ABSTRACT
PURPOSE: The biceps femoris tendon (BFT) and lateral collateral ligament (LCL) in the knee were formerly known to form a conjoined tendon at the fibular attachment site. However, the BFT and LCL are attached into the fibular head in various patterns. We classified insertion patterns of the BFT and LCL using MR imaging, and analyzed whether the LCL attaches to the fibular head or not. MATERIALS AND METHODS: A total of 494 consecutive knee MRIs of 470 patients taken between July 2012 and December 2012 were retrospectively reviewed. There were 224 males and 246 females, and patient age varied from 10 to 88 (mean, 48.6). The exclusion criteria were previous surgery and poor image quality. Using 3T fat-suppressed proton density-weighted axial images, the fibular insertion patterns of the BFT and LCL were classified into following types: type I (the LCL passes between the anterior arm and direct arm of the BFT's long head), type II (the LCL joins with anterior arm of the long head of the BFT), type III (the BFT and LCL join to form a conjoined tendon), type IV (the LCL passes laterally around the anterior margin of the BFT), and type V (the LCL passes posteriorly to the direct arm of the BFT's long head). RESULTS: Among the 494 cases of the knee MRI, there were 433 (87.65%) type I cases, 21 (4.25%) type II cases, 2 (0.4%) type III cases, 16 (3.23%) type IV cases, and 22 (4.45%) type V cases. There were 26 cases (5.26%) in which the LCL and BFT were not attached into the fibular head. CONCLUSION: The fibular attachment pattern of the BFT and LCL shows diverse types in MR imaging. The LCL does not adhere to the head in some patients.
Subject(s)
Female , Humans , Male , Arm , Head , Knee , Lateral Ligament, Ankle , Magnetic Resonance Imaging , Protons , Retrospective Studies , TendonsABSTRACT
Objective To introduce a procedure, proximally based conjoined t en don transfer, which is to be used for coracoclavicular ligment reconstruction in the treatment of acromioclavicular separation. Methods From 2001 to 2003, 26 pa tients with acromioclavicular dislocation of Rockwood Grades Ⅲ-Ⅴwere treated with transfer of the lateral half of the conjoined tendon to the distal clavicle in a proximally based fashion with additional coracoclavicular fixation. Radiol ogy was used to evaluate the acromioclavicular correspondence. ASES (American Sh oulder &Elbow Surgeon) score, SST (Simple Shoulder Test) form and Constant-Mur ley score were adopted to evaluate the shoulder functions. Results Follow-ups o f 22.6 months on average revealed that the height of distal clavicle reached ana tomic reduction in all the cases during operation. At the latest follow-up, the mean ASES score was 94.2, the mean VAS(Visual Analog Scale) score for pain was 1.2,the mean forward flexion was 150?,and the mean external rotation was 35? . The mean Constant-Murley score was 92.8. The number of positive answers to th e SST was 11. The overall satisfaction rate was 88.5%(23/26) and all patients r eplied with “Yes”when questioned with “Do you want to accept the same operati on if the same condition happens to your contralateral shoulder?”Conclusions Th is surgical procedure proves reliable without sacrificing the coracoacromial lig ament during coracoclavicular reconstruction. When the patients are complicated with fresh or old rotator cuff injury, or the coracoclavicular ligament is thin, or long ligament is needed in the reconstruction, the proximally based conjoine d tendon can be served as a good source of autograft ligament.