Morphometric analysis of cruciate ligaments

Introduction: Anterior cruciate ligaments (ACL) and posterior cruciate ligaments (PCL) are tough band of fibrousstructures extending between tibia and femur. Cruciate ligaments are at risk of injury in sports personnel.Injured ligaments are treated by reconstruction surgeries which require the morphometric understanding.Therefore, this study intended to find the length and width of ACL and PCL in cadavers and by MRI in healthyindividuals.Material and methods: Thirty embalmed cadaver knees were dissected to expose the ligaments. Length and widthof the ligaments was measured by the Vernier’s calipers. Thirty MRIs of knee joint with no previous detected kneepathology were obtained and reviewed. The data was tabulated for statistical analysis. Student‘t’ test was usedfor comparison. P value <0.05 was considered as statistically significant.Results: In the cadavers, ACL was significantly longer than PCL in length (p <0.014). PCL width was larger than ACLwidth (p <0.001).Conclusion: The present study contributes to the relative morphometric data on ACL and PCL and stresses that PCLis shorter and wider than ACL making it a more stable structure.

Influência do posicionamento radiográfico no cálculo interobservador do ângulo do platô tibial em cães / Influence of radiographic positioning in the interobserver measuring of the tibial plateau angle in dogs

O objetivo deste trabalho foi demonstrar que o posicionamento radiográfico inadequado do membro pélvico de cães (imagens obliquadas) afeta a mensuração do ângulo do platô tibial (APT), levando à maior variação entre observadores. Foram realizadas duas projeções radiográficas nos membros pélvicos direito e esquerdo, uma em perfil verdadeiro e a outra com o membro obliquado em 21 cães provenientes do atendimento clínico cirúrgico do Hospital Veterinário da Universidade de Cuiabá, em Cuiabá-MT. Os critérios de inclusão foram cães livres de histórico ou afecção ortopédica nos membros pélvicos, pesando entre 15 e 40 quilos, sem predileção por raça ou sexo, entre dois e sete anos de idade. Foram obtidas 42 imagens radiográficas em perfil verdadeiro e 42 imagens radiográficas obliquadas. Três observadores com experiência em cálculo do APT fizeram as mensurações. Nos cálculos das imagens em perfil verdadeiro, o observador 1 obteve uma média de 23,35º ± 2,82; o observador 2, média de 23,88º ± 4,83; e o observador 3, média de 24,54º ± 4,01, não sendo encontrada diferença significativa entre o cálculo dos três avaliadores, P=0,944 (P > 0,05), nas imagens em perfil verdadeiro. Nos cálculos das imagens obliquadas, o observador 1 obteve uma média de 21,69º ± 4,22; o observador 2, média de 19,42º ± 5,92; e o observador 3, média de 22,64º ± 5,23, e foi encontrada diferença significativa entre o cálculo dos três observadores, P=0,016 (P < 0,05). Com esses dados, pôde-se demonstrar que a imagem radiográfica obliquada compromete o valor final do cálculo do ângulo do platô tibial em cães, levando à variação numérica estatisticamente significativa entre observadores. Conclui-se, assim, que um posicionamento correto do membro pélvico, em perfil verdadeiro, deve ser sempre utilizado para a obtenção de imagens, com o objetivo de mensurar o valor do APT.(AU)

This work aimed at demonstrating that an inadequate radiographic position of pelvic limbs of dogs, from a strict lateral radiographic view, resulted in oblique images, affecting the measurement of the tibial plateau angle (TPA). There were two radiographic projections of the right and the left pelvic limb, one in strict lateral radiographic view and another with inclined hind limb in 21 dogs from the clinical surgical assistance at Hospital Veterinário of Universidade de Cuiabá in Cuiabá-MT. Inclusion criteria were dogs free from pelvic hind limbs orthopedic affection records, weighing between 15 and 40 kilos, without a preference for breed or gender and ageing between two and seven years old. A total of 42 radiographic images in strict lateral radiographic view and 42 inclined limb radiographic views were obtained. Three observers with TPA calculation experience made measurements. In the calculus for the strict lateral radiographic view the first observer has reached an average of 23,35º ± 2,82, the second observer 23,88º ± 4,83 and the third observer 24,54º ± 4,01. No significant statistic differences among the calculus of the three evaluators p=0,944 (P>0,05) was found. In the calculus of the inclined limbs radiographic views the first observer reached an average of 21,69º ± 4,22, the second observer 19,42º ± 5,92 and the third observer 22,64º ±. 5,23. Significant statistic difference in the calculus of the three observers, p=0,016, that is to say, P<0,05 was found. The data indicated that the inclined limb radiographic image compromises the final value of the calculation of tibial plateau angle in dogs. Thus, correct positioning of the pelvic limb, in a strict lateral radiographic view, must be always used for obtaining images aiming at measuring the value of TPA.(AU)

Interpretación de la maniobra de pivote mediante el uso de acelerómetros en pacientes que acuden a consulta ortopédica / Interpretation of the pivot test using accelerometers in the orthopedic practice

Los ligamentos cruzados (LC) de la rodilla, anterior (A) y posterior (P), localizados dentro de la articulación, unen fémur y tibia, dando estabilidad sobre la dirección anteroposterior de un hueso sobre otro. El LCA puede lesionarse mediante rotaciones provocadas en algún deporte que implique giro con el pie apoyado sobre el suelo. Las lesiones del LCA se determinan con maniobras como la de Lachman, cajón y pivote. Se utilizan acelerómetros que permiten graficar la maniobra de pivote en pacientes que acuden a consulta ortopédica, utilizando la prueba de KT1000 como estándar de oro. El trabajo ha sido aprobado por el Comité de Ética del Hospital. Estudio descriptivo entre casos y controles. Resultados: 92 pacientes aceptaron participar mediante consentimiento informado, nueve casos resultaron con KT1000 positivo, de los negativos, seleccionamos nueve controles afines a edad y género. Alteraciones de KT1000 fueron mayores en mujeres (78%) y en 67% de los casos la pierna alterada fue la derecha. Los resultados promedio de KT1000 en casos fue de 5.44 mm, en controles de 0.66 mm. Los acelerómetros permitieron graficar la maniobra de pivote y observamos gráficas similares tanto en casos y controles, solamente se muestran diferencias notables en un paciente masculino con KT1000 de 15 mm que fue sometido a reparación de LCA izquierdo, la maniobra se realizó al estar sedado. Concluimos que el paciente, en estado consciente, pone resistencia en la maniobra, a diferencia de la obtenida con anestesia, y que el uso de acelerómetros permite documentar la maniobra de pivote observando diferencias entre un LCA normal y uno lesionado.

The anterior (A) and posterior (P) cruciate ligaments (CL) of the knee, located inside the joint, connect the femur and the tibia and thus provide stability in the anteroposterior axis of one bone over the other. The anterior cruciate ligament (ACL) may be injured as a result of rotation when practicing a sport involving turning with the foot on the ground. ACL injuries are diagnosed with maneuvers like the Lachman, drawer and pivot. Accelerometers were used to plot the pivot maneuver in patients seeing the orthopedist surgeon using the KT1000 test as gold standard. This case-control descriptive study was approved by the Hospital's Ethics Committee. Results: 92 patients accepted to participate through an informed consent; nine cases were KT1000 positive, and nine age- and gender-matched controls were selected among KT1000 negative patients. KT1000 alterations were greater among females (78%) and in 67% of cases the right leg was affected. Mean KT1000 results were 5.44 mm in cases and 0.66 mm in controls. Accelerometers allowed plotting the pivot maneuver and the resulting charts for cases and controls were similar. Remarkable differences were seen only in one male patient with a 15 mm KT1000, who underwent repair of the left ACL; the maneuver was performed under sedation. We concluded that conscious patients oppose the maneuver, unlike anesthetized patients, and that the use of accelerometers helps document the pivot maneuver which, in turn, helps detect differences between a normal ACL and an injured one.

Clinical observation on reconstructing the anterior and posterior cruciate ligaments of knee joint with allograft-tendon by arthroscopy / 局解手术学杂志

Objective To compare the clinical effect of reconstructing the anterior and posterior cruciate ligaments of knee joint with al-lografttendon and autogenous tendon transplantation. Methods 130 patients with anterior and posterior cruciate ligaments of knee fractured were randomly divided into two groups:the observation group were given allogeneic tendon transplantation while the control group were autol-ogous tendon transplantation. Observed the clinical efficacy of the two groups. Results The operation time of the observation group was ob-viously less than control group(P0. 05);the Lysholm and Tengner score of the two groups were significantly higher compared with the preoperative scores with a statistically significant difference (P0. 05). Conclusion Allogeneic tendon transplantation has similar curative effect with autologous tendon transplantation, both of them are good transplantation material for anterior and posterior cruciate ligaments reconstruction.

Surgical Treatments of the Acute Anterior Cruciate Ligament Injuries / 대한정형외과학회잡지

Primary repair of anterior cruciate ligament is superior to late reconstruction procedures for two reasons; objective stability is more easily restored due to intact secondary restraints not subjected to chronic stress, and the quality of the joint is superior with greater chance of intact menisci and normal articular cartilage not yet damaged through recurrent subluxation. We present the result of thirty-eight kness in thirty-seven patients who had been treated with primary repair of augmented repair for acute ACL rupture from March, 1984 to August, 1990. Twenty-one knees were treated with primary repair and seventeen knees augmented repair. At an average 33 months follow up, the results obtained were as follows: 1. The patients were 23 males and 14 females with an average age of 27.1 years. 2. Twenty four knees were injuried during athletic endeavors, 9 knees by automobile accident, and 5 knees by landing from height. In 18 knees anterior cruciate ligament was ruptured at the proximal attachment, in 17 knees at the midsubstance tear and in 3 at the near distal attachment. 3. The average interval from injury to operation was 7.5 days (ranged from 1 to 14 days). 4. The results were evaluated by Hospital for Special Surgery knee rating scale (modified by Marshall) at an average 33 months (range from 13 months to 7 years and 6 months) follow-up study. 16 (76%) out of 21 knees treated with primary repair were rated as good or excellent. 12 (86%) out of 14 knees treated with augmented repair were rated as good or excellent. As the result of this study, acutely torn anterior cruciate ligaments appear to be successfully treated with primary repair or augmented repair according to torn site and shape of ligaments.