Anthropometry of the cruciate ligaments of the knee: MRI study of the human four-bar linkage device

The knee acts as a functional unit whose stability depends on the equilibrium of its constituents. The set formed by the cruciate ligaments (CL), the femoral condyles and the tibial plateau, could be understood as a functional unit with a central pivot called the four-bar linkage. The union of the insertion sites of both CL reproduces a crossed union device of four three-dimensional bars that mimic the kinematic behaviour of the knee. The relationship between the femoral and tibial insertions of the anterior and posterior cruciate ligaments (ACL and PCL) is a constant value to be determined in the healthy human population. We included 200 magnetic resonance images (MRI) of healthy knees and measured real distances between the insertion points in the tibia and femur of both CL. We processed these data using the Cruliant-ETSIB® program to show the dimensions of each bar in full scale. We determined absolute variables: ACL, PCL, the distance between tibial insertions (TIDI) and the distance between femoral insertions (FEDI). We measured relative variables as well: TIDI/PCL, FEDI/PCL, PCL/ACL, TIDI/FEDI. There is a human proportion in healthy knees defined by the quotient TIDI/FEDI whose value is 1,45. The use of this quotient is proposed as a reference to optimise the location of the tibial and femoral insertions during reconstructive ligament surgery of the CL, as well as to assess the success of the reconstruction

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Tratamiento farmacológico para la Osteoporosis y su influencia en el proceso de consolidación de las fracturas / Pharmacologic treatment for osteoporosis and its influence on fracture healing

Las fracturas por fragilidad o secundarias a la osteoporosis se pueden considerar como un importante problema de Salud Pública por las consecuencias en términos de mortalidad y morbilidad que generan. Y las previsiones para el futuro, teniendo en cuenta el progresivo envejecimiento de la población y el aumento de la esperanza de vida, no son nada optimistas. Suponen y supondrán un importante consumo de recursos. Una de las estrategias que ha demostrado eficacia para su prevención, es el tratamiento farmacológico. Pero este tratamiento puede afectar de una manera u otra al proceso de consolidación, uno de los objetivos primarios fundamentales en su manejo. En este trabajo de revisión queremos establecer, en base a la evidencia actual, cómo afectan todos y cada uno de los fármacos indicados para el tratamiento de la osteoporosis al proceso de consolidación de las fracturas por fragilidad, una cuestión que genera dudas e incertidumbres en el traumatólogo, cuya responsabilidad y papel en el escenario de la prevención, es fundamental

Osteoporotic fragility fractures can be seen as a major public health problem because their consequences in terms of mortality and morbidity. Taking into account the progressive ageing of the population and the increase in life expectancy, the expectative in the next future are not optimistic. They are and will be an important focus of health resources consumption. One of the strategies that have proven be effective for fracture prevention, is the antiosteoporotic pharmacological treatment. This type of treatments can affect bone healing process in one way or another. In this review, based on the current scientific evidence, we want to establish how each one of the drugs prescribed for the osteoporosis treatment affects the bone healing process of fragility fractures, an issue that generates doubts and uncertainties in the orthopaedic surgeon, whom responsibility and role in fracture prevention is essential