Posterolateral Bundles Of Anterior Cruciate Ligament Research Articles

Length Difference of Anteromedial and Posterolateral Bundles of Anterior Cruciate Ligament in Flexion and Extension (Cadaver Study)

We aimed to measure lengths of both anteromedial (AM) and posterolateral (PL) bundles of anterior cruciate ligament (ACL) in flexion and extension, and analyse statistically. 20 knees of 10 human cadavers were studied in Republic of Turkey Ministry Of Justice Forensic Medicine Institute. All the subjects were male (100%). An anterior longitudinal incision was made and After passing subcutaneous tissue, knee joint was visualized with a medial parapatellar approach. Lengths of both AM and PL bundles of ACL in flexion and extension were measured in millimetres with flexible ruler scale. Data was analysed statistically. Wilcoxon test was used for statistical analysis. Mean age was 46.5 (32-62). A statistically significant difference was seen in lengths of both AM and PL bundles of ACL in flexion and extension (p<0.05). Difference in lengths of bundles of AM and PL in flexion and extension is statistically significant. Whereas, any statistical difference was not noted in comparison of length differences among bundles during flexion and extension (z=0.085, p=0.932). Difference in lengths’ of bundles of AM and PL in flexion and extension was seen statistically significant in our study. In single-bundle technique, only AM bundle of ACL is reconstructed. Besides, both AM and PL bundles of ACL are reconstructed in double-bundle technique. AM and PL bundles have distinct features and lengths in different flexion degrees. We emphasize to review this entity while determining reconstruction technique for ACL-deficient patients.

Simulated anterior cruciate ligament reconstruction using preoperative three-dimensional computed tomography

The aim of this study was to ascertain the ideal far anteromedial portal location to avoid damaging the medial femoral condyle in anterior cruciate ligament (ACL) reconstruction. Forty patients received preoperative computed tomography (CT) scans at 120° of knee flexion. Three-dimensional CT (3D CT) reconstruction of the knee was performed using volume rendering. The insertion of anteromedial (AM) and posterolateral bundle of ACL of the femur was marked on the 3D CT. A line (Line A) was drawn 8-mm proximal and parallel to the anterior ridge of the medial tibial plateau. A tangential line to the medial femoral condyle was drawn from the AM position that was already marked to Line A. The length from the intersection of the lines to the medial edge of the patellar tendon was measured. In all 40 patients, the mean length between the medial edge of the patellar tendon and the far anteromedial portal was 27.5±0.7mm (range 19.8-34.5). In men 29.5±0.7mm (range 25-34.5); 28.7±0.8mm in the shorter group (height≤170cm) and 30.1±1.2mm in the taller group (height≥170cm). In women 25.5±1.0mm (range 19.8-30.5); 22.9±1.0mm in the shorter group (height≤158cm) and 29.6±0.5mm in the taller group (height≥158cm). An optimum far anteromedial portal position was proposed. Knowing the optimum location of the far anteromedial portal position before surgery allows the surgeons to perform more safety ACL reconstruction. IV.

Arthroscopic augmentation technique with 4-strand semitendinosus tendon for partial tears of the anterior cruciate ligament

Objective To introduce an augmentation technique with 4-strand semitendinesus ten-don in treatment of partial anterior cruciate ligament (ACL) injury of under arthroscope and investigate the clinical outcome of the technique. Methods A total of 26 patients with posterolateral bundle rup-tures of ACL were treated arthroscopically with 4-strand semitendinosus tendon augmentation. The Inter-nationnal Knee Documentation Committee (IKDC) and Lysholm knee score scale were used for evaluation of knee function. The side-to-side difference in anterior knee laxity was examined by KT-1000 (25 de-grees flexion and 301b). Results There was no knee extension limitation, with knee flexion of 130°-150 °(average 142°). The patients were followed up for 12-18 months, which showed grade A in 25 pa-tients (96%) and grade B in one (4%) according to IKDC grade at final follow-up. The subjective IK-DC score was increased from preoperative (71.4±3.7) points to (95.8±3.4) points at final follow-up (t =9.836,P <0.01). The average side-to-side difference in maximal manual test with KT-1000 ar-thrometer at 25° flexion decreased from preoperative (5.1±1.2) mm to (2.1±1.3)mm at final follow-up (t = 10.48 ,P < 0.01). The Lysholm score of all patients was (76.7±3.2) preoperatively and (95. 7±2.4) at final follow-up (t =7.356,P<0.01). Conclusion Augmentation with 4-strand semiten-dinosus tendon under arthroscope can attain excellent clinical results and good anterior stability in treat-ment of partial tears of posterolateral bundle of ACL. Key words: Arthroscopy; Anterior cruciate ligament; Reconstruction

Lateral radiographic study of the tibial sagital insertions of the anteromedial and posterolateral bundles of human anterior cruciate ligament

Recently, the femoral attachments of anteromedial and posterolateral bundles of anterior cruciate ligament (ACL) have been extensively discussed, however, few publications have mentioned radiographic measurements of the tibial insertions of two bundles. The aim of this study is to determine the radiographic measurements of the tibial sagital insertions for anteromedial (AM) and posterolateral (PL) bundles of ACL. Thirty-one cadaveric proximal tibias were used. After identification of the AM and PL bundles insertion sites on the tibia, the insertion center and the other anatomic landmarks were marked with a lead pin, and lateral radiographs were taken. Sagital percentage is a percentage of the location of the insertion point calculated from the anterior margin of the tibia in the anteroposterior direction. Anterior edge of ACL averaged 25.0%, center of AM averaged 34.6%, center of PL averaged 38.4%, posterior edge of ACL averaged 50.2%. This study defines the radiographic location of the tibial insertions of the anteromedial and posterolateral bundles of ACL. This contributes to more precise evaluation of anatomical double bundle ACL reconstruction surgery postoperatively.