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Sample records for posterior ligamentous complex

  1. Injuries of the posterior cruciate ligament.

    PubMed

    Moyer, R A; Marchetto, P A

    1993-04-01

    A review of the anatomy and biomechanics of the posterior cruciate ligament, and the systematic approach for the diagnosis and treatment of isolated posterior cruciate ligament injuries and posterior cruciate ligament insufficiency in combination with other ligamentous instabilities is discussed.

  2. Posterior cruciate ligament of the knee (image)

    MedlinePlus

    The posterior cruciate ligament (PCL) is a powerful ligament extending from the top-rear surface of the tibia to the bottom-front surface of the femur. The ligament prevents the knee joint from posterior instability.

  3. Postoperative rehabilitation of the posterior cruciate ligament.

    PubMed

    Edson, Craig J; Fanelli, Gregory C; Beck, John D

    2010-12-01

    Diagnosis and management of posterior cruciate ligament injuries has evolved, and now the treatment often includes surgical intervention. The purpose of this paper is to define the current approach to postsurgical management after the posterior cruciate ligament reconstruction, review conservative management, and discuss surgical outcomes using a specified program.

  4. [Posterior longitudinal ligament ossification: case report].

    PubMed

    Tella, Oswaldo Inácio de; Herculano, Marco Antonio; Paiva Neto, Manoel Antonio; Faedo Neto, Atílio; Crosera, João Francisco

    2006-03-01

    Posterior longitudinal ligament ossification of cervical spine is a rare condition among caucasians. A 42 years old japanese patient with progressive walking difficulty was diagnosed with this pathology by CT scan and MRI and treated surgically by an anterior approach with arthrodesis. Pathophysiology, racial prevalence, clinical picture, radiological characteristics and surgical approaches options are revised.

  5. Diagnostic accuracy of ultrasound for detecting posterior ligamentous complex injuries of the thoracic and lumbar spine: A systematic review and meta-analysis

    PubMed Central

    Gabriel, Alcalá-Cerra; Ángel, J. Paternina-Caicedo; Juan, J. Gutiérrez-Paternina; Luis, R. Moscote-Salazar; Hernando, R. Alvis-Miranda; Rubén, Sabogal-Barrios

    2013-01-01

    Background: Posterior ligamentous complex injuries of the thoracolumbar (TL) spine represent a major consideration during surgical decision-making. However, X-ray and computed tomography imaging often does not identify those injuries and sometimes magnetic resonance imaging (MRI) is not available or is contraindicated. Objective: To determine the diagnostic accuracy of the ultrasound for detecting posterior ligamentous complex injuries in the TL spine. Materials and Methods: A systematic review was carried out through four international databases and proceedings of scientific meetings. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and their 95% confidence intervals (CIs) were estimated, by using weighted averages according to the sample size of each study. Summary receiver operating characteristic was also estimated. Results: A total of four articles were included in the meta-analysis, yielding a summary estimate: Sensitivity, 0.89 (95% CI, 0.86-0.92); specificity, 1.00 (95% CI, 0.98-1.00); positive likelihood ratio, 224.49 (95% CI, 30.43-1656.26); negative likelihood ratio, 0.11 (95% CI, 0.05-0.19); and diagnostic odds ratio, 2,268.13 (95% CI, 265.84-19,351.24). There was no statistically significant heterogeneity among results of included studies. Summary: Receiver operating characteristic (±standard error) was 0.928 ± 0.047. Conclusion and Recommendation: The present meta-analysis showed that ultrasound has a high accuracy for diagnosing posterior ligamentous complex injuries in patients with flexion distraction, compression, or burst TL fractures. On the basis of present results, ultrasound may be considered as a useful alternative when magnetic resonance imaging (MRI) is unavailable or contraindicated, or when its results are inconclusive. PMID:24381453

  6. Paediatric intrasubstance posterior cruciate ligament rupture.

    PubMed

    Scott, Chloe E H; Murray, Alastair W

    2011-01-01

    The authors present the case of a 4-year-old boy who sustained an intrasubstance posterior cruciate ligament (PCL) tear whist trampolining. He was managed non-operatively with return to full function by 8 months. A high index of suspicion is required when assessing paediatric hyperflexion/extension injuries at the knee as ligamentous injury may occur without osteochondral fracture and may be missed on routine radiographs. Early MRI can identify such injuries in addition to osteochondral avulsions which are often amenable to acute internal fixation. In the case of paediatric intrasubstance PCL tears, it appears that non-operative management yields a good functional outcome in the short term in the skeletally immature.

  7. Double bundle posterior cruciate ligament reconstruction: surgical technique and results.

    PubMed

    Fanelli, Gregory C; Beck, John D; Edson, Craig J

    2010-12-01

    The keys to successful posterior cruciate ligament reconstruction are to identify and treat all pathology, use strong graft material, accurately place tunnels in anatomic insertion sites, minimize graft bending, use a mechanical graft tensioning device, use primary and back-up graft fixation, and use the appropriate postoperative rehabilitation program. Adherence to these technical principles results in successful single and double-bundle arthroscopic transtibial tunnel posterior cruciate ligament reconstruction based upon stress radiography, arthrometer, knee ligament rating scales, and patient satisfaction measurements.

  8. Posterior Cruciate Ligament: Focus on Conflicting Issues

    PubMed Central

    Lee, Yong Seuk

    2013-01-01

    There is little consensus on how to optimally reconstruct the posterior cruciate ligament (PCL) and the natural history of injured PCL is also unclear. The graft material (autograft vs. allograft), the type of tibial fixation (tibial inlay vs. transtibial tunnel), the femoral tunnel position within the femoral footprint (isometric, central, or eccentric), and the number of bundles in the reconstruction (1 bundle vs. 2 bundles) are among the many decisions that a surgeon must make in a PCL reconstruction. In addition, there is a paucity of information on rehabilitation after reconstruction of the PCL and posterolateral structures. This article focused on the conflicting issues regarding the PCL, and the scientific rationales behind some critical points are discussed. PMID:24340144

  9. Posterior cruciate ligament: focus on conflicting issues.

    PubMed

    Lee, Yong Seuk; Jung, Young Bok

    2013-12-01

    There is little consensus on how to optimally reconstruct the posterior cruciate ligament (PCL) and the natural history of injured PCL is also unclear. The graft material (autograft vs. allograft), the type of tibial fixation (tibial inlay vs. transtibial tunnel), the femoral tunnel position within the femoral footprint (isometric, central, or eccentric), and the number of bundles in the reconstruction (1 bundle vs. 2 bundles) are among the many decisions that a surgeon must make in a PCL reconstruction. In addition, there is a paucity of information on rehabilitation after reconstruction of the PCL and posterolateral structures. This article focused on the conflicting issues regarding the PCL, and the scientific rationales behind some critical points are discussed.

  10. Features extraction in anterior and posterior cruciate ligaments analysis.

    PubMed

    Zarychta, P

    2015-12-01

    The main aim of this research is finding the feature vectors of the anterior and posterior cruciate ligaments (ACL and PCL). These feature vectors have to clearly define the ligaments structure and make it easier to diagnose them. Extraction of feature vectors is obtained by analysis of both anterior and posterior cruciate ligaments. This procedure is performed after the extraction process of both ligaments. In the first stage in order to reduce the area of analysis a region of interest including cruciate ligaments (CL) is outlined in order to reduce the area of analysis. In this case, the fuzzy C-means algorithm with median modification helping to reduce blurred edges has been implemented. After finding the region of interest (ROI), the fuzzy connectedness procedure is performed. This procedure permits to extract the anterior and posterior cruciate ligament structures. In the last stage, on the basis of the extracted anterior and posterior cruciate ligament structures, 3-dimensional models of the anterior and posterior cruciate ligament are built and the feature vectors created. This methodology has been implemented in MATLAB and tested on clinical T1-weighted magnetic resonance imaging (MRI) slices of the knee joint. The 3D display is based on the Visualization Toolkit (VTK).

  11. Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction.

    PubMed

    Fanelli, G C; Giannotti, B F; Edson, C J

    1996-02-01

    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).

  12. Rupture of Posterior Cruciate Ligament: Diagnosis and Treatment Principles

    PubMed Central

    Nam, Shin Woo

    2011-01-01

    Posterior cruciate ligament (PCL) injuries associated with multiple ligament injuries can be easily diagnosed, but isolated PCL tears are less symptomatic, very difficult to diagnose, and frequently misdiagnosed. If a detailed investigation of the history of illness suggests a PCL injury, careful physical examinations including the posterior drawer test, dial test, varus and valgus test should be done especially if the patient complains of severe posterior knee pain in >90° of flexion. Vascular assessment and treatment should be done to avoid critical complications. An individualized treatment plan should be established after consideration of the type of tear, time after injury, associated collateral ligament injuries, bony alignment, and status of remnant. The rehabilitation should be carried out slower than that after anterior cruciate ligament reconstruction. PMID:22570824

  13. Rupture of posterior cruciate ligament: diagnosis and treatment principles.

    PubMed

    Lee, Beom Koo; Nam, Shin Woo

    2011-09-01

    Posterior cruciate ligament (PCL) injuries associated with multiple ligament injuries can be easily diagnosed, but isolated PCL tears are less symptomatic, very difficult to diagnose, and frequently misdiagnosed. If a detailed investigation of the history of illness suggests a PCL injury, careful physical examinations including the posterior drawer test, dial test, varus and valgus test should be done especially if the patient complains of severe posterior knee pain in >90° of flexion. Vascular assessment and treatment should be done to avoid critical complications. An individualized treatment plan should be established after consideration of the type of tear, time after injury, associated collateral ligament injuries, bony alignment, and status of remnant. The rehabilitation should be carried out slower than that after anterior cruciate ligament reconstruction.

  14. Posterior Cruciate Ligament Reconstruction in Patients with Generalized Joint Laxity

    PubMed Central

    Kim, Sung-Jae; Chang, Ji-Hoon

    2008-01-01

    Generalized joint laxity has been considered a risk factor causing late failure of reconstructed anterior cruciate ligaments, although it is unknown whether that is the case for reconstructed posterior cruciate ligaments. We hypothesized patients with generalized joint laxity, compared with those without laxity, would have similar postoperative knee stability, range of motion, and functional scores after posterior cruciate ligament reconstruction. The Beighton and Horan criteria were used to determine generalized joint laxity. We enrolled 24 patients with generalized joint laxity (Group L) and 29 patients without any positive findings of joint laxity (Group N) matched by gender and age. The average side-by-side differences of posterior tibial translation were 4.72 mm in Group L and 3.63 mm in Group N. We observed no differences in posterior tibial translation with differing graft materials or combined procedures. In Group L the International Knee Documentation Committee score was normal in 12.5% and nearly normal in 45.8% whereas in Group N, 24.1% were normal and 55.2% nearly normal. Patients with generalized joint laxity showed more posterior laxity than patients without joint laxity. Generalized joint laxity therefore appears to be a risk factor associated with posterior laxity after posterior cruciate ligament reconstruction. Level of Evidence: Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18843524

  15. A Worldwide Analysis of the Reliability and Perceived Importance of an Injury to the Posterior Ligamentous Complex in AO Type A Fractures

    PubMed Central

    Schroeder, Gregory D.; Kepler, Christopher K.; Koerner, John D.; Oner, F. Cumhur; Fehlings, Michael G.; Aarabi, Bizhan; Dvorak, Marcel F.; Reinhold, Max; Kandziora, Frank; Bellabarba, Carlo; Chapman, Jens R.; Vialle, Luiz R.; Vaccaro, Alexander R.

    2015-01-01

    Study Design Survey of spine surgeons. Objective To determine the reliability with which international spine surgeons identify a posterior ligamentous complex (PLC) injury in a patient with a compression-type vertebral body fracture (type A). Methods A survey was sent to all AOSpine members from the six AO regions of the world. The survey consisted of 10 cases of type A fractures (2 subtype A1, 2 subtype A2, 3 subtype A3, and 3 subtype A4 fractures) with appropriate imaging (plain radiographs, computed tomography, and/or magnetic resonance imaging), and the respondent was asked to identify fractures with a PLC disruption, as well as to indicate if the integrity of the PLC would affect their treatment recommendation. Results Five hundred twenty-nine spine surgeons from all six AO regions of the world completed the survey. The overall interobserver reliability in determining the integrity of the PLC was slight (kappa = 0.11). No substantial regional or experiential difference was identified in determining PLC integrity or its absence; however, a regional difference was identified (p < 0.001) in how PLC integrity influenced the treatment of type A fractures. Conclusion The results of this survey indicate that there is only slight international reliability in determining the integrity of the PLC in type A fractures. Although the biomechanical importance of the PLC is not in doubt, the inability to reliably determine the integrity of the PLC may limit the utility of the M1 modifier in the AOSpine Thoracolumbar Spine Injury Classification System. PMID:26430591

  16. Avulsion fracture of the posterior cruciate ligament in an uncommon location associated with distal injury to the patellar ligament.

    PubMed

    E Albuquerque, Rodrigo Pires; da Palma, Idemar Monteiro; Cobra, Hugo; de Paula Mozella, Alan; Vaques, Victor

    2015-01-01

    Avulsion fractures of the posterior cruciate ligament in unusual locations are rare injuries. We report the first case in the literature of an avulsion fracture of the posterior cruciate ligament associated with distal injury to the patellar ligament. The aim of this study was to present a novel case, the therapy used and the clinical follow-up.

  17. Suture Bridge Fixation Technique for Posterior Cruciate Ligament Avulsion Fracture.

    PubMed

    Lee, Kwang Won; Yang, Dae Suk; Lee, Gyu Sang; Choy, Won Sik

    2015-12-01

    We presented a surgical technique including a suture bridge technique with relatively small incision for the reduction and fixation of posterior ligament avulsion fractures. A suture anchor was used to hold the avulsed fragment and a knotless anchor was used to continuously compress the bony fragment into the fracture site, thereby maintaining reduction during healing.

  18. FEMORAL INSERTION OF THE POSTERIOR CRUCIATE LIGAMENT: AN ANATOMICAL STUDY

    PubMed Central

    de Paula Leite Cury, Ricardo; Severino, Nilson Roberto; Camargo, Osmar Pedro Arbix; Aihara, Tatsuo; Neto, Leopoldo Viana Batista; Goarayeb, Dedley Nelson

    2015-01-01

    Objective: To identify objective parameters to guide correct location of the posterior cruciate ligament (PCL) in the femur. Methods: The PCLs of 20 human cadavers were resected. The following portions were measured: distance from the most distal portion of the PCL, close to the roof, to the most anterior edge of the cartilage (AB); distance from the most proximal portion of the PCL, close to the roof, to the most anterior cartilage (AC); distance between the two parts of the ligament close to the roof (BC); distance from the distal edge in its posterior portion, to the more posterior joint edge (DE); distance from the distal edge of the ligament in its posterior portion, to the intercondylar roof (DF); and finally, the format of the ligament insertion and area of coverage on the femoral condyle. Results: The PCL has the shape of a quarter ellipse, with an average area of 153.5mm2. The mean distances found were: AB of 2.1mm, AC of 10.7mm, BC of 8.6mm DE of 12.4mm and DF of 16.8mm. Conclusions: The edge close to the roof of the anterolateral bundle is closer to the joint cartilage (2.1mm) than the posteromedial bundle is, which is 12.4mm from the edge proximal to the cartilage. These references should assist in better and more accurate positioning of femoral tunnels in PCL reconstruction. PMID:27027059

  19. Anatomic Double-Bundle Posterior Cruciate Ligament Reconstruction.

    PubMed

    Chahla, Jorge; Nitri, Marco; Civitarese, David; Dean, Chase S; Moulton, Samuel G; LaPrade, Robert F

    2016-02-01

    The posterior cruciate ligament (PCL) is known to be the main posterior stabilizer of the knee. Anatomic single-bundle PCL reconstruction, focusing on reconstruction of the larger anterolateral bundle, is the most commonly performed procedure. Because of the residual posterior and rotational tibial instability after the single-bundle procedure and the inability to restore the normal knee kinematics, an anatomic double-bundle PCL reconstruction has been proposed in an effort to re-create the native PCL footprint more closely and to restore normal knee kinematics. We detail our technique for an anatomic double-bundle PCL reconstruction using Achilles and anterior tibialis tendon allografts. PMID:27284530

  20. Posterior Wall Blowout in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Mitchell, Justin J.; Dean, Chase S.; Chahla, Jorge; Menge, Travis J.; Cram, Tyler R.; LaPrade, Robert F.

    2016-01-01

    Violation of the posterior femoral cortex, commonly referred to as posterior wall blowout, can be a devastating intraoperative complication in anterior cruciate ligament (ACL) reconstruction and lead to loss of graft fixation or early graft failure. If cortical blowout occurs despite careful planning and adherence to proper surgical technique, a thorough knowledge of the anatomy and alternative fixation techniques is imperative to ensure optimal patient outcomes. This article highlights anatomic considerations for femoral tunnel placement in ACL reconstruction and techniques for avoidance and salvage of a posterior wall blowout. PMID:27335885

  1. Tibial inlay posterior cruciate ligament reconstruction: surgical technique and results.

    PubMed

    McAllister, David R; Hussain, Suleman M

    2010-12-01

    Posterior cruciate ligament (PCL) injuries occur much less frequently than other ligament injuries of the knee such as anterior cruciate ligament injuries. There is general agreement for nonoperative treatment for lower grade injuries such as type I PCL injuries. However, for more severe injuries which may require surgery, there is no consensus on an optimal reconstruction method. Multiple arthroscopic and open techniques exist to reconstruct the PCL. Limited clinical outcomes data reveals good short-term clinical results with different reconstruction options. Biomechanical data has helped further the understanding regarding the performance of different reconstructions. This article will present a surgical technique for single bundle tibial inlay reconstruction of the PCL along with the objective biomechanical data that supports this reconstruction.

  2. Popliteal artery injury during posterior cruciate ligament reconstruction.

    PubMed

    Cenni, Marcos Henrique Frauendorf; do Nascimento, Bruno Fajardo; Carneiro, Guilherme Galvão Barreto; de Andrade, Rodrigo Cristiano; Pinheiro Júnior, Lúcio Flávio Biondi; Nicolai, Oscar Pinheiro

    2015-01-01

    This study reports a case of popliteal artery injury during arthroscopic reconstruction of the posterior cruciate ligament. The evolution of the injury is described and comments are made regarding the anatomy of this artery and potential risks of this surgical technique. This study had the aims of alerting the medical community, especially knee surgeons, regarding a severe surgical complication and discussing the ways of preventing it.

  3. Potential role of the posterior cruciate ligament synovio-entheseal complex in joint effusion in early osteoarthritis: a magnetic resonance imaging and histological evaluation of cadaveric tissue and data from the Osteoarthritis Initiative

    PubMed Central

    Binks, D.A.; Bergin, D.; Freemont, A.J.; Hodgson, R.J.; Yonenaga, T.; McGonagle, D.; Radjenovic, A.

    2014-01-01

    Summary Objective This study explored posterior cruciate ligament (PCL) synovio-entheseal complex (SEC) microanatomy to determine whether it may participate in the early osteoarthritis (OA) disease process. Methods SEC microanatomy and OA features were evaluated in 14 non-arthritic cadaveric knees (mean age = 69.9) using magnetic resonance imaging (MRI) and histology. MRI images of 49 subjects selected from the progression cohort of the Osteoarthritis Initiative (OAI) were evaluated by a musculoskeletal radiologist using an original semi-quantitative method for features associated with OA at the PCL tibial enthesis. Statistical analysis was performed using chi-square and Wilcoxon signed-rank tests to evaluate associations between SEC configuration and OA features. Results The PCL formed a SEC-like structure encompassing bone- and ligament-lining intra-articular cartilages to which the posterior root of the medial meniscus contributed. Degenerative features at the PCL-SEC included: neovascularisation (44%), enthesis chondrocyte clustering (44%), collagen matrix fissuring at the enthesis (56%) and in the PCL itself (67%), tidemark duplication (44%), bone remodelling (44%) and microscopic inflammatory changes (33%). In the OAI cohort, SEC-related pathology included bone marrow lesions (BMLs) (69%) and osteophytosis (94%) at locations that corresponded to SEC-related cartilages. Posterior joint recess effusion (49%) was linked to MRI abnormalities at PCL-SEC cartilages (χ2 = 7.27, P = 0.007). Conclusions The PCL has a prominent SEC configuration that is associated with microscopic OA changes in aged clinically non-diseased joints. MRI determined knee OA commonly exhibited pathological features at this site which was associated with adjacent joint effusion. Thus, the PCL-SEC could play a hitherto unappreciated role in the early OA disease process. PMID:25008208

  4. Mucoid Degeneration of Posterior Cruciate Ligament with Secondary Impingement of Anterior Cruciate Ligament: A Rare Case Report

    PubMed Central

    Wang, Joon Ho; Jangir, Rajat R

    2015-01-01

    Introduction: Mucoid degeneration of cruciate ligament is well known entity, but symptomatic lesions are rare. It is even rarer to find a symptomatic posterior cruciate ligament mucoid degeneration than anterior cruciate ligament. Case Report: A 65-years-old female presented to our hospital complaining of pain in right knee joint on terminal extension since 6 months. On clinical examination, there was a flexion deformity of 5 degree and a further flexion of 150 degree with mild pain exacerbated by extension. MRI of the right knee joint showed a diffusely thickened posterior cruciate ligament (PCL) with increased intra ligamentous signal intensity on T2-weighted images. The arthroscopic findings of grossly thickened PCL with a yellowish hue are characteristic and the PCL was filled with a yellowish substance. We excised the yellowish substance from the PCL as precisely as possible not to damage the remaining PCL fiber (Limited Debulking). We did notchplasty of lateral wall and roof to accommodate the Anterior Cruciate Ligament and avoid impingement. Conclusion: Posterior cruciate ligament may enlarge significantly and may push the Anterior Cruciate Ligament in the notch and may lead to the anterior cruciate ligament (ACL) impingement symptoms. Partial Debulking of Posterior Cruciate Ligament and notchplasty is effective treatment with immediate postoperative pain relief and good functional results. PMID:27299097

  5. A new simplified onlay technique for posterior cruciate ligament reconstruction.

    PubMed

    Salim, Rodrigo; Fogagnolo, Fabricio; Kfuri, Mauricio

    2014-08-01

    The integrity of posterior cruciate ligament (PCL) is essential for the normal kinematics of the knee. Injury to the PCL has adverse consequences, with worsening of functional performance and an increased risk to develop osteoarthritis. Conservative treatment is sometimes adopted, not only because it is an acceptable option for selected patients but also due to the lack of consensus in the orthopedic literature regarding the best surgical method. Hereby we describe a simplified technique for onlay PCL reconstruction pointing out possible advantages if compared with the traditional transtibial or inlay techniques.

  6. Arthroscopic posterior cruciate ligament reconstruction with allograft versus autograft

    PubMed Central

    Sun, Xiujiang; Zhang, Jianfeng; Qu, Xiaoyi

    2015-01-01

    Introduction The aim of the study was to compare and analyze retrospectively the outcomes of arthroscopic posterior cruciate ligament reconstruction with autograft versus allograft. Material and methods Seventy-one patients who underwent arthroscopic posterior cruciate ligament reconstruction with an autograft or allograft met our inclusion criteria. There were 36 patients in the autograft group and 35 patients in the allograft group. All the patients were evaluated by physical examination and a functional ligament test. Comparative analysis was done in terms of operation time, incision length, fever time, postoperative infection rate, incidence of numbness and dysesthesia around the incision, as well as a routine blood test. Results The average follow-up of the autograft group was 3.2 ±0.2 years and that of the allograft group was 3.3 ±0.6 years; there was no significant difference (p > 0.05). No differences existed in knee range of motion, Lysholm scores, International Knee Documentation Committee standard evaluation form and Tegner activity score at final follow-up (p > 0.05), except that patients in the allograft group had a shorter operation time and incision length and a longer fever time (p < 0.05). We found a difference in posterior drawer test and KT-2000 arthrometer assessment (p < 0.05). The posterior tibia displacement averaged 3.8 ±1.5 mm in the autograft group and 4.8 ±1.7 mm in the allograft group (p < 0.05). The incidence of numbness and dysesthesia around the incision in the autograft group was higher than that in the allograft group (p < 0.05). There was no infection postoperatively. The white blood cells and neutrophils in the allograft group increased more than those in the autograft group postoperatively (p < 0.05). Conclusions Both groups of patients had satisfactory outcomes after the operation. However, in the instrumented posterior laxity test, the autograft gave better results than the allograft. No differences in functional scores

  7. A Comparison of Anterior and Posterior Cruciate Ligament Laxity Between Female and Male Basketball Players.

    ERIC Educational Resources Information Center

    Weesner, Carol L.; And Others

    1986-01-01

    The anterior cruciate ligament and posterior cruciate ligament laxity of 90 uninjured male and female high school players were measured. No significant differences were found, indicating that the greater female injury rate may be due to inadequate conditioning, not greater knee ligament laxity. (Author/MT)

  8. REHABILITATION PROTOCOL AFTER ISOLATED POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

    PubMed Central

    de Paula Leite Cury, Ricardo; Kiyomoto, Henry Dan; Rosal, Gustavo Fogolin; Bryk, Flávio Fernandes; de Oliveira, Victor Marques; de Camargo, Osmar Pedro Arbix

    2015-01-01

    To create a rehabilitation protocol following reconstruction of the posterior cruciate ligament (PCL), through a literature review. The literature review was conducted in the Medline and Embase databases, to search for data on biomechanical concepts and analyses relating to the posterior cruciate ligament of the knee. The search strategy was set up using the following rules: problem or injury in association with anatomical location terms; or surgical intervention procedure in association with rehabilitation terms. We began the process in this manner and subsequently introduced restrictions on certain terms to improve the search specificity. To design the protocol, a table was created for better data assessment, based on the time that elapsed between surgery and the start of physiotherapy. A rehabilitation protocol was created to improve weight-bearing control in the initial weeks after surgery, with the aid of a knee brace. Our aim was to achieve gains in total range of motion of the knee, which should be attained by the third month, thereby avoiding contractures resulting from the tissue healing process. Strengthening exercises and sensory-motor training were guided accordingly, thus avoiding overload on the graft and respecting the healing phases. The protocol proposed through this review was based on the current evidence relating to this subject. PMID:27047844

  9. REHABILITATION PROTOCOL AFTER ISOLATED POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION.

    PubMed

    de Paula Leite Cury, Ricardo; Kiyomoto, Henry Dan; Rosal, Gustavo Fogolin; Bryk, Flávio Fernandes; de Oliveira, Victor Marques; de Camargo, Osmar Pedro Arbix

    2012-01-01

    To create a rehabilitation protocol following reconstruction of the posterior cruciate ligament (PCL), through a literature review. The literature review was conducted in the Medline and Embase databases, to search for data on biomechanical concepts and analyses relating to the posterior cruciate ligament of the knee. The search strategy was set up using the following rules: problem or injury in association with anatomical location terms; or surgical intervention procedure in association with rehabilitation terms. We began the process in this manner and subsequently introduced restrictions on certain terms to improve the search specificity. To design the protocol, a table was created for better data assessment, based on the time that elapsed between surgery and the start of physiotherapy. A rehabilitation protocol was created to improve weight-bearing control in the initial weeks after surgery, with the aid of a knee brace. Our aim was to achieve gains in total range of motion of the knee, which should be attained by the third month, thereby avoiding contractures resulting from the tissue healing process. Strengthening exercises and sensory-motor training were guided accordingly, thus avoiding overload on the graft and respecting the healing phases. The protocol proposed through this review was based on the current evidence relating to this subject.

  10. Posterior Cruciate Ligament Function Following Total Knee Arthroplasty

    PubMed Central

    Emodi, George J; Callaghan, John J; Pedersen, Douglas R; Brown, Thomas D

    1999-01-01

    One of the most commonly cited reasons for retaining the posterior cruciate ligament (PCL) during total knee arthroplasty is to preserve femoral rollback and theoretically improve extensor mechanism efficiency (lengthening the moment arm). This study was undertaken to assess PCL function in this regard and to delineate the effects of joint line elevation that can be manipulated intraoperatively by the surgeon. The anterior movement of tibiofemoral contact following PCL resection at flexion angles 60 degrees demonstrated the beneficial effect of the PCL on extensor function. This anterior translation and the concomitant increases in quadriceps tendon load and patellofemoral contact pressures were consistently observed. This study demonstrated that small changes of the joint line position significantly influenced PCL strain and knee kinematics. In order to preserve the desired functions that would be lost with an overly lax PCL and to avoid the potential adverse effects of an overly tight PCL (posterior edge loading and increased tibiofemoral contact), the surgeon should make every effort to restore the preoperative joint line. If this is not possible, consideration should be given to posterior cruciate recession or use of a posterior cruciate substituting design. PMID:10847521

  11. Editorial Commentary: Posterior Cruciate Ligament Reconstruction--Do Not Abandon the C-Arm Quite Yet.

    PubMed

    Hunt, Timothy J

    2016-03-01

    Accurate tibial tunnel placement using the arthroscopically-assisted anatomic fovea landmark technique in transtibial posterior cruciate ligament reconstruction is possible without the use of fluoroscopic imaging. However, until a prospective, randomized controlled trial comparing the C-arm and anatomic fovea landmark techniques is completed, abandonment of the C-arm in posterior cruciate ligament reconstruction cannot be recommended.

  12. Popliteal pseudoaneurysm after arthroscopic posterior cruciate ligament reconstruction.

    PubMed

    van Dorp, Karin B; Breugem, Stefan J M; Driessen, Marcel J M

    2014-09-01

    This report presents the case of a 30-year-old motocross (BMX) cyclist with a third-degree posterior cruciate ligament rupture. The technique used for reconstruction was the transtibial single-bundle autologous hamstring technique. Unfortunately, the procedure was complicated by a popliteal pseudoaneurysm, which was located in line with the tibial canal. The pseudoaneurysm was treated with an end-to-end anastomosis and the patient recovered without further complaints. In this case, the popliteal artery was damaged most probably by the edge of the reamer or the guide wire during removal. Vascular complications can be limb- and life-threatening. This case report aims to increase the awareness of this serious complication with a review of the literature. PMID:25229050

  13. Emerging Updates on the Posterior Cruciate Ligament: A Review of the Current Literature.

    PubMed

    LaPrade, Christopher M; Civitarese, David M; Rasmussen, Matthew T; LaPrade, Robert F

    2015-12-01

    The posterior cruciate ligament (PCL) is recognized as an essential stabilizer of the knee. However, the complexity of the ligament has generated controversy about its definitive role and the recommended treatment after injury. A proper understanding of the functional role of the PCL is necessary to minimize residual instability, osteoarthritic progression, and failure of additional concomitant ligament graft reconstructions or meniscal repairs after treatment. Recent anatomic and biomechanical studies have elucidated the surgically relevant quantitative anatomy and confirmed the codominant role of the anterolateral and posteromedial bundles of the PCL. Although nonoperative treatment has historically been the initial treatment of choice for isolated PCL injury, possibly biased by the historically poorer objective outcomes postoperatively compared with anterior cruciate ligament reconstructions, surgical intervention has been increasingly used for isolated and combined PCL injuries. Recent studies have more clearly elucidated the biomechanical and clinical effects after PCL tears and resultant treatments. This article presents a thorough review of updates on the clinically relevant anatomy, epidemiology, biomechanical function, diagnosis, and current treatments for the PCL, with an emphasis on the emerging clinical and biomechanical evidence regarding each of the treatment choices for PCL reconstruction surgery. It is recommended that future outcomes studies use PCL stress radiographs to determine objective outcomes and that evidence level 1 and 2 studies be performed to assess outcomes between transtibial and tibial inlay reconstructions and also between single- and double-bundle PCL reconstructions.

  14. Posterior femoral translation in medial pivot total knee arthroplasty of posterior cruciate ligament retaining type

    PubMed Central

    Cho, Su Hyun; Cho, Hyung Lae; Lee, Soo Ho; Jin, Hong Ki

    2013-01-01

    Purpose To report clinical results and demonstrate posterior femoral translation (PFT) in medial pivot total knee arthroplasty (TKA) of posterior cruciate ligament (PCL) retaining type. Materials and methods A prospective study was performed upon thirty consecutive subjects who were operated on with medial pivot TKA of PCL retaining type between March 2009 and March 2010 and had been followed up for at least 2 years. Clinically, the knee society knee score and function score were used. In full extension and active flexion lateral radiograph, anteroposterior (AP) condylar position and magnitude of PFT was determined. Results At last follow-up, the mean knee society knee score and function score improved significantly compared to preoperative scores. The AP condylar positions were consistently posterior to midline throughout the entire range of flexion. The PFTs averaged 0.31 (±0.12) of half length of tibial base plate and were greater in higher flexion cases (r = 0.56, p = 0.0012). There were no cases having either component migration or radiolucent line wider than 2 mm except for one case showing instability related to trauma. Conclusions In medial pivot TKA of PCL retaining type, clinical outcomes were satisfactory and posterior femoral translations were consistently observed during progressive flexions of knees at two- to three-year follow-up. PMID:24403754

  15. Complex posterior urethral injury

    PubMed Central

    Kulkarni, Sanjay B.; Joshi, Pankaj M.; Hunter, Craig; Surana, Sandesh; Shahrour, Walid; Alhajeri, Faisal

    2015-01-01

    Objective To assess treatment strategies for seven different scenarios for treating complex pelvic fracture urethral injury (PFUI), categorised as repeat surgery for PFUI, ischaemic bulbar urethral necrosis (BUN), repair in boys and girls aged ⩽12 years, in patients with a recto-urethral fistula, or bladder neck incontinence, or with a double block at the bulbomembranous urethra and bladder neck/prostate region. Patients and methods We retrospectively reviewed the success rates and surgical procedures of these seven complex scenarios in the repair of PFUI at our institution from 2000 to 2013. Results In all, >550 PFUI procedures were performed at our centre, and 308 of these patients were classified as having a complex PFUI, with 225 patients available for follow-up. The overall success rates were 81% and 77% for primary and repeat procedures respectively. The overall success rate of those with BUN was 76%, using various methods of novel surgical techniques. Boys aged ⩽12 years with PFUI required a transpubic/abdominal approach 31% of the time, compared to 9% in adults. Young girls with PFUI also required a transpubic/abdominal urethroplasty, with a success rate of 66%. In patients with a recto-urethral fistula the success rate was 90% with attention to proper surgical principles, including a three-stage procedure and appropriate interposition. The treatment of bladder neck incontinence associated with the tear-drop deformity gave a continence rate of 66%. Children with a double block at the bulbomembranous urethra and at the bladder neck-prostate junction were all continent after a one-stage transpubic/abdominal procedure. Conclusion An understanding of complex pelvic fractures and their appropriate management can provide successful outcomes. PMID:26019978

  16. Biomechanic effect of posterior cruciate ligament rupture on lateral meniscus

    PubMed Central

    Lei, Pengfei; Sun, Rongxin; Hu, Yihe; Li, Kanghua; Liao, Zhan

    2015-01-01

    Objective: This study aims to investigate the biomechanical effect of posterior cruciate ligament (PCL) rupture on lateral meniscus. Method: The stresses of anterior horn, caudomedial part and posterior horn of lateral meniscus in cadaveric knees were recorded when the knee joints were loaded 200 to 1000 N at 0, 30, 60 and 90° of flexion. Twelve knees were tested before PCL transection (intact group), and 6 each were then tested after anterolateral bundle (ALB group) and postmedial bundle (PMB group) transection. The same knees were finally tested after complete PCL transection. Result: At 0°of knee flexion, the stresses of the anterior horn, caudomedial part and posterior horn were negative and compressive, and were not significantly different between intact and ALB groups, and between completely transected and PMB groups at 200 and 400 N. The stresses of the anterior horn and caudomedial part were greater in completely transected and PMB groups than in intact and ALB groups. The stresses of the posterior horn were smaller in PMB and completely transected groups than in intact and ALB groups. At 600-1000 N, the stresses were significantly different between the groups. The absolute stresses of the anterior horn and caudomedial part were in order of completely transected > PMB > ALB > intact group, while these of the posterior horn were reversed. At 30° of knee flexion, the stresses of the three parts were not significantly different between intact and PMB groups nor between completely transected and ALB groups at 200 and 400 N. The stresses in the anterior horn and caudomedial part were negative and different between completely transected and ALB groups, and positive and different between intact and PMB groups. The stresses in the posterior horn were positive and different between completely transected and ALB groups, and negative and different between intact and PMB groups. At loads of > 600 N, the stresses in the anterior horn and caudomedial part were

  17. Bicondylar tibial plateau fracture after posterior cruciate ligament reconstruction.

    PubMed

    Griesser, Michael J; McCoy, Brett W; Hussain, Waqas M; Saluan, Paul

    2015-03-01

    The authors present a report of a bicondylar tibial plateau fracture in an adolescent athlete after posterior cruciate ligament (PCL) reconstruction. The procedure was performed via arthroscopic transtibial PCL reconstruction with quadrupled semi-tendinosus and gracilis autograft. The patient recovered uneventfully postoperatively and was able to participate in high-level sports activity, such as baseball and track, with no limitations, no subjective complaints, and no episodes of instability. He continued to be asymptomatic up to 3.5 years postoperatively. Almost 4 years postoperatively, the patient reinjured the left knee during recreational noncontact football and was seen emergently. Plain radiographs, magnetic resonance image scan, and computed tomography scan at the time of injury showed a bicondylar tibial plateau fracture with intra-articular involvement. Operative intervention was undertaken for open reduction and internal fixation of the bicondylar tibial plateau fracture. A plate was placed along the medial aspect of the tibia with locking and nonlocking screws, and the joint line was restored appropriately. The patient recovered uneventfully and at the most recent follow-up had full active and passive range of motion, had no subjective or objective evidence of instability, and had returned to full activity with no restrictions. The patient had no history of multiple fractures or any medical or pharmacologic history that predisposed him to decreased bone density. This case shows a unique possible complication after transtibial PCL reconstruction in an adolescent patient.

  18. Bicondylar tibial plateau fracture after posterior cruciate ligament reconstruction.

    PubMed

    Griesser, Michael J; McCoy, Brett W; Hussain, Waqas M; Saluan, Paul

    2015-03-01

    The authors present a report of a bicondylar tibial plateau fracture in an adolescent athlete after posterior cruciate ligament (PCL) reconstruction. The procedure was performed via arthroscopic transtibial PCL reconstruction with quadrupled semi-tendinosus and gracilis autograft. The patient recovered uneventfully postoperatively and was able to participate in high-level sports activity, such as baseball and track, with no limitations, no subjective complaints, and no episodes of instability. He continued to be asymptomatic up to 3.5 years postoperatively. Almost 4 years postoperatively, the patient reinjured the left knee during recreational noncontact football and was seen emergently. Plain radiographs, magnetic resonance image scan, and computed tomography scan at the time of injury showed a bicondylar tibial plateau fracture with intra-articular involvement. Operative intervention was undertaken for open reduction and internal fixation of the bicondylar tibial plateau fracture. A plate was placed along the medial aspect of the tibia with locking and nonlocking screws, and the joint line was restored appropriately. The patient recovered uneventfully and at the most recent follow-up had full active and passive range of motion, had no subjective or objective evidence of instability, and had returned to full activity with no restrictions. The patient had no history of multiple fractures or any medical or pharmacologic history that predisposed him to decreased bone density. This case shows a unique possible complication after transtibial PCL reconstruction in an adolescent patient. PMID:25760514

  19. Advanced imaging of the scapholunate ligamentous complex.

    PubMed

    Shahabpour, Maryam; Staelens, Barbara; Van Overstraeten, Luc; De Maeseneer, Michel; Boulet, Cedric; De Mey, Johan; Scheerlinck, Thierry

    2015-12-01

    The scapholunate joint is one of the most involved in wrist injuries. Its stability depends on primary and secondary stabilisers forming together the scapholunate complex. This ligamentous complex is often evaluated by wrist arthroscopy. To avoid surgery as diagnostic procedure, optimization of MR imaging parameters as use of three-dimensional (3D) sequences with very thin slices and high spatial resolution, is needed to detect lesions of the intrinsic and extrinsic ligaments of the scapholunate complex. The paper reviews the literature on imaging of radial-sided carpal ligaments with advanced computed tomographic arthrography (CTA) and magnetic resonance arthrography (MRA) to evaluate the scapholunate complex. Anatomy and pathology of the ligamentous complex are described and illustrated with CTA, MRA and corresponding arthroscopy. Sprains, mid-substance tears, avulsions and fibrous infiltrations of carpal ligaments could be identified on CTA and MRA images using 3D fat-saturated PD and 3D DESS (dual echo with steady-state precession) sequences with 0.5-mm-thick slices. Imaging signs of scapholunate complex pathology include: discontinuity, nonvisualization, changes in signal intensity, contrast extravasation (MRA), contour irregularity and waviness and periligamentous infiltration by edema, granulation tissue or fibrosis. Based on this preliminary experience, we believe that 3 T MRA using 3D sequences with 0.5-mm-thick slices and multiplanar reconstructions is capable to evaluate the scapholunate complex and could help to reduce the number of diagnostic arthroscopies.

  20. Surgical Treatment of a Rare Isolated Bilateral Agenesis of Anterior and Posterior Cruciate Ligaments

    PubMed Central

    2014-01-01

    The isolated bilateral agenesis of both cruciate ligaments is a rare congenital disorder. A 17-year-old male came to our attention due to an alteration in gait pattern, pain, and tendency to walk on the forefoot with his knee flexed. The patient did not recall previous injuries. Upon physical examination anterior and posterior chronic instability were observed. Radiographic examination of both knees showed hypoplasia of the tibial eminence, a hypoplastic lateral femoral condyle, and a narrow intercondylar notch. MRI brought to light a bilateral agenesis of both posterior cruciate ligaments. Arthroscopic evaluation confirmed bilateral isolated agenesis of both cruciate ligaments. We recommended a rehabilitation program to prepare the patient for the arthroscopic construction of both cruciate ligaments. PMID:25197599

  1. Surgical treatment of a rare isolated bilateral agenesis of anterior and posterior cruciate ligaments.

    PubMed

    Cerulli, G; Amanti, A; Placella, G

    2014-01-01

    The isolated bilateral agenesis of both cruciate ligaments is a rare congenital disorder. A 17-year-old male came to our attention due to an alteration in gait pattern, pain, and tendency to walk on the forefoot with his knee flexed. The patient did not recall previous injuries. Upon physical examination anterior and posterior chronic instability were observed. Radiographic examination of both knees showed hypoplasia of the tibial eminence, a hypoplastic lateral femoral condyle, and a narrow intercondylar notch. MRI brought to light a bilateral agenesis of both posterior cruciate ligaments. Arthroscopic evaluation confirmed bilateral isolated agenesis of both cruciate ligaments. We recommended a rehabilitation program to prepare the patient for the arthroscopic construction of both cruciate ligaments.

  2. Mechanoreceptors found in a posterior cruciate ligament from a well-functioning total knee arthroplasty retrieval.

    PubMed

    Mihalko, William M; Creek, Aaron T; Mary, Michelle N; Williams, John L; Komatsu, David E

    2011-04-01

    Histologic analysis of the posterior cruciate ligament has been reported in the normal and osteoarthritic knee but not after cruciate-retaining (CR) total knee arthroplasty (TKA). Retention of the posterior cruciate ligament during TKA has been debated as to whether it is beneficial in stability and function. If the presence of mechanoreceptors is shown to be maintained in CR TKA, then there may be an argument for retention. This case report used a retrieval of a well-functioning TKA specimen that had a CR TKA. To prove the presence of mechanoreceptors within the ligament, immunohistochemistry techniques using S100 protein and neurofilament protein were used. This specimen had pacini and lamellar type of mechanoreceptors present on immunohistochemistry analysis. The presence or retention of mechanoreceptors and innervations of the ligament may indicate an advantage when retained during TKA.

  3. Initial evaluation of posterior cruciate ligament injuries: history, physical examination, imaging studies, surgical and nonsurgical indications.

    PubMed

    Lopez-Vidriero, Emilio; Simon, David A; Johnson, Donald H

    2010-12-01

    Compared with anterior cruciate ligament injuries, posterior cruciate ligament injuries are a rare event. The mechanisms are predictable and a thorough physical examination is mandatory to rule out or define combined injury patterns. Stress radiography and magnetic resonance imaging studies are very helpful adjuncts. Acute and chronic injuries require slightly different approaches. As our understanding of normal and pathologic knee joint kinematics develops, nonoperative rehabilitation goals and operative techniques continue to evolve.

  4. Ligamentous injuries of the knee: anterior cruciate, medial collateral, posterior cruciate, and posterolateral corner injuries.

    PubMed

    Morelli, Vincent; Bright, Crystal; Fields, Ashley

    2013-06-01

    This article discusses athletic injuries of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and posterolateral corner. Best evidence to date validates that conservative management of ACL ruptures is a reasonable strategy. Current data also seem to advocate nonoperative management of PCL injuries. All isolated MCL injuries, regardless of grade, are usually treated with a brief period of immobilization and symptomatic management. Although the surgical literature often advocates surgical treatment of posterolateral corner injuries, there have been no randomized trials substantiating that these injuries are best treated surgically.

  5. Surgical treatment of acute and chronic anterior and posterior cruciate ligament and lateral side injuries of the knee.

    PubMed

    Levy, Bruce A; Boyd, Joel L; Stuart, Michael J

    2011-06-01

    Combined anterior cruciate ligament, posterior cruciate ligament, and lateral-sided injuries of the knee most often occurs secondary to a forced varus moment or after knee dislocation. Management controversies include the optimal timing of surgery, operative techniques, and postoperative rehabilitation. Recent systematic literature reviews have demonstrated higher rates of failure with repair of the lateral and posterolateral corner structures, as opposed to reconstruction. However, the ideal ligament reconstruction techniques remain unclear. This chapter will review the combined anterior cruciate ligament/posterior cruciate ligament/lateral-sided injury pattern, including the physical examination findings, imaging, timing of surgery, graft selection, operative techniques, and postoperative rehabilitation protocols.

  6. Suspensory Anterior Tibial Fixation in the Anatomic Transtibial Posterior Cruciate Ligament Reconstruction

    PubMed Central

    Elazab, Ashraf; Lee, Yong Seuk; Kang, Seo Goo

    2016-01-01

    The transtibial technique is the most relevant among many surgical techniques for posterior cruciate ligament reconstruction, and many types of fixation devices are used for tibial fixation according to the technique and the length of the graft. However, bone density in the fixation areas should be taken into consideration when choosing the fixation device to achieve rigid and stable fixation. However, density is not a substantial issue for anteromedial cortical fixation using a cortical suspension device. We describe tibial fixation with a TightRope RT (Arthrex, Naples, FL), which is a cortical suspension device, in anatomic transtibial posterior cruciate ligament reconstruction. PMID:27073781

  7. Multiple Looping Technique for Tibial Fixation in Posterior Cruciate Ligament Reconstruction of the Knee

    PubMed Central

    Noh, Jung Ho; Yoon, Kyoung Ho; Song, Sang Jun; Roh, Young Hak; Lee, Jae Woo

    2015-01-01

    The outcomes of posterior cruciate ligament reconstruction may be negatively affected by insufficient tibial tunnel fixation due to relatively lower bone density of the proximal tibia. We introduce a new technique of tibial fixation for posterior cruciate ligament reconstruction using free tendon Achilles allograft that is less affected by the bone density of the tibial metaphysis. PMID:25973367

  8. Compression of the Popliteal Artery after Posterior Cruciate Ligament Reconstruction Using the Tibial Inlay Technique

    PubMed Central

    Seo, Seung Suk; Kim, Do Hun; Park, Byung Yoon

    2015-01-01

    Popliteal artery compression rarely occurs after posterior cruciate ligament (PCL) reconstruction using the tibial inlay technique that allows for direct visualization of the surgical field. However, we experienced a popliteal artery compression after PCL reconstruction performed using the technique, which eventually required re-operation. Here, we report this rare case and discuss reasons of popliteal artery compression. PMID:26673356

  9. All-Inside Posterior Cruciate Ligament Reconstruction: GraftLink Technique

    PubMed Central

    Prince, Matthew R.; Stuart, Michael J.; King, Alexander H.; Sousa, Paul L.; Levy, Bruce A.

    2015-01-01

    Posterior cruciate ligament (PCL) injuries account for nearly 20% of knee ligament injuries. PCL injuries can occur in isolation or, more commonly, in the setting of multiligamentous knee injuries. Isolated PCL disruptions are commonly treated nonoperatively; however, symptomatic grade III injuries, as well as PCL injuries found in multiligamentous injuries, are frequently treated surgically. Several reconstructive techniques exist for the treatment of PCL deficiency without a clear optimal approach. We describe our preferred operative technique to reconstruct the PCL using an all-inside arthroscopic approach with a quadrupled tibialis anterior or peroneus longus allograft with both tibial and femoral suspensory fixation. PMID:26900564

  10. All-Inside Posterior Cruciate Ligament Reconstruction: GraftLink Technique.

    PubMed

    Prince, Matthew R; Stuart, Michael J; King, Alexander H; Sousa, Paul L; Levy, Bruce A

    2015-10-01

    Posterior cruciate ligament (PCL) injuries account for nearly 20% of knee ligament injuries. PCL injuries can occur in isolation or, more commonly, in the setting of multiligamentous knee injuries. Isolated PCL disruptions are commonly treated nonoperatively; however, symptomatic grade III injuries, as well as PCL injuries found in multiligamentous injuries, are frequently treated surgically. Several reconstructive techniques exist for the treatment of PCL deficiency without a clear optimal approach. We describe our preferred operative technique to reconstruct the PCL using an all-inside arthroscopic approach with a quadrupled tibialis anterior or peroneus longus allograft with both tibial and femoral suspensory fixation. PMID:26900564

  11. Arthroscopic All-Inside Posterior Cruciate Ligament Reconstruction: Overcoming the "Killer Turn".

    PubMed

    Vasdev, Attique; Rajgopal, Ashok; Gupta, Himanshu; Dahiya, Vivek; Tyagi, Vipin Chand

    2016-06-01

    One of the most challenging arthroscopic surgical procedures is posterior cruciate ligament (PCL) reconstruction. PCL injuries account for 20% of all knee ligament-related injuries. These may be isolated or occur as part of poly-ligament injuries. With the possibility of PCL reconstruction with the all-inside technique, there has been a surge in interest in treating PCL injuries. With the PCL being one of the strongest ligaments in the body and a primary restraint to posterior translation of the tibia, the need for PCL reconstruction is being more and more recognized. Surgeons often find it difficult to negotiate the so-called killer turn while attempting arthroscopic PCL reconstruction. We describe the use of the GraftLink graft construct through the posteromedial portal in 7 patients (6 male and 1 female patient) with isolated PCL injuries, which we believe not only allows us to perform the all-inside PCL reconstruction but also does away with the difficulty of the killer turn encountered while performing the arthroscopic PCL reconstruction.

  12. Arthroscopic posterior cruciate ligament reconstruction using four-strand hamstring tendon graft and interference screws.

    PubMed

    Pinczewski, L A; Thuresson, P; Otto, D; Nyquist, F

    1997-10-01

    We describe an arthroscopic technique for reconstruction of the posterior cruciate ligament (PCL) using a four-strand hamstring tendon graft. The femoral tunnel is drilled via the anterolateral portal and the tibial tunnel through the skin incision from the graft harvest. The graft is pulled through the tunnels with pullout sutures and fastened with interference screws. The results to date are good and the procedure can often be performed as day surgery. PMID:9343661

  13. Anatomic Graft Passage in Remnant-Preserving Posterior Cruciate Ligament Reconstruction

    PubMed Central

    Ahn, Jin Hwan; Lee, Sang Hak

    2014-01-01

    Posterior cruciate ligament (PCL) reconstruction with preservation of the remnant PCL fibers has been performed under the assumption that preserving the fibers contributes to knee kinematics, grafted tendon healing, and recovery of proprioception. This technical note presents a single-bundle, transtibial PCL reconstruction with anatomic graft passage between the remnant PCL fibers. The operation is performed using the posterior trans-septal portal, which can provide excellent visualization while preserving a large amount of remnant PCL fibers. In addition, this technique allows for anatomic graft passage without soft-tissue impingement, and it minimizes the risk of nonanatomic positioning of the PCL grafts. PMID:25473610

  14. Comparison of knee laxity and isokinetic muscle strength in patients with a posterior cruciate ligament injury.

    PubMed

    Jeon, Kyoungkyu

    2016-03-01

    [Purpose] The aim of this study was to compare knee laxity and isokinetic muscle strength in patients with an isolated posterior cruciate ligament injury. [Subjects and Methods] Twenty high school rugby players with a previous posterior cruciate ligament injury and abnormal findings higher than surgical grade I were included. Laxity with 132 N of pressure was measured using Kneelax 3 to assess the stability of the posterior cruciate ligament, and flexor and extensor torques were measured at 60°/sec, 180°/sec, and 240°/sec to measure the isokinetic muscle strength of the knee joint. The average and standard deviation values were extracted from all data to assess the measured data. [Results] Regarding the ipsilateral and contralateral laxity, the deviation value at the peak force and maximum manual drawer was statistically significant. The peak torque and peak torque per body weight in isokinetic measurements were significantly different only for knee extensor torque at 60°/sec, 180°/sec, and 240°/sec. [Conclusion] Return to normal activities post injury is important. Thus base data gathered by comparing patients' ipsilateral and contralateral sides will serve as essential criteria for structuring future rehabilitation programs to facilitate functional improvements.

  15. Posterior humeral avulsion of the glenohumeral ligament (PHAGL) in anterior shoulder instability

    PubMed Central

    Vedova, Franco Della; Ibáñez, Maximiliano; Alvarez, Victoria; Lépore, Salvador; Sulzle, Vanina Ojeda; Galan, Hernán; Slullitel, Daniel

    2015-01-01

    Introduction: Bankart lesion is the anterior glenohumeral instability most common associated injury. Tears at glenohumeral ligaments can be intra substance or at humeral insertion, this location may be the cause of instability. Posterior humeral avulsion of the glenohumeral ligament (PHAGL) can be an isolated or associated cause of instability and it is usually related to the posterior glenohumeral instability. The aim of this article is to report the clinical assessment and postoperative outcomes of 6 patients with PHAGL with anterior shoulder instability. Materials and Methods: We evaluated six patients with PHAGL due to anterior glenohumeral instability arthroscopically repaired. All 6 patients developed the lesion after a sports-related trauma. Sixty six per cent of patients had associated intra-articular shoulder pathologies. The diagnosis with MRI arthrogram (with gadolinium) was performed preoperatively in 50% of patients. Postoperative evaluation was made with Rowe, ASES and WOSI scores. Results: All patients returned to their previous sports level. One patient had a recurrence. Postoperative scores results are WOSI: 13.13%, Rowe 83.33 and ASES 95.83. Discussion: Humeral avulsions of glenohumeral ligaments represent 25% of capsulolabral injuries. PHAGL injury was initially described as a cause of posterior instability, but according to two other series, our study shows that this lesion may also cause anterior instability. It is critical to have a high index of suspicion and make a correct arthroscopic examination to diagnose this injury, because arthroscopic repair of PHAGL has good postoperative outcomes.

  16. Comparison of knee laxity and isokinetic muscle strength in patients with a posterior cruciate ligament injury

    PubMed Central

    Jeon, Kyoungkyu

    2016-01-01

    [Purpose] The aim of this study was to compare knee laxity and isokinetic muscle strength in patients with an isolated posterior cruciate ligament injury. [Subjects and Methods] Twenty high school rugby players with a previous posterior cruciate ligament injury and abnormal findings higher than surgical grade I were included. Laxity with 132 N of pressure was measured using Kneelax 3 to assess the stability of the posterior cruciate ligament, and flexor and extensor torques were measured at 60°/sec, 180°/sec, and 240°/sec to measure the isokinetic muscle strength of the knee joint. The average and standard deviation values were extracted from all data to assess the measured data. [Results] Regarding the ipsilateral and contralateral laxity, the deviation value at the peak force and maximum manual drawer was statistically significant. The peak torque and peak torque per body weight in isokinetic measurements were significantly different only for knee extensor torque at 60°/sec, 180°/sec, and 240°/sec. [Conclusion] Return to normal activities post injury is important. Thus base data gathered by comparing patients’ ipsilateral and contralateral sides will serve as essential criteria for structuring future rehabilitation programs to facilitate functional improvements. PMID:27134367

  17. Comparison of knee laxity and isokinetic muscle strength in patients with a posterior cruciate ligament injury.

    PubMed

    Jeon, Kyoungkyu

    2016-03-01

    [Purpose] The aim of this study was to compare knee laxity and isokinetic muscle strength in patients with an isolated posterior cruciate ligament injury. [Subjects and Methods] Twenty high school rugby players with a previous posterior cruciate ligament injury and abnormal findings higher than surgical grade I were included. Laxity with 132 N of pressure was measured using Kneelax 3 to assess the stability of the posterior cruciate ligament, and flexor and extensor torques were measured at 60°/sec, 180°/sec, and 240°/sec to measure the isokinetic muscle strength of the knee joint. The average and standard deviation values were extracted from all data to assess the measured data. [Results] Regarding the ipsilateral and contralateral laxity, the deviation value at the peak force and maximum manual drawer was statistically significant. The peak torque and peak torque per body weight in isokinetic measurements were significantly different only for knee extensor torque at 60°/sec, 180°/sec, and 240°/sec. [Conclusion] Return to normal activities post injury is important. Thus base data gathered by comparing patients' ipsilateral and contralateral sides will serve as essential criteria for structuring future rehabilitation programs to facilitate functional improvements. PMID:27134367

  18. Technical tips: reconstruction of deep and superficial deltoid ligaments by peroneus longus tendon in stage 4 posterior tibial tendon dysfunction.

    PubMed

    Lui, T H

    2014-12-01

    The deltoid ligament is composed of the superficial and deep layers. Disruption of the deltoid ligament can occur in rotational ankle fracture, chronic ankle instability, or stage 4 posterior tibial tendon dysfunction. Correcting valgus tilt at the time of flatfoot reconstruction in case of stage 4 posterior tibial tendon dysfunction may prevent future collapse and the need for ankle arthrodesis or possibly ankle arthroplasty. We describe a technique of reconstruction of both the superficial and deep deltoid ligaments by peroneus longus tendon. PMID:25457670

  19. What you need to know about ossification of the posterior longitudinal ligament to optimize cervical spine surgery: A review

    PubMed Central

    Epstein, Nancy E.

    2014-01-01

    What are the risks, benefits, alternatives, and pitfalls for operating on cervical ossification of the posterior longitudinal ligament (OPLL)? To successfully diagnose OPLL, it is important to obtain Magnetic Resonance Images (MR). These studies, particularly the T2 weighted images, provide the best soft-tissue documentation of cord/root compression and intrinsic cord abnormalities (e.g. edema vs. myelomalacia) on sagittal, axial, and coronal views. Obtaining Computed Tomographic (CT) scans is also critical as they best demonstrate early OPLL, or hypertrophied posterior longitudinal ligament (HPLL: hypo-isodense with punctate ossification) or classic (frankly ossified) OPLL (hyperdense). Furthermore, CT scans reveal the “single layer” and “double layer” signs indicative of OPLL penetrating the dura. Documenting the full extent of OPLL with both MR and CT dictates whether anterior, posterior, or circumferential surgery is warranted. An adequate cervical lordosis allows for posterior cervical approaches (e.g. lamionplasty, laminectomy/fusion), which may facilitate addressing multiple levels while avoiding the risks of anterior procedures. However, without lordosis and with significant kyphosis, anterior surgery may be indicated. Rarely, this requires single/multilevel anterior cervical diskectomy/fusion (ACDF), as this approach typically fails to address retrovertebral OPLL; single or multilevel corpectomies are usually warranted. In short, successful OPLL surgery relies on careful patient selection (e.g. assess comorbidities), accurate MR/CT documentation of OPLL, and limiting the pros, cons, and complications of these complex procedures by choosing the optimal surgical approach. Performing OPLL surgery requires stringent anesthetic (awake intubation/positioning) and also the following intraoperative monitoring protocols: Somatosensory evoked potentials (SSEP), motor evoked potentials (MEP), and electromyography (EMG). PMID:24843819

  20. Increased Prevalence of Ossification of Posterior Longitudinal Ligament and Increased Bone Mineral Density in Patients with Ossification of Nuchal Ligament

    PubMed Central

    Kim, Ki-Wan; Eun, Jong-Pil

    2016-01-01

    Objective There are also few studies demonstrating the relationship between ossification of nuchal ligament (ONL) and ossification of posterior longitudinal ligament (OPLL). We compared the prevalence, location, and type of OPLL between patients with ONL and matched patients without ONL.We also compared the bone mineral densities (BMDs) between the 2 groups. Methods total of 124 cervical ONL patients were enrolled in this study. The control group of 124 patients was matched with 124 patients with ONL by age and sex on a 1:1 basis to minimize confounding factors. We reviewed the prevalence, location, and type of OPLL in both groups. Results The prevalence of OPLL was almost 2.5 times greater in patients with ONL than those without ONL. The mean value of BMD in patients with ONL was greater at the lumbar spine (L1-L4) than in patients without ONL. The mean T score of the lumbar spine was 0.25±1.68 in the patients with ONL and -0.73±1.64 in the patients without ONL. Conclusion The prevalence of OPLL in patients with ONL was significantly higher than in patients without ONL. Because ONL is innocuous and may be seen more readily than OPLL on simple cervical radiographs, clinicians should consider the possibility of coexisting OPLL when ONL, especially extensive ONL, is detected in patients with neck pain, radiculopathy, or myelopathy, to facilitate proper treatment. PMID:27799994

  1. Immunohistochemical analysis of the neural structures of the posterior cruciate ligament in osteoarthritis patients submitted to total knee arthroplasty: an analysis of thirty-four cases

    PubMed Central

    Martins, Glaucus Cajaty; Camanho, Gilberto; Rodrigues, Mara Ibis

    2015-01-01

    OBJECTIVES: Many authors recommend posterior cruciate ligament-retaining arthroplasty with the intention to maintain the proprioception properties of this ligament. Preservation of the neuroreceptors and nervous fibers may be essential for retaining the proprioception function of the posterior cruciate ligament. The present study was thus developed to evaluate the presence of neural structures in the posterior cruciate ligament resected during posterior stabilized arthroplasty in osteoarthritis patients. In particular, clinical, radiographic and histological parameters were correlated with the presence or absence of neural structures in the posterior cruciate ligament. METHODS: In total, 34 posterior cruciate ligament specimens were stained with hematoxylin-eosin and Gomori trichrome. An immunohistochemical analysis using antibodies against the S100 protein and neurofilaments was also performed. The presence of neural structures was correlated with parameters such as tibiofemoral angulation, histological degeneration of the posterior cruciate ligament, Ahlbäck radiological classification, age, gender and the histologic pattern of the synovial neurovascular bundle around the posterior cruciate ligament. RESULTS: In total, 67.5% of the cases presented neural structures in the posterior cruciate ligament. In 65% of the cases, the neurovascular bundle was degenerated. Nervous structures were more commonly detected in varus knees than in valgus knees (77% versus 50%). Additionally, severe histologic degeneration of the posterior cruciate ligament was related to neurovascular bundle degeneration. CONCLUSIONS: Severe posterior cruciate ligament degeneration was related to neurovascular bundle compromise. Neural structures were more commonly detected in varus knees. Intrinsic neural structures were detected in the majority of the posterior cruciate ligaments of patients submitted to knee arthroplasty for osteoarthritis. PMID:25789514

  2. A Comparison of Anterior and Posterior Cruciate Ligament Laxity Between Female and Male Basketball Players.

    PubMed

    Weesner, C L; Albohm, M J; Ritter, M A

    1986-05-01

    In brief: The incidence and severity of knee injuries is greater in female than male basketball players. To gain insight into this phenomenon, anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) laxity of 90 noninjured female and male high school basketball players were tested with an arthrometer and compared. With leg flexion of 25° ± 5° and 70° ± 5°, no statistically significant differences were found in ACL laxity, nor were significant right-left differences found. Differences in PCL laxity were not consistent. Thus, inadequate conditioning rather than laxity may be the major factor responsible for the higher incidence of knee injuries in female basketball players. If so, adequate preseason and inseason conditioning programs need to be implemented to correct this deficiency.

  3. Management of Posterior Cruciate Ligament Injuries: An Evidence-Based Review.

    PubMed

    Bedi, Asheesh; Musahl, Volker; Cowan, James B

    2016-05-01

    Isolated injuries of the posterior cruciate ligament are uncommon, are often caused by a posteriorly directed force to the proximal tibia, and result in abnormal knee kinematics and function. A thorough clinical evaluation, including history, physical examination, and imaging, is required to rule out a concomitant structural knee injury. No clear prognostic factors predict outcomes, and ideal management remains uncertain. Nonsurgical management is advocated for isolated grade I or II posterior cruciate ligament injuries or for grade III injuries in patients with mild symptoms or low activity demands. Surgical management is reserved for high-demand athletes or patients in whom nonsurgical management has been unsuccessful. Although biomechanical studies have identified differences between single-bundle, double-bundle, transtibial, and tibial inlay reconstruction techniques, the optimal surgical technique has not been established. No high-quality evidence is available regarding immobilization, weight-bearing, bracing, or rehabilitation protocols for patients treated either nonsurgically or surgically. Additional long-term clinical studies with homogeneous patient populations are needed to identify the ideal management of these injuries.

  4. Surgical treatment of posterior cruciate ligament insufficiency in the United States.

    PubMed

    Wang, Dean; Berger, Neal; Cohen, Jeremiah R; Lord, Elizabeth L; Wang, Jeffrey C; Hame, Sharon L

    2015-04-01

    The purpose of this study was to investigate the latest trends and demographics of surgical treatment of posterior cruciate ligament (PCL) insufficiency in the United States. Patients who underwent surgical treatment of PCL insufficiency from 2007 to 2011 were identified by searching the International Classification of Diseases, Ninth Revision, Clinical Modification codes and Current Procedural Terminology codes in the PearlDiver Patient Records Database (PearlDiver Technologies, Warsaw, Indiana), a publicly available national database of insurance records. The chronicity of injury, year of procedure, age, sex, region of the United States the surgery was performed, and other concomitant meniscus and ligamentous operations were elicited for each patient. In total, 701 cases of surgical PCL procedures (222 isolated and 479 combined) were identified. More PCL surgeries were completed for acute injuries (74%) than for chronic injuries (26%). Among associated procedures, meniscectomies and meniscus repairs were performed for 293 (41%) and 51 (7%) patients, respectively. Meniscectomies were completed in 77 (35%) isolated reconstructions vs 216 (45%) combined reconstructions (P=.01; odds ratio, 0.65). Of the combined PCL surgeries, anterior cruciate ligament (ACL)/PCL was the most common (62%), followed by ACL/PCL/collateral ligament repair (11%) and PCL/other ligamentous reconstruction (9%). No specific trends were observed in the yearly number of PCL procedures performed. The peak number of isolated PCL surgeries was observed in a younger age group (20-29 years) than that of combined PCL surgeries (30-39 years) (P<.01). Surgical treatment for PCL insufficiency remains reserved for acute multiligamentous knee injuries, with ACL/PCL operations being the most common combined procedure.

  5. The Effect of Tibial Posterior Slope on Contact Force and Ligaments Stresses in Posterior-Stabilized Total Knee Arthroplasty-Explicit Finite Element Analysis

    PubMed Central

    Lee, Hwa-Yong; Kang, Kyoung-Tak; Kim, Sung-Hwan; Park, Kwan-Kyu

    2012-01-01

    Purpose The purpose of this study is to evaluate the effect of change in tibial posterior slope on contact force and ligament stress using finite element analysis. Materials and Methods A 3-dimensional finite element model for total knee arthroplasty was developed by using a computed tomography scan. For validation, the tibial translations were compared with previous studies. The finite element analysis was conducted under the standard gait cycle, and contact force on ultra-high molecular weight polyethylene (UHMWPE) and stresses on lateral and medial collateral ligaments were evaluated. Results The tibial translations showed similarity with previous studies. As the tibial posterior slope angle increases, the contact stress area increased and was well distributed, and the contact force on UHMWPE decreased overall. However, the maximum contact force in the case for 10° case was greater than those for others. The stresses on ligaments were the greatest and smallest in 0° and 10° cases, respectively. Conclusions The higher tibial posterior slope angle leads to the lower contact stress and more extensive stress distribution overall in posterior-stabilized total knee arthroscopy. However, it does not absolutely mean the smallest contact force. The stresses on ligaments increased with respect to the smaller tibial posterior slope angle. PMID:22708109

  6. Displaced avulsion fractures of the posterior cruciate ligament: Treated by stellate steel plate fixation

    PubMed Central

    Li, Lijun; Tian, Wei

    2015-01-01

    Background: The open reduction with internal fixation is an effective approach for treatment of avulsion fracture of posterior cruciate ligament. The previously used internal fixation materials including hollow screws, absorbable screw, tension bands and sutures have great defects such as insufficient fixation strength, susceptibility to re-fracture, etc. Stellate steel plate is novel material for internal fixation which has unique gear-like structure design. We used stellate steel plate for treatment of displaced avulsion fractures of posterior cruciate ligament in this study. Materials and Methods: 14 patients (9 men, 5 women; aged, 19–35 years; mean age, 28 years) with displaced avulsion fractures of the tibial insertion of the posterior cruciate ligament were retrospectively analyzed between June 2009 and June 2011. The mean duration from injury to the operation was 8.3 days (range 6–15 days). All the patients were treated with open reduction and internal fixation of a stellate steel plate (DePuy, Raynham, MA 02767, USA). The Lysholm-Tegner knee function score criteria were used to analyze results. Results: The mean followup was 24.6 months (range 18–32 months). After 6 months, all the fractures healed and knee joint activity was normal, with no knee stiffness or instability. The Lysholm-Tegner scores were 97.1 ± 1.7 points at the final followup. Conclusion: Owing to its unique gear structure, the stellate steel plate design can effectively fix an avulsion fracture block and it is a simple operation with short postoperative rehabilitation time and firm fixation. PMID:26015605

  7. Genomic study of ossification of the posterior longitudinal ligament of the spine

    PubMed Central

    IKEGAWA, Shiro

    2014-01-01

    Ossification of the posterior longitudinal ligament of the spine (OPLL) is a common disease after the middle age. OPLL frequently causes serious neurological problems due to compression of the spinal cord and/or nerve roots. OPLL occurs in patients with monogenic metabolic diseases including rickets/osteomalacia and hypoparathyroidism; however most of OPLL is idiopathic and is considered as a multi-factorial (polygenic) disease influenced by genetic and environmental factors. Genomic studies for the genetic factors of OPLL have been conducted, mainly in Japan, including linkage and association studies. This paper reviews the recent progress in the genomic study of OPLL and comments on its future direction. PMID:25504229

  8. Genetics of Ossification of the Posterior Longitudinal Ligament of the Spine: A Mini Review

    PubMed Central

    2014-01-01

    Ossification of the posterior longitudinal ligament of the spine (OPLL) is a common disease in aging populations and sometimes results in serious neurological problems due to compression of the spinal cord and nerve roots. OPLL is a multi-factorial (polygenic) disease controlled by genetic and environmental factors. Studies searching for the genetic component of OPLL, using linkage and association analyses, are in progress and several susceptibility genes have been reported. This paper reviews the recent progress in the genetic study of OPLL and comments on its future task. PMID:25006569

  9. Posterior Cruciate Ligament Retention versus Posterior Stabilization for Total Knee Arthroplasty: A Meta-Analysis

    PubMed Central

    Wang, Ying; Bian, Yanyan; Feng, Bin; Weng, Xisheng

    2016-01-01

    Introduction Although being debated for many years, the superiority of posterior cruciate-retaining (CR) total knee arthroplasty (TKA) and posterior-stabilized (PS) TKA remains controversial. We compare the knee scores, post-operative knee range of motion (ROM), radiological outcomes about knee kinematic and complications between CR TKA and PS TKA. Methods Literature published up to August 2015 was searched in PubMed, Embase and Cochrane databases, and meta-analysis was performed using the software, Review Manager version 5.3. Results Totally 14 random control trials (RCTs) on this topic were included for the analysis, which showed that PS and CR TKA had no significant difference in Knee Society knee Score (KSS), pain score (KSPS), Hospital for Special Surgery score (HSS), kinematic characteristics including postoperative component alignment, tibial posterior slope and joint line, and complication rate. However, PS TKA is superior to CR TKA regarding post-operative knee range of motion (ROM) [Random Effect model (RE), Mean Difference (MD) = -7.07, 95% Confidential Interval (CI) -10.50 to -3.65, p<0.0001], improvement of ROM (Fixed Effect model (FE), MD = -5.66, 95% CI -10.79 to -0.53, p = 0.03) and femoral-tibial angle [FE, MD = 0.85, 95% CI 0.46 to 1.25, p<0.0001]. Conclusions There are no clinically relevant differences between CR and PS TKA in terms of clinical, functional, radiological outcome, and complications, while PS TKA is superior to CR TKA in respects of ROM, while whether this superiority matters or not in clinical practice still needs further investigation and longer follow-up. PMID:26824368

  10. Current Arthroscopic Concepts in Repairing Posterior Cruciate Ligament Tibial-Sided Avulsions.

    PubMed

    Malempati, Chaitu; Felder, Jerrod; Elliott, Michael; Brunkhorst, Joseph; Miller, Mark; Johnson, Darren L

    2015-09-01

    Posterior cruciate ligament (PCL) injuries are extremely rare and most commonly occur in the trauma setting. They can lead to instability, pain, diminished function, and eventual arthrosis. Several techniques of arthroscopic PCL repair for tibial-sided bony avulsions have been described in the literature; however, no single technique has emerged as the gold standard to predictably restore posterior knee stability, PCL function, and knee biomechanics. The authors believe that the best results will come from procedures that re-create the normal human anatomy and knee kinematics. In this article, 3 arthroscopic methods of PCL avulsion repairs performed at 2 academic institutions are analyzed. The techniques described here provide good options for the treatment of these injuries.

  11. A review of ultrasonographic methods for the assessment of the anterior cruciate ligament in patients with knee instability – diagnostics using a posterior approach

    PubMed Central

    Kielar, Maciej

    2016-01-01

    Aim The purpose of the study was to improve the ultrasonographic assessment of the anterior cruciate ligament by an inclusion of a dynamic element. The proposed functional modification aims to restore normal posterior cruciate ligament tension, which is associated with a visible change in the ligament shape. This method reduces the risk of an error resulting from subjectively assessing the shape of the posterior cruciate ligament. It should be also emphasized that the method combined with other ultrasound anterior cruciate ligament assessment techniques helps increase diagnostic accuracy. Methods Ultrasonography is used as an adjunctive technique in the diagnosis of anterior cruciate ligament injury. The paper presents a sonographic technique for the assessment of suspected anterior cruciate ligament insufficiency supplemented by the use of a dynamic examination. This technique can be recommended as an additional procedure in routine ultrasound diagnostics of anterior cruciate ligament injuries. Results Supplementing routine ultrasonography with the dynamic assessment of posterior cruciate ligament shape changes in patients with suspected anterior cruciate ligament injury reduces the risk of subjective errors and increases diagnostic accuracy. This is important especially in cases of minor anterior knee instability and bilateral anterior knee instability. Conclusions An assessment of changes in posterior cruciate ligament using a dynamic ultrasound examination effectively complements routine sonographic diagnostic techniques for anterior cruciate ligament insufficiency.

  12. A review of ultrasonographic methods for the assessment of the anterior cruciate ligament in patients with knee instability – diagnostics using a posterior approach

    PubMed Central

    Kielar, Maciej

    2016-01-01

    Aim The purpose of the study was to improve the ultrasonographic assessment of the anterior cruciate ligament by an inclusion of a dynamic element. The proposed functional modification aims to restore normal posterior cruciate ligament tension, which is associated with a visible change in the ligament shape. This method reduces the risk of an error resulting from subjectively assessing the shape of the posterior cruciate ligament. It should be also emphasized that the method combined with other ultrasound anterior cruciate ligament assessment techniques helps increase diagnostic accuracy. Methods Ultrasonography is used as an adjunctive technique in the diagnosis of anterior cruciate ligament injury. The paper presents a sonographic technique for the assessment of suspected anterior cruciate ligament insufficiency supplemented by the use of a dynamic examination. This technique can be recommended as an additional procedure in routine ultrasound diagnostics of anterior cruciate ligament injuries. Results Supplementing routine ultrasonography with the dynamic assessment of posterior cruciate ligament shape changes in patients with suspected anterior cruciate ligament injury reduces the risk of subjective errors and increases diagnostic accuracy. This is important especially in cases of minor anterior knee instability and bilateral anterior knee instability. Conclusions An assessment of changes in posterior cruciate ligament using a dynamic ultrasound examination effectively complements routine sonographic diagnostic techniques for anterior cruciate ligament insufficiency. PMID:27679732

  13. Physical examination and in vivo kinematics in two posterior cruciate ligament retaining total knee arthroplasty designs.

    PubMed

    Ploegmakers, M J M; Ginsel, B; Meijerink, H J; de Rooy, J W; de Waal Malefijt, M C; Verdonschot, N; Banks, S A

    2010-06-01

    The aim of this study was to investigate anteroposterior instability in the CKS and the PFC total knee arthroplasty (TKA) designs. Physical examinations, including VAS, IKS and WOMAC were performed in combination with a detailed fluoroscopic measurement technique for three-dimensional kinematic assessment of TKA design function. Anteroposterior instability rated with the IKS was not significantly different (p=0.34), but patients with a CKS design showed more limitations according to the WOMAC joint stiffness total score, and for items regarding higher flexion activities in the WOMAC score for knee disability. Kinematic analyses showed that the CKS design tended to have more anterior sliding of the femur on the tibia during mid- and deep flexion activities. The sliding distance was larger at the medial than at the lateral side. This phenomenon has also been described for posterior cruciate ligament deficient knees. Furthermore, the CKS design showed a significantly lower range of tibial rotation (p<0.05) from maximum extension to maximum flexion during deep knee bend activities. Kinematic differences can be ascribed to posterior cruciate ligament deficiency/laxity or differences in TKA designs.

  14. All-arthroscopic treatment of tibial avulsion fractures of the posterior cruciate ligament

    PubMed Central

    Gwinner, Clemens; Hoburg, Arnd; Wilde, Sophie; Schatka, Imke; Krapohl, Björn Dirk; Jung, Tobias M.

    2016-01-01

    Background: The posterior cruciate ligament (PCL) avulsion fracture from its tibial insertion is a rare condition. Despite the further technical advent in refixation of avulsion fractures, the reported failure rate of current approaches remains high and the optimal surgical technique has not been elucidated yet. The purpose of the current study is to present an all-inside arthroscopic reconstruction technique for bony tibial avulsion fractures of the PCL and initial clinical outcomes. Methods: Patients underwent a thorough clinical and radiological examination of both knees at 3, 6, 12, 18, and if possible also at 24 months. Clinical evaluation included subjective and objective IKDC 2000, Lysholm score, and KOOS score. Radiographic imaging studies included CT scans for assessment of osseous integration and anatomic reduction of the bony avulsion. In addition to that posterior stress radiographs of both knees using the Telos device (Arthrex, Naples, USA) were conducted to measure posterior tibial translation. Results: A total of four patients (1 female, 3 male; ø 38 (± 18) years), who underwent arthroscopic refixation of a PCL avulsion fracture using the Tight Rope device were enrolled in this study. Mean follow up was 22 [18–24] months. The mean subjective IKDC was 72.6% (± 9.9%). Regarding the objective IKDC three patients accounted for grade A, one patient for grade C. The Lysholm score yielded 82 (± 6.9) points. The KOOS score reached 75% (± 13%; symptoms 76%, pain 81%, function 76%, sports 66%, QoL 64%). All patients showed complete osseous integration and anatomic reduction of the bony avulsion. The mean posterior tibial translation at final follow up was 2.8 [0–7] mm. Conclusions: All-arthroscopic treatment of tibial avulsion fractures of the posterior cruciate ligament provides satisfactory clinical results in a preliminary patient cohort. It is a reproducible technique, which minimizes soft tissue damage and obviates a second surgery for hardware

  15. Quantifiable Imaging Biomarkers for Evaluation of the Posterior Cruciate Ligament Using 3-T Magnetic Resonance Imaging

    PubMed Central

    Wilson, Katharine J.; Surowiec, Rachel K.; Ho, Charles P.; Devitt, Brian M.; Fripp, Jurgen; Smith, W. Sean; Spiegl, Ulrich J.; Dornan, Grant J.; LaPrade, Robert F.

    2016-01-01

    Background: Quantitative magnetic resonance imaging (MRI) techniques, such as T2 and T2 star (T2*) mapping, have been used to evaluate ligamentous tissue in vitro and to identify significant changes in structural integrity of a healing ligament. These studies lay the foundation for a clinical study that uses quantitative mapping to evaluate ligaments in vivo, particularly the posterior cruciate ligament (PCL). To establish quantitative mapping as a clinical tool for identifying and evaluating chronic or acute PCL injuries, T2 and T2* values first must be determined for an asymptomatic population. Purpose: To quantify T2 and T2* mapping properties, including texture variables (entropy, variance, contrast, homogeneity), of the PCL in an asymptomatic population. It was hypothesized that biomarker values would be consistent throughout the ligament, as measured across 3 clinically relevant subregions (proximal, middle, and distal thirds) in the asymptomatic cohort. Study Design: Cross-sectional study; Level of evidence, 4. Methods: Unilateral knee MRI scans were acquired for 25 asymptomatic subjects with a 3.0-T MRI system using T2 and T2* mapping sequences in the sagittal plane. The PCL was manually segmented and divided into thirds (proximal, middle, and distal). Summary statistics for T2 and T2* values were calculated. Intra- and interrater reliability was assessed across 3 raters to 2 time points. Results: The asymptomatic PCL cohort had mean T2 values of 36.7, 29.2, and 29.6 ms in the distal, middle, and proximal regions, respectively. The distal PCL exhibited significantly higher mean, variance, and contrast and lower homogeneity of T2 values than the middle and proximal subregions (P < .05). T2* results exhibited substantial positive skew and were therefore presented as median and quartile (Q) values. Median T2* values were 7.3 ms (Q1-Q3, 6.8-8.9 ms), 7.3 ms (Q1-Q3, 7.0-8.5 ms), and 7.3 ms (Q1-Q3, 6.4-8.2 ms) in the distal, middle, and proximal subregions

  16. Editorial Commentary: Should We Repair Posterior Cruciate Ligament Tibial Avulsion Fractures by Opening the Hood or Through the Tailpipe?

    PubMed

    Miller, G Klaud

    2016-01-01

    While the controversy of open versus arthroscopic methods has been settled for many procedures in favor of arthroscopic treatment, the article by Sabat et al. all shows that posterior cruciate ligament tibial avulsion fractures can be equally well treated with either open or arthroscopic techniques. PMID:26743409

  17. Editorial Commentary: Should We Repair Posterior Cruciate Ligament Tibial Avulsion Fractures by Opening the Hood or Through the Tailpipe?

    PubMed

    Miller, G Klaud

    2016-01-01

    While the controversy of open versus arthroscopic methods has been settled for many procedures in favor of arthroscopic treatment, the article by Sabat et al. all shows that posterior cruciate ligament tibial avulsion fractures can be equally well treated with either open or arthroscopic techniques.

  18. Two-strand posterior cruciate ligament reconstruction with a quadriceps tendon-patellar bone autograft: technical considerations and clinical results.

    PubMed

    Noyes, Frank R; Barber-Westin, Sue D

    2006-01-01

    In patients with complete posterior cruciate ligament (PCL) ruptures in which 10 mm or more of increased posterior tibial translation is detected, associated knee disorders must be treated at the same time as the PCL injury. Varus malalignment and any abnormal medial or lateral ligament deficiency must be corrected before or with PCL reconstruction to avoid the risk of failure of the PCL graft. Gait retraining is recommended for patients with abnormal knee hyperextension patterns before ligament reconstruction is performed. Advances in PCL reconstruction include the use of a two-strand graft that may be placed using either a tibial inlay or an all-arthroscopic tibial tunnel technique. Biomechanical studies have shown a reduction in graft tension and improved load sharing in these constructs compared with single-strand reconstructions. The tibial inlay method can be used in athletic patients, and it also is required in PCL revisions in which a prior tibial tunnel must be avoided to achieve graft fixation. The tibial tunnel technique is used to treat dislocated knees for which reconstruction of multiple knee ligaments is required or when prior arterial injury or posterior skin or muscle damage limits the indications for a posterior open approach. Postoperative rehabilitation should protect the PCL graft from high forces and repetitive cyclic knee motions during the first 4 weeks postoperatively.

  19. Minimally invasive central corpectomy for ossified posterior longitudinal ligament in the cervical spine.

    PubMed

    Hirano, Yoshitaka; Mizuno, Junichi; Nakagawa, Hiroshi; Itoh, Yasunobu; Kubota, Keiichi; Watanabe, Sadayoshi; Matsuoka, Hidenori; Numazawa, Shinichi; Tomii, Masato; Watanabe, Kazuo

    2011-01-01

    Minimally invasive central corpectomy (MICC) for cervical segmental ossified posterior longitudinal ligament (OPLL) is described. The procedure of MICC includes upper- or lower-half central corpectomy of the involved cervical spine, transdiscal decompression of the adjacent disc level, dissection and partial removal of the OPLL, removal of the OPLL behind the vertebral body via these windows, and fusion with cylindrical titanium cages. Anterior plate fixation is not necessary. From January 2008 to December 2009 we surgically treated three patients with cervical OPLL by MICC. All three patients showed remarkable improvement of their symptoms within a few days after the operation. No neurological or radiological complication was observed during that period. MICC is beneficial in avoiding complete corpectomy and long fusion, usage of an anterior plate, and usage of a large external orthosis. MICC also reduces the risk of postoperative esophageal perforation due to a screw backing out of the plate. PMID:20888772

  20. Late Occurrence of Cervicothoracic Ossification of Posterior Longitudinal Ligaments in a Surgically Treated Thoracic OPLL Patient

    PubMed Central

    Hyun, Seung-Jae; Hong, Seung-Chyul

    2010-01-01

    Ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine is rare, even in the Far East. A 45-year-old female presented with a 4-month history of progressive motor weakness in the lower extremities, numbness below the midthoracic area, and spastic gait disturbance. Neuroradiological examinations revealed massive OPLLs at the T4-T6 levels with severe anterior compression of the spinal cord. Anterior decompressive corpectomies with bone grafts were performed from T4 to T6 using a trans-thoracic approach. After surgery, the patient made an uneventful recovery. However, eleven years after surgery, the patient developed recurrent lower extremity weakness and spastic gait disturbance. De novo OPLLs at the C6-T2 levels were responsible for the severe spinal cord compression on this occasion. After second surgery, paralysis in both legs was resolved. We present a rare case of late cervicothoracic OPLL in a patient surgically treated for thoracic OPLL. PMID:20157380

  1. The Role of Posterior Longitudinal Ligament in Cervical Disc Replacement: An Ovine Cadaveric Biomechanical Analysis

    PubMed Central

    Yu, Cheng-Cheng; Hao, Ding-Jun; Ma, Yu-Li; Huang, Da-Geng; Li, Hou-Kun; Feng, Hang; Hou, Qian

    2016-01-01

    Background Cervical disc replacement (CDR) has been widely used to restore and maintain mobility and function of the treated and adjacent motion segments. Posterior longitudinal ligament (PLL) resection has been shown to be efficient in anterior cervical decompression and fusion. However, less is known about the biomechanical effect of PLL removal versus preservation in cervical disc arthroplasty. Material/Methods Three motion segments of 24 ovine cervical spines (C2–C5) were evaluated in a robotic spine system with axial compressive loads of 50 N. These cervical spines were divided in three groups according to the following conditions: (1) intact spine, (2) C3/C4 CDR with the Prestige LP prosthesis and PLL preservation, and (3) C3/C4 CDR with the Prestige LP prosthesis and PLL removal. The ranges of motion (ROMs) were recorded and analyzed in each group. Results The C3/C4 ROM in group 3 (CDR with PLL removed) increased significantly in flexion-extension and axial rotation compared with group 1 (intact spine). Moreover, in flexion-extension, the mean total ROM was significantly larger in group 3 than in group 1. All the ROM observed in group 2 (CDR with PLL preserved) did not significantly differ from the ROM observed in group 1. Conclusions Compared with intact spines, CDR with PLL removal partly increased ROM. Moreover, the ROM in CDR with PLL preservation did not significantly differ from the ROM observed in intact spines. The PLL appears to contribute to the balance and stability of the cervical spine and should thus be preserved in cervical disc replacement provided that the posterior longitudinal ligament is not degenerative and the compression can be removed without PLL takedown. PMID:27243444

  2. The Role of Posterior Longitudinal Ligament in Cervical Disc Replacement: An Ovine Cadaveric Biomechanical Analysis.

    PubMed

    Yu, Cheng-Cheng; Hao, Ding-Jun; Ma, Yu-Li; Huang, Da-Geng; Li, Hou-Kun; Feng, Hang; Hou, Qian

    2016-05-31

    BACKGROUND Cervical disc replacement (CDR) has been widely used to restore and maintain mobility and function of the treated and adjacent motion segments. Posterior longitudinal ligament (PLL) resection has been shown to be efficient in anterior cervical decompression and fusion. However, less is known about the biomechanical effect of PLL removal versus preservation in cervical disc arthroplasty. MATERIAL AND METHODS Three motion segments of 24 ovine cervical spines (C2-C5) were evaluated in a robotic spine system with axial compressive loads of 50 N. These cervical spines were divided in three groups according to the following conditions: (1) intact spine, (2) C3/C4 CDR with the Prestige LP prosthesis and PLL preservation, and (3) C3/C4 CDR with the Prestige LP prosthesis and PLL removal. The ranges of motion (ROMs) were recorded and analyzed in each group. RESULTS The C3/C4 ROM in group 3 (CDR with PLL removed) increased significantly in flexion-extension and axial rotation compared with group 1 (intact spine). Moreover, in flexion-extension, the mean total ROM was significantly larger in group 3 than in group 1. All the ROM observed in group 2 (CDR with PLL preserved) did not significantly differ from the ROM observed in group 1. CONCLUSIONS Compared with intact spines, CDR with PLL removal partly increased ROM. Moreover, the ROM in CDR with PLL preservation did not significantly differ from the ROM observed in intact spines. The PLL appears to contribute to the balance and stability of the cervical spine and should thus be preserved in cervical disc replacement provided that the posterior longitudinal ligament is not degenerative and the compression can be removed without PLL takedown.

  3. Ossified Posterior Longitudinal Ligament With Massive Ossification of the Anterior Longitudinal Ligament Causing Dysphagia in a Diffuse Idiopathic Skeletal Hyperostosis Patient.

    PubMed

    Murayama, Kazuhiro; Inoue, Shinichi; Tachibana, Toshiya; Maruo, Keishi; Arizumi, Fumihiro; Tsuji, Shotaro; Yoshiya, Shinichi

    2015-08-01

    Descriptive case report.To report a case of a diffuse idiopathic skeletal hyperostosis (DISH) patient with both massive ossification of the anterior longitudinal ligament (OALL) leading to severe dysphagia as well as ossification of the posterior longitudinal ligament (OPLL) causing mild cervical myelopathy, warranting not only an anterior approach but also a posterior one.Although DISH can cause massive OALL in the cervical spine, severe dysphagia resulting from DISH is a rare occurrence. OALLs are frequently associated with OPLL. Treatment for a DISH patient with OPLL in setting of OALL-caused dysphagia is largely unknown.A 70-year-old man presented with severe dysphagia with mild cervical myelopathy. Neurological examination showed mild spastic paralysis and hyper reflex in his lower extremities. Plane radiographs and computed tomography of the cervical spine revealed a discontinuous massive OALL at C4-5 and continuous type OPLL at C2-6. Magnetic resonance imaging revealed pronounced spinal cord compression due to OPLL at C4-5. Esophagram demonstrated extrinsic compression secondary to OALL at C4-5.We performed posterior decompressive laminectomy with posterior lateral mass screw fixation, as well as both resection of OALL and interbody fusion at C4-5 by the anterior approach. We performed posterior decompressive laminectomy with posterior lateral mass screw fixation, as well as both resection of OALL and interbody fusion at C4-5 by the anterior approach. Severe dysphagia markedly improved without any complications.We considered that this patient not only required osteophytectomy and fusion by the anterior approach but also required decompression and spinal fusion by the posterior approach to prevent both deterioration of cervical myelopathy and recurrence of OALL after surgery. PMID:26266365

  4. Surgical treatment of acute and chronic anterior and posterior cruciate ligament and medial-side injuries of the knee.

    PubMed

    Hubert, Mark G; Stannard, James P

    2011-06-01

    KD-IIIM knee injuries are challenging injuries that can do well when anatomic reconstruction techniques are used. This article describes the authors preferred reconstructions, timing of surgery, and rehabilitation techniques. The reconstructions are generally initiated 3 or 4 weeks after the injury when the local soft tissue injury allows and associated fractures have already been stabilized. The posterior cruciate ligament, posteromedial corner, and meniscus injuries are addressed in the initial operation. The corresponding author prefers to come back 6 weeks later and reconstruct the anterior cruciate ligament and assure that acceptable progress has been made regarding knee motion.

  5. Unique Anatomic Feature of the Posterior Cruciate Ligament in Knees Associated With Osteochondritis Dissecans

    PubMed Central

    Ishikawa, Masakazu; Adachi, Nobuo; Yoshikawa, Masahiro; Nakamae, Atsuo; Nakasa, Tomoyuki; Ikuta, Yasunari; Hayashi, Seiju; Deie, Masataka; Ochi, Mitsuo

    2016-01-01

    Background: Osteochondritis dissecans (OCD) of the knee is a disorder in juveniles and young adults; however, its etiology still remains unclear. For OCD at the medial femoral condyle (MFC), it is sometimes observed that the lesion has a connection with fibers of the posterior cruciate ligament (PCL). Although this could be important information related to the etiology of MFC OCD, there is no report examining an association between the MFC OCD and the PCL anatomy. Purpose: To investigate the anatomic features of knees associated with MFC OCD, focusing especially on the femoral attachment of the PCL, and to compare them with knees associated with lateral femoral condyle (LFC) OCD and non-OCD lesions. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively reviewed 39 patients (46 knees) with OCD lesions who had undergone surgical treatment. Using magnetic resonance imaging (MRI) scans, the PCL attachment at the lateral wall of the MFC was measured on the coronal sections, and the knee flexion angle was also measured on the sagittal sections. As with non-OCD knees, we reviewed and analyzed 25 knees with anterior cruciate ligament (ACL) injuries and 16 knees with meniscal injuries. Results: MRIs revealed that the femoral PCL footprint was located in a significantly more distal position in the patients with MFC OCD compared with patients with LFC OCD and ACL and meniscal injuries. There was no significant difference in knee flexion angle among the 4 groups. Conclusion: The PCL in patients with MFC OCD attached more distally at the lateral aspect of the MFC compared with knees with LFC OCD and ACL and meniscal injuries. PMID:27294170

  6. From wall graft to roof graft: reassessment of femoral posterior cruciate ligament positioning.

    PubMed

    Raphael, Bradley S; Maak, Travis; Cross, Michael B; Plaskos, Christopher; Wickiewicz, Thomas; Amis, Andrew; Pearle, Andrew

    2011-09-01

    In many technique guides for posterior cruciate ligament (PCL) reconstruction, the PCL is depicted on the wall of the medial femoral condyle (MFC). We hypothesized that most of the anterolateral (AL) bundle originates on the roof of the intercondylar notch (ICN), not on the wall. Using a surgical navigation system, we delineated and morphed in the computer the entire PCL footprint-the AL bundle, the posteromedial (PM) bundle, and the Humphrey ligament (HL)-of 7 fresh-frozen cadaveric specimens. A clock face was defined in the en face view, with the 12-o'clock axis pointing anteriorly through the top of the notch and the roof being the region between 10 o'clock and 2 o'clock. The AL-bundle, PM-bundle, and HL positions were calculated in terms of this clock-face definition. Mean centroids (o'clock position) over all specimens of AL bundle, PM bundle, and HL were, respectively, 10:49, 9:43, and 9:00 on the left knee and 1:11, 2:17, and 3:00 on the right knee. Mean areas were 63 mm(2) (AL bundle), 63 mm(2) (PM bundle), and 45 mm(2) (HL). In 5 of the 7 specimens tested, 100% of the AL bundle originated on the roof of the ICN. Conversely, 66% of the PM bundle and 100% of the HL inserted on the wall of the MFC rather than on the intercondylar roof. Using computer navigation software, we determined that most of the AL bundle originates on the roof of the ICN and that the PM bundle is centered near the transition between the roof and the wall of the MFC. These findings contradict the depiction in most technique guides for PCL reconstruction. Implant companies and surgeons should modify their techniques to shift PCL graft tunnels from the wall of the MFC to the roof of the ICN. PMID:22022678

  7. Biomechanical Evaluation of Posterior Cruciate Ligament Reconstruction With Quadriceps Versus Achilles Tendon Bone Block Allograft

    PubMed Central

    Forsythe, Brian; Haro, Marc S.; Bogunovic, Ljiljana; Collins, Michael J.; Arns, Thomas A.; Trella, Katie J.; Shewman, Elizabeth F.; Verma, Nikhil N.; Bach, Bernard R.

    2016-01-01

    Background: Long-term studies of posterior cruciate ligament (PCL) reconstruction suggest that normal stability is not restored in the majority of patients. The Achilles tendon allograft is frequently utilized, although recently, the quadriceps tendon has been introduced as an alternative option due to its size and high patellar bone density. Purpose/Hypothesis: The purpose of this study was to compare the biomechanical strength of PCL reconstructions using a quadriceps versus an Achilles allograft. The hypothesis was that quadriceps bone block allograft has comparable mechanical properties to those of Achilles bone block allograft. Study Design: Controlled laboratory study. Methods: Twenty-nine fresh-frozen cadaveric knees were assigned to 1 of 3 groups: (1) intact PCL, (2) PCL reconstruction with Achilles tendon allograft, or (3) PCL reconstruction with quadriceps tendon allograft. After reconstruction, all supporting capsular and ligamentous tissues were removed. Posterior tibial translation was measured at neutral and 20° external rotation. Each specimen underwent a preload, 2 cyclic loading protocols of 500 cycles, then load to failure. Results: Construct creep deformation was significantly lower in the intact group compared with both Achilles and quadriceps allograft (P = .008). The intact specimens reached the greatest ultimate load compared with both reconstructions (1974 ± 752 N, P = .0001). The difference in ultimate load for quadriceps versus Achilles allograft was significant (P = .048), with the quadriceps group having greater maximum force during failure testing. No significant differences were noted between quadriceps versus Achilles allograft for differences in crosshead excursion during cyclic testing (peak-valley [P-V] extension stretch), creep deformation, or stiffness. Construct stiffness measured during the failure test was greatest in the intact group (117 ± 9 N/mm, P = .0001) compared with the Achilles (43 ± 11 N/mm) and quadriceps (43

  8. Acute augmentation for interstitial insufficiency of the posterior cruciate ligament. A two to five year clinical and radiographic study

    PubMed Central

    Chan, Terence Wai-kit; Kong, Chi-Chung; Del Buono, Angelo; Maffulli, Nicola

    2016-01-01

    Summary Background there is need to ascertain clinical and imaging outcomes after posterior cruciate ligament (PCL) augmentation. Methods we performed a retrospective analysis of clinical, imaging and functional data on 21 physically active males who underwent arthroscopic trans-tibial augmentation of the PCL for symptomatic grade III PCL insufficiency. The average follow-up time was 50 months (24–60 months). The Lysholm knee score was administered to all the patients, ligament laxity was evaluated with the posterior drawer test, the KT-1000 arthrometer, and the anteromedial tibial step-off. Standing antero-posterior, lateral and Merchant’s view radiographs were taken preoperatively and at annual follow-up. Results post-operatively, ligament laxity and Lysholm knee scores were significantly improved than at baseline. Sixteen patients (73%) returned to pre-injury sport activity level, 3 patients (14%) returned to a lower level, 2 had to stop. We found radiographic degenerative changes in 5 of 22 affected knees (23%), with evidence of a statistically significant association between the occurrence of degenerative changes and the interval time from injury to surgery and duration of the follow up. Conclusions arthroscopic transtibial single bundle autograft hamstring augmentation significantly improves the function of the knee, with an overall satisfactory outcome of 82% at 2–5 years from surgery. PMID:27331032

  9. Total Knee Arthroplasty Designed to Accommodate the Presence or Absence of the Posterior Cruciate Ligament

    PubMed Central

    Harman, Melinda K.; Bonin, Stephanie J.; Leslie, Chris J.; Banks, Scott A.; Hodge, W. Andrew

    2014-01-01

    Evidence for selecting the same total knee arthroplasty prosthesis whether the posterior cruciate ligament (PCL) is retained or resected is rarely documented. This study reports prospective midterm clinical, radiographic, and functional outcomes of a fixed-bearing design implanted using two different surgical techniques. The PCL was completely retained in 116 knees and completely resected in 43 knees. For the entire cohort, clinical knee (96 ± 7) and function (92 ± 13) scores and radiographic outcomes were good to excellent for 84% of patients after 5–10 years in vivo. Range of motion averaged 124° ± 9°, with 126 knees exhibiting ≥120° flexion. Small differences in average knee flexion and function scores were noted, with the PCL-resected group exhibiting an average of 5° more flexion but an average function score that was 7 points lower compared to the PCL-retained group. Fluoroscopic analysis of 33 knees revealed stable tibiofemoral translations. This study demonstrates that a TKA articular design with progressive congruency in the lateral compartment can provide for femoral condyle rollback in maximal flexion activities and achieve good clinical and functional performance in patients with PCL-retained and PCL-resected TKA. This TKA design proved suitable for use with either surgical technique, providing surgeons with the choice of maintaining or sacrificing the PCL. PMID:25374697

  10. Tenosynovial giant cell tumor arising from the posterior cruciate ligament: a case report and literature review.

    PubMed

    Xu, Zhihong; Mao, Ping; Chen, Dongyang; Shi, Dongquan; Dai, Jin; Yao, Yao; Jiang, Qing

    2015-01-01

    The localized form of tenosynovial giant cell tumor or pigmented villonodular synovitis is rarely intraarticular in the knee. We reported a 40-year-old woman with a tenosynovial giant cell tumor arising from posterior cruciate ligament (PCL). She suffered sudden knee pain and locking without any reason for two days. A mass with a size of 1.7 × 0.8 × 0.7 cm in the fossa intercondyloidea was detected on the MRI. After one time hyperextension physical examination the patients felt sudden pain relief. During the arthroscopy examination, a loose soft tissue mass was found under the lateral meniscus. Only the synovium tissue lesion on the proximal PCL was detected. The mass had a conceivable thin pedicel and the shape matched well with the tumor bed on the PCL. The histopathology of the mass demonstrated a tenosynovial giant cell tumor. At six weeks follow-up, no clinical evidence of recurrence was noted. A Literature Review of tenosynovial giant cell tumor or pigmented villonodular synovitis arising from the PCL is present.

  11. Posterior Cruciate Ligament (pcl) Reconstruction by Transtibial Tunnel:. Suggestions of Lengthening and Slippage Ratio

    NASA Astrophysics Data System (ADS)

    Kim, Jay-Jung; Kim, Cheol-Woong

    This paper examined the biomechanical fatigue behavior of Achilles tendon autograft after posterior cruciate ligament (PLC) reconstructions. It experimented with various fixation devices and locations on the degree of initial lengthening and slippage to investigate the relationship between lengthening and slippage ratios among calcaneal and soft tissue fixation methods. Eight specimens of proximal tibia and Achilles tendon grafts were harvested from cadavers and classified into four groups according to the type of transtibial fixation technique. A cyclic load ranging from 50N to 250N was applied to each graft when fixed to the proximal tibia at 55 degrees. The soft tissue fixation method, which uses an interference screw, demonstrated a 56.4% ratio of slippage to total elongation. The use of a double cross-pin with the same method demonstrated a 45.4% slippage ratio. The former was associated with approximately 2 mm less total elongation and 13% more slippage than lengthening compared to the latter. This result was predominantly due to the poor standard of fixation compared to the same method using a double cross-pin.

  12. Posterior longitudinal ligament resection or preservation in anterior cervical decompression surgery.

    PubMed

    Avila, M J; Skoch, J; Sattarov, K; Abbasi Fard, S; Patel, A; Walter, C M; Baaj, A A

    2015-07-01

    We reviewed the literature to determine differences in clinical outcomes for the removal or preservation of the posterior longitudinal ligament (PLL) in anterior cervical discectomy and fusion (ACDF). The outcomes are surgeon and case-dependent for both practices. A literature review was performed in PubMed from the years 1960 to 2014 to identify studies describing surgeries where the PLL was removed or preserved during ACDF. Searches were performed using Medical Subject Headings (MeSH) and references included in the reviewed articles were also considered. Additionally we searched recent articles that cited those from the original search. The search yielded 79 articles and 115 pertinent citations. These 194 articles were reviewed for specific discussions of PLL resection or preservation. Four articles containing 122 patients were included in the final analysis. In 69 patients the PLL was removed and in 53 the PLL was preserved. Both groups improved in clinical scores during follow up. One patient in the PLL removal group had a cerebrospinal fluid leak. MRI and correlative outcome data suggest that a non-ossified PLL itself does not contribute to significant cord compression. Postoperative MRI of patients with the PLL removed showed a larger spinal cord diameter. Resection of the PLL is safe and common in ACDF surgery but there does not appear to be a demonstrable clinical difference in patients where it is resected. The ultimate decision is likely surgeon and case-dependent. Randomized trials could further determine the importance of PLL removal in ACDF treated patients.

  13. Posterior Cruciate Ligament Reconstruction Using Single-Bundle Achilles Allograft with Open Tibial Inlay Fixation

    PubMed Central

    Zehir, Sinan; Elmalı, Nurzat; Çalbıyık, Murat; Taşdemir, Zeki; Sağlam, Fevzi

    2014-01-01

    Objectives: PCL reconstruction research has shown that the tibial inlay and transtibial tunnel procedures offer similar biomechanical results. The purpose of this study was to evaluate the early results of PCL reconstruction using a single-bundle Achilles allograft and tibial inlay fixation. Methods: We retrospectively studied 14 patients who had undergone PCL reconstruction using the direct tibial inlay fixation technique from 2009 to 2013, with a mean follow-up of 13.4 months. (6-28 months). The patients were 11males and 3 females with an average age of 29.2 years (17-41 years). Ipsilateral femoral shaft fractures were determined in 2 cases, ipsilateral trochanteric fracture in 1 case and popliteal artery injury in 1 case. Surgery was performed within 2-4 weeks. Spanning-joint external fixation was applied to 2 patients because of gross instability with failure to maintain reduction in a brace. Combined reconstructions involving the posterolateral corner (9/14), anterior cruciate ligament (ACL (11/14)), or medial collateral ligament (MCL (1/14)) were performed. All PCL reconstructions were performed with Achilles allograft. In 1 case with arterial injury, the repair was made by a cardiovascular surgeon. In 2 case, deep infection developed, which was controlled with debridement and antibiotic treatment. Superficial peroneal nerve injury in 1 case was treated with tenolysis in the 6th month, then partial healing was seen at 18 months. In all patients, the preoperative posterior drawer (PD) examination was positive. All patients were evaluated with preoperative and postoperative examination and x-rays. The International Knee Documentation Committee (IKDC) evaluation was applied to all patients at the final follow-up. Results: Postoperative PD examination demonstrated the following: 0 (normal) in 4 patients, 1+ in 7 patients, and 2+ in 3 patients, compared to the preoperative PD of 3+ or greater in all patients. Preoperative IKDC objective evaluation rated all knees

  14. Resect or not to resect: the role of posterior longitudinal ligament in lumbar total disc replacement.

    PubMed

    Cakir, Balkan; Richter, Marcus; Schmoelz, Werner; Schmidt, René; Reichel, Heiko; Wilke, Hans Joachim

    2012-06-01

    With regard to the literature, several factors are considered to have an impact on postoperative mobility after lumbar total disc replacement (TDR). As TDR results in a distraction of the ligamentous structures, theoretically the postoperatively disc height and ligamentous integrity have also an influence on biomechanics of a treated segment. The purpose of the study was to evaluate the influence of posterior longitudinal ligament (PLL) resection and segmental distraction on range of motion (ROM). Six human, lumbar spines (L2-L3) were tested with pure moments of ±7.5 Nm in a spine loading apparatus. The ROM was determined in all three motion planes. Testing sequences included: (1) intact state, (2) 10 mm prosthesis (PLL intact), (3) 10 mm prosthesis (PLL resected), (4) 12 mm prosthesis (PLL resected). The prosthesis used was a prototype with a constrained design using the ball-and-socket principle. The implantation of the 10 mm prosthesis already increased the disc height significantly (intact: 9.9 mm; 10 mm prosthesis: 10.6 mm; 12 mm prosthesis: 12.7 mm). Compared to the intact status, the implantation of the 10 mm prosthesis resulted in an increase of ROM for flexion/extension (8.6° vs 10.8°; P = 0.245) and axial rotation (2.9° vs 4.5°; P = 0.028), whereas lateral bending decreased (9.0° vs 7.6°; P = 0.445). The resection of the PLL for the 10 mm prosthesis resulted in an increase of ROM in all motion planes compared to the 10 mm prosthesis with intact PLL (flexion/extension: 11.4°, P = 0.046; axial rotation: 5.1°, P = 0.046; lateral bending: 8.6°, P = 0.028). The subsequent implantation of a 12 mm prosthesis, with resected PLL, resulted in a significant decrease of ROM in all motion planes compared to the 10 mm prosthesis with intact PLL (flexion/extension: 8.4°, P = 0.028; axial rotation: 3.3°, P = 0.028; lateral bending: 5.1°, P = 0.028). Compared to the intact status, the 12 mm prosthesis with resected PLL only

  15. Outcome of Simultaneous Arthroscopic Anterior Cruciate Ligament and Posterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft: A Multicenter Prospective Study

    PubMed Central

    Panigrahi, Ranajit; Kumari Mahapatra, Amita; Priyadarshi, Ashok; Singha Das, Dibya; Palo, Nishit; Ranjan Biswal, Manas

    2016-01-01

    Background: Multiligamentous injuries of knee are a complex problem in orthopaedics. Combined ACL-PCL injuries are uncommon, usually associated with knee dislocations. Extremity vascular status is essential because of possible arterio-venous compromise. These complex injuries require a systematic evaluation and treatment. Single setting simultaneous arthroscopic ACL and PCL reconstruction or a staged approach can be adopted to treat these cases. Objectives: To evaluate functional outcome of simultaneous arthroscopic ACL and PCL reconstruction with hamstring tendon autograft in multiligamentous knee injuries. Patients and Methods: This prospective study was performed on 20 patients with combined ACL-PCL injuries who underwent simultaneous arthroscopic ACL-PCL reconstruction with hamstring tendon. Evaluation of functional outcome was by IKDC and Lysholm-Tegner scores. Results: In 20 patients, mean age 34 years, return to full-time work and to full sports was 8 weeks and 6.2 months respectively. All patients had full range of motion except 2 patients with < 5 degrees flexion loss; 90% had negative Lachmann test; 95% had negative pivot shift and 10% patients had mild posterior drawer at 90 degrees (1+) at final follow up. Mean IKDC score was 90 (range 81 - 94); mean Tegner activity score was 7 and mean Lysholm knee score was 89. 85% returned to preinjury activity level and a 90% satisfaction rate. Conclusions: Simultaneous arthroscopic ACL and PCL reconstructions using hamstring tendon for combined ACL and PCL injuries is a clinically effective, safe, time saving and cost-effective procedure with better patient compliance and reproducible for a timely return of motion, strength, and function with favorable outcome. PMID:27217932

  16. Compression Angle of Ossification of the Posterior Longitudinal Ligament and Its Clinical Significance in Cervical Myelopathy

    PubMed Central

    Lee, Nam; Yoon, Do Heum; Kim, Keung Nyun; Shin, Hyun Chul; Shin, Dong Ah

    2016-01-01

    Objectives The correction of clinical and radiologic abnormalities in patients with symptomatic ossification of the posterior longitudinal ligament (OPLL) is the current mainstay of treatment. This study aimed to identify radiographic predictors of severity of myelopathy in patients with symptomatic OPLL. Methods Fifty patients with symptomatic cervical OPLL were enrolled. Based on Japanese Orthopedic Association (JOA) scores, patients were divided into either the mild myelopathy (n=31) or severe myelopathy (n=19) group. All subjects underwent preoperative plain cervical roentgenogram, computed tomography (CT), and MR imaging (MRI). Radiological parameters (C2–7 sagittal vertical axis, SVA; C2–7 Cobb angle; C2–7 range of motion, ROM; OPLL occupying ratio; and compression angle) were compared. Compression angle of OPLL was defined as the angle between the cranial and caudal surfaces of OPLL at the maximum level of cord compression Results The occupying ratio of the spinal canal, C2–7 Cobb angle, C2–7 SVA, types of OPLL, and C2–7 ROM of the cervical spine were not statistically different between the two groups. However, the OPLL compression angle was significantly greater (p=0.003) in the severe myelopathy group than in the mild myelopathy group and was inversely correlated with JOA score (r=-0.533, p<0.01). Furthermore, multivariate regression analysis demonstrated that the compression angle (B=-0.069, p<0.001) was significantly associated with JOA scores (R=0.647, p<0.005). Conclusion Higher compression angles of OPLL have deleterious effects on the spinal cord and decrease preoperative JOA scores.

  17. Compression Angle of Ossification of the Posterior Longitudinal Ligament and Its Clinical Significance in Cervical Myelopathy

    PubMed Central

    Lee, Nam; Yoon, Do Heum; Kim, Keung Nyun; Shin, Hyun Chul; Shin, Dong Ah

    2016-01-01

    Objectives The correction of clinical and radiologic abnormalities in patients with symptomatic ossification of the posterior longitudinal ligament (OPLL) is the current mainstay of treatment. This study aimed to identify radiographic predictors of severity of myelopathy in patients with symptomatic OPLL. Methods Fifty patients with symptomatic cervical OPLL were enrolled. Based on Japanese Orthopedic Association (JOA) scores, patients were divided into either the mild myelopathy (n=31) or severe myelopathy (n=19) group. All subjects underwent preoperative plain cervical roentgenogram, computed tomography (CT), and MR imaging (MRI). Radiological parameters (C2–7 sagittal vertical axis, SVA; C2–7 Cobb angle; C2–7 range of motion, ROM; OPLL occupying ratio; and compression angle) were compared. Compression angle of OPLL was defined as the angle between the cranial and caudal surfaces of OPLL at the maximum level of cord compression Results The occupying ratio of the spinal canal, C2–7 Cobb angle, C2–7 SVA, types of OPLL, and C2–7 ROM of the cervical spine were not statistically different between the two groups. However, the OPLL compression angle was significantly greater (p=0.003) in the severe myelopathy group than in the mild myelopathy group and was inversely correlated with JOA score (r=-0.533, p<0.01). Furthermore, multivariate regression analysis demonstrated that the compression angle (B=-0.069, p<0.001) was significantly associated with JOA scores (R=0.647, p<0.005). Conclusion Higher compression angles of OPLL have deleterious effects on the spinal cord and decrease preoperative JOA scores. PMID:27651865

  18. The characteristic clinical symptoms of C-4 radiculopathy caused by ossification of the posterior longitudinal ligament.

    PubMed

    Katsumi, Keiichi; Yamazaki, Akiyoshi; Watanabe, Kei; Hirano, Toru; Ohashi, Masayuki; Endo, Naoto

    2014-05-01

    Cervical radiculopathy of the C2-4 spinal nerves is a rare condition and is poorly documented in terms of clinical symptoms, hindering its detection during initial patient screening based on imaging diagnostics. The authors describe in detail the clinical symptoms and successful surgical treatment of a patient diagnosed with isolated C-4 radiculopathy. This 41-year-old man suffered from sleep disturbance because of pain behind the right ear, along the right clavicle, and at the back of his neck on the right side. The Jackson and Spurling tests were positive, with pain radiating to the area behind the patient's ear. Unlike in cases of radiculopathy involving the C5-8 spinal nerves, no loss of upper-extremity motor function was seen. Magnetic resonance imaging showed foraminal stenosis at the C3-4 level on the right side, and multiplanar reconstruction CT revealed a beak-type ossification of the posterior longitudinal ligament in the foraminal region at the same level. In the absence of intracranial lesions or spinal cord compressive lesions, the positive Jackson and Spurling tests and the C3-4 foraminal stenosis were indicative of isolated C-4 radiculopathy. Microscopic foraminotomy was performed at the C3-4 vertebral level and the ossified lesion was resected. The patient's symptoms completely resolved immediately after surgery. To the authors' knowledge, this report is the first to describe the symptomatic features of isolated C-4 radiculopathy, in a case in which the diagnosis has been confirmed by both radiological findings and surgical outcome. Based on this case study, the authors conclude that the characteristic symptoms of C-4 radiculopathy are the presence of pain behind the ear and in the clavicular region in the absence of upper-limb involvement.

  19. Posterior Wall Blowout During Anterior Cruciate Ligament Reconstruction: Suspensory Cortical Fixation With a Screw and Washer Post.

    PubMed

    Mitchell, Justin J; Chahla, Jorge; Dean, Chase S; Menge, Travis J; Vap, Alexander R; Cram, Tyler R; LaPrade, Robert F

    2016-06-01

    Posterior wall blowout can be a devastating intraoperative complication in anterior cruciate ligament reconstruction. This loss of osseous containment can cause difficulty with graft fixation and can potentially lead to early graft failure if unrecognized and left untreated. If cortical blowout occurs despite careful planning and proper surgical technique, a thorough knowledge of the local anatomy and surgical salvage options is paramount to ensure positive patient outcomes. This article highlights our preferred salvage technique using suspensory cortical fixation with a screw and washer construct. PMID:27656377

  20. Occupational consequences after isolated reconstruction of the insufficient posterior cruciate ligament

    PubMed Central

    2014-01-01

    Background With incorrect or even without treatment, acute injuries of the posterior cruciate ligament (PCL) can lead to chronic instability of the knee joint. After delayed treatment, negative occupational changes and reduced quality of life can occur. These aspects have not yet been investigated. The purpose of this study was to evaluate occupational consequences after isolated reconstruction in cases of chronic PCL insufficiency. Findings 12 patients treated with PCL reconstruction in a single bundle technique, using hamstring tendon grafts, were evaluated. All patients were operated upon at least 3 months after injury. Mean time of follow-up was 51 ± 18.2 months (14–75). Radiological assessment (Telos stress device) showed a side comparison of total translation of 4.5 ± 2.6 mm. Occupational consequences have been evaluated by the classification system “REFA”. Median time incapacity for work was 8 weeks. Nearly all patients achieved the mental status of the normal population (SF-36), but physical status was still restricted. A pre- to postoperative improvement of the clinical scores could be seen: Lysholm-Score: 46.4 ± 17.3 to 84.7 ± 14.1, HSS-Score: 74.3 ± 10.5 to 88.3 ± 10.7. Postoperative evaluated scores were: Tegner score: 4.8 ± 1.2, IKDC score: 80.0 ± 16.2, VPS: 3.4 ± 2.7. Patients with low physical load in their workplace described significantly better clinical results in every clinical score (p < .05) and less pain than patients with high physical load prior to the accident (VPS: REFA < 2: 2.4 ± 2.6, REFA ≥ 2: 5.5 ± 1.7; p < 0.05). Conclusions Operative treated patients with a chronic PCL insufficiency achieve an improvement of the clinical result. Patients with low physical load at their workplace achieve less restrictions. PMID:24684773

  1. Could failure of the spring ligament complex be the driving force behind the development of the adult flatfoot deformity?

    PubMed

    Williams, Geraint; Widnall, James; Evans, Paul; Platt, Simon

    2014-01-01

    We conducted an investigation into the relative associations of magnetic resonance imaging (MRI)-defined pathologic features of the spring ligament and/or tibialis posterior tendon with radiographic evidence of a planovalgus foot position. A total of 161 patient images (MRI and plain radiographs) obtained from the foot and ankle clinic (2008 to 2011) were retrospectively reviewed. All 161 patients (64 male and 97 female; mean age 45.9 years, range 18 to 86) were included in the analysis. Lateral weightbearing radiographs were analyzed for the talo-first metatarsal angle ≥ 5°, calcaneal pitch ≤ 20°, and talocalcaneal angle ≥ 45°. A positive finding for ≥ 1 measurements identified a radiographic planovalgus position of the foot. The radiographic deformity was analyzed against the MRI evidence of either spring ligament or tibialis posterior tendon pathologic features for significance (p < .05). Evidence of a spring ligament abnormality was strongly associated with a planovalgus foot position, reaching high levels of statistical significance in all 3 categories of radiographic deformity (odds ratio 9.2, p < .0001). Abnormalities of the tibialis posterior tendon failed to demonstrate significance, unless grade I changes were excluded, and grade II and III appearances were analyzed in isolation (odds ratio 2.9, p = .04). Although absolute causal relationships were not tested, this investigation has clearly demonstrated that MRI-defined abnormalities of the spring ligament complex are possibly of at least equal importance to tibialis posterior dysfunction for the presence of a moderate to severe radiographic planovalgus foot position.

  2. Could failure of the spring ligament complex be the driving force behind the development of the adult flatfoot deformity?

    PubMed

    Williams, Geraint; Widnall, James; Evans, Paul; Platt, Simon

    2014-01-01

    We conducted an investigation into the relative associations of magnetic resonance imaging (MRI)-defined pathologic features of the spring ligament and/or tibialis posterior tendon with radiographic evidence of a planovalgus foot position. A total of 161 patient images (MRI and plain radiographs) obtained from the foot and ankle clinic (2008 to 2011) were retrospectively reviewed. All 161 patients (64 male and 97 female; mean age 45.9 years, range 18 to 86) were included in the analysis. Lateral weightbearing radiographs were analyzed for the talo-first metatarsal angle ≥ 5°, calcaneal pitch ≤ 20°, and talocalcaneal angle ≥ 45°. A positive finding for ≥ 1 measurements identified a radiographic planovalgus position of the foot. The radiographic deformity was analyzed against the MRI evidence of either spring ligament or tibialis posterior tendon pathologic features for significance (p < .05). Evidence of a spring ligament abnormality was strongly associated with a planovalgus foot position, reaching high levels of statistical significance in all 3 categories of radiographic deformity (odds ratio 9.2, p < .0001). Abnormalities of the tibialis posterior tendon failed to demonstrate significance, unless grade I changes were excluded, and grade II and III appearances were analyzed in isolation (odds ratio 2.9, p = .04). Although absolute causal relationships were not tested, this investigation has clearly demonstrated that MRI-defined abnormalities of the spring ligament complex are possibly of at least equal importance to tibialis posterior dysfunction for the presence of a moderate to severe radiographic planovalgus foot position. PMID:24556481

  3. A Case of Successful Foraminotomy for Severe Bilateral C5 Palsy following Posterior Decompression and Fusion Surgery for Cervical Ossification of Posterior Longitudinal Ligament

    PubMed Central

    Toyone, Tomoaki; Shirahata, Toshiyuki; Ozawa, Tomoyuki; Matsuoka, Akira; Jin, Yoichi; Inagaki, Katsunori

    2016-01-01

    We report a very rare (5~7%) case of bilateral C5 palsy after cervical surgery. A 71-year-old male patient with cervical ossification of posterior longitudinal ligament (OPLL) with foraminal stenosis at bilateral C4/5 underwent posterior decompression and fusion surgery. After surgery, muscle weakness in his both deltoid and biceps was detected and gradually deteriorated to complete paralysis. Postoperative MRI showed sufficient decompression of the spinal cord and posterior shifting. Subsequently, an additional bilateral foraminotomy at C4/5 was performed, with a suspicion that bilateral foraminal stenosis at C4/5 may have been the cause of the paresis. After foraminotomy, muscular contraction was seen in both deltoid and biceps. Finally, complete motor recovery was achieved in a year. Although the gold standard procedure for the prevention and treatment of postoperative C5 palsy has not yet been established, an additional foraminotomy may be recommended for severe C5 palsy in cases of foraminal stenosis even after the occurrence of palsy. PMID:27672463

  4. A Case of Successful Foraminotomy for Severe Bilateral C5 Palsy following Posterior Decompression and Fusion Surgery for Cervical Ossification of Posterior Longitudinal Ligament.

    PubMed

    Kudo, Yoshifumi; Toyone, Tomoaki; Shirahata, Toshiyuki; Ozawa, Tomoyuki; Matsuoka, Akira; Jin, Yoichi; Inagaki, Katsunori

    2016-01-01

    We report a very rare (5~7%) case of bilateral C5 palsy after cervical surgery. A 71-year-old male patient with cervical ossification of posterior longitudinal ligament (OPLL) with foraminal stenosis at bilateral C4/5 underwent posterior decompression and fusion surgery. After surgery, muscle weakness in his both deltoid and biceps was detected and gradually deteriorated to complete paralysis. Postoperative MRI showed sufficient decompression of the spinal cord and posterior shifting. Subsequently, an additional bilateral foraminotomy at C4/5 was performed, with a suspicion that bilateral foraminal stenosis at C4/5 may have been the cause of the paresis. After foraminotomy, muscular contraction was seen in both deltoid and biceps. Finally, complete motor recovery was achieved in a year. Although the gold standard procedure for the prevention and treatment of postoperative C5 palsy has not yet been established, an additional foraminotomy may be recommended for severe C5 palsy in cases of foraminal stenosis even after the occurrence of palsy. PMID:27672463

  5. A Case of Successful Foraminotomy for Severe Bilateral C5 Palsy following Posterior Decompression and Fusion Surgery for Cervical Ossification of Posterior Longitudinal Ligament

    PubMed Central

    Toyone, Tomoaki; Shirahata, Toshiyuki; Ozawa, Tomoyuki; Matsuoka, Akira; Jin, Yoichi; Inagaki, Katsunori

    2016-01-01

    We report a very rare (5~7%) case of bilateral C5 palsy after cervical surgery. A 71-year-old male patient with cervical ossification of posterior longitudinal ligament (OPLL) with foraminal stenosis at bilateral C4/5 underwent posterior decompression and fusion surgery. After surgery, muscle weakness in his both deltoid and biceps was detected and gradually deteriorated to complete paralysis. Postoperative MRI showed sufficient decompression of the spinal cord and posterior shifting. Subsequently, an additional bilateral foraminotomy at C4/5 was performed, with a suspicion that bilateral foraminal stenosis at C4/5 may have been the cause of the paresis. After foraminotomy, muscular contraction was seen in both deltoid and biceps. Finally, complete motor recovery was achieved in a year. Although the gold standard procedure for the prevention and treatment of postoperative C5 palsy has not yet been established, an additional foraminotomy may be recommended for severe C5 palsy in cases of foraminal stenosis even after the occurrence of palsy.

  6. A Case of Successful Foraminotomy for Severe Bilateral C5 Palsy following Posterior Decompression and Fusion Surgery for Cervical Ossification of Posterior Longitudinal Ligament.

    PubMed

    Kudo, Yoshifumi; Toyone, Tomoaki; Shirahata, Toshiyuki; Ozawa, Tomoyuki; Matsuoka, Akira; Jin, Yoichi; Inagaki, Katsunori

    2016-01-01

    We report a very rare (5~7%) case of bilateral C5 palsy after cervical surgery. A 71-year-old male patient with cervical ossification of posterior longitudinal ligament (OPLL) with foraminal stenosis at bilateral C4/5 underwent posterior decompression and fusion surgery. After surgery, muscle weakness in his both deltoid and biceps was detected and gradually deteriorated to complete paralysis. Postoperative MRI showed sufficient decompression of the spinal cord and posterior shifting. Subsequently, an additional bilateral foraminotomy at C4/5 was performed, with a suspicion that bilateral foraminal stenosis at C4/5 may have been the cause of the paresis. After foraminotomy, muscular contraction was seen in both deltoid and biceps. Finally, complete motor recovery was achieved in a year. Although the gold standard procedure for the prevention and treatment of postoperative C5 palsy has not yet been established, an additional foraminotomy may be recommended for severe C5 palsy in cases of foraminal stenosis even after the occurrence of palsy.

  7. The effect of graft strength on knee laxity and graft in-situ forces after posterior cruciate ligament reconstruction.

    PubMed

    Lai, Yu-Shu; Chen, Wen-Chuan; Huang, Chang-Hung; Cheng, Cheng-Kung; Chan, Kam-Kong; Chang, Ting-Kuo

    2015-01-01

    Surgical reconstruction is generally recommended for posterior cruciate ligament (PCL) injuries; however, the use of grafts is still a controversial problem. In this study, a three-dimensional finite element model of the human tibiofemoral joint with articular cartilage layers, menisci, and four main ligaments was constructed to investigate the effects of graft strengths on knee kinematics and in-situ forces of PCL grafts. Nine different graft strengths with stiffness ranging from 0% (PCL rupture) to 200%, in increments of 25%, of an intact PCL's strength were used to simulate the PCL reconstruction. A 100 N posterior tibial drawer load was applied to the knee joint at full extension. Results revealed that the maximum posterior translation of the PCL rupture model (0% stiffness) was 6.77 mm in the medial compartment, which resulted in tibial internal rotation of about 3.01°. After PCL reconstruction with any graft strength, the laxity of the medial tibial compartment was noticeably improved. Tibial translation and rotation were similar to the intact knee after PCL reconstruction with graft strengths ranging from 75% to 125% of an intact PCL. When the graft's strength surpassed 150%, the medial tibia moved forward and external tibial rotation greatly increased. The in-situ forces generated in the PCL grafts ranged from 13.15 N to 75.82 N, depending on the stiffness. In conclusion, the strength of PCL grafts have has a noticeable effect on anterior-posterior translation of the medial tibial compartment and its in-situ force. Similar kinematic response may happen in the models when the PCL graft's strength lies between 75% and 125% of an intact PCL.

  8. The effect of graft strength on knee laxity and graft in-situ forces after posterior cruciate ligament reconstruction.

    PubMed

    Lai, Yu-Shu; Chen, Wen-Chuan; Huang, Chang-Hung; Cheng, Cheng-Kung; Chan, Kam-Kong; Chang, Ting-Kuo

    2015-01-01

    Surgical reconstruction is generally recommended for posterior cruciate ligament (PCL) injuries; however, the use of grafts is still a controversial problem. In this study, a three-dimensional finite element model of the human tibiofemoral joint with articular cartilage layers, menisci, and four main ligaments was constructed to investigate the effects of graft strengths on knee kinematics and in-situ forces of PCL grafts. Nine different graft strengths with stiffness ranging from 0% (PCL rupture) to 200%, in increments of 25%, of an intact PCL's strength were used to simulate the PCL reconstruction. A 100 N posterior tibial drawer load was applied to the knee joint at full extension. Results revealed that the maximum posterior translation of the PCL rupture model (0% stiffness) was 6.77 mm in the medial compartment, which resulted in tibial internal rotation of about 3.01°. After PCL reconstruction with any graft strength, the laxity of the medial tibial compartment was noticeably improved. Tibial translation and rotation were similar to the intact knee after PCL reconstruction with graft strengths ranging from 75% to 125% of an intact PCL. When the graft's strength surpassed 150%, the medial tibia moved forward and external tibial rotation greatly increased. The in-situ forces generated in the PCL grafts ranged from 13.15 N to 75.82 N, depending on the stiffness. In conclusion, the strength of PCL grafts have has a noticeable effect on anterior-posterior translation of the medial tibial compartment and its in-situ force. Similar kinematic response may happen in the models when the PCL graft's strength lies between 75% and 125% of an intact PCL. PMID:26001045

  9. The Effect of Graft Strength on Knee Laxity and Graft In-Situ Forces after Posterior Cruciate Ligament Reconstruction

    PubMed Central

    Lai, Yu-Shu; Chen, Wen-Chuan; Huang, Chang-Hung; Cheng, Cheng-Kung; Chan, Kam-Kong; Chang, Ting-Kuo

    2015-01-01

    Surgical reconstruction is generally recommended for posterior cruciate ligament (PCL) injuries; however, the use of grafts is still a controversial problem. In this study, a three-dimensional finite element model of the human tibiofemoral joint with articular cartilage layers, menisci, and four main ligaments was constructed to investigate the effects of graft strengths on knee kinematics and in-situ forces of PCL grafts. Nine different graft strengths with stiffness ranging from 0% (PCL rupture) to 200%, in increments of 25%, of an intact PCL’s strength were used to simulate the PCL reconstruction. A 100 N posterior tibial drawer load was applied to the knee joint at full extension. Results revealed that the maximum posterior translation of the PCL rupture model (0% stiffness) was 6.77 mm in the medial compartment, which resulted in tibial internal rotation of about 3.01°. After PCL reconstruction with any graft strength, the laxity of the medial tibial compartment was noticeably improved. Tibial translation and rotation were similar to the intact knee after PCL reconstruction with graft strengths ranging from 75% to 125% of an intact PCL. When the graft’s strength surpassed 150%, the medial tibia moved forward and external tibial rotation greatly increased. The in-situ forces generated in the PCL grafts ranged from 13.15 N to 75.82 N, depending on the stiffness. In conclusion, the strength of PCL grafts have has a noticeable effect on anterior-posterior translation of the medial tibial compartment and its in-situ force. Similar kinematic response may happen in the models when the PCL graft’s strength lies between 75% and 125% of an intact PCL. PMID:26001045

  10. Erupted complex odontoma of the posterior maxilla: A rarity

    PubMed Central

    Verma, Sonika; Arul, A. Sri Kennath J.; Arul, A. Sri Sennath J.; Chitra, S.

    2015-01-01

    Complex odontomas, hamartomas of aborted tooth development, mainly occur in posterior part of the mandible and rarely erupt into the oral cavity. The spontaneous eruption may be associated with pain, inflammation of adjacent soft tissues or recurrent infection. The present case of complex odontoma is of particular interest due to its apparent eruption in the maxillary posterior segment, its association with agenesis of the second molar and impacted third molar; with the lesion being completely asymptomatic. PMID:26604611

  11. Erupted complex odontoma of the posterior maxilla: A rarity.

    PubMed

    Verma, Sonika; Arul, A Sri Kennath J; Arul, A Sri Sennath J; Chitra, S

    2015-08-01

    Complex odontomas, hamartomas of aborted tooth development, mainly occur in posterior part of the mandible and rarely erupt into the oral cavity. The spontaneous eruption may be associated with pain, inflammation of adjacent soft tissues or recurrent infection. The present case of complex odontoma is of particular interest due to its apparent eruption in the maxillary posterior segment, its association with agenesis of the second molar and impacted third molar; with the lesion being completely asymptomatic.

  12. Comparison of the operation of arthroscopic tibial inlay and traditional tibial inlay for posterior cruciate ligament reconstruction

    PubMed Central

    Lu, Daifeng; Xiao, Mochao; Lian, Yongyun; Zhou, Yong; Liu, Xuefeng

    2014-01-01

    Objective: To perform dual-bundle reconstruction of posterior cruciate ligament using full arthroscopic tibial inlay technology with self-designed tibia tunnel drilling system and to compare the effect of arthroscopic tibial inlay versus traditional technique for posterior cruciate ligament reconstruction. Material and methods: 32 patients were randomly divided into experiment group (improved tibial inlay, n = 17) and control group (traditional tibial inlay, n = 15). Self-designed tibia tunnel drill system was used to produce intraoperative deep-limited bone tunnel. During follow-up, the location of the bone block and the healing situation were checked by knee X-ray and spiral CT scan. Blood loss, operation time and nerve vascular injuries were evaluated. Results: Mean intraoperative blood loss was 123.53 ± 74.05 ml in the improved tibial inlay group compared with 332 ± 114.26 ml in the traditional tibial inlay group (t = 6.12, P < 0.05). Mean operation time was 235.27 ± 58.88 min in the improved tibial inlay group compared with 346.37 ± 59.67 min in the traditional tibial inlay group (t = 5.19, P < 0.05). Posterior drawer test were negative in 15 cases, slight positive in 2 with improved tibial inlay technique compared with 14 negative cases and 2 positive cases of traditional tibial Inlay technique. The X-ray and spiral CT scan showed the location of the bone block were perfect and healed well with the patent who received improved tibial inlay technology after 12 weeks postoperatively. Conclusion: Accurate depth-limited bone tunnel can be produced by the tibia tunnel drill system with minor trauma, less bleeding and reducing of nerves or vessels and the recent clinical effects of PCL reconstruction were pretty good. PMID:25419349

  13. Conservative treatment of isolated posterior cruciate ligament injury in professional baseball players: a report of two cases.

    PubMed

    Iwamoto, J; Takeda, T; Suda, Y; Otani, T; Matsumoto, H

    2004-02-01

    Conservative treatment is currently recommended for most isolated posterior cruciate ligament (PCL) injuries in athletes. However, it is not known whether conservative treatment is applicable even in high performance athletes with isolated PCL injury. The results in two extremely high performance athletes, professional baseball players with isolated acute PCL injury treated conservatively are reported. A catcher and an out fielder, who were regular players, hurt their knees in baseball games. Magnetic resonance images of the knee detected complete PCL rupture. Following a carefully guided physical therapy program, a 3-week period of immobilization of the knee in full extension was achieved with a knee brace, while performing hard quadriceps muscle strengthening exercise, and then running exercise was started. Six to eight weeks after injury, they were able to return fully to their original sporting activity despite tibial posterior translation on posterior drawer test, and to sustain this activity over 2 years. Switching of weight-bearing to non-weight-bearing in a deep knee flexion is considered to contribute to subjective instability in athletes with PCL-deficiency. Probably because our cases, even though extremely high performance athletes were infrequently subjected to such a situation while playing baseball, they were able to return to their pre-injury level of athletic performance without severe subjective instability through conservative treatment.

  14. Outcome of posterior decompression with instrumented fusion surgery for K-line (-) cervical ossification of the longitudinal ligament.

    PubMed

    Saito, Junya; Maki, Satoshi; Kamiya, Koshiro; Furuya, Takeo; Inada, Taigo; Ota, Mitsutoshi; Iijima, Yasushi; Takahashi, Kazuhisa; Yamazaki, Masashi; Aramomi, Masaaki; Mannoji, Chikato; Koda, Masao

    2016-10-01

    We investigated the outcome of posterior decompression and instrumented fusion (PDF) surgery for patients with K-line (-) ossification of the posterior longitudinal ligament (OPLL) of the cervical spine, who may have a poor surgical prognosis. We retrospectively analyzed the outcome of a series of 27 patients who underwent PDF without correction of cervical alignment for K-line (-) OPLL and were followed-up for at least 1 year after surgery. We had performed double-door laminoplasty followed by posterior instrumented fusion without excessive correction of cervical spine alignment. The preoperative Japanese Orthopedic Association (JOA) score for cervical myelopathy was 8.0 points and postoperative JOA score was 11.9 points on average. The mean JOA score recovery rate was 43.6%. The average C2-C7 angle was 2.2° preoperatively and 3.1° postoperatively. The average maximum occupation ratio of OPLL was 56.7%. In conclusion, PDF without correcting cervical alignment for patients with K-line (-) OPLL showed moderate neurological recovery, which was acceptable considering K-line (-) predicts poor surgical outcomes. Thus, PDF is a surgical option for such patients with OPLL. PMID:27591553

  15. Ultrasound-guided aspiration and steroid injection of a posterior cruciate ligament ganglion cyst: report of a case.

    PubMed

    Vilella, Giuseppe Maria; Guerrisi, Pietro; Lucignani, Giulia; Pasquali, Gaia; Drudi, Francesco Maria

    2015-09-01

    Ganglion cysts are benign masses that originate from mucinous degeneration of the connective tissues and are quite rare when arising from the knee joint. Symptoms are often represented by pain, joint tenderness, effusion and occasional swelling with a palpable mass in the popliteal region of the knee. Percutaneous aspiration followed by a corticosteroid injection of a ganglion cyst has either a diagnostic or therapeutic meaning and its guidance through ultrasound allows the operator to make more accurate the procedure, ensuring the correct placement of the needle inside the lesion. We report our experience in the treatment of a voluminous ganglion cyst of the posterior cruciate ligament performed through the ultrasound guidance in a symptomatic young patient.

  16. Histopathological Changes in the Human Posterior Cruciate Ligament During Aging and Osteoarthritis: Correlations with ACL and Cartilage Changes

    PubMed Central

    Levy, Yadin D.; Hasegawa, Akihiko; Patil, Shantanu; Koziol, James A.; Lotz, Martin K.; D’Lima, Darryl D.

    2012-01-01

    Objectives To determine the histological patterns of posterior cruciate ligament (PCL) degeneration during aging and in relation to changes in articular cartilage and anterior cruciate ligament (ACL) across the entire adult age spectrum. Methods Human knee joints (n=120 from 65 donors) were processed within 72 hours postmortem. Articular cartilage surfaces were graded macroscopically. Each PCL was histologically evaluated for inflammation, mucinous changes, chondroid metaplasia, cystic changes and orientation of collagen fibers. Severity of PCL degeneration was classified as normal, mild, moderate or severe. PCL scores were compared to ACL and cartilage scores from the same knees. Results All knees had intact PCL. Histologically, 6% were normal, 76% showed mild, 12% moderate and 9% severe degeneration. Fiber disorientation was the most prevalent and severe change. Histological grades of PCL and ACL correlated but significantly fewer PCL than ACL showed severe changes. There was weaker correlation between aging and total histological PCL scores (R=0.26) compared to aging and ACL scores (R=0.42). ACL scores correlated with cartilage scores (R=0.54) while PCL scores increased with severity of OA from grades 0 to III but not between OA grades III to IV (R=0.32). In knees with ruptured ACL, the PCL scores correlated with cartilage scores of the lateral compartment. Conclusions PCL histopathological changes are less severe than in the ACL. PCL degeneration was associated with ACL and cartilage damage. The lack of correlation with age indicates independent pathways for PCL versus ACL degeneration. PMID:22872023

  17. Interposition of the Posterior Cruciate Ligament into the Medial Compartment of the Knee Joint on Coronal Magnetic Resonance Imaging

    PubMed Central

    Kim, Hyun Su; Park, Ki Jeong; Wang, Joon Ho; Choe, Bong-Keun

    2016-01-01

    Objective The purpose of our study was to evaluate the overall prevalence and clinical significance of interposition of the posterior cruciate ligament (PCL) into the medial compartment of the knee joint in coronal magnetic resonance imaging (MRI). Materials and Methods We retrospectively reviewed 317 consecutive patients referred for knee MRI at our institution between October 2009 and December 2009. Interposition of the PCL into the medial compartment of the knee joint on proton coronal MRI was evaluated dichotomously (i.e., present or absent). We analyzed the interposition according to its prevalence as well as its relationship with right-left sidedness, gender, age, and disease categories (osteoarthritis, anterior cruciate ligament tear, and medial meniscus tear). Results Prevalence of interposition of PCL into the medial compartment of the knee joint was 47.0% (149/317). There was no right (50.0%, 83/166) to left (43.7%, 66/151) or male (50.3%, 87/173) to female (43.1%, 62/144) differences in the prevalence. There was no significant association between the prevalence and age, or the disease categories. Conclusion Interposition of the PCL into the medial compartment of the knee joint is observed in almost half of patients on proton coronal MRI of the knee. Its presence is not associated with any particular factors including knee pathology and may be regarded as a normal MR finding. PMID:26957909

  18. Ossification of the posterior longitudinal ligament related genes identification using microarray gene expression profiling and bioinformatics analysis.

    PubMed

    He, Hailong; Mao, Lingzhou; Xu, Peng; Xi, Yanhai; Xu, Ning; Xue, Mingtao; Yu, Jiangming; Ye, Xiaojian

    2014-01-10

    Ossification of the posterior longitudinal ligament (OPLL) is a kind of disease with physical barriers and neurological disorders. The objective of this study was to explore the differentially expressed genes (DEGs) in OPLL patient ligament cells and identify the target sites for the prevention and treatment of OPLL in clinic. Gene expression data GSE5464 was downloaded from Gene Expression Omnibus; then DEGs were screened by limma package in R language, and changed functions and pathways of OPLL cells compared to normal cells were identified by DAVID (The Database for Annotation, Visualization and Integrated Discovery); finally, an interaction network of DEGs was constructed by string. A total of 1536 DEGs were screened, with 31 down-regulated and 1505 up-regulated genes. Response to wounding function and Toll-like receptor signaling pathway may involve in the development of OPLL. Genes, such as PDGFB, PRDX2 may involve in OPLL through response to wounding function. Toll-like receptor signaling pathway enriched genes such as TLR1, TLR5, and TLR7 may involve in spine cord injury in OPLL. PIK3R1 was the hub gene in the network of DEGs with the highest degree; INSR was one of the most closely related genes of it. OPLL related genes screened by microarray gene expression profiling and bioinformatics analysis may be helpful for elucidating the mechanism of OPLL.

  19. Inside-Out Antegrade Tibial Tunnel Drilling Through the Posterolateral Portal Using a Flexible Reamer in Posterior Cruciate Ligament Reconstruction

    PubMed Central

    Alentorn-Geli, Eduard; Stuart, Joseph J.; Choi, J.H. James; Toth, Alison P.; Moorman, Claude T.; Taylor, Dean C.

    2015-01-01

    Posterior cruciate ligament (PCL) reconstruction using the transtibial drilling or arthroscopic tibial-inlay technique has a risk of injury to the popliteal neurovascular bundle because a pin is drilled anterior to posterior. Intraoperative fluoroscopy is used to decrease the risk of neurovascular injury. In addition, graft passage in the transtibial technique may be problematic because of a sharp turn when placing the graft into the tibial tunnel, which may damage graft fibers. In the surgical technique described in this report, the posteromedial portal is used for visualization and the posterolateral portal is used for debridement of the PCL tibial footprint and the synovial fold closest to the PCL. A curved guide is placed from the posterolateral portal to the tibial footprint, and a flexible pin is drilled across the tibia. The tibial tunnel is then created using a flexible reamer under direct visualization up to the desired length, and a graft can be positioned in the tibial tunnel through the posterolateral portal. This technique has the potential advantages of decreasing the risk of injury to the popliteal neurovascular bundle (use of anteriorly directed, inside-out drilling), avoiding a sharp turn during graft passage, and allowing accurate and anatomic tibial tunnel placement without intraoperative fluoroscopy. PMID:26900551

  20. One-incision endoscopic technique for posterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft.

    PubMed

    Chen, Chih-Hwa; Chen, Wen-Jer; Shih, Chun-Hsiung

    2001-03-01

    Quadriceps tendon-patellar bone autograft is an alternative graft choice for posterior cruciate ligament (PCL) reconstruction. A 2-incision technique with outside-in fixation at the femoral condyle is generally used. In this article, we describe a 1-incision endoscopic technique for PCL reconstruction with quadriceps tendon-patellar bone autograft. The graft consists of a proximal patellar bone plug and central quadriceps tendon. The bone plug is trapezoidal, 20 mm long, 10 mm wide, and 8 mm thick. The tendon portion is 80 mm long, 10 mm wide, and 6 mm thick, including the full-thickness of the rectus femoris and partial thickness of the vastus intermedius. Three arthroscopic portals, including anteromedial, anterolateral, and posteromedial, are used. All procedures are performed in an endoscopic manner with only 1 incision at the proximal tibia. At the femoral side, the bone plug is fixed by an interference screw. At the tibial side, the tendon portion is fixed by a suture to a screw on the anterior cortex and an interference bioscrew in the posterior tibial tunnel opening. Quadriceps tendon autograft has the advantages of being self-available, allowing for easier arthroscopic technique, and providing comparable graft size. The 1-incision technique provides a simple reconstruction method for PCL insufficiency without a second incision at the medial femoral condyle.

  1. The anterior cruciate ligament-lateral meniscus complex: A histological study.

    PubMed

    Furumatsu, Takayuki; Kodama, Yuya; Maehara, Ami; Miyazawa, Shinichi; Fujii, Masataka; Tanaka, Takaaki; Inoue, Hiroto; Ozaki, Toshifumi

    2016-01-01

    The anterior root of the lateral meniscus (LM) dives underneath the tibial attachment of the anterior cruciate ligament (ACL). Although the distinct role of meniscal attachments has been investigated, the relationship between the LM anterior insertion (LMAI) and ACL tibial insertion (ACLTI) remains unclear. This study histologically analyzed the LMAI and ACLTI. Samples were divided into four regions in an anterior-to-posterior direction. Histological measurements of these insertion sites were performed using safranin O-stained coronal sections. Distribution and signal densities of type I and II collagen were quantified. The ACLTI and LMAI formed the ACL-LM complex via fiber connections. The anterior part of the ACLTI had a widespread attachment composed of dense fibers. Attachment fibers of the LMAI became dense and wide gradually at the middle-to-posterior region. The ACL-LM transition zone (ALTZ) was observed between the LMAI and the lateral border of the ACLTI at the middle part of the ACL tibial footprint. Type II collagen density of the LMAI was higher than that of the ACLTI and ALTZ. Our results can help create an accurate tibial bone tunnel within the dense ACL attachment during ACL reconstruction surgery.

  2. Immunohistochemical evaluation for outflow reconstruction using opened round ligament in living donor right posterior sector graft liver transplantation: A case report

    PubMed Central

    Sanada, Yukihiro; Sakuma, Yasunaru; Sasanuma, Hideki; Miki, Atsushi; Katano, Takumi; Hirata, Yuta; Okada, Noriki; Yamada, Naoya; Ihara, Yoshiyuki; Urahashi, Taizen; Sata, Naohiro; Yasuda, Yoshikazu; Mizuta, Koichi

    2016-01-01

    Utilizing the opened round ligament as venous grafts during liver transplantation is useful but controversial, and there are no pathological analyses of this procedure. Herein, we describe the first reported case of a pathological analysis of an opened round ligament used as a venous patch graft in a living donor liver transplantation (LDLT). A 13-year-old female patient with biliary atresia underwent LDLT using a posterior segment graft from her mother. The graft had two hepatic veins (HVs), which included the right HV (RHV; 15 mm) and the inferior RHV (IRHV; 20 mm). The graft RHV and IRHV were formed into a single orifice using the donor’s opened round ligament (60 mm × 20 mm) as a patch graft during bench surgery; it was then anastomosed end-to-side with the recipient inferior vena cava. The recipient had no post-transplant complications involving the HVs, but she died of septic shock with persistent cholangitis and jaundice 86 d after LDLT. The HV anastomotic site had no stenosis or thrombus on autopsy. On pathology, there was adequate patency and continuity between the recipient’s HV and the donor’s opened round ligament. In addition, the stains for CD31 and CD34 on the inner membrane of the opened round ligament were positive. Hepatic venous reconstruction using the opened round ligament as a venous patch graft is effective in LDLT, as observed on pathology.

  3. Immunohistochemical evaluation for outflow reconstruction using opened round ligament in living donor right posterior sector graft liver transplantation: A case report

    PubMed Central

    Sanada, Yukihiro; Sakuma, Yasunaru; Sasanuma, Hideki; Miki, Atsushi; Katano, Takumi; Hirata, Yuta; Okada, Noriki; Yamada, Naoya; Ihara, Yoshiyuki; Urahashi, Taizen; Sata, Naohiro; Yasuda, Yoshikazu; Mizuta, Koichi

    2016-01-01

    Utilizing the opened round ligament as venous grafts during liver transplantation is useful but controversial, and there are no pathological analyses of this procedure. Herein, we describe the first reported case of a pathological analysis of an opened round ligament used as a venous patch graft in a living donor liver transplantation (LDLT). A 13-year-old female patient with biliary atresia underwent LDLT using a posterior segment graft from her mother. The graft had two hepatic veins (HVs), which included the right HV (RHV; 15 mm) and the inferior RHV (IRHV; 20 mm). The graft RHV and IRHV were formed into a single orifice using the donor’s opened round ligament (60 mm × 20 mm) as a patch graft during bench surgery; it was then anastomosed end-to-side with the recipient inferior vena cava. The recipient had no post-transplant complications involving the HVs, but she died of septic shock with persistent cholangitis and jaundice 86 d after LDLT. The HV anastomotic site had no stenosis or thrombus on autopsy. On pathology, there was adequate patency and continuity between the recipient’s HV and the donor’s opened round ligament. In addition, the stains for CD31 and CD34 on the inner membrane of the opened round ligament were positive. Hepatic venous reconstruction using the opened round ligament as a venous patch graft is effective in LDLT, as observed on pathology. PMID:27678368

  4. The Value of Accurate Magnetic Resonance Characterization of Posterior Cruciate Ligament Tears in the Setting of Multiligament Knee Injury: Imaging Features Predictive of Early Repair vs Reconstruction.

    PubMed

    Goiney, Christoper C; Porrino, Jack; Twaddle, Bruce; Richardson, Michael L; Mulcahy, Hyojeong; Chew, Felix S

    2016-01-01

    Multiligament knee injury (MLKI) represents a complex set of pathologies treated with a wide variety of surgical approaches. If early surgical intervention is performed, the disrupted posterior cruciate ligament (PCL) can be treated with primary repair or reconstruction. The purpose of our study was to retrospectively identify a critical length of the distal component of the torn PCL on magnetic resonance imaging (MRI) that may predict the ability to perform early proximal femoral repair of the ligament, as opposed to reconstruction. A total of 50 MLKIs were managed at Harborview Medical Center from May 1, 2013, through July 15, 2014, by an orthopedic surgeon. Following exclusions, there were 27 knees with complete disruption of the PCL that underwent either early reattachment to the femoral insertion or reconstruction and were evaluated using preoperative MRI. In a consensus fashion, 2 radiologists measured the proximal and distal fragments of each disrupted PCL using preoperative MRI in multiple planes, as needed. MRI findings were correlated with what was performed at surgery. Those knees with a distal fragment PCL length of ≥41mm were capable of, and underwent, early proximal femoral repair. With repair, the distal stump was attached to the distal femur. Alternatively, those with a distal PCL length of ≤32mm could not undergo repair because of insufficient length and as such, were reconstructed. If early surgical intervention for an MLKI involving disruption of the PCL is considered, attention should be given to the length of the distal PCL fragment on MRI to plan appropriately for proximal femoral reattachment vs reconstruction. If the distal PCL fragment measures ≥41mm, surgical repair is achievable and can be considered as a surgical option.

  5. Ossification of the posterior longitudinal ligament in three geographically and genetically different populations of ankylosing spondylitis and other spondyloarthropathies

    PubMed Central

    Ramos-Remus, C.; Russell, A.; Gomez-Vargas, A.; Hernandez-Chavez, A.; Maksymowych, W.; Gamez-Nava, J.; Gonzalez-Lopez, L.; Garcia-Hernandez, A.; Meono-Morales, E.; Burgos-Vargas, R.; Suarez-Almazor, M.

    1998-01-01

    STUDY DESIGN—Cross sectional.
RESEARCH QUESTIONS—(a) Is any clinical variable of ankylosing spondylitis (AS) associated with the presence of ossification of the posterior longitudinal ligament (OPLL)? and (b) Is OPLL present in patients with AS from different geographical or genetic backgrounds?
METHODS—Three groups were assembled: (1) a prospective group of 103 consecutive AS patients from two community based rheumatology clinics from Guadalajara, who were evaluated using: a questionnaire with disease characteristic variables; clinical assessment by a neurologist; lateral radiographic views of the cervical spine and somatosensory evoked potentials (SSEP). (2) Fifty one spondyloarthropathies (SpA) patients from Mexico city whose cervical spine films were retrospectively reviewed. (3) Thirty nine AS patients from Edmonton, Canada whose cervical spine films were retrospectively reviewed and compared with 72 controls.
RESULTS—Group 1: 74% of the 103 patients were men and 86% were HLA-B27 positive. The mean age was 35 years, and mean (SD) disease duration 10 (8) years. OPLL was reported in 16 patients (15.5%; 95%C I 9, 22). OPLL was statistically associated with older age (p=0.001), longer disease duration (p=0.001), clinical myelopathy (p=0.03), worst functional index (p=0.042), restricted axial movement measurements (all p<0.001), radiological sacroiliitis (p<0.001 for linear association), osteitis pubis (p=0.009), hip involvement (p=0.006 for linear association), and abnormal SSEP (p=0.008). Group 2: 92% of 51 patients were men; the mean age was 30 years and the mean (SD) disease duration 11 (7) years. OPLL was reported in 15 (29%, 95%CI 17, 41) patients (nine AS, two psoriatic arthritis, three juvenile AS, and one Reiter's syndrome). Group 3: 95% of the 39 patients were men; the mean of age was 46 years and disease duration of 18 (10) years. OPLL was reported in nine (23%; 95%CI 10, 36) patients, including one with psoriatic arthritis

  6. FEMORAL ROLL BACK IN TOTAL KNEE ARTHROPLASTY: COMPARISON BETWEEN PROSTHESES THAT PRESERVE AND SACRIFICE THE POSTERIOR CRUCIATE LIGAMENT

    PubMed Central

    Carvalho Júnior, Lúcio Honório de; Machado Soares, Luiz Fernando; Gonçalves, Matheus Braga Jacques; Costa, Leonardo Lanziotti; Costa, Lincoln Paiva; Lessa, Rodrigo Rosa; Pereira, Marcelo Lobo

    2015-01-01

    To compare the rollback of the contact point between the femoral component and the tibial polyethylene as the knee is flexed, in two types of total knee arthroplasty: one that sacrifices and the other that preserves the posterior cruciate ligament (PCL). Methods: Under fluoroscopy, 36 knees from 32 patients who underwent total knee arthroplasty were evaluated. Using lateral images, the contact points between the femur and the tibial polyethylene with the knee in complete extension and at 90° of flexion were measured, thereby measuring the percentage rollback of the femur in arthroplasties in which the PCL was sacrificed and in those in which it was preserved. Results: The mean percentage rollback of the femur was 13.24% in the cases in which the PCL was sacrificed and 5.75% in the cases in which it was preserved. The difference between these measurements was statistically significant (p = 0.026615). Conclusion: In total knee arthroplasty, sacrificing the PCL increased the rollback of the contact point between the femur and tibia as the knee was flexed up to 90°. PMID:27027031

  7. Relationship between Mucoid Degeneration of the Anterior Cruciate Ligament and Posterior Tibial Slope in Patients with Total Knee Arthroplasty

    PubMed Central

    Youm, Yoon-Seok; Cho, Hye-Yong; Jung, Seung-Hyun

    2016-01-01

    Purpose The purpose was to analyze the relationship between posterior tibial slope (PTS) and mucoid degeneration of the anterior cruciate ligament (ACL) in patients with total knee arthroplasty. Materials and Methods Four hundred and twenty-four patients (24 males and 400 females; 636 knees) who received total knee arthroplasty for osteoarthritis were included. Their mean age was 68.9 years (range, 48 to 88 years). The patients were classified into three groups according to the status of ACL; normal ACL group (group I), mucoid degeneration of ACL group (group II) and ruptured or absent ACL group (group III). Plain lateral radiographs were used to measure the PTS and the values were compared among groups. Results There were no significant differences with regard to gender, age and left-to-right side ratio among groups (p>0.05). The mean PTS was 9.9° (range, 0.6° to 20.1°) in group I (161 knees), 10.8° (range, 0.2° to 21.8°) in group II (342 knees) and 12.3° (range, 2° to 22.2°) in group III (133 knees), which showed significant differences (p<0.001). Conclusions The patients with mucoid degeneration of the ACL and those with ruptured or absent ACL had greater PTS than those with normal ACL. These findings suggest that an increased PTS may be one of the causative factors for mucoid degeneration of the ACL. PMID:26955611

  8. Diagnosis and treatment of injuries to the posterolateral ligament complex.

    PubMed

    Rue, John-Paul; Kilcoyne, Kelly; Dickens, Jonathan; Kluk, Matthew

    2011-09-01

    Posterolateral corner (PLC) injuries are an often unrecognized and disabling injury that frequently accompanies other ligamentous disruptions. The spectrum of injury severity and heterogeneity of treatment options have made comparison of outcomes difficult. Several clinical studies and reviews have focused on the outcomes and treatment algorithms of knee dislocations or multiligamentous knee injuries. There is, however, a paucity of data in the literature analyzing the clinical outcomes and treatment recommendations of isolated PLC injuries or PLC injuries in combination with a single cruciate ligament tear. Furthermore, to our knowledge there is no review that analyzes the different repair or reconstructive techniques and assesses the clinical outcomes of these techniques.

  9. Treatment of posterior cruciate ligament avulsion fractures of the tibia using a toothed plate and hollow lag screw

    PubMed Central

    Chen, Wei; Luo, Wei; Chen, Zhiqing; Jiang, Yi

    2016-01-01

    INTRODUCTION To investigate the feasibility and clinical efficacy of using a toothed plate and hollow lag screw in the surgical treatment of posterior cruciate ligament (PCL) avulsion fractures of the tibia. METHODS A total of 21 patients were treated with open reduction and internal fixation using a toothed plate and hollow lag screw, through a posteromedial approach using an inverted L-shaped incision. The patients were allowed appropriate functional exercises, including knee flexion and extension, after removal of the plaster at postoperative weeks 3–6. The follow-up period was between six months and two years. RESULTS This was a retrospective study of patients with PCL avulsion fractures of the tibia caused by road traffic accidents (n = 9), sports-related injuries (n = 6), falls (n = 5) and machinery-related injuries (n = 1). 20 patients presented with fresh fractures and one with an old fracture. The patients (13 men, eight women) had a mean age of 41.5 (range 19–72) years. Anatomical reduction of the fracture and satisfactory fixation were achieved in all 21 patients. Bony union was achieved in all patients at 8–12 weeks after surgery. Six months after surgery, knee flexion was 121.9° ± 10.4° and extension was 0°. According to the Lysholm Knee Scoring Scale, 19 patients were rated as ‘excellent’ and two as ‘good’. CONCLUSION The use of a toothed plate and hollow lag screw could be a simple and reliable approach for PCL avulsion fractures of the tibia. Patients achieved good knee function after surgery. PMID:26831316

  10. A Comparison of Arthroscopically Assisted Single and Double Bundle Tibial Inlay Reconstruction for Isolated Posterior Cruciate Ligament Injury

    PubMed Central

    Lee, Dong Chul; Park, Chul Hyun; Kim, Won Ho; Jung, Kwang Am

    2010-01-01

    Background This study evaluated the clinical results of arthroscopically assisted single and double bundle tibial inlay reconstructions of an isolated posterior cruciate ligament (PCL) injury. Methods This study reviewed the data for 14 patients who underwent a single bundle tibial inlay PCL reconstruction (Group A) and 16 patients who underwent a double bundle tibial inlay PCL reconstruction (Group B) between August 1999 and August 2002. The mean follow-up period in groups A and B was 90.5 months and 64 months, respectively. Results The Lysholm knee scores in groups A and B increased from an average of 43.3 ± 7.04 and 44.7 ± 5.02 preoperatively to 88.1 ± 7.32 and 88.7 ± 9.11 points at the final follow-up, respectively. In group A, stress radiography using a Telos device showed that the preoperative mean side-to-side differences (SSDs) of 9.5 ± 1.60 mm at 30° of flexion and 9.8 ± 1.70 mm at 90° of flexion were improved to 2.8 ± 1.19 mm and 3.0 ± 1.1 mm, respectively. In group B, the preoperative SSDs of 10.4 ± 1.50 mm at 30° of flexion and 10.7 ± 1.60 mm at 90° of flexion improved to 2.7 ± 1.15 mm and 2.6 ± 0.49 mm, respectively. There was no significant difference in the clinical scores and radiologic findings between the two groups. Conclusions Single bundle and double bundle PCL reconstructions using the tibial inlay technique give satisfactory clinical results in patients with an isolated PCL injury, and there are no significant differences in the clinical and radiological results between the two techniques. These results suggest that it is unnecessary to perform the more technically challenging double bundle reconstruction using the tibial inlay technique in an isolated PCL injury. PMID:20514264

  11. Arthroscopic fixation of an avulsion fracture of the tibia involving the posterior cruciate ligament: a modified technique in a series of 22 cases.

    PubMed

    Chen, L B; Wang, H; Tie, K; Mohammed, A; Qi, Y J

    2015-09-01

    A total of 22 patients with a tibial avulsion fracture involving the insertion of the posterior cruciate ligament (PCL) with grade II or III posterior laxity were reduced and fixed arthroscopically using routine anterior and double posteromedial portals. A double-strand Ethibond suture was inserted into the joint and wrapped around the PCL from anterior to posterior to secure the ligament above the avulsed bony fragment. Two tibial bone tunnels were created using the PCL reconstruction guide, aiming at the medial and lateral borders of the tibial bed. The ends of the suture were pulled out through the bone tunnels and tied over the tibial cortex between the openings of the tunnels to reduce and secure the bony fragment. Satisfactory reduction of the fracture was checked arthroscopically and radiographically. The patients were followed-up for a mean of 24.5 months (19 to 28). Bone union occurred six weeks post-operatively. At final follow-up, all patients had a negative posterior drawer test and a full range of movement. KT-1000 arthrometer examination showed that the mean post-operative side-to-side difference improved from 10.9 mm (standard deviation (sd) 0.7) pre-operatively to 1.5 mm (sd 0.6) (p = 0.001). The mean Tegner and the International Knee Documentation Committee scores improved significantly (p = 0.001). The mean Lysholm score at final follow-up was 92.0 (85 to 96). We conclude that this technique is convenient, reliable and minimally invasive and successfully restores the stability and function of the knee.

  12. Dynamic failure properties of the porcine medial collateral ligament-bone complex for predicting injury in automotive collisions.

    PubMed

    Peck, Louis; Billiar, Kristen; Ray, Malcolm

    2010-03-09

    The goal of this study was to model the dynamic failure properties of ligaments and their attachment sites to facilitate the development of more realistic dynamic finite element models of the human lower extremities for use in automotive collision simulations. Porcine medial collateral ligaments were chosen as a test model due to their similarities in size and geometry with human ligaments. Each porcine medial collateral ligament-bone complex (n = 12) was held in a custom test fixture placed in a drop tower to apply an axial impulsive impact load, applying strain rates ranging from 0.005 s(-1) to 145 s(-1). The data from the impact tests were analyzed using nonlinear regression to construct model equations for predicting the failure load of ligament-bone complexes subjected to specific strain rates as calculated from finite element knee, thigh, and hip impact simulations. The majority of the ligaments tested failed by tibial avulsion (75%) while the remaining ligaments failed via mid-substance tearing. The failure load ranged from 384 N to 1184 N and was found to increase with the applied strain rate and the product of ligament length and cross-sectional area. The findings of this study indicate the force required to rupture the porcine MCL increases with the applied bone-to-bone strain rate in the range expected from high speed frontal automotive collisions.

  13. Dynamic Failure Properties of the Porcine Medial Collateral Ligament-Bone Complex for Predicting Injury in Automotive Collisions

    PubMed Central

    Peck, Louis; Billiar, Kristen; Ray, Malcolm

    2010-01-01

    The goal of this study was to model the dynamic failure properties of ligaments and their attachment sites to facilitate the development of more realistic dynamic finite element models of the human lower extremities for use in automotive collision simulations. Porcine medial collateral ligaments were chosen as a test model due to their similarities in size and geometry with human ligaments. Each porcine medial collateral ligament-bone complex (n = 12) was held in a custom test fixture placed in a drop tower to apply an axial impulsive impact load, applying strain rates ranging from 0.005 s-1 to 145 s-1. The data from the impact tests were analyzed using nonlinear regression to construct model equations for predicting the failure load of ligament-bone complexes subjected to specific strain rates as calculated from finite element knee, thigh, and hip impact simulations. The majority of the ligaments tested failed by tibial avulsion (75%) while the remaining ligaments failed via mid-substance tearing. The failure load ranged from 384 N to 1184 N and was found to increase with the applied strain rate and the product of ligament length and cross-sectional area. The findings of this study indicate the force required to rupture the porcine MCL increases with the applied bone-to-bone strain rate in the range expected from high speed frontal automotive collisions. PMID:20461229

  14. Incidental Anterior Cruciate Ligament Calcification: Case Report

    PubMed Central

    Hayashi, Hisami; Fischer, Hans

    2016-01-01

    The calcification of knee ligaments is a finding noted only in a handful of case reports. The finding of an anterior cruciate ligament calcification has been reported once in the literature. Comparable studies involving the posterior cruciate ligament, medial collateral ligament and an ossicle within the anterior cruciate ligament are likewise discussed in reports of symptomatic patients. We report a case of incidentally discovered anterior cruciate ligament calcification. We discuss the likely etiology and clinical implications of this finding. PMID:27200163

  15. Incidental Anterior Cruciate Ligament Calcification: Case Report.

    PubMed

    Hayashi, Hisami; Fischer, Hans

    2016-03-01

    The calcification of knee ligaments is a finding noted only in a handful of case reports. The finding of an anterior cruciate ligament calcification has been reported once in the literature. Comparable studies involving the posterior cruciate ligament, medial collateral ligament and an ossicle within the anterior cruciate ligament are likewise discussed in reports of symptomatic patients. We report a case of incidentally discovered anterior cruciate ligament calcification. We discuss the likely etiology and clinical implications of this finding.

  16. Comparison of clinical outcomes in decompression and fusion versus decompression only in patients with ossification of the posterior longitudinal ligament: a meta-analysis.

    PubMed

    Mehdi, Syed K; Alentado, Vincent J; Lee, Bryan S; Mroz, Thomas E; Benzel, Edward C; Steinmetz, Michael P

    2016-06-01

    OBJECTIVE Ossification of the posterior longitudinal ligament (OPLL) is a pathological calcification or ossification of the PLL, predominantly occurring in the cervical spine. Although surgery is often necessary for patients with symptomatic neurological deterioration, there remains controversy with regard to the optimal surgical treatment. In this systematic review and meta-analysis, the authors identified differences in complications and outcomes after anterior or posterior decompression and fusion versus after decompression alone for the treatment of cervical myelopathy due to OPLL. METHODS A MEDLINE, SCOPUS, and Web of Science search was performed for studies reporting complications and outcomes after decompression and fusion or after decompression alone for patients with OPLL. A meta-analysis was performed to calculate effect summary mean values, 95% CIs, Q statistics, and I(2) values. Forest plots were constructed for each analysis group. RESULTS Of the 2630 retrieved articles, 32 met the inclusion criteria. There was no statistically significant difference in the incidence of excellent and good outcomes and of fair and poor outcomes between the decompression and fusion and the decompression-only cohorts. However, the decompression and fusion cohort had a statistically significantly higher recovery rate (63.2% vs 53.9%; p < 0.0001), a higher final Japanese Orthopaedic Association score (14.0 vs 13.5; p < 0.0001), and a lower incidence of OPLL progression (< 1% vs 6.3%; p < 0.0001) compared with the decompression-only cohort. There was no statistically significant difference in the incidence of complications between the 2 cohorts. CONCLUSIONS This study represents the only comprehensive review of outcomes and complications after decompression and fusion or after decompression alone for OPLL across a heterogeneous group of surgeons and patients. Based on these results, decompression and fusion is a superior surgical technique compared with posterior

  17. Comparison of clinical outcomes in decompression and fusion versus decompression only in patients with ossification of the posterior longitudinal ligament: a meta-analysis.

    PubMed

    Mehdi, Syed K; Alentado, Vincent J; Lee, Bryan S; Mroz, Thomas E; Benzel, Edward C; Steinmetz, Michael P

    2016-06-01

    OBJECTIVE Ossification of the posterior longitudinal ligament (OPLL) is a pathological calcification or ossification of the PLL, predominantly occurring in the cervical spine. Although surgery is often necessary for patients with symptomatic neurological deterioration, there remains controversy with regard to the optimal surgical treatment. In this systematic review and meta-analysis, the authors identified differences in complications and outcomes after anterior or posterior decompression and fusion versus after decompression alone for the treatment of cervical myelopathy due to OPLL. METHODS A MEDLINE, SCOPUS, and Web of Science search was performed for studies reporting complications and outcomes after decompression and fusion or after decompression alone for patients with OPLL. A meta-analysis was performed to calculate effect summary mean values, 95% CIs, Q statistics, and I(2) values. Forest plots were constructed for each analysis group. RESULTS Of the 2630 retrieved articles, 32 met the inclusion criteria. There was no statistically significant difference in the incidence of excellent and good outcomes and of fair and poor outcomes between the decompression and fusion and the decompression-only cohorts. However, the decompression and fusion cohort had a statistically significantly higher recovery rate (63.2% vs 53.9%; p < 0.0001), a higher final Japanese Orthopaedic Association score (14.0 vs 13.5; p < 0.0001), and a lower incidence of OPLL progression (< 1% vs 6.3%; p < 0.0001) compared with the decompression-only cohort. There was no statistically significant difference in the incidence of complications between the 2 cohorts. CONCLUSIONS This study represents the only comprehensive review of outcomes and complications after decompression and fusion or after decompression alone for OPLL across a heterogeneous group of surgeons and patients. Based on these results, decompression and fusion is a superior surgical technique compared with posterior

  18. A review of the anatomical, biomechanical and kinematic findings of posterior cruciate ligament injury with respect to non-operative management.

    PubMed

    Chandrasekaran, Sivashankar; Ma, David; Scarvell, Jennifer M; Woods, Kevin R; Smith, Paul N

    2012-12-01

    An understanding of the kinematics of posterior cruciate ligament (PCL) deficiency is important for the diagnosis and management of patients with isolated PCL injury. The kinematics of PCL injury has been analysed through cadaveric and in vivo imaging studies. Cadaveric studies have detailed the anatomy of the PCL. It consists of two functional bundles, anterolateral and posteromedial, which exhibit different tensioning patterns through the arc of knee flexion. Isolated sectioning of the PCL and its related structures in cadaveric specimens has defined its primary and secondary restraining functions. The PCL is the primary restraint to posterior tibia translation above 30° and is a secondary restraint below 30° of knee flexion. Furthermore, sectioning of the PCL produces increased chondral deformation forces in the medial compartment as the knee flexes. However, the drawback of cadaveric studies is that they can not replicate the contribution of surrounding neuromuscular structures to joint stability that occurs in the clinical setting. To address this, there have been in vivo studies that have examined the kinematics of the PCL deficient knee using imaging modalities whilst subjects perform dynamic manoeuvres. These studies demonstrate significant posterior subluxation of the medial tibia as the knee flexes. The results of these experimental studies are in line with clinical consequences of PCL deficiency. In particular, arthroscopic evaluation of subjects with isolated PCL injuries demonstrate an increased incidence of chondral lesions in the medial compartment. Yet despite the altered kinematics with PCL injury only a minority of patients require surgery for persistent instability and the majority of athletes are able to return to sport following a period of non-operative rehabilitation. Specifically, non-operative management centres on a programme of quadriceps strengthening and hamstring inhibition to minimise posterior tibial load. The mechanism behind the

  19. A newly developed robot suit hybrid assistive limb facilitated walking rehabilitation after spinal surgery for thoracic ossification of the posterior longitudinal ligament: a case report.

    PubMed

    Sakakima, Harutoshi; Ijiri, Kosei; Matsuda, Fumiyo; Tominaga, Hiroyuki; Biwa, Takanori; Yone, Kazunori; Sankai, Yoshiyuki

    2013-01-01

    Most patients with thoracic ossification of the posterior longitudinal ligament (OPLL) exhibit delayed recovery of gait dysfunction after spinal injury. The hybrid assistive limb (HAL) is a new robot suit controlling knee and hip joint motion by detecting very weak bioelectric signals on the surface of the skin. This study is to report the feasibility and benefits of patient-assistive HAL walking rehabilitation for facilitating locomotor function after spinal surgery. The patient was a 60-year-old woman with thoracic OPLL, and her motor and sensory paralyses did not improve after spinal surgery, indicating severe impairment in the paretic legs. The subject underwent 6 HAL sessions per week for 8 weeks, consisting of a standing and sitting exercise and walking on the ground with HAL. Clinical outcomes were evaluated before and after HAL training and 1 year after surgery. The subject improved considerably as a result of HAL training. Subsequently, her walking ability recovered rapidly, and she was able to walk unaided six months after surgery. This case study suggests that HAL training is a feasible and effective option to facilitating locomotor function and the early HAL training with physiotherapy may enhance motor recovery of patients with residual paralysis after surgery.

  20. Injury mechanisms of the ligamentous cervical C2-C3 Functional Spinal Unit to complex loading modes: Finite Element study.

    PubMed

    Mustafy, Tanvir; Moglo, Kodjo; Adeeb, Samer; El-Rich, Marwan

    2016-01-01

    The cervical spine sustains high rate complex loading modes during Motor Vehicle Crashes (MVCs) which may produce severe injuries accompanied with soft and/or hard tissue failure. Although previous numerical and experimental studies have provided insights on the cervical spine behavior under various loading scenarios, its response to complex impact loads and the resulting injury mechanisms are not fully understood. A validated Finite Element (FE) model of the ligamentous cervical C2-C3 Functional Spinal Unit (FSU) was utilized to assess the spinal response to six combined impact loading modes; flexion-extension combined with compression and distraction, and lateral bending and axial rotation combined with distraction. The FE model used time and rate-dependent material laws which permit assessing bone fracture and ligament failure. Spinal load-sharing, stresses in the spinal components, intradiscal pressure (IDP) change in the nucleus as well as contact pressure in the facet joints were predicted. Bone and ligaments failure occurrence and initiation instants were investigated. Results showed that spinal load-sharing varied with loading modes. Lateral bending combined with distraction was the most critical loading mode as it increased stresses and strains significantly and produced failure in most of the spinal components compared to other modes. The facet joints and surrounding cancellous bone as well as ligaments particularly the capsular (CL) and flavum (FL) ligaments were the most vulnerable structures to rapid flexion-extension, axial rotation and lateral bending combined with distraction or compression. The excessive stress and strain resulted from these loading modes produced rupture of the CL and FL ligaments and failure in the cancellous bone. The detection of failure initiation as well as fracture assessment demonstrated the vulnerability of ligaments to tensile combined loads and the major contribution of the bony structures in resisting compressive

  1. Endoscopic Repair of the Superficial Deltoid Ligament and Spring Ligament.

    PubMed

    Lui, Tun Hing

    2016-06-01

    The plantar calcaneonavicular ligament, also known as the spring ligament, is an important static stabilizer of the medial longitudinal foot arch. Compromise of this ligament is a primary causative factor of peritalar subluxation, and it should be repaired in addition to treatment of tibialis posterior tendon abnormalities. Open repair of the ligament requires extensive soft-tissue dissection. The development of the high distal portal for posterior tibial tendoscopy allows repair of the ligament endoscopically. This, together with endoscopically assisted reconstruction of the tibialis posterior tendon, allows complete endoscopic treatment of stage 2 posterior tibial tendon deficiency. The major structure at risk is the medial plantar nerve. This technique is technically demanding and should be reserved for experienced foot and ankle arthroscopists. PMID:27656387

  2. Effect of culture complex of BMSCs and sodium hydroxide- and GRGDSPC-treated PET on the reconstruction of injured anterior cruciate ligament in a rabbit model

    PubMed Central

    Huang, Jianming; Chen, Fengrong; Jian, Guojian; Ye, Zhiyang; Wang, Zimin; Liu, Haoyuan; Kang, Yifan

    2015-01-01

    Ligament reconstruction is an effective therapy for anterior cruciate ligament (ACL) rupture. Polyethylene terephthalate (PET) artificial ligaments have recently gained popularity in clinical ACL reconstruction for its advantage in the improvement of keen function. However, the application of PET in clinical treatment is limited by its poor bioactivity and biocompatibility. Recently, bone marrow-derived mesenchymal stem cells (BMSCs) have been widely studied in regenerative medical therapy due to their multi-lineage differentiation. Previous study also indicated that BMSCs may promote the healing of tendon-bone interface of injured ligament. We speculate that BMSCs may enhance the curative effect of PET artificial ligament on the tendon-bone-healing in ligament reconstruction. In this study, the PET materials were first modified with sodium hydroxide hydrolysis and GRGDSPC peptide which was able to improve its bioactivity and biocompatibility. Then, the effects of modified PET materials on the adhesion, proliferation and differentiation of BMSCs were examined. The in vitro co-culture of BMSCs and modified PET showed the modified PET promoted the adhesion, proliferation and differentiation of BMSCs. Further, the effect of culture complex of BMSCs and modified PET artificial ligament co-culture system on the injured ligament reconstruction was investigated in vivo. Results showed not only better growth and differentiation of BMSCs but also satisfactory healing of the injured ligament was observed after implantation of this culture complex into the injured ligament of rabbits. Our study provides a brand-new solution for ACL reconstruction. PMID:26221227

  3. Effect of culture complex of BMSCs and sodium hydroxide- and GRGDSPC-treated PET on the reconstruction of injured anterior cruciate ligament in a rabbit model.

    PubMed

    Huang, Jianming; Chen, Fengrong; Jian, Guojian; Ye, Zhiyang; Wang, Zimin; Liu, Haoyuan; Kang, Yifan

    2015-01-01

    Ligament reconstruction is an effective therapy for anterior cruciate ligament (ACL) rupture. Polyethylene terephthalate (PET) artificial ligaments have recently gained popularity in clinical ACL reconstruction for its advantage in the improvement of keen function. However, the application of PET in clinical treatment is limited by its poor bioactivity and biocompatibility. Recently, bone marrow-derived mesenchymal stem cells (BMSCs) have been widely studied in regenerative medical therapy due to their multi-lineage differentiation. Previous study also indicated that BMSCs may promote the healing of tendon-bone interface of injured ligament. We speculate that BMSCs may enhance the curative effect of PET artificial ligament on the tendon-bone-healing in ligament reconstruction. In this study, the PET materials were first modified with sodium hydroxide hydrolysis and GRGDSPC peptide which was able to improve its bioactivity and biocompatibility. Then, the effects of modified PET materials on the adhesion, proliferation and differentiation of BMSCs were examined. The in vitro co-culture of BMSCs and modified PET showed the modified PET promoted the adhesion, proliferation and differentiation of BMSCs. Further, the effect of culture complex of BMSCs and modified PET artificial ligament co-culture system on the injured ligament reconstruction was investigated in vivo. Results showed not only better growth and differentiation of BMSCs but also satisfactory healing of the injured ligament was observed after implantation of this culture complex into the injured ligament of rabbits. Our study provides a brand-new solution for ACL reconstruction.

  4. Effect of culture complex of BMSCs and sodium hydroxide- and GRGDSPC-treated PET on the reconstruction of injured anterior cruciate ligament in a rabbit model.

    PubMed

    Huang, Jianming; Chen, Fengrong; Jian, Guojian; Ye, Zhiyang; Wang, Zimin; Liu, Haoyuan; Kang, Yifan

    2015-01-01

    Ligament reconstruction is an effective therapy for anterior cruciate ligament (ACL) rupture. Polyethylene terephthalate (PET) artificial ligaments have recently gained popularity in clinical ACL reconstruction for its advantage in the improvement of keen function. However, the application of PET in clinical treatment is limited by its poor bioactivity and biocompatibility. Recently, bone marrow-derived mesenchymal stem cells (BMSCs) have been widely studied in regenerative medical therapy due to their multi-lineage differentiation. Previous study also indicated that BMSCs may promote the healing of tendon-bone interface of injured ligament. We speculate that BMSCs may enhance the curative effect of PET artificial ligament on the tendon-bone-healing in ligament reconstruction. In this study, the PET materials were first modified with sodium hydroxide hydrolysis and GRGDSPC peptide which was able to improve its bioactivity and biocompatibility. Then, the effects of modified PET materials on the adhesion, proliferation and differentiation of BMSCs were examined. The in vitro co-culture of BMSCs and modified PET showed the modified PET promoted the adhesion, proliferation and differentiation of BMSCs. Further, the effect of culture complex of BMSCs and modified PET artificial ligament co-culture system on the injured ligament reconstruction was investigated in vivo. Results showed not only better growth and differentiation of BMSCs but also satisfactory healing of the injured ligament was observed after implantation of this culture complex into the injured ligament of rabbits. Our study provides a brand-new solution for ACL reconstruction. PMID:26221227

  5. Prevalence and Distribution of Ossified Lesions in the Whole Spine of Patients with Cervical Ossification of the Posterior Longitudinal Ligament A Multicenter Study (JOSL CT study).

    PubMed

    Hirai, Takashi; Yoshii, Toshitaka; Iwanami, Akio; Takeuchi, Kazuhiro; Mori, Kanji; Yamada, Tsuyoshi; Wada, Kanichiro; Koda, Masao; Matsuyama, Yukihiro; Takeshita, Katsushi; Abematsu, Masahiko; Haro, Hirotaka; Watanabe, Masahiko; Watanabe, Kei; Ozawa, Hiroshi; Kanno, Haruo; Imagama, Shiro; Fujibayashi, Shunsuke; Yamazaki, Masashi; Matsumoto, Morio; Nakamura, Masaya; Okawa, Atsushi; Kawaguchi, Yoshiharu

    2016-01-01

    Ossification of the posterior longitudinal ligament (OPLL) can cause severe and irreversible paralysis in not only the cervical spine but also the thoracolumbar spine. To date, however, the prevalence and distribution of OPLL in the whole spine has not been precisely evaluated in patients with cervical OPLL. Therefore, we conducted a multi-center study to comprehensively evaluate the prevalence and distribution of OPLL using multi-detector computed tomography (CT) images in the whole spine and to analyze what factors predict the presence of ossified lesions in the thoracolumbar spine in patients who were diagnosed with cervical OPLL by plain X-ray. Three hundred and twenty-two patients with a diagnosis of cervical OPLL underwent CT imaging of the whole spine. The sum of the levels in which OPLL was present in the whole spine was defined as the OP-index and used to evaluate the extent of ossification. The distribution of OPLL in the whole spine was compared between male and female subjects. In addition, a multiple regression model was used to ascertain related factors that affected the OP-index. Among patients with cervical OPLL, women tended to have more ossified lesions in the thoracolumbar spine than did men. A multiple regression model revealed that the OP-index was significantly correlated with the cervical OP-index, sex (female), and body mass index. Furthermore, the prevalence of thoracolumbar OPLL in patients with a cervical OP-index ≥ 10 was 7.8 times greater than that in patients with a cervical OP-index ≤ 5. The results of this study reveal that the extent of OPLL in the whole spine is significantly associated with the extent of cervical OPLL, female sex, and obesity. PMID:27548354

  6. A musculoskeletal modeling approach for estimating anterior cruciate ligament strains and knee anterior-posterior shear forces in stop-jumps performed by young recreational female athletes.

    PubMed

    Kar, Julia; Quesada, Peter M

    2013-02-01

    The central goal of this study was to contribute to the advancements being made in determining the underlying causes of anterior cruciate ligament (ACL) injuries. ACL injuries are frequently incurred by recreational and professional young female athletes during non-contact impact activities in sports like volleyball and basketball. This musculoskeletal-neuromuscular study investigated stop-jumps and factors related to ACL injury like knee valgus and internal-external moment loads, knee anterior-posterior (AP) shear forces, ACL strains and internal forces. Motion capture data was obtained from the landing phase of stop-jumps performed by eleven young recreational female athletes and electromyography (EMG) data collected from quadriceps, hamstring and gastrocnimius muscles which were then compared to numerically estimated activations. Numerical simulation tools used were Inverse Kinematics, Computed Muscle Control and Forward Dynamics and the knee modeled as a six degree of freedom joint. Results showed averaged peak strains of 12.2 ± 4.1% in the right and 11.9 ± 3.0% in the left ACL. Averaged peak knee AP shear forces were 482.3 ± 65.7 N for the right and 430.0 ± 52.4 N for the left knees, approximately equal to 0.7-0.8 times body weight across both knees. A lack of symmetry was observed between the knees for valgus angles (p < 0.04), valgus moments (p < 0.001) and muscle activations (p < 0.001), all of which can be detrimental to ACL stability during impact activities. Comparisons between recorded EMG data and estimated muscle activations show the relation between electrical signal and muscle depolarization. In summary, this study outlines a musculoskeletal simulation approach that provides numerical estimations for a number of variables associated with ACL injuries in female athletes performing stop-jumps.

  7. Prevalence and Distribution of Ossified Lesions in the Whole Spine of Patients with Cervical Ossification of the Posterior Longitudinal Ligament A Multicenter Study (JOSL CT study)

    PubMed Central

    Hirai, Takashi; Yoshii, Toshitaka; Iwanami, Akio; Takeuchi, Kazuhiro; Mori, Kanji; Yamada, Tsuyoshi; Wada, Kanichiro; Koda, Masao; Matsuyama, Yukihiro; Takeshita, Katsushi; Abematsu, Masahiko; Haro, Hirotaka; Watanabe, Masahiko; Watanabe, Kei; Ozawa, Hiroshi; Kanno, Haruo; Imagama, Shiro; Fujibayashi, Shunsuke; Yamazaki, Masashi; Matsumoto, Morio; Nakamura, Masaya; Okawa, Atsushi; Kawaguchi, Yoshiharu

    2016-01-01

    Ossification of the posterior longitudinal ligament (OPLL) can cause severe and irreversible paralysis in not only the cervical spine but also the thoracolumbar spine. To date, however, the prevalence and distribution of OPLL in the whole spine has not been precisely evaluated in patients with cervical OPLL. Therefore, we conducted a multi-center study to comprehensively evaluate the prevalence and distribution of OPLL using multi-detector computed tomography (CT) images in the whole spine and to analyze what factors predict the presence of ossified lesions in the thoracolumbar spine in patients who were diagnosed with cervical OPLL by plain X-ray. Three hundred and twenty-two patients with a diagnosis of cervical OPLL underwent CT imaging of the whole spine. The sum of the levels in which OPLL was present in the whole spine was defined as the OP-index and used to evaluate the extent of ossification. The distribution of OPLL in the whole spine was compared between male and female subjects. In addition, a multiple regression model was used to ascertain related factors that affected the OP-index. Among patients with cervical OPLL, women tended to have more ossified lesions in the thoracolumbar spine than did men. A multiple regression model revealed that the OP-index was significantly correlated with the cervical OP-index, sex (female), and body mass index. Furthermore, the prevalence of thoracolumbar OPLL in patients with a cervical OP-index ≥ 10 was 7.8 times greater than that in patients with a cervical OP-index ≤ 5. The results of this study reveal that the extent of OPLL in the whole spine is significantly associated with the extent of cervical OPLL, female sex, and obesity. PMID:27548354

  8. Differences of Intra-Articular Graft Length between Sandwich-Style Reconstruction and Zhao-Style Non-Remnant-Preserving Double-Bundle Reconstruction of Posterior Cruciate Ligament

    PubMed Central

    Xu, Caiqi; Zhao, Song; Dong, Shikui; Zhang, Yang; Zhao, Jinzhong

    2016-01-01

    Appropriate graft length within the joint and inside the osseous tunnel is essential for achieving posterior stability and adequate anchorage strength. Because of the curving path and thickness of the graft in double-bundle posterior cruciate ligament (PCL) reconstruction, especially in double-bundle PCL augmentation (with remnant preservation), the actual intra-articular length of PCL grafts, which remains unknown, may be longer than previously published values. The main purpose of the current study is to measure the actual intra-articular graft length required in sandwich-style PCL reconstruction (remnant-preserving double-bundle PCL augmentation) and Zhao-style non-remnant-preserving double-bundle PCL reconstruction (semi-anatomic double-bundle PCL reconstruction using double-double tunnel with tibial medial and lateral arrangement). Nine matched pairs of intact cadaveric knees were randomized between two groups and respectively received sandwich-style PCL reconstruction (remnant-preserving group) and Zhao-style non-remnant-preserving double-bundle PCL reconstruction (non-remnant-preserving group). The tunnel positions were exactly the same in two groups. The anterolateral (AL) bundle was reconstructed with four-stranded semitendinosus tendon, and the posteromedial (PM) bundle was reconstructed with four-stranded gracilis tendon. For each bundle, the length of the graft portion within the joint was measured. The current study indicated that in remnant-preserving group, the average intra-articular exposed portion was 42.0 mm (SD, 1.3 mm; range, 40.0 mm to 43.4 mm) for the AL bundle and 32.5 mm (SD, 2.9 mm; range, 27.8 mm to 35.8 mm) for the PM bundle. In non-remnant-preserving group, the intra-articular exposed portion was 34.5 mm (SD, 1.0 mm; range, 32.7 mm to 36.0 mm) for the AL bundle and 29.1 mm (SD, 2.1 mm; range, 25.2 mm to 31.9 mm) for the PM bundle. For both the AL and PM bundles, significant differences were found in average intra-articular graft length

  9. MR imaging of cruciate ligaments.

    PubMed

    Naraghi, Ali; White, Lawrence M

    2014-11-01

    Cruciate ligament injuries, and in particular injuries of the anterior cruciate ligament (ACL), are the most commonly reconstructed ligamentous injuries of the knee. As such, accurate preoperative diagnosis is essential in optimal management of patients with cruciate ligament injuries. This article reviews the anatomy and biomechanics of the ACL and posterior cruciate ligament (PCL) and describes the magnetic resonance (MR) imaging appearances of complete and partial tears. Normal postoperative appearances of ACL and PCL reconstructions as well as MR imaging features of postoperative complications will also be reviewed.

  10. Comparison of anterior decompression and fusion versus laminoplasty in the treatment of multilevel cervical ossification of the posterior longitudinal ligament: a systematic review and meta-analysis

    PubMed Central

    Liu, Weijun; Hu, Ling; Chou, Po-Hsin; Liu, Ming; Kan, Wusheng; Wang, Junwen

    2016-01-01

    Purpose A meta-analysis was conducted to evaluate the clinical outcomes, complications, reoperation rates, and late neurological deterioration between anterior decompression and fusion (ADF) and laminoplasty (LAMP) in the treatment of multilevel cervical ossification of the posterior longitudinal ligament (OPLL). Methods All related studies published up to August 2015 were acquired by searching PubMed and EMBASE. Exclusion criteria were case reports, revision surgeries, combined anterior and posterior surgeries, the other posterior approaches including laminectomy or laminectomy and instrumented fusion, non-English studies, and studies with quality assessment scores of <7. The main end points including Japanese Orthopedic Association (JOA) score, recovery rate of JOA, cervical lordosis, complication rate, reoperation rate, and late neurological deterioration were analyzed. All available data was analyzed using RevMan 5.2.0 and Stata 12.0. Results A total of seven studies were included in the meta-analysis. The mean surgical level of ADF was 3.1, and the mean preoperative occupation ratios of ADF and LAMP group were 55.9% and 51.9%, respectively. No statistical difference was observed with regard to preoperative occupation ratio and preoperative JOA score. Although LAMP group had a higher preoperative cervical lordosis than ADF group (P<0.05, weighted mean difference [WMD] =−5.73, 95% confidence interval [CI] =−9.67–−1.80), significantly decreased cervical lordosis was observed in LAMP group after operation. ADF group had higher postoperative JOA score (P<0.05, WMD =2.18, 95% CI =0.98–3.38) and neurological recovery rate (P<0.05, WMD =27.22, 95% CI =15.20–39.23). Furthermore, ADF group had a lower late neurological deterioration rate than the LAMP group (P<0.05, risk difference =0.16, 95% CI =0.04–0.73). The complication rates of both groups had no statistical difference. However, LAMP group had a significantly lower reoperation rate than ADF group

  11. POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH AUTOGRAFT OF THE DOUBLE SEMITENDINOSUS MUSCLES AND MIDDLE THIRD OF THE QUADRICEPS TENDON WITH DOUBLE FEMORAL AND SINGLE TIBIAL TUNNELS: CLINICAL RESULTS IN TWO YEARS FOLLOW UP

    PubMed Central

    Cury, Ricardo de Paula Leite; Severino, Nilson Roberto; Camargo, Osmar Pedro Arbix; Aihara, Tatsuo; de Oliveira, Victor Marques; Avakian, Roger

    2015-01-01

    Objective: To evaluate the surgical aspects that may offer good anatomic and functional results in posterior cruciate ligament (PCL) reconstruction using an autologous graft of the quadriceps tendon and double semitendinosus through a double femoral tunnel. Methods: Fourteen patients with isolated PCL lesions, instability and pain were operated on by arthroscopy and evaluated according to the International Knee Documentation Committee (IKDC) and Lysholm scales. Posterior knee laxity was examined with a KT1000 arthrometer. Results: The mean postoperative posterior side-to-side difference was between 0-2 mm in 57.1% of patients and between 3 and 5 mm in 35.7% of cases. The average Lysholm score was 93 points in the final follow-up. In the IKDC evaluation, 3 patients were graded A, 10 were graded B, and 1 patient was graded C. Conclusions: Double bundle arthroscopic PCL reconstruction based on the anatomical positioning of the tunnels, with double semitendinosus tendon and single quadriceps, provides a clinically evident reduction in symptoms and restores satisfactory stability, although no statistically significant difference was found due to the small sample. PMID:27027083

  12. Mead acid (20:3n-9) and n-3 polyunsaturated fatty acids are not associated with risk of posterior longitudinal ligament ossification: results of a case-control study.

    PubMed

    Hamazaki, Kei; Kawaguchi, Yoshiharu; Nakano, Masato; Yasuda, Taketoshi; Seki, Shoji; Hori, Takeshi; Hamazaki, Tomohito; Kimura, Tomoatsu

    2015-05-01

    Ossification of the posterior longitudinal ligament (OPLL) involves the replacement of ligamentous tissue with ectopic bone. Although genetics and heritability appear to be involved in the development of OPLL, its pathogenesis remains to be elucidated. Given previous findings that 5,8,11-eicosatrienoic acid [20:3n-9, Mead acid (MA)] has depressive effects on osteoblastic activity and anti-angiogenic effects, and that n-3 polyunsaturated fatty acids (PUFAs) have a preventive effect on heterotopic ossification, we hypothesized that both fatty acids would be involved in OPLL development. To examine the biological significance of these and other fatty acids in OPLL, we conducted this case-control study involving 106 patients with cervical OPLL and 109 age matched controls. Fatty acid composition was determined from plasma samples by gas chromatography. Associations between fatty acid levels and incident OPLL were evaluated by logistic regression. Contrary to our expectations, we found no significant differences between patients and controls in the levels of MA or n-3 PUFAs (e.g., eicosapentaenoic acid and docosahexaenoic acid). Logistic regression analysis did not reveal any associations with OPLL risk for MA or n-3 PUFAs. In conclusion, no potential role was found for MA or n-3 PUFAs in ectopic bone formation in the spinal canal.

  13. Treatment of medial collateral ligament injuries.

    PubMed

    Miyamoto, Ryan G; Bosco, Joseph A; Sherman, Orrin H

    2009-03-01

    The medial collateral ligament is the most frequently injured ligament of the knee. The anatomy and biomechanical role of this ligament and the associated posteromedial structures of the knee continue to be explored. Prophylactic knee bracing has shown promise in preventing injury to the medial collateral ligament, although perhaps at the cost of functional performance. Most isolated injuries are treated nonsurgically. Recent studies have investigated ligament-healing variables, including modalities such as ultrasound and nonsteroidal anti-inflammatory drugs. Concomitant damage to the anterior or posterior cruciate ligaments is a common indication to surgically address the high-grade medial collateral ligament injury. The optimal treatment of multiligamentous knee injuries continues to evolve, and controversy exists surrounding the role of medial collateral ligament repair/reconstruction, with data supporting both conservative and surgical management. PMID:19264708

  14. Response of individual thoracolumbar spine ligaments under high-rate deformation.

    PubMed

    Iwaskiw, Alexander S; Armiger, Robert S; Ott, Kyle A; Wickwire, Alexis C M; Merkle, Andrew C

    2012-01-01

    Under-Body Blast (UBB) has emerged as the predominant threat to ground vehicles and Warfighter survivability. The force transference from the vehicle structure to the human body has resulted in serious injuries, with the thoracolumbar spine frequently damaged. Computational models of the human body are being generated to model human response and develop injury mitigation strategies. To effectively model the spine mechanics, the thoracolumbar ligaments, which serve varying roles in contributing to spine stability, must be characterized at relevant strains and strain rates. Adaptation of cervical spine testing methods has allowed for testing of isolated spinal ligaments including the Anterior Longitudinal Ligament (ALL), Posterior Longitudinal Ligament (PLL), and Ligamentum Flavum (LF). A high-rate servo-hydraulic test machine was used to execute a tensile test protocol for 24 complexes with loading rates ranging from 240 - 2800 mm/s and displacements of 25%, 50%, 75%, 100%, and 300% of the measured ligament length. Non-contact strain field measurements were recorded to produce a three dimensional strain field of the ligament surface. In order to provide the ligament data in a form which can be incorporated in the human computational models, analytical methods for modeling the ligament response are being investigated. Ultimately, this model will be optimized to be utilized in computational models of the lumbar spine. PMID:22846283

  15. Ultrasound of the elbow with emphasis on detailed assessment of ligaments, tendons, and nerves.

    PubMed

    De Maeseneer, Michel; Brigido, Monica Kalume; Antic, Marijana; Lenchik, Leon; Milants, Annemieke; Vereecke, Evie; Jager, Tjeerd; Shahabpour, Maryam

    2015-04-01

    The high resolution and dynamic capability of ultrasound make it an excellent tool for assessment of superficial structures. The ligaments, tendons, and nerves about the elbow can be fully evaluated with ultrasound. The medial collateral ligament consists of an anterior and posterior band that can easily be identified. The lateral ligament complex consists of the radial collateral ligament, ulnar insertion of the annular ligament, and lateral ulnar collateral ligament, easily identified with specialized probe positioning. The lateral ulnar collateral ligament can best be seen in the cobra position. On ultrasound medial elbow tendons can be followed nearly up to their common insertion. The pronator teres, flexor carpi radialis, palmaris longus, and flexor digitorum superficialis can be identified. The laterally located brachioradialis and extensor carpi radialis longus insert on the supracondylar ridge. The other lateral tendons can be followed up to their common insertion on the lateral epicondyle. The extensor digitorum, extensor carpi radialis brevis, extensor digiti minimi, and extensor carpi ulnaris can be differentiated. The distal biceps tendon is commonly bifid. For a complete assessment of the distal biceps tendon specialized views are necessary. These include an anterior axial approach, medial and lateral approach, and cobra position. In the cubital tunnel the ulnar nerve is covered by the ligament of Osborne. Slightly more distally the ulnar nerve courses between the two heads of the flexor carpi ulnaris. An accessory muscle, the anconeus epitrochlearis can cover the ulnar nerve at the cubital tunnel, and is easily identified on ultrasound. The radial nerve divides in a superficial sensory branch and a deep motor branch. The motor branch, the posterior interosseous nerve, courses under the arcade of Frohse where it enters the supinator muscle. At the level of the dorsal wrist the posterior interosseous nerve is located at the deep aspect of the extensor

  16. Posterior malleolus fracture.

    PubMed

    Irwin, Todd A; Lien, John; Kadakia, Anish R

    2013-01-01

    Posterior malleolus fractures are a common component of ankle fractures. The morphology is variable; these fractures range from small posterolateral avulsion injuries to large displaced fracture fragments. The integrity of the posterior malleolus and its ligamentous attachment is important for tibiotalar load transfer, posterior talar stability, and rotatory ankle stability. Fixation of posterior malleolus fractures in the setting of rotational ankle injuries has certain benefits, such as restoring articular congruity and rotatory ankle stability, as well as preventing posterior talar translation, but current indications are unclear. Fragment size as a percentage of the anteroposterior dimension of the articular surface is often cited as an indication for fixation, although several factors may contribute to the decision, such as articular impaction, comminution, and syndesmotic stability. Outcome studies show that, in patients with ankle fractures, the presence of a posterior malleolus fracture negatively affects prognosis. Notable variability is evident in surgeon practice. PMID:23281469

  17. Dependence Independence Measure for Posterior and Anterior EMG Sensors Used in Simple and Complex Finger Flexion Movements: Evaluation Using SDICA.

    PubMed

    Naik, Ganesh R; Baker, Kerry G; Nguyen, Hung T

    2015-09-01

    Identification of simple and complex finger flexion movements using surface electromyography (sEMG) and a muscle activation strategy is necessary to control human-computer interfaces such as prosthesis and orthoses. In order to identify these movements, sEMG sensors are placed on both anterior and posterior muscle compartments of the forearm. In general, the accuracy of myoelectric classification depends on several factors, which include number of sensors, features extraction methods, and classification algorithms. Myoelectric classification using a minimum number of sensors and optimal electrode configuration is always a challenging task. Sometimes, using several sensors including high density electrodes will not guarantee high classification accuracy. In this research, we investigated the dependence and independence nature of anterior and posterior muscles during simple and complex finger flexion movements. The outcome of this research shows that posterior parts of the hand muscles are dependent and hence responsible for most of simple finger flexion. On the other hand, this study shows that anterior muscles are responsible for most complex finger flexion. This also indicates that simple finger flexion can be identified using sEMG sensors connected only on anterior muscles (making posterior placement either independent or redundant), and vice versa is true for complex actions which can be easily identified using sEMG sensors on posterior muscles. The result of this study is beneficial for optimal electrode configuration and design of prosthetics and other related devices using a minimum number of sensors.

  18. Total hip replacement through a posterior approach using a 22 mm diameter femoral head : the role of the transverse acetabular ligament and capsular repair in reducing the rate of dislocation.

    PubMed

    Kumar, V; Sharma, S; James, J; Hodgkinson, J P; Hemmady, M V

    2014-09-01

    Despite a lack of long-term follow-up, there is an increasing trend towards using femoral heads of large diameter in total hip replacement (THR), partly because of the perceived advantage of lower rates of dislocation. However, increasing the size of the femoral head is not the only way to reduce the rate of dislocation; optimal alignment of the components and repair of the posterior capsule could achieve a similar effect. In this prospective study of 512 cemented unilateral THRs (Male:Female 230:282) performed between 2004 and 2011, we aimed to determine the rate of dislocation in patients who received a 22 mm head on a 9/10 Morse taper through a posterior approach with capsular repair and using the transverse acetabular ligament (TAL) as a guide for the alignment of the acetabular component. The mean age of the patients at operation was 67 years (35 to 89). The mean follow-up was 2.8 years (0.5 to 6.6). Pre- and post-operative assessment included Oxford hip, Short Form-12 and modified University of California Los Angeles and Merle D'Aubigne scores. The angles of inclination and anteversion of the acetabular components were measured using radiological software. There were four dislocations (0.78%), all of which were anterior. In conclusion, THR with a 22 mm diameter head performed through a posterior approach with capsular repair and using the TAL as a guide for the alignment of the acetabular component was associated with a low rate of dislocation. PMID:25183591

  19. Visual receptive fields in the striate-recipient zone of the lateral posterior-pulvinar complex.

    PubMed

    Chalupa, L M; Abramson, B P

    1989-01-01

    The lateral posterior (LP)-pulvinar complex of the cat is known to contain multiple visual areas. In the present study, we examined the receptive field properties of single neurons isolated in the lateral division of this complex (the LPI). The LPI is designated the striate-recipient zone because it is the only region of the LP-pulvinar receiving cortical projections from areas 17 and 18. The recordings revealed that the striate-recipient zone of LP comprises 2 subareas, which we have termed LPI-1 and LPI-2. In the main segment (LPI-1), virtually all cells responded securely to visual stimuli. The vast majority of these neurons were binocular, with relatively small and well-defined receptive fields. More than half of the cells were found to be directionally selective, and almost this many were orientation specific. The orientation tuning of these cells was found to be quite precise, comparable to complex cells in area 17. In contrast, in the small dorsolateral segment of the striate-recipient zone (the LPI-2), a substantial proportion of cells could not be visually activated. Here, the visual cells had very large receptive fields, and relatively few were direction or orientation selective. The LPI-2 receives subcortical inputs from the superficial layers of the superior colliculus, the hypothalamus, and cerebellum, while the LPI-1 is innervated only by cortical axons. It is suggested that the subcortical connections of the LPI-2 account for the differences in the response properties of the 2 striate-recipient areas. The present results, in conjunction with our previous findings on the principal tectorecipient zone (Chalupa et al., 1983), permit 2 generalizations regarding the functional organization of the cat's LP-pulvinar complex. First, there are clear differences among the visual areas of the LP-pulvinar in the cellular processing of visual information. Second, these functional differences can be related to the principal sources of visual input to the various

  20. Kinematic analysis of anterior cruciate ligament reconstruction in total knee arthroplasty

    PubMed Central

    Liu, Hua-Wei; Ni, Ming; Zhang, Guo-Qiang; Li, Xiang; Chen, Hui; Zhang, Qiang; Chai, Wei; Zhou, Yong-Gang; Chen, Ji-Ying; Liu, Yu-Liang; Cheng, Cheng-Kung; Wang, Yan

    2016-01-01

    Background: This study aims to retain normal knee kinematics after knee replacement surgeries by reconstructing anterior cruciate ligament during total knee arthroplasty. Method: We use computational simulation tools to establish four dynamic knee models, including normal knee model, posterior cruciate ligament retaining knee model, posterior cruciate ligament substituting knee model, and anterior cruciate ligament reconstructing knee model. Our proposed method utilizes magnetic resonance images to reconstruct solid bones and attachments of ligaments, and assemble femoral and tibial components according representative literatures and operational specifications. Dynamic data of axial tibial rotation and femoral translation from full-extension to 135 were measured for analyzing the motion of knee models. Findings: The computational simulation results show that comparing with the posterior cruciate ligament retained knee model and the posterior cruciate ligament substituted knee model, reconstructing anterior cruciate ligament improves the posterior movement of the lateral condyle, medial condyle and tibial internal rotation through a full range of flexion. The maximum posterior translations of the lateral condyle, medial condyle and tibial internal rotation of the anterior cruciate ligament reconstructed knee are 15.3 mm, 4.6 mm and 20.6 at 135 of flexion. Interpretation: Reconstructing anterior cruciate ligament in total knee arthroplasty has been approved to be an more efficient way of maintaining normal knee kinematics comparing to posterior cruciate ligament retained and posterior cruciate ligament substituted total knee arthroplasty. PMID:27347334

  1. Ligamentous laxity across C0-C1-C2 complex. Axial torque-rotation characteristics until failure.

    PubMed

    Goel, V K; Winterbottom, J M; Schulte, K R; Chang, H; Gilbertson, L G; Pudgil, A G; Gwon, J K

    1990-10-01

    The axial torque until failure of the ligamentous occipito-atlanto-axial complex (C0-C1-C2) subjected to axial angular rotation (theta) was characterized using a biaxial MTS system. A special fixture and gearbox that permitted right axial rotation of the specimen until failure without imposing any additional constraints were designed to obtain the data. The average values for the axial rotation and torque at the point of maximum resistance were, respectively, 68.1 degrees and 13.6 N-m. The specimens offered minimal resistance (approximately 0.5 N-m), up to an average axial rotation of 21 degrees across the complex. The torque-angular rotation (T-theta) curve can be divided into four regions: regions of least and steadily increasing resistances, a transition zone that connects these two regions, and the increasing resistance region to the point of maximum resistance. The regions of least and steadily increasing resistances may be represented by two straight lines with average slopes of 0.028 and 0.383 N-m/degree, respectively. Post-test dissection of the specimens disclosed the following. The point of maximum resistance corresponded roughly to the value of axial rotation at which complete bilateral rotary dislocation of the C1-C2 facets occurred. The types of injuries observed were related to the magnitude of axial rotation imposed on a specimen during testing. Soft-tissue injuries alone (like stretch/rupture of the capsular ligaments, subluxation of the C1-C2 facets, etc.) were confined to specimens rotated up to or close to the point of maximum resistance. The specimens that were subjected to rotations up to the point of maximum resistance of the curve spontaneously reduced completely on removal from the testing apparatus. Spontaneous reduction was not possible for specimens tested slightly beyond their points of maximum resistance.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Representation of Perceptual Color Space in Macaque Posterior Inferior Temporal Cortex (the V4 Complex).

    PubMed

    Bohon, Kaitlin S; Hermann, Katherine L; Hansen, Thorsten; Conway, Bevil R

    2016-01-01

    The lateral geniculate nucleus is thought to represent color using two populations of cone-opponent neurons [L vs M; S vs (L + M)], which establish the cardinal directions in color space (reddish vs cyan; lavender vs lime). How is this representation transformed to bring about color perception? Prior work implicates populations of glob cells in posterior inferior temporal cortex (PIT; the V4 complex), but the correspondence between the neural representation of color in PIT/V4 complex and the organization of perceptual color space is unclear. We compared color-tuning data for populations of glob cells and interglob cells to predictions obtained using models that varied in the color-tuning narrowness of the cells, and the color preference distribution across the populations. Glob cells were best accounted for by simulated neurons that have nonlinear (narrow) tuning and, as a population, represent a color space designed to be perceptually uniform (CIELUV). Multidimensional scaling and representational similarity analyses showed that the color space representations in both glob and interglob populations were correlated with the organization of CIELUV space, but glob cells showed a stronger correlation. Hue could be classified invariant to luminance with high accuracy given glob responses and above-chance accuracy given interglob responses. Luminance could be read out invariant to changes in hue in both populations, but interglob cells tended to prefer stimuli having luminance contrast, regardless of hue, whereas glob cells typically retained hue tuning as luminance contrast was modulated. The combined luminance/hue sensitivity of glob cells is predicted for neurons that can distinguish two colors of the same hue at different luminance levels (orange/brown). PMID:27595132

  3. Representation of Perceptual Color Space in Macaque Posterior Inferior Temporal Cortex (the V4 Complex)

    PubMed Central

    Bohon, Kaitlin S.; Hermann, Katherine L.; Hansen, Thorsten

    2016-01-01

    Abstract The lateral geniculate nucleus is thought to represent color using two populations of cone-opponent neurons [L vs M; S vs (L + M)], which establish the cardinal directions in color space (reddish vs cyan; lavender vs lime). How is this representation transformed to bring about color perception? Prior work implicates populations of glob cells in posterior inferior temporal cortex (PIT; the V4 complex), but the correspondence between the neural representation of color in PIT/V4 complex and the organization of perceptual color space is unclear. We compared color-tuning data for populations of glob cells and interglob cells to predictions obtained using models that varied in the color-tuning narrowness of the cells, and the color preference distribution across the populations. Glob cells were best accounted for by simulated neurons that have nonlinear (narrow) tuning and, as a population, represent a color space designed to be perceptually uniform (CIELUV). Multidimensional scaling and representational similarity analyses showed that the color space representations in both glob and interglob populations were correlated with the organization of CIELUV space, but glob cells showed a stronger correlation. Hue could be classified invariant to luminance with high accuracy given glob responses and above-chance accuracy given interglob responses. Luminance could be read out invariant to changes in hue in both populations, but interglob cells tended to prefer stimuli having luminance contrast, regardless of hue, whereas glob cells typically retained hue tuning as luminance contrast was modulated. The combined luminance/hue sensitivity of glob cells is predicted for neurons that can distinguish two colors of the same hue at different luminance levels (orange/brown).

  4. Representation of Perceptual Color Space in Macaque Posterior Inferior Temporal Cortex (the V4 Complex)

    PubMed Central

    Bohon, Kaitlin S.; Hermann, Katherine L.; Hansen, Thorsten

    2016-01-01

    Abstract The lateral geniculate nucleus is thought to represent color using two populations of cone-opponent neurons [L vs M; S vs (L + M)], which establish the cardinal directions in color space (reddish vs cyan; lavender vs lime). How is this representation transformed to bring about color perception? Prior work implicates populations of glob cells in posterior inferior temporal cortex (PIT; the V4 complex), but the correspondence between the neural representation of color in PIT/V4 complex and the organization of perceptual color space is unclear. We compared color-tuning data for populations of glob cells and interglob cells to predictions obtained using models that varied in the color-tuning narrowness of the cells, and the color preference distribution across the populations. Glob cells were best accounted for by simulated neurons that have nonlinear (narrow) tuning and, as a population, represent a color space designed to be perceptually uniform (CIELUV). Multidimensional scaling and representational similarity analyses showed that the color space representations in both glob and interglob populations were correlated with the organization of CIELUV space, but glob cells showed a stronger correlation. Hue could be classified invariant to luminance with high accuracy given glob responses and above-chance accuracy given interglob responses. Luminance could be read out invariant to changes in hue in both populations, but interglob cells tended to prefer stimuli having luminance contrast, regardless of hue, whereas glob cells typically retained hue tuning as luminance contrast was modulated. The combined luminance/hue sensitivity of glob cells is predicted for neurons that can distinguish two colors of the same hue at different luminance levels (orange/brown). PMID:27595132

  5. Representation of Perceptual Color Space in Macaque Posterior Inferior Temporal Cortex (the V4 Complex).

    PubMed

    Bohon, Kaitlin S; Hermann, Katherine L; Hansen, Thorsten; Conway, Bevil R

    2016-01-01

    The lateral geniculate nucleus is thought to represent color using two populations of cone-opponent neurons [L vs M; S vs (L + M)], which establish the cardinal directions in color space (reddish vs cyan; lavender vs lime). How is this representation transformed to bring about color perception? Prior work implicates populations of glob cells in posterior inferior temporal cortex (PIT; the V4 complex), but the correspondence between the neural representation of color in PIT/V4 complex and the organization of perceptual color space is unclear. We compared color-tuning data for populations of glob cells and interglob cells to predictions obtained using models that varied in the color-tuning narrowness of the cells, and the color preference distribution across the populations. Glob cells were best accounted for by simulated neurons that have nonlinear (narrow) tuning and, as a population, represent a color space designed to be perceptually uniform (CIELUV). Multidimensional scaling and representational similarity analyses showed that the color space representations in both glob and interglob populations were correlated with the organization of CIELUV space, but glob cells showed a stronger correlation. Hue could be classified invariant to luminance with high accuracy given glob responses and above-chance accuracy given interglob responses. Luminance could be read out invariant to changes in hue in both populations, but interglob cells tended to prefer stimuli having luminance contrast, regardless of hue, whereas glob cells typically retained hue tuning as luminance contrast was modulated. The combined luminance/hue sensitivity of glob cells is predicted for neurons that can distinguish two colors of the same hue at different luminance levels (orange/brown).

  6. [Comparative roentgenographical study on the incidence of ossification of the posterior longitudinal ligament and other degenerative changes of the cervical spine among Japanese, Koreans, Americans and Germans (author's transl)].

    PubMed

    Izawa, K

    1980-05-01

    Ossification of the posterior longitudinal liagment (OPLL) of the cervical spine which causes narrowing of the spinal canal has been reported to occur in about three percent of adult Japanese, whereas only sporadical cases have been reported outside Japan. Whether this indicates a real ethnic difference of the disease incidence or simply reflects a difference of attention toward this disease has been one of the questions raised by many workers. In order to clarify this, the author reviewed a large number of roentgenograms of the cervical spine in Japan (Juntendo University Hospital), Korea (Sebrance Hospital and Hanko Sacred Heart Hospital), the United States (Mayo Clinic and Dr. Cloward's Office in Hawaii), and West Germany (Mainz University Hospital). The rate of appearance of OPLL was compared between these ethnic groups. In addition to this, the rate of appearance of calcification of the nuchal ligament and other degenerative changes of the cervical spine such as osteophyte formation and narrowing of the intervertebral disc space was also studied and statistically analysed. Results 1. OPLL: The author found OPLL in 143 out of 6,994 (2.06%) Japanese individuals above 20 years of age. The incidence was lower in Koreans being 0.95%. This was much more pronounced and significant in the United States (Mayo Clinic) and in Germany, where only a few cases were found (Table 6). However, it is interesting to note that six cases found at Dr. Cloward's office in Hawaii included two Japanese. The author concludes that the incidence of OPLL is significantly higher in Japanese than in Caucasians, although the reason for this still remains to be studied. 2. Calcification of the nuchal ligament: This calcification (Barsony) was found in 10.2% among Japanese and in 11.3% among Koreans, whereas in 6.1% among Americans and in 4.5% among GErmans (Table 13). The author proposes that this significantly higher incidence of this calcification among Japanese and Koreans may have

  7. Cruciate ligament loading during common knee rehabilitation exercises.

    PubMed

    Escamilla, Rafael F; Macleod, Toran D; Wilk, Kevin E; Paulos, Lonnie; Andrews, James R

    2012-09-01

    Cruciate ligament injuries are common and may lead to dysfunction if not rehabilitated. Understanding how to progress anterior cruciate ligament and posterior cruciate ligament loading, early after injury or reconstruction, helps clinicians prescribe rehabilitation exercises in a safe manner to enhance recovery. Commonly prescribed therapeutic exercises include both weight-bearing exercise and non-weight-bearing exercise. This review was written to summarize and provide an update on the available literature on cruciate ligament loading during commonly used therapeutic exercises. In general, weight-bearing exercise produces smaller loads on the anterior cruciate ligament and posterior cruciate ligament compared with non-weight-bearing exercise. The anterior cruciate ligament is loaded less at higher knee angles (i.e. 50-100 degrees). Squatting and lunging with a more forward trunk tilt and moving the resistance pad proximally on the leg during the seated knee extension unloads the anterior cruciate ligament. The posterior cruciate ligament is less loaded at lower knee angles (i.e. 0-50 degrees), and may be progressed from level ground walking to a one-leg squat, lunges, wall squat, leg press, and the two-leg squat (from smallest to greatest). Exercise type and technique variation affect cruciate ligament loading, such that the clinician may prescribe therapeutic exercises to progress ligament loading safely, while ensuring optimal recovery of the musculoskeletal system.

  8. Cruciate ligament loading during common knee rehabilitation exercises.

    PubMed

    Escamilla, Rafael F; Macleod, Toran D; Wilk, Kevin E; Paulos, Lonnie; Andrews, James R

    2012-09-01

    Cruciate ligament injuries are common and may lead to dysfunction if not rehabilitated. Understanding how to progress anterior cruciate ligament and posterior cruciate ligament loading, early after injury or reconstruction, helps clinicians prescribe rehabilitation exercises in a safe manner to enhance recovery. Commonly prescribed therapeutic exercises include both weight-bearing exercise and non-weight-bearing exercise. This review was written to summarize and provide an update on the available literature on cruciate ligament loading during commonly used therapeutic exercises. In general, weight-bearing exercise produces smaller loads on the anterior cruciate ligament and posterior cruciate ligament compared with non-weight-bearing exercise. The anterior cruciate ligament is loaded less at higher knee angles (i.e. 50-100 degrees). Squatting and lunging with a more forward trunk tilt and moving the resistance pad proximally on the leg during the seated knee extension unloads the anterior cruciate ligament. The posterior cruciate ligament is less loaded at lower knee angles (i.e. 0-50 degrees), and may be progressed from level ground walking to a one-leg squat, lunges, wall squat, leg press, and the two-leg squat (from smallest to greatest). Exercise type and technique variation affect cruciate ligament loading, such that the clinician may prescribe therapeutic exercises to progress ligament loading safely, while ensuring optimal recovery of the musculoskeletal system. PMID:23025167

  9. Comparison of the Japanese Orthopaedic Association Score and the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire Scores: Time-Dependent Changes in Patients with Cervical Spondylotic Myelopathy and Posterior Longitudinal Ligament

    PubMed Central

    Iwasaki, Motoki; Sakaura, Hironobu; Fujimori, Takahito; Nagamoto, Yukitaka; Yoshikawa, Hideki

    2015-01-01

    Study Design Prospective cohort study. Purpose To identify differences in time-dependent perioperative changes between the Japanese Orthopaedic Association (JOA) score and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) score in patients with cervical spondylotic myelopathy (CSM) and posterior longitudinal ligament (OPLL) who underwent cervical laminoplasty. Overview of Literature The JOA score does not take into consideration patient satisfaction or quality of life. Accordingly, the JOACMEQ was designed in 2007 as a patient-centered assessment tool. Methods We studied 21 patients who underwent cervical laminoplasty. We objectively evaluated the time-dependent changes in JOACMEQ scores and JOA scores for all patients before surgery and at 2 weeks, 3 months, 6 months, and 1 year after surgery. Results The average total JOA score and the recovery rate improved significantly after surgery in both groups, with a slightly better recovery rate in the OPLL group. Cervical spine function improved significantly in the CSM group but not in the OPLL group. Upper- and lower-extremity functions were more stable in the CSM group than in the OPLL group. The effectiveness rate of the JOACMEQ for measuring quality of life was quite low in both groups. In both groups, the Spearman contingency coefficients were dispersed widely except for upper- and lower-extremity function. Conclusions Scores for upper- and lower-extremity function on the JOACMEQ correlated well with JOA scores. Because the JOACMEQ can also assess cervical spine function and quality of life, factors that cannot be assessed by the JOA score alone, the JOACMEQ is a more comprehensive evaluation tool. PMID:25705334

  10. Association of miR-146a, miR-149, miR-196a2, and miR-499 Polymorphisms with Ossification of the Posterior Longitudinal Ligament of the Cervical Spine

    PubMed Central

    Jeon, Young Joo; Kumar, Hemant; Sohn, Seil; Min, Hyoung Sik; Lee, Jang Bo; Kuh, Sung Uk; Kim, Keung Nyun; Kim, Jung Oh; Kim, Ok Joon; Ropper, Alexander E.; Kim, Nam Keun; Han, In Bo

    2016-01-01

    Background Ossification of the posterior longitudinal ligament (OPLL) of the spine is considered a multifactorial and polygenic disease. We aimed to investigate the association between four single nucleotide polymorphisms (SNPs) of pre-miRNAs [miR-146aC>G (rs2910164), miR-149T>C (rs2292832), miR-196a2T>C (rs11614913), and miR-499A>G (rs3746444)] and the risk of cervical OPLL in the Korean population. Methods The genotypic frequencies of these four SNPs were analyzed in 207 OPLL patients and 200 controls by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay. Findings For four SNPs in pre-miRNAs, no significant differences were found between OPLL patients and controls. However, subgroup analysis based on OPLL subgroup (continuous: continuous type plus mixed type, segmental: segmental and localized type) showed that miR-499GG genotype was associated with an increased risk of segmental type OPLL (adjusted odds ratio = 4.314 with 95% confidence interval: 1.109–16.78). In addition, some allele combinations (C-T-T-G, G-T-T-A, and G-T-C-G of miR-146a/-149/-196a2/-499) and combined genotypes (miR-149TC/miR-196a2TT) were associated with increased OPLL risk, whereas the G-T-T-G and G-C-C-G allele combinations were associated with decreased OPLL risk. Conclusion The results indicate that GG genotype of miR-499 is associated with significantly higher risks of OPLL in the segmental OPLL group. The miR-146a/-149/-196a2/-499 allele combinations may be a genetic risk factor for cervical OPLL in the Korean population. PMID:27454313

  11. Histological characteristics and ultrastructure of polyethylene terephthalate LARS ligament after the reconstruction of anterior cruciate ligament in rabbits

    PubMed Central

    Yu, Shao-Bin; Yang, Rong-Hua; Zuo, Zhong-Nan; Dong, Qi-Rong

    2014-01-01

    Polyethylene terephthalate LARS ligament were the remnant of LARS ligament used for repairing posterior cruciate ligament obtained from operation. We want to study histological characteristics and ultrastructure of polyethylene terephthalate LARS ligament after the reconstruction of anterior cruciate ligament in rabbits. Therefore, we replaced the original ACL with polyethylene terephthalate LARS ligament which was covering with the remnant of ACL in 9 rabbits (L-LARS group), while just only polyethylene terephthalate LARS ligament were transplanted in 3 rabbits (LARS group) with the remnant of ACL. Compared with group LARS, inflammatory cell reaction and foreign body reaction were more significant in group L-LARS. Moreover, electron microscopy investigation showed the tissue near LARS fibers was highly cellular with a matrix of thin collagen fibrils (50-100 nm) in group L-LARS. These above findings suggest the polyethylene terephthalate LARS ligament possess the high biocompatibility, which contributes to the polyethylene terephthalate LARS covered with recipient connective tissues. PMID:25356104

  12. Unilateral aplasia of both cruciate ligaments

    PubMed Central

    2010-01-01

    Aplasia of both cruciate ligaments is a rare congenital disorder. A 28-year-old male presented with pain and the feeling of instability of his right knee after trauma. The provided MRI and previous arthroscopy reports did not indicate any abnormalities except cruciate ligament tears. He was referred to us for reconstruction of both cruciate ligaments. The patient again underwent arthroscopy which revealed a hypoplasia of the medial trochlea and an extremely narrow intercondylar notch. The tibia revealed a missing anterior cruciate ligament (ACL) footprint and a single bump with a complete coverage with articular cartilage. There was no room for an ACL graft. A posterior cruciate ligament could not be identified. The procedure was ended since a ligament reconstruction did not appear reasonable. A significant notch plasty if not a partial resection of the condyles would have been necessary to implant a ligament graft. It is most likely that this would not lead to good knee stability. If the surgeon would have retrieved the contralateral hamstrings at the beginning of the planned ligament reconstruction a significant damage would have occurred to the patient. Even in seemingly clear diagnostic findings the arthroscopic surgeon should take this rare abdnormality into consideration and be familiar with the respective radiological findings. We refer the abnormal finding of only one tibial spine to as the "dromedar-sign" as opposed to the two (medial and a lateral) tibial spines in a normal knee. This may be used as a hint for aplasia of the cruciate ligaments. PMID:20184748

  13. Posterior cruciate ligament (PCL) injury - aftercare

    MedlinePlus

    ... your health care provider if: You have an increase in swelling or pain Self-care does not seem to help You lose feeling in your foot Your foot and leg feels cold or changes color If you have surgery, call the doctor if ...

  14. Coracoclavicular Ligament Reconstruction

    PubMed Central

    Li, Qi; Hsueh, Pei-ling; Chen, Yun-feng

    2014-01-01

    Abstract Operative intervention is recommended for complete acromioclavicular (AC) joint dislocation to restore AC stability, but the best operative technique is still controversial. Twelve fresh-frozen male cadaveric shoulders (average age, 62.8 ± 7.8 years) were equally divided into endobutton versus the modified Weaver-Dunn groups. Each potted scapula and clavicle was fixed in a custom made jig to allow translation and load to failure testing using a Zwick BZ2.5/TS1S material testing machine (Zwick/Roell Co, Germany). A systematic review of 21 studies evaluating reconstructive methods for coracoclavicular or AC joints using a cadaveric model was also performed. From our biomechanical study, after ligament reconstruction, the triple endobutton technique demonstrated superior, anterior, and posterior displacements similar to that of the intact state (P > 0.05). In the modified Weaver-Dunn reconstruction group, however, there was significantly greater anterior (P < 0.001) and posterior (P = 0.003) translation after ligament reconstruction. In addition, there was no significant difference after reconstruction between failure load of the triple endobutton group and that of the intact state (686.88 vs 684.9 N, P > 0.05), whereas the failure load after the modified Weaver-Dunn reconstruction was decreased compared with the intact state (171.64 vs 640.86 N, P < 0.001). From our systematic review of 21 studies, which involved comparison of the modified Weaver-Dunn technique with other methods, the majority showed that the modified Weaver-Dunn procedure had significantly (P < .05) greater laxity than other methods including the endobutton technique. The triple endobutton reconstruction proved superior to the modified Weaver-Dunn technique in restoration of AC joint stability and strength. Triple endobutton reconstruction of the coracoclavicular ligament is superior to the modified Weaver-Dunn reconstruction in controlling both superior and

  15. The Cruciate Ligaments in Total Knee Arthroplasty.

    PubMed

    Parcells, Bertrand W; Tria, Alfred J

    2016-01-01

    The early knee replacements were hinge designs that ignored the ligaments of the knee and resurfaced the joint, allowing freedom of motion in a single plane. Advances in implant fixation paved the way for modern designs, including the posterior-stabilized (PS) total knee arthroplasty (TKA) that sacrifices both cruciate ligaments while substituting for the posterior cruciate ligament (PCL), and the cruciate-retaining (CR) TKA designs that sacrifice the anterior cruciate ligament but retain the PCL. The early bicruciate retaining (BCR) TKA designs suffered from loosening and early failures. Townley and Cartier designed BCR knees that had better clinical results but the surgical techniques were challenging.Kinematic studies suggest that normal motion relies on preservation of both cruciate ligaments. Unicompartmental knee arthroplasty retains all knee ligaments and closely matches normal motion, while PS and CR TKA deviate further from normal. The 15% to 20% dissatisfaction rate with current TKA has renewed interest in the BCR design. Replication of normal knee kinematics and proprioception may address some of the dissatisfaction.

  16. Mesenchymal stem cell isolation and characterization from human spinal ligaments.

    PubMed

    Asari, Toru; Furukawa, Ken-Ichi; Tanaka, Sunao; Kudo, Hitoshi; Mizukami, Hiroki; Ono, Atsushi; Numasawa, Takuya; Kumagai, Gentaro; Motomura, Shigeru; Yagihashi, Soroku; Toh, Satoshi

    2012-01-27

    Mesenchymal stem cells (MSCs) have a fibroblast-like morphology, multilineage potential, long-term viability and capacity for self-renewal. While several articles describe isolating MSCs from various human tissues, there are no reports of isolating MSCs from human spinal ligaments, and their localization in situ. If MSCs are found in human spinal ligaments, they could be used to investigate hypertrophy or ossification of spinal ligaments. To isolate and characterize MSCs from human spinal ligaments, spinal ligaments were harvested aseptically from eight patients during surgery for lumbar spinal canal stenosis and ossification of the posterior longitudinal ligament. After collagenase digestion, nucleated cells were seeded at an appropriate density to avoid colony-to-colony contact. Cells were cultured in osteogenic, adipogenic or chondrogenic media to evaluate their multilineage differentiation potential. Immunophenotypic analysis of cell surface markers was performed by flow cytometry. Spinal ligaments were processed for immunostaining using MSC-related antibodies. Cells from human spinal ligaments could be extensively expanded with limited senescence. They were able to differentiate into osteogenic, adipogenic or chondrogenic cells. Flow cytometry revealed that their phenotypic characteristics met the minimum criteria of MSCs. Immunohistochemistry revealed the localization of CD90-positive cells in the collagenous matrix of the ligament, and in adjacent small blood vessels. We isolated and expanded MSCs from human spinal ligaments and demonstrated localization of MSCs in spinal ligaments. These cells may play an indispensable role in elucidating the pathogenesis of numerous spinal diseases.

  17. Posterior Ankle and Hind Foot Arthroscopy

    PubMed Central

    Gökkuş, Kemal; Aydın, Ahmet Turan

    2014-01-01

    ) Results: The mean pre operative AOFAS score was 50.75, the mean post operative AOFAS score was 93.75. Complications were noted. Complex regional pain syndrome (CRPS) and oedema was diagnosed during early post operative period in one patient (%4.7), resolved with physical therapy. Conclusion: The most common procedures were osteochondral lesion debritement and curettage with multidrilling /microfracture (10), isolated os trigonum excision (2), tenolysis of the flexor hallucis longus tendon with os trigonum excision (6 ), debritment of the thickened posterior talofibular ligament (2), endoscopic partial calcanectomy for Haglund’s deformity (1) . Our experience demostrated that posterior ankle and hind foot arthroscopy can be performed with low rate of major postoperative complication.

  18. Evaluation of Knee Ligament Mechanics Using Computational Models.

    PubMed

    Guess, Trent M; Razu, Swithin; Jahandar, Hamidreza

    2016-02-01

    The steady maturation of computational biomechanics is providing the musculoskeletal health community with exciting avenues for enhancing orthopedic practice and rehabilitation. Computational knee models deliver tools that may improve the efficiency and outcomes of orthopedic research and methods through analysis of virtual surgeries and devices. They also provide insight into the interaction of knee structures and can predict what cannot be directly measured such as loading on our cartilage and ligaments during movement. This project created subject-specific computational knee models of two young adult females using magnetic resonance imaging-derived knee geometries and passive leg motion measured by a motion capture system. The knee models produced passive ligament lengthening patterns similar to experimental measurements available in the literature. The models also predicted cruciate ligament forces during passive flexion with and without applying anterior-posterior tibia forces that were similar to experimental measurements available in the literature. The biomechanics of the posterior oblique ligament (POL) and the anterior cruciate ligament bundles during combined tibia internal-external rotation torque and anterior-posterior forces through deep flexion were then examined. The study showed that the central arm of the POL: (1) produces a maximum constraining force when the knee is at full extension, (2) constrains internal tibial rotation at extension, and (3) constrains posterior tibial translation at extension. The POL reinforces the constraint of the anterior cruciate ligament to internal rotation at extension and provides constraint for posterior tibial translation at extension, a position where the posterior cruciate ligament provides minimal posterior translation constraint.

  19. Spatiotemporal profiles of receptive fields of neurons in the lateral posterior nucleus of the cat LP-pulvinar complex

    PubMed Central

    Piché, Marilyse; Thomas, Sébastien

    2015-01-01

    The pulvinar is the largest extrageniculate thalamic visual nucleus in mammals. It establishes reciprocal connections with virtually all visual cortexes and likely plays a role in transthalamic cortico-cortical communication. In cats, the lateral posterior nucleus (LP) of the LP-pulvinar complex can be subdivided in two subregions, the lateral (LPl) and medial (LPm) parts, which receive a predominant input from the striate cortex and the superior colliculus, respectively. Here, we revisit the receptive field structure of LPl and LPm cells in anesthetized cats by determining their first-order spatiotemporal profiles through reverse correlation analysis following sparse noise stimulation. Our data reveal the existence of previously unidentified receptive field profiles in the LP nucleus both in space and time domains. While some cells responded to only one stimulus polarity, the majority of neurons had receptive fields comprised of bright and dark responsive subfields. For these neurons, dark subfields' size was larger than that of bright subfields. A variety of receptive field spatial organization types were identified, ranging from totally overlapped to segregated bright and dark subfields. In the time domain, a large spectrum of activity overlap was found, from cells with temporally coinciding subfield activity to neurons with distinct, time-dissociated subfield peak activity windows. We also found LP neurons with space-time inseparable receptive fields and neurons with multiple activity periods. Finally, a substantial degree of homology was found between LPl and LPm first-order receptive field spatiotemporal profiles, suggesting a high integration of cortical and subcortical inputs within the LP-pulvinar complex. PMID:26289469

  20. Degenerative alterations of the cementum-periodontal ligament complex and early tooth loss in a young patient with periodontal disease.

    PubMed

    Petruţiu, S A; Buiga, Petronela; Roman, Alexandra; Danciu, Theodora; Mihu, Carmen Mihaela; Mihu, D

    2012-01-01

    Premature exfoliation of primary or permanent teeth in children or adolescents is extremely rare and it can be a manifestation of an underlying systemic disease. This study aims to present the histological aspects associated with early tooth loss in a case of periodontal disease developed without local inflammation and with minimal periodontal pockets and attachment loss. The maxillary left second premolar was extracted together with a gingival collar attached to the root surface. The histological analysis recorded the resorption of the cementum in multiple areas of the entire root surface with the connective tissue of the desmodontium invading the lacunae defects. The connective tissue rich in cells occupied the periodontal ligamentar space and the resorptive areas. No inflammation was obvious in the periodontal ligament connective tissue. This report may warn clinicians about the possibility of the association of cemental abnormalities with early tooth loss.

  1. Deltoid ligament strain after correction of acquired flatfoot deformity by triple arthrodesis.

    PubMed

    Song, S J; Lee, S; O'Malley, M J; Otis, J C; Sung, I H; Deland, J T

    2000-07-01

    Deltoid insufficiency represents a difficult surgical challenge. We have witnessed patients who have developed a valgus tibiotalar deformity following a properly positioned triple arthrodesis. To investigate whether the triple arthrodesis itself, by creating a rigid triple joint complex below the ankle, leads to increased strain of the deltoid complex, a flatfoot model was created in 8 fresh-frozen below-knee amputation specimens. Each specimen was loaded in three gait cycle (GC) positions: Heel strike (0% GC), midstance (10% GC), and heel rise (40% GC). The three components of the ground reaction force (GRF) and the tendon forces consistent with those respective positions were applied. To simulate a posterior tibial tendon insufficient state the posterior tibial tendon was not loaded. Strain at the tibiocalcaneal fibers of the superficial deltoid ligament complex was determined at each of the three foot positions. A triple arthrodesis was performed and the deltoid strains were again recorded for each position. A significant increase in the strain of the deltoid ligament was observed for only the heel rise position (p=0.007) in our cadaver model following triple arthrodesis. The results favor medializing the calcaneus following arthrodesis to protect the deltoid complex. PMID:10919623

  2. Expanding the Limits of Posterior Aortic Translocation: Biventricular Correction of Complex Transposition With Complete Atrioventricular Septal Defect and Heterotaxy.

    PubMed

    Sugiura, Junya; Bierbach, Benjamin; Hraska, Viktor

    2016-02-01

    This case report describes successful repair of d-transposition of the great arteries with severe left ventricular outflow tract obstruction and complete atrioventricular septal defect associated with heterotaxy by the use of posterior aortic translocation combined with repair of the atrioventricular septal defect and systemic venous anomalies. PMID:26777936

  3. Artificial Ligaments: Promise or Panacea?

    ERIC Educational Resources Information Center

    Lubell, Adele

    1987-01-01

    The Food and Drug Administration has approved a prosthetic ligament for limited use in persons with damaged anterior cruciate ligaments (ACL). This article addresses ligament repair, ACL tears, current treatment, development of the Gore-Tex artificial ligament, other artificial ligaments in process, and arguments for and against their use.…

  4. Tendon and ligament imaging

    PubMed Central

    Hodgson, R J; O'Connor, P J; Grainger, A J

    2012-01-01

    MRI and ultrasound are now widely used for the assessment of tendon and ligament abnormalities. Healthy tendons and ligaments contain high levels of collagen with a structured orientation, which gives rise to their characteristic normal imaging appearances as well as causing particular imaging artefacts. Changes to ligaments and tendons as a result of disease and injury can be demonstrated using both ultrasound and MRI. These have been validated against surgical and histological findings. Novel imaging techniques are being developed that may improve the ability of MRI and ultrasound to assess tendon and ligament disease. PMID:22553301

  5. The Epidural Ligaments (of Hofmann): A Comprehensive Review of the Literature

    PubMed Central

    Tardieu, Gabrielle G; Loukas, Marios; Moisi, Marc; Chapman, Jens; Oskouian, Rod J; Tubbs, R. Shane

    2016-01-01

    The epidural space contains the internal vertebral venous plexus, adipose, and other connective tissues. In the anatomical literature, there are nonspecific descriptions of varying fibrous connective tissue bands in the epidural space, mainly mentioned in the lumbar region, that tether the dural sac to the posterior longitudinal ligament, the vertebral canal, and the ligamentum flavum. These ligaments have been termed as Hofmann’s ligaments. This review expands on the anatomy and function of Hofmann’s ligaments, increasing the awareness of their presence and serves as an impetus for further study of their histology, innervation, and function.  PMID:27752405

  6. [Secondary ligament instabilities in the area of the elbow joint].

    PubMed

    Wirth, C J

    1988-08-01

    Secondary capsular or ligamentous injuries around the elbow joint, which are generally a rare finding, can give rise to medial, lateral, anterior, and posterior instability. Medial instability is especially bothersome during sporting activities, such as javelin throwing and baseball, and requires tightening or replacement of the ulnar collateral ligament. On the lateral side it is particularly the subluxation of the head of the radius that makes surgical tightening of the annular ligament essential. Anterior instability, which would cause the joint to dislocate anteriorly, is extremely rare and does not lead to secondary problems. Posterolateral, chronically recurrent, dislocation of the elbow joint, however, is intolerable for the patient, and many operative stabilizing procedures have been performed, mostly in isolated patients, in attempts at correction. The current method of choice consists in tightening of the dorsoradial capsular pouch in combination with osseous refixation of the slack radial ligament.

  7. [Age, activity and strength of knee ligaments].

    PubMed

    Kasperczyk, W J; Rosocha, S; Bosch, U; Oestern, H J; Tscherne, H

    1991-07-01

    The cruciate ligaments of older persons are thought to have diminished biomechanical properties. On the other hand, joint immobilization also leads to similar functional losses in ligaments. It can be difficult to differentiate between these factors in older and immobile persons. The anterior and posterior cruciate ligaments of six younger (average age 30 years) and six older (average age 64.7 years) donors with similar levels of activity were subjected to biomechanical testing. Each sample had to meet the following conditions: appropriate age, no chronic vascular and cardiopulmonary disease found on autopsy, no signs of osteoarthrosis and no knee injuries. The material properties of maximum stress (e.g. ACL: young/old 24/21N/mm2), elastic modulus (e.g. ACL: young/old 144/129 MPa), and strain (e.g. ACL: young/old 25/28%), did not differ significantly (p less than 0.05). This indicates that older persons who are active do not necessarily show functional losses in the cruciate ligaments. Other data found in the literature can be ascribed to immobilization influences. In this data many of the older test persons had chronic vascular insufficiency, cardiopulmonary disease or malignancies.

  8. The Characterization of Mechanical Properties of a Rabbit Femur-Anterior Cruciate Ligament-Tibia Complex During Cyclic Loading

    NASA Astrophysics Data System (ADS)

    Sekiguchi, Hidetaka; Han, Jungsoo; Ryu, Jaiyoung; Han, Changsoo

    The purpose of this study was to investigate the effect of cyclic loading, which produced the condition of ACLs during sports activities, on tensile properties of femur-ACL-tibia complexes (FATCs). Paired FATCs of 40 New Zealand white rabbits were tested on a materials testing machine. One specimen of each pair was designated as a control and loaded until failure. The contralateral specimen was loaded cyclically (1.4 Hz, 1 hr.) with 20%, 30%, 40%, or 50% of ultimate tensile strength (UTS) of the control and then loaded until failure. The UTS and mode of failure were recorded after each test. Five specimens ruptured during cyclic loading in the 50% group. In the 40% group, the mean value of UTS of cycled specimens was significantly lower than that of controls. There was no statistically significant difference in UTS values between control and cycled specimens in the 20% and 30% groups. Cycled specimens had a significantly higher incidence of substance failure than controls. Our results demonstrated that FATCs have the strength to withstand cyclic loading within normal sports activity levels. However, FACTs can be damaged by cyclic loading under strenuous sports activity levels. We speculate that cyclic loading makes the ACL substance weaker than the insertion site.

  9. In vitro investigation of a tissue-engineered cell-tendon complex mimicking the transitional architecture at the ligament-bone interface.

    PubMed

    Wang, Zhibing; Zhang, Yuan; Zhu, Jie; Dong, Shiwu; Jiang, Tao; Zhou, Yue; Zhang, Xia

    2015-03-01

    Restoration of the transitional ligament-bone interface is critical for graft-bone integration. We postulated that an allogenic scaffold mimicking the fibrogenic, chondrogenic, and osteogenic transition gradients could physiologically promote ligament-bone incorporation. The aim of this study was to construct and characterize a composite tendon scaffold with a continuous and heterogeneous transition region mimicking a native ligament insertion site. Genetically modified heterogeneous cell populations were seeded within specific regions of decellularized rabbit Achilles tendons to fabricate a stratified scaffold containing three biofunctional regions supporting fibrogenesis, chondrogenesis, and osteogenesis. The observed morphology, architecture, cytocompatibility, and biomechanics of the scaffolds demonstrated their improved bio-physico-chemical properties. The formation of the transitional regions was augmented via enhanced delivery of two transcription factors, sex determining region Y-box 9 and runt-related transcription factor 2, which also triggered early up-regulated expression of cartilage- and bone-relevant markers, according to quantitative PCR and immunoblot analyses. Gradient tissue-specific matrix formation was also confirmed within the predesignated regions via histological staining and immunofluorescence assays. These results suggest that a transitional interface could be replicated on an engineered tendon through stratified tissue integration. The scaffold offers the advantages of a multitissue transition involving controlled cellular interactions and matrix heterogeneity, which can be applied for the regeneration of the ligament-bone interface.

  10. Ligament shortening: an experimental approach

    NASA Astrophysics Data System (ADS)

    Vangsness, C. Thomas; Mitchell, William; Saadat, Vahid; Nimni, Marcel

    1994-09-01

    Joint injury often involves a stretching or loosening of the supporting ligaments. This joint laxity can be increasingly deleterious over time and may lead to osteoarthritis. Decreasing joint laxity is a clinical goal of ligament reconstructions. No study has addressed the possibility of tightening ligaments by heat. This pilot study examined the mechanical and histological effects of the shrinkage of human ligaments.

  11. Quantifying the Nonlinear, Anisotropic Material Response of Spinal Ligaments

    NASA Astrophysics Data System (ADS)

    Robertson, Daniel J.

    Spinal ligaments may be a significant source of chronic back pain, yet they are often disregarded by the clinical community due to a lack of information with regards to their material response, and innervation characteristics. The purpose of this dissertation was to characterize the material response of spinal ligaments and to review their innervation characteristics. Review of relevant literature revealed that all of the major spinal ligaments are innervated. They cause painful sensations when irritated and provide reflexive control of the deep spinal musculature. As such, including the neurologic implications of iatrogenic ligament damage in the evaluation of surgical procedures aimed at relieving back pain will likely result in more effective long-term solutions. The material response of spinal ligaments has not previously been fully quantified due to limitations associated with standard soft tissue testing techniques. The present work presents and validates a novel testing methodology capable of overcoming these limitations. In particular, the anisotropic, inhomogeneous material constitutive properties of the human supraspinous ligament are quantified and methods for determining the response of the other spinal ligaments are presented. In addition, a method for determining the anisotropic, inhomogeneous pre-strain distribution of the spinal ligaments is presented. The multi-axial pre-strain distributions of the human anterior longitudinal ligament, ligamentum flavum and supraspinous ligament were determined using this methodology. Results from this work clearly demonstrate that spinal ligaments are not uniaxial structures, and that finite element models which account for pre-strain and incorporate ligament's complex material properties may provide increased fidelity to the in vivo condition.

  12. Putative proprioceptive function of the pelvic ligaments: biomechanical and histological studies.

    PubMed

    Varga, Endre; Dudas, Bertalan; Tile, Marvin

    2008-08-01

    The sacrospinous (SS) and sacrotuberous (ST) ligaments of the pelvic ring are known as mechanical stabilisers of the pelvic girdle, primarily against rotational forces in the sagittal and horizontal planes. Earlier studies, however, raised the possibility that ST/SS ligaments possess significant proprioceptive function, while the mechanical role of these ligaments in maintaining the structural integrity of the pelvis is of less importance. The aim of this study is to determine whether the function of these ligaments is strictly to provide mechanical stability or if they have any additional functional properties, i.e., proprioception. In order to reveal the function of the SS/ST ligaments, biomechanical studies of cadaver pelvis were used along with the histological analysis of the ligaments. Following measurements to determine the accurate mechanical role of the pelvic ligaments, the strength of these ligaments was significantly less than we earlier expected. For this reason other functions of the SS/ST ligaments were considered, including the proprioceptive role. Indeed, histological studies revealed ramifying nerve terminals in the SS/ST ligaments. These terminals may represent the morphological substrate of the proprioceptive function associated with the ligaments. Our studies revealed that SS/ST ligaments might have a significant proprioceptive function providing information of the position of the pelvis. Consequently, the mechanical role of the ligaments in maintaining the structural integrity of the pelvis may be significantly less than previously assumed. Understanding the function of the SS/ST ligaments is crucial for providing more precise guidelines for patient management with injuries to the posterior pelvic region.

  13. Spatial Change of Cruciate Ligaments in Rat Embryo Knee Joint by Three-Dimensional Reconstruction.

    PubMed

    Zhang, Xiangkai; Aoyama, Tomoki; Takaishi, Ryota; Higuchi, Shinya; Yamada, Shigehito; Kuroki, Hiroshi; Takakuwa, Tetsuya

    2015-01-01

    This study aimed to analyze the spatial developmental changes of rat cruciate ligaments by three-dimensional (3D) reconstruction using episcopic fluorescence image capture (EFIC). Cruciate ligaments of Wister rat embryos between embryonic day (E) 16 and E20 were analyzed. Samples were sectioned and visualized using EFIC. 3D reconstructions were generated using Amira software. The length of the cruciate ligaments, distances between attachment points to femur and tibia, angles of the cruciate ligaments and the cross angle of the cruciate ligaments were measured. The shape of cruciate ligaments was clearly visible at E17. The lengths of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) increased gradually from E17 to E19 and drastically at E20. Distances between attachment points to the femur and tibia gradually increased. The ACL angle and PCL angle gradually decreased. The cross angle of the cruciate ligaments changed in three planes. The primordium of the 3D structure of rat cruciate ligaments was constructed from the early stage, with the completion of the development of the structures occurring just before birth.

  14. Endoscopic Intermetatarsal Ligament Decompression.

    PubMed

    Lui, Tun Hing

    2015-12-01

    Morton neuroma is an entrapment of the intermetatarsal nerve by the deep intermetatarsal ligament. It is usually treated conservatively. Surgery is considered if there is recalcitrant pain that is resistant to conservative treatment. The surgical options include resection of the neuroma or decompression of the involved nerve. Decompression of the nerve by release of the intermetatarsal ligament can be performed by either an open or minimally invasive approach. We describe 2-portal endoscopic decompression of the intermetatarsal nerve. The ligament is released by a retrograde knife through the toe-web portal under arthroscopic guidance through the plantar portal.

  15. Endoscopic Intermetatarsal Ligament Decompression.

    PubMed

    Lui, Tun Hing

    2015-12-01

    Morton neuroma is an entrapment of the intermetatarsal nerve by the deep intermetatarsal ligament. It is usually treated conservatively. Surgery is considered if there is recalcitrant pain that is resistant to conservative treatment. The surgical options include resection of the neuroma or decompression of the involved nerve. Decompression of the nerve by release of the intermetatarsal ligament can be performed by either an open or minimally invasive approach. We describe 2-portal endoscopic decompression of the intermetatarsal nerve. The ligament is released by a retrograde knife through the toe-web portal under arthroscopic guidance through the plantar portal. PMID:27284515

  16. The ligament augmentation device: an historical perspective.

    PubMed

    Kumar, K; Maffulli, N

    1999-05-01

    Anterior cruciate ligament (ACL) injury is the most common ligament injury in the knee, and a significant number of patients may develop progressive instability and disability despite aggressive rehabilitation. Various materials have been used for its reconstruction. These include autografts, allografts, prosthetic ligaments, and synthetic augmentation of the biological tissue. The concept of ligament augmentation device (LAD) arose from the observation that biological grafts undergo a phase of degeneration and loss of strength before being incorporated. The LAD is meant to protect the biological graft during this vulnerable phase. However, it provokes an inflammatory reaction in the knee, and has been found to delay maturation of autogenous graft in humans. In experimental situations, the LAD has been found to share loads in a composite graft. It has also been found to be substantially stronger than the biological graft. However, in clinical situations no significant advantages have been observed with the use of LAD to augment patellar tendon or hamstring reconstruction of the chronic ACL-deficient knee or in the acute setting to augment repair of the torn ACL. There are very few reports of the use of LAD in reconstruction of the posterior cruciate ligament, and again these do not suggest any advantage in its use. Insertion of the LAD implies the introduction of a foreign material into the knee, has been associated with complications such as reactive synovitis and effusions, and may also be associated with an increased risk of infection. At present, there is no evidence that its routine use should be advocated in uncomplicated reconstructions of the ACL using biological grafts.

  17. The ligament augmentation device: an historical perspective.

    PubMed

    Kumar, K; Maffulli, N

    1999-05-01

    Anterior cruciate ligament (ACL) injury is the most common ligament injury in the knee, and a significant number of patients may develop progressive instability and disability despite aggressive rehabilitation. Various materials have been used for its reconstruction. These include autografts, allografts, prosthetic ligaments, and synthetic augmentation of the biological tissue. The concept of ligament augmentation device (LAD) arose from the observation that biological grafts undergo a phase of degeneration and loss of strength before being incorporated. The LAD is meant to protect the biological graft during this vulnerable phase. However, it provokes an inflammatory reaction in the knee, and has been found to delay maturation of autogenous graft in humans. In experimental situations, the LAD has been found to share loads in a composite graft. It has also been found to be substantially stronger than the biological graft. However, in clinical situations no significant advantages have been observed with the use of LAD to augment patellar tendon or hamstring reconstruction of the chronic ACL-deficient knee or in the acute setting to augment repair of the torn ACL. There are very few reports of the use of LAD in reconstruction of the posterior cruciate ligament, and again these do not suggest any advantage in its use. Insertion of the LAD implies the introduction of a foreign material into the knee, has been associated with complications such as reactive synovitis and effusions, and may also be associated with an increased risk of infection. At present, there is no evidence that its routine use should be advocated in uncomplicated reconstructions of the ACL using biological grafts. PMID:10355719

  18. Definition of the To Be Named Ligament and Vertebrodural Ligament and Their Possible Effects on the Circulation of CSF

    PubMed Central

    Zheng, Nan; Yuan, Xiao-Ying; Li, Yun-Fei; Chi, Yan-Yan; Gao, Hai-Bin; Zhao, Xin; Sharkey, John

    2014-01-01

    Few studies have been conducted specifically on the dense connective tissue located in the posterior medial part of the cervical epidural space. This study was undertaken to examine the presence of this connection between the cervical dura mater and the posterior wall of spinal canal at the level of C1–C2. 30 head-neck specimens of Chinese adults were used. Gross dissection was performed on the suboccipital regions of the 20 specimens. Having been treated with the P45 plastination method, 10 specimens were sliced (9 sagittal and 1 horizontal sections). As a result, a dense fibrous band was identified in the nuchal ligament of 29 specimens (except for one horizontal section case). This fascial structure arose from the tissue of the posterior border of the nuchal ligament and then projected anteriorly and superiorly to enter the atlantoaxial interspace. It was termed as to be named ligament (TBNL). In all 30 specimens the existence of a fibrous connection was found between the posterior aspect of the cervical dura mater and the posterior wall of the spinal canal at the level of the atlas to the axis. This fibrous connection was identified as vertebrodural ligament (VDL). The VDL was mainly subdivided into three parts, and five variations of VDL were identified. These two structures, TBNL and VDL, firmly link the posterior aspect of cervical dura mater to the rear of the atlas-axis and the nuchal region. According to these findings, the authors speculated that the movements of the head and neck are likely to affect the shape of the cervical dural sleeve via the TBNL and VDL. It is hypothesized that the muscles directly associated with the cervical dural sleeve, in the suboccipital region, may work as a pump providing an important force required to move the CSF in the spinal canal. PMID:25084162

  19. Definition of the to be named ligament and vertebrodural ligament and their possible effects on the circulation of CSF.

    PubMed

    Zheng, Nan; Yuan, Xiao-Ying; Li, Yun-Fei; Chi, Yan-Yan; Gao, Hai-Bin; Zhao, Xin; Yu, Sheng-Bo; Sui, Hong-Jin; Sharkey, John

    2014-01-01

    Few studies have been conducted specifically on the dense connective tissue located in the posterior medial part of the cervical epidural space. This study was undertaken to examine the presence of this connection between the cervical dura mater and the posterior wall of spinal canal at the level of C1-C2. 30 head-neck specimens of Chinese adults were used. Gross dissection was performed on the suboccipital regions of the 20 specimens. Having been treated with the P45 plastination method, 10 specimens were sliced (9 sagittal and 1 horizontal sections). As a result, a dense fibrous band was identified in the nuchal ligament of 29 specimens (except for one horizontal section case). This fascial structure arose from the tissue of the posterior border of the nuchal ligament and then projected anteriorly and superiorly to enter the atlantoaxial interspace. It was termed as to be named ligament (TBNL). In all 30 specimens the existence of a fibrous connection was found between the posterior aspect of the cervical dura mater and the posterior wall of the spinal canal at the level of the atlas to the axis. This fibrous connection was identified as vertebrodural ligament (VDL). The VDL was mainly subdivided into three parts, and five variations of VDL were identified. These two structures, TBNL and VDL, firmly link the posterior aspect of cervical dura mater to the rear of the atlas-axis and the nuchal region. According to these findings, the authors speculated that the movements of the head and neck are likely to affect the shape of the cervical dural sleeve via the TBNL and VDL. It is hypothesized that the muscles directly associated with the cervical dural sleeve, in the suboccipital region, may work as a pump providing an important force required to move the CSF in the spinal canal.

  20. Anterior cruciate ligament tunnel placement.

    PubMed

    Wolf, Brian R; Ramme, Austin J; Britton, Carla L; Amendola, Annunziato

    2014-08-01

    The purpose of this cadaveric study was to analyze variation in anterior cruciate ligament (ACL) tunnel placement between surgeons and the influence of preferred surgical technique and surgeon experience level using three-dimensional (3D) computed tomography (CT). In this study, 12 surgeons drilled ACL tunnels on six cadaveric knees each. Surgeons were divided by experience level and preferred surgical technique (two-incision [TI], medial portal [MP], and transtibial [TT]). ACL tunnel aperture locations were analyzed using 3D CT scans and compared with radiographic ACL footprint criteria. The femoral tunnel location from front to back within the notch demonstrated a range of means of 16% with the TI tunnels the furthest back. A range of means of only 5% was found for femoral tunnel low to high positions by technique. The anterior to posterior tibial tunnel measure demonstrated wider variation than the medial to lateral position. The mean tibial tunnel location drilled by TT surgeons was more posterior than surgeons using the other techniques. Overall, 82% of femoral tunnels and 78% of tibial tunnels met all radiographic measurement criteria. Slight (1-7%) differences in mean tunnel placement on the femur and tibia were found between experienced and new surgeons. The location of the femoral tunnel aperture in the front to back plane relative to the notch roof and the anterior to posterior position on the tibia were the most variable measures. Surgeon experience level did not appear to significantly affect tunnel location. This study provides background information that may be beneficial when evaluating multisurgeon and multicenter collaborative ACL studies.

  1. A rare anatomic variant of the superior glenohumeral ligament.

    PubMed

    Pradhan, R L; Itoi, E; Watanabe, W; Yamada, S; Nagasawa, H; Shimizu, T; Wakabayashi, I; Sato, K

    2001-01-01

    The attachment of the superior glenohumeral ligament (SGHL) to the upper pole of the glenoid is variable and 3 types have been described. We report an anatomic variant of SGHL attachment to the upper pole of the glenoid that has not heretofore been reported in the literature. In this case, the SGHL overrode the biceps origin, continued to the superior labrum posteriorly, and had no attachment to the middle glenohumeral ligament or the anterior labrum. This variant was detected during routine arthroscopic examination undertaken before surgery on a rotator cuff tear.

  2. Cervical ligamentous instability in a canine in vivo model.

    PubMed

    Whitehill, R; Moran, D J; Fechner, R E; Ruch, W W; Drucker, S; Hooper, W E; McCoig, J A

    1987-12-01

    A canine in vivo model of midcervical ligamentous instability was developed by dividing the anterior longitudinal ligament, anulus fibrosus, and all posterior ligamentous structures including the ligamentum flavum. The natural history of healing in the model, the effect on its healing by an adjacent one-level arthrodesis, and the effect of a one-level arthrodesis on normal adjacent ligamentous structures were studied radiographically, mechanically, and histologically. The authors determined that healing takes place primarily by anterior scar formation in their instability model but not to a degree sufficient to recreate normal mechanical stability. After three months, healing in the model was not affected by an adjacent arthrodesis; however, acutely, instability apparently was increased as three animals became quadriplegic between the second and fourth postoperative days. Arthrodesis did not affect adjacent normal ligamentous structures, during this period. Incomplete healing in the authors' model supports those who advocate arthrodesis as the treatment of choice for destabilizing cervical ligamentous injury. The authors previously reported the case of a patient who sustained bilateral facet dislocations adjacent to an arthrodesed segment and questioned whether this resulted from a stress-concentrating effect. This study indicates that this could well have been the case acutely. Thus, inadvertent exclusion of an unstable segment from an arthrodesis has potentially catastrophic results. Finally, the authors also have previously questioned whether arthrodesis of a midcervical segment could lead to instability of adjacent normal segments. This project does not support such a concern, at least for the three postoperative months of study. PMID:3441821

  3. [Anterior cruciate ligament-plasty using the "U-dos" technique].

    PubMed

    Morales-Trevizo, C; Paz-García, M; Leal-Berumen, I; Leal-Contreras, C; Berumen-Nafarrate, E

    2013-01-01

    The knee is a compound diarthrodial joint, vulnerable to serious injuries such as ligament injuries of: medial collateral ligament, lateral collateral ligament, anterior cruciate ligament and posterior cruciate ligament, as cruciate ligaments limit rotation movement in the joint. The purpose of our study was to create a new technique to treat injuries of the anterior cruciate ligament, which is composed of two bundles--anteromedial and posterolateral--trying to achieve an anatomical reconstruction that allows for a normal biomechanical recovery. This technique reduces the use of fixation material and costs. The diagnosis of anterior cruciate ligament injuries was made with the pivot shift test. There are currently two repair methods for anterior cruciate ligament injuries: single bundle or double bundle repair; none of these techniques is considered as the gold standard, as their results are very similar. This paper describes a technique used for the treatment of anterior cruciate ligament injuries, known as "U-dos", and its clinical results. Cross-sectional, observational study that enrolled 20 patients with total anterior cruciate ligament injuries who underwent anterior cruciate ligament plasty using the "U-dos" technique between June 2009 and June 2010. The technique requires the use of bone bank allograft, in this case of the anterior tibial ligament. Patients were assessed using the Lysholm scale and the pivot shift test. Our results show that all the pivot shift tests were negative and assessments according to the Lysholm scale were from normal to excellent in 95% of cases (19/20). Only one failure was reported, with avulsion of the graft attachment which required a surgical intervention.

  4. Glenoid avulsion of the glenohumeral ligaments as a cause of recurrent anterior shoulder instability.

    PubMed

    Wolf, Eugene M; Siparsky, Patrick N

    2010-09-01

    Although the Bankart lesion is accepted as the primary pathology responsible for recurrent shoulder instability, recognition of other soft-tissue lesions has improved the surgical treatment for this common problem. Whereas humeral avulsion of the glenohumeral ligaments has been acknowledged as a cause of anterior shoulder instability, we have not found any reported cases of glenoid avulsion of the glenohumeral ligaments. We describe 3 cases of recurrent anterior shoulder instability due to glenoid avulsion of the glenohumeral ligaments. The avulsed ligaments were repaired to the labrum and glenoid, restoring the glenohumeral ligament-labral complex.

  5. Evaluation and treatment of chronic medial collateral ligament injuries of the knee.

    PubMed

    Azar, Frederick M

    2006-06-01

    Injuries to the medial collateral ligament (MCL) can occur as isolated injuries or in conjunction with injuries to other structures about the knee. Most grade I and II MCL injuries without meniscal avulsion, alone or in combination with anterior or posterior cruciate ligament injuries, can be treated nonoperatively. Grade III or complete tears also can be treated nonoperatively, but only after careful exclusion of any associated injuries that may require surgical treatment. Treatment recommendations also have been based on the location of the MCL tear and the associated injuries. Surgical treatment may include reconstruction of the anterior and posterior cruciate ligaments with primary repair of the MCL. Chronic medial knee injuries often are associated with concomitant ligament injuries, which also must be treated. Treatment options include nonoperative (bracing, activity modification, and rehabilitation) and operative reconstruction. PMID:17135952

  6. Monocular and binocular response properties of cells in the striate-recipient zone of the cat's lateral posterior-pulvinar complex.

    PubMed

    Casanova, C; Freeman, R D; Nordmann, J P

    1989-08-01

    1. We have studied response properties of single cells in the striate-recipient zone of the cat's lateral posterior-pulvinar (LP-P) complex. This zone is in the lateral section of the lateral posterior nucleus (LP1). Our purpose was to determine basic response characteristics of these cells and to investigate the possibility that the LP-P complex is a center of integration that is dominated by input from visual cortex. 2. The majority (72%) of cells in the striate-recipient zone respond to drifting sinusoidal gratings with unmodulated discharge. 3. Cells in the LP1 are selective to the orientation of gratings, and tuning functions have a mean bandwidth of 31 degrees. More than one-half of these units are direction-selective. The preferred orientation and the tuning widths for the two eyes are generally well matched. However, a few cells exhibited the interesting property of opposite preferred directions for the two eyes. Orientation tuning for a small group of cells was different for the mean discharge and first harmonic components, suggesting a convergence from different inputs to these cells. 4. Two-thirds of LP1 cells are tuned to low spatial frequencies (less than 0.5 c/deg). The tuning is broad with a mean bandwidth of 2.2 octaves. The remaining one-third of the units are low-pass because they show no attenuation of their responses to low spatial frequencies. Both eyes exhibit the same spatial frequency preference and the same spatial frequency tuning. There is a high correlation between spatial frequency and orientation selectivities. 5. All cells tested are tuned for temporal frequency with a sharp attenuation for low frequencies. The optimal values range between 4 and 8 Hz, and the mean bandwidth is 2.2 octaves. 6. Cells in LP1 are mostly binocular. When monocular, cells are almost always contralaterally driven. Dichoptic presentation of gratings reveals the presence of strong binocular interaction. In almost all cases, these interactions are phase specific

  7. Medial Collateral Ligament (MCL) Injuries

    MedlinePlus

    ... often occur among active teens, especially athletes. A torn medial collateral ligament (MCL) — a ligament that helps ... the more serious injuries. Teens who have a torn MCL tend to play contact sports, like football ...

  8. Characterization and role of the immune response during ligament healing

    NASA Astrophysics Data System (ADS)

    Chamberlain, Connie S.

    Scar formation of ligaments after rupture remains a great challenge. Ligament healing involves a complex, coordinated series of events that form a neo-ligament, which is more disorganized and fibrotic in character than the native tissue. The repair process may extend from months to years, and the injured ligament never fully recovers its original mechanical properties. With little intrinsic healing potential, ruptures of the anterior cruciate ligament (ACL) are usually reconstructed. The "healed" tissues, however, do not regenerate native tissues or recapitulate their mechanical function. ACL grafts often lengthen (incidents range from 40-100%) and their strength can drop by ˜50% after remodeling. Reconstructed knees are often less stable and fail to restore normal joint kinematics. Our overall goal is to improve healing, making ligaments more regenerative. The first 2 studies characterized ligament healing in a spatial and temporal manner over 28 days. The experiments demonstrated creeping substitution and the potential role of the immune system to control the repair and/or regenerative process. From these studies, macrophages were identified as significant players during healing. Macrophages paralleled creeping substitution, were abundant within the healing ligament, and potentially played a destructive role via matrix phagocytosis. The role of macrophages during early ligament healing was then evaluated using liposome-encapsulated clodronate to inhibit phagocytosing macrophages. Clodronate attenuated the early infiltration of macrophages, resulting in delayed structural and functional healing. Macrophage re-infiltration into the wound resulted in continued ligament healing. These results suggested that early inhibition of phagocytosing macrophages is detrimental to ligament healing. The final experiment evaluated the effects of interleukin-4 on ligament healing. Interleukin-4 (IL-4) is reported to stimulate the Th2 lymphocyte/M2 macrophage pathway, reducing

  9. Anatomic Reconstruction Technique for a Plantar Calcaneonavicular (Spring) Ligament Tear.

    PubMed

    Palmanovich, Ezequiel; Shabat, Shay; Brin, Yaron S; Feldman, Viktor; Kish, Benny; Nyska, Meir

    2015-01-01

    Acquired flatfoot deformity in adults is usually due to partial or complete tearing of the posterior tibial tendon, with secondary failure of other structures such as the plantar calcaneonavicular (spring) ligament (SL), which maintain the medial longitudinal arch. In flexible cases, the tibialis posterior can be replaced with the flexor digitorum longus. It is common practice to suture the SL directly in the case of a tear; however, if the tear is complete, suturing directly to the ligament alone will not be possible. Reconstruction of the ligament is needed; however, no validated methods are available to reconstruct this ligament. The operative technique of SL reconstruction described in this report as a part of acquired flatfoot deformity reconstruction consists of augmenting remnants of the spring from the navicularis to the sustentaculum tali and suspending it to the medial malleolus using 2-mm-wide, long-chain polyethylene suture tape. This technique results in the firm anatomic reconstruction of the SL, in addition to "classic" medial arch reconstruction. We recommend SL reconstruction for medial arch reconstruction when the SL is torn. PMID:26253476

  10. Snow skiing combined anterior cruciate ligament/medial collateral ligament disruptions.

    PubMed

    Barber, F A

    1994-02-01

    Recent reports indicate that combined anterior cruciate ligament/medial collateral ligament (ACL/MCL) knee injuries are usually associated with a lateral meniscus tear. In our center, snow skiing is the athletic activity most frequently associated with this double-ligament injury complex. A sports-specific analysis was undertaken to evaluate the hypothesis that the snow skiing ligament injury is different from similar injuries caused by other athletic activities. Of a total of 64 acute arthroscopically confirmed tears of both the MCL and ACL, 23 were caused by snow skiing and 41 by nonskiing activities. There were fewer lateral meniscus tears in skiers (43%) when compared with the nonskiers (88%). Skiers also had fewer medial meniscus tears (13%) than did nonskiers (37%). No medial meniscus tears occurred in the absence of a lateral meniscus tear. Although 78% of the skiers were women, only 12% of the nonskiers were women. Skiers were older (average age 35 years) than the nonskiers (average age 28 years). The right knee was injured almost twice as frequently as the left. These data suggest that the double (ACL/MCL) ligament injury in skiers might be distinctly different from that in nonskiers.

  11. [VARIANT ANATOMY OF SPLENIC LIGAMENTS AND ARTERIES PASSING THROUGH THEM].

    PubMed

    Gaivoronskiy, I V; Kotiv, B N; Alekseyev, V S; Nichiporuk, G I

    2015-01-01

    The research was performed on 15 non embalmed bodies and 32 abdominal complexes of adult individuals. The comparative study of variant anatomy of splenic ligaments and architectonics of arteries passing through them was carried out to substantiate the mobilization of splenopancreatic complex. Anatomical and angiographic restudied were carried out using preparation, morphometry, injection of gastric, pancreatic and splenic vascular bed with red lead suspension. It was established that the form and sizes of splenic ligaments and their interrelation with the branches of the splenic artery were variable. The minimal and maximal sizes of gastrolienal, phrenicosplenic and splenocolic ligaments differed 2-3 times. In most cases, spleen was fixed in abdominal cavity by many short ligaments. It was shown that architectonics and topography of main branches of spleen artery were determined by morphometric characteristics of the spleen proper and its ligaments. The knowledge of splenic ligament variant anatomy allows a new perspective to approach to substantiate different methods of the mobilization of spleno-pancreatic complex during surgical operations on organs of the upper part of the peritoneal cavity and organ-preserving surgery of the spleen.

  12. Identifying diagnostically-relevant resting state brain functional connectivity in the ventral posterior complex via genetic data mining in autism spectrum disorder.

    PubMed

    Baldwin, Philip R; Curtis, Kaylah N; Patriquin, Michelle A; Wolf, Varina; Viswanath, Humsini; Shaw, Chad; Sakai, Yasunari; Salas, Ramiro

    2016-05-01

    Exome sequencing and copy number variation analyses continue to provide novel insight to the biological bases of autism spectrum disorder (ASD). The growing speed at which massive genetic data are produced causes serious lags in analysis and interpretation of the data. Thus, there is a need to develop systematic genetic data mining processes that facilitate efficient analysis of large datasets. We report a new genetic data mining system, ProcessGeneLists and integrated a list of ASD-related genes with currently available resources in gene expression and functional connectivity of the human brain. Our data-mining program successfully identified three primary regions of interest (ROIs) in the mouse brain: inferior colliculus, ventral posterior complex of the thalamus (VPC), and parafascicular nucleus (PFn). To understand its pathogenic relevance in ASD, we examined the resting state functional connectivity (RSFC) of the homologous ROIs in human brain with other brain regions that were previously implicated in the neuro-psychiatric features of ASD. Among them, the RSFC of the VPC with the medial frontal gyrus (MFG) was significantly more anticorrelated, whereas the RSFC of the PN with the globus pallidus was significantly increased in children with ASD compared with healthy children. Moreover, greater values of RSFC between VPC and MFG were correlated with severity index and repetitive behaviors in children with ASD. No significant RSFC differences were detected in adults with ASD. Together, these data demonstrate the utility of our data-mining program through identifying the aberrant connectivity of thalamo-cortical circuits in children with ASD. Autism Res 2016, 9: 553-562. © 2015 International Society for Autism Research, Wiley Periodicals, Inc.

  13. The effects of transection of the anterior cruciate ligament on healing of the medial collateral ligament. A biomechanical study of the knee in dogs.

    PubMed

    Woo, S L; Young, E P; Ohland, K J; Marcin, J P; Horibe, S; Lin, H C

    1990-03-01

    The effect of concurrent injury to the anterior cruciate ligament on the healing of injuries of the medial collateral ligament was studied in dogs. In Group I, isolated transection of the medial collateral ligament was performed; in Group II, transection of the medial collateral ligament with partial transection of the anterior cruciate ligament; and in Group III, complete transection of both the medial collateral ligament and the anterior cruciate ligament. The three groups of animals were examined six and twelve weeks postoperatively with respect to varus-valgus rotation of the knee and tensile properties of the femur-medial collateral ligament-tibia complex. The varus-valgus rotation of the knee was found to be the largest in Group-III specimens at all time-periods and was 3.5 times greater than the control values at twelve weeks. Group-I and Group-II specimens also showed large varus-valgus rotations at time zero, but the rotations returned to the control values by twelve weeks. For the structural properties of the femur-medial collateral ligament-tibia complex, the values for ultimate load for Groups I and II reached the control values by twelve weeks, while that for Group III remained at only 80 per cent of the control value. Both energy absorbed at failure and linear stiffness for all three groups were less than those for the controls at six weeks, and only linear stiffness returned to the control values by twelve weeks. For the mechanical (material) properties of the healed ligament substance, the values for modulus and tensile strength were markedly lower than the control values for all groups at six weeks. By twelve weeks, the tensile strength of Group-I specimens had increased to 52 per cent of the control value, while those of Groups II and III were only 45 and 14 per cent, respectively. Our results demonstrate that healing of the transected medial collateral ligament is adversely affected by concomitant transection of the anterior cruciate ligament

  14. Bioengineered anterior cruciate ligament

    NASA Technical Reports Server (NTRS)

    Altman, Gregory (Inventor); Kaplan, David (Inventor); Vunjak-Novakovic, Gordana (Inventor); Martin, Ivan (Inventor)

    2001-01-01

    The present invention provides a method for producing an anterior cruciate ligament ex vivo. The method comprises seeding pluripotent stem cells in a three dimensional matrix, anchoring the seeded matrix by attachment to two anchors, and culturing the cells within the matrix under conditions appropriate for cell growth and regeneration, while subjecting the matrix to one or more mechanical forces via movement of one or both of the attached anchors. Bone marrow stromal cells are preferably used as the pluripotent cells in the method. Suitable matrix materials are materials to which cells can adhere, such as a gel made from collagen type I. Suitable anchor materials are materials to which the matrix can attach, such as Goinopra coral and also demineralized bone. Optimally, the mechanical forces to which the matrix is subjected mimic mechanical stimuli experienced by an anterior cruciate ligament in vivo. This is accomplished by delivering the appropriate combination of tension, compression, torsion, and shear, to the matrix. The bioengineered ligament which is produced by this method is characterized by a cellular orientation and/or matrix crimp pattern in the direction of the applied mechanical forces, and also by the production of collagen type I, collagen type III, and fibronectin proteins along the axis of mechanical load produced by the mechanical forces. Optimally, the ligament produced has fiber bundles which are arranged into a helical organization. The method for producing an anterior cruciate ligament can be adapted to produce a wide range of tissue types ex vivo by adapting the anchor size and attachment sites to reflect the size of the specific type of tissue to be produced, and also adapting the specific combination of forces applied, to mimic the mechanical stimuli experienced in vivo by the specific type of tissue to be produced. The methods of the present invention can be further modified to incorporate other stimuli experienced in vivo by the

  15. Rethinking "posterior" tongue-tie.

    PubMed

    Douglas, Pamela Sylvia

    2013-12-01

    Currently, many clinicians who help with breastfeeding problems are diagnosing "posterior" tongue-tie in infants and performing or referring for frenotomy. In this "Speaking Out" article, I argue that the diagnosis of "posterior" tongue-tie has successfully raised awareness of the importance of impaired tongue function in breastfeeding difficulty. However, the diagnosis of "posterior" tongue-tie also applies a reductionist, medicalized theoretical frame to the complex problem of impaired tongue function, risking unintended outcomes. Impaired tongue function arises out of multiple interacting and co-evolving factors, including the interplay between social behaviors concerning breastfeeding and mother-infant biology. Consideration of theoretical frames is vital if we are to build an evidence base through efficient use of the scarce resources available for clinical breastfeeding research and minimize unintended outcomes.

  16. Ex Vivo Growth of Bioengineered Ligaments and Other Tissues

    NASA Technical Reports Server (NTRS)

    Altman, Gregory; Kaplan, David L.; Martin, Ivan; Vunjak-Novakovic, Gordana

    2005-01-01

    A method of growing bioengineered tissues for use in surgical replacement of damaged anterior cruciate ligaments has been invented. An anterior cruciate ligament is one of two ligaments (the other being the posterior cruciate ligament) that cross in the middle of a knee joint and act to prevent the bones in the knee from sliding forward and backward relative to each other. Anterior cruciate ligaments are frequently torn in sports injuries and traffic accidents, resulting in pain and severe limitations on mobility. By making it possible to grow replacement anterior cruciate ligaments that structurally and functionally resemble natural ones more closely than do totally synthetic replacements, the method could create new opportunities for full or nearly full restoration of functionality in injured knees. The method is also adaptable to the growth of bioengineered replacements for other ligaments (e.g., other knee ligaments as well as those in the hands, wrists, and elbows) and to the production of tissues other than ligaments, including cartilage, bones, muscles, and blood vessels. The method is based on the finding that the histomorphological properties of a bioengineered tissue grown in vitro from pluripotent cells within a matrix are affected by the direct application of mechanical force to the matrix during growth generation. This finding provides important new insights into the relationships among mechanical stress, biochemical and cell-immobilization methods, and cell differentiation, and is applicable to the production of the variety of tissues mentioned above. Moreover, this finding can be generalized to nonmechanical (e.g., chemical and electromagnetic) stimuli that are experienced in vivo by tissues of interest and, hence, the method can be modified to incorporate such stimuli in the ex vivo growth of replacements for the various tissues mentioned above. In this method, a three-dimensional matrix made of a suitable material is seeded with pluripotent stem

  17. Ulnar collateral ligament of the elbow.

    PubMed

    Safran, Marc; Ahmad, Christopher S; Elattrache, Neal S

    2005-11-01

    Recent advances in the diagnosis and treatment of the overhead athlete's elbow has led the medical community to understand that the ulnar collateral ligament (UCL) of the elbow is more commonly injured than originally thought. Injury can result in secondary symptoms and problems in other regions of the elbow. Sports requiring an overhead motion, such as throwing a ball, hitting a ball overhead, or serving a tennis ball, imparts a valgus stress on the elbow that is resisted by the UCL. Throwing sidearm or hitting a forehand in tennis, squash, or racquetball may also impart a valgus stress to the elbow. Repeated or excessive valgus stress places a force on the UCL that may result in injury to the ligament. Injury to the UCL may result in problems in other areas of the elbow, including the ulnar nerve, the flexor-pronator musculotendinous unit, the radiocapitellar joint and the posterior compartment of the elbow, in addition to being a cause of loose bodies within the elbow. This article reviews the anatomy, biomechanics, and pathophysiology of injury to the UCL and injuries to the other structures that result from UCL injury. Also reviewed are patient history, examination techniques, tests that help confirm the diagnosis of UCL injury, and treatment of the injured UCL.

  18. Andreas Vesalius' 500th Anniversary: First Description of the Mammary Suspensory Ligaments.

    PubMed

    Brinkman, Romy J; Hage, J Joris

    2016-09-01

    Sir Astley Paston Cooper has, to date, been acknowledged to be the first to describe the suspensory ligaments of the breast, or Cooper's ligaments, in 1840. We found these ligaments to be recorded in the first edition of 'De Humani Corporis Fabrica Libri Septem' by Andreas Vesalius, published in 1543. To commemorate Vesalius' 500th birthday, we quote and discuss this earlier record. Vesalius' record of the nature and function of the fleshy membrane between mammary gland and pectoral muscle, the hard fat intervening the mammary glands, and the fibers running from the fleshy membrane to the skin are a clear representation of posterior layer of the superficial fascial system, the fibro-adipose stroma surrounding and linking the mammary glandular elements, and the suspensory ligaments as we know them. Vesalius recorded the anatomy and function of the latter structures nearly 300 years before Sir Astley Paston Cooper did. PMID:26943658

  19. Andreas Vesalius' 500th Anniversary: First Description of the Mammary Suspensory Ligaments.

    PubMed

    Brinkman, Romy J; Hage, J Joris

    2016-09-01

    Sir Astley Paston Cooper has, to date, been acknowledged to be the first to describe the suspensory ligaments of the breast, or Cooper's ligaments, in 1840. We found these ligaments to be recorded in the first edition of 'De Humani Corporis Fabrica Libri Septem' by Andreas Vesalius, published in 1543. To commemorate Vesalius' 500th birthday, we quote and discuss this earlier record. Vesalius' record of the nature and function of the fleshy membrane between mammary gland and pectoral muscle, the hard fat intervening the mammary glands, and the fibers running from the fleshy membrane to the skin are a clear representation of posterior layer of the superficial fascial system, the fibro-adipose stroma surrounding and linking the mammary glandular elements, and the suspensory ligaments as we know them. Vesalius recorded the anatomy and function of the latter structures nearly 300 years before Sir Astley Paston Cooper did.

  20. Anatomy and histology of apical support: a literature review concerning cardinal and uterosacral ligaments.

    PubMed

    Ramanah, Rajeev; Berger, Mitchell B; Parratte, Bernard M; DeLancey, John O L

    2012-11-01

    The objective of this work was to collect and summarize relevant literature on the anatomy, histology, and imaging of apical support of the upper vagina and the uterus provided by the cardinal (CL) and uterosacral (USL) ligaments. A literature search in English, French, and German languages was carried out with the keywords apical support, cardinal ligament, transverse cervical ligament, Mackenrodt ligament, parametrium, paracervix, retinaculum uteri, web, uterosacral ligament, and sacrouterine ligament in the PubMed database. Other relevant journal and textbook articles were sought by retrieving references cited in previous PubMed articles. Fifty references were examined in peer-reviewed journals and textbooks. The USL extends from the S2 to the S4 vertebra region to the dorsal margin of the uterine cervix and/or to the upper third of the posterior vaginal wall. It has a superficial and deep component. Autonomous nerve fibers are a major constituent of the deep USL. CL is defined as a perivascular sheath with a proximal insertion around the origin of the internal iliac artery and a distal insertion on the cervix and/or vagina. It is divided into a cranial (vascular) and a caudal (neural) portions. Histologically, it contains mainly vessels, with no distinct band of connective tissue. Both the deep USL and the caudal CL are closely related to the inferior hypogastric plexus. USL and CL are visceral ligaments, with mesentery-like structures containing vessels, nerves, connective tissue, and adipose tissue.

  1. Hindlimb unloading alters ligament healing

    NASA Technical Reports Server (NTRS)

    Provenzano, Paolo P.; Martinez, Daniel A.; Grindeland, Richard E.; Dwyer, Kelley W.; Turner, Joanne; Vailas, Arthur C.; Vanderby, Ray Jr

    2003-01-01

    We investigated the hypothesis that hindlimb unloading inhibits healing in fibrous connective tissue such as ligament. Male rats were assigned to 3- and 7-wk treatment groups with three subgroups each: sham control, ambulatory healing, and hindlimb-suspended healing. Ambulatory and suspended animals underwent surgical rupture of their medial collateral ligaments, whereas sham surgeries were performed on control animals. After 3 or 7 wk, mechanical and/or morphological properties were measured in ligament, muscle, and bone. During mechanical testing, most suspended ligaments failed in the scar region, indicating the greatest impairment was to ligament and not to bone-ligament insertion. Ligament testing revealed significant reductions in maximum force, ultimate stress, elastic modulus, and low-load properties in suspended animals. In addition, femoral mineral density, femoral strength, gastrocnemius mass, and tibialis anterior mass were significantly reduced. Microscopy revealed abnormal scar formation and cell distribution in suspended ligaments with extracellular matrix discontinuities and voids between misaligned, but well-formed, collagen fiber bundles. Hence, stress levels from ambulation appear unnecessary for formation of fiber bundles yet required for collagen to form structurally competent continuous fibers. Results support our hypothesis that hindlimb unloading impairs healing of fibrous connective tissue. In addition, this study provides compelling morphological evidence explaining the altered structure-function relationship in load-deprived healing connective tissue.

  2. Anterior cruciate ligament - updating article.

    PubMed

    Luzo, Marcus Vinicius Malheiros; Franciozi, Carlos Eduardo da Silveira; Rezende, Fernando Cury; Gracitelli, Guilherme Conforto; Debieux, Pedro; Cohen, Moisés

    2016-01-01

    This updating article on the anterior cruciate ligament (ACL) has the aim of addressing some of the most interesting current topics in this field. Within this stratified approach, it contains the following sections: ACL remnant; anterolateral ligament and combined intra and extra-articular reconstruction; fixation devices; and ACL femoral tunnel creation techniques. PMID:27517015

  3. Anterior cruciate ligament - updating article.

    PubMed

    Luzo, Marcus Vinicius Malheiros; Franciozi, Carlos Eduardo da Silveira; Rezende, Fernando Cury; Gracitelli, Guilherme Conforto; Debieux, Pedro; Cohen, Moisés

    2016-01-01

    This updating article on the anterior cruciate ligament (ACL) has the aim of addressing some of the most interesting current topics in this field. Within this stratified approach, it contains the following sections: ACL remnant; anterolateral ligament and combined intra and extra-articular reconstruction; fixation devices; and ACL femoral tunnel creation techniques.

  4. Three-dimensional spiral computed tomographic cysto-urethrography for post-traumatic complex posterior urethral strictures associated with urethral-rectal fistula.

    PubMed

    Sa, Ying Long; Xu, Yue Min; Feng, Chao; Ye, Xu Xiao; Song, Lu Jie

    2013-01-01

    To evaluate the value of three-dimensional spiral computed tomography/cysto-urethrography (CTCUG) in diagnosing posterior urethral strictures associated with urethrorectal fistulas (URF). Between June 2008 and March 2012, 38 patients with posterior urethral strictures associated with URFs were examined by CTCUG, retrograde urethrography (RUG) and cysto-urethrography (CUG). Urethral reconstruction was undertaken and URFs were surgically repaired in all patients. The length of the urethral defect, location and size of URFs were recorded. Data from radiological examinations were compared with surgical findings. No statistically significant difference was found in the length of stricture measured using CTCUG (4.31 ± 2.28 cm) or conventional urethrography (4.02 ± 3.12 cm; p > 0.05), However, the accuracy in determining the location of the stricture was higher with CTCUG (93.12%) than with conventional urethrography (70.59%; p < 0.05). CTCUG identified URFs in all 38 patients (100%), whereas URFs were only observed in 27 patients (71%) using conventional urethrography. In conclusion, CTCUG was more accurate, safer and provided more details of URFs and urethral defects than conventional urethrography in patients with posterior urethral strictures associated with URFs.

  5. Ligament Mediated Fragmentation of Viscoelastic Liquids

    NASA Astrophysics Data System (ADS)

    Keshavarz, Bavand; Houze, Eric C.; Moore, John R.; Koerner, Michael R.; McKinley, Gareth H.

    2016-10-01

    The breakup and atomization of complex fluids can be markedly different than the analogous processes in a simple Newtonian fluid. Atomization of paint, combustion of fuels containing antimisting agents, as well as physiological processes such as sneezing are common examples in which the atomized liquid contains synthetic or biological macromolecules that result in viscoelastic fluid characteristics. Here, we investigate the ligament-mediated fragmentation dynamics of viscoelastic fluids in three different canonical flows. The size distributions measured in each viscoelastic fragmentation process show a systematic broadening from the Newtonian solvent. In each case, the droplet sizes are well described by Gamma distributions which correspond to a fragmentation-coalescence scenario. We use a prototypical axial step strain experiment together with high-speed video imaging to show that this broadening results from the pronounced change in the corrugated shape of viscoelastic ligaments as they separate from the liquid core. These corrugations saturate in amplitude and the measured distributions for viscoelastic liquids in each process are given by a universal probability density function, corresponding to a Gamma distribution with nmin=4 . The breadth of this size distribution for viscoelastic filaments is shown to be constrained by a geometrical limit which can not be exceeded in ligament-mediated fragmentation phenomena.

  6. Collagen Microstructure in the Vocal Ligament: Initial Results on the Potential Effects of Smoking

    PubMed Central

    Kelleher, Jordan E.; Siegmund, Thomas; Chan, Roger W.

    2014-01-01

    Objective This investigation quantitatively characterizes the collagenous microstructure of human vocal ligament specimens excised postmortem from non-smokers and smokers. Study Design Retrospective Cohort Study Methods Second harmonic generation (SHG) imaging was performed at three anatomical locations of vocal ligament specimens: anterior, mid-membranous, and posterior regions. Two microstructural parameters were extracted from the SHG images: (1) normalized fiber density, and (2) fiber dispersion coefficient, quantifying the degree of collagen fiber dispersion about a preferred direction. Results For both the non-smoker and smoker subjects, the fiber dispersion coefficient was heterogeneous. Differences in the collagenous structure of non-smokers and smoker subjects were pronounced at the mid-membranous location. However, the directionality of the heterogeneity in the smoker subjects was opposite to that in the non-smoker subjects. Specifically, the fiber dispersion coefficient in the non-smoker subjects was lower in the midmembranous region (indicating more fiber alignment) than at the anterior/posterior regions, but for the smoker subjects the fiber dispersion coefficient was higher at the mid-membranous region. The normalized fiber density was near constant in the non-smoker subjects, but the smoker subjects had fewer fibers in the mid-membranous region than at the anterior/posterior regions. Conclusion Spatial microstructural variations may exist in the vocal fold ligament both in non-smokers and smokers. Smoking appears to influence the degree and direction of microstructure heterogeneity in the vocal fold ligament. PMID:24473992

  7. Rotational stability of a posterior stabilized total knee arthroplasty.

    PubMed

    Whiteside, L A; Amador, D D

    1989-05-01

    The effect of the posterior stabilizing mechanism on rotational stability in total knee arthroplasty (TKA) was investigated in six cadaver knees using a special knee-testing device. The device evaluated varus-valgus, rotational, and anteroposterior (AP) stability in the normal knee compared to a posterior stabilized TKA with either a rotationally constrained or an unconstrained articular surface. None of the stability parameters was significantly different from normal in either configuration of the tibial surface, but the constrained surface did decrease rotational deflection compared to the rotationally unconstrained surfaces. These findings show that rotational constraint in a posterior stabilized TKA is not necessary to achieve rotational stability as long as varus-valgus stability is achieved by appropriately tensioning the collateral ligaments. PMID:2706852

  8. Histological study of the annular ligament in the rabbitfish eye (Siganus sp.).

    PubMed

    Asli, Marziye; Mansoori, Forooghsadat; Sattari, Amir

    2012-01-01

    Rabbitfish is economically valuable teleost species which lives in shallow coastal waters. Two species of rabbit fish have been recognized in southern sea of Iran (Persian gulf) as namely Siganus sutor and Siganus javus. In the current study, in order to investigate the histology of the annular ligament of the S. javus' eye, the prepared sections of the eyes of twelve healthy specimens were studied under light microscope. The results revealed that annular ligament is a crescent shape structure which is situated between the scleral stroma anteriorly and the iris posteriorly. It contains a vascularized, amorphous and granular matrix with fibers of dense connective tissue; high glycogen content and melanin pigments. PMID:25653773

  9. Histological study of the annular ligament in the rabbitfish eye (Siganus sp.).

    PubMed

    Asli, Marziye; Mansoori, Forooghsadat; Sattari, Amir

    2012-01-01

    Rabbitfish is economically valuable teleost species which lives in shallow coastal waters. Two species of rabbit fish have been recognized in southern sea of Iran (Persian gulf) as namely Siganus sutor and Siganus javus. In the current study, in order to investigate the histology of the annular ligament of the S. javus' eye, the prepared sections of the eyes of twelve healthy specimens were studied under light microscope. The results revealed that annular ligament is a crescent shape structure which is situated between the scleral stroma anteriorly and the iris posteriorly. It contains a vascularized, amorphous and granular matrix with fibers of dense connective tissue; high glycogen content and melanin pigments.

  10. Histological study of the annular ligament in the rabbitfish eye (Siganus sp.)

    PubMed Central

    Asli, Marziye; Mansoori, Forooghsadat; Sattari, Amir

    2012-01-01

    Rabbitfish is economically valuable teleost species which lives in shallow coastal waters. Two species of rabbit fish have been recognized in southern sea of Iran (Persian gulf) as namely Siganus sutor and Siganus javus. In the current study, in order to investigate the histology of the annular ligament of the S. javus’ eye, the prepared sections of the eyes of twelve healthy specimens were studied under light microscope. The results revealed that annular ligament is a crescent shape structure which is situated between the scleral stroma anteriorly and the iris posteriorly. It contains a vascularized, amorphous and granular matrix with fibers of dense connective tissue; high glycogen content and melanin pigments. PMID:25653773

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

    PubMed

    Stäubli, H U; Schatzmann, L; Brunner, P; Rincón, L; Nolte, L P

    1999-01-01

    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.

  12. Comparison of material properties in fascicle-bone units from human patellar tendon and knee ligaments.

    PubMed

    Butler, D L; Kay, M D; Stouffer, D C

    1986-01-01

    The fascicle material properties in bone-fascicle-bone units were determined for the anterior and posterior cruciate ligaments (ACL, PCL), the lateral collateral ligament (LCL) and the patellar tendon (PT) from three young human donor knees. Groups of fascicles from each tissue were isolated with intact bone ends and failed at a high strain rate in a saline bath at 37 degrees C. In each knee tested the load related material properties (linear modulus, maximum stress and energy density to maximum stress) for the patellar tendon were significantly larger than corresponding values for the cruciate and collateral ligaments. Bundles from different ligaments in the same knee were similar to each other in their mechanical behavior. In addition, no significant differences were present in the maximum strains recorded for any of the four tissue types examined. The results presented have implications in studies of ligament injury. They are also important in the design and use of synthetic and biological ligament replacements and in tissue and whole knee modeling.

  13. Acute finger injuries: part I. Tendons and ligaments.

    PubMed

    Leggit, Jeffrey C; Meko, Christian J

    2006-03-01

    Improper diagnosis and treatment of finger injuries can cause deformity and dysfunction over time. A basic understanding of the complex anatomy of the finger and of common tendon and ligament injury mechanisms can help physicians properly diagnose and treat finger injuries. Evaluation includes a general musculoskeletal examination as well as radiography (oblique, anteroposterior, and true lateral views). Splinting and taping are effective treatments for tendon and ligament injuries. Treatment should restrict the motion of injured structures while allowing uninjured joints to remain mobile. Although family physicians are usually the first to evaluate patients with finger injuries, it is important to recognize when a referral is needed to ensure optimal outcomes.

  14. Risk Factors for Anterior Cruciate Ligament Injury

    PubMed Central

    Smith, Helen C.; Vacek, Pamela; Johnson, Robert J.; Slauterbeck, James R.; Hashemi, Javad; Shultz, Sandra

    2012-01-01

    Context: Injuries to the anterior cruciate ligament (ACL) of the knee are immediately debilitating and can cause long-term consequences, including the early onset of osteoarthritis. It is important to have a comprehensive understanding of all possible risk factors for ACL injury to identify individuals who are at risk for future injuries and to provide an appropriate level of counseling and programs for prevention. Objective: This review, part 1 of a 2-part series, highlights what is known and still unknown regarding anatomic and neuromuscular risk factors for injury to the ACL from the current peer-reviewed literature. Data Sources: Studies were identified from MEDLINE (1951–March 2011) using the MeSH terms anterior cruciate ligament, knee injury, and risk factors. The bibliographies of relevant articles and reviews were cross-referenced to complete the search. Study Selection: Prognostic studies that utilized the case-control and prospective cohort study designs to evaluate risk factors for ACL injury were included in this review. Results: A total of 50 case-control and prospective cohort articles were included in the review, and 30 of these studies focused on neuromuscular and anatomic risk factors. Conclusions: Several anatomic and neuromuscular risk factors are associated with increased risk of suffering ACL injury—such as female sex and specific measures of bony geometry of the knee joint, including decreased intercondylar femoral notch size, decreased depth of concavity of the medial tibial plateau, increased slope of the tibial plateaus, and increased anterior-posterior knee laxity. These risk factors most likely act in combination to influence the risk of ACL injury; however, multivariate risk models that consider all the aforementioned risk factors in combination have not been established to explore this interaction. PMID:23016072

  15. Posterior Tibial Tendon Dysfunction

    MedlinePlus

    ... when the posterior tibial tendon becomes inflamed or torn. As a result, the tendon may not be ... repetitive use. Once the tendon becomes inflamed or torn, the arch will slowly fall (collapse) over time. ...

  16. LARS Artificial Ligament Versus ABC Purely Polyester Ligament for Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Iliadis, Dimitrios Ph.; Bourlos, Dimitrios N.; Mastrokalos, Dimitrios S.; Chronopoulos, Efstathios; Babis, George C.

    2016-01-01

    Background: Graft choice for anterior cruciate ligament (ACL) reconstruction is of critical importance. Various grafts have been used so far, with autografts long considered the optimal solution for the treatment of ACL-deficient knees. Limited data are available on the long-term survivorship of synthetic grafts. Purpose: To compare the functional outcome and survivorship of ACL reconstructions performed using the LARS (ligament augmentation and reconstruction system) ligament and the ABC (active biosynthetic composite) purely polyester ligament. Study Design: Case series; Level of evidence, 4. Methods: The results of 72 patients who underwent primary arthroscopic ACL reconstruction with the LARS ligament and 31 cases with an ABC purely polyester ligament were reviewed. The mean follow-up periods for the LARS and ABC groups were 9.5 and 5.1 years, respectively. A survivorship analysis of the 2 synthetic grafts was performed using the Kaplan-Meier method with a log-rank test (Mantel-Cox, 95% CI). Lysholm, Tegner activity, Knee injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) scores as well as laxity measurements obtained using a KT-1000 arthrometer were recorded for all intact grafts, and a Mann-Whitney U test was used for comparison reasons. Results: The rupture rates for LARS and ABC grafts were 31% (95% CI, 20%-42%) and 42% (95% CI, 25%-59%), respectively. For intact grafts, the mean Lysholm score was good for both groups (90 for the LARS group and 89 for the ABC group), with the majority of patients returning to their preinjury level of activities, and the mean IKDC score was 90 for the LARS group and 86 for the ABC group. Conclusion: The rupture rates of both LARS and ABC grafts were both high. However, the LARS ligament provided significantly better survivorship compared with the ABC ligament at short- to midterm follow-up (95% CI). PMID:27453894

  17. Functional regeneration of ligament-bone interface using a triphasic silk-based graft.

    PubMed

    Li, Hongguo; Fan, Jiabing; Sun, Liguo; Liu, Xincheng; Cheng, Pengzhen; Fan, Hongbin

    2016-11-01

    The biodegradable silk-based scaffold with unique mechanical property and biocompatibility represents a favorable ligamentous graft for tissue-engineering anterior cruciate ligament (ACL) reconstruction. However, the low efficiency of ligament-bone interface restoration barriers the isotropic silk graft to common ACL therapeutics. To enhance the regeneration of the silk-mediated interface, we developed a specialized stratification approach implementing a sequential modification on isotropic silk to constitute a triphasic silk-based graft in which three regions respectively referring to ligament, cartilage and bone layers of interface were divided, followed by respective biomaterial coating. Furthermore, three types of cells including bone marrow mesenchymal stem cells (BMSCs), chondrocytes and osteoblasts were respectively seeded on the ligament, cartilage and bone region of the triphasic silk graft, and the cell/scaffold complex was rolled up as a multilayered graft mimicking the stratified structure of native ligament-bone interface. In vitro, the trilineage cells loaded on the triphasic silk scaffold revealed a high proliferative capacity as well as enhanced differentiation ability into their corresponding cell lineage. 24 weeks postoperatively after the construct was implanted to repair the ACL defect in rabbit model, the silk-based ligamentous graft exhibited the enhancement of osseointegration detected by a robust pullout force and formation of three-layered structure along with conspicuously corresponding matrix deposition via micro-CT and histological analysis. These findings potentially broaden the application of silk-based ligamentous graft for ACL reconstruction and further large animal study. PMID:27566867

  18. Indirect posterior composite resins.

    PubMed

    Leinfelder, Karl F

    2005-07-01

    The use of indirect posterior composite restorations has facilitated the generation of ideal anatomic form, marginal adaptation, and appropriate proximal contact and contour. Unfortunately, however, the use of post-cure heat treatments has done little to enhance the overall clinical performance of the restoration. The development of new curing techniques in conjunction with modifications of the formulae have contributed to a substantial improvement in both the mechanical characteristics and long-term clinical performance of indirect posterior composite resins.

  19. Congenital abnormalities of the posterior fossa.

    PubMed

    Bosemani, Thangamadhan; Orman, Gunes; Boltshauser, Eugen; Tekes, Aylin; Huisman, Thierry A G M; Poretti, Andrea

    2015-01-01

    The frequency and importance of the evaluation of the posterior fossa have increased significantly over the past 20 years owing to advances in neuroimaging. Nowadays, conventional and advanced neuroimaging techniques allow detailed evaluation of the complex anatomic structures within the posterior fossa. A wide spectrum of congenital abnormalities has been demonstrated, including malformations (anomalies due to an alteration of the primary developmental program caused by a genetic defect) and disruptions (anomalies due to the breakdown of a structure that had a normal developmental potential). Familiarity with the spectrum of congenital posterior fossa anomalies and their well-defined diagnostic criteria is crucial for optimal therapy, an accurate prognosis, and correct genetic counseling. The authors discuss the spectrum of posterior fossa malformations and disruptions, with emphasis on neuroimaging findings (including diagnostic criteria), neurologic presentation, systemic involvement, prognosis, and risk of recurrence.

  20. Congenital abnormalities of the posterior fossa.

    PubMed

    Bosemani, Thangamadhan; Orman, Gunes; Boltshauser, Eugen; Tekes, Aylin; Huisman, Thierry A G M; Poretti, Andrea

    2015-01-01

    The frequency and importance of the evaluation of the posterior fossa have increased significantly over the past 20 years owing to advances in neuroimaging. Nowadays, conventional and advanced neuroimaging techniques allow detailed evaluation of the complex anatomic structures within the posterior fossa. A wide spectrum of congenital abnormalities has been demonstrated, including malformations (anomalies due to an alteration of the primary developmental program caused by a genetic defect) and disruptions (anomalies due to the breakdown of a structure that had a normal developmental potential). Familiarity with the spectrum of congenital posterior fossa anomalies and their well-defined diagnostic criteria is crucial for optimal therapy, an accurate prognosis, and correct genetic counseling. The authors discuss the spectrum of posterior fossa malformations and disruptions, with emphasis on neuroimaging findings (including diagnostic criteria), neurologic presentation, systemic involvement, prognosis, and risk of recurrence. PMID:25590398

  1. Aging, vertebral density, and disc degeneration alter the tensile stress-strain characteristics of the human anterior longitudinal ligament.

    PubMed

    Neumann, P; Ekström, L A; Keller, T S; Perry, L; Hansson, T H

    1994-01-01

    The mechanical properties of the human lumbar anterior longitudinal ligament were investigated, and the influence of aging, disc degeneration, and vertebral bone density on these properties was determined. Tensile mechanical properties of the vertebra-anterior longitudinal ligament-vertebra complex were determined for 16 segments from cadavera of individuals who had been 21-79 years old (mean, 52.1 years) at the time of death. Regional strain patterns associated with three sites across the width and three sites along the length of the anterior longitudinal ligament were measured with use of a video-based motion analysis system. In the young, normal anterior longitudinal ligament, the elastic moduli of the insertion and substance regions of the ligament were similar (approximately 500 MPa). During aging (21-79 years), the elastic modulus of the substance region increased 2-fold, whereas the elastic modulus of the insertion decreased 3-fold; this resulted in an approximately 5-fold difference in elastic modulus between these regions in the older spine. The strength of the bone-ligament complex decreased approximately 2-fold (from 29 to 13 MPa) over this same age range. The outer portion of the anterior longitudinal ligament consistently had the highest peak tensile strains (11.8 +/- 2.7%) in all of the specimens examined. Preparations with nondegenerated discs and high bone density were significantly stronger (66%) and failed in the ligament substance; in contrast, segments from older individuals with degenerated discs and lower bone density failed in the ligament insertion regions.

  2. The tibialis posterior tendon.

    PubMed

    Lhoste-Trouilloud, A

    2012-02-01

    The tibialis posterior tendon is the largest and anteriormost tendon in the medial ankle. It produces plantar flexion and supination of the ankle and stabilizes the plantar vault. Sonographic assessment of this tendon is done with high-frequency, linear-array transducers; an optimal examination requires transverse retromalleolar, longitudinal retromalleolar, and distal longitudinal scans, as well as dynamic studies. Disorders of the posterior tibial tendon include chronic tendinopathy with progressive rupture, tenosynovitis, acute rupture, dislocation and instability, enthesopathies. The most common lesion is a progressive "chewing gum" lesion that develops in a setting of chronic tendinopathy; it is usually seen in overweight women over 50 years of age with valgus flat feet. Medial ankle pain must also be carefully investigated, and the presence of instability assessed with dynamic maneuvers (forced inversion, or dorsiflexion) of the foot. Sonography plays an important role in the investigation of disorders involving the posterior tibial tendon.

  3. Knee model sensitivity to cruciate ligaments parameters: a stability simulation study for a living subject.

    PubMed

    Bertozzi, Luigi; Stagni, Rita; Fantozzi, Silvia; Cappello, Angelo

    2007-01-01

    If the biomechanic function of the different anatomical sub-structures of the knee joint was needed in physiological conditions, the only possible way is a modelling approach. Subject-specific geometries and kinematic data, acquired from the same living subject, were the foundations of the 3D quasi-static knee model developed. Each cruciate ligament was modelled by means of 25 elastic springs, paying attention to the anatomical twisting of the fibres. The sensitivity of the model to the cross-sectional area was performed during the anterior/posterior tibial translations, the sensitivity to all the cruciate ligaments parameters was performed during the internal/external rotations. The model reproduced very well the mechanical behaviour reported in literature during anterior/posterior translations, in particular considering 30% of the mean insertional area. During the internal/external tibial rotations, similar behaviour of the axial torques was obtained in the three sensitivity analyses. The overlapping of the ligaments was assessed at about 25 degrees of internal axial rotation. The presented model featured a good level of accuracy in combination with a low computational weight, and it could provide an in vivo estimation of the role of the cruciate ligaments during the execution of daily living activities.

  4. Tibialis Posterior Tendon Entrapment Within Posterior Malleolar Fracture Fragment.

    PubMed

    Fantry, Amanda; Lareau, Craig; Vopat, Bryan; Blankenhorn, Brad

    2016-01-01

    Management of posterior malleolus fractures continues to be controversial, with respect to both need for fixation and fixation methods. Fixation methods include an open posterior approach to the ankle as well as percutaneous reduction and fixation with or without arthroscopy for visualization of the articular surface. Plain radiographs are unreliable in identifying fracture pattern and intraoperative reduction, making arthroscopy a valuable adjunct to posterior malleolus fracture management. In this article, we report a case of tibialis posterior tendon entrapment within a posterior malleolus fracture, as identified by arthroscopy and managed with open reduction. Tibialis posterior tendon entrapment within a posterior malleolus has not been previously reported. Ankle arthroscopy for posterior malleolus fractures provides an opportunity to identify soft-tissue or tendinous entrapment, articular surface reduction, and articular cartilage injuries unlikely to be identified with fluoroscopy alone and should be considered in reduction and fixation of posterior malleolus fractures.

  5. Tibialis Posterior Tendon Entrapment Within Posterior Malleolar Fracture Fragment.

    PubMed

    Fantry, Amanda; Lareau, Craig; Vopat, Bryan; Blankenhorn, Brad

    2016-01-01

    Management of posterior malleolus fractures continues to be controversial, with respect to both need for fixation and fixation methods. Fixation methods include an open posterior approach to the ankle as well as percutaneous reduction and fixation with or without arthroscopy for visualization of the articular surface. Plain radiographs are unreliable in identifying fracture pattern and intraoperative reduction, making arthroscopy a valuable adjunct to posterior malleolus fracture management. In this article, we report a case of tibialis posterior tendon entrapment within a posterior malleolus fracture, as identified by arthroscopy and managed with open reduction. Tibialis posterior tendon entrapment within a posterior malleolus has not been previously reported. Ankle arthroscopy for posterior malleolus fractures provides an opportunity to identify soft-tissue or tendinous entrapment, articular surface reduction, and articular cartilage injuries unlikely to be identified with fluoroscopy alone and should be considered in reduction and fixation of posterior malleolus fractures. PMID:26991573

  6. Anterior cruciate ligament allograft transplantation for intraarticular ligamentous reconstruction.

    PubMed

    Goertzen, M; Dellmann, A; Gruber, J; Clahsen, H; Bürrig, K F

    1992-01-01

    A multiplicity of surgical operations have been developed in an attempt to achieve satisfactory function after anterior cruciate ligament (ACL) repair. None of these procedures have been able to reproduce the fiber organization anatomy of attachment site, vascularity, or function of the ACL. Twenty-nine foxhounds received a deep-frozen bone-ACL-bone allograft and a ligament augmentation device (LAD). Biomechanical, microvascular, and histological changes were evaluated 3, 6, and 12 months following implantation. The maximum loads of the allograft/LADs were 34.3% (387.2 N) after 3 months, 49.3% (556.6 N) after 6 months, and 61.1% (698.8 N) after a year. The maximum load was 69.1% (780 N). In general, after 6 months the allografts showed normal collagen orientation. The allografts demonstrated no evidence of infection or immune reaction. No bone ingrowth into the LAD was observed. Polarized light microscopy and periodic acid-schiff staining showed that the new bone-ligament substance interface had intact fiber orientation at the area of the ligament insertion. Microvascular examination using the Spalteholtz technique revealed revascularization and the importance of an infrapatellar fat pad for the nourishment of ACL allografts.

  7. Anterior cruciate ligament allograft transplantation for intraarticular ligamentous reconstruction.

    PubMed

    Goertzen, M; Dellmann, A; Gruber, J; Clahsen, H; Bürrig, K F

    1992-01-01

    A multiplicity of surgical operations have been developed in an attempt to achieve satisfactory function after anterior cruciate ligament (ACL) repair. None of these procedures have been able to reproduce the fiber organization anatomy of attachment site, vascularity, or function of the ACL. Twenty-nine foxhounds received a deep-frozen bone-ACL-bone allograft and a ligament augmentation device (LAD). Biomechanical, microvascular, and histological changes were evaluated 3, 6, and 12 months following implantation. The maximum loads of the allograft/LADs were 34.3% (387.2 N) after 3 months, 49.3% (556.6 N) after 6 months, and 61.1% (698.8 N) after a year. The maximum load was 69.1% (780 N). In general, after 6 months the allografts showed normal collagen orientation. The allografts demonstrated no evidence of infection or immune reaction. No bone ingrowth into the LAD was observed. Polarized light microscopy and periodic acid-schiff staining showed that the new bone-ligament substance interface had intact fiber orientation at the area of the ligament insertion. Microvascular examination using the Spalteholtz technique revealed revascularization and the importance of an infrapatellar fat pad for the nourishment of ACL allografts. PMID:1389780

  8. Graft impingement in anterior cruciate ligament reconstruction.

    PubMed

    Iriuchishima, Takanori; Shirakura, Kenji; Fu, Freddie H

    2013-03-01

    Anterior cruciate ligament (ACL) graft impingement is one of the most troubling complications in ACL reconstruction. In the previous strategy of isometric "non-anatomical" ACL reconstruction, posterior tibial tunnel placement and notchplasty were recommended to avoid graft impingement. Recently, the strategy of ACL reconstruction is shifting towards "anatomical" reconstruction. In anatomical ACL reconstruction, the potential risk of graft impingement is higher than in non-anatomical reconstruction because the tibial tunnel is placed at a more anterior portion on the tibia. However, there have been few studies reporting on graft impingement in anatomical ACL reconstruction. This study will provide a review of graft impingement status in both non-anatomical and the more recent anatomical ACL reconstruction techniques. In conclusion, with the accurate creation of bone tunnels within ACL native footprint, the graft impingement might not happen in anatomical ACL reconstruction. For the clinical relevance, to prevent graft impingement, surgeons should pay attention of creating correct anatomical tunnels when they perform ACL reconstruction. Level of evidence IV.

  9. The influence of the mechanical behaviour of the middle ear ligaments: a finite element analysis.

    PubMed

    Gentil, F; Parente, M; Martins, P; Garbe, C; Jorge, R N; Ferreira, A; Tavares, João Manuel R S

    2011-01-01

    The interest in computer modelling of biomechanical systems, mainly by using the finite element method (FEM), has been increasing, in particular for analysis of the mechanical behaviour of the human ear. In this work, a finite element model of the middle ear was developed to study the dynamic structural response to harmonic vibrations for distinct sound pressure levels applied on the eardrum. The model includes different ligaments and muscle tendons with elastic and hyperelastic behaviour for these supportive structures. Additionally, the nonlinear behaviour of the ligaments and muscle tendons was investigated, as they are the connection between ossicles by contact formulation. Harmonic responses of the umbo and stapes footplate displacements, between 100 Hz and 10 kHz, were obtained and compared with previously published work. The stress state of ligaments (superior, lateral, and anterior of malleus and superior and posterior of incus) was analysed, with the focus on balance of the supportive structures of the middle ear, as ligaments make the link between the ossicular chain and the walls of the tympanic cavity. The results obtained in this work highlight the importance of using hyperelastic models to simulate the mechanical behaviour for the ligaments and tendons.

  10. Leiomyosarcoma of the Broad Ligament With Fever Presentation: A Case Report and Review of Literature

    PubMed Central

    Chaichian, Shahla; Mehdizadehkashi, Abolfazl; Tahermanesh, Kobra; Moazzami, Bahram; Jesmi, Fatemeh; Rafiee, Moezedinjavad; Goharimoghaddam, Katayoun

    2016-01-01

    Introduction Leiomyosarcoma is a rare gynecologic malignancy that accounts for less than 1% of gynecological malignancies. Leiomyosarcoma of the broad ligament is an even rarer condition. According to Gardner’s criteria, the diagnosis is made when the mass is completely separated from the uterus and adnexa. So far, 23 cases of primary leiomyosarcoma of the broad ligament have been reported in the literature published in English. Case Presentation In September 2014, a 55-year-old, gravida 3, para 3 woman with a BMI of 30 and a chief complaint of fever and dizziness was admitted to the infectious-diseases ward of the Pars general hospital affiliated with Iran University of Medical Sciences in Tehran, Iran. Her symptoms had begun two weeks before. The results of a fever workup and examination for infectious, metabolic, and immunologic problems were all negative. Imaging modalities revealed an endometrial polyp, two calcified myoma in the body of the uterus, and a solid, heterogeneous 70-mm mass in the right para-cervical space, posterior to the broad ligament, and far from the ovary. After surgery, a histologic report revealed leiomyosarcoma. Conclusions Although a leiomyosarcoma of the broad ligament is rare, practitioners should consider it when dealing with masses in the region of the broad ligament. If there is any suspicion of malignancy, especially in the presence of fever, it is recommended to avoid morcellation during laparoscopy. PMID:27330834

  11. Ulnar Collateral Ligament Reconstruction

    PubMed Central

    Erickson, Brandon J.; Bach, Bernard R.; Cohen, Mark S.; Bush-Joseph, Charles A.; Cole, Brian J.; Verma, Nikhil N.; Nicholson, Gregory P.; Romeo, Anthony A.

    2016-01-01

    Background: Ulnar collateral ligament reconstruction (UCLR) is a common surgery performed in professional, collegiate, and high school athletes. Purpose: To report patient demographics, surgical techniques, and outcomes of all UCLRs performed at a single institution from 2004 to 2014. Study Design: Case series; Level of evidence, 4. Methods: All patients who underwent UCLR from January 1, 2004, through December 31, 2014, at a single institution were identified. Charts were reviewed to determine patient age, sex, date of surgery, sport played, athletic level, surgical technique, graft type, and complications. Data were collected prospectively, and patients were contacted via phone calls to obtain the return-to-sport rate, Conway-Jobe score, Andrews-Timmerman score, and Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow score. Continuous variable data were reported as weighted means, and categorical variable data were reported as frequencies with percentages. Results: A total of 187 patients (188 elbows) underwent UCLR during the study period (92% male; mean age, 19.6 ± 4.7 years; 78.2% right elbows). There were 165 baseball players (87.8% of all patients), 155 of whom were pitchers (82.5% of all patients). Ninety-seven (51.6%) were college athletes, 68 (36.2%) high school athletes, and 7 (3.7%) professional athletes at the time of surgery. The docking technique was used in 110 (58.5%) patients while the double-docking technique was used in 78 (41.5%). An ipsilateral palmaris longus graft was used in 110 (58.5%) patients while a hamstring autograft was used in 48 (25.5%) patients. The ulnar nerve was subcutaneously transposed in 79 (42%) patients. Clinical follow-up data were available on 85 patients. Mean follow-up was 60 ± 30.8 months. Overall, 94.1% of patients were able to return to sport and had a Conway-Jobe score of good/excellent while 4.3% had a score of fair. The mean KJOC score was 90.4 ± 6.7 and mean Andrews-Timmerman score was 92.5 ± 7

  12. LIGAMENT-CONTROLLED EFFERVESCENT ATOMIZATION

    EPA Science Inventory

    The operating principles and performance of a new type of spray nozzle are presented. This nozzle, termed a "ligament-controlled effervescent atomizer," was developed to allow consumer product manufacturers to replace volatile organic compound (VOC) solvents with water and hydroc...

  13. Posterior microphthalmos pigmentary retinopathy syndrome.

    PubMed

    Pehere, Niranjan; Jalali, Subhadra; Deshmukh, Himanshu; Kannabiran, Chitra

    2011-04-01

    Posterior Microphthalmos Pigmentary Retinopathy Syndrome (PMPRS). Posterior microphthalmos (PM) is a relatively infrequent type of microphthalmos where posterior segment is predominantly affected with normal anterior segment measurements. Herein, we report two siblings with posterior microphthalmos retinopathy syndrome with postulated autosomal recessive mode of inheritance. A 13-year-old child had PM and retinitis pigmentosa (RP) and his 7-year-old sister had PM, RP, and foveoschisis. The genetics of this syndrome and variable phenotype is discussed. Importance of being aware of posterior microphthalmos and its posterior segment associations is highlighted.

  14. Anterior Cruciate Ligament Reconstruction in Patients with Generalized Joint Laxity

    PubMed Central

    Kim, Sung-Jae; Kumar, Praveen

    2010-01-01

    Generalized joint laxity is a genetically determined component of overall joint flexibility. The incidence of joint laxity in the overall population is approximately 5% to 20%, and its prevalence is higher in females. Recently it was noticed that individuals with generalized joint laxity are not only prone to anterior cruciate ligament injuries but also have inferior results after a reconstruction. Therefore, an anterior cruciate ligament reconstruction in patients with generalized laxity should be undertaken with caution due to the higher expected failure rate from the complexity of problems associated with this condition. It is also necessary to identify the risk factors for the injury as well as for the post operative outcome in this population. A criterion that includes all the associated components is necessary for the proper screening of individuals for generalized joint laxity. Graft selection for an anterior cruciate reconstruction in patients with ligament laxity is a challenge. According to the senior author, a hamstring autograft is an inferior choice and a double bundle reconstruction with a quadriceps tendon-bone autograft yields better results than a single bundle bone-patella tendon-bone autograft. Future studies comparing the different grafts available might be needed to determine the preferred graft for this subset of patients. Improved results after an anterior cruciate ligament reconstruction can be achieved by proper planning and careful attention to each step beginning from the clinical examination to the postoperative rehabilitation. PMID:20808583

  15. Anterior cruciate ligament reconstruction in patients with generalized joint laxity.

    PubMed

    Kim, Sung-Jae; Kumar, Praveen; Kim, Sung-Hwan

    2010-09-01

    Generalized joint laxity is a genetically determined component of overall joint flexibility. The incidence of joint laxity in the overall population is approximately 5% to 20%, and its prevalence is higher in females. Recently it was noticed that individuals with generalized joint laxity are not only prone to anterior cruciate ligament injuries but also have inferior results after a reconstruction. Therefore, an anterior cruciate ligament reconstruction in patients with generalized laxity should be undertaken with caution due to the higher expected failure rate from the complexity of problems associated with this condition. It is also necessary to identify the risk factors for the injury as well as for the post operative outcome in this population. A criterion that includes all the associated components is necessary for the proper screening of individuals for generalized joint laxity. Graft selection for an anterior cruciate reconstruction in patients with ligament laxity is a challenge. According to the senior author, a hamstring autograft is an inferior choice and a double bundle reconstruction with a quadriceps tendon-bone autograft yields better results than a single bundle bone-patella tendon-bone autograft. Future studies comparing the different grafts available might be needed to determine the preferred graft for this subset of patients. Improved results after an anterior cruciate ligament reconstruction can be achieved by proper planning and careful attention to each step beginning from the clinical examination to the postoperative rehabilitation.

  16. The Hox-4.8 gene is localized at the 5' extremity of the Hox-4 complex and is expressed in the most posterior parts of the body during development.

    PubMed

    Dollé, P; Izpisúa-Belmonte, J C; Boncinelli, E; Duboule, D

    1991-12-01

    We report the isolation and expression pattern of a novel mouse homeobox gene, Hox-4.8. Hox-4.8 is the most 5'-located homeobox gene in the HOX-4 complex. Sequence analysis confirmed that Hox-4.8 is a member of the subfamily of AbdominalB-related Hox-4 genes and revealed strong interspecies conservation. As for the human locus, Hox-4.8 is probably the last Hox gene in this part of the HOX-4 complex. During development, Hox-4.8 transcripts are restricted to the extremities of the embryonic anteroposterior axis and limbs as well as in the developing tail bud and to the most posterior segment of the gut (the rectum). Within the limb mesenchyme, Hox-4.8 is expressed in more posterodistal regions than those of its neighbour Hox-4.7. Hence, Hox-4.8 expression appears to be related to the last significant phenotypic changes towards the extremities of the embryonic body and limb axes. PMID:1685889

  17. Anterior cruciate ligament and medial collateral ligament injuries.

    PubMed

    Bollier, Matthew; Smith, Patrick A

    2014-10-01

    The diagnosis and treatment of combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries have evolved over the past 30 years. A detailed physical examination along with careful review of the magnetic resonance imaging and stress radiographs will guide decision making. Early ACL reconstruction and acute MCL repair are recommended when there is increased medial joint space opening with valgus stress in extension, a significant meniscotibial deep MCL injury (high-riding medial meniscus), or a displaced tibial-sided superficial MCL avulsion (stener lesion of the knee). Delayed ACL reconstruction to allow for MCL healing is advised when increased valgus laxity is present only at 30 degrees of flexion and not at 0 degree. However, at the time of ACL surgery, medial stability has to be re-assessed after the reconstruction is completed. In patients with neutral alignment in the chronic setting, graft reconstruction of both the ACL and MCL is recommended.

  18. Detailed ophthalmologic evaluation of posterior microphthalmos.

    PubMed

    Alkin, Zeynep; Ozkaya, Abdullah; Karakucuk, Yalcin; Demirok, Ahmet

    2014-01-01

    We performed various ophthalmic investigations in order to confirm the diagnosis and document the various features of posterior microphthalmos in a 21-year-old male. Ophthalmic examination revealed low vision with high hyperopia, papillomacular folds, midperipheral pigmentary changes and crowded optic discs. The optic discs were small and crowded with increased nerve fiber layer thickness. Fundus fluorescein angiography showed reduced diameter of a capillary free zone. Anterior segment (AS) optical coherence tomography demonstrated near normal anterior chamber depths, but markedly diminished anterior chamber angles. In spite of the increased corneal thickness and steep corneas, lens thickness and endothelial cell counts were normal. Sclerochoroidal thickening and foreshortening of the globes were detected with B-scan ultrasonography. Electroretinographic findings and visual field tests were similar to those in pigmentary retinopathy. Posterior microphthalmos is a complex eye disorder, which affects predominantly the posterior segment but also involves the AS of the eye.

  19. Biomechanics of the anterior cruciate ligament: Physiology, rupture and reconstruction techniques.

    PubMed

    Domnick, Christoph; Raschke, Michael J; Herbort, Mirco

    2016-02-18

    The influences and mechanisms of the physiology, rupture and reconstruction of the anterior cruciate ligament (ACL) on kinematics and clinical outcomes have been investigated in many biomechanical and clinical studies over the last several decades. The knee is a complex joint with shifting contact points, pressures and axes that are affected when a ligament is injured. The ACL, as one of the intra-articular ligaments, has a strong influence on the resulting kinematics. Often, other meniscal or ligamentous injuries accompany ACL ruptures and further deteriorate the resulting kinematics and clinical outcomes. Knowing the surgical options, anatomic relations and current evidence to restore ACL function and considering the influence of concomitant injuries on resulting kinematics to restore full function can together help to achieve an optimal outcome.

  20. Biomechanics of the anterior cruciate ligament: Physiology, rupture and reconstruction techniques

    PubMed Central

    Domnick, Christoph; Raschke, Michael J; Herbort, Mirco

    2016-01-01

    The influences and mechanisms of the physiology, rupture and reconstruction of the anterior cruciate ligament (ACL) on kinematics and clinical outcomes have been investigated in many biomechanical and clinical studies over the last several decades. The knee is a complex joint with shifting contact points, pressures and axes that are affected when a ligament is injured. The ACL, as one of the intra-articular ligaments, has a strong influence on the resulting kinematics. Often, other meniscal or ligamentous injuries accompany ACL ruptures and further deteriorate the resulting kinematics and clinical outcomes. Knowing the surgical options, anatomic relations and current evidence to restore ACL function and considering the influence of concomitant injuries on resulting kinematics to restore full function can together help to achieve an optimal outcome. PMID:26925379

  1. Posterior cruciate supplementing total knee replacement using conforming inserts and cruciate recession. Effect on range of motion and radiolucent lines.

    PubMed

    Scott, R D; Thornhill, T S

    1994-12-01

    This study was performed to determine if a sagittally curved conforming tibial insert can be used with a retained, but balanced, posterior cruciate ligament without deleterious effects on range of motion (ROM) and tibial radiolucencies, as compared with a flatter insert that is less conforming and does not require cruciate balancing. The authors reviewed 50 consecutive primary knees implanted with flatter posterior lipped inserts and 50 consecutive primary knees with curved inserts and posterior cruciate ligament balancing. The average ROM for both groups was the same postoperatively as preoperatively: 111 degrees for the posterior lipped inserts and 113 degrees for the curved inserts. The incidence of tibial radiolucent lines was 8% for both groups. The authors conclude that sagittally curved, more conforming tibial inserts with retained, but balanced, posterior cruciate ligaments, do not adversely effect ROM and tibial radiolucencies. Their use forms an attractive compromise between the schools of cruciate preservation and cruciate substitution, maximizing their advantages while minimizing their disadvantages. Functional ROM can be achieved while bone stock is preserved, the joint line is restored, and wear characteristics are improved.

  2. Bioreactor Design for Tendon/Ligament Engineering

    PubMed Central

    Wang, Tao; Gardiner, Bruce S.; Lin, Zhen; Rubenson, Jonas; Kirk, Thomas B.; Wang, Allan; Xu, Jiake

    2013-01-01

    Tendon and ligament injury is a worldwide health problem, but the treatment options remain limited. Tendon and ligament engineering might provide an alternative tissue source for the surgical replacement of injured tendon. A bioreactor provides a controllable environment enabling the systematic study of specific biological, biochemical, and biomechanical requirements to design and manufacture engineered tendon/ligament tissue. Furthermore, the tendon/ligament bioreactor system can provide a suitable culture environment, which mimics the dynamics of the in vivo environment for tendon/ligament maturation. For clinical settings, bioreactors also have the advantages of less-contamination risk, high reproducibility of cell propagation by minimizing manual operation, and a consistent end product. In this review, we identify the key components, design preferences, and criteria that are required for the development of an ideal bioreactor for engineering tendons and ligaments. PMID:23072472

  3. Cyclic loading in knee ligament injuries.

    PubMed

    Weisman, G; Pope, M H; Johnson, R J

    1980-01-01

    The effect of cyclic loading on knee ligaments was studied both in vivo and in vitro. The compliance of the medial collateral ligaments of athletes participating in hockey, basketball, soccer, and downhill skiing was determined by using a specially built machine. Tests were conducted before and after participation in the various sports. Most subjects tested showed an increased compliance after their respective sporting activities. This observation was confirmed in the laboratory by imparting cyclic loading to 10 people under controlled conditions. The in vitro studies were conducted on the medial collateral ligaments of rats. These were tested to determine the effect of cyclic loading on the strength and stiffness of the ligaments. Results show a clear relationship between decreased stiffness or softening and a reduction in strength of the ligament. The amount of softening was related to the cyclic stress in the ligament.

  4. [Colposuspension of the sacrospinal ligament].

    PubMed

    Neri Ruz, E S; Ruiz Moreno, J A; Cárdenas Salinas, J

    1998-10-01

    During a period of 15 years, at the Hospital Central Militar, 36 operations were done to fix the vaginal cupule to sacrocyatic ligament, as therapeutic or preventive surgery; most of the fixations were together with vaginal hysterectomy by genital prolapse; and six of them were as surgical therapy of vaginal cupule prolapse. Complications were in 2.8% (one case), recidive of cupule prolapse and in 2.8% pudendal vein lesion. Long term result has been excellent, with minimal morbidity.

  5. Posterior Urethral Strictures.

    PubMed

    Gelman, Joel; Wisenbaugh, Eric S

    2015-01-01

    Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra. Emergency management includes suprapubic tube placement. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture (which is usually obliterative with a distraction defect) after suprapubic tube placement or urethral catheter removal, the standard of care is delayed urethral reconstruction with excision and primary anastomosis. This paper reviews the management of patients who suffer pelvic fracture urethral injuries and the techniques of preoperative urethral imaging and subsequent posterior urethroplasty. PMID:26691883

  6. Posterior Urethral Strictures

    PubMed Central

    Gelman, Joel; Wisenbaugh, Eric S.

    2015-01-01

    Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra. Emergency management includes suprapubic tube placement. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture (which is usually obliterative with a distraction defect) after suprapubic tube placement or urethral catheter removal, the standard of care is delayed urethral reconstruction with excision and primary anastomosis. This paper reviews the management of patients who suffer pelvic fracture urethral injuries and the techniques of preoperative urethral imaging and subsequent posterior urethroplasty. PMID:26691883

  7. Posterior Tibial Tendon Transfer.

    PubMed

    Shane, Amber M; Reeves, Christopher L; Cameron, Jordan D; Vazales, Ryan

    2016-01-01

    When performed correctly with the right patient population, a tibialis posterior muscle/tendon transfer is an effective procedure. Many different methods have been established for fixating the tendon, each of which has its' own indications. Passing through the interosseous membrane is the preferred and recommended method and should be used unless this is not possible. Good surgical planning based on patient needs and expectations, along with excellent postoperative care including early range of motion and physical therapy minimizes risk of complications and allows for the optimal outcome to be achieved. PMID:26590722

  8. Two-Stage Revision Anterior Cruciate Ligament Reconstruction.

    PubMed

    Erickson, Brandon J; Cvetanovich, Gregory; Waliullah, Khalid; Khair, Michael; Smith, Patrick; Bach, Bernard; Sherman, Seth

    2016-05-01

    The number of primary anterior cruciate ligament (ACL) tears is rapidly increasing. In patients who wish to return to their preoperative level of function, specifically as it pertains to participation in sports, the gold standard of treatment following an ACL tear remains an anterior cruciate ligament (ACL) reconstruction. Despite a majority of good/excellent results following primary ACL reconstruction, there is a growing subset of patients with persistent or recurrent functional instability who require revision ACL reconstruction. Preoperative planning for revision ACL reconstruction requires a careful understanding of the root cause of ACL failure, including possible technical causes of primary ACL failure and the presence of combined knee pathology that was not addressed at the index ACL reconstruction. The decision to perform 2-stage revision ACL reconstruction is multifactorial and is reached by technical considerations that may make a 1-stage revision less optimal, including tunnel widening, arthrofibrosis, active infection, and others. Concomitant knee pathology such as meniscal deficiency, malalignment (including an increase in posterior tibial slope), chondral lesions, and other ligamentous laxity may also require a staged approach to treatment. This evidence-based review covers the indications for 2-stage revision ACL reconstruction, surgical techniques, evidence for and technique of bone grafting prior ACL tunnels, and outcomes of 2-stage revision stratified by initial cause of ACL reconstruction failure. With proper preoperative planning and an understanding of the cause of failure following the primary ACL reconstruction, revision ACL reconstruction can offer excellent outcomes in the motivated patient. [Orthopedics. 2016; 39(3):e456-e464.]. PMID:27045480

  9. Posterior Cortical Atrophy

    PubMed Central

    Crutch, Sebastian J; Lehmann, Manja; Schott, Jonathan M; Rabinovici, Gil D; Rossor, Martin N; Fox, Nick C

    2013-01-01

    Posterior cortical atrophy (PCA) is a neurodegenerative syndrome that is characterized by a progressive decline in visuospatial, visuoperceptual, literacy and praxic skills. The progressive neurodegeneration affecting parietal, occipital and occipito-temporal cortices which underlies PCA is attributable to Alzheimer's disease (AD) in the majority of patients. However, alternative underlying aetiologies including Dementia with Lewy Bodies (DLB), corticobasal degeneration (CBD) and prion disease have also been identified, and not all PCA patients have atrophy on clinical imaging. This heterogeneity has led to diagnostic and terminological inconsistencies, caused difficulty comparing studies from different centres, and limited the generalizability of clinical trials and investigations of factors driving phenotypic variability. Significant challenges remain in identifying the factors associated with both the selective vulnerability of posterior cortical regions and the young age of onset seen in PCA. Greater awareness of the syndrome and agreement over the correspondence between syndrome-and disease-level classifications are required in order to improve diagnostic accuracy, research study design and clinical management. PMID:22265212

  10. Bicruciate Ligament Reconstruction in a Professional Rugby Player: Clinical Presentation and Literature Review

    PubMed Central

    Bohu, Yoann; Klouche, Shahnaz; Herman, Serge; Gerometta, Antoine; Lefevre, Nicolas

    2015-01-01

    The association of an anterior cruciate ligament (ACL) tear and a posterior cruciate ligament (PCL) injury is rare in athletes, and to our knowledge it has never been described in a professional rugby player. We report the case of a 27-year-old international professional rugby player who presented with an ACL tear associated with chronic posterior laxity on a former PCL tear. The procedure associated arthroscopic ACL and PCL reconstruction in a one-stage operation with two autografts, bone-patellar tendon-bone and hamstring tendon, respectively. At 7 months postoperatively, the patient had returned to playing rugby at the same level of play. The therapeutic strategy successfully met the established goals of returning to sports at the same level of play with excellent functional results after 2 years of follow-up. A literature review was performed via PubMed. The inclusion criteria were the studies in English language, assessing the return-to-sport after bicruciate ligament reconstruction in athletes. Eight studies were included in analysis. Only one study has focused on the return-to-sport in 24 competitive athletes and two other studies have included 1 professional athlete each. The overall rate of the return-to-sport after bicruciate reconstruction varied between 100% and 50%. PMID:26491590

  11. Novel posterior fixation keratoprosthesis

    NASA Astrophysics Data System (ADS)

    Lacombe, Emmanuel

    1992-08-01

    The keratoprosthesis is the last solution for corneally blind patients that cannot benefit from corneal transplants. Keratoprostheses that have been designed to be affixed anteriorly usually necessitate multi-step surgical procedures and are continuously subjected to the extrusion forces generated by the positive intraocular pressure; therefore, clinical results in patients prove inconsistent. We proposed a novel keratoprosthesis concept that utilizes posterior corneal fixation which `a priori' minimizes the risk of aqueous leakage and expulsion. This prosthesis is implanted in a single procedure thereby reducing the number of surgical complications normally associated with anterior fixation devices. In addition, its novel design makes this keratoprosthesis implantable in phakic eyes. With an average follow-up of 13 months (range 3 to 25 months), our results on 21 cases are encouraging. Half of the keratoprostheses were implanted in severe burn cases, with the remainder in cases of pseudo- pemphigus. Good visual results and cosmetic appearance were obtained in 14 of 21 eyes.

  12. Location and tension of the medial palpebral ligament.

    PubMed

    Hwang, Kun; Huan, Fan; Nam, Yong Seok; Han, Seung Ho; Kim, Dae Joong

    2013-11-01

    The aim of this study was to elucidate the precise anatomic location and tension of the medial palpebral ligament (MPL). Eleven hemifaces of 10 fresh Korean adult cadavers were used in this study. Nine specimens were used for measurement of dissection and tension, and 2 were used for histologic study. Measurements of tensile strength of each part of the MPL and Horner muscle were performed using a force gauge.The MPL consisted of 2 layers in all specimens dissected. The superficial layer of the palpebral ligament (SMPL) was observed from the anterior lacrimal crest to the upper and lower tarsal plates. The deep layer of the palpebral ligament (DMPL) lay from the anterior lacrimal crest to the posterior lacrimal crest, covering the lacrimal sac. The Horner muscle was observed at the posterior lacrimal crest just lateral to the attachment of the DMPL and ran laterally to the tarsal plate deep to the SMPL. The SMPL began at 4.5 ± 2.3 mm lateral to the nasomaxillary suture line to the upper and lower tarsal plates. Its transverse length was 9.6 ± 1.5 mm, and vertical width was 2.4 ± 0.7 mm, and its thickness was 4.5 ± 2.3 mm. The transverse length of the DMPL was 3.7 ± 0.4 mm, and its vertical width was 2.9 ± 1.3 mm, with a thickness of 0.3 ± 0.1 mm. The transverse length of the Horner muscle was 7.6 ± 1.9 mm, and its vertical width was 4.06 ± 1.5 mm, with a thickness of 0.4 ± 0.1 mm. The tensile strength of the SMPL was 13.4 ± 3.2 N, that of the DMPL was 4.1 ± 1.7 N, and that for Horner muscle was 9.0 ± 3.1 N. The tensile strength of the SMPL was significantly higher than that of the DMPL (P = 0.003).We reconfirmed that the MPL consisted of 2 layers: superficial layer and deep layer. Our results might be of use in surgeries of the medial canthi.

  13. Posterior instability caused by batter's shoulder.

    PubMed

    Kang, Richard W; Mahony, Gregory T; Harris, Thomas C; Dines, Joshua S

    2013-10-01

    In summary, batter’s shoulder is a rare and only recently recognized entity. This condition is posterior shoulder instability caused by a missed attempt at hitting a pitch, especially with an outside pitch. The lack of counterforce from hitting a ball produces increased forces imparted on the posterior capsulolabral complex of the lead shoulder during batting. If the player fails conservative management, she or he can undergo an arthroscopic posterior labral repair instead of debridement. After treatment, the player can expect to return to play after approximately 6 to 7 months. Initial results from a small, retrospective series demonstrate greater than 90% excellent results. These findings are similar to current literature for arthroscopic treatment of posterior instability, which reports success rates that range from 75% to 91%. Longer-term follow-up will be needed to determine the natural history and prognosis or batter’s shoulder. Based on initial results, the authors predict good to excellent results for most players with batter’s shoulder who undergo proper treatment. Additionally, with the exception of switch hitters, the nonthrowing arm is affected. This can also improve the athlete’s return to play.

  14. Posterior instability caused by batter's shoulder.

    PubMed

    Kang, Richard W; Mahony, Gregory T; Harris, Thomas C; Dines, Joshua S

    2013-10-01

    In summary, batter’s shoulder is a rare and only recently recognized entity. This condition is posterior shoulder instability caused by a missed attempt at hitting a pitch, especially with an outside pitch. The lack of counterforce from hitting a ball produces increased forces imparted on the posterior capsulolabral complex of the lead shoulder during batting. If the player fails conservative management, she or he can undergo an arthroscopic posterior labral repair instead of debridement. After treatment, the player can expect to return to play after approximately 6 to 7 months. Initial results from a small, retrospective series demonstrate greater than 90% excellent results. These findings are similar to current literature for arthroscopic treatment of posterior instability, which reports success rates that range from 75% to 91%. Longer-term follow-up will be needed to determine the natural history and prognosis or batter’s shoulder. Based on initial results, the authors predict good to excellent results for most players with batter’s shoulder who undergo proper treatment. Additionally, with the exception of switch hitters, the nonthrowing arm is affected. This can also improve the athlete’s return to play. PMID:24079435

  15. The effect of exercise on anterior-posterior knee laxity.

    PubMed

    Steiner, M E; Grana, W A; Chillag, K; Schelberg-Karnes, E

    1986-01-01

    A commercial knee laxity testing device was used to quantitate anterior and posterior laxity before and after exercise. Measurements were made at 20 degrees of knee flexion and with a displacement force of 133 N (30 pounds). In sedentary controls no significant change in laxity was noted over 2 hours. Squat power lifters sustained no significant change in laxity after a series of squats (0.4 to 0.7 cm) using 1.6 times body weight. However, 18% to 20% increases in mean anterior and posterior laxity were noted in college basketball players after 90 minutes of practice and in recreational runners after a 10 km race. The role of muscle relaxation in such tests was also evaluated by measuring laxity in normal knees before and during general anesthesia. Negligible laxity change was noted. Thus, functionally "complete" muscle relaxation can be obtained during testing in the cooperative individual. In conclusion, basketball players and distance runners experienced a transient increase in anterior and posterior laxity during exercise. Power lifters doing squats did not demonstrate a significant change in laxity. It appears that repetitive physiologic stresses at a high strain rate produce significant ligamentous laxity, while a relatively few large stresses at a low strain rate do not.

  16. Ligament length patterns, strength, and rotational axes of the knee joint.

    PubMed

    Trent, P S; Walker, P S; Wolf, B

    1976-06-01

    Using intact fresh specimens, the cruciate ligament lengths for positions of flexion and internal-external rotation were computed using a non-invasive technique; using photographic methods, the centers of transverse rotation on the tibia and the direction of the flexion axis were also obtained. The anterior cruciate was found to be particularly effective in restraining internal tibial rotation; the ability of the posterior cruciate to restrain external rotation, however, depended strongly on the transverse axis location. Ligament length changes during flexion were found to be small in the absence of rotary torque and anteroposterior forces. The average internal rotation occurring during flexion was 37 degrees, half of which took place during the first 15 degrees of flexion. Ultimate rupture strengths of approximately 60 kh for the cruciates were measured, with stiffnesses of 16 kg/mm.

  17. Effect of malpositioned anterior cruciate ligament replacement on knee joint structures: a biomechanical model.

    PubMed

    Horas, Uwe; Meissner, Stefan A; Kraus, Ralf; Heiss, Christian; Schnettler, Reinhard

    2011-12-01

    Any sort of malpositioning of anterior cruciate ligament (ACL) replacement leads to an overload of single fibers of the ACL replacement. As long as this does not result in a tear of these fibers so that isometry of the ACL replacement is restored, the abnormal forces acting in and on the ACL replacement are transmitted from the ACL replacement to the remainder of the knee joint structures. We assumed that the posterior cruciate ligament (PCL) is notably affected. The present biomechanical model illustrates the relevant force vectors and reveals the extent of the effect of malpositioned ACL replacement on knee joint structures, particularly the PCL. Further investigations are needed to find out if the presumably occurring overload of a malpositioned ACL replacement can be calculated from its position on an individual basis. This may help deduce recommendations for ACL replacement procedures in the future.

  18. Posterior Tibialis Tendon Dysfunction: Overview of Evaluation and Management.

    PubMed

    Yao, Kaihan; Yang, Timothy Xianyi; Yew, Wei Ping

    2015-06-01

    EDUCATIONAL OBJECTIVES As a result of reading this article, physicians should be able to: 1. Recognize posterior tibialis tendon dysfunction and begin to include it in differential diagnoses. 2. Recall the basic anatomy and pathology of the posterior tibialis tendon. 3. Assess a patient for posterior tibialis tendon dysfunction with the appropriate investigations and stratify the severity of the condition. 4. Develop and formulate a treatment plan for a patient with posterior tibialis tendon dysfunction. The posterior tibialis is a muscle in the deep posterior compartment of the calf that plays several key roles in the ankle and foot. Posterior tibialis tendon dysfunction is a complex but common and debilitating condition. Degenerative, inflammatory, functional, and traumatic etiologies have all been proposed. Despite being the leading cause of acquired flatfoot, it is often not recognized early enough. Knowledge of the anatomical considerations and etiology of posterior tibialis tendon dysfunction, as well as key concepts in its evaluation and management, will allow health care professionals to develop appropriate intervention strategies to prevent further development of flatfoot deformities. PMID:26091214

  19. Changes in dynamic medial tibiofemoral contact mechanics and kinematics after injury of the anterior cruciate ligament: a cadaveric model.

    PubMed

    Bedi, Asheesh; Chen, Tony; Santner, Thomas J; El-Amin, Saadiq; Kelly, Natalie H; Warren, Russell F; Maher, Suzanne A

    2013-09-01

    The effects of tears of the anterior cruciate ligament on knee kinematics and contact mechanics during dynamic everyday activities, such as gait, remains unclear. The objective of this study was to characterize anterior cruciate ligament-deficient knee contact mechanics and kinematics during simulated gait. Nine human cadaveric knees were each augmented with a sensor capable of measuring dynamic normal contact stresses on the tibial plateau, mounted on a load-controlled simulator, and subjected to physiological, multidirectional, dynamic loads to mimic gait. Using a mixed model with random knee identifiers, confidence intervals were constructed for contact stress before and after anterior cruciate ligament transection at two points in the gait cycle at which axial force peaked (14% and 45% of the gait cycle). Kinematic and contact mechanics changes after anterior cruciate ligament transection were highly variable across knees. Nonetheless, a statistically significant increase in contact stress in the posterior-central aspect of the medial tibial plateau at 45% of the gait cycle was identified, the location of which corresponds to the location of degenerative changes that are frequently found in patients with chronic anterior cruciate ligament injury. The variability in the contact stress in other regions of the medial plateau at 45% of the gait cycle was partly explained by the variations in osseous geometry across the nine knees tested. At 14% of gait, there was no significant change in peak contact stress after anterior cruciate ligament transection in any of the four quadrants, and none of the possible explanatory variables showed statistical significance. Understanding the variable effect of anterior cruciate ligament injury on contact mechanics based on geometric differences in osseous anatomy is of paramount clinical importance and may be invaluable to select the best reconstruction techniques and counsel patients on their individual risk of subsequent

  20. Anatomy of the ankle ligaments: a pictorial essay.

    PubMed

    Golanó, Pau; Vega, Jordi; de Leeuw, Peter A J; Malagelada, Francesc; Manzanares, M Cristina; Götzens, Víctor; van Dijk, C Niek

    2016-04-01

    Understanding the anatomy of the ankle ligaments is important for correct diagnosis and treatment. Ankle ligament injury is the most frequent cause of acute ankle pain. Chronic ankle pain often finds its cause in laxity of one of the ankle ligaments. In this pictorial essay, the ligaments around the ankle are grouped, depending on their anatomic orientation, and each of the ankle ligaments is discussed in detail.

  1. Gossypiboma mimicking posterior urethral stricture

    PubMed Central

    Kumar, Bindey; Kumar, Prem; Sinha, Sanjay Kumar; Sinha, Neelam; Hasan, Zaheer; Thakur, Vinit Kumar; Anand, Utpal; Priyadarshi, Rajiv Nayan; Mandal, Manish

    2013-01-01

    INTRODUCTION Foreign bodies in the urogenital tract are not uncommon. Hairpins, glass rods, umbilical tapes, ball point pen are described in lower urogenital tract. Retained gauze piece (gossypiboma) in posterior urethra may cause diagnostic dilemma. Symptoms and investigations may mimic stricture of posterior urethra. PRESENTATION OF CASE Two cases of retained gauze pieces in the urethra are described here. The micturating cystourethrogram was suggestive of posterior urethral stricture. DISCUSSION Two cases described here had retained gauze piece as a cause of filling defect and abnormal appearance in the micturating cystourethrogram. Gossypiboma may be a possibility where posterior urethral stricture are seen after previous surgery in paediatric age group. CONCLUSION In the setting of previous urogenital surgery gossypiboma should be kept in the differential diagnosis where posterior urethral stricture are seen in the paediatric age group. PMID:23500749

  2. Transverse ligament of the knee in humans.

    PubMed

    Ratajczak, Wojciech; Jakubowicz, Marian; Pytel, Andrzej

    2003-01-01

    The purpose of this study was to trace the histological structure of the transverse ligament of the knee and its relation to the inferior lateral genicular artery. Investigations were carried out on 20 lower limbs (10 males, and 10 females) from the Department of Anatomy. It was found that close to the attachment of the transverse ligament to the menisci, bundles of fibres pass in vertical, oblique and horizontal directions, occupying a wide area on the anterior margin of the menisci. These fibres intermingle with bundles of the fibrocartilage of the menisci. In the area of the lateral attachment the inferior lateral genicular artery passes anteriorly to the transverse ligament, giving off numerous branches to the ligament. The medial part of the transverse ligament presents a thick rounded structure, surrounded by loose connective tissue. The fibres are arranged irregularly in bundles running horizontally on a tortuous course and with single spindle-like cells with darkly stained nuclei. The cells are not found at the ends of the ligament. Numerous blood vessels are observed between the bundles of fibres and on the periphery of the ligament.

  3. Translational and rotational knee joint stability in anterior and posterior cruciate-retaining knee arthroplasty.

    PubMed

    Lo, JiaHsuan; Müller, Otto; Dilger, Torsten; Wülker, Nikolaus; Wünschel, Markus

    2011-12-01

    This study investigated passive translational and rotational stability properties of the intact knee joint, after bicruciate-retaining bi-compartmental knee arthroplasty (BKA) and after posterior cruciate retaining total knee arthroplasty (TKA). Fourteen human cadaveric knee specimens were used in this study, and a robotic manipulator with six-axis force/torque sensor was used to test the joint laxity in anterior-posterior translation, valgus-varus, and internal-external rotation. The results show the knee joint stability after bicruciate-retaining BKA is similar to that of the native knee. On the other hand, the PCL-retaining TKA results in inferior joint stability in valgus, varus, external rotation, anterior and, surprisingly, posterior directions. Our findings suggest that, provided functional ligamentous structures, bicruciate-retaining BKA is a biomechanically attractive treatment for joint degenerative disease.

  4. Functional tissue engineering of ligament healing

    PubMed Central

    2010-01-01

    Ligaments and tendons are dense connective tissues that are important in transmitting forces and facilitate joint articulation in the musculoskeletal system. Their injury frequency is high especially for those that are functional important, like the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) of the knee as well as the glenohumeral ligaments and the rotator cuff tendons of the shoulder. Because the healing responses are different in these ligaments and tendons after injury, the consequences and treatments are tissue- and site-specific. In this review, we will elaborate on the injuries of the knee ligaments as well as using functional tissue engineering (FTE) approaches to improve their healing. Specifically, the ACL of knee has limited capability to heal, and results of non-surgical management of its midsubstance rupture have been poor. Consequently, surgical reconstruction of the ACL is regularly performed to gain knee stability. However, the long-term results are not satisfactory besides the numerous complications accompanied with the surgeries. With the rapid development of FTE, there is a renewed interest in revisiting ACL healing. Approaches such as using growth factors, stem cells and scaffolds have been widely investigated. In this article, the biology of normal and healing ligaments is first reviewed, followed by a discussion on the issues related to the treatment of ACL injuries. Afterwards, current promising FTE methods are presented for the treatment of ligament injuries, including the use of growth factors, gene delivery, and cell therapy with a particular emphasis on the use of ECM bioscaffolds. The challenging areas are listed in the future direction that suggests where collection of energy could be placed in order to restore the injured ligaments and tendons structurally and functionally. PMID:20492676

  5. The Simultaneous Modeling Technique: closing gaps in posteriors.

    PubMed

    Scolavino, Salvatore; Paolone, Gaetano; Orsini, Giovanna; Devoto, Walter; Putignano, Angelo

    2016-01-01

    Direct posterior restorations represent a widespread procedure in daily practice. Occlusal layering is often considered a complex task, generally not predictable and often requiring several occlusal adjustments. Moreover, direct posterior restorations are time consuming, as many small increments must be applied and cured individually to control shrinkage stress. Several authors have proposed different material layering techniques for posteriors. The authors of this article propose a simplified approach, which primarily aims to help the clinician perform quick, simple, predictable, and natural-looking occlusal modeling, reducing the need for occlusal adjustments.

  6. The Simultaneous Modeling Technique: closing gaps in posteriors.

    PubMed

    Scolavino, Salvatore; Paolone, Gaetano; Orsini, Giovanna; Devoto, Walter; Putignano, Angelo

    2016-01-01

    Direct posterior restorations represent a widespread procedure in daily practice. Occlusal layering is often considered a complex task, generally not predictable and often requiring several occlusal adjustments. Moreover, direct posterior restorations are time consuming, as many small increments must be applied and cured individually to control shrinkage stress. Several authors have proposed different material layering techniques for posteriors. The authors of this article propose a simplified approach, which primarily aims to help the clinician perform quick, simple, predictable, and natural-looking occlusal modeling, reducing the need for occlusal adjustments. PMID:26835524

  7. Postoperative posterior spinal wound infections.

    PubMed

    Massie, J B; Heller, J G; Abitbol, J J; McPherson, D; Garfin, S R

    1992-11-01

    The incidence of postoperative spinal infections increases with the complexity of the procedure. Diskectomy is associated with less than a 1% risk of infection; spinal fusion without instrumentation is associated with a 1%-5% risk; and fusion with instrumentation may be associated with a risk of 6% or more. Twenty-two postoperative posterior spinal infections that occurred during a three-year period were reviewed for this report. Staphylococcus aureus was the most frequent organism cultured (more than 50% of the cases). Other recurring organisms were Staphylococcus epidermis, Peptococcus, Enterobacter cloacae, and Bacteroides. Many patients had multiple organisms. Risk factors appeared to include advanced age, prolonged hospital bed rest, obesity, diabetes, immunosuppression, and infection at remote sites. Operative factors included prolonged surgery (greater than five hours), high volume of personnel moving through the operating room, and instrumentation. Postoperative contamination may occur and may be related to prolonged postoperative bed rest, skin maceration (thoracolumbosacral orthoses), and drainage tubes exiting distally from lumbar wounds (toward the rectum). Effective treatment includes early diagnosis, surgical debridement and irrigation, and parenteral antibiotics. Superficial infections were treated successfully with wound closure over outflow tubes, and deep infections with inflow-outflow systems. Maintaining the instrumentation in place was possible in most cases. Parenteral antibiotics were maintained for six weeks in every case. PMID:1395319

  8. Role of biomechanics in the understanding of normal, injured, and healing ligaments and tendons

    PubMed Central

    Jung, Ho-Joong; Fisher, Matthew B; Woo, Savio L-Y

    2009-01-01

    Ligaments and tendons are soft connective tissues which serve essential roles for biomechanical function of the musculoskeletal system by stabilizing and guiding the motion of diarthrodial joints. Nevertheless, these tissues are frequently injured due to repetition and overuse as well as quick cutting motions that involve acceleration and deceleration. These injuries often upset this balance between mobility and stability of the joint which causes damage to other soft tissues manifested as pain and other morbidity, such as osteoarthritis. The healing of ligament and tendon injuries varies from tissue to tissue. Tendinopathies are ubiquitous and can take up to 12 months for the pain to subside before one could return to normal activity. A ruptured medial collateral ligament (MCL) can generally heal spontaneously; however, its remodeling process takes years and its biomechanical properties remain inferior when compared to the normal MCL. It is also known that a midsubstance anterior cruciate ligament (ACL) tear has limited healing capability, and reconstruction by soft tissue grafts has been regularly performed to regain knee function. However, long term follow-up studies have revealed that 20–25% of patients experience unsatisfactory results. Thus, a better understanding of the function of ligaments and tendons, together with knowledge on their healing potential, may help investigators to develop novel strategies to accelerate and improve the healing process of ligaments and tendons. With thousands of new papers published in the last ten years that involve biomechanics of ligaments and tendons, there is an increasing appreciation of this subject area. Such attention has positively impacted clinical practice. On the other hand, biomechanical data are complex in nature, and there is a danger of misinterpreting them. Thus, in these review, we will provide the readers with a brief overview of ligaments and tendons and refer them to appropriate methodologies used to

  9. Synthetic grafts for anterior cruciate ligament reconstruction.

    PubMed

    Longo, Umile Giuseppe; Rizzello, Giacomo; Berton, Alessandra; Fumo, Caterina; Maltese, Ludovica; Khan, Wasim S; Denaro, Vincenzo

    2013-11-01

    Several artificial biomaterials are available as ligament grafts. No ideal prosthesis mimicking natural human tissue have been found to date. The emerging field of tissue engineering holds the promise to use artificial ligaments as a viable alternative to the patellar or hamstring tendon autografts. Preliminary studies support the idea that these biomaterials have the ability to provide an alternative for autogenous grafts. However, no definitive conclusions have been found. Additionally, the incidence of postoperative complications varies within different studies. Prospective investigations are required to better understand the potential of artificial biomaterials as ligament grafts.

  10. Ligamentous laxity in secondary school athletes.

    PubMed

    Grana, W A; Moretz, J A

    1978-10-27

    An increase in ligamentous laxity has been said to predispose athletes to injury of the joint. To evaluate the usefulness of testing ligamentous laxity to predict a predisposition to injury in secondary school athletes, 166 male football players, 84 female basketball players, and 32 male basketball players were tested. The results were compared with those for 167 males and 223 females in high school but not involved in interscholastic sports. No correlation could be found between ligamentous laxity and the occurrence or type of injury.

  11. [Ankle braces prevent ligament injuries].

    PubMed

    Karlsson, Jon

    2002-09-01

    The Cochrane collaboration has performed a meta-analysis of all studies found on the prevention of ankle ligament injuries, frequent in sports like soccer, European handball and basketball. Interventions include the use of modified footwear and associated supports, training programmes and health education. Five randomized trials totalling 3,954 participants were included. With the exception of ankle disc training, all prophylactic interventions entailed the application of an external ankle support in the form of a semi-rigid orthosis, air-cast or high top shoes. The studies showed a significant reduction in the number of ankle sprains in individuals allocated to external ankle support. This reduction was greater for those with a previous history of ankle sprains.

  12. Anatomical reconstruction of popliteofibular ligament using looped biceps femoris tendon: a case report.

    PubMed

    Watanabe, Nobuyoshi; Yoshino, Nobuyuki; Fukuda, Yukihisa; Fujita, Nobuhiko; Takai, Shinro

    2008-04-01

    We describe a case of popliteofibular ligament (PFL) injury, successfully treated with a new anatomic reconstruction technique looping the biceps femoris tendon (BT). The anterior half of the BT was split longitudinally from the fibular insertion, cut at the proximal end and left attached at the insertion. The proximal end of the BT was looped back in a slit made in the popliteal tendon (PT) at the original anatomical insertion site of the PFL, and passed through the tunnel from the posterior and the baseball suture was tightened on the anterior cortex of fibular head.

  13. Anterior cruciate ligament repair - Series (image)

    MedlinePlus

    ... removed using a shaver or other instruments. Bone tunnels are made to place the new ligament (patellar ... used to secure the graft in the bone tunnels, although other methods of fixation are used depending ...

  14. Revision Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Wilde, Jeffrey; Bedi, Asheesh; Altchek, David W.

    2014-01-01

    Context: Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures, with more than 200,000 ACL tears occurring annually. Although primary ACL reconstruction is a successful operation, success rates still range from 75% to 97%. Consequently, several thousand revision ACL reconstructions are performed annually and are unfortunately associated with inferior clinical outcomes when compared with primary reconstructions. Evidence Acquisition: Data were obtained from peer-reviewed literature through a search of the PubMed database (1988-2013) as well as from textbook chapters and surgical technique papers. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinical outcomes after revision ACL reconstruction are largely based on level IV case series. Much of the existing literature is heterogenous with regard to patient populations, primary and revision surgical techniques, concomitant ligamentous injuries, and additional procedures performed at the time of the revision, which limits generalizability. Nevertheless, there is a general consensus that the outcomes for revision ACL reconstruction are inferior to primary reconstruction. Conclusion: Excellent results can be achieved with regard to graft stability, return to play, and functional knee instability but are generally inferior to primary ACL reconstruction. A staged approach with autograft reconstruction is recommended in any circumstance in which a single-stage approach results in suboptimal graft selection, tunnel position, graft fixation, or biological milieu for tendon-bone healing. Strength-of-Recommendation Taxonomy (SORT): Good results may still be achieved with regard to graft stability, return to play, and functional knee instability, but results are generally inferior to primary ACL reconstruction: Level B. PMID:25364483

  15. Biomechanical Evaluation of Ligamentous Stabilizers of the Scaphoid and Lunate

    PubMed Central

    Short, Walter H.; Werner, Frederick W.; Green, Jason K.; Masaoka, Shunji

    2007-01-01

    This study evaluated the effects of sectioning the scapholunate interosseous ligament, radioscaphocapitate ligament, and scaphotrapezial ligament on the kinematics of the scaphoid and lunate. Eight cadaver upper extremities were placed in a wrist joint simulator and moved in continuous cycles of flexion-extension and radial-ulnar deviation. Positional data of the scaphoid and lunate were obtained in the intact state, after the scapholunate ligament was cut; after the scapholunate and scaphotrapezial ligaments were cut; after the scapholunate, scaphotrapezial, and radioscaphocapitate ligaments were cut; and after all 3 ligaments were cut and the specimen was placed through an additional 1,000 cycles of flexion-extension. Cutting the scapholunate ligament caused changes in scaphoid and lunate motion during flexion-extension, but not radial-ulnar deviation. Additional sectioning of the scaphotrapezial ligament followed by the radioscaphocapitate ligament caused further kinematic changes in these carpal bones. One thousand cycles of motion after all 3 ligaments were sectioned caused additional kinematic changes in the scaphoid and lunate. The scapholunate ligament appears to be the primary stabilizer between the scaphoid and lunate. The radioscaphocapitate and scaphotrapezial ligaments are secondary restraints. Repetitive cyclic motion after ligament sectioning appears to have additional deleterious effects on carpal kinematics. PMID:12457349

  16. Medial Patellofemoral Ligament Reconstruction: Fixation Technique Biomechanics.

    PubMed

    Russo, Franco; Doan, Joshua; Chase, Derek C; Farnsworth, Christine L; Pennock, Andrew T

    2016-05-01

    Introduction The medial patellofemoral ligament (MPFL) is the primary soft-tissue stabilizer of the patella and it is often reconstructed in patients with recurrent patella instability. This biomechanical analysis evaluates the integrity of four methods of MPFL reconstruction subjected to cyclic loading using a porcine model. Methods Four techniques of MPFL reconstruction were analyzed using a 4 mm flexor tendon graft, all with two points of patellar fixation to best recreate the native MPFL anatomy. The four techniques were: (1) interference screw technique, (2) suture anchor technique, (3) converging tunnel technique, and (4) two bone tunnel technique. Maximum load, yield load, and stiffness of the graft fixation/bone complex were analyzed, and statistics were performed with SPSS and significance set at a p-value of < 0.05. Results The converging tunnel technique demonstrated the highest maximum load and yield load, significantly higher than the interference screw or suture anchor groups (p = 0.007). In addition, the converging tunnel technique demonstrated the greatest stiffness with significantly greater stiffness than the two bone tunnel techniques (p = 0.016). Conclusion The combination of strength and stiffness, the avoidance of patella implants, and the creation of a single transosseous tunnel make the converging tunnel technique a desirable technique for MPFL reconstructions. PMID:26190788

  17. Failure of Anterior Cruciate Ligament Reconstruction.

    PubMed

    Samitier, Gonzalo; Marcano, Alejandro I; Alentorn-Geli, Eduard; Cugat, Ramon; Farmer, Kevin W; Moser, Michael W

    2015-10-01

    The present review classifies and describes the multifactorial causes of anterior cruciate ligament (ACL) surgery failure, concentrating on preventing and resolving such situations. The article particularly focuses on those causes that require ACL revision due to recurrent instability, without neglecting those that affect function or produce persistent pain. Although primary ACL reconstruction has satisfactory outcome rates as high as 97%, it is important to identify the causes of failure, because satisfactory outcomes in revision surgery can drop to as much as 76%. It is often possible to identify a primary or secondary cause of ACL surgery failure; even the most meticulous planning can give rise to unexpected findings during the intervention. The adopted protocol should therefore be sufficiently flexible to adapt to the course of surgery. Preoperative patient counseling is essential. The surgeon should limit the patient's expectations for the outcome by explaining the complexity of this kind of procedure. With adequate preoperative planning, close attention to details and realistic patient expectations, ACL revision surgery may offer beneficial and satisfactory results for the patient. PMID:26550585

  18. Failure of Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Samitier, Gonzalo; Marcano, Alejandro I.; Alentorn-Geli, Eduard; Cugat, Ramon; Farmer, Kevin W; Moser, Michael W

    2015-01-01

    The present review classifies and describes the multifactorial causes of anterior cruciate ligament (ACL) surgery failure, concentrating on preventing and resolving such situations. The article particularly focuses on those causes that require ACL revision due to recurrent instability, without neglecting those that affect function or produce persistent pain. Although primary ACL reconstruction has satisfactory outcome rates as high as 97%, it is important to identify the causes of failure, because satisfactory outcomes in revision surgery can drop to as much as 76%. It is often possible to identify a primary or secondary cause of ACL surgery failure; even the most meticulous planning can give rise to unexpected findings during the intervention. The adopted protocol should therefore be sufficiently flexible to adapt to the course of surgery. Preoperative patient counseling is essential. The surgeon should limit the patient’s expectations for the outcome by explaining the complexity of this kind of procedure. With adequate preoperative planning, close attention to details and realistic patient expectations, ACL revision surgery may offer beneficial and satisfactory results for the patient. PMID:26550585

  19. Arthroscopic repair for a flap tear of the posterior horn of the lateral meniscus adjacent to its tibial insertion.

    PubMed

    Shino, K; Hamada, M; Mitsuoka, T; Kinoshita, H; Toritsuka, Y

    1995-08-01

    A flap tear of the posterior horn of the lateral meniscus adjacent to its tibial insertion combined with acute rupture of the anterior cruciate ligament was successfully repaired arthroscopically by a combination of advancement of the tip of the flap into a drill hole created in the tibia and an inside-out stacked suture technique using Henning instrumentation in two cases. However, the long-term function of the repaired menisci, which was reduced several millimeters in circumferential length, is still unknown.

  20. Rehabilitation of anterior cruciate ligament injuries.

    PubMed

    Halling, A H; Howard, M E; Cawley, P W

    1993-04-01

    Rehabilitation of the anterior cruciate ligament absent or reconstructed knee is becoming a true artform. Accelerated, but controlled rehabilitation, is becoming more commonplace. Scientific-based data along with clinical experiences are the basis of the rehabilitation guidelines brought forth in this article. Anterior cruciate ligament strain and implications for exercise, continuous passive motion, proprioceptive exercise, and the role of knee bracing are all discussed in relation to the overall rehabilitation program.

  1. Anterior cruciate ligament allograft transplantation. Long-term function, histology, revascularization, and operative technique.

    PubMed

    Nikolaou, P K; Seaber, A V; Glisson, R R; Ribbeck, B M; Bassett, F H

    1986-01-01

    In recent years much effort has been devoted to finding a satisfactory replacement for the injured ACL. None of the reconstruction techniques used in the past can be considered ideal because of their inability to duplicate the complex geometry, structure, and function of the ligament. Current advances in allograft transplantation and cryopreservation have led us to design and implement an experimental model for testing the feasibility of cryopreserved ACL allotransplantation. Groups of dogs were used to evaluate the effect of cryopreservation on ligament strength and to compare the relative performance of both autograft and allograft ACL transplants up to 18 months after implantation. The ligaments were examined mechanically, histologically, and microangiographically. The cryopreservation process and duration of storage had no effect on the biomechanical or structural properties of the ligament. The mechanical integrity of the allografts was similar to that of the autografts, with both achieving nearly 90% of control ligament strength by 36 weeks. Revascularization approached normal by 24 weeks in both autograft and allograft. No evidence of structural degradation or immunological reaction was seen. Based on these results, we believe that a cryopreserved ACL allograft can provide the ideal material for ACL reconstruction. We have outlined a surgical technique for harvesting and implanting this graft clinically.

  2. Anterior cruciate ligament allograft transplantation. Long-term function, histology, revascularization, and operative technique.

    PubMed

    Nikolaou, P K; Seaber, A V; Glisson, R R; Ribbeck, B M; Bassett, F H

    1986-01-01

    In recent years much effort has been devoted to finding a satisfactory replacement for the injured ACL. None of the reconstruction techniques used in the past can be considered ideal because of their inability to duplicate the complex geometry, structure, and function of the ligament. Current advances in allograft transplantation and cryopreservation have led us to design and implement an experimental model for testing the feasibility of cryopreserved ACL allotransplantation. Groups of dogs were used to evaluate the effect of cryopreservation on ligament strength and to compare the relative performance of both autograft and allograft ACL transplants up to 18 months after implantation. The ligaments were examined mechanically, histologically, and microangiographically. The cryopreservation process and duration of storage had no effect on the biomechanical or structural properties of the ligament. The mechanical integrity of the allografts was similar to that of the autografts, with both achieving nearly 90% of control ligament strength by 36 weeks. Revascularization approached normal by 24 weeks in both autograft and allograft. No evidence of structural degradation or immunological reaction was seen. Based on these results, we believe that a cryopreserved ACL allograft can provide the ideal material for ACL reconstruction. We have outlined a surgical technique for harvesting and implanting this graft clinically. PMID:3777311

  3. Comparison of aesthetic posterior restorations.

    PubMed

    Trushkowsky, R D

    1991-09-01

    In the past decade there has been an increased desire by the profession and the public for an aesthetic restoration that will restore a posterior tooth to its original form and function. The currently available aesthetic posterior restoration materials and techniques are porcelain, cast ceramic, direct composite, direct-indirect composite, indirect composite, and CAD-CAM fabrications. The indications and contraindications of these restorative materials and proper diagnosis and case selection are described.

  4. An improved OpenSim gait model with multiple degrees of freedom knee joint and knee ligaments.

    PubMed

    Xu, Hang; Bloswick, Donald; Merryweather, Andrew

    2015-08-01

    Musculoskeletal models are widely used to investigate joint kinematics and predict muscle force during gait. However, the knee is usually simplified as a one degree of freedom joint and knee ligaments are neglected. The aim of this study was to develop an OpenSim gait model with enhanced knee structures. The knee joint in this study included three rotations and three translations. The three knee rotations and mediolateral translation were independent, with proximodistal and anteroposterior translations occurring as a function of knee flexion/extension. Ten elastic elements described the geometrical and mechanical properties of the anterior and posterior cruciate ligaments (ACL and PCL), and the medial and lateral collateral ligaments (MCL and LCL). The three independent knee rotations were evaluated using OpenSim to observe ligament function. The results showed that the anterior and posterior bundles of ACL and PCL (aACL, pACL and aPCL, pPCL) intersected during knee flexion. The aACL and pACL mainly provided force during knee flexion and adduction, respectively. The aPCL was slack throughout the range of three knee rotations; however, the pPCL was utilised for knee abduction and internal rotation. The LCL was employed for knee adduction and rotation, but was slack beyond 20° of knee flexion. The MCL bundles were mainly used during knee adduction and external rotation. All these results suggest that the functions of knee ligaments in this model approximated the behaviour of the physical knee and the enhanced knee structures can improve the ability to investigate knee joint biomechanics during various gait activities.

  5. Estrogen-dependent tensile properties of the rabbit knee medial collateral ligament.

    PubMed

    Räsänen, T; Messner, K

    2000-02-01

    The influence of oophorectomy or continuous administration of estradiol on the tensile properties of the rabbit knee medial collateral ligament was investigated. Young postpubertal female New Zealand white rabbits were either oophorectomized or underwent a sham operation. The sham-operated animals received in addition a daily dosage of 4 mg 17beta-estradiol. After 5 months the animals were killed, and the material properties of the bone-ligament-bone complex in one knee were determined using a material testing machine and video system, and compared to non-treated control animals. There was no difference in elastic modulus between the groups. However, the ligaments from low-dose estrogen-treated animals had a smaller cross-sectional area and a higher ultimate tensile strength than those from controls or oophorectomized rabbits (P<0.04-0.0003).

  6. Failure modes and fracture toughness in partially torn ligaments and tendons.

    PubMed

    Von Forell, Gregory A; Hyoung, Peter S; Bowden, Anton E

    2014-07-01

    Ligaments and tendons are commonly torn during injury, yet the likelihood that untreated initial tears could lead to further tearing or even full rupture has proven challenging to predict. In this work, porcine Achilles tendon and human anterior longitudinal ligament samples were tested using both standard fracture toughness methods and complex loading conditions. Failure modes for each of 14 distinct testing cases were evaluated using a total of 131 soft tissue tests. Results showed that these soft tissues were able to completely resist any further crack propagation of an initial tear, regardless of fiber orientation or applied loading condition. Consequently, the major concern for patients with tendon or ligament tears is likely not reduction in ultimate tissue strength due to stress risers at the tip of the tear, but rather a question of whether or not the remaining cross-section is large enough to support the anticipated loading.

  7. Lower Limb Kinematics and Dynamic Postural Stability in Anterior Cruciate Ligament-Reconstructed Female Athletes

    PubMed Central

    Delahunt, Eamonn; Chawke, Mark; Kelleher, Judy; Murphy, Katie; Prendiville, Anna; Sweeny, Lauren; Patterson, Matt

    2013-01-01

    Context: Deficits in lower limb kinematics and postural stability are predisposing factors to the development of knee ligamentous injury. The extent to which these deficits are present after anterior cruciate ligament (ACL) reconstruction is still largely unknown. The primary hypothesis of the present study was that female athletes who have undergone ACL reconstruction and who have returned to sport participation would exhibit deficits in dynamic postural stability as well as deficiencies in hip- and knee-joint kinematics when compared with an age-, activity-, and sex-matched uninjured control group. Objective: To investigate dynamic postural stability as quantified by the Star Excursion Balance Test (SEBT) and simultaneous hip- and knee-joint kinematic profiles in female athletes who have undergone ACL reconstruction. Design: Descriptive laboratory study. Setting: University motion-analysis laboratory. Patients or Other Participants: Fourteen female athletes who had previously undergone ACL reconstruction (ACL-R) and 17 age- and sex-matched uninjured controls. Intervention(s): Each participant performed 3 trials of the anterior, posterior-medial, and posterior-lateral directional components of the SEBT. Main Outcome Measure(s): Reach distances for each directional component were quantified and expressed as a percentage of leg length. Simultaneous hip- and knee-joint kinematic profiles were recorded using a motion-analysis system. Results: The ACL-R group had decreased reach distances on the posterior-medial (P < .01) and posterior-lateral (P < .01) directional components of the SEBT. During performance of the directional components of the SEBT, ACL-R participants demonstrated altered hip-joint frontal-, sagittal-, and transverse-plane kinematic profiles (P < .05), as well as altered knee-joint sagittal-plane kinematic profiles (P < .05). Conclusions: Deficits in dynamic postural stability and concomitant altered hip- and knee-joint kinematics are present after ACL

  8. Image-Guided Intervention of the Postoperative Foot and Ankle After Ligament and Tendon Repair.

    PubMed

    Khanna, Monica; Walker, Miny; Amiras, Dimitri; Rosenfeld, Peter

    2016-02-01

    This review article describes the potential range of image-guided interventional procedures performed following foot and ankle ligament and/or tendon repair. Diagnosis of the cause of recurrent or persistent pain/symptoms in this postoperative group is challenging and requires a coordinated clinical and radiologic assessment. This directs appropriate treatment including image-guided intervention that may be used both as a diagnostic tool and a therapeutic option. There is a paucity of high-quality studies on the role of image-guided intervention in the foot and ankle after ligament/tendon repair. Many of the procedures used in this group are extrapolated from other areas of the body or the preoperative scenario. We review the role of imaging to identify the cause of postsurgical symptoms and to direct appropriate image-guided intervention. The available injectables and their roles are discussed. Specific surgical procedures are described including lateral ligament repair, Achilles repair, posterior tibialis tendon surgery, and peroneal tendon surgery. PMID:27077592

  9. Patterns of attachment of the myodural bridge by the rectus capitis posterior minor muscle.

    PubMed

    Yuan, Xiao-Ying; Yu, Sheng-Bo; Li, Yun-Fei; Chi, Yan-Yan; Zheng, Nan; Gao, Hai-Bin; Luan, Bing-Yi; Zhang, Zhao-Xi; Sui, Hong-Jin

    2016-03-01

    The myodural bridge was first described by Hack in 1995 and was thought to be related to chronic cervicogenic headaches. For a long time, few studies revealed the patterns of the myodural bridge considering the rectus capitis posterior minor muscle. In this study, P45 plastination technology and anatomical dissection were performed on head specimens, and four different terminal region types of the rectus capitis posterior minor muscle were observed, including the posterior atlanto-occipital interspace, posterior arch of the atlas and posterior atlanto-axial interspace. We propose that the myodural complex structures in the posterior atlanto-occipital and posterior atlanto-axial interspace have cooperative effects on cerebrospinal fluid and work together. This force might be an important source for the circulation of cerebrospinal fluid. PMID:25859757

  10. Patterns of attachment of the myodural bridge by the rectus capitis posterior minor muscle.

    PubMed

    Yuan, Xiao-Ying; Yu, Sheng-Bo; Li, Yun-Fei; Chi, Yan-Yan; Zheng, Nan; Gao, Hai-Bin; Luan, Bing-Yi; Zhang, Zhao-Xi; Sui, Hong-Jin

    2016-03-01

    The myodural bridge was first described by Hack in 1995 and was thought to be related to chronic cervicogenic headaches. For a long time, few studies revealed the patterns of the myodural bridge considering the rectus capitis posterior minor muscle. In this study, P45 plastination technology and anatomical dissection were performed on head specimens, and four different terminal region types of the rectus capitis posterior minor muscle were observed, including the posterior atlanto-occipital interspace, posterior arch of the atlas and posterior atlanto-axial interspace. We propose that the myodural complex structures in the posterior atlanto-occipital and posterior atlanto-axial interspace have cooperative effects on cerebrospinal fluid and work together. This force might be an important source for the circulation of cerebrospinal fluid.

  11. Cartilaginous and ligamentous degeneration of the wrist. Anatomic study.

    PubMed

    Fortems, Y; de Smet, L; Fabry, G

    1994-01-01

    The growing precision of diagnostic techniques (MRI, arthrography, arthroscopy) and the consequent increase of the diagnosis of cartilaginous and ligamentous lesions of the wrist led us to undertake a detailed anatomical study of the carpus and to extend this study to the search for correlations between these lesions and the radio-ulnar index. Fifty one cadaveric wrists were dissected from an elderly population (mean age of 76 years). Cartilaginous lesions were found in two-thirds of radioulnar joints of the wrist with a marked predominance for the lunate bone (43%). The triangular cartilage of the fibrocartilaginous complex (TFCC) was perforated in 23 wrists (46%). We established a correlation between the radio-ulnar index and perforations of the TFCC (p < 0.05), as well as the thickness of this structure (p < 0.05). The relationship between age and rupture of intrinsic ligaments (p < 0.05), and the radio-ulnar index (p < 0.05) and age was also established. We present our figures, discuss the clinical implications, and draw the following conclusions from this study. 1) The carpus is a complex joint which is subject to age-related degeneration. 2) The large number of cartilaginous lesions observed in this study must be taken into account in the interpretation of MRI and the "over" precise results of arthroscopy. PMID:7531478

  12. Capsular tear in line with the inferior glenohumeral ligament: a cause of anterior glenohumeral instability in 2 patients.

    PubMed

    Rothberg, David L; Burks, Robert T

    2009-08-01

    Anterior glenohumeral instability typically involves lesions associated with the inferior glenohumeral ligament complex. Multiple lesions have been described in this setting, including Bankart, humeral avulsion of the inferior glenohumeral ligament complex, and mid-substance capsular tears. These lesions are indicative of the high-force traumatic nature of anterior shoulder dislocation. Two cases of recurrent anterior shoulder instability are presented with a capsular tear perpendicular to the usual orientation and not consistent to the amount of force involved in a dislocation. Arthroscopy revealed a capsular defect from the glenoid to the humeral head in the anterior inferior glenohumeral ligamentous complex in both. This lesion is an unusual circumstance, providing another pathology to include in the differential diagnosis of anterior glenohumeral instability.

  13. [Iris suture fixation of posterior-chamber elastic intraocular lens in ligament apparatus laxity].

    PubMed

    Pashtaev, N P; Bat'kov, E N; Zotov, V V

    2010-01-01

    An original MIOL-23 multifocal elastic intraocular lens (IOL) was used to operate 5 eyes with acquired lens dislocation and traumatic cataract. By making self-sealing tunnel incision, ILO was implanted into the capsular sac and sutured to the iris. MIOL-23 implantation caused an increase in mean visual acuity. The IOL took up a correct position. Elastic IOL implantation with iris suture fixation is an efficient and safe mode of additional ILO support. PMID:20645577

  14. Children's understanding of posterior probability.

    PubMed

    Girotto, Vittorio; Gonzalez, Michel

    2008-01-01

    Do young children have a basic intuition of posterior probability? Do they update their decisions and judgments in the light of new evidence? We hypothesized that they can do so extensionally, by considering and counting the various ways in which an event may or may not occur. The results reported in this paper showed that from the age of five, children's decisions under uncertainty (Study 1) and judgments about random outcomes (Study 2) are correctly affected by posterior information. From the same age, children correctly revise their decisions in situations in which they face a single, uncertain event, produced by an intentional agent (Study 3). The finding that young children have some understanding of posterior probability supports the theory of naive extensional reasoning, and contravenes some pessimistic views of probabilistic reasoning, in particular the evolutionary claim that the human mind cannot deal with single-case probability. PMID:17391661

  15. Anatomical factors affecting the selection of an operative approach for fibular fractures involving the posterior malleolus

    PubMed Central

    WANG, XU; MA, XIN; ZHANG, CHAO; HUANG, JIAZHANG; JIANG, JIANYUAN

    2013-01-01

    Several operative approaches are available at present for the exposure and fixation of distal fibular fractures combined with posterior malleolus fractures. The present study was designed to study the anatomical characteristics of the distal fibula and to thereby evaluate the advantages and limitations of various operative approaches, as well as their indications for specific conditions. Ten leg specimens from below the knee joint were dissected using posterior, lateral and posterolateral approaches to the fibula. The adjacent vulnerable structures, including nerves, blood vessels, tendons and ligaments, were carefully examined and their distances from the posterior malleolus were recorded. The distance was 7.2±4.1 mm between the sural nerve and the posterior section of the fibula, 79.2±23.5 mm between the lateral malleolus tip and the point where the shape changes in the lower fibula and 66.4±17.4 mm between the lateral malleolus and the jointed tendon of the peroneal and flexor hallux longus muscles. The widest anteroposterior diameter of the distal fibula was 27.3±3.5 mm. Various approaches have certain advantages and limitations when these anatomical factors are taken into account. The choice should be based on the height of the fibular fracture line, the type of posterior malleolus fracture, the effect of the fracture on the stability of the ankle joint and the materials used for internal fixation. PMID:23403714

  16. Bone-patellar tendon-bone autograft versus LARS artificial ligament for anterior cruciate ligament reconstruction.

    PubMed

    Pan, Xiaoyun; Wen, Hong; Wang, Lide; Ge, Tichi

    2013-10-01

    The optimized graft for use in anterior cruciate ligament (ACL) reconstruction is still in controversy. The bone-patellar tendon-bone (BPTB) autograft has been accepted as the gold standard for ACL reconstruction. However, donor site morbidities cannot be avoided after this treatment. The artificial ligament of ligament advanced reinforcement system (LARS) has been recommended for ACL reconstruction. The purpose of this study is to compare the midterm outcome of ACL reconstruction using BPTB autografts or LARS ligaments. Between July 2004 and March 2006, the ACL reconstruction using BPTB autografts in 30 patients and LARS ligaments in 32 patients was performed. All patients were followed up for at least 4 years and evaluated using the Lysholm knee score, Tegner score, International Knee Documentation Committee (IKDC) score, and KT-1000 arthrometer test. There were no significant differences between the two groups with respect to the data of Lysholm scores, Tegner scores, IKDC scores, and KT-1000 arthrometer test at the latest follow-up. Our study demonstrates that the similarly good clinical results are obtained after ACL reconstruction using BPTB autografts or LARS ligaments at midterm follow-up. In addition to BPTB autografts, the LARS ligament may be a satisfactory treatment option for ACL rupture.

  17. Surgical treatment of anterior cruciate ligament injury in adults.

    PubMed

    Alazzawi, Sulaiman; Sukeik, Mohamed; Ibrahim, Mazin; Haddad, Fares S

    2016-04-01

    Anterior cruciate ligament injury is among the most common soft tissue injuries of the knee joint and reconstruction of the anterior cruciate ligament is the gold standard treatment for young active symptomatic patients. This review summarizes the surgical treatment of anterior cruciate ligament injury.

  18. International Comparative Evaluation of Knee Replacement with Fixed or Mobile Non-Posterior-Stabilized Implants

    PubMed Central

    Namba, Robert; Graves, Stephen; Robertsson, Otto; Furnes, Ove; Stea, Susanna; Puig-Verdié, Lluis; Hoeffel, Daniel; Cafri, Guy; Paxton, Elizabeth; Sedrakyan, Art

    2014-01-01

    Background: Mobile-bearing total knee prostheses were designed to reduce wear and improve implant survivorship following total knee arthroplasty. However, the benefit of mobile-bearing total knee arthroplasty remains unproven. Both mobile-bearing and fixed-bearing total knee arthroplasty implants are available in posterior-stabilized and non-posterior-stabilized designs. With the latter, the implant does not recreate the function of the posterior cruciate ligament (PCL) with a posterior-stabilizing cam mechanism. The purpose of the present study was to compare mobile-bearing, non-posterior-stabilized devices with fixed-bearing, non-posterior-stabilized devices used in total knee arthroplasty through a novel multinational study design. Methods: Through the use of a distributed health data network, primary total knee arthroplasties performed for osteoarthritis from 2001 to 2010 were identified from six national and regional total joint arthroplasty registries. Multivariate meta-analysis was performed with use of linear mixed models, with the primary outcome of interest being revision for any reason. Survival probabilities and their standard errors were extracted from each registry for each unique combination of the covariates. Results: A total of 319,616 patients (60% female) underwent non-posterior-stabilized total knee arthroplasty. A fixed-bearing, non-posterior-stabilized design was used in 258,190 (81%) of the knees and a mobile-bearing, non-posterior-stabilized design in 61,426 (19%) of the knees. Sixty-nine percent of the patients who received a fixed-bearing implant were over sixty-five years of age, compared with 63% of those who received a mobile-bearing implant. Mobile-bearing designs had a higher risk of revision, with a hazard ratio of 1.43 (95% confidence interval, 1.36 to 1.51; p < 0.001). Conclusions: Previous comparisons of mobile-bearing and fixed-bearing total knee arthroplasty outcomes have been inconclusive. The current study utilized an advanced

  19. Unsuccessful outcomes after posterior urethroplasty.

    PubMed

    Engel, Oliver; Fisch, Margit

    2015-03-01

    Posterior urethroplasty is the most common strategy for the treatment of post-traumatic urethral injuries. Especially in younger patients, post-traumatic injuries are a common reason for urethral strictures caused by road traffic accidents, with pelvic fracture or direct trauma to the perineum. In many cases early endoscopic realignment is the first attempt to restore the junction between proximal and distal urethra, but in some cases primary realignment is not possible or not enough to treat the urethral injury. In these cases suprapubic cystostomy alone and delayed repair by stricture excision and posterior urethroplasty is an alternative procedure to minimise the risk of stricture recurrence.

  20. Acute modification of biomechanical properties of the bone-ligament insertion to rat limb unweighting.

    PubMed

    Vanderby, R; Vailas, A C; Graf, B K; Thielke, R J; Ulm, M J; Kohles, S S; Kunz, D N

    1990-05-01

    We investigated the acute adaptation of the rat femur-medial collateral ligament-tibia (FMT) complex to 7 days of limb unweighting by means of a hind-limb suspension protocol. Male, young adult, Harlan Sprague-Dawley rats were randomly assigned to either control or suspended groups. Rats deprived of hind limb-to-ground contact forces had a 42% decrease in soleus muscle mass compared with the control group. Medial collateral ligament (MCL) length and cross-sectional area were measured, and each FMT complex was tension tested to failure. All failed at their tibia-MCL insertion. The ultimate load in the FMT and the peak Kirchhoff stress in the MCL (occurring immediately before insertion site failure) were significantly reduced in the suspended group. The suspended MCLs were 9.7% larger in area and 5.7% shorter in length than the controls under the same preload (0.25 N). We found no significant differences between the control and suspended MCLs in Green strain, stretch, or deformation immediately before insertion site failure, nor did we find a significant difference in the MCL tangent modulus. This study indicates that even acute periods of limb unweighting can structurally compromise bone-ligament insertions. Further, this study implies that the adaptations responsible for this structural compromise must involve acute changes in the intrinsic zone (or zones) of the bone-ligament insertion.

  1. Lateral Ulnar Collateral Ligament Reconstruction: An Analysis of Ulnar Tunnel Locations.

    PubMed

    Anakwenze, Oke A; Khanna, Krishn; Levine, William N; Ahmad, Christopher S

    2016-02-01

    We conducted a study to determine precise ulnar tunnel location during lateral ulnar collateral ligament reconstruction to maximize bony bridge and graft construct perpendicularity. Three-dimensional computer models of 15 adult elbows were constructed. These elbow models were manipulated for simulated 4-mm tunnel drilling. The proximal ulna tunnels were placed at the radial head-neck junction and sequentially 0, 5, and 10 mm posterior to the supinator crest. The bony bridges created by these tunnels were measured. Location of the humeral isometric point was determined and marked as the humeral tunnel location. Graft configuration was simulated. Using all the simulated ulna tunnels, we measured the proximal and distal limbs of the graft. In addition, we measured the degree of perpendicularity of the graft limbs. The ulnar tunnel bony bridge was significantly longer with more posterior placement of the proximal tunnel relative to the supinator crest. An increase in degree of perpendicularity of graft to ulnar tunnels was noted with posterior shifts in proximal tunnel location. Posterior placement of the proximal ulna tunnel allows for a larger bony bridge and a more geometrically favorable reconstruction.

  2. Stereolithography for Posterior Fossa Cranioplasty

    PubMed Central

    Agner, Celso; Dujovny, Manuel; Evenhouse, Raymond; Charbel, Fady T.; Sadler, Lewis

    1998-01-01

    Posterior fossa cranioplasty has been suggested for improvement of neurological symptoms following craniectomy. However, there is no particular recommendation in the literature about techniques for prosthesis manufacture and implantation. We report our experience using rapid prototyping technology and stereolithography for pre-surgical implant design and production of cranioplasties. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5 PMID:17171056

  3. Neonatal posterior fossa subdural hematoma.

    PubMed

    Coker, S; Beltran, R; Fine, M

    1987-07-01

    Hemorrhage into the posterior fossa is a rare neurosurgical emergency in neonates. CT scanning is diagnostic. Blood layering under the apex of the tentorium cerebelli, however, may resemble a dilated vascular structure, and the rigidity of the pressured tentorium may prevent upward transmission of increased intracranial pressure, resulting in a soft fontanelle.

  4. Thumb Ligament Injuries in the Athlete.

    PubMed

    Owings, F Patterson; Calandruccio, James H; Mauck, Benjamin M

    2016-10-01

    Hand injuries account for up to 15% of sports injuries and are common in contact sports and in sports with a high risk of falling. Appropriate management requires knowledge of the type of injury, demands of the sport and position, competitive level of the athlete, future athletic demands and expectations, and the role of rehabilitation and protective splints for return to play. Management of the athlete requires aggressive and expedient diagnostic intervention and treatment. This article describes ligamentous injuries to the thumb, including thumb carpometacarpal dislocations, thumb metacarpophalangeal dislocations, collateral ligament injuries and interphalangeal dislocations, their evaluation, treatment and outcomes. PMID:27637666

  5. An Important Cause of Pes Planus: The Posterior Tibial Tendon Dysfunction

    PubMed Central

    Erol, Kemal; Karahan, Ali Yavuz; Kerimoğlu, Ülkü; Ordahan, Banu; Tekin, Levent; Şahin, Muhammed; Kaydok, Ercan

    2015-01-01

    Posterior tibial tendon dysfunction (PTTD) is an important cause of acquired pes planus that frequently observed in adults. Factors that play a role in the development of PTTD such as age-related tendon degeneration, inflammatory arthritis, hypertension, diabetes mellitus, obesity, peritendinous injections and more rarely acute traumatic rupture of the tendon. PTT is the primary dynamic stabilizer of medial arch of the foot. Plantar flexion and inversion of the foot occurs with contraction of tibialis posterior tendon, and arch of the foot becomes elaveted while midtarsal joints are locked and midfoot-hindfoot sets as rigid. Thus, during the walk gastrocnemius muscle works more efficiently. If the PTT does not work in the order, other foot ligaments and joint capsule would be increasingly weak and than pes planus occurs. We present a 10-year-old female patient diagnosed as PTTD and conservative treatment with review of the current literature. PMID:25918629

  6. An important cause of pes planus: the posterior tibial tendon dysfunction.

    PubMed

    Erol, Kemal; Karahan, Ali Yavuz; Kerimoğlu, Ülkü; Ordahan, Banu; Tekin, Levent; Şahin, Muhammed; Kaydok, Ercan

    2015-01-28

    Posterior tibial tendon dysfunction (PTTD) is an important cause of acquired pes planus that frequently observed in adults. Factors that play a role in the development of PTTD such as age-related tendon degeneration, inflammatory arthritis, hypertension, diabetes mellitus, obesity, peritendinous injections and more rarely acute traumatic rupture of the tendon. PTT is the primary dynamic stabilizer of medial arch of the foot. Plantar flexion and inversion of the foot occurs with contraction of tibialis posterior tendon, and arch of the foot becomes elaveted while midtarsal joints are locked and midfoot-hindfoot sets as rigid. Thus, during the walk gastrocnemius muscle works more efficiently. If the PTT does not work in the order, other foot ligaments and joint capsule would be increasingly weak and than pes planus occurs. We present a 10-year-old female patient diagnosed as PTTD and conservative treatment with review of the current literature. PMID:25918629

  7. Anterior cruciate ligament rupture: differences between males and females.

    PubMed

    Sutton, Karen M; Bullock, James Montgomery

    2013-01-01

    The rate of anterior cruciate ligament (ACL) rupture is three times higher in female athletes than in male athletes. Intrinsic factors such as increased quadriceps angle and increased posterior tibial slope may predispose girls and women to ACL injury. Compared with males, females have smaller notch widths and smaller ACL cross-sectional area; however, no conclusive correlation between ACL size and notch dimension exists, especially in relation to risk of ACL injury. Female athletes who land with the knees in inadequate flexion and in greater-than-normal valgus and external rotation are at increased risk of ACL injury. No conclusive link has been made between ACL injury and the menstrual cycle. Neuromuscular intervention protocols have been shown to reduce the rate of injury in girls and women. Females are more likely than males to have a narrow A-shaped intercondylar notch, and special surgical considerations are required in such cases. Following ACL reconstruction, female athletes are more likely than male athletes to rupture the contralateral ACL; however, males and females are equally likely to rupture the reconstructed knee. Although self-reported outcomes in the first 2 years following reconstruction are worse for females than for males, longer-term studies demonstrate no difference between males and females.

  8. Arthroscopic dorsal capsulo-ligamentous repair in the treatment of chronic scapho-lunate ligament tears.

    PubMed

    Wahegaonkar, Abhijeet L; Mathoulin, Christophe L

    2013-05-01

    unaffected wrist. The mean difference for the VAS score was -5.46 (SEM = 0.19; p < 0.0001). The mean post-operative grip strength of the affected side was 38.42 ± 10.27 kg (range 20-60 kg) as compared with mean pre-operative grip strength of 24.07 ± 10.51 kg (range 8-40 kg) (p < 0.0001). The mean post-operative grip strength of the operated side was 93.4% of the unaffected side. The DISI was corrected in all cases on post-operative radiographs. The mean difference between the post-and pre-operative SL angles was -8.95° (SEM = 1.28°; p < 0.0001). The mean post-operative DASH score was 8.3 ± 7.82 as compared with mean pre-operative DASH score of 46.04 ± 16.57 (p < 0.0001). There was a negative co-relation between the overall DASH score and the post-operative correction of the DISI deformity with a lower DASH score associated with increasing SL angles. Discussion The dorsal portion of the scapholunate ligament is critical for the stability scapholunate articulation, largely due to its attachment to the dorsal capsule. We have recently conducted a multi-centric anatomical study with international collaboration demonstrating the critical importance of this dorsal scapholunate complex. The all arthroscopic capsulo-ligamentous repair technique provides reliable results in addition to avoiding postoperative stiffness. The overall results at a mean follow-up period of more than 2 years in our series of young, active patients appear to be encouraging. PMID:24436807

  9. Reconstruction of the Scapholunate Ligament Using Capitohamate Bone-Ligament-Bone.

    PubMed

    Nakamura, Toshiyasu; Abe, Koji; Iwamoto, Takuji; Ochi, Kensuke; Sato, Kazuki

    2015-11-01

    Background The biomechanical properties of the capitohamate (CH) ligament are equivalent to those of the scapholunate (SL) interosseous ligament. We reconstructed the SL ligament using the CH bone-ligament-bone substitute for chronic injury of the SL ligament. Patients and Methods Beginning in 2008, 15 wrists of 14 patients with an average age of 38 years underwent this procedure with a minimum follow-up of 2 years. Thirteen wrists had an SL joint gap more than 3 mm, and two had a complete SL ligament disruption with a severe dorsal intercalated segment instability (DISI) deformity. Kirschner wires (K-wires) were removed 8 weeks after the surgery, then active ROM exercise began. Pain (on visual analog scale [VAS]), wrist motion (angle), radiographic characteristics, such as SL gap (mm) and SL angle, and Modified Mayo Wrist Score (MMWS) were evaluated. Technique The SL joint was reduced by manipulation or with the use of joysticks, then temporary fixed with K-wires. A dorsal trough was then made between the scaphoid and the lunate. The proximal half of the CH ligament was harvested with attached bone from the capitate and hamate (CH bone-ligament-bone), inset into the SL trough, and fixed firmly with 1.2-mm diameter titanium screws in the scaphoid and lunate, respectively. Results The VAS improved from 77 preoperatively to 12 postoperatively. The average wrist extension/flexion was 74°/60°. There was no ossification of the reconstructed SL at the final follow-up. The SL gap improved from an average of 4.8 mm to an average of 2.1 mm, and the SL angle changed from 67° to 55°. The MMWS improved to 82 points postoperatively from a preoperative average of 47 with eight excellent, five good, and two fair results.

  10. The left triangular ligament of the liver and the structures in its free edge (appendix fibrosa hepatis) in Chinese and Canadian cadavers.

    PubMed

    Gao, X H; Roberts, A

    1986-05-01

    The left triangular ligament of the liver was studied in 42 Chinese adult male cadavers and 50 Canadian adult cadavers. The free edge of the left triangular ligament was examined histologically in 37 of the Chinese and all 50 of the Canadian cadavers. The average length of the left triangular ligament in the 42 Chinese was 13.9 cm and 11.5 cm in the 50 Canadian. The Canadian sample was composed of 24 adult female cadavers with an average length of 10.7 cm and of 26 adult male cadavers with an average length of 12.3 cm. In a previous study (1980) of 58 Chinese adult male cadavers, the average length of the left triangular ligament was 12.7 cm. This resulted in an average length of 13.2 cm for the 100 Chinese cadavers. These findings greatly exceed the lengths given in the textbooks, and there is no significant difference between the male Chinese and Canadian cadavers. It was found that almost all the left triangular ligaments were attached to the superior surface of the left lobe of the liver. The left suprahepatic space was subdivided by this ligament into anterior and posterior spaces. Each of the left triangular ligaments had a long free edge which extended from the lateral extremity of the left lobe of the liver to the diaphragm. Histological examination of the free edges revealed the presence of blood vessels in all of the 37 Chinese suitable for study and the 50 Canadian cadavers.(ABSTRACT TRUNCATED AT 250 WORDS)

  11. Examining the relation of osteochondral lesions of the talus to ligamentous and lateral ankle tendinous pathologic features: a comprehensive MRI review in an asymptomatic lateral ankle population.

    PubMed

    Galli, Melissa M; Protzman, Nicole M; Mandelker, Eiran M; Malhotra, Amit D; Schwartz, Edward; Brigido, Stephen A

    2014-01-01

    Given the frequency and burden of ankle sprains, the pathologic features identified on magnetic resonance imaging (MRI) scans are widely known in the symptomatic population. Ankle MRI pathologic features in the asymptomatic population, however, are poorly understood. Such examinations are rarely undertaken unless an ankle has been injured or is painful. We report the systematic MRI findings from the reports of 108 consecutive asymptomatic lateral ankles (104 patients). Our purpose was to (1) report the prevalence of osteochondral lesions of the talus (OLTs) and pathologic features of the medial and lateral ligaments, peroneal tendons, and superior peroneal retinaculum (SPR); (2) correlate the presence of OLTs with the pathologic features of the medial and lateral ligaments, peroneal tendons, and SPR; and (3) correlate ligamentous discontinuity with the peroneal pathologic features, OLTs, and SPR pathologic features. A total of 16 OLTs (14.81%) were present (13 medial and 3 lateral). Of the 16 patients with OLTs, 8 (50.00%) had concomitant peroneal pathologic findings. Healthy medial and lateral ligaments were noted in 41 patients (37.96%), and ligamentous discontinuity was grade I in 25 (23.15%), II in 32 (29.63%), III in 5 (4.63%), and grade IV in 5 patients (4.63%). A weak positive correlation was found between attenuation or tears of the superficial deltoid and medial OLTs (phi coefficient = 0.23, p = .0191) and a moderate positive correlation between tears of the posterior talofibular ligament and lateral OLTs (phi coefficient = 0.30, p = .0017). Additionally, a moderate positive correlation between ligamentous discontinuity and tendinopathy of the peroneus brevis was noted [Spearman's coefficient(106) = 0.29, p = .0024]. These findings add to the evidence of concomitant pathologic features in the asymptomatic population. To definitively assess causation and evaluate the clinical evolution of radiologic findings, future, prospective, longitudinal

  12. Relation of the fibular head sign to other signs of anterior cruciate ligament insufficiency. A follow-up letter to the editor.

    PubMed

    al-Duri, Z

    1992-02-01

    The fibular head sign is a clinical finding that seems not to have been previously reported for the diagnosis of chronic anterior cruciate ligament insufficiency (ACLI) associated with lateral rotatory instability of the knee joint. The fibular head could be palpated as a prominent bony lump, felt subcutaneously in the posterior lateral corner of the popliteal fossa. In a prospective study of 20 patients with ACLI, the mean age of the patients (15 males, five females) at the time of assessment was 26 years (range, 18-57 years). The left knee was involved in 11 patients, the right knee in the remaining nine patients. All the patients sustained their knee ligament injury in sporting activities except one patient who was involved in a motor vehicular accident. The majority of the patients had instability-related symptoms for more than six months. After history taking, physical examination in the clinic, and examination under anesthesia, and arthroscopy in the operating room of all patients, it was determined that there were 13 ACL injuries, four posterior cruciate ligament (PCL) injuries, and three combined A/PCL injuries. All ACL injury patients had a prominent fibular head sign. Other associated signs included passive hyperextension of 10-20 degrees, and major anterolateral, and to a lesser degree a posterolateral, rotatory instability. The fibular head sign was negative in isolated posterior cruciate injuries and in combined A/PCL injuries.

  13. Smart instrumentation for determination of ligament stiffness and ligament balance in total knee arthroplasty.

    PubMed

    Hasenkamp, W; Villard, J; Delaloye, J R; Arami, A; Bertsch, A; Jolles, B M; Aminian, K; Renaud, P

    2014-06-01

    Ligament balance is an important and subjective task performed during total knee arthroplasty (TKA) procedure. For this reason, it is desirable to develop instruments to quantitatively assess the soft-tissue balance since excessive imbalance can accelerate prosthesis wear and lead to early surgical revision. The instrumented distractor proposed in this study can assist surgeons on performing ligament balance by measuring the distraction gap and applied load. Also the device allows the determination of the ligament stiffness which can contribute a better understanding of the intrinsic mechanical behavior of the knee joint. Instrumentation of the device involved the use of hall-sensors for measuring the distractor displacement and strain gauges to transduce the force. The sensors were calibrated and tested to demonstrate their suitability for surgical use. Results show the distraction gap can be measured reliably with 0.1mm accuracy and the distractive loads could be assessed with an accuracy in the range of 4N. These characteristics are consistent with those have been proposed, in this work, for a device that could assist on performing ligament balance while permitting surgeons evaluation based on his experience. Preliminary results from in vitro tests were in accordance with expected stiffness values for medial collateral ligament (MCL) and lateral collateral ligament (LCL).

  14. Anterolateral Meniscofemoral Ligament of the Lateral Meniscus

    PubMed Central

    Kim, Young-Mo; Yeon, Kyu-Woong; Lee, Ki-Young

    2016-01-01

    Anatomical variations of the meniscus are a common anomaly that knee surgeons frequently encounter. However, anomalies of the anterior horn of the lateral meniscus (AHLM) are extremely rare. In this report, we present a newly discovered anomaly of the AHML: an anterolateral meniscofemoral ligament is described with clinical features and radiographic and arthroscopic findings.

  15. Isolated unilateral rupture of the alar ligament.

    PubMed

    Wong, Sui-To; Ernest, Kimberly; Fan, Grace; Zovickian, John; Pang, Dachling

    2014-05-01

    Only 6 cases of isolated unilateral rupture of the alar ligament have been previously reported. The authors report a new case and review the literature, morbid anatomy, and pathogenesis of this rare injury. The patient in their case, a 9-year-old girl, fell head first from a height of 5 feet off the ground. She presented with neck pain, a leftward head tilt, and severe limitation of right rotation, extension, and right lateral flexion of the neck. Plain radiographs and CT revealed no fracture but a shift of the dens toward the right lateral mass of C-1. Magnetic resonance imaging of the cervical spine showed signal hyperintensity within the left dens-atlas space on both T1- and T2-weighted sequences and interruption of the expected dark signal representing the left alar ligament, suggestive of its rupture. After 12 weeks of immobilization in a Guilford brace, MRI showed lessened dens deviation, and the patient attained full and painless neck motion. Including the patient in this case, the 7 patients with this injury were between 5 and 21 years old, sustained the injury in traffic accidents or falls, presented with marked neck pain, and were treated with external immobilization. All patients had good clinical outcome. The mechanism of injury is hyperflexion with rotation. Isolated unilateral alar ligament rupture is a diagnosis made by excluding associated fracture, dislocation, or disruption of other major ligamentous structures in the craniovertebral junction. CT and MRI are essential in establishing the diagnosis. External immobilization is adequate treatment.

  16. Anterolateral Meniscofemoral Ligament of the Lateral Meniscus

    PubMed Central

    Kim, Young-Mo; Yeon, Kyu-Woong; Lee, Ki-Young

    2016-01-01

    Anatomical variations of the meniscus are a common anomaly that knee surgeons frequently encounter. However, anomalies of the anterior horn of the lateral meniscus (AHLM) are extremely rare. In this report, we present a newly discovered anomaly of the AHML: an anterolateral meniscofemoral ligament is described with clinical features and radiographic and arthroscopic findings. PMID:27595080

  17. Anterolateral Meniscofemoral Ligament of the Lateral Meniscus.

    PubMed

    Kim, Young-Mo; Joo, Yong-Bum; Yeon, Kyu-Woong; Lee, Ki-Young

    2016-09-01

    Anatomical variations of the meniscus are a common anomaly that knee surgeons frequently encounter. However, anomalies of the anterior horn of the lateral meniscus (AHLM) are extremely rare. In this report, we present a newly discovered anomaly of the AHML: an anterolateral meniscofemoral ligament is described with clinical features and radiographic and arthroscopic findings.

  18. Causes of anterior cruciate ligament injuries.

    PubMed

    Ristić, Vladimir; Ninković, Srdan; Harhaji, Vladimir; Milankov, Miroslav

    2010-01-01

    In order to prevent anterior cruciate ligament injuries it is necessary to define risk factors and to analyze the most frequent causes of injuries--that being the aim of this study. The study sample consisted of 451 surgically treated patients, including 400 sportsmen (65% of them being active and 35% recreational sportsmen), 29% female and 71% male; of whom 90% were younger than 35. Sports injuries, as the most frequent cause of anterior cruciate ligament injuries, were recorded in 88% of patients (non-contact ones in 78% and contact ones in 22%), injuries occurring in everyday activities in 11% and in traffic in 1%. Among sportsmen, reconstruction of the anterior cruciate ligament was most frequently performed in football players (48%), then in handball players (22%), basketball players (13%), volleyball players (8%), martial arts fighters (4%). However, the injury incidence was the highest among the active basketball players (1 injured among 91 active players). Type of footwear, warming up before the activity, genetic predisposition and everyday therapy did not have a significant influence on getting injured. Anterior cruciate ligament injuries happened three times more often during matches, in the middle and at the end of a match and training session (79%), at landing after the jump or when changing direction of movement (75%) without a contact with other competitors, on dry surfaces (79%), among not so well prepared sportsmen.

  19. Isolated left posterior insular infarction and convergent roles in verbal fluency, language, memory, and executive function

    PubMed Central

    Ruthirago, Doungporn; DeToledo, John C.

    2016-01-01

    The posterior insular cortex—a complex structure interconnecting various brain regions for different functions—is a rare location for ischemic stroke. We report a patient with isolated left posterior insular infarction who presented with multiple cognitive impairment, including impairment in semantic and phonemic verbal fluency. PMID:27365876

  20. Histo-mechanical properties of the swine cardinal and uterosacral ligaments.

    PubMed

    Tan, Ting; Davis, Frances M; Gruber, Daniel D; Massengill, Jason C; Robertson, John L; De Vita, Raffaella

    2015-02-01

    The focus of this study was to determine the structural and mechanical properties of two major ligaments that support the uterus, cervix, and vagina: the cardinal ligament (CL) and the uterosacral ligament (USL). The adult swine was selected as animal model. Histological analysis was performed on longitudinal and cross sections of CL and USL specimens using Masson׳s trichrome and Verhoeff-van Giesson staining methods. Scanning electron microscopy was employed to visualize the through-thickness organization of the collagen fibers. Quasi-static uniaxial tests were conducted on specimens that were harvested from the CL/USL complex of a single swine. Dense connective tissue with a high content of elastin and collagen fibers was observed in the USL. Loose connective tissue with a considerable amount of smooth muscle cells and ground substance was detected in both the CL and USL. Collagen fibers, smooth muscle cells, blood vessels, and nerve fibers were arranged primarily in the plane of the ligaments. The USL was significantly stronger than the CL with higher ultimate stress and tangent modulus of the linear region of the stress-strain curve. Knowledge about the mechanical properties of the CL and USL will aid in the design of novel mesh materials, stretching routines, and surgical procedures for pelvic floor disorders.

  1. Restoring proximal integrity in posterior composite resin restorations: innovations using Ceromers.

    PubMed

    Liebenberg, W H

    1998-03-01

    Clinicians are increasingly being called upon to satisfy the restorative demands of patients requesting tooth coloured restorations but unable to afford an optimum indirect restorative option. Consequently, in clinical practice the envelope of what was hitherto considered the limit of appropriate application of the direct posterior composite resin technique is increasingly being stretched. Although our aesthetic endeavours are fairly easily accomplished in the posterior dentition, interproximal integrity is in many instances wanting and a major cause of restorative failure. This report highlights some of the authors innovations using Ceromers which satisfy the complex variables of clinical practice optimizing proximal contour, allowing for the successful utilization of posterior composite resin in the posterior dentition.

  2. Creep of posterior dental composites.

    PubMed

    Papadogianis, Y; Boyer, D B; Lakes, R S

    1985-01-01

    The creep of microspecimens of posterior dental composites was studied using a torsional creep apparatus. Shear stresses were maintained for 3 h and recovery was followed for 50 h. Creep curves were obtained at 21, 37, and 50 degrees C and four torque levels. The effect of conditioning the specimens in water up to 8 weeks was studied. The posterior composites exhibited linear viscoelastic behavior at low deformations. They had higher shear moduli and greater resistance to creep than conventional and microfilled composites. In aging experiments, maximum shear moduli occurred when specimens were 48 h to 1 week old. Subsequent softening was attributed to water absorption. Residual strain was highest when the composites were stressed within 24 h of initiating polymerization. Residual strain was very low in specimens 48 h to 8 weeks of age.

  3. Osteosarcoma of the posterior maxilla

    PubMed Central

    Prabhusankar, K.; Karande, Amol; Jerry, Jeethu J.; Rishal, Yousef

    2016-01-01

    Osteosarcoma is a very uncommon tumor of the maxillofacial region. Due to the occurrence of the tumor at a young age and its aggressive nature, radical surgery forms the only modality of treatment. A combination of radiotherapy and postoperative chemotherapy has been used for the management of this tumor. A case report of osteosarcoma of the posterior maxilla in an adolescent with a 1-year disease-free follow-up is presented in this report. PMID:27652252

  4. Osteosarcoma of the posterior maxilla.

    PubMed

    Prabhusankar, K; Karande, Amol; Jerry, Jeethu J; Rishal, Yousef

    2016-08-01

    Osteosarcoma is a very uncommon tumor of the maxillofacial region. Due to the occurrence of the tumor at a young age and its aggressive nature, radical surgery forms the only modality of treatment. A combination of radiotherapy and postoperative chemotherapy has been used for the management of this tumor. A case report of osteosarcoma of the posterior maxilla in an adolescent with a 1-year disease-free follow-up is presented in this report. PMID:27652252

  5. Osteosarcoma of the posterior maxilla

    PubMed Central

    Prabhusankar, K.; Karande, Amol; Jerry, Jeethu J.; Rishal, Yousef

    2016-01-01

    Osteosarcoma is a very uncommon tumor of the maxillofacial region. Due to the occurrence of the tumor at a young age and its aggressive nature, radical surgery forms the only modality of treatment. A combination of radiotherapy and postoperative chemotherapy has been used for the management of this tumor. A case report of osteosarcoma of the posterior maxilla in an adolescent with a 1-year disease-free follow-up is presented in this report.

  6. Distal Radius Attachments of the Radiocarpal Ligaments: An Anatomical Study

    PubMed Central

    Zumstein, M. A.; Hasan, A. P.; McGuire, D. T.; Eng, Kevin; Bain, Gregory Ian

    2013-01-01

    Background Understanding the anatomy of the ligaments of the distal radius aids in the surgical repair of ligamentous injuries and the prediction of intraarticular fracture patterns. Purposes (1) to measure the horizontal and vertical distances of the origins of the radiocarpal ligaments from the most ulnar corner of the sigmoid notch and the joint line, respectively; and (2) to express them as a percentile of the total width of the bony distal radius. Methods We dissected 8 cadaveric specimens and identified the dorsal radiocarpal, radioscaphocapitate, and the long and short radiolunate ligaments. Results The dorsal radiocarpal ligament attached from the 16th to the 52nd percentile of the radial width. The radioscaphocapitate ligament attached around the radial styloid from the 86th percentile volarly to the 87th percentile dorsally. The long radiolunate ligament attached from the 59th to the 85th percentile, and the short radiolunate ligament attached from the 14th to the 41st percentile. Discussion There was a positive correlation between the radial width and the horizontal distance of the ligaments from the sigmoid notch. These findings may aid individualized surgical repair or reconstruction adjusted to patient size and enable further standardized research on distal radial fractures and their relationship with radiocarpal ligaments. PMID:24436840

  7. The Combined “Double Pulley”–Simple Knot Technique for Arthroscopic Shoulder Posterior Labral Repair and Capsular Shift

    PubMed Central

    Parnes, Nata; Carey, Paul; Morman, Monica; Carr, Brian

    2016-01-01

    Posterior shoulder instability is more prevalent than traditionally believed. Surgical repairs of posterior shoulder instability have overall good success rates. However, in elite overhead and throwing athletes, a low rate of return to the preinjury level of play after repair remains a challenge. The 2 goals of posterior shoulder stabilization surgery are secure fixation of the labrum to the glenoid and retensioning of the posterior capsulolabral complex. Recent studies have shown significant advantages of arthroscopic anatomic repair over open nonanatomic techniques. We report a combined double pulley–simple knot technique for arthroscopic fixation of posterior labral tears and capsular shift. The technique incorporates several advantages of this hybrid fixation method. PMID:27069863

  8. Combined Posterior and Anterior Ankle Arthroscopy

    PubMed Central

    Scholten, Peter E.; van Dijk, C. Niek

    2012-01-01

    Treatment of combined anterior and posterior ankle pathology usually consists of either combined anterior and posterior arthrotomies or anterior ankle arthroscopy with an additional posterolateral portal. The first technique bears the risk of complications associated with the extensive exposure, the latter technique provides limited access to the posterior ankle joint. A case is described of combined anterior and posterior arthroscopy, with the patient lying prone and then turned supine, addressing both anterior and posterior ankle pathologies in one tempo. This minimally invasive combined approach allows quick recovery and early return to work and sports activities. PMID:23227391

  9. Anterior cruciate ligament injuries in female athletes: why are women more susceptible?

    PubMed

    Moeller, J L; Lamb, M M

    1997-04-01

    Anterior cruciate ligament (ACL) injuries occur most frequently in planting and cutting sports such as basketball, soccer, and volleyball. National Collegiate Athletic Association injury data show that female athletes injure the ACL more frequently than their male counterparts do. The greater incidence of ACL injuries in women probably stems from complex, interrelated factors, possibly including hamstring-quadriceps strength imbalances, joint laxity, and the use of ankle braces. Successful treatment often includes surgery.

  10. Anterior cruciate ligament ganglion causing flexion restriction: a case report and review of literature

    PubMed Central

    Koh, Thean Howe Bryan; Lee, Keng Thiam

    2016-01-01

    Ganglion cysts originating from the anterior cruciate ligament (ACL) are uncommon. Often asymptomatic, they infrequently present with non-specific symptoms such as knee pain, stiffness, clicks, locking or restriction of knee extension. However, the patient we report presented with knee flexion restriction. A 37-year-old Chinese gentleman, with no history of knee trauma, presented with left knee pain. Left knee range of motion (ROM) was from 0 to 110 degrees. Magnetic resonance imaging (MRI) scan revealed a 1.5 cm × 3.3 cm × 1.7 cm cyst located in the intercondylar region arising from the ACL and extending predominantly posteriorly. Arthroscopy confirmed an intrasubstance ACL ganglion cyst, which was extending posteriorly. Complete excision of the cyst was performed. At 1-year follow-up, the patient regained knee flexion of 130 degrees. We describe one of the largest ACL ganglion cysts. Such cysts often extend anteriorly and impinge onto the roof of the intercondylar notch during knee extension, thus restricting extension. The restriction in knee motion in our patient was in flexion instead; this was because the cyst took an unusual course of extension predominantly in the posterior direction. Although rare, it must be included as a possible differential diagnosis when patients present with such knee symptoms. PMID:27386493

  11. Essentials of anterior cruciate ligament rupture management.

    PubMed

    Klinge, Stephen A; Sawyer, Gregory A; Hulstyn, Michael J

    2013-05-01

    Anterior cruciate ligament (ACL) rupture is a common knee injury and an understanding of current medical knowledge regarding its management is essential. Accurate and prompt diagnosis requires an awareness of injury mechanisms and risk factors, common symptoms and physical/radiologic findings. Early mobilization and physical therapy improves outcomes regardless of treatment modality. Many older patients regain sufficient stability and function after non-operative rehabilitation. Early ACL reconstruction is appropriate for younger patients and those who engage in activities requiring frequent pivoting and rapid direction changes. ACL surgery involves reconstruction of the torn ligament tissue with various replacement graft options, each with advantages and disadvantages. The guidance of a knowledgeable and experienced therapist is required throughout an intensive and prolonged rehabilitation course. Generally excellent outcomes and low complication rates are expected, but treatment does not prevent late osteoarthritis.

  12. Prevention of ligament injuries to the knee.

    PubMed

    Baker, B E

    1990-01-01

    Disruption of the ligamentous structures of the knee are commonly seen in competitive sports. Factors affecting the rate of injury include the sport, the participant, conditioning and technique, the level of competition, rules enforcement, the type of playing surface, and footwear. The role of prophylactic and functional bracing is controversial. Currently, prophylactic bracing has not been shown, conclusively, to be protective. Functional braces appear to have a capacity to provide some protective effect. PMID:2192897

  13. Prevention of anterior cruciate ligament injuries.

    PubMed

    Hewett, T E; Myer, G D; Ford, K R

    2001-12-01

    Numerous studies have found that female athletes who participate in jumping and pivoting sports are four to six times more likely to sustain a knee ligament injury, such as anterior cruciate ligament (ACL) injury, than male athletes participating in the same sports [1-8]. A widening gender gap in the number of serious knee ligament injuries exists due to geometric growth in female athletic participation, coupled with the four- to sixfold higher injury rate. More than 50,000 serious knee injuries are projected to occur in female varsity intercollegiate and high school athletics each year [9, 10]. Most ACL injuries occur by noncontact mechanisms, often during landing from a jump or making a lateral pivot while running [2, 11]. Knee instability, due to ligament dominance (decreased medial-lateral neuromuscular control of the joint), quadriceps dominance (increased quadriceps recruitment and decreased hamstring recruitment and strength), and leg dominance (side-to-side differences in strength, flexibility, and coordination) are possible contributing factors to the increased incidence of knee injury in female athletes [5, 6]. In this review, dynamic neuromuscular analysis (DNA) training is defined, and a rationale is presented for correcting the neuromuscular imbalances that may result in dynamic knee instability during sports play. Dynamic neuromuscular training has been shown to increase knee stability and decrease knee injury rates in female athletes [5, 12.., 13.]. Preliminary research on athlete screening and injury prediction based on the three aforementioned imbalances also is presented with recommendations for developing screening protocols for the identification of high-risk athletes.

  14. Clinical Outcomes of Medial Meniscus Posterior Root Tears

    PubMed Central

    Krych, Aaron John; Reardon, Patrick J.; Pareek, Ayoosh; Peter, Logan; Dahm, Diane L.; Levy, Bruce A.; Stuart, Michael J.

    2016-01-01

    Objectives: Medial meniscus posterior root tears (MMPRTs) present a unique challenge for both patients and surgeons as these tears have shown to be biomechanically equivalent to complete meniscectomy. However, little is known about the natural history of these lesions. Therefore, the purpose of this study is to describe the clinical course of MMPRTs with respect to subsequent operative and non-operative treatments, and associated comorbidities. Methods: Over 2600 MRIs were identified by searching radiologist reads for the terms “root” or “root tear” from 2005-2013. Presence or absence of MMPRTs and other associated boney, meniscal, or ligamentous injuries were identified and recorded. Of these MRIs, 102 MRIs from 102 patients who had unrepaired MMPRTs with minimum 2-year follow-up and no prior ligamentous surgery were followed. These MRIs were evaluated to confirm the presence of a meniscal root tear and the presence or absence of associated meniscal or ligamentous injuries, as well as meniscal extrusion, subchondral edema, or insufficiency fractures. Chart review was performed to obtain the treatment summary after diagnosis. Radiographs from before and after the diagnosis of MMPRT were reviewed and Kellgren-Lawrence scores were determined. Finally, the association between concomitant boney, ligamentous, or meniscal injuries, patient factors, and rate of arthroplasty, as well as final Kellgren-Lawrence scores were evaluated. Chi-square analysis was used for categorical variables, and Wilcoxon Rank-Sums was used for continuous variables. Kaplan-Meier analysis was used to evaluate the effect of meniscal extrusion on the time-dependant rate of arthroplasty. Results: 104 patients (43 M:61F) were diagnosed with MMPRTs at a mean age of 54±13. These patients were followed for a mean of 66±26 months. 75 (74%) patients had associated meniscal extrusion, 64 (62%) had associated subchondral edema, and 14 (13%) had associated insufficiency fractures at the time of

  15. Optimal management of ulnar collateral ligament injury in baseball pitchers.

    PubMed

    Hibberd, Elizabeth E; Brown, J Rodney; Hoffer, Joseph T

    2015-01-01

    The ulnar collateral ligament stabilizes the elbow joint from valgus stress associated with the throwing motion. During baseball pitching, this ligament is subjected to tremendous stress and injury if the force on the ulnar collateral ligament during pitching exceeds the physiological limits of the ligament. Injuries to the throwing elbow in baseball pitchers result in significant time loss and typically surgical intervention. The purpose of this paper is to provide a review of current information to sports medicine clinicians on injury epidemiology, injury mechanics, injury risk factors, injury prevention, surgical interventions, nonsurgical interventions, rehabilitation, and return to play outcomes in baseball pitchers of all levels. PMID:26635490

  16. Optimal management of ulnar collateral ligament injury in baseball pitchers

    PubMed Central

    Hibberd, Elizabeth E; Brown, J Rodney; Hoffer, Joseph T

    2015-01-01

    The ulnar collateral ligament stabilizes the elbow joint from valgus stress associated with the throwing motion. During baseball pitching, this ligament is subjected to tremendous stress and injury if the force on the ulnar collateral ligament during pitching exceeds the physiological limits of the ligament. Injuries to the throwing elbow in baseball pitchers result in significant time loss and typically surgical intervention. The purpose of this paper is to provide a review of current information to sports medicine clinicians on injury epidemiology, injury mechanics, injury risk factors, injury prevention, surgical interventions, nonsurgical interventions, rehabilitation, and return to play outcomes in baseball pitchers of all levels. PMID:26635490

  17. Thumb ulnar collateral and radial collateral ligament injuries.

    PubMed

    Schroeder, Nicole S; Goldfarb, Charles A

    2015-01-01

    Thumb metacarpophalangeal ulnar and radial collateral ligament injuries occur frequently in the competitive athlete. Collateral ligament integrity is essential to joint stability, pinch strength, and pain-free motion. Acute rupture of the ulnar collateral ligament is due to a sudden radial deviation force on the abducted thumb and is referred to as skier's thumb. An ulnar-directed force causes injury to the radial collateral ligament. The degree of joint instability on clinical examination allows classification of these injuries and guides management. Surgical repair of acute, complete tears results in good outcomes and allows for return to sporting activity.

  18. Optimal management of ulnar collateral ligament injury in baseball pitchers.

    PubMed

    Hibberd, Elizabeth E; Brown, J Rodney; Hoffer, Joseph T

    2015-01-01

    The ulnar collateral ligament stabilizes the elbow joint from valgus stress associated with the throwing motion. During baseball pitching, this ligament is subjected to tremendous stress and injury if the force on the ulnar collateral ligament during pitching exceeds the physiological limits of the ligament. Injuries to the throwing elbow in baseball pitchers result in significant time loss and typically surgical intervention. The purpose of this paper is to provide a review of current information to sports medicine clinicians on injury epidemiology, injury mechanics, injury risk factors, injury prevention, surgical interventions, nonsurgical interventions, rehabilitation, and return to play outcomes in baseball pitchers of all levels.

  19. Imaging of meniscus and ligament injuries of the knee.

    PubMed

    Faruch-Bilfeld, M; Lapegue, F; Chiavassa, H; Sans, N

    2016-01-01

    Magnetic resonance imaging has now an indisputable role for the diagnosis of meniscus and ligament injuries of the knee. Some technical advances have improved the diagnostic capabilities of magnetic resonance imaging so that diagnoses, which may change the therapeutic approach, such as a partial tear of the anterior cruciate ligament or confirmation of unstable meniscal injuries, are now made easier. This article describes the essential about magnetic resonance imaging technique and pathological results for the menisci, collateral ligaments and damage to the central pivot of the cruciate knee ligaments. PMID:27452631

  20. Minimally Invasive Anterolateral Ligament Reconstruction in the Setting of Anterior Cruciate Ligament Injury.

    PubMed

    Sonnery-Cottet, Bertrand; Barbosa, Nuno Camelo; Tuteja, Sanesh; Daggett, Matt; Kajetanek, Charles; Thaunat, Mathieu

    2016-02-01

    Recent evidence on the anatomy, function, and biomechanical properties of the anterolateral ligament has led to the recognition of the importance of this structure in the rotational control of the knee. This article describes a technique that allows for minimally invasive anterolateral ligament reconstruction as a complement to most techniques of anterior cruciate ligament reconstruction. A gracilis tendon autograft is harvested and prepared in a double-strand, inverted V-shaped graft. The graft is percutaneously placed through a femoral stab incision, and each strand is then passed deep to the iliotibial band, emerging through each tibial stab incision. After the femoral-end loop graft is fixed, the tibial fixation of each strand is performed in full extension for optimal isometry. PMID:27274456

  1. Anterolateral Ligament of the Knee: Back to the Future in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Bonasia, Davide Edoardo; D’Amelio, Andrea; Pellegrino, Pietro; Rosso, Federica; Rossi, Roberto

    2015-01-01

    Although the importance of the anterolateral stabilizing structures of the knee in the setting of anterior cruciate ligament (ACL) injuries has been recognized since many years, most of orthopedic surgeons do not take into consideration the anterolateral structures when performing an ACL reconstruction. Anatomic single or double bundle ACL reconstruction will improve knee stability, but a small subset of patients may experience some residual anteroposterior and rotational instability. For this reason, some researchers have turned again towards the anterolateral aspect of the knee and specifically the anterolateral ligament. The goal of this review is to summarize the existing knowledge regarding the anterolateral ligament of the knee, including anatomy, histology, biomechanics and imaging. In addition, the most common anterolateral reconstruction/tenodesis techniques are described together with their respective clinical outcomes. PMID:26330991

  2. [Ligamentous knee injuries in children and adolescents].

    PubMed

    Drenck, T C; Akoto, R; Meenen, N M; Heitmann, M; Preiss, A; Frosch, K- H

    2016-07-01

    Due to an increase in sporting activities, the number of injuries of the immature knee is continuously increasing. These injuries necessitate a special approach regarding the particular anatomical situation with open growth plates. Three of the most commonly occurring injuries are rupture of the anterior cruciate ligament, patella dislocation and meniscus injuries. The clinical results for conservative treatment of ruptures of the anterior cruciate ligament in the growth phase are inferior to operative treatment. Transepiphyseal reconstruction has been shown to be a safe treatment method and provides good clinical results. Therapy of patella instability in children has shown poor results and new surgical techniques have been introduced to perform an anatomical reconstruction of the medial patellofemoral ligament as well as to improve distal alignment. Isolated injuries to the meniscus are rare and discoid meniscus is a special phenomenon occurring in infancy. Meniscus injuries should be treated with primary sutures rather than resection. A discoid meniscus should be resected with extreme caution and anatomically reconstructed. PMID:27385203

  3. Longevity of Posterior Composite Restorations

    PubMed Central

    Opdam, N.J.M.; van de Sande, F.H.; Bronkhorst, E.; Cenci, M.S.; Bottenberg, P.; Pallesen, U.; Gaengler, P.; Lindberg, A.; Huysmans, M.C.D.N.J.M.; van Dijken, J.W.

    2014-01-01

    The aim of this meta-analysis, based on individual participant data from several studies, was to investigate the influence of patient-, materials-, and tooth-related variables on the survival of posterior resin composite restorations. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a search resulting in 12 longitudinal studies of direct posterior resin composite restorations with at least 5 years’ follow-up. Original datasets were still available, including placement/failure/censoring of restorations, restored surfaces, materials used, reasons for clinical failure, and caries-risk status. A database including all restorations was constructed, and a multivariate Cox regression method was used to analyze variables of interest [patient (age; gender; caries-risk status), jaw (upper; lower), number of restored surfaces, resin composite and adhesive materials, and use of glass-ionomer cement as base/liner (present or absent)]. The hazard ratios with respective 95% confidence intervals were determined, and annual failure rates were calculated for subgroups. Of all restorations, 2,816 (2,585 Class II and 231 Class I) were included in the analysis, of which 569 failed during the observation period. Main reasons for failure were caries and fracture. The regression analyses showed a significantly higher risk of failure for restorations in high-caries-risk individuals and those with a higher number of restored surfaces. PMID:25048250

  4. Huge interparietal posterior fontanel meningohydroencephalocele

    PubMed Central

    Dos Santos, Manuel Filipe Dias; de Santa Barbara, Rita de Cassia

    2015-01-01

    Congenital encephalocele is a neural tube defect characterized by a sac-like protrusion of the brain, meninges, and other intracranial structures through the skull, which is caused by an embryonic development abnormality. The most common location is at the occipital bone, and its incidence varies according to different world regions. We report a case of an 1-month and 7-day-old male child with a huge interparietal-posterior fontanel meningohydroencephalocele, a rare occurrence. Physical examination and volumetric computed tomography were diagnostic. The encephalocele was surgically resected. Intradural and extradural approaches were performed; the bone defect was not primarily closed. Two days after surgery, the patient developed hydrocephaly requiring ventriculoperitoneal shunting. The surgical treatment of the meningohydroencephalocele of the interparietal-posterior fontanel may be accompanied by technical challenges and followed by complications due to the presence of large blood vessels under the overlying skin. In these cases, huge sacs herniate through large bone defects including meninges, brain, and blood vessels. The latter present communication with the superior sagittal sinus and ventricular system. A favorable surgical outcome generally follows an accurate strategy taking into account individual features of the lesion. PMID:26484324

  5. Posterior cerebral artery territory infarctions.

    PubMed

    Cereda, Carlo; Carrera, Emmanuel

    2012-01-01

    Infarctions in the territory of the posterior cerebral artery (PCA) occur in about 5-10% of all ischemic strokes. The PCA can be divided into 'deep' (P1 and P2 segments) and 'superficial' (P3 and P4) segments. Occlusion of paramedian perforating arteries arising from P1 causes rostral midbrain infarction with or without thalamic lesion. The classical clinical triad after thalamomesencephalic infarcts is hypersomnolence, cognitive deficits and vertical oculomotor paresis. Two main arterial groups arise from P2: infarction in the territory of the thalamogeniculate arteries causes severe contralateral hypesthesia and ataxia, whereas infarction in the territory of the posterior choroidal arteries results in sectoranopia with involvement of the lateral geniculate body. After superficial PCA infarcts, visual field defects and somatosensory deficits are the most frequent signs. Additionally, disorders of reading may be seen after unilateral left infarction and disorientation for place and visual neglect after right lesion. After bilateral PCA infarcts, amnesia, cortical blindness (the patient cannot see but pretend he can) may occur. Acute thrombolysis is as useful after PCA infarctions as after anterior circulation strokes. Mortality after PCA strokes is low, but long-term behavioral and cognitive deficits are underestimated.

  6. A new snowboard injury caused by "FLOW" bindings: a complete deltoid ligament and anterior talofibular ankle ligament rupture.

    PubMed

    Haverkamp, Daniel; Hoornenborg, Daniel; Maas, Mario; Kerkhoffs, Gino

    2014-05-01

    We present a case of a snowboard injury that caused a combination of a complete deltoid and anterior talofibular ligament rupture, without bony or syndesmotic injury. Initial surgical repair for both ligaments was performed. We describe the etiology of this injury to demonstrate the cause and existence of medial and lateral ankle ligament rupture without osseous and syndesmotic involvement and to create awareness of these types of injuries. PMID:24901589

  7. Combined Reconstruction of the Medial Patellofemoral Ligament With Quadricipital Tendon and the Medial Patellotibial Ligament With Patellar Tendon

    PubMed Central

    Hinckel, Betina Bremer; Gobbi, Riccardo Gomes; Demange, Marco Kawamura; Bonadio, Marcelo Batista; Pécora, José Ricardo; Camanho, Gilberto Luis

    2016-01-01

    Although the medial patellotibial ligament (MPTL) has been neglected regarding its function in patellar stability, recently, its importance in terminal extension and during flexion has been recognized. Indications for reconstruction of the medial patellofemoral ligament combined with the MPTL are extension subluxation, flexion instability, children with anatomic risk factors for patellar instability, and knee hyperextension associated with generalized laxity. We describe a combined reconstruction of the medial patellofemoral ligament with quadricipital tendon and reconstruction of the MPTL with patellar tendon autografts. PMID:27073782

  8. The development of the posterior body in zebrafish.

    PubMed

    Kanki, J P; Ho, R K

    1997-02-01

    In order to understand the developmental mechanisms of posterior body formation in the zebrafish, a fate map of the zebrafish tailbud was generated along with a detailed analysis of tailbud cell movements. The fate map of the zebrafish tailbud shows that it contains tissue-restricted domains and is not a homogeneous blastema. Furthermore, time-lapse analysis shows that some cell movements and behaviors in the tailbud are similar to those seen during gastrulation, while others are unique to the posterior body. The extension of axial mesoderm and the continuation of ingression throughout zebrafish tail development suggests the continuation of processes initiated during gastrulation. Unique properties of zebrafish posterior body development include the bilateral distribution of tailbud cell progeny and the exhibition of different forms of ingression within specific tailbud domains. The ingression of cells in the anterior tailbud only gives rise to paraxial mesoderm, at the exclusion of axial mesoderm. Cells of the posterior tailbud undergo subduction, a novel form of ingression resulting in the restriction of this tailbud domain to paraxial mesodermal fates. The intermixing of spinal cord and muscle precursor cells, as well as evidence for pluripotent cells within the tailbud, suggest that complex inductive mechanisms accompany these cell movements throughout tail elongation. Rates of cell proliferation in the tailbud were examined and found to be relatively low at the tip of the tail indicating that tail elongation is not due to growth at its posterior end. However, higher rates of cell proliferation in the dorsomedial region of the tail may contribute to the preferential posterior movement of cells in this tailbud region and to the general extension of the tail. Understanding the cellular movements, cell fates and gene expression patterns in the tailbud will help to determine the nature of this important aspect of vertebrate development. PMID:9043069

  9. Reconstruction of anterior cruciate ligament and anterolateral ligament using interlinked hamstrings - technical note.

    PubMed

    Ferreira, Marcio de Castro; Zidan, Flavio Ferreira; Miduati, Francini Belluci; Fortuna, Caio Cesar; Mizutani, Bruno Moreira; Abdalla, Rene Jorge

    2016-01-01

    Recent anatomical and biomechanical studies on the anterolateral ligament (ALL) of the knee have shown that this structure has an important function in relation to joint stability, especially when associated with anterior cruciate ligament (ACL) injury. However, the criteria for its reconstruction have not yet been fully established and the surgical techniques that have been described present variations regarding anatomical points and fixation materials. This study presents a reproducible technique for ALL and ACL reconstruction using hamstring tendons, in which three interference screws are used for fixation.

  10. Reconstruction of anterior cruciate ligament and anterolateral ligament using interlinked hamstrings - technical note.

    PubMed

    Ferreira, Marcio de Castro; Zidan, Flavio Ferreira; Miduati, Francini Belluci; Fortuna, Caio Cesar; Mizutani, Bruno Moreira; Abdalla, Rene Jorge

    2016-01-01

    Recent anatomical and biomechanical studies on the anterolateral ligament (ALL) of the knee have shown that this structure has an important function in relation to joint stability, especially when associated with anterior cruciate ligament (ACL) injury. However, the criteria for its reconstruction have not yet been fully established and the surgical techniques that have been described present variations regarding anatomical points and fixation materials. This study presents a reproducible technique for ALL and ACL reconstruction using hamstring tendons, in which three interference screws are used for fixation. PMID:27517028

  11. Achieving ligament stability and correct rotational alignment of the femur in knee arthroplasty: a study using the Medial Pivot knee.

    PubMed

    Shakespeare, David; Kinzel, Vera; Ledger, Michael

    2005-12-01

    In a series of 90 Medial Pivot arthroplasties rotational alignment of the femur was achieved by provisionally reconstructing the lateral side of the joint and tensioning the medial side with feeler gauges. Axial CT scans were employed to measure the rotational alignment relative to surgical epicondylar axis. In valgus knees the cutting block was externally rotated to adjust for posterolateral bone loss. The mean rotational alignment of the femur was 0.6 degrees of external rotation (S.D. 1.3, range 3 degrees of ER to 4 degrees of IR). The mean laxity of the medial ligament was 1 mm in flexion (SD 1, range 0-5 mm) and 0.5 mm in flexion (S.D. 0.5, range 0-2 mm) In those knees in which the medial ligament had been released the CT alignment was perfect, but when internally rotated against the hip 3-4 mm of gapping was noted. In valgus knees the mean rotation of the femoral component was 0.8 degrees of internal rotation (S.D. 1.5, range 1 degrees of IR to 4 degrees of ER). In spite of externally rotating the cutting block there was still a tendency to internally rotate the femur in some knees. This simple technique achieves the two goals of ligament stability and correct rotational alignment in a high proportion of cases. It may be applicable to any instrument system which employs posterior referencing.

  12. Transient Paraparesis After Laminectomy in a Patient with Multi-Level Ossification of the Spinal Ligament

    PubMed Central

    Shim, Jae-Jun; Doh, Jae-Won; Yoon, Seok-Mann; Bae, Hack-Gun; Yun, Il-Gyu

    2004-01-01

    Acute neurologic deterioration is not a rare event in the surgical decompression for thoracic spinal stenosis. We report a case of transient paraparesis after decompressive laminectomy in a 50-yr-old male patient with multi-level thoracic ossification of the ligamentum flavum and cervical ossification of the posterior longitudinal ligament. Decompressive laminectomy from T9 to T11 was performed without gross neurological improvement. Two weeks after the first operation, laminoplasty from C4 to C6 and additional decompressive laminectomies of T3, T4, T6, and T8 were performed. Paraparesis developed 3 hr after the second operation, which recovered spontaneously 5 hr thereafter. CT and MRI were immediately performed, but there were no corresponding lesions. Vascular compromise of the borderlines of the arterial supply by microthrombi might be responsible for the paraparesis. PMID:15308861

  13. Medial collateral ligament bursitis in a 12-year-old girl.

    PubMed

    Barclay, Caroline; Springgay, Gemma; van Beek, Edwin J R; Rolf, Christer G

    2005-06-01

    A 12-year-old female athlete, training for an international career in pentathlon, was referred to our clinic because of 2 years of recurrent localized swelling and activity-related pain in the medial aspect of her right knee, since falling from a horse and hitting her knees on the ground. She had been examined by a number of doctors over this period and treated with physiotherapy without a proper diagnosis and with no improvement. She could run only very limited distances before excruciating pain and swelling, and she had to abandon participation in competitions. During rest, the swelling decreased but never disappeared entirely. Clinical examination revealed minor effusion and localized tenderness on palpation around the medial joint line. Magnetic resonance imaging showed fluid between the medial capsule and medial collateral ligament, but could not identify any connection to the joint. Arthroscopy revealed a cleavage in the posterior medial joint capsule, superior and close to the medial meniscus, that was connected to the medial collateral ligament bursa. The cleavage was simply expanded, which emptied the bursa, followed by compression bandage and ice for 2 weeks. An immediate positive effect was observed and she could run pain free without swelling within 3 weeks of surgery. Six months after surgery, there has been no recurrence. To our knowledge, this is the first time this injury has been described in a child.

  14. Anterior cruciate ligament reconstruction with preservation of remnant bundle using hamstring autograft: technical note.

    PubMed

    Ahn, Jin Hwan; Lee, Yong Seuk; Ha, Hae Chan

    2009-08-01

    During an arthroscopic examination for an anterior cruciate ligament (ACL) reconstruction, there is a relatively thick remnant ACL tibial stump attached to the posterior cruciate ligament (PCL) or rarely remained between the femur origin and the tibia insertion. We thought that preservation of the remnant ACL original bundle might promote graft healing or be helpful in preserving the proprioception and function to stabilize the knee. Therefore, we established a remnant preservation procedure without additional instruments during an ACL reconstruction using a bio-cross pin (RIGIDfix system: Mitek, Johnson & Johnson, USA) for the femoral tunnel fixation. The remnant ACL was sutured (usually three stitches) using a suture hook (Linvatec, Largo, FL), and both ends of the sutures were pulled to the far anteromedial (AM) portal. These sutures protected the remnant tissue during the ACL reconstruction because medial traction of these sutures can provide a wide view during the reconstruction. After the femoral and tibial tunnel formation, these sutures were pulled out to the inferior sleeve of the cross pin using a previously inserted wire loop via an inferior sleeve. After graft passage, a superior cross pin was first fixed and tibial fixation was then performed. Finally, inferior cross pin fixation was performed and ties were made at the entrance of the inferior cross pin. PMID:18299859

  15. Endoscopic management of posterior epistaxis: a review.

    PubMed

    McClurg, S W; Carrau, R

    2014-02-01

    The paradigm for the management of epistaxis, specifically posterior epistaxis, has undergone significant changes in the recent past. Recent prospective and retrospective data has shown that the endonasal surgical management of posterior epistaxis is superior to posterior nasal packing and angiography/embolization with regards to various factors including pain, cost-effectiveness, risk and overall control of bleeding. Endonasal endoscopic surgical techniques for posterior epistaxis include direct cauterization and transnasal endoscopic sphenopalatine/ posterior nasal artery ligation or cauterization with or without control of the anterior ethmoidal artery. Despite the evidence provided by the current literature, a universal treatment protocol has not yet been established. This review article provides an up-to-date assessment of the available literature, and presents a structured paradigm for the management of posterior epistaxis.

  16. Placement technique for direct posterior composite restorations.

    PubMed

    Javaheri, D S

    2001-04-01

    Due to improved materials, instrumentation, and placement techniques, composite resins have overcome the traditional complications associated with wear resistance, microleakage, sensitivity, and tight anatomical contacts. Composite resins have been utilized with increased frequency for direct posterior restorations capable of satisfying the growing aesthetic expectations of contemporary dental patients. When properly placed, posterior composites can provide successful and predictable restorations. This article presents clinical considerations for the aesthetic conservation of posterior restorations with composite resin materials.

  17. Multiclass Posterior Probability Twin SVM for Motor Imagery EEG Classification.

    PubMed

    She, Qingshan; Ma, Yuliang; Meng, Ming; Luo, Zhizeng

    2015-01-01

    Motor imagery electroencephalography is widely used in the brain-computer interface systems. Due to inherent characteristics of electroencephalography signals, accurate and real-time multiclass classification is always challenging. In order to solve this problem, a multiclass posterior probability solution for twin SVM is proposed by the ranking continuous output and pairwise coupling in this paper. First, two-class posterior probability model is constructed to approximate the posterior probability by the ranking continuous output techniques and Platt's estimating method. Secondly, a solution of multiclass probabilistic outputs for twin SVM is provided by combining every pair of class probabilities according to the method of pairwise coupling. Finally, the proposed method is compared with multiclass SVM and twin SVM via voting, and multiclass posterior probability SVM using different coupling approaches. The efficacy on the classification accuracy and time complexity of the proposed method has been demonstrated by both the UCI benchmark datasets and real world EEG data from BCI Competition IV Dataset 2a, respectively. PMID:26798330

  18. Return to Play Following Anterior Cruciate Ligament Reconstruction.

    PubMed

    Morris, Ryan C; Hulstyn, Michael J; Fleming, Braden C; Owens, Brett D; Fadale, Paul D

    2016-10-01

    Anterior cruciate ligament reconstructions are commonly performed in an attempt to return an athlete to sports activities. Accelerated rehabilitation has made recovery for surgery more predictable and shortened the timeline for return to play. Despite success with and advancements in anterior cruciate ligament reconstructions, some athletes still fail to return to play. PMID:27543405

  19. Management of anterior cruciate ligament injury: pathophysiology and treatment.

    PubMed

    Alazzawi, Sulaiman; Sukeik, Mohamed; Ibrahim, Mazin; Haddad, Fares S

    2016-04-01

    Anterior cruciate ligament injury, a common soft tissue injury of the knee joint, is increasing in incidence particularly in young active people. It causes instability of the knee that leads to meniscal tears, cartilage defects and early osteoarthritis. This review summarizes aspects of anterior cruciate ligament injury management.

  20. What does the transverse carpal ligament contribute to carpal stability?

    PubMed

    Vanhees, Matthias; Verstreken, Frederik; van Riet, Roger

    2015-02-01

    Background The transverse carpal ligament is well known for its involvement in carpal tunnel syndrome, and sectioning of this ligament remains the definite treatment for this pathology. Some authors believe that the transverse carpal ligament is an important stabilizer of the carpal arch, whereas others do not consider it to be significant. Several studies have been performed, both in vivo and in in vitro. Sectioning of the transverse carpal ligament does not seem to have any effect on the width of the carpal arch in the unloaded condition. However, patients will load the arch during their activities of daily living. Materials and Methods A cadaveric study was done with distraction of the carpal bones before and after sectioning the transverse carpal ligament. Results With the transverse carpal ligament intact, the carpal arch is mobile, with distraction leading up to 50% widening of the arch. Sectioning of the transverse carpal ligament resulted in a significant widening of the carpal arch by a further 30%. Conclusions Loading of the carpal arch after sectioning of the transeverse carapal ligament leads to a significant increase in intracarpal mobility. This will inevitably influence carpal kinematics in the patient and might be responsible for some complications after simple carpal tunnel releases, such as pillar pain, palmar tenderness, and loss of grip strength.

  1. External rotation views in the diagnosis of posterior colliculus fracture of the medial malleolus.

    PubMed

    Ebraheim, N A; Wong, F Y

    1996-05-01

    A 25-year-old white man sustained a fracture dislocation of the right ankle with a displaced fracture of the lateral malleolus while playing basketball. He also sustained a fracture of the medial aspect of the distal tibia, in addition to an apparent deltoid ligament injury. The patient underwent open reduction and internal fixation of the lateral malleolus and insertion of a syndesmotic screw. Intraoperatively, external rotation radiographs of the ankle were obtained to determine the origin of the fracture of the medial side of the ankle joint. The radiographs clearly showed a minimally displaced fracture of the posterior colliculus. Posterior colliculus fracture can be occult. This fracture may not be clearly visible on plain antero-posterior or mortise-view radiographs and external rotation is necessary for its diagnosis. This fracture is usually minimally displaced and can be satisfactorily treated conservatively. The patient's leg was placed in a short-leg cast for 6 weeks. Follow-up radiographs revealed healing of the fracture.

  2. Anterolateral Ligament Reconstruction Technique: An Anatomic-Based Approach.

    PubMed

    Chahla, Jorge; Menge, Travis J; Mitchell, Justin J; Dean, Chase S; LaPrade, Robert F

    2016-06-01

    Restoration of anteroposterior laxity after an anterior cruciate ligament reconstruction has been predictable with traditional open and endoscopic techniques. However, anterolateral rotational stability has been difficult to achieve in a subset of patients, even with appropriate anatomic techniques. Therefore, differing techniques have attempted to address this rotational laxity by augmenting or reconstructing lateral-sided structures about the knee. In recent years, there has been a renewed interest in the anterolateral ligament as a potential contributor to residual anterolateral rotatory instability in anterior cruciate ligament-deficient patients. Numerous anatomic and biomechanical studies have been performed to further define the functional importance of the anterolateral ligament, highlighting the need for surgical techniques to address these injuries in the unstable knee. This article details our technique for an anatomic anterolateral ligament reconstruction using a semitendinosus tendon allograft. PMID:27656361

  3. Specialisation of extracellular matrix for function in tendons and ligaments

    PubMed Central

    Birch, Helen L.; Thorpe, Chavaunne T.; Rumian, Adam P.

    2013-01-01

    Summary Tendons and ligaments are similar structures in terms of their composition, organisation and mechanical properties. The distinction between them stems from their anatomical location; tendons form a link between muscle and bone while ligaments link bones to bones. A range of overlapping functions can be assigned to tendon and ligaments and each structure has specific mechanical properties which appear to be suited for particular in vivo function. The extracellular matrix in tendon and ligament varies in accordance with function, providing appropriate mechanical properties. The most useful framework in which to consider extracellular matrix differences therefore is that of function rather than anatomical location. In this review we discuss what is known about the relationship between functional requirements, structural properties from molecular to gross level, cellular gene expression and matrix turnover. The relevance of this information is considered by reviewing clinical aspects of tendon and ligament repair and reconstructive procedures. PMID:23885341

  4. Trimalleolar fracture with a double fragment of the posterior malleolus: a case report and modified operative approach to internal fixation.

    PubMed

    Karachalios, T; Roidis, N; Karoutis, D; Bargiotas, K; Karachalios, G G

    2001-02-01

    Fractures of the medial and lateral malleoli are frequently associated with fractures of the posterior malleolus, comprising trimalleolar fractures. The posterior fragment may be posteromedial or posterolateral and its size determines the necessity for surgical or non-surgical treatment. The authors describe a case of trimalleolar fracture with double involvement of the posterior malleolus, both a posteromedial and posterolateral fragment. A modified transmalleolar operative approach for internal fixation is recommended when dealing with such complex trimalleolar fractures of the ankle.

  5. The Synergistic Role of the Lateral Meniscus Posterior Root and the ALL in Providing Anterolateral Rotational Stability of the Knee

    PubMed Central

    Getgood, Alan M.; Lording, Timothy; Corbo, Gillian; Burkhart, Tim A.

    2016-01-01

    Objectives: Injury to the anterolateral ligament (ALL) has been reported to contribute to high-grade anterolateral laxity following anterior cruciate ligament (ACL) injury. Failure to address ALL injury has been suggested as a cause of persistent rotational laxity following ACL reconstruction. However, lateral meniscus posterior root (LMPR) tears have also has been shown to cause increased internal rotation and anterior translation of the knee. Due to the anatomic relationship of the ALL and the lateral meniscus, we hypothesize that the ALL and lateral meniscus work synergistically, and that a tear to the LMPR will have the same effect on anterolateral laxity as an ALL tear in the ACL deficient knee. Methods: Sixteen fresh frozen cadaveric knee specimens (mid -femur to mid-tibia) were potted into a hip simulator (femur) and a six degree-of-freedom load cell (tibia). Two rigid optical trackers were inserted into the proximal femur and distal tibia, allowing for the motion of the tibia with respect to the femur to be tracked during biomechanical tests. A series of points on the femur and tibia were digitized to create bone coordinate systems that were used to calculate the kinematic variables. Biomechanical testing involved applying a 5 Nm internal rotation moment to the tibia while the knee was in full extension and tested sequentially in the following three conditions: i) ACLintact; ii) Partial ACL injury (ACLam) -anteromedial bundle sectioned; iii) Full ACL injury (ACLfull). The specimens were then randomized to either have the ALL sectioned first (ALLsec) followed by the LMPRsec or vice versa. Internal rotation and anterior translation of the tibia with respect to the femur were calculated. A mixed two-way (serial sectioning by ALL section order) repeated measures ANOVA (α = 0.05). Results: Compared to the ACLintact condition, internal rotation was found to be 1.78° (p=0.06), 3.74° (p=0.001), and 3.84° (p=0.001) greater following ACLfull, LMPRsec and ALLsec

  6. Pseudoaneurysm of the Posterior Tibial Artery After Posterior Tibial Tendon Transfer.

    PubMed

    Elabdi, Monsef; Roukhsi, Redouane; Tijani, Youssef; Chtata, Hassan; Jaafar, Abdeloihab

    2016-01-01

    Pseudoaneurysm of the posterior tibial artery is an uncommon condition that, left untreated, can lead to hemorrhage, thrombosis, or emboli. We present the case of a 54-year-old male who developed pseudoaneurysm of the posterior tibial artery 4 months after undergoing tibialis posterior tendon transfer for management of peroneal nerve palsy, which had developed as a complication of hip arthroplasty. PMID:26972754

  7. All-inside anterior cruciate ligament reconstruction.

    PubMed

    Blackman, Andrew J; Stuart, Michael J

    2014-10-01

    All-inside anterior cruciate ligament (ACL) reconstruction has undergone a series of modifications over the past 20 years. Current techniques offer the advantages of improved cosmesis, less postoperative pain, decreased bone removal, and gracilis preservation. Few all-inside ACL reconstruction outcome studies are available; therefore, additional research is necessary to compare the results to conventional techniques. The purpose of this article is to review the evolution of all-inside ACL reconstruction, the advantages and disadvantages, our preferred technique, and clinical experience to date.

  8. Consistently inconsistent, the posterior vaginal wall.

    PubMed

    Hale, Douglass S; Fenner, Dee

    2016-03-01

    Posterior vaginal wall prolapse is one of the most common prolapses encountered by gynecological surgeons. What appears to be a straightforward condition to diagnose and treat surgically for physicians has proven to be frustratingly unpredictable with regard to symptom relief for patients. Functional disorders such as dyssynergic defecation and constipation are often attributed to posterior vaginal wall prolapse. Little scientific evidence supports this assumption, emphasizing that structure and function are not synonymous when treating posterior vaginal wall prolapse. Rectoceles, enteroceles, sigmoidoceles, peritoneoceles, rectal and intraanal intussusception, rectal prolapse, and descending perineal syndrome are all conditions that have an impact on the posterior vaginal wall. All too often these different anatomic conditions are treated with the same surgical approach, addressing a posterior vaginal wall bulge with a traditional posterior colporrhaphy. Studies that examine the correlation between stage of posterior wall prolapse and patient symptoms have failed to reliably do so. Surgical outcomes measured by prolapse staging appear successful, yet patient expectations are often not met. As increasing attention is being placed on patient satisfaction outcomes concerning surgical treatments, this fact will need to be addressed. Surgeons will have to clearly communicate what can and what cannot be expected with surgical repair of posterior vaginal wall prolapse.

  9. Neurolinguistic Aspects of Finnish Posterior Aphasia.

    ERIC Educational Resources Information Center

    Niemi, Jussi; Koivuselka-Sallinen, Paivi

    Examination of the lexical errors (phonological paraphasias and neologisms) of two posterior aphasic patients who are speakers of Finnish, a highly synthetic language, revealed that the lexical difficulties generally typical of posterior aphasics were found in these patients as well. The typical lexical difficulties clustered around open class…

  10. Cementum and Periodontal Ligament Regeneration.

    PubMed

    Menicanin, Danijela; Hynes, K; Han, J; Gronthos, S; Bartold, P M

    2015-01-01

    The unique anatomy and composition of the periodontium make periodontal tissue healing and regeneration a complex process. Periodontal regeneration aims to recapitulate the crucial stages of wound healing associated with periodontal development in order to restore lost tissues to their original form and function and for regeneration to occur, healing events must progress in an ordered and programmed sequence both temporally and spatially, replicating key developmental events. A number of procedures have been employed to promote true and predictable regeneration of the periodontium. Principally, the approaches are based on the use of graft materials to compensate for the bone loss incurred as a result of periodontal disease, use of barrier membranes for guided tissue regeneration and use of bioactive molecules. More recently, the concept of tissue engineering has been integrated into research and applications of regenerative dentistry, including periodontics, to aim to manage damaged and lost oral tissues, through reconstruction and regeneration of the periodontium and alleviate the shortcomings of more conventional therapeutic options. The essential components for generating effective cellular based therapeutic strategies include a population of multi-potential progenitor cells, presence of signalling molecules/inductive morphogenic signals and a conductive extracellular matrix scaffold or appropriate delivery system. Mesenchymal stem cells are considered suitable candidates for cell-based tissue engineering strategies owing to their extensive expansion rate and potential to differentiate into cells of multiple organs and systems. Mesenchymal stem cells derived from multiple tissue sources have been investigated in pre-clinical animal studies and clinical settings for the treatment and regeneration of the periodontium.

  11. Continence after posterior sagittal anorectoplasty.

    PubMed

    Langemeijer, R A; Molenaar, J C

    1991-05-01

    Posterior sagittal anorectoplasty (PSARP) was introduced in 1982 by Peña and De Vries as a new operation for patients with a high anorectal malformation. The degree of postoperative continence is reported to be high. During the past decade, too, new insights have been gained into the embryology of anorectal malformations. Evaluation of PSARP in relation to current understanding of the development and anatomy of the anorectum and the pelvic floor has led us to conclude that optimal continence cannot be expected. Fifty patients with a high anorectal malformation underwent PSARP between June 1983 and May 1990. Postoperative follow-up consisted of anamnesis (subjective) and electrostimulation, defecography, and anorectal manometry (objective). All patients are alive, and all but one are being evaluated regularly. Subjectively, the majority of patients were more or less incontinent, with soiling of pants at least once a day. On the basis of objective criteria, virtually all patients appeared to be incontinent, and in only one patient was the mechanism of defecation almost unimpaired after PSARP. From this study, we conclude that although PSARP provides a good aesthetic result, patients will never acquire normal continence.

  12. Non-anatomical reconstruction of lateral ulnar collateral ligament of the elbow after tumor resection.

    PubMed

    Hanada, Masuo; Kadota, H; Matsunobu, T; Shimada, E; Iwamoto, Y

    2015-11-01

    We present the case of an 80-year-old man with a tumor recurrence on his right arm 6 years after initial treatment. The lateral aspect of the elbow joint, involving overlaying skin, muscles, tendons, joint capsule, lateral collateral ligament complex, the lateral 1/3 of the capitellum, and lateral epicondyle of humerus were excised in the tumor resection. Intraoperative assessment revealed multidirectional instability of the elbow, and joint stabilization was needed. Because the lateral epicondyle was resected, graft placement in an anatomical position was impossible to carry out. Therefore, non-anatomical reconstruction of lateral ulnar collateral ligament with palmaris longus tendon graft was performed. The skin was reconstructed using an antegrade pedicled radial forearm flap. For wrist extension reconstruction, the pronator quadratus tendon was transferred to the extensor carpi radialis brevis tendon. One year after the operation, elbow range of motion was 5-130°. The patient remains symptom free. The Mayo elbow performance score is good. The Musculoskeletal Tumor Society rating score is excellent. To our knowledge, this is the first report of an elbow lateral ulnar collateral ligament reconstruction after tumor resection.

  13. Physical examination and imaging of medial collateral ligament and posteromedial corner of the knee.

    PubMed

    Craft, Jason A; Kurzweil, Peter R

    2015-06-01

    The medial collateral ligament (MCL) is the most commonly injured knee ligament. Most will heal well with nonoperative treatment. However, not all medial knee injuries are the same. A detailed physical examination can help determine the severity of the medial-sided injury. When combined with advanced imaging, the examination will delineate damage to associated medial knee structures, including the location of MCL damage, posteromedial capsule injuries, and combined cruciate injuries. Failure to recognize MCL injuries that may be prone to chronic laxity can lead to significant disability, joint damage, and failure of concomitant cruciate ligament reconstructions. Magnetic resonance imaging is the mainstay of diagnostic imaging, with coronal sequences allowing full assessment of the MCL complex. Tangential views aid in the diagnosis of concomitant injuries. Stress radiography can play a role in evaluating MCL healing and subtle chronic laxity. Ultrasonography is also gaining acceptance as a means to assess MCL injuries. Use of a detailed examination and advanced imaging will allow optimal treatment of medial knee injuries and improve clinical outcomes.

  14. Posterior capsular fibrosis in professional baseball pitchers: case series of MR arthrographic findings in six patients with glenohumeral internal rotational deficit.

    PubMed

    Tehranzadeh, Arash D; Fronek, Jan; Resnick, Donald

    2007-01-01

    In the high-performance athlete, acquired thickening of the posterior joint capsule is a proposed etiology for glenohumeral internal rotational deficit (GIRD). The purpose of this study was to present our MR arthrographic imaging observations of posterior capsular thickening in professional baseball players who present with reduced throwing velocity related to pain and clinical findings of internal rotational deficit of the glenohumeral joint. Our observations of MR imaging features in patients with clinical and arthroscopic manifestations of GIRD lesions include articular surface partial thickness tears of the supraspinatus and infraspinatus tendons, superoposterior subluxation of the humeral head and SLAP tears of the labrum. Although no empiric standard currently exists for the axial dimension thickness of the shoulder capsule, we have observed a thickened appearance of the posterior band of the inferior glenohumeral ligament in these patients.

  15. Estimation of Ligament Loading and Anterior Tibial Translation in Healthy and ACL-Deficient Knees During Gait and the Influence of Increasing Tibial Slope Using EMG-Driven Approach

    PubMed Central

    Shao, Qi; MacLeod, Toran D.; Manal, Kurt

    2010-01-01

    The purpose of this study was to develop a biomechanical model to estimate anterior tibial translation (ATT), anterior shear forces, and ligament loading in the healthy and anterior cruciate ligament (ACL)-deficient knee joint during gait. This model used electromyography (EMG), joint position, and force plate data as inputs to calculate ligament loading during stance phase. First, an EMG-driven model was used to calculate forces for the major muscles crossing the knee joint. The calculated muscle forces were used as inputs to a knee model that incorporated a knee–ligament model in order to solve for ATT and ligament forces. The model took advantage of using EMGs as inputs, and could account for the abnormal muscle activation patterns of ACL-deficient gait. We validated our model by comparing the calculated results with previous in vitro, in vivo, and numerical studies of healthy and ACL-deficient knees, and this gave us confidence on the accuracy of our model calculations. Our model predicted that ATT increased throughout stance phase for the ACL-deficient knee compared with the healthy knee. The medial collateral ligament functioned as the main passive restraint to anterior shear force in the ACL-deficient knee. Although strong co-contraction of knee flexors was found to help restrain ATT in the ACL-deficient knee, it did not counteract the effect of ACL rupture. Posterior inclination angle of the tibial plateau was found to be a crucial parameter in determining knee mechanics, and increasing the tibial slope inclination in our model would increase the resulting ATT and ligament forces in both healthy and ACL-deficient knees. PMID:20683675

  16. Pollical oblique ligament in humans and non-human primates.

    PubMed

    Shrewsbury, Marvin

    2003-04-01

    A morphological study of the oblique ligament in the thumb is presented. The ligament was consistently described in human specimens and compared with dissections of non-human primates from different species. The oblique ligament was found in some, but not all, specimens in each of the following species examined: chimpanzee, orangutan, gibbon, anubis baboon, hamadryas baboon, squirrel monkey, lemur and marmoset. A revised identity of the oblique ligament is proposed as a reinforced distal border of a fibro-osseous annular pollical flexor sheath and whose function is not independent of the flexor sheath. The constant presence and tendinous trait of the pollical oblique ligament in humans, when compared with non-human primates, supports the notion that the oblique ligament strengthens the pollical flexor sheath in humans for restraint of the flexor pollicis longus tendon during forceful precision pinching. A derivation of the pollical oblique ligament is considered as representing a vestigial radial limb of a flexor pollicis superficialis tendon in the thumb.

  17. [Arthroscopic reconstruction of the anterior cruciate ligament using double anteromedial and posterolateral bundles].

    PubMed

    Franceschi, J P; Sbihi, A; Champsaur, P

    2002-11-01

    We propose a method for repairing the anterior cruciate ligament which takes advantage of the multifascular nature of the ligament to achieve better physiological anteroposterior and rotational stability compared with conventional methods. Arthroscopic reconstruction of the anteromedial and posterolateral bundles of the ligament closely reproduces normal anatomy. We have used this technique in 92 patients with anterior cruciate ligament laxity and present here the mid-term results. The hamstring tendons (gracilis and semitendinosus) are harvested carefully to obtain good quality grafts. Arthroscopic preparation of the notch allows careful cleaning of the axial aspect of the lateral condyle; it is crucial to well visualize the region over the top and delimit the 9 h-12 h zone for the right knee or the 12-15 h zone for the left knee. The femoral end of the anteromedial tunnel lies close to the floor of the intercondylar notch, 5 to 10 mm in front of the posterior border of the lateral condyle, at 13 h for the left knee and 11 h for the right knee. The femoral end of the posterolateral tunnel lies more anteriorly, at 14 h for the left knee and 10 h for the right knee. The tibial end of the posterolateral tunnel faces the anterolateral spike of the tibia. The tibial end of the anteromedial tunnel lies in front of the apex of the two tibial spikes half way between the anteromedial spike and the anterolateral spike, 8 mm in front of the protrusion of the posteriolateral pin. The posterolateral graft is run through the femoral and tibial tunnels first. A cortical fixation is used for the femoral end. The femoral end of the anteromedial graft is then fixed in the same way. The tibial fixation begins with the posterolateral graft with the knee close to full extension. The anteromedial graft is fixed with the knee in 90 degrees flexion. Thirty patients were reviewed at least six months after the procedure. Mean age was 28.2 years. Mean overall IKDC score was 86% (36% A and

  18. [Fusion in adolescent idiopathic scoliosis : Anterior, posterior or combined? One-stage or two-stage?].

    PubMed

    Quack, V; Rath, B; Schenker, H; Schulze, A; El Mansy, Y; Tingart, M; Betsch, M

    2015-11-01

    Scoliosis is a complex, three-dimensional spinal deformity with various causes. Adolescent idiopathic scoliosis (AIS) is the most common form. Surgical treatment is indicated for curves greater than 45-50° meaured using the Cobb method. We can distinguish among posterior, anterior or combined surgical procedures. Today, the posterior, transpedicular approach has revolutionized scoliosis surgery. This review gives an overview of current surgical options in scoliosis treatment.

  19. Anatomy of the anterior cruciate ligament with regard to its two bundles.

    PubMed

    Petersen, Wolf; Zantop, Thore

    2007-01-01

    The anterior cruciate ligament (ACL) consists of two major fiber bundles, namely the anteromedial and posterolateral bundle. When the knee is extended, the posterolateral bundle (PL) is tight and the anteromedial (AM) bundle is moderately lax. As the knee is flexed, the femoral attachment of the ACL becomes a more horizontal orientation; causing the AM bundle to tighten and the PL bundle to relax. There is some degree of variability for the femoral origin of the anterome-dial and posterolateral bundle. The anteromedial bundle is located proximal and anterior in the femoral ACL origin (high and deep in the notch when the knee is flexed at 90 degrees ); the posterolateral bundle starts in the distal and posterior aspect of the femoral ACL origin (shallow and low when the knee is flexed at 90 degrees ). In the frontal plane the anteromedial bundle origin is in the 10:30 clock position and the postero-lateral bundle origin in the 9:30 clock position. At the tibial insertion the ACL fans out to form the foot region. The anteromedial bundle insertion is in the anterior part of the tibial ACL footprint, the posterolateral bundle in the posterior part. While the anteromedial bundle is the primary restraint against anterior tibial translation, the posterolateral bundle tends to stabilize the knee near full extension, particularly against rotatory loads.

  20. SHOULDER POSTERIOR INTERNAL IMPINGEMENT IN THE OVERHEAD ATHLETE

    PubMed Central

    Grant‐Nierman, Meggan; Lucas, Brennen

    2013-01-01

    Posterior internal impingement (PII) of the glenohumeral joint is a common cause of shoulder complex pain in the overhead athlete. This impingement is very different from standard outlet impingement seen in shoulder patients. Internal impingement is characterized by posterior shoulder pain when the athlete places the humerus in extreme external rotation and abduction as in the cocking phase of pitching or throwing. Impingement in this position occurs between the supraspinatus and or infraspinatus and the glenoid rim. Understanding regarding this pathology continues to evolve. Definitive understanding of precipitating factors, causes, presentation and methods of treatment have yet to be determined. A high index of suspicion should be used when attempting to make this diagnosis. This current concepts review presents the current thinking regarding pathophysiology, evaluation, and treatment of this condition. Level of Evidence: 5 PMID:23593557

  1. In vivo motion of femoral condyles during weight-bearing flexion after anterior cruciate ligament rupture using biplane radiography.

    PubMed

    Chen, Kaining; Yin, Li; Cheng, Liangjun; Li, Chuan; Chen, Cheng; Yang, Liu

    2013-01-01

    The purpose of this study was to investigate in vivo three- dimensional tibiofemoral kinematics and femoral condylar motion in knees with anterior cruciate ligament (ACL) deficiency during a knee bend activity. Ten patients with unilateral ACL rupture were enrolled. Both the injured and contralateral normal knees were imaged using biplane radiography at extension and at 15°, 30°, 60°, 90°, and 120° of flexion. Bilateral knees were next scanned by computed tomography, from which bilateral three-dimensional knee models were created. The in vivo tibiofemoral motion at each flexion position was reproduced through image registration using the knee models and biplane radiographs. A joint coordinate system containing the geometric center axis of the femur was used to measure the tibiofemoral motion. In ACL deficiency, the lateral femoral condyle was located significantly more posteriorly at extension and at 15° (p < 0.05), whereas the medial condylar position was changed only slightly. This constituted greater posterior translation and external rotation of the femur relative to the tibia at extension and at 15° (p < 0.05). Furthermore, ACL deficiency led to a significantly reduced extent of posterior movement of the lateral condyle during flexion from 15° to 60° (p < 0.05). Coupled with an insignificant change in the motion of the medial condyle, the femur moved less posteriorly with reduced extent of external rotation during flexion from 15° to 60° in ACL deficiency (p < 0.05). The medial- lateral and proximal-distal translations of the medial and lateral condyles and the femoral adduction-abduction rotation were insignificantly changed after ACL deficiency. The results demonstrated that ACL deficiency primarily changed the anterior-posterior motion of the lateral condyle, producing not only posterior subluxation at low flexion positions but also reduced extent of posterior movement during flexion from 15° to 60°. Key PointsThree-dimensional tibiofemoral

  2. Mechanical properties of the human lumbar anterior longitudinal ligament.

    PubMed

    Neumann, P; Keller, T S; Ekström, L; Perry, L; Hansson, T H; Spengler, D M

    1992-10-01

    A new technique incorporating a motion analysis system and a materials testing machine was used to investigate regional differences in the tensile mechanical properties of the lumbar spine anterior longitudinal ligament (ALL). Bone-ALL-bone specimens were prepared from young human cadaveric motion segments with no disc or bony pathology. Each specimen was distracted until failure at a constant crosshead displacement rate of 2.5 mm s-1 (approximately 1.0% strain per second). Strains were evaluated from digitized video recordings of markers attached to the ALL at 12 sites along its length and width, including the ligament substance and insertions. The 'overall' strain in the ligament was calculated from the outermost pairs of markers along the ligament length. The average tensile strength, the 'overall' tensile modulus and the 'overall' strain of the ALL at failure were 27.4 MPa (S.D. 5.9), 759 MPa (S.D. 336) and 4.95% (S.D. 1.51), respectively. Large and significant variations in the strains were present along the width and length of the ALL. Peak substance strains were over twofold greater than peak strains at the ligament insertion sites, whereas across the ligament width, peak strains in the outer portion of the ligament were over 40% greater than in the central region. Failure consistently occurred in the ligament mid-substance and ultimate strains at the ligament failure site averaged 12.1% (S.D. 2.3). These results indicate that the strains are highly nonuniform in the normal ALL.

  3. Posterior labral injury in contact athletes.

    PubMed

    Mair, S D; Zarzour, R H; Speer, K P

    1998-01-01

    Nine athletes (seven football offensive linemen, one defensive lineman, and one lacrosse player) were found at arthroscopy to have posterior labral detachment from the glenoid. In our series, this lesion is specific to contact athletes who engage their opponents with arms in front of the body. All patients had pain with bench pressing and while participating in their sport, diminishing their ability to play effectively. Conservative measures were ineffective in relieving their symptoms. Examination under anesthesia revealed symmetric glenohumeral translation bilaterally, without evidence of posterior instability. Treatment consisted of glenoid rim abradement and posterior labral repair with a bioabsorbable tack. All patients returned to complete at least one full season of contact sports and weightlifting without pain (minimum follow-up, > or = 2 years). Although many injuries leading to subluxation of the glenohumeral joint occur when an unanticipated force is applied, contact athletes ready their shoulder muscles in anticipation of impact with opponents. This leads to a compressive force at the glenohumeral joint. We hypothesize that, in combination with a posteriorly directed force at impact, the resultant vector is a shearing force to the posterior labrum and articular surface. Repeated exposure leads to posterior labral detachment without capsular injury. Posterior labral reattachment provides consistently good results, allowing the athlete to return to competition.

  4. Broad Ligament Pregnancy - Success Story of a Laparoscopically Managed Case.

    PubMed

    Nayar, Jayashree; Nair, Sobha S

    2016-07-01

    Abdominal pregnancies constitute 1% of ectopic pregnancies, among which broad ligament pregnancy is a rare form. The maternal mortality rate has been reported to be as high as 20%. The diagnosis is seldom established before surgery. Laparoscopic management of broad ligament ectopic pregnancy is the ideal form of treatment in appropriately selected patients. We present the case report of successful laparoscopic treatment of a 3x3.5cm broad ligament pregnancy. A search of literature shows that ours is the 6(th) case report of such a rare ectopic pregnancy managed endoscopically successfully. PMID:27630914

  5. Falciform ligament abscess after omphalitis: report of a case.

    PubMed

    Moon, Suk-Bae; Lee, Hae Won; Park, Kwi-Won; Jung, Sung-Eun

    2010-07-01

    A falciform ligament abscess is a rare type of intra-abdominal abscess. A 2-yr-old male, who had omphalitis two months previously, presented with a fever and right upper quadrant abdominal pain. The ultrasound and CT scan showed an abdominal wall abscess located anterior to the liver, which was refractory to conservative management with percutaneous drainage and antibiotics. On the third recurrence, surgical exploration was performed and revealed an abscess arising from the falciform ligament; the falciform ligament was excised. A follow up ultrasound confirmed complete resolution of the abscess with no further recurrence.

  6. Combined anterolateral ligament and anatomic anterior cruciate ligament reconstruction of the knee.

    PubMed

    Smith, James O; Yasen, Sam K; Lord, Breck; Wilson, Adrian J

    2015-11-01

    Although anatomic anterior cruciate ligament (ACL) reconstruction is established for the surgical treatment of anterolateral knee instability, there remains a significant cohort of patients who continue to experience post-operative instability. Recent advances in our understanding of the anatomic, biomechanical and radiological characteristics of the native anterolateral ligament (ALL) of the knee have led to a resurgent interest in reconstruction of this structure as part of the management of knee instability. This technical note describes our readily reproducible combined minimally invasive technique to reconstruct both the ACL and ALL anatomically using autologous semitendinosus and gracilis grafts. This method of ALL reconstruction can be easily integrated with all-inside ACL reconstruction, requiring minimal additional operative time, equipment and expertise. Level of evidence V.

  7. Ultrastructure of periprosthetic Dacron knee ligament tissue. Two cases of ruptured anterior cruciate ligament reconstruction.

    PubMed

    Salvi, M; Velluti, C; Misasi, M; Bartolozzi, P; Quacci, D; Dell'Orbo, C

    1991-04-01

    Light- and electron-microscopic investigations were performed on two failed Dacron ligaments that had been removed from 2 patients shortly after failure of the implant 2-3 years after reconstruction of the anterior cruciate ligament. Two different cell populations and matrices were correlated with closeness to the Dacron threads. Fibroblasts surrounded by connective tissue with collagen fibrils were located far from the Dacron threads. Roundish cells, appearing to be myofibroblasts surrounded by a more lax connective tissue and elastic fibers, were found close to the Dacron threads. The presence of myofibroblasts and the matrix differentiation could be attributed to the different mechanical forces acting on the Dacron and on the connective tissue because of their different coefficients of elasticity. The sparse occurrence of inflammatory cells in the synovial membrane and in the connective tissue surrounding the Dacron supports the biologic inertness of this artificial material. However, the repair tissue was not structured to resist tension stresses.

  8. Partial tears of the anterior cruciate ligament. Progression to complete ligament deficiency.

    PubMed

    Noyes, F R; Mooar, L A; Moorman, C T; McGinniss, G H

    1989-11-01

    In a prospective seven-year study, we treated 32 patients with partial ruptures of the anterior cruciate ligament (ACL) verified by arthroscopy. Twelve knees (38%) progressed to complete ACL deficiency with positive pivot shift tests and increased anteroposterior translation on tests with the KT-1000 arthrometer. Patients with partial ACL tears frequently had limitation for strenuous sports, while those developing ACL deficiency had additional functional limitations involving recreational activities. Three factors were statistically significant in predicting which partial tears would develop complete ACL deficiency: the amount of ligament tearing--one-fourth tears infrequently progressed, one-half tears progressed in 50% and three-fourth tears in 86%; a subtle increase in initial anterior translation; and the occurrence of a subsequent re-injury with giving-way.

  9. Feasibility of utilizing the patellar ligament angle for assessing cranial cruciate ligament rupture in dogs

    PubMed Central

    Lee, Jung-ha

    2014-01-01

    The patellar ligament angle (PLA) was assessed in 105 normal stifle joints of 79 dogs and 33 stifle joints of 26 dogs with a ruptured cranial cruciate ligament (CrCL). The PLA of stifles with complete CrCL rupture was significantly lower than that of normal stifles, particularly at a flexion angle of 60~80° in both plain and stress views. If the PLA was <90.55° on the stress view with a 60~80° flexion angle, the dog was diagnosed with a complete rupture of the CrCL with a sensitivity of 83.9% and specificity of 100%. In conclusion, measuring the PLA is a quantitative method for diagnosing complete CrCL rupture in canines. PMID:24962409

  10. Ligament-muscle reflex arc after anterior cruciate ligament reconstruction: electromyographic evaluation.

    PubMed

    Biedert, R M; Zwick, E B

    1998-01-01

    The purpose of this study was to determine if a ligament-muscle reflex arc exists between the bone-patellar tendon-bone autograft after anterior cruciate ligament (ACL) reconstruction and the hamstring muscle group. We studied four patients, average age 34.2 years (range 32-36 years). The mean time between the ACL reconstruction and the study examination was 56.2 months (range 5-108 months). All patients underwent a second-look arthroscopy for meniscal injuries, cyclops lesions, or adhesions. Five patients with a normal ACL served as a control group before we performed an arthroscopic meniscectomy. Electromyographic (EMG) activity was measured using fine wire electrodes under two different testing conditions. No unequivocal EMG activity could be detected in the ACL-reconstructed knees when we pulled on the graft or in the controls. Three of four patients and all controls felt pain when we touched the graft or normal ACL or applied strain on it with the hook. In conclusion, the ACL autograft presents a noxious sensory innervation, the Lachman test maneuver stimulates a reflex arc with hamstrings activation, and an unequivocal ligament-muscle reflex arc from the graft to the hamstring muscle group could not be demonstrated. PMID:9833113

  11. Human periodontal ligament cell sheets can regenerate periodontal ligament tissue in an athymic rat model.

    PubMed

    Hasegawa, Masateru; Yamato, Masayuki; Kikuchi, Akihiko; Okano, Teruo; Ishikawa, Isao

    2005-01-01

    Conventional periodontal regeneration methods remain insufficient to attain complete and reliable clinical regeneration of periodontal tissues. We have developed a new method of cell transplantation using cell sheet engineering and have applied it to this problem. The purpose of this study was to investigate the characteristics of human periodontal ligament (HPDL) cell sheets retrieved from culture on unique temperature-responsive culture dishes, and to examine whether these cell sheets can regenerate periodontal tissues. The HPDL cell sheets were examined histologically and biochemically, and also were transplanted into a mesial dehiscence model in athymic rats. HPDL cells were harvested from culture dishes as a contiguous cell sheet with abundant extracellular matrix and retained intact integrins that are susceptible to trypsin-EDTA treatment. In the animal study, periodontal ligament-like tissues that include an acellular cementum-like layer and fibrils anchoring into this layer were identified in all the athymic rats transplanted with HPDL cell sheets. This fibril anchoring highly resembles native periodontal ligament fibers; such regeneration was not observed in nontransplanted controls. These results suggest that this technique, based on the concept of cell sheet engineering, can be useful for periodontal tissue regeneration. PMID:15869425

  12. Investigation of impact loading rate effects on the ligamentous cervical spinal load-partitioning using finite element model of functional spinal unit C2-C3.

    PubMed

    Mustafy, Tanvir; El-Rich, Marwan; Mesfar, Wissal; Moglo, Kodjo

    2014-09-22

    The cervical spine functions as a complex mechanism that responds to sudden loading in a unique manner, due to intricate structural features and kinematics. The spinal load-sharing under pure compression and sagittal flexion/extension at two different impact rates were compared using a bio-fidelic finite element (FE) model of the ligamentous cervical functional spinal unit (FSU) C2-C3. This model was developed using a comprehensive and realistic geometry of spinal components and material laws that include strain rate dependency, bone fracture, and ligament failure. The range of motion, contact pressure in facet joints, failure forces in ligaments were compared to experimental findings. The model demonstrated that resistance of spinal components to impact load is dependent on loading rate and direction. For the loads applied, stress increased with loading rate in all spinal components, and was concentrated in the outer intervertebral disc (IVD), regions of ligaments to bone attachment, and in the cancellous bone of the facet joints. The highest stress in ligaments was found in capsular ligament (CL) in all cases. Intradiscal pressure (IDP) in the nucleus was affected by loading rate change. It increased under compression/flexion but decreased under extension. Contact pressure in the facet joints showed less variation under compression, but increased significantly under flexion/extension particularly under extension. Cancellous bone of the facet joints region was the only component fractured and fracture occurred under extension at both rates. The cervical ligaments were the primary load-bearing component followed by the IVD, endplates and cancellous bone; however, the latter was the most vulnerable to extension as it fractured at low energy impact.

  13. Posterior Hip Pain in an Athletic Population

    PubMed Central

    Frank, Rachel M.; Slabaugh, Mark A.; Grumet, Robert C.; Virkus, Walter W.; Bush-Joseph, Charles A.; Nho, Shane J.

    2010-01-01

    Context: Posterior hip pain is a relatively uncommon but increasingly recognized complaint in the orthopaedic community. Patient complaints and presentations are often vague or nonspecific, making diagnosis and subsequent treatment decisions difficult. The purposes of this article are to review the anatomy and pathophysiology related to posterior hip pain in the athletic patient population. Evidence Acquisition: Data were collected through a thorough review of the literature via a MEDLINE search of all relevant articles between 1980 and 2010. Results: Many patients who complain of posterior hip pain actually have pain referred from another part of the body—notably, the lumbar spine or sacroiliac joint. Treatment options for posterior hip pain are typically nonoperative; however, surgery is warranted in some cases. Conclusions: Recent advancements in the understanding of hip anatomy, pathophysiology, and treatment options have enabled physicians to better diagnosis athletic hip injuries and select patients for appropriate treatment. PMID:23015944

  14. [Pathogenesis of posterior capsule opacification in pseudophakia].

    PubMed

    Łukaszewska-Smyk, Agnieszka; Kałuzny, Józef

    2009-01-01

    The lens epithelial cells of A and E type are involved in pathogenesis of posterior capsule opacification (PCO). They undergo metaplasia into microfibroblasts, then migrate towards posterior capsule where they proliferate and form opacification. These processes are stimulated by cytokines and interleukines. The extracellular matrix which constitutes a scaffold for migration and attachment of epithelial cells plays an important role in PCO formation. Integrines intercede in this process.

  15. Anterior cruciate ligament tears: reconstruction and rehabilitation.

    PubMed

    Smith, Mary Atkinson; Smith, W Todd; Kosko, Paul

    2014-01-01

    Tears of the anterior cruciate ligament (ACL) are common knee injuries experienced by athletes and people with active lifestyles. It is important for members of the healthcare team to take an evidence-based approach to the diagnosis, surgical management, and postoperative rehabilitation of patients with an ACL-deficient knee. Mechanism of ACL injury and diagnostic testing is consistent throughout the literature. Patients frequently opt for ACL reconstruction, and many surgical techniques for ACL reconstruction are available with no clear consensus regarding superiority. Surgeon preference dictates the type of reconstruction and graft choice utilized. No standardized pre- and postoperative rehabilitation protocol exists. However, rehabilitation plays an important role in functional outcomes. A comprehensive rehabilitation program is needed pre- and postoperatively to produce positive patient outcomes.

  16. Medial Patellofemoral Ligament Reconstruction: A Comprehensive Review

    PubMed Central

    Kim, Hee-June

    2015-01-01

    It has been suggested that in the majority of patellar dislocation cases, the medial patellofemoral ligament (MPFL) is disrupted with a high recurrence rate especially in female patients. Although MPFL tear is not the primary cause of instability, MPFL reconstruction is effective for stabilizing the knee and may alone prevent lateral patellar dislocation. There is limited but growing evidence that MPFL reconstruction for patellofemoral instability leads to excellent functional outcomes. Growing awareness of the biomechanical contribution of the MPFL has led to an upsurge in the publication of techniques and trials dealing with reconstructive techniques, warranting a review that includes the most recent evidence. The aim of this article was to review and summarize the recent literatures concerning MPFL reconstruction and provide a comprehensive review of previous studies ranging from basic science to current surgical techniques and results. PMID:26389065

  17. Ligaments: a source of musculoskeletal disorders.

    PubMed

    Solomonow, Moshe

    2009-04-01

    The mechanical and neurological properties of ligaments are reviewed and updated with recent development from the perspective which evaluates their role as a source of neuromusculoskeletal disorders resulting from exposure to sports and occupational activities. Creep, tension-relaxation, hysteresis, sensitivity to strain rate and strain/load frequency were shown to result not only in mechanical functional degradation but also in the development of sensory-motor disorders with short- and long-term implication on function and disability. The recently exposed relationships between collagen fibers, applied mechanical stimuli, tissue micro-damage, acute and chronic inflammation and neuromuscular disorders are delineated with special reference to sports and occupational stressors such as load duration, rest duration, work/rest ratio, number of repetitions of activity and velocity of movement. PMID:19329050

  18. Infections in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Stucken, Charlton; Garras, David N.; Shaner, Julie L.; Cohen, Steven B.

    2013-01-01

    Context: Anterior cruciate ligament (ACL) reconstruction is a safe, common, and effective method of restoring stability to the knee after injury, but evolving techniques of reconstruction carry inherent risk. Infection after ACL reconstruction, while rare, carries a high morbidity, potentially resulting in a poor clinical outcome. Evidence Acquisition: Data were obtained from previously published peer-reviewed literature through a search of the entire PubMed database (up to December 2012) as well as from textbook chapters. Results: Treatment with culture-specific antibiotics and debridement with graft retention is recommended as initial treatment, but with persistent infection, consideration should be given to graft removal. Graft type likely has no effect on infection rates. Conclusion: The early diagnosis of infection and appropriate treatment are necessary to avoid the complications of articular cartilage damage and arthrofibrosis. PMID:24427432

  19. Surgical Dissection of the Anterolateral Ligament.

    PubMed

    Daggett, Matthew; Busch, Kyle; Sonnery-Cottet, Bertrand

    2016-02-01

    Recent investigations into the structure and function of the anterolateral ligament (ALL) have resulted in renewed interest in the role of the lateral extra-articular structures in rotational control of the knee. With increased focus on the ALL, debate about the anatomic characteristics, the functional role in knee stability, and even the existence of this lateral structure has ensued. This article describes our dissection method for the ALL. Through careful dissection and precise elevation of the iliotibial band, the ALL can be clearly identified as a distinct structure with an attachment near the lateral epicondyle on the femur and an insertion in a fan-like fashion onto the tibia, between the Gerdy tubercle and the fibular head. This investigation provides the surgeon with anatomic landmarks to use during surgical reconstruction of the ALL. PMID:27274451

  20. Isolated fibular collateral ligament injuries in athletes.

    PubMed

    Sikka, Robby S; Dhami, Ranjodh; Dunlay, Ryan; Boyd, Joel L

    2015-03-01

    Isolated injuries to the fibular collateral ligament (FCL) are rare. Although recent data suggest that operative and nonoperative treatment can both result in good functional outcomes, limited data exist on return to play for nonoperative treatment of FCL injuries and the value of magnetic resonance imaging in predicting prognosis. In this article, we present a review of the current literature and present a focused review regarding the diagnosis, treatment, and prognosis of FCL injuries, as well as the senior authors experience and a cohort of National Football League players. Magnetic resonance imaging can be useful to predict the length of disability in isolated FCL injuries, and both operative and nonoperative management of isolated FCL injuries successfully resulted in return to play in all players in several series of elite athletes; however, nonoperative management may result in faster return to play. Evaluation of potential concomitant injury is imperative in treatment of FCL injuries.

  1. Individualized anatomic anterior cruciate ligament reconstruction.

    PubMed

    van Eck, Carola F; Widhalm, Harrald; Murawski, Christopher; Fu, Freddie H

    2015-02-01

    Anterior cruciate ligament (ACL) injuries are often seen in young participants in sports such as soccer, football, and basketball. Treatment options include conservative management as well as surgical intervention, with the goal of enabling the patient to return to cutting and pivoting sports and activities. Individualized anatomic ACL reconstruction is a surgical technique that tailors the procedure to the individual patient using preoperative measurements on plain radiographs and magnetic resonance imaging and intraoperative measurement to map the patients' native ACL anatomy in order to replicate it as closely as possible. Anatomic ACL reconstruction, therefore, is defined as reconstruction of the ACL to its native dimensions, collagen orientation, and insertion site. The surgical reconstruction is followed by a specific rehabilitation protocol that is designed to enable the patient to regain muscle strength and proprioception while facilitating healing of the reconstructed ACL prior to the patient's returning to sports activities.

  2. Anterior cruciate ligament injuries: etiology and prevention.

    PubMed

    Brophy, Robert H; Silvers, Holly J; Mandelbaum, Bert R

    2010-03-01

    The relatively high risk of noncontact anterior cruciate ligament (ACL) rupture among female athletes has been a major impetus for investigation into the etiology of this injury. A number of risk factors have been identified, both internal and external to the athlete, including neuromuscular, anatomical, hormonal, shoe-surface interaction, and environmental, such as weather. The anatomic and neuromuscular risk factors, often gender related, are the focus of most ACL injury prevention programs. Although studies have shown that biomechanic- centered prevention programs can reduce the risk of ACL injury, many questions remain unanswered. More research is needed to increase our understanding of the risk factors for ACL injury; how injury prevention programs work and can the clinical application of such programs be optimized. PMID:20160623

  3. Digital infrared thermal imaging following anterior cruciate ligament reconstruction.

    PubMed

    Barker, Lauren E; Markowski, Alycia M; Henneman, Kimberly

    2012-03-01

    This case describes the selective use of digital infrared thermal imaging for a 48-year-old woman who was being treated by a physical therapist following left anterior cruciate ligament (ACL) reconstruction with a semitendinosus autograft. PMID:22383168

  4. The clinical implications of the oblique retinacular ligament.

    PubMed

    Adkinson, Joshua M; Johnson, Shepard P; Chung, Kevin C

    2014-03-01

    The oblique retinacular ligament originates from the flexor tendon sheath, courses past the proximal interphalangeal joint, and merges with the lateral extensor tendon. There has been disagreement regarding the contribution of the oblique retinacular ligament to coordinated movements between the proximal and distal interphalangeal joints. Landsmeer postulated that it acts as a dynamic tenodesis that tightens with proximal interphalangeal joint extension, causing obligatory distal interphalangeal joint extension. However, studies have shown that the oblique retinacular ligament is variably present and often attenuated, which diminishes its presumed role in finger movement. Despite this, the concept of a checkrein linking interphalangeal joint motion heralded the development of effective and reproducible surgical interventions for swan-neck and mallet deformities. This article examines the controversy regarding the existence of the oblique retinacular ligament, its plausible functionality, and clinical implications in the practice of hand surgery. PMID:24559632

  5. Tendon and ligament adaptation to exercise, immobilization, and remobilization.

    PubMed

    Wren, T A; Beaupré, G S; Carter, D R

    2000-01-01

    This study provides a theoretical and computational basis for understanding and predicting how tendons and ligaments adapt to exercise, immobilization, and remobilization. In a previous study, we introduced a model that described the growth and development of tendons and ligaments. In this study, we use the same model to predict changes in the cross-sectional area, modulus, and strength of tendons and ligaments due to increased or decreased loading. The model predictions are consistent with the results of experimental exercise and immobilization studies performed by other investigators. These results suggest that the same fundamental principles guide both development and adaptation. A basic understanding of these principles can contribute both to prevention of tendon and ligament injuries and to more effective rehabilitation when injury does occur.

  6. Posterior Wnts Have Distinct Roles in Specification and Patterning of the Planarian Posterior Region.

    PubMed

    Sureda-Gómez, Miquel; Pascual-Carreras, Eudald; Adell, Teresa

    2015-11-05

    The wnt signaling pathway is an intercellular communication mechanism essential in cell-fate specification, tissue patterning and regional-identity specification. A βcatenin-dependent signal specifies the AP (Anteroposterior) axis of planarians, both during regeneration of new tissues and during normal homeostasis. Accordingly, four wnts (posterior wnts) are expressed in a nested manner in central and posterior regions of planarians. We have analyzed the specific role of each posterior wnt and the possible cooperation between them in specifying and patterning planarian central and posterior regions. We show that each posterior wnt exerts a distinct role during re-specification and maintenance of the central and posterior planarian regions, and that the integration of the different wnt signals (βcatenin dependent and independent) underlies the patterning of the AP axis from the central region to the tip of the tail. Based on these findings and data from the literature, we propose a model for patterning the planarian AP axis.

  7. Vertigo due to posterior circulation stroke.

    PubMed

    Kim, Ji Soo; Lee, Hyung

    2013-07-01

    Stroke in the distribution of the posterior circulation may present as acute onset spontaneous vertigo and imbalance. Although vertigo due to posterior circulation stroke is usually associated with other neurologic symptoms or signs, small infarcts in the cerebellum or brainstem can present with vertigo without other localizing symptoms. Approximately 17% of patients with isolated posterior inferior cerebellar artery territory infarction presented with isolated vertigo, nystagmus, and postural unsteadiness. A head impulse test can differentiate acute isolated vertigo associated with cerebellar stroke from more benign disorders involving the inner ear. Sometimes acute isolated audiovestibular loss can be the initial symptom of impending posterior circulation ischemic stroke (particularly within the territory of the anterior inferior cerebellar artery). In this case, evaluation of isolated audiovestibular loss may prevent the progression of acute vertigo and hearing loss into more widespread areas of infarction in the posterior circulation. In this article, the clinical syndromes and signs of acute vestibular syndrome due to posterior circulation stroke involving the brainstem and cerebellum are summarized.

  8. Resorbable polymer fibers for ligament augmentation.

    PubMed

    Dürselen, L; Dauner, M; Hierlemann, H; Planck, H; Claes, L E; Ignatius, A

    2001-01-01

    Resorbable augmentation devices for cruciate ligament surgery have been developed to temporarily protect healing tendon grafts or sutured ligaments against high tensile loads during the postoperative healing period. Materials available at present [e.g., polydioxanone (PDS)] show a half-life tensile strength of only 4-6 weeks, whereas the process of revitalization and recovering of the transplanted tendon graft can take up to 12 months. Therefore, a device that provides gradually decreasing mechanical properties with a half-time strength of at least 6 months would be desirable. In order to obtain a suitable material, we investigated the degradation kinetics of a variety of different resorbable fibers made of poly(L-lactide) and poly(L-lactide-co-glycolide). The fiber materials differed in processing and treatment parameters like thermal posttreatment, irradiation, and fiber diameter. The fibers were degraded in vitro and were tested for mechanical properties and molecular weight at various time points up to 72 weeks. The half-time strength of the materials ranged between 5 and 64 weeks, depending on their treatment parameters. In contrast, the stiffness did not decrease adequately. However, an augmentation stiffness that does not change much versus time could not provide a gradual increase in graft load, which is important to stimulate the orientation of the collagenous tissue. Therefore, design of an augmentation construct braided out of more than one quickly degrading fiber materials is suggested. After the breakdown of the faster-degrading fiber components the stiffness would automatically decrease by the diminution of the load-carrying fiber volume. PMID:11745519

  9. Creep behaviour and creep mechanisms of normal and healing ligaments

    NASA Astrophysics Data System (ADS)

    Thornton, Gail Marilyn

    Patients with knee ligament injuries often undergo ligament reconstructions to restore joint stability and, potentially, abate osteoarthritis. Careful literature review suggests that in 10% to 40% of these patients the graft tissue "stretches out". Some graft elongation is likely due to creep (increased elongation of tissue under repeated or sustained load). Quantifying creep behaviour and identifying creep mechanisms in both normal and healing ligaments is important for finding clinically relevant means to prevent creep. Ligament creep was accurately predicted using a novel yet simple structural model that incorporated both collagen fibre recruitment and fibre creep. Using the inverse stress relaxation function to model fibre creep in conjunction with fibre recruitment produced a superior prediction of ligament creep than that obtained from the inverse stress relaxation function alone. This implied mechanistic role of fibre recruitment during creep was supported using a new approach to quantify crimp patterns at stresses in the toe region (increasing stiffness) and linear region (constant stiffness) of the stress-strain curve. Ligament creep was relatively insensitive to increases in stress in the toe region; however, creep strain increased significantly when tested at the linear region stress. Concomitantly, fibre recruitment was evident at the toe region stresses; however, recruitment was limited at the linear region stress. Elevating the water content of normal ligament using phosphate buffered saline increased the creep response. Therefore, both water content and fibre recruitment are important mechanistic factors involved in creep of normal ligaments. Ligament scars had inferior creep behaviour compared to normal ligaments even after 14 weeks. In addition to inferior collagen properties affecting fibre recruitment and increased water content, increased glycosaminoglycan content and flaws in scar tissue were implicated as potential mechanisms of scar creep

  10. Mechano-regulation of Collagen Biosynthesis in Periodontal Ligament

    PubMed Central

    Kaku, Masaru; Yamauchi, Mitsuo

    2014-01-01

    Purpose Periodontal ligament (PDL) plays critical roles in the development and maintenance of periodontium such as tooth eruption and dissipation of masticatory force. The mechanical properties of PDL are mainly derived from fibrillar type I collagen, the most abundant extracellular component. Study selection The biosynthesis of type I collagen is a long, complex process including a number of intra- and extracellular post-translational modifications. The final modification step is the formation of covalent intra- and intermolecular cross-links that provide collagen fibrils with stability and connectivity. Results It is now clear that collagen post-translational modifications are regulated by groups of specific enzymes and associated molecules in a tissue-specific manner; and these modifications appear to change in response to mechanical force. Conclusions This review focuses on the effect of mechanical loading on collagen biosynthesis and fibrillogenesis in PDL with emphasis on the post-translational modifications of collagens, which is an important molecular aspect to understand in the field of prosthetic dentistry. PMID:25311991

  11. The 5-Strand Hamstring Graft in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Lee, Rushyuan Jay; Ganley, Theodore J.

    2014-01-01

    The use of anterior cruciate ligament reconstruction in the pediatric and adolescent population has been increasing in recent years. Autograft hamstring graft is favored in this population, but these patients often have smaller hamstring tendons that yield smaller final graft constructs. These smaller grafts are associated with an increased need for revision surgery. We describe a technique for obtaining a larger-diameter anterior cruciate ligament graft construct from autologous hamstring graft without allograft supplementation. PMID:25473619

  12. [Chondroblastoma in the anterior cruciate ligament origo: a case report].

    PubMed

    Aydin, Hafız; Turhan, Ahmet Uğur; Karataş, Metin; Onay, Atilgan; Yildiz, Kadriye

    2012-01-01

    Chondroblastoma is a rarely seen cartilage originated tumor. It is mostly localized in the epiphysis of long bones. In this article, we present an 18-year-old male case in whom the tumor was located in the right distal femoral lateral condyle and destroyed anterior cruciate ligament origo. The tumor was curetted and the cavity was filled with cement. Anterior cruciate ligament resection was mandatory for this treatment. The patient had no complaint in the postoperative period.

  13. Ulnar collateral ligament injuries in the throwing athlete.

    PubMed

    Bruce, Jeremy R; Andrews, James R

    2014-05-01

    Repetitive valgus forces on the throwing elbow place significant stress on that joint. This stress can cause structural damage and injury to the ulnar collateral ligament. Many acute injuries of the throwing elbow are caused by repetitive chronic wear. Although much work has been done on injury prevention in youth who are pitchers, overuse injury in throwing sports constitutes an epidemic. Failing nonsurgical management, ulnar collateral ligament reconstruction is a viable option to return the throwing athlete to competition. PMID:24788447

  14. Ulnar collateral ligament injuries in the throwing athlete.

    PubMed

    Bruce, Jeremy R; Andrews, James R

    2014-05-01

    Repetitive valgus forces on the throwing elbow place significant stress on that joint. This stress can cause structural damage and injury to the ulnar collateral ligament. Many acute injuries of the throwing elbow are caused by repetitive chronic wear. Although much work has been done on injury prevention in youth who are pitchers, overuse injury in throwing sports constitutes an epidemic. Failing nonsurgical management, ulnar collateral ligament reconstruction is a viable option to return the throwing athlete to competition.

  15. [Chondroblastoma in the anterior cruciate ligament origo: a case report].

    PubMed

    Aydin, Hafız; Turhan, Ahmet Uğur; Karataş, Metin; Onay, Atilgan; Yildiz, Kadriye

    2012-01-01

    Chondroblastoma is a rarely seen cartilage originated tumor. It is mostly localized in the epiphysis of long bones. In this article, we present an 18-year-old male case in whom the tumor was located in the right distal femoral lateral condyle and destroyed anterior cruciate ligament origo. The tumor was curetted and the cavity was filled with cement. Anterior cruciate ligament resection was mandatory for this treatment. The patient had no complaint in the postoperative period. PMID:22765492

  16. Is biologic width of anterior and posterior teeth similar?

    PubMed

    Rasouli Ghahroudi, Amir Alireza; Khorsand, Afshin; Yaghobee, Siamak; Haghighati, Farideh

    2014-01-01

    The biologic width (BW) includes attached epithelial cells and connective tissue attachment complex being very important in the periodontal health during prosthetic treatments as invading this zone can cause bone resorption and gingival recession. The present study investigated biologic width values in the normal periodontium in anterior and posterior teeth. 30 patients that referred from restorative department to periodontics department of Tehran University of medical sciences who need crown lengthening procedure on their teeth with no history of orthodontic, prosthodontic and periodontal treatment were randomly enrolled in this cross-sectional trial. Sulcus depths (SD) as well as the distance between free gingival margin and the bone crest (FB) of anterior and posterior teeth were measured by UNC-15 probe and compared. periodontium thickness was also assessed. The data were subjected to Student t test. Mean BW in the 43 anterior and 47 posterior teeth was measured and not significantly different (1.4651±0.39 mm vs. 1.6312±0.49 mm) was observed; however, BW was significantly more in the teeth with thick periodontium compared to those with thin periodontium (1.703±0.5 vs. 1.408±0.35; P=0.002). BW not only is different in individuals but also could be dissimilar in different teeth and should be calculated independently prior to restorative treatments. PMID:25325207

  17. Posterior urethral polyp with type I posterior urethral valves: a rare association in a neonate.

    PubMed

    Kesan, Krushnakumar V; Gupta, Rahul Kumar; Kothari, Paras; Gupta, Abhaya; Mudkhedkar, Kedar; Kamble, Ravikiran; Dikshit, K Vishesh

    2014-06-01

    Urethral polyp is a rare cause of bladder outlet obstruction, voiding dysfunction, and hematuria in the pediatric age group. Urethral polyps are rarely associated with other congenital urinary tract anomalies. In this study, we report a case of solitary posterior urethral polyp with type I posterior urethral valve in a 7-day-old neonate presented with urinary retention and deranged renal function. The polyp was diagnosed on cystoscopy. Transurethral resection of the polyp with posterior urethral valve fulguration was performed. Pathologic assessment revealed a fibroepithelial lesion, which was consistent with congenital posterior urethral polyp.

  18. Cable-Augmented, Quad Ligament Tenodesis Scapholunate Reconstruction.

    PubMed

    Bain, Gregory I; Watts, Adam C; McLean, James; Lee, Yu C; Eng, Kevin

    2015-11-01

    Maintaining reduction of the scapholunate interval after reconstruction can be difficult. The authors performed scapholunate reconstruction using tensionable suture anchors in 8 patients. The anchors provide a fixed cable that both fixes the graft, and reduces the scapholunate diastasis and maintains reduction. The flexor carpi radialis tendon graft stabilizes not only the volar scaphotrapezial ligament, and dorsal scapholunate ligament, but also the dorsal intercarpal and dorsal radiocarpal ligament. The Berger flap is closed using an ulnar advancement capsulodesis that further reinforces the dorsal intercarpal and dorsal radiocarpal ligament. The mean pain score improved from 5.8 to 2.1. Mean extension was 56° (91% of contralateral side), flexion 44° (70% of contralateral side), and grip strength was 41kg (95% of the contralateral side). The mean scapholunate angle was 71°, radiolunate angle 16° and scapholunate interval 3.0 mm. The cable augmented, quad ligament scapholunate ligament reconstruction offers theoretical advantages but long term follow up is required.

  19. Arthroscopically assisted anatomical coracoclavicular ligament reconstruction using tendon graft.

    PubMed

    Yoo, Yon-Sik; Seo, Young-Jin; Noh, Kyu-Cheol; Patro, Bishu Prasad; Kim, Do-Young

    2011-07-01

    We describe a method of arthroscopically assisted, mini-open, anatomical reconstruction of the coracoclavicular ligament. This method restores both components of the native ligament with the aim of achieving maximum stability with minimal disruption of the normal anatomy. Using the same principles of ligament reconstruction that are employed in other joints, transosseous tunnels are created following the native footprints of the conoid and trapezoid ligaments and an autologous graft is fixed using a PEEK screw. Adequate healing of the ligament occurs within the bone, to prevent stress risers with an appropriate working length. This procedure is unique, as it replaces the torn ligament with a natural substitute, in the appropriate location, through a minimally invasive procedure. This technique would be suitable for treatment of patients with either grade III or V acute acromioclavicular dislocations. Clinical outcomes for the first 13 consecutive patients treated with this procedure are reported, revealing excellent satisfaction rates with a Constant score of 96.6 at final follow-up.

  20. The sacrotuberous and the sacrospinous ligament--a virtual reconstruction.

    PubMed

    Hammer, N; Steinke, H; Slowik, V; Josten, C; Stadler, J; Böhme, J; Spanel-Borowski, K

    2009-10-01

    Little is known about the morphometric properties of the sacrotuberous ligament (ST) and the sacrospinous ligament (SS). The influence of ligaments on pelvic stability and the extent of reconstruction in case of instability are controversially discussed. The ST and the SS of 55 human subjects fixed in alcohol solution and of four fresh cadavers were measured. Both ligaments were defined as geometric figures. The ST was a contorted bifrustum, while the SS was a contorted frustum, both with elliptic planes. In all cases investigated, the ST and the SS fibres were twisted. For men, the ST and the SS had a mean length of 64 and 38 mm. For women, lengths of 70 and 46 mm were measured in the ST and the SS. The ST length, height and cross-sectional area showed gender-specific differences at statistically significant level. The ST and the SS volumes correlated closely, regardless of gender or side. Measurements of fresh ligaments of four unfixed cadavers showed similar results. The data obtained were then used to generate computer-based three-dimensional models of both ligaments, using the Catia software. Conclusively, the virtually generated ST and SS are suitable models to be included in pelvic fracture simulation, using the finite element method.

  1. [PARTICULAR QUALITIES OF DIAGNOSTIC ACUTE LATERAL ANKLE LIGAMENT INJURIES].

    PubMed

    Krasnoperov, S N; Shishka, I V; Golovaha, M L

    2015-01-01

    Delayed diagnosis of acute lateral ankle ligaments injury and subsequent inadequate treatment leads to the development of chronic instability and rapid progression of degenerative processes in the joint. The aim of our work was to improve treatment results by developing an diagnostic algorithm and treatment strategy of acute lateral ankle ligament injuries. The study included 48 patients with history of acute inversion ankle injury mechanism. Diagnostic protocol included clinical and radiological examination during 48 hours and after 7-10 days after injury. According to the high rate of inaccurate clinical diagnosis in the first 48 hours of the injury a short course of conservative treatment for 7-10 days is needed with follow-up and controlling clinical and radiographic instability tests. Clinical symptoms of ankle inversion injury showed that the combination of local tenderness in the projection of damaged ligaments, the presence of severe periarticular hematoma in the lateral department and positive anterior drawer and talar tilt tests in 7-10 days after the injury in 87% of cases shows the presence of ligament rupture. An algorithm for diagnosis of acute lateral ankle ligament injury was developed, which allowed us to determine differential indications for surgical repair of the ligaments and conservative treatment of these patients.

  2. Periprosthetic fractures of the acetabulum during cup insertion: posterior column stability is crucial.

    PubMed

    Laflamme, G-Yves; Belzile, Etienne L; Fernandes, Julio C; Vendittoli, Pascal A; Hébert-Davies, Jonah

    2015-02-01

    Periprosthetic hip fractures around acetabular components are rare with little information available to guide surgical management of these complex injuries. A retrospective review of intraoperative isolated acetabular periprosthetic fractures from three tertiary surgical units was done. A total of 32 patients were identified with 9 initially missed. Acetabular components were stable (type 1) in 11 patients with no failures; unstable (type 2) in 12 patients and treated with supplemental fixation. Non-union and displacement were correlated with absent posterior column plating. Missed fractures (type 3) had the highest reoperation rate. Anterior patterns all healed, whereas fractures with posterior column instability had a 67% failure rate. Periprosthetic acetabular fracture can heal successfully with posterior column stability. Plating is mandatory for large posterior wall fragments to achieve osteointegration.

  3. Combined Intra- and Extra-articular Reconstruction of the Anterior Cruciate Ligament: The Reconstruction of the Knee Anterolateral Ligament

    PubMed Central

    Helito, Camilo Partezani; Bonadio, Marcelo Batista; Gobbi, Riccardo Gomes; da Mota e Albuquerque, Roberto Freire; Pécora, José Ricardo; Camanho, Gilberto Luis; Demange, Marco Kawamura

    2015-01-01

    We present a new technique for the combined intra- and extra-articular reconstruction of the anterior cruciate ligament. Intra-articular reconstruction is performed in an outside-in manner according to the precepts of the anatomic femoral tunnel technique. Extra-articular reconstruction is performed with the gracilis tendon while respecting the anatomic parameters of the origin and insertion points and the path described for the knee anterolateral ligament. PMID:26258037

  4. Morphology of the transverse ligament of the atlas and the alar ligaments in the silver fox (Vulpes vulpes var)

    PubMed Central

    2013-01-01

    Background Recent new anatomical and histological features of craniocervical junction in dogs and cats were described providing evidence of differences between the carnivore species. No information on these structures in foxes exists. Results Two parts of the alar ligaments were found. A longer one aroused from dens of axis to the internal (medial) surface of the occipital condyles and was called apical part. A shorter part originated from the entire length of the lateral edge of the dens of axis and terminated on the internal wall of the vertebral foramen of atlas and thus was called the lateral part. The transverse ligament of the atlas was widened in the mid region, above the dens of axis, and thickened at enthesis. Periosteal fibrocartilage was detected in the transverse ligament of the atlas at the enthesis, and sesamoid fibrocartilage was present on periphery in the middle of the ligament. Conclusions The craniocervical junction in foxes differs in part from other carnivores such as dogs and cats but resembles that of mesaticephalic dogs. The sesamoid and periosteal fibrocartilage supports the transverse ligament of the atlas whereas the alar ligaments have no cartilage. PMID:23557095

  5. Posterior Predictive Bayesian Phylogenetic Model Selection

    PubMed Central

    Lewis, Paul O.; Xie, Wangang; Chen, Ming-Hui; Fan, Yu; Kuo, Lynn

    2014-01-01

    We present two distinctly different posterior predictive approaches to Bayesian phylogenetic model selection and illustrate these methods using examples from green algal protein-coding cpDNA sequences and flowering plant rDNA sequences. The Gelfand–Ghosh (GG) approach allows dissection of an overall measure of model fit into components due to posterior predictive variance (GGp) and goodness-of-fit (GGg), which distinguishes this method from the posterior predictive P-value approach. The conditional predictive ordinate (CPO) method provides a site-specific measure of model fit useful for exploratory analyses and can be combined over sites yielding the log pseudomarginal likelihood (LPML) which is useful as an overall measure of model fit. CPO provides a useful cross-validation approach that is computationally efficient, requiring only a sample from the posterior distribution (no additional simulation is required). Both GG and CPO add new perspectives to Bayesian phylogenetic model selection based on the predictive abilities of models and complement the perspective provided by the marginal likelihood (including Bayes Factor comparisons) based solely on the fit of competing models to observed data. [Bayesian; conditional predictive ordinate; CPO; L-measure; LPML; model selection; phylogenetics; posterior predictive.] PMID:24193892

  6. Ulnar Collateral Ligament Reconstruction; the Rush Experience

    PubMed Central

    Erickson, Brandon J.; Bach, Bernard R.; Cohen, Mark S.; Bush-Joseph, Charles A.; Cole, Brian J.; Verma, Nikhil N.; Nicholson, Gregory P.; Romeo, Anthony A.

    2016-01-01

    Objectives: Background: Ulnar collateral ligament reconstruction (UCLR) is now a common surgery performed in both professional, as well as high level athletes Purpose: To report the patient demographics, surgical techniques, and outcomes of all UCLR performed at a single institution from 2004-2014 Hypothesis: UCLR will be performed mostly in male pitchers and will have a complication rate of less than 5%. Methods: Methods: The surgical database of one institution was searched from January 1st 2004-December 31st 2014 for the current procedural terminology (CPT) code 24346 “Reconstruction medial collateral ligament, elbow, with tendon graft (includes harvesting of graft)”. Charts were reviewed to determine patient age, gender, date of surgery, sport played, athletic level, surgical technique, graft type, and complications were recorded. Patients were contacted via phone calls to obtain the return to sport rate, Conway-Jobe score, Timmerman & Andrews score, and Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow score. Results: Results: One hundred eighty-nine patients underwent UCLR during the study period (92% male, average age 19.6 +/- 4.9 years, 77.8% were right elbows). There were 166 baseball players (87.8% of all patients), 156 of which were pitchers (82.5% of all patients). Ninety-eight (51.6%) were college athletes, 62 (36%) were high school athletes, and 25 (13.2%) were professional athletes at the time of surgery. The docking technique was used in 111 (58.7%) patients while the double docking technique was used in 78 (41.3%). An ipsilateral palmaris longus graft was used in 111 (58.7%) of patients while a hamstring autograft was used in 48 (25.4%) patients. The ulnar nerve was subcutaneously transposed in 79 (41.8%) patients. Overall 95.7% of patients were able to return to sport and had a Conway-Jobe score of good/excellent while 4.3% had a score of fair. The average KJOC score was 94.7 +/- 5.7 and average Timmerman-Andrews score was 93.7 +/- 7

  7. Posterior leukoencephalopathy syndrome in children and adolescents.

    PubMed

    Alehan, Füsun; Erol, Ilknur; Agildere, A Muhtesem; Ozcay, Figen; Baskin, Esra; Cengiz, Nurcan; Alioglu, Bülent; Haberal, Mehmet

    2007-04-01

    Posterior leukoencephalopathy syndrome is a recently identified clinical and radiologic entity. The characteristic radiologic findings are bilateral gray and white matter edema in the posterior regions of the cerebral hemispheres. This article reports clinical and radiologic findings in 10 consecutive episodes of posterior leukoencephalopathy syndrome that were diagnosed in 9 children and adolescents. The causes were immunosuppressive therapy in 7 patients and a combination of renal failure and hypertension in 3. The most common presenting symptoms were seizure and altered consciousness; others included headache, sixth nerve palsy, and cortical blindness. Imaging demonstrated abnormalities in the parietal and occipital lobes in all 10 episodes. The signs and symptoms resolved after immunosuppressive agents were reduced or discontinued, or after uremia and hypertension were corrected. Four patients underwent follow-up cranial imaging, and the images showed nearly complete or complete resolution. The syndrome was clinically reversible in all patients.

  8. Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature

    PubMed Central

    Keyhani, Sohrab; Vaziri, Arash Sharafat; shafiei, Hossein; Mardani-Kivi, Mohsen

    2015-01-01

    A rare and devastating complication following anterior cruciate ligament (ACL) revision reconstruction is femoral fracture. A 35-year old male soccer player with a history of ACL tear from one year ago, who underwent arthroscopic ACL reconstruction and functioned well until another similar injury caused ACL re-rupture. Revision of ACL reconstruction was performed and after failure of graft tension during the pumping, a fluoroscopic assessment showed a femoral condyle fracture. The patient referred to our knee clinic and was operated on in two stages first fixation of the fracture and then ACL re-revision after fracture healing was complete. Not inserting multiple guide pins, keeping a safe distance from the posterior cortex and giving more attention during graft tensioning, especially in revision surgeries, are all small points that can reduce the risk of fracture during the revision of ACL reconstruction. PMID:26110183

  9. Imaging the posterior mediastinum: a multimodality approach.

    PubMed

    Occhipinti, Mariaelena; Heidinger, Benedikt H; Franquet, Elisa; Eisenberg, Ronald L; Bankier, Alexander A

    2015-01-01

    The posterior mediastinum contains several structures that can produce a wide variety of pathologic conditions. Descending thoracic aorta, esophagus, azygos and hemiazygos veins, thoracic duct, lymph nodes, adipose tissue, and nerves are all located in this anatomical region and can produce diverse abnormalities. Although chest radiography may detect many of these pathologic conditions, computed tomography and magnetic resonance are the imaging modalities of choice for further defining the relationship of posterior mediastinal lesions to neighboring structures and showing specific imaging features that narrow the differential diagnosis. This review emphasizes modality-related answers to morphologic questions, which provide precise diagnostic information. PMID:25993732

  10. Preformed posterior stainless steel crowns: an update.

    PubMed

    Croll, T P

    1999-02-01

    For almost 50 years, dentists have used stainless steel crowns for primary and permanent posterior teeth. No other type of restoration offers the convenience, low cost, durability, and reliability of such crowns when interim full-coronal coverage is required. Preformed stainless steel crowns have improved over the years. Better luting cements have been developed and different methods of crown manipulation have evolved. This article reviews stainless steel crown procedures for primary and permanent posterior teeth. Step-by-step placement of a primary molar stainless steel crown is documented and permanent molar stainless steel crown restoration is described. A method for repairing a worn-through crown also is reviewed.

  11. Arthroscopic Approach to Posterior Ankle Impingement.

    PubMed

    Theodoulou, Michael H; Bohman, Laura

    2016-10-01

    Posterior ankle pain can occur for many reasons. If it is produced by forced plantarflexion of the foot, it is often a result of impingement from an enlarged posterior talar process or an os trigonum. This condition may present in an acute or chronic state. Management is initially nonoperative, but surgical treatments are available. This condition is often seen in athletes, so procedures that limit surgical trauma and allow early return to activity are ideal. An arthroscopic approach for this disorder produces good outcomes with limited complications. Understanding the indications, local anatomy, and surgical technique, allows good, reproducible outcomes.

  12. Large posterior abdominal masses: computed tomographic localization.

    PubMed

    Engel, I A; Auh, Y H; Rubenstein, W A; Whalen, J P; Kazam, E

    1983-10-01

    Large posterior abdominal masses, particularly those in the right upper abdomen, may be difficult to localize correctly into the peritoneal or retroperitoneal compartments. The following signs were found to be reliable CT indicators of retroperitoneal location: obliteration of the perinephric fat outlining the psoas muscle; lateral displacement of the fat outlining the posterior right lobe of the liver; rotation of the intrahepatic portal veins to the left; anterior displacement of the inferior vena cava and renal veins; and anterior displacement of the ascending colon, descending duodenum, or pancreatic head.

  13. Arthroscopic Approach to Posterior Ankle Impingement.

    PubMed

    Theodoulou, Michael H; Bohman, Laura

    2016-10-01

    Posterior ankle pain can occur for many reasons. If it is produced by forced plantarflexion of the foot, it is often a result of impingement from an enlarged posterior talar process or an os trigonum. This condition may present in an acute or chronic state. Management is initially nonoperative, but surgical treatments are available. This condition is often seen in athletes, so procedures that limit surgical trauma and allow early return to activity are ideal. An arthroscopic approach for this disorder produces good outcomes with limited complications. Understanding the indications, local anatomy, and surgical technique, allows good, reproducible outcomes. PMID:27599438

  14. Arthroscopic Reinsertion of Lateral Collateral Ligament, Anterior Capsular Plication, and Coronoid Tunneling Technique for Chronic Elbow Posterolateral Rotatory Instability.

    PubMed

    Arrigoni, Paolo; D'Ambrosi, Riccardo; Nicoletti, Simone; Randelli, Pietro

    2016-06-01

    Posterolateral rotatory instability (PLRI) of the elbow is a chronic condition that results from lateral collateral ligament complex injury and presents with pain, clicking, and subluxation within the flexion and extension arcs of elbow motion. The primary cause involves a lesion of the lateral collateral ligament complex and its avulsion from the lateral epicondyle. In most cases, it is the result of trauma such as a fall on an outstretched hand or any other mechanism that imparts axial compression, valgus force, and supination. Several surgical techniques have been described for the treatment of PLRI, but there is no consensus regarding the ideal surgical treatment. The advantages of an arthroscopic approach for the treatment of PLRI are first diagnostic. Arthroscopy allows for visualization and diagnosis of every compartment of the elbow. The main steps of the surgical procedure consist of reinsertion of the lateral collateral ligament, anterior capsular plication, and coronoid tunneling. By use of this technique, it is possible to perform an anatomic repair and provide stability of the elbow. PMID:27656364

  15. Ultrastructural and morphological characteristics of human anterior cruciate ligament and hamstring tendons.

    PubMed

    Zhu, Jingxian; Zhang, Xin; Ma, Yong; Zhou, Chunyan; Ao, Yingfang

    2012-09-01

    Hamstring tendons are a commonly used substitute for anterior cruciate ligament (ACL) reconstruction. Ligaments and tendons are similar in composition but the ACL is more complex than hamstring tendons in function and gross morphology, which are highly dependent on its structure and ultrastructure. The purpose of this study was to compare the morphology and ultrastructure of normal human ACL and hamstring tendons, including the cell type and arrangement, expression level of proteoglycans, diameter, and density of collagen fibrils. Twenty semitendinosus or gracilis tendons and 20 ACL specimens were harvested from patients with ACL rupture or osteoarthritis undergoing routine total knee arthroplasty. The specimens were examined histologically and the ultrastructure was observed using scanning and transmission electron microscopy. Semitendinosus and gracilis tendons showed a homogeneous arrangement of collagen fibers and cell type. They had lower fibril density and more widely distributed fibril diameters. In the ACL, there was a more complex arrangement of collagen fibers, distribution of proteoglycans and different cell types. Electronic microscopy demonstrated a combination of parallel, helical and nonlinear networks of ACL fibrils, and fibril diameters were smaller and more nonuniform. This study compared the anatomy of normal human ACL and hamstring tendons, which may provide a standard for evaluating hamstring tendons grafts after ACL reconstruction and may facilitate the application of hamstring tendons in clinical applications.

  16. Three-dimensional characterization of the anterior cruciate ligament's femoral footprint.

    PubMed

    Westermann, Robert; Sybrowsky, Christian; Ramme, Austin; Amedola, Annuziati; Wolf, Brian R

    2014-02-01

    There is increasing use of three-dimensional (3D) computed tomography (CT) for researching anterior cruciate ligament (ACL) reconstructions and tunnel placement. However, there is limited 3D CT data on the ACL footprint. The purpose of this study is to define the native ACL femoral footprint using 3D surface reconstructions of computed tomography (CT) imaging of cadaveric knees. The femoral insertion of the ACL was meticulously dissected and marked with drill holes in seven cadaveric knees. CT scans were performed on each specimen, and 3D computer models were created. Distance from the condyle edges to the margins of the footprint were referenced to the total condylar size. This was performed both parallel and perpendicular to the femoral axis as well as the intercondylar notch. The mean condylar depth (c/C) ratios along the axis of the femur were 0.45 ± 0.06 for the anterior border, 0.44 ± 0.08 for the posterior border, 0.26 ± 0.07 for the proximal border, and 0.63 ± 0.08 for the distal border. The mean notch (n/N) ratios for the four margins were 0.37 ± 0.04 for the anterior border, 0.67 ± 0.08 for the posterior border, 0.49 ± 0.07 for the proximal margin, and 0.50 ± 0.06 for the distal border. The mean c/C ratios parallel the intercondylar notch measured 0.23 ± 0.03 for the anterior border, 0.27 ± 0.04 for the posterior border, 0.37 ± 0.04 for the proximal border, and 0.12 ± 0.02 for the distal border. The mean n/N ratios perpendicular to the intercondylar notch measured 0.11 ± 0.06 for the anterior border, 0.52 ± 0.09 the posterior border, 0.29 ± 0.06 for the proximal border, and 0.30 ± 0.06 for the distal border. This study provides reference measures of the femoral footprint of the ACL using 3D CT. It will assist future studies that use advanced imaging to evaluate accuracy of ACL reconstruction.

  17. Principles of postoperative anterior cruciate ligament rehabilitation.

    PubMed

    Saka, Tolga

    2014-09-18

    It is known that anterior cruciate ligament (ACL) reconstruction needs to be combined with detailed postoperative rehabilitation in order for patients to return to their pre-injury activity levels, and that the rehabilitation process is as important as the reconstruction surgery. Literature studies focus on how early in the postoperative ACL rehabilitation period rehabilitation modalities can be initiated. Despite the sheer number of studies on this topic, postoperative ACL rehabilitation protocols have not been standardized yet. Could common, "ossified" knowledge or modalities really prove themselves in the literature? Could questions such as "is postoperative brace use really necessary?", "what are the benefits of early restoration of the range of motion (ROM)?", "to what extent is neuromuscular electrical stimulation (NMES) effective in the protection from muscular atrophy?", "how early can proprioception training and open chain exercises begin?", "should strengthening training start in the immediate postoperative period?" be answered for sure? My aim is to review postoperative brace use, early ROM restoration, NMES, proprioception, open/closed chain exercises and early strengthening, which are common modalities in the very comprehensive theme of postoperative ACL rehabilitation, on the basis of several studies (Level of Evidence 1 and 2) and to present the commonly accepted ways they are presently used. Moreover, I have presented the objectives of postoperative ACL rehabilitation in tables and recent miscellaneous studies in the last chapter of the paper.

  18. [Rehabilitation after arthroscopic anterior cruciate ligament reconstruction].

    PubMed

    Smékal, D; Kalina, R; Urban, J

    2006-12-01

    Rehabilitation is an important part of therapy in patients who have had arthroscopic anterior cruciate ligament reconstruction. A well-designed rehabilitation program avoids potential graft damage and speeds up patients' return to their full function level. The course of rehabilitation depends on the type of surgery, mode of fixation and possible co-existing injury to the knee's soft tissues. The rehabilitation program presented here is based on the present-day knowledge of neurophysiological and biomechanical principles and is divided into five phases. In the pre-operative phase (I), the main objective is to prepare patients for surgery in terms of maximum muscle strength and range of motion. It also includes providing full information on the procedure. In the early post-operative phase (II) we are concerned with pain alleviation and reduction of knee edema. After suture removal we begin with soft techniques for the patella and post-operative physical therapy to reduce scarring. In the next post-operative phase (III) patients are able to walk with their full weight on the extremity operated on, and we continue doing exercises that improve flexor/extensor co-contraction. In this phase we also begin with exercises improving the patient's proprioceptive and sensorimotor functions. In the late post-operative phase (IV) we go on with exercises promoting proprioception of both lower extremities with the aim of increasing muscle control of the knee joints. In the convalescent phase (V) patients gradually return to their sports activities.

  19. Principles of postoperative anterior cruciate ligament rehabilitation.

    PubMed

    Saka, Tolga

    2014-09-18

    It is known that anterior cruciate ligament (ACL) reconstruction needs to be combined with detailed postoperative rehabilitation in order for patients to return to their pre-injury activity levels, and that the rehabilitation process is as important as the reconstruction surgery. Literature studies focus on how early in the postoperative ACL rehabilitation period rehabilitation modalities can be initiated. Despite the sheer number of studies on this topic, postoperative ACL rehabilitation protocols have not been standardized yet. Could common, "ossified" knowledge or modalities really prove themselves in the literature? Could questions such as "is postoperative brace use really necessary?", "what are the benefits of early restoration of the range of motion (ROM)?", "to what extent is neuromuscular electrical stimulation (NMES) effective in the protection from muscular atrophy?", "how early can proprioception training and open chain exercises begin?", "should strengthening training start in the immediate postoperative period?" be answered for sure? My aim is to review postoperative brace use, early ROM restoration, NMES, proprioception, open/closed chain exercises and early strengthening, which are common modalities in the very comprehensive theme of postoperative ACL rehabilitation, on the basis of several studies (Level of Evidence 1 and 2) and to present the commonly accepted ways they are presently used. Moreover, I have presented the objectives of postoperative ACL rehabilitation in tables and recent miscellaneous studies in the last chapter of the paper. PMID:25232521

  20. Principles of postoperative anterior cruciate ligament rehabilitation

    PubMed Central

    Saka, Tolga

    2014-01-01

    It is known that anterior cruciate ligament (ACL) reconstruction needs to be combined with detailed postoperative rehabilitation in order for patients to return to their pre-injury activity levels, and that the rehabilitation process is as important as the reconstruction surgery. Literature studies focus on how early in the postoperative ACL rehabilitation period rehabilitation modalities can be initiated. Despite the sheer number of studies on this topic, postoperative ACL rehabilitation protocols have not been standardized yet. Could common, “ossified” knowledge or modalities really prove themselves in the literature? Could questions such as “is postoperative brace use really necessary?”, “what are the benefits of early restoration of the range of motion (ROM)?”, “to what extent is neuromuscular electrical stimulation (NMES) effective in the protection from muscular atrophy?”, “how early can proprioception training and open chain exercises begin?”, “should strengthening training start in the immediate postoperative period?” be answered for sure? My aim is to review postoperative brace use, early ROM restoration, NMES, proprioception, open/closed chain exercises and early strengthening, which are common modalities in the very comprehensive theme of postoperative ACL rehabilitation, on the basis of several studies (Level of Evidence 1 and 2) and to present the commonly accepted ways they are presently used. Moreover, I have presented the objectives of postoperative ACL rehabilitation in tables and recent miscellaneous studies in the last chapter of the paper. PMID:25232521

  1. Injury to ulnar collateral ligament of thumb.

    PubMed

    Madan, Simerjit Singh; Pai, Dinker R; Kaur, Avneet; Dixit, Ruchita

    2014-02-01

    Injury of the ulnar collateral ligament (UCL) of thumb can be incapacitating if untreated or not treated properly. This injury is notorious for frequently being missed by inexperienced health care personnel in emergency departments. It has frequently been described in skiers, but also occurs in other sports such as rugby, soccer, handball, basketball, volleyball and even after a handshake. The UCL of the thumb acts as a primary restraint to valgus stress and is injured if hyperabduction and hyperextension forces are applied to the first metacarpophalangeal joint. The diagnosis is best established clinically, though MRI is the imaging modality of choice. Many treatment options exist, surgical treatment being offered depending on various factors, including timing of presentation (acute or chronic), grade (severity of injury), displacement (Stener lesion), location of tear (mid-substance or peripheral), associated or concomitant surrounding tissue injury (bone, volar plate, etc.), and patient-related factors (occupational demands, etc.). This review aims to identify the optimal diagnostic techniques and management options for UCL injury available thus far.

  2. Broad Ligament Hernia-Associated Bowel Obstruction

    PubMed Central

    López-Loredo, A.; León, J. F. García

    2007-01-01

    Background and Objective: We present the case of a female patient 29 years of age with antecedents of laparoscopic laser ablation for endometriosis, laparoscopic appendectomy, and umbilical hernioplasty. Methods: The patient was admitted to the hospital's emergency room for abdominal pain in the epigastrium, transfixing, irradiating to both upper quadrants and to the lumbar region, accompanied by nausea and gastrobiliary vomiting. Lipase determination was 170 mg/dL. Other laboratory findings were normal. Plain abdominal films on the patient's admission were normal, and computed tomography (CT) showed data compatible with acute pancreatitis. Without improvement during the patient's hospital stay, pain and vomiting increased in intensity and frequency. Results: New abdominal x-rays revealed dilatation of small bowel loops. Management was begun for intestinal obstruction, with intravenous hydration and placement of a nasogastric tube without a good response. At 48 hours, a diagnostic laparoscopy was performed, revealing a 3-cm internal hernia in the left broad ligament in which a 20-cm segment of terminal ileum was encased. We performed liberation of the ileal segment and closed the hernial orifice by using the laparoscopic approach. Conclusion: The patient's evolution was excellent. PMID:17651574

  3. Mechanoresponsive Properties of the Periodontal Ligament.

    PubMed

    Huang, L; Liu, B; Cha, J Y; Yuan, G; Kelly, M; Singh, G; Hyman, S; Brunski, J B; Li, J; Helms, J A

    2016-04-01

    The periodontal ligament (PDL) functions as an enthesis, a connective tissue attachment that dissipates strains created by mechanical loading. Entheses are mechanoresponsive structures that rapidly adapt to changes in their mechanical loading; here we asked which features of the PDL are sensitive to such in vivo loading. We evaluated the PDL in 4 physiologically relevant mechanical environments, focusing on mitotic activity, cell density, collagen content, osteogenic protein expression, and organization of the tissue. In addition to examining PDLs that supported teeth under masticatory loading and eruptive forces, 2 additional mechanical conditions were created and analyzed: hypoloading and experimental tooth movement. Collectively, these data revealed that the adult PDL is a remarkably quiescent tissue and that only when it is subjected to increased loads--such as those associated with mastication, eruption, and orthodontic tooth movement-does the tissue increase its rate of cell proliferation and collagen production. These data have relevance in clinical scenarios where PDL acclimatization can be exploited to optimize tooth movement. PMID:26767771

  4. Gait patterns after anterior cruciate ligament reconstruction.

    PubMed

    Bulgheroni, P; Bulgheroni, M V; Andrini, L; Guffanti, P; Giughello, A

    1997-01-01

    The aim of this study is to analyse the changes in select gait parameters following anterior cruciate ligament (ACL) reconstruction. The study was performed on 15 subjects who underwent ACL reconstruction by the bone-patellar tendon-bone technique. Gait analysis was performed using the Elite three-dimensional (3D) optoelectronic system (BTS), a Kistler force platform and the Telemg telemetric electromyograph (BTS). Kinematic data were recorded for the principal lower limb joints (hip, knee and ankle). The examined muscles include vastus lateralis, rectus femoris, biceps femoris and semitendinosus. The results obtained from the operated subjects were compared with those of 10 untreated subjects and 5 subjects without ACL damage. In the operated subjects the knee joint angular values regained a normal flexion pattern for the injured limb during the stance phase. The analysis of joint moments shows: (a) sagittal plane: recovery of the knee flexion moment at loading response and during preswing; (b) frontal plane: recovery of the normal patterns for both hip and knee adduction-abduction moments during the entire stance phase. The examination of ground reaction forces reveals the recovery of frontal component features. The EMG traces show the normal biphasic pattern for the operated subjects as compared to the untreated subjects. The results suggest that the gait parameters shift towards normal value patterns.

  5. Medial patellofemoral ligament reconstruction in patellar instability

    PubMed Central

    Krishna Kumar, MS; Renganathan, Sankarram; Joseph, Clement J; Easwar, TR; Rajan, David V

    2014-01-01

    Background: Medial patellofemoral ligament (MPFL) is one of the major static medial stabilising structures of the patella. MPFL is most often damaged in patients with patellar instability. Reconstruction of MPFL is becoming a common surgical procedure in treating patellar instability. We hypothesised that MPFL reconstruction was adequate to treat patients with patellar instability if the tibial tubercle and the centre of the trochlear groove (TT-TG) value was less than 20 mm and without a dysplastic trochlea. Materials and Methods: 30 patients matching our inclusion criteria and operated between April 2009 and May 2011 were included in the study. MPFL reconstruction was performed using gracilis tendon fixed with endobutton on the patellar side and bio absorbable interference screw or staple on the femoral side. Patients were followed up with subjective criteria, Kujala score and Lysholm score. Results: The mean duration of followup was 25 months (range 14-38 months). The mean preoperative Kujala score was 47.5 and Lysholm score was 44.7. The mean postoperative Kujala score was 87 and Lysholm score was 88.06. None of the patients had redislocation. Conclusion: MPFL reconstruction using gracilis tendon gives excellent results in patients with patellar instability with no redislocations. Some patients may have persistence of apprehension. PMID:25298558

  6. Round ligament lipoma mimicking acute appendicitis in a 24-week pregnant female: a case report.

    PubMed

    Miller, T J; Paulk, D G

    2013-04-01

    An exhaustive search of the literature using the Pub Med database revealed no reports of round ligament lipomas mimicking acute appendicitis in pregnant patients. There are relatively few articles on round ligament lipomas and even less on round ligament lipomas during pregnancy. This case report is on a 27-year-old 24-week pregnant female who presented with signs and symptoms similar to acute appendicitis who in fact had a large right pelvic round ligament lipoma that was causing her pain.

  7. Bone tunnel enlargement on anterior cruciate ligament reconstruction

    PubMed Central

    Leonardi, Adriano Barros de Aguiar; Duarte, Aires; Severino, Nilson Roberto

    2014-01-01

    Objective: To assess the presence of tibial bone tunnel enlargement after surgical reconstruction of the anterior cruciate ligament using quadruple graft of the flexor tendons and correlate the functional results in their presence. Methods: The studied lasted six months and included 25 patients, with ages ranging from 18 to 43 years old. Assessment was based on radiographs taken immediately postoperatively and at the third and sixth month of follow up in the anterior cruciate ligament reconstruction. Reconstruction of ligaments was performed with tendon grafts of the semitendinosus and gracilis muscle fixated in the femur with transverse metal screw and in the tibia with interference screws. Patients were evaluated objectively by tests ligament, graded from zero to four crosses and subjectively by the Lysholm method preoperative and after sixth month follow up. Results: Significant increase in the tunnels diameters were observed, 20.56% for radiographs in the anteroposterior view, 26.48% in profile view and 23.22% in computed tomography. Descriptive statistics showed significant improvement in subjective and objective clinical parameters. Conclusions: The bone tunnel enlargement is a phenomenon found in the first months after surgical reconstruction of the anterior cruciate ligament and it has no implications on clinical outcomes in the short term. Level of Evidence II, Prospective Study. PMID:25328430

  8. Artificial phrenoesophageal ligament. An experimental study in dogs.

    PubMed

    Sader, A A; Dantas, R O; Campos, A D; Evora, P R B

    2016-01-01

    This report deals with the preparation of a 'true' artificial phrenoesophageal ligament aimed at restoring effective anchoring of the esophagus to the diaphragm, keeping the esophagogastric sphincter in the abdomen. A total of 24 mongrel dogs were assigned to four groups: (i) Group I (n = 4): the esophageal diaphragm hiatus left wide open; (ii) Group II (n = 8): the anterolateral esophagus walls were attached to the diaphragm by the artificial ligament and the esophageal hiatus was left wide opened; (iii) Group III (n = 5): in addition to the use of the artificial ligament, the esophageal hiatus was narrowed with two retroesophageal stitches; (iv) Group IV (n = 7): the only procedure was the esophageal hiatus narrowing with two retroesophageal stitches. The phrenoesophagogastric connections were released, sparing the vagus nerves. Five animals of groups III and IV, which did not develop hiatal hernia, were submitted to esophageal manometry immediately before and 15 days after surgery. In group I, all animals developed huge sliding hiatal hernias. In group II, two dogs (25%) had a paraesophageal hernia between the two parts of the artificial ligament. In group III, neither sliding hiatal hernia nor paraesophageal hernia occurred. In group IV, two animals (28.6%) developed sliding esophageal hiatus hernia. Regarding esophageal manometry, postoperative significant difference between groups III and IV (P = 0.008) was observed. Thus, the artificial phrenoesophageal ligament maintained the esophagus firmly attached to the diaphragm in all animals and the esophagogastric sphincter pressure was significantly higher in this group. PMID:25604516

  9. Quasi-linear viscoelastic characterization of human hip ligaments.

    PubMed

    Kemper, Andrew R; McNally, Craig; Smith, Byron; Duma, Stefan M

    2007-01-01

    The object of this study was to develop a quasi-linear viscoelastic model for the iliofemoral and ischiofemoral hip ligaments. In order to accomplish this, a total of 56 axial tension tests were performed on 8 bone-ligament-bone specimens prepared from 4 fresh frozen male cadavers. Each specimen went through a battery of 7 tests including a series of step-and-hold tests and load-and-unload ramp tests. The bone-ligament-bone specimens were situated so that the load from a servo-hydraulic Material Testing System would be applied on the long axis of each ligament. The reduced relaxation data was fit to a two exponential damping function while the instantaneous elastic response was fit to a power-law function. These two constituents were then combined to create a single constitutive equation for each ligament. The quasi-linear viscoelastic model presented in this study can be used to improve the biofidelity of computational models of the human hip. PMID:17487102

  10. Reduction of artifacts in computer simulation of breast Cooper's ligaments

    NASA Astrophysics Data System (ADS)

    Pokrajac, David D.; Kuperavage, Adam; Maidment, Andrew D. A.; Bakic, Predrag R.

    2016-03-01

    Anthropomorphic software breast phantoms have been introduced as a tool for quantitative validation of breast imaging systems. Efficacy of the validation results depends on the realism of phantom images. The recursive partitioning algorithm based upon the octree simulation has been demonstrated as versatile and capable of efficiently generating large number of phantoms to support virtual clinical trials of breast imaging. Previously, we have observed specific artifacts, (here labeled "dents") on the boundaries of simulated Cooper's ligaments. In this work, we have demonstrated that these "dents" result from the approximate determination of the closest simulated ligament to an examined subvolume (i.e., octree node) of the phantom. We propose a modification of the algorithm that determines the closest ligament by considering a pre-specified number of neighboring ligaments selected based upon the functions that govern the shape of ligaments simulated in the subvolume. We have qualitatively and quantitatively demonstrated that the modified algorithm can lead to elimination or reduction of dent artifacts in software phantoms. In a proof-of concept example, we simulated a 450 ml phantom with 333 compartments at 100 micrometer resolution. After the proposed modification, we corrected 148,105 dents, with an average size of 5.27 voxels (5.27nl). We have also qualitatively analyzed the corresponding improvement in the appearance of simulated mammographic images. The proposed algorithm leads to reduction of linear and star-like artifacts in simulated phantom projections, which can be attributed to dents. Analysis of a larger number of phantoms is ongoing.

  11. Psychological Aspects of Recovery Following Anterior Cruciate Ligament Reconstruction.

    PubMed

    Christino, Melissa A; Fantry, Amanda J; Vopat, Bryan G

    2015-08-01

    Recovery following anterior cruciate ligament reconstruction is an arduous process that requires a significant mental and physical commitment to rehabilitation. Orthopaedic research in recent years has focused on optimizing anterior cruciate ligament surgical techniques; however, despite stable anterior cruciate ligament reconstructions, many athletes still never achieve their preinjury ability or even return to sport. Psychological factors associated with patient perceptions and functional outcomes following anterior cruciate ligament reconstruction are important to acknowledge and understand. Issues related to emotional disturbance, motivation, self-esteem, locus of control, and self-efficacy can have profound effects on patients' compliance, athletic identity, and readiness to return to sport. The psychological aspects of recovery play a critical role in functional outcomes, and a better understanding of these concepts is essential to optimize the treatment of patients undergoing anterior cruciate ligament reconstruction, particularly those who plan to return to sport. Identifying at-risk patients, encouraging a multidisciplinary approach to patient care, and providing early referral to a sports psychologist may improve patient outcomes and increase return-to-play rates among athletes.

  12. Decellularized Periodontal Ligament Cell Sheets with Recellularization Potential

    PubMed Central

    Farag, A.; Vaquette, C.; Theodoropoulos, C.; Hamlet, S.M.; Hutmacher, D.W.; Ivanovski, S.

    2014-01-01

    The periodontal ligament is the key tissue facilitating periodontal regeneration. This study aimed to fabricate decellularized human periodontal ligament cell sheets for subsequent periodontal tissue engineering applications. The decellularization protocol involved the transfer of intact human periodontal ligament cell sheets onto melt electrospun polycaprolactone membranes and subsequent bi-directional perfusion with NH4OH/Triton X-100 and DNase solutions. The protocol was shown to remove 92% of DNA content. The structural integrity of the decellularized cell sheets was confirmed by a collagen quantification assay, immunostaining of human collagen type I and fibronectin, and scanning electron microscopy. ELISA was used to demonstrate the presence of residual basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), and hepatocyte growth factor (HGF) in the decellularized cell sheet constructs. The decellularized cell sheets were shown to have the ability to support recellularization by allogenic human periodontal ligament cells. This study describes the fabrication of decellularized periodontal ligament cell sheets that retain an intact extracellular matrix and resident growth factors and can support repopulation by allogenic cells. The decellularized hPDL cell sheet concept has the potential to be utilized in future “off-the-shelf” periodontal tissue engineering strategies. PMID:25270757

  13. Median Arcuate Ligament Syndrome in a patient with Crohn's disease

    PubMed Central

    Sturiale, Alessandro; Alemanno, Giovanni; Giudici, Francesco; Addasi, Rami; Bellucci, Francesco; Tonelli, Francesco

    2013-01-01

    INTRODUCTION The Median Arcuate Ligament Syndrome is a rare condition characterized by postprandial abdominal pain, bowel function disorder and weight loss. We report the first case to our knowledge of Crohn's disease and Median Arcuate Ligament Syndrome. PRESENTATION OF CASE The patient was a 33 year-old female with a previous diagnosis of Crohn's disease. Acute postprandial abdominal pain affected the patient every day; she was, therefore, referred to US-Doppler and magnetic resonance angiography of the abdominal vessels and received a diagnosis of Median Arcuate Ligament Syndrome. Consequently, the patient was surgically treated, releasing the vascular compression. After the operation, she reported a complete relief from postprandial pain which was one of her major concerns. Subocclusive symptoms occurred after six months due to the inflammatory reactivation of the terminal ileitis. DISCUSSION The diagnosis of Median Arcuate Ligament Syndrome is mainly based on the exclusion of other intestinal disorders but it should be always confirmed using noninvasive tests such as US-Doppler, angio-CT or magnetic resonance angiography. CONCLUSION This case demonstrates that the Median Arcuate Ligament Syndrome could be the major cause of symptoms, even in presence of other abdominal disorders. PMID:23500743

  14. Artificial phrenoesophageal ligament. An experimental study in dogs.

    PubMed

    Sader, A A; Dantas, R O; Campos, A D; Evora, P R B

    2016-01-01

    This report deals with the preparation of a 'true' artificial phrenoesophageal ligament aimed at restoring effective anchoring of the esophagus to the diaphragm, keeping the esophagogastric sphincter in the abdomen. A total of 24 mongrel dogs were assigned to four groups: (i) Group I (n = 4): the esophageal diaphragm hiatus left wide open; (ii) Group II (n = 8): the anterolateral esophagus walls were attached to the diaphragm by the artificial ligament and the esophageal hiatus was left wide opened; (iii) Group III (n = 5): in addition to the use of the artificial ligament, the esophageal hiatus was narrowed with two retroesophageal stitches; (iv) Group IV (n = 7): the only procedure was the esophageal hiatus narrowing with two retroesophageal stitches. The phrenoesophagogastric connections were released, sparing the vagus nerves. Five animals of groups III and IV, which did not develop hiatal hernia, were submitted to esophageal manometry immediately before and 15 days after surgery. In group I, all animals developed huge sliding hiatal hernias. In group II, two dogs (25%) had a paraesophageal hernia between the two parts of the artificial ligament. In group III, neither sliding hiatal hernia nor paraesophageal hernia occurred. In group IV, two animals (28.6%) developed sliding esophageal hiatus hernia. Regarding esophageal manometry, postoperative significant difference between groups III and IV (P = 0.008) was observed. Thus, the artificial phrenoesophageal ligament maintained the esophagus firmly attached to the diaphragm in all animals and the esophagogastric sphincter pressure was significantly higher in this group.

  15. Lateral collateral ligament deficiency of the elbow joint: A modeling approach.

    PubMed

    Rahman, Munsur; Cil, Akin; Bogener, James W; Stylianou, Antonis P

    2016-09-01

    A computational model capable of predicting the effects of lateral collateral ligament deficiency of the elbow joint would be a valuable tool for surgical planning and prediction of the long-term consequences of ligament deficiency. The purpose of this study was to simulate lateral collateral ligament deficiency during passive flexion using a computational multibody elbow joint model and investigate the effects of ligament insufficiency on the kinematics, ligament loads, and articular contact characteristics (area, pressure). The elbow was placed initially at approximately 20° of flexion and a 345 mm vertical downward motion profile was applied over 40 s to the humerus head. The vertical displacement induced flexion from the initial position to a maximum flexion angle of 135°. The study included simulations for intact, radial collateral ligament deficient, lateral ulnar collateral ligament deficient, and combined radial and lateral ulnar collateral ligament deficient elbow. For each condition, relative bone kinematics, contact pressure, contact area, and intact ligament forces were predicted. Intact and isolated radial collateral ligament deficient elbow simulations were almost identical for all observed outcomes. Minor differences in kinematics, contact area and pressure were observed for the isolated lateral ulnar collateral ligament deficient elbow compared to the intact elbow, but no elbow dislocation was detected. However, sectioning both ligaments together induced substantial differences in kinematics, contact area, and contact pressure, and caused complete dislocation of the elbow joint. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1645-1655, 2016.

  16. Dynamic sonography with valgus stress to assess elbow ulnar collateral ligament injury in baseball pitchers.

    PubMed

    De Smet, Arthur A; Winter, Thomas C; Best, Thomas M; Bernhardt, David T

    2002-11-01

    Sonography is a valuable method for imaging superficial tendons and ligaments. The ability to obtain comparison images easily with dynamic stress allows assessment of ligament and tendon integrity. We studied the medial elbow joints of two baseball pitchers using MR imaging and dynamic sonography. Both sonography and MR imaging identified the ulnar collateral ligament tears. Dynamic sonography uniquely demonstrated the medial joint instability.

  17. In vivo measurements and numerical analysis of the biomechanical characteristics of the human periodontal ligament.

    PubMed

    Keilig, L; Drolshagen, M; Tran, K L; Hasan, I; Reimann, S; Deschner, J; Brinkmann, K T; Krause, R; Favino, M; Bourauel, C

    2016-07-01

    The periodontal ligament is a complex tissue with respect to its biomechanical behaviour. It is important to understand the mechanical behaviour of the periodontal ligament during physiological loading in healthy patients as well as during the movement of the tooth in orthodontic treatment or in patients with periodontal disease, as these might affect the mechanical properties of the periodontal ligament (PDL). Up to now, only a limited amount of in vivo data is available concerning this issue. The aim of this study has been to determine the time dependent material properties of the PDL in an experimental in vivo study, using a novel device that is able to measure tooth displacement intraorally. Using the intraoral loading device, tooth deflections at various velocities were realised in vivo on human teeth. The in vivo investigations were performed on the upper left central incisors of five volunteers aged 21-33 years with healthy periodontal tissue. A deflection, applied at the centre of the crown, was linearly increased from 0 to 0.15mm in a loading period of between 0.1 and 5.0s. Individual numerical models were developed based on the experimental results to simulate the relationship between the applied force and tooth displacement. The numerical force/displacement curves were fitted to the experimental ones to obtain the material properties of the human PDL. For the shortest loading time of 0.1s, the experimentally determined forces were between 7.0 and 16.2N. The numerically calculated Young's modulus varied between 0.9MPa (5.0s) and 1.2MPa (0.1s). By considering the experimentally and numerically obtained force curves, forces decreased with increasing loading time. The experimental data gained in this study can be used for the further development and verification of a multiphasic constitutive law of the PDL.

  18. Posterior Probabilities for a Consensus Ordering.

    ERIC Educational Resources Information Center

    Fligner, Michael A.; Verducci, Joseph S.

    1990-01-01

    The concept of consensus ordering is defined, and formulas for exact and approximate posterior probabilities for consensus ordering are developed under the assumption of a generalized Mallows' model with a diffuse conjugate prior. These methods are applied to a data set concerning 98 college students. (SLD)

  19. Posterior predictive Bayesian phylogenetic model selection.

    PubMed

    Lewis, Paul O; Xie, Wangang; Chen, Ming-Hui; Fan, Yu; Kuo, Lynn

    2014-05-01

    We present two distinctly different posterior predictive approaches to Bayesian phylogenetic model selection and illustrate these methods using examples from green algal protein-coding cpDNA sequences and flowering plant rDNA sequences. The Gelfand-Ghosh (GG) approach allows dissection of an overall measure of model fit into components due to posterior predictive variance (GGp) and goodness-of-fit (GGg), which distinguishes this method from the posterior predictive P-value approach. The conditional predictive ordinate (CPO) method provides a site-specific measure of model fit useful for exploratory analyses and can be combined over sites yielding the log pseudomarginal likelihood (LPML) which is useful as an overall measure of model fit. CPO provides a useful cross-validation approach that is computationally efficient, requiring only a sample from the posterior distribution (no additional simulation is required). Both GG and CPO add new perspectives to Bayesian phylogenetic model selection based on the predictive abilities of models and complement the perspective provided by the marginal likelihood (including Bayes Factor comparisons) based solely on the fit of competing models to observed data. PMID:24193892

  20. A Complication of Posterior Malleolar Fracture Fixation.

    PubMed

    Patel, Ankit; Charles, Loren; Ritchie, James

    2016-01-01

    We present a case of tibial nerve impingement by an anteroposterior screw inserted for stabilization of a posterior malleolar fracture. This specific complication has not previously been described in published studies, although numerous reports have described various forms of peripheral nerve entrapment. We discuss the merits of fixation of these fractures using a posterolateral approach.

  1. Subspecialization in the human posterior medial cortex

    PubMed Central

    Bzdok, Danilo; Heeger, Adrian; Langner, Robert; Laird, Angela R.; Fox, Peter T.; Palomero-Gallagher, Nicola; Vogt, Brent A.; Zilles, Karl; Eickhoff, Simon B.

    2014-01-01

    The posterior medial cortex (PMC) is particularly poorly understood. Its neural activity changes have been related to highly disparate mental processes. We therefore investigated PMC properties with a data-driven exploratory approach. First, we subdivided the PMC by whole-brain coactivation profiles. Second, functional connectivity of the ensuing PMC regions was compared by task-constrained meta-analytic coactivation mapping (MACM) and task-unconstrained resting-state correlations (RSFC). Third, PMC regions were functionally described by forward/reverse functional inference. A precuneal cluster was mostly connected to the intraparietal sulcus, frontal eye fields, and right temporo-parietal junction; associated with attention and motor tasks. A ventral posterior cingulate cortex (PCC) cluster was mostly connected to the ventromedial prefrontal cortex and middle left inferior parietal cortex (IPC); associated with facial appraisal and language tasks. A dorsal PCC cluster was mostly connected to the dorsomedial prefrontal cortex, anterior/posterior IPC, posterior midcingulate cortex, and left dorsolateral prefrontal cortex; associated with delay discounting. A cluster in the retrosplenial cortex was mostly connected to the anterior thalamus and hippocampus. Furthermore, all PMC clusters were congruently coupled with the default mode network according to task-constrained but not task-unconstrained connectivity. We thus identified distinct regions in the PMC and characterized their neural networks and functional implications. PMID:25462801

  2. Selective contribution of each hamstring muscle to anterior cruciate ligament protection and tibiofemoral joint stability in leg-extension exercise: a simulation study.

    PubMed

    Biscarini, Andrea; Botti, Fabio Massimo; Pettorossi, Vito Enrico

    2013-09-01

    A biomechanical model was developed to simulate the selective effect of the co-contraction force provided by each hamstring muscle on the shear and compressive tibiofemoral joint reaction forces, during open kinetic-chain knee-extension exercises. This model accounts for instantaneous values of knee flexion angle [Formula: see text], angular velocity and acceleration, and for changes in magnitude, orientation, and application point of external resistance. The tibiofemoral shear force (TFSF) largely determines the tensile force on anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). Biceps femoris is the most effective hamstring muscle in decreasing the ACL-loading TFSF developed by quadriceps contractions for [Formula: see text]. In this range, the semimembranosus generates the dominant tibiofemoral compressive force, which enhances joint stability, opposes anterior/posterior tibial translations, and protects cruciate ligaments. The semitendinosus force provides the greatest decreasing gradient of ACL-loading TFSF for [Formula: see text], and the greatest increasing gradient of tibiofemoral compressive force for [Formula: see text]. However, semitendinosus efficacy is strongly limited by its small physiological section. Hamstring muscles behave as a unique muscle in enhancing the PCL-loading TFSF produced by quadriceps contractions for [Formula: see text]. The levels of hamstrings co-activation that suppress the ACL-loading TFSF considerably shift when the knee angular acceleration is changed while maintaining the same level of knee extensor torque by a concurrent adjustment in the magnitude of external resistance. The knowledge of the specific role and the optimal activation level of each hamstring muscle in ACL protection and tibiofemoral stability are fundamental for planning safe and effective rehabilitative knee-extension exercises.

  3. Selective contribution of each hamstring muscle to anterior cruciate ligament protection and tibiofemoral joint stability in leg-extension exercise: a simulation study.

    PubMed

    Biscarini, Andrea; Botti, Fabio Massimo; Pettorossi, Vito Enrico

    2013-09-01

    A biomechanical model was developed to simulate the selective effect of the co-contraction force provided by each hamstring muscle on the shear and compressive tibiofemoral joint reaction forces, during open kinetic-chain knee-extension exercises. This model accounts for instantaneous values of knee flexion angle [Formula: see text], angular velocity and acceleration, and for changes in magnitude, orientation, and application point of external resistance. The tibiofemoral shear force (TFSF) largely determines the tensile force on anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). Biceps femoris is the most effective hamstring muscle in decreasing the ACL-loading TFSF developed by quadriceps contractions for [Formula: see text]. In this range, the semimembranosus generates the dominant tibiofemoral compressive force, which enhances joint stability, opposes anterior/posterior tibial translations, and protects cruciate ligaments. The semitendinosus force provides the greatest decreasing gradient of ACL-loading TFSF for [Formula: see text], and the greatest increasing gradient of tibiofemoral compressive force for [Formula: see text]. However, semitendinosus efficacy is strongly limited by its small physiological section. Hamstring muscles behave as a unique muscle in enhancing the PCL-loading TFSF produced by quadriceps contractions for [Formula: see text]. The levels of hamstrings co-activation that suppress the ACL-loading TFSF considerably shift when the knee angular acceleration is changed while maintaining the same level of knee extensor torque by a concurrent adjustment in the magnitude of external resistance. The knowledge of the specific role and the optimal activation level of each hamstring muscle in ACL protection and tibiofemoral stability are fundamental for planning safe and effective rehabilitative knee-extension exercises. PMID:23670482

  4. On the scaling behavior of hardness with ligament diameter of nanoporous-Au: Constrained motion of dislocations along the ligaments

    SciTech Connect

    Viswanath, R. N.; Polaki, S. R.; Rajaraman, R.; Abhaya, S.; Chirayath, V. A.; Amarendra, G.; Sundar, C. S.

    2014-06-09

    The scaling behavior of hardness with ligament diameter and vacancy defect concentration in nanoporous Au (np-Au) has been investigated using a combination of Vickers Hardness, Scanning electron microscopy, and positron lifetime measurements. It is shown that for np-Au, the hardness scales with the ligament diameter with an exponent of −0.3, that is, at variance with the conventional Hall-Petch exponent of −0.5 for bulk systems, as seen in the controlled experiments on cold worked Au with varying grain size. The hardness of np-Au correlates with the vacancy concentration C{sub V} within the ligaments, as estimated from positron lifetime experiments, and scales as C{sub V}{sup 1/2}, pointing to the interaction of dislocations with vacancies. The distinctive Hall-Petch exponent of −0.3 seen for np-Au, with ligament diameters in the range of 5–150 nm, is rationalized by invoking the constrained motion of dislocations along the ligaments.

  5. Dorsal intercarpal ligament capsulodesis for predynamic and dynamic scapholunate instability.

    PubMed

    Luchetti, R; Zorli, I Papini; Atzei, A; Fairplay, T

    2010-01-01

    We treated a prospective series of 18 patients (nine men and nine women) with a mean age of 35 years (range 15 to 57), with chronic predynamic or dynamic scapholunate instability by a dorsal intercarpal ligament capsulodesis using the modified Mayo technique. All the patients were assessed by the modified Mayo wrist score and DASH questionnaire. Wrist arthroscopy was done in all patients before open surgery in order to grade the scapholunate instability and correlate the findings with the radiographic and MRI results. At an average follow-up of 45 months (range 34 to 60) pain significantly diminished (P < 0.05) with improvement in the grip strength (P < 0.005) in all 18 cases. Wrist motion remained almost the same. The mean Mayo wrist score improved from 62 to 84 (P < 0.005).We recommend dorsal capsulodesis by using the dorsal intercarpal ligament flap for the treatment of scapholunate dissociation, when the ligament is still repairable.

  6. Stress radiography in the diagnosis of anterior cruciate ligament deficiency.

    PubMed

    Garcés, G L; Perdomo, E; Guerra, A; Cabrera-Bonilla, R

    1995-01-01

    A prospective study was carried out to test the sensitivity and specificity of stress radiography in detecting anterior cruciate ligament deficiency in both knees of 116 patients using the Telos device. In 47 of these a total or partial rupture of the anterior cruciate ligament was diagnosed by arthroscopy, while the ligament was intact in the remaining 69 patients. The mean difference in radiological translation between the injured and the normal knee was greater than 5 mm (p < 0.001) in those with anterior cruciate deficiency, and less than 3 mm in the others. A differential displacement of up to 3 mm was considered normal. The sensitivity of the method was less than 67% and the specificity was 100%. Clinical diagnosis had a sensitivity of 70.2% and a specificity of 98.5%. Our findings suggest that, although a differential translation of more than 3 mm can be diagnostic, smaller differences do not rule out anterior cruciate deficiency.

  7. Current Rehabilitation Concepts for Anterior Cruciate Ligament Surgery in Athletes.

    PubMed

    Malempati, Chaitu; Jurjans, John; Noehren, Brian; Ireland, Mary L; Johnson, Darren L

    2015-11-01

    The anterior cruciate ligament is the most commonly disrupted ligament in the knee in high-performance athletes. Most recently, advancements in surgical technique and graft fixation have enabled athletes to participate in early postoperative rehabilitation, focusing on range of motion and progressing to patellar mobilization, strengthening, and neuromuscular control. Several rehabilitation protocols exist with variations in specific exercises, progression through phases, and key components. The ultimate goal of rehabilitation is to return the athlete to preinjury performance level, including motion and strength, without injuring or elongating the graft. Each athlete is unique; thus, safe return to play should be individualized rather than follow a particular postoperative month or time line. This article provides an overview of the application and the scientific basis for formulating a rehabilitation protocol prior to and following anterior cruciate ligament surgery.

  8. Compartment syndrome with mononeuropathies after anterior cruciate ligament reconstruction.

    PubMed

    Kindle, Brett J; Murthy, Naveen; Stolp, Kathryn

    2015-05-01

    Compartment syndrome rarely follows anterior cruciate ligament reconstruction. However, when it does, it may result in mononeuropathies that are amenable to neurolysis. The authors of this study present an 18-yr-old woman who sustained a right anterior cruciate ligament tear and underwent uneventful anterior cruciate ligament reconstruction using femoral and popliteal nerve blocks. Postoperatively, she developed compartment syndrome requiring emergent fasciotomies. At 11 wks after fasciotomy, results of electrophysiologic tests showed evidence of severe fibular and tibial neuropathies. Magnetic resonance images showed extensive tricompartmental myonecrosis. Fibular and tibial neurolysis as well as decompression were performed, followed by intensive outpatient rehabilitation. At the 6-mo follow-up, she reported resolution of pain as well as significant improvement in sensation, strength, and function. Early recognition and intervention are crucial to prevent serious neurologic damage. Excessive tourniquet pressure and anesthetic nerve blocks may have been responsible.

  9. Interfascicular reconstruction of the peroneal nerve after knee ligament injury.

    PubMed

    McMahon, M S; Craig, S M

    1994-06-01

    Peroneal palsy is the most common lower extremity nerve injury. Although most studies emphasize particularly poor prognosis after traction injuries to the peroneal nerve, interfascicular nerve grafting has emerged as a promising technique. We describe the case of a 20-year-old man who sustained a traction injury to the peroneal nerve (0/5 foot dorsiflexion and eversion) concomitant with tears of the anterior cruciate and lateral collateral ligaments. Interfascicular sural nerve grafting (10-14 cm in length) was performed 7 months after injury and 6 months after ligament reconstruction. The patient recovered motor strength (4+/5) in both anterior and lateral compartments by 2 years' postsurgery. The results obtained indicate that interfascicular nerve grafting is a valuable technique for reconstruction of the disrupted peroneal nerve; it provides sufficient benefit to justify the time, expense, and effort involved. An aggressive approach is thus recommended in patients with peroneal nerve disruption in the setting of multiple knee ligament injuries.

  10. Rehabilitation concerns following anterior cruciate ligament reconstruction.

    PubMed

    Frndak, P A; Berasi, C C

    1991-11-01

    Rehabilitation following anterior cruciate ligament reconstruction is a subject of controversy in the orthopaedic and rehabilitation literature. With an increasing number of these operations currently being performed and with the advent of arthroscopically assisted ACL reconstruction over the past several years, particular rehabilitation needs and problems have been identified in association with these patients. Various authors have stressed one or a combination of a few basic themes which outline the basic rehabilitation concerns following ACL reconstruction. The most fundamental concern is the need to initiate motion very soon after surgery. Prolonged postoperative immobilisation is known to cause serious complications after ACL reconstruction which can be avoided by early motion. Positions or activities which may apply excessive stress to a newly reconstructed ACL must also be considered. The amount of protection required by the graft will vary depending upon the type of graft used and the quality of fixation obtained intraoperatively. Most authors agree that nonweightbearing, active resistive quadriceps exercises should be avoided for an extended period, while closed chain exercises may be initiated much earlier. Strength recovery is obviously important for the quadriceps postoperatively, but maximal strength returns of all of the muscles about the knee must be pursued. Hamstring strength is of particular concern as this may provide an active support to the reconstructed ACL. Sensory loss in the knee after ACL disruption should also be addressed during rehabilitation, prior to a patient's return to full athletic activity. Progressive neuromuscular re-education exercises which rely on sensory input from intact pericapsular structures are encouraged. A final concern is the role of bracing after ACL reconstruction.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1763251

  11. Biomechanical Evaluation of Medial Patellofemoral Ligament Reconstruction

    PubMed Central

    Duchman, Kyle R; DeVries, Nicole A; McCarthy, Mark A; Kuiper, Justin J; Grosland, Nicole M; Bollier, Matthew J

    2013-01-01

    Background The medial patellofemoral ligament (MPFL) is the most frequently injured soft tissue structure following acute lateral patellar dislocation. MPFL reconstruction has become a popular option to restore patellar stability following lateral patellar dislocation due to the high incidence of recurrent instability following conservative management. Anatomic reconstruction of the MPFL minimizes graft length changes during full knee range of motion and restores patellar stability. Materials & Methods Four fresh frozen cadaver specimens underwent biomechanical testing in a materials testing machine. With the knee fixed in 30° of flexion, the patella was translated laterally a distance of 10 mm and continuous force-displace- ment data was collected with the intact MPFL and again following a newly described MPFL reconstruction technique. Lateral force-displacement and stiffness data were calculated, allowing comparison between the intact and reconstructed MPFL. Results The average lateral restraining force provided by the intact MPFL was 10.6 ± 5.7, 36.6 ± 2.7, and 69.0 ± 5.9 N while the lateral restraining force following MPFL reconstruction was 0.4 ± 4.3, 50.3 ± 16.3, and 110.2 ± 17.5 N at 1, 5, and 10 mm of lateral displacement, respectively. Conclusion Anatomic MPFL reconstruction displays similar lateral restraining force compared to the intact MPFL at low levels of lateral displacement. At higher levels of displacement, the reconstructed MPFL provides increased lateral restraining force compared to the intact MPFL, improving patellar stability in pathologic knees. PMID:24027463

  12. Antero-posterior Duplicate Exstrophy with a Wet Bladder Plate: A Diagnostic Dilemma

    PubMed Central

    Thakkar, Nirali Chirag; Raj, Prince; Sarin, Yogesh Kumar

    2016-01-01

    Variants of exstrophy are rare anomalies seen in the spectrum of bladder exstrophy-epispadias complex. We present a rare case of duplicate exstrophy with a wet bladder plate. This is a deviation from the classical description of antero-posterior duplicate exstrophy that is associated with a dry bladder plate. PMID:27433455

  13. BOLD Response to Motion Verbs in Left Posterior Middle Temporal Gyrus during Story Comprehension

    ERIC Educational Resources Information Center

    Wallentin, Mikkel; Nielsen, Andreas Hojlund; Vuust, Peter; Dohn, Anders; Roepstorff, Andreas; Lund, Torben Ellegaard

    2011-01-01

    A primary focus within neuroimaging research on language comprehension is on the distribution of semantic knowledge in the brain. Studies have shown that the left posterior middle temporal gyrus (LPMT), a region just anterior to area MT/V5, is important for the processing of complex action knowledge. It has also been found that motion verbs cause…

  14. Rate-dependent extensional "dynamic ligaments" using shear thickening fluids

    NASA Astrophysics Data System (ADS)

    Nenno, Paul T.; Wetzel, Eric D.

    2014-04-01

    A novel "dynamic ligament" smart material that exhibits a strongly rate-dependent response in extension is developed and characterized. The devices, based on elastomeric polymers and shear thickening fluids, exhibit low resistance to extension at rates below 10 mm/s, but when stretched at 100 mm/s or higher resist with up to 7 × higher force. A link between the shear thickening fluid's rheology and the dynamic ligament's tensile performance is presented to explain the rate-dependent response. Future recommendations for improving device performance are presented, along with a host of different potential application areas including safety equipment, adaptive braces, sporting goods, and military equipment.

  15. Return to Play Following Ulnar Collateral Ligament Reconstruction.

    PubMed

    Cain, Edward Lyle; McGonigle, Owen

    2016-10-01

    Ulnar collateral ligament injury in the overhead athlete typically presents as activity-related pain with loss of velocity and control. Treatment options range from nonoperative rehabilitation to ligament reconstruction. Surgical reconstruction is frequently required to allow the athlete to return to competition and many surgical techniques have been described. The rehabilitation process to return back to overhead athletics, in particular pitching, is prolonged and requires progression through multiple phases. Despite this, surgical treatment has been shown by multiple investigators to be successful at returning athletes to their previous level of competition.

  16. Anterior Cruciate Ligament: Structure, Injuries and Regenerative Treatments.

    PubMed

    Negahi Shirazi, Ali; Chrzanowski, Wojciech; Khademhosseini, Ali; Dehghani, Fariba

    2015-01-01

    Anterior cruciate ligament (ACL) is one of the most vulnerable ligaments of the knee. ACL impairment results in episodic instability, chondral and meniscal injury and early osteoarthritis. The poor self-healing capacity of ACL makes surgical treatment inevitable. Current ACL reconstructions include a substitution of torn ACL via biological grafts such as autograft, allograft. This review provides an insight of ACL structure, orientation and properties followed by comparing the performance of various constructs that have been used for ACL replacement. New approaches, undertaken to induce ACL regeneration and fabricate biomimetic scaffolds, are also discussed. PMID:26545750

  17. Delayed diagnosis of isolated alar ligament rupture: A case report

    PubMed Central

    Kaufmann, Robin A; Marzi, Ingo; Vogl, Thomas J

    2015-01-01

    Ligament disruptions at the craniovertebral junction are typically associated with atlantoaxial rotatory dislocation during upper cervical spine injuries and require external orthoses or surgical stabilization. Only in few patients isolated ruptures of the alar ligament have been reported. Here we present a further case, in which the diagnosis was initially obscured by a misleading clinical symptomatology but finally established six month following the trauma, demonstrating the value of contrast-enhanced high resolution 3 Tesla magnetic resonance imaging in identifying this particular lesion. PMID:26516433

  18. Anterior Cruciate Ligament: Structure, Injuries and Regenerative Treatments.

    PubMed

    Negahi Shirazi, Ali; Chrzanowski, Wojciech; Khademhosseini, Ali; Dehghani, Fariba

    2015-01-01

    Anterior cruciate ligament (ACL) is one of the most vulnerable ligaments of the knee. ACL impairment results in episodic instability, chondral and meniscal injury and early osteoarthritis. The poor self-healing capacity of ACL makes surgical treatment inevitable. Current ACL reconstructions include a substitution of torn ACL via biological grafts such as autograft, allograft. This review provides an insight of ACL structure, orientation and properties followed by comparing the performance of various constructs that have been used for ACL replacement. New approaches, undertaken to induce ACL regeneration and fabricate biomimetic scaffolds, are also discussed.

  19. Anterior Cruciate Ligament Reconstruction in Ehlers-Danlos Syndrome.

    PubMed

    Williams, John; Hutt, Jonathan; Rickman, Mark

    2015-01-01

    This report details the reconstruction of the anterior cruciate ligament in an 18-year-old man with Ehlers-Danlos syndrome (EDS). The reduced mechanical properties of the tissue in EDS can pose a challenge to the orthopaedic surgeon. In this case, we describe the use of a hamstring autograft combined with a Ligament Advanced Reinforcement System (LARS). There was a good radiographical, clinical, and functional outcome after two years. This technique gave a successful outcome in the reconstruction of the ACL in a patient with EDS and therefore may help surgeons faced with the same clinical scenario. PMID:26221555

  20. Pathologic conditions of the ligaments and tendons of the knee.

    PubMed

    El-Dieb, Adam; Yu, Joseph S; Huang, Guo-Shu; Farooki, Shella

    2002-09-01

    Excellent spatial resolution and unparalleled contrast resolution have allowed MRI to emerge as the dominant imaging modality for diagnosis of ligament and tendon pathology of the knee joint This article presents several important mechanisms of injury associated with tendon and ligament disruptions. When present, the pattern of bone contusions may reveal the vector of force. When one is aware of the mechanism of injury, it is possible to analyze systematically the structures of the knee and maximize the detection of pathology. Recognition of a knee dislocation pattern is important because the diagnosis may be unsuspected, and the clinician may have to be alerted to the possibility of vascular and neural injury.