ABSTRACT
Background: The intercondylar notch (ICN) is an important element of knee morphometry, in close relation to the anterior cruciate ligament (ACL). To find the average are of the anterior notch in each ICN specific shape (A-, W-, or U-shape). Methods: Magnetic resonance imaging (MRI) scans were independently analyzed by two experts, one orthopedic surgeon and one imaging physician. In all cases, the following measurements were done according to the existing definitions: ICN type, aICN area. Results: 65 cases (A-35.4%, W-26.2%, U-38,5%) were included in study; A and W notch types have smaller aICN areas, while U-type notch has bigger aICN area. Conclusion: The anterior intercondylar notch area varies significantly for each specific shape (A-, W, or U-shape), and does not corelates with height. This needs to be considered during ACL reconstruction, when choosing graft size.
Subject(s)
Anterior Cruciate Ligament Reconstruction , Anterior Cruciate Ligament , Magnetic Resonance Imaging , Humans , Magnetic Resonance Imaging/methods , Anterior Cruciate Ligament Reconstruction/methods , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament/anatomy & histology , Anterior Cruciate Ligament/diagnostic imaging , Female , Male , Knee Joint/surgery , Knee Joint/anatomy & histology , Knee Joint/diagnostic imaging , Treatment Outcome , Adult , Anterior Cruciate Ligament Injuries/surgery , Middle AgedABSTRACT
OBJECTIVE: This study evaluates the amplitude of the anatomical-mechanical angle (AMA-angle) using 4 measuring methods of the tibial distal anatomical axes (DAA) previously described, comparing the literature results to determine if there are significant differences in patients with cranial cruciate ligament (CrCL) rupture. ANIMALS: This study was comprised of 30 tibiae (29 dogs), including 1 bilateral case. METHODS: A retrospective study was selected for this research. DAA measurements were performed on all surgically confirmed cases of canine CrCL rupture at Hospital Veterinário de Especialidades Bruselas from 2019 to 2022. Four different published methods (identified by surname of the corresponding author of the original publication) were compared. Tibial measurements were made using Veterinary Preoperative Orthopedic Planning Pro software (https://vpop-pro.com/) on mediolateral radiographic projections obtained from a digital database. RESULTS: The mean (range) in the DAA method conducted by Hulse obtained a AMA-angle of 5.4° (3.3 to 8.1°), 3.0° (0 to 5.8°) for Osmond et al, 3.2° (0.9 to 6°) for Miles, and 5.9° (2.4 to 8.8°) for Tudury. Differences among the means of the AMA-angle of the authors methods were found with a statistical difference (P < .05), except between Osmond and Miles. The mean AMA-angle with the Osmond method concurred with previous study results that determined the magnitude using the same measurement method of DAA in patients with CrCL rupture. CLINICAL RELEVANCE: The AMA-angle magnitude has been associated with higher sensitivity and specificity for predicting the development of CrCL rupture compared to other anatomical factors evaluated; therefore, future comparisons with different methods of measurement of the DAA between healthy and affected patients are recommended to determine whether any of them can increase the percentage value as a predictive factor for the occurrence of this condition.
Subject(s)
Anterior Cruciate Ligament Injuries , Tibia , Animals , Dogs/injuries , Dogs/anatomy & histology , Anterior Cruciate Ligament Injuries/veterinary , Tibia/anatomy & histology , Retrospective Studies , Rupture/veterinary , Male , Female , Anterior Cruciate Ligament/anatomy & histology , Anterior Cruciate Ligament/diagnostic imaging , Dog Diseases/diagnostic imagingABSTRACT
The aim of this study was to reveal the influence of the morphological variations of the Blumensaat's line on anteromedial (AM) and posterolateral (PL) femoral tunnel position in anatomical double-bundle anterior cruciate ligament (ACL) reconstruction.Fifty-three subjects undergoing anatomical double-bundle ACL reconstruction were included (29 female, 24 male; median age 27.4 years; range: 14-50 years). Using an inside-out transportal technique, the PL tunnel position was made on a line drawn vertically from the bottommost point of the lateral condyle at 90 degrees of knee flexion, spanning a distance of 5 to 8 mm, to the edge of the joint cartilage. AM tunnel position was made 2 mm distal to the PL tunnel position. Following Iriuchishima's classification, the morphology of the Blumensaat's line was classified into straight and hill (large and small) types. Femoral tunnel position was determined using the quadrant method. A Mann-Whitney U test was performed to compare straight and hill type knees according to AM and PL femoral tunnel position.There were 18 straight and 35 hill type knees (13 small and 22 large hill). AM and PL femoral tunnel position in straight type knees were 21.7 ± 7.0 and 33.6 ± 10.5% in the shallow-deep direction, and 42.1 ± 11.1 and 72.1 ± 8.5% in the high-low direction, respectively. In hill type knees, AM and PL femoral tunnel position were 21.3 ± 5.8 and 36.9 ± 7.1% in the shallow-deep direction, and 44.6 ± 10.7 and 72.1 ± 9.7% in the high-low direction, respectively. No significant difference in AM or PL femoral tunnel position was detected between straight and hill type knees.AM and PL femoral tunnel position in anatomical double-bundle ACL reconstruction was not affected by the morphological variations of the Blumensaat's line. Surgeons do not need to consider Blumensaat's line morphology if AM and PL femoral tunnel position is targeted at the bottommost point of the lateral condyle. This was a level of evidence III study.
Subject(s)
Anterior Cruciate Ligament Reconstruction , Femur , Humans , Anterior Cruciate Ligament Reconstruction/methods , Female , Male , Femur/surgery , Femur/anatomy & histology , Adult , Adolescent , Middle Aged , Young Adult , Knee Joint/surgery , Anterior Cruciate Ligament Injuries/surgery , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament/anatomy & histologyABSTRACT
OBJECTIVE: The aim of this study was to provide normative ultrashort echo time magnetic resonance imaging (UTE MRI) data of the patellar ligament (PL), cranial cruciate ligament (CrCL) and caudal cruciate ligament (CdCL) in non-lame Beagles. STUDY DESIGN: Eight stifles from four subjects obtained immediately postmortem were imaged using UTE MRI in the true sagittal plane. Regions of interest were drawn manually and the total (T2*), short T2* (T2*S) and long T2* (T2*L) values of the signal decay were calculated to evaluate the bound and free water components of the tendon. The T2*S, T2*L and T2* values were compared between the PL, CrCL and CdCL RESULTS: The mean and standard deviation of T2*S, T2*L and T2* were as follows: 0.54 ± 0.13, 4.65 ± 1.08 and 8.35 ± 0.82 ms for the PL; 0.46 ± 0.14, 5.99 ± 0.52 and 8.88 ± 0.4 ms for the CrCL and 0.41 ± 0.13, 7.06 ± 0.57 and 9.26 ± 0.18 ms for the CdCL. Significant differences were found between the T2*L component of the PL and each CrCL/CdCL and a smaller difference was noted between the T2*L of the CrCL and CdCL (p = 0.05). No difference of the T2*S value was found between any of the ligaments. CONCLUSION: Establishing normative UTE data of the canine stifle is valuable for comparison in future studies in which normal and damaged ligaments may be evaluated, particularly in those affected limbs in which no instability is identified on physical examination in which normal and damaged ligaments may be evaluated.
Subject(s)
Anterior Cruciate Ligament , Magnetic Resonance Imaging , Animals , Dogs/anatomy & histology , Magnetic Resonance Imaging/veterinary , Magnetic Resonance Imaging/methods , Anterior Cruciate Ligament/diagnostic imaging , Anterior Cruciate Ligament/anatomy & histology , Male , Female , Stifle/diagnostic imaging , Stifle/anatomy & histology , Patellar Ligament/diagnostic imaging , Patellar Ligament/anatomy & histology , Reference ValuesABSTRACT
Bony risk factors for anterior cruciate ligament (ACL) injuries have been investigated during past 2 decades. Deep posterior femoral condylar depth, measured by the lateral femoral condyle ratio, influences anterolateral instability and the graft survival following ACL reconstructions. Before planning of revision ACL reconstruction, other bony risk factors, including the posterior tibial slope and intercondylar notch width, should be carefully evaluated to protect the ACL graft.
Subject(s)
Anterior Cruciate Ligament Injuries , Anterior Cruciate Ligament Reconstruction , Anterior Cruciate Ligament , Femur , Tibia , Humans , Anterior Cruciate Ligament Injuries/surgery , Femur/anatomy & histology , Tibia/anatomy & histology , Tibia/surgery , Risk Factors , Anterior Cruciate Ligament Reconstruction/methods , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament/anatomy & histologyABSTRACT
PURPOSE: The study aimed to obtain a comprehensive 3D visualization of knee specimens, including the cruciate ligaments and corresponding femoral and tibial bone insertions using a non-destructive micro-CT method. METHODS: Knee specimens were fixed in anatomical positions and chemically dehydrated before being scanned using micro-CT with a voxel size of 17.5 µm. RGBA (red, green, blue, alpha) transfer functions were applied to virtually colorize each structure. Following micro-CT scanning, the samples were rehydrated, decalcified, and trimmed based on micro-CT 3D reconstructions as references. Histological evaluations were performed on the trimmed samples. Histological and micro-CT images were registered to morphologically and densitometrically assess the 4-layer insertion of the ACL into the bone. RESULTS: The output of the micro-CT images of the knee in extension and flexion allowed a clear differentiation of the morphologies of both soft and hard tissues, such as the ACL, femoral and tibial bones, and cartilage, and the subsequent creation of 3D composite models useful for accurately tracing the entire morphology of the ligament, including its fiber and bundle components, the trajectory between the femur and tibia, and the size, extension, and morphology of its insertions into the bones. CONCLUSION: The implementation of the non-destructive micro-CT method allowed complete visualization of all the different components of the knee specimens. This allowed correlative imaging by micro-CT and histology, accurate planning of histological sections, and virtual anatomical and microstructural analysis. The micro-CT approach provided an unprecedented 3D level of detail, offering a viable means to study ACL anatomy.
Subject(s)
Anterior Cruciate Ligament Injuries , Anterior Cruciate Ligament , Humans , Anterior Cruciate Ligament/diagnostic imaging , Anterior Cruciate Ligament/anatomy & histology , X-Ray Microtomography , Imaging, Three-Dimensional/methods , Knee Joint/diagnostic imaging , Tibia/diagnostic imaging , Femur/diagnostic imagingABSTRACT
PURPOSE: Little is known about risk factors for sustaining a posterior cruciate ligament (PCL) rupture. Identifying risk factors is the first step in preventing a PCL rupture from occurring. The morphology of the knee in patients who ruptured their PCL may differ from that of control patients. The hypothesis was that the intercondylar notch dimensions, 3-D volumes of the intercondylar notch and, the 3-D volumes of both the ACL and the PCL were correlated to the presence of a PCL rupture. METHODS: The magnetic resonance imaging (MRI) scans of 30 patients with a proven PCL rupture were compared to 30 matched control patients with proven intact ACL and PCL. Control patients were selected from patients with knee trauma during sports but without cruciate ligament injury. Patients have been matched for age, height, weight, BMI, and sex. The volumes of the intercondylar notch and both the ACL and PCL were measured on 3D reconstructions. Second, the bicondylar width, the notch width, and the notch width index were measured of all subjects. The relationship between our measurements and the presence of a PCL rupture was analysed. RESULTS: The results show a significant difference in the volumes of the intercondylar notch and the ACL between patients with a ruptured PCL and control patients. Patients with a PCL rupture have smaller intercondylar notch volumes and smaller ACL volumes. There were no significant differences in the bicondylar width, notch width, and notch width index. In the control patients, a significant correlation between the volume of the PCL and the volume of the ACL was found (0.673, p < 0.001). CONCLUSION: Patients with a PCL rupture have smaller intercondylar volumes and smaller ACL volumes when compared to control patients. Second, patients with smaller ACL volumes have smaller PCL volumes. This study shows, for the first time, that there are significant size and volume differences in the shape of the knee between patients with a PCL rupture and control patients. LEVEL OF EVIDENCE: IV.
Subject(s)
Anterior Cruciate Ligament Injuries , Knee Injuries , Posterior Cruciate Ligament , Soft Tissue Injuries , Sprains and Strains , Humans , Anterior Cruciate Ligament/anatomy & histology , Posterior Cruciate Ligament/diagnostic imaging , Knee Joint/anatomy & histology , Knee Injuries/pathology , Magnetic Resonance Imaging/methods , Risk Factors , Sprains and Strains/complications , Rupture/pathology , Anterior Cruciate Ligament Injuries/complications , Femur/pathologyABSTRACT
The ligamentum mucosum (LM) is a ligamentous structure within the synovial layer of the knee joint capsule. For a long time LM was perceived as the vestigial remnant from the embryological development of the knee. However, last years have shown increased interest in this structure due to its potentially significant clinical role. Fifty-one, 12 females (mean age 83.1 ± 3.4 years) and 39 males (mean age 84.2 ± 6.8 years) fixed in 10% formalin were examined. Upon dissection, the following morphological features of the LM were assessed: the types of LM, morphometric measurement and histological analysis of each type. The LM was present in 66.7% of all examined specimens. Three different types were recognized: Type I (55.9%)-single band with attachment to the intercondylar notch, Type IIa-bifurcated ligament with attachment to the anterior cruciate ligament, Type IIb-bifurcated ligament with both attachments to the intercondylar notch, Type III-double ligament with two independent bands and attachments to the intercondylar notch and to the knee joint capsule. The LM is variable and probably evolutionary changes are the reason. In our study we propose the new clinically useful classification supported by its anatomical and histological characteristics. Type IIa seems to be the most important from the clinical point of view, as it may be responsible for clinical issues and should be paid attention while diagnosing patients suffering from anterior cruciate ligament torn or anterior knee pain.
Subject(s)
Anterior Cruciate Ligament Injuries , Knee Joint , Male , Female , Humans , Aged , Aged, 80 and over , Knee Joint/anatomy & histology , Anterior Cruciate Ligament/anatomy & histology , Knee , Lower Extremity , Femur/anatomy & histologyABSTRACT
BACKGROUND: This study evaluated and compared the expression of VEGF, CD34, and α-SMA in the anterior cruciate ligaments and medial collateral ligaments in healthy human knees in order to enrich the epiligament theory regarding ligament healing after injury. METHODS: Samples from the mid-substance of the anterior cruciate ligament and the medial collateral ligament of 12 fresh knee joints were used. Monoclonal antibodies against CD34, α-SMA, and VEGF were used for immunohistochemical analysis. Photomicrographs were analyzed using the ImageJ software. RESULTS: The epiligament of the anterior cruciate ligament showed slightly higher expression of CD34, α-SMA, and VEGF than the epiligament of the medial collateral ligament. Overall, among the tested markers, α-SMA expression was most pronounced in anterior cruciate ligament epiligament images and CD34 dominated in medial collateral ligament epiligament images. The intensity of DAB staining for CD34, α-SMA, and VEGF was higher in vascular areas of the epiligament than in epiligament connective tissue. CONCLUSIONS: The results illustrate that CD34, α-SMA, and VEGF are expressed in the human epiligament. The differences between the epiligament of the investigated ligaments and the fact that CD34, α-SMA, and VEGF, which are known to have a definite role in ligament healing, are predominantly expressed in the main vascular part of the ligament-epiligament complex enlarge the existing epiligament theory. Future investigations regarding better ligament healing should not overlook the epiligament tissue.
Subject(s)
Anterior Cruciate Ligament , Collateral Ligaments , Medial Collateral Ligament, Knee , Wound Healing , Humans , Actins/metabolism , Anterior Cruciate Ligament/anatomy & histology , Anterior Cruciate Ligament/metabolism , Anterior Cruciate Ligament Injuries/metabolism , Anterior Cruciate Ligament Injuries/pathology , Knee Joint/anatomy & histology , Knee Joint/metabolism , Medial Collateral Ligament, Knee/anatomy & histology , Medial Collateral Ligament, Knee/metabolism , Vascular Endothelial Growth Factor A/metabolism , Wound Healing/physiology , Antigens, CD34/metabolismABSTRACT
The anterior cruciate ligament (ACL) plays a significant role in knee stability, protects the joint under multiple loading conditions and shows complex biomechanics. Beside mechanical stability, the ACL seems to play a crucial role in proprioception, and it is well known, that ACL injuries can cause functional deficits due to decreased proprioception. However, the mechanism of proprioception is not completely understood yet. In this context, primary cilia (PC), which play a significant role in the signaling between the intra- and extracellular space, could be of interest. However, until today, primary cilia are not yet described in human ACL. In total, seven human ACL's underwent transmission electron microscopical examination. Three cadaveric ACL's and four freshly injured ACL's were examined. Single cells of each ACL were examined regarding the presence of axonemes or basal bodies, which represent components of a PC. In total, 276 cells of the cadaveric ACL's and 180 cells of the injured ACL's were examined. Basal bodies could be detected in three of the four specimens of the injured ACL's as well as in one of the three cadaveric ACL's, resulting in a mean positivity of 2.54% in the cadaveric group and 2.78% in the injured group. In case of PC-presence, only one PC per cell could be detected. No statistically significant difference regarding the frequency could be detected between both groups. In this pilot-study, we present for the first time an ultrastructural study of human ACLs with respect to the occurrence of PC and any structural and morphological features of these complex and dynamic cell organelles. PCs are present in almost all non-hematopoietic tissues of the human body. However, there are different reports on the number, incidence, orientation, and morphology of these cell organelles in the respective tissues. Compared to other tissues and ligaments of other species, we found a significantly lower rate of PC positive cells. This observation might represent a tissue-specific characteristic of ACL tissue. However, our observations need to be explored in more detail in further studies.
Subject(s)
Anterior Cruciate Ligament Injuries , Anterior Cruciate Ligament , Humans , Anterior Cruciate Ligament/anatomy & histology , Anterior Cruciate Ligament/physiology , Pilot Projects , Cilia , Knee Joint , CadaverABSTRACT
PURPOSE: The aim of this anatomical study was to describe the anatomy of the meniscal roots and their relationships with respect to the main adjacent structures in order to improve their surgical reconstruction. METHODS: Fourteen knees were included. The mean age of the donors was 92 years (range 89-96). We studied the general characteristics of the anterior and posterior roots of the medial meniscus and lateral meniscus by measuring their widths at their base and area. We investigated the relations between anterior and posterior roots of the medial and lateral menisci with respect to the anterior and posterior cruciate ligaments (ACL and PCL). RESULTS: The mean width of the anterior root of the lateral meniscus was 10.5 ± 1.4 mm. The mean width of the anterior root of the medial meniscus was 10 ± 1.5 mm. The mean width of the posterior root of lateral meniscus was 11.4 ± 1.4 mm. The mean width of the posterior root of medial meniscus was 10.5 ± 1.0 mm. The mean distance between the anterior cruciate ligament and the anterior root of lateral meniscus was 9.8 ± 2.9 mm, for the medial meniscus it was 15.9 ± 3.4 mm. The mean distance between the posterior cruciate ligament and the posterior root of the lateral meniscus was 11.5 ± 2.7 mm, for the medial meniscus, it was 11 ± 2.6 mm. CONCLUSION: The anterior and posterior meniscal roots have precise landmarks, and this article contributes to define the location of the meniscal roots with respect to their adjacent anatomical structures: ACL, PCL and intercondylar tubercle. Having precise measures of the distances between the meniscus roots and these structures allows knee surgeons to perform ACL reconstruction, meniscal root repair and meniscal allograft transplantation.
Subject(s)
Anterior Cruciate Ligament Injuries , Surgeons , Aged, 80 and over , Anterior Cruciate Ligament/anatomy & histology , Anterior Cruciate Ligament Injuries/surgery , Cadaver , Humans , Knee Joint/surgery , Menisci, Tibial/anatomy & histology , Menisci, Tibial/surgeryABSTRACT
The anterior cruciate ligament and posterior cruciate ligament are key stabilizers of the knee. Magnetic resonance (MR) imaging excels at depiction of injury in both the native and reconstructed cruciate ligaments as well as associated injuries. This article reviews the anatomy, injury patterns, and relevant surgical techniques crucial to making accurate interpretation of MR imaging of the cruciate ligaments.
Subject(s)
Anterior Cruciate Ligament Injuries , Posterior Cruciate Ligament , Anterior Cruciate Ligament/anatomy & histology , Anterior Cruciate Ligament/diagnostic imaging , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament Injuries/diagnostic imaging , Anterior Cruciate Ligament Injuries/pathology , Anterior Cruciate Ligament Injuries/surgery , Humans , Knee Joint/anatomy & histology , Magnetic Resonance Imaging/methods , Posterior Cruciate Ligament/diagnostic imaging , Posterior Cruciate Ligament/injuries , Posterior Cruciate Ligament/surgeryABSTRACT
It is difficult to measure the dimensions of the anterior cruciate ligament (ACL) in vivo, which makes choosing an individualized graft size for ACL reconstruction particularly troublesome. The morphology and function of porcine ACL have been reported to be similar to the native human ACL. This study aimed to identify bony morphological parameters on X-ray images that were significantly correlated with features of the native ACL. Anteroposterior X-ray images of 19 porcine knees were obtained. The width, height and area of the femoral notch, the widths of the femoral and tibial condyles and the width and area of the interspinal fossa of the tibia were measured. ACL length was measured using a caliper. The ACL was then resected and the outline of the bone insertion sites were marked and photographed for measuring the areas of the insertion sites. The excised ACL substance was scanned using X-ray microscopy and reconstructed to measure the medial-lateral (ML) and anterior-posterior (AP) widths, the long and short axes and cross-sectional area of the ACL isthmus. Linear regression analyses showed that the area of the interspinal fossa of the tibia was significantly correlated with the long axis and ML width of the ACL, and with the AP / ML width (p value = 0.038, 0.032 and 0.016 respectively). The width of the femoral condyle was significantly correlated with the area of the tibial insertion and the length and ML width of the ACL (p value = 0.013, 0.000 and 0.038 respectively). The area of the interspinal fossa of the tibia / notch width index (NWI) was significantly correlated with the long axis / short axis of the ACL (p value = 0.016). The width of the interspinal fossa of tibia / NWI was significantly correlated with the short axis of the ACL isthmus (p value = 0.009). However, the dimensions of the femoral intercondylar notch and the width of the interspinal fossa of the tibia were not significantly correlated with any of the ACL parameters. In conclusion, the dimension of the interspinal fossa of the tibia and the width of the femoral condyle measured from X-ray images might be used to estimate the shape and size of the ACL, which might be helpful for choosing a suitable graft size for ACL reconstruction. DATA STATEMENT: All data relevant to the study are included in the article.
Subject(s)
Anterior Cruciate Ligament Reconstruction , Anterior Cruciate Ligament , Animals , Anterior Cruciate Ligament/anatomy & histology , Femur/anatomy & histology , Femur/diagnostic imaging , Humans , Knee Joint/anatomy & histology , Magnetic Resonance Imaging , Swine , Tibia/anatomy & histology , Tibia/diagnostic imagingABSTRACT
BACKGROUND: The study aimed to (1) investigate the variability of the femoral ACL center in ACL-ruptured patients, (2) identify whether the currently available over-the-top femoral ACL guides could allow for anatomical reconstruction of the native ACL footprint. MATERIAL AND METHODS: Magnetic resonance images of 95 knees with an ACL rupture were used to create three-dimensional models of the femur. The femoral ACL footprint area was outlined on each model, and the location of the femoral ACL center was reported using an anatomical coordinate system. The distance of the femoral ACL center from the over-the-top position was measured. RESULTS: The femoral ACL center demonstrated a high intersubject variability ranging from 1.8 mm (9%) to 12.3 mm (60%) posterior and from 7.7 mm (37%) distal to 4.8 mm (23%) proximal using the posterior condyle circle reference. The average distance of the femoral ACL center from the over-the-top position was 1.9 ± 1.5 mm posterior and 13.8 ± 2.7 mm distal, respectively. The contemporary over-the-top femoral ACL aimers could restore the femoral ACL center in only 6.5% of the patients. CONCLUSIONS: The femoral ACL center demonstrated a high variation on its location, which resulted in a high intersubject variability from the over-the-top position. The contemporary over-the-top femoral tunnel guides do not provide sufficient offset to allow for an anatomical ACL reconstruction. Anteromedial-portal specific femoral ACL guides with a femoral offset ranging from 10 to 18 mm in the proximal/distal direction are required to restore the native ACL footprint.
Subject(s)
Anterior Cruciate Ligament/anatomy & histology , Femur/anatomy & histology , Knee Joint/anatomy & histology , Tibia/anatomy & histology , Adolescent , Adult , Anterior Cruciate Ligament/diagnostic imaging , Anterior Cruciate Ligament Injuries/surgery , Anterior Cruciate Ligament Reconstruction , Female , Humans , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Knee Joint/diagnostic imaging , Magnetic Resonance Imaging , Male , Middle Aged , Retrospective Studies , Tibia/diagnostic imaging , Young AdultABSTRACT
Gait analysis as subjective visual assessment forms the foundation of the veterinarian's lameness examination. Pelvic limb lameness is frequently seen in dogs and the stifle joint with its cruciate ligaments, is a main cause of lameness due to cruciate ligament deficiency. In this study, we developed an open-source three-dimensional musculoskeletal pelvic limb model of a 30 kg Labrador Retriever including cruciate ligaments, simulating the gait cycle of the walking movement with the open-source programs NMSBuilder (Institutio Ortopedico Rizzoli, Bologna, Italy) and OpenSim (National Center for Simulation in Rehabilitation Research (NCSRR), Stanford, CA, USA). The computer model generated muscle activations based on motion data. The computed activations were similar to experimental electromyogram data. Highest joint torque was in extension/flexion in the stifle joint at 54 Nm at 14% of the gait cycle with cruciate ligaments. Highest stifle joint reaction force was 408 N at 16% of the gait cycle and was reduced after adding cruciate ligaments. Especially the cranial cruciate ligament loads up to 102 N (34% body weight). Cranial cruciate ligament forces increase with stifle extension and decrease with stifle flexion. On the contrary, the caudal cruciate ligament loads up to 27 N (9% body weight) during the swing phase with a flexed stifle joint. The model was validated with electromyogram data. The model's predictions are plausible because joint torques and forces match the applied ground reaction forces in curve progression and in timing. This model forms a basis for further investigations into stifle surgery after cruciate ligament deficiency.
Subject(s)
Anterior Cruciate Ligament/anatomy & histology , Computer Simulation , Dogs/anatomy & histology , Models, Anatomic , Pelvic Bones/anatomy & histology , Stifle/anatomy & histology , Animals , Biomechanical Phenomena , Gait , Hindlimb/anatomy & histology , Italy , Male , RotationABSTRACT
OBJECTIVES: To evaluate whether anthropometric data can predict anterior cruciate ligament (ACL) sizes on magneti resonance imaging (MRI) in Asian population. BACKGROUND: Reconstruction of ACL has been performed over a decade ago. Recently, more individualized ACL reconstruction is performed taking account of each patient's ACL characteristics. However, there has been limited study regarding ACL sizes in Asian Indonesian population. This study aimed to evaluate the role of anthropometric data in ACL sizes using MRI in Asian Indonesian population. STUDY DESIGN: Retrospective Study. METHOD: A series of 531 knees from 420 patients with knee pain and intact ACL confirmed by MRI study. Length, width and inclination angle of ACL were measured using a T2-weighted sagittal MRI 3.0 Tesla Magnetom Skyra. Height, weight, body mass index (BMI) and age were recorded. Multiple regression analysis was used to determine relationship between the anthropometric data and size of ACL measurements. RESULT: ACL length and width were significantly different between male and female, consecutively. Mean ACL length was 35.36 ± 3.63 mm, male was significantly longer (36.59 ± 3.24 mm) compared to female (32.77 ± 2.99 mm), p < 0.0001. Mean ACL width was 10.23 ± 1.84 mm, male was significantly wider (10.85 ± 1.59 mm) compared to female (8.93 ± 1.64 mm), p < 0.0001. The mean ACL inclination angle was 47.75° ± 3.07° (range 40.17°-57.12°). The strongest correlation for ACL length was height and weight (r = 0.437; r = 0.341 consecutively, p < 0.0001). Females had stronger correlation compared to males for ACL length (R2 = 0.489 vs R2 = 0.418). ACL width showed weak correlation with anthropometric data. The following regression analysis equation was obtained for ACL length: ACL length = 60.697 - 0.11*age + 0.461*weight (kg) - 16.522*height (meter) - 1.093*BMI (R2 = 0.539; p < 0.0001). CONCLUSION: Anthropometric data can be utilized as a predictor of ACL length in Asian Indonesian population. The ACL length in Asian Indonesian population is shorter than that in Western population study.
Subject(s)
Anterior Cruciate Ligament/anatomy & histology , Body Weights and Measures , Adolescent , Adult , Anterior Cruciate Ligament/diagnostic imaging , Anterior Cruciate Ligament/pathology , Asian People/statistics & numerical data , Body Mass Index , Body Weights and Measures/statistics & numerical data , Female , Humans , Indonesia/epidemiology , Knee/anatomy & histology , Knee/diagnostic imaging , Knee/pathology , Knee Joint/anatomy & histology , Knee Joint/diagnostic imaging , Knee Joint/pathology , Magnetic Resonance Imaging/methods , Male , Organ Size , Retrospective Studies , Young AdultABSTRACT
SUMMARY: The aim of the present study was to evaluate the importance of the epiligament for the difference in the healing potential of the knee anterior cruciate and medial collateral ligament. To do so, we compared the structure of the anterior cruciate and the medial collateral ligament and evaluated the differences in the expression of collagen types I, III and V in a rat knee. We have also conducted a comparative quantitative analysis of the number of cells per mm2 in the two ligaments. Tissue samples were obtained from the anterior cruciate and medial collateral ligament of 10 knee joints taken from five 8-month-old Wistar rats. We used standard hematoxylin and eosin staining, in addition to immunohistochemical staining with monoclonal antibodies against collagen types I, III and V. A semi-quantitative analysis of the expression was made through ImageJ, while Student's T-test was used for the statistical analysis. Our results showed higher expression of all collagen types in the epiligament, compared to the ligament proper and difference in the expression between the medial collateral and the anterior cruciate ligament in favor of the first. We also reported a statistically significant difference in the number of cells per mm2 between the two ligaments and their epiligaments. Our findings show a higher number of cells and a stronger expression of certain collagen types in the epiligament of the medial collateral compared to the anterior cruciate ligament, which may be related to the difference in their healing potential.
RESUMEN: El objetivo del presente estudio fue evaluar la importancia del epiligamento para la diferencia en el potencial de curación del ligamento cruzado anterior y colateral medial de la rodilla. Comparamos la estructura del ligamento cruzado anterior y el ligamento colateral medial y evaluamos las diferencias en la expresión de los tipos de colágeno I, III y V en una rodilla de rata. También se realizó un análisis cuantitativo comparativo del número de células por mm2 en los dos ligamentos. Se obtuvieron muestras de tejido del ligamento cruzado anterior y colateral medial de 10 articulaciones de rodilla tomadas de cinco ratas Wistar de 8 meses de edad. Utilizamos tinción estándar con hematoxilina y eosina, además de tinción inmunohistoquímica con anticuerpos monoclonales contra colágeno tipo I, III y V. Se realizó un análisis semicuantitativo de la expresión mediante ImageJ, mientras que para el análisis estadístico se utilizó la prueba T de Student. Nuestros resultados mostraron una mayor expresión de todos los tipos de colágeno en el epiligamento, en comparación con el ligamento y una diferencia en la expresión entre el ligamento colateral medial y el ligamento cruzado anterior. También informamos una diferencia estadísticamente significativa en el número de células por mm2 entre los dos ligamentos y sus epiligamentos. Nuestros hallazgos muestran un mayor número de células y una expresión mayor de ciertos tipos de colágeno en el epiligamento colateral medial en comparación con el ligamento cruzado anterior, lo que puede estar relacionado con la diferencia en su potencial de curación.
Subject(s)
Animals , Male , Rats , Anterior Cruciate Ligament/anatomy & histology , Collagen/metabolism , Medial Collateral Ligament, Knee/anatomy & histology , Immunohistochemistry , Anterior Cruciate Ligament/metabolism , Rats, Wistar , Medial Collateral Ligament, Knee/metabolismABSTRACT
Despite a well-established role of anterior cruciate ligament (ACL) anatomy on its biomechanics, little is known on how ACL anatomy develops and changes during skeletal growth. We hypothesized that ACL size and orientation will change by age during skeletal growth and maturation with different trends in males vs females. Magnetic resonance images of 269 unique knees (3-18 years old; 51% female) were used to measure ACL length, cross-sectional area, length-to-cross-sectional area ratio, and elevation angles. In both males and females, ACLs became longer, thicker, and more vertical in sagittal and coronal planes by increasing age (R2 > 0.2; P < .001 for all associations). ACL cross-sectional area-to-length ratio increased by age only in males (R2 = 0.06; P = .003). Despite similar ACL sizes between males and females at early age, adolescent males had significantly longer and thicker ACLs compared to the age-matched females (P < .05). There were no sex differences in ACL elevation angles (P > .2) except for larger coronal elevation in 7 to 10 years old females compared to age-matched males (P = .012). Observed changes in ACL cross-sectional area-to-length ratio indicate that age- and sex-dependent changes in ACL size are not homogenous. The trends seen in normalized ACL size measurements suggest that unlike ACL cross-sectional area, ACL length is primarily controlled by body size. Smaller ACLs and lower cross-sectional growth rates observed in females may be contributing factors to the higher risk of ACL injuries in females. Further investigations are required to identify the intrinsic and extrinsic factors responsible for these discrepancies.
Subject(s)
Aging , Anterior Cruciate Ligament/diagnostic imaging , Anterior Cruciate Ligament/growth & development , Bone and Bones/diagnostic imaging , Sex Factors , Adolescent , Age Factors , Anterior Cruciate Ligament/anatomy & histology , Body Size , Bone Development , Bone and Bones/anatomy & histology , Child , Child, Preschool , Female , Humans , Imaging, Three-Dimensional , Knee Joint/anatomy & histology , Magnetic Resonance Imaging , MaleABSTRACT
PURPOSE: Managing anterior cruciate ligament (ACL) injuries in skeletally immature patients remains difficult. The main aim of this study was to retrospectively compile normative data on the cross-sectional area (CSA) of the semitendinosus tendon (ST) and the diameter of the ACL in children and young adults. METHODS: Knee magnetic resonance imaging (MRI) examinations were performed for a 2-year period in 132 patients (83 female and 49 male patients). The mean age was 14.9 years (8-18 years). Measurements of the ST CSA were performed on axial views in greyscale by two independent researchers. The ACL diameter was measured as well. RESULTS: The results show the CSA of the ST was related to age, and its growth was not linear. The highest growth rate of the CSA of the ST occurred at age 12-13 at the level of the femoral growth plate and at the level of the tibial plateau. The growth of the ACL diameter was linear until 18 years of age. CONCLUSIONS: ST growth (measured in CSA increments) is almost complete at the age of 13, even though the growth is not linear. ACL growth measured in diameter increments proceeds linearly from 8 to 18 years of age. MRI is a clinically useful tool for assessing hamstring tendon grafts preoperatively. LEVEL OF EVIDENCE: Level III, diagnostic studies.
Subject(s)
Anterior Cruciate Ligament Injuries/pathology , Anterior Cruciate Ligament Injuries/surgery , Anterior Cruciate Ligament/anatomy & histology , Anterior Cruciate Ligament/growth & development , Tendons/anatomy & histology , Tendons/growth & development , Adolescent , Age Factors , Anterior Cruciate Ligament/diagnostic imaging , Anterior Cruciate Ligament Reconstruction/methods , Child , Female , Hamstring Tendons/transplantation , Humans , Magnetic Resonance Imaging/methods , Male , Retrospective Studies , Tendons/diagnostic imaging , Time FactorsABSTRACT
An understanding of knee ligament anatomy and biomechanics is foundational for physicians treating knee injuries, especially the more rare and morbid multiligamentous knee injuries. This chapter examines the roles that the cruciate and collateral anatomy and morphology play in their kinematics. Additionally, the biomechanics of the ACL, PCL, MCL, and LCL are discussed as they have surgical and reconstructive implications.