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PubMed1988

[Computed arthrotomographic evaluation of chronic lesions of the cruciate ligaments].

The high incidence of cruciate ligament injuries as a result of acute knee trauma with hemarthrosis and abuse of diagnostic arthroscopies call for a suitable radiological imaging of the central pivot. Computed Arthrotomography (CAT) was used to examine the knee joint in 20 cases of clinically suspected chronic cruciate ligament injury. The images were correlated with arthroscopic and/or arthrotomic findings. Thirteen lesions of the anterior cruciate ligament (ACL) (65%) were found, plus 1 lesion of the posterior cruciate ligament (PCL) (5%), 2 associated lesions of ACL + PCL (10%), and 4 normal cases. Confirmation of pathology was available in all cases but one by arthroscopy and/or surgery. The central pivot diseases were classified as follows: absence, detachment, partial or complete tear. CAT findings of cruciate ligament injuries are emphasized and the role of the technique as compared to arthroscopy is discussed. CAT is useful in 3-D evaluation of central pivot and detection of different cruciate ligament injuries, with high sensitivity-specificity for ACL and high specificity-moderate sensitivity for PCL. In the evaluation of the chronic unstable knee, CAT is highly accurate and gives the surgeon useful information towards the planning of therapeutic procedures. CAT is almost non-invasive, well tolerated and easy to perform in out-patients, which make it a first-choice procedure in the screening of chronic ligament injuries.

Accidents, Traffic↗
PubMed1988

Growth of the rabbit deltoid ligament.

To determine the longitudinal growth pattern of ligaments, the rabbit deltoid ligament was selected for study to eliminate the confounding issue of underlying physeal growth seen in studies of the medial collateral ligament. Using a surgical microscope, marking sutures dividing the ligament into quarters were placed in the deltoid ligaments of five-week-old New Zealand white rabbits. Ten weeks later the animals were killed, the intervals remeasured, and percent of enlargement was calculated for each interval. The range of enlargement was 33%-37%, indicating relatively uniform growth throughout the ligament, with no detectable ligament growth plate or growth center.

Animals↗
PubMed1987

The combined anterior cruciate and medial collateral ligament replacement by various materials: a comparative animal study.

On 30 sheep, a combined replacement of the anterior cruciate and medial collateral ligament of the right knee was performed with four different materials. Dacron prostheses and glutaraldehyde-preserved bovine tendon prostheses as well as braided ligament prostheses made of carbon fibers and braided resorbable polydioxanone fibers surrounded by lyophilized dura in their intra-articular part were used. Ten unoperated sheep served as a control group. After 1 year the animals were sacrificed and the knee joints were explanted and biomechanically as well as histomorphologically investigated. The gross inspection of the joints showed no ruptured medial collateral ligament replacement but did show partially and totally ruptured anterior cruciate ligament replacements. The Dacron prosthesis was broken in 50% of the cases, whereas for the other materials one ruptured ligament replacement each (12.5%) could be observed. The anterior drawer test and the determination of the tensile stiffness of the remaining ligament replacements revealed that none of the operated knees achieved the properties of the normal control knees. However, the carbon fiber implants had the best result of all prostheses tested. For all materials except the resorbable polydioxanone, abrasion particles could be found in the anterior cruciate ligament and in the synovial membrane. The tissue reaction to these particles was a mild synovitis for carbon fragments, a strong synovitis for Dacron particles, and a chronic inflammatory response to bovine tendon fragments with macrophage granulomas and fibrosis.

Animals↗
PubMed1986

[An x-ray computed tomographic study of peritoneal ligaments and various mesos].

The CT analysis of peritoneal ligaments and mesos is possible thanks to the fluid contrast introduced by ascites, but also by identification of their contents: fat and opacified vascular elements. Ascites renders easy the display of the falciform ligament. Other displayed ligaments are the smaller omentum, the gastrosplenic ligament, the splenopancreatic ligament, the phrenolienal and phrenocolonic ligaments, the mesocolon, the mesosigmoid, the mesentery and the broad ligaments. The radioanatomic patterns of those peritoneal elements are depicted.

Ascites↗
PubMed1986

Defects of the broad ligament of the uterus.

A case of intestinal obstruction resulting from passage of the entire small bowel and cecum and its mesentery through a fenestration in the broad ligament of the uterus is presented. A review of the literature reveals that broad ligament defects may occur in multiple locations, which may be responsible for intestinal obstruction. A simple classification of broad ligament defects is proposed. Type 1 defects occur caudal to the round ligament of the uterus. Type 2 defects occur above the round ligament. Type 3 defects occur between the round ligament and the remainder of the broad ligament, through the meso-ligamentum teres.

Adnexa Uteri↗
PubMed1986

[Clinical aspects and therapy of fibular ligament ruptures in childhood].

Injuries to the lateral ligament of the ankle are frequently encountered in adolescence and require just as much care in diagnosis and management as in adults. There is a strikingly high rate of tears with an avulsion of the bony or cartilaginous insertion of the anterior talo-fibular ligament in younger children. The most likely causes are the higher elasticity and strength of ligaments, as well as the special situation of ligament insertion during growth. Experience has shown operative treatment to be superior to conservative measures. Only a surgical procedure can allow exact adaptation of the ruptured ligaments and especially a reinsertion of cartilaginous or bony fragments after avulsion injury. Old tears often make a reinsertion very difficult if not impossible. In these cases, resection of the fragments and reconstruction of ligaments are suggested if necessary. For more operative and technical details, the recently edited monograph from Zwipp should be consulted; it also contains many interesting points regarding the physiology, pathology and clinical importance of injuries to the lateral ligament of the ankle.

Adolescent↗
PubMed1983

Mechanical properties of ligament replacement with carbon fibres.

1. The tensile strength and modulus of elasticity of carbon fibres are comparable to those of stainless steel. 2. The small diameter (7-8 microns) produces high fibre flexibility, permitting braiding and weaving of this material. 3. The strength of braided ligament prostheses is about 2-3 times higher than the rupture strength of natural knee ligaments. 4. The elasticity and extensibility of a ligament prosthesis made of braided carbon fibres are higher than when there is a unidirectional arrangement. 5. The growth of connective tissue between the braided carbon fibres increases the elasticity and extensibility of the ligament replacement in vivo, so that 50-110% of the values for natural ligaments can be achieved. 6. The low shearing strength of the carbon fibres can be increased by a layer of collagen. 7. Intraosseous anchorages of the carbon fibre ligaments after 12 weeks of implantation exhibit strengths corresponding to 49-107% of the rupture strength of natural ligaments.

Animals↗
PubMed1984

[Constraints on the knee caused by meniscal and ligament derangement. Study of the internal condylotibial joint. Experimental cinematic method].

In a previous paper the authors have demonstrated that the polycentric curve of the surface of the medial condyle of the femur is a logarithmic spiral arch whose centre is the point of attachment of the medial ligament. In the present study, the totality of the menisco-ligamentous system was considered and studied on cadavers following a geometric model. It is shown that the ligament system controls combined or successive movements of gliding or rotation of the condyle on the tibial plateau in such a way as to avoid any cam effect or additional strain. Division of ligaments or excision of a meniscus leads to an increase in strain which varies in relation to the type of lesion. The increase is moderate after division of the anterior cruciate ligament, greater after division of the posterior cruciate ligament and severe after meniscectomy especially when associated with ligamentous division.

Biomechanical Phenomena↗
PubMed1982

The influence of an experimental immune synovitis on the failure mode and strength of the rabbit anterior cruciate ligament.

The strength and failure mode of a fresh femur-anterior cruciate ligament-tibia complex was studied in normal rabbits and after the induction of an experimental immune synovitis. Five modes of failure were observed: (1) through the anterior cruciate ligament alone; (2) through a small piece of bone with the anterior cruciate ligament attached; (3) through a condyle; (4) through the metaphysis; and (5) through the diaphysis. In the normal complex, failure always occurred through the anterior cruciate ligament. In the controls, the average ratio of failure-load to body weight was seventy-four newtons per kilogram. After induction of an immune synovitis this ratio was significantly reduced, to twenty-two newtons per kilogram. Synovial cathepsin-D enzyme activity in these knees was 5.27 micromoles per hour per milligram of protein, which was significantly elevated when compared with the control level of 0.26. Histological examination of the anterior cruciate ligament after induction of the immune synovitis but before strength-testing demonstrated loss of the normal undulating fiber orientation, disorganization of the normal cellular pattern, and a decrease in the staining of the interstitial matrix with Mallory trichrome. There was a moderate infiltration of mononuclear and polymorphonuclear inflammatory cells in the body of the ligament. Histological studies of the ligament after strength-testing showed that the failure resulted in a mop-like appearance and morphological characteristics similar to those observed before testing.

Animals↗
PubMedDate not supplied

The challenge of prosthetic cruciate ligament replacement.

Prosthetic replacement of the anterior cruciate ligament has become very important because of the failure of late reconstruction of anterior cruciate ligament injuries. Models of prostheses have failed, because they have never met the functional, physiologic and biomechanical characteristics of the normal anterior cruciate ligament. Studying the biomechanical characteristics of the normal anterior cruciate ligament, we have found that normal cruciate ligaments have measurable strength, yield points and ultimate tensile strength and show remarkable elasticity. We have also found that cruciate ligaments change their length during normal flexion/extension, and go through a limited elastic non-plastic deformation. We have devised a composite prosthesis, made of a compressible inner core around which a non-elastic fiber is woven in a helical fashion, with a predetermined angle. The construction has the essential characteristics of the normal ligament.

Animals↗
PubMed1980

Nutrient pathways of the cruciate ligaments. An experimental study using the hydrogen wash-out technique.

We used the hydrogen wash-out technique to determine the rate of wash-out of an inert tracer from the posterior cruciate ligament in dogs and rabbits after we had detached the ligament from bone and synovial structures, and after we had isolated it from the synovial tissue with aluminum foil. These rates were compared with those from controls and no differences could be found between them. The uptake of tritiated proline administered intravenously was also shown not to be significantly different in the detached ligament as compared with an intact ligament. Isolation of the ligament from contact with the synovial lining prevented the uptake of hydrogen. Cruciate ligaments removed from the knee and placed in the suprapatellar pouch appeared viable after eight to ten days. These findings suggest that diffusion can serve as a major pathway for delivery of nutrients to the cruciate ligaments.

Animals↗
PubMed1995

MR imaging of normal and injured wrist ligaments.

MR imaging is a rapidly evolving modality for examining the ligaments of the wrist. Recent improvements in magnet design and receiver coil technology have allowed consistent visualization of the wrist ligaments. Image quality can be optimized by selection of the proper receiver coil, careful attention to patient comfort and positioning, and selection of a dedicated imaging protocol. The carpal ligaments can be classified as capsular or interosseous ligaments, with the most important interosseous ligaments being the SLL and LTL as well as the triangular fibrocartilage. It is important for radiologists to understand the anatomy of the carpal ligaments in addition to the normal range of MR appearances as basis for comparison with torn or degenerated carpal ligaments.

Humans↗
PubMed1995

A comparison of spinal ligaments--differences between bipeds and quadrupeds.

Following dissection, the spinal ligaments were observed in a selection of bipedal, pseudobipedal and quadrupedal animals during a search for an appropriate animal model for investigating the innervation of these ligaments. Midline spinal ligaments were found in all animals while lateral spinal ligaments could only be observed in bipedal (human) and pseudobipedal (avian) species. The presence of lateral spinal ligaments in these animals and their absence in quadrupeds suggests that the development of the lateral ligaments reflects a mechanical challenge unique to the erect spine and that these lateral spinal ligaments are fundamental to the stability of an erect posture.

Animals↗
PubMed1994

The posterior cruciate ligament in total knee surgery. Save, sacrifice, or substitute?

To determine the role of the posterior cruciate ligament in total knee arthroplasty, 242 consecutive primary total knee arthroplasties were included in 1 of 3 sequential groups. Group I included 77 Press Fit Condylar total knee replacements in which the posterior cruciate ligament was completely released from its tibial attachment. In Group II, there were 80 Press Fit Condylar total knee replacements in which the posterior cruciate ligament was retained. Group III consisted of 85 total knee replacements with a posterior cruciate-substituting device (Insall-Burstein II). All patients were observed at least 2 years and evaluated by the Knee Society's Clinical and Functional Scoring System, including a radiographic evaluation. No differences were found between the posterior cruciate ligament sacrificed group and the posterior cruciate ligament preserved group. The 1 significant difference among the 3 groups was in range of motion (ROM). Groups I and II averaged 103 degrees and 104 degrees motion respectively, whereas Group III, the posterior cruciate-substituting group, averaged 112 degrees (p = 0.001). In addition, only in Group III was the lower 95% confidence limit of the mean ROM > 90 degrees. These findings suggest that preserving the posterior cruciate ligament does not consistently lead to improved functional ROM. The posterior cruciate ligament-substituting device historically has demonstrated excellent survivorship and appears to offer greater ROM.

Adult↗
PubMed1994

Management of insufficiency of posterior cruciate ligaments.

BACKGROUND: This study aims to evaluate the role of different methods in management of insufficiency of posterior cruciate ligament (PCL) that were used in VGH-Taipei. METHODS: 129 cases with insufficiency of PCL were collected to evaluate, according to functional and dynamic criteria, the results of different managements which were graded as good, fair, or poor. The patients were divided into 3 groups, i.e. group 1 with conservative rehabilitation therapy, group II with surgical reattachment, and group III with surgical ligament reconstruction that had 3 subgroups including IIIa reconstruction with medial head of gastrocnemius, IIIb with patellar tendon and IIIc with artificial ligament. The artificial ligaments used were Leeds-Keio ligament (group IIIcl), Dacron ligament (group IIIc2) and Goretex ligament (group IIIc3). The duration from injury to treatment varied from 3 days to 12 years with mean 45 weeks. The followup period was from 38 months to 112 months with mean 62 months. RESULTS: The results revealed 6 cases of good grade (25%) and 18 cases of fair grade (75%) in group 1, 20 cases of good grade (95%) and 1 case of fair grade (5%) in group II, 14 cases of good grade (40%), 10 cases of fair grade (29%) and 11 cases of poor grade (31%) in group IIIa, 3 cases of good grade (100%) in group IIIb, 13 cases of good grade (82%) and 3 cases of fair grade (18%) in group IIIcl, 19 cases of good grade (83%), 3 cases of fair grade (12%) and 1 case of poor grade (4%) in group IIIc2, and 3 cases of good grade (43%), 3 cases of fair grade (43%), and 1 case of poor grade (14%) in group IIIc3. CONCLUSIONS: Conservative intervention could be satisfactory in some cases with PCL insufficiency, especially in cases with isolated PCL injury, while surgical methods is mandatory in the others, especially in cases with chronic symptomatic PCL insufficiency.

Adolescent↗
PubMed1996

Bilateral cryptorchidism in a dog with persistent cranial testis suspensory ligaments and inverted gubernacula: report of a case with implications for understanding normal and aberrant testis descent.

The genital system of a dog with bilateral intra-abdominal testes is described. External virilisation was normal except for an empty scrotum. Internally there was a prostate of normal macroscopic and histological appearances and, bilaterally, a fully developed male genital tract. Testicular vasculature was normal. Cranial to each testis, there was a strong ligament lying at the free edge of the gonadal/genital mesentery and running between the cranial tip of the testis/epididymis and the area craniolateral of the ipsilateral kidney. It was impossible to push the testes into the inguinal canal because of this strong ligament. Caudal to each testis, there was an elongated whitish structure between the caudal pole of the epididymis and the area of the internal inguinal ring. On closer inspection this structure appeared to be the inverted and elongated processus vaginalis sac. There was a minor ligament at the free border of the inguinal fold of the genital mesentery between the tip of this inverted processus vaginalis and the adjacent junction of the cauda epididymidis and vas deferens. The findings suggest that persistence of the fetal cranial gonadal suspensory ligaments could have been the major aetiological factor in this case of cryptorchidism. Their persistence could have prevented caudal outgrowth of the processus vaginalis with its consequent development into an intra-abdominal papilla-like structure. Inappropriate persistence of the cranial suspensory ligaments in male rodents, pig, and cattle has been associated with insufficient exposure of their primordia to androgen during fetal life. It is uncertain whether a similar deficiency could underlie persistence of these structures in the present specimen. The findings add further weight to the hypothesis that regression of the cranial gonadal suspensory ligament in males is a key event in the process of testis descent. The human homologue of this ligament deserves more attention in the analysis and treatment of human cryptorchidism.

Animals↗
PubMed1996

Relation of ligament damage with site specific cartilage loss and osteophyte formation in collagenase induced osteoarthritis in mice.

OBJECTIVE: To investigate the correlation between initial ligament damage and development of subsequent osteoarthritic changes. METHODS: Collagenase was injected intraarticularly into the knee joint of mice of strain C57B16 or C57B110. After 3 days, ligament damage was evaluated by measurements of knee laxity in the anterior-posterior direction as a measure of cruciate ligament function, and in the varus-valgus direction as a measure of collateral ligament function. The amount and location of cartilage loss and osteophyte formation were determined at Day 42. RESULTS: Significant correlations between the amount of laxity changes and the severity of cartilage loss (r = 0.78), the amount of laxity changes and the size of osteophytes (r = 0.87), and between the severity of cartilage loss and osteophyte size (r = 0.94) were demonstrated. The amount of cartilage loss and the degree of osteophyte formation at the medial side of the joint depended mainly on the severity of cruciate ligament damage. This is contrast to changes at the lateral side of the joint, which appeared not to be associated with the severity of ligament damage. CONCLUSION: A strong relationship exists between the severity of cruciate ligament damage and the severity of osteoarthritic changes on the medial side of the joint. In the lateral joint compartment, prone to spontaneous osteoarthritis in the mouse strain studied, this relation is absent.

Animals↗
PubMed1996

[Carpal ligament lesions associated with fresh distal radius fractures: arthroscopic study of 54 cases].

AIM: Intracarpal ligamentous tears and fractures of the distal radius may have a similar injury mechanism. We performed arthroscopy of the wrist in 54 patients with distal radius fracture to find out the frequency of associated ligamentous tears. RESULTS: 41% of the patients with an extraarticular fracture of the distal radius had at least one severe ligamentous tear of a carpal ligament. In the group of patients with intraarticular fracture we detected ligamentous tears even in 89%. Most frequent were tears of the lunotriquetral ligament. DISCUSSION: Associated ligamentous tears are more common than expected. These tears may be of importance in the outcome of treatment of distal radius fractures.

Adolescent↗