Cruciate Ligament Research Articles

Role of Physiotherapy in Preventing Failure of Primary Anterior Cruciate Ligament Reconstruction: 首次前十字韌帶重建手術後物理治療所扮演的角色

Background/PurposeAnterior cruciate ligament (ACL) reconstruction is routinely performed in sports medicine. We aimed to determine if there is any protective effect of postoperative physiotherapy in preventing graft rupture after primary ACL reconstruction (ACLR). MethodsA retrospective case–control study was carried out, with demographic data, concomitant meniscal injury, and intraoperative fixation methods matched. The number of sessions of physiotherapy attended by the rupture group and nonrupture group were compared using binary logistic regression. ResultsNo significant relationship between the frequency of postoperative physiotherapy and occurrence of graft rupture after primary ACLR was identified. ConclusionFurther research is needed to verify the effect of physiotherapy in the prevention of graft rupture after primary ACLR.

Mechanoreceptors of the ligaments and tendons around the knee.

Proprioceptive inputs from the joints and limbs arise from mechanoreceptors in the muscles, ligaments and tendons. The knee joint has a wide range of movements, and proper neuroanatomical organization is critical for knee stability. Four ligaments (the anterior (ACL) and posterior (PCL) cruciate ligaments and the medial (MCL) and lateral (LCL) collateral ligaments) and four tendons (the semitendinosus (STT), gracilis (GT), popliteal (PoT), and patellar (PaT) tendons) from eight fresh frozen cadavers were harvested. Each harvested tissue was divided into its bone insertion side and its tendinous part for immunohistochemical examination using S100 staining. Freeman-Wyke's classification was used to identify the mechanoreceptors. The mechanoreceptors were usually located close to the bone insertion. Free nerve endings followed by Ruffini endings were the most common mechanoreceptors overall. No Pacini corpuscles were observed; free nerve endings and Golgi-like endings were most frequent in the PCL (PCL-PaT: P = 0.0.1, PCL-STT: P = 0.00), and Ruffini endings in the popliteal tendon (PoT-PaT: P = 0.00, Pot-STT: P = 0.00, PoT-LCL: P = 0.00, PoT-GT: P = 0.00, PoT-ACL: P = 0.09). The cruciate ligaments had more mechanoreceptors than the medial structures (MS) or the patellar tendon (CR-Pat: P = 0.000, CR-MS: P = 0.01). The differences in mechanoreceptor distributions between the ligaments and tendons could reflect the different roles of these structures in the dynamic coordination of knee motion. Clin. Anat. 29:789-795, 2016. © 2016 Wiley Periodicals, Inc.

Arthroscopic Ethibond suture and anchor fixation for avulsion fracture of anterior cruciate ligament tibial insertion

Objective To investigate the clinical effect of Ethibond suture and anchor fixation by arthroscopic technique for the treatment of avulsion fracture of the anterior cruciate ligament (ACL) tibial insertion. Methods Twenty patients with avulsion fracture of the ACL tibial insertion hospitalized between July 2013 and June 2014 were collected retrospectively. There were 12 males and 8 females, aged 18-41 years (mean, 25.3 years). All patients were identified with type Ⅱ and type Ⅲ fractures according to the Meyers-McKeever classification. Results of Lachman test and anterior drawer test were both positive. All patients accepted the operation that avulsion fracture of the ACL tibial insertion was treated with the Ethibond suture and anchor fixation by arthroscopic technique within 3 weeks after injury. Follow-up X-ray examinations were carried out to evaluate the bone union. Lysholm and international knee documentation committee (IKDC) scores were used to evaluate the function of knee joint postoperatively. Results Operation time was 45-70 min (mean, 50 min). Blood loss was 5-15 ml (mean, 10 ml). Follow-up was conducted for 12-24 months (mean, 16.3 months). Postoperative X-ray showed the reduction was satisfactory. Lachman test and anterior drawer test were both negative after operation. Knee functions were recovered to normal. Lysholm and IKDC scores were 89-96 points [(93.5±2.3)points] and 84-96 points [(91.0±3.9)points]respectively at the final follow-up, improved compared to the preoperative 42-61 points [(51.1±6.2)points] and 46-68 points [(55.2±7.0)points] (both P<0.05). Conclusion Arthroscopic Ethibond suture and anchor fixation for avulsion fracture of the ACL tibial insertion is an effective procedure with the advantages of small trauma, reliable fixation, good functional recovery and satisfactory clinical effect. Key words: Anterior cruciate ligament; Tibial fractures; Arthroscopes; Suture anchors; Fracture fixation

Research advances on the development of osteoarthritis after anterior cruciate ligament reconstruction

Anterior cruciate ligament is the most important ligament to maintain the anterior and rotation stability of knee joint. Rupture of anterior cruciate ligament is one of the most common injuries of knee joint, and thus leads to knee instability and traumatic osteoarthritis. Anterior cruciate ligament reconstruction is usually performed to restore the anterior stability of knee joint, and is considered to reduce the secondary injury of medial meniscus, lateral meniscus and cartilage. Thus anterior cruciate ligament reconstruction can improve the function of knee joint. Traditional single bundle technique to reconstruct anterior cruciate ligament has been performed for many years. This technique can restore the anterior stability of knee joint and has excellent clinical results. Nearly 61% patients showed obvious radiographic osteoarthritis 20 years after anterior cruciate ligament reconstruction using bone-patella-bone graft. But, there is no agreement regarding to reduce the development of osteoarthritis after reconstruction of anterior cruciate ligament. However, it has been reported that osteoarthritis would develop after reconstruction of anterior cruciate ligament in long term follow up study. Recently, with the further understanding of anatomy of biomechanics of anterior cruciate ligament, new techniques for anterior cruciate ligament reconstruction are developed, such as double bundle reconstruction, anatomic reconstruction and individual reconstruction. It remains controversial that whether these new technique can prevent the development of osteoarthritis after rupture of anterior cruciate ligament. Currently, no reconstruction technique for anterior cruciate ligament is perfect, and every technique has advantages and disadvantages. In terms of reducing the prevalence of osteoarthritis after reconstruction of anterior cruciate ligament, which technique is the best still remains unclear. New treatment and evaluation methods should be developed. In the future, not only the restoration of stability of knee joint should be considered, but also the articular cartilage contact kinematics including tibiofemoral joint and patellofemoral joint after anterior cruciate ligament recon-struction. Reduction of the development of osteoarthritis is an important topic after reconstruction of anterior cruciate ligament.

Cruciate ligament-derived mesenchymal stem cells: a potential cell source for cartilage regeneration

Background: Mesenchymal stem cells (MSCs) have been widely investigated for potential in tissue regeneration. The aim of this study was to compare the proliferation and induced differentiation potentials of MSCs isolated from bone marrow (BMSCs), adipose (AMSCs) and cruciate ligament (CLMSCs). Methods: BMSCs, AMSCs and CLMSCs were isolated and identified by flow cytometry with CD markers. Their clonogenicity, proliferation and multi-differentiation capacities were also analyzed. The mRNA expression of adipogenic, osteogenic, and chondrogenic markers at basal state and after multi-lineage inductions was examined using quantitative real-time polymerase chain reaction (qRT-PCR). Results: BMSCs, AMSCs and CLMSCs showed similar positive expression for CD29, CD90, and negative for CD45. Comparative analyses suggested the superior colony forming and proliferation capacity in CLMSCs. When induced toward adipo-, osteo- and chondro-lineages, BMSCs, AMSCs and CLMSCs could successfully differentiate toward target lineages. At basal state and after multi-lineage inductions, AMSCs expressed the highest level of adipogenic markers [peroxisome proliferator-activated receptor gamma 2 (PPARγ2) and CCAAT enhancer binding protein alpha (c/EBPα)]; BMSCs expressed the highest level of osteogenic markers [Alpl, Bglap, Runx2, bone morphogenetic protein 2 (Bmp2), and Spp1]; CLMSCs expressed the highest level of chondrogenic markers (Col2A1, Acan, and Sox9). Conclusions: This study demonstrates that CLMSCs and AMSCs exhibit superiority in cell proliferation compared to BMSCs. CLMSCs can be a potential cell source for clinical application in cartilage regeneration.

Reconstruction of anterior cruciate ligament of knee joint with single bundle allograft under arthroscopic

Objective To introduce the treatment efficacy of using allograft muscle ligament anatomical to rebuild anterior cruciate ligament(ACL) of knee joint under the arthroscopy. Methods Sixty-two cases patients with ACL rupture in anterior cruciate ligament reconstruction under arthroscopy.Allograft ligaments were used as graft, a bone tunnel was established in the proximal tibia and distal femur, and the graft was fixed by the extrusion screw.After the operation, the knee joint was fixed for 12 weeks, and the subjective evaluation was carried out according to the Lysholm and Larson knee score standards; in order to assess the stability of the ligament and the functional recovery of the knee joint, objective evaluation was carried out according to Lachman test in patients. Results The preoperative average Lysholm scale was (43.1±2.1) points, the final average score of 2 years after the reconstruction of the ligament was (91.0 + 2.3) points, there was significant difference(t=3.460, P=0.001). The preoperative average Larson scale was (41.0±2.9) points, the final average score of 2 years after the reconstruction of the ligament was (90.1±3.5) points, there was significant difference(t=3.232, P=0.001). Lachman test results were negative in 62 patients at the end of the review.No serious postoperative complications occurred, no knee infection, deep vein thrombosis and stiffness.All the patients can be completely straight 1 year after operation, knees up to 120 degrees.All patients were satisfied with the function at the end of the follow-up, no joint instability, no re-rupture occurred during the follow-up period. Conclusion Using the allogeneic single beam anatomy of anterior cruciate ligament reconstruction under arthroscopy can obtain satisfactory clinical efficacy. Key words: Arthroscopy; Anterior cruciate ligament; Allograft; Single beam; The anatomy of the reconstruction

Curative effect analysis of arthroscopic transtibial single-bundle posterior cruciate ligament residual reconstruction using artificial ligament compared with hamstring tendon autograft

Objective To compare the curative effect of arthroscopic transtibial single-bundle posterior cruciate ligament(PCL) reconstruction using LARS artificial ligament and hamstring tendon autograft. Methods Thirty-seven patients who underwent isolated single-bundle PCL reconstruction with remnant preservation technique were evaluated.They were divided into LARS group(n=19) and 4-strand hamstring tendon autograft(4SHG) group(n=18). Minimum follow-up was 2 years.Patients were evaluated preoperatively and postoperatively at the latest follow-up with several parameters, including the international knee documentation committee(IKDC) score, Lysholm knee score, Tegner activity rating and physical examination. Results After operation, in LARS group, Lysholm sorce was 89(51, 100) points, Tegner sorce was 6(1, 9) points, IKDC sorces were normal of 5 cases, nearly normal of 10 cases, abnormal of 3 cases, and obviously abnormal of 1 case, significantly improved compared with before operation(62(28, 98) points, 2(1, 5) points, abnormal IKDC score of 8 cases, obviously abnormal of 11 cases; P<0.001). In 4SHG group, Lysholm sorce was 84(36, 100) points, Tegner sorce was 6(1, 9) points, IKDC sorces were normal of 5 cases, nearly normal of 9 cases, abnormal of 3 cases, and obviously abnormal of 1 case, better than before operation(64(28, 98) points, 2(1, 5) points, IKDC score abnormal of 8 cases, obviously abnormal of 10 cases; P<0.001). There was significant difference about Lysholm sorce between two groups after operation(P=0.037). The drawer test results show that, after operation, there were 15 case of grade 0, 4 cases of grade 1 in LARS group, 3 cases of grade 0, 11 cases of grade 1, 4 cases of grade 2 in 4SHG group, all improved significantly compared with before operation, and the differences were statistically significant(LARS group: χ2=38.000, P<0.001; 4SHG group: χ2=29.143, P<0.001), and the grade of patients in LARS group were superior to 4SHG group after operation(χ2=15.251, P<0.001). Conclusion The clinical effect of using a LARS ligament for PCL reconstruction is more useful than using a 4SHG. Key words: Posterior cruciate ligament; Arthroscopy; LARS artificial ligament; Hamstring tendon

Open and closed kinetic chain exercises promote the recovery of function after anterior cruciate ligament reconstruction

Objective To compare the clinical effects of open kinetic chain (OKC) exercises with those of closed kinetic chain (CKC) exercises and limited open kinetic chain combined with closed kinetic chain exercises on rehabilitation after the anterior cruciate ligament reconstruction. Methods Ninety-four patients recovering from single-bundle anterior ligament reconstructions were enrolled and randomly divided into an OKC group (n=33), a CKC group (n=30) or a limited open kinetic chain combined with closed kinetic chain group (combined group) (n=31). Lysholm score, International Knee Documentation Committee (IKDC) score, KT-1000, and active and passive range of motion were evaluated for the 3 groups three and six months after the surgery. Results Three months after surgery, significant differences were found among the 3 groups in Lysholm scores[(87.00±4.79), (83.67±3.55) and (86.71±3.62) respectively], IKDC scores[(89.45±4.79), (86.40±3.76) and (88.58±3.60) respectively], KT-1000[(1.99±0.30), (1.05±0.26) and (1.02±0.24) mm], as well as active and passive range of motion[(10.06±2.06), (7.73±1.41) and (8.10±1.35) mm; (9.76±2.26), (7.87±1.89) and (8.39±1.62) mm](P 0.05), but significant differences were found in KT-1000, and active and passive range of motion(P 0.05), but significant differences between them in active and passive range of motion (P<0.05). There were no significant differences between the CKC and combined groups in Lysholm scores, IKDC scores, KT-1000, and active and passive range of motion(P<0.05). Conclusion Combining limited open kinetic chain exercise with closed kinetic chain exercise is safe and reliable in the rehabilitation after anterior cruciate ligament reconstruction. Key words: Anterior cruciate ligament; Open kinetic chain; Closed kinetic chain; Exercise therapy

MRI features and differential diagnosis of real and pseudo-tears of lateral meniscus at the insertion site of meniscofemoral ligament

Objective To analyze MRI features of real tears and pseudotears of posterior horn of the lateral meniscus (PHLM) at the insertion site of meniscofemoral ligament(MFL), and to discuss main points of differential diagnosis. Methods MR images of 32 patients with PHLM tears and 30 patients with anterior cruciate ligament tears but without PHLM tears confirmed by arthroscopy were analyzed retrospectively. Another 20 asymptomatic volunteers as controls underwent MR examination and analyzed. The number of consecutive slices displaying longitudinal increased signal in sagittal images and the length in axial images were evaluated. The one-way analysis of variance, χ2 test and ROC curve were used to analyze diagnostic value of different MRI findings. Results Longitudinal line with abnormal increased signal (pseudotear) was found in 82.0% (41/50) normal insertion site of MFLs. The typical MRI finding of real tears was peripheral longitudinal linear high signal in PHLM which reached the margin of articular surface. In sagittal images, longitudinal linear high signal was shown in (5.8±1.2) slices in knees of real tears, which was more than (2.6±1.1) slices and (2.7±1.4) slices in pseudo-tear groups (F=60.9, P<0.01). The area under ROC curve was 0.96 for differentiating real tear from pseudo-tear using the number of consecutive slices displaying longitudinal increased signal in sagittal images. With a threshold of five or more consecutive images with abnormal longitudinal increased signal as the positive standard of continuous-line sign, the overall sensitivity, specificity and accuracy for diagnosing real tear were 90.6% (29/32), 90.2% (37/41) and 90.4% (66/73), respectively. The axial images showed that the length of increased signal line in the outer of PHLM was (16.4±4.9) mm in patients with real tears, which was longer than pseudo-tear groups with length of (8.1±3.2) mm and (6.0±3.1) mm (F=17.0, P<0.01). The area under ROC curve was 0.92 for differentiating real tear from pseudo-tear using the length in axial images. The zip sign was defined when its length was not less than 10 mm. The sensitivity, specificity and accuracy of the zip sign was 84.4% (27/32), 90.2% (37/41) and 87.7% (64/73) respectively. In coronal images, high signal of MFL attachment insertion was shown in 71.9% (23/32), 60.0% (15/25) and 10/16 cases, there was no significant difference (χ2=0.98, P=0.61). Conclusion The continuous-line sign and zip sign are characteristic findings of PHLM tears at the insertion site of MFL attachment, which are valuable for differential diagnosis with pseudotears at the insertion site of MFL. Key words: Menisci, tibial; Ligaments; Wounds and injuries; Magnetic resonance imaging

Clinical outcomes after multiligament injured knees: medial versus lateral reconstructions.

The purpose of this study was to analyse the clinical outcomes of multiligament injured knees with respect to the medial collateral ligament and posteromedial corner (PMC) repair or reconstruction versus the posterolateral corner (PLC) reconstruction in patients operated according to a codified surgical protocol. Patients were divided into two groups depending on whether PMC or PLC was injured. Cruciate ligaments as well as PMC or PLC were reconstructed/repaired in a one-stage procedure. At minimum of 1-year follow-up, objective and subjective International Knee Documentation Committee (IKDC) forms, Lysholm score and sports activity level were recorded. Thirty-nine patients with a median follow-up time of 57months (range 12-129) were reviewed. No significant difference was found for functional scores between acute PMC and PLC subgroups. In Group PLC, subjective outcomes tend to be better in the acute than in chronic reconstruction subgroup. A one-stage protocol with early surgery rather than delayed reconstruction produced better clinical outcomes whatever the injured collateral ligament, medial or lateral. In the future, early and chronic reconstructions as well as each injury pattern should be considered as separate entities in studies on multiple ligament injured knees to reach a better level of evidence. IV.

Unusual Presentation of Gout: Intratendinous Tophus in the Patellar Tendon.

©2016 Turkish League Against Rheumatism. All rights reserved. Gout is a clinical disorder resulting from urate crystal deposition.1 Tendinopathy and enthesopathy are extra-articular gout manifestations. The common sites involved in knee are the popliteus tendon, cruciate ligaments, and quadriceps tendon.2 Although patellar tendon has been mentioned as a possible involvement site, to our knowledge, only three case reports exist in the literature, two of which were reported in triathletes mimicking patellar tendonitis precipitated due to prolonged exercises.3-5 In this article, we report a 34-year-old male patient with eight years history of gout who presented with one week history of pain and swelling of extremities. He underwent excision of the olecranon bursae and biopsy from the tophus involving first toe three years ago. Recurrent gouty attacks were treated with nonsteroidal anti-inflammatory drugs, colchicines (1 mg/day), and analgesics. Serum uric acid level was 11.9 mg/dL, C-reactive protein was 18.2 mg/dL. Allopurinol had been discontinued due to elevated liver enzymes (alanine transaminase: 132 U/L; aspartate aminotransferase: 85 U/L). Physical examination demonstrated tophi overlying the toe, and tenderness over the caudal aspect of patella. The patellar tendon was slightly thickened on radiographs. Soft tissue tophus at the interphalangeal joint causing adjacent erosive changes, and swelling of olecranon bursae were seen (Figure 1). Magnetic resonance imaging showed fusiform mass-like thickening of the proximal patellar tendon, measuring 30x16 mm, with intermediate signal on T1 weighted and T2 weighted images. Edema of the tendon at insertion and patellar cortical irregularities not seen on radiograms were demonstrated (Figure 2).

Pulsed ultrasound regulates angiogenesis and vascular invasion of the osteochondral junction in arthritic knee cartilage

Objective To observe the effect of low-intensity pulsed ultrasound (LIPUS) on angiogenesis and vascular invasion in the osteochondral junctions of rabbits with osteoarthritis. Methods Eighteen 2 to 2.5 kg New Zealand rabbits were randomly divided into an early control group (EC), an early osteoarthritis group (EO) and an osteoarthritis plus LIPUS treatment group (ET), each of 6. The rabbits of the EO and ET groups received anterior cruciate ligament resection at their left hind limbs, while those of the EC group were sham-operated. The ET group was exposed to LIPUS radiation four weeks later when osteoarthritis had been established, while the EO and EC groups were exposed to fake LIPUS radiation. After four weeks of treatment the rabbits were sacrificed and pathological changes in the articular surface of the femoral condyle were assessed using Safranin O-fast green cartilage staining. Western blotting was used to examine the expression of integrin β1, p-FAK, p-JNK, p-p38, VEGF and chondromodulin-1(ChM-1). Results Compared with the EC group, significantly more angiogenesis and vascular invasion was observed in the osteochondral junctions of the EO and ET groups, with more vessels at the osteochondral junction and marked disorder of the tidal line broken up by vessels. The expression of integrin β1, p-FAK, VEGF, p-p38 and p-JNK was significantly higher in the EO group than in the EC group, while ChM-1 expression was significantly lower. Compared with the EO group, the expression of integrin β1, p-FAK and ChM-1 in the ET group was significantly higher, while that of VEGF, p38 and p-JNK was significantly lower. Conclusions LIPUS inhibited angiogenesis and vascular invasion in the osteochondral junctions of the osteoarthritic rabbits through activating an integrin β1-FAK-p38/JNK-VEGF/ChM-1 pathway. Key words: Osteoarthritis; Angiogenesis; Vascular endothelial growth factor; Ultrasound; Integrin β1

Resurfaced Allograft-Prosthetic Composite for Proximal Tibial Reconstruction in Children.

Reconstruction of the proximal part of the tibia in children with use of an unconstrained tibial component cemented in an allograft-prosthetic composite after proximal tibial resection spares the distal femoral physis and articular cartilage, maintains the bone stock of the tibia, and allows the allograft to be adapted to the small tibial dimension in very young patients. Make a longitudinal incision medially or laterally, depending on the side of the biopsy (usually medial), encompassing and encircling the biopsy site. A parapatellar arthrotomy is performed, and the cruciate ligaments are cut close to the femoral attachment. Retract the medial gastrocnemius muscle and then isolate and protect the popliteal and posterior tibial vessels. Perform an osteotomy of the tibiofibular joint and the tibial shaft at the appropriate level as determined on the basis of the preoperative imaging, and then complete the resection. Cut and prepare the allograft according to the specimen dimensions. Cement the tibial component of an unconstrained total knee prosthesis in the allograft and place the trial device. Place the trial composite device and then fix the composite device to the host tibia and suture the capsule and ligaments. Immobilize the knee with an above-the-knee plaster cast, which is worn for six weeks, and then have the patient perform progressive functional rehabilitation. The rate of postoperative infection after proximal tibial reconstruction with a resurfaced allograft composite in children has been found to be no higher than that with other reconstructive techniques for the proximal part of the tibia; our series had a 5% rate of deep infection.IndicationsContraindicationsPitfalls & Challenges.

Histological and biochemical characteristics of the rabbit anterior cruciate ligament in comparison to potential autografts.

Tissue engineering of an anterior cruciate ligament (ACL) implant with ACL cells requires detailed analysis of the tissue characteristics that should be mimicked. Therefore, we studied the histological and biochemical properties of rabbit derived ACLs in comparison to other knee-associated tendons that are used as autografts in men. Rabbit derived ACLs and Musculus (M.) semimembranosus, M. semitendinosus tendons and patellar ligaments were explanted from adult New Zealand white rabbits and analyzed histologically for tissue organization (e.g. cellularity, nuclear shapes, elastic fibers), total collagen and sulfated glycosaminoglycan (sGAG) contents. Gene expression analysis was performed for the main extracellular matrix (ECM) components type I collagen, decorin and the glycoprotein tenomodulin. The ACLs had a dimension of 1.39x0.39x0.1 cm in situ. They were characterized by high sGAG content in comparison to the other tendons/ligaments, whereas the total collagen content did not differ. ACLs possessed higher cellularity and lower feret diameter of the cell nuclei compared with the investigated rabbit-derived tendons. In ACLs long elastic fibers were observed. Concerning the gene expression level, lower transcription of tenomodulin was detected in the ACL compared with the other tendons, without significant difference in the decorin gene expression. The M. semitendinosus tendon had a significantly higher type I collagen expression than the ACL and the other investigated tendons. This phenotypical characterization of the lapine ACL presented in this study provides some key standards to evaluate tissue engineered ACL constructs to be tested in the rabbit model.

Posterior Cruciate Ligament Ganglion: Case Report

Intra-articular ganglion of the knee is uncommon and it shows non-specific symptoms. In this report, we present for a treatment of the ganglion arising from the PCL and the mechanism of pain. The case is a 33-year-old male with pain in his left knee. On presentation, he had no history of locking or giving way of the knee, but had pain on standing. At the first medical examination, the range of motion of his knee was full, with no loss of extension, and there was no effusion or swelling, but the terminal knee flexion was painful. McMurray’s test was negative, and the collateral and cruciate ligaments were clinically stable. On MRI, ganglion cysts droved from PCL appear as well-defined cystic multiloculated masses. The patient underwent arthroscopy through the standard anteromedial and anterolateral portals. Consequently, it was diagnosed as a ganglion cyst. The pain disappeared completely after the surgery and neither PCL ganglion nor symptoms recurred up to 9 months post-surgery. The intra-articular ganglion of the knee often is asymptomatic and discovered incidentally. But the reports of ganglion cysts of the knee have been increasing with the increasing availability and use of MRI. We considered that the mechanism of the pain due to ganglion in the cruciate ligament was stimulation of the synovial nerve terminal. One key point for consideration in this study is that arthroscopy should be performed through posterior portal to observe the whole of the PCL and ganglion cysts because it was difficult to observe both the PCL and ganglion cysts with anterior portal. While arthroscopy did not confirm continuity of the ACL and meniscus, it was considered that the ganglion cysts developed in the PCL because of the continuity with the PCL.

Ligament and meniscus loading in the ovine stifle joint during normal gait

BackgroundThe ovine stifle joint is an ideal preclinical model to study knee joint biomechanics. Knowledge of the ovine ligamentous and meniscal loading during normal gait is currently limited. MethodsThe in vivo kinematics of the ovine stifle joint (N=4) were measured during “normal” gait using a highly accurate instrumented spatial linkage (ISL, 0.3±0.2mm). These motions were reproduced in vitro using a unique robotic testing platform and the loads carried by the anterior/posterior cruciate ligaments (ACL/PCL), medial/lateral collateral ligaments (MCL/LCL), and medial/lateral menisci (MM/LM) during gait were determined. ResultsConsiderable inter-subject variability in tissue loads was observed. The load in the ACL was near zero at hoof-strike (0% gait) and reached a peak (100 to 300N) during early-stance (~10% gait). The PCL reached a peak load (200 to 500N) just after hoof-strike (~5% gait) and was mostly unloaded throughout the remainder of stance. Load in the MCL was substantially lower than the cruciate ligaments, reaching a maximum of 50 to 100N near the beginning of stance. The LCL carried a negligible amount of load through the entire gait cycle. There was also a major contribution of the MM and LM to load transfer from the femur to the tibia during normal gait. The total meniscal load reached a maximum average between 350 and 550N during gait. ConclusionKnowledge of joint function during normal motion is essential for understanding normal and pathologic joint states. The considerable variability in the magnitudes and patterns of tissue loads among animals simulates clinical variability in humans. Level of evidenceIII.

Can Both Cruciate Ligaments Be Preserved in Knee Arthroplasty? Eight- to Nine-Year Follow-Up of a Bicompartmental Knee Replacement.

Preservation of native knee anatomy may confer improved patient satisfaction, as suggested by patient satisfaction scores in unicondylar versus total knee replacement. Bicompartmental knee replacement (BKR) implants similarly promote native tissue preservation. We retrospectively reviewed 42 consecutive patients who underwent BKR from 2006 to 2007. Outcome measures were evaluated. At an average follow-up of 103 months (range 87-110), 34/42 (81%) of implants survived. Among the retained implants, the Knee Society Score (KSS) grade was excellent in 26/34 (76.5%), good in 5/34 (14.7%), fair in 3/34 (8.8%), and poor in 0/34 (0%) of cases. Midterm results of BKR demonstrated 81% survival and 76% with excellent KSS grading. Despite a 20% revision rate at the short-term follow-up, the retained implants functioned well at the midterm follow-up.

Breakage of the Femoral Cross-Pin with Impending Rupture of the Popliteal Vessels after Anterior Cruciate Ligament Reconstruction

24세의 남자 환자로 동아대학교병원 내원 3주 전 지역 병원에서 전방십자인대 재건술을 시행하였다. 지역 병원에서의 재건술에 는 transtibial technique을 이용하여 대퇴부 터널을 만든 뒤 동종 아킬레스건을 삽입하였고 대퇴골은 cross-pin system인 Rigidfix (Depuy Mitek Inc., Raynham, MA, USA)를 이용하여 고정하였으 며 경골은 생체흡수성 간섭 나사와 4.5 mm 피질골 나사를 워셔와 함께 고정하였다. 술 후 2주경 수동적 관절 운동을 90까지 시행 하였으며 당시 특별한 통증이나 불편감 등의 문제는 없다고 판단 하여 부분 체중 부하를 시행하였다고 하였다. 그러나 환자가 술 후 16일경 관절 운동 도중 무릎에서 ‘뚝’하는 소리가 들리는 것을 인지하여 자기공명영상 촬영을 비롯한 추가적인 검사를 시행한 후 대퇴골 cross-pin의 파열 의심 소견과 후방의 신경혈관의 손상 이 우려되어 본원 응급실로 전원되었다. pISSN : 1226-2102, eISSN : 2005-8918 350

Cryosurgery as Additional Treatment in Tenosynovial Giant Cell Tumors.

Introduction. Tenosynovial giant cell tumors (TGCT) emerge from the synovium and can behave aggressively. Surgical resection is the standard treatment. However, up to half of the patients with diffuse type show recurrences. Several additional treatments have been applied to reduce recurrences; none of these treatments was proven to be superior to surgical resection solely. This article describes the results of additional cryosurgery to surgical resection. Materials and Methods. We retrospectively evaluated 141 TGCT patients, between 1999 and 2007. Twelve patients had additional cryosurgery. The knee (n = 8), hip (n = 2), ankle (n = 1), and elbow (n = 1) were affected. Primary outcome variables were treatment indications, recurrences, and complications. Results. Indications for additional cryosurgery were extended disease, bone involvement, and locations that are difficult to surgically get disease-free such as cruciate ligaments. Five patients had recurrent disease, all of which had prior treatments. None of the primary treated patients had recurrent disease. One patient had a deep infection. Discussion. Cryosurgery may serve as an additional treatment for diffuse TCGT in selected cases. However, because of the small number of patients and the heterogeneous group we could not prove an advantage of additional cryosurgery over surgical resection only. Cryosurgery should be considered for further evaluation in a prospective study. If there is any effect it would be helpful, especially in patients with multiple TGCT recurrences.

Compensatory component of PRP-technology and knee-joint osteoarthrosis of dogs

Input: Osteoarthrosis belongs to heterogenous group of diseases with similar morphological and clinical implications that leads to the cartilage and subchondral bone lesion, as well as lesion of other joint components (synovium, ligaments, capsule and periarticular muscles) (patent RU 2117997, 2240602, 2240603, 22464304, 22464305, 2271139, 2271140, 2303436, 2323694, 2323695) . Aim of research – to develop treatment technology of animals with aseptic osteoarthrosis by applying thrombocyte rich plasma. Objectives: The objects of the study were dogs with knee-joint osteoarthrosis of I-III level. Every animal was older than 6 years old, with a live weight ≥30 kg. Methods: clinical, X-ray research, endoscopy. Results: A week later after the autoplasma re-introduction, positive dynamics in all the animals was observed. In particular, lameness decreased, volume of the affected limb muscles recovered a little. At the end of therapy lameness disappeared in all animals virtually, but in some animals it was appeared after loading. Regain mobility joint crepitus disappeared. Joint mobility was recovered, crepitation disappeared. At the end of the treatment, control radiography of affected limbs showed a positive dynamics, consist in unevenness reducing of the articular surface, size of osteophytes reducing, osteosclerosis percent reduction. In the time of re-arthroscopy at the end of treatment some positive dynamics had observed; chondromalacia of I stage was marked, edema and hyperemia of synovial villi reduction, no generalized synovitis, no pulping of partial anterior cruciate ligament in particular. Discussion: Leanness, joint rigidity reduction in all animals by the end of the treatment course proves the presence of anti-inflammatory, regenerative effect of thrombocyte-rich plasma. Chondroprotective effect of platelet-derived growth factor cause reduction of edema of the synovial membrane and cartilage chondromalacia reduction, and reduction in the size of the cartilage defects observed during arthroscopic visualization. Lack of side effects and complications indicate high availability and safety of the method, in comparison with the standard treatment methods of animal osteoarthritis.