intermetatarsal ligament and plantar aponeurosis on movements of the first metatarsal. All muscular structures controlling movements of the first ray in cadaver feet were detached and static ligament structures retained for study. Using a specially designed test system, a static load was applied to the metatarsal to produce flexion, extension, abduction or adduction moments. The first intermetatarsal ligament and the plantar aponeurosis were detached sequentially and a movement map of the first metatarsal in the frontal plane was obtained using the Isotrak II magnetic measuring system. RESULTS: The first intermetatarsal ligament was shown to be an important stabiliser of the first metatarsal in all directions. The plantar aponeurosis was shown to be a secondary stabiliser resisting medial and dorsal rotation of the metatarsal after division of the first intermetatarsal ligament. INTERPRETATION: Recognition of the importance of the plantar aponeurosis and the first intermetatarsal ligament in the normal foot has implications for our understanding of hallux valgus.

Biomechanical Phenomena↗
PubMed2006

Nonlinear finite element analysis for musculoskeletal biomechanics of medial and lateral plantar longitudinal arch of Virtual Chinese Human after plantar ligamentous structure failures.

BACKGROUND: Musculoskeletal diseases of the foot such as stress fractures, tendonitis and subsequent pain are commonly associated with elevated stresses/strains of abnormal plantar arch after plantar ligamentous structure failures. The goal of this study was to develop anatomically detailed, finite element models of the medial and lateral plantar longitudinal arch, and to investigate bone and muscle stresses resulting from plantar fasciotomy and major plantar ligament injuries. METHODS: Nonlinear finite element models of the second ray and the fifth ray of plantar longitudinal arches were constructed on the basis of CT and MR images of Virtual Chinese Human "female No. 1". The models assumed a balanced standing load configuration. Three different degrees of passive intrinsic muscle tensions (weak, moderate, or severe) were used in conjunction with simulations of plantar fasciotomy and major plantar ligament injury. FINDINGS: Plantar fasciotomy caused von Mises stress increases in the bones and plantar ligaments while major plantar ligament injuries caused stress increases in the bones, flexor tendons, and plantar fascia. Increasing intrinsic muscle passive tensions decreased stress/strain levels in the medial and lateral arch, and adjusted abnormal tension/compression stress flows of both arches to close to the normal biomechanical states. INTERPRETATION: This study shows that plantar longitudinal arches are concordant combination of bony structures, intrinsic muscles, plantar fascia and ligaments. After plantar ligamentous structure failures, intrinsic muscles have to contribute to stabilize the plantar arches. This mechanism may reduce the risk of developing stress fractures, tendonitis and pain syndrome.

Biomechanical Phenomena↗
PubMed2006

Ankle anatomy for the arthroscopist. Part II: Role of the ankle ligaments in soft tissue impingement.

The biomechanical anatomy of the ankle ligaments continues to be a subject of interest because detailed knowledge of these structures is essential for proper diagnosis and treatment of the injuries affecting them. Lesions to the ankle ligaments are one of the most common sports injuries and the origin of soft tissue impingement syndrome. Together with the ligaments of the tibiofibular syndesmosis, two large ligamentous complexes are the main static stabilizers of the ankle joint: the lateral collateral ligament and the medial collateral (or deltoid) ligament. This article provides an anatomic description of the various ligaments of the ankle joint, with particular emphasis on specific anatomic details that are often omitted or little known and that have considerable clinical interest because of their involvement in soft tissue syndrome.

Ankle Injuries↗
PubMed2006

Three-dimensional imaging of the carpal ligaments.

This article provides a new perspective and detailed anatomic description of the attachments of the carpometacarpal (CMC) ligaments, intercarpal ligaments, and radiocarpal ligaments, which are described and illustrated using a unique combination of detailed dissection, CT imaging, and three-dimensional digitization. Detailed information is also provided about the ligamentous attachments of the CMC joints, carpal bones, and distal radius. This information advances the current knowledge and understanding of the normal anatomy and its impact on the mechanics of the radiocarpal intercarpal ligaments and the CMC joints, and should help surgeons to assess and treat injuries and degenerative changes seen in the wrist and CMC joints. Furthermore, this additional knowledge of the ligaments will help to further understand wrist kinematics and, more precisely, the function of the individual ligaments and their roles in joint motion and stability and injuries.

Carpal Bones↗
PubMed2005

Structural properties of the medial collateral ligament complex of the human knee.

The anatomy of the medial collateral ligament (MCL) complex consists of three identifiable passive restraining structures: the longitudinal fibres of the superficial medial collateral ligament (sMCL), the deep medial collateral ligament (dMCL), and the posteromedial capsule (PMC). The purpose of this study was to measure and compare the structural properties of these three individual structures. Eight human cadaveric knees (age 72-89 years, mean = 77 years, S.D. 5.3) were harvested and bone-ligament-bone tensile testing specimens prepared. After preconditioning, the specimens were extended to failure at 1000 mm/min in an Instron tensile testing machine. Ligament bundles failed either mid-substance or at their bony attachments. The ligament bundles had maximum loads of 534 N (sMCL), 194 N (dMCL), 425 N (PMC) and failed at 10.2, 7.1, and 12.0 mm mean extension, respectively. The maximum load and linear stiffness of the sMCL were significantly higher than those of the dMCL but not the PMC. The maximum load of the PMC was significantly higher than that of the dMCL; the linear stiffness of the PMC was higher than that of the dMCL but this did not reach statistical significance. The dMCL failed at a significantly lower extension than the other structures. The sMCL bundles that failed at their bony attachment were remounted using a freezing clamp fixture and again extended to failure, resulting in mid-substance failure at 884 N (74% higher). This study has shown that the PMC of the knee has comparable structural properties to the long superficial MCL and the short, deep MCL. In summary, the structural properties of the different component structures of the medial ligament complex indicate possible functional significance.

Aged↗
PubMed2005

Anatomy of the collateral ligaments of the proximal interphalangeal joint.

PURPOSE: To study and clarify the anatomy of the proper collateral ligaments and accessory collateral ligaments of the proximal interphalangeal joint. METHODS: The collateral ligaments of 8 proximal interphalangeal joints were dissected under an operating microscope to gain an appreciation of their fiber direction and the anatomy of their origin and insertion. Two undissected joints were studied histologically. RESULTS: The proper collateral ligament was found to arise widely from dorsal and proximal to and from the fovea on the side of the head of the proximal phalanx and insert for some distance on most of the side of the base of the middle phalanx. The ligament is stout and its fibers are oriented parallel to the middle phalanx in all positions of the joint. The accessory collateral ligament was found to be a less substantial structure lying between the proper collateral ligament and the volar plate. CONCLUSIONS: The anatomy shown by this study is quite different from that shown in most of the anatomic and hand surgery literature, particularly in line drawings.

Cadaver↗
PubMed2006

Immunohistochemical detection of relaxin binding to the volar oblique ligament.

PURPOSE: Excess laxity in the volar oblique ligament may predispose the thumb to trapeziometacarpal joint osteoarthritis. A greater prevalence of trapeziometacarpal joint osteoarthritis in women suggests a hormonal cause and relaxin is a hormone that may have some involvement. This conclusion emerges from relaxin's diverse tissue tropism, stimulation of collagenase production in cultured fibroblasts, and reports of increased joint laxity during pregnancy. We used immunohistochemistry to assess the potential of the volar oblique ligament to bind relaxin. METHODS: Eight volar oblique ligaments were obtained intraoperatively from perimenopausal women having basal joint arthroplasty with ligament reconstruction using the flexor carpi radialis tendon. Tissue specimens were snap-frozen in liquid nitrogen and stored at -80 degrees C until processing. Specimens then were cryosectioned, treated with a chelating rinse, incubated overnight with recombinant human relaxin, fixed, blocked, and exposed to antirelaxin antibody. Treatment with a universal aminoethylcarbizole staining kit was used to visualize areas of ligament-ligand binding. Both tissue and procedural controls served to establish binding specificity. RESULTS: Abundant staining was observed with the positive control (cervix) and all 8 volar oblique ligaments. Little or no staining was present in fibrocartilage (negative control) or procedural controls. CONCLUSIONS: Relaxin binds to the volar oblique ligament with specificity, implying a receptor-mediated process. Limitations of the procedure could not confirm binding saturability, necessitating additional study.

Cervix Uteri↗
PubMedDate not supplied

Tensile strength of ligaments after thermal shrinkage depending on time and immobilization: in vivo study in the rabbit.

The effects of immobilization on healing collagenous tissue treated with thermal shrinkage are investigated in an in vivo rabbit model. Thermal shrinkage was performed on 45 of 50 medial collateral ligaments in 25 mature New Zealand rabbit knees. In half of the knees, the joints were immobilized. Animals were killed at 0, 3, 6, and 9 weeks postoperatively. Failure loads of ligaments were determined, and morphologic changes were evaluated by electron microscopy. The failure load of shrunken ligaments was significantly lower than that of the intact ligaments on the day of operation (P<.05). Shrunken ligaments reached their highest failure loads in the third week within the first 9 weeks. The immobilized ligaments remained weaker than the mobile group, but this difference was statistically significant only in the ninth week (P<.05). Immobilization seems to have negative effects on the healing ligament. Ideal timing for remobilization is still controversial, and abandoning immobilization protocols for longer than 3 weeks should be considered.

Animals↗
PubMed2004

A prospective analysis of incidence and severity of quadriceps inhibition in a consecutive sample of 100 patients with complete acute anterior cruciate ligament rupture.

BACKGROUND: Weakness of the quadriceps femoris muscle after anterior cruciate ligament injury and reconstruction has been attributed to incomplete voluntary activation of the muscle. The literature is conflicting on the incidence of incomplete voluntary quadriceps activation after anterior cruciate ligament injury because of differences in testing methods and population biases. The purpose of this study was to systematically examine the incidence and severity of quadriceps voluntary activation failure in both lower extremities after acute anterior cruciate ligament injury. We hypothesized that the incidence of quadriceps inhibition would be higher in the anterior cruciate ligament injured limbs than the uninvolved limbs, that the incidence of inhibition in the anterior cruciate ligament deficient limbs would be larger than in our historical sample of healthy young individuals tested in the same manner and that there would be no difference in inhibition by gender. STUDY DESIGN: Prospective, descriptive. METHODS: One hundred consecutive patients with acute anterior cruciate ligament rupture (39 women and 61 men) were tested when range of motion was restored and effusion resolved, an average of 6 weeks after injury. A burst superimposition technique was used to assess quadriceps muscle activation and strength in all patients. Dependent t-tests were used to compare side-to-side differences in quadriceps strength. Independent t-tests were used to compare incidence of activation failure by gender and make comparisons to historical data on young, active individuals. RESULTS: The average involved side quadriceps activation was 0.92, and ranged from 0.60 to 1.00. The incidence of incomplete activation in the involved side quadriceps was 33 per cent and uninvolved side quadriceps was 31 per cent after acute anterior cruciate ligament rupture. The incidence of incomplete activation bilaterally was 21 per cent. There was no difference in incidence of quadriceps inhibition by gender. CONCLUSION: The incidence of voluntary quadriceps inhibition on the involved side was three times that of uninjured, active young subjects, but the magnitude was not large. The incidence of quadriceps inhibition on the uninjured side was similar to the injured side. CLINICAL RELEVANCE: Both the incidence and magnitude of quadriceps inhibition after ACL rupture are lower than have previously been reported. The conventional wisdom, therefore, that quadriceps inhibition is a significant problem in this population is challenged by the results of this study. Differences between this study and others include sufficient practice to ensure a maximal effort contraction and rigorous inclusion criteria. The findings have implications for strength testing as well as rehabilitation. The quadriceps index, an assessment of the injured side quadriceps strength deficit may be affected by the presence of voluntary activation failure in the uninvolved side.

Adolescent↗
PubMed2004

The effects of extracorporeal shock-wave therapy on the ultrasonographic and histologic appearance of collagenase-induced equine forelimb suspensory ligament desmitis.

Extracorporeal shock-wave therapy (ESWT) may stimulate healing of desmitis in multiple species. The objective of this study was to evaluate the ultrasonographic and histologic appearance of collagenase-induced suspensory ligament (SUL) desmitis in untreated ligaments and ligaments treated with ESWT in horses. Four mature horses had SUL desmitis induced in both forelimbs. Beginning 3 weeks after induction of the lesions, one ligament per horse was treated 3 times at 3-week intervals with ESWT. The percent lesion, echogenicity and fiber alignment scores of the SULs were evaluated at 3-week intervals for a total of 15 weeks. At the completion of the study, the horses were euthanized and the SULs collected, fixed and processed for histopathologic evaluation. Ultrasonography showed treated SULs had a smaller percent lesion at the maximal injury zone (p = 0.001), and the total percent lesion (p = 0.01), total fiber alignment score (p = 0.0167) and total echogenicity (p = 0.0023) were all smaller in the treated ligaments. The fiber alignment score and echogenicity were not statistically different at the maximal injury zone. The treated SULs had a more concentrated area of metachromasia associated with healing than the untreated ligaments, where metachromasia appeared more diffuse throughout the ligament. ESWT improved the rate of healing as assessed ultrasonographically.

Animals↗
PubMed2003

Neuromuscular disorder in response to anterior cruciate ligament creep.

OBJECTIVE: To determine the effect of creep developed in the anterior cruciate ligament and other viscoelastic knee structures on the function of the flexor and extensor muscles of males and females. DESIGN: Static load applied to the proximal tibia of young healthy male and female subjects in a laboratory setting with maximal voluntary knee flexion and extension performed before and after the load application. BACKGROUND: Static loads applied to various joints during occupational and sports activities are epidemiologically linked to higher than normal rates of disability reports. The physiological and biomechanical processes active in the development of such a neuromuscular disorder are not known. We hypothesize that creep developed in the anterior cruciate ligament due to prolonged static load will have pronounced impact on the reflexive activation of the associated musculature in a manner that may increase the risk of injury. Females are expected to be exposed to higher risk than males. METHODS: Male and female groups performed maximal voluntary knee flexion and extension before and after applying 200 and 150 N, respectively, to the proximal tibia for a 10 min period. Flexion and extension forces as well as electromyograph from agonist and antagonist muscles were measured at 35 degrees and 90 degrees knee flexion. Data was analyzed through repeated measures of analysis of variance. RESULTS: It was found that in extension, quadriceps electromyographic activity increased significantly after anterior cruciate ligament creep while hamstrings co-activation did not change. There was also a trend towards increased extension force after creep was developed, with significant effect of gender (larger increase in females). Similarly, significant increase in hamstrings electromyographic activity and a trend towards increased force during knee flexion was observed but with no effect of gender. Electromyographic spasms from the flexors and extensors were recorded in 30% of the subjects during the 10 min static loading period at 90 degrees angle and from the flexors only at 35 degrees. Creep in the ligament was marginally greater in females than in males with a significant effect of angle, being greater at 35 degrees than in 90 degrees knee flexion. CONCLUSIONS: The results suggest that ligament creep may develop a neuromuscular disorder consisting of spasms, increased electromyography and force in the agonist muscles without compensation from the antagonist. Static loading of a joint, therefore, may develop a neuromuscular disorder compounded with laxity of the ligaments and subject the individual to increased risk of injury. RELEVANCE: The data provides evidence that prolonged static loads applied to the anterior cruciate ligament and associated viscoelastic structures results in unbalanced muscular activation which puts individuals at increased exposure to injury. Work and sports activities should be scheduled while minimizing periods of static joint loading and emphasizing sufficient rest periods to allow recovery of creep and return to balanced muscular activation and co-activation.

Adaptation, Physiological↗
PubMed1996

The role of the iliolumbar ligament in low back pain.

Low back pain is caused by a variety of etiologies. Some clinicians have postulated that much low back pain is due to trauma to the iliolumbar ligament. The iliolumbar ligament is one of the three pelvic-lumbar ligaments and develops during the 12th week of gestation. The iliolumbar ligament appears to be a major stabilizing component between the vertebral spine and the pelvis. The innervation of the iliolumbar ligament appears similar to the posterior lumbar ligaments. Our hypothesis is: micro-trauma to the iliolumbar ligament is the primary cause of many cases of chronic low back pain because (1) it is the weakest component of the multifidus triangle; (2) there is increased susceptibility to injury due to its angulated attachment; (3) it is a primary inhibitor of excess sacral flexion; (4) it is a highly innervated nociceptive tissue; and (5) it plays an increased role with progressive disc degeneration.

Back Pain↗
PubMed1998

An anatomic study of the ligamentous structure of the triangular fibrocartilage complex.

An anatomic study of the ligamentous structures of the triangular fibrocartilage complex and their attachments on the ulnar styloid was performed using 27 embalmed cadaver wrists. The dorsal and palmar distal radioulnar ligaments of the triangular fibrocartilage complex in each specimen contained a superficial and a deep portion. The deep portion of both ligaments inserted on the fovea of the ulna. The superficial portion of both ligaments surrounded the articular disc uniting at the ulnar-most portion of the articular disc. The tissue that is between the ulnar aspect of the superficial ligament (and integrated on its periphery) and the ulnar capsule is defined as the meniscus homologue. Anatomic variations in the meniscus homologue and the prestyloid recess (the cavity adjacent to the ulnar styloid) were seen in 1 of 3 ways; the narrow opening type in 74% of specimens, the wide opening type in 11%, and the no opening type in 15%. The ulnotriquetral ligament inserted on the palmar-radial aspect of the base of the ulnar styloid and the ulnolunate ligament inserted on the palmar border of the articular disc.

Cadaver↗
PubMed1988

Determination of graft tension before fixation in anterior cruciate ligament reconstruction.

This study was performed to determine the tension needed to be applied on an anterior cruciate ligament graft before fixation to obtain normal anteroposterior translation following an anterior cruciate ligament reconstruction. Ten fresh-frozen cadaver knees underwent arthroscopy and were determined to have intact anterior and posterior cruciate ligaments and both menisci. A knee arthrometer (model KT 1000. MedMetric Corp., San Diego, CA, U.S.A.) was used to determine the anteroposterior translation with a 20 lb load. The anterior cruciate ligament was arthroscopically sectioned, and a repeat arthrometer measurement was made. Isometric points in the femur and tibia were determined using a tension isometer before drilling bony tunnels. The central third patellar tendon (bone-tendon-bone) complex, semitendinosus that was doubled on itself, and an iliotibial band approximately 3 cm wide were harvested. The grafts were separately passed through the knee, the femoral end was secured, and various tensions were applied to the tibial end before fixation. Repeat knee arthrometer measurements were performed after each new tension was applied. Arthrometer testing was continued until the postreconstruction 20 lb anterior drawer equalled the anterior cruciate ligament intact drawer. The patellar tendon returned the knee to its preoperative condition with a mean 3.6 lb of tension, the semitendinosus with 8.5 lb. and the iliotibial band with 13.6 lb. All these differences were statistically significant (p less than 0.01). The tension that needs to be applied to a graft during an anterior cruciate ligament reconstruction appears to be tissue specific. It is hoped that precise intraoperative tensioning of anterior cruciate ligament grafts will lead to more reproducible anterior cruciate reconstruction results.

Aged↗