Anatomic single-bundle anterior cruciate ligament reconstruction improves walking economy: hamstrings tendon versus patellar tendon grafts.

Science.gov (United States)

Iliopoulos, Efthymios; Galanis, Nikiforos; Zafeiridis, Andreas; Iosifidis, Michael; Papadopoulos, Pericles; Potoupnis, Michael; Geladas, Nikolaos; Vrabas, Ioannis S; Kirkos, John

2017-10-01

Anterior cruciate ligament (ACL) injury is associated with a pathologic gait pattern and increased energy cost during locomotion. ACL reconstruction could improve the gait pattern. Hamstrings tendon (HAM) and bone-patellar tendon-bone (BPTB) grafts are usually used for reconstruction. The aim of this study was to compare the efficacy of anatomic ACL reconstruction with HAM and BPTB grafts on improving and normalizing the energy cost and physiologic reserves during flat, uphill, and downhill walking. Twenty male subjects with unilateral ACL injuries were randomly assigned to ACL reconstruction with a HAM (n = 10) or BPTB (n = 10) graft. Ten matched controls were also enrolled. All participants performed three 8-min walking tasks at 0, +10, and -10 % gradients before and 9 months after surgery. Energy cost (oxygen consumption, VO 2 ), heart rate (HR), and ventilation (VE) were measured. Lysholm/IKDC scores were recorded. Pre-operatively, VO 2 , HR, and VE were higher in the HAM and BPTB groups than in controls during walking at 0, +10, and -10 % gradients (p energy cost and nearly normalized locomotion economy and cardiorespiratory reserves during flat, uphill, and downhill walking. The improved locomotion economy is an additional benefit of anatomic ACL reconstruction, irrespective of the type of graft used, that the orthopaedic surgeons should consider. II.

A mini-invasive adductor magnus tendon transfer technique for medial patellofemoral ligament reconstruction: a technical note.

Science.gov (United States)

Sillanpää, Petri J; Mäenpää, Heikki M; Mattila, Ville M; Visuri, Tuomo; Pihlajamäki, Harri

2009-05-01

Patellar dislocations are associated with injuries to the medial patellofemoral ligament (MPFL). Several techniques for MPFL reconstruction have been recently published with some disadvantages involved, including large skin incisions and donor site morbidity. Arthroscopic stabilizing techniques carry the potential of inadequate restoration of MPFL function. We present a minimally invasive technique for MPFL reconstruction using adductor magnus tendon autograft. This technique is easily performed, safe, and provides a stabilizing effect equal to current MPFL reconstructions. Skin incision of only 3-4 cm is located at the level of the proximal half of the patella. After identifying the distal insertion of the adductor magnus tendon, a tendon harvester is introduced to harvest the medial two-thirds of the tendon, while the distal insertion is left intact. The adductor magnus tendon is cut at 12-14 cm from its distal insertion and transferred into the patellar medial margin. Two suture anchors are inserted through the same incision at the superomedial aspect of the patella in the anatomic MPFL origin. The graft is tightened at 30 degrees knee flexion. Aftercare includes 4 weeks of brace treatment with restricted range of motion.

Magnetic resonance imaging appearance of the flexor carpi radialis tendon after harvest in ligamentous reconstruction tendon interposition arthroplasty

International Nuclear Information System (INIS)

Beall, Douglas P.; Fish, Jon R.; Ritchie, Eric R.; Tran, Hoang N.; Ingari, John V.; Campbell, Scot E.; Grayson, David E.; Sanders, Timothy G.; Mundis, Gregory; Lehman, Thomas P.

2006-01-01

To determine whether the post-harvest magnetic resonance (MR) imaging appearance of flexor carpi radialis (FCR) tendons, harvested during ligamentous reconstruction tendon interposition (LRTI) of the thumb carpometacarpal (CMC) joint arthroplasty, is consistent with tendon regeneration. Operative reports and patient medical records for all patients undergoing LRTI arthroplasty between 1995 and 2003 at our institution were reviewed. MR images of the patients' forearms and wrists were obtained and interpreted by two musculoskeletal radiologists. Using the flexor carpi ulnaris (FCU) tendon as an internal standard, the extent of FCR tendon regeneration was expressed as a percentage by dividing the volume of regenerated FCR tendon by the volume of the FCU tendon. Fourteen patients who had the full thickness of the FCR tendon harvested and who were available for MR imaging were identified and included in the study. At least partial regeneration of the FCR tendon occurred in 11 of the 14 patients (79%). Of these, 2 patients (14%), demonstrated complete, or nearly complete regeneration. Partial regeneration of the FCR tendon was seen in 9 of the 14 patients (64%). In 3 patients (21%), there was no appreciable regeneration of the FCR tendon. Among patients who underwent full-thickness harvest of the FCR tendon for LRTI arthroplasty of the first CMC joint, the follow-up MR imaging appearance of the flexor carpi radialis tendon was consistent with tendon regeneration in 79% of those examined. (orig.)

An Isolated Medial Patellofemoral Ligament Reconstruction with Patellar Tendon Autograft

Directory of Open Access Journals (Sweden)

Dariusz Witoński

2013-01-01

Full Text Available The aim of the study was to evaluate the results of the medial patellofemoral ligament reconstruction with a medial strip of patellar tendon autograft after a minimum 2-year followup. Ten patients (10 knees were operated on by one surgeon, according to the modified technique, described by Camanho, without any bone plug at free graft end. The mean age of the patients was 27.2 years (ranging from 18 to 42 years. The mean follow-up period was 3 years and 7 months. All patients were reviewed prospectively. At the last follow-up visit, all the patients demonstrated a significant improvement in terms of patellofemoral joint stability, all aspects of the KOOS questionnaire, and Kujala et al.’s score (59.7 points preoperatively and 84.4 points at the last followup. No patient revealed recurrent dislocation. The SF-36 score revealed a significant improvement in bodily pain, general health, physical role functioning, social role functioning, and physical functioning domains. The described MPFL reconstruction with the use of the medial 1/3rd of patella tendon is an effective procedure that gives satisfactorily patellofemoral joint functions, improves the quality of life, and provides much pain relief. It is relatively simple, surgically not extensive, and economically cost-effective procedure.

Miscellaneous conditions of tendons, tendon sheaths, and ligaments.

Science.gov (United States)

Dyson, S J; Dik, K J

1995-08-01

The use of diagnostic ultrasonography has greatly enhances our ability to diagnose injuries of tendons and tendon sheaths that were previously either unrecognized or poorly understood. For may of these injuries, there is currently only a small amount of follow-up data. This article considers injuries of the deep digital flexor tendon and its accessory ligament, the carpal tunnel syndrome soft tissue swellings on the dorsal aspect of the carpus, intertubercular (bicipital) bursitis and bicipital tendinitis, injuries of the gastrocnemius tendon, common calcaneal tendinitis, rupture of peroneus (fibularis tertius) and ligaments injuries of the back.

Do peak torque angles of muscles change following anterior cruciate ligament reconstruction using hamstring or patellar tendon graft?

Science.gov (United States)

Yosmaoğlu, Hayri Baran; Baltacı, Gül; Sönmezer, Emel; Özer, Hamza; Doğan, Deha

2017-12-01

This study aims to compare the effects of anterior cruciate ligament (ACL) reconstruction using autogenous hamstring or patellar tendon graft on the peak torque angle. The study included 132 patients (103 males, 29 females; mean age 29±9 year) who were performed ACL reconstruction with autogenous hamstring or patellar tendon graft. The peak torque angles in the quadriceps and hamstring muscles were recorded using an isokinetic dynamometer. Angle of peak knee flexion torque occurred significantly earlier within the range of motion on the operated side than nonoperated side at 180°/second in the hamstring tendon group. Angle of peak knee extension torque occurred significantly earlier within the range of motion on the operated side than nonoperated side at 180°/second in the patellar tendon group. There were no statistically significant differences in the flexion and extension peak torque angles between the operated and nonoperated knees at 60°/second in both groups. The angle of peak torque at relatively high angular velocities is affected after ACL reconstruction in patients with hamstring or patellar tendon grafts. The graft donor site directly influences this parameter. This finding may be important for clinicians in terms of preventing re-injury.

Isokinetic evaluation of internal/external tibial rotation strength after the use of hamstring tendons for anterior cruciate ligament reconstruction.

Science.gov (United States)

Armour, Tanya; Forwell, Lorie; Litchfield, Robert; Kirkley, Alexandra; Amendola, Ned; Fowler, Peter J

2004-01-01

Evaluation of the knee after an anterior cruciate ligament reconstruction with the use of the semitendinosus and gracilis (hamstring) autografts has primarily focused on flexion and extension strength. The semitendinosus and gracilis muscles contribute to internal tibial rotation, and it has been suggested that harvest of these tendons for the purpose of an anterior cruciate ligament reconstruction contributes to internal tibial rotation weakness. Internal tibial rotation strength may be affected by the semitendinosus and gracilis harvest after anterior cruciate ligament reconstruction. Prospective evaluation of internal and external tibial rotation strength. Inclusion criteria for subjects (N = 30): unilateral anterior cruciate ligament reconstruction at least 2 years previously, a stable anterior cruciate ligament (problems after initial knee reconstruction, a normal contralateral knee, and the ability to comply with the testing protocol. In an attempt to minimize unwanted subtalar joint motion, subjects were immobilized using an ankle brace and tested at angular velocities of 60 degrees /s, 120 degrees /s, and 180 degrees /s at a knee flexion angle of 90 degrees . The mean peak torque measurements for internal rotation strength of the operative limb (60 degrees /s, 17.4 +/- 4.5 ft-lb; 120 degrees /s, 13.9 +/- 3.3 ft-lb; 180 degrees /s, 11.6 +/- 3.0 ft-lb) were statistically different compared to the nonoperated limb (60 degrees /s, 20.5 +/- 4.7 ft-lb; 120 degrees /s, 15.9 +/- 3.8 ft-lb; 180 degrees /s, 13.4 +/- 3.8 ft-lb) at 60 degrees /s (P = .012), 120 degrees /s (P = .036), and 180 degrees /s (P = .045). The nonoperative limb demonstrated greater strength at all speeds. The mean torque measurements for external rotation were statistically similar when compared to the nonoperated limb at all angular velocities. We have shown through our study that patients who undergo surgical intervention to repair a torn anterior cruciate ligament with the use of autogenous

Allograft tendon reconstruction of the anterior talofibular ligament and calcaneofibular Ligament in the treatment of chronic ankle instability.

Science.gov (United States)

Wang, Weikai; Xu, Guo Hong

2017-04-08

The purpose was retrospectively to investigate functional and clinical outcomes after anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) reconstruction using a single allograft. Patients with severe chronic lateral instability of the ankle underwent surgery after conservative treatment failed. Ultrasounds of the ankle were performed, and if the AFTL and CFL were completely torn without enough soft tissue for repair, the ligaments were reconstructed using allograft tendon. Outcomes were assessed by clinical examination, stress radiography, ultrasound, the American Orthopaedic Foot and Ankle Society score (AOFAS), and Karlsson Ankle Functional score (KAFS) before surgery and at final follow-up. Nineteen patients, ten men and nine women with mean age of 27.9 years (range, 19-41 years), underwent reconstruction. Mean follow-up was 30 months (range, 24-40 months). At final follow-up, all patients had returned to activity without instability, pain, or limited range of motion. On stress radiography, mean talar tilt angle decreased from 17.32° ± 3.58° before surgery to 4.16° ± 1.12° at follow-up (p surgery to 3.97 ± 0.99 mm at follow-up (p < 0.05). Mean AOFAS improved from 64.00 ± 18.43 to 90.32 ± 5.17 points (p < 0.001), and mean KAFS improved from 50.84 ± 16.73 to 90.89 ± 5.08 points (p < 0.001). Ultrasound showed the reconstructed ligaments maintained good continuity and excellent tension. No case of infection and immunological rejection was reported. This novel reconstruction technique takes into account the anatomical specialty of AFTL and CFL. This case series showed increased stability of the ankle in clinical and functional outcomes. The trial registration number (TRN) and date of registration: ChiCTR-ORC-17010796 , Mar 6th 2017. Retrospectively registered.

The Role of Bioreactors in Ligament and Tendon Tissue Engineering.

Science.gov (United States)

Mace, James; Wheelton, Andy; Khan, Wasim S; Anand, Sanj

2016-01-01

Bioreactors are pivotal to the emerging field of tissue engineering. The formation of neotissue from pluripotent cell lineages potentially offers a source of tissue for clinical use without the significant donor site morbidity associated with many contemporary surgical reconstructive procedures. Modern bioreactor design is becoming increasingly complex to provide a both an expandable source of readily available pluripotent cells and to facilitate their controlled differentiation into a clinically applicable ligament or tendon like neotissue. This review presents the need for such a method, challenges in the processes to engineer neotissue and the current designs and results of modern bioreactors in the pursuit of engineered tendon and ligament.

Treatment of peroneal tendon dislocation and coexisting medial and lateral ligamentous laxity in the ankle joint.

Science.gov (United States)

Ziai, Pejman; Sabeti-Aschraf, Manuel; Fehske, Kai; Dlaska, Constantin E; Funovics, Philipp; Wenzel, Florian; Graf, Alexandra; Buchhorn, Tomas

2011-06-01

Acute dislocation of the peroneal tendon is caused by massive combined flexion-torsion trauma supported by preexisting ligamentous laxity of the ankle joint. This study aimed to investigate the clinical outcome of combined treatment of peroneal tendon dislocation and lateral and medial ligamentous laxity. Between 2005 and 2007, forty-two patients with peroneal tendon dislocation and coexisting ligamentous laxity were treated. The superior extensor retinaculum was reconstructed using anchor technique and periosteal flap repair, whereas the preexisting ligamentous laxity with regard to the extensor inferior retinaculum was addressed using anchor reconstruction. All patients underwent arthroscopy prior to surgery. Thirty-eight of a total of 42 patients (aged 17-31) completed the 24-month follow-up. Clinical and arthroscopic examination was accomplished consistently by always the same two surgeons. Postoperative follow-up comprised clinical evaluation after 3, 6, 12 and 24 months. Clinical results showed a significant (Pankle joint following arthroscopy results in good clinical outcome and high patient satisfaction. Case series, Level IV.

Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction With a Free Quadriceps Tendon Autograft.

Science.gov (United States)

Caterev, Sergiu; Nistor, Dan Viorel; Todor, Adrian

2016-10-01

Anatomic double-bundle anterior cruciate ligament (ACL) reconstruction aims to restore the 2 functional bundles of the ACL in an attempt to better reproduce the native biomechanics of the injured knee and promote long-term knee health. However, this concept is not fully accepted and is not performed on a standard basis. In addition, the superiority of this technique over the conventional single-bundle technique has been questioned, especially the long-term clinical results. One of the down sides of the double-bundle reconstruction is the complexity of the procedure, with increased risks, operative time, and costs compared with the single-bundle procedure. Also, the revision procedure, if necessary, is more challenging. We propose a technique that has some advantages over the traditional double-bundle procedure, using a single femoral tunnel, 2 tibial tunnels, and a free quadriceps tendon autograft.

Firm anchoring between a calcium phosphate-hybridized tendon and bone for anterior cruciate ligament reconstruction in a goat model

Energy Technology Data Exchange (ETDEWEB)

Mutsuzaki, Hirotaka [Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami Ami-machi, Inashiki-gun, Ibaraki 300-0394 (Japan); Sakane, Masataka; Ochiai, Naoyuki [Department of Orthopaedic Surgery, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575 (Japan); Hattori, Shinya; Kobayashi, Hisatoshi, E-mail: sakane-m@md.tsukuba.ac.j [Biomaterial Center, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044 (Japan)

2009-08-15

Using an alternative soaking process improved the tendon-bone attachment for a calcium phosphate (CaP)-hybridized tendon graft. We characterized the deposited CaP on and in tendons and analyzed the histology and mechanical properties of the tendon-bone interface in anterior cruciate ligament (ACL) reconstruction in goats. The tendon grafts to be implanted were soaked ten times alternately in a Ca-containing solution and a PO{sub 4}-containing solution for 30 s each. Needlelike CaP nanocrystals including low-crystalline apatite were deposited on and between collagen fibrils from the surface to a depth of 200{mu}m inside the tendon. The structure resembles the extracellular matrix of bone. In animal experiments, the CaP-hybridized tendon directly bonded with newly formed bone at 6 weeks (n = 3), while fibrous bonding was observed in the control (n = 3). The ultimate failure load was not statistically different between the CaP (n = 7) and control (n = 7). However, in the failure mode, all the tendon-bone interfaces were intact in the CaP group, while three of seven specimens were pulled out from bone tunnels in the control. The result suggested that the strength of the tendon-bone interface in the CaP group is superior to that in the control group. Clinically, firm tendon-bone anchoring may lead to good results without the knee instability associated with the loosening of the bone-tendon junction in ACL reconstruction.

[Isokinetic assessment with two years follow-up of anterior cruciate ligament reconstruction with patellar tendon or hamstring tendons].

Science.gov (United States)

Condouret, J; Cohn, J; Ferret, J-M; Lemonsu, A; Vasconcelos, W; Dejour, D; Potel, J-F

2008-12-01

This retrospective multicentric study was designed to assess the outcome of quadriceps and hamstrings muscles two years after Anterior Cruciate Ligament (ACL) reconstruction and compare muscles recovery depending on the type of graft and individual variables like age, gender, level of sport, but also in terms of discomfort, pain and functional score. The results focused on the subjective and objective IKDC scores, SF36, the existence or not of subjective disorders and their location. The review included isokinetic muscle tests concentric and eccentric extensors/flexors but also internal rotators/external rotators with analysis of mean work and mean power. One hundred and twenty-seven patients were included with an average age 29 years (+/-10). They all had an ACL reconstruction with patellar tendon or hamstring tendon with single or double bundles. In the serie, the average muscles deficit at two years was 10% for the flexors and extensors but with a significant dispersion. Significant differences were not noted in the mean values of all parameters in term of sex or age (over 30 years or not), neither the type of sport, nor of clinical assessment (Class A and B of objective IKDC score), nor the existence of anterior knee pain. There was a relationship between the level of extensor or flexor recovery and the quality of functional results with minimal muscle deficits close to 5% if the IKDC score was over 90 and deficits falling to 15% in the group with IKDC score less than 90. The type of reconstruction (patellar tendon versus hamstrings) had an influence on the muscle deficit. For extensors, the recovery was the same in the two groups, more than 90% at two years and the distribution of these two populations by level of deficit was quite the same. For flexors, residual deficits were significantly higher in the hamstrings group on the three studied parameters whatever the speed and the type of contraction (concentric or eccentric) with an average deficit of 14 to 18

Clinical and radiological outcomes after a quasi-anatomical reconstruction of medial patellofemoral ligament with gracilis tendon autograft.

Science.gov (United States)

Monllau, Joan C; Masferrer-Pino, Àngel; Ginovart, Gerard; Pérez-Prieto, Daniel; Gelber, Pablo E; Sanchis-Alfonso, Vicente

2017-08-01

To analyse the clinical and radiological outcomes of a quasi-anatomical reconstruction of the medial patellofemoral ligament (MPFL) with a gracilis tendon autograft. Patients with objective recurrent patellar instability that were operated on from 2006 to 2012 were included. A quasi-anatomical surgical technique was performed using a gracilis tendon autograft. It was anatomically attached at the patella, and the adductor magnus tendon was also used as a pulley for femoral fixation (non-anatomical reconstruction). The IKDC, Kujala and Lysholm scores as well as Tegner and VAS for pain were collected preoperatively and at final follow-up. Radiographic measurements of patellar position tilt and signs of osteoarthritis (OA) as well as trochlear dysplasia were also recorded. Thirty-six patients were included. The mean age at surgery was 25.6 years. After a minimum 27 months of follow-up, all functional scores significantly improved (p patellofemoral surfaces at the short term, as shown by the absence of radiological signs of OA in the CT scan. The procedure has been shown to be safe and suitable for the treatment of chronic patellar instability, including in adolescents with open physis. A new effective, inexpensive and easy-to-perform technique is described to reconstruct MPFL in the daily clinical practice. Therapeutic case series, Level IV.

Mechanical Loading Improves Tendon-Bone Healing in a Rabbit Anterior Cruciate Ligament Reconstruction Model by Promoting Proliferation and Matrix Formation of Mesenchymal Stem Cells and Tendon Cells

Directory of Open Access Journals (Sweden)

Fanglong Song

2017-02-01

Full Text Available Background/Aims: This study investigated the effect of mechanical stress on tendon-bone healing in a rabbit anterior cruciate ligament (ACL reconstruction model as well as cell proliferation and matrix formation in co-culture of bone-marrow mesenchymal stem cells (BMSCs and tendon cells (TCs. Methods: The effect of continuous passive motion (CPM therapy on tendon-bone healing in a rabbit ACL reconstruction model was evaluated by histological analysis, biomechanical testing and gene expressions at the tendon-bone interface. Furthermore, the effect of mechanical stretch on cell proliferation and matrix synthesis in BMSC/TC co-culture was also examined. Results: Postoperative CPM therapy significantly enhanced tendon-bone healing, as evidenced by increased amount of fibrocartilage, elevated ultimate load to failure levels, and up-regulated gene expressions of Collagen I, alkaline phosphatase, osteopontin, Tenascin C and tenomodulin at the tendon-bone junction. In addition, BMSC/TC co-culture treated with mechanical stretch showed a higher rate of cell proliferation and enhanced expressions of Collagen I, Collagen III, alkaline phosphatase, osteopontin, Tenascin C and tenomodulin than that of controls. Conclusion: These results demonstrated that proliferation and differentiation of local precursor cells could be enhanced by mechanical stimulation, which results in enhanced regenerative potential of BMSCs and TCs in tendon-bone healing.

Do cells contribute to tendon and ligament biomechanics?

Directory of Open Access Journals (Sweden)

Niels Hammer

Full Text Available Acellular scaffolds are increasingly used for the surgical repair of tendon injury and ligament tears. Despite this increased use, very little data exist directly comparing acellular scaffolds and their native counterparts. Such a comparison would help establish the effectiveness of the acellularization procedure of human tissues. Furthermore, such a comparison would help estimate the influence of cells in ligament and tendon stability and give insight into the effects of acellularization on collagen.Eighteen human iliotibial tract samples were obtained from nine body donors. Nine samples were acellularized with sodium dodecyl sulphate (SDS, while nine counterparts from the same donors remained in the native condition. The ends of all samples were plastinated to minimize material slippage. Their water content was adjusted to 69%, using the osmotic stress technique to exclude water content-related alterations of the mechanical properties. Uniaxial tensile testing was performed to obtain the elastic modulus, ultimate stress and maximum strain. The effectiveness of the acellularization procedure was histologically verified by means of a DNA assay.The histology samples showed a complete removal of the cells, an extensive, yet incomplete removal of the DNA content and alterations to the extracellular collagen. Tensile properties of the tract samples such as elastic modulus and ultimate stress were unaffected by acellularization with the exception of maximum strain.The data indicate that cells influence the mechanical properties of ligaments and tendons in vitro to a negligible extent. Moreover, acellularization with SDS alters material properties to a minor extent, indicating that this method provides a biomechanical match in ligament and tendon reconstruction. However, the given protocol insufficiently removes DNA. This may increase the potential for transplant rejection when acellular tract scaffolds are used in soft tissue repair. Further research

Experimental and Numerical Analysis of Screw Fixation in Anterior Cruciate Ligament Reconstruction

Science.gov (United States)

Chizari, Mahmoud; Wang, Bin; Snow, Martyn; Barrett, Mel

2008-09-01

This paper reports the results of an experimental and finite element analysis of tibial screw fixation in anterior cruciate ligament (ACL) reconstruction. The mechanical properties of the bone and tendon graft are obtained from experiments using porcine bone and bovine tendon. The results of the numerical study are compared with those from mechanical testing. Analysis shows that the model may be used to establish the optimum placement of the tunnel in anterior cruciate ligament reconstruction by predicting mechanical parameters such as stress, strain and displacement at regions in the tunnel wall.

[Reconstruction of medial patellofemoral ligament with transposition of great adductor muscular tendon for the treatment of teenagers' recurrent patellar dislocation].

Science.gov (United States)

Shao, Chuan-Qiang; Chen, Chang-Chun; Zhao, Chun-Cheng; Yang, Hong-Mei; Kang, Yan-Zhong

2017-06-25

To investigate surgical method and clinical curative effects of medial patellofemoral ligament (MPFL) reconstruction with great adductor muscular tendon in treating teenagers' recurrent patellar dislocation. From May 2012 to September 2014, 19 patients with recurrent dislocation of patellar, including 6 males and 13 females with an average of 16 years old (ranged from 13 to 17 years), the courses of disease ranged from 3 to 18 months(averaged 6 months). All patients were underwent great adductor muscular tendon transposition to reconstruct medial patellofemoral ligament. The curative effects were evaluated by preoperative and postoperative with Lysholm scores and Patellofemoral angle and Q angle. All patients were followed up from 12 to 18 months with an average of 16.5 months. Primary healing was achieved at stage I. No pain, swelling and patellar dislocation or subluxation occurred. Patellofemoral angle increased from preoperative (-3.8±4.9)° to (10.3±4.1)° postoperatively. Q angle decreased from preoperative(16.4±3.1)° to(10.5±1.2)° postoperatively; Lysholm scores were improved from preoperative (68.6±8.5) to (93.7±6.5) final follow-up ( P teenagers' recurrent patellar dislocation.

[Application of silk-based tissue engineering scaffold for tendon / ligament regeneration].

Science.gov (United States)

Hu, Yejun; Le, Huihui; Jin, Zhangchu; Chen, Xiao; Yin, Zi; Shen, Weiliang; Ouyang, Hongwei

2016-03-01

Tendon/ligament injury is one of the most common impairments in sports medicine. The traditional treatments of damaged tissue repair are unsatisfactory, especially for athletes, due to lack of donor and immune rejection. The strategy of tissue engineering may break through these limitations, and bring new hopes to tendon/ligament repair, even regeneration. Silk is a kind of natural biomaterials, which has good biocompatibility, wide range of mechanical properties and tunable physical structures; so it could be applied as tendon/ligament tissue engineering scaffolds. The silk-based scaffold has robust mechanical properties; combined with other biological ingredients, it could increase the surface area, promote more cell adhesion and improve the biocompatibility. The potential clinical application of silk-based scaffold has been confirmed by in vivo studies on tendon/ligament repairing, such as anterior cruciate ligament, medial collateral ligament, achilles tendon and rotator cuff. To develop novel biomechanically stable and host integrated tissue engineered tendon/ligament needs more further micro and macro studies, combined with product development and clinical application, which will give new hope to patients with tendon/ligament injury.

A Canine Arthroscopic Anterior Cruciate Ligament Reconstruction Model for Study of Synthetic Augmentation of Tendon Allografts.

Science.gov (United States)

Cook, James L; Smith, Pat; Stannard, James P; Pfeiffer, Ferris; Kuroki, Keiichi; Bozynski, Chantelle C; Cook, Cristi

2017-09-01

Novel graft types, fixation methods, and means for augmenting anterior cruciate ligament (ACL) reconstructions require preclinical validation prior to safe and effective clinical application. The objective of this study was to describe and validate a translational canine model for all-inside arthroscopic complete ACL reconstruction using a quadriceps tendon allograft with internal brace (QTIB). With institutional approval, adult research hounds underwent complete transection of the native ACL followed by all-inside ACL reconstruction using the novel QTIB construct with suspensory fixation ( n  = 10). Contralateral knees were used as nonoperated controls ( n  = 10). Dogs were assessed over a 6-month period using functional, diagnostic imaging, gross, biomechanical, and histologic outcome measures required for preclinical animal models. Study results suggest that the novel QTIB construct used for complete ACL reconstruction can provide sustained knee stability and function without the development of premature osteoarthritis in a rigorous and valid preclinical model. The unique configuration of the QTIB construct-the combination of a tendon allograft with a synthetic suture tape internal brace-allowed for an effective biologic-synthetic load-sharing ACL construct. It prevented early failure, allowed for direct, four-zone graft-to-bone healing, and functional graft remodeling while avoiding problems noted with use of all-synthetic grafts. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Loss of reduction and complications of coracoclavicular ligament reconstruction with autogenous tendon graft in acute acromioclavicular dislocations.

Science.gov (United States)

Choi, Nam Hong; Lim, Seok Min; Lee, Sang Young; Lim, Tae Kang

2017-04-01

This study was conducted to report loss of reduction and complications after single-tunnel coracoclavicular (CC) ligament reconstruction with autogenous semitendinosus tendon graft for acute acromioclavicular (AC) joint dislocations. This retrospective study included patients with acute, unstable AC dislocations (surgery within 6 weeks after trauma). We excluded patients with chronic injury and distal clavicle fractures with CC ligaments disruption. We measured the CC distance on anteroposterior radiographs of both clavicles, preoperatively, immediately postoperatively, and at the final follow-up visit. We evaluated clinical outcomes using the American Shoulder and Elbow Surgeons Shoulder Assessment and the University of California, Los Angeles Shoulder Rating Scale scores and perioperative complications. There were 30 patients (27 men and 3 women) with mean age of 41 years (range, 19-70 years). The mean follow-up period was 31 months (range, 12-186 months). Mean CC distance was 15.5 ± 3.7 mm (84% ± 14% of the contralateral shoulder) preoperatively, 8.9 ± 2.6 mm (9% ± 40%) immediately postoperatively (P 25% increase of CC distance) developed in 14 patients (47%), and complications occurred in 6 patients (20%), including 3 distal clavicle fractures through the tunnel. Final clinical scores were significantly lower in patients with complications (27 vs. 33 of the University of California, Los Angeles assessment [P < .001] and 81 vs. 95 of the American Shoulder and Elbow Surgeons Shoulder assessment [P < .001]). In acute AC joint dislocation, single-tunnel CC ligament reconstruction using autogenous tendon graft resulted in loss of reduction rate of 47% and a complication rate of 20%. The development of complications adversely affected clinical outcomes. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

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

Directory of Open Access Journals (Sweden)

Jung Ho-Joong

2009-05-01

Full Text Available Abstract 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

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

Science.gov (United States)

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

[EFFECTIVENESS COMPARISON OF CORACOCLAVICULAR LIGAMENT RECONSTRUCTION BETWEEN BY AUTOLOGOUS AND ALLOGENEIC TENDON GRAFTS COMBINED WITH HOOK PLATE FIXATION FOR TREATING ACROMIOCLAVICULAR JOINT DISLOCATION].

Science.gov (United States)

Yin, Fei; Sun, Zhenzhong; Wei, Xuming; Liu, Xueguang; Zhou, Ming; Zhuang, Yin; Song, Sheng

2016-05-08

To compare the effectiveness of coracoclavicular ligament reconstruction between by using autologous plantaris tendon graft combined with hook plate fixation and allogeneic tendon graft combined with hook plate fixation for treating acromiocavicular joint dislocation. Thirty-three patients with acromioclavicular joint dislocation who accorded with the inclusion criteria between January 2013 and June 2014 were assigned into 2 groups. The patients were treated with autologous plantaris tendon graft combined with hook plate fixation in group A ( n =17), and with allogeneic tendon graft combined with hook plate fixation in group B ( n =16). Thirteen-one patients was followed up more than 12 months (15 in group A and 16 in group B). There was no significant difference in gender, age, cause of injury, sides, time between injury and surgery, and type of dislocation ( P >0.05). The assessments included operation time, hospitalization time, hospitalization expenses, shoulder range of motion, gap of acromioclavicular, Constant-Murley scores, and visual analogue scale (VAS) for pain. The operation time of group A was significantly longer than that of group B, and the hospitalization expense was significantly lower than that of group B ( P 0.05). No redislocation of acromioclavicular joint and rejection reaction occurred during follow-up. At last follow-up, there was no significant difference in shoulder range of motion, Constant-Murley score, and VAS score between 2 groups ( P >0.05). Coracoclavicular ligament reconstruction by autologous plantaris tendon or allogeneic tendon graft combined with hook plate fixation for the treatment of acromioclavicular joint dislocation can achieve good effectiveness. The appropriate treatment should be chosen according to the patient's economic situation.

Three-Dimensional Bio-Printed Scaffold Sleeves With Mesenchymal Stem Cells for Enhancement of Tendon-to-Bone Healing in Anterior Cruciate Ligament Reconstruction Using Soft-Tissue Tendon Graft.

Science.gov (United States)

Park, Sin Hyung; Choi, Yeong-Jin; Moon, Sang Won; Lee, Byung Hoon; Shim, Jin-Hyung; Cho, Dong-Woo; Wang, Joon Ho

2018-01-01

To investigate the efficacy of the insertion of 3-dimensional (3D) bio-printed scaffold sleeves seeded with mesenchymal stem cells (MSCs) to enhance osteointegration between the tendon and tunnel bone in anterior cruciate ligament (ACL) reconstruction in a rabbit model. Scaffold sleeves were fabricated by 3D bio-printing. Before ACL reconstruction, MSCs were seeded into the scaffold sleeves. ACL reconstruction with hamstring tendon was performed on both legs of 15 adult rabbits (aged 12 weeks). We implanted 15 bone tunnels with scaffold sleeves with MSCs and implanted another 15 bone tunnels with scaffold sleeves without MSCs before passing the graft. The specimens were harvested at 4, 8, and 12 weeks. H&E staining, immunohistochemical staining of type II collagen, and micro-computed tomography of the tunnel cross-sectional area were evaluated. Histologic assessment was conducted with a histologic scoring system. In the histologic assessment, a smooth bone-to-tendon transition through broad fibrocartilage formation was identified in the treatment group, and the interface zone showed abundant type II collagen production on immunohistochemical staining. Bone-tendon healing histologic scores were significantly higher in the treatment group than in the control group at all time points. Micro-computed tomography at 12 weeks showed smaller tibial (control, 9.4 ± 0.9 mm 2 ; treatment, 5.8 ± 2.9 mm 2 ; P = .044) and femoral (control, 9.6 ± 2.9 mm 2 ; treatment, 6.0 ± 1.0 mm 2 ; P = .03) bone-tunnel areas in the treated group than in the control group. The 3D bio-printed scaffold sleeve with MSCs exhibited excellent results in osteointegration enhancement between the tendon and tunnel bone in ACL reconstruction in a rabbit model. If secure biological healing between the tendon graft and tunnel bone can be induced in the early postoperative period, earlier, more successful rehabilitation may be facilitated. Three-dimensional bio-printed scaffold sleeves with

Collateral ligament reconstruction of the chronic thumb injury with bio-tenodesis screw fixation

DEFF Research Database (Denmark)

Gvozdenovic, Robert; Boeckstyns, Michel

2014-01-01

We describe a new technique for the reconstruction of chronic lesions of the collateral ligaments of the metacarpophalangeal ligaments of the thumb, using a Bio-Tenodesis screw for the fixation of a tendon graft in a triangular manner with proximal apex and allowing early mobilization, starting 2...

Development of hybrid polymer scaffolds for potential applications in ligament and tendon tissue engineering

Energy Technology Data Exchange (ETDEWEB)

Sahoo, Sambit [Tissue Repair Lab, Division of Bioengineering, National University of Singapore, Singapore 117574 (Singapore); Cho-Hong, James Goh [Tissue Repair Lab, Division of Bioengineering, National University of Singapore, Singapore 117574 (Singapore); Siew-Lok, Toh [Tissue Repair Lab, Division of Bioengineering, National University of Singapore, Singapore 117574 (Singapore)

2007-09-15

Fibre-based scaffolds have been widely used for tendon and ligament tissue engineering. Knitted scaffolds have been proved to favour collagenous matrix deposition which is crucial for tendon/ligament reconstruction. However, such scaffolds have the limitation of being dependent on a gel system for cell seeding, which is unstable in a dynamic environment such as the knee joint. This study developed three types of hybrid scaffolds, based on knitted biodegradable polyester scaffolds, aiming to improve mechanical properties and cell attachment and proliferation on the scaffolds. The hybrid scaffolds were created by coating the knitted scaffolds with a thin film of poly ({epsilon}-caprolactone) (group I), poly (D, L-lactide-co-glycolide) nanofibres (group II) and type 1 collagen (group III). Woven scaffolds were also fabricated and compared with the various hybrid scaffolds in terms of their mechanical properties during in vitro degradation and cell attachment and growth. This study demonstrated that the coating techniques could modulate the mechanical properties and facilitate cell attachment and proliferation in the hybrid scaffold, which could be applied with promise in tissue engineering of tendons/ligaments.

Development of hybrid polymer scaffolds for potential applications in ligament and tendon tissue engineering

International Nuclear Information System (INIS)

Sahoo, Sambit; Cho-Hong, James Goh; Siew-Lok, Toh

2007-01-01

Fibre-based scaffolds have been widely used for tendon and ligament tissue engineering. Knitted scaffolds have been proved to favour collagenous matrix deposition which is crucial for tendon/ligament reconstruction. However, such scaffolds have the limitation of being dependent on a gel system for cell seeding, which is unstable in a dynamic environment such as the knee joint. This study developed three types of hybrid scaffolds, based on knitted biodegradable polyester scaffolds, aiming to improve mechanical properties and cell attachment and proliferation on the scaffolds. The hybrid scaffolds were created by coating the knitted scaffolds with a thin film of poly (ε-caprolactone) (group I), poly (D, L-lactide-co-glycolide) nanofibres (group II) and type 1 collagen (group III). Woven scaffolds were also fabricated and compared with the various hybrid scaffolds in terms of their mechanical properties during in vitro degradation and cell attachment and growth. This study demonstrated that the coating techniques could modulate the mechanical properties and facilitate cell attachment and proliferation in the hybrid scaffold, which could be applied with promise in tissue engineering of tendons/ligaments

Medial Patellofemoral Ligament Reconstruction Using the Hamstring Tendon for Patellofemoral Joint Instability in an 81-Year-Old Female.

Science.gov (United States)

Takahashi, Tsuneari; Takeshita, Katsushi

2017-01-01

Chronic patellofemoral instability occurs mainly in adolescent females and can also be induced by medial patellofemoral ligament (MPFL) injury. There are no case reports of MPFL reconstruction for chronic patellofemoral instability due to MPFL injury in aged populations. 81-year-old female presented with left knee pain, giving way, and patellar instability while climbing stairs, which continued for 18 months. Patellar apprehension test was positive, and roentgenogram showed lateral patellar subluxation. Conservative therapy was not successful; hence, we performed a lateral release and MPFL reconstruction surgery. After arthroscopic lateral release, the hamstring tendon was harvested, and a graft composite made of doubled hamstring tendon and polyester tape with a suspensory fixation device was prepared. Then, a femoral bone tunnel was constructed in a socket shape at the anatomical footprint of the MPFL. The graft was passed through the femoral tunnel, and free ends of the graft composite were sutured to the periosteum of the patella, using two suture anchors at 60° of knee flexion with patellar reduction. Physiotherapy was gradually started using a patella-stabilizing orthosis on the first postoperative day. Her Kujala score improved from 66 to 97 points, and Barthel index score improved from 70 to 100 points at 1 year after surgery. She neither developed patellofemoral joint OA nor had any recurrence of symptoms at the 5-year postoperative follow up. MPFL reconstruction using the hamstring tendon is an effective procedure for patients with chronic patellofemoral instability even after the age of 80 years.

Tissue-engineering strategies for the tendon/ligament-to-bone insertion.

Science.gov (United States)

Smith, Lester; Xia, Younan; Galatz, Leesa M; Genin, Guy M; Thomopoulos, Stavros

2012-01-01

Injuries to connective tissues are painful and disabling and result in costly medical expenses. These injuries often require reattachment of an unmineralized connective tissue to bone. The uninjured tendon/ligament-to-bone insertion (enthesis) is a functionally graded material that exhibits a gradual transition from soft tissue (i.e., tendon or ligament) to hard tissue (i.e., mineralized bone) through a fibrocartilaginous transition region. This transition is believed to facilitate force transmission between the two dissimilar tissues by ameliorating potentially damaging interfacial stress concentrations. The transition region is impaired or lost upon tendon/ligament injury and is not regenerated following surgical repair or natural healing, exposing the tissue to risk of reinjury. The need to regenerate a robust tendon-to-bone insertion has led a number of tissue engineering repair strategies. This review treats the tendon-to-bone insertion site as a tissue structure whose primary role is mechanical and discusses current and emerging strategies for engineering the tendon/ligament-to-bone insertion in this context. The focus lies on strategies for producing mechanical structures that can guide and subsequently sustain a graded tissue structure and the associated cell populations.

Magnetic resonance imaging of ankle ligaments and tendon injuries

International Nuclear Information System (INIS)

Breitenseher, M.; Trattnig, S.; Kukla, C.; Daebler, C.; Helbich, T.; Haller, J.; Imhof, H.

1995-01-01

Today MRI allows evaluation of the integrity of injured ankle ligaments. The major difficulty in MRI is inconsistency in visualization by inadequate appreciation of the three-dimensional orientation of each ankle ligament. Using this technique, 52 patients with sprained ankles underwent MRI. The integrity of rupture of the collateral lateral ligaments was obtained in all 52 ankles. Full-lenght visualization is essential for evaluation of the ankle ligaments with MRI. In these 52 patients the angle of tilt on the stress X-ray was compared with the rate of MRI findings showing an injury affecting two ligaments. We found that none of the patients in whom the angle of lateral tilt was less than 5 had rupture of two laterial ligaments, while 32% of patients with angles of tilt of 6-14 and 42% of those with angles of tilt over 15 on stress X-ray had two ruptured lateral ligaments. The advantages of MRI are that it offers the best visualization of the extent of the tendon lesion. MRI, however, seems to be superior to US in detecting and quantifying lesions of the Achilles tendon. Therefore, MRI may be indicated in particularly difficult cases of tendons injuries in the foot. (orig.) [de

Outcomes of the patellar tendon and hamstring graft anterior cruciate ligament reconstructions in patients aged above 50 years

Directory of Open Access Journals (Sweden)

Tarun Bali

2015-01-01

Full Text Available Background: The treatment of anterior cruciate ligament (ACL injury consists of arthroscopic ACL reconstruction with patellar tendon or hamstring graft. Satisfactory results have been reported so far in the younger age group. Dilemma arises regarding the suitability of ACL reconstruction in the patients aged 50 years and above. This retrospective analyses the outcome of ACL reconstruction in patients aged 50 years and above at the time of presentation. Materials and Methods: 55 patients aged 50 years and above presented to our institution with symptomatic ACL tear and were managed with arthroscopic reconstruction with patellar tendon/hamstring graft. 22 patients underwent ACL reconstruction with bone- patellar tendon-bone graft and the remaining 33 with a hamstring graft. Evaluation of functional outcome was performed using International Knee Documentation Committee (IKDC and Lysholm scoring in the preoperative period, at the end of 1 year and at the final followup. Radiographic evaluation was performed using the Kellgren–Lawrence grading system. Results: The mean preoperative IKDC score was 39.7 ± 3.3. At the end of 1-year following the operation, the mean IKDC score was 73.6 ± 4.9 and at the final followup was 67.8 ± 7.7. The mean preoperative Lysholm score was 40.4 ± 10.3. At the end of 1-year following the intervention, the mean Lysholm score was 89.7 ± 2.1 and at final followup was 85.3 ± 2.5. Overall, 14 out of 42 patients who underwent radiographic assessment showed progression of osteoarthritis changes at the final followup after the intervention. Conclusion: In our study, there was a statistically significant improvement in the IKDC and Lysholm scores following the intervention. There was a slight deterioration in the scores at the final followup but the overall rate of satisfaction was still high and most of the patients were able to do their routine chores and light exercises suitable for their age group. Around one-third of

Effects of knee immobilization on morphological changes in the semitendinosus muscle-tendon complex after hamstring harvesting for anterior cruciate ligament reconstruction. Evaluation using three-dimensional computed tomography

International Nuclear Information System (INIS)

Nakamae, Atsuo; Adachi, Nobuo; Nakasa, Tomoyuki; Nishimori, Makoto; Ochi, Mitsuo; Deie, Masataka

2012-01-01

It is desirable to maintain the morphology of the semitendinosus muscle-tendon complex after tendon harvesting for anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to evaluate the effect of knee immobilization on morphological changes in the semitendinosus muscle-tendon complex. In total, 39 patients who underwent ACL reconstruction with autologous semitendinosus tendons were included in this study. After surgery, the knee was immobilized for 3 days in 1 group of patients (group 1; 24 patients; control group) and for a longer period (10-14 days) in the other group (group 2; 15 patients). Three-dimensional computed tomography (3D CT) examination was performed at 6 and/or 12 months after the surgery for all patients. Morphological changes in the semitendinosus muscle-tendon complex (proximal shift of the semitendinosus muscle-tendon junction, width of the regenerated semitendinosus tendons, re-insertion sites of the regenerated tendons, and rate of semitendinosus tendon regeneration) were evaluated. Successful regeneration of the semitendinosus tendon was confirmed in all patients in group 2. In group 1, 3D CT showed that regeneration of the semitendinosus tendon was unsuccessful in 1 of the 24 patients. The average length of the proximal shift of the semitendinosus muscle-tendon junction was 7.3±2.5 cm in group 1 and 7.2±1.9 cm in group 2. There were no significant differences between the 2 groups with regard to the morphological changes in the semitendinosus muscle-tendon complex. This study showed that the structure of regenerated tendons could be clearly identified in 38 of 39 cases (97.4%) after ACL reconstruction. However, prolonged knee immobilization (10-14 days) could not prevent morphological changes in the semitendinosus muscle-tendon complex. (author)

Assessment of rotatory instability after anterior cruciate ligament reconstruction with a bone-patellar tendon-bone graft

International Nuclear Information System (INIS)

Tashiro, Yasutaka; Okazaki, Ken; Miura, Hiromasa

2010-01-01

Anatomically oriented anterior cruciate ligament (ACL) reconstruction has been advocated recently, but its effect on rotatory instability remains to be cleared objectively. The purpose of this study was to quantitatively evaluate rotatory instability in ACL reconstructed knees with a bone-patellar tendon-bone (BTB) graft using an open MRI system. Eighteen subjects underwent arthroscopic ACL reconstruction with a BTB graft. The tibial tunnel was placed in the center of the ACL footprint. The femoral tunnel was drilled transtibially at the 10:00 to 10:30-o'clock position for the right knees. Subjects were examined using a Slocum anterolateral rotatory instability test in open MRI. Anterior tibial translation was measured at the medial and lateral compartments by evaluating sagittal images. Anterior knee stability was evaluated using the KT-2000 arthrometer. The clinical knee function was assessed with the Lysholm and Tegner scoring scales before and after the surgery. Side-to-side differences of anterolateral tibial translation was 0.1 mm. Side-to-side difference on KT-2000 arthrometer measurement was 1.8 mm. The Lysholm score improved to 96 and the latest Tegner score reached substantially the preinjury level. ACL reconstruction with a BTB graft was successful in restoring rotatory stability as well as anterior stability and knee function. (author)

Magnetic resonance evaluation of anterior cruciate ligament repair using the patellar tendon double bone block technique

International Nuclear Information System (INIS)

Autz, G.; Singson, R.D.; Goodwin, C.

1991-01-01

The magnetic resonance (MR) appearance of the anterior cruciate ligament reconstruction was determined in 20 clinically stable and 2 clinically unstable knees for a total of 22 examinations. All patients studied had undergone knee reconstruction using the patellar tendon as graft material. The reconstructed anterior cruciate ligament varies in appearance. It appeared as a thick, well-defined, low signal band on T1- and T2-weighted sagittal and coronal images in 14 of 22 examinations. The remaining 8 knees showed a graft having one or more thin and attenuated, low signal intensity bands in the sagittal and/or coronal plane. Arthroscopy confirmed an intact but lax graft in the clinically unstable knees. (orig.)

Magnetic resonance evaluation of anterior cruciate ligament repair using the patellar tendon double bone block technique

Energy Technology Data Exchange (ETDEWEB)

Autz, G.; Singson, R.D. (St. Luke' s Roosevelt Hospital Center, New York, NY (United States). Dept. of Radiology); Goodwin, C. (St. Luke' s Roosevelt Hospital Center, New York, NY (United States). Dept. of Orthopedics)

1991-11-01

The magnetic resonance (MR) appearance of the anterior cruciate ligament reconstruction was determined in 20 clinically stable and 2 clinically unstable knees for a total of 22 examinations. All patients studied had undergone knee reconstruction using the patellar tendon as graft material. The reconstructed anterior cruciate ligament varies in appearance. It appeared as a thick, well-defined, low signal band on T1- and T2-weighted sagittal and coronal images in 14 of 22 examinations. The remaining 8 knees showed a graft having one or more thin and attenuated, low signal intensity bands in the sagittal and/or coronal plane. Arthroscopy confirmed an intact but lax graft in the clinically unstable knees. (orig.).

Novel strategies in tendon and ligament tissue engineering: Advanced biomaterials and regeneration motifs

OpenAIRE

Kuo Catherine K; Marturano Joseph E; Tuan Rocky S

2010-01-01

Abstract Tendon and ligaments have poor healing capacity and when injured often require surgical intervention. Tissue replacement via autografts and allografts are non-ideal strategies that can lead to future problems. As an alternative, scaffold-based tissue engineering strategies are being pursued. In this review, we describe design considerations and major recent advancements of scaffolds for tendon/ligament engineering. Specifically, we outline native tendon/ligament characteristics criti...

Arthroscopic assisted tendon reconstruction for triangular fibrocartilage complex irreparable tears.

Science.gov (United States)

Luchetti, R; Atzei, A

2017-05-01

We report our 11-year experience of performing arthroscopically assisted triangular fibrocartilage complex reconstruction in the treatment of chronic distal radio-ulnar joint instability resulting from irreparable triangular fibrocartilage complex injuries. Eleven patients were treated. Three skin incisions were made in order to create radial and ulna tunnels for passage of the tendon graft, which is used to reconstruct the dorsal and palmar radio-ulnar ligaments, under fluoroscopic and arthroscopic guidance. At a mean follow-up of 68 months all but one had a stable distal radio-ulnar joint. Pain and grip strength, Mayo wrist score, Disability of the Arm Hand and Shoulder and patient-rated wrist and hand evaluation scores improved. The ranges of forearm rotation remained largely unchanged. Complications included an early tendon graft tear, two late-onset graft ruptures, one ulna styloid fracture during surgery and persistent wrist discomfort during forearm rotation requiring tendon graft revision in one case. An arthroscopic assisted approach for triangular fibrocartilage complex reconstruction appears safe and produces comparable results with the open technique. IV.

Modified Weaver-Dunn Procedure Versus The Use of Semitendinosus Autogenous Tendon Graft for Acromioclavicular Joint Reconstruction.

Science.gov (United States)

Hegazy, Galal; Safwat, Hesham; Seddik, Mahmoud; Al-Shal, Ehab A; Al-Sebai, Ibrahim; Negm, Mohame

2016-01-01

The optimal operative method for acromioclavicular joint reconstruction remains controversial. The modified Weaver-Dunn method is one of the most popular methods. Anatomic reconstruction of coracoclavicular ligaments with autogenous tendon grafts, widely used in treating chronic acromioclavicular joint instability, reportedly diminishes pain, eliminates sequelae, and improves function as well as strength. To compare clinical and radiologic outcomes between a modified Weaver-Dunn procedure and an anatomic coracoclavicular ligaments reconstruction technique using autogenous semitendinosus tendon graft. Twenty patients (mean age, 39 years) with painful, chronic Rockwood type III acromioclavicular joint dislocations were subjected to surgical reconstruction. In ten patients, a modified Weaver-Dunn procedure was performed, in the other ten patients; autogenous semitendinosus tendon graft was used. The mean time between injury and the index procedure was 18 month (range from 9 - 28). Clinical evaluation was performed using the Oxford Shoulder Score and Nottingham Clavicle Score after a mean follow-up time of 27.8 months. Preoperative and postoperative radiographs were compared. In the Weaver-Dunn group the Oxford Shoulder Score improved from 25±4 to 40±2 points. While the Nottingham Clavicle Score increased from 48±7 to 84±11. In semitendinosus tendon graft group, the Oxford Shoulder Score improved from 25±3 points to 50±2 points and the Nottingham Clavicle Score from 48±8 points to 95±8, respectively. Acromioclavicular joint reconstruction using the semitendinosus tendon graft achieved better Oxford Shoulder Score and Nottingham Clavicle Score compared to the modified Weaver-Dunn procedure.

Transportal anterior cruciate ligament reconstruction with quadrupled hamstring tendon graft: A prospective outcome study

Directory of Open Access Journals (Sweden)

Chandan Kumar

2017-01-01

Full Text Available Background: Anterior cruciate ligament (ACL reconstruction has been one of the most commonly performed procedures throughout the world. Unsatisfactory outcome with conventional ACL reconstruction has been attributed to nonanatomic graft placement. Researchers have advised placing the graft in the native footprint of ACL to avoid nonanatomic graft placement. The goal of this study was to analyze the outcome of anatomic single bundle ACL reconstruction using transportal technique. Materials and Methods: This was a prospective outcome study conducted on 85 consecutive patients of ACL reconstruction of which 62 patients met inclusion and exclusion criteria and were analyzed for final results. All the patients underwent ACL reconstruction by quadrupled hamstring tendon graft using transportal technique and the accessory anteromedial (AAM portal for femoral tunnel creation. The graft was fixed with endobutton on femoral side and bioabsorbable screw on the tibial side. Patients were evaluated for range of motion, International Knee Documentation Committee (IKDC score, and Lysholm scores at a minimum followup period of 2 years. The mean pre- and postoperative scores were compared using Wilcoxon signed-rank test. Results: The mean Lysholm and IKDC scores improved significantly (P < 0.0001 from preoperative value. According to IKDC score, 90.3% (n = 56 were either normal or near normal at final followup. According to Lysholm score, 75.8% of patients had excellent and 13.3% had good results. Preoperatively, pivot shift was present in 85.5% (n = 53 of patients which reduced to 4.8% (n = 3 postoperatively. Infection and knee stiffness occurred in two patients, and femoral tunnel blowout and graft re-rupture occurred in one patient each. Conclusion: Anatomic ACL reconstruction by AAM portal is a reproducible technique which gives good clinical outcome at short-term followup.

Engineering tendon and ligament tissues: present developments towards successful clinical products.

Science.gov (United States)

Rodrigues, Márcia T; Reis, Rui L; Gomes, Manuela E

2013-09-01

Musculoskeletal diseases are one of the leading causes of disability worldwide. Among them, tendon and ligament injuries represent an important aspect to consider in both athletes and active working people. Tendon and ligament damage is an important cause of joint instability, and progresses into early onset of osteoarthritis, pain, disability and eventually the need for joint replacement surgery. The social and economical burden associated with these medical conditions presents a compelling argument for greater understanding and expanding research on this issue. The particular physiology of tendons and ligaments (avascular, hypocellular and overall structural mechanical features) makes it difficult for currently available treatments to reach a complete and long-term functional repair of the damaged tissue, especially when complete tear occurs. Despite the effort, the treatment modalities for tendon and ligament are suboptimal, which have led to the development of alternative therapies, such as the delivery of growth factors, development of engineered scaffolds or the application of stem cells, which have been approached in this review. Copyright © 2012 John Wiley & Sons, Ltd.

Sources of adult mesenchymal stem cells for ligament and tendon tissue engineering.

Science.gov (United States)

Dhinsa, Baljinder S; Mahapatra, Anant N; Khan, Wasim S

2015-01-01

Tendon and ligament injuries are common, and repair slowly with reduced biomechanical properties. With increasing financial demands on the health service and patients to recover from tendon and ligament injuries faster, and with less morbidity, health professionals are exploring new treatment options. Tissue engineering may provide the answer, with its unlimited source of natural cells that in the correct environment may improve repair and regeneration of tendon and ligament tissue. Mesenchymal stem cells have demonstrated the ability to self renew and have multilineage differentiation potential. The use of bone marrow-derived mesenchymal stem cells has been reported, however significant in vitro culture expansion is required due to the low yield of cells, which has financial implications. Harvesting of bone marrow cells also has associated morbidity. Several studies have looked at alternative sources for mesenchymal stem cells. Reports in literature from animal studies have been encouraging, however further work is required. This review assesses the potential sources of mesenchymal stem cells for tissue engineering in tendons and ligaments.

Sports Injury-Related Fingers and Thumb Deformity Due to Tendon or Ligament Rupture.

Science.gov (United States)

Bai, Rong-Jie; Zhang, Hui-Bo; Zhan, Hui-Li; Qian, Zhan-Hua; Wang, Nai-Li; Liu, Yue; Li, Wen-Ting; Yin, Yu-Ming

2018-05-05

Hand injuries are very common in sports, such as skiing and ball sports. One of the major reasons causing hand and finger deformity is due to ligament and tendon injury. The aim of this study was to investigate if the high-resolution 3T magnetic resonance imaging (MRI) can demonstrate the complex anatomy of the fingers and thumb, especially the tendons and ligaments, and provide the accurate diagnosis of clinically important fingers and thumbs deformity due to ligamentous and tendinous injuries during sport activities. Sixteen fresh un-embalmed cadaveric hands were harvested from eight cadavers. A total of 20 healthy volunteers' hands and 44 patients with fingers or thumb deformity due to sports-related injuries were included in this study. All subjects had MR examination with T1-weighted images and proton density-weighted imaging with fat suppression (PD FS) in axial, coronal, and sagittal plane, respectively. Subsequently, all 16 cadaveric hands were sliced into 2-mm thick slab with a band saw (six in coronal plane, six in sagittal plane, and four in axial plane). The correlation of anatomic sections and the MRI characteristics of tendons of fingers and the ulnar collateral ligament (UCL) at the metacarpal phalangeal joint (MCPJ) of thumb between 20 healthy volunteers and 44 patients (confirmed by surgery) were analyzed. The normal ligaments and tendons in 16 cadaveric hands and 20 volunteers' hands showed uniform low-signal intensity on all the sequences of the MRI. Among 44 patients with tendinous and ligamentous injuries in the fingers or thumb, 12 cases with UCL injury at MCPJ of the thumb (Stener lesion = 8 and non-Stener lesion = 4), 6 cases with the central slip injury, 12 cases with terminal tendon injury, and 14 cases with flexor digitorum profundus injury. The ligaments and tendons disruption manifested as increased signal intensity and poor definition, discontinuity, and heterogeneous signal intensity of the involved ligaments and tendons. Sports

Effects of glucosamine on proteoglycan loss by tendon, ligament and joint capsule explant cultures.

Science.gov (United States)

Ilic, M Z; Martinac, B; Samiric, T; Handley, C J

2008-12-01

To investigate the effect of glucosamine on the loss of newly synthesized radiolabeled large and small proteoglycans by bovine tendon, ligament and joint capsule. The kinetics of loss of (35)S-labeled large and small proteoglycans from explant cultures of tendon, ligament and joint capsule treated with 10mM glucosamine was investigated over a 10-day culture period. The kinetics of loss of (35)S-labeled small proteoglycans and the formation of free [(35)S]sulfate were determined for the last 10 days of a 15-day culture period. The proteoglycan core proteins were analyzed by gel electrophoresis followed by fluorography. The metabolism of tendon, ligament and joint capsule explants exposed to 10mM glucosamine was evaluated by incorporation of [(3)H]serine and [(35)S]sulfate into protein and glycosaminoglycans, respectively. Glucosamine at 10mM stimulated the loss of small proteoglycans from ligament explant cultures. This was due to the increased loss of both macromolecular and free [(35)S]sulfate to the medium indicating that glucosamine affected the release of small proteoglycans as well as their intracellular degradation. The degradation pattern of small proteoglycans in ligament was not affected by glucosamine. In contrast, glucosamine did not have an effect on the loss of large or small proteoglycans from tendon and joint capsule or large proteoglycans from ligament explant cultures. The metabolism of cells in tendon, ligament and joint capsule was not impaired by the presence of 10mM glucosamine. Glucosamine stimulated the loss of small proteoglycans from ligament but did not have an effect on small proteoglycan catabolism in joint capsule and tendon or large proteoglycan catabolism in ligament, tendon or synovial capsule. The consequences of glucosamine therapy at clinically relevant concentrations on proteoglycan catabolism in joint fibrous connective tissues need to be further assessed in an animal model.

Knee flexor strength recovery following hamstring tendon harvest for anterior cruciate ligament reconstruction: a systematic review

Directory of Open Access Journals (Sweden)

Clare Ardern

2009-07-01

Full Text Available The hamstring tendons are an increasingly popular graft choice for anterior cruciate ligament reconstruction due to preservation of quadriceps function and the absence of anterior knee pain post-operatively. Two commonly used hamstring grafts are a quadruple strand semitendinosus graft (4ST and a double strand semitendinosus-double strand gracilis graft (2ST-2G. It has been suggested that concurrent harvest of the semitendinsous and gracilis tendons may result in sub-optimal hamstring strength recovery as the gracilis may play a role in reinforcing the semitendinosus particularly in deep knee flexion angles. The objective of this systematic review was to synthesize the findings of available literature and determine whether semitendinosus and gracilis harvest lead to post-operative hamstring strength deficits when compared to semitendinosus harvest alone. Seven studies were identified which compared hamstring strength outcomes between the common hamstring graft types. The methodological quality of each paper was assessed, and where possible effect sizes were calculated to allow comparison of results across studies. No differences were reported between the groups in isokinetic hamstring strength. Deficits in hamstring strength were reported in the 2ST-2G groups when compared to the 4ST groups in isometric strength testing at knee flexion angles ≥70°, and in the standing knee flexion angle. Preliminary evidence exists to support the hypothesis that harvesting the semitendinosus tendon alone is preferable to harvesting in combination with the gracilis tendon for minimizing post-operative hamstring strength deficits at knee flexion angles greater than 70°. However, due to the paucity of research comparing strength outcomes between the common hamstring graft types, further investigation is warranted to fully elucidate the implications for graft harvest.

MR evaluation of the knee following anterior cruciate ligament reconstruction

International Nuclear Information System (INIS)

Rak, K.M.; Gillogly, S.D.; Schaefer, R.A.; Yakes, W.F.

1991-01-01

This paper evaluates the role of MR imaging of the knee after anterior cruciate ligament (ACL) reconstruction. Seventy-five MR examinations were performed in 52 patients following ACL reconstruction with patellar tendon autografts. MR imaging demonstrated a well-defined autograft in 63 of 70 clinically stable autografts. Of 5 clinically lax reconstructions, none appeared will defined on MR images. Compared with the clinical examination, MR imaging was 90.7% accurate. MR imaging demonstrated time-related healing of the patellar tendon donor site, with persistent thickening indicative of tendinitis. Positions of the femoral and tibial bone tunnels could be assessed. Knee joint effusions tended to resolve completely within 7 months after operations, with the presence and degree of effusion in the earlier postoperative interval being unrelated to the clinical outcome. Ancillary disorders in the knee, such as meniscal tears and osteochondral defects, could also be evaluated in this postoperative population

Arthroscopic procedures and therapeutic results of anatomical reconstruction of the coracoclavicular ligaments for acromioclavicular Joint dislocation.

Science.gov (United States)

Takase, K; Yamamoto, K

2016-09-01

Surgical treatment is recommended for type 5 acromioclavicular joint dislocation on Rockwood's classification. We believe that anatomic repair of the coracoclavicular ligaments best restores the function of the acromioclavicular joint. We attempted to correctly reconstruct the anatomy of the coracoclavicular ligaments under arthroscopy, and describe the minimally invasive arthroscopic procedure. There were 22 patients; mean age at surgery, 38.1 years. Mean time to surgery was 13.2 days. Mean follow-up was 3 years 2 months. The palmaris longus tendon was excised from the ipsilateral side to replace the conoid ligament, while artificial ligament was used for reconstructing the trapezoid ligament. Both ligament reconstructions were performed arthroscopically. No temporary fixation of the acromioclavicular joint was performed. On postoperative radiographic evaluation, 4 patients showed subluxation and 2 showed dislocation of the acromioclavicular joint; the other 16 patients had maintained reduction at the final consultation. MR images 1year after surgery clearly revealed the reconstructed ligaments in 19 patients. Only 1 patient showed osteoarthritis of the acromioclavicular joint. Although it requires resection of the ipsilateral palmaris longus for grafting, we believe that anatomic reconstruction of both coracoclavicular ligaments best restores the function of the acromioclavicular joint. 4. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Revision with suture-tape augmentation after failed collateral ligament reconstruction for chronic interphalangeal instability of the hallux.

Science.gov (United States)

Cho, Byung-Ki; Park, Ji-Kang; Choi, Seung-Myung; SooHoo, Nelson F

2017-12-01

Chronic varus instability or recurrent subluxation following isolated interphalangeal dislocation of the hallux is a rare injury. No consensus has been reached regarding the best joint-salvage procedure for patients with the failed collateral ligament reconstruction using tendon graft. We report a case who achieved satisfactory clinical outcome through a modified surgical procedure (revision collateral ligament reconstruction augmented with suture-tape). Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Coracoclavicular ligament reconstruction with the autogenous anterior half of the peroneus longus tendon for distal clavicle fracture (Neer type Ⅱ-b: A report of 26 cases

Directory of Open Access Journals (Sweden)

Guang-you YANG

2017-12-01

Full Text Available Objective To explore the clinical effect of coracoclavicular ligament reconstruction with the autogenous anterior half of peroneus longus tendon (AHPLT for distal clavicle fracture (Neer type Ⅱ-b. Methods The clinical data were retrospectively analyzed of 26 Neer type Ⅱ-b distal clavicle fracture surgically treated by coracoclavicular ligament reconstruction with autogenous AHPLT in Ganyu District People's Hospital of Lianyungang from June 2012 to May 2015. Among the 26 cases, 16 males and 10 females, aged from 19-56 years (average 38.7 years. Fracture occurred in left side in 18 cases and in right side in 8 cases. Postoperative observations were done on fracture healing, shoulder and ankle-foot function recovery. Results For all the 26 cases, surgical incisions were healed well, and no infection, vascular and peroneal nerve injury and iatrogenic fracture occurred. Follow-up was carried out for 10-24 months with average of 15.3 months. All the fractures were healed within 12-20 weeks with an average of 14.6 weeks. One patient was found of losing the fracture reduction part during the follow-up process, and then got eventual healing by extending the limb brake time. Another patient was found of slight tendon sensation disorder with no significant effect on daily life and exercise, and the symptoms disappeared 6 months later. At the last follow-up, the Constant-Murley score was 92-100 with an average of 97.8 points. The ankle-hind foot score of American Society of Ankle and Orthopedics was excellent. Conclusion Reconstruction of coracoclavicular ligament with autogenous AHPLT is an effective treatment for Neer type Ⅱ-b distal clavicle fracture with good safety and without negative effect on the ankle-foot function, and thus it is worthy of wider clinical use. DOI: 10.11855/j.issn.0577-7402.2017.12.12

All-Inside Single-Bundle Reconstruction of the Anterior Cruciate Ligament with the Anterior Half of the Peroneus Longus Tendon Compared to the Semitendinosus Tendon: A Two-Year Follow-Up Study.

Science.gov (United States)

Bi, Mingguang; Zhao, Chen; Zhang, Shuijun; Yao, Bin; Hong, Zheping; Bi, Qing

2018-02-08

The anterior half of the peroneus longus tendon (AHPLT) has been reported to be acceptable for ligament reconstruction with respect to strength and safety. However, there is little information regarding the clinical outcomes after using the AHPLT compared with other autograft tendons. A prospective randomized controlled study was performed to compare the results of 62 cases of all-inside anatomical single-bundle anterior cruciate ligament (ACL) reconstruction using the AHPLT and 62 cases using semitendinosus graft with an average of 30.0 ± 3.6 months' follow-up. Tunnel placements of enrolled cases were measured on three-dimensional (3D) computed tomography (CT) and X-ray imaging. Knee stability was assessed using the anterior drawer test, pivot shift test, and KT-1000. The International Knee Documentation Committee (IKDC) 2000 subjective score was used to evaluate functional outcomes. The American Orthopedic Foot and Ankle Score (AOFAS) and the assessment of eversion muscle strength were performed to evaluate the function of the ankle donor site. Tunnel positions, which were confirmed with 3D CT, were in the anatomical positions. At the final follow-up, there were no significant differences between the semitendinosus group and the AHPLT group in the IKDC score (90.4 ± 7.1 vs. 89.3. ± 8.4), KT 1000 measurements (1.71 ± 0.57 vs. 1.85 ± 0.77), pivot shift test, and Visual Analogue Scale (VAS) (0.15 ± 0.36 vs. 0.10 ± 0.30). No obvious ankle site complications were found at 24 months. The average AOFAS score of the AHPLT group was comparable to that of the semitendinosus tendon group (99.1 ± 1.40 vs. 99.5 ± 1.21). There was no significant difference in clinical outcomes or knee stability between the semitendinosus group and the AHPLT group at the 2-year follow-up. An AHPLT autograft may be a good alternative for all-inside ACL reconstruction with respect to its strength, safety, and donor site morbidity. Thieme Medical

Tendon allograft sterilized by peracetic acid/ethanol combined with gamma irradiation.

Science.gov (United States)

Zhou, Mo; Zhang, Naili; Liu, Xiaoming; Li, Youchen; Zhang, Yumin; Wang, Xusheng; Li, Baoming; Li, Baoxing

2014-07-01

Research and clinical applications have demonstrated that the effects of tendon allografts are comparable to those of autografts when reconstructing injured tendons or ligaments, but allograft safety remains problematic. Sterilisation could eliminate or decrease the possibility of disease transmission, but current methods seldom achieve satisfactory sterilisation without affecting the mechanical properties of the tendon. Peracetic acid-ethanol in combination with low-dose gamma irradiation (PE-R) would inactivate potential deleterious microorganisms without affecting mechanical and biocompatible properties of tendon allograft. Controlled laboratory design. HIV, PPV, PRV and BVDV inactivation was evaluated. After verifying viral inactivation, the treated tendon allografts were characterised by optical microscopy, scanning electron microscopy and tensile testing, and the cytocompatibility was assessed with an MTT assay and by subcutaneous implantation. Effective and efficient inactivation of HIV, PPV, PRV and BVDV was observed. Histological structure and ultrastructure were unchanged in the treated tendon allograft, which also exhibited comparable biomechanical properties and good biocompatibility. The preliminary results confirmed our hypothesis and demonstrated that the PE-R tendon allograft has significant potential as an alternative to ligament/tendon reconstruction. Tendon allografts have been extensively used in ligament reconstruction and tendon repair. However, current sterilisation methods have various shortcomings, so PE-R has been proposed. This study suggests that PE-R tendon allograft has great potential as an alternative for ligament/tendon reconstruction. Sterilisation has been a great concern for tendon allografts. However, most sterilisation methods cannot inactivate viruses and bacteria without impairing the mechanical properties of the tendon allograft. Peracetic acid/ethanol with gamma irradiation can effectively inactivate viruses and bacteria

A Review on Biomechanics of Anterior Cruciate Ligament and Materials for Reconstruction

Science.gov (United States)

Marieswaran, M.; Jain, Ishita; Garg, Bhavuk; Sharma, Vijay

2018-01-01

The anterior cruciate ligament is one of the six ligaments in the human knee joint that provides stability during articulations. It is relatively prone to acute and chronic injuries as compared to other ligaments. Repair and self-healing of an injured anterior cruciate ligament are time-consuming processes. For personnel resuming an active sports life, surgical repair or replacement is essential. Untreated anterior cruciate ligament tear results frequently in osteoarthritis. Therefore, understanding of the biomechanics of injury and properties of the native ligament is crucial. An abridged summary of the prominent literature with a focus on key topics on kinematics and kinetics of the knee joint and various loads acting on the anterior cruciate ligament as a function of flexion angle is presented here with an emphasis on the gaps. Briefly, we also review mechanical characterization composition and anatomy of the anterior cruciate ligament as well as graft materials used for replacement/reconstruction surgeries. The key conclusions of this review are as follows: (a) the highest shear forces on the anterior cruciate ligament occur during hyperextension/low flexion angles of the knee joint; (b) the characterization of the anterior cruciate ligament at variable strain rates is critical to model a viscoelastic behavior; however, studies on human anterior cruciate ligament on variable strain rates are yet to be reported; (c) a significant disparity on maximum stress/strain pattern of the anterior cruciate ligament was observed in the earlier works; (d) nearly all synthetic grafts have been recalled from the market; and (e) bridge-enhanced repair developed by Murray is a promising technique for anterior cruciate ligament reconstruction, currently in clinical trials. It is important to note that full extension of the knee is not feasible in the case of most animals and hence the loading pattern of human ACL is different from animal models. Many of the published reviews on

Tendinography for diagnosing injuries to tendons and ligaments

International Nuclear Information System (INIS)

Grevsten, S.; Eriksson, K.

1979-01-01

A radiographic method of tendinography is described. In rabbits no inflammatory reaction in the Achilles tendon was observed 12 to 15 days after injection of contrast medium. Effects of examination of two healthy subjects and a patient with a traumatic condition are described. Suitable amounts and concentrations of contrast medium for examinations of Achilies tendon and cruciate ligaments are discussed. (Auth.)

Use of a strontium-enriched calcium phosphate cement in accelerating the healing of soft-tissue tendon graft within the bone tunnel in a rabbit model of anterior cruciate ligament reconstruction.

Science.gov (United States)

Kuang, G M; Yau, W P; Lu, W W; Chiu, K Y

2013-07-01

We investigated whether strontium-enriched calcium phosphate cement (Sr-CPC)-treated soft-tissue tendon graft results in accelerated healing within the bone tunnel in reconstruction of the anterior cruciate ligament (ACL). A total of 30 single-bundle ACL reconstructions using tendo Achillis allograft were performed in 15 rabbits. The graft on the tested limb was treated with Sr-CPC, whereas that on the contralateral limb was untreated and served as a control. At timepoints three, six, nine, 12 and 24 weeks after surgery, three animals were killed for histological examination. At six weeks, the graft-bone interface in the control group was filled in with fibrovascular tissue. However, the gap in the Sr-CPC group had already been completely filled in with new bone, and there was evidence of the early formation of Sharpey fibres. At 24 weeks, remodelling into a normal ACL-bone-like insertion was found in the Sr-CPC group. Coating of Sr-CPC on soft tissue tendon allograft leads to accelerated graft healing within the bone tunnel in a rabbit model of ACL reconstruction using Achilles tendon allograft.

FUNCTIONAL OUTCOME OF ACCELERATED REHABILITATION IN ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH BONE PATELLAR TENDON BONE GRAFT A PROSPECTIVE STUDY

Directory of Open Access Journals (Sweden)

Hiranyakumar

2016-03-01

Full Text Available INTRODUCTION An ideal rehabilitation program post anterior cruciate ligament reconstruction enables an individual to return to pre injury levels at a faster rate with minimal to no risk of reinjury to the graft. Rehabilitation protocols have changed considerably over time in the past. It has become “aggressive”, meaning an intensive rehabilitation which includes greater variety of exercises and sports related training. AIM OF THE STUDY The aim of our study is to assess the outcome of accelerated rehabilitation post anterior cruciate ligament (ACL reconstruction. METHODOLOGY 106 patients were operated by a single surgeon underwent arthroscopic anterior cruciate ligament reconstruction using bone patella tendon bone graft and partial meniscectomy for associated meniscal tear. Patients were put on an accelerated rehabilitation protocol designed in our institute on first post-operative day, under the guidance of a physical therapist in consultation with the operated surgeon. Patients were followed up at 3 weeks, 6 months and 9 months, post onset of rehabilitation, patients were assessed using KT1000 Arthrometer and Lysholm knee scoring system. RESULTS Out of 106 patients, who were selected, 96(91% were males and 10(9% were females. The mean pre-operative Lysholm score was 55.09. Post operatively, while on accelerated rehabilitation program the Lysholm scores were 69.73 at 3 weeks, 89.13 at 6 months and 89.19 at 9 months. In our pre-operative evaluation mean KT 1000 arthrometer score was 10.53 and post-operative at six months was 3.49. At nine months 105 patients had excellent results whereas 1 patient had good result. CONCLUSION Accelerated rehabilitation protocol enables the patient to functionally recover faster to pre injury levels. A rehabilitation protocol for 6 months is sufficient in enabling a patient to get back to pre-injury levels. Functional outcome is the same with or without associated meniscal injuries.

Bioactive nanofibers for fibroblastic differentiation of mesenchymal precursor cells for ligament/tendon tissue engineering applications.

Science.gov (United States)

Sahoo, Sambit; Ang, Lay-Teng; Cho-Hong Goh, James; Toh, Siew-Lok

2010-02-01

Mesenchymal stem cells and precursor cells are ideal candidates for tendon and ligament tissue engineering; however, for the stem cell-based approach to succeed, these cells would be required to proliferate and differentiate into tendon/ligament fibroblasts on the tissue engineering scaffold. Among the various fiber-based scaffolds that have been used in tendon/ligament tissue engineering, hybrid fibrous scaffolds comprising both microfibers and nanofibers have been recently shown to be particularly promising. With the nanofibrous coating presenting a biomimetic surface, the scaffolds can also potentially mimic the natural extracellular matrix in function by acting as a depot for sustained release of growth factors. In this study, we demonstrate that basic fibroblast growth factor (bFGF) could be successfully incorporated, randomly dispersed within blend-electrospun nanofibers and released in a bioactive form over 1 week. The released bioactive bFGF activated tyrosine phosphorylation signaling within seeded BMSCs. The bFGF-releasing nanofibrous scaffolds facilitated BMSC proliferation, upregulated gene expression of tendon/ligament-specific ECM proteins, increased production and deposition of collagen and tenascin-C, reduced multipotency of the BMSCs and induced tendon/ligament-like fibroblastic differentiation, indicating their potential in tendon/ligament tissue engineering applications. 2009 International Society of Differentiation. Published by Elsevier B.V. All rights reserved.

Acromioclavicular Reconstruction using Autogenous Semitendinosus Tendon Graft and the Importance of Postoperative Rehabilitation: A Case Report

Directory of Open Access Journals (Sweden)

Jade PY Ho

2013-11-01

Full Text Available We present a case of chronic acromioclavicular joint dislocation (Rockwood type 5 in which the choice of acromioclavicular reconstruction using autogenous semitendinosus tendon graft was made due to its superiority in anatomical reconstruction of the coracoclavicular ligaments, and the impact of postoperative rehabilitation on the recovery of this patient. We also discuss the rationale behind this.

* Fabrication and Characterization of Biphasic Silk Fibroin Scaffolds for Tendon/Ligament-to-Bone Tissue Engineering.

Science.gov (United States)

Font Tellado, Sònia; Bonani, Walter; Balmayor, Elizabeth R; Foehr, Peter; Motta, Antonella; Migliaresi, Claudio; van Griensven, Martijn

2017-08-01

Tissue engineering is an attractive strategy for tendon/ligament-to-bone interface repair. The structure and extracellular matrix composition of the interface are complex and allow for a gradual mechanical stress transfer between tendons/ligaments and bone. Thus, scaffolds mimicking the structural features of the native interface may be able to better support functional tissue regeneration. In this study, we fabricated biphasic silk fibroin scaffolds designed to mimic the gradient in collagen molecule alignment present at the interface. The scaffolds had two different pore alignments: anisotropic at the tendon/ligament side and isotropic at the bone side. Total porosity ranged from 50% to 80% and the majority of pores (80-90%) were ligament, enthesis, and cartilage markers significantly changed depending on pore alignment in each region of the scaffolds. In conclusion, the biphasic scaffolds fabricated in this study show promising features for tendon/ligament-to-bone tissue engineering.

Editorial Commentary: All-Inside Anterior Cruciate Ligament Reconstruction Can Afford Satisfactory Clinical Outcome and Functional Stability.

Science.gov (United States)

Yoshiya, Shinichi

2016-02-01

Anatomic all-inside anterior cruciate ligament reconstruction using the autogenous semitendinosus tendon graft can afford satisfactory outcomes, achieving significant postoperative improvement in all clinical parameters. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Molecular characterization and function of tenomodulin, a marker of tendons and ligaments that integrate musculoskeletal components

Directory of Open Access Journals (Sweden)

Chisa Shukunami, DDS, PhD

2016-11-01

Full Text Available Tendons and ligaments are dense fibrous bands of connective tissue that integrate musculoskeletal components in vertebrates. Tendons connect skeletal muscles to the bone and function as mechanical force transmitters, whereas ligaments bind adjacent bones together to stabilize joints and restrict unwanted joint movement. Fibroblasts residing in tendons and ligaments are called tenocytes and ligamentocytes, respectively. Tenomodulin (Tnmd is a type II transmembrane glycoprotein that is expressed at high levels in tenocytes and ligamentocytes, and is also present in periodontal ligament cells and tendon stem/progenitor cells. Tnmd is related to chondromodulin-1 (Chm1, a cartilage-derived angiogenesis inhibitor, and both Tnmd and Chm1 are expressed in the CD31− avascular mesenchyme. The conserved C-terminal hydrophobic domain of these proteins, which is characterized by the eight Cys residues to form four disulfide bonds, may have an anti-angiogenic function. This review highlights the molecular characterization and function of Tnmd, a specific marker of tendons and ligaments.

Proteomic differences between native and tissue‐engineered tendon and ligament

Science.gov (United States)

Tew, Simon R.; Peffers, Mandy; Canty‐Laird, Elizabeth G.; Comerford, Eithne

2016-01-01

Tendons and ligaments (T/Ls) play key roles in the musculoskeletal system, but they are susceptible to traumatic or age‐related rupture, leading to severe morbidity as well as increased susceptibility to degenerative joint diseases such as osteoarthritis. Tissue engineering represents an attractive therapeutic approach to treating T/L injury but it is hampered by our poor understanding of the defining characteristics of the two tissues. The present study aimed to determine differences in the proteomic profile between native T/Ls and tissue engineered (TE) T/L constructs. The canine long digital extensor tendon and anterior cruciate ligament were analyzed along with 3D TE fibrin‐based constructs created from their cells. Native tendon and ligament differed in their content of key structural proteins, with the ligament being more abundant in fibrocartilaginous proteins. 3D T/L TE constructs contained less extracellular matrix (ECM) proteins and had a greater proportion of cellular‐associated proteins than native tissue, corresponding to their low collagen and high DNA content. Constructs were able to recapitulate native T/L tissue characteristics particularly with regard to ECM proteins. However, 3D T/L TE constructs had similar ECM and cellular protein compositions indicating that cell source may not be an important factor for T/L tissue engineering. PMID:27080496

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

International Nuclear Information System (INIS)

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

2015-01-01

Highlights: •Medial and lateral tendons: the different muscles forming these tendons can be followed up to the insertion. The imaging anatomy is reviewed. •Medial and lateral ligaments: the anatomy is complex and specialized imaging planes and arm positions are necessary for accurate assessment. •Biceps tendon: the anatomy of the distal biceps and lacertus fibrosus are discussed and illustrated with cadaveric correlation. •US imaging of the nerves about the elbow and visualization of the possible compression points is discussed. -- Abstract: 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

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

Energy Technology Data Exchange (ETDEWEB)

De Maeseneer, Michel, E-mail: Michel.demaeseneer@uzbrussel.be [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium); Brigido, Monica Kalume, E-mail: Mbrigido@med.umich.edu [Department of Radiology, University of Michigan, Ann Arbor, MI (United States); Antic, Marijana, E-mail: Misscroa@gmail.com [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium); Lenchik, Leon, E-mail: Llenchik@wakehealth.edu [Department of Radiology, Wake Forest University, Winston-Salem, NC (United States); Milants, Annemieke, E-mail: Annemieke.Milants@gmail.com [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium); Vereecke, Evie, E-mail: Evie.Vereecke@kuleuven-kulak.be [Department of Anatomy, KULAK, Katholieke Universiteit Leuven, Campus Kortrijk, Kortrijk (Belgium); Jager, Tjeerd [Aalsters Stedelijk Ziekenhuis, Aalst (Belgium); Shahabpour, Maryam, E-mail: Maryam.Shahabpour@uzbrussel.be [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium)

2015-04-15

Highlights: •Medial and lateral tendons: the different muscles forming these tendons can be followed up to the insertion. The imaging anatomy is reviewed. •Medial and lateral ligaments: the anatomy is complex and specialized imaging planes and arm positions are necessary for accurate assessment. •Biceps tendon: the anatomy of the distal biceps and lacertus fibrosus are discussed and illustrated with cadaveric correlation. •US imaging of the nerves about the elbow and visualization of the possible compression points is discussed. -- Abstract: 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

A Review on Biomechanics of Anterior Cruciate Ligament and Materials for Reconstruction

Directory of Open Access Journals (Sweden)

M. Marieswaran

2018-01-01

Full Text Available The anterior cruciate ligament is one of the six ligaments in the human knee joint that provides stability during articulations. It is relatively prone to acute and chronic injuries as compared to other ligaments. Repair and self-healing of an injured anterior cruciate ligament are time-consuming processes. For personnel resuming an active sports life, surgical repair or replacement is essential. Untreated anterior cruciate ligament tear results frequently in osteoarthritis. Therefore, understanding of the biomechanics of injury and properties of the native ligament is crucial. An abridged summary of the prominent literature with a focus on key topics on kinematics and kinetics of the knee joint and various loads acting on the anterior cruciate ligament as a function of flexion angle is presented here with an emphasis on the gaps. Briefly, we also review mechanical characterization composition and anatomy of the anterior cruciate ligament as well as graft materials used for replacement/reconstruction surgeries. The key conclusions of this review are as follows: (a the highest shear forces on the anterior cruciate ligament occur during hyperextension/low flexion angles of the knee joint; (b the characterization of the anterior cruciate ligament at variable strain rates is critical to model a viscoelastic behavior; however, studies on human anterior cruciate ligament on variable strain rates are yet to be reported; (c a significant disparity on maximum stress/strain pattern of the anterior cruciate ligament was observed in the earlier works; (d nearly all synthetic grafts have been recalled from the market; and (e bridge-enhanced repair developed by Murray is a promising technique for anterior cruciate ligament reconstruction, currently in clinical trials. It is important to note that full extension of the knee is not feasible in the case of most animals and hence the loading pattern of human ACL is different from animal models. Many of the

Magnetic resonance imaging of the elbow. Part II: Abnormalities of the ligaments, tendons, and nerves

Energy Technology Data Exchange (ETDEWEB)

Kijowski, Richard; Tuite, Michael; Sanford, Matthew [University of Wisconsin Hospital, Department of Radiology, Madison, WI (United States)

2005-01-01

Part II of this comprehensive review on magnetic resonance imaging of the elbow discusses the role of magnetic resonance imaging in evaluating patients with abnormalities of the ligaments, tendons, and nerves of the elbow. Magnetic resonance imaging can yield high-quality multiplanar images which are useful in evaluating the soft tissue structures of the elbow. Magnetic resonance imaging can detect tears of the ulnar collateral ligament and lateral collateral ligament of the elbow with high sensitivity and specificity. Magnetic resonance imaging can determine the extent of tendon pathology in patients with medial epicondylitis and lateral epicondylitis. Magnetic resonance imaging can detect tears of the biceps tendon and triceps tendon and can distinguishing between partial and complete tendon rupture. Magnetic resonance imaging is also helpful in evaluating patients with nerve disorders at the elbow. (orig.)

Optimal Contrast Agent Staining of Ligaments and Tendons for X-Ray Computed Tomography.

Science.gov (United States)

Balint, Richard; Lowe, Tristan; Shearer, Tom

2016-01-01

X-ray computed tomography has become an important tool for studying the microstructures of biological soft tissues, such as ligaments and tendons. Due to the low X-ray attenuation of such tissues, chemical contrast agents are often necessary to enhance contrast during scanning. In this article, the effects of using three different contrast agents--iodine potassium iodide solution, phosphotungstic acid and phosphomolybdic acid--are evaluated and compared. Porcine anterior cruciate ligaments, patellar tendons, medial collateral ligaments and lateral collateral ligaments were used as the basis of the study. Three samples of each of the four ligament/tendon types were each assigned a different contrast agent (giving a total of twelve samples), and the progression of that agent through the tissue was monitored by performing a scan every day for a total period of five days (giving a total of sixty scans). Since the samples were unstained on day one, they had been stained for a total of four days by the time of the final scans. The relative contrast enhancement and tissue deformation were measured. It was observed that the iodine potassium iodide solution penetrated the samples fastest and caused the least sample shrinkage on average (although significant deformation was observed by the time of the final scans), whereas the phosphomolybdic acid caused the greatest sample shrinkage. Equations describing the observed behaviour of the contrast agents, which can be used to predict optimal staining times for ligament and tendon X-ray computed tomography, are presented.

Proteomic differences between native and tissue-engineered tendon and ligament.

Science.gov (United States)

Kharaz, Yalda A; Tew, Simon R; Peffers, Mandy; Canty-Laird, Elizabeth G; Comerford, Eithne

2016-05-01

Tendons and ligaments (T/Ls) play key roles in the musculoskeletal system, but they are susceptible to traumatic or age-related rupture, leading to severe morbidity as well as increased susceptibility to degenerative joint diseases such as osteoarthritis. Tissue engineering represents an attractive therapeutic approach to treating T/L injury but it is hampered by our poor understanding of the defining characteristics of the two tissues. The present study aimed to determine differences in the proteomic profile between native T/Ls and tissue engineered (TE) T/L constructs. The canine long digital extensor tendon and anterior cruciate ligament were analyzed along with 3D TE fibrin-based constructs created from their cells. Native tendon and ligament differed in their content of key structural proteins, with the ligament being more abundant in fibrocartilaginous proteins. 3D T/L TE constructs contained less extracellular matrix (ECM) proteins and had a greater proportion of cellular-associated proteins than native tissue, corresponding to their low collagen and high DNA content. Constructs were able to recapitulate native T/L tissue characteristics particularly with regard to ECM proteins. However, 3D T/L TE constructs had similar ECM and cellular protein compositions indicating that cell source may not be an important factor for T/L tissue engineering. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Tendon and ligament as novel cell sources for engineering the knee meniscus.

Science.gov (United States)

Hadidi, P; Paschos, N K; Huang, B J; Aryaei, A; Hu, J C; Athanasiou, K A

2016-12-01

The application of cell-based therapies in regenerative medicine is hindered by the difficulty of acquiring adequate numbers of competent cells. For the knee meniscus in particular, this may be solved by harvesting tissue from neighboring tendons and ligaments. In this study, we have investigated the potential of cells from tendon and ligament, as compared to meniscus cells, to engineer scaffold-free self-assembling fibrocartilage. Self-assembling meniscus-shaped constructs engineered from a co-culture of articular chondrocytes and either meniscus, tendon, or ligament cells were cultured for 4 weeks with TGF-β1 in serum-free media. After culture, constructs were assessed for their mechanical properties, histological staining, gross appearance, and biochemical composition including cross-link content. Correlations were performed to evaluate relationships between biochemical content and mechanical properties. In terms of mechanical properties as well as biochemical content, constructs engineered using tenocytes and ligament fibrocytes were found to be equivalent or superior to constructs engineered using meniscus cells. Furthermore, cross-link content was found to be correlated with engineered tissue tensile properties. Tenocytes and ligament fibrocytes represent viable cell sources for engineering meniscus fibrocartilage using the self-assembling process. Due to greater cross-link content, fibrocartilage engineered with tenocytes and ligament fibrocytes may maintain greater tensile properties than fibrocartilage engineered with meniscus cells. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Clavicular bone tunnel malposition leads to early failures in coracoclavicular ligament reconstructions.

Science.gov (United States)

Cook, Jay B; Shaha, James S; Rowles, Douglas J; Bottoni, Craig R; Shaha, Steven H; Tokish, John M

2013-01-01

Modern techniques for the treatment of acromioclavicular (AC) joint dislocations have largely centered on free tendon graft reconstructions. Recent biomechanical studies have demonstrated that an anatomic reconstruction with 2 clavicular bone tunnels more closely matches the properties of native coracoclavicular (CC) ligaments than more traditional techniques. No study has analyzed tunnel position in regard to risk of early failure. To evaluate the effect of clavicular tunnel position in CC ligament reconstruction as a risk of early failure. Case series; Level of evidence, 4. A retrospective review was performed of a consecutive series of CC ligament reconstructions performed with 2 clavicular bone tunnels and a free tendon graft. The population was largely a young, active-duty military group of patients. Radiographs were analyzed for the maintenance of reduction and location of clavicular bone tunnels using a picture archiving and communication system. The distance from the lateral border of the clavicle to the center of each bone tunnel was divided by the total clavicular length to establish a ratio. Medical records were reviewed for operative details and functional outcome. Failure was defined as loss of intraoperative reduction. The overall failure rate was 28.6% (8/28) at an average of 7.4 weeks postoperatively. Comparison of bone tunnel position showed that medialized bone tunnels were a significant predictor for early loss of reduction for the conoid (a ratio of 0.292 vs 0.248; P = .012) and trapezoid bone tunnels (a ratio of 0.171 vs 0.128; P = .004); this correlated to an average of 7 to 9 mm more medial in the reconstructions that failed. Reconstructions performed with a conoid ratio of ≥0.30 were significantly more likely to fail (5/5, 100%) than were those performed lateral to a ratio of 0.30 (3/23, 13.0%) (P < .01). There were no failures when the conoid ratio was <0.25 (0/10, 0%). Conoid tunnel placement was also statistically significant for

Anterior cruciate ligament reconstruction using bone plug-free quadriceps tendon autograft: intermediate-term clinical outcome after 24-36 months.

Science.gov (United States)

Schulz, Arndt P; Lange, Vivien; Gille, Justus; Voigt, Christine; Fröhlich, Susanne; Stuhr, Markus; Jürgens, Christian

2013-01-01

Although known as a possible graft option for decades, quadriceps tendon grafts have often been termed a second-line graft option. We report a consecutive case series using this method as the primary treatment line. The rationale for this study was to evaluate the midterm results of this method in a prospective and consecutive case series. The primary study question was to determine the clinical results 24-36 months after primary anterior cruciate ligament (ACL) reconstruction using a bone plug-free quadriceps tendon autograft fixed with bioabsorbable cross-pins. The study population included 55 patients, of whom 24 were female (43.6%). The mean age at the index procedure was 31.7 years (15-58 years). All patients received an ACL construction using a bone block-free quadriceps tendon graft fixed with resorbable cross-pins. The postoperative regimen included partial weight-bearing for 3 weeks and flexion limited to 90° for six weeks; an orthosis was not used. The mean follow-up duration was 29.5 months (24.3-38.5 months) after the index procedure. The International Knee Documentation Committee (IKDC) subjective score and examination form was assessed, as well as the Lysholm and Gillquist score and the Tegner activity index. The Rolimeter arthrometer was used to assess the anterior laxity of the knee. Graft harvesting was possible in all cases; a bony extension was never required. On average, graft length was measured at 8.8 cm (7.5-10 cm). The mean IKDC subjective score at follow-up was 80.44 points (55.17-100 points, standard deviation [SD] 12.05). The mean preinjury Tegner activity index was 4.98 (2-7) compared to a mean value of 4.16 (2-7, SD 0.8) at follow-up. There was a mean loss of 0.82 index points. The average Lysholm and Gillquist score was 89 points (65-100, SD 17.7). Of the results, 89.1% were in the good or very good groups; in one case (1.8%), the result was poor, while the rest were fair. ACL reconstruction using a bone plug-free quadriceps tendon

Anterior cruciate ligament reconstruction in a rabbit model using silk-collagen scaffold and comparison with autograft.

Directory of Open Access Journals (Sweden)

Fanggang Bi

Full Text Available The objective of the present study was to perform an in vivo assessment of a novel silk-collagen scaffold for anterior cruciate ligament (ACL reconstruction. First, a silk-collagen scaffold was fabricated by combining sericin-extracted knitted silk fibroin mesh and type I collagen to mimic the components of the ligament. Scaffolds were electron-beam sterilized and rolled up to replace the ACL in 20 rabbits in the scaffold group, and autologous semitendinosus tendons were used to reconstruct the ACL in the autograft control group. At 4 and 16 weeks after surgery, grafts were retrieved and analyzed for neoligament regeneration and tendon-bone healing. To evaluate neoligament regeneration, H&E and immunohistochemical staining was performed, and to assess tendon-bone healing, micro-CT, biomechanical test, H&E and Russell-Movat pentachrome staining were performed. Cell infiltration increased over time in the scaffold group, and abundant fibroblast-like cells were found in the core of the scaffold graft at 16 weeks postoperatively. Tenascin-C was strongly positive in newly regenerated tissue at 4 and 16 weeks postoperatively in the scaffold group, similar to observations in the autograft group. Compared with the autograft group, tendon-bone healing was better in the scaffold group with trabecular bone growth into the scaffold. The results indicate that the silk-collagen scaffold has considerable potential for clinical application.

The frondiform ligament and pseudotenosynovitis of the extensor digitorum longus tendon: MRI evaluation with cadaveric correlation

International Nuclear Information System (INIS)

Zember, Jonathan; Rosenberg, Zehava; Mba-Jones, Chimere; Bencardino, Jenny; Rossi, Ignacio

2016-01-01

Fluid along the frondiform ligament, the sinus tarsi stem of the inferior extensor retinaculum (IER), can approximate the extensor digitorum longus (EDL), at times simulating tenosynovitis. Our purpose, based on MRI and cadaveric studies, was to further evaluate this scantly described phenomenon, to identify associated findings and to alert the radiologists to the potential pitfall of over diagnosing EDL tenosynovitis. Two musculoskeletal radiologists retrospectively reviewed the radiology reports and MRI studies of 258 ankle MRI exams, performed at our institution, for fluid along the frondiform ligament extending toward the EDL. No patient had EDL pathology clinically. MRI was performed in two cadaveric ankles following injection of the sinus tarsi and EDL tendon sheath, under ultrasound guidance. Altogether, 31 MRIs demonstrated fluid extending from the sinus tarsi along the frondiform ligament toward the EDL. In 30 cases (97 %), the fluid partially surrounded the tendon, without tendon sheath distension. Based on the radiology reports, in 11 of the 31 cases (35 %), the fluid was misinterpreted as abnormal. Most common associated findings included ligamentous injury, posterior tibial tendon (PTT) tear, flat-foot, and osteoarthrosis. In the cadavers, fluid extended along the frondiform ligament toward the EDL after sinus tarsi injection; there was no communication between EDL tendon sheath and the sinus tarsi. Fluid within the sinus tarsi can extend along the frondiform ligament and partially surround the EDL, manifesting as pseudotenosynovitis. This phenomenon, often seen with ligamentous tears or PTT dysfunction, should not be misdiagnosed as true pathology of the EDL. (orig.)

Successful anterior cruciate ligament reconstruction and meniscal repair in osteogenesis imperfecta.

Science.gov (United States)

Park, Jae-Young; Cho, Tae-Joon; Lee, Myung Chul; Han, Hyuk-Soo

2018-03-20

A case of anterior cruciate ligament (ACL) reconstruction with meniscal repair in an osteogenesis imperfecta patient is reported. A 24-year-old female with osteogenesis imperfecta type 1a suffered from a valgus extension injury resulting in tear of ACL and medial meniscus. She underwent an arthroscopic-assisted ACL reconstruction and medial meniscus repair. Meniscal tear at the menisco-capsular junction of the posterior horn of medial meniscus was repaired with three absorbable sutures via inside-out technique. ACL reconstruction was then performed with a bone-patellar tendon-bone allograft. The patient was followed up for 1 year with intact ACL grafts and healed medial meniscus. This case report showed that successful ACL reconstruction and meniscal repair is possible in an osteogenesis imperfecta patient.Level of evidence V.

An in vitro biomechanical comparison of anterior cruciate ligament reconstruction: single bundle versus anatomical double bundle techniques

Directory of Open Access Journals (Sweden)

Sandra Umeda Sasaki

2008-01-01

Full Text Available INTRODUCTION: Anterior cruciate ligament ruptures are frequent, especially in sports. Surgical reconstruction with autologous grafts is widely employed in the international literature. Controversies remain with respect to technique variations as continuous research for improvement takes place. One of these variations is the anatomical double bundle technique, which is performed instead of the conventional single bundle technique. More recently, there has been a tendency towards positioning the two bundles through double bone tunnels in the femur and tibia (anatomical reconstruction. OBJECTIVES: To compare, through biomechanical tests, the practice of anatomical double bundle anterior cruciate ligament reconstruction with a patellar graft to conventional single bundle reconstruction with the same amount of patellar graft in a paired experimental cadaver study. METHODS: Nine pairs of male cadaver knees ranging in age from 44 to 63 years were randomized into two groups: group A (single bundle and group B (anatomical reconstruction. Each knee was biomechanically tested under three conditions: intact anterior cruciate ligament, reconstructed anterior cruciate ligament, and injured anterior cruciate ligament. Maximum anterior dislocation, rigidity, and passive internal tibia rotation were recorded with knees submitted to a 100 N horizontal anterior dislocation force applied to the tibia with the knees at 30, 60 and 90 degrees of flexion. RESULTS: There were no differences between the two techniques for any of the measurements by ANOVA tests. CONCLUSION: The technique of anatomical double bundle reconstruction of the anterior cruciate ligament with bone-patellar tendon-bone graft has a similar biomechanical behavior with regard to anterior tibial dislocation, rigidity, and passive internal tibial rotation.

Outcome of hamstring ligament harvest for Anterior Cruciate Ligament reconstruction with allograft versus autograft: a clinical trial

Directory of Open Access Journals (Sweden)

Mehdi Moghtadaei

2013-11-01

Full Text Available Background: The goal of this study was to evaluate, functional capacity of the knee in flexion and internal rotation after hamstring ligament harvest for Anterior Cruciate Ligament (ACL reconstruction.Methods: Fifty patients (male and 18-45 years old with isolated ACL injury, randomly allocated in two equal groups (in one group, ACL reconstruction was performed with Tibialis Posterior allograft and in another group with quadruple hamstring ligament auto graft and before and 6 months after surgery in both groups isokinetic flexion strength and isometric internal rotation strength of knee evaluated with Biodex System 4 dynamometer and rotational torque recorder, in order. Isokinetic flexion strength evaluated in sitting and prone position; the later position was performed for deep flexion strength evaluation. Also subjective and objective assessment of all patients pre operatively and 6 months post operatively was documented with International Knee Documentation Committee (IKDC questionnaire. In this study for first time, rotational torque strength of knee was recorded with new design measure, from isometric aspect and not isokinetic.Results: Although significant improvements in IKDC scores, flexion and internal rotation capacity of the knee were observed in both groups, post operatively in respect to pre operatively; there was no significant difference between 2 groups. (P<0.05 or more than 95% confidence Interval of the differenceConclusion: This study demonstrates that ACL reconstruction surgery, improves knee performance in flexion and internal rotation, regardless of hamstring tendon harvesting. Considering potential complications of allograft (for example: transfer of harmful diseases from donor to recipient, it is logical to use hamstring auto graft ligament for ACL reconstruction surgery. Because result of this study is not longstanding follow up and limited to male sex, for more worthfull conclusion, we suggest future study in both sex

A retrospective review of bone tunnel enlargement after anterior cruciate ligament reconstruction with hamstring tendons fixed with a metal round cannulated interference screw in the femur.

Science.gov (United States)

Kobayashi, Masahiko; Nakagawa, Yasuaki; Suzuki, Takashi; Okudaira, Shuzo; Nakamura, Takashi

2006-10-01

To assess bone tunnel enlargement after anterior cruciate ligament (ACL) reconstruction with the use of hamstring tendons fixed with a round cannulated interference (RCI) screw in the femur. A consecutive series of 30 ACL reconstructions performed with hamstring tendons fixed with an RCI screw in the femur and with staples via Leeds-Keio ligament in the tibia was retrospectively reviewed. The clinical outcome was evaluated through the Lysholm score. Anterior instability was tested by Telos-SE (Telos Japan, Tokyo, Japan) measurement. The location and angle of each femoral and tibial tunnel were measured with the use of plain radiographs, and bone tunnel enlargement greater than 2 mm detected any time 3, 6, 12, and 24 months postoperatively was defined as positive. Each factor (location and angle of the tunnels, sex, affected side, age, Lysholm score, and Telos-SE measurement) was compared between enlarged and nonenlarged groups. Positive enlargement of the bone tunnel (>2.0 mm) was observed in 36.7% (11 of 30) on the femoral side and 33.3% (10 of 30) on the tibial side, and in 6 knees of both sides. Half of patients (15 of 30) had an enlarged tunnel on the femoral or the tibial side until 1 year postoperatively. In most cases, enlargement reached maximum at 6 months postoperatively. Female patients tended to have an enlarged tunnel, especially on the femoral side (P < .05). Tunnel enlargement was not correlated with location and angle of the tunnels. Moreover, no difference was found in Lysholm score and Telos-SE measurement between enlarged and nonenlarged groups, although the nonenlarged group tended to exhibit higher Lysholm score and lesser instability. Bone tunnel enlargement of the femoral or tibial side was observed in half of patients (6 in both sides, 5 only in the femur, and 4 only in the tibia) after ACL reconstruction was performed with a hamstring tendon fixed with an RCI screw. Female patients had a greater chance for enlargement of the femoral tunnel

A tricalcium phosphate/polyether ether ketone anchor bionic fixation device for anterior cruciate ligament reconstruction: Safety and efficacy in a beagle model.

Science.gov (United States)

Mao, Genwen; Qin, Zili; Li, Zheng; Li, Xiang; Qiu, Yusheng; Bian, Weiguo

2018-05-02

The goal of this study was to develop a bionic fixation device based on the use of a tricalcium phosphate/polyether ether ketone anchor and harvesting of the ulnar carpal flexor muscle tendon for application as a ligament graft in a beagle anterior cruciate ligament (ACL) reconstruction model, with the goal of accelerating the ligament graft-to-bone tunnel healing and providing a robust stability through exploration of this new kind of autologous ligament graft. The safety and efficacy of this fixation device were explored 3 and 6 months after surgery in a beagle ACL reconstruction model using biomechanical tests and comprehensive histological observation. The data were compared using a two-tailed Student's t test and a paired t test. A p value <0.05 was defined as statistically significant. All the models were successfully established. This fixation device possessed the excellent mechanical properties for ACL reconstruction. A comprehensive histological observation revealed that a cartilage layer was visible in the transition zone between the tendon and bone interface at both 3 and 6 months postoperation. The trabecular of the new bone was observed six months after surgery and was found to be similar to a direct connection. This fixation technique provided not only a robust primary mechanical fixation but also a bionic fixation for long-term knee joint stability by accelerating the healing of the tendon to the bone tunnel, showing a high potential for use in clinical practice. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2018. © 2018 Wiley Periodicals, Inc.

Acromioclavicular joint dislocation: a comparative biomechanical study of the palmaris-longus tendon graft reconstruction with other augmentative methods in cadaveric models

Directory of Open Access Journals (Sweden)

Sengupta S

2007-11-01

Full Text Available Abstract Background Acromioclavicular injuries are common in sports medicine. Surgical intervention is generally advocated for chronic instability of Rockwood grade III and more severe injuries. Various methods of coracoclavicular ligament reconstruction and augmentation have been described. The objective of this study is to compare the biomechanical properties of a novel palmaris-longus tendon reconstruction with those of the native AC+CC ligaments, the modified Weaver-Dunn reconstruction, the ACJ capsuloligamentous complex repair, screw and clavicle hook plate augmentation. Hypothesis There is no difference, biomechanically, amongst the various reconstruction and augmentative methods. Study Design Controlled laboratory cadaveric study. Methods 54 cadaveric native (acromioclavicular and coracoclavicular ligaments were tested using the Instron machine. Superior loading was performed in the 6 groups: 1 in the intact states, 2 after modified Weaver-Dunn reconstruction (WD, 3 after modified Weaver-Dunn reconstruction with acromioclavicular joint capsuloligamentous repair (WD.ACJ, 4 after modified Weaver-Dunn reconstruction with clavicular hook plate augmentation (WD.CP or 5 after modified Weaver-Dunn reconstruction with coracoclavicular screw augmentation (WD.BS and 6 after modified Weaver-Dunn reconstruction with mersilene tape-palmaris-longus tendon graft reconstruction (WD. PLmt. Posterior-anterior (horizontal loading was similarly performed in all groups, except groups 4 and 5. The respective failure loads, stiffnesses, displacements at failure and modes of failure were recorded. Data analysis was carried out using a one-way ANOVA, with Student's unpaired t-test for unpaired data (S-PLUS statistical package 2005. Results Native ligaments were the strongest and stiffest when compared to other modes of reconstruction and augmentation except coracoclavicular screw, in both posterior-anterior and superior directions (p WD.ACJ provided additional

MRI of anterior cruciate ligament repair with patellar and hamstring tendon autografts

International Nuclear Information System (INIS)

Jansson, K.A.; Karjalainen, P.T.; Harilainen, A.; Sandelin, J.; Tallroth, K.; Soila, K.; Aronen, H.J.

2001-01-01

Objective. Several MRI sequences were used to evaluate the 2-year postoperative appearance of asymptomatic knee with a torn anterior cruciate ligament (ACL) reconstructed with bone-patellar tendon-bone (BTB) and semitendinosus and gracilis (STG) tendon autografts.Design and patients. Two groups with successful repair of ACL tear with BTB (n=10) or STG (n=10) autografts were imaged at 1.5 T with sagittal and oblique coronal proton density-, T2-weighted and sagittal STIR sequences and plain and contrast-enhanced oblique coronal T1-weighted sequences. The appearance of the graft and periligamentous tissues was evaluated.Results. In all 20 cases, the ACL graft showed homogeneous, low signal intensity with periligamentous streaks of intermediate signal intensity on T2-weighted images. In 10 cases, localised areas of intermediate signal intensity were seen in the intra-articular segment of the graft on proton density- and T1-weighted images. The graft itself did not show enhancement in either of the two groups, but mild to moderate periligamentous enhancement was detected in 10 cases.Conclusion. The MRI appearance of ACL autograft is variable on proton density- and T1-weighted images. Periligamentous tissue showing contrast enhancement is a typical MRI finding after clinically successful ACL reconstruction. (orig.)

Fibrocartilage in the attachment zones of the quadriceps tendon and patellar ligament of man.

OpenAIRE

Evans, E J; Benjamin, M; Pemberton, D J

1990-01-01

Differences are reported in the quantities and distribution of uncalcified fibrocartilage at the attachment sites of the quadriceps tendon and the patellar ligament. The largest quantity of fibrocartilage was characteristic of the quadriceps tendon. A prominent wedge of fibrocartilage was seen in the proximal part of the tibial attachment of the patellar ligament, though there was no fibrocartilage in the most superficial fibres. Little fibrocartilage was seen at the patellar attachment of th...

Anterior cruciate ligament reconstruction using bone plug-free quadriceps tendon autograft: intermediate-term clinical outcome after 24–36 months

Directory of Open Access Journals (Sweden)

Schulz AP

2013-11-01

Full Text Available Arndt P Schulz,1 Vivien Lange,2 Justus Gille,1 Christine Voigt,3 Susanne Fröhlich,4 Markus Stuhr,1 Christian Jürgens5 1Department of Orthopedics, Trauma, and Sports Medicine, University Hospital Lübeck, Lübeck, Germany; 2Department of Rehabilitation, Sana Regio Klinikum, Wedel, Germany; 3Department of Sports Medicine and Arthroscopy, Diakoniekrankenhaus Friederikenstift, Hannover, Germany; 4Department of Orthopedics, University of Rostock, Rostock, Germany; 5Department of Orthopedics, Trauma, and Sports Medicine, BG Trauma Hospital Hamburg, Hamburg, Germany Introduction: Although known as a possible graft option for decades, quadriceps tendon grafts have often been termed a second-line graft option. We report a consecutive case series using this method as the primary treatment line. The rationale for this study was to evaluate the midterm results of this method in a prospective and consecutive case series. The primary study question was to determine the clinical results 24–36 months after primary anterior cruciate ligament (ACL reconstruction using a bone plug-free quadriceps tendon autograft fixed with bioabsorbable cross-pins. Materials and methods: The study population included 55 patients, of whom 24 were female (43.6%. The mean age at the index procedure was 31.7 years (15–58 years. All patients received an ACL construction using a bone block-free quadriceps tendon graft fixed with resorbable cross-pins. The postoperative regimen included partial weight-bearing for 3 weeks and flexion limited to 90° for six weeks; an orthosis was not used. The mean follow-up duration was 29.5 months (24.3–38.5 months after the index procedure. The International Knee Documentation Committee (IKDC subjective score and examination form was assessed, as well as the Lysholm and Gillquist score and the Tegner activity index. The Rolimeter arthrometer was used to assess the anterior laxity of the knee. Results: Graft harvesting was possible in all cases

Biology and augmentation of tendon-bone insertion repair

OpenAIRE

Lui, PPY; Zhang, P; Chan, KM; Qin, L

2010-01-01

Abstract Surgical reattachment of tendon and bone such as in rotator cuff repair, patellar-patella tendon repair and anterior cruciate ligament (ACL) reconstruction often fails due to the failure of regeneration of the specialized tissue ("enthesis") which connects tendon to bone. Tendon-to-bone healing taking place between inhomogenous tissues is a slow process compared to healing within homogenous tissue, such as tendon to tendon or bone to bone healing. Therefore special attention must be ...

Open dislocation of the proximal interphalangeal joint of the little finger subsequent to chronic radial collateral ligament injury: a case report of primary ligament reconstruction with a half-slip of the flexor digitorum superficialis: Case Report.

Science.gov (United States)

Wada, Kazuma; Hibino, Naohito; Kondo, Kenji; Yoshioka, Shinji; Terai, Tomoya; Henmi, Tatsuhiko; Sairyo, Koichi

2015-01-01

Open dislocation of the proximal interphalangeal (PIP) joint is relatively rare. We report a case of a 32-year-old man who had open dislocation of the PIP joint of the little finger while playing American football. He had a history of chronic radial collateral ligament injury. We reconstructed the radial collateral ligament with a half-slip of the flexor digitorum superficialis tendon.

Preoperative cryotherapy use in anterior cruciate ligament reconstruction.

Science.gov (United States)

Koyonos, Loukas; Owsley, Kevin; Vollmer, Emily; Limpisvasti, Orr; Gambardella, Ralph

2014-12-01

Unrelieved postoperative pain may impair rehabilitation, compromise functional outcomes, and lead to patient dissatisfaction. Preemptive multimodal analgesic techniques may improve outcomes after surgery. We hypothesized that patients using preoperative cryotherapy plus a standardized postoperative treatment plan will have lower pain scores and require less pain medication compared with patients receiving a standardized postoperative treatment plan alone after arthroscopically assisted anterior cruciate ligament reconstruction (ACLR). A total of 53 consecutive patients undergoing arthroscopically assisted ACLR performed by one of seven surgeons were randomly assigned to one of two groups. Group 1 received no preoperative cryotherapy and group 2 received 30 to 90 minutes of preoperative cryotherapy to the operative leg using a commercial noncompressive cryotherapy unit. Visual analog scale pain scores and narcotic use were recorded for the first 4 days postoperatively. Total hours of cold therapy and continuous passive motion (CPM) use and highest degree of flexion achieved were recorded as well. Group 1 consisted of 26 patients (15 allograft Achilles tendon and 11 autograft bone patellar tendon bone [BPTB]), and group 2 consisted of 27 patients (16 allograft Achilles tendon and 11 autograft BPTB). Group 2 patients reported less pain (average 1.3 units, p cryotherapy, hours of CPM use, or maximum knee flexion achieved. Complications did not occur in either group. This is the first report we are aware of showing the postoperative effects of preoperative cryotherapy. Our results support the safety and efficacy of preoperative cryotherapy in a multimodal pain regimen for patients undergoing ACL reconstruction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Bioresorbable pins and interference screws for fixation of hamstring tendon grafts in anterior cruciate ligament reconstruction surgery: a randomized controlled trial.

Science.gov (United States)

Stengel, Dirk; Casper, Dirk; Bauwens, Kai; Ekkernkamp, Axel; Wich, Michael

2009-09-01

Biodegradable cross-pins have been shown to provide higher failure loads than do screws for fixation of hamstring tendons under laboratory conditions. To compare the clinical results of biodegradable pins (RigidFix) and interference screws (BioCryl) for fixation of hamstring grafts in arthroscopically assisted anterior cruciate ligament reconstruction. Study Design Randomized controlled trial; Level of evidence, 1. To test the hypothesis of a difference of 1.0 +/- 1.2 mm in anterior knee laxity between the two fixation options, 54 patients were randomly assigned to groups via a block randomization scheme and sealed envelopes. All patients underwent standardized hamstring graft reconstruction and had similar postoperative aftercare by an accelerated rehabilitation protocol. Measures assessed at baseline and after 1 and 2 years of follow-up included (1) the side-to-side difference in anterior laxity (KT-1000 arthrometer), (2) Short Form 36 physical and mental component scores, and (3) the International Knee Documentation Committee form scores. After 1 and 2 years, 26 and 21 patients in the BioCryl group and 28 and 24 patients in the RigidFix group were available for follow-up examination. No significant difference was noted in instrumented anterior translation between BioCryl and RigidFix fixation: 1 year, 0.11 (95% CI, -0.60 to 0.82; P = .7537); 2 years, 0.33 (95% CI, -0.43 to 1.08 mm; P = .3849). Also, there were no significant differences in the mean physical and mental component scores and International Knee Documentation Committee form scores and in overall complication and surgical revision rates. A pin dislocation was classified as the sole procedure-specific serious adverse event. Bioresorbable pins do not provide better clinical results than do resorbable interference screws for hamstring graft fixation in anterior cruciate ligament reconstruction surgery.

Trends in Materials Science for Ligament Reconstruction.

Science.gov (United States)

Sava, Oana Roxana; Sava, Daniel Florin; Radulescu, Marius; Albu, Madalina Georgiana; Ficai, Denisa; Veloz-Castillo, Maria Fernanda; Mendez-Rojas, Miguel Angel; Ficai, Anton

2017-01-01

The number of ligament injuries increases every year and concomitantly the need for materials or systems that can reconstruct the ligament. Limitations imposed by autografts and allografts in ligament reconstruction together with the advances in materials science and biology have attracted a lot of interest for developing systems and materials for ligament replacement or reconstruction. This review intends to synthesize the major steps taken in the development of polymer-based materials for anterior cruciate ligament, their advantages and drawbacks and the results of different in vitro and in vivo tests. Until present, there is no successful polymer system for ligament reconstruction implanted in humans. The developing field of synthetic polymers for ligament reconstruction still has a lot of potential. In addition, several nano-structured materials, made of nanofibers or in the form of ceramic/polymeric nanocomposites, are attracting the interest of several groups due to their potential use as engineered scaffolds that mimic the native environment of cells, increasing the chances for tissue regeneration. Here, we review the last 15 years of literature in order to obtain a better understanding on the state-of-the-art that includes the usage of nano- and poly-meric materials for ligament reconstruction, and to draw perspectives on the future development of the field. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Ligament Tissue Engineering and Its Potential Role in Anterior Cruciate Ligament Reconstruction

OpenAIRE

Yates, E. W.; Rupani, A.; Foley, G. T.; Khan, W. S.; Cartmell, S.; Anand, S. J.

2011-01-01

Tissue engineering is an emerging discipline that combines the principle of science and engineering. It offers an unlimited source of natural tissue substitutes and by using appropriate cells, biomimetic scaffolds, and advanced bioreactors, it is possible that tissue engineering could be implemented in the repair and regeneration of tissue such as bone, cartilage, tendon, and ligament. Whilst repair and regeneration of ligament tissue has been demonstrated in animal studies, further research ...

Experimental and Computational Investigation of Viscoelasticity of Native and Engineered Ligament and Tendon

Science.gov (United States)

Ma, J.; Narayanan, H.; Garikipati, K.; Grosh, K.; Arruda, E. M.

The important mechanisms by which soft collagenous tissues such as ligament and tendon respond to mechanical deformation include non-linear elasticity, viscoelasticity and poroelasticity. These contributions to the mechanical response are modulated by the content and morphology of structural proteins such as type I collagen and elastin, other molecules such as glycosaminoglycans, and fluid. Our ligament and tendon constructs, engineered from either primary cells or bone marrow stromal cells and their autogenous matricies, exhibit histological and mechanical characteristics of native tissues of different levels of maturity. In order to establish whether the constructs have optimal mechanical function for implantation and utility for regenerative medicine, constitutive relationships for the constructs and native tissues at different developmental levels must be established. A micromechanical model incorporating viscoelastic collagen and non-linear elastic elastin is used to describe the non-linear viscoelastic response of our homogeneous engineered constructs in vitro. This model is incorporated within a finite element framework to examine the heterogeneity of the mechanical responses of native ligament and tendon.

Reconstruction of Ligament and Tendon Defects Using Cell Technologies.

Science.gov (United States)

Chailakhyan, R K; Shekhter, A B; Ivannikov, S V; Tel'pukhov, V I; Suslin, D S; Gerasimov, Yu V; Tonenkov, A M; Grosheva, A G; Panyushkin, P V; Moskvina, I L; Vorob'eva, N N; Bagratashvili, V N

2017-02-01

We studied the possibility of restoring the integrity of the Achilles tendon in rabbits using autologous multipotent stromal cells. Collagen or gelatin sponges populated with cells were placed in a resorbable Vicryl mesh tube and this tissue-engineered construct was introduced into a defect of the middle part of the Achilles tendon. In 4 months, histological analysis showed complete regeneration of the tendon with the formation of parallel collagen fibers, spindle-shaped tenocytes, and newly formed vessels.

Allogeneic versus autologous derived cell sources for use in engineered bone-ligament-bone grafts in sheep anterior cruciate ligament repair.

Science.gov (United States)

Mahalingam, Vasudevan D; Behbahani-Nejad, Nilofar; Horine, Storm V; Olsen, Tyler J; Smietana, Michael J; Wojtys, Edward M; Wellik, Deneen M; Arruda, Ellen M; Larkin, Lisa M

2015-03-01

The use of autografts versus allografts for anterior cruciate ligament (ACL) reconstruction is controversial. The current popular options for ACL reconstruction are patellar tendon or hamstring autografts, yet advances in allograft technologies have made allogeneic grafts a favorable option for repair tissue. Despite this, the mismatched biomechanical properties and risk of osteoarthritis resulting from the current graft technologies have prompted the investigation of new tissue sources for ACL reconstruction. Previous work by our lab has demonstrated that tissue-engineered bone-ligament-bone (BLB) constructs generated from an allogeneic cell source develop structural and functional properties similar to those of native ACL and vascular and neural structures that exceed those of autologous patellar tendon grafts. In this study, we investigated the effectiveness of our tissue-engineered ligament constructs fabricated from autologous versus allogeneic cell sources. Our preliminary results demonstrate that 6 months postimplantation, our tissue-engineered auto- and allogeneic BLB grafts show similar histological and mechanical outcomes indicating that the autologous grafts are a viable option for ACL reconstruction. These data indicate that our tissue-engineered autologous ligament graft could be used in clinical situations where immune rejection and disease transmission may preclude allograft use.

Common Peroneal Nerve Palsy with Multiple-Ligament Knee Injury and Distal Avulsion of the Biceps Femoris Tendon

Directory of Open Access Journals (Sweden)

Takeshi Oshima

2015-01-01

Full Text Available A multiple-ligament knee injury that includes posterolateral corner (PLC disruption often causes palsy of the common peroneal nerve (CPN, which occurs in 44% of cases with PLC injury and biceps femoris tendon rupture or avulsion of the fibular head. Approximately half of these cases do not show functional recovery. This case report aims to present a criteria-based approach to the operation and postoperative management of CPN palsy that resulted from a multiple-ligament knee injury in a 22-year-old man that occurred during judo. We performed a two-staged surgery. The first stage was to repair the injuries to the PLC and biceps femoris. The second stage involved anterior cruciate ligament reconstruction. The outcomes were excellent, with a stable knee, excellent range of motion, and improvement in the palsy. The patient was able to return to judo competition 27 weeks after the injury. To the best of our knowledge, this is the first case report describing a return to sports following CPN palsy with multiple-ligament knee injury.

Anatomic double-bundle anterior cruciate ligament reconstruction using hamstring tendons with minimally required initial tension.

Science.gov (United States)

Mae, Tatsuo; Shino, Konsei; Matsumoto, Norinao; Natsu-Ume, Takashi; Yoneda, Kenji; Yoshikawa, Hideki; Yoneda, Minoru

2010-10-01

Our purpose was to clarify the clinical outcomes at 2 years after anatomic double-bundle anterior cruciate ligament (ACL) reconstruction with 20 N of the initial tension, which was the minimally required initial tension to perform the reconstruction successfully according to our previous report about the pre-tension necessary to restore the laxity found in the opposite knee (7.3 N; range, 2.2 to 14 N). Of 64 patients who underwent anatomic double-bundle ACL reconstruction with autogenous semitendinosus tendon, 45 were periodically examined for 2 years. Two double-looped grafts were fixed with EndoButton CL devices (Smith & Nephew Endoscopy, Andover, MA) on the femoral side and Double Spike Plates (Smith & Nephew Endoscopy) on the tibial side, while a total of 20 N of initial tension (10 N to each graft) was applied at 20° of knee flexion. The International Knee Documentation Committee Knee Examination Form and Lysholm score were used for the subjective assessment, whereas range of motion and knee stability were evaluated as the objective assessment. Grafts were evaluated in 25 patients with second-look arthroscopy. According to the International Knee Documentation Committee subjective assessment, 62% of knees were graded as normal and 38% as nearly normal. The Lysholm score was 72 points in the preoperative period and improved to 99 points at 2 years' follow-up. A loss of knee extension of less than 3° was found in 2 patients. The pivot-shift test was evaluated as negative in all patients except for 5 as a glide. KT-2000 knee arthrometer side-to-side difference (MEDmetric, San Diego, CA) was 0.1 ± 0.9 mm at 2 years' follow-up. Of the subset of grafts evaluated by second-look arthroscopy, most were considered to have good synovial coverage and to be taut. The anatomic double-bundle ACL reconstruction with 20 N of low initial tension yielded good clinical outcomes at 2 years postoperatively, and second-look arthroscopic findings were excellent. Level IV

One-stage bilateral anterior cruciate ligament reconstruction with use of hamstring tendon autografts: a case report

Directory of Open Access Journals (Sweden)

Matjaž Sajovic

2007-12-01

Full Text Available Background: Bilateral ACL rupture is not a common clinical problem, but the incidence of the bilateral knee injuries is increasing especially within highly sports active population. Mechanism of the injury rarely causes simultaneous bilateral ACL tear. Usually unilateral injury of the knee has occurred and later on contralateral injury has taken place.Patient and methods: Case report presented an unusual problem of a patient with chronic bilateral ACL – deficient knees and constitutionally very thin patellar tendons. Author decided to perform onestage bilateral ACL reconstructions using hamstring tendon autographs so as not too weaken his quadriceps muscles by compromising his extensor mechanism.Results: At three years follow-up the patient’s opinion was that both ACL reconstructed knees had normal function, and he had returned to his preinjury activity level. The overall result of the Lysholm knee score for left knee was 100 and for right one 95. Both knees had full range of motion, Lachman and pivot shift signs were negative.Conclusions: Two-stage bilateral ACL reconstruction is much more time consuming for the patient and expensive for health insurance, so one-stage bilateral ACL reconstruction is a logical solution of the problem.

Fibril deformation under load of the rabbit Achilles tendon and medial collateral ligament femoral entheses.

Science.gov (United States)

Sevick, Johnathan L; Abusara, Ziad; Andrews, Stephen H; Xu, Minjia; Khurshid, Saad; Chatha, Jansher; Hart, David A; Shrive, Nigel G

2018-04-10

Microscopic visualization under load of the region connecting ligaments/tendons to bone, the enthesis, has been performed previously; however, specific investigation of individual fibril deformation may add insight to such studies. Detailed visualization of fibril deformation would inform on the mechanical strategies employed by this tissue in connecting two mechanically disparate materials. Clinically, an improved understanding of enthesis mechanics may help guide future restorative efforts for torn or injured ligaments/tendons, where the enthesis is often a point of weakness. In this study, a custom ligament/tendon enthesis loading device was designed and built, a unique method of sample preparation was devised, and second harmonic and two-photon fluorescence microscopy were used to capture the fibril-level load response of the rabbit Achilles tendon and medial collateral ligament femoral entheses. A focus was given to investigation of the mechanical problem of fibril embedment. Resultant images indicate a rapid (occurring over approximately 60 μm) change in fibril orientation at the interface of ligament/tendon and calcified fibrocartilage early in the loading regime, before becoming relatively constant. Such a change in fibril angle helps confirm the materially graded region demonstrated by others, while, in this case, providing additional insight into fibril bending. We speculate that the scale of the mechanical problem (i.e., fibril diameters being on the order of 250 nm) allows fibrils to bend over the small (relative to the imaging field of view, but large relative to fibril diameter) distances observed; thus, potentially lessening required embedment lengths. Nevertheless, this behavior merits further investigation to be confirmed. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Dynamic restraint capacity of the hamstring muscles has important functional implications after anterior cruciate ligament injury and anterior cruciate ligament reconstruction.

Science.gov (United States)

Bryant, Adam L; Creaby, Mark W; Newton, Robert U; Steele, Julie R

2008-12-01

The purpose of this study was to investigate the relation between knee functionality of anterior cruciate ligament deficient (ACLD) and anterior cruciate ligament reconstruction (ACLR) patients and hamstring antagonist torque generated during resisted knee extension. Cross-sectional. Laboratory based. Male ACLD subjects (n=10) (18-35 y) and 27 matched males who had undergone ACLR (14 patella tendon [PT] grafts and 13 combined semitendinosus/gracilis tendon grafts). Not applicable. Knee functionality was rated (0- to 100-point scale) by using the Cincinnati Knee Rating System. Using electromyography data from the semitendinosus (ST) and biceps femoris muscles, we created a mathematical model to estimate the opposing torque generated by the hamstrings during isokinetic knee extension in 10 degrees intervals from 80 degrees to 10 degrees knee flexion. Pearson product-moment correlations revealed that more functional ACLD subjects generated significantly (Phamstring antagonist torque throughout knee extension. In contrast, more functional PT subjects produced significantly lower hamstring antagonist torque at 80 degrees to 70 degrees knee flexion, whereas no significant associations were found between hamstring antagonist torque and knee functionality for the ST/gracilis tendon subjects. An increased hamstring antagonist torque generated by the more functional ACLD subjects, reflective of increased hamstring contractile force, is thought to represent a protective mechanism to compensate for mechanical instability. The restoration of anterior knee stability through ACLR negates the need for augmented hamstring antagonist torque.

Graft fixation in cruciate ligament reconstruction.

Science.gov (United States)

Brand, J; Weiler, A; Caborn, D N; Brown, C H; Johnson, D L

2000-01-01

Cruciate ligament reconstruction has progressed dramatically in the last 20 years. Anatomic placement of ligament substitutes has fostered rehabilitation efforts that stress immediate and full range of motion, immediate weightbearing, neuromuscular strength and coordination, and early return to athletic competition (3 months). This has placed extreme importance on secure graft fixation at the time of ligament reconstruction. Current ligament substitutes require a bony or soft tissue component to be fixed within a bone tunnel or on the periosteum at a distance from the normal ligament attachment site. Fixation devices have progressed from metal to biodegradable and from far to near-normal native ligament attachment sites. Ideally, the biomechanical properties of the entire graft construct would approach those of the native ligament and facilitate biologic incorporation of the graft. Fixation should be done at the normal anatomic attachment site of the native ligament (aperture fixation) and, over time, allow the biologic return of the histologic transition zone from ligament to fibrocartilage, to calcified fibrocartilage, to bone. The purpose of this article is to review current fixation devices and techniques in cruciate ligament surgery.

Collagenolytic activity is produced by rabbit ligaments and tendon

International Nuclear Information System (INIS)

Harper, J.; Amiel, D.; Harper, E.

1986-01-01

The authors examined the patellar tendon (PT), anterior cruciate ligament (ACL) and medial collateral ligament (MCL) from normal rabbits for collagenase activity. All three connective tissues contain large amounts of collagen and the catabolism of this structural protein is important to their integrity. The authors cultured each tissue in serum free medium for 14 days. Collagenase was produced by all three connective tissues after a lag period of up to 7 days, as detected by the 14 C-glycine peptide-release assay. Culture media that did not express enzyme the authors found to contain inhibitory activity. The collagenases and inhibitors from each tissue have been quantitated and characterized. After 9 days the collagenase activity for the rabbit periarticular tissues was 6.1 (PT), 4.4 (MCL) and 8.6 (ACL) units per milligram of secreted protein. The cleavage site of all three collagenases was found to be similar to that observed for rabbit skin collagenase, and generation of reaction products TC/sup A/ and TC/sup B/ was demonstrated by collagenases from PT, MCL and ACL. These results suggest that the metabolism of ligaments and tendon is regulated by the production of zymogen, active collagenase and inhibitor, similar to other connective tissues. The role of these components in joint injury and joint diseases is currently being investigated

Reconstruction of ACL Ligament rupture: results of 96 operation

Directory of Open Access Journals (Sweden)

Tahmasebi MN

2009-04-01

Full Text Available "nBackground: Anterior Cruciate Ligament (ACL is one of the main knee stabilizing ligaments. Because of high incidence of ACL tearing especially in young athletes its reconstruction is very important. The aim of this study was to evaluate short-term results of anterior cruciate ligament ruptures using four strand hamstring auto graft and Bone patellar tendon autograph. "nMethods: The study group included 96 patients (3 female and 93 male with ACL teared who had been referred to our center in 5 years period (2002-2007. The subject which were Accessed in this study included meniscal injury concomitant chondral injury, determine the most common cause of ACL tearing, comparision of IKDC and lysholm score in all patients before and after surgery, and limitation of rang of motion of knee post operation. "nResults: Involvement was in the right knee in 38 patients and in the left knee in 58 patients. Mean age of patients was 27.6 years (19-48. Mean surgical delay was 18 month (1-77. The most common cause of tear was playing soccer. Meniscal injury was in 78 patients. (Medial meniscus in 63 patients, lateral meniscus in 29 patients Concommitent chondral injury was in 54 patients (56.25%. 68% of patients returned to preoperative functions sport activity. There was no limitation in extension and there was 6 patients limitation in flexion about 20º. In last visit of patients IKDS in class A and B was 96. "nConclusion: It is seem that arthroscopic reconstruction of ACL is a safe and good method in treatment of Knee stability. Use of IKDC and lysholm score for comparision of patients before and after surgery is helpful. The operation should be done early after injury. Reconstruction of ACL in older patients in the abscense of DJD is effective.

Ipsilateral free semitendinosus tendon graft transfer for reconstruction of chronic tears of the Achilles tendon

Directory of Open Access Journals (Sweden)

Gougoulias Nikolaos

2008-07-01

Full Text Available Abstract Background Many techniques have been developed for the reconstruction of the Achilles tendon in chronic tears. In presence of a large gap (greater than 6 centimetres, tendon augmentation is required. Methods We present our method of minimally invasive semitendinosus reconstruction for the Achilles tendon using one para-midline and one midline incision. Results The first incision is a 5 cm longitudinal incision, made 2 cm proximal and just medial to the palpable end of the residual tendon. The second incision is 3 cm long and is also longitudinal but is 2 cm distal and in the midline to the distal end of the tendon rupture. The distal and proximal Achilles tendon stumps are mobilised. After trying to reduce the gap of the ruptured Achilles tendon, if the gap produced is greater than 6 cm despite maximal plantar flexion of the ankle and traction on the Achilles tendon stumps, the ipsilateral semitendinosus tendon is harvested. The semitendinosus tendon is passed through small incisions in the substance of the proximal stump of the Achilles tendon, and it is sutured to the Achilles tendon. It is then passed beneath the intact skin bridge into the distal incision, and passed from medial to lateral through a transverse tenotomy in the distal stump. With the ankle in maximal plantar flexion, the semitendinosus tendon is sutured to the Achilles tendon at each entry and exit point Conclusion This minimally invasive technique allows reconstruction of the Achilles tendon using the tendon of semitendinosus preserving skin integrity over the site most prone to wound breakdown, and can be especially used to reconstruct the Achilles tendon in the presence of large gap (greater than 6 centimetres.

Unusual variation of the rotator interval: insertional abnormality of the pectoralis minor tendon and absence of the coracohumeral ligament

International Nuclear Information System (INIS)

Lee, Shin Jae; Ha, Doo Hoe; Lee, Sang Min

2010-01-01

To evaluate the anomalous insertion of the pectoralis minor tendon with absence of the coracohumeral ligament on MR arthrography and to demonstrate the associated findings seen with this anatomical variation. We retrospectively reviewed the 335 MR arthrograms of the shoulder joint (mean age 37.8 years) performed from March 2000 to February 2008. Images were evaluated with attention to anomalous insertion of the pectoralis minor tendon and the coracohumeral ligament. Anomalous insertion of the pectoralis minor tendon was demonstrated in 5 out of 335 shoulders (1.5%). The pectoralis minor tendons crossed over the coracoid process and attached directly to a glenohumeral joint capsule, and the coracohumeral ligament was absent in these 5 patients. In these patients, injected contrast material was noted to extend over the coracoid process along the course of the pectoralis minor tendon. Among 5 patients, 3 patients (60%) were diagnosed with SLAP (superior labrum anterior to posterior) lesions. Anomalous insertion of the pectoralis minor tendon to the glenohumeral joint capsule and associated absence of the coracohumeral ligament is well demonstrated on MR arthrography. It is an unusual variant of the pectoralis minor muscle insertion, and may be a possible contributing factor in the development of a SLAP lesion. (orig.)

Development of Tissue-Engineered Ligaments: Elastin Promotes Regeneration of the Rabbit Medial Collateral Ligament.

Science.gov (United States)

Hirukawa, Masaki; Katayama, Shingo; Sato, Tatsuya; Yamada, Masayoshi; Kageyama, Satoshi; Unno, Hironori; Suzuki, Yoshiaki; Miura, Yoshihiro; Shiratsuchi, Eri; Hasegawa, Masahiro; Miyamoto, Keiichi; Horiuchi, Takashi

2017-12-21

When ligaments are injured, reconstructive surgery is sometimes required to restore function. Methods of reconstructive surgery include transplantation of an artificial ligament and autotransplantation of a tendon. However, these methods have limitations related to the strength of the bone-ligament insertion and biocompatibility of the transplanted tissue after surgery. Therefore, it is necessary to develop new reconstruction methods and pursue the development of artificial ligaments. Elastin is a major component of elastic fibers and ligaments. However, the role of elastin in ligament regeneration has not been described. Here, we developed a rabbit model of a medial collateral ligament (MCL) rupture and treated animal knees with exogenous elastin [100 µg/(0.5 mL·week)] for 6 or 12 weeks. Elastin treatment increased gene expression and protein content of collagen and elastin (gene expression, 6-fold and 42-fold, respectively; protein content, 1.6-fold and 1.9-fold, respectively), and also increased the elastic modulus of MCL increased with elastin treatment (2-fold) compared with the controls. Our data suggest that elastin is involved in the regeneration of damaged ligaments. © 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Braided and Stacked Electrospun Nanofibrous Scaffolds for Tendon and Ligament Tissue Engineering.

Science.gov (United States)

Rothrauff, Benjamin B; Lauro, Brian B; Yang, Guang; Debski, Richard E; Musahl, Volker; Tuan, Rocky S

2017-05-01

Tendon and ligament injuries are a persistent orthopedic challenge given their poor innate healing capacity. Nonwoven electrospun nanofibrous scaffolds composed of polyesters have been used to mimic the mechanics and topographical cues of native tendons and ligaments. However, nonwoven nanofibers have several limitations that prevent broader clinical application, including poor cell infiltration, as well as tensile and suture-retention strengths that are inferior to native tissues. In this study, multilayered scaffolds of aligned electrospun nanofibers of two designs-stacked or braided-were fabricated. Mechanical properties, including structural and mechanical properties and suture-retention strength, were determined using acellular scaffolds. Human bone marrow-derived mesenchymal stem cells (MSCs) were seeded on scaffolds for up to 28 days, and assays for tenogenic differentiation, histology, and biochemical composition were performed. Braided scaffolds exhibited improved tensile and suture-retention strengths, but reduced moduli. Both scaffold designs supported expression of tenogenic markers, although the effect was greater on braided scaffolds. Conversely, cell infiltration was superior in stacked constructs, resulting in enhanced cell number, total collagen content, and total sulfated glycosaminoglycan content. However, when normalized against cell number, both designs modulated extracellular matrix protein deposition to a similar degree. Taken together, this study demonstrates that multilayered scaffolds of aligned electrospun nanofibers supported tenogenic differentiation of seeded MSCs, but the macroarchitecture is an important consideration for applications of tendon and ligament tissue engineering.

Ligamentization of tendon grafts treated with an endogenous preparation rich in growth factors: gross morphology and histology.

Science.gov (United States)

Sánchez, Mikel; Anitua, Eduardo; Azofra, Juan; Prado, Roberto; Muruzabal, Francisco; Andia, Isabel

2010-04-01

To investigate whether the application of a particular platelet-rich plasma preparation rich in growth factors (PRGF) during anterior cruciate ligament (ACL) surgery gives a potential advantage for better tendon graft ligamentization. This study included 37 volunteers who underwent either conventional (control group, n = 15) or PRGF-assisted (n = 22) ACL reconstruction with an autogenous hamstring and required second-look arthroscopy to remove hardware or loose bodies, treat meniscal tears or plica syndrome, or resect cyclops lesions at 6 to 24 months after ACL surgery. The gross morphologies of the grafts were evaluated on second-look arthroscopy by use of the full arthroscopic score (0 to 4 points) to evaluate graft thickness and apparent tension (0 to 2 points) plus synovial coverage (0 to 2 points). At the same time, biopsy specimens were harvested uniformly from the grafted tendons. In these specimens the histologic transformation of the tendon graft to ACL-like tissue was evaluated by use of the Ligament Tissue Maturity Index, and a score to assess the progression of new connective tissue enveloping the graft was created by use of 3 criteria previously used to characterize changes during ligament healing: cellularity, vascularity, and collagen properties. The overall arthroscopic evaluation of PRGF-treated grafts showed an excellent rating in 57.1% of the knees (score of 4) and a fair rating in 42.9% (score of 2 or 3). In contrast, evaluation of untreated grafts showed an excellent rating in 33.3% of the knees, a fair rating in 46.7%, and a poor rating in 20% (score of 0 or 1). Overall, arthroscopic evaluations were not statistically different between PRGF and control groups (P = .051). PRGF treatment influenced the histologic characteristics of the tendon graft, resulting in tissue that was more mature than in controls (P = .024). Histologically evident newly formed connective tissue enveloping the graft was present in 77.3% of PRGF-treated grafts and 40% of

Arthroscopic intra- and extra-articular anterior cruciate ligament reconstruction with gracilis and semitendinosus tendons: a review

OpenAIRE

Marcacci, Maurilio; Zaffagnini, Stefano; Marcheggiani Muccioli, Giulio Maria; Neri, Maria Pia; Bondi, Alice; Nitri, Marco; Bonanzinga, Tommaso; Grassi, Alberto

2011-01-01

The purposes of this paper are to summarize the concepts relating to the use of a combined intra-articular and extra-articular reconstructive procedure in the arthroscopic treatment of a torn ACL and to review several operative techniques utilizing gracilis and semitendinosus tendons that are currently in use to treat this instability. The highly satisfactory results obtained over the time show that a combination of intra- and extra-articular procedures for ACL reconstruction is a valid surgi...

A bFGF-releasing silk/PLGA-based biohybrid scaffold for ligament/tendon tissue engineering using mesenchymal progenitor cells.

Science.gov (United States)

Sahoo, Sambit; Toh, Siew Lok; Goh, James C H

2010-04-01

An ideal scaffold that provides a combination of suitable mechanical properties along with biological signals is required for successful ligament/tendon regeneration in mesenchymal stem cell-based tissue engineering strategies. Among the various fibre-based scaffolds that have been used, hybrid fibrous scaffolds comprising both microfibres and nanofibres have been recently shown to be particularly promising. This study developed a biohybrid fibrous scaffold system by coating bioactive bFGF-releasing ultrafine PLGA fibres over mechanically robust slowly-degrading degummed knitted microfibrous silk scaffolds. On the ECM-like biomimetic architecture of ultrafine fibres, sustained release of bFGF mimicked the ECM in function, initially stimulating mesenchymal progenitor cell (MPC) proliferation, and subsequently, their tenogeneic differentiation. The biohybrid scaffold system not only facilitated MPC attachment and promoted cell proliferation, with cells growing both on ultrafine PLGA fibres and silk microfibres, but also stimulated tenogeneic differentiation of seeded MPCs. Upregulated gene expression of ligament/tendon-specific ECM proteins and increased collagen production likely contributed to enhancing mechanical properties of the constructs, generating a ligament/tendon analogue that has the potential to be used to repair injured ligaments/tendons. Copyright 2010 Elsevier Ltd. All rights reserved.

Enhanced biological properties of biomimetic apatite fabricated polycaprolactone/chitosan nanofibrous bio-composite for tendon and ligament regeneration.

Science.gov (United States)

Wu, Geng; Deng, Xuefeng; Song, Jinqi; Chen, Feiqiang

2018-01-01

The development of tailored nanofibrous scaffolds for tendon and ligament tissue engineering has been a goal of clinical research for current researchers. Here, we establish a formation of novel nanofibrous matrix with significant mechanical and biological properties by electro-spinning process. The fine fibrous morphology of the nanostructured hydroxyapatite (HAp) dispersed in the polycaprolactone/chitosan (HAp-PCL/CS) nanofibrous matrix was exhibited by microscopic (SEM and TEM) techniques. The favorable mechanical properties (load and modulus) were achieved. The load and modulus of the HAp-PCL/CS composite fibers was 250.1N and 215.5MPa, which is very similar to that of standard value of the human tendon and ligament tissues. The cellular responses and biocompatibility of HAp-PCL/CS nanofibrous scaffolds were investigated with human osteoblast (HOS) cells for tendon regeneration and examined the primary osteoblast mechanism by in vitro method. The morphological (FE-SEM and fluorescence) microscopic images clearly exhibited that HOS cells are well attached and flatted on the nanofibrous composites. The HAp dispersed PCL/CS nanofibrous scaffolds promoted higher adhesion and proliferation of HOS cells comparable to the nanofibrous scaffolds without HAp nanoparticles. The physic-chemical and biological properties of the synthesized nanofibrous scaffold were very close to that of normal ligament and tendon in human body. Over all, these studied results confirmed that the prepared nanofibrous scaffolds will be effective biomaterial of tendon ligament regeneration applications. Copyright © 2017 Elsevier B.V. All rights reserved.

[Reconstruction of the extensor pollicis longus tendon by transposition of the extensor indicis tendon].

Science.gov (United States)

Loos, A; Kalb, K; Van Schoonhoven, J; Landsleitner Dagger, B

2003-12-01

Rupture of the extensor pollicis longus-tendon (EPL) is a frequent complication after distal radius fractures. Other traumatic and non-traumatic reasons for this tendon lesion are known, including a theory about a disorder in the blood supply to the tendon itself. We examined 40 patients after reconstruction of the EPL-tendon in a mean follow-up time of 30 months. All patients were clinically examined and a DASH questionnaire was answered by all patients. The method to reconstruct the EPL-tendon was the transposition of the extensor indicis-tendon. After the operations the thumb was put in a splint for four weeks in a "hitch-hiker's-position". 31 ruptures of the tendon (77.5 %) were a result of trauma. In 20 of them (50 %) a distal radius fracture had occurred. Clinical examination included measurements of the movement of the thumb- and index-finger joints, the grip strength and the maximal span of the hand. Significant differences were not found. The isolated extension of the index finger was possible in all patients. But it was reduced in ten cases which represent 25 %. Our results were evaluated by the Geldmacher score to evaluate the reconstruction of the EPL-tendon. 20 % excellent, 65 % good, 12.5 % fair and 2.5 % poor results were reached. The Geldmacher score was used critically. We suggest its modification for the evaluation of thumb abduction. The DASH score reached a functional value of ten points which represents a very good result. In conclusion the extensor indicis-transposition is a safe method to reconstruct the EPL-tendon. Its substantial advantage is taking a healthy muscle as the motor, thereby avoiding the risk of using a degenerated muscle in late tendon reconstruction. A powerful extension of the index finger will be maintained by physical education. Generally, the loss of the extension of the index finger is negligible. It does not disturb the patients. But it has to be discussed with the patient before the operation.

Imaging of posterior cruciate ligament (PCL) reconstruction: normal postsurgical appearance and complications

Energy Technology Data Exchange (ETDEWEB)

Alcala-Galiano, Andrea; Baeva, Maria; Jose Argueeso, Maria [Hospital ASEPEYO Coslada, Department of Radiology, Madrid (Spain); Ismael, Maryem [Hospital ASEPEYO Coslada, Department of Traumatology and Orthopaedic Surgery, Madrid (Spain)

2014-12-15

This article reviews the normal postsurgical anatomy and appearance of PCL reconstructions on MDCT and MRI with the different operative techniques considering the type of tibial fixation, use of a single or double bundle, type of tendon graft and the fixation material. Tunnel positioning, appearance of the ligament graft and findings at the donor site are considered. Imaging signs of PCL graft failure and its possible causes are discussed. Imaging manifestations of other potential complications of both the PCL graft and donor sites are described, such as laxity, impingement, arthrofibrosis, ganglion cyst formation or complications related to the fixation material. (orig.)

Low-Magnitude, High-Frequency Vibration Fails to Accelerate Ligament Healing but Stimulates Collagen Synthesis in the Achilles Tendon.

Science.gov (United States)

Thompson, William R; Keller, Benjamin V; Davis, Matthew L; Dahners, Laurence E; Weinhold, Paul S

2015-05-01

Low-magnitude, high-frequency vibration accelerates fracture and wound healing and prevents disuse atrophy in musculoskeletal tissues. To investigate the role of low-magnitude, high-frequency vibration as a treatment to accelerate healing of an acute ligament injury and to examine gene expression in the intact Achilles tendon of the injured limb after low-magnitude, high-frequency vibration. Controlled laboratory study. Complete surgical transection of the medial collateral ligament (MCL) was performed in 32 Sprague-Dawley rats, divided into control and low-magnitude, high-frequency vibration groups. Low-magnitude, high-frequency vibration started on postoperative day 2, and rats received vibration for 30 minutes a day for 12 days. All rats were sacrificed 2 weeks after the operation, and their intact and injured MCLs were biomechanically tested or used for histological analysis. Intact Achilles tendons from the injured limb were evaluated for differences in gene expression. Mechanical testing revealed no differences in the ultimate tensile load or the structural stiffness between the control and vibration groups for either the injured or intact MCL. Vibration exposure increased gene expression of collagen 1 alpha (3-fold), interleukin 6 (7-fold), cyclooxygenase 2 (5-fold), and bone morphogenetic protein 12 (4-fold) in the intact Achilles tendon when compared with control tendons ( P frequency vibration treatment, significant enhancements in gene expression were observed in the intact Achilles tendon. These included collagen, several inflammatory cytokines, and growth factors critical for tendons. As low-magnitude, high-frequency vibration had no negative effects on ligament healing, vibration therapy may be a useful tool to accelerate healing of other tissues (bone) in multitrauma injuries without inhibiting ligament healing. Additionally, the enhanced gene expression in response to low-magnitude, high-frequency vibration in the intact Achilles tendon suggests the

Simultaneous bilateral anterior cruciate ligament reconstruction: Cost comparison and functional results

Directory of Open Access Journals (Sweden)

Matjaž Sajovic

2014-04-01

Full Text Available Background: The ideal treatment for patients presenting with bilateral anterior cruciate ligament (ACL deficiency remains controversial. The purpose was to evaluate cost and mid-term functional results after one-stage bilateral ACL reconstruction using either hamstring or patella tendon autograft.Methods: We compared the mid-term outcome of 7 patients (14 knees who had one-stage bilateral ACL reconstruction with that of a matched group of patients who had unilateral reconstruction (21 patients.Results: The median duration of hospital stay was 4 nights (range 3 to 5 for the bilateral group and 2 nights (range, 1 to 4 for the control group. The duration of rehabilitation process in patients from the control group with unilateral ACL reconstruction was one week shorter (9 versus 8 weeks. In the bilateral group, the median Lysholm score was 96 (range 85–100 and in the control group, the median score was 93 (range 81–100. The median time to return to full-time work and to full sports was 9 weeks and 7 months for the simultaneous bilateral group and 8 weeks and 6 months for the unilateral group. Six patients (86 % in the bilateral group and 17 patients (81 % in the control group were still performing at their pre-injury level of activity. The Health Insurance Institute of Slovenia saves EUR 2,925 when we perform simultaneous bilateral ACL reconstruction instead of two stage ACL reconstruction.Conclusions: Mid-term clinical results suggested that simultaneous bilateral ACL reconstruction using either hamstring or patella tendon autograft is clinically effective. For patients presenting with symptomatic bilateral ACL deficient knees, one stage bilateral ACL reconstruction is reproducible, cost effective, and does not compromise functional results.

Tunnel widening in anterior cruciate ligament reconstruction

DEFF Research Database (Denmark)

Clatworthy, M G; Annear, P; Bulow, J U

1999-01-01

We report a prospective series evaluating the incidence and degree of tunnel widening in a well-matched series of patients receiving a hamstring or patella tendon graft for anterior cruciate ligament (ACL) deficiency. We correlated tunnel widening with clinical factors, knee scores, KT-1000 and i...

Biology and augmentation of tendon-bone insertion repair

Directory of Open Access Journals (Sweden)

Lui PPY

2010-08-01

Full Text Available Abstract Surgical reattachment of tendon and bone such as in rotator cuff repair, patellar-patella tendon repair and anterior cruciate ligament (ACL reconstruction often fails due to the failure of regeneration of the specialized tissue ("enthesis" which connects tendon to bone. Tendon-to-bone healing taking place between inhomogenous tissues is a slow process compared to healing within homogenous tissue, such as tendon to tendon or bone to bone healing. Therefore special attention must be paid to augment tendon to bone insertion (TBI healing. Apart from surgical fixation, biological and biophysical interventions have been studied aiming at regeneration of TBI healing complex, especially the regeneration of interpositioned fibrocartilage and new bone at the healing junction. This paper described the biology and the factors influencing TBI healing using patella-patellar tendon (PPT healing and tendon graft to bone tunnel healing in ACL reconstruction as examples. Recent development in the improvement of TBI healing and directions for future studies were also reviewed and discussed.

Functional tissue engineering of ligament healing

Directory of Open Access Journals (Sweden)

Hsu Shan-Ling

2010-05-01

Full Text Available Abstract 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.

[Evaluation of early physiotherapy in patients after surgical treatment of cruciate ligament injury by bone-tendon-bone method].

Science.gov (United States)

Klupiński, Kamil; Krekora, Katarzyna; Woldańska-Okońska, Marta

2014-01-01

Anterior cruciate ligament (ACL) is one of the most important structures of the knee joint. It has a stabilizing function and causes sliding movement between the articular surfaces. Most frequently there comes to the anterior cruciate ligament injury during practicing sports such as skiing, football, sports which require sudden turns and those which are associated with jumps for height like basketball and volleyball. The aim of study was to evaluate of the outcomes of complex physiotherapy after reconstruction of anterior cruciate ligament by bone -tendon-bone (BTB) method. The study involved 41 patients, 8 women and 33 men, aged 20 to 45 years, body height 1.60-1.90 cm and body weight 50-100 kg. The patients were divided into two groups. Group I included 26 patients (3 women and 23 men) after arthroscopic ACL reconstruction. Group II--control-group included 15 patients (5 women and 10 men) after ACL injury but not subjected to the ligament reconstruction. The patients from both groups underwent rehabilitation according to the same rehabilitation program suggested by the Medical Magnus Clinic in Lodz, which consisted in performing daily exercises in open and closed kinetic chains. All group I and II patients were examined three times: after surgery (before the start of the rehabilitation), in the sixth week of rehabilitation and 12 weeks afterwards. The clinical examination included: measurement of the range of movement in the knee joint, the measurement of musculoskeletal strength with Lovett scale, knee pain assessment using Visual Analog Scale (VAS), transpatellar anthropometric measurement of the knee joint, linear measurements of the thigh and shin (at two points: 5 and 10 cm above the patellar apex and at two points: 5 and 10 cm below the patellar base). Introduction of early highly specialized physiotherapy has been demonstrated to contribute to the improvement of the rehabilitation outcomes and to the shortening of the therapy. A statistically significant

Percutaneous lateral ligament reconstruction with allograft for chronic lateral ankle instability.

Science.gov (United States)

Youn, Hyunkook; Kim, Yong Sang; Lee, Jongseok; Choi, Woo Jin; Lee, Jin Woo

2012-02-01

The majority of lateral ankle instability can be treated successfully with conservative method. However, if such treatments fail, surgical treatment should be considered. A wide variety of procedures have been introduced to treat chronic lateral ankle instability. The percutaneous method avoids dissection which is associated with open surgery and can lead to excessive morbidity. The purpose of this study was to evaluate the clinical and radiological outcomes of percutaneous lateral ligament reconstruction with an allograft in the treatment of chronic lateral ankle instability. Between October 2006 and April 2009, percutaneous lateral ligament reconstruction using an allograft was performed on 15 ankles in 13 patients for chronic lateral ankle instability. The patients included in this study satisfied at least one of the following criteria: a previously failed reconstruction of the ligament, severe ankle instability (more than 15 degrees of talar tilt, more than 10 mm of anterior drawer), general laxity of ligaments, body mass index (BMI) higher than 25. The mean followup period was 18.1 (range, 12 to 40) months. The grafted tendon was secured by double tenodeses at both the talus and calcaneus or triple tenodeses which included a fibular tenodesis. The clinical outcomes were evaluated with Visual Analogue Scale (VAS) for pain, Karlsson-Peterson ankle score, and patients' subjective satisfaction. The radiological results were evaluated using the varus tilting angle and the anterior displacement distance. The VAS improved from preoperative 3.7 ±2.2 to 1.6 ±1.3 at the last followup (p = 0.002). The Karlsson-Peterson ankle score increased from 54.2 ±8.8 to 80.9 ±7.2 (p = 0.001). Patients were satisfied in 13 cases (86.7%) with excellent or good results. Radiologically, the mean varus tilting angle was 15.5 ±4.4 degrees preoperatively and 7.3 ±3.6 at the last followup (p = 0.001). The anterior drawer distance was 10.1 ±3.3 mm preoperatively and 7.2 ±2.7 mm at

MR anatomy study of the elbow, with emphasis in ligaments and tendons structure - methodology

International Nuclear Information System (INIS)

Vilela, Sonia de Aguiar; Fernandes, Artur da Rocha Correa; Barbieri, Antonio; Turrini, Elisabete; Juliano, Yara

1999-01-01

Seventeen MR exams of the elbow joints of fifteen healthy volunteers were obtained on T1 spin-echo sequences in the transversal, coronal and sagital planes. Eight anatomic structures were selected and evaluated by three independent blind readers. The aim of this study was to establish the frequency of visibility as well to determine the best plane to characterize these anatomic structures and also to analyze the interobserver variability. The readers analyzed the exams using the same criteria: degree 0 (structure not visible); degree 1 (structure visible and partially delineated); degree 2 (structure well visible and well delineated). The structure visibility showed variability close related to the degree (1 or 2) chosen by the readers to define the structure visualization and mainly in the transverse plane. The coronal plane was showed to be the ideal to evaluate the collateral ligaments, the common extensor tendon and the com,mon flexor tendon, otherwise the sagital plane was useful to define triceps and braquial tendons. The biceps tendon and annular ligament were well defined in the transverse plane. The usefulness of this study is to establish the ideal planes to evaluate these anatomic structures, and develop faster protocols. (author)

Scaffolds for Tendon and Ligament Repair and Regeneration

Science.gov (United States)

Ratcliffe, Anthony; Butler, David L; Dyment, Nathaniel A; Cagle, Paul J; Proctor, Christopher S; Ratcliffe, Seena S; Flatow, Evan L

2015-01-01

Enhanced tendon and ligament repair would have a major impact on orthopaedic surgery outcomes, resulting in reduced repair failures and repeat surgeries, more rapid return to function, and reduced health care costs. Scaffolds have been used for mechanical and biologic reinforcement of repair and regeneration with mixed results. This review summarizes efforts made using biologic and synthetic scaffolds using rotator cuff and ACL as examples of clinical applications, discusses recent advances that have shown promising clinical outcomes, and provides insight into future therapy. PMID:25650098

Kinematic analysis of anterior cruciate ligament reconstruction in total knee arthroplasty

Science.gov (United States)

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

Reconstruction of the Anterior Cruciate Ligament : Alternative Strategies

NARCIS (Netherlands)

van Eijk, F.

2009-01-01

This thesis describes the long-term results of reconstruction of the anterior cruciate ligament with an allograft. Due to the poor results found, further studies were performed to investigate alternative strategies for reconstruction of the anterior cruciate ligament in the field of tissue

Reconstruction of the Anterior Cruciate Ligament : Alternative Strategies

OpenAIRE

van Eijk, F.

2009-01-01

This thesis describes the long-term results of reconstruction of the anterior cruciate ligament with an allograft. Due to the poor results found, further studies were performed to investigate alternative strategies for reconstruction of the anterior cruciate ligament in the field of tissue engineering.

The accuracy of MRI in assessing graft integrity after anterior cruciate ligament reconstruction

International Nuclear Information System (INIS)

Nakayama, Yoshihito; Shirai, Yasumasa; Narita, Tetsuya; Mori, Atsushi; Kobayashi, Kaoru

2001-01-01

To evaluate the efficacy of MRI in assessing anterior cruciate ligament (ACL) reconstruction graft integrity, we compared MRI findings with arthroscopic findings in 52 patients who had undergone arthroscopically assisted ACL reconstruction using semitendinosus and gracilis tendons augmented by woven polyester. MRI and arthroscopy were carried out 12 months after the operation. The MR appearance of ACL grafts was categorized into 3 types by signal intensity and continuity of the ligament according to Rak's method: well-defined type: the graft was visualized as a smoothly continuous band with low signal over the entire course; intermediate type: signal intensity increased and a low-signal band was visualized only in part of the graft; indiscernible type: the graft was not identified through the joint cavity due to markedly increased signal intensity. When the MR appearance of intermediate or indiscernible types was defined as torn, the grafts were presumed to be torn in 9 patients whose arthroscopic findings were 7 intact and 2 torn grafts. All cases with intact MRI findings were intact on arthroscopic examination. Thus, the sensitivity, specificity and accuracy of MRI as an evaluative tool for ACL graft tears were 100%, 86% and 86.5%, respectively. (author)

Reconstructed anterior cruciate ligaments using patellar tendon ligament grafts: diagnostic value of contrast-enhanced MRI in a 2-year follow-up regimen

Energy Technology Data Exchange (ETDEWEB)

Vogl, T.J.; Schmitt, J.; Lubrich, J.; Hochmuth, K.; Diebold, T. [Dept. of Diagnostic and Interventional Radiology, Frankfurt Univ. (Germany); Del Tredici, K. [Dept. of Clinical Neuroanatomy, Frankfurt Univ. (Germany); Suedkamp, N. [Dept. of Traumatology and Orthopedics, Humboldt University, Berlin (Germany)

2001-08-01

We analyzed prospectively the diagnostic efficacy of contrast-enhanced MRI following anterior cruciate neoligament (ACL) reconstruction. One hundred fifty-six MR examinations were performed 2, 12, 52, 76, and 104 weeks post-operatively on 68 patients with ACL transplants. Sagittal, parasagittal, and coronal images using unenhanced T1- and T2-weighted spin-echo sequences, and post-contrast images utilizing T1-weighted spin-echo and fat-saturated sequences, were acquired. Results were correlated with those of the pivot shift, Lachman, and a mechanical test. The MR examination criteria included morphological analysis, signal intensity, transplant contrast enhancement, secondary signs (e.g., elongation of normal ligaments), and comparison with clinically standardized test results. Two weeks post-operatively all neoligaments showed homogeneous low signal intensity on T1- and T2-weighted spin-echo sequences indistinguishable from that of normal cruciate or patellar ligaments [contrast-to-noise ratio (C/N) on T1:1.6], with a 9% percentile enhancement. At 12-52 weeks, signal intensity increased (C/N:6.7), with a mean 50% percentile enhancement. The 1-year follow-up allowed no definite assessment of the neoligament's course. At 76 and 104 weeks, significant decrements in signal intensity (C/N:3.0) and ligamentous percentile enhancement (25%) occurred. All patients tested displayed stable transplants 2 years post-operatively. Contrast-enhanced MRI allows accurate evaluation of morphology and function up to 3 months post-operatively and 1-2 years following ACL reconstructive surgery. (orig.)

Rotational and translational stability of different methods for direct acromioclavicular ligament repair in anatomic acromioclavicular joint reconstruction.

Science.gov (United States)

Beitzel, Knut; Obopilwe, Elifho; Apostolakos, John; Cote, Mark P; Russell, Ryan P; Charette, Ryan; Singh, Hardeep; Arciero, Robert A; Imhoff, Andreas B; Mazzocca, Augustus D

2014-09-01

Many reconstructions of acromioclavicular (AC) joint dislocations have focused on the coracoclavicular (CC) ligaments and neglected the functional contribution of the AC ligaments and the deltotrapezial fascia. To compare the modifications of previously published methods for direct AC reconstruction in addition to a CC reconstruction. The hypothesis was that there would be significant differences within the variations of surgical reconstructions. Controlled laboratory study. A total of 24 cadaveric shoulders were tested with a servohydraulic testing system. Two digitizing cameras evaluated the 3-dimensional movement. All reconstructions were based on a CC reconstruction using 2 clavicle tunnels and a tendon graft. The following techniques were used to reconstruct the AC ligaments: a graft was shuttled underneath the AC joint back from anterior and again sutured to the acromial side of the joint (group 1), a graft was fixed intramedullary in the acromion and distal clavicle (group 2), a graft was passed over the acromion and into an acromial tunnel (group 3), and a FiberTape was fixed in a cruciate configuration (group 4). Anterior, posterior, and superior translation, as well as anterior and posterior rotation, were tested. Group 1 showed significantly less posterior translation compared with the 3 other groups (P < .05) but did not show significant differences compared with the native joint. Groups 3 and 4 demonstrated significantly more posterior translation than the native joint. Group 1 showed significantly less anterior translation compared with groups 2 and 3. Group 3 demonstrated significantly more anterior translation than the native joint. Group 1 demonstrated significantly less superior translation compared with the other groups and with the native joint. The AC joint of group 1 was pulled apart less compared with all other reconstructions. Only group 1 reproduced the native joint for the anterior rotation at the posterior marker. Group 4 showed

Controlled Bioactive Molecules Delivery Strategies for Tendon and Ligament Tissue Engineering using Polymeric Nanofibers.

Science.gov (United States)

Hiong Teh, Thomas Kok; Hong Goh, James Cho; Toh, Siew Lok

2015-01-01

The interest in polymeric nanofibers has escalated over the past decade given its promise as tissue engineering scaffolds that can mimic the nanoscale structure of the native extracellular matrix. With functionalization of the polymeric nanofibers using bioactive molecules, localized signaling moieties can be established for the attached cells, to stimulate desired biological effects and direct cellular or tissue response. The inherently high surface area per unit mass of polymeric nanofibers can enhance cell adhesion, bioactive molecules loading and release efficiencies, and mass transfer properties. In this review article, the application of polymeric nanofibers for controlled bioactive molecules delivery will be discussed, with a focus on tendon and ligament tissue engineering. Various polymeric materials of different mechanical and degradation properties will be presented along with the nanofiber fabrication techniques explored. The bioactive molecules of interest for tendon and ligament tissue engineering, including growth factors and small molecules, will also be reviewed and compared in terms of their nanofiber incorporation strategies and release profiles. This article will also highlight and compare various innovative strategies to control the release of bioactive molecules spatiotemporally and explore an emerging tissue engineering strategy involving controlled multiple bioactive molecules sequential release. Finally, the review article concludes with challenges and future trends in the innovation and development of bioactive molecules delivery using polymeric nanofibers for tendon and ligament tissue engineering.

Trends in primary and revision anterior cruciate ligament reconstruction among National Basketball Association team physicians.

Science.gov (United States)

Mall, Nathan A; Abrams, Geoffrey D; Azar, Frederick M; Traina, Steve M; Allen, Answorth A; Parker, Richard; Cole, Brian J

2014-06-01

Anterior cruciate ligament (ACL) tears are common in athletes. Techniques and methods of treatment for these injuries continue to vary among surgeons. Thirty National Basketball Association (NBA) team physicians were surveyed during the NBA Pre-Draft Combine. Survey questions involved current and previous practice methods of primary and revision ACL reconstruction, including technique, graft choice, rehabilitation, and treatment of combined ACL and medial collateral ligament injuries. Descriptive parametric statistics, Fisher exact test, and logistic regression were used, and significance was set at α = 0.05. All 30 team physicians completed the survey. Eighty-seven percent indicated they use autograft (81% bone-patellar tendon-bone) for primary ACL reconstruction in NBA athletes, and 43% indicated they use autograft for revision cases. Fourteen surgeons (47%) indicated they use an anteromedial portal (AMP) for femoral tunnel drilling, whereas 5 years earlier only 4 (13%) used this technique. There was a significant (P = .009) positive correlation between fewer years in practice and AMP use. NBA team physicians' use of an AMP for femoral tunnel drilling has increased over the past 5 years.

Proteomic Analysis of Human Tendon and Ligament: Solubilization and Analysis of Insoluble Extracellular Matrix in Connective Tissues.

Science.gov (United States)

Sato, Nori; Taniguchi, Takako; Goda, Yuichiro; Kosaka, Hirofumi; Higashino, Kosaku; Sakai, Toshinori; Katoh, Shinsuke; Yasui, Natsuo; Sairyo, Koichi; Taniguchi, Hisaaki

2016-12-02

Connective tissues such as tendon, ligament and cartilage are mostly composed of extracellular matrix (ECM). These tissues are insoluble, mainly due to the highly cross-linked ECM proteins such as collagens. Difficulties obtaining suitable samples for mass spectrometric analysis render the application of modern proteomic technologies difficult. Complete solubilization of them would not only elucidate protein composition of normal tissues but also reveal pathophysiology of pathological tissues. Here we report complete solubilization of human Achilles tendon and yellow ligament, which is achieved by chemical digestion combined with successive protease treatment including elastase. The digestion mixture was subjected to liquid chromatography-mass spectrometry. The low specificity of elastase was overcome by accurate mass analysis achieved using FT-ICR-MS. In addition to the detailed proteome of both tissues, we also quantitatively determine the major protein composition of samples, by measuring peak area of some characteristic peptides detected in tissue samples and in purified proteins. As a result, differences between human Achilles tendon and yellow ligament were elucidated at molecular level.

Tissue-engineered collateral ligament composite allografts for scapholunate ligament reconstruction: an experimental study.

Science.gov (United States)

Endress, Ryan; Woon, Colin Y L; Farnebo, Simon J; Behn, Anthony; Bronstein, Joel; Pham, Hung; Yan, Xinrui; Gambhir, Sanjiv S; Chang, James

2012-08-01

In patients with chronic scapholunate (SL) dissociation or dynamic instability, ligament repair is often not possible, and surgical reconstruction is indicated. The ideal graft ligament would recreate both anatomical and biomechanical properties of the dorsal scapholunate ligament (dorsal SLIL). The finger proximal interphalangeal joint (PIP joint) collateral ligament could possibly be a substitute ligament. We harvested human PIP joint collateral ligaments and SL ligaments from 15 cadaveric limbs. We recorded ligament length, width, and thickness, and measured the biomechanical properties (ultimate load, stiffness, and displacement to failure) of native dorsal SLIL, untreated collateral ligaments, decellularized collateral ligaments, and SL repairs with bone-collateral ligament-bone composite collateral ligament grafts. As proof of concept, we then reseeded decellularized bone-collateral ligament-bone composite grafts with green fluorescent protein-labeled adipo-derived mesenchymal stem cells and evaluated them histologically. There was no difference in ultimate load, stiffness, and displacement to failure among native dorsal SLIL, untreated and decellularized collateral ligaments, and SL repairs with tissue-engineered collateral ligament grafts. With pair-matched untreated and decellularized scaffolds, there was no difference in ultimate load or stiffness. However, decellularized ligaments revealed lower displacement to failure compared with untreated ligaments. There was no difference in displacement between decellularized ligaments and native dorsal SLIL. We successfully decellularized grafts with recently described techniques, and they could be similarly reseeded. Proximal interphalangeal joint collateral ligament-based bone-collateral ligament-bone composite allografts had biomechanical properties similar to those of native dorsal SLIL. Decellularization did not adversely affect material properties. These tissue-engineered grafts may offer surgeons another

Anterior-Posterior Instability of the Knee Following ACL Reconstruction with Bone-Patellar Tendon-Bone Ligament in Comparison with Four-Strand Hamstrings Autograft

Directory of Open Access Journals (Sweden)

A. G. Angoules

2013-01-01

Full Text Available Purpose. To evaluate anterior-posterior knee laxity using two different autografts. Material-Methods. 40 patients, (34 males and 6 women, 17–54 years old (mean: 31, were included in the present study. Group A (4SHS = 20 underwent reconstruction using four-strand hamstrings, and group B (BPBT = 20 underwent reconstruction using bone-patellar tendon-bone autograft. Using the KT-1000 arthrometer, knee instability was calculated in both knees of all patients preoperatively and 3, 6, and 12 months after surgery at the ACL-operated knee. The contralateral healthy knee was used as an internal control group. Results. Anterior-posterior instability using the KT1000 Arthrometer was found to be increased after ACL insufficiency. The recorded laxity improved after arthroscopic ACL reconstruction in both groups. However, statistically significant greater values were detected in the bone-patellar tendon-bone group, which revealed reduction of anteroposterior stability values to an extent, where no statistical significance with the normal values even after 3 months after surgery was observed. Conclusions. Anterior-Posterior instability of the knee improved significantly after arthroscopic ACL reconstruction. The bone-patellar tendon-bone graft provided an obvious greater stability.

Double-bundle PCL reconstruction using autologous hamstring tendons: outcome with a minimum 2-year follow-up

Directory of Open Access Journals (Sweden)

Ricardo de Paula Leite Cury

Full Text Available ABSTRACT OBJECTIVE: To present the outcomes of posterior cruciate ligament (PCL double-bundle reconstruction using autologous hamstring tendons, with a minimum follow-up of two years. METHODS: Evaluation of 16 cases of PCL injury that underwent double-bundle reconstruction with autogenous hamstring tendons, between 2011 and 2013. The final sample consisted of 16 patients, 15 men and one woman, with a mean age of 31 years (21-49. The predominant mechanism was motorcycle accident in half of the cases. There was a mean interval of 15 months between the time of lesion and the surgery (three to 52 months. Five lesions were isolated and 11, associated. Clinical evaluation, application of validated scores, and measurements with use of the KT-1000 were performed. RESULTS: The analysis showed a mean preoperative Lysholm score of 50 points (28-87, progressing to 94 points (85-100 postoperatively. The IKDC score also demonstrated improvement. In the preoperative evaluation, four and 12 patients were respectively classified as C (abnormal and D (very unusual, and in the postoperative evaluation six as A (normal and ten as B (close to normal. In the post-operative evaluation by KT1000 arthrometer, 13 patients showed difference between 0-2 mm and 3 between 3 and 5 mm, when compared with the contralateral side. CONCLUSION: Autologous hamstring tendons are a viable option in double-bundle reconstruction of the PCL, with good clinical results in a minimum follow-up of two years.

Predictors and effects of patellofemoral pain following hamstring-tendon ACL reconstruction.

Science.gov (United States)

Culvenor, Adam G; Collins, Natalie J; Vicenzino, Bill; Cook, Jill L; Whitehead, Timothy S; Morris, Hayden G; Crossley, Kay M

2016-07-01

Patellofemoral pain is a frequent and troublesome complication following anterior cruciate ligament reconstruction (ACLR), irrespective of graft source. Yet, little is known about the factors associated with patellofemoral pain following hamstring-tendon ACLR. Retrospective analysis of potential patellofemoral pain predictors, and cross-sectional analysis of possible patellofemoral pain consequences. Potential predictors (pre-injury patellofemoral pain and activity level, concomitant patellofemoral cartilage damage and meniscectomy, age, sex, and surgical delay) and consequences (hopping performance, quality of life, kinesiophobia, and return to sport rates and attitudes) of patellofemoral pain 12 months following hamstring-tendon ACLR were assessed in 110 participants using univariate and multivariate analyses. Thirty-three participants (30%) had patellofemoral pain at 12 months post-ACLR. Older age at the time of ACLR was the only predictor of post-operative patellofemoral pain. Following ACLR, those with patellofemoral pain had a higher body mass index, and worse physical performance, quality of life, kinesiophobia and return to sport attitudes. Patellofemoral pain has a significant burden on individuals 12 months following hamstring-tendon ACLR. Clinicians need to be cognisant of patellofemoral pain, particularly in older individuals and those with a higher body mass index. The importance of considering psychological factors that are not typically addressed during ACLR rehabilitation, such as kinesiophobia, quality of life and return to sport attitudes is emphasised. Copyright © 2016. Published by Elsevier Ltd.

Can osseous landmarks in the distal medial humerus be used to identify the attachment sites of ligaments and tendons: paleopathologic-anatomic imaging study in cadavers

Energy Technology Data Exchange (ETDEWEB)

Buck, Florian M. [Veterans Administration Medical Center, Department of Radiology, San Diego, CA (United States); Institut fuer Diagnostische Radiologie, Uniklinik Balgrist, Zurich (Switzerland); Zoner, Cristiane S.; Cardoso, Fabiano; Gheno, Ramon; Nico, Marcelo A.C.; Trudell, Debra J.; Resnick, Donald [Veterans Administration Medical Center, Department of Radiology, San Diego, CA (United States); Randall, Tori D. [San Diego Museum of Man, Physical Anthropology, San Diego, CA (United States)

2010-09-15

To describe osseous landmarks that allow identification of the attachments of the ligaments and tendons in the distal medial aspect of the humerus. Reliable osseous landmarks in the distal medial aspect of the humerus were identified in 34 well-preserved specimens from a paleopathologic collection. These osseous landmarks were then sought in magnetic resonance (MR) images of ten cadaveric elbow specimens so that the ease of their visualization and optimal imaging plane could be assessed. To assign these osseous landmarks to specific attachments of the tendons and ligaments in the distal medial humerus, we cut the specimens in slices and photographed and examined them. Subsequently, the prevalence of these osseous landmarks as well as the attachment sites of the tendons and ligaments in this location was determined. We determined ten reliable osseous landmarks in the distal medial aspect of the humerus, their prevalence and ease of identification, and their relationship to the attachments of the tendons and ligaments at the medial distal humerus. It is possible to use osseous landmarks at the distal medial humerus to facilitate identification of the different attachments of tendons and ligaments when MR images of the elbow are assessed. (orig.)

Strength of suture anchor versus transosseous tunnel in anatomic reconstruction of the ankle lateral ligaments: a biomechanical study.

Science.gov (United States)

Li, Hong-Yun; Hua, Ying-Hui; Wu, Zi-Ying; Chen, Bo; Chen, Shi-Yi

2013-11-01

The purpose of this study was to compare the biomechanical characteristics of fixation with 2-suture anchors versus transosseous tunnel fixation in anatomic reconstruction of the ankle lateral ligaments. Six matched pairs of human cadaveric ankles underwent anatomic lateral ankle reconstruction, and fixation of the graft on the talus was achieved with 2 suture anchors or a transosseous tunnel. Ankles for the transosseous tunnel group were chosen at random, with the paired contralateral ankles used for the 2-suture anchor group. Half of the peroneus brevis tendon was harvested as a graft. For each technique, one end of the tendon was secured to the original insertion point of the anterior talofibular ligament (ATFL) at the talus, whereas the other end was armed with 2 No. 5 nonabsorbable sutures (Ethicon, Somerville, NJ) and passed through the bone tunnel in the fibula. Biomechanical testing was performed by applying the force in line with the graft. Load to failure was determined at a displacement rate of 50 mm/min. The load-displacement curve, maximum load at failure (N), and stiffness (N/mm) were recorded and compared between the 2 techniques. There was no difference between constructs in the 2-suture anchor group and the transosseous tunnel group in terms of the ultimate load and stiffness (161.8 ± 47.6 N v 171.9 ± 76.0 N; P = .92; 4.59 ± 1.85 N/mm v 5.77 ± 1.98 N/mm; P = .35). Most constructs failed because of anchor pullout in the 2-suture anchor group (5 of 6) and fracture of the bony bridge in the transosseous tunnel group (6 of 6). The strength of fixation with suture anchors in anatomic reconstruction of the ankle lateral ligaments was equivalent to transosseous tunnel fixation as determined with biomechanical testing. However, this study did not prove that one is advantageous over the other. Both techniques showed excellent biomechanical results. Therefore, the 2-suture anchor fixation approach can be safely used in anatomic reconstruction of the

Psychological Aspects of Recovery Following Anterior Cruciate Ligament Reconstruction.

Science.gov (United States)

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. Copyright 2015 by the American Academy of Orthopaedic Surgeons.

[EFFECT OF RECOMBINANT ADENOVIRUS-BONE MORPHOGENETIC PROTEIN 12 TRANSFECTION ON DIFFERENTIATION OF PERIPHERAL BLOOD MESENCHYMAL STEM CELLS INTO TENDON/LIGAMENT CELLS].

Science.gov (United States)

Fu, Weili; Chen, Gang; Tang, Xin; Li, Qi; Ll, Jian

2015-04-01

To research the effect of recombinant adenovirus-bone morphogenetic protein 12 (Ad-BMP-12) transfection on the differentiation of peripheral blood mesenchymal stem cells (MSCs) into tendon/ligament cells. Peripheral blood MSCs were isolated from New Zealand rabbits (3-4 months old) and cultured in vitro until passage 3. The recombinant adenoviral vector system was prepared using AdEasy system, then transfected into MSCs at passage 3 (transfected group); untransfected MSCs served as control (untransfected group). The morphological characteristics and growth of transfected cells were observed under inverted phase contrast microscope. The transfection efficiency and green fluorescent protein (GFP) expression were detected by flow cytometry (FCM) and fluorescence microscopy. After cultured for 14 days in vitro, the expressions of tendon/ligament-specific markers were determined by immunohistochemistry and real-time fluorescent quantitative PCR. GFP expression could be observed in peripheral blood MSCs at 8 hours after transfection. At 24 hours after transfection, the cells had clear morphology and grew slowly under inverted phase contrast microscope and almost all expressed GFP at the same field under fluorescence microscopy. FCM analysis showed that the transfection efficiency of the transfected group was 99.57%, while it was 2.46% in the untransfected group. The immunohistochemistry showed that the expression of collagen type I gradually increased with culture time in vitro. Real-time fluorescent quantitative PCR results showed that the mRNA expressions of the tendon/ligament-specific genes (Tenomodulin, Tenascin-C, and Decorin) in the transfected group were significantly higher than those in untransfected group (0.061+/- 0.013 vs. 0.004 +/- 0.002, t = -7.700, P=0.031; 0.029 +/- 0.008 vs. 0.003 +/- 0.001, t = -5.741, P=0.020; 0.679 +/- 0.067 vs. 0.142 +/- 0.024, t = -12.998, P=0.000). Ad-BMP-12 can significantly promote differentiation of peripheral blood MSCs into

Proteomic differences between native and tissue?engineered tendon and ligament

OpenAIRE

Kharaz, Yalda A.; Tew, Simon R.; Peffers, Mandy; Canty?Laird, Elizabeth G.; Comerford, Eithne

2016-01-01

Tendons and ligaments (T/Ls) play key roles in the musculoskeletal system, but they are susceptible to traumatic or age?related rupture, leading to severe morbidity as well as increased susceptibility to degenerative joint diseases such as osteoarthritis. Tissue engineering represents an attractive therapeutic approach to treating T/L injury but it is hampered by our poor understanding of the defining characteristics of the two tissues. The present study aimed to determine differences in the ...

Sports Injury-Related Fingers and Thumb Deformity Due to Tendon or Ligament Rupture

Directory of Open Access Journals (Sweden)

Rong-Jie Bai

2018-01-01

Conclusions: Sports injury-related fingers and thumb deformity are relatively common. MRI is an accurate method for evaluation of the anatomy and pathologic conditions of the fingers and thumb. It is a useful tool for accurate diagnosis of the sports-related ligaments and tendons injuries in hand.

Revision allograft reconstruction of the lateral collateral ligament complex in elbows with previous failed reconstruction and persistent posterolateral rotatory instability.

Science.gov (United States)

Baghdadi, Yaser M K; Morrey, Bernard F; O'Driscoll, Shawn W; Steinmann, Scott P; Sanchez-Sotelo, Joaquin

2014-07-01

Primary reconstruction of the lateral collateral ligament complex (LCLC) using graft tissue restores elbow stability in many, but not all, elbows with acute or chronic posterolateral rotatory instability (PLRI). Revision reconstruction using a tendon allograft is occasionally considered for persistent PLRI, but the outcome of revision ligament reconstruction in this setting is largely unknown. We determined whether revision allograft ligament reconstruction can (1) restore the stability and (2) result in improved elbow scores for patients with persistent PLRI of the elbow after a previous failed primary reconstructive attempt and in the context of the diverse pathology being addressed. Between 2001 and 2011, 160 surgical elbow procedures were performed at our institution for the LCLC reconstruction using allograft tissue. Only patients undergoing revision allograft reconstruction of the LCLC for persistent PLRI with a previous failed primary reconstructive attempt using graft tissue and at least I year of followup were included in the study. Eleven patients (11 elbows) fulfilled our inclusion criteria and formed our study cohort. The cohort consisted of six female patients and five male patients. The mean age at the time of revision surgery was 36 years (range, 14-59 years). The revision allograft reconstruction was carried out after a mean of 3 years (range, 2.5 months to 9 years) from a failed attempted reconstruction of the LCLC. Osseous deficiency to some extent was identified in the preoperative radiographs of eight elbows. Mean followup was 5 years (range, 1-12 years). Revision allograft reconstruction of the LCLC restored elbow stability in eight of the 11 elbows; two of the three elbows with persistent instability were operated on a third time (at 6 and 7 months after allograft revision reconstruction). For elbows with no persistent instability, the mean Mayo Elbow Performance Score at most recent followup was 83 points (range, 60-100 points), and

Tissue engineering of ligaments for reconstructive surgery.

Science.gov (United States)

Hogan, MaCalus V; Kawakami, Yohei; Murawski, Christopher D; Fu, Freddie H

2015-05-01

The use of musculoskeletal bioengineering and regenerative medicine applications in orthopaedic surgery has continued to evolve. The aim of this systematic review was to address tissue-engineering strategies for knee ligament reconstruction. A systematic review of PubMed/Medline using the terms "knee AND ligament" AND "tissue engineering" OR "regenerative medicine" was performed. Two authors performed the search, independently assessed the studies for inclusion, and extracted the data for inclusion in the review. Both preclinical and clinical studies were reviewed, and the articles deemed most relevant were included in this article to provide relevant basic science and recent clinical translational knowledge concerning "tissue-engineering" strategies currently used in knee ligament reconstruction. A total of 224 articles were reviewed in our initial PubMed search. Non-English-language studies were excluded. Clinical and preclinical studies were identified, and those with a focus on knee ligament tissue-engineering strategies including stem cell-based therapies, growth factor administration, hybrid biomaterial, and scaffold development, as well as mechanical stimulation modalities, were reviewed. The body of knowledge surrounding tissue-engineering strategies for ligament reconstruction continues to expand. Presently, various tissue-engineering techniques have some potential advantages, including faster recovery, better ligamentization, and possibly, a reduction of recurrence. Preclinical research of these novel therapies continues to provide promising results. There remains a need for well-designed, high-powered comparative clinical studies to serve as a foundation for successful translation into the clinical setting going forward. Level IV, systematic review of Level IV studies. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Kinematic analysis of anterior cruciate ligament reconstruction in total knee arthroplasty

OpenAIRE

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 ima...

In vivo structural and cellular remodeling of engineered bone-ligament-bone constructs used for anterior cruciate ligament reconstruction in sheep.

Science.gov (United States)

Florida, Shelby E; VanDusen, Keith W; Mahalingam, Vasudevan D; Schlientz, Aleesa J; Wojtys, Edward M; Wellik, Deneen M; Larkin, Lisa M

2016-11-01

Anterior cruciate ligament (ACL) ruptures rank among the most prevalent and costly sports-related injuries. Current tendon grafts used for ACL reconstruction are limited by suboptimal biomechanical properties. We have addressed these issues by engineering multiphasic bone-ligament-bone (BLB) constructs that develop structural and mechanical properties similar to native ACL. The purpose of this study was to examine the acute remodeling process that occurs as the BLB grafts advance toward the adult ligament phenotype in vivo. Thus, we implanted BLB constructs fabricated from male cells into female host sheep and allowed 3, 7, 14, or 28 days (n = 4 at each time point) for recovery. To address whether or not graft-derived cells were even necessary, a subset of BLB constructs (n = 3) were acellularized, implanted, and allowed 28 days for recovery. At each recovery time point, the following histological analyses were performed: picrosirius red staining to assess collagen alignment and immunohistochemistry to assess both graft development and host immune response. Polymerase chain reaction (PCR) analysis, performed on every explanted BLB, was used to detect the presence of graft-derived male cells remaining in the constructs and/or migration into surrounding host tissue. The analysis of the PCR and histology samples revealed a rapid migration of host-derived macrophages and neutrophils into the graft at 3 days, followed by increased collagen density and alignment, vascularization, innervation, and near complete repopulation of the graft with host cells within 28 days. This study provides a greater understanding of the processes of ligament regeneration in our BLB constructs as they remodel toward the adult ligament phenotype.

Braided nanofibrous scaffold for tendon and ligament tissue engineering.

Science.gov (United States)

Barber, John G; Handorf, Andrew M; Allee, Tyler J; Li, Wan-Ju

2013-06-01

Tendon and ligament (T/L) injuries present an important clinical challenge due to their intrinsically poor healing capacity. Natural healing typically leads to the formation of scar-like tissue possessing inferior mechanical properties. Therefore, tissue engineering has gained considerable attention as a promising alternative for T/L repair. In this study, we fabricated braided nanofibrous scaffolds (BNFSs) as a potential construct for T/L tissue engineering. Scaffolds were fabricated by braiding 3, 4, or 5 aligned bundles of electrospun poly(L-lactic acid) nanofibers, thus introducing an additional degree of flexibility to alter the mechanical properties of individual scaffolds. We observed that the Young's modulus, yield stress, and ultimate stress were all increased in the 3-bundle compared to the 4- and 5-bundle BNFSs. Interestingly, acellular BNFSs mimicked the normal tri-phasic mechanical behavior of native tendon and ligament (T/L) during loading. When cultured on the BNFSs, human mesenchymal stem cells (hMSCs) adhered, aligned parallel to the length of the nanofibers, and displayed a concomitant realignment of the actin cytoskeleton. In addition, the BNFSs supported hMSC proliferation and induced an upregulation in the expression of key pluripotency genes. When cultured on BNFSs in the presence of tenogenic growth factors and stimulated with cyclic tensile strain, hMSCs differentiated into the tenogenic lineage, evidenced most notably by the significant upregulation of Scleraxis gene expression. These results demonstrate that BNFSs provide a versatile scaffold capable of supporting both stem cell expansion and differentiation for T/L tissue engineering applications.

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

Science.gov (United States)

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. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

[Case-control study on Chinese medicine fumigation and massage therapy for the treatment of knee stability and func tional recovery after anterior cruciate ligament reconstruction operation].

Science.gov (United States)

Min, Zhong-han; Zhou, Ying; Jing, Lin; Zhang, Hong-mei; Wang, Sheng; Chen, Wei-heng; Chen, Ping-quan

2016-05-01

To study clinical outcomes of Chinese medidine fumigation and massage therapy for the treatment of knee stability and functional recovery after anterior cruciate ligament reconstruction operation,and to explore the effect on tendon-bone healing. Total 50 patients were divided into two groups: the control group (normal rehabilitation therapy group),the treatment group (Chinese medicine fumigation and manipulation group). There were 25 patients in the control group, including 16 males and 9 females, who were treated with isometric muscle training, with the gradually enlarging amplitude of flexion and progressive loading of bearing training for knee recovery. There were 25 patients in the treatment group, including 15 males and 10 females,who were treated with the conventional rehabilitation therapy combined with Chinese medicine fumigation and massage therapy. The Chinese herbs named as Haitongpi decoction was steamed by a special equipment to fumigate the knee after operation; Based on the biomechanical parameters of the ligament reconstruction, the massage therapy was designed to control the degree of the knee flexion and release the adhesion for early recovery of knee functions. The Lysholm knee function evaluation system was used, and MRI examination was performed to measure the change in width of ligament tunnel in femur and tibia to evaluate the safety and stability of the treatment. Lysholm system showed that two groups both had improving results from the 1st month after operation to the 3rd month (treatment group, F=36.54, P0.05), indicating that Chinese rehabilitation therapy was a safety treatment without the influence on the loosing of tendon. Chinese medicine fumigation and massage therapy can early improve the knee function after the anterior cruciate ligament reconstruction operation without the disturbance of the knee stability.

[Experimental study on co-culture of human fibroblasts on decellularized Achilles tendon].

Science.gov (United States)

Wang, Zhibing; Zhang, Xia; Guo, Xinyu; Qin, Chuan

2013-07-01

To investigate the preparation of decellularized Achilles tendons and the effect of co-culture of human fibroblasts on the scaffold so as to provide a scaffold for the tissue engineered ligament reconstruction. Achilles tendons of both hind limbs were harvested from 10 male New Zealand white rabbits (5-month-old; weighing, 4-5 kg). The Achilles tendons were decellularized using trypsin, Triton X-100, and sodium dodecyl sulfate (SDS), and then gross observation, histological examination, and scanning electron microscope (SEM) observation were performed; the human fibroblasts were seeded on the decellularized Achilles tendon, and then cytocompatibility was tested using the cell counting kit 8 method at 1, 3, 5, 7, and 9 days after co-culture. At 4 weeks after co-culture, SEM, HE staining, and biomechanical test were performed for observing cell-scaffold composite, and a comparison was made with before and after decellularization. After decellularization, the tendons had integrated aponeurosis and enlarged volume with soft texture and good toughness; there was no loose connective tissue and tendon cells between tendon bundles, the collagen fibers arranged loosely with three-dimensional network structure and more pores between tendon bundles; and it had good cytocompatibility. At 4 weeks after co-culture, cells migrated into the pores, and three-dimensional network structure disappeared. By biomechanical test, the tensile strength and Young's elastic modulus of the decellularized Achilles tendon group decreased significantly when compared with normal Achilles tendons group and cell-scaffold composite group (P Achilles tendons group and cell-scaffold composite group (P > 0.05). There was no significant difference in elongation at break among 3 groups (P > 0.05). The decellularized Achilles tendon is biocompatible to fibroblasts. It is suit for the scaffold for tissue engineered ligament reconstruction.

Dose-dependent variations in blood flow evaluation of canine nerve, nerve graft, tendon, and ligament tissue by the radiolabeled-microsphere technique

International Nuclear Information System (INIS)

Riggi, K.; Wood, M.B.; Ilstrup, D.M.

1990-01-01

This study evaluates the dose-dependent accuracy of the radionuclide-labeled microsphere technique for blood flow evaluation in nerve, tendon, and ligament. In eight dogs, blood flows were determined for nerve, nerve graft, tendon, and ligament tissue by simultaneous injection of high- and low-dose microspheres with different radiolabels. The results demonstrated no significant differences in blood flow as measured from the small number of microspheres (less than 400) and the high number (more than 400) for nerve and tendon tissue. For nerve tissue, microsphere counts of 50 to 100, 100 to 200, 200 to 300, and more than 300 produced mean percentage errors of 12.74% (n = 5, SEM = 4.52), 5.45% (n = 13, SEM = 1.22), 10.22% (n = 6, SEM = 4.37), and 17.08% (n = 12, SEM = 3.30), respectively. For tendon tissue, the same microsphere subdivisions had mean percentage errors of 7.47% (n = 4, SEM = 2.66), 3.63% (n = 6, SEM = 1.34), 15.54% (n = 4, SEM = 4.43), and 12.91% (n = 1), respectively. For ligament tissue, percentage errors were consistently higher; microsphere counts of 30 to 100, 100 to 200, and 200 to 300 produced mean errors of 20.14% (n = 4, SEM = 6.38), 18.66% (n = 4, SEM = 6.24), and 25.78% (n = 2, SEM = 1.97), respectively. Although there was no direct relationship between percentage error and number of microspheres retrieved, we suggest that microsphere counts in the range of 100 to 200 should be considered acceptable for nerve and tendon in the canine. Ligament tissue seems to be less well suited to the microsphere technique; however, further study is warranted

Immediate postoperative anterior knee stability: double- versus triple-bundle anterior cruciate ligament reconstructions.

Science.gov (United States)

Mae, Tatsuo; Shino, Konsei; Matsumoto, Norinao; Yoneda, Kenji; Yoshikawa, Hideki; Nakata, Ken

2013-02-01

The purpose of this study was to compare the triple-bundle (TB) anterior cruciate ligament (ACL) reconstruction with the double-bundle (DB) ACL reconstruction in immediate postoperative anterior knee stability. This study involved 133 patients who had undergone the anatomic ACL reconstruction with autogenous hamstring tendon unilaterally. Then 83 patients (mean age, 28.8 years) underwent the DB between November 2004 and December 2005, and 50 patients (mean age, 29.6 years) underwent the TB ACL reconstruction between January and December 2006. The 2 femoral tunnels were created in the ideal ACL attachment area, whereas 2 tibial tunnels for the DB and 3 tunnels for the TB were created in the ACL footprint. The 2 doubled tendon grafts were fixed with EndoButton-CL (Smith & Nephew Endoscopy, Andover, MA) on the femur. The grafts were fixed to the tibia using a Double Spike Plate and a screw under the total initial tension of 20 N at 20° of flexion, after meticulous in situ pretensioning using a tensioning boot. Then immediate postoperative anterior knee laxity in response to 89 N of anterior load was measured by one experienced examiner (T.M.) with the KT-2000 Knee Arthrometer (MEDmedtric, San Diego, CA) under general anesthesia at 30° of knee flexion with muscle relaxants. The measured anterior laxity was 3.4 ± 1.2 mm in the DB and 2.5 ± 0.7 mm in the TB ACL reconstruction, a statistically significant difference. The side-to-side difference of the laxity was -3.2 ± 1.6 mm in the DB and -4.2 ± 2.0 mm in the TB, again a significant difference. TB ACL reconstruction resulted in better immediate postoperative anterior knee stability than DB ACL reconstruction under 89 N of anterior tibial load (P = .031). Level III, therapeutic retrospective comparative study. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Influence of the position of the foot on MRI signal in the deep digital flexor tendon and collateral ligaments of the distal interphalangeal joint in the standing horse.

Science.gov (United States)

Spriet, M; Zwingenberger, A

2009-05-01

Hyperintense signal is sometimes observed in ligaments and tendons of the equine foot on standing magnetic resonance examination without associated changes in size and shape. In such cases, the presence of a true lesion or an artifact should be considered. A change in position of a ligament or tendon relative to the magnetic field can induce increased signal intensity due to the magic angle effect. To assess if positional rotation of the foot in the solar plane could be responsible for artifactual changes in signal intensity in the collateral ligaments of the distal interphalangeal joint and in the deep digital flexor tendon. Six isolated equine feet were imaged with a standing equine magnetic resonance system in 9 different positions with different degrees of rotation in the solar plane. Rotation of the limb induced a linear hyperintense signal on all feet at the palmar aspect of one of the lobes of the deep digital flexor tendon and at the dorsal aspect of the other lobe. Changes in signal intensity in the collateral ligaments of the distal interphalangeal joint occurred with rotation of the limb only in those feet where mediolateral hoof imbalance was present. The position and conformation of the foot influence the signal intensity in the deep digital flexor tendon and in the collateral ligaments of the distal interphalangeal joint. The significance of increased signal intensity in the deep digital flexor tendon and in the collateral ligaments of the distal interphalangeal joint should be interpreted with regard to the position and the conformation of the foot.

Biomechanical and immunohistochemical analysis of high hydrostatic pressure-treated Achilles tendons

International Nuclear Information System (INIS)

Diehl, P.; Steinhauser, E.; Gollwitzer, H.; Heister, C.; Schauwecker, J.; Schmitt, M.; Milz, S.; Mittelmeier, W.

2006-01-01

Reconstruction of bone defects caused by malignant tumors is carried out in different ways. At present, tumor-bearing bone segments are devitalized mainly by extracorporeal irradiation or autoclaving, but both methods have substantial disadvantages. In this regard, high hydrostatic pressure (HHP) treatment of the bone is a new, advancing technology that has been used in preclinical testing to inactivate normal cells and tumor cells without altering the biomechanical properties of the bone. The aim of this study was to examine the biomechanical and immunohistochemical properties of tendons after exposure to HHP and to evaluate whether preservation of the bony attachment of tendons and ligaments is possible. For this, 19 paired Achilles tendons were harvested from both hindlimbs of 4-month-old pigs. After preparation, the cross-sectional area of each tendon was determined by magnetic resonance imaging (MRI). For each animal, one of the two tendons was taken at random and exposed to a pressure of 300 MPa (n=9) or 600 MPa (n=10). The contralateral tendon served as an untreated control. The biomechanical properties of the tendons remained unchanged with respect to the tested parameters: Young's modulus (MPa) and tensile strength (MPa). This finding is in line with immunohistochemical labeling results, as no difference in the labeling pattern of collagen I and versican was observed when comparing the HHP group (at 600 MPa) to the untreated control group. We anticipate that during orthopedic surgery HHP can serve as a novel, promising methodical approach to inactivate Achilles tendon and bone cells without altering the biomechanical properties of the tendons. This should allow one to preserve the attachment of tendon and ligaments to the devitalized bone and to facilitate functional reconstruction. (author)

Ectopic mineralization of cartilage and collagen-rich tendons and ligaments in Enpp1asj-2J mice.

Science.gov (United States)

Zhang, Jieyu; Dyment, Nathaniel A; Rowe, David W; Siu, Sarah Y; Sundberg, John P; Uitto, Jouni; Li, Qiaoli

2016-03-15

Generalized arterial calcification of infancy (GACI), an autosomal recessive disorder caused by mutations in the ENPP1 gene, manifests with extensive mineralization of the cardiovascular system. A spontaneous asj-2J mutant mouse has been characterized as a model for GACI. Previous studies focused on phenotypic characterization of skin and vascular tissues. This study further examined the ectopic mineralization phenotype of cartilage, collagen-rich tendons and ligaments in this mouse model. The mice were placed on either control diet or the "acceleration diet" for up to 12 weeks of age. Soft connective tissues, such as ear (elastic cartilage) and trachea (hyaline cartilage), were processed for standard histology. Assessment of ectopic mineralization in articular cartilage and fibrocartilage as well as tendons and ligaments which are attached to long bones were performed using a novel cryo-histological method without decalcification. These analyses demonstrated ectopic mineralization in cartilages as well as tendons and ligaments in the homozygous asj-2J mice at 12 weeks of age, with the presence of immature osteophytes displaying alkaline phosphatase and tartrate-resistant acid phosphatase activities as early as at 6 weeks of age. Alkaline phosphatase activity was significantly increased in asj-2J mouse serum as compared to wild type mice, indicating increased bone formation rate in these mice. Together, these data highlight the key role of ENPP1 in regulating calcification of both soft and skeletal tissues.

Trochleoplasty and medial patellofemoral ligament reconstruction for recurrent patellar dislocation

Directory of Open Access Journals (Sweden)

K Raghuveer Reddy

2012-01-01

Full Text Available We report a case of recurrent patellar dislocation with high-grade trochlear dysplasia which persisted despite two previous operations. We did a Dejour′s sulcus deepening trochleoplasty, medial patellofemoral ligament reconstruction, and lateral retinacular release. Trochleoplasty and medial patellofemoral ligament reconstruction is required in patients with high grade trochlear dysplasia.

Heparin functionalization increases retention of TGF-β2 and GDF5 on biphasic silk fibroin scaffolds for tendon/ligament-to-bone tissue engineering.

Science.gov (United States)

Font Tellado, Sònia; Chiera, Silvia; Bonani, Walter; Poh, Patrina S P; Migliaresi, Claudio; Motta, Antonella; Balmayor, Elizabeth R; van Griensven, Martijn

2018-05-01

The tendon/ligament-to-bone transition (enthesis) is a highly specialized interphase tissue with structural gradients of extracellular matrix composition, collagen molecule alignment and mineralization. These structural features are essential for enthesis function, but are often not regenerated after injury. Tissue engineering is a promising strategy for enthesis repair. Engineering of complex tissue interphases such as the enthesis is likely to require a combination of biophysical, biological and chemical cues to achieve functional tissue regeneration. In this study, we cultured human primary adipose-derived mesenchymal stem cells (AdMCs) on biphasic silk fibroin scaffolds with integrated anisotropic (tendon/ligament-like) and isotropic (bone/cartilage like) pore alignment. We functionalized those scaffolds with heparin and explored their ability to deliver transforming growth factor β2 (TGF-β2) and growth/differentiation factor 5 (GDF5). Heparin functionalization increased the amount of TGF-β2 and GDF5 remaining attached to the scaffold matrix and resulted in biological effects at low growth factor doses. We analyzed the combined impact of pore alignment and growth factors on AdMSCs. TGF-β2 and pore anisotropy synergistically increased the expression of tendon/ligament markers and collagen I protein content. In addition, the combined delivery of TGF-β2 and GDF5 enhanced the expression of cartilage markers and collagen II protein content on substrates with isotropic porosity, whereas enthesis markers were enhanced in areas of mixed anisotropic/isotropic porosity. Altogether, the data obtained in this study improves current understanding on the combined effects of biological and structural cues on stem cell fate and presents a promising strategy for tendon/ligament-to-bone regeneration. Regeneration of the tendon/ligament-to-bone interphase (enthesis) is of significance in the repair of ruptured tendons/ligaments to bone to improve implant integration and

Histological Observation of Regions around Bone Tunnels after Compression of the Bone Tunnel Wall in Ligament Reconstruction

International Nuclear Information System (INIS)

Maeda, Shintaro; Ishikawa, Hiroki; Tanigawa, Naoaki; Miyazaki, Kyosuke; Shioda, Seiji

2012-01-01

The objectives of this study were to investigate the time-course of influence of compression of bone tunnel wall in ligament reconstruction on tissue around the bone tunnel and to histologically examine the mechanism of preventing the complication of bone tunnel dilation, using rabbit tibia. A model in which the femoral origin of the extensor digitorum longus tendon was cut and inserted into a bone tunnel made proximal to the tibia was prepared in the bilateral hind legs of 20 Japanese white rabbits. In each animal, a tunnel was made using a drill only in the right leg, while an undersized bone tunnel was made by drilling and then dilated by compression using a dilator to the same tunnel size as that in the right leg. Animals were sacrificed at 0, 2, 4, 8 and 12 weeks after surgery (4 animals at each time point). Observation of bone tunnels by X-ray radiography showed osteosclerosis in the 2- and 4-week dilation groups. Osteosclerosis appeared as white lines around the bone tunnel on X-ray radiography. This suggests that dilation promotes callus formation in the bone tunnel wall and prevents the complication of bone tunnel enlargement after ligament reconstruction

A Biomechanical Analysis of Different Clavicular Tunnel Diameters in Anatomic Acromioclavicular Ligament Reconstruction.

Science.gov (United States)

Voss, Andreas; Beitzel, Knut; Alaee, Farhang; Dukas, Alex; Herbst, Elmar; Obopilwe, Elifho; Apostolakos, John; DiVenere, Jessica; Singh, Hardeep; Cote, Mark P; Mazzocca, Augustus D

2016-08-01

To evaluate the biomechanical stability of a tendon-to-clavicle bone interface fixation of a graft in revision acromioclavicular reconstruction. Fifteen fresh-frozen cadaveric shoulders were used. All specimens underwent bone density evaluation. For the primary reconstruction, a 5-mm semitendinosus allograft was inserted into a 5-mm bone tunnel at 25 and 45 mm from the lateral end of the clavicle using a 5.5 × 8-mm PEEK (polyether ether ketone) tenodesis screw. Each single graft was fixed in a cryo-clamp and cyclically loaded from 5 to 70 N for 3,000 cycles, followed by load-to-failure testing at a rate of 120 mm/min to simulate the revision case. To simulate tunnel widening, the tunnels of the revision series were over-drilled with an 8-mm drill, and a 5-mm semitendinosus graft with an 8 × 12-mm PEEK tenodesis screw was inserted. Biomechanical testing was then repeated. The bone mineral density analysis showed a significantly higher density at the 45-mm hole compared with the 25-mm hole (P = .001). The ultimate load to failure increased from the 5.5-mm screw to the 8-mm screw at the 45-mm hole position (P = .001). There was no statistically significant difference at the 25-mm hole position (P = .934). No statistical significance for graft elongation comparing the 5.5-mm screw and the 8-mm screw at the 25-mm (P = .156) and 45-mm (P = .334) positions could be found. Comparable biomechanical stability for the tendon-to-bone interface fixation in different clavicular tunnel diameters simulating primary and revision reconstruction was achieved. There is a lack of literature regarding revision acromioclavicular joint reconstruction, but our biomechanical results show comparable stability to primary reconstruction. These data provide support for the use of anatomic acromioclavicular ligament reconstruction in revision cases. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Clinical evaluation of bone- patellar tendon- bone grafts for anterior cruciate ligament injury

International Nuclear Information System (INIS)

Nakamura, Yasuhiro

2011-01-01

One thousand and thirty-eight cases of Anterior Cruciate Ligament (ACL) rupture were treated between January 2002 and November 2010. Eight hundred sixty-six cases (83.9%) were observed for at least six months. All cases were reconstructed with a bone to tendon to bone (BTB) graft from the patella. Much effort was made to return the patient to a competitive sports activity level within one year. The age at suffering from the initial injury ranged from 9 to 74 years old with a mean of 24.7 years old. There were 493 female (50.7%) and 427 male (49.3%) cases. The injured side was right in 408 cases and left in 458 cases. The mean postoperative observation period was 449.2 days. The number of patients who felt 80% or more certain that they could return to competitive sports activities was 538 (61.9%). From the MRI findings, continuity of the reconstructed graft was observed in 793 cases (98.5%). Arthroscopy after reconstruction was performed in 775 cases (89.5%). The reconstructed ACL was observed to be covered with an adequate synovium in 629 cases (81.2%). The medial meniscus and lateral meniscus showed no changes in 657 cases (84.8%) and 666 cases (85.9%) respectively. Reconstructions performed less than two weeks after injury showed no significant differences in terms of Range Of Motion (ROM), arthroscopic findings, or the number of patients who could return to competitive sports activities. Statistically significantly more patients who underwent their reconstruction at an age over forty experienced a loss motion of five degree in extension or ten degree in flexion and resumed a lower level of sports activities. Patients who underwent the reconstruction could return to exercises for muscle strengthening and ROMs within 2 weeks. Patients over forty years old who underwent their reconstruction could prevent their menisci from fraying, tearing, or undergoing osteoarthritic changes. (author)

Extra-articular subcutaneous "inverted king post-truss" ligament reconstruction for severe swan neck deformity (snapping finger).

Science.gov (United States)

de Soras, X; de Mourgues, P; Pradel, P; Urien, J-P; Beaudoin, E

2017-02-01

A swan neck deformity (SND) can be well tolerated for a long time, until the appearance of a disabling "snapping finger". In its most advanced condition, the other hand is needed to initiate finger flexion. We propose a technique of extra-articular, subcutaneous ligament reconstruction with an "inverted king post-truss" configuration use in roofs and to reinforce railway bridges. An artificial ligament (MaxBraid™ polyethylene surgical suture, 5 metric, Biomet) makes a figure of eight between transosseous tunnels in the proximal and middle phalanges, crossing over top of the A3 pulley. We limited our series to severe SND cases with "snapping finger". We excluded isolated SNDs without functional disability. Eleven patients were followed for 3.4 years on average. The cause was an acute injury 8 times (7 balloon accidents), rheumatoid arthritis 2 times and overuse once (saxophone). Only one case was a poor outcome of mallet finger. The 11 patients were reassessed by a telephone survey. Two patients underwent reoperation: one for a ligament rupture, the other one for a knot that became untied. One patient had a suspected late rupture but without recurrence of the disabling snapping finger. The 11 patients considered themselves improved by the intervention. Nine patients did not notice any difference between their operated finger and the contralateral side. Return to manual activity was possible once the skin had healed. The technique is simpler than the spiral oblique retinacular ligament (SORL) reconstruction technique described by Thomson-Littler and also less demanding because it does not involve the distal interphalangeal joint. It requires only a short incision in the volar crease of the proximal interphalangeal joint. No tendon or ligament is sacrificed. Neither postoperative immobilization nor lengthy physical therapy is needed. Complications can be avoided by selecting the appropriate artificial ligament material and careful knot tying. Copyright © 2016 SFCM

Anterior Cruciate Ligament Reconstruction in Ehlers-Danlos Syndrome

Directory of Open Access Journals (Sweden)

John Williams

2015-01-01

Full Text Available 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.

Acromioclavicular joint reconstruction with coracoacromial ligament transfer using the docking technique

Directory of Open Access Journals (Sweden)

Gobezie Reuben

2009-01-01

Full Text Available Abstract Background Symptomatic Acromioclavicular (AC dislocations have historically been surgically treated with Coracoclavicular (CC ligament reconstruction with transfer of the Coracoacromial (CA ligament. Tensioning the CA ligament is the key to success. Methods Seventeen patients with chronic, symptomatic Type III AC joint or acute Type IV and V injuries were treated surgically. The distal clavicle was resected and stabilized with CC ligament reconstruction using the CA ligament. The CA ligament was passed into the medullary canal and tensioned, using a modified 'docking' technique. Average follow-up was 29 months (range 12–57. Results Postoperative ASES and pain significantly improved in all patients (p = 0.001. Radiographically, 16 (94% maintained reduction, and only 1 (6% had a recurrent dislocation when he returned to karate 3 months postoperatively. His ultimate clinical outcome was excellent. Conclusion The docking procedure allows for tensioning of the transferred CA ligament and healing of the ligament in an intramedullary bone tunnel. Excellent clinical results were achieved, decreasing the risk of recurrent distal clavicle instability.

Clinical follow-up of horses treated with allogeneic equine mesenchymal stem cells derived from umbilical cord blood for different tendon and ligament disorders.

Science.gov (United States)

Van Loon, Vic J F; Scheffer, Carmen J W; Genn, Herman J; Hoogendoorn, Arie C; Greve, Jan W

2014-01-01

Mesenchymal stem cells (MSCs) offer promise as therapeutic aids in the repair of tendon and ligament disorders in sport horses. Equine allogeneic MSCs derived from umbilical cord blood (eUCB-MSCs) can be obtained in a minimally invasive fashion with successful propagation of MSCs. The objective of this study was to determine the applicability and therapeutic effect of eUCB-MSCs on tendinitis of the superficial digital flexor tendon, desmitis of the suspensory ligament, tendinitis of the deep digital flexor tendon, and desmitis of the inferior check ligament in clinical cases. A retrospective clinical study was performed. At two equine clinics, 52 warmblood horses were treated with cultured eUCB-MSCs between 2009 and 2012. About 2-10 × 10(6) cells per lesion were administered. When a lesion was treated twice, the total amount could run up to 20 × 10(6) cells. Pearson's chi-squared test was used to compare the effect of the injured structure on the success rate, as well as the effect of the age of the horse. Based on repeated examinations, 40 horses (77%) returned to work on the same or a higher level based on information provided by the owner. Neither the injured structure nor the age of the horse had a statistically significant influence on the result. Overall, the results of treatment of some tendon and ligament injuries with eUCB-MSCs in clinical cases are promising.

Mechanoactive scaffold induces tendon remodeling and expression of fibrocartilage markers.

Science.gov (United States)

Spalazzi, Jeffrey P; Vyner, Moira C; Jacobs, Matthew T; Moffat, Kristen L; Lu, Helen H

2008-08-01

Biological fixation of soft tissue-based grafts for anterior cruciate ligament (ACL) reconstruction poses a major clinical challenge. The ACL integrates with subchondral bone through a fibrocartilage enthesis, which serves to minimize stress concentrations and enables load transfer between two distinct tissue types. Functional integration thus requires the reestablishment of this fibrocartilage interface on reconstructed ACL grafts. We designed and characterized a novel mechanoactive scaffold based on a composite of poly-alpha-hydroxyester nanofibers and sintered microspheres; we then used the scaffold to test the hypothesis that scaffold-induced compression of tendon grafts would result in matrix remodeling and the expression of fibrocartilage interface-related markers. Histology coupled with confocal microscopy and biochemical assays were used to evaluate the effects of scaffold-induced compression on tendon matrix collagen distribution, cellularity, proteoglycan content, and gene expression over a 2-week period. Scaffold contraction resulted in over 15% compression of the patellar tendon graft and upregulated the expression of fibrocartilage-related markers such as Type II collagen, aggrecan, and transforming growth factor-beta3 (TGF-beta3). Additionally, proteoglycan content was higher in the compressed tendon group after 1 day. The data suggest the potential of a mechanoactive scaffold to promote the formation of an anatomic fibrocartilage enthesis on tendon-based ACL reconstruction grafts.

Towards an ideal polymer scaffold for tendon/ligament tissue engineering

Science.gov (United States)

Sahoo, Sambit; Ouyang, Hong Wei; Goh, James Cho-Hong; Tay, Tong-Earn; Toh, Siew Lok

2005-04-01

Tissue engineering holds promise in treating injured tendons and ligaments by replacing the injured tissues with "engineered tissues" with identical mechanical and functional characteristics. A biocompatible, biodegradable, porous scaffold with optimized architecture, sufficient surface area for cell attachment, growth and proliferation, faborable mechanical properties, and suitable degradation rate is a pre-requisite to achieve success with this aproach. Knitted poly(lactide-co-glycolide) (PLGA) scaffolds comprising of microfibers of 25 micron diameter were coated with PLGA nanofibers on their surfaces by electrospinning technique. A cell suspension of pig bone marrow stromal cells (BMSC) was seeded on the scaffolds by pipetting, and the cell-scaffold constructs were cultured in a CO2 incubator, at 37°C for 1-2 weeks. The "engineered tissues" were then assessed for cell attachment and proliferation, tissue formation, and mechanical properties. Nanofibers, of diameter 300-900 nm, were spread randomly over the knitted scaffold. The reduction in pore-size from about 1 mm (in the knitted scaffold) to a few micrometers (in the nano-microscaffold) allowed cell seeding by direct pipetting, and eliminated the need of a cell-delivery system like fibrin gel. BMSCs were seen to attach and proliferate well on the nano-microscaffold, producing abundant extracellular matrix. Mechanical testing revealed that the cell-seeded nano-microscaffolds possessed slightly higher values of failure load, elastic-region stiffness and toe-region stiffness, than the unseeded scaffolds. The combination of superior mechanical strength and integrity of knitted microfibers, with the large surface area and improved hydrophilicity of the electrospun nanofibers facilitated cell attachment and new tissue formation. This holds promise in tissue engineering of tendon/ligament.

Reconstruction of the anterior cruciate ligament: dynamic strain evaluation of the graft

Czech Academy of Sciences Publication Activity Database

Handl, Milan; Držík, M.; Cerulli, G.; Povýšil, C.; Chlpík, J.; Varga, F.; Amler, Evžen; Trč, T.

2007-01-01

Roč. 15, - (2007), s. 233-241 ISSN 0942-2056 R&D Projects: GA AV ČR(CZ) 1ET400110403 Institutional research plan: CEZ:AV0Z50390512 Keywords : Anterior cruciate ligament * Tendon * Material properties Subject RIV: BO - Biophysics Impact factor: 1.626, year: 2007

Mechanical Actuation Systems for the Phenotype Commitment of Stem Cell-Based Tendon and Ligament Tissue Substitutes.

Science.gov (United States)

Govoni, Marco; Muscari, Claudio; Lovecchio, Joseph; Guarnieri, Carlo; Giordano, Emanuele

2016-04-01

High tensile forces transmitted by tendons and ligaments make them susceptible to tearing or complete rupture. The present standard reparative technique is the surgical implantation of auto- or allografts, which often undergo failure.Currently, different cell types and biomaterials are used to design tissue engineered substitutes. Mechanical stimulation driven by dedicated devices can precondition these constructs to a remarkable degree, mimicking the local in vivo environment. A large number of dynamic culture instruments have been developed and many appealing results collected. Of the cells that have been used, tendon stem cells are the most promising for a reliable stretch-induced tenogenesis, but their reduced availability represents a serious limitation to upscaled production. Biomaterials used for scaffold fabrication include both biological molecules and synthetic polymers, the latter being improved by nanotechnologies which reproduce the architecture of native tendons. In addition to cell type and scaffold material, other variables which must be defined in mechanostimulation protocols are the amplitude, frequency, duration and direction of the applied strain. The ideal conditions seem to be those producing intermittent tension rather than continuous loading. In any case, all physical parameters must be adapted to the specific response of the cells used and the tensile properties of the scaffold. Tendon/ligament grafts in animals usually have the advantage of mechanical preconditioning, especially when uniaxial cyclic forces are applied to cells engineered into natural or decellularized scaffolds. However, due to the scarcity of in vivo research, standard protocols still need to be defined for clinical applications.

[ARTHROSCOPIC STUDY OF REMNANT-PRESERVED RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT].

Science.gov (United States)

Lu, Daifeng; Xiao, Mochao; Zhang, Yunpeng; Yan, Shi; Dong, Feng; Lian, Yongyun

2015-08-01

To investigate the value of ligament remnant preservation during anterior cruciate ligament (ACL) reconstruction by observing the integrity, the tension, the synovial membrane covering, and the color of the reconstructed ligament under arthroscopy. Between January 2011 and December 2013, 122 patients who underwent ACL reconstruction and arthroscopic internal fixation removal at 1 year after reconstruction were included in this study. Of these cases, 61 cases underwent ACL reconstruction using the remnant-preserved technique (preservation group); the other 61 cases underwent ACL reconstruction using non remnant-preserved technique (non preservation group). There was no significant difference in gender, age, injury side, body mass index, type of injury, the time from injury to reconstruction, and the result of KT-2000 examination between 2 groups (P > 0.05). The reconstructed ACL were observed under arthroscopy when internal fixation was removed, and the effectiveness was evaluated according to the criteria of AO Yingfang. In preservation group, the results were excellent in 34 cases, good in 22 cases, fair in 4 cases, and poor in 1 case; and in non preservation group, the results were excellent in 29 cases, good in 20 cases, fair in 10 cases, and poor in 2 cases; and there was no significant difference between 2 groups (Z= -1.320, P=0.187). In ACL reconstruction, the remnant-preserved technique is not obviously better than non remnant-preserved technique in the integrity, tension, membrane covering, and color.

Reconstruction of the anterior cruciate ligament of the knee

Directory of Open Access Journals (Sweden)

Nikolić Dragan

2006-01-01

Full Text Available Background/Aim. Numerous papers on reconstruction of the anterior cruciate ligament of the knee (ACL contribute to the significance of this method. The aim of this study was to analyze the outcome of the use of this surgical treatment method regardless the type of surgical intervention, graft, and the choice of the material for fixing. Methods. The study included 324 patients treated within the period from April 1997 to April 2004. Arthroscopically assisted ACL reconstruction was typically performed using the central one-third of the patellar ligament, as a graft, with bone blocks. Fixing was performed using screws (spongy or interferential, Mitek type. In the cases who required revision of the surgery, we used a graft m. semitendinosus and m. gracilise (STG or a graft of the patellar ligament (B-Pt-B. Fixation in these cases was performed using absorptive wedges according to the Rigidfix technique or metallic implants. Results. The analysis included the results of the reconstruction of the anterior cruciate ligament of the knee (B-Pt-B or STG graft in 139 of the knees. Chronic injuries were revealed in 132 (94.9% of the knees. According to the anamnesis and clinical findings, the feeling of instability prevailed in 132 (94.9% of the knees, pain in 72 (51.7%, effluents in 24 (17.2%, and blockages in 13 (9.3%. Early and late postoperative complications were noticeable in 3.5% each. Hypotrophy of the upper knee musculature up to 2 cm was present in 53.9% of the operated knees, while minor contractions in 13.6% of them. The final result of the reconstruction graded begusing the Lysholm Scale was 85.2, simultaneous reconstructions of other ligaments 75.3, and revision surgery 68.0. First-grade degenerative postoperative changes according to the K/L Scale were found in 55.0% of the surgically treated knees, while the worst, four-grade one in 2.5%. Conclusion. On the basis of these findings, we can conclude that this method is the method of choice in

Absence of sensory function in the reconstructed anterior cruciate ligament

DEFF Research Database (Denmark)

Krogsgaard, Michael R; Fischer-Rasmussen, Torsten; Dyhre-Poulsen, Poul

2011-01-01

-constructions were stimulated. The sensory threshold was 3.4 times higher in the ACL than in the PCL. Stimulus amplitudes were increased to 1.5-2.0 times the sensory threshold, and a typical inhibitory reflex could be elicited in 9 patients. The latency was the same as for the reflex from the PCL. The stimulus......Cruciate ligaments provide sensory information that cause excitatory as well as inhibitory effects to the activity of the muscles around the knee. The aim of the study was to determine whether these muscular reflexes are reestablished after anterior cruciate ligament (ACL) re-construction. Wire...... electrodes were inserted during arthroscopy into the normal posterior cruciate ligament (PCL) and the reconstructed ACL in 11 patients who had a successful ACL re-construction 8 months to 12 years earlier. After the anesthesia had subsided, the PCL was stimulated electrically through the electrodes...

Mini-open reconstruction of lateral collateral ligaments of ankle with partial tendon of its peroneus brevis%小切口取部分腓骨短肌腱重建踝关节外侧副韧带

Institute of Scientific and Technical Information of China (English)

陈前博; 唐康来; 吴雪晖; 徐格; 谭晓康; 周兵华; 周运平; 许建中

2008-01-01

Objective To describe a new technique with mini-open reconstruction of lateral ligaments of ankle with partial tendon of its peroneus brevis and evaluate its effect in treatment of chronic lateral ankle instability. Methods A total of 11 cases of chronic lateral ankle instability;at mean age of 27.6 years(16-42 years),were treated with mini-open reconstruction of the lateral ligaments of the ankle with partial tendon of its peroneus brevis.The mean delay between the initial episode of ankle sprain and the surgery was 10.3 months(4-32 months).Postoperatively,all cases were examined with MRI,stress X-rays and comparative stability of bilateral ankle inspection at clinical follow-up.The function of the ankle were evaluated bv American Orthopaedic Foot & Ankle Society (AOFAS)score and ankle-hind foot scale. Results The average duration of follow-up was 17.5 months(12-37 months).The mean AOFAS ankle-hindfoot score was 88.3 points(72-96 points)at the time of the latest follow-up,including excellent result in 6 cases(55%),good in 4(36%)and fair in 1(9%).MRI results showed that the ruptured lateral collateral ligaments of the ankle were repaired and remodeled very well in all patients.There was no recurrence of the ankle instability or other complications. Conclusion Mini-open reconstruction of the lateral ligaments of ankle with partial tendon of its peroneus brevis is safe and effective for treatment of chronic lateral ankle instability.%目的 介绍小切口取部分腓骨短肌腱解剖重建外侧副韧带治疗慢性踝关节外侧不稳的疗效.方法 11例慢性踝关节外侧不稳患者接受小切口取部分腓骨短肌腱解剖重建踝关节外侧副韧带的手术治疗,年龄16～42岁,平均27.6岁.术前病程4～32个月,平均10.3个月.术后定期行双侧踝关节对比稳定检查、应力位X线片及MRI检查,并按美国足踝外科协会(AOFAS)踝-后足功能评分表进行功能评分.结果 11例患者术后平均随访17.5个月(12～37�

Primary Anterior Cruciate Ligament Reconstruction. How Do We Do It?

Directory of Open Access Journals (Sweden)

Todor Adrian

2016-11-01

Full Text Available Anterior cruciate ligament (ACL tears are frequently seen in current practice mostly affecting the young, active subjects, and usually require ligament reconstruction in order to restore normal knee kinematics. As worldwide interest in anatomic reconstruction grew over the last decade, we have also refined our technique in order to restore the anatomical function as near to the normal as possible. This anatomical restoration concept is believed to prevent the onset of osteoarthritis, which the non-anatomic reconstructions fail to attain. The knowledge gained from the ACL anatomy, function and kinematics has helped in developing the current anatomic methods of reconstruction, which take into account patient anatomy, the rupture pattern, as well as the comorbidities. We present our approach to anatomical single- and double-bundle ACL reconstruction.

Treatment of recurrent patellar dislocation via knee arthroscopy combined with C-arm fluoroscopy and reconstruction of the medial patellofemoral ligament.

Science.gov (United States)

Li, Li; Wang, Hongbo; He, Yun; Si, Yu; Zhou, Hongyu; Wang, Xin

2018-06-01

Recurrent patellar dislocations were treated via knee arthroscopy combined with C-arm fluoroscopy, and reconstruction of the medial patellofemoral ligaments. Between October 2013 and March 2017, 52 cases of recurrent patellar dislocation [27 males and 25 females; age, 16-47 years (mean, 21.90 years)] were treated. Arthroscopic exploration was performed and patellofemoral joint cartilage injuries were repaired. It was subsequently determined whether it was necessary to release the lateral patellofemoral support belt. Pre-operative measurements were used to decide whether tibial tubercle osteotomy was required. Medial patellofemoral ligaments were reconstructed using autologous semitendinosus tendons. Smith and Nephew model 3.5 line anchors were used to double-anchor the medial patellofemoral margin. On the femoral side, the medial patellofemoral ligament was fixed using 7-cm, absorbable, interfacial compression screws. All cases were followed for 1-40 months (average, 21 months). The Q angle, tibial tuberosity trochlear groove distance, Insall-Salvati index, patellofemoral angle, lateral patellofemoral angle and lateral shift were evaluated on X-Ray images using the picture archiving and communication system. Subjective International Knee Documentation Committee (IKDC) knee joint functional scores and Lysholm scores were recorded. Post-operative fear was absent, and no patellar re-dislocation or re-fracture was noted during follow-up. At the end of follow-up, the patellofemoral angle (0.22±4.23°), lateral patellofemoral angle (3.44±1.30°), and lateral shift (0.36+0.14°) differed significantly from the pre-operative values (all, Ppatellofemoral ligament was effective.

Anterior cruciate ligament reconstruction with tibial attachment preserving hamstring graft without implant on tibial side

Directory of Open Access Journals (Sweden)

Skand Sinha

2018-01-01

Full Text Available Background: Tibial attachment preserving hamstring graft could prevent potential problems of free graft in anterior cruciate ligament (ACL reconstruction such as pull out before graft-tunnel healing or rupture before ligamentization. Different implants have been reportedly used for tibial side fixation with this technique. We investigated short-term outcome of ACL reconstruction (ACLR with tibial attachment sparing hamstring graft without implant on the tibial side by outside in technique. Materials and Methods: Seventy nine consecutive cases of ACL tear having age of 25.7 ± 6.8 years were included after Institutional Board Approval. All subjects were male. The mean time interval from injury to surgery was of 7.5 ± 6.4 months. Hamstring tendons were harvested with open tendon stripper leaving the tibial insertion intact. The free ends of the tendons were whip stitched, quadrupled, and whip stitched again over the insertion site of hamstring with fiber wire (Arthrex. Single bundle ACLR was done by outside in technique and the femoral tunnel was created with cannulated reamer. The graft was pulled up to the external aperture of femoral tunnel and fixed with interference screw (Arthrex. The scoring was done by Lysholm, Tegner, and KT 1000 by independent observers. All cases were followed up for 2 years. Results: The mean length of quadrupled graft attached to tibia was 127.65 ± 7.5 mm, and the mean width was 7.52 ± 0.78 mm. The mean preoperative Lysholm score of 47.15 ± 9.6, improved to 96.8 ± 2.4 at 1 year. All cases except two returned to the previous level of activity after ACLR. There was no significant difference statistically between preinjury (5.89 ± 0.68 and postoperative (5.87 ± 0.67 Tegner score. The anterior tibial translation (ATT (KT 1000 improved from 11.44 ± 1.93 mm to 3.59 ± 0.89 mm. The ATT of operated knee returned to nearly the similar value as of the opposite knee (3.47 ± 1.16 mm. The Pivot shift test was negative in

An osteogenesis/angiogenesis-stimulation artificial ligament for anterior cruciate ligament reconstruction.

Science.gov (United States)

Li, Hong; Li, Jinyan; Jiang, Jia; Lv, Fang; Chang, Jiang; Chen, Shiyi; Wu, Chengtie

2017-05-01

To solve the poor healing of polyethylene terephthalate (PET) artificial ligament in bone tunnel, copper-containing bioactive glass (Cu-BG) nanocoatings on PET artificial ligaments were successfully prepared by pulsed laser deposition (PLD). It was hypothesized that Cu-BG coated PET (Cu-BG/PET) grafts could enhance the in vitro osteogenic and angiogenic differentiation of rat bone marrow mesenchymal stem cells (rBMSCs) and in vivo graft-bone healing after anterior cruciate ligament (ACL) reconstruction in a goat model. Scanning electron microscope and EDS mapping analysis revealed that the prepared nanocoatings had uniform element distribution (Cu, Ca, Si and P) and nanostructure. The surface hydrophilicity of PET grafts was significantly improved after depositing Cu-BG nanocoatings. The in vitro study displayed that the Cu-BG/PET grafts supported the attachment and proliferation of rBMSCs, and significantly promoted the expression of HIF-1α gene, which up-regulated the osteogenesis-related genes (S100A10, BMP2, OCN) and angiogenesis-related genes (VEGF) in comparison with PET or BG coated PET (BG/PET) grafts which do not contain Cu element. Meanwhile, Cu-BG/PET grafts promoted the bone regeneration at the graft-host bone interface and decreased graft-bone interface width, thus enhancing the bonding strength as well as angiogenesis (as indicated by CD31 expression) in the goat model as compared with BG/PET and pure PET grafts. The study demonstrates that the Cu-containing biomaterials significantly promote osteogenesis and angiogenesis in the repair of bone defects of large animals and thus offering a promising method for ACL reconstruction by using Cu-containing nanobioglass modified PET grafts. It remains a significant challenge to develop an artificial graft with distinct osteogenetic/angiogenetic activity to enhance graft-bone healing for ligament reconstruction. To solve these problems, copper-containing bioactive glass (Cu-BG) nanocoatings on PET artificial

Pain level after ACL reconstruction: A comparative study between free quadriceps tendon and hamstring tendons autografts.

Science.gov (United States)

Buescu, Cristian Tudor; Onutu, Adela Hilda; Lucaciu, Dan Osvald; Todor, Adrian

2017-03-01

The objective of this study was to compare the pain levels and analgesic consumption after single bundle ACL reconstruction with free quadriceps tendon autograft versus hamstring tendon autograft. A total of 48 patients scheduled for anatomic single-bundle ACL reconstruction were randomized into two groups: the free quadriceps tendon autograft group (24 patients) and the hamstring tendons autograft group (24 patients). A basic multimodal analgesic postoperative program was used for all patients and rescue analgesia was provided with tramadol, at pain scores over 30 on the Visual Analog Scale. The time to the first rescue analgesic, the number of doses of tramadol and pain scores were recorded. The results within the same group were compared with the Wilcoxon signed test. Supplementary analgesic drug administration proved significantly higher in the group of subjects with hamstring grafts, with a median (interquartile range) of 1 (1.3) dose, compared to the group of subjects treated with a quadriceps graft, median = 0.5 (0.1.25) (p = 0.009). A significantly higher number of subjects with a quadriceps graft did not require any supplementary analgesic drug (50%) as compared with subjects with hamstring graft (13%; Z-statistics = 3.01, p = 0.002). The percentage of subjects who required a supplementary analgesic drug was 38% higher in the HT group compared with the FQT group. The use of the free quadriceps tendon autograft for ACL reconstruction leads to less pain and analgesic consumption in the immediate postoperative period compared with the use of hamstrings autograft. Level I Therapeutic study. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

Development of Radiation Fusion Technology for the Ruptured Ligament Reconstruction with a Porcine Xenograft

International Nuclear Information System (INIS)

Kim, Jaehun; Kim, Jaekyung; Park, Jongheum

2013-08-01

This project was accomplished to develop the radiation fusion technology for production of bioitransplant materials (tendon/ligament) which have high bio-suitability, resulting in import replacement and improved industrial competency and public health. The major results of this project are development of the technology to remove immunogen, which repressing immune rejection, response, development of cross-linking technology to improve physical properties, development of the technology to improve safety and remove pathogenic sources, evaluation of tissue suitability and reconstruction through short/long term animal experiment, and development of materials for customized preclinical use. From the results, we can expect the replacement of import and establishment of export base by development of hetero-tissues, establishment of safe supply and improvement of public health for high demand of biotissue product because of low birth rate, aging society, and industralization

Biomechanical Effects of Acromioplasty on Superior Capsule Reconstruction for Irreparable Supraspinatus Tendon Tears.

Science.gov (United States)

Mihata, Teruhisa; McGarry, Michelle H; Kahn, Timothy; Goldberg, Iliya; Neo, Masashi; Lee, Thay Q

2016-01-01

Acromioplasty is increasingly being performed for both reparable and irreparable rotator cuff tears. However, acromioplasty may destroy the coracoacromial arch, including the coracoacromial ligament, consequently causing a deterioration in superior stability even after superior capsule reconstruction. The purpose of this study was to investigate the effects of acromioplasty on shoulder biomechanics after superior capsule reconstruction for irreparable supraspinatus tendon tears. The hypothesis was that acromioplasty with superior capsule reconstruction would decrease the area of subacromial impingement without increasing superior translation and subacromial contact pressure. Controlled laboratory study. Seven fresh-frozen cadaveric shoulders were evaluated using a custom shoulder testing system. Glenohumeral superior translation, the location of the humeral head relative to the glenoid, and subacromial contact pressure and area were compared among 4 conditions: (1) intact shoulder, (2) irreparable supraspinatus tendon tear, (3) superior capsule reconstruction without acromioplasty, and (4) superior capsule reconstruction with acromioplasty. Superior capsule reconstruction was performed using the fascia lata. Compared with the intact shoulder, the creation of an irreparable supraspinatus tear significantly shifted the humeral head superiorly in the balanced muscle loading condition (without superior force applied) (0° of abduction: 2.8-mm superior shift [P = .0005]; 30° of abduction: 1.9-mm superior shift [P = .003]) and increased both superior translation (0° of abduction: 239% of intact [P = .04]; 30° of abduction: 199% of intact [P = .02]) and subacromial peak contact pressure (0° of abduction: 308% of intact [P = .0002]; 30° of abduction: 252% of intact [P = .001]) by applying superior force. Superior capsule reconstruction without acromioplasty significantly decreased superior translation (0° of abduction: 86% of intact [P = .02]; 30° of abduction: 75

Postoperative US of leg tendon reconstruction

International Nuclear Information System (INIS)

Draghi, F.; Calliada, F.; Fulle, I.; Madonia, L.; Bottinelli, O.; Campani, R.

1999-01-01

The role of ultrasound (US) in the postoperative assessment of tendon reconstruction is not clearly defined and there is non systematic arrangement of US patterns. The authors examined 34 patients submitted to surgery or conservative treatment for total/partial tear or musculotendinous detachment of patellar or Achilles tendon in the last 5 years. All patients underwent physical and US examinations. The surgical tendon exhibited the same US patterns in 23/28 patients: it was markedly enlarged (three-/fourfold the normal diameter) and more rounded, with inhomogeneous and hypoechoic appearance not only at the tear/surgical site but also above and below it, for some cm. Small hyperechoic images, mainly dots, were seen in 19 cases, which were referable to small calcifications and stitches. More and larger calcifications were found in 8 patients, where they were associated with anechoic degeneration areas. Color Doppler US showed moderate or strong hypervascularization around the tear in the first months post injury. US patterns did not correlate with physical findings, but color Doppler patterns did. In 6 cases of musculotendinous detachment submitted to conservative treatment, US showed enlargement and hypoechogenicity in the injury site only, with no involvement of the remaining tendon. US was also used to time and guide drainage of perilesional hematomas, which were often quite large. US is the method of choice in the postoperative follow-up of tendon tears and musculotendinous detachments because it shows abnormal signs which are missed at clinics and provides additional information needed for treatment planning [it

Combined medial and lateral anatomic ligament reconstruction for chronic rotational instability of the ankle.

Science.gov (United States)

Buchhorn, Tomas; Sabeti-Aschraf, Manuel; Dlaska, Constantin E; Wenzel, Florian; Graf, Alexandra; Ziai, Pejman

2011-12-01

This study aimed to extend knowledge on the arthroscopic evaluation of the unstable ankle joint and the outcome of ligament reconstruction on rotational instability. In contrast to previous studies, we investigated the combined repair of lateral and medial ligaments. Ninety-six patients underwent medial and lateral ligament reconstruction between 2006 and 2008, 81 of whom, with a mean age of 31.9 (range, 14 to 44) years, completed the 12-month followup and were therefore included in this study (Table 1). Clinical, radiographic, and concomitant arthroscopic examination was performed prior to the ligament stabilization. Postoperative followup included clinical and radiographic evaluation after 3, 6, and 12 months. Arthroscopy showed a lesion of the anterior fibulotalar ligament (AFTL), calcaneofibular ligament (CFL), and tibiocalcanear ligament (TCL) (Deep part of deltoid ligament complex) in 67 patients. An avulsion of the proximal insertion point of the ATTL was additionally found in 14 cases. Clinical results 3 months after surgery showed a significant increase in the AOFAS-Hindfoot Score as well as a significant decrease of the Visual Analogue-Scale for pain (VAS) (p ankle joint in most cases has an injury of the lateral ligaments and a component of the deltoid, the TCL, but rarely with a combined lesion of the TCL and the anterior tibiotalar ligament (ATTL) (Superficial part of deltoid ligament complex). The combined lateral and medial ligament reconstruction with an anchor technique had a good clinical outcome with high patient satisfaction with few complications.

A modified Larson’s method of posterolateral corner reconstruction of the knee reproducing the physiological tensioning pattern of the lateral collateral and popliteofibular ligaments

Directory of Open Access Journals (Sweden)

Niki Yasuo

2012-06-01

Full Text Available Abstract Background Consensus has been lacking as to how to reconstruct the posterolateral corner (PLC of the knee in patients with posterolateral instability. We describe a new reconstructive technique for PLC based on Larson's method, which reflects the physiological load-sharing pattern of the lateral collateral ligament (LCL and popliteofibular ligament (PFL. Findings Semitendinosus graft is harvested, and one limb of the graft comprises PFL and the other comprises LCL. Femoral bone tunnels for the LCL and popliteus tendon are made at their anatomical insertions. Fibular bone tunnel is prepared from the anatomical insertion of the LCL to the proximal posteromedial portion of the fibular head, which corresponds to the insertion of the PFL. The graft end for popliteus tendon is delivered into the femoral bone tunnel and secured on the medial femoral condyle. The other end for LCL is passed through the fibular tunnel from posterior to anterior. While the knee is held in 90 of flexion, the graft is secured in the fibular tunnel using a 5 mm interference screw. Then, the LCL end is passed into the femoral bone tunnel and secured at the knee in extension. Conclusions Differential tension patterns between LCL and PFL is critical when securing these graft limbs. Intrafibular fixation of the graft using a small interference screw allows us to secure these two graft limbs independently with intended tension at the intended flexion angle of the knee.

[Reconstruction of chronic Achilles tendon rupture with flexor hallucis longus tendon harvested using a minimally invasive technique].

Science.gov (United States)

Miao, Xudong; Wu, Yongping; Tao, Huimin; Yang, Disheng

2011-07-01

To evaluate the effectiveness of flexor hallucis longus tendon harvested using a minimally invasive technique in reconstruction of chronic Achilles tendon rupture. Between July 2006 and December 2009, 22 patients (22 feet) with chronic Achilles tendon rupture were treated, including 16 males and 6 females with a median age of 48 years (range, 28-65 years). The disease duration was 27-1,025 days (median, 51 days). Twenty-one patients had hooflike movement's history and 1 patient had no obvious inducement. The result of Thompson test was positive in 22 cases. The score was 53.04 +/- 6.75 according to American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score system. MRI indicated that the gap of the chronic Achilles tendon rupture was 4.2-8.0 cm. A 3 cm-long incision was made vertically in the plantar aspect of the midfoot and a 1 cm-long transverse incision was made in a plantar flexor crease at the base of the great toe to harvest flexor hallucis longus tendon. The flexor hallucis longus tendon was 10.5-13.5 cm longer from tuber calcanei to the end of the Achilles tendon, and then the tendon was fixed to the tuber calcanei using interface screws or anchor nail after they were woven to form reflexed 3-bundle and sutured. Wound healed by first intention in all patients and no early complication occurred. Twenty-two patients were followed up 12-42 months (mean, 16.7 months). At 12 months after operation, The AOFAS ankle and hindfoot score was 92.98 +/- 5.72, showing significant difference when compared with that before operation (t= -40.903, P=0.000). The results were excellent in 18 cases, good in 2 cases, and fair in 2 cases with an excellent and good rate of 90.9%. No sural nerve injury, posterior tibial nerve injury, plantar painful scar, medial plantar nerve injury, and lateral plantar nerve injury occurred. Chronic Achilles tendon rupture reconstruction with flexor hallucis longus tendon harvested using a minimally invasive technique offers a

The concept of individualized anatomic anterior cruciate ligament (ACL) reconstruction

NARCIS (Netherlands)

Hofbauer, M.; Muller, B. [=Bart; Murawski, C. D.; van Eck, C. F.; Fu, F. H.

2014-01-01

To describe the concept of individualized anatomic anterior cruciate ligament (ACL) reconstruction. The PubMed/Medline database was searched using keywords pertaining to ACL reconstruction. Relevant articles were reviewed in order to summarize important concepts of individualized surgery in ACL

work in miners following anterior cruciate ligament reconstruction

African Journals Online (AJOL)

Return to work in miners following anterior cruciate ligament reconstruction. ... Patients were evaluated in terms of range of motion (ROM) values; Lysholm, Cincinati and ... pain inside the knee were the most significant reason which affected ...

Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies

OpenAIRE

Sanchis-Alfonso, Vicente; Montesinos-Berry, Erik; Ramirez-Fuentes, Cristina; Leal Blanquet, Joan; Gelber, Pablo-Eduardo; Monllau García, Juan Carlos

2017-01-01

Patellar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the patella through a medial patellofemoral ligament (MPFL) reconstruction. Foreseeably, an increasing number of revision surgeries of the reconstructed MPFL will be seen in upcoming years. In this paper, the causes of failed MPFL reconstruction are analyzed: (1) incorrect surgical ...

Effect of Medial Patellofemoral Ligament Reconstruction Method on Patellofemoral Contact Pressures and Kinematics.

Science.gov (United States)

Stephen, Joanna M; Kittl, Christoph; Williams, Andy; Zaffagnini, Stefano; Marcheggiani Muccioli, Giulio Maria; Fink, Christian; Amis, Andrew A

2016-05-01

There remains a lack of evidence regarding the optimal method when reconstructing the medial patellofemoral ligament (MPFL) and whether some graft constructs can be more forgiving to surgical errors, such as overtensioning or tunnel malpositioning, than others. The null hypothesis was that there would not be a significant difference between reconstruction methods (eg, graft type and fixation) in the adverse biomechanical effects (eg, patellar maltracking or elevated articular contact pressure) resulting from surgical errors such as tunnel malpositioning or graft overtensioning. Controlled laboratory study. Nine fresh-frozen cadaveric knees were placed on a customized testing rig, where the femur was fixed but the tibia could be moved freely from 0° to 90° of flexion. Individual quadriceps heads and the iliotibial tract were separated and loaded to 205 N of tension using a weighted pulley system. Patellofemoral contact pressures and patellar tracking were measured at 0°, 10°, 20°, 30°, 60°, and 90° of flexion using pressure-sensitive film inserted between the patella and trochlea, in conjunction with an optical tracking system. The MPFL was transected and then reconstructed in a randomized order using a (1) double-strand gracilis tendon, (2) quadriceps tendon, and (3) tensor fasciae latae allograft. Pressure maps and tracking measurements were recorded for each reconstruction method in 2 N and 10 N of tension and with the graft positioned in the anatomic, proximal, and distal femoral tunnel positions. Statistical analysis was undertaken using repeated-measures analyses of variance, Bonferroni post hoc analyses, and paired t tests. Anatomically placed grafts during MPFL reconstruction tensioned to 2 N resulted in the restoration of intact medial joint contact pressures and patellar tracking for all 3 graft types investigated (P > .050). However, femoral tunnels positioned proximal or distal to the anatomic origin resulted in significant increases in the mean

The role of the anterolateral ligament in ACL insufficient and reconstructed knees on rotary stability

DEFF Research Database (Denmark)

Tavlo, Mette; Eljaja, S; Tranum-Jensen, Jørgen

2016-01-01

Studies suggest that the anterolateral ligament (ALL) is important for knee stability. The purpose was to clarify ALL's effect on rotatory and anterior-posterior stability in the anterior cruciate ligament (ACL)-insufficient and reconstructed knees and the effect of reconstruction of an insuffici......Studies suggest that the anterolateral ligament (ALL) is important for knee stability. The purpose was to clarify ALL's effect on rotatory and anterior-posterior stability in the anterior cruciate ligament (ACL)-insufficient and reconstructed knees and the effect of reconstruction...... of an insufficient ALL. Eighteen cadaveric knees were included. Stability was tested for intact (+ALL), detached (-ALL) and reconstructed (+ reALL) ALL, with ACL removed (-ACL) and reconstructed (+ACL) in six combinations. All were tested in 0, 30, 60, and 90 °C flexion. Anterior-posterior stability was measured...... with a rolimeter. Rotation with a torque of 8.85 Nm was measured photographically. The ALL was well defined in 78% of knees. ACL reconstruction had a significant effect on anterior-posterior stability. Detaching the ALL had a significant effect on internal rotatory stability and on anterior-posterior stability...

The role of mechanical loading in ligament tissue engineering.

Science.gov (United States)

Benhardt, Hugh A; Cosgriff-Hernandez, Elizabeth M

2009-12-01

Tissue-engineered ligaments have received growing interest as a promising alternative for ligament reconstruction when traditional transplants are unavailable or fail. Mechanical stimulation was recently identified as a critical component in engineering load-bearing tissues. It is well established that living tissue responds to altered loads through endogenous changes in cellular behavior, tissue organization, and bulk mechanical properties. Without the appropriate biomechanical cues, new tissue formation lacks the necessary collagenous organization and alignment for sufficient load-bearing capacity. Therefore, tissue engineers utilize mechanical conditioning to guide tissue remodeling and improve the performance of ligament grafts. This review provides a comparative analysis of the response of ligament and tendon fibroblasts to mechanical loading in current bioreactor studies. The differential effect of mechanical stimulation on cellular processes such as protease production, matrix protein synthesis, and cell proliferation is examined in the context of tissue engineering design.

Anatomic deltoid ligament repair with anchor-to-post suture reinforcement: technique tip.

Science.gov (United States)

Lack, William; Phisitkul, Phinit; Femino, John E

2012-01-01

The deltoid ligament is the primary ligamentous stabilizer of the ankle joint. Both superficial and deep components of the ligament can be disrupted with a rotational ankle fracture, chronic ankle instability, or in late stage adult acquired flatfoot deformity. The role of deltoid ligament repair in these conditions has been limited and its contribution to arthritis is largely unknown. Neglect of the deltoid ligament in the treatment of ankle injuries may be due to difficulties in diagnosis and lack of an effective method for repair. Most acute repair techniques address the superficial deltoid ligament with direct end-to-end repair, fixation through bone tunnels, or suture anchor repair of avulsion injuries. Deep deltoid ligament repair has been described using direct end-to-end repair with sutures, as well as by autograft and allograft tendon reconstruction utilizing various techniques. Newer tenodesis techniques have been described for late reconstruction of both deep and superficial components in patients with stage 4 adult acquired flatfoot deformity. We describe a technique that provides anatomic ligament-to-bone repair of the superficial and deep bundles of the deltoid ligament while reducing the talus toward the medial malleolar facet of the tibiotalar joint with anchor-to-post reinforcement of the ligamentous repair. This technique may protect and allow the horizontally oriented fibers of the deep deltoid ligament to heal with the appropriate resting length while providing immediate stability of the construct.

Current Concepts for Injury Prevention in Athletes After Anterior Cruciate Ligament Reconstruction

OpenAIRE

Hewett, Timothy E.; Di Stasi, Stephanie L.; Myer, Gregory D.

2012-01-01

Ligament reconstruction is the current standard of care for active patients with an anterior cruciate ligament (ACL) rupture. Although the majority of ACL reconstruction (ACLR) surgeries successfully restore the mechanical stability of the injured knee, postsurgical outcomes remain widely varied. Less than half of athletes who undergo ACLR return to sport within the first year after surgery, and it is estimated that approximately 1 in 4 to 1 in 5 young, active athletes who undergo ACLR will g...

Anterolateral Ligament of the Knee Shows Variable Anatomy in Pediatric Specimens.

Science.gov (United States)

Shea, Kevin G; Milewski, Matthew D; Cannamela, Peter C; Ganley, Theodore J; Fabricant, Peter D; Terhune, Elizabeth B; Styhl, Alexandra C; Anderson, Allen F; Polousky, John D

2017-06-01

Anterior cruciate ligament (ACL) reconstruction failure rates are highest in youth athletes. The role of the anterolateral ligament in rotational knee stability is of increasing interest, and several centers are exploring combined ACL and anterolateral ligament reconstruction for these young patients. Literature on the anterolateral ligament of the knee is sparse in regard to the pediatric population. A single study on specimens younger than age 5 years demonstrated the presence of the anterolateral ligament in only one of eight specimens; therefore, much about the prevalence and anatomy of the anterolateral ligament in pediatric specimens remains unknown. We sought to (1) investigate the presence or absence of the anterolateral ligament in prepubescent anatomic specimens; (2) describe the anatomic relationship of the anterolateral ligament to the lateral collateral ligament; and (3) describe the anatomic relationship between the anterolateral ligament and the physis. Fourteen skeletally immature knee specimens (median age, 8 years; range, 7-11 years) were dissected (12 male, two female specimens). The posterolateral structures were identified in all specimens, including the lateral collateral ligament and popliteus tendon. The presence or absence of the anterolateral ligament was documented in each specimen, along with origin, insertion, and dimensions, when applicable. The relationship of the anterolateral ligament origin to the lateral collateral ligament origin was recorded. The anterolateral ligament was identified in nine of 14 specimens. The tibial attachment point was consistently located in the same region on the proximal tibia, between the fibular head and Gerdy's tubercle; however, the femoral origin of the anterolateral ligament showed considerable variation with respect to the lateral collateral ligament origin. The median femoral origin of the anterolateral ligament was 10 mm (first interquartile 6 mm, third interquartile 13) distal to the distal

Ligament Augmentation and Reconstruction System Failures in Repair of Grade V Acromioclavicular Joint Dislocation

Directory of Open Access Journals (Sweden)

Martin K.-H. Li

2017-01-01

Full Text Available The Ligament Augmentation and Reconstruction System® (LARS® represents a popular synthetic anatomical reduction method for acromioclavicular joint dislocation by means of coracoclavicular ligament reconstruction. To our knowledge, no early failure has been documented in the literature. We present two unusual cases of LARS failure, one at four months after implant and the other at three weeks, without obvious causes, requiring re-do reconstruction, and discuss potential contributory factors.

The anatomy and isometry of a quasi-anatomical reconstruction of the medial patellofemoral ligament.

Science.gov (United States)

Pérez-Prieto, Daniel; Capurro, Bruno; Gelber, Pablo E; Ginovart, Gerard; Reina, Francisco; Sanchis-Alfonso, Vicente; Monllau, Joan C

2017-08-01

To describe the anatomy of the medial patellofemoral ligament (MPFL) and its relationship to the Adductor Magnus (AM) tendon as well as the behaviour exhibited in length changes during knee flexion. Ten cadaveric knees were dissected. The length from the superior and inferior patellar origin of the MPFL to its femoral insertion was measured at different degrees of knee flexion (0°, 30°, 60°, 90° and 120°). The same measures were made from both patellar origins of the MPFL up to the femoral insertion of the AM. The distance between the insertion of the AM and the Hunter canal was also measured. In general, isometry up to 90° was seen in all measures of the MPFL and those of the AM. The most isometric behaviour was seen in 2 measures: the length of the AM femoral insertion up to the inferior origin of the MPFL on the patella and the length of the femoral insertion of the MPFL up to the inferior origin of the MPFL on the patella. Similar behaviour was seen regardless of the anatomical or quasi-anatomical femoral point of attachment (n.s.). The distance from the AM tendon to the Hunter canal had a mean value of 78.6 mm (SD 9.4 mm). The behaviour exhibited during the changes in the length of the anatomical femoral footprint of the MPFL and the AM is similar. Neurovascular structures were not seen at risk. This is relevant in the daily clinical practice since the AM tendon might be a suitable point of insertion for MPFL reconstruction.

Probabilistic model of ligaments and tendons: Quasistatic linear stretching

Science.gov (United States)

Bontempi, M.

2009-03-01

Ligaments and tendons have a significant role in the musculoskeletal system and are frequently subjected to injury. This study presents a model of collagen fibers, based on the study of a statistical distribution of fibers when they are subjected to quasistatic linear stretching. With respect to other methodologies, this model is able to describe the behavior of the bundle using less ad hoc hypotheses and is able to describe all the quasistatic stretch-load responses of the bundle, including the yield and failure regions described in the literature. It has two other important results: the first is that it is able to correlate the mechanical behavior of the bundle with its internal structure, and it suggests a methodology to deduce the fibers population distribution directly from the tensile-test data. The second is that it can follow fibers’ structure evolution during the stretching and it is possible to study the internal adaptation of fibers in physiological and pathological conditions.

Ultrasonography of ankle ligaments

International Nuclear Information System (INIS)

Peetrons, P.A.; Silvestre, A.; Cohen, M.; Creteur, V.

2002-01-01

The lateral collateral ligament of the ankle is a complex of 3 ligaments: The anterior and posterior talofibular ligaments and the calcaneofibular ligament; these ligaments work together to support the lateral aspect of the ankle. The anterior talofibular (ATF) ligament (Fig. 1) runs from the anterior of the talus. The probe is placed in a slightly oblique position from the malleolus toward the forefoot. The ligament is hyperechoic when its fibres are perpendicular to the ultrasound beam (anisotropy artifact is present in ligaments as well as in tendons). It is approximately 2 mm thick and, during examination, must be straight and tight from one insertion point to the other, as seen in Fig. 2. The posterior talofibular (PTF) ligament, which runs from the posterior part of the malleolus to the posterior part of the talus, is difficult to see on US, being partially or sometimes completely hidden by the malleolus. The calcaneofibular ligament forms the middle portion of the lateral collateral ligament. It is tight between the inferior part of the lateral malleolus and the calcaneus, and runs in a slightly posterior oblique direction toward the heel (Fig. 3). The ligament lies on the deep surface of the fibular tendons, forming a hammock to fall deep on the calcaneus surface (Fig. 4). The calcaneofibular ligament is approximately 2-3 nun thick and is hyperechoic in the distal two-thirds only because of the obliquity of the proximal part. When examining this ligament, it is mandatory that the ankle be flexed dorsally; this stretches the ligament so that it can be seen clearly. (author)

MRI of anterior cruciate ligament autografts

International Nuclear Information System (INIS)

Ogi, Shigeyuki; Ariizumi, Mitsuko; Yamagishi, Tsuneo; Agata, Toshihiko; Tada, Shinpei; Fukuda, Kunihiko

2000-01-01

The purpose of this study was to assess the usefulness of MRI in the evaluation of autografts after anterior cruciate ligament reconstruction. The subjects were 110 patients with anterior cruciate ligament reconstruction using patellar tendon autografts who underwent clinical examination, MRI, and arthroscopy of the knee. T1- and T2-weighted MR images were obtained in sagittal plane. Clinical findings were categorized into three groups: normal, borderline, and abnormal. The MRI appearances of the autografts were categorized into three types: straight continuous band (type I), interrupted band (type II) and generalized increased intensity band (type III). The clinical findings and MRI findings were compared with arthroscopic findings. Ninety-six percent of the type I showed no autograft tear on arthroscopy. In comparison with the clinical findings, MRI was found to be well correlated with arthroscopic findings. In conclusion, if the clinical findings are normal, patients are to be followed-up without MRI and arthroscopy. However, if clinical findings are either borderline or abnormal, MRI should be performed prior to arthroscopy. (author)

Patellofemoral pressure changes after static and dynamic medial patellofemoral ligament reconstructions

NARCIS (Netherlands)

Rood, A.; Hannink, G.; Lenting, A.; Groenen, K.; Koëter, S.; Verdonschot, Nicolaas Jacobus Joseph; van Kampen, A.

2015-01-01

Background: Reconstructing the medial patellofemoral ligament (MPFL) has become a key procedure for stabilizing the patella. Different techniques to reconstruct the MPFL have been described: static techniques in which the graft is fixed rigidly to the bone or dynamic techniques with soft tissue

Patellofemoral Pressure Changes After Static and Dynamic Medial Patellofemoral Ligament Reconstructions

NARCIS (Netherlands)

Rood, A.; Hannink, G.; Lenting, A.; Groenen, K.; Koeter, S.; Verdonschot, N.J.; Kampen, A. van

2015-01-01

BACKGROUND: Reconstructing the medial patellofemoral ligament (MPFL) has become a key procedure for stabilizing the patella. Different techniques to reconstruct the MPFL have been described: static techniques in which the graft is fixed rigidly to the bone or dynamic techniques with soft tissue

Iliotibial band autograft versus bone-patella-tendon-bone autograft, a possible alternative for ACL reconstruction

DEFF Research Database (Denmark)

Stensbirk, Frederik; Thorborg, Kristian; Konradsen, Lars

2014-01-01

PURPOSE: The long-term results after using the iliotibial band autograft (ITB) in anterior cruciate ligament (ACL) reconstruction are not fully known. If equal in quality to conventional methods, the ITB graft could be a useful alternative as a primary graft, in revision surgery or multi-ligament......PURPOSE: The long-term results after using the iliotibial band autograft (ITB) in anterior cruciate ligament (ACL) reconstruction are not fully known. If equal in quality to conventional methods, the ITB graft could be a useful alternative as a primary graft, in revision surgery or multi...

Reconstruction of Bile Duct Injury and Defect with the Round Ligament.

Science.gov (United States)

Dokmak, Safi; Aussilhou, Béatrice; Ragot, Emilia; Tantardini, Camille; Cauchy, François; Ponsot, Philippe; Belghiti, Jacques; Sauvanet, Alain; Soubrane, Olivier

2017-09-01

Lateral injury of the bile duct can occur after cholecystectomy, bile duct dissection, or exploration. If direct repair is not possible, conversion to bilioenteric anastomosis can be needed with the risk of long-term bile duct infections and associated complications. We developed a new surgical technique which consist of reconstructing the bile duct with the round ligament. The vascularized round ligament is completely mobilized until its origin and used for lateral reconstruction of the bile duct to cover the defect. T tube was inserted and removed after few months. Patency of the bile duct was assessed by cholangiography, the liver function test and magnetic resonance imaging (MRI). Two patients aged 33 and 59 years old underwent lateral reconstruction of the bile duct for defects secondary to choledocotomy for stone extraction or during dissection for Mirizzi syndrome. The defects measured 2 and 3 cm and occupied half of the bile duct circumference. The postoperative course was marked by low output biliary fistula resolved spontaneously. In one patient, the T tube was removed at 3 months after surgery and MRI at 9 months showed strictly normal aspect of the bile duct with normal liver function test. The second patient is going very well 2 months after surgery and the T tube is closed. Lateral reconstruction of the bile duct can be safely achieved with the vascularized round ligament. We will extend our indications to tubular reconstruction.

Dorsal capsulodesis associated with arthoscopy-assisted scapholunate ligament reconstruction using a palmaris longus tendon graft

Directory of Open Access Journals (Sweden)

Victor Bignatto Carvalho

Full Text Available ABSTRACT OBJECTIVES: To measure the quality of life, the time to work return, and clinical, functional, and radiographic parameters of patients treated with dorsal capsulodesis associated with scapholunate (SL reconstruction, assisted by arthroscopy. METHODS: From January 2015 to September 2016, 14 adult patients with SL dissociation underwent surgical treatment with the SL reconstruction procedure assisted by arthroscopy, using the new technique proposed in this study. All patients were assessed by the occupational therapy department at regular intervals after surgery and performed the same sequence of rehabilitation. The parameters analyzed were: range of motion (ROM, Disability of the Arm, Shoulder, and Hand (DASH, visual analog scale (VAS, and radiographic analysis to visualize the pre- and postoperative SL gap and the pre- and postoperative dorsal intercalated segment instability (DISI deformity the. The complications and the time to return to work activities were described. RESULTS: The follow-up time was 12 months (3-17. The ROM averaged 321° (96.9% of the normal side. VAS was 1.79/10 (1-6. DASH was 6.50/100 (1-30. The time to work return work was 4.42 months (2-17. As for complications, one patient developed SLAC, and underwent four-corner fusion one year after ligament reconstruction. Currently, he has experienced pain relief, with a functional range of motion of the wrist, and has not yet returned to professional activities. The preoperative SL gap was 4.29 mm (2-7; in the postoperative period, it was 1.79 mm (1-4. The DISI deformity was present in ten patients with SL angle > 70° (preoperative and it was corrected after surgery, in all patients. SLAC stage I was identified in a patient. Arthroscopy was performed in all cases. The SL instability was classified as Geissler grade III in four cases and as grade IV in ten cases. CONCLUSION: The new approach (dorsal capsulodesis associated with SL reconstruction, assisted by arthroscopy

Technical note: Anterior cruciate ligament reconstruction in the presence of an intramedullary femoral nail using anteromedial drilling.

Science.gov (United States)

Lacey, Matthew; Lamplot, Joseph; Walley, Kempland C; DeAngelis, Joseph P; Ramappa, Arun J

2017-05-18

To describe an approach to anterior cruciate ligament (ACL) reconstruction using autologous hamstring by drilling via the anteromedial portal in the presence of an intramedullary (IM) femoral nail. Once preoperative imagining has characterized the proposed location of the femoral tunnel preparations are made to remove all of the hardware (locking bolts and IM nail). A diagnostic arthroscopy is performed in the usual fashion addressing all intra-articular pathology. The ACL remnant and lateral wall soft tissues are removed from the intercondylar, to provide adequate visualization of the ACL footprint. Femoral tunnel placement is performed using a transportal ACL guide with desired offset and the knee flexed to 2.09 rad. The Beath pin is placed through the guide starting at the ACL's anatomic footprint using arthroscopic visualization and/or fluoroscopic guidance. If resistance is met while placing the Beath pin, the arthroscopy should be discontinued and the obstructing hardware should be removed under fluoroscopic guidance. When the Beath pin is successfully placed through the lateral femur, it is overdrilled with a 4.5 mm Endobutton drill. If the Endobutton drill is obstructed, the obstructing hardware should be removed under fluoroscopic guidance. In this case, the obstruction is more likely during Endobutton drilling due to its larger diameter and increased rigidity compared to the Beath pin. The femoral tunnel is then drilled using a best approximation of the graft's outer diameter. We recommend at least 7 mm diameter to minimize the risk of graft failure. Autologous hamstring grafts are generally between 6.8 and 8.6 mm in diameter. After reaming, the knee is flexed to 1.57 rad, the arthroscope placed through the anteromedial portal to confirm the femoral tunnel position, referencing the posterior wall and lateral cortex. For a quadrupled hamstring graft, the gracilis and semitendinosus tendons are then harvested in the standard fashion. The tendons are whip

Relationship between peri-incisional dysesthesia and the vertical and oblique incisions on the hamstrings harvest in anterior cruciate ligament reconstruction

Directory of Open Access Journals (Sweden)

Marcos Laube Leite

Full Text Available ABSTRACT OBJECTIVE: To compare the incidence of peri-incisional dysesthesia according to the skin incision technique for hamstring tendon graft harvest in anterior cruciate ligament reconstruction. METHODS: Thirty-three patients with ACL rupture were separated in two groups: group 1, with 19 patients submitted to the oblique skin incision to access the hamstrings and group 2-14 patients operated by vertical skin incision technique. The selected patients were assessed after surgery. Demographic data and prevalence of dysesthesia was measured by digital pressure around the skin incision and classified according to the Highet scale. RESULTS: The total rate of dysesthesia was 42% (14 patients. Five patients (26% on the oblique incision group reported dysesthesia symptoms. On the group submitted to the vertical incision technique, the involvement was 64% (nine patients. On the 33 knees evaluated, the superior lateral area was the most affected skin region, while the superior medial and inferior medial regions were affected in only one patient (7.1%. No statistical differences between both groups were observed regarding patients' weight, age, and height¸ as well as skin incision length. CONCLUSION: Patients who underwent reconstruction of the anterior cruciate ligament using the oblique access technique had five times lower incidence of peri-incisional dysesthesia when compared with those in whom the vertical access technique was used.

Optimizing the reconstruction filter in cone-beam CT to improve periodontal ligament space visualization: An in vitro study

International Nuclear Information System (INIS)

Houno, Yuuki; Kodera, Yoshie; Hishikawa, Toshimitsu; Naitoh, Munetaka; Mitani, Akio; Noguchi, Toshihide; Ariji, Eiichiro; Gotoh, Kenichi

2017-01-01

Evaluation of alveolar bone is important in the diagnosis of dental diseases. The periodontal ligament space is difficult to clearly depict in cone-beam computed tomography images because the reconstruction filter conditions during image processing cause image blurring, resulting in decreased spatial resolution. We examined different reconstruction filters to assess their ability to improve spatial resolution and allow for a clearer visualization of the periodontal ligament space. Cone-beam computed tomography projections of 2 skull phantoms were reconstructed using 6 reconstruction conditions and then compared using the Thurstone paired comparison method. Physical evaluations, including the modulation transfer function and the Wiener spectrum, as well as an assessment of space visibility, were undertaken using experimental phantoms. Image reconstruction using a modified Shepp-Logan filter resulted in better sensory, physical, and quantitative evaluations. The reconstruction conditions substantially improved the spatial resolution and visualization of the periodontal ligament space. The difference in sensitivity was obtained by altering the reconstruction filter. Modifying the characteristics of a reconstruction filter can generate significant improvement in assessments of the periodontal ligament space. A high-frequency enhancement filter improves the visualization of thin structures and will be useful when accurate assessment of the periodontal ligament space is necessary

Optimizing the reconstruction filter in cone-beam CT to improve periodontal ligament space visualization: An in vitro study

Energy Technology Data Exchange (ETDEWEB)

Houno, Yuuki; Kodera, Yoshie [Graduate School of Medicine, Nagoya University, Nagoya (Japan); Hishikawa, Toshimitsu; Naitoh, Munetaka; Mitani, Akio; Noguchi, Toshihide; Ariji, Eiichiro [Aichi Gakuin University, Nisshin (Japan); Gotoh, Kenichi [Div. of Radiology, Dental Hospital, Aichi Gakuin University, Nisshin (Japan)

2017-09-15

Evaluation of alveolar bone is important in the diagnosis of dental diseases. The periodontal ligament space is difficult to clearly depict in cone-beam computed tomography images because the reconstruction filter conditions during image processing cause image blurring, resulting in decreased spatial resolution. We examined different reconstruction filters to assess their ability to improve spatial resolution and allow for a clearer visualization of the periodontal ligament space. Cone-beam computed tomography projections of 2 skull phantoms were reconstructed using 6 reconstruction conditions and then compared using the Thurstone paired comparison method. Physical evaluations, including the modulation transfer function and the Wiener spectrum, as well as an assessment of space visibility, were undertaken using experimental phantoms. Image reconstruction using a modified Shepp-Logan filter resulted in better sensory, physical, and quantitative evaluations. The reconstruction conditions substantially improved the spatial resolution and visualization of the periodontal ligament space. The difference in sensitivity was obtained by altering the reconstruction filter. Modifying the characteristics of a reconstruction filter can generate significant improvement in assessments of the periodontal ligament space. A high-frequency enhancement filter improves the visualization of thin structures and will be useful when accurate assessment of the periodontal ligament space is necessary.

Presence of Bacteria in Spontaneous Achilles Tendon Ruptures.

Science.gov (United States)

Rolf, Christer G; Fu, Sai-Chuen; Hopkins, Chelsea; Luan, Ju; Ip, Margaret; Yung, Shu-Hang; Friman, Göran; Qin, Ling; Chan, Kai-Ming

2017-07-01

The structural pathology of Achilles tendon (AT) ruptures resembles tendinopathy, but the causes remain unknown. Recently, a number of diseases were found to be attributed to bacterial infections, resulting in low-grade inflammation and progressive matrix disturbance. The authors speculate that spontaneous AT ruptures may also be influenced by the presence of bacteria. Bacteria are present in ruptured ATs but not in healthy tendons. Cross-sectional study; Level of evidence, 3. Patients with spontaneous AT ruptures and patients undergoing anterior cruciate ligament (ACL) reconstruction were recruited for this study. During AT surgical repair, excised tendinopathic tissue was collected, and healthy tendon samples were obtained as controls from hamstring tendon grafts used in ACL reconstruction. Half of every sample was reserved for DNA extraction and the other half for histology. Polymerase chain reaction (PCR) was conducted using 16S rRNA gene universal primers, and the PCR products were sequenced for the identification of bacterial species. A histological examination was performed to compare tendinopathic changes in the case and control samples. Five of 20 AT rupture samples were positive for the presence of bacterial DNA, while none of the 23 hamstring tendon samples were positive. Sterile operating and experimental conditions and tests on samples, controlling for harvesting and processing procedures, ruled out the chance of postoperative bacterial contamination. The species identified predominantly belonged to the Staphylococcus genus. AT rupture samples exhibited histopathological features characteristic of tendinopathy, and most healthy hamstring tendon samples displayed normal tendon features. There were no apparent differences in histopathology between the bacterial DNA-positive and bacterial DNA-negative AT rupture samples. The authors have demonstrated the presence of bacterial DNA in ruptured AT samples. It may suggest the potential involvement of bacteria

Mechanical properties of human bone-tendon-bone grafts preserved by different methods and radiation sterilised

International Nuclear Information System (INIS)

Kaminski, A.; Gut, G.

2008-01-01

Full text: Patellar tendon auto and allografts are commonly used in orthopaedic surgery for reconstruction of the anterior crucial ligaments (ACL). Autografts are mainly used for primary reconstruction, while allografts are useful for revision surgery. To avoid the risk of infection diseases transmission allografts should be radiation-sterilised. As radiation-sterilisation is supposed to decrease the mechanical strength of tendon tissue, it is important to establish methods of allografts preservation and sterilisation resulting in their best quality and safety. Therefore, the purpose of the study was to compare the tensile strength of the central one third of human patellar tendon (as used for ACL reconstruction), preserved by different methods (deep fresh freezing, lyophilisation) and subsequently radiation-sterilised with doses of 0 (control), 25, 50 or 100 kGy. Bone-tendon-bone grafts were prepared from cadaveric human patella tendon with both patellar and tibial attachments. BTB grafts were preserved by deep freezing, glicerolisation or lyophilisation and radiation-sterilised with doses of 0 (control), 25, 50 or 100 kGy. To estimate mechanical properties all samples were subjected to tensile tests to failure using Instron system. Before these tests all lyophilised grafts were rehydrated. We found decrease of tensile strength of irradiated grafts compared to non-irradiated controls. Obtained results of the mechanical testing of studied grafts indicate their potential usefulness for clinical applications.(Author)

The immediate intervention effects of robotic training in patients after anterior cruciate ligament reconstruction

OpenAIRE

Hu, Chunying; Huang, Qiuchen; Yu, Lili; Ye, Miao

2016-01-01

[Purpose] The purpose of this study was to examine the immediate effects of robot-assisted therapy on functional activity level after anterior cruciate ligament reconstruction. [Subjects and Methods] Participants included 10 patients (8 males and 2 females) following anterior cruciate ligament reconstruction. The subjects participated in robot-assisted therapy and treadmill exercise on different days. The Timed Up-and-Go test, Functional Reach Test, surface electromyography of the vastus late...

Five-Strand versus Four-Strand Hamstring Tendon Graft Technique for Anterior Cruciate Ligament Reconstruction: A Biomechanical Comparison.

Science.gov (United States)

Vaillant, Eric R; Parks, Brent G; Camire, Lyn M; Hinton, Richard Y

2017-11-01

The aim of this article is to compare diameter and stiffness, displacement, and strain in a five-strand versus four-strand hamstring graft for anterior cruciate ligament reconstruction. Eight matched pairs of lower extremities underwent four-strand or five-strand hamstring graft reconstruction. Diameter was significantly higher in the five-strand versus the four-strand construct ( p  = 0.002). No significant difference was found between the groups in construct displacement or stiffness. Significantly higher strain was observed in the inner limb versus the outer limb in the four-strand construct ( p  = 0.001) and in the inner limb versus the fifth limb in the 5-strand construct ( p  = 0.004). A fifth limb added to a four-strand hamstring graft significantly increased graft diameter but did not significantly change stiffness or displacement, suggesting that attachment of additional graft material via suture did not provide for full incorporation of the added limb into the graft at time zero. The inner limb in both constructs absorbed significantly greater load than did other limbs. The use of suture to attach additional material to a four-strand hamstring graft may not contribute to improved biomechanical qualities of the graft at time zero. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Biomechanical and histologic evaluation of tissue engineered ligaments using chitosan and hyaluronan hybrid polymer fibers: a rabbit medial collateral ligament reconstruction model.

Science.gov (United States)

Irie, Toru; Majima, Tokifumi; Sawaguchi, Naohiro; Funakoshi, Tadanao; Nishimura, Shin-Ichiro; Minami, Akio

2011-05-01

In this study, we used a rabbit medial collateral ligament reconstruction model to evaluate a novel chitosan-based hyaluronan hybrid polymer fiber scaffold for ligament tissue engineering and to examine whether mechanical forces exerted in an in vivo model increased extracellular matrix production by seeded fibroblasts. Scaffolds were used 2 weeks after incubation with fibroblasts obtained from the same rabbit in a cell-seeded scaffold (CSS) group and without cells in a noncell-seeded scaffold (NCSS) group. At 3, 6, and 12 weeks after surgery, the failure loads of the engineered ligaments in the CSS groups were significantly greater than those in the NCSS groups. At 6 weeks after surgery, the reconstructed tissue of the CSS group was positive for type I collagen, whereas that in the NCSS group was negative for type I collagen. At 12 weeks after surgery, the reconstructed tissue stained positive for type I collagen in the CSS group, but negative in the NCSS group. Our results indicate that the scaffold material enhanced the production of type I collagen and led to improved mechanical strength in the engineered ligament in vivo. Copyright © 2011 Wiley Periodicals, Inc.

Reconstruction of chronic acromioclavicular joint disruption with artificial ligament prosthesis

Directory of Open Access Journals (Sweden)

Chouhan Devendra Kumar

2013-08-01

Full Text Available 【Abstract】Objective: Management of Rockwood type 3 acromioclavicular disruptions is a matter of debate. Should we adopt conservative or operative measures at first presentation? It is not clear but most of the evidences are in favour of conservative management. We present our expe-rience in managing these patients surgically. Methods: We present a prospective series of eight cases of chronic Rockwood type 3 acromioclavicular joint disruptions treated surgically. Anatomical reconstruction of the coracoclavicular ligament was done by artificial braided polyester ligament prosthesis. Results: All the patients were able to perform daily activities from an average of the 14th postoperative day. All patients felt an improvement in pain, with decrease in ave-rage visual analogue scale from preoperative 6.5 points (range 3-9 points to 2.0 points (range 0-5 points, Constant score from 59% to 91% and American Shoulder and Elbow Surgeons shoulder score from 65 to 93 points postoperatively. These results improved or at least remained stationary on midterm follow-up, and no deterioration was recorded at an average follow-up of 46 months. Conclusion: This midterm outcome analysis of the artificial ligament prosthesis is the first such follow-up study with prosthesis. Our results are encouraging and justify the further use and evaluation of this relatively new and easily reproducible technique. Key words: Acromioclavicular joint; Prostheses and implants; Reconstructive surgical procedures; Ligaments

Acromioclavicular joint reconstruction using a tendon graft: a biomechanical study comparing a novel “sutured throughout” tendon graft to a standard tendon graft

Directory of Open Access Journals (Sweden)

Naziri Qais

2016-01-01

Full Text Available Background: With a recurrence rate of over 30%, techniques that offer stronger acromioclavicular (AC joint reconstruction through increased graft strength may provide longevity. The purpose of our study was to determine the biomechanical strength of a novel tendon graft sutured throughout compared to a native tendon graft in Grade 3 anatomical AC joint reconstruction. Methods: For this in vitro experiment, nine paired (n = 18 embalmed cadaveric AC joints of three males and six females (age 86 years, range 51–94 years were harvested. Anatomic repair with fresh bovine Achilles tendon grafts without bone block was simulated. Specimens were divided into two groups; with group 1 using grafts with ultra-high molecular-weight polyethylene (UHMWPE suture ran throughout the entire length. In group 2, reconstruction with only native allografts was performed. The distal scapula and humerus were casted in epoxy compound and mounted on the mechanical testing machine. Tensile tests were performed using a mechanical testing machine at the rate of 50 mm/min. Maximum load and displacement to failure were collected. Results: The average load to failure was significantly higher for group 1 compared to group 2, with mean values of 437.5 N ± 160.7 N and 94.4 N ± 43.6 N, (p = 0.001. The average displacement to failure was not significantly different, with 29.7 mm ± 10.6 mm in group 1 and 25 mm ± 9.1 mm in group 2 (p = 0.25. Conclusion: We conclude that a UHMWPE suture reinforced graft can provide a 3.6 times stronger AC joint reconstruction compared to a native graft.

Long-term interventions effects of robotic training on patients after anterior cruciate ligament reconstruction

OpenAIRE

Hu, Chunying; Huang, Qiuchen; Yu, Lili; Zhou, Yue; Gu, Rui; Ye, Miao; Ge, Meng; Xu, Yanfeng; Liu, Jianfeng

2016-01-01

[Purpose] The aim of this study was to examine the long-term interventions effects of robot-assisted therapy rehabilitation on functional activity levels after anterior cruciate ligament reconstruction. [Subjects and Methods] The subjects were 8 patients (6 males and 2 females) who received anterior cruciate ligament reconstruction. The subjects participated in robot-assisted therapy lasting for one month. The Timed Up-and-Go test, 10-Meter Walk test, Functional Reach Test, surface electromyo...

Tendon 'turnover lengthening' technique.

Science.gov (United States)

Cerovac, S; Miranda, B H

2013-11-01

Tendon defect reconstruction is amongst the most technically challenging areas in hand surgery. Tendon substance deficiency reconstruction techniques include lengthening, grafting, two-stage reconstruction and tendon transfers, however each is associated with unique challenges over and above direct repair. We describe a novel 'turnover lengthening' technique for hand tendons that has successfully been applied to the repair of several cases, including a case of attritional flexor and traumatic extensor tendon rupture in two presented patients where primary tenorrhaphy was not possible. In both cases a good post-operative outcome was achieved, as the patients were happy having returned back to normal activities of daily living such that they were discharged 12 weeks post-operatively. Our technique avoids the additional morbidity and complications associated with grafting, transfers and two stage reconstructions. It is quick, simple and reproducible for defects not exceeding 3-4 cm, provides a means of immediate one stage reconstruction, no secondary donor site morbidity and does not compromise salvage by tendon transfer and/or two-stage reconstruction in cases of failure. To our knowledge no such technique has been previously been described to reconstruct such hand tendon defects. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

BONE TUNNEL WIDENING AFTER ANTERIOR CRUCIATE LIGAMENT AUTOPLASTY WITH HAMSTRINGS (LITERATURE REVIEW

Directory of Open Access Journals (Sweden)

V. V. Slastinin

2017-01-01

Full Text Available ABSTRACT Such a phenomenon as bone tunnel widening after anterior cruciate ligament autoplasty with hamstrings has been known for 30 years. Despite the long history of this issue, the etiology is still not fully understood. The process of expansion of the bone tunnels is influenced by many factors such as graft fixation technique, surgical technique and rehabilitation protocol, as well as various biological factors. It is believed that this phenomenon has no influence on a functional result, but may create serious problems in revision anterior cruciate ligament surgery. Given the growing interest in the use of hamstring tendon grafts for anterior cruciate ligament reconstruction, increasing number of these operations and as a result, of revision procedures, the search for methods of bone tunnel widening prevention is becoming more urgent.

A Novel Surgical Technique for Fixation of Recurrent Acromioclavicular Dislocations: AC Dog Bone Technique in Combination with Autogenous Semitendinosus Tendon Graft

Directory of Open Access Journals (Sweden)

Patrick Holweg

2017-01-01

Full Text Available Various surgical techniques have been described for the fixation of acromioclavicular (AC dislocations. However, recurrent dislocation is one of the main complications associated with the majority of these techniques. We report a case of postoperative AC joint redislocation. In order to overcome recurrent dislocation after revision surgery, a reconstruction of the conoid and trapezoid ligament with the use of a free tendon graft in combination with a FiberTape was provided within a novel surgical technique. After 12 months, the patient was very satisfied with the functional outcome. The patient achieved excellent results in the Constant (98 points, SPADI (0 points, and QuickDASH score (0 points. The described technique results in an anatomic reconstruction of the AC joint. The nonrigid nature of the intervention seems to restore the normal arthrokinematics by reconstructing the coracoclavicular ligaments with an autograft which is then protected by the AC Dog Bone artificial ligaments during the healing period. The arthroscopic approach to the AC joint with minimal exposure reduces the risks and complications of the intervention. This is the first case in literature that utilizes the artificial dog bone ligament securing the autograft in an anatomic AC reconstruction.

Anatomy and histology of the transverse humeral ligament.

Science.gov (United States)

Snow, Brian J; Narvy, Steven J; Omid, Reza; Atkinson, Roscoe D; Vangsness, C Thomas

2013-10-01

The classic literature describes the transverse humeral ligament (THL) as a distinct anatomic structure with a role in biceps tendon stability; however, recent literature suggests that it is not a distinct anatomic structure. The purpose of this study was to evaluate the gross and microscopic anatomy of the THL, including a specific investigation of the histology of this ligament. Thirty frozen, embalmed cadaveric specimens were dissected to determine the gross anatomy of the THL. Seven specimens were evaluated histologically for the presence of mechanoreceptors and free nerve endings. Two tissue layers were identified in the area described as the THL. In the deep layer, fibers of the subscapularis tendon were found to span the bicipital groove with contributions from the coracohumeral ligament and the supraspinatus tendon. Superficial to this layer was a fibrous fascial covering consisting of distinct bands of tissue. Neurohistology staining revealed the presence of free nerve endings but no mechanoreceptors. This study's findings demonstrate that the THL is a distinct structure continuous with the rotator cuff tendons and the coracohumeral ligament. The finding of free nerve endings in the THL suggests a potential role as a shoulder pain generator. Copyright 2013, SLACK Incorporated.

Does Donor Age of Nonirradiated Achilles Tendon Allograft Influence Mid-Term Results of Revision ACL Reconstruction?

Science.gov (United States)

Zaffagnini, Stefano; Roberti di Sarsina, Tommaso; Bonanzinga, Tommaso; Nitri, Marco; Macchiarola, Luca; Stefanelli, Federico; Lucidi, Gianandrea; Grassi, Alberto

2018-01-01

Purpose  The purpose of the present study was to investigate if the donor age of nonirradiated Achilles tendon allograft could influence the clinical results of revision anterior cruciate ligament (ACL) reconstruction. Methods  All patients that underwent ACL revision between 2004 and 2008 with at least 4 years of follow-up were included. For all the patients that met the inclusion criteria, the age of the graft donor was obtained from the tissue bank. Lysholm score was administered to patients that met inclusion criteria. In addition, patients were divided in two groups based on the donor age (<45 years vs. ≥45 years), and the baseline characteristics and outcomes were compared. Results  Fifty-two patients were evaluated at a mean 4.8 ± 0.8 years follow-up with Lysholm score. The Lysholm significantly improved from 62.3 ± 6.6 at preoperative status to 84.4 ± 12.3 at final follow-up. The mean donor age was 48.7 ± 8.4 years; a significant difference in Lysholm score was noted between patients that received an allograft with a donor age <45 years (14 patients; 27%) and those receiving an allograft with a donor age ≥45 years (38; 73%) (89.5 ± 3.2 vs. 80.1 ± 11.1, respectively; p  = 0.0469). The multiple regression model showed the donor age, the final follow-up, and the preoperative Lysholm score as significant predictors of postoperative Lysholm score ( p  < 0.0002). Conclusion  Donor age of nonirradiated Achilles tendon allograft influenced the mid-term results of revision ACL reconstruction, thus advising the use of grafts from young donors. Level of Evidence  Level III, retrospective comparative study. PMID:29675501

Absence of sensory function in the reconstructed anterior cruciate ligament

DEFF Research Database (Denmark)

Krogsgaard, Michael R; Fischer-Rasmussen, Torsten; Dyhre-Poulsen, Poul

2011-01-01

Cruciate ligaments provide sensory information that cause excitatory as well as inhibitory effects to the activity of the muscles around the knee. The aim of the study was to determine whether these muscular reflexes are reestablished after anterior cruciate ligament (ACL) re-construction. Wire...... and the sensory threshold was determined. Stimulus amplitudes were increased to 1.5-2.0 times the sensory threshold, and inhibitory reflexes could be elicited from PCL in the quadriceps during active extension and in the hamstrings muscles during active flexion in all patients. Subsequently the ACL re...... amplitudes necessary to elicit reflexes from the ACL re-constructions were 2, 9 times higher than amplitudes that elicited reflexes from the PCL. Sensation and afferent reflex activity required a much stronger stimulus in the ACL graft compared to normal PCL. We suggest that the reason...

Effect of repeated freezing-thawing on the Achilles tendon of rabbits.

Science.gov (United States)

Chen, Lianxu; Wu, Yanping; Yu, Jiakuo; Jiao, Zhaode; Ao, Yingfang; Yu, Changlong; Wang, Jianquan; Cui, Guoqing

2011-06-01

The increased use of allograft tissue in the reconstruction of anterior cruciate ligament has brought more focus to the effect of storage and treatment on allograft. The purpose of this study was to observe the effect of histology and biomechanics on Achilles tendon in rabbits through repeated freezing-thawing before allograft tendon transplantation. Rabbit Achilles tendons were harvested and processed according to the manufacture's protocol of tissue bank, and freezing-thawing was repeated three times (group 1) and ten times (group 2). Those received only one cycle were used as controls. Then, tendons in each group were selected randomly to make for histological observations and biomechanics test. Histological observation showed that the following changes happened as the number of freezing-thawing increased: the arrangement of tendon bundles and collagen fibrils became disordered until ruptured, cells disrupted and apparent gaps appeared between tendon bundle because the formation of ice crystals. There were significant differences between the experimental and control groups in the values of maximum load, energy of maximum load and maximum stress, whereas no significant differences existed in other values such as stiffness, maximum strain, elastic modulus, and energy density. Therefore, repeated freezing-thawing had histological and biomechanical effect on Achilles tendon in rabbits before allograft tendon transplantation. This indicates that cautions should be taken in the repeated freezing-thawing preparation of allograft tendons in clinical application.

[Arthroscopic double-row reconstruction of high-grade subscapularis tendon tears].

Science.gov (United States)

Plachel, F; Pauly, S; Moroder, P; Scheibel, M

2018-04-01

Reconstruction of tendon integrity to maintain glenohumeral joint centration and hence to restore shoulder functional range of motion and to reduce pain. Isolated or combined full-thickness subscapularis tendon tears (≥upper two-thirds of the tendon) without both substantial soft tissue degeneration and cranialization of the humeral head. Chronic tears of the subscapularis tendon with higher grade muscle atrophy, fatty infiltration, and static decentration of the humeral head. After arthroscopic three-sided subscapularis tendon release, two double-loaded suture anchors are placed medially to the humeral footprint. Next to the suture passage, the suture limbs are tied and secured laterally with up to two knotless anchors creating a transosseous-equivalent repair. The affected arm is placed in a shoulder brace with 20° of abduction and slight internal rotation for 6 weeks postoperatively. Rehabilitation protocol including progressive physical therapy from a maximum protection phase to a minimum protection phase is required. Overhead activities are permitted after 6 months. While previous studies have demonstrated superior biomechanical properties and clinical results after double-row compared to single-row and transosseous fixation techniques, further mid- to long-term clinical investigations are needed to confirm these findings.

Quadriceps rate of torque development and disability in individuals with anterior cruciate ligament reconstruction.

Science.gov (United States)

Davis, Hope C; Troy Blackburn, J; Ryan, Eric D; Luc-Harkey, Brittney A; Harkey, Matthew S; Padua, Darin A; Pietrosimone, Brian

2017-07-01

The purpose of this study was to determine associations between self-reported function (International Knee Documentation Committee Index), isometric quadriceps strength and rate of torque development in individuals with a unilateral anterior cruciate ligament reconstruction. Forty-one individuals [31% male, BMI mean 25 (SD 4) kg/m 2 , months post anterior cruciate ligament reconstruction mean 49 (SD 40)] completed the self-reported function and isometric quadriceps function testing. Rate of torque development was assessed at 0-100ms (early), 100-200ms (late) ms, and peak following the onset of contraction. Associations were examined between rate of torque development, strength, and self-reported function. Linear regression was used to determine the unique amount of variance explained by the combination of rate of torque development and strength. Higher rate of torque development 100-200ms is weakly associated with higher self-reported function in individuals with a unilateral anterior cruciate ligament reconstruction (r=0.274, p=0.091); however, rate of torque development 100-200ms does not predict a significant amount of variance in self-reported function after accounting for strength (ΔR 2 =0.003, P=0.721). Quadriceps strength has a greater influence on self-reported function compared to rate of torque development in individuals with an anterior cruciate ligament reconstruction with time from surgery. Copyright © 2017 Elsevier Ltd. All rights reserved.

Benefits of sagittal-oblique MRI reconstruction of anterior cruciate ligament of the knee

International Nuclear Information System (INIS)

Nenezić, D.

2015-01-01

Full text: MRI examination of the anterior cruciate ligament (ACL) of the knee gives valuable information for conventional, physiatrist and/or arthroscopic microinvasiv treatment. three planar MRI examination and 3D reconstructions are highly precise in the analysis of the intra and periarticular structures, with exceptions of anterior cruciate ligament. Direct contact with the roof of the intercondilar fossa (in the full extension during the examination) and its specific orientation makes visualization of ACL diagnostically problematic. In a one year period precise protocol for MRI visualization of ACL was tested and applied as “Sagittal Oblique MRI Reconstruction”. In short, it has been Angled biplanar reconstruction in the parasagital and paratransversal planes (patientrelated and arbitrary selected in full extension), on T2, 2mm slice and 0,2 mm gap. 153 MRI examinations of the patients with lesions of the ACL were included in the study in the Clinical Center of Montenegro during 2005 year. Beside standard Knee MRI protocol all patients had the Sagittal Oblique MRI reconstruction of ACL and the Flexion MRI examination, to compare with. The Sagittal Oblique MRI reconstruction of ACL it is adapted to the concrete morphology of the patients ACL and it does not depend of the volume of the examined knee. In comparison with the Standard Knee MRI protocol and with the Flexion MRI examination, the Sagittal Oblique MRI reconstruction of ACL takes less time to perform, and the ligament is shown in fool length at three to five slices, which is more than with the both compared protocols. Sagittal Oblique MRI Reconstruction of ACL is therefore patient dependable, orientated in shape of concrete ligament of the patient’s knee. In combination with age, occupation, physical activity and level of patients while to contribute in healing process, the Sagittal Oblique MRI reconstruction of ACL contribute to scholastic approach, as highest benefit to patients with

ARTHROSCOPIC RECONSTRUCTION OF THE KNEE POSTERIOR CRUCIATE LIGAMENT

Directory of Open Access Journals (Sweden)

I. A. Kuznetsov

2011-01-01

Full Text Available In this article there were published diagnostic and surgery principles and the clinical results of arthroscopic single bundle posterior cruciate ligament (PCL reconstruction in patients with chronic PCL instability not responding to conservative treatment. There were treated 27 patients with PCL instability since 2006 till 2010. 10 of 27 patients were available for followup with an average elapsed time of 6,1 years between onset of injury and surgery and an average duration of 1,8 years between reconstruction and evaluation. Although there still is some controversy on the indication for treatment of PCL injury, we conclude on the basis of our findings that arthroscopic reconstruction of symptomatic chronic PCL instability can be greatly beneficial.

Magnetic resonance imaging evaluation of cruciate ligaments after arthroscopic reconstruction

Directory of Open Access Journals (Sweden)

Amit Kharat

2017-01-01

Full Text Available Background: Due to increase in road traffic and sports injuries, tears of anterior cruciate ligament (ACL and the posterior cruciate ligament (PCL of the knee are common. Magnetic resonance imaging (MRI is emerging as an important tool of diagnosis and evaluation of these injuries. Methods: We carried out a prospective study on role of MRI on ten patients who had undergone ACL or PCL repair over a period of six months. In this report we present three illustrative cases to capture the spectrum of findings in our series to underline the role of MRI in management of such injuries and discuss the modalities of the procedure. Results: In our series, as demonstrated by the cases, MRI had an important role in diagnosis and evaluation of injuries to the cruciate ligaments. Conclusion: MRI can play an important role, particularly in tertiary centres, in diagnosis and evaluation of reconstructed ACL and PCL ligaments of the knee joint.

A RETROSPECTIVE ANALYSIS OF ARTHROSCOPIC ACL RECONSTRUCTION WITH HAMSTRING TENDON GRAFT

Directory of Open Access Journals (Sweden)

Ashish R. Agarwal

2017-08-01

Full Text Available BACKGROUND ACL reconstruction is one of the commonest knee surgeries done. Young adults are the commonest patients; thus, this injury has a large impact on socioeconomic status of the family. The aim of the study is to study the outcome of arthroscopic ACL reconstruction with hamstring tendon graft. MATERIALS AND METHODS 50 patients following up in the OPD who had undergone ACL reconstruction with hamstring tendon graft are evaluated. Patients who had other lesions, such meniscal injuries or collateral injuries were discarded. These patients were evaluated by using Tegner and Lysholm score of 6 months, 12 months and 24 months. Settings- It is a retrospective analysis of the data collected from the patients who were opiated at Nair Hospital. RESULTS 90% of patients in the study were males. Mean age of the study population is 30.7 years. All the patients in the study had instability as a symptom, while 80% of them also had pain. Six months after surgery, according to Tegner and Lysholm score, 52% patients had good outcome, while 48% had fair outcome. At 2 years, 98% of study population had excellent outcome. CONCLUSION Arthroscopic ACL reconstruction with hamstring graft is an effective way of treating ACL tear.

Arthroscopic-Assisted Triangular Fibrocartilage Complex Reconstruction.

Science.gov (United States)

Chu-Kay Mak, Michael; Ho, Pak-Cheong

2017-11-01

Injury of the triangular fibrocartilage complex (TFCC) is a common cause of ulnar-sided wrist pain. Volar and dorsal radioulnar ligaments and their foveal insertion are the most important stabilizing components of the TFCC. In irreparable tears, anatomic reconstruction of the TFCC aims to restore normal biomechanics and stability of the distal radioulnar joint. We proposed a novel arthroscopic-assisted technique using a palmaris longus tendon graft. Arthroscopic-assisted TFCC reconstruction is a safe and effective approach with outcomes comparable to conventional open reconstruction and may result in a better range of motion from minimizing soft tissue dissection and subsequent scarring. Copyright © 2017 Elsevier Inc. All rights reserved.

Repeated freeze-thaw cycles reduce the survival rate of osteocytes in bone-tendon constructs without affecting the mechanical properties of tendons.

Science.gov (United States)

Suto, Kaori; Urabe, Ken; Naruse, Kouji; Uchida, Kentaro; Matsuura, Terumasa; Mikuni-Takagaki, Yuko; Suto, Mitsutoshi; Nemoto, Noriko; Kamiya, Kentaro; Itoman, Moritoshi

2012-03-01

Frozen bone-patellar tendon bone allografts are useful in anterior cruciate ligament reconstruction as the freezing procedure kills tissue cells, thereby reducing immunogenicity of the grafts. However, a small portion of cells in human femoral heads treated by standard bone-bank freezing procedures survive, thus limiting the effectiveness of allografts. Here, we characterized the survival rates and mechanisms of cells isolated from rat bones and tendons that were subjected to freeze-thaw treatments, and evaluated the influence of these treatments on the mechanical properties of tendons. After a single freeze-thaw cycle, most cells isolated from frozen bone appeared morphologically as osteocytes and expressed both osteoblast- and osteocyte-related genes. Transmission electron microscopic observation of frozen cells using freeze-substitution revealed that a small number of osteocytes maintained large nuclei with intact double membranes, indicating that these osteocytes in bone matrix were resistant to ice crystal formation. We found that tendon cells were completely killed by a single freeze-thaw cycle, whereas bone cells exhibited a relatively high survival rate, although survival was significantly reduced after three freeze-thaw cycles. In patella tendons, the ultimate stress, Young's modulus, and strain at failure showed no significant differences between untreated tendons and those subjected to five freeze-thaw cycles. In conclusion, we identified that cells surviving after freeze-thaw treatment of rat bones were predominantly osteocytes. We propose that repeated freeze-thaw cycles could be applied for processing bone-tendon constructs prior to grafting as the treatment did not affect the mechanical property of tendons and drastically reduced surviving osteocytes, thereby potentially decreasing allograft immunogenecity.

COMPARATIVE STUDY OF CLINICAL OUTCOME OF ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION BONE PATELLAR TENDON BONE GRAFT V/S HAMSTRING GRAFT

Directory of Open Access Journals (Sweden)

Priyank

2015-08-01

fulfilling the predetermined inclusion and exclusion criteria were included in the study. STATISTICAL METHODS : Intergroup comparison was analysed by K - Independent sample t test. Intragroup comparison was analysed by Paired t - test. RESULTS : Patients were divided into two groups and treated with using Bone - patellar tendon - bone graft and Hamstring graft respectively. Mean age group of patients was 29.16 yrs. (range 16 - 51yrs and 30.88 yrs. (range 19 - 48yrs in group A and B respectively we found the incidence of ACL injury in 15 - 44 years age group to be greater than twice the general population. A mean delay in surgery of 4.66 months (range 2 - 12 months since the time of injury in group A and 4.46 months (range 2 - 7 months in group B was observed. Subjective IKDC evaluation was done at the end of 12 months. Ther e was no difference in both the groups in the terms of effusion, passive motion, knee compartment findings, ligament examination, X - ray findings. Functional test and IKDC grade of both the groups showed statistically very highly significant improvement. Ho wever, there was statistically very high Harvest site pathology in group A. CONCLUSION : We found that there is statistically no significant difference in the overall clinical outcome between hamstring autograft with transfix and bone - patellar tendon bone autograft with interference screw except that the patellar tendon group had a greater tendency of having donor site morbidity compared to the hamstring tendon group.

Valgus osteotomy of the tibia with a Puddu plate combined with anterior cruciate ligament reconstruction

Directory of Open Access Journals (Sweden)

Albuquerque Roberto Freire da Mota e

2003-01-01

Full Text Available Anterior knee instability associated with a varus deformity is a complex condition with several treatment possibilities. Among these, anterior cruciate ligament (ACL associated to a simultaneous valgus tibial osteotomy is a increasing indication. This simultaneous procedure adds technical issues to those related to the isolated surgeries. Thus, the osteotomy plane and location of fixation hardware shouldn?t conflict with tibial tunnel and ACL graft fixation. Authors analyze the relations between a opening tibial valgus osteotomy stabilized with a Puddu plate and ACL reconstruction with a patellar tendon graft fixated with interference screws in 10 human cadaver knees. A straight oblique tibial osteotomy starting on the medial tibial cortex and oriented laterally and proximally was performed on all knees with a 10mm opening medially and stabilized with a Puddu plate on the most posterior aspect of the medial tibia, and a tibial tunnel drilled 50° to tibial plateau. With this technique there was no intersection between tibial tunnel or interference screw and the osteotomy or the plate fixation screws.

Ligament Tissue Engineering

OpenAIRE

Khan, Wasim Sardar

2016-01-01

Ligaments are commonly injured in the knee joint, and have a poor capacity for healing due to their relative avascularity. Ligament reconstruction is well established for injuries such as anterior cruciate ligament rupture, however the use of autografts and allografts for ligament reconstruction are associated with complications, and outcomes are variable. Ligament tissue engineering using stem cells, growth factors and scaffolds is a novel technique that has the potential to provide an unlim...

Reconstruction of long digital extensor tendon by cranial tibial muscle fascia graft in a dog.

Science.gov (United States)

Sabiza, Soroush; Khajeh, Ahmad; Naddaf, Hadi

2016-01-01

Tendon rupture in dogs is generally the result of a direct trauma. This report described the use of adjacent muscle autogenic fascial graft for reconstruction of distal rupture of long digital extensor tendon in a dog. A two-year-old male mix breed dog, was presented with a non-weight bearing lameness of the right hind limb and a deep rupture of lateral side of right tarsus. History taking revealed that this rupture appeared without any apparent cause, when walking around the farm, three days before. Radiography was done and no fracture was observed. Hyperextension of right tarsal joint compared to left limb was observed. Under general anesthesia, after dissections of the ruptured area, complete rupture of long digital extensor tendon was revealed. Then, we attempted to locate the edge of the tendon, however, the tendon length was shortened approximately 1 cm. Hence, a strip of 1 cm length from fascia of cranial tibial muscle was harvested to fill the defect. The graft was sutured to the two ends of tendon using locking loop pattern. Subcutaneous layers and the skin were sutured routinely. Ehmer sling bandage was applied to prevent weight bearing on the surgical region. Re-examination and phone contact with the owner eight weeks and six months postoperatively revealed a poor lameness and excellent function of the dog, respectively. It could be concluded that the fascia of adjacent muscles can be used as an autogenic graft for reconstruction of some tendon ruptures.

[Calcaneo-fibular ligament surgery for chronic lateral instability of the upper ankle : Broström technique with modification by Wille. Video article].

Science.gov (United States)

Kosiol, J; Wille, M; Putzer, D; Biedermann, R

2015-11-01

An acute ligament rupture of the lateral ligament complex of the ankle joint is treated without surgery. Treatment failure may lead to a chronically unstable situation of the ankle joint, in which case surgery is an effective procedure for stabilizing the ruptured ligaments. Anatomical reconstruction is the best operative technique if the ligament tissue is of good quality. In our video we demonstrate a new possibility for the positioning of an anchor to tighten the calcaneo-fibular ligament. Modified Broström repairs are described in the literature in which the calcaneo-fibular ligament is released and reattached to the fibula to tighten it. We present the option to release the ligament at the calcaneus and reattach it using a suture anchor. This offers the advantage of preventing the possible dislocation of the peroneal tendons.

Effect of the Interposition of Calcium Phosphate Materials on Tendon-Bone Healing During Repair of Chronic Rotator Cuff Tear.

Science.gov (United States)

Zhao, Song; Peng, Lingjie; Xie, Guoming; Li, Dingfeng; Zhao, Jinzhong; Ning, Congqin

2014-08-01

The current nature of tendon-bone healing after rotator cuff (RC) repair is still the formation of granulation tissue at the tendon-bone interface rather than the formation of fibrocartilage, which is the crucial structure in native tendon insertion and can be observed after knee ligament reconstruction. The interposition of calcium phosphate materials has been found to be able to enhance tendon-bone healing in knee ligament reconstruction. However, whether the interposition of these kinds of materials can enhance tendon-bone healing or even change the current nature of tendon-bone healing after RC repair still needs to be explored. The interposition of calcium phosphate materials during RC repair would enhance tendon-bone healing or change its current nature of granulation tissue formation into a more favorable process. Controlled laboratory study. A total of 144 male Sprague-Dawley rats underwent unilateral detachment of the supraspinatus tendon, followed by delayed repair after 3 weeks. The animals were allocated into 1 of 3 groups: (1) repair alone, (2) repair with Ca5(PO4)2SiO4 (CPS) bioceramic interposition, or (3) repair with hydroxyapatite (HA) bioceramic interposition at the tendon-bone interface. Animals were sacrificed at 2, 4, or 8 weeks postoperatively, and microcomputed tomography (micro-CT) was used to quantify the new bone formation at the repair site. New fibrocartilage formation and collagen organization at the tendon-bone interface was evaluated by histomorphometric analysis. Biomechanical testing of the supraspinatus tendon-bone complex was performed. Statistical analysis was performed using 1-way analysis of variance. Significance was set at P repair, CPS bioceramic significantly increased the area of fibrocartilage at the tendon-bone interface compared with the control and HA groups. Moreover, CPS and HA bioceramics had significantly improved collagen organization. Biomechanical tests indicated that the CPS and HA groups have greater ultimate

Popliteal artery injury during posterior cruciate ligament reconstruction

Directory of Open Access Journals (Sweden)

Marcos Henrique Frauendorf Cenni

2015-06-01

Full Text Available 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.

[Treatment of complete acromioclavicular joint dislocation with transfer of the medial half of the coracoacromial ligament to reconstruct the coracoclavicular ligament].

Science.gov (United States)

Dong, Wen-Wei; Shi, Zeng-Yuan; Liu, Zheng-Xin; Mao, Hai-Jiao

2015-04-01

To explore the operation methods and clinical effects of transfer of the medial half of the coracoacromial ligament to reconstruct the coracoclavicular ligament in treating complete acromioclavicular joint dislocation. From January 2006 to June 2012,26 patients with acute complete acromioclavicular joint dislocation underwent surgery. Transfer of the medial half of the coracoacromial ligament to reconstruct the coracoclavicular ligament, additional clavical hoot plate and Kirschner wires fixation, were performed in all the patients. Among the patients, 18 patients were male and 8 patients were female, with an average age of 36.7 years old (ranged from 25 to 51 years). The duration from injury to operation was from 3 to 12 days with an average of 5 days. According to the Rockwood classification, 4 cases were grade III and 22 cases were grade V . Clinical manifestation included local swelling, tenderness with snapping, limitation of shoulder joint motion. In preoperative bilateral shoulder joint X-rays, the injured coracoclavicular distance was (16.2 ± 5.0) mm which was significantly wider than that of uninjured sides (7.6 ± 1.0) mm. Clinical results were evaluated according to X-rays and Constant-Murley score. All incisions obtained primary healing after operation without complication of infection, internal fixation breakage, redislocation. All the patients were followed up from 12 to 30 months with an average of 18 months. Kirschner wires and internal fixation plate were removed at 1 month and 8-10 months after operation, respectively. At final follow-up, the motion of shoulder joint recovered to normal and a no pain joint was obtained. According to Constant-Murley score, 24 cases got excellent results and 2 cases good. There was no significant difference after operation between the injured coracoclavicular distance and the uninjured contralateral side [(7.7 ± 1.2) mm vs (7.6 ± 1.0) mm), P > 0.05]. Transfer of the medial half of the coracoacromial ligament to

Temporal growth factor release from platelet-rich plasma, trehalose lyophilized platelets, and bone marrow aspirate and their effect on tendon and ligament gene expression.

Science.gov (United States)

McCarrel, Taralyn; Fortier, Lisa

2009-08-01

Platelet-rich plasma (PRP) has generated substantial interest for tendon and ligament regeneration because of the high concentrations of growth factors in platelet alpha-granules. This study compared the temporal release of growth factors from bone marrow aspirate (BMA), PRP, and lyophilized platelet product (PP), and measured their effects on tendon and ligament gene expression. Blood and BMA were collected and processed to yield PRP and plasma. Flexor digitorum superficialis tendon (FDS) and suspensory ligament (SL) explants were cultured in 10% plasma in DMEM (control), BMA, PRP, or PP. TGF-beta1 and PDGF-BB concentrations were determined at 0, 24, and 96 h of culture using ELISA. Quantitative RT-PCR for collagen types I and III (COL1A1, COL3A1), cartilage oligomeric matrix protein (COMP), decorin, and matrix metalloproteinases-3 and 13 (MMP-3, MMP-13) was performed. TGF-beta1 and PDGF-BB concentrations were highest in PRP and PP. Growth factor quantity was unchanged in BMA, increased in PRP, and decreased in PP over 4 days. TGF-beta1 and platelet concentrations were positively correlated. Lyophilized PP and PRP resulted in increased COL1A1:COL3A1 ratio, increased COMP, and decreased MMP-13 expression. BMA resulted in decreased COMP and increased MMP-3 and MMP-13 gene expression. Platelet concentration was positively correlated with COL1A1, ratio of COL1A1:COL3A1, and COMP, and negatively correlated with COL3A1, MMP-13, and MMP-3. White blood cell concentration was positively correlated with COL3A1, MMP3, and MMP13, and negatively correlated with a ratio of COL1A1:COL3A1, COMP, and decorin. These findings support further in vivo investigation of PRP and PP for treatment of tendonitis and desmitis. Copyright 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Sex Hormones and Tendon

DEFF Research Database (Denmark)

Hansen, Mette; Kjaer, Michael

2016-01-01

The risk of overuse and traumatic tendon and ligament injuries differ between women and men. Part of this gender difference in injury risk is probably explained by sex hormonal differences which are specifically distinct during the sexual maturation in the teenage years and during young adulthood....... The effects of the separate sex hormones are not fully elucidated. However, in women, the presence of estrogen in contrast to very low estrogen levels may be beneficial during regular loading of the tissue or during recovering after an injury, as estrogen can enhance tendon collagen synthesis rate. Yet...... has also been linked to a reduced responsiveness to relaxin. The present chapter will focus on sex difference in tendon injury risk, tendon morphology and tendon collagen turnover, but also on the specific effects of estrogen and androgens....

Anterior cruciate ligament reconstruction with a novel porcine xenograft: the initial Italian experience

Science.gov (United States)

ZAFFAGNINI, STEFANO; GRASSI, ALBERTO; MUCCIOLI, GIULIO MARIA MARCHEGGIANI; DI SARSINA, TOMMASO ROBERTI; RAGGI, FEDERICO; BENZI, ANDREA; MARCACCI, MAURILIO

2015-01-01

At the current state of the art in anterior cruciate ligament (ACL) reconstruction, multiple techniques have been presented but none has given clearly defined and improved results. One of the main issues concerns the choice of graft. The concept of using xenograft tissue, defined as a graft tissue from one species and destined for implantation in an unlike species, was introduced in order to try to overcome the mechanical and biological concerns associated with synthetic materials and the safety and quality concerns and availability problems of allograft tissue. Xenograft tissue carries the risk of producing an immunological reaction. In order to try to overcome or attenuate the immune response against porcine xenograft tissue, the Z-Process® (Aperion Biologics Inc, San Antonio, Texas, USA) has been developed and used to produce the Z-Lig® family of devices for ACL reconstruction procedures. Z-Lig® is a tendon graft with or without bone blocks, sourced from animal tissue in a manner consistent with what has normally been sourced from human tissue, and processed to overcome anti-Gal-mediated rejection and to attenuate other immunological recognition in humans. All this while ensuring sterility, viral inactivation and preservation of mechanical proprieties appropriate for an ACL reconstruction device. The Z-Lig® device has been tested in skeletally mature monkeys and given interesting and promising results from the preclinical performance and safety profile point of view. On this basis, it was possible to proceed with the first clinical trial involving humans, which gave similar encouraging results. The Z-Lig® device has also been implanted in Italy at the Rizzoli Orthopaedic Institute in Bologna, as a part of international multicenter prospective randomized blinded controlled study aimed at comparing xenograft with allograft tissue. PMID:26605257

Outcomes in Anterior Cruciate Ligament Reconstruction Surgery

Directory of Open Access Journals (Sweden)

Roman Mihai

2016-11-01

Full Text Available Improving the outcomes in reconstructive surgery of the anterior cruciate ligament (ACL requires a rigorous and permanent assessment of specific parameters. Therefore, we can increase the degree of reproducibility of the procedure and identify particular aspects in order to achieve an adequate and individualized therapeutic approach for each case. In order to accomplish this goal, the use of complex means (scores of quantifying results is required. That includes objective means of verifying the parameters in knee surgery, and a subjective evaluation of the patient in order to compare the results.

Distal insertions of the semimembranosus tendon: MR imaging with anatomic correlation

Energy Technology Data Exchange (ETDEWEB)

Maeseneer, Michel de [Universitair Ziekenhuis Brussel, Department of Radiology, Jette, Brussels (Belgium); Vrije Universiteit Brussel, Department of Experimental Anatomy, Brussels (Belgium); Shahabpour, Maryam; Milants, Annemieke; Ridder, Filip de; Mey, Johan de [Universitair Ziekenhuis Brussel, Department of Radiology, Jette, Brussels (Belgium); Lenchik, Leon [Wake Forest University, Department of Radiology, Winston-Salem, NC (United States); Cattrysse, Erik [Vrije Universiteit Brussel, Department of Experimental Anatomy, Brussels (Belgium)

2014-06-15

The purpose of this study is to investigate the distal insertions of the semimembranosus tendon with MR imaging, correlated with findings in cadavers. Four fresh cadaveric specimens were studied with 3-T MR imaging. Sequences included proton density (PD) sequences (TE, 13; TR, 4957; FOV, 170 x 170; matrix, 424 x 413; NA, 2; slice thickness, 2.5 mm) in the axial, coronal, and sagittal planes and 3D fast field echo (FFE) sequences (TR 9.4; TE 6.9; FOV, 159 x 105; matrix, 200 x 211; NA, 2; slice thickness, 0.57 mm). One specimen was dissected and three specimens were sectioned with a bandsaw in the axial, coronal, and sagittal plane. The sections were photographed and correlated with MR images. To standardize the analysis, the semimembranosus muscle and tendon were assessed at seven levels for the axial sections, and at three levels for the coronal and sagittal sections. Anatomic dissection revealed six insertions of the distal semimembranosus tendon: direct arm, anterior arm, posterior oblique ligament extension, oblique popliteal ligament extension, distal tibial expansion (popliteus aponeurosis), and meniscal arm. Axial MR images showed five of six insertions: direct arm, anterior arm, oblique popliteal ligament extension, posterior oblique ligament extension, and distal tibial expansion. Sagittal MR images showed four of six insertions: direct arm, anterior arm, oblique popliteal ligament arm, and distal tibial expansion. Sagittal MR images were ideal for showing the direct arm insertion, but were less optimal than the axial images for showing the other insertions. The anterior arm was seen but volume averaging was present with the gracilis tendon. Coronal MR images optimally revealed the anterior arm, although magic angle artifact was present at its posterior aspect. The common semimembranosus tendon and meniscal arm were also well depicted. The division in anterior arm, direct arm, and oblique popliteal ligament arm was poorly seen on coronal images due to

Exercise Rehabilitation after Anterior Cruciate Ligament Reconstruction

Directory of Open Access Journals (Sweden)

Keun Ok An

2017-06-01

Full Text Available OBJECTIVES Exercise rehabilitation after anterior cruciate ligament (ACL reconstruction has changed dramatically in recent years. In this review, we discuss recent changes in exercise programs related to ACL rehabilitation. METHODS We conducted a literature review of recently published articles related exercise programs after ACL reconstruction. RESULTS The accelerated rehabilitation program, which allows patients to achieve full extension ofthe knee early in the postoperative period, is now a widely practiced rehabilitation program. A prospective study of rehabilitation programs after ACL reconstruction showed that early joint exercises do not interfere with the healing of grafts. Instead, they alleviate pain, thereby reducing the negative impact. Moreover, according to several biomechanical studies, open kinetic chain exercises are potentially disadvantageous to knee stability. There is no evidence that early weight bearing results in weakening of graft distraction or internal fixation compared with delayed weight bearing. CONCLUSIONS In conclusion, prevention of ACL injuries and rehabilitative exercise training can help to achieve optimal exercise performance while avoiding the risk of sports-related injury.

A CLINICAL STUDY OF ARTHROSCOPIC MANAGEMENT OF ANTERIOR C RUCIATE LIGAMENT INJURIES OF KNEE JOINT

Directory of Open Access Journals (Sweden)

Paragjyoti

2015-09-01

Full Text Available BACKGROUND : Anterior C ruciate L igament (ACL tear is a common sports injury of the knee. There are a lot of controversies related to the management of this injury and more than 2000 papers have been published on the various aspects of the topic. Arthroscopic reconstruction of the ACL with autogenous graft material is widely used nowadays. The two most commonly used grafts are the central one - third of the patellar ligament (bone - tendon - bone, BTB and the hamstring tendon ( S emitendinosus - gracilis, STG construct but the former graft leads to increased donor site morbidity & hurdles in postoperative rehab & pain. The aim of the study is to study the Arthroscopic management of anterior cruciate ligament injury of knee joint using quadrupled hamstring graft. METHOD: The study was carried out on 30 cases of anterior cruciate ligament injury of knee joint attending the OPD and emergency of department of Orthopaedics, Silchar Medical College & Hospital who met the inclusion criteria. An informed consent was obtained from each patient prior to participation in the study. All the patients were examined in detail and worked up to obtain pre - anaesthetic clearance. X - rays and MRI were done routinely in all the cases. Clinical and radiological parameters were recorded. Arthroscopic anterior cruciate ligament reconstruction with quadrupled hamstring graft was done in all the patients. Concomitant meniscal inju ries were treated according to the merit of the injury. Patients were followed up at regular intervals and outcome variables were assessed and recorded. RESULTS: Results of our study clearly showed that arthroscopic ACL reconstruction using quadrupled hamstring graft is a safe, effective and reproducible procedure in restoring knee function with minimal donor site morbidity. At follow up evaluation, all patients had good outcomes in terms of clinical stability, range of motion and general symptoms. CONCLUSION: From the results in this study

Biomechanical evaluation of native acromioclavicular joint ligaments and two reconstruction techniques in the presence of the sternoclavicular joint: A cadaver study.

Science.gov (United States)

Masionis, Povilas; Šatkauskas, Igoris; Mikelevičius, Vytautas; Ryliškis, Sigitas; Bučinskas, Vytautas; Griškevičius, Julius; Martin Oliva, Xavier; Monzó Planella, Mariano; Porvaneckas, Narūnas; Uvarovas, Valentinas

2017-01-01

Where is over 100 reconstruction techniques described for acromioclavicular (AC) joint reconstruction. Although, it is not clear whether the presence of the sternoclavicular (SC) joint influences the biomechanical properties of native AC ligaments and reconstruction techniques. The purpose of the present study was to investigate the biomechanical properties of native AC joint ligaments and two reconstruction techniques in cadavers with the SC joint still present. We tested eight fresh-frozen cadaver hemithoraces for superior translation (70 N load) and translation increment after 1000 cycles (loading from 20 to 70 N) in a controlled laboratory study. There were three testing groups created: native ligaments, the single coracoclavicular loop (SCL) technique, and the two coracoclavicular loops (TCL) technique. Superior translation was measured after static loading. Translation increment was calculated as the difference between superior translation after cyclic and static loading. Native AC ligaments showed significantly lower translation than the SCL ( p = 0.023) and TCL ( p = 0.046) groups. The SCL had a significantly lower translation increment than native AC ligaments ( p = 0.028). There was no significant difference between reconstruction techniques in terms of translation ( p = 0.865) and translation increment ( p = 0.113). Native AC joint ligaments had better static properties than both reconstruction techniques and worse dynamic biomechanical properties than the SCL technique. The SCL technique appeared to be more secure than the TCL technique. The presence of the SC joint did not have an observable influence on test results.

Complete acromioclavicular joint dislocation treated with reconstructed ligament by trapezius muscle fascia and observation of fascial metaplasia.

Science.gov (United States)

Wang, Chaoliang; Huang, Sufang; Wang, Yingzhen; Sun, Xuesheng; Zhu, Tao; Li, Qiang; Lin, Chu

2015-01-01

We evaluated the long-term clinical results of acute complete acromioclavicular dislocations treated by reconstruction of the acromioclavicular and coracoclavicular ligament using trapezius muscle fascia. Open reduction and internal fixation was performed using the clavicular hook plate in 12 patients with acute complete acromioclavicular joint dislocation, and the acromioclavicular and coracoclavicular ligaments were reconstructed using trapezius muscle fascia. Radiographic evaluations were conducted postoperatively. We evaluated the functional results with constant scoring system and radiological results at the final follow-up visit. The mean Constant score at the final follow-up visit was 91.67 (range, 81 to 100). The results were excellent in eight patients (66.7%) and good in four patients (33.3%). Three patients with scores from 80 to 90 had mild pain during activity, but this did not affect the range of motion of the shoulder. All patients have returned to their preoperative work without any limitations. Compared with the contralateral side, radiography showed anatomical reposition in the vertical plane in all cases. The hook-plate fixation with ligament reconstruction was successful in treating AC dislocations. The acromioclavicular and coracoclavicular ligament were reconstructed by trapezius muscle fascia that keep the distal clavicle stable both vertically and horizontally after type III injuries.

Complete acromioclavicular joint dislocation treated with reconstructed ligament by trapezius muscle fascia and observation of fascial metaplasia

Directory of Open Access Journals (Sweden)

Wang Chaoliang

2015-01-01

Full Text Available We evaluated the long-term clinical results of acute complete acromioclavicular dislocations treated by reconstruction of the acromioclavicular and coracoclavicular ligament using trapezius muscle fascia. Open reduction and internal fixation was performed using the clavicular hook plate in 12 patients with acute complete acromioclavicular joint dislocation, and the acromioclavicular and coracoclavicular ligaments were reconstructed using trapezius muscle fascia. Radiographic evaluations were conducted postoperatively. We evaluated the functional results with constant scoring system and radiological results at the final follow-up visit. The mean Constant score at the final follow-up visit was 91.67 (range, 81 to 100. The results were excellent in eight patients (66.7% and good in four patients (33.3%. Three patients with scores from 80 to 90 had mild pain during activity, but this did not affect the range of motion of the shoulder. All patients have returned to their preoperative work without any limitations. Compared with the contralateral side, radiography showed anatomical reposition in the vertical plane in all cases. The hook-plate fixation with ligament reconstruction was successful in treating AC dislocations. The acromioclavicular and coracoclavicular ligament were reconstructed by trapezius muscle fascia that keep the distal clavicle stable both vertically and horizontally after type III injuries.

Medial patellofemoral ligament reconstruction: patient selection and perspectives

Directory of Open Access Journals (Sweden)

Baer MR

2017-09-01

Full Text Available Michael R. Baer, Jeffrey A. Macalena Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA Abstract: Patellofemoral instability is a painful and often recurring disorder with many negative long-term consequences. After a period of failed nonoperative management, surgical intervention has been used to reduce the incidence of patellar subluxation and dislocations. Medial patellofemoral ligament (MPFL reconstruction successfully addresses patellofemoral instability by restoring the deficient primary medial patellar soft tissue restraint. When planning MPFL reconstruction for instability, it is imperative to consider the patient’s unique anatomy including the tibial tuberosity–trochlear groove (TT–TG distance, trochlear dysplasia, and patella alta. Additionally, it is important to individualize surgical treatment in the skeletally immature, hypermobile, and athletic populations. Keywords: MPFL, indications, considerations, contraindications

Anterior cruciate ligament reconstruction with 4-strand hamstring autograft and accelerated rehabilitation: a 10-year prospective study on clinical results, knee osteoarthritis and its predictors.

Science.gov (United States)

Janssen, Rob P A; du Mée, Arthur W F; van Valkenburg, Juliette; Sala, Harm A G M; Tseng, Carroll M

2013-09-01

Analysis of long-term clinical and radiological outcomes after anterior cruciate ligament (ACL) reconstruction with special attention to knee osteoarthritis and its predictors. A prospective, consecutive case series of 100 patients. Arthroscopic transtibial ACL reconstruction was performed using 4-strand hamstring tendon autografts with a standardized accelerated rehabilitation protocol. Analysis was performed preoperatively and 10 years postoperatively. Clinical examination included Lysholm and Tegner scores, IKDC, KT-1000 testing (MEDmetric Co., San Diego, CA, USA) and leg circumference measurements. Radiological evaluation included AP weight bearing, lateral knee, Rosenberg and sky view X-rays. Radiological classifications were according to Ahlbäck and Kellgren & Lawrence. Statistical analysis included univariate and multivariate logistic regressions. RESULTS CLINICAL OUTCOME: A significant improvement (p test, IKDC score and one-leg hop test. A pivot shift phenomenon (glide) was still present in 43 (50%) patients and correlated with lower levels of activity (p test. Transtibial ACL reconstruction with 4-strand hamstring autograft and accelerated rehabilitation restored anteroposterior knee stability. Clinical parameters and patient satisfaction improved significantly. At 10-year follow-up, radiological signs of OA were present in 53.5 % of the subjects. Risk factors for OA were meniscectomy prior to or at the time of ACL reconstruction and chondral lesions at the time of ACL reconstruction. II.

[Successive ruptures of patellar and Achilles tendons. Anabolic steroids in competitive sports].

Science.gov (United States)

Isenberg, J; Prokop, A; Skouras, E

2008-01-01

Derivatives of testosterone or of 19-nor-testosterone are used as anabolics for the purpose of improving performance although the effect of anabolics is known still to be under discussion. The use of anabolic steroids continues among competitive athletes despite increased controls and increasingly frequent dramatic incidents connected with them. Whereas metabolic dysfunction during anabolic use is well documented, ruptures of the large tendons are rarely reported. Within 18 months, a 29-year-old professional footballer needed surgery for rupture of the patellar tendon and of both Achilles tendons. Carefully directed questioning elicited confirmation that he had taken different anabolic steroids regularly for 3 years with the intention of improving his strength. After each operation anabolic steroids were taken again at a high dosage during early convalescence and training. Minimally invasive surgery and open suturing techniques led to complete union of the Achilles tendons in good time. Training and anabolic use (metenolon 300 mg per week) started early after suturing of the patellar tendon including bone tunnels culminated in histologically confirmed rerupture after 8 weeks. After a ligament reconstruction with a semitendinosus tendon graft with subsequent infection, the tendon and reserve traction apparatus were lost. Repeated warnings of impaired healing if anabolic use was continued had been given without success. In view of the high number of unrecorded cases in competitive and athletic sports, we can assume that the use of anabolic steroids is also of quantitative relevance in the operative treatment of tendon ruptures.

GH receptor blocker administration and muscle-tendon collagen synthesis in humans

DEFF Research Database (Denmark)

Nielsen, Rie Harboe; Doessing, Simon; Goto, Kazushige

2011-01-01

Collagen is the predominant structural protein in tendons and ligaments, and can be controlled by hormonal changes. In animals, injections of insulin-like growth factor I (IGF-I) has been shown to increase collagen synthesis in tendons and ligaments and to improve structural tissue healing......, but the effect of local IGF-I administration on tendon collagen synthesis in human has not been studied. The purpose of this study was to study whether local injections of IGF-I would have a stimulating effect on tendon collagen synthesis. Twelve healthy nonsmoking men [age 62 ± 1 years (mean ± SEM), BMI 27 ± 1......] participated. Two injections of either human recombinant IGF-I (0.1 mL Increlex©) or saline (control) into each patellar tendon were performed 24-h apart, respectively. Tendon collagen fractional synthesis rate (FSR) was measured by stable isotope technique in the hours after the second injection...

X-ray computed tomography of the anterior cruciate ligament and patellar tendon

Science.gov (United States)

Shearer, Tom; Rawson, Shelley; Castro, Simon Joseph; Balint, Richard; Bradley, Robert Stephen; Lowe, Tristan; Vila-Comamala, Joan; Lee, Peter David; Cartmell, Sarah Harriet

2014-01-01

Summary The effect of phosphotungstic acid (PTA) and iodine solution (IKI) staining was investigated as a method of enhancing contrast in the X-ray computed tomography of porcine anterior cruciate ligaments (ACL) and patellar tendons (PT). We show that PTA enhanced surface contrast, but was ineffective at penetrating samples, whereas IKI penetrated more effectively and enhanced contrast after 70 hours of staining. Contrast enhancement was compared when using laboratory and synchrotron based X-ray sources. Using the laboratory source, PT fascicles were tracked and their alignment was measured. Individual ACL fascicles could not be identified, but identifiable features were evident that were tracked. Higher resolution scans of fascicle bundles from the PT and ACL were obtained using synchrotron imaging techniques. These scans exhibited greater contrast between the fascicles and matrix in the PT sample, facilitating the identification of the fascicle edges; however, it was still not possible to detect individual fascicles in the ACL. PMID:25332942

Does flexible tunnel drilling affect the femoral tunnel angle measurement after anterior cruciate ligament reconstruction?

NARCIS (Netherlands)

Muller, Bart; Hofbauer, Marcus; Atte, Akere; van Dijk, C. Niek; Fu, Freddie H.

2015-01-01

To quantify the mean difference in femoral tunnel angle (FTA) as measured on knee radiographs between rigid and flexible tunnel drilling after anatomic anterior cruciate ligament (ACL) reconstruction. Fifty consecutive patients that underwent primary anatomic ACL reconstruction with a single femoral

Identification of Novel Equine (Equus caballus Tendon Markers Using RNA Sequencing

Directory of Open Access Journals (Sweden)

Jan M. Kuemmerle

2016-11-01

Full Text Available Although several tendon-selective genes exist, they are also expressed in other musculoskeletal tissues. As cell and tissue engineering is reliant on specific molecular markers to discriminate between cell types, tendon-specific genes need to be identified. In order to accomplish this, we have used RNA sequencing (RNA-seq to compare gene expression between tendon, bone, cartilage and ligament from horses. We identified several tendon-selective gene markers, and established eyes absent homolog 2 (EYA2 and a G-protein regulated inducer of neurite outgrowth 3 (GPRIN3 as specific tendon markers using RT-qPCR. Equine tendon cells cultured as three-dimensional spheroids expressed significantly greater levels of EYA2 than GPRIN3, and stained positively for EYA2 using immunohistochemistry. EYA2 was also found in fibroblast-like cells within the tendon tissue matrix and in cells localized to the vascular endothelium. In summary, we have identified EYA2 and GPRIN3 as specific molecular markers of equine tendon as compared to bone, cartilage and ligament, and provide evidence for the use of EYA2 as an additional marker for tendon cells in vitro.

Complications of anterior cruciate ligament reconstruction: MR imaging

Energy Technology Data Exchange (ETDEWEB)

Papakonstantinou, Olympia; Chung, Christine B.; Chanchairujira, Kullanuch; Resnick, Donald L. [Department of Radiology, Veterans Affairs Medical Center, University of California, 3350 La Jolla Village Dr., San Diego, CA 92161 (United States)

2003-05-01

Arthroscopic reconstruction of the anterior cruciate ligament (ACL) using autografts or allografts is being performed with increasing frequency, particularly in young athletes. Although the procedure is generally well tolerated, with good success rates, early and late complications have been documented. As clinical manifestations of graft complications are often non-specific and plain radiographs cannot directly visualize the graft and the adjacent soft tissues, MR imaging has a definite role in the diagnosis of complications after ACL reconstruction and may direct subsequent therapeutic management. Our purpose is to review the normal MR imaging of the ACL graft and present the MR imaging findings of a wide spectrum of complications after ACL reconstruction, such as graft impingement, graft rupture, cystic degeneration of the graft, postoperative infection of the knee, diffuse and localized (i.e., cyclops lesion) arthrofibrosis, and associated donor site abnormalities. Awareness of the MR imaging findings of complications as well as the normal appearances of the normal ACL graft is essential for correct interpretation. (orig.)

Complications of anterior cruciate ligament reconstruction: MR imaging

International Nuclear Information System (INIS)

Papakonstantinou, Olympia; Chung, Christine B.; Chanchairujira, Kullanuch; Resnick, Donald L.

2003-01-01

Arthroscopic reconstruction of the anterior cruciate ligament (ACL) using autografts or allografts is being performed with increasing frequency, particularly in young athletes. Although the procedure is generally well tolerated, with good success rates, early and late complications have been documented. As clinical manifestations of graft complications are often non-specific and plain radiographs cannot directly visualize the graft and the adjacent soft tissues, MR imaging has a definite role in the diagnosis of complications after ACL reconstruction and may direct subsequent therapeutic management. Our purpose is to review the normal MR imaging of the ACL graft and present the MR imaging findings of a wide spectrum of complications after ACL reconstruction, such as graft impingement, graft rupture, cystic degeneration of the graft, postoperative infection of the knee, diffuse and localized (i.e., cyclops lesion) arthrofibrosis, and associated donor site abnormalities. Awareness of the MR imaging findings of complications as well as the normal appearances of the normal ACL graft is essential for correct interpretation. (orig.)

Local delivery of controlled-release simvastatin to improve the biocompatibility of polyethylene terephthalate artificial ligaments for reconstruction of the anterior cruciate ligament

Directory of Open Access Journals (Sweden)

Zhang P

2016-01-01

Full Text Available Peng Zhang,1,* Fei Han,2,* Yunxia Li,1 Jiwu Chen,1 Tianwu Chen,1 Yunlong Zhi,1 Jia Jiang,1 Chao Lin,2 Shiyi Chen,1 Peng Zhao2 1Department of Sports Medicine, Huashan Hospital, Fudan University, 2Shanghai East Hospital, The Institute for Biomedical Engineering and Nanoscience, School of Medicine, Tongji University, Shanghai, People’s Republic of China *These authors contributed equally to this work Abstract: The Ligament Advanced Reinforcement System has recently been widely used as the primary graft of choice in anterior cruciate ligament (ACL reconstruction. But the biological graft–bone healing still remains a problem. Previous studies have shown that simvastatin (SIM stimulates bone formation. The objective of this study was to investigate whether surface coating with collagen containing low-dose SIM microsphere could enhance the surface biocompatibility of polyethylene terephthalate (PET artificial ligaments to accelerate graft-to-bone healing. The in vitro studies demonstrated that bone marrow stromal cells on the collagen-coated PET scaffolds (COL/PET and simvastatin/collagen-coated PET scaffolds (SIM/COL/PET proliferated vigorously. Compared with the PET group and the COL/PET group, SIM could induce bone marrow stromal cells’ osteoblastic differentiation, high alkaline phosphatase activity, more mineralization deposition, and more expression of osteoblast-related genes, such as osteocalcin, runt-related transcription factor 2, bone morphogenetic protein-2, and vascular endothelial growth factor, in the SIM/COL/PET group. In vivo, rabbits received ACL reconstruction with different scaffolds. Histological analysis demonstrated that graft–bone healing was significantly greater with angiogenesis and osteogenesis in the SIM/COL/PET group than the other groups. In addition, biomechanical testing at the eighth week demonstrated a significant increase in the ultimate failure load and stiffness in the SIM/COL/PET group. The low dose of SIM

Anchor proximal migration in the medial patellofemoral ligament reconstruction in skeletally immature patients

Directory of Open Access Journals (Sweden)

Fabiano Kupczik

2013-09-01

Full Text Available The medial patellofemoral ligament (MPFL injury has been considered instrumental in lateral patellar instability after patellar dislocation. Consequently, the focus on the study of this ligament reconstruction has increased in recent years. The MPFL femoral anatomical origin point has great importance at the moment of reconstruction surgery, because a graft fixation in a non anatomical position may result in medial overload, medial subluxation of the patella or excessive tensioning of the graft with subsequent failure. In the pediatric population, the location of this point is highlighted by the presence of femoral physis. The literature is still controversial regarding the best placement of the graft. We describe two cases of skeletally immature patients in whom LPFM reconstruction was performed. The femoral fixation was through anchors that were placed above the physis. With the growth and development of the patients, the femoral origin point of the graft moved proximally, resulting in failure in these two cases.

Local administration of insulin-like growth factor-I (IGF-I) stimulates tendon collagen synthesis in humans

DEFF Research Database (Denmark)

Hansen, Mette; Boesen, Anders; Holm, Lars

2013-01-01

Collagen is the predominant structural protein in tendons and ligaments, and can be controlled by hormonal changes. In animals, injections of insulin-like growth factor I (IGF-I) has been shown to increase collagen synthesis in tendons and ligaments and to improve structural tissue healing, but t...

Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies

Science.gov (United States)

Sanchis-Alfonso, Vicente; Montesinos-Berry, Erik; Ramirez-Fuentes, Cristina; Leal-Blanquet, Joan; Gelber, Pablo E; Monllau, Joan Carles

2017-01-01

Patellar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the patella through a medial patellofemoral ligament (MPFL) reconstruction. Foreseeably, an increasing number of revision surgeries of the reconstructed MPFL will be seen in upcoming years. In this paper, the causes of failed MPFL reconstruction are analyzed: (1) incorrect surgical indication or inappropriate surgical technique/patient selection; (2) a technical error; and (3) an incorrect assessment of the concomitant risk factors for instability. An understanding of the anatomy and biomechanics of the MPFL and cautiousness with the imaging techniques while favoring clinical over radiological findings and the use of common sense to determine the adequate surgical technique for each particular case, are critical to minimizing MPFL surgery failure. Additionally, our approach to dealing with failure after primary MPFL reconstruction is also presented. PMID:28251062

Strategies to engineer tendon/ligament-to-bone interface: Biomaterials, cells and growth factors.

Science.gov (United States)

Font Tellado, Sonia; Balmayor, Elizabeth R; Van Griensven, Martijn

2015-11-01

Integration between tendon/ligament and bone occurs through a specialized tissue interface called enthesis. The complex and heterogeneous structure of the enthesis is essential to ensure smooth mechanical stress transfer between bone and soft tissues. Following injury, the interface is not regenerated, resulting in high rupture recurrence rates. Tissue engineering is a promising strategy for the regeneration of a functional enthesis. However, the complex structural and cellular composition of the native interface makes enthesis tissue engineering particularly challenging. Thus, it is likely that a combination of biomaterials and cells stimulated with appropriate biochemical and mechanical cues will be needed. The objective of this review is to describe the current state-of-the-art, challenges and future directions in the field of enthesis tissue engineering focusing on four key parameters: (1) scaffold and biomaterials, (2) cells, (3) growth factors and (4) mechanical stimuli. Copyright © 2015 Elsevier B.V. All rights reserved.

Reconstrução do LCA com o uso dos tendões dos músculos flexores mediais do joelho e fixação femoral com o sistema de Rigidifix®: relato preliminar Anterior cruciate ligament reconstruction using double hamstrings tendon graft and the femoral fixation by Rigidifix®: preliminary Study

Directory of Open Access Journals (Sweden)

Carlos Alberto Cury Faustino

2004-12-01

Full Text Available O autor descreve a técnica de reconstrução do LCA no tratamento das instabilidades anterior do joelho, utilizando os tendões dos músculos flexores mediais do joelho (semitendíneo e grácil, fixados no fêmur pelo sistema de Rigidfix®; e na tíbia, com parafuso de interferência absorvível, através de um estudo preliminar de 54 joelhos operados. Na avaliação final pela escala de Lysholm os pacientes evoluíram de 46 pontos no pré-operatório para 92 pontos no pós-operatório.The author describes the reconstruction technique of the anterior cruciate ligament reconstruction using the hamstrings tendon (semitendinosus and gracilis in the management of anterior instabilities of the knee joint. Rigidfix® system is used to fix the graft on the femur and an absorbable interference screw was used for tibial fixation in a preliminary study in 54 knees. The final evaluation based on Lysholm score showed an improvement from 46 (preoperative to 92 (postoperative.

Functional Outcome Following Arthroscopic ACL Reconstruction with Rigid Fix: A Retrospective Observational Study

Directory of Open Access Journals (Sweden)

Satish Shervegar

2015-10-01

Full Text Available Background: No uniform consensus exists to decide type of fixation for arthroscopic anterior cruciate ligament reconstruction. Hypothsis: There is similar functional outcome after rigid fix compared to other methods of fixation which has been published. Study design: Retrospective observational study. Methods: A total of 50 patients underwent arthroscopic anterior cruciate ligament reconstruction with hamstring tendons using femoral Rigid fix cross-pin and interference screw tibial fixation. The evaluation methods were clinical examination, IKDC scores, Lysholm and pre injury and post reconstruction Tegner score. Patients were followed up from minimum of 6 months to 4 year seven months. Results: C In our study of sample size 50 we found that mean age of patients was 30.8 Years with male preponderance. Mean post operative IKDC and Lysholm score has been 75.6 and 84.4 respectively.Mean Tegner pre-injury score and post reconstruction score has been 5.4 and 4.26 .Box plot comparison of pre injury and post operativeTegner score reveals a statistically significant difference with respect to paired t test P Conclusions: Arthroscopic anterior cruciate ligament reconstruction with femoral rigid fix cross pins and tibial interference screws results in comparable short term to midterm functional results compared to other types of fixation

Functional Outcome Following Arthroscopic ACL Reconstruction with Rigid Fix: A Retrospective Observational Study

Directory of Open Access Journals (Sweden)

Satish Shervegar

2015-09-01

Full Text Available Background: No uniform consensus exists to decide type of fixation for arthroscopic anterior cruciate ligament reconstruction. Hypothsis: There is similar functional outcome after rigid fix compared to other methods of fixation which has been published. Study design: Retrospective observational study. Methods: A total of 50 patients underwent arthroscopic anterior cruciate ligament reconstruction with hamstring tendons using femoral Rigid fix cross-pin and interference screw tibial fixation. The evaluation methods were clinical examination, IKDC scores, Lysholm and pre injury and post reconstruction Tegner score. Patients were followed up from minimum of 6 months to 4 year seven months. Results: C In our study of sample size 50 we found that mean age of patients was 30.8 Years with male preponderance. Mean post operative IKDC and Lysholm score has been 75.6 and 84.4 respectively.Mean Tegner pre-injury score and post reconstruction score has been 5.4 and 4.26 .Box plot comparison of pre injury and post operativeTegner score reveals a statistically significant difference with respect to paired t test P Conclusions: Arthroscopic anterior cruciate ligament reconstruction with femoral rigid fix cross pins and tibial interference screws results in comparable short term to midterm functional results compared to other types of fixation

Exploring the in vitro and in vivo compatibility of PLA, PLA/GNP and PLA/CNT-COOH biodegradable nanocomposites: Prospects for tendon and ligament applications.

Science.gov (United States)

Correia Pinto, Viviana; Costa-Almeida, Raquel; Rodrigues, Ilda; Guardão, Luísa; Soares, Raquel; Miranda Guedes, Rui

2017-08-01

Anterior cruciate ligament (ACL) reconstructive surgeries are the most frequent orthopedic procedures in the knee. Currently, existing strategies fail in completely restoring tissue functionality and have a high failure rate associated, presenting a compelling argument towards the development of novel materials envisioning ACL reinforcement. Tendons and ligaments, in general, have a strong demand in terms of biomechanical features of developed constructs. We have previously developed polylactic acid (PLA)-based biodegradable films reinforced either with graphene nanoplatelets (PLA/GNP) or with carboxyl-functionalized carbon nanotubes (PLA/CNT-COOH). In the present study, we comparatively assessed the biological performance of PLA, PLA/GNP, and PLA/CNT-COOH by seeding human dermal fibroblasts (HFF-1) and studying cell viability and proliferation. In vivo tests were also performed by subcutaneous implantation in 6-week-old C57Bl/6 mice. Results showed that all formulations studied herein did not elicit cytotoxic responses in seeded HFF-1, supporting cell proliferation up to 3 days in culture. Moreover, animal studies indicated no physiological signs of severe inflammatory response after 1 and 2 weeks after implantation. Taken together, our results present a preliminary assessment on the compatibility of PLA reinforced with GNP and CNT-COOH nanofillers, highlighting the potential use of these carbon-based nanofillers for the fabrication of reinforced synthetic polymer-based structures for ACL reinforcement. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 2182-2190, 2017. © 2017 Wiley Periodicals, Inc.

Does well maintained graft provide consistent return to play after medial ulnar collateral ligament reconstruction of the elbow joint in elite baseball players?

Science.gov (United States)

Park, Jin-Young; Oh, Kyung-Soo; Bahng, Seung-Chul; Chung, Seok-Won; Choi, Jin-Ho

2014-06-01

Several studies have reported the clinical outcomes of medial ulnar collateral ligament (MUCL) reconstruction of the elbow joint in throwing athletes, including the rate of return to sports. However, little has been known about the imaging outcomes after MUCL reconstruction. The aim of this study is to report the clinical and imaging outcomes after MUCL reconstruction using figure of eight fashion in the elite and professional baseball players. This study included 17 baseball players, who underwent MUCL reconstruction between July 2007 and May 2010. The average follow-up period was 48.6 months. Imaging assessment consisted of preoperative plain and stress radiographs, magnetic resonance imaging, and postoperative serial ultrasonography. The clinical assessments were composed of visual analogue scale (VAS) for pain, range of motion, and the Conway scale. The mean VAS score was 6.4 (range, 3 to 8) preoperatively and 2.2 (range, 0 to 4) postoperatively (p returned to sports at the same or higher level compared to preinjury. Serial ultrasonography revealed well-maintained grafts at 3 and 12 months in all of the players. Five out of 17 players showed decreased echogenecity in the common flexor tendon at 3 months, which was considered as remaining tissue swelling and resolved completely at 12 months. All grafts are well-maintained until 12-months based on the ultrasonographic findings, although only 53% of the players returned to preinjury level.

Rotator cuff tendon connections with the rotator cable.

Science.gov (United States)

Rahu, Madis; Kolts, Ivo; Põldoja, Elle; Kask, Kristo

2017-07-01

The literature currently contains no descriptions of the rotator cuff tendons, which also describes in relation to the presence and characteristics of the rotator cable (anatomically known as the ligamentum semicirculare humeri). The aim of the current study was to elucidate the detailed anatomy of the rotator cuff tendons in association with the rotator cable. Anatomic dissection was performed on 21 fresh-frozen shoulder specimens with an average age of 68 years. The rotator cuff tendons were dissected from each other and from the glenohumeral joint capsule, and the superior glenohumeral, coracohumeral, coracoglenoidal and semicircular (rotator cable) ligaments were dissected. Dissection was performed layer by layer and from the bursal side to the joint. All ligaments and tendons were dissected in fine detail. The rotator cable was found in all specimens. It was tightly connected to the supraspinatus (SSP) tendon, which was partly covered by the infraspinatus (ISP) tendon. The posterior insertion area of the rotator cable was located in the region between the middle and inferior facets of the greater tubercle of the humerus insertion areas for the teres minor (TM), and ISP tendons were also present and fibres from the SSP extended through the rotator cable to those areas. The connection between the rotator cable and rotator cuff tendons is tight and confirms the suspension bridge theory for rotator cuff tears in most areas between the SSP tendons and rotator cable. In its posterior insertion area, the rotator cable is a connecting structure between the TM, ISP and SSP tendons. These findings might explain why some patients with relatively large rotator cuff tears can maintain seamless shoulder function.

Ultrastructure of periprosthetic Dacron knee ligament tissue. Two cases of ruptured anterior cruciate ligament reconstruction.

Science.gov (United States)

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.

Liposomal Bupivacaine for Pain Control After Anterior Cruciate Ligament Reconstruction: A Prospective, Double-Blinded, Randomized, Positive-Controlled Trial.

Science.gov (United States)

Premkumar, Ajay; Samady, Heather; Slone, Harris; Hash, Regina; Karas, Spero; Xerogeanes, John

2016-07-01

Local anesthetics are commonly administered into surgical sites as a part of multimodal pain control regimens. Liposomal bupivacaine is a novel formulation of bupivacaine designed for slow diffusion of a single dose of local anesthetic over a 72-hour period. While early results are promising in various settings, no studies have compared pain management regimens containing liposomal bupivacaine to traditional regimens in patients undergoing anterior cruciate ligament (ACL) reconstruction. To evaluate liposomal bupivacaine in comparison with 0.25% bupivacaine hydrochloride (HCl) for pain control after ACL reconstruction. Randomized controlled trial; Level of evidence, 1. A total of 32 adult patients undergoing primary ACL reconstruction with a soft tissue quadriceps tendon autograft between July 2014 and March 2015 were enrolled. All patients received a femoral nerve block immediately before surgery. Patients then received either a 40-mL suspension of 20 mL Exparel (1 vial of bupivacaine liposome injectable suspension) and 20 mL 0.9% injectable saline or 20 mL 0.5% bupivacaine HCl and 20 mL 0.9% injectable saline, which was administered into the graft harvest site and portal sites during surgery. Patients were given either a postoperative smartphone application or paper-based journal to record data for 1 week after ACL reconstruction. Of the 32 patients recruited, 29 patients were analyzed (90.6%). Two patients were lost to follow-up, and 1 was excluded because of a postoperative hematoma. There were no statistically significant differences in postoperative pain, medication use, pain location, recovery room time, or mobility between the 2 study groups. There were comparable outcomes with 0.25% bupivacaine HCl at a 200-fold lower cost than liposomal bupivacaine. This study does not support the widespread use of liposomal bupivacaine for pain control after ACL reconstruction in the setting of a femoral nerve block. ClinicalTrials.gov NCT02189317. © 2016 The Author(s).

Anterior cruciate ligament reconstruction failure after tibial shaft malunion.

Science.gov (United States)

LaFrance, Russell M; Gorczyca, John T; Maloney, Michael D

2012-02-17

Anterior cruciate ligament (ACL) reconstruction is common, with >100,000 procedures performed each year in the United States. Several factors are associated with failure, including poor surgical technique, graft incorporation failure, overly aggressive rehabilitation, and trauma. Tibial shaft fracture is also common and frequently requires operative intervention. Failure to reestablish the anatomic alignment of the tibia may cause abnormal forces across adjacent joints, which can cause degenerative joint disease or attritional failure of the surrounding soft tissues. This article describes a case of ACL reconstruction failure after a tibial fracture that resulted in malunion. Excessive force across the graft from lower-extremity malalignment and improper tunnel placement likely contributed to the attritional failure of the graft. This patient required a staged procedure for corrective tibial osteotomy followed by revision ACL reconstruction. This article describes ACL reconstruction failure, tibial shaft malunions, their respective treatments, the technical details of each procedure, and the technical aspects that must be considered when these procedures are done in a staged manner by 2 surgeons. Copyright 2012, SLACK Incorporated.

Improved visualization of collateral ligaments of the ankle: multiplanar reconstructions based on standard 2D turbo spin-echo MR images

International Nuclear Information System (INIS)

Duc, Sylvain R.; Mengiardi, Bernard; Pfirrmann, Christian W.A.; Hodler, Juerg; Zanetti, Marco

2007-01-01

The purpose of the study was to evaluate the visualization of the collateral ankle ligaments on multiplanar reconstructions (MPR) based on standard 2D turbo spin-echo images. Coronal and axial T2-weighted turbo spin-echo and MPR angled parallel to the course of the ligaments of 15 asymptomatic and 15 symptomatic ankles were separately analyzed by two musculoskeletal radiologists. Image quality was assessed in the asymptomatic ankles qualitatively. In the symptomatic ankles interobserver agreement and reader confidence was determined for each ligament. On MPR the tibionavicular and calcaneofibular ligaments were more commonly demonstrated on a single image than on standard MR images (reader 1: 13 versus 0, P=0.002; reader 2: 14 versus 1, P=0.001 and reader 1: 13 versus 2, P=0.001; reader 2: 14 versus 0, P<0.001). The tibionavicular ligament was considered to be better delineated on MPR by reader 1 (12 versus 3, P=0.031). In the symptomatic ankles, reader confidence was greater with MPR for all ligaments except for the tibiocalcanear ligament (both readers) and the anterior and posterior talofibular ligaments (for reader 2). Interobserver agreement was increased with MPR for the tibionavicular ligament. Multiplanar reconstructions of 2D turbo spin-echo images improve the visualization of the tibionavicular and calcaneofibular ligaments and strengthen diagnostic confidence for these ligaments. (orig.)

Anterior cruciate ligament reconstruction using autologous hamstring single-bundle Rigidfix technique compared with single-bundle Transfix technique

Directory of Open Access Journals (Sweden)

Mousavi Hamid

2012-01-01

Full Text Available Background: Initial fixation strength is critical for the early post-operative rehabilitation of patients with anterior cruciate ligament (ACL reconstructions. However, even the best femoral fixation devices remain controversial. We compared the results of 2 of the femoral fixation techniques,Rigidfix and Transfix. Materials and Methods: A total of 30 patients with unilateral ACL deficiency were randomly assigned to 1 of 2 groups. In Group A an anatomic single-bundle ACL reconstruction was performed using Rigidfix technique(Mitek, Norwood,MA, Group B were treated by a single bundle using Transfix technique(Arthrex, Naples, FL, USA. For tibial fixation, a bioabsorbable Intrafix interference screw was used for all the groups and the graft was fashioned from the semitendinosus and gracilis tendons in all patients. The patients were subjected to a clinical evaluation, with assessment of the anterior drawer, Lachman′s and the pivot-shift tests. They also completed the International Knee Documentation Committee (IKDC score. Results: At a mean of 14 months (12-17 followup there were no significant differences concerning time between injury and range of movement between the 2 groups. However, the Rigidfix group showed significantly better results for the subjective assessment of knee function ( P = 0.002. The Lachman, anterior drawer, and pivot-shift tests also showed no significant difference between the 2 groups. The IKDC scale showed no significant difference among the groups ( P < 0.001.There was no difference regarding duration of operation and cost of the operation between the 2 groups.On clinical evaluation there was no significant difference between the 2 groups. However, regardless of the technique, all knees were improved by ACL reconstruction compared with their preoperative status. Conclusion: Both techniques can be used for reconstruction of ACL. Other factors, such as psychic profile of the patients should be considered for surgery

Strategies for revision surgery after primary double-bundle anterior cruciate ligament (ACL) reconstruction

NARCIS (Netherlands)

Hofbauer, Marcus; Muller, Bart; Murawski, Christopher D.; Baraga, Michael; van Eck, Carola Franziska; Fu, Freddie H.

2013-01-01

The purpose of this article was to discuss pre- and intra-operative considerations as well as surgical strategies for different femoral and tibial tunnel scenarios in revision surgery following primary double-bundle anterior cruciate ligament (ACL) reconstruction. Based on the current literature of

COMPARATIVE STUDY OF ARTHROSCOPIC SINGLE BUNDLE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION AND NON-ANATOMICAL DOUBLE BUNDLE WITH SINGLE TIBIAL TUNNEL ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH SEMITENDINOSUS ± GRACILIS AUTOGRAFTS USING LAXOMETRY

Directory of Open Access Journals (Sweden)

Sivananda

2016-01-01

Full Text Available BACKGROUND The knee joint is the most commonly injured of all joints and the ACL is the most commonly injured ligament. Arthroscopic reconstruction of ACL has become gold standard in treating these injuries. AIM 1. To compare the short-term results of ACL reconstruction using single bundle (one Tibial + one Femoral tunnel and non-anatomical double-bundle (one Tibial + two Femoral tunnels techniques using Hamstrings (Semitendinosus ± Gracilis graft. 2. To evaluate ACL graft reconstruction stability measured by laxometry and to find out an association with clinical findings. MATERIAL & METHODS We performed a prospective study between 2014-2015 of 20 case of ACL injuries & compared single bundle reconstruction with Non – anatomical double Bundle reconstruction with semitendinosus ± Gracilis, Autograft using laxometry. CONCLUSION Arthroscopic Non-anatomical double ACL Reconstruction is Bio-mechanically stable reconstruction resembling anatomy of the ACL.

Biomechanical Comparison of Five Posterior Cruciate Ligament Reconstruction Techniques.

Science.gov (United States)

Nuelle, Clayton W; Milles, Jeffrey L; Pfeiffer, Ferris M; Stannard, James P; Smith, Patrick A; Kfuri, Mauricio; Cook, James L

2017-07-01

No surgical technique recreates native posterior cruciate ligament (PCL) biomechanics. We compared the biomechanics of five different PCL reconstruction techniques versus the native PCL. Cadaveric knees ( n  = 20) were randomly assigned to one of five reconstruction techniques: Single bundle all-inside arthroscopic inlay, single bundle all-inside suspensory fixation, single bundle arthroscopic-assisted open onlay (SB-ONL), double bundle arthroscopic-assisted open inlay (DB-INL), and double bundle all-inside suspensory fixation (DB-SUSP). Each specimen was potted and connected to a servo-hydraulic load frame for testing in three conditions: PCL intact, PCL deficient, and PCL reconstructed. Testing consisted of a posterior force up to 100 N at a rate of 1 N/s at four knee flexion angles: 10, 30, 60, and 90 degrees. Three material properties were measured under each condition: load to 5 mm displacement, maximal displacement, and stiffness. Data were normalized to the native PCL, compared across techniques, compared with all PCL-intact knees and to all PCL-deficient knees using one-way analysis of variance. For load to 5 mm displacement, intact knees required significantly ( p  < 0.03) more load at 30 degrees of flexion than all reconstructions except the DB-SUSP. At 60 degrees of flexion, intact required significantly ( p  < 0.01) more load than all others except the SB-ONL. At 90 degrees, intact, SB-ONL, DB-INL, and DB-SUSP required significantly more load ( p  < 0.05). Maximal displacement testing showed the intact to have significantly ( p  < 0.02) less laxity than all others except the DB-INL and DB-SUSP at 60 degrees. At 90 degrees the intact showed significantly ( p  < 0.01) less laxity than all others except the DB-SUSP. The intact was significantly stiffer than all others at 30 degrees ( p  < 0.03) and 60 degrees ( p  < 0.01). Finally, the intact was significantly ( p  < 0.05) stiffer than all others except the DB

Anterior cruciate ligament repair - past, present and future.

Science.gov (United States)

Mahapatra, Piyush; Horriat, Saman; Anand, Bobby S

2018-06-15

This article provides a detailed narrative review on the history and current concepts surrounding ligamentous repair techniques in athletic patients. In particular, we will focus on the anterior cruciate ligament (ACL) as a case study in ligament injury and ligamentous repair techniques. PubMed (MEDLINE), EMBASE and Cochrane Library databases for papers relating to primary anterior cruciate ligament reconstruction were searched by all participating authors. All relevant historical papers were included for analysis. Additional searches of the same databases were made for papers relating to biological enhancement of ligament healing. The poor capacity of the ACL to heal is one of the main reasons why the current gold standard surgical treatment for an ACL injury in an athletic patient is ACL reconstruction with autograft from either the hamstrings or patella tendon. It is hypothesised that by preserving and repairing native tissues and negating the need for autograft that primary ACL repair may represent a key step change in the treatment of ACL injuries. The history of primary ACL repair will be discussed and the circumstances that led to the near-abandonment of primary ACL repair techniques will be reviewed. There has been a recent resurgence in interest with regards to primary ACL repair. Improvements in imaging now allow for identification of tear location, with femoral-sided injuries, being more suitable for repair. We will discuss in details strategies for improving the mechanical and biological environment in order to allow primary healing to occur. In particular, we will explain mechanical supplementation such as Internal Brace Ligament Augmentation and Dynamic Intraligamentary Stabilisation techniques. These are novel techniques that aim to protect the primary repair by providing a stabilising construct that connects the femur and the tibia, thus bridging the repair. In addition, biological supplementation is being investigated as an adjunct and we will

Ultrasonographic assessment of the proximal digital annular ligament in the equine forelimb

International Nuclear Information System (INIS)

Dik, K.J.; Boroffka, S.; Stolk, P.

1994-01-01

Ultrasonography was used with 6 normal cadaver forelimbs of Dutch Warmblood horses to delineate the ultrasonographic anatomy of the palmar pastern region, with emphasis on the proximal digital annular ligament. Using a 5.5 MHz sector scanner, the thin proximal digital annular ligament was not visible on offset sonograms. Only if the digital sheath in the normal limb was distended was the distal border of this ligament outlined. In all normal limbs the palmarodistal thickness of the combined skin-proximal digital annular ligament layer in the mid-pastern region was 2 mm. The flexor tendons and distal sesamoidean ligaments were easily identified as hyperechoic structures. Distension of the digital sheath in the normal limbs clearly outlined the anechoic digital sheath pouches. In 4 lame horses ultrasonography aided the diagnosis of functional proximal digital annular ligament constriction. In all 4 diseased forelimbs ultrasonography demonstrated thickening of the skin-proximal digital annular ligament layer and distension of the digital sheath. In one of these limbs the distended digital sheath was also thickened. The flexor tendons and distal sesamoidean ligaments were normal. There was no radiographic evidence of additional bone or joint lesions

Ultrasonographic assessment of the proximal digital annular ligament in the equine forelimb.

Science.gov (United States)

Dik, K J; Boroffka, S; Stolk, P

1994-01-01

Ultrasonography was used with 6 normal cadaver forelimbs of Dutch Warmblood horses to delineate the ultrasonographic anatomy of the palmar pastern region, with emphasis on the proximal digital annular ligament. Using a 5.5 MHz sector scanner, the thin proximal digital annular ligament was not visible on offset sonograms. Only if the digital sheath in the normal limb was distended was the distal border of this ligament outlined. In all normal limbs the palmarodistal thickness of the combined skin-proximal digital annular ligament layer in the mid-pastern region was 2 mm. The flexor tendons and distal sesamoidean ligaments were easily identified as hyperechoic structures. Distension of the digital sheath in the normal limbs clearly outlined the anechoic digital sheath pouches. In 4 lame horses ultrasonography aided the diagnosis of functional proximal digital annular ligament constriction. In all 4 diseased forelimbs ultrasonography demonstrated thickening of the skin-proximal digital annular ligament layer and distension of the digital sheath. In one of these limbs the distended digital sheath was also thickened. The flexor tendons and distal sesamoidean ligaments were normal. There was no radiographic evidence of additional bone or joint lesions.

Do psychosocial interventions improve rehabilitation outcomes after anterior cruciate ligament reconstruction? A systematic review.

Science.gov (United States)

Coronado, Rogelio A; Bird, Mackenzie L; Van Hoy, Erin E; Huston, Laura J; Spindler, Kurt P; Archer, Kristin R

2018-03-01

To examine the role of psychosocial interventions in improving patient-reported clinical outcomes, including return to sport/activity, and intermediary psychosocial factors after anterior cruciate ligament reconstruction. MEDLINE/PubMed, CINAHL, PsycINFO, and Web of Science were searched from each database's inception to March 2017 for published studies in patients after anterior cruciate ligament reconstruction. Studies were included if they reported on the effects of a postoperative psychosocial intervention on a patient-reported clinical measure of disability, function, pain, quality of life, return to sport/activity, or intermediary psychosocial factor. Data were extracted using a standardized form and summary effects from each article were compiled. The methodological quality of randomized trials was assessed using the Physiotherapy Evidence Database Scale and scores greater than 5/10 were considered high quality. A total of 893 articles were identified from the literature search. Of these, four randomized trials ( N = 210) met inclusion criteria. The four articles examined guided imagery and relaxation, coping modeling, and visual imagery as postoperative psychosocial interventions. Methodological quality scores of the studies ranged from 5 to 9. There were inconsistent findings for the additive benefit of psychosocial interventions for improving postoperative function, pain, or self-efficacy and limited evidence for improving postoperative quality of life, anxiety, or fear of reinjury. No study examined the effects of psychosocial interventions on return to sport/activity. Overall, there is limited evidence on the efficacy of postoperative psychosocial interventions for improving functional recovery after anterior cruciate ligament reconstruction.

Surgical treatment of subacute and chronic valgus instability in multiligament-injured knees with superficial medial collateral ligament reconstruction using Achilles allografts: a quantitative analysis with a minimum 2-year follow-up.

Science.gov (United States)

Liu, Xin; Feng, Hua; Zhang, Hui; Hong, Lei; Wang, Xue Song; Zhang, Jin; Shen, Jie Wei

2013-05-01

Symptomatic medial collateral ligament (MCL) instability is rare, and it is frequently associated with multiligament injuries. Most clinical investigations have failed to clearly define the specific objective outcome measures assessing the stability of the MCL quantitatively before and after the reconstruction procedure. To quantitatively evaluate the early clinical outcomes of patients with valgus instability of knee joints who had undergone superficial MCL reconstruction using Achilles tendon allografts. Case series; Level of evidence, 4. From August 2005 to December 2010, 19 consecutive patients with MCL injuries were included in this study. The inclusion criteria were (1) a subacute or chronic MCL injury, with a time from initial injury to surgery of longer than 3 weeks, and (2) valgus laxity graded C or D according to the International Knee Documentation Committee (IKDC). All patients underwent superficial MCL reconstruction using Achilles tendon allografts. To evaluate the laxity of the MCL preoperatively and postoperatively, valgus stress radiographs using a Telos device were used. Other assessments included the IKDC subjective functional evaluation and Lysholm score estimation. Sixteen of the 19 patients (12 men and 4 women) were available for final follow-up. The median age of the patients was 37 years (range, 19-53 years); mean body mass index (BMI) was 26.4 (range, 21.7-29.4). The mean time from injury to surgery was 15.9 months (range, 24 days to 84 months), and median follow-up period was 34 months (range, 24-67 months). The mean medial knee laxity (side-to-side difference) was 8.9 ± 3.2 mm (range, 6-15.9 mm) preoperatively and 1.1 ± 0.9 mm (range, -1.1 to 3.2 mm) postoperatively (P < .001). The preoperative mean IKDC subjective knee functional score was 49.8 ± 6.9 (range, 31-57.5), while the postoperative functional score was 84.3 ± 6.0 (range, 71.3-93.1) (P < .001). The mean Lysholm score was 69.3 ± 5.9 (range, 55-78) preoperatively and 88.6 �

Open capsular and ligament reconstruction with semitendinosus hamstring autograft successfully controls superior and posterior translation for type V acromioclavicular joint dislocation.

Science.gov (United States)

Garofalo, Raffaele; Ceccarelli, Enrico; Castagna, Alessandro; Calvisi, Vittorio; Flanagin, Brody; Conti, Marco; Krishnan, Sumant G

2017-07-01

Appropriate surgical management for type V complete acromioclavicular (AC) joint dislocation remains controversial. The purpose of this paper is to retrospectively report the clinical and radiographic outcomes of an open surgical technique consisting for AC joint ligamentous and capsular reconstruction using autologous hamstring tendon grafts and semi-permanent sutures. Between January 2005 and December 2011, 32 consecutive patients with symptomatic type V complete AC joint dislocation underwent surgical treatment using the same technique. The median time from injury to surgery was 45 days (range 24-90). The average median postoperative clinical and radiographic follow-up time was 30 months (range 24-33). Clinical outcomes measures included the ASES score, the visual analog score (VAS), and subjective patient satisfaction score. Minimum follow-up was 2 years. ASES score increased from a median of 38.2 ± 6.2 preoperative to 92.1 ± 4.7 postoperatively (p ≤ 0.05). The median VAS score improved from 62 mm (range 45-100 mm) preoperatively to 8 mm (range 0-20 mm) at final follow-up (p ≤ 0.05). No patient experienced pain or discomfort with either direct palpation of the AC joint or with cross-body adduction. Final radiographs demonstrated symmetric AC joint contour in 25/32 (78%) patients. Seven patients (22%) radiographically demonstrated superior translation of the distal clavicle relative to the superior margin of the acromion but less than 50% of the clavicular width. 30/32 patients (93%) were able to return to their pre-injury level of work and sports activities. This novel surgical technique using a free graft and braided suture for simultaneous coracoclavicular ligament and AC joint capsular reconstruction successfully controls superior and posterior translations after type V AC joint dislocation and minimizes the incidence of persistent postoperative AC joint subluxation. Retrospective case series, Level IV.

Effects of Wii balance board exercises on balance after posterior cruciate ligament reconstruction.

Science.gov (United States)

Puh, Urška; Majcen, Nia; Hlebš, Sonja; Rugelj, Darja

2014-05-01

To establish the effects of training on Wii balance board (WBB) after posterior cruciate ligament (PCL) reconstruction on balance. Included patient injured her posterior cruciate ligament 22 months prior to the study. Training on WBB was performed 4 weeks, 6 times per week, 30-45 min per day. Center of pressure (CoP) sway during parallel and one-leg stance, and body weight distribution in parallel stance were measured. Additionally, measurements of joint range of motion and limb circumferences were taken before and after training. After training, the body weight was almost equally distributed on both legs. Decrease in CoP sway was most significant for one-leg stance with each leg on compliant surface with eyes open and closed. The knee joint range of motion increased and limb circumferences decreased. According to the results of this single case report, we might recommend the use of WBB for balance training after PCL reconstruction. Case series with no comparison group, Level IV.

The influence of electromyographic biofeedback therapy on knee extension following anterior cruciate ligament reconstruction: a randomized controlled trial

Directory of Open Access Journals (Sweden)

Christanell Franz

2012-11-01

Full Text Available Abstract Background Loss of knee extension and a deficit in quadriceps strength are frequently found following anterior cruciate ligament (ACL reconstruction. The aim of this study was to investigate whether the addition of Eletromyographic Biofeedback (EMG BFB therapy for the vastus medialis muscle to the in the early phase of the standard rehabilitation programme could improve the range of knee extension and strength after ACL reconstruction more than a standard rehabilitation programme. The correlation between EMG measurement and passive knee extension was also investigated. Method Sixteen patients, all of whom underwent endoscopic ACL reconstruction using patellar tendon autograft, were randomly assigned to two groups: • Control group (8 patients: standard rehabilitation protocol; with full weight-bearing postoperative, knee brace (0° extension, 90° flexion, electrical stimulation, aquatics and proprioceptive training. • The EMG BFB group (8 patients: EMG BFB was added to the standard rehabilitation protocol within the first postoperative week and during each session for the next 6 weeks. Each patent attended a total of 16 outpatient physiotherapy sessions following surgery. High-Heel-Distance (HHD Test, range of motion (ROM and integrated EMG (iEMG for vastus medialis were measured preoperatively, and at the 1, 2, 4 and 6-week follow ups. Additionally, knee function, swelling and pain were evaluated using standardized scoring scales. Results At 6 weeks, passive knee extension (p  0.01 differences were found between the two groups for the assessment of knee function, swelling and pain. Conclusion The results indicate that EMG BFB therapy, in the early phase of rehabilitation after ACL reconstruction, is useful in enhancing knee extension. Improved innervation of the vastus medialis can play a key role in the development of postoperative knee extension. EMG BFB therapy is a simple, inexpensive and valuable adjunct to conventional

Early Results of Anatomic Double Bundle Anterior Cruciate Ligament Reconstruction

OpenAIRE

Demet Pepele

2014-01-01

Aim: The goal in anterior cruciate ligament reconstruction (ACLR) is to restore the normal anatomic structure and function of the knee. In the significant proportion of patients after the traditional single-bundle ACLR, complaints of instability still continue. Anatomic double bundle ACLR may provide normal kinematics in knees, much closer to the natural anatomy. The aim of this study is to clinically assess the early outcomes of our anatomical double bundle ACLR. Material and Method: In our ...

Synthetic Augmented Suture Anchor Reconstruction for a Complete Traumatic Distal Triceps Tendon Rupture in a Male Professional Bodybuilder with Postoperative Biomechanical Assessment

Directory of Open Access Journals (Sweden)

Maria-Elissavet Nikolaidou

2014-01-01

Full Text Available Bodybuilding is a high-risk sport for distal triceps tendon ruptures. Management, especially in high-demanding athletes, is operative with suture anchor refixation technique being frequently used. However, the rate of rerupture is high due to underlying poor tendon quality. Thus, additional augmentation could be useful. This case report presents a reconstruction technique for a complete traumatic distal triceps tendon rupture in a bodybuilder with postoperative biomechanical assessment. A 28-year-old male professional bodybuilder was treated with a synthetic augmented suture anchor reconstruction for a complete triceps tendon rupture of his right dominant elbow. Postoperative biomechanical assessment included isokinetic elbow strength and endurance testing by using multiple angular velocities to simulate the “off-season” and “precompetition” phases of training. Eighteen months postoperatively and after full return to training, the biomechanical assessment indicated that the strength and endurance of the operated elbow joint was fully restored with even higher ratings compared to the contralateral healthy arm. The described reconstruction technique can be considered as an advisable option in high-performance athletes with underlying poor tendon quality due to high tensile strength and lack of donor site morbidity, thus enabling them to restore preinjury status and achieve safe return to sports.

Synthetic Augmented Suture Anchor Reconstruction for a Complete Traumatic Distal Triceps Tendon Rupture in a Male Professional Bodybuilder with Postoperative Biomechanical Assessment

Science.gov (United States)

Nikolaidou, Maria-Elissavet; Banke, Ingo J.; Laios, Thomas; Petsogiannis, Konstantinos; Mourikis, Anastasios

2014-01-01

Bodybuilding is a high-risk sport for distal triceps tendon ruptures. Management, especially in high-demanding athletes, is operative with suture anchor refixation technique being frequently used. However, the rate of rerupture is high due to underlying poor tendon quality. Thus, additional augmentation could be useful. This case report presents a reconstruction technique for a complete traumatic distal triceps tendon rupture in a bodybuilder with postoperative biomechanical assessment. A 28-year-old male professional bodybuilder was treated with a synthetic augmented suture anchor reconstruction for a complete triceps tendon rupture of his right dominant elbow. Postoperative biomechanical assessment included isokinetic elbow strength and endurance testing by using multiple angular velocities to simulate the “off-season” and “precompetition” phases of training. Eighteen months postoperatively and after full return to training, the biomechanical assessment indicated that the strength and endurance of the operated elbow joint was fully restored with even higher ratings compared to the contralateral healthy arm. The described reconstruction technique can be considered as an advisable option in high-performance athletes with underlying poor tendon quality due to high tensile strength and lack of donor site morbidity, thus enabling them to restore preinjury status and achieve safe return to sports. PMID:24711944

Pectoralis Major Tear with Retracted Tendon: How to Fill the Gap? Reconstruction with Hamstring Autograft and Fixation with an Interference Screw

Directory of Open Access Journals (Sweden)

L. Baverel

2017-01-01

Full Text Available Rupture of the pectoralis major tendon is considered an uncommon injury and a significant number of ruptures are missed or diagnosed late, leading to a chronic tear. We report an open reconstruction technique and its outcomes in a case of chronic and retracted PM tear. At the last follow-up (12 months, the patient was pain-free, with a visual analogic scale at 0 all the time. He was very satisfied concerning the cosmetic and clinical results. The constant score was 93%, the SST value 95%, and the Quick DASH score 4.5. MRI performed one year postoperatively confirmed the continuity between PM tendon and graft, even if the aspect of the distal tendon seemed to be thinner than normal PM tendon. The excellent clinical outcomes at one-year follow-up suggest that PM tear with major tendon retraction can be reliably reconstructed with hamstring autograft, using a bioabsorbable screw to optimize the fixation device. This technique has proven its simplicity and efficiency to fill the gap.

“‘Doc’ do I need an anterior cruciate ligament reconstruction? What happens if I do not reconstruct the cruciate ligament?”

Directory of Open Access Journals (Sweden)

KS Dhillon

2014-11-01

Full Text Available We are all aware that there has been a dramatic increase in the number of anterior cruciate ligament (ACL reconstructions that are carried out here in Malaysia as well as around the world. The numbers of ACL injuries have undoubtedly increased over the years with greater participation of young adults in sporting activities. However it is not certain whether the increase in the numbers of reconstructions can be accounted for by the increasing numbers of ACL injuries. Without doubt commercial interests as well the influence of the biomedical companies have a role to play. In the past the rationale for surgical treatment of an ACL tear was that the ACL is vital for knee function and that in the long term ACL deficiency will lead to more injuries of the meniscus and more degeneration of the joint. This belief was prevalent because the natural history of an ACL deficient knee and the ultimate outcome of reconstruction of the ACL were both not known. However in recent years a substantial amount of research has been published, which has elucidated the natural history of ACL deficient knees as well as the long term outcome of reconstruction of the ACL.

Clinical Outcomes After Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability Among Patients With Trochlear Dysplasia.

Science.gov (United States)

Liu, Joseph N; Brady, Jacqueline M; Kalbian, Irene L; Strickland, Sabrina M; Ryan, Claire Berdelle; Nguyen, Joseph T; Shubin Stein, Beth E

2018-03-01

Medial patellofemoral ligament (MPFL) reconstruction has become one of the most common and widely used procedures to regain stability among patients with recurrent lateral patellar dislocation. While recent studies demonstrated low recurrence rates, improved patient-reported outcome measures, and a high rate of return to sports, limited literature explored its effectiveness as an isolated intervention in the context of trochlear dysplasia. To determine the efficacy of isolated MPFL reconstruction in treating patellar instability in the setting of trochlear dysplasia. Case series; Level of evidence, 4. This was a retrospective review of consecutive patients who underwent uni- or bilateral medial patellofemoral ligament reconstruction for patellofemoral instability with a minimum 2-year follow-up. No osteotomies were included. Pre- and postoperative assessment included ligamentous laxity, patellar crepitus, tilt, translation, apprehension, and radiographic features, including tibial tubercle-trochlear groove (TT-TG) distance, Dejour classification, and Caton-Deschamps index. A total of 121 MPFL reconstructions were included. Mean age at surgery was 23.8 years, and 4.4 dislocation events occurred before surgery. Mean follow-up was 44 months; 76% of patients were female. Mean preoperative TT-TG ratio was 13.5, and mean Caton-Deschamps ratio was 1.2; 92% of patients had Dejour B, C, or D trochlear dysplasia. Kujala score improved from 55.0 preoperatively to 90.0 ( P patellofemoral instability, despite the presence of trochlear dysplasia. Most patients are able to return to sports by 1 year postoperatively at the same or higher level of play.

The 'bridging sign', a MR finding for combined full-thickness tears of the subscapularis tendon and the supraspinatus tendon

International Nuclear Information System (INIS)

Jung, Jin Young; Yoon, Young Cheol; Cha, Dong Ik; Yoo, Jae-Chul; Jung, Jee Young

2013-01-01

Background: In daily practice, we discovered one of the secondary magnetic resonance (MR) findings of the subscapularis (SSC) tendon tear, the 'bridging sign', which has not been previously described. Purpose: To describe the 'bridging sign' on shoulder MR imaging and its radiological and clinical significance in patients with SSC tendon tear. Material and Methods: Twenty-nine patients who had undergone shoulder arthroscopy and had full-thickness tear of the subscapularis tendon were enrolled. The medical records of the 29 patients were retrospectively reviewed for the duration of shoulder pain, rotator cuff tears, and associated arthroscopic findings: biceps tendon abnormality and superior glenoid labral tear. Then, preoperative shoulder MR images were retrospectively reviewed for the presence or absence of the 'bridging sign' and associated MR findings: periarticular fluid and fatty atrophy of the supraspinatus and subscapularis muscles. The type of rotator cuff tear associated with the 'bridging sign' was assessed and the sensitivity, specificity, and accuracy of the 'bridging sign' for the diagnosis of a certain type of rotator cuff tear were calculated. Associated arthroscopic and MR findings and mean duration of the shoulder pain between the patients with and without the 'bridging sign' were compared. Results: The 'bridging sign' was seen in 17 of 29 patients and corresponded to a complex of the torn and superomedially retracted subscapularis tendon, coracohumeral ligament, and superior glenohumeral ligament, adhered to the anterior margin of the torn supraspinatus (SSP) tendon on arthroscopy. All patients with the 'bridging sign' had combined full-thickness tear (FTT) of the cranial 1/2 portion of the subscapularis tendon and anterior 1/2 portion of the SSP tendon. The sensitivity, specificity, and accuracy of the 'bridging sign' for the diagnosis of combined FTTs of the SSC tendon and anterior portion of the SSP tendon were 81.0%, 100%, and 86

Press-fit Femoral Fixation in ACL Reconstruction using Bone-Patellar Tendon-Bone Graft

Directory of Open Access Journals (Sweden)

Kaseb Mohammad Hasan

2009-05-01

Full Text Available Bone-patellar tendon auto graft is probably the most widely used graft for ACL reconstruction. Several methods for graft fixation have been described. To avoid intra-articular hardware we adopt biological fixation with a femoral trapezoidal press-fit fixation. A prospective study was performed on 30 consecutive active people who underwent ACL reconstruction with this technique by two surgeons between september2004 and march2007 (mean follow-up 15.2 months. Results were evaluated by an independent examiner using radiography, subjective and objective evaluation. Assessment using the IKDC knee scoring revealed 92% of the patients with a normal or nearly normal knee joint. Lysholm's score was 63.6(40- 86 preoperatively and 91.88(73-100 at the latest follow up (P < 0.005. No patient complained of instability at latest follow up. The quadriceps muscle showed mild atrophy at 3 and 6 months and at final follow-up. Five Patients complained of anterior knee pain and had a positive kneeling test. We found no graft displacement on follow up radiographs. All cases showed radiological evidence of graft osteointegration at last follow up. Our results show that press-fit fixation of trapezoidal bone graft in femoral tunnel is a simple, reliable, and cost-effective alternative for ACL recon-struction using bone-patellar tendon-bone graft.

A Modified Method for Reconstruction of Chronic Rupture of the Quadriceps Tendon after Total Knee Replacement

Directory of Open Access Journals (Sweden)

S Singh

2008-11-01

Full Text Available We describe herein a modified technique for reconstruction of chronic rupture of the quadriceps tendon in a patient with bilateral total knee replacement and distal realignment of the patella. The surgery involved the application of a Dacron graft and the ‘double eights’ technique. The patient achieved satisfactory results after surgery and we believe that this technique of reconstruction offers advantages over other methods.

The immediate intervention effects of robotic training in patients after anterior cruciate ligament reconstruction.

Science.gov (United States)

Hu, Chunying; Huang, Qiuchen; Yu, Lili; Ye, Miao

2016-07-01

[Purpose] The purpose of this study was to examine the immediate effects of robot-assisted therapy on functional activity level after anterior cruciate ligament reconstruction. [Subjects and Methods] Participants included 10 patients (8 males and 2 females) following anterior cruciate ligament reconstruction. The subjects participated in robot-assisted therapy and treadmill exercise on different days. The Timed Up-and-Go test, Functional Reach Test, surface electromyography of the vastus lateralis and vastus medialis, and maximal extensor strength of isokinetic movement of the knee joint were evaluated in both groups before and after the experiment. [Results] The results for the Timed Up-and-Go Test and the 10-Meter Walk Test improved in the robot-assisted rehabilitation group. Surface electromyography of the vastus medialis muscle showed significant increases in maximum and average discharge after the intervention. [Conclusion] The results suggest that walking ability and muscle strength can be improved by robotic training.

Tibial Slope Strongly Influences Knee Stability After Posterior Cruciate Ligament Reconstruction: A Prospective 5- to 15-Year Follow-up.

Science.gov (United States)

Gwinner, Clemens; Weiler, Andreas; Roider, Manoussos; Schaefer, Frederik M; Jung, Tobias M

2017-02-01

The reported failure rate after posterior cruciate ligament (PCL) reconstruction remains high. Previous studies have shown that the tibial slope (TS) influences sagittal plane laxity. Consequently, alterations of TS might have an effect on postoperative knee stability after PCL reconstruction. We hypothesized that flattening of TS is associated with increased posterior laxity after PCL reconstruction. Cohort study; Level of evidence 3. This study consisted of 48 patients who underwent PCL reconstruction in a single-surgeon series. Eight patients underwent an isolated PCL reconstruction, 27 patients underwent an additional posterolateral corner reconstruction, and 13 patients underwent a combined reconstruction of the PCL, anterior cruciate ligament, and posterolateral corner. Three blinded observers measured TS and the side-to-side difference (SSD) of posterior tibial translation (PTT) before and after PCL reconstruction using standardized stress radiographs. The minimum follow-up was 5 years. At a mean follow-up of 103 months (range, 65-187), the mean SSD of PTT was significantly reduced (10.9 ± 2.9 vs 4.9 ± 4.3 mm; P slope.

Extra-articular tenodesis combined with an anterior cruciate ligament reconstruction in acute anterior cruciate ligament tear in elite female football players.

Science.gov (United States)

Guzzini, Matteo; Mazza, Daniele; Fabbri, Mattia; Lanzetti, Riccardo; Redler, Andrea; Iorio, Carlo; Monaco, Edoardo; Ferretti, Andrea

2016-10-01

The growing popularity of elite soccer among female participants has led to increased incidents of anterior cruciate ligament (ACL) ruptures. Many authors underline a positive glide after ACL reconstruction (ACLR), especially in women. In fact, an isolated intra-articular ACLR may be inadequate to control rotational instability after a combined injury of the ACL and the peripheral structures of the knee. Extra-articular procedures are sometimes used in primary cases displaying excessive antero-lateral rotatory instability. The purpose of this case series was to report subjective and objective outcomes after combined ACL and lateral extra-articular tenodesis (LET) with a minimum 4-year follow-up in a selected high-risk population of elite female football players. Between January 2007 and December 2010, 16 elite Italian female football players were included in the study. All patients underwent the same surgical technique: anatomical ACLR with autogenous semitendinosus and gracilis tendons. After the intra-articular reconstruction was performed, an additional extra-articular MacIntosh modified Coker-Arnold procedure was carried out. Patients were assessed pre- and post-operatively with the subjective and objective International Knee Documentation Committee (IKDC) evaluation form, Tegner activity scale (TAS) and Lysholm score. Joint laxity was assessed with KT-1000 by measuring the side-to-side (S/S) differences in displacement at manual maximum (mm) testing. At a mean follow-up of 72.6 ± 8.1 months, two independent examiners reviewed all players. All of the patients had a fully recovered range of motion. Lachman test was negative in all patients (100 %). The evaluation of joint laxity and clinical evaluation showed a statistically significant improvement. No patients experienced complication or a re-rupture. The rationale of combining extra-articular procedures with ACLR is to restrict the internal rotation of the reconstructed knee, taking advantage of its

Editorial Commentary: The All-Epiphyseal Anterior Cruciate Ligament Distal Femoral Approach: Sockets or Tunnels?

Science.gov (United States)

Cordasco, Frank A

2018-05-01

I believe that the distal femoral approach for anterior cruciate ligament reconstruction in the skeletally immature athlete with 3 to 6 years of remaining growth is best performed with an all-inside, all-epiphyseal technique using sockets rather than an outside-in approach creating tunnels. A shorter socket rather than a longer tunnel exposes a smaller surface area of the lateral distal femoral physis to potential compromise and resultant valgus malalignment. In addition, exiting the lateral femoral aspect of the epiphysis with a full-diameter tunnel as compared with a smaller diameter drill hole used to prepare a socket places the posterior articular cartilage, the lateral collateral ligament and anterolateral ligament footprints, and the popliteus tendon insertion at risk. My preference for sockets is also related to my belief that they provide a superior biologic milieu for graft incorporation compared with a full-length tunnel with the attendant violation of the lateral femoral cortex of the epiphysis. Copyright © 2018 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Medial collateral ligament healing one year after a concurrent medial collateral ligament and anterior cruciate ligament injury: an interdisciplinary study in rabbits.

Science.gov (United States)

Yamaji, T; Levine, R E; Woo, S L; Niyibizi, C; Kavalkovich, K W; Weaver-Green, C M

1996-03-01

The optimal treatment for concurrent injuries to the medial collateral and anterior cruciate ligaments has not been determined, despite numerous clinical and laboratory studies. The objective of this study was to examine the effect of surgical repair of the medial collateral ligament on its biomechanical and biochemical properties 52 weeks after such injuries. In the left knee of 12 skeletally mature New Zealand White rabbits, the medial collateral ligament was torn and the anterior cruciate ligament was transected and then reconstructed. This is an experimental model previously developed in our laboratory. In six rabbits, the torn ends of the medial collateral ligament were repaired, and in the remaining six rabbits, the ligament was not repaired. Fifty-two weeks after injury, we examined varus-valgus and anterior-posterior knee stability; structural properties of the femur-medial collateral ligament-tibia complex; and mechanical properties, collagen content, and mature collagen crosslinking of the medial collateral ligament. We could not detect significant differences between repair and nonrepair groups for any biomechanical or biochemical property. Our data support clinical findings that when the medial collateral and anterior cruciate ligaments are injured concurrently and the anterior cruciate ligament is reconstructed, conservative treatment of the ruptured medial collateral ligament can result in successful healing.

Postoperative evaluation after anterior cruciate ligament reconstruction: Measurements and abnormalities on radiographic and CT imaging

Energy Technology Data Exchange (ETDEWEB)

Kim, Min Cheol; Choi, Yun Sun; KIm, Hyoung Seop; Choi, Nam Hong [Nowon Eulji Medical Center, Eulji University, Seoul (Korea, Republic of)

2016-11-15

Reconstruction of a ruptured anterior cruciate ligament (ACL) is a well-established procedure for repair of ACL injury. Despite improvement of surgical and rehabilitation techniques over the past decades, up to 25% of patients still fail to regain satisfactory function after an ACL reconstruction. With development of CT imaging techniques for reducing metal artifacts, multi-planar reconstruction, and three-dimensional reconstruction, early post-operative imaging is increasingly being used to provide immediate feedback to surgeons regarding tunnel positioning, fixation, and device placement. Early post-operative radiography and CT imaging are easy to perform and serve as the baseline examinations for future reference.

Review of evolution of tunnel position in anterior cruciate ligament reconstruction.

Science.gov (United States)

Rayan, Faizal; Nanjayan, Shashi Kumar; Quah, Conal; Ramoutar, Darryl; Konan, Sujith; Haddad, Fares S

2015-03-18

Anterior cruciate ligament (ACL) rupture is one of the commonest knee sport injuries. The annual incidence of the ACL injury is between 100000-200000 in the United States. Worldwide around 400000 ACL reconstructions are performed in a year. The goal of ACL reconstruction is to restore the normal knee anatomy and kinesiology. The tibial and femoral tunnel placements are of primordial importance in achieving this outcome. Other factors that influence successful reconstruction are types of grafts, surgical techniques and rehabilitation programmes. A comprehensive understanding of ACL anatomy has led to the development of newer techniques supplemented by more robust biological and mechanical concepts. In this review we are mainly focussing on the evolution of tunnel placement in ACL reconstruction, focusing on three main categories, i.e., anatomical, biological and clinical outcomes. The importance of tunnel placement in the success of ACL reconstruction is well researched. Definite clinical and functional data is lacking to establish the superiority of the single or double bundle reconstruction technique. While there is a trend towards the use of anteromedial portals for femoral tunnel placement, their clinical superiority over trans-tibial tunnels is yet to be established.

Bone anchors or interference screws? A biomechanical evaluation for autograft ankle stabilization.

Science.gov (United States)

Jeys, Lee; Korrosis, Sotiris; Stewart, Todd; Harris, Nicholas J

2004-01-01

Autograft stabilization uses free semitendinosus tendon grafts to anatomically reconstruct the anterior talofibular ligament. Study aims were to evaluate the biomechanical properties of Mitek GII anchors compared with the Arthrex Bio-Tenodesis Screw for free tendon reconstruction of the anterior talofibular ligament. There are no differences in load to failure and percentage specimen elongation at failure between the 2 methods. Controlled laboratory study using porcine models. Sixty porcine tendon constructs were failure tested. Re-creating the pull of the anterior talofibular ligament, loads were applied at 70 degrees to the bones. Thirty-six tendons were fixed to porcine tali and tested using a single pull to failure; 10 were secured with anchors and No. 2 Ethibond, 10 with anchors and FiberWire, 10 with screws and Fiberwire, and 6 with partially gripped screws. Cyclic preloading was conducted on 6 tendons fixed by anchors and on 6 tendons fixed by screws before failure testing. Two groups of 6 components fixed to the fibula were also tested. The talus single-pull anchor group produced a mean load of 114 N and elongation of 37% at failure. The talus single-pull screw group produced a mean load of 227 N and elongation of 22% at failure (P anchors. The improved biomechanics of interference screws suggests that these may be more suited to in vivo reconstruction of the anterior talofibular ligament than are bone anchors.

Tourniquet-induced cardiovascular responses in anterior cruciate ligament reconstruction surgery under general anesthesia: Effect of preoperative oral amantadine

Directory of Open Access Journals (Sweden)

Ashraf Abd Elmawgood

2015-01-01

Conclusion: Preoperative oral amantadine reduced tourniquet induced hypertension and postoperative analgesic requirements in anterior cruciate ligament reconstruction surgery under general anesthesia.

Step Cut Lengthening: A Technique for Treatment of Flexor Pollicis Longus Tendon Rupture.

Science.gov (United States)

Chong, Chew-Wei; Chen, Shih-Heng

2018-04-01

Reconstruction of a tendon defect is a challenging task in hand surgery. Delayed repair of a ruptured flexor pollicis longus (FPL) tendon is often associated with tendon defect. Primary repair of the tendon is often not possible, particularly after debridement of the unhealthy segment of the tendon. As such, various surgical treatments have been described in the literature, including single-stage tendon grafting, 2-stage tendon grafting, flexor digitorum superficialis tendon transfer from ring finger, and interphalangeal joint arthrodesis. We describe step cut lengthening of FPL tendon for the reconstruction of FPL rupture. This is a single-stage reconstruction without the need for tendon grafting or tendon transfer. To our knowledge, no such technique has been previously described.

Biomechanical Measures During Landing and Postural Stability Predict Second Anterior Cruciate Ligament Injury After Anterior Cruciate Ligament Reconstruction and Return to Sport

Science.gov (United States)

Paterno, Mark V.; Schmitt, Laura C.; Ford, Kevin R.; Rauh, Mitchell J.; Myer, Gregory D.; Huang, Bin; Hewett, Timothy E.

2016-01-01

Background Athletes who return to sport participation after anterior cruciate ligament reconstruction (ACLR) have a higher risk of a second anterior cruciate ligament injury (either reinjury or contralateral injury) compared with non–anterior cruciate ligament–injured athletes. Hypotheses Prospective measures of neuromuscular control and postural stability after ACLR will predict relative increased risk for a second anterior cruciate ligament injury. Study Design Cohort study (prognosis); Level of evidence, 2. Methods Fifty-six athletes underwent a prospective biomechanical screening after ACLR using 3-dimensional motion analysis during a drop vertical jump maneuver and postural stability assessment before return to pivoting and cutting sports. After the initial test session, each subject was followed for 12 months for occurrence of a second anterior cruciate ligament injury. Lower extremity joint kinematics, kinetics, and postural stability were assessed and analyzed. Analysis of variance and logistic regression were used to identify predictors of a second anterior cruciate ligament injury. Results Thirteen athletes suffered a subsequent second anterior cruciate ligament injury. Transverse plane hip kinetics and frontal plane knee kinematics during landing, sagittal plane knee moments at landing, and deficits in postural stability predicted a second injury in this population (C statistic = 0.94) with excellent sensitivity (0.92) and specificity (0.88). Specific predictive parameters included an increase in total frontal plane (valgus) movement, greater asymmetry in internal knee extensor moment at initial contact, and a deficit in single-leg postural stability of the involved limb, as measured by the Biodex stability system. Hip rotation moment independently predicted second anterior cruciate ligament injury (C = 0.81) with high sensitivity (0.77) and specificity (0.81). Conclusion Altered neuromuscular control of the hip and knee during a dynamic landing task

Long-term interventions effects of robotic training on patients after anterior cruciate ligament reconstruction.

Science.gov (United States)

Hu, Chunying; Huang, Qiuchen; Yu, Lili; Zhou, Yue; Gu, Rui; Ye, Miao; Ge, Meng; Xu, Yanfeng; Liu, Jianfeng

2016-08-01

[Purpose] The aim of this study was to examine the long-term interventions effects of robot-assisted therapy rehabilitation on functional activity levels after anterior cruciate ligament reconstruction. [Subjects and Methods] The subjects were 8 patients (6 males and 2 females) who received anterior cruciate ligament reconstruction. The subjects participated in robot-assisted therapy lasting for one month. The Timed Up-and-Go test, 10-Meter Walk test, Functional Reach Test, surface electromyography of the vastus lateralis and vastus medialis, and extensor strength of isokinetic movement of the knee joint were evaluated before and after the intervention. [Results] The average value of the of vastus medialis EMG, Functional Reach Test, and the maximum and average extensor strength of the knee joint isokinetic movement increased significantly, and the time of the 10-Meter Walk test decreased significantly. [Conclusion] These results suggest that walking ability and muscle strength can be improved by robotic walking training as a long-term intervention.

Long bicipital tendon of the shoulder: normal anatomy and pathologic findings on MR imaging.

Science.gov (United States)

Erickson, S J; Fitzgerald, S W; Quinn, S F; Carrera, G F; Black, K P; Lawson, T L

1992-05-01

The tendon of the long head of the biceps muscle (long bicipital tendon) has a complex course from its muscle belly to its insertion onto the supraglenoid tubercle/glenoid labrum. It is stabilized by numerous tendinous and ligamentous structures and is, in turn, partly responsible for maintenance of normal glenohumeral function. In this report we describe the anatomy of this tendon, correlating high-resolution MR images with cryomicrotome sections. We illustrate typical MR findings in pathologic conditions affecting the long bicipital tendon sheath, the substance of the tendon, and finally the tendon position.

Effects of training on collagen fibril populations in the suspensory ligament and deep digital flexor tendon of young thoroughbreds.

Science.gov (United States)

Patterson-Kane, J C; Firth, E C; Parry, D A; Wilson, A M; Goodship, A E

1998-01-01

To determine the effect of a specific galloping exercise regimen on collagen fibril mass-average diameters (MAD) in the deep digital flexor tendon (DDFT) and suspensory ligament (SL) of young Thoroughbreds. 12 Thoroughbred fillies, 21 +/- 1 (mean +/- SD) months old. 6 horses underwent a specific 18-month treadmill training program involving galloping exercise. The remaining 6 horses served as controls, undertaking low-volume walking exercise over the same period. Sections were excised from the midpoint of the DDFT and SL, and small strips were dissected from central and peripheral locations for each structure. Fibril diameters were measured from micrographs of transverse ultrathin sections, using a computerized image analysis program. An MAD value was calculated for the central and peripheral regions of the DDFT and SL for each horse. Values for both regions were compared between exercised and control horses. The MAD did not change significantly with exercise for either the DDFT or the SL. Loading of the DDFT as a result of this exercise regimen was not sufficient to stimulate collagen fibril hypertrophy, in keeping with current data that indicate this tendon, compared with the SL and superficial digital flexor tendon (SDFT), is subjected to low loads. Microtrauma, in terms of reduction in fibril MAD, may have occurred in the SL at a site different from that sampled. Another possibility is that, between the trot and the gallop, loading of the SL does not increase to the same extent as that of the SDFT.

Muscles, Ligaments and Tendons Journal - Basic principles and recommendations in clinical and field Science Research: 2016 Update.

Science.gov (United States)

Padulo, Johnny; Oliva, Francesco; Frizziero, Antonio; Maffulli, Nicola

2016-01-01

The proper design and implementation of a study as well as a balanced and well-supported evaluation and interpretation of its main findings are of crucial importance when reporting and disseminating research. Also accountability, funding acknowledgement and adequately declaring any conflict of interest play a major role in science. Since the Muscles, Ligaments and Tendons Journal (MLTJ) is committed to the highest scientific and ethical standards, we encourage all Authors to take into account and to comply, as much as possible, to the contents and issues discussed in this official editorial. This could be useful for improving the quality of the manuscripts, as well as to stimulate interest and debate and to promote constructive change, reflecting upon uses and misuses within our disciplines belonging to the field of "Clinical and Sport - Science Research".

Development of a Tissue-Engineered Artificial Ligament: Reconstruction of Injured Rabbit Medial Collateral Ligament With Elastin-Collagen and Ligament Cell Composite Artificial Ligament.

Science.gov (United States)

Hirukawa, Masaki; Katayama, Shingo; Sato, Tatsuya; Inoue, Kota; Niwa, Kosuke; Ito, Naoya; Hattori, Tetsuya; Hosoi, Takashi; Unno, Hironori; Suzuki, Yoshiaki; Hasegawa, Masahiro; Miyamoto, Keiichi; Horiuchi, Takashi

2018-04-16

Ligament reconstruction using a tissue-engineered artificial ligament (TEAL) requires regeneration of the ligament-bone junction such that fixation devices such as screws and end buttons do not have to be used. The objective of this study was to develop a TEAL consisting of elastin-coated polydioxanone (PDS) sutures covered with elastin and collagen fibers preseeded with ligament cells. In a pilot study, a ring-type PDS suture with a 2.5 mm (width) bone insertion was constructed with/without elastin coating (Ela-coat and Non-coat) and implanted into two bone tunnels, diameter 2.4 mm, in the rabbit tibia (6 cases each) to access the effect of elastin on the bond strength. PDS specimens taken together with the tibia at 6 weeks after implantation indicated growth of bone-like hard tissues around bone tunnels accompanied with narrowing of the tunnels in the Ela-coat group and not in the Non-coat group. The drawout load of the Ela-coat group was significantly higher (28.0 ± 15.1 N, n = 4) than that of the Non-coat group (7.6 ± 4.6 N, n = 5). These data can improve the mechanical bulk property of TEAL through extracellular matrix formation. To achieve this TEAL model, 4.5 × 10 6 ligament cells were seeded on elastin and collagen fibers (2.5 cm × 2.5 cm × 80 µm) prior to coil formation around the elastin-coated PDS core sutures having ball-shape ends with a diameter of 2.5 mm. Cell-seeded and cell-free TEALs were implanted across the femur and the tibia through bone tunnels with a diameter of 2.4 mm (6 cases each). There was no incidence of TEAL being pulled in 6 weeks. Regardless of the remarkable degradation of PDS observed in the cell-seeded group, both the elastic modulus and breaking load of the cell-seeded group (n = 3) were comparable to those of the sham-operation group (n = 8) (elastic modulus: 15.4 ± 1.3 MPa and 18.5 ± 5.7 MPa; breaking load: 73.0 ± 23.4 N and 104.8 ± 21.8 N, respectively) and higher than those

A radiographic investigation to determine the safety of suture anchor systems for pediatric modified Broström ankle ligament reconstruction.

Science.gov (United States)

Hazratwala, Kaushik; Best, Alistair; Kopplin, Matthew; Giza, Eric; Sullivan, Martin

2005-03-01

The modified Broström ligament reconstruction using anchor sutures has been performed in adults with clinical success; however, the safety parameters for the use of suture anchors in adolescent lateral ankle ligament reconstruction have not been established. To perform a radiographic analysis comparing the depth of penetration of suture anchors in adult ankle ligament reconstruction with the average distance of the physis from the tip of the fibula in adolescents. Cross-sectional study, Level of evidence, 4. Forty postoperative ankle radiographs of adult patients who had a modified Broström procedure were compared with 40 normal adolescent ankle radiographs. In the adult group, the distance of the suture anchor penetration from the distal tip of the fibula was measured; in the adolescent group, the distance of the physis from the distal tip of the fibula was measured. The mean depth of the suture anchors was 17 mm (range, 14-21 mm) from the tip of the fibula in the adult group, and the mean distance of the growth plate was 23 mm (range, 18-29 mm) in the adolescent group. Eight radiographs from the adolescent group (20%) had a physis measurement of ankle ligament repair in the skeletally immature patient using suture anchors.

Bone tunnel change develops within two weeks of double-bundle anterior cruciate ligament reconstruction using hamstring autograft: A comparison of different postoperative immobilization periods using computed tomography.

Science.gov (United States)

Shimizu, Ryo; Adachi, Nobuo; Ishifuro, Minoru; Nakamae, Atsuo; Ishikawa, Masakazu; Deie, Masataka; Ochi, Mitsuo

2017-10-01

The purpose of this study was to evaluate bone tunnel changes following anterior cruciate ligament (ACL) reconstruction during the early postoperative period using computed tomography (CT), and to understand the impact of postoperative immobilization on these changes. Twenty patients who underwent double-bundle ACL reconstruction using hamstring tendon autografts were included. We subcategorized patients into two groups: patients who underwent isolated ACL reconstruction and had three days of knee immobilization (Group A, n=10); and patients with concomitant meniscus injuries who underwent ACL reconstruction and meniscus repair simultaneously (Group B, n=10) had their knees immobilized for two weeks after surgery. Bone tunnel enlargement was evaluated using CT imaging at one to three days, two weeks, one month, three months and six months after surgery. The cross-sectional area of the femoral and tibial tunnels was measured, and enlargement rate was calculated. The tunnel center location at two weeks after surgery was also evaluated. The mean cross-sectional area adjacent to the joint space of the femoral and tibial tunnels significantly increased immediately after surgery, especially in the first month (P0.01). There was no significant difference in tunnel enlargement rate between group A and B. Tunnel center location changed even in the first two weeks. Bone tunnel enlargement following double-bundle ACL reconstruction occurred at an earlier time point after surgery than anticipated. Postoperative immobilization could not prevent bone tunnel enlargement, but might prevent tunnel migration. Copyright © 2017 Elsevier B.V. All rights reserved.

One stage revision single-bundle anterior cruciate ligament reconstruction with impacted morselized bone graft following a failed double-bundle reconstruction

Directory of Open Access Journals (Sweden)

Ho Jong Ra

2017-01-01

Full Text Available Although double-bundle anterior cruciate ligament (ACL reconstruction has theoretical benefits such as more accurate reproduction of ACL anatomy, it is technically more demanding surgery. This report describes the case of a one stage revision single-bundle ACL reconstruction after primary double-bundle ACL reconstruction. A professional dancer had an ACL previously reconstructed with a double-bundle technique, but the femoral tunnels were malpositioned resulting in residual laxity and rotational instability. The previous femoral tunnel positions were vertical and widened. The previous vertical tunnels were filled with impacted bone graft and a revision single-bundle ACL reconstruction was performed via the new femoral tunnel with a 2 O'clock position between the previous two tunnels. After 10 months of postoperative rehabilitation, the patient returned to professional dancing with sound bony union and without any residual instability.

Engineering the bone-ligament interface using polyethylene glycol diacrylate incorporated with hydroxyapatite.

Science.gov (United States)

Paxton, Jennifer Z; Donnelly, Kenneth; Keatch, Robert P; Baar, Keith

2009-06-01

Ligaments and tendons have previously been tissue engineered. However, without the bone attachment, implantation of a tissue-engineered ligament would require it to be sutured to the remnant of the injured native tissue. Due to slow repair and remodeling, this would result in a chronically weak tissue that may never return to preinjury function. In contrast, orthopaedic autograft reconstruction of the ligament often uses a bone-to-bone technique for optimal repair. Since bone-to-bone repairs heal better than other methods, implantation of an artificial ligament should also occur from bone-to-bone. The aim of this study was to investigate the use of a poly(ethylene glycol) diacrylate (PEGDA) hydrogel incorporated with hydroxyapatite (HA) and the cell-adhesion peptide RGD (Arg-Gly-Asp) as a material for creating an in vitro tissue interface to engineer intact ligaments (i.e., bone-ligament-bone). Incorporation of HA into PEG hydrogels reduced the swelling ratio but increased mechanical strength and stiffness of the hydrogels. Further, HA addition increased the capacity for cell growth and interface formation. RGD incorporation increased the swelling ratio but decreased mechanical strength and stiffness of the material. Optimum levels of cell attachment were met using a combination of both HA and RGD, but this material had no better mechanical properties than PEG alone. Although adherence of the hydrogels containing HA was achieved, failure occurs at about 4 days with 5% HA. Increasing the proportion of HA improved interface formation; however, with high levels of HA, the PEG HA composite became brittle. This data suggests that HA, by itself or with other materials, might be well suited for engineering the ligament-bone interface.

Finite Element Modelling of a Novel Anterior Cruciate Ligament Repairing Device

Directory of Open Access Journals (Sweden)

A.Vairis

2014-07-01

Full Text Available The knee anterior cruciate ligament which connects the femur to the tibia is often torn during sudden twisting motions resulting in knee instability with surgery being an effective treatment where the torn ligament is replaced with a graft. This study provides qualitative stress information on a restored knee which has been repaired using a novel device. This device has been designed to reduce graft damage and to minimize post-surgery complications. The device as well as the intact knee have been modelled in 3D and studied using finite elements to assess the mechanical behaviour of the device under different loads. Results are evaluated and compared to equivalent published works. They showed that high stresses appear where tendons wrap around objects like the securing pin of the knee ligament repair device, while the highest stresses are away from the repair device components indicating that the device design does not affect the graft. Developed stresses were within the tendon elastic range, and load case direction does not affect significantly the developed stresses on the circumference of tendons in the most stressed region.

Three-Dimensional Anatomic Evaluation of the Anterior Cruciate Ligament for Planning Reconstruction

Directory of Open Access Journals (Sweden)

Yuichi Hoshino

2012-01-01

Full Text Available Anatomic study related to the anterior cruciate ligament (ACL reconstruction surgery has been developed in accordance with the progress of imaging technology. Advances in imaging techniques, especially the move from two-dimensional (2D to three-dimensional (3D image analysis, substantially contribute to anatomic understanding and its application to advanced ACL reconstruction surgery. This paper introduces previous research about image analysis of the ACL anatomy and its application to ACL reconstruction surgery. Crucial bony landmarks for the accurate placement of the ACL graft can be identified by 3D imaging technique. Additionally, 3D-CT analysis of the ACL insertion site anatomy provides better and more consistent evaluation than conventional “clock-face” reference and roentgenologic quadrant method. Since the human anatomy has a complex three-dimensional structure, further anatomic research using three-dimensional imaging analysis and its clinical application by navigation system or other technologies is warranted for the improvement of the ACL reconstruction.

Should the Ipsilateral Hamstrings Be Used for Anterior Cruciate Ligament Reconstruction in the Case of Medial Collateral Ligament Insufficiency? Biomechanical Investigation Regarding Dynamic Stabilization of the Medial Compartment by the Hamstring Muscles.

Science.gov (United States)

Herbort, Mirco; Michel, Philipp; Raschke, Michael J; Vogel, Nils; Schulze, Martin; Zoll, Alexander; Fink, Christian; Petersen, Wolf; Domnick, Christoph

2017-03-01

Semitendinosus and gracilis muscles are frequently harvested for autologous tendon grafts for cruciate ligament reconstruction. This study investigated the joint-stabilizing effects of these hamstring muscles in cases of insufficiency of the medial collateral ligament (MCL). First, both the semitendinosus and gracilis muscles can actively stabilize the joint against valgus moments in the MCL-deficient knee. Second, the stabilizing influence of these muscles decreases with an increasing knee flexion angle. Controlled laboratory study. The kinematics was examined in 10 fresh-frozen human cadaveric knees using a robotic/universal force moment sensor system and an optical tracking system. The knee kinematics under 5- and 10-N·m valgus moments were determined in the different flexion angles of the (1) MCL-intact and (2) MCL-deficient knee using the following simulated muscle loads: (1) 0-N (idle) load, (2) 200-N semitendinosus (ST) load, and (3) 280-N (200/80-N) combined semitendinosus/gracilis (STGT) load. Cutting the MCL increased the valgus angle under all tested conditions and angles compared with the MCL-intact knee by 4.3° to 8.1° for the 5-N·m valgus moment and 6.5° to 11.9° for the 10-N·m valgus moment ( P .05). The combined 280-N simulated STGT load significantly reduced the valgus angle in 0°, 10°, and 20° of flexion under 5- and 10-N·m valgus moments ( P .05). In 60° and 90° of flexion, ST and STGT loads did not decrease the resulting valgus angle of the MCL-deficient knee without hamstring loads ( P > .05 vs deficient; P = .0001 vs intact). In this human cadaveric study, semitendinosus and gracilis muscles successfully stabilize valgus moments applied to the MCL-insufficient knee when the knee is near extension. In the valgus-unstable knee, these data suggest that the hamstring muscles should be preserved in (multi-) ligament surgery when possible.

One-stage Pelnac Reconstruction in Full-thickness Skin Defects with Bone or Tendon Exposure

Directory of Open Access Journals (Sweden)

Xianghong Lou, MS

2018-03-01

Full Text Available Summary:. Dermal regeneration template, such as Integra and Pelnac, was originally designed for treating large area burn injury by inducing regeneration of dermis. To date, it has been widely applied in various acute and chronic wound sites. The present study demonstrated that application of artificial dermis alone induced 1-stage wound healing for wounds with bone or tendon exposure that should usually be repaired by flap surgery. Eight patients who presented with skin defects with bone and/or tendon exposure were treated by 1-stage Pelnac approach. All wounds healed within 20 weeks without skin graft or flap surgery. The wound area was reconstructed by nearly normal skin structure and linear scar. In the case of scalp defect, evidence of hair follicle cell migration and regeneration during healing process was observed. Thereby, the 1-stage Pelnac reconstitution can be considered as a novel method for inducing regrowth of epidermis and hair follicles to cure large full-thickness skin defect with bone and tendon exposure in 1 stage.

Magnetic resonance imaging of cyclops lesion as a cause of persistent morbidity after anterior cruciate ligament reconstruction

OpenAIRE

Amit Kharat; Sahil Garg; Amarjit Singh; Vilas Kulkarni

2015-01-01

Localized anterior arthrofibrosis (cyclops lesion) is having around 1-9.8% frequency rate after anterior cruciate ligament (ACL) reconstruction. It has been reported to be a significant cause of loss of knee extension after reconstruction of the ACL of the knee. We present a case report of a patient with prior ACL reconstruction who presented with pain and loss of extension following surgery. MR imaging revealed the typical features of cyclops lesion. Repeat arthroscopy excision of the lesion...

Functional Outcome and Graft Retention in Patients With Septic Arthritis After Anterior Cruciate Ligament Reconstruction: A Systematic Review.

Science.gov (United States)

Makhni, Eric C; Steinhaus, Michael E; Mehran, Nima; Schulz, Brian S; Ahmad, Christopher S

2015-07-01

To provide a comprehensive review of clinical and functional outcomes after treatment for septic arthritis after anterior cruciate ligament reconstruction. A systematic review of the literature was performed. Two reviewers assessed and confirmed the methodologic quality of each study. Studies that met the inclusion criteria were assessed for pertinent data, and when available, similar outcomes were combined to generate frequency-weighted means. Nineteen studies met the inclusion and exclusion criteria for this review, reporting on a total of 203 infected knees. The mean age was 27.5 years and the mean length of follow-up was 44.2 months, with male patients comprising 88% of the population. Hamstring and bone-patellar tendon-bone autografts were used in 63% and 33% of patients, respectively, with 78% of patients retaining their grafts. The studies reported mean flexion and extension deficits of 5.8° and 1.0°, respectively, and laxity testing showed a mean difference of 1.9 mm. The studies reported mean Lysholm, International Knee Documentation Committee, and Tegner scores of 82.1, 68.2, and 5.6, respectively. Of the patients, 83% reported an ability to return to activities of daily living whereas 67% reported a return to their preinjury level of athletics. Evidence of new degenerative changes was seen in 22% of patients. Septic arthritis after anterior cruciate ligament reconstruction remains a very infrequent event, affecting 0.5% of patients. On average, outcomes in these patients are comparable with those in patients in whom infection does not develop, including postoperative range of motion, residual instability, Lysholm scores, and return to preinjury level of activity. These patients do exhibit decreased International Knee Documentation Committee scores compared with patients without septic arthritis, however. The impact of this differential is not clear, but this scoring difference suggests that septic arthritis may be associated with more severe symptoms

Nano/micro hybrid scaffold of PCL or P3HB nanofibers combined with silk fibroin for tendon and ligament tissue engineering.

Science.gov (United States)

Naghashzargar, Elham; Farè, Silvia; Catto, Valentina; Bertoldi, Serena; Semnani, Dariush; Karbasi, Saeed; Tanzi, Maria Cristina

2015-07-04

A novel biodegradable nano/micro hybrid structure was obtained by electrospinning P3HB or PCL nanofibers onto a twisted silk fibroin (SF) structure, with the aim of fabricating a suitable scaffold for tendon and ligament tissue engineering. The electrospinning (ES) processing parameters for P3HB and PCL were optimized on 2D samples, and applied to produce two different nano/micro hybrid constructs (SF/ES-PCL and SF/ES-P3HB).Morphological, chemico-physical and mechanical properties of the novel hybrid scaffolds were evaluated by SEM, ATR FT-IR, DSC, tensile and thermodynamic mechanical tests. The results demonstrated that the nanofibers were tightly wrapped around the silk filaments, and the crystallinity of the SF twisted yarns was not influenced by the presence of the electrospun polymers. The slightly higher mechanical properties of the hybrid constructs confirmed an increase of internal forces due to the interaction between nano and micro components. Cell culture tests with L929 fibroblasts, in the presence of the sample eluates or in direct contact with the hybrid structures, showed no cytotoxic effects and a good level of cytocompatibility of the nano/micro hybrid structures in term of cell viability, particularly at day 1. Cell viability onto the nano/micro hybrid structures decreased from the first to the third day of culture when compared with the control culture plastic, but appeared to be higher when compared with the uncoated SF yarns. Although additional in vitro and in vivo tests are needed, the original fabrication method here described appears promising for scaffolds suitable for tendon and ligament tissue engineering.

Femoral Condyle Fracture during Anterior Cruciate Ligament Reconstruction

Directory of Open Access Journals (Sweden)

Selahattin Ozyurek

2015-07-01

Full Text Available Dear Editor,We have greatly enjoyed reading the case report entitled “‘Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature in the issue of Arch Bone Jt Surg. 2015;3(2 with great interest. We would like to commend the authors for their detailed and valuable work. Although various case reports have described postoperative distal femur fracture at a range of time intervals (1,2 intraoperative intra-articular distal femur fracture is a unique entity.However, we believe that some important additional observations seem necessary to be contributed through this study. In this article, the authors stated that, to the best of their knowledge, there is no other case report in the literature introducing a femoral condyle fracture during arthroscopic ACL reconstruction or revision reconstruction. Nevertheless, we would like to call the attention of the readers to the fact that that the literature contains one additional case report re‌porting on intraoperative distal femoral coronal plane (Hoffa fracture during primary ACL reconstruction (2. Werner BC and Miller MD presented of case report of an intraoperative distal femoral coronal plane (Hoffa fracture that occurred during independent femoral tunnel drilling and dilation in a primary ACL reconstruction. As in the their case, this type of fracture can occur with appropriately placed femoral tunnels, but the risk can increase with larger graft diameters in patients with smaller lateral femoral condyles The patient was treated with open reduction and internal fixation, without compromise of graft stability and with good recovery of function. We believe that tailoring graft size to the size of the patient is important to prevent similar adverse events.

Cryotherapy with dynamic intermittent compression for analgesia after anterior cruciate ligament reconstruction. Preliminary study.

Science.gov (United States)

Murgier, J; Cassard, X

2014-05-01

Cryotherapy is a useful adjunctive analgesic measure in patients with postoperative pain following anterior cruciate ligament (ACL) surgery. Either static permanent compression or dynamic intermittent compression can be added to increase the analgesic effect of cryotherapy. Our objective was to compare the efficacy of these two compression modalities combined with cryotherapy in relieving postoperative pain and restoring range of knee motion after ligament reconstruction surgery. When combined with cryotherapy, a dynamic and intermittent compression is associated with decreased analgesic drug requirements, less postoperative pain, and better range of knee motion compared to static compression. We conducted a case-control study of consecutive patients who underwent anterior cruciate ligament reconstruction at a single institution over a 3-month period. Both groups received the same analgesic drug protocol. One group was managed with cryotherapy and dynamic intermittent compression (Game Ready(®)) and the other with cryotherapy and static compression (IceBand(®)). Of 39 patients, 20 received dynamic and 19 static compression. In the post-anaesthesia recovery unit, the mean visual analogue scale (VAS) pain score was 2.4 (range, 0-6) with dynamic compression and 2.7 (0-7) with static compression (P=0.3); corresponding values were 1.85 (0-9) vs. 3 (0-8) (P=0.16) after 6 hours and 0.6 (0-3) vs. 1.14 (0-3) (P=0.12) at discharge. The cumulative mean tramadol dose per patient was 57.5mg (0-200mg) with dynamic compression and 128.6 mg (0-250 mg) with static compression (P=0.023); corresponding values for morphine were 0mg vs. 1.14 mg (0-8 mg) (Pcryotherapy decreases analgesic drug requirements after ACL reconstruction and improves the postoperative recovery of range of knee motion. Level III, case-control study. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Anterior cruciate ligament graft tensioning. Is the maximal sustained one-handed pull technique reproducible?

Directory of Open Access Journals (Sweden)

Hirpara Kieran M

2011-07-01

Full Text Available Abstract Background Tensioning of anterior cruciate ligament (ACL reconstruction grafts affects the clinical outcome of the procedure. As yet, no consensus has been reached regarding the optimum initial tension in an ACL graft. Most surgeons rely on the maximal sustained one-handed pull technique for graft tension. We aim to determine if this technique is reproducible from patient to patient. Findings We created a device to simulate ACL reconstruction surgery using Ilizarov components and porcine flexor tendons. Six experienced ACL reconstruction surgeons volunteered to tension porcine grafts using the device to see if they could produce a consistent tension. None of the surgeons involved were able to accurately reproduce graft tension over a series of repeat trials. Conclusions We conclude that the maximal sustained one-handed pull technique of ACL graft tensioning is not reproducible from trial to trial. We also conclude that the initial tension placed on an ACL graft varies from surgeon to surgeon.

Anterior cruciate ligament graft tensioning. Is the maximal sustained one-handed pull technique reproducible?

LENUS (Irish Health Repository)

O'Neill, Barry J

2011-07-20

Abstract Background Tensioning of anterior cruciate ligament (ACL) reconstruction grafts affects the clinical outcome of the procedure. As yet, no consensus has been reached regarding the optimum initial tension in an ACL graft. Most surgeons rely on the maximal sustained one-handed pull technique for graft tension. We aim to determine if this technique is reproducible from patient to patient. Findings We created a device to simulate ACL reconstruction surgery using Ilizarov components and porcine flexor tendons. Six experienced ACL reconstruction surgeons volunteered to tension porcine grafts using the device to see if they could produce a consistent tension. None of the surgeons involved were able to accurately reproduce graft tension over a series of repeat trials. Conclusions We conclude that the maximal sustained one-handed pull technique of ACL graft tensioning is not reproducible from trial to trial. We also conclude that the initial tension placed on an ACL graft varies from surgeon to surgeon.

Medial Patellofemoral Ligament Reconstruction: Impact of Knee Flexion Angle During Graft Fixation on Dynamic Patellofemoral Contact Pressure-A Biomechanical Study.

Science.gov (United States)

Lorbach, Olaf; Zumbansen, Nikolaus; Kieb, Matthias; Efe, Turgay; Pizanis, Antonius; Kohn, Dieter; Haupert, Alexander

2018-04-01

Objective evaluation of the optimal graft tension angle to fully restore patellofemoral contact pressure in reconstruction of the medial patellofemoral ligament (MPFL) in comparison to the native knee. Twelve cadaveric knee specimens were fixed in a custom-made fixation device. A sensitive pressure film (Tekscan) was fixed in the patellofemoral joint, and patellofemoral contact pressure was assessed during a dynamic flexion movement from 0° to 90°. The MPFL was cut and measurements were repeated. Reconstruction of the MPFL was performed with the gracilis tendon subsequently fixed in the femur at 15°, 30°, 45°, 60°, 75°, and 90° of knee flexion under controlled tension (2 N). The sequence of the flexion angles was alternated. Pressure measurements were repeated after every fixation of the graft. No significant differences were seen in the overall patellofemoral contact pressure compared to the native knee (P > .05). However, medial patellofemoral pressure showed a significant increased patellofemoral contact pressure after MPFL reconstruction at a knee flexion angle during graft fixation of 15° (P = .027), 45° (P = .050, P = .044), and 75° (P = .039). Moreover, proximal/distal patellofemoral contact pressure revealed a significantly reduced contact pressure at 15° (P = .003), 30° (P = .009), 45° (P = .025), 75° (P = .021), and 90° (P = .022) of flexion distal after MPFL reconstruction compared with the intact knee. Lateral patellofemoral contact pressure was significantly reduced in all performed reconstructions (P angle during graft fixation for MPFL reconstruction did not have a significant impact on the overall patellofemoral contact pressure. However, selective medial, proximal, distal, and lateral patellofemoral contact pressure was significantly altered for all reconstructions. Fixation of the MPFL graft at 60° of flexion was able to most closely restore patellofemoral contact pressure compared with the intact knee. Based on the

PERONEAL TENDON LESIONS IN ATHLETES (REVIEW

Directory of Open Access Journals (Sweden)

E. E. Achkasov

2016-01-01

Full Text Available The authors analyzed scientific literature in respect of various issues in treatment of athletes with peroneal muscles lesions starting from 1987 till 2016. Key search and publications selection was made in PubMed and russian national electronic scientific library eLIBRARY. Peroneal tendons pathology is not the major but the underestimated cause of pain in lateral and hindfoot as well as of foot dysfunction which is difficult to distinguish from lesions of lateral ligaments of the ankle joint. Untreated lesions of peroneal tendons can result in chronic ankle pain and significant functional disorders. The purpose of the present paper is to improve the current comprehension of anatomy, to identify factors contributing to pathology, to perform diagnostic evaluation of peroneal tendons and to review current treatment options of such lesions.

Aesthetically and functionally satisfying reconstruction of an Achilles tendon and overlying skin defect in a 15 year old girl: a case report.

Science.gov (United States)

Wurzer, Paul; Eberl, Robert; Kamolz, Lars-Peter; Parvizi, Daryousch; Rappl, Thomas; Spendel, Stephan

2015-03-01

Achilles tendon and overlying soft tissue reconstruction presents an interdisciplinary challenge. In the literature many possible procedures are described, but each reconstruction in this region has its specific demands. Single stage reconstruction is normally pursued, but it is not always the best procedure for the patient, either aesthetically or functionally. We present a case of a 15 year old girl who suffered a soft tissue defect of 10cm×6cm in size at the area of the Achilles tendon due to a contact burn by an exhaust pipe during a motorcycle accident. For this case, reconstruction of the soft tissue defect using a free temporoparietal fascial flap (TPFF) and a full-thickness skin autograft was the best means to provide a satisfying result for both the patient and the surgeon. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

The popliteal fibular ligament in acute knee trauma: patterns of injury on MR imaging

Energy Technology Data Exchange (ETDEWEB)

McKean, D.; Thomee, E.; Grant, D.; Teh, J.L.; Mansour, R. [Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Headington, Oxford (United Kingdom); Yoong, P. [Royal Berkshire NHS Foundation Trust, Royal Berkshire Hospital, Reading (United Kingdom); Yanny, S. [Buckinghamshire Healthcare NHS Trust, Stoke Mandeville Hospital, Aylesbury (United Kingdom)

2015-10-15

To describe the patterns of injury associated with injury to the popliteofibular ligament injury. A retrospective review was performed of 180 MRI scans undertaken for acute knee trauma. Scans were excluded if the time of injury was over 4 weeks from the time of the scan, or if there was a history of septic arthritis, inflammatory arthropathy, previous knee surgery, or significant artefact. An agreed criterion for assessing the structures of the posterolateral ligamentous complex was defined and in each scan, the popliteofibular ligament (PFL) was scored as normal or injured. The menisci, ligaments, and tendons of each knee were also assessed. The mean age was 25.7 years (range, 9-65 years) and 72.2 % (n = 130) patients were male. The PFL was injured in 36 cases (20 %). There is a significant association between PFL injury and ACL rupture (p = 0.0001), ITB injury (p = 0.0001), PCL injury (p = 0.0373), in addition to associations with injury to other posterolateral corner structures including the lateral collateral ligament (p = 0.0001), biceps femoris tendon (p = 0.0014), and popliteus tendon (p = 0.0014). Of our series of PFL injuries, nine cases (25 %) were associated with further injuries of posterolateral corner structures and in 27 cases (75 %) the PFL was the only posterolateral corner structure torn. PFL injury is not uncommon in acute knee trauma and is associated with significant internal derangement of the knee, especially anterior cruciate ligament rupture, ITB sprain, and injury to other structures within the posterolateral corner. (orig.)

CAIPIRINHA accelerated SPACE enables 10-min isotropic 3D TSE MRI of the ankle for optimized visualization of curved and oblique ligaments and tendons

Energy Technology Data Exchange (ETDEWEB)

Kalia, Vivek [University of Vermont Medical Center, Department of Radiology, Burlington, VT (United States); Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Section of Musculoskeletal Radiology, Baltimore, MD (United States); Fritz, Benjamin [University Medical Center Freiburg, Department of Radiology, Freiburg im Breisgau (Germany); Johnson, Rory [Siemens Healthcare USA, Inc, Cary, NC (United States); Gilson, Wesley D. [Siemens Healthcare USA, Inc, Baltimore, MD (United States); Raithel, Esther [Siemens Healthcare GmbH, Erlangen (Germany); Fritz, Jan [Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Section of Musculoskeletal Radiology, Baltimore, MD (United States)

2017-09-15

To test the hypothesis that a fourfold CAIPIRINHA accelerated, 10-min, high-resolution, isotropic 3D TSE MRI prototype protocol of the ankle derives equal or better quality than a 20-min 2D TSE standard protocol. Following internal review board approval and informed consent, 3-Tesla MRI of the ankle was obtained in 24 asymptomatic subjects including 10-min 3D CAIPIRINHA SPACE TSE prototype and 20-min 2D TSE standard protocols. Outcome variables included image quality and visibility of anatomical structures using 5-point Likert scales. Non-parametric statistical testing was used. P values ≤0.001 were considered significant. Edge sharpness, contrast resolution, uniformity, noise, fat suppression and magic angle effects were without statistical difference on 2D and 3D TSE images (p > 0.035). Fluid was mildly brighter on intermediate-weighted 2D images (p < 0.001), whereas 3D images had substantially less partial volume, chemical shift and no pulsatile-flow artifacts (p < 0.001). Oblique and curved planar 3D images resulted in mildly-to-substantially improved visualization of joints, spring, bifurcate, syndesmotic, collateral and sinus tarsi ligaments, and tendons (p < 0.001, respectively). 3D TSE MRI with CAIPIRINHA acceleration enables high-spatial resolution oblique and curved planar MRI of the ankle and visualization of ligaments, tendons and joints equally well or better than a more time-consuming anisotropic 2D TSE MRI. (orig.)

CAIPIRINHA accelerated SPACE enables 10-min isotropic 3D TSE MRI of the ankle for optimized visualization of curved and oblique ligaments and tendons

International Nuclear Information System (INIS)

Kalia, Vivek; Fritz, Benjamin; Johnson, Rory; Gilson, Wesley D.; Raithel, Esther; Fritz, Jan

2017-01-01

To test the hypothesis that a fourfold CAIPIRINHA accelerated, 10-min, high-resolution, isotropic 3D TSE MRI prototype protocol of the ankle derives equal or better quality than a 20-min 2D TSE standard protocol. Following internal review board approval and informed consent, 3-Tesla MRI of the ankle was obtained in 24 asymptomatic subjects including 10-min 3D CAIPIRINHA SPACE TSE prototype and 20-min 2D TSE standard protocols. Outcome variables included image quality and visibility of anatomical structures using 5-point Likert scales. Non-parametric statistical testing was used. P values ≤0.001 were considered significant. Edge sharpness, contrast resolution, uniformity, noise, fat suppression and magic angle effects were without statistical difference on 2D and 3D TSE images (p > 0.035). Fluid was mildly brighter on intermediate-weighted 2D images (p < 0.001), whereas 3D images had substantially less partial volume, chemical shift and no pulsatile-flow artifacts (p < 0.001). Oblique and curved planar 3D images resulted in mildly-to-substantially improved visualization of joints, spring, bifurcate, syndesmotic, collateral and sinus tarsi ligaments, and tendons (p < 0.001, respectively). 3D TSE MRI with CAIPIRINHA acceleration enables high-spatial resolution oblique and curved planar MRI of the ankle and visualization of ligaments, tendons and joints equally well or better than a more time-consuming anisotropic 2D TSE MRI. (orig.)

The 'bridging sign', a MR finding for combined full-thickness tears of the subscapularis tendon and the supraspinatus tendon

Energy Technology Data Exchange (ETDEWEB)

Jung, Jin Young [Dept. of Radiology, Saint Paul' s Hospital, The Catholic Univ. of Korea, Seoul (Korea, Republic of); Yoon, Young Cheol; Cha, Dong Ik [Dept. of Radiology, Samsung Medical Center, Sungkyunkwan Univ, School of Medicine, Seoul (Korea, Republic of)], e-mail: ycyoon@skku.edu; Yoo, Jae-Chul [Dept. of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of); Jung, Jee Young [Dept. of Radiology, School of Medicine, Chung-Ang Univ., Seoul (Korea, Republic of)

2013-02-15

Background: In daily practice, we discovered one of the secondary magnetic resonance (MR) findings of the subscapularis (SSC) tendon tear, the 'bridging sign', which has not been previously described. Purpose: To describe the 'bridging sign' on shoulder MR imaging and its radiological and clinical significance in patients with SSC tendon tear. Material and Methods: Twenty-nine patients who had undergone shoulder arthroscopy and had full-thickness tear of the subscapularis tendon were enrolled. The medical records of the 29 patients were retrospectively reviewed for the duration of shoulder pain, rotator cuff tears, and associated arthroscopic findings: biceps tendon abnormality and superior glenoid labral tear. Then, preoperative shoulder MR images were retrospectively reviewed for the presence or absence of the 'bridging sign' and associated MR findings: periarticular fluid and fatty atrophy of the supraspinatus and subscapularis muscles. The type of rotator cuff tear associated with the 'bridging sign' was assessed and the sensitivity, specificity, and accuracy of the 'bridging sign' for the diagnosis of a certain type of rotator cuff tear were calculated. Associated arthroscopic and MR findings and mean duration of the shoulder pain between the patients with and without the 'bridging sign' were compared. Results: The 'bridging sign' was seen in 17 of 29 patients and corresponded to a complex of the torn and superomedially retracted subscapularis tendon, coracohumeral ligament, and superior glenohumeral ligament, adhered to the anterior margin of the torn supraspinatus (SSP) tendon on arthroscopy. All patients with the 'bridging sign' had combined full-thickness tear (FTT) of the cranial 1/2 portion of the subscapularis tendon and anterior 1/2 portion of the SSP tendon. The sensitivity, specificity, and accuracy of the 'bridging sign' for the diagnosis of combined FTTs of

Tissue engineered devices for ligament repair, replacement and ...

African Journals Online (AJOL)

PRECIOUS

2009-12-29

Dec 29, 2009 ... available, and the success rates for long term clinical outcome are 85 - 90% ... Schematic of a stress-strain curve for ligament or tendon displaying the toe, ...... monkey: I. A model for chronic xenograft rejection. Transplantation,.

Anatomical Footprint of the Tibialis Anterior Tendon: Surgical Implications for Foot and Ankle Reconstructions

Directory of Open Access Journals (Sweden)

Madeleine Willegger

2017-01-01

Full Text Available This study aimed to analyze precisely the dimensions, shapes, and variations of the insertional footprints of the tibialis anterior tendon (TAT at the medial cuneiform (MC and first metatarsal (MT1 base. Forty-one formalin-fixed human cadaveric specimens were dissected. After preparation of the TAT footprint, standardized photographs were made and the following parameters were evaluated: the footprint length, width, area of insertion, dorsoplantar location, shape, and additional tendon slips. Twenty feet (48.8% showed an equal insertion at the MC and MT1, another 20 feet (48.8% had a wide insertion at the MC and a narrow insertion at the MT1, and 1 foot (2.4% demonstrated a narrow insertion at the MC and a wide insertion at the MT1. Additional tendon slips inserting at the metatarsal shaft were found in two feet (4.8%. Regarding the dorsoplantar orientation, the footprints were located medial in 29 feet (70.7% and medioplantar in 12 feet (29.3%. The most common shape at the MT1 base was the crescent type (75.6% and the oval type at the MC (58.5%. The present study provided more detailed data on the dimensions and morphologic types of the tibialis anterior tendon footprint. The established anatomical data may allow for a safer surgical preparation and a more anatomical reconstruction.

In vitro tendon tissue development from human fibroblasts demonstrates collagen fibril diameter growth associated with a rise in mechanical strength

DEFF Research Database (Denmark)

Herchenhan, Andreas; Bayer, Monika L; Svensson, René B

2013-01-01

Collagen-rich tendons and ligaments are important for joint stability and force transmission, but the capacity to form new tendon is poorly understood. In the present study, we investigated mechanical strength, fibril size, and structure during development of tendon-like tissue from adult human...

Comparative study on anterior cruciate ligament reconstruction: determination of isometric points with and without navigation

Directory of Open Access Journals (Sweden)

Fabio J. Angelini

2010-01-01

Full Text Available OBJECTIVES: To compare the accuracy of tunnel placement and graft isometry for anterior cruciate ligament reconstruction performed using a computer-assisted navigation system (Orthopilot and using traditional instruments. METHODS: The anterior cruciate ligament was removed intact from 36 pairs of human cadaver knees. From each pair, one knee was randomized to Group 1 (conventional and the other to Group 2 (Orthopilot. An inelastic suture was then passed through the central points of the tibial and femoral tunnels. Neither of the tunnels was drilled. All knees were then dissected, and six parameters were obtained: distances from the tibial tunnel center to the 1 posterior cruciate ligament, 2 anterior horn of the lateral meniscus and 3 medial tibial spine; 4 distance from the femoral tunnel center to the posterior femoral cortex; 5 femoral tunnel coronal angle; and 6 variation of the distance from the femoral to the tibial tunnel with the knee extended and at 90 degrees of flexion. RESULTS: The variation of the distance from the femoral to the tibial tunnel during flexion and extension was smaller in the Orthopilot group (better isometry compared to the conventional group. There were no statistical differences in any other parameters between the groups, and all tunnels were considered to be in satisfactory positions. DISCUSSION: The results obtained for anterior cruciate ligament reconstruction depend on precise isometric point positioning, and a navigation system is a precision tool that can assist surgeons in tunnel positioning. CONCLUSION: No differences in tunnel position were observed between the groups. Nonetheless, better isometry was achieved in the Orthopilot group than with conventional instruments.

Enhancement of Tendon–Bone Healing for Anterior Cruciate Ligament (ACL Reconstruction Using Bone Marrow-Derived Mesenchymal Stem Cells Infected with BMP-2

Directory of Open Access Journals (Sweden)

Shiyi Chen

2012-10-01

Full Text Available At present, due to the growing attention focused on the issue of tendon–bone healing, we carried out an animal study of the use of genetic intervention combined with cell transplantation for the promotion of this process. Here, the efficacy of bone marrow stromal cells infected with bone morphogenetic protein-2 (BMP-2 on tendon–bone healing was determined. A eukaryotic expression vector containing the BMP-2 gene was constructed and bone marrow-derived mesenchymal stem cells (bMSCs were infected with a lentivirus. Next, we examined the viability of the infected cells and the mRNA and protein levels of BMP-2-infected bMSCs. Gastrocnemius tendons, gastrocnemius tendons wrapped by bMSCs infected with the control virus (bMSCs+Lv-Control, and gastrocnemius tendons wrapped by bMSCs infected with the recombinant BMP-2 virus (bMSCs+Lv-BMP-2 were used to reconstruct the anterior cruciate ligament (ACL in New Zealand white rabbits. Specimens from each group were harvested four and eight weeks postoperatively and evaluated using biomechanical and histological methods. The bMSCs were infected with the lentivirus at an efficiency close to 100%. The BMP-2 mRNA and protein levels in bMSCs were significantly increased after lentiviral infection. The bMSCs and BMP-2-infected bMSCs on the gastrocnemius tendon improved the biomechanical properties of the graft in the bone tunnel; specifically, bMSCs infected with BMP-2 had a positive effect on tendon–bone healing. In the four-week and eight-week groups, bMSCs+Lv-BMP-2 group exhibited significantly higher maximum loads of 29.3 ± 7.4 N and 45.5 ± 11.9 N, respectively, compared with the control group (19.9 ± 6.4 N and 21.9 ± 4.9 N (P = 0.041 and P = 0.001, respectively. In the eight-week groups, the stiffness of the bMSCs+Lv-BMP-2 group (32.5 ± 7.3 was significantly higher than that of the bMSCs+Lv-Control group (22.8 ± 7.4 or control groups (12.4 ± 6.0 (p = 0.036 and 0.001, respectively. Based on the

"Anatomic" anterior cruciate ligament reconstruction: a systematic review of surgical techniques and reporting of surgical data

NARCIS (Netherlands)

van Eck, Carola F.; Schreiber, Verena M.; Mejia, Hector A.; Samuelsson, Kristian; van Dijk, C. Niek; Karlsson, Jon; Fu, Freddie H.

2010-01-01

PURPOSE: The aim of this systematic review was to evaluate studies published on anatomic double-bundle anterior cruciate ligament (ACL) reconstruction. METHODS: A systematic electronic search was performed by use of the Medline and Embase databases. Studies that were published from January 1995 to

All-Epiphyseal Anterior Cruciate Ligament Femoral Tunnel Drilling: Avoiding Injury to the Physis, Lateral Collateral Ligament, Anterolateral Ligament, and Popliteus-A 3-Dimensional Computed Tomography Study.

Science.gov (United States)

Shea, Kevin G; Cannamela, Peter C; Fabricant, Peter D; Terhune, Elizabeth B; Polousky, John D; Milewski, Matthew D; Anderson, Allen F; Ganley, Theodore J

2018-01-25

To investigate the relation of the at-risk structures (distal femoral physis, lateral collateral ligament, anterolateral ligament, popliteus, and articular cartilage) during all-epiphyseal femoral tunnel drilling. A second purpose was 2-fold: (1) to develop recommendations for tunnel placement and orientation that anatomically reconstruct the anterior cruciate ligament (ACL) while minimizing the risk of injury to these at-risk structures, and (2) to allow for maximal tunnel length to increase the amount of graft in the socket to facilitate healing. Three-dimensional models of 6 skeletally immature knees (aged 7-11 years) were reconstructed from computed tomography and used to simulate all-epiphyseal femoral tunnels. Tunnels began within the ACL footprint and were directed laterally or anterolaterally, with the goal of avoiding injury to at-risk structures. The spatial relation between the ideal tunnel and these structures was evaluated. Full-length tunnels and partial length condyle sockets were simulated in the models using the same trajectories. An anterolateral tunnel could be placed to avoid direct injury to lateral structures. The safe zone on the anterolateral aspect of the femur was larger than that of a tunnel with a direct lateral trajectory (median 127 mm 2 vs 83 mm 2 , P = .028). Anterolateral tunnels were longer than direct lateral tunnels (median 30 mm vs 24 mm, P = .041). Safe angles for anterolateral tunnels were 34° to 40° from the posterior condylar axis; direct lateral tunnels were drilled 4° to 9° from the posterior condylar axis. Sockets could be placed without direct injury to structures at risk with either orientation. An all-epiphyseal ACL femoral tunnel can be placed without causing direct injury to at-risk structures. A tunnel angled anterolaterally from the ACL origin is longer and has a larger safe zone compared with the direct lateral tunnel. The largest safe zone for femoral all-epiphyseal ACL drilling was (1) anterior to

Peak knee biomechanics and limb symmetry following unilateral anterior cruciate ligament reconstruction: Associations of walking gait and jump-landing outcomes.

Science.gov (United States)

Pfeiffer, Steven J; Blackburn, J Troy; Luc-Harkey, Brittney; Harkey, Matthew S; Stanley, Laura E; Frank, Barnett; Padua, Darin; Marshall, Stephen W; Spang, Jeffrey T; Pietrosimone, Brian

2018-03-01

Aberrant walking-gait and jump-landing biomechanics may influence the development of post-traumatic osteoarthritis and increase the risk of a second anterior cruciate ligament injury, respectively. It remains unknown if individuals who demonstrate altered walking-gait biomechanics demonstrate similar altered biomechanics during jump-landing. Our aim was to determine associations in peak knee biomechanics and limb-symmetry indices between walking-gait and jump-landing tasks in individuals with a unilateral anterior cruciate ligament reconstruction. Thirty-five individuals (74% women, 22.1 [3.4] years old, 25 [3.89] kg/m 2 ) with an anterior cruciate ligament reconstruction performed 5-trials of self-selected walking-gait and jump-landing. Peak kinetics and kinematics were extracted from the first 50% of stance phase during walking-gait and first 100 ms following ground contact for jump-landing. Pearson product-moment (r) and Spearman's Rho (ρ) analyses were used to evaluate relationships between outcome measures. Significance was set a priori (P ≤ 0.05). All associations between walking-gait and jump-landing for the involved limb, along with the majority of associations for limb-symmetry indices and the uninvolved limb, were negligible and non-statistically significant. There were weak significant associations for instantaneous loading rate (ρ = 0.39, P = 0.02) and peak knee abduction angle (ρ = 0.36, p = 0.03) uninvolved limb, as well as peak abduction displacement limb-symmetry indices (ρ= - 0.39, p = 0.02) between walking-gait and jump-landing. No systematic associations were found between walking-gait and jump-landing biomechanics for either limb or limb-symmetry indices in people with unilateral anterior cruciate ligament reconstruction. Individuals with an anterior cruciate ligament reconstruction who demonstrate high-involved limb loading or asymmetries during jump-landing may not demonstrate similar biomechanics during

Unilateral aplasia of both cruciate ligaments

Directory of Open Access Journals (Sweden)

Liem Dennis

2010-02-01

Full Text Available Abstract 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.

Inferior tendon graft to bone tunnel healing at the tibia compared to that at the femur after anterior cruciate ligament reconstruction

International Nuclear Information System (INIS)

Lui, P.P.Y.; Ho, G.; Shum, W.T.; Lee, Y.W.; Ho, P.Y.; Lo, W.N.; Lo, C.K.

2010-01-01

Tunnel widening after anterior cruciate ligament (ACL) reconstruction (ACLR) is commonly reported without a clear understanding of the mechanism. This study aimed to quantify the spatiotemporal change of the newly formed bone mass, bone tunnel diameter, and area along both bone tunnels using micro-computed tomography (μCT) and correlated the result with histology. ACLR was performed in 24 rabbits. At baseline and weeks 2, 6, and 12, the juxta-articular, middle, and exit segments of both tunnels were harvested for μCT and histological evaluation. μCT and histology revealed significant bone tunnel and graft-bone tunnel healing, respectively, only at week 6 after reconstruction. Despite this, the mean tunnel diameter and area remained relatively unchanged with time. The newly formed bone mass [new bone volume/total bone volume (BV/TV) ratio] and its bone mineral density (BMD) were both higher, whereas the mean tunnel diameter and area were significantly smaller at the femoral tunnel compared to those at the tibial tunnel at weeks 6 and 12 and at week 12, respectively. These were consistent with histological findings, which showed inferior graft remodeling and integration at the tibial tunnel at weeks 6 and 12. The BV/TV increased, whereas the mean tunnel diameter and area decreased toward the exit segment of both tunnels. However, whereas better histological healing occurred at the femoral exit segment, poorer graft remodeling and Sharpey's fiber formation occurred at the tibial exit segment. Poor healing was observed during the initial 6 weeks, particularly that of the tibia, after ACLR. Bone resorption was rapid during healing, resulting in unchanged tunnel diameter and area with time. (author)

Improved data illustration in complex multi-ligament knee reconstruction surgery: using the historical principles of Florence Nightingale and John Venn.

Science.gov (United States)

Meyers, Paul D; McNicholas, Mike J

2008-04-01

The collection of multi-ligament knee reconstruction procedure data generates long tabulated lists of featureless abbreviations, which are often difficult to interpret and present. As demonstrated with the launch of the Scandinavian anterior cruciate ligament registries, such data are under increasing scrutiny. When developing a visual tool to improve the interpretation, presentation, and ongoing collection of data within this field, much can be learnt from the historical teachings of Florence Nightingale and John Venn. Unknown to many, Florence Nightingale was a pioneer of graphic data illustration, becoming a Fellow of the Royal Statistical Society in 1858. Further advances in the visualization of complex data relations were made by John Venn, who introduced the Venn diagram in 1880. With this background in mind, the present work has been based upon the senior author's case series of 70 patients undergoing complex knee-ligament reconstruction at Warrington Hospital, from 2001 to the present time. Although obviously not negating the need for tabulated data, the graphic representation put forward here successfully supplements featureless tabulated lists of abbreviations and can be updated easily and regularly. Providing a clear, bright illustration that is free from patient identifiers, it can be used in presentations and publications, and freely accessed by a multidisciplinary team. It assists in the identification of injury patterns, can accommodate illustration of associated factors such as meniscal injury, and clearly demonstrates each hospital's multi-ligament knee reconstruction experience. This facilitates comparison and collaboration between hospitals and promotes research.

Kartogenin with PRP promotes the formation of fibrocartilage zone in the tendon-bone interface.

Science.gov (United States)

Zhou, Yiqin; Zhang, Jianying; Yang, Jinsong; Narava, Manoj; Zhao, Guangyi; Yuan, Ting; Wu, Haishan; Zheng, Nigel; Hogan, MaCalus V; Wang, James H-C

2017-12-01

Treatment of tendon-bone junction injuries is a challenge because tendon-bone interface often heals poorly and the fibrocartilage zone, which reduces stress concentration, at the interface is not formed. In this study, we used a compound called kartogenin (KGN) with platelet-rich plasma (PRP) to induce the formation of fibrocartilage zone in a rat tendon graft-bone tunnel model. The experimental rats received KGN-PRP or PRP injections in the tendon graft-bone tunnel interface. The control group received saline. After 4, 8 and 12 weeks, Safranin O staining of the tendon graft-bone tunnels revealed abundant proteoglycans in the KGN-PRP group indicating the formation of cartilage-like transition zone. Immunohistochemical and immuno-fluorescence staining revealed collagen types I (Col-I) and II (Col-II) in the newly formed fibrocartilage zone. Both fibrocartilage zone formation and maturation were healing time dependent. In contrast, the PRP and saline control groups had no cartilage-like tissues and minimal Col-I and Col-II staining. Some gaps were also present in the saline control group. Finally, pull-out strength in the KGN-PRP-treated group at 8 weeks was 1.4-fold higher than the PRP-treated group and 1.6-fold higher than the saline control group. These findings indicate that KGN, with PRP as a carrier, promotes the formation of fibrocartilage zone between the tendon graft and bone interface. Thus, KGN-PRP may be used as a convenient cell-free therapy in clinics to promote fibrocartilage zone formation in rotator calf repair and anterior cruciate ligament reconstruction, thereby enhancing the mechanical strength of the tendon-bone interface and hence the clinical outcome of these procedures. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Short-term results of medial patellofemoral ligament reconstruction for patellar dislocation

International Nuclear Information System (INIS)

Sakuraba, Koji; Miura, Hiromasa; Matsuda, Shuichi; Okazaki, Ken; Iwamoto, Yukihide; Fukuoka, Shinji

2009-01-01

The short-term results of medial patellofemoral ligament (MPFL) reconstruction were reviewed. MPFL reconstruction surgery was performed on 13 patients (13 knees, three male, five female, mean age 24.1 years) with recurrent and habitual dislocation of the patella. After average 18.5 month follow-up, there has been no recurrence of dislocation and limitation of range of motion except for one case. The mean Kujula score was 60±20.2 preoperatively and 91±15 postoperatively. According to the Crosby and Insall grading system, six ceses were excellent, six cases were good, and one case was fair to poor. On axial radiographs, the mean congruence angle was 31.3±21.4deg preoperatively and -3.65±20.72deg postoperatively. The mean tilting angle was 32.1±7.9deg preoperatively and 21.9±8.39deg postoperatively. The mean lateral shift was 41.6±9.7% preoperatively and 24.5±9.9% postoperatively. These results demonstrate the short-term effectiveness of MPFL reconstruction. (author)

Muscles, Ligaments and Tendons Journal – Basic principles and recommendations in clinical and field Science Research: 2016 Update

Science.gov (United States)

Padulo, Johnny; Oliva, Francesco; Frizziero, Antonio; Maffulli, Nicola

2016-01-01

Summary The proper design and implementation of a study as well as a balanced and well-supported evaluation and interpretation of its main findings are of crucial importance when reporting and disseminating research. Also accountability, funding acknowledgement and adequately declaring any conflict of interest play a major role in science. Since the Muscles, Ligaments and Tendons Journal (MLTJ) is committed to the highest scientific and ethical standards, we encourage all Authors to take into account and to comply, as much as possible, to the contents and issues discussed in this official editorial. This could be useful for improving the quality of the manuscripts, as well as to stimulate interest and debate and to promote constructive change, reflecting upon uses and misuses within our disciplines belonging to the field of “Clinical and Sport - Science Research”. PMID:27331026

Does posteromedial chondromalacia reduce rate of return to play after ulnar collateral ligament reconstruction?

Science.gov (United States)

Osbahr, Daryl C; Dines, Joshua S; Rosenbaum, Andrew J; Nguyen, Joseph T; Altchek, David W

2012-06-01

Biomechanical studies suggest ulnohumeral chondral and ligamentous overload (UCLO) explains the development of posteromedial chondromalacia (PMC) in throwing athletes with ulnar collateral ligament (UCL) insufficiency. UCL reconstruction reportedly allows 90% of baseball players to return to prior or a higher level of play; however, players with concomitant posteromedial chondromalacia may experience lower rates of return to play. The purpose of this investigation is to determine: (1) the rates of return to play of baseball players undergoing UCL reconstruction and posteromedial chondromalacia; and (2) the complications occurring after UCL reconstruction in the setting of posteromedial chondromalacia. We retrospectively reviewed 29 of 161 (18%) baseball players who were treated for the combined posteromedial chondromalacia and UCL injury. UCL reconstruction was accomplished with the docking technique, and the PMC was addressed with nothing or débridement if Grade 2 or 3 and with débridement or microfracture if Grade 4. The mean age was 19.6 years (range, 16-23 years). Most players were college athletes (76%) and pitchers (93%). We used a modified four-level scale of Conway et al. to assess return to play with 1 being the highest level (return to preinjury level of competition or performance for at least one season after UCL reconstruction). The minimum followup was 24 months (mean, 37 months; range, 24-52 months). Return to play was Level 1 in 22 patients (76%), Level 2 in four patients (14%), Level 3 in two patients (7%), and Level 4 in one (3%) patient. Our data suggest baseball players with concomitant PMC, may have lower rates of return to the same or a higher level of play compared with historical controls. Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.

Comparison of paper and electronic surveys for measuring patient-reported outcomes after anterior cruciate ligament reconstruction.

Science.gov (United States)

Bojcic, Jamie L; Sue, Valerie M; Huon, Tomy S; Maletis, Gregory B; Inacio, Maria C S

2014-01-01

This study compared response rates of paper and electronic versions of the Knee injury Osteoarthritis and Outcome Score questionnaire and examined the characteristics of patients who responded to each survey method. A total of 1486 patients registered by the Kaiser Permanente Anterior Cruciate Ligament Reconstruction Registry between 2005 and 2010 were included in this study. Response rates by survey modality for the overall cohort, by the specific time periods, and by age and sex at time of anterior cruciate ligament reconstruction were compared using χ(2) tests or the Fisher exact test when appropriate. Independent Student t tests were used to compare the Knee injury Osteoarthritis and Outcome Scores of survey respondents. The overall survey response rate was 42%. The 36% response rate in the electronic-survey group was significantly higher than the 22% response rate in the paper-survey group (p survey produced higher response rates, it is not sufficient alone to replace the traditional paper version among this Kaiser Permanente population.

Magnetic resonance imaging of cyclops lesion as a cause of persistent morbidity after anterior cruciate ligament reconstruction

Directory of Open Access Journals (Sweden)

Amit Kharat

2015-01-01

Full Text Available Localized anterior arthrofibrosis (cyclops lesion is having around 1-9.8% frequency rate after anterior cruciate ligament (ACL reconstruction. It has been reported to be a significant cause of loss of knee extension after reconstruction of the ACL of the knee. We present a case report of a patient with prior ACL reconstruction who presented with pain and loss of extension following surgery. MR imaging revealed the typical features of cyclops lesion. Repeat arthroscopy excision of the lesion is the only treatment to reduce the morbidity of the patient.

Simultaneous MPFL and LPFL reconstruction for recurrent lateral patellar dislocation with medial patellofemoral instability

Directory of Open Access Journals (Sweden)

Masashi Kusano

2014-01-01

Full Text Available We report an extremely rare case of both recurrent lateral patella dislocation and medial patellofemoral instability, following prior operations to correct patella maltracking. Manual translation of the patella revealed medial and lateral instability with a positive apprehension sign. 3-D computer modelling of kinematics based on MRI data demonstrated that the patella deviated laterally at full extension and translated medially with knee flexion. The medial and lateral patellofemoral ligaments were reconstructed simultaneously with hamstring tendons, alleviating peripatellar pain and patellar instability in both directions.

Evidence-Based ACL Reconstruction

Directory of Open Access Journals (Sweden)

E. Carlos RODRIGUEZ-MERCHAN

2015-01-01

Full Text Available There is controversy in the literature regarding a number of topics related to anterior cruciate ligament (ACLreconstruction. The purpose of this article is to answer the following questions: 1 Bone patellar tendon bone (BPTB reconstruction or hamstring reconstruction (HR; 2 Double bundle or single bundle; 3 Allograft or authograft; 4 Early or late reconstruction; 5 Rate of return to sports after ACL reconstruction; 6 Rate of osteoarthritis after ACL reconstruction. A Cochrane Library and PubMed (MEDLINE search of systematic reviews and meta-analysis related to ACL reconstruction was performed. The key words were: ACL reconstruction, systematic reviews and meta-analysis. The main criteria for selection were that the articles were systematic reviews and meta-analysesfocused on the aforementioned questions. Sixty-nine articles were found, but only 26 were selected and reviewed because they had a high grade (I-II of evidence. BPTB-R was associated with better postoperative knee stability but with a higher rate of morbidity. However, the results of both procedures in terms of functional outcome in the long-term were similar. The double-bundle ACL reconstruction technique showed better outcomes in rotational laxity, although functional recovery was similar between single-bundle and double-bundle. Autograft yielded better results than allograft. There was no difference between early and delayed reconstruction. 82% of patients were able to return to some kind of sport participation. 28% of patients presented radiological signs of osteoarthritis with a follow-up of minimum 10 years.

Broken Bioabsorbable Tibial Interference Screw after Anterior Cruciate Ligament (ACL Reconstruction using a Semitendinosus-gracilis Graft: A Case Report

Directory of Open Access Journals (Sweden)

Huang ME Deborah

2012-07-01

Full Text Available When a patient presents with knee pain and locking after an anterior cruciate ligament (ACL reconstruction, a new meniscal injury or an osteochondral loose body are usually considered for differential diagnosis. We present the case of a 22-year-old female with just these complaints 6 months after ACL reconstruction surgery. Magnetic resonance imaging (MRI of the knee showed a broken screw tip which was later arthroscopically removed. At arthroscopy, an 11mm long broken bioabsorbable interference screw tip was found lying in the intercondylar notch; this resulted in a 0.5cm Outerbridge grade II chondral ulcer located at mid- patella. Both menisci and cruciate ligaments were intact and no other loose bodies were found in the knee joint.

Negative pressure wound therapy in the management of late deep infections after open reconstruction of achilles tendon rupture.

Science.gov (United States)

Mosser, Philipp; Kelm, Jens; Anagnostakos, Konstantinos

2015-01-01

Infection is a major complication after open reconstruction of Achilles tendon ruptures. We report on the use of vacuum-assisted closure (VAC) therapy in the treatment of late deep infections after open Achilles tendon reconstruction. Six patients (5 males [83.33%], 1 female [16.67%]; mean age, 52.8 [range 37 to 66] years) were been treated using an identical protocol. Surgical management consisted of debridement, lavage, and necrectomy of infected tendon parts. The VAC therapy was used for local wound preconditioning and infection management. A continuous negative pressure of 125 mm Hg was applied on each wound. For final wound closure, a split-thickness skin graft was performed. The skin graft healing process was also supported by VAC therapy during the first 5 days. The VAC dressings were changed a mean average of 3 (range 1 to 4) times until split-thickness skin grafting could be performed. The mean total duration of the VAC therapy was 13.6 ± 5.9 days. The mean hospital stay was 31.2 ± 15.9 days. No complications with regard to bleeding, seroma, or hematoma formation beneath the skin graft were observed. At a mean follow-up duration of 29.9 (range 4 to 65) months, no re-infection or infection persistence was observed. The VAC device seems to be a valuable tool in the treatment of infected tendons. The generalization of these conclusions should await the results of future studies with larger patient series. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Return to National Basketball Association Competition Following Anterior Cruciate Ligament and Fibular Collateral Ligament Injuries: A Case Report.

Science.gov (United States)

LaPrade, Robert F; O'Brien, Luke; Kennedy, Nicholas I; Cinque, Mark E; Chahla, Jorge

2017-01-01

Numerous outcome studies regarding anterior cruciate ligament (ACL) reconstruction demonstrate the ability of athletes to return to a high level of play. However, to our knowledge, there is limited literature regarding return to play following injury to both the ACL and the fibular collateral ligament (FCL). We describe the case of a National Basketball Association (NBA) player who sustained a combined ACL and FCL knee injury and subsequently underwent surgical reconstruction of both affected ligaments. He was able to return to a preinjury level of competition at 9 months postoperatively. It is possible for athletes to return to competitive basketball and maintain a high production level following a single-staged reconstruction of both the ACL and the FCL.

Avaliação do resultado da reconstrução artroscópica do ligamento cruzado anterior do joelho com enxerto dos tendões flexores Evaluation of the results of arthroscopic ACL reconstruction with autogenous flexor tendons

Directory of Open Access Journals (Sweden)

Alexandre Almeida

2010-01-01

Full Text Available OBJETIVO: Avaliar o resultado da reconstrução do ligamento cruzado anterior (LCA com o autoenxerto dos tendões flexores da coxa. Serão analisados os dados com relação ao sexo, ao índice de massa corporal (IMC e a associação com fratura no membro inferior (MI. MÉTODOS: Foi analisado um grupo de 265 pacientes submetidos à artroscopia do joelho para fins de reconstrução do LCA com enxerto ipsilateral dos tendões flexores da coxa no período de 6 de julho de 2000 a 19 de novembro de 2007. RESULTADOS: 176 pacientes foram avaliados com média de 34,95 ± 18,8 meses (mediana 31 meses (IIQ: 20-48 meses. A avaliação mínima foi aos 12 meses e a máxima aos 87 meses. Obtivemos 138 (78,4% pacientes com resultado excelente, 22 (12,5% com resultado bom, oito (4,5% com resultado regular e oito (4,5% pacientes apresentaram resultado ruim. Não foi considerada significativa a maior incidência de bons e excelentes resultados para o sexo masculino (p = 0,128, para os pacientes com IMC OBJETIVE: To evaluate the results of single band arthroscopic anterior cruciate ligament (ACL reconstruction with flexor tendon autografts. We analyzed data about sex, body mass index (BMI and lower limb fracture associated with the initial trauma. METHODS: Two hundred and sixty-five patients who underwent arthroscopic anterior cruciate ligament (ACL reconstruction with ipsilateral thigh flexor tendon autografts from July 6, 2000, to November 19, 2007, were evaluated. RESULTS: One hundred and seventy-six patients were evaluated at an average follow up time of 34.95 ± 18.8 months (Median 31 months (IIQ: 20 - 48 months. The minimum evaluation time was 12 months and the maximum 87 months. One hundred and thirty-eight (78.4% patients had excellent results, 22 (12.5% patients good, 8 (4.5% patients fair, and 8 (4.5% poor results. No statistical significance was found for the better results for males (p = 0.128, for patients with a BMI < 25 (p = 0.848, or for patients

Satisfactory outcomes following combined unicompartmental knee replacement and anterior cruciate ligament reconstruction.

Science.gov (United States)

Volpin, Andrea; Kini, S G; Meuffels, D E

2017-03-31

There exist limited options for treatment of patients with combined medial compartment arthritis and anterior cruciate ligament (ACL) deficiency. Ideal treatment is one that offers lasting relief of symptoms not compromising any future surgery. Unicompartmental knee replacement has shown consistently good results in the relatively young and active population, but there is a high reported incidence of failure up to 20%, if performed in ACL-deficient knees. One of the recognized treatment modality is combined ACL reconstruction and unicompartmental arthroplasty. A systematic review was conducted looking at the demographics, techniques, complications and outcome of combined ACL reconstruction with unicompartmental knee arthroplasty. A systematic literature search within the online Medline, PubMed Database, EMBASE, Web of Science, Cochrane and Google Scholar was carried out until October 2016 to identify relevant articles. A study was defined eligible if it met the following inclusion criteria: the surgical procedure combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction; patient's clinical and/or functional outcomes were reported; any complications intra-operatively and post-operatively were reported; and the full-text articles, written in English, German, Italian, Dutch or Spanish, were available. Quality and risk of bias assessments were done using standardized criteria set. A total of 8 studies met the inclusion criteria encompassing 186 patients who were treated with simultaneous ACL reconstruction and unicompartmental knee arthroplasty. The mean age was 50.5 years (range from 44 to 56) with a mean follow-up of 37.6 months (range from 24 to 60). There was an improvement in mean Oxford Score from 27.5 to 36.8. Complications reported included tibial inlay dislocation (n = 3), conversion to a total knee arthroplasty (n = 1), infection requiring two-stage revision (n = 2), deep-vein thrombosis (n = 1), stiffness requiring

Patellofemoral Pressure Changes After Static and Dynamic Medial Patellofemoral Ligament Reconstructions.

Science.gov (United States)

Rood, Akkie; Hannink, Gerjon; Lenting, Anke; Groenen, Karlijn; Koëter, Sander; Verdonschot, Nico; van Kampen, Albert

2015-10-01

Reconstructing the medial patellofemoral ligament (MPFL) has become a key procedure for stabilizing the patella. Different techniques to reconstruct the MPFL have been described: static techniques in which the graft is fixed rigidly to the bone or dynamic techniques with soft tissue fixation. Static MPFL reconstruction is most commonly used. However, dynamic reconstruction deforms more easily and presumably functions more like the native MPFL. The aim of the study was to evaluate the effect of the different MPFL fixation techniques on patellofemoral pressures compared with the native situation. The hypothesis was that dynamic reconstruction would result in patellofemoral pressures closer to those generated in an intact knee. Controlled laboratory study. Seven fresh-frozen knee specimens were tested in an in vitro knee joint loading apparatus. Tekscan pressure-sensitive films fixed to the retropatellar cartilage measured mean patellofemoral and peak pressures, contact area, and location of the center of force (COF) at fixed flexion angles from 0° to 110°. Four different conditions were tested: intact, dynamic, partial dynamic, and static MPFL reconstruction. Data were analyzed using linear mixed models. Static MPFL reconstruction resulted in higher peak and mean pressures from 60° to 110° of flexion (P .05). The COF in the static reconstruction group moved more medially on the patella from 50° to 110° of flexion compared with the other conditions. The contact area showed no significant differences between the test conditions. After static MPFL reconstruction, the patellofemoral pressures in flexion angles from 60° to 110° were 3 to 5 times higher than those in the intact situation. The pressures after dynamic MPFL reconstruction were similar as compared with those in the intact situation, and therefore, dynamic MPFL reconstruction could be a safer option than static reconstruction for stabilizing the patella. This study showed that static MPFL reconstruction

The anatomy of the coracohumeral ligament and its relation to the subscapularis muscle.

Science.gov (United States)

Arai, Ryuzo; Nimura, Akimoto; Yamaguchi, Kumiko; Yoshimura, Hideya; Sugaya, Hiroyuki; Saji, Takahiko; Matsuda, Shuichi; Akita, Keiichi

2014-10-01

Only a few reports describe the extension of the coracohumeral ligament to the subscapularis muscle. The purposes of this study were to histo-anatomically examine the structure between the ligament and subscapularis and to discuss the function of the ligament. Nineteen intact embalmed shoulders were used. In 9 shoulders, the expansion of the ligament was anatomically observed, and in 6 of these 9, the muscular tissue of the supraspinatus and subscapularis was removed to carefully examine the attachments to the tendons of these muscles. Five shoulders were frozen and sagittally sectioned into 3-mm-thick slices. After observation, histologic analysis was performed on 3 of these shoulders. In the remaining 5 shoulders, the coracoid process was harvested to investigate the ligament origin. The coracohumeral ligament originated from the horizontal limb and base of the coracoid process and enveloped the cranial part of the subscapularis muscle. The superficial layer of the ligament covered a broad area of the anterior surface of the muscle. Laterally, it protruded between the long head of the biceps tendon and subscapularis and attached to the tendinous floor, which extended from the subscapularis insertion. Histologically, the ligament consisted of irregular and sparse fibers abundant in type III collagen. The coracohumeral ligament envelops the whole subscapularis muscle and insertion and seems to function as a kind of holder for the subscapularis and supraspinatus muscles. The ligament is composed of irregular and sparse fibers and contains relatively rich type III collagen, which would suggest flexibility. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Fibrin Gels Exhibit Improved Biological, Structural, and Mechanical Properties Compared with Collagen Gels in Cell-Based Tendon Tissue-Engineered Constructs

Science.gov (United States)

Dyment, Nathaniel A.; Lu, Yinhui; Rao, Marepalli; Shearn, Jason T.; Rowe, David W.; Kadler, Karl E.; Butler, David L.

2015-01-01

The prevalence of tendon and ligament injuries and inadequacies of current treatments is driving the need for alternative strategies such as tissue engineering. Fibrin and collagen biopolymers have been popular materials for creating tissue-engineered constructs (TECs), as they exhibit advantages of biocompatibility and flexibility in construct design. Unfortunately, a few studies have directly compared these materials for tendon and ligament applications. Therefore, this study aims at determining how collagen versus fibrin hydrogels affect the biological, structural, and mechanical properties of TECs during formation in vitro. Our findings show that tendon and ligament progenitor cells seeded in fibrin constructs exhibit improved tenogenic gene expression patterns compared with their collagen-based counterparts for approximately 14 days in culture. Fibrin-based constructs also exhibit improved cell-derived collagen alignment, increased linear modulus (2.2-fold greater) compared with collagen-based constructs. Cyclic tensile loading, which promotes the maturation of tendon constructs in a previous work, exhibits a material-dependent effect in this study. Fibrin constructs show trending reductions in mechanical, biological, and structural properties, whereas collagen constructs only show improved tenogenic expression in the presence of mechanical stimulation. These findings highlight that components of the mechanical stimulus (e.g., strain amplitude or time of initiation) need to be tailored to the material and cell type. Given the improvements in tenogenic expression, extracellular matrix organization, and material properties during static culture, in vitro findings presented here suggest that fibrin-based constructs may be a more suitable alternative to collagen-based constructs for tissue-engineered tendon/ligament repair. PMID:25266738

Trends in Revision Elbow Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers.

Science.gov (United States)

Wilson, Alexander T; Pidgeon, Tyler S; Morrell, Nathan T; DaSilva, Manuel F

2015-11-01

To determine the frequency of revision elbow ulnar collateral ligament (UCL) reconstruction in professional baseball pitchers. Data were collected on 271 professional baseball pitchers who underwent primary UCL reconstruction. Each player was evaluated retrospectively for occurrence of revision UCL reconstructive surgery to treat failed primary reconstruction. Data on players who underwent revision UCL reconstruction were compiled to determine total surgical revision incidence and revision rate by year. The incidence of early revision was analyzed for trends. Average career length after primary UCL reconstruction was calculated and compared with that of players who underwent revision surgery. Logistic regression analysis was performed to assess risk factors for revision including handedness, pitching role, and age at the time of primary reconstruction. Between 1974 and 2014, the annual incidence of primary UCL reconstructions among professional pitchers increased, while the proportion of cases being revised per year decreased. Of the 271 pitchers included in the study, 40 (15%) required at least 1 revision procedure during their playing career. Three cases required a second UCL revision reconstruction. The average time from primary surgery to revision was 5.2 ± 3.2 years (range, 1-13 years). The average length of career following primary reconstruction for all players was 4.9 ± 4.3 years (range, 0-22 years). The average length of career following revision UCL reconstruction was 2.5 ± 2.4 years (range, 0-8 years). No risk factors for needing revision UCL reconstruction were identified. The incidence of primary UCL reconstructions among professional pitchers is increasing; however, the rate of primary reconstructions requiring revision is decreasing. Explanations for the decreased revision rate may include improved surgical technique and improved rehabilitation protocols. Therapeutic IV. Copyright © 2015 American Society for Surgery of the Hand. Published by

Morphology of the dorsal and lateral calcaneocuboid ligaments.

Science.gov (United States)

Dorn-Lange, Nadja V; Nauck, Tanja; Lohrer, Heinz; Arentz, Sabine; Konerding, Moritz A

2008-09-01

The dorsolateral calcaneocuboid ligaments have different configurations. In the literature they are only described as either the dorsal or lateral calcaneocuboid ligament. However, recent reconstructive surgical techniques may benefit from a better understanding of the anatomy. The aims of this study were to classify the morphology and attachments of the dorso-lateral calcaneocuboid ligaments and to determine their dimensions. The dorso-lateral aspects of the calcaneocuboid joint of 30 cadaver feet were dissected to expose the associated ligaments. Further, we evaluated possible bony landmarks of the calcaneus that could imply which shape or course the ligament would have in a specific individual. Our findings showed a wide variety of configurations in shape, number, and attachment sites. A constant dorsal ligament and an additional narrower lateral ligament was detectable in half of the cases. The majority of the dorso-lateral calcaneocuboid ligament-complex had an upward course and fanning out from proximal to distal. No bony predictor for the ligaments' shape or course was found. The dorso-lateral ligament-complex of the calcaneocuboid joint revealed a wide variety of configurations. Better understanding of the anatomy of these ligaments may aid in the anatomic reconstruction of these ligaments.

INFLUENCE OF DIFFERENT LEVELS OF SPORTS ACTIVITIES ON THE QUALITY OF LIFE AFTER THE RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT.

Science.gov (United States)

Ninković, Srđan; Avramov, Snežana; Harhaji, Vladimir; Obradović, Mirko; Vranješ, Miodrag; Milankov, Miroslav

2015-01-01

The goal of this study was to examine the nature and presence of influence of different levels of sports activity on the life quality of the patients a year after the reconstruction of anterior cruciate ligament. The study included 185 patients operated at the Department of Orthopedic Surgery and Traumatology of the Clinical Centre of Vojvodina, who were followed for twelve months. Data were collected using the modified Knee Injury and Osteoarthritis Outcome Score questionnaire which included the Lysholm scale. This study included 146 male and 39 female subjects. The reconstruction of anterior cruciate ligament was equally successful in both gender groups. In relation to different types of sports activity, there were no differences in the overall life quality measured by the questionnaire and its subscales, regardless of the level (professional or recreational). However, regarding the level of sports activities, there were differences among the subjects engaged in sports activities at the national level as compared with those going in for sports activities at the recreational level, and particularly in comparison with physically inactive population. A significant correlation was not found by examining the aforementioned relationship between sports activities. This study has shown that the overall life quality a year after the reconstruction of the anterior cruciate ligament does not differ in relation to either the gender of the subjects or the type of sports activity, while the level of sports activity does have some influence on the quality of life. Professional athletes have proved to train significantly more intensively after this reconstruction than those going in for sports recreationally.

Ropivacaine alters the mechanical properties of hamstring tendons: In vitro controlled mechanical testing of tendons from living donors.

Science.gov (United States)

Ollivier, M; Sbihi, J; Sbihi, A; Pithioux, M; Parratte, S; Argenson, J-N

2017-11-01

Intraarticular or periarticular injection of ropivacaine (RI) is an element of current knee surgery practices. The goal of this study was to determine the effects of RI on the mechanical properties of hamstring tendons. We hypothesized that RI would have a detrimental effect on the mechanical properties of periarticular soft tissues METHODS: A tensile test to failure was performed on 120 hamstring tendon segments harvested during ACL reconstruction surgery in 120 patients. Two sets of tensile tests were done. The first evaluated the effect of RI itself on the mechanical properties of tendons: 30 samples were soaked for 1hour in a 2% RI solution and compared to 30 samples soaked in a saline solution (control group). The second evaluated the effect of RI concentration on the mechanical properties of hamstring tendons: 30 samples were soaked for 1hour in a 2% RI solution and 30 samples were soaked in a 7.5% RI solution. In the first test, 29 samples from each group were analyzed as two samples (one in each group) failed at the grip interface. The specimens exposed to 2% RI had lower ultimate tensile strength (Δ=4.4MPa, P=0.001), strain energy (Δ=13MPa, P=0.001) and Young's modulus (Δ=1.6MPa, P=0.02) than the specimens in the control group. There was no significant difference in the strain at failure between groups (Δ=5%, P=0.3). In the second test, one specimen from the 7.5% RI group failed during the preloading and was excluded. There was no significant difference in terms of the load at failure and ultimate tensile stress (Δ=0.45MPa, P=0.6) and strain energy (Δ=0.49MPa, P=0.49) between the two groups. There were significant differences in terms of elongation at failure (Δ=28%, P=0.0003) and Young's modulus (Δ=2.6MPa, P=0.005), with the specimens exposed to 7.5% RI undergoing greater deformation and having a lower Young's modulus. While local RI injections are widely performed in clinical practice, the results of this in vitro study point to short

STUDY OF ANTERIOR CRUCIATE LIGAMENT INJURY AND ITS MANAGEMENT

Directory of Open Access Journals (Sweden)

Tummala Venkata

2016-03-01

Full Text Available BACKGROUND The anterior cruciate ligament is the weaker of the two cruciate ligaments stabilizing the knee joint, and therefore gets torn easier than the posterior cruciate ligament. OBJECTIVE To determine pattern of anterior cruciate ligament injury and its management in a tertiary care center. MATERIALS AND METHODS A prospective study was carried out for two years, 28 patients with ACL injury were included. A detailed history regarding the pattern of injury was noted and ACL reconstruction was done using BT Bautograft with mini-arthrotomy and arthroscopic assisted ACL reconstruction. RESULTS The mean age of the study subjects was 30.6±7.3 years & majority were males. Majority of the ACL injury was sports related & was on the right knee. 64% underwent arthroscopic assisted ACL reconstruction & majority of them had normal range of motion of the knee. CONCLUSION Our present study concludes that most common age group involved was 20-30 years & ACL injury was more common among males. Patients with an early ACL reconstruction were more satisfied with the end result. Also, ACL reconstruction techniques using BTB auto graft leads to good ligamentous stability and function of the knee.

Case-control study to estimate the performance of dual-energy computed tomography for anterior cruciate ligament tears in patients with history of knee trauma

Energy Technology Data Exchange (ETDEWEB)

Glazebrook, Katrina N.; Leng, Shuai; Murthy, Naveen S.; Howe, B.M.; Ringler, Michael D.; McCollough, Cynthia H.; Fletcher, J.G. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Brewerton, Lee J. [Alberta Health Services South Zone, Department of Radiology, Lethbridge, Alberta (Canada); Carter, Rickey E. [Mayo Clinic, Department of Biostatistics, Rochester, MN (United States); Rhee, Peter C.; Dahm, Diane L.; Stuart, Michael J. [Mayo Clinic, Department of Orthopedics, Rochester, MN (United States)

2014-03-15

Computed tomography (CT) is used to assess for fracture after knee trauma, but identification of ligamentous injuries may also be beneficial. Our purpose is to assess the potential of dual-energy computed tomography (DECT) for the detection of complete anterior cruciate ligament (ACL) disruption. Sixteen patients with unilateral traumatic ACL disruption (average of 58 days following trauma) confirmed by MRI, and 11 control patients without trauma, underwent DECT of both knees. For each knee, axial, sagittal, and oblique sagittal images (with DECT bone removal, single-energy (SE) bone removal, and DECT tendon-specific color mapping) were reconstructed. Four musculoskeletal radiologists randomly evaluated the 324 DECT reconstructed series (54 knees with 6 displays) separately, to assess for ACL disruption using a five-point scale (1 = definitely not torn, to 5 = definitely torn). ROC analysis was used to compare performance across readers and displays. Sagittal oblique displays (mixed kV soft tissue, SE bone removal, and DECT bone removal) demonstrated higher areas under the curve for ACL disruption (AUC = 0.95, 0.93 and 0.95 respectively) without significant differences in performance between readers (p > 0.23). Inter-reader agreement was also better for these display methods (ICC range 0.62-0.69) compared with other techniques (ICC range 0.41-0.57). Mean sensitivity for ACL disruption was worst for DECT tendon-specific color map and axial images (24 % and 63 % respectively). DECT knee images with oblique sagittal reconstructions using either mixed kV or bone removal displays (either DECT or SE) depict ACL disruption in the subacute or chronic setting with reliable identification by musculoskeletal radiologists. (orig.)

Nonlinear model for viscoelastic behavior of Achilles tendon.

Science.gov (United States)

Kahn, Cyril J F; Wang, Xiong; Rahouadj, Rachid

2010-11-01

Although the mechanical properties of ligament and tendon are well documented in research literature, very few unified mechanical formulations can describe a wide range of different loadings. The aim of this study was to propose a new model, which can describe tendon responses to various solicitations such as cycles of loading, unloading, and reloading or successive relaxations at different strain levels. In this work, experiments with cycles of loading and reloading at increasing strain level and sequences of relaxation were performed on white New Zealand rabbit Achilles tendons. We presented a local formulation of thermodynamic evolution outside equilibrium at a representative element volume scale to describe the tendon's macroscopic behavior based on the notion of relaxed stress. It was shown that the model corresponds quite well to the experimental data. This work concludes with the complexity of tendons' mechanical properties due to various microphysical mechanisms of deformation involved in loading such as the recruitment of collagen fibers, the rearrangement of the microstructure (i.e., collagens type I and III, proteoglycans, and water), and the evolution of relaxed stress linked to these mechanisms.

approach to and management of acute ankle ligamentous injuries

African Journals Online (AJOL)

Enrique

Tibionavicular part. Medial (deltoid) ligament of ankle {. Table I. Differential diagnosis of acute ankle injury. ATFL sprain. CFL sprain. Syndesmosis sprain. Anterior process calcaneus fracture. Lateral process talus fracture. Fifth metatarsal base fracture. Subtalar injury. Peroneal tendon injury. Osteochondral injury of the talus.

The effects of medial ulnar collateral ligament reconstruction on Major League pitching performance.

Science.gov (United States)

Keller, Robert A; Steffes, Matthew J; Zhuo, David; Bey, Michael J; Moutzouros, Vasilios

2014-11-01

Medial ulnar collateral ligament (MUCL) reconstruction is commonly performed on Major League Baseball (MLB) pitchers. Previous studies have reported that most pitchers return to presurgical statistical performance levels after MUCL reconstruction. Pitching performance data--specifically, earned run average (ERA), walks and hits per inning pitched (WHIP), winning percentage, and innings pitched--were acquired for 168 MLB pitchers who had undergone MUCL reconstruction. These data were averaged over the 3 years before surgery and the 3 years after surgery and also acquired from 178 age-matched, uninjured MLB pitchers. Of the pitchers who had MUCL reconstruction surgery, 87% returned to MLB pitching. However, compared with presurgical data, pitching performance declined in terms of ERA (P = .001), WHIP (P = .011), and innings pitched (P = .026). Pitching performance also declined in the season before the surgery compared with previous years (ERA, P = .014; WHIP, P = .036; innings pitched, P risk factor for requiring surgery. In addition, there is an increased risk of MUCL reconstruction for pitchers who enter the major leagues at a younger age. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Biomechanics of the arch of the foot. Pre- and postoperative radiological examination

International Nuclear Information System (INIS)

Kristen, K.H.

2007-01-01

The human foot is a complex biomechanical structure. The arch of the foot is formed by the bony and articular structure of the midfoot and supported by strong ligaments and tendons. The normal arch develops in childhood. Tendon and ligament rupture and degeneration often lead to flattening of the arch. Frequent painful conditions include hallux valgus deformity and rupture of the posterior tibial tendon both leading to flat feet. Radiological examination is necessary in a standardized, full weight bearing standing position. The standing dorsoplantar view shows hallux valgus angle and intermetatarsal 1/2 angle. The side view shows Lisfranc joint instability and decrease of the talometatarsal angle. Talonavicular instability is a frequent secondary sign of spring ligament and posterior tibial tendon lesion. After failure of conservative therapy, corrective surgery with osteotomy and realignment procedure of the malpositioned bones in combination with tendon and ligament reconstruction is the state of the art procedure. In postoperative follow-up a standing X-ray of the foot is again the standard tool. Additional MRI and CT examinations help to detect bone and cartilage lesions and tendon/ligament ruptures. (orig.) [de

Association between incision technique for hamstring tendon harvest in anterior cruciate ligament reconstruction and the risk of injury to the infra-patellar branch of the saphenous nerve: a meta-analysis.

Science.gov (United States)

Grassi, Alberto; Perdisa, Francesco; Samuelsson, Kristian; Svantesson, Eleonor; Romagnoli, Matteo; Raggi, Federico; Gaziano, Teide; Mosca, Massimiliano; Ayeni, Olufemi; Zaffagnini, Stefano

2018-02-08

To determine how the incision technique for hamstring tendon (HT) harvest in anterior cruciate ligament (ACL) reconstruction affects the risk of injury to the IPBSN and clinical outcome. A systematic literature search of the MEDLINE/Pubmed, Cochrane Central Register of Controlled Trials (CENTRAL) and EBSCOhost electronic databases and clinicaltrials.gov for unpublished studies was performed to identify comparative studies investigating injury to the IPBSN after HT ACL reconstruction by comparing at least two different incision techniques. Data were extracted for the number of patients with evidence of any neurologic deficit corresponding to injury to the IPBSN, area of sensory deficit, the Lysholm score and patient satisfaction. The mean difference (MD) in study outcome between incision groups was assessed. The relative risk (RR) and the number needed to treat (NNT) were calculated. The Chi-square and Higgins' I 2 tests were applied to test heterogeneity. Data were pooled using a Mantel-Haenszel random-effects model if the statistical heterogeneity was > 50% and a fixed-effects model if the statistical heterogeneity was < 50%. The risk of bias was evaluated according to the Cochrane Database questionnaire and the quality of evidence was graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. A total of eight studies (three randomized controlled trials (RCTs) and five comparative studies) were included, of which six compared vertical and oblique incisions, one horizontal and vertical incisions, and one compared all three techniques. HT harvest was performed through a vertical incision in 329 patients, through an oblique incision in 195 patients and through a horizontal incision in 151 patients. Considering the meta-analysis of the RCTs, the performance of a vertical incision significantly increased the risk of causing IPBSN deficiency compared with both oblique and horizontal incision [RR 1.65 (CI 1

Gender differences in the knee adduction moment after anterior cruciate ligament reconstruction surgery.

Science.gov (United States)

Webster, Kate E; McClelland, Jodie A; Palazzolo, Simon E; Santamaria, Luke J; Feller, Julian A

2012-04-01

The external knee adduction moment during gait has previously been associated with knee pain and osteoarthritis (OA). Recently, the knee adduction moment has been shown to be increased following anterior cruciate ligament (ACL) reconstruction surgery and has been suggested as a potential mechanism for the progression of early onset knee OA in this population. No study has investigated the gender differences in gait biomechanics following ACL reconstruction. To examine gender differences in gait biomechanics following ACL reconstruction surgery. 36 subjects (18 females, 18 males) who had previously undergone ACL reconstruction surgery (mean time since surgery 20 months) underwent gait analysis at a self-selected walking speed. Males and females were well matched for age, time since surgery and walking speed. Maximum flexion and adduction angles and moments were recorded during the stance phase of level walking and compared between the male and female groups. The knee adduction moment was 23% greater in the female compared with the male ACL group. No gender differences were seen in the sagittal plane. No differences were seen between the reconstructed and contralateral limb. The higher knee adduction moment seen in females compared with males may suggest an increased risk for the development of OA in ACL-reconstructed females.

Comparing Dimensions of Four-Strand Hamstring Tendon Grafts with Native Anterior and Posterior Cruciate Ligaments

Directory of Open Access Journals (Sweden)

Barış Yılmaz

2016-01-01

Full Text Available Background. The aim of the study was to evaluate whether or not there was any incompatibility between four-strand hamstring tendons taken from the same knee and the dimensions of the ACL and PCL. Methods. 15 fresh frozen cadaver hamstrings were prepared as four-strand grafts and measurements made of the ACL and PCL circumferences in the midsection were made in the narrowest part of the midsection. The cross-section areas and diameters were calculated with geometric calculations used to measure the cross-sectional area of cylinders. Accepting that the geometric insertions were elliptical, the length, width, and area were calculated for entry areas. Results. A significant relationship at 96.2% was determined between the ACL mid and the hamstring diameter. A significant relationship at 96.7% was determined between the ACL and the hamstring mid area. A significant relationship at 96.4% was determined between the PCL mid and the hamstring diameter. A significant relationship at 95.7% was determined between the PCL and the hamstring mid area. Conclusion. For the reconstruction of ACL and PCL, it was determined that there is less incompatibility between the four-strand hamstring tendons taken from the same knee and the dimensions of the midsection PCL compared to the ACL dimensions.

[Bursitis with severe tendon and muscle necrosis on the lateral stifle area in cattle].

Science.gov (United States)

Nuss, K; Räber, M; Sydler, T; Muggli, E; Hässig, M; Guscetti, F

2011-11-01

In 21 animals, chronic swelling on the lateral aspect of the stifle also known as «perigonitis», «stable-syndrome» or «bursitis bicipitalis femoris» were evaluated. Ultrasonography showed increased fluid in the distal subtendinous bursa of the biceps femoris muscle and structural changes in the tendons, muscles, subcutis and fasciae. Soft tissue swelling and an irregular contour of the lateral tibial condyle were typical signs on radiographs. Macroscopic changes were found at the insertion of the biceps femoris muscle, the distal subtendinous bursa of the biceps femoris muscle, the lateral collateral ligament of the stifle, the origin of muscles on the lateral femoral condyle and the lateral tibial condyle. They mainly consisted of tendon and muscle tissue necrosis with granulation tissue. Histology revealed areas of coagulation necrosis in tendons and ligaments, in which occasionally Onchocerca spp. were seen. The severity of lesions correlated well with the clinical signs, which were associated with a poor prognosis in advanced cases.

IFSSH Flexor Tendon Committee report 2014: from the IFSSH Flexor Tendon Committee (Chairman: Jin Bo Tang).

Science.gov (United States)

Tang, Jin Bo; Chang, James; Elliot, David; Lalonde, Donald H; Sandow, Michael; Vögelin, Esther

2014-01-01

Hand surgeons continue to search for the best surgical flexor tendon repair and treatment of the tendon sheaths and pulleys, and they are attempting to establish postoperative regimens that fit diverse clinical needs. It is the purpose of this report to present the current views, methods, and suggestions of six senior hand surgeons from six different countries - all experienced in tendon repair and reconstruction. Although certainly there is common ground, the report presents provocative views and approaches. The report reflects an update in the views of the committee. We hope that it is helpful to surgeons and therapists in treating flexor tendon injuries.

The Cost-Effectiveness of Anterior Cruciate Ligament Reconstruction in Competitive Athletes.

Science.gov (United States)

Stewart, Bruce A; Momaya, Amit M; Silverstein, Marc D; Lintner, David

2017-01-01

Competitive athletes value the ability to return to competitive play after the treatment of anterior cruciate ligament (ACL) injuries. ACL reconstruction has high success rates for return to play, but some studies indicate that patients may do well with nonoperative physical therapy treatment. To evaluate the cost-effectiveness of the treatment of acute ACL tears with either initial surgical reconstruction or physical therapy in competitive athletes. Economic and decision analysis; Level of evidence, 2. The incremental cost, incremental effectiveness, and incremental cost-effectiveness ratio (ICER) of ACL reconstruction compared with physical therapy were calculated from a cost-effectiveness analysis of ACL reconstruction compared with physical therapy for the initial management of acute ACL injuries in competitive athletes. The ACL reconstruction strategy and the physical therapy strategy were represented as Markov models. Costs and quality-adjusted life-years (QALYs) were evaluated over a 6-year time horizon and were analyzed from a societal perspective. Quality of life and probabilities of clinical outcomes were obtained from the peer-reviewed literature, and costs were compiled from a large academic hospital in the United States. One-way, 2-way, and probabilistic sensitivity analyses were used to assess the effect of uncertainty in variables on the ICER of ACL reconstruction. The ICER of ACL reconstruction compared with physical therapy was $22,702 per QALY gained. The ICER was most sensitive to the quality of life of returning to play or not returning to play, costs, and duration of follow-up but relatively insensitive to the rates and costs of complications, probabilities of return to play for both operative and nonoperative treatments, and discount rate. ACL reconstruction is a cost-effective strategy for competitive athletes with an ACL injury.

Disorders of the origin of the suspensory ligament: A diagnostic challenge

International Nuclear Information System (INIS)

Lischer, Ch.J.; Bischofberger, A.S.; Fürst, A.; Lang, J.; Ueltschi, G.

2006-01-01

Lameness in horses due to pain originating from the proximal metacarpal/metatarsal region remains a diagnostic challenge. In cases of obvious lameness the pain can be localised to this region by diagnostic anaesthesia. Because a variety of disorders can cause lameness in this region different imaging modalities including radiography, ultrasonography and scintigraphy should be used to arrive at an accurate diagnosis. Even though a precise anatomic-pathologic diagnosis can still be an enigma, because not only bone and joints, but also soft tissue structures including the proximal suspensory ligament, its origin at the proximal metacarpus/metatarsus, its fascia, the superficial fascia, as well as the intermetacarpal/metatarsal ligaments, the accessory ligament of the deep digital flexor tendon and both digital flexor tendons may be involved. Magnet resonance tomography (MRT) shows a high diagnostic sensitivity in imaging soft tissue structures and bone. In horses MRT is still at the beginning. The MRT appearance of the proximal metacarpal/metatarsal region has not yet been evaluated in detail and there are only few anatomic studies of the origin of the suspensory ligament in horses. The first experiences showed, that more gross and histologic examinations are necessary to fully interpret MRT-images and to differentiate pathologic alterations from clinically not relevant variations [de

Evaluation of the performance of three tenodesis techniques for the treatment of scapholunate instability: flexion-extension and radial-ulnar deviation.

Science.gov (United States)