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At least 1,531 records · Page 85Linked to original sources
PubMed1997

Chronically injured posterior cruciate ligament: magnetic resonance imaging.

Magnetic resonance imaging has been said to be highly reliable for diagnosis of acute posterior cruciate ligament insufficiency. In the present study, 13 patients whose posterior cruciate ligament insufficiency had been documented by magnetic resonance imaging within 10 weeks of the acute injury were recalled for a followup examination and magnetic resonance imaging. The followup interval ranged from 5 months to 4 years. In only 23% of the cases did the posterior cruciate ligament still appear discontinuous on followup magnetic resonance imaging. In the remaining 77%, the posterior cruciate ligament was continuous from tibia to femur, although it appeared abnormally arcuate or hyperbuckled. Conventional interpretation of these magnetic resonance images would suggest that the posterior cruciate ligament had healed. Nevertheless, by clinical examination results, these same patients all were judged to have posterior cruciate ligament insufficiency. Thus, it was concluded that although magnetic resonance imaging may be reliable for evaluation of acute posterior cruciate ligament injury, magnetic resonance imaging findings should not be used to infer functional status in chronic cases.

Chronic Disease↗
PubMed1997

CT of the normal suspensory ligaments of the ossicles in the middle ear.

PURPOSE: To establish the range of normal variation in the CT appearance of the middle ear ligaments and the stapedius tendon as an aid in detecting abnormal changes in these structures. METHODS: CT scans of the temporal bone in 75 normal middle ears, obtained with 1-mm-thick sections, were reviewed by two observers, who rated the visibility of the structures of interest on a scale of 1 to 5. RESULTS: The anterior, superior, and lateral malleal ligaments and the medial and lateral parts of the posterior incudal ligament were seen in 68%, 46%, 95%, 26%, and 34% of the ears, respectively. The stapedius tendon was seen in 27% of the cases. When visible, the ligaments were judged to be complete in 90% to 100% of the ears and the stapedius tendon was complete in 65% of cases. Their width varied considerably. Interobserver variability was high for most observations. CONCLUSION: CT scans are more likely to show the malleal than the incudal ligaments. Although the interobserver agreement was statistically significant for most study parameters, the percentage of agreement above that expected by chance was low. When seen, the ligaments usually appeared complete. Understanding the normal range of appearance may help identify abnormalities of the ligaments and tendons of the middle ear.

Adolescent↗
PubMed1997

[Anatomic study of the pubic-urethral ligaments in women: role of urethral suspension].

OBJECTIVE: In 1963, the studies by Zacharin emphasized the importance of the suspensory apparatus of the female urethra, consisting of two non-extensible fibrous bands composed of 3 distinct ligaments. The objectives of this study were to evaluate the role of these ligaments in support of the urethra and to define the value of their preservation in cystectomy with bladder replacement in women. MATERIAL AND METHODS: Five fresh female cadavres with a mean age 78 years (range: 75-82) were used for dissection of the suspensory apparatus of the urethra via a suprapubic then sagittal approach by section of the pelvis 2 cm from the midline. Histological studies of the urethra were then performed. RESULTS: The suspensory apparatus of the urethra was found to be a paired, symmetrical system composed of 2 paired and symmetrical fibrous bands. Dissection of these bands revealed three anterior, intermediate and posterior pubourethral ligaments. The posterior pubourethral ligament was inserted on the anterior and lateral surfaces of the urethra and vagina (underneath the bladder neck) on anatomical studies, but also on histological sections. Section of the posterior pubourethral ligament allowed great mobility of half of the urethra. Section of these ligaments totally released the urethra from the pubis. CONCLUSION: Our study confirmed the importance of this ligamentous system in suspension of the urethra and demonstrated the value of preservation of these structures in cystectomy with bladder replacement in women.

Aged↗
PubMed1998

Relationship of the meniscofemoral ligaments of the knee to lateral meniscus tears: magnetic resonance imaging evaluation.

This study sought to determine if the presence or absence of meniscofemoral ligaments exerts an influence on the prevalence of tears of the lateral meniscus. We reviewed the sagittal and coronal magnetic resonance images of 173 knees for lateral meniscus tears and the presence of the meniscofemoral ligaments. One or both meniscofemoral ligaments were present in 142 of 173 knees (82%). Fifty-four knees had lateral meniscus tears, 27 of which involved the posterior horn. Thirty-three percent of knees with meniscofemoral ligaments had a lateral meniscus tear, and 23% of knees without meniscofemoral ligaments had a lateral meniscus tear (no significant difference). We found no association between the presence of the meniscofemoral ligaments and tears of the lateral meniscus. Our study questions the importance of preserving or reconstructing these ligaments in instances of meniscal transplantation.

Adolescent↗
PubMed1998

Scar formation and ligament healing.

Ligaments are highly organized, dense, fibrous connective-tissue structures that provide stability to joints and participate in joint proprioception. Injuries to ligaments induce a healing response that is characterized by the formation of a scar. The scar tissue is weaker, larger and creeps more than normal ligament and is associated with an increased amount of minor collagens (types III, V and VI), decreased collagen cross-links and an increased amount of glycosaminoglycans. Studies have shown that certain surgical variables alter the healing of ligaments. Such factors include the size of gap between the healing ligament, ends, the use of motion in a stable joint and the presence of multiple ligamentous injuries. Research on ligament healing includes studies on low-load and failure-load properties, alterations in the expression of matrix molecules, cytokine modulation of healing and gene therapy as a method to alter matrix protein and cytokine production.

Animals↗
PubMed2007

Posterior horn lateral meniscal tears simulating meniscofemoral ligament attachment in the setting of ACL tear: MRI findings.

PURPOSE: We have noted apparent far lateral meniscal attachment of the meniscofemoral ligament (MFL) with an anterior cruciate ligament (ACL) tear. This study evaluates MFL attachment and association with posterior horn lateral meniscus (PHLM) tear. MATERIALS AND METHODS: Nine months of knee arthroscopy reports were reviewed to classify the PHLM and ACL as torn or normal. After excluding those with prior knee surgery, MR images were reviewed by two radiologists to determine the number of images lateral to PCL, which showed the ligaments of Humphrey and Wrisberg visible as structures separate from the PHLM. Any patient with abnormal PHLM surface signal not continuous with the MFL was excluded. MRI findings were compared with arthroscopy using Student's t test and Fisher's exact test. RESULTS: Of the 54 participants, 5 had PHLM tears and 49 were normal. Twenty-one had ACL tears; all those with an PHLM tear had an ACL tear. The ligament of Humphrey inserted on average 0.9 consecutive images lateral to the PCL without an PHLM tear and 4.7 with an PHLM tear; the ligament of Wrisberg inserted on average 3.0 consecutive images without an PHLM tear and 4.5 with an PHLM tear (slice thickness/gap = 3 mm/0.5 mm). There was a significant association between PHLM tear and number of images (p = 0.0028), and between ACL tear and this type of PHLM tear (p = 0.0064). CONCLUSION: Apparent far lateral meniscal extension of a meniscofemoral ligament (greater than or equal to four images lateral to the PCL) should be considered as a possible PHLM tear, especially in the setting of an ACL tear.

Adolescent↗
PubMed2005

The multiple-ligament injured knee: evaluation, treatment, and results.

The multiple-ligament injured knee is a complex problem in orthopaedic surgery. Most dislocated knees involve tears of the anterior and posterior cruciate ligaments (ACL/PCL) and at least 1 collateral ligament complex. Careful assessment of the extremity vascular status is essential because of the possibility of arterial and/or venous compromise. These complex injuries require a systematic approach to evaluation and treatment. Physical examination and imaging studies enable the surgeon to make a correct diagnosis and to formulate a treatment plan. Arthroscopically assisted combined ACL/PCL reconstruction is a reproducible procedure. Knee stability is improved postoperatively when evaluated using knee ligament rating scales, arthrometer testing, and stress radiographic analysis. Acute medial collateral ligament (MCL) tears, when combined with ACL/PCL tears, may in certain cases be treated with bracing. Posterolateral corner injuries combined with ACL/PCL tears are best treated with primary repair as indicated, combined with reconstruction using a post of strong autograft (split biceps tendon, biceps tendon, semitendinosus) or allograft (Achilles tendon, bone-patellar tendon-bone) tissue. Surgical timing depends on the ligaments injured, the vascular status of the extremity, reduction stability, and the overall health of the patient. We prefer to use allograft tissue for reconstruction in these cases because of the strength of these large grafts and the absence of donor site morbidity.

Achilles Tendon↗
PubMed2006

Anterior cruciate ligament biology and its relationship to injury forces.

Anterior cruciate ligament injury is determined by two variables: the ultimate failure load of the ligament and the mechanical load applied to the ligament. All factors that contribute to anterior cruciate ligament injury must do so by affecting one or both of these two basic variables. Some factors, such as sex hormones and tissue remodeling, have a multifaceted effect on the failure load of the anterior cruciate ligament and the magnitude of the load applied to it. The model also illustrates the potentially profound effects that sex hormones and tissue remodeling likely have on female susceptibility to anterior cruciate ligament injuries.

Animals↗
PubMed2000

Cruciate ligament forces in the human knee during rehabilitation exercises.

OBJECTIVE: To determine the cruciate ligament forces occurring during typical rehabilitation exercises.Design. A combination of non-invasive measurements with mathematical modelling of the lower limb.Background. Direct measurement of ligament forces has not yet been successful in vivo in humans. A promising alternative is to calculate the forces mathematically. METHODS: Sixteen subjects performed isometric and isokinetic or squat exercises while the external forces and limb kinematics were measured. Internal forces were calculated using a geometrical model of the lower limb and the "dynamically determinate one-sided constraint" analysis procedure. RESULTS: During isokinetic/isometric extension, peak anterior cruciate ligament forces, occurring at knee angles of 35-40 degrees, may reach 0.55x body-weight. Peak posterior cruciate ligament forces are lower and occur around 90 degrees. During isokinetic/isometric flexion, peak posterior cruciate forces, which occur around 90 degrees, may exceed 4x body-weight; the anterior cruciate is not loaded. During squats, the anterior cruciate is lightly loaded at knee angles up to 50 degrees, after which the posterior cruciate is loaded. Peak posterior cruciate forces occur near the lowest point of the squat and may reach 3.5x body-weight. CONCLUSIONS: For anterior cruciate injuries, squats should be safer than isokinetic or isometric extension for quadriceps strengthening, though isokinetic or isometric flexion may safely be used for hamstrings strengthening. For posterior cruciate injuries, isokinetic extension at knee angles less than 70 degrees should be safe but isokinetic flexion and deep squats should be avoided until healing is well-advanced. RELEVANCE: Good rehabilitation is vital for a successful outcome to cruciate ligament injuries. Knowledge of ligament forces can aid the physician in the design of improved rehabilitation protocols.

Adult↗
PubMed1996

Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction.

This article presents the minimum 2-year results (range, 24 to 48 months) of 20 arthroscopically assisted combined anterior cruciate ligament/posterior cruciate ligament (ACL/PCL) reconstructions, evaluated preoperatively and postoperatively using the Tegner, Lysholm, and Hospital for Special Surgery knee ligament rating scales, and the KT 1000 knee ligament arthrometer (Medmetric Corp, San Diego, CA). There were 16 men or boys, 4 women or girls; 9 right, 11 left; 10 acute, and 10 chronic knee injuries. Ligament injuries included 1 ACL/PCL tear, 2 ACL/PCL/medial collateral ligament (MCL)/posterior lateral corner tears. 7 ACL/PCL/MCL tears, and 10 ACL/PCL/posterior lateral corner tears. ACLs were reconstructed using autograft or allograft patellar tendons. PCLs were reconstructed using allograft Achilles tendon, or autograft patellar tendon. MCL tears were successfully treated with bracing. Posterior lateral instability was successfully treated with long head of the biceps femoris tendon tenodesis. Tegner, Lysholm, and Hospital for Special Surgery knee ligament rating scales significantly improved preoperatively to postoperatively (P = .0001). Corrected anterior KT 1000 measurements improved from preoperative to postoperative status (P = .0078).

Adolescent↗
PubMedDate not supplied

Characteristics of the isokinetic performance of patients with injured cruciate ligaments.

The torques of the quadriceps muscle in patients with cruciate ligament injuries were evaluated under isokinetic contraction. There were 30 patients with anterior cruciate ligament injuries, 19 with posterior cruciate ligament injuries, and 30 controls. The torques of concentric and eccentric contractions in anterior cruciate ligament-injured knees showed a significant difference from those in the uninjured sides at extension angles of less than 45 degrees, yet the values of the peak torques for concentric and eccentric contractions were the same as those for the uninjured sides. The torques of concentric and eccentric contractions in posterior cruciate ligament-injured knees showed a significant difference from the uninjured sides at flexion angles of more than 36 degrees. The peak torques for concentric and eccentric contraction also showed a significant difference from the uninjured sides. The concentric and eccentric peak torque angles of the injured knees were similar to those of the uninjured sides in all subjects. The ratios of eccentric to concentric peak torque of the contralateral knees in the anterior cruciate ligament-injured groups did not show a significant difference from those of the controls. The evaluation of the biomechanical change in these categories is of great advantage in determining proper methods of treatment and rehabilitation.

Adolescent↗
PubMedDate not supplied

Mechanical tensile properties of the quadriceps tendon and patellar ligament in young adults.

We analyzed mechanical tensile properties of 16 10-mm wide, full-thickness central parts of quadriceps tendons and patellar ligaments from paired knees of eight male donors (mean age, 24.9 years). Uniaxial tensile testing was performed in a servohydraulic materials testing machine at an extension rate of 1 mm/sec. Sixteen specimens were tested unconditioned and 16 specimens were tested after cyclic preconditioning (200 cycles between 50 N and 800 N at 0.5 Hz). Mean cross-sectional areas measured 64.6 +/- 8.4 mm2 for seven unconditioned and 61.9 +/- 9.0 mm2 for eight preconditioned quadriceps tendons and were significantly larger than those values of seven unconditioned and seven preconditioned patellar ligaments (36.8 +/- 5.7 mm2 and 34.5 +/- 4.4 mm2, respectively). Mean ultimate tensile stress values of unconditioned patellar ligaments were significantly larger than those values of unconditioned quadriceps tendons: 53.4 +/- 7.2 N/mm2 and 33.6 +/- 8.1 N/mm2, respectively. Strain at failure was 14.4% +/- 3.3% for preconditioned patellar ligaments and 11.2% +/- 2.2% for preconditioned quadriceps tendons (P = 0.0428). Preconditioned patellar ligaments exhibited significantly higher elastic modulus than preconditioned quadriceps tendons. Based on mechanical tensile properties analyses, the quadriceps tendon-bone construct may represent a versatile alternative graft in primary and revision anterior and posterior cruciate ligament reconstruction.

Adult↗
PubMed2005

Clinical outcome at a minimum of five years after reconstruction of the anterior cruciate ligament.

BACKGROUND: We are not aware of any previous studies in which independent measurements of function with validated outcome questionnaires such as the Knee Injury and Osteoarthritis Outcome Score and the International Knee Documentation Committee score were evaluated five years after reconstruction of the anterior cruciate ligament. We hypothesized that patient demographics, mechanism of injury, and intra-articular injuries and their treatment are factors associated with function five years after reconstruction of the anterior cruciate ligament. METHODS: A consecutive series of unilateral, arthroscopically assisted primary reconstructions of the anterior cruciate ligament performed by one surgeon using a patellar tendon graft was evaluated. Data on patient demographics, injury variables, and intra-articular lesions noted at the time of surgery were collected prospectively. Multivariable regression analysis was used to identify independent predictors of outcomes as measured with five questionnaires. RESULTS: Sixty-nine percent (217) of 314 knees with a reconstruction of the anterior cruciate ligament were followed for an average of 5.4 years. The average age at the time of the operation was twenty-seven years. Independent predictors of a worse outcome, which was measured with the overall Knee Injury and Osteoarthritis Outcome Score, the International Knee Documentation Committee score, the Lysholm score, and the Western Ontario and McMaster Universities Osteoarthritis Index score, included the patient's recollection of hearing or feeling a pop at the time of the injury, a weight gain of >15 lb (6.8 kg), and no change in educational level since the surgery. There was a lack of association between the outcome and either the occurrence or the form of treatment of a meniscal tear or chondromalacia of the articular cartilage. CONCLUSIONS: To our knowledge, we performed the first prospective cohort study to evaluate the prognosis following reconstruction of the anterior cruciate ligament by identifying significant associations between multiple variables and clinical outcomes as measured with validated questionnaires. The clinician can counsel patients about the intermediate-term functional outcomes of reconstructions of the anterior cruciate ligament on the basis of these findings. Suggestions regarding weight control and future education may improve intermediate-term outcomes.

Adult↗
PubMed2005

[Infectious complications after arthroscopic replacement of the cruciate ligaments].

PURPOSE OF THE STUDY: Infection following replacement of the cruciate ligaments of the knee joint may result in not only graft failure but also complete destruction of the joint. The aim of this study was to report the authors' experience with the diagnosis and therapy of this, fortunately occasional, complication. MATERIAL: In the period from October 1999 till June 2003, a total of 2372 arthroscopic operations of the knee joint were carried out; of these, 908 were cruciate ligament replacements. Three surgeons using the same technique were involved. An autologous graft taken from the ligamentum patellae and fixed with interference screws was used in 857 knees, and a graft derived from the tendon of the semitendinosus or the gracilis muscle, with "endobutton" fixation, was employed. Two kinds of inflammatory complications were recorded in the early post-operative period, i. e., infection of the articular cavity and infected subcutaneous hematoma at site of graft collection. METHODS: When infection of the articular cavity was suspected because of severe pain, perspiration, motion restriction, articular exudate and increased temperature, arthrocentesis was performed and a sample of the fluid withdrawn was sent for cultivation; laboratory tests (blood counts, erythrocyte sedimentation rate, C-reactive protein) were carried out and antibiotic therapy was started. When there was no subsidence of signs within 24 h, revision surgery was carried out without waiting for the results of laboratory examination. Coagula from inside of the cavity were removed through a short incision on the lateral side of the suprapatellar recess and, after repeated thorough irrigation, a suction drain was inserted. Antibiotic therapy was administered parenterally. Infected subcutaneous hematoma, associated with edema, reddening and tension of the skin, pain, fluctuation and, in some cases, high temperature, was treated by disintegration of the wound, removal of the hematoma, debridement and thorough irrigation. After drain insertion, the wound was closed by suture. The development of infectious complications was assessed in relation to the risk factors described in the literature, namely, patient's age, operating room time and tourniquet application, previous infections of the upper respiratory or urinary tracts, previous surgery on the same joint and the season in which the operation was performed. RESULTS: A total of 37 revision operations following replacement of the cruciate ligaments of the knee joint were carried out; of these, 29 involved the articular cavity. An infectious agent was found in six cases (0.7 % of the total number of cruciate ligament replacements). Eight knees were treated for hematoma in the wound at site of graft collection and, in seven of them, Staphylococcus aureus was isolated (0.8 % of the total number of crucial ligament replacements). For recurrent problems the distal fixation material had to be removed in two patients at 6 and 12 months, respectively. Afterwards the patients were free from symptoms. The only risk factor for the development of infection was found to be previous surgery on the same joint. DISCUSSION: The authors prefer early revision surgery in the cases showing signs of developing infection in the articular cavity or hematoma in the wound after graft collection. Therefore the results of positive cultivation were fewer in comparison with other relevant reports. In revision surgery on the articular cavity, the authors made a 2-cm incision on the lateral side of the suprapatellar recess, which enabled them to wash out all coagula, in comparison to other authors who recommend irrigation with the use of arthroscopic apparatus only. The early intervention made it possible to keep all grafts in situ. The only factor associated with a higher occurrence of complications in our patients was a previous operation on the same joint. CONCLUSIONS: On the basis of their experience with arthroscopic replacement of the cruciate ligaments, the authors recommend an active approach if the development of infectious complications is suspected. In our patients, no persisting sequelae were recorded.

Anterior Cruciate Ligament↗
PubMed1996

[Knee joint ligament reconstruction--indications, results].

Cruciate ligament injuries have increased in number in the last 10 to 20 years. Nonoperative treatment of ligament injuries about the knee joint has lost some of its popularity; however, there are only very few randomized prospective studies demonstrating that operative reconstructions of knee ligament injuries do have a positive effect on preventing late osteoarthritic changes. In contrast, one of the best studies recently published shows that there may even be some increased rate of osteoarthritis in reconstructed patients. Why this? The concept of the 'Envelope of Load Acceptance' may explain, why some of the patients who opt for a nonoperative treatment of cruciate ligament injuries do very well. They lower the load and frequency to the knee joint and diminish their activity level. Patients with successfully treated ligament lesions about the knee joint may wish to go back to their preinjury level and may want to reach their preinjury 'shell' of load acceptance [Scott Dye, 1995]; however, this may already be too much for their knees [physiological overload] and may eventually lead to the osteoarthritic changes about the knee joint. Careful consultation of each individual patient's case of knee ligament injuries is essential for the successful treatment, a treatment which may reduce the rate of osteoarthritis and reduce costs for the injured and the community.

Anterior Cruciate Ligament↗
PubMed1998

[Ligament ruptures].

Ligamentous injuries of the knee are becoming commoner and commoner. They can involve the anterior cruciate ligament, the posterior cruciate ligament, or both ligaments together. The anterior cruciate ligament is the sportsman's injury. The diagnosis is a clinical one, with other diagnostic techniques only being used in the doubtful case. The treatment is well established, with surgery in the young and sportive patient, and a trial of non-operative treatment in the less active patient. The results of treatment are good. The posterior cruciate ligament is injured less commonly, and the diagnosis is sometimes missed. The injury is usually tolerated well, and the results of surgery are less reliable. For these reasons surgery is only performed in carefully selected patients.

Anterior Cruciate Ligament↗
PubMed1993

Pressure distribution at the knee joint. Influence of varus and valgus deviation without and with ligament dissection.

Traumata or repetitive microtraumata, malalignment with varus or valgus deviation, or chronic joint instability are discussed in the aetiology of osteoarthritis and osteochondritis dissecans of the knee. Biomechanical factors influencing the patterns of pressure distribution at the articular surface and the subchondral bone are suggested to be most important in the pathogenesis. Consequently, the patterns of pressure distribution at the femoral condyles of weight-bearing knee joints were investigated in a cadaveric biostatic model. The pressure in the articular joint space was evaluated with pressure-sensitive films of the knee in different joint positions in the coronal plane (10 degrees varus, 10 degrees valgus, and neutral position) without and with medial collateral ligament (MCL), lateral CL (LCL), MCL + anterior cruciate ligament (ACL) or LCL + ACL ligament division. Results demonstrated that the location of the contact area and the peak pressure depended on the joint position and stage of ligamentous division. Without ligament division, a maximum peak pressure was observed at the medial condyle in the neutral and varus positions. Only in the valgus position did the lateral condyle show a higher peak of pressure than the medial condyle. Ligament division of the LCL and LCL + ACL resulted in an increase of peak pressure at the medial condyle, particularly in the varus position. Division of the MCL and MCL + ACL ligament complex reduced the differences between the medial and lateral condyle. In the valgus position, the peak pressure was significantly higher at the lateral condyle. The absolute maximum peak pressure was measured in the varus position at the medial condyle after division of the LCL and ACL.(ABSTRACT TRUNCATED AT 250 WORDS)

Cadaver↗
PubMed2005

Multimedia article. Laparoscopic management of median arcuate ligament syndrome.

Median arcuate ligament syndrome is a rare disorder resulting from luminal narrowing of the celiac artery by the insertion of the diaphragmatic muscle fibers or fibrous bands of the celiac nervous plexus. The syndrome is characterized by weight loss, postprandial abdominal pain, nausea, vomiting, and an epigastric bruit. Surgical management entails complete division of the median arcuate ligament. The video demonstrates the laparoscopic release of the median arcuate ligament in a patient with median arcuate ligament syndrome. The patient is a 22-year-old male with a 6-month history of epigastric abdominal pain, nausea, vomiting, a 140-lb. weight loss, and an epigastric bruit on physical exam. Aortography demonstrated a >or=90% extrinsic compression of the celiac artery. A full laparoscopic skeletonization of the celiac artery and branch vessels was performed. Intraoperative duplex U/S demonstrated flow rate reduction after the median arcuate ligament release. A postoperative CT angiogram demonstrated no residual stenosis. The patient was discharged on postoperative day 3 and remained asymptomatic after 7 months of follow-up. Laparoscopic release of the median arcuate ligament is a novel approach to the management of celiac artery compression syndrome. The role of minimally invasive techniques to manage median arcuate ligament syndrome is evolving but they appear to be a safe alternative to open surgery.

Abdominal Pain↗