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PubMed1979

[Intra-articular or extra-articular substitution of cruciate ligament--a critical study (author's transl)].

Intra- and extra-articular methods of cruciate ligament substitution are available for treating old anteromedial knee-joint instability. Twelve patients with intra-articular cruciate ligament substitution (median third of the patellar ligaments as free transplant) and 24 patients with extra-articular cruicate ligament substitution (operation according to Nciholas) were examined with particular reference to improved stability as follow-up examinations, the results being subjected to comparative evaluation. Intra-artricular cruciate ligament substitution reduces or eliminates the pre-operative instability of the joint which is due to insufficiency of the cruciate liagment, whereas the extra-articular cruciate ligament substitution produces a significantly more frequent reduction of elimination of the instability of the valgus position and of the anteromedial instability. The combination of both methods to remove anteromedial instability of the knee joint may seem a very useful solution of the problem, but it should be limited to a restricted group of patients because it involves also contain disadvantages which make it unsuitable for indiscriminate application.

Aftercare↗
PubMed2000

Intra-articular ganglion cysts of the cruciate ligaments.

Intra-articular ganglion cysts of the cruciate ligaments are associated with non-specific clinical signs and symptoms. Familiarity with the MR appearances in particular is important to make an accurate diagnosis, exclude associated abnormalities, and avoid misdiagnosis.

Anterior Cruciate Ligament↗
PubMed2002

Intra-articular anterior cruciate ligament reconstruction using patellar tendon allograft in the skeletally immature patient.

PURPOSE: Tears of the anterior cruciate ligament (ACL) are becoming more prevalent in the skeletally immature patient. We report our results with intra-articular transphyseal ACL reconstruction in this patient population. TYPE OF STUDY: Retrospective analysis. METHODS: Ten skeletally immature athletes underwent transphyseal intra-articular ACL reconstruction using patellar tendon allograft. The patients ranged from 9 to 15 years of age. Clinical outcomes were measured using the Lysholm and International Knee Documentation Committee scoring systems, follow-up radiographs, clinical examination, and KT-1000 testing. RESULTS: Mean follow-up was 40 months. The average Lysholm score was 95, and 9 of 10 patients reported normal or nearly normal knee function. There was no clinical or objective evidence of instability, limb-length discrepancy, or early physeal arrest. Nine of 10 patients returned to their preinjury level of athletics. CONCLUSIONS: Skeletally immature athletes with symptomatic complete ACL tears who do not want to modify their athletic activity may benefit from intra-articular ACL reconstruction using patellar tendon allografts. Special attention to bone plug and interference screw placement will reduce the risk of early physeal arrest.

Adolescent↗
PubMed2002

Intra- and extra-articular anterior cruciate ligament reconstruction utilizing autogeneous semitendinosus and gracilis tendons: 5-year clinical results.

This prospective study examined 50 patients who underwent ACL surgery using hamstring tendons with a modification including intra- and extra-articular reconstruction. All patients were athletes competing at a high level in various sports. Full return to sports was allowed at 4 months. IKDC score and KT-2000 were used for assessing clinical outcome at a mean of 6.4 years (5-7 years) Resumption of sport, Tegner activity score, and isokinetic test were also used. The IKDC score showed 92% of normal or nearly normal knees. Of the 50 patients 48 regained full extension, and only two had extension deficit between 0 degrees and 3 degrees. KT evaluation was less than 3 mm in 38 cases (76%), 3-5 mm in 9 (18%), and more than 5 mm in 3 (6%). In 90% of cases the patient resumed sport at the same level. The mean Tegner activity score was 8.1 (5-10). The isokinetic test showed no deficit for hamstring and quadriceps muscles. Removal of staples was necessary in eight cases (16%) due to femoral lateral bursitis. Acute reconstruction had significantly better clinical assessment of abnormal laxity and KT value. Men had significantly better results then women. This technique demonstrated a high reliability, low morbidity, low functional deficit and fast recovery using hamstring grafts.

Acute Disease↗
PubMed1990

Cyclops syndrome: loss of extension following intra-articular anterior cruciate ligament reconstruction.

Arthrofibrosis is one of the recognized complications following traditional anterior cruciate ligament (ACL) reconstruction. With the advent of arthroscopic assisted ACL reconstructions, the extent of potential arthrofibrosis appeared to be less. However, 13 patients after intra-articular ACL reconstruction using a patella tendon autograft developed a similar symptom complex. In addition to postoperative loss of full extension, there was an audible and palpable clunk with terminal extension. These patients had similar arthroscopic findings of a nodule that formed anterolateral to the tibial tunnel placement of the graft. The arthroscopic appearance of the soft tissue mass with its surface vessels was reminiscent of a "cyclops." After arthroscopy with debridement and manipulation of the knee, extension was improved in all cases. The average range of motion immediately after the procedure was 6.0-130 degrees, compared with 16-103 degrees preoperatively. The range of motion at last follow-up averaged 3.8 degrees of extension and 138 degrees of flexion. All patients had greater than 130 degrees of flexion. There were no complications attributed to the manipulation and arthroscopic lysis of adhesions, and no patient experienced loss of graft integrity or knee stability. The "cyclops" nodule was examined grossly and microscopically and demonstrated peripheral fibrous tissue with a central region of granulation tissue in all specimens. In addition, two specimens were noted to include bony fragments and three specimens contained cartilaginous tissue.

Adult↗
PubMed1998

Arthroscopic intra- and extra-articular anterior cruciate ligament reconstruction with gracilis and semitendinosus tendons.

Numerous surgical procedures have been developed and used for anterior cruciate ligament (ACL) reconstruction. Patellar tendon is probably the most common graft used, but gracilis and semitendinous tendons present some interesting advantages: small incision, large graft when doubled, characteristics close to ACL, rapid harvest. We describe a combined intra- and extra-articular arthroscopic ACL reconstruction using hamstring tendons which includes some original steps. The tendons are harvested, leaving the distal insertion intact, and sutured together. After drilling of the tibial tunnel, an over-the-top arrangement is formed, creating a groove in the posterolateral aspect of the femur. The tendons are then fixed with double staples in the groove, and their remaining part is fixed distally to Gerdy's tubercle passing under the fascia, but over the lateral collateral ligament (LCL). This technique ensures sufficient strength in the graft and permits correction of any associated instability, because of the presence of the extra-articular portion of the tendons. Furthermore, the over-the-top arrangement reduces trauma and possible pitfalls related to tunnel construction and permits isometry of the extra-articular portion to be established. Forty patients involved in sports activity were prospectively selected and evaluated at a minimum 2 years' follow-up. IKDC score and Lysholm score were used for clinical evaluation, and the KT-2000 was used for instrumental laxity measurements. Resumption of sport and time to that point were recorded as well as Tegner activity score. We had 92.5% normal and fairly normal knees according to IKDC score and only 7.5% abnormal knees. Mean Lysholm score was 95. Mean Tegner score was 7.2. KT-2000 showed a mean injured/uninjured difference of 2.1 mm. In all, 90% of patients resumed sports at the same level, 67.5% in 3-4 months and 27.5% in 4-6 months. The highly satisfactory results of this series with no major complications confirm the reliability of this technique and the possibility of guaranteeing functional behaviour in the knee.

Adolescent↗
PubMed2005

Ultrastructural study of the extra-articular Leeds-Keio ligament prosthesis.

BACKGROUND: There have been several histological studies of the Leeds-Keio ligament in anterior cruciate ligament reconstruction, but there have been few of the Leeds-Keio ligament in the extra-articular portion. AIMS/METHODS: To report the histological and ultrastructural findings of two cases of medial patellofemoral ligament reconstruction using the Leeds-Keio ligament, removed 6.1 years and 8.7 years after implantation. RESULTS: In both cases, the tissue over the Leeds-Keio ligament was a ligament-like tissue. Electron microscopy showed that the diameter of the collagen fibrils in the tissue over the Leeds-Keio ligament was unimodal in the case investigated 6.1 years after implantation but bimodal in the case investigated after 8.7 years. CONCLUSIONS: The tissue over the Leeds-Keio ligament may continue to grow with prolonged periods of mechanical stress.

Adolescent↗
PubMed1989

Acetylcholine sensitivity of the spine-test articular capsule of the sea urchin Eucidaris tribuloides.

1. The changes in the consistence of the spine-test articular capsule, or ligament, of the primary spines of Eucidaris tribuloides induced by acetylcholine (ACh) have been studied. Two complementary techniques were used: (a) "forced-vibration", which detects variations in the stiffness of the ligament along a single diametral plane; and (b) "forced-rotation" which records the spatial distribution of those changes. 2. ACh (1 microM to 1 mM) caused a rapid increase in the resistive force opposed by the ligament to passive stretching. Similar effects were elicited by several monoquaternary, N-substituted derivatives of trimethylammonium. 3. The opposite effect, i.e. softening, was induced by decamethonium, dimethylphenylpiperazine, and 2-ketoamyltrimethylammonium. 4. The involvement in these effects of ACh-binding groups with pharmacological properties similar to those of the "anionic sites" of nicotinic ACh receptors is suggested.

Acetylcholine↗
PubMed1993

Pharmacological sensitivity of the articular capsule of the primary spines of Eucidaris tribuloides.

1. This paper describes the effects of several cholinergic agonists and antagonists, and of beta-phenylethylamine (PEA) and some of its derivatives, on the articular capsule, or ligament, of the primary spines of Eucidaris tribuloides. 2. Carbamylcholine (CCh), methacholine (MeACh), nicotine, and muscarine exert a stiffening effect similar to that of acetylcholine (ACh), although the time course of their actions varies widely. 3. Atropine induced stiffening and blocked and responses to muscarine and MeACh. The responses to MeACh were blocked also by 4-diphenylacetoxy-N-methylpiperidine, suggesting the presence in the ligament of type M3 muscarinic receptors, in addition to nicotinic ones. d-Tubocurarine induced stiffness of the ligament and failed to block the responses to ACh and nicotine. 4. While ACh induced only a slight desensitization, CCh caused a long-lasting blockade of the stiffening effects of the cholinergic agonists. This shows that the receptors for ACh have a site or sites that recognize the ester moieties of these molecules. 5. Eserine and neostigmine potentiate the responses to acetylcholine, indicating the presence of acetylcholinesterase in the ligament. 6. beta-Phenylethylamine, epinephrine, norepinephrine, and dopamine induce diphasic responses; usually a brief softening followed by a slow and irreversible stiffening of the ligament. 7. In contrast to the above, tyramine and octopamine elicit a simple softening of ligaments which are stiff as a result of handling or by exposure to cholinergic agonists. However, tyramine and octopamine do not soften ligaments which become stiff as a result of exposure to adrenergic agonists.

Acetylcholine↗
PubMed1997

Cruciate ligament graft intra-articular distances.

Although the length of the anterior and posterior cruciate ligaments have been well characterized in the literature, we are not aware of any studies of the actual length of grafts used in reconstruction of these ligaments. We dissected and measured these distances for 18 cadaver knees of varying size and sex. The precise location of ideal guide pin placement was located based on current recommendations, and the intra-articular graft length was measured with a micrometer by two separate observers. We found that the average intra-articular graft length for the anterior cruciate ligament is 23.56 mm (SD, 0.98 mm), the posterior cruciate ligament is 30.72 mm (SD, 2.61 mm) and the patella tendon graft intertendinous distance is 43.33 mm (SD, 4.21 mm) We conclude that the intra-articular distance for cruciate ligament grafts is less than published values for the ligaments themselves, and that the patella tendon graft is of adequate length to be used for reconstruction of these ligaments.

Anterior Cruciate Ligament↗
PubMed1998

COMP (cartilage oligomeric matrix protein) is synthesized in ligament, tendon, meniscus, and articular cartilage.

The presence of cartilage oligomeric matrix protein (COMP) in extracts of ligament, tendon, meniscus, and canine articular cartilage was demonstrated by Western blot analysis using anti-dog COMP antibody. When the tissues were cultured in the presence of [35-S]methionine/cysteine, metabolically labeled COMP was purified from the culture media and from tissue extracts by DEAE-cellulose gel chromatography. SDS-Polyacrylamide gel electrophoresis (SDS-PAGE) followed by autoradiography and immunoblotting under reducing and non-reducing conditions revealed that COMP is synthesized by the cells of these connective tissues. Increased levels of COMP in samples of both synovial fluid and serum of patients with various joint diseases may not only be derived from cartilage but also from ligaments and tendons. COMP is not a highly tissue-specific cartilage molecule.

Animals↗