Origin Of Lateral Collateral Ligament Research Articles

The Use of Fluoroscopy Leads to Improved Identification of the Femoral Lateral Collateral Ligament Origin Site When Compared With Traditional Tactile Techniques

To determine whether a fluoroscopic technique can be used to improve the accuracy of the determination of the femoral origin of the lateral collateral ligament (LCL). A 1-cm incision was made over the lateral epicondyle in 13 fresh-frozen cadaveric knee specimens, and the LCL origin was determined first by palpation and then with a previously described fluoroscopic method. Both points for the LCL origin were marked with 2-mm Kirschner wires. The distances between the center of the anatomic LCL origin and the LCL origin points determined by palpation and fluoroscopic imaging were calculated. An independent t-test was used to compare the distances between the anatomic LCL origin center and the determined LCL origin points. The LCL origin points determined by fluoroscopic imaging were significantly (P= .005) closer to the anatomic center of the LCL origin point than the ones determined by palpation (3.2mm ± 1.6mm vs 5.0mm ± 1.6mm, respectively). A total of 92.7% fluoroscopically determined LCL origin points were within a 5mm radius surrounding the anatomic LCL origin point. In contrast, only 53.8% LCL origin points determined by palpation were within a 5mm radius surrounding the anatomic LCL origin point. The use of palpation to identify the LCL origin may not be an accurate method for performing an isometric and anatomic LCL reconstruction. The use of fluoroscopic imaging appears to be a feasible method for identifying the LCL origin in clinical practice and may increase the accuracy of LCL origin identification. Fluoroscopic guidance improves accuracy in determining the anatomic LCL origin, which may help avoiding tunnel malplacement during LCL reconstruction. CLINICALRELEVANCE: The use of a previously described radiographic method for identifying the LCL origin may be used to achieve a more anatomic LCL reconstruction.

Anatomical and radiological evaluation of less invasive stabilisation system (LISS) in correlation with knee lateral collateral ligament insertion

IntroductionThe Less Invasive Stabilisation System (LISS) is an angle-stable plate that enables treatment of distal femoral comminuted and periprosthetic fracture. As it is placed through a minimally-invasive lateral approach, lateral knee pain is a commonly described symptom after its application. This study investigates knee lateral collateral ligament (LCL) iatrogenic injury during LISS plate fixation. A cadaver study was performed and a retrospective radiological investigation with the analysis of its clinical application was conducted to evaluate possible knee LCL damage. MethodsThe cadaver study included 13 human lower extremities, treated with LISS. After application, lateral knee side was dissected, implants were removed and distances between the drill holes and LCL origin were measured. In the retrospective radiological evaluation, postoperative X-rays for patients treated with distal femoral LISS plate in the University Hospital Regensburg, Germany from January 2010 to December 2015 were examined. Following a protocol described by Pietrini et al., the LCL origin on postoperative X-rays was calculated, both in lateral and anterior-posterior (AP) view, and distances between the plate and its closest locking screw to the LCL origin were measured. ResultsIn the cadaver study, the mean distance between the closest drilling hole and the ligament origin was 14.0mm (range 9–21mm; SD 3.8mm). Twenty-two patients matched the inclusion criteria for the retrospective radiological study. In lateral view, the mean distance between the origin and the closest locking screw was 6.3mm (range 0–16.4mm; SD 4.7mm); the mean distance between the origin and the plate was 3.1mm (range 0–13.9mm; SD 4.1mm). In AP view, the mean distance between LCL origin and the nearest screw was 2.4mm (range 0–7.6mm; SD 2.4mm). The mean distance between the origin and the most distal locking screw was 9.2mm (range 0–17.5mm; SD 4.0mm). DiscussionThe LISS is a safe option to treat distal femoral fractures in respect to the LCL. Due to close proximity, the LCL might be harmed; therefore, lateral knee pain or lateral instability after implantation should be assessed in further treatment.

Lateral Radiographic Landmarks for ACL and LCL Footprint Origins During All-Epiphyseal Femoral Drilling in Skeletally Immature Knees.

This study was conducted to evaluate the spatial relationship of the anterior cruciate ligament (ACL) and lateral collateral ligament (LCL) femoral footprint origins in knee specimens from skeletally immature donors as viewed on lateral radiographs. Fourteen cadaver specimens of skeletally immature knees from children between 7 and 11 years old at the time of death were examined through gross dissection. Metallic pins were placed at the center of the ACL and LCL femoral footprints, and computed tomography (CT) scans were performed. Sagittal plane CT images were merged to create a view analogous to an intraoperative C-arm image with overlaid ACL and LCL ligament footprints. Ligament origins were then measured as a percent of the epiphyseal depth (% P-A [posterior-anterior]) and height (% P-D [proximal-distal]). The ACL origin was centered at a point located 14% (14% P-A) of the total lateral femoral condyle (LFC) depth from the most posterior aspect of the LFC and 38% (38% P-D) of the LFC height from the most proximal aspect of the posterior physis. The LCL origin was centered at a point 27% P-A and 37% P-D. When viewed on a sagittal CT reconstruction analogous to a perfect lateral intraoperative fluoroscopic view, the ACL footprint origin is posterior and slightly inferior to the LCL origin. Both origins are distal to the distal femoral physis and are posterior to the origin of the popliteus. This study demonstrates a consistent relationship between the origin of the ACL and LCL, which may be useful in guiding safe tunnel placement during all-epiphyseal ACL reconstruction in skeletally immature knees. This anatomic reference can be used intraoperatively to guide and radiographically evaluate ACL tunnel placement while avoiding the LCL origin in skeletally immature patients.

Optimizing the rehabilitation of elbow lateral collateral ligament injuries: a biomechanical study

Elbow lateral collateral ligament (LCL) injury may arise after trauma or lateral surgical approaches. The optimal method of rehabilitating the LCL-insufficient elbow is unclear. Therapists often prescribe active motion exercises with the forearm pronated. Recently, overhead exercises have become popular as they may enable gravity to compress the elbow joint, improving stability, although this has not been proved biomechanically. This investigation aimed to quantify the effects of several variables used in LCL injury rehabilitation on elbow stability. Seven cadaveric specimens were tested in a custom elbow motion simulator in 3 arm positions (overhead, dependent, and varus) and 2 forearm positions (pronation and supination) during passive and simulated active elbow extension. Three injury patterns were studied (intact, LCL injury, and LCL with common extensor origin injury). An electromagnetic tracking device measured ulnohumeral kinematics. Following combined LCL and common extensor origin injury, overhead positioning enhanced elbow stability relative to the other arm positions (P < .01 in pronation; P = .04 in supination). Active motion stabilized the LCL-deficient elbow in the dependent (P = .02) and varus (P < .01) positions. Pronation improved stability in the overhead (P = .05), dependent (P = .06), and varus (P < .01) positions. Rehabilitation with the arm overhead improves elbow stability after LCL injury. Initiating earlier range of motion in this "safe position" might decrease elbow stiffness and allow optimal ligament healing. If exercises are done in the dependent position, active motion with forearm pronation should be encouraged. Varus arm positioning should be avoided.

Is it safe to reconstruct the knee Anterolateral Ligament with a femoral tunnel? Frequency of Lateral Collateral Ligament and Popliteus Tendon injury

This study sought to determine the safety limits for performing a femoral bone tunnel to reconstruct the knee anterolateral ligament (ALL) by establishing its distance from the lateral collateral ligament (LCL) and the popliteus muscle tendon (PT) on the lateral femoral condyle. Anatomic study on 48 knee cadaveric specimens. The femoral attachments of the studied structures were isolated, and the distance between them was measured. For each cadaver, the percentage of cases in which at least 50 % of the LCL and PT would be injured when using 4- to 12-mm-diameter drills in an ALL reconstruction procedure was evaluated. The LCL and PT were 3.8 mm and 10.2 mm distant from the ALL, respectively. A 4-mm tunnel would cause LCL injury in 8.3 % of cases, with increasing incidence of injury up to 87.5 % with a 12-mm drill. Injury to the PT would start with the 10-mm drill, causing injury in 2.0 % of cases. Performing a tunnel in the center of the ALL may cause an iatrogenic injury to the LCL origin. No cases of PT injury are expected to occur with drills smaller than 10 mm.

The Sagittal Plane Angle and Tunnel-Related Complications in Double-Bundle Anterior Cruciate Ligament Reconstruction Using the Transportal Technique: An In Vivo Imaging Study

To evaluate the relation between the tunnel angle in the 3 orthogonal planes, especially the sagittal plane, which can be influenced by knee flexion during drilling, and the incidence of complications from the transportal technique using in vivo imaging data. Fifty-one patients who underwent anatomic double-bundle anterior cruciate ligament reconstruction by the transportal technique were evaluated retrospectively. A 3-dimensional surface model was made using an axial computed tomography scan obtained after anterior cruciate ligament reconstruction. The tunnel length, posterior cortical damage, proximity between the outer orifice of the tunnel and lateral collateral ligament (LCL) origin, and medial femoral condyle cartilage damage were evaluated on a 3-dimensional computed tomography scan and 3-T magnetic resonance imaging. Correlations between those parameters and the tunnel angle in the coronal, axial, and sagittal planes were analyzed. A tunnel length of less than 30 mm developed in 4 cases (8%) in the anteromedial tunnel and in 1 case (2%) in the posterolateral (PL) tunnel. Posterior cortical damage developed in 12 cases (23%). A distance from the outer orifice of the tunnel to the LCL origin of less than 3 mm occurred in 18 cases (35.2%) in the PL tunnel. Medial femoral condyle cartilage damage was detected in 3 cases (6%). A positive correlation was observed between the sagittal angle and anteromedial tunnel length (P = .002, r = 0.547). The sagittal angle in the group with posterior cortical damage was lower than that in the group with no posterior cortical damage (P = .002). A negative correlation was observed between the distance from the outer orifice of the PL tunnel to the LCL origin and the sagittal angle (P = .002, r = -0.55). Drilling at a higher angle in the sagittal plane decreased the incidence of posterior cortical damage and a short anteromedial tunnel. However, drilling at a higher angle shortened the distance to the LCL origin for the PL tunnel. Level IV, therapeutic case series.

Estudo anatômico do ligamento anterolateral do joelho

ObjectiveDescribe the knee anterolateral ligament (ALL) and establish its anatomical marks of origin and insertion. MethodsDissection of the anterolateral aspect of the knee was performed in six cadavers. After isolation of the ALL, its lenght, width and thickness were measured as its places of origin and insertion. The ALL origin was documented in relation to the lateral collateral ligament (LCL) origin and the insertion was documented in relation to the Gerdy tubercle, fibullar head and lateral meniscus. After the first two dissections, the ligament was removed and sent to histologycal analysis. ResultsThe ALL was clearly identified in all knees. Its origin in the lateral epycondile was on average 0.5mm distal and 2.5mm anterior to the LCL. In the tibia, two insertions were observed, one in the lateral meniscus and another in the proximal tibia, about 4.5mm distal to the articular cartilage, between the Gerdy tubercle and the fibullar head. The average measures obtained were: 35.1mm lenght, 6.8mm width and 2.6mm thickness. In the ligament histological analysis, dense connective tissue was observed. ConclusionThe ALL is a constant structure in the knee anterolateral region. Its origin is anterior and distal to the LCL origin. In the tibia, it has two insertions, one in the lateral meniscus and another in the proximal tibia between the Gerdy tubercle and the fibullar head.

Anatomical study on the anterolateral ligament of the knee

ObjectiveDescribe the knee anterolateral ligament (ALL) and establish its anatomical marks of origin and insertion. MethodsDissection of the anterolateral aspect of the knee was performed in six cadavers. After isolation of the ALL, its lenght, width and thickness were measured as its places of origin and insertion. The ALL origin was documented in relation to the lateral collateral ligament (LCL) origin and the insertion was documented in relation to the Gerdy tubercle, fibullar head and lateral meniscus. After the first two dissections, the ligament was removed and sent to histologycal analysis. ResultsThe ALL was clearly identified in all knees. Its origin in the lateral epycondile was on average 0.5mm distal and 2.5mm anterior to the LCL. In the tibia, two insertions were observed, one in the lateral meniscus and another in the proximal tibia, about 4.5mm distal to the articular cartilage, between the Gerdy tubercle and the fibullar head. The average measures obtained were: 35.1mm lenght, 6.8mm width and 2.6mm thickness. In the ligament histological analysis, dense connective tissue was observed. ConclusionThe ALL is a constant structure in the knee anterolateral region. Its origin is anterior and distal to the LCL origin. In the tibia, it has two insertions, one in the lateral meniscus and another in the proximal tibia between the Gerdy tubercle and the fibullar head.

Femoral Radiographic Landmarks for Lateral Collateral Ligament Reconstruction and Repair

Background Little work has been made regarding the use of radiographic landmarks in fibular collateral ligament reconstruction. Radiographic tools can be of use to the surgeon in posterolateral reconstruction as secondary checks in the setting of tissue and bony attrition. Hypothesis Using standardized radiographic imaging, a zone for femoral tunnel placement in lateral collateral ligament (LCL) reconstruction can be identified. Study Design Descriptive laboratory study. Methods Eight fresh-frozen unmatched knees, free of any osseous or articular pathological changes, were selected for dissection (mean age, 61.3 years). Skin and surrounding soft tissues were left intact. Subsequent dissection was carried out to identify the true origin of the LCL. A radiographic marker was applied. True lateral radiographs of the distal femur (posterior condyles overlapping) were taken. Digital radiographic images were obtained and analyzed. Results The Blumensaat line was found to be closely associated with the LCL origin on lateral radiographic imaging. On average, the LCL ligament was found to be 58% (±4.7%) across the width of the condyle and 2.3 mm (±2.3 mm) distal to the Blumensaat line. In all specimens, the anatomical LCL origin was found to have less than 5 mm variance from the mean. Conclusion The LCL origin is located within a specific region that is noted to have a small amount of variance. This is of benefit to the clinician in the traumatic and reconstructive setting where the true origin may not be easily identifiable through dissection. Clinical Relevance Intraoperative fluoroscopic imaging can be used as an adjunctive tool for femoral tunnel placement during posterolateral corner and LCL reconstruction.