Search

Anterior cruciate bone-ligament-bone preparations of wild primates tested in tension failed at a higher load and greater elongation, and absorbed more energy, at a fast rate of deformation than at a slow rate. The major mode of specimen failure changed from a predominance of tibial avulsion fractures at the slow rate to ligament disruption at the fast rate. Failure at the two deformation rates commonly occurred by a serial mechanism involving from one to all components of the bone-ligament-bone unit to different degrees. Factors important in ligament-failure properties included: (1) rate-dependent behaviors, (2) geometrical arrangement of collagen fibers, (3) surrounding ground-substance effects, (4) osseous insertion-site effects, and (5) the influence of non-physiological experimental loading conditions and disuse-induced changes in specimens.

Within two months of a knee injury involving valgus and external-rotation stress or rapid deceleration, twenty-one patients had arthroscopy. Despite blood in the joint (nineteen had hemarthrosis), useful information for diagnosis and treatment was obtained in eighteen patients. A characteristic deformity of the meniscus indicative of rupture of its peripheral attachment was identified and the extent of injury to the capsular ligaments could be assessed. It was also possible to visualize isolated tears of the anterior cruciate ligament and to identify those that might be repaired surgically.

The anatomical and functional details of the cruciate ligamants of the knee were studied on 20 cadaver knees and 24 fresh knees. Each anterior cruciate ligament was found to consist of 2 parts: a distinct anteromedial band (AMB) and a main posterolateral part. The exact geometry of the ligaments and their relationship to bony landmarks were recorded in detail. The state of the cruciate ligaments, i.e. tightness or looseness was recorded in the various positions of the knee as the basis for classification of the function of the various anatomical components. Selective cutting of the anterior cruciate ligament resulted in an increase of anterior drawer flexion and extension. External and internal rotation were increased in both flexion and extionsion. Hyperextension also was increased. It is suggested that the AMB of the anterior cruciate is responsible for the in anteroposterior drawer with flexion. The selective cutting of the posterior cruciate ligament demonstrated that it is important in the flexed knee and produces an.increased posterior drawer sign. Rotational stability was unchanged in extension, but altered in flexion after cutting the posterior cruciate.

In 20% der veralteten Kreuzbandverletzungen besteht nur eine Elongation des vorderen Kreuzbandes. Nachuntersuchungen zeigten, das die Raffnaht nicht immer eine bleibende Straffung des vorderen Kreuzbandes gewahrleistet. Uberlegungen zur Ursache der Fehlergebnisse werden angestellt, und eine Abanderung des Verfahrens im Sinne der knochernen distalen Ansatzversetzung wird beschrieben.

Loss of the anterior cruciate ligament (ACL) in the dog results in a predictable type of arthritis. This condition can be prevented by successful prosthetic substitution of the anterior cruciate ligament (ACL). The condition is a practical model, and a sensitive index of success and failure for evaluation of prototype prostheses. Changes in the joint can be differentiated on the basis of cruciate insufficiency and reaction to the synthetic implant. The model was defined by replacing the ACL with a mesh or tape Dacron prosthesis in 16 Beagle dogs. Gait and anterior drawer sign are unreliable parameters of ACL insufficiency in dogs. At sacrifice up to 3 years postoperatively, 8 joints out of 32 joints were without arthritic changes. Arthritis developed in all joints in which the prosthesis elongated or broke. Failure always occurred intra-articularly at the mouth of a bone tunnel. Successes were inconsistent even with a single material and animal breed. The drillhole techniques used in ACL reconstructions are difficult to standardize. Variability in placement of the prosthesis is compounded by cutting action of bone edges. Porous mesh did not provide a lattice for true ligament regeneration through the joint. Fixation was not a problem in this series.

In a biomechanical and morphological study of cadaver knees and a clinical end-result study of fifty patients with tears of the anterior cruciate ligament, the structure and function of the ligament, the mechanism of injury, and the results of various forms of therapy were analyzed. It was concluded that tension of the anterior cruciate ligament varies during knee motion, being least at from 40 to 50 degrees of flexion; that there are adequate intraligamentous blood vessels and nerves for healing to occur; that isolated tears of the anterior cruciate ligament do occur (probably as the result of internal-rotation displacement of the tibia with respect to the femur); that such tears are frequently associated with meniscal tears; and that early results of operative or non-operative treatment of the anterior cruciate ligament are acceptable although late instability may occur.

Rupture of the anterior cruciate ligament constitutes a major disability in young athletes and those patients with persistent disabling instability who have failed to respond to conservative treatment. A new method of reconstruction by means of semitendinsous tenodesis was used in five patients with satisfactory end results after an average follow-up of 21.4 months. Limited clinical experience indicates that with this method less anteroposterior instability persists than with other methods.

An estimated 70,000 to 100,000 anterior cruciate ligament reconstructions are performed each year in the United States. With the increasing number of anterior cruciate ligament surgeries being performed, a concomitant increase in intraoperative complications can be expected. Complications include those associated with tunnel placement, notchplasty, graft fixation and advancement, suture laceration, graft laceration, guidewire insertion and removal, intra-articular hardware, posterior cruciate ligament laceration, compartment syndrome, and vascular injury.

Objectives : To evaluate the effect of KinesioTaping on knee joint proprioception of patient withreconstructed anterior cruciate ligament.Methods: Randomized trial, cross-­over study design, was done in Rehabilitation outpatient clinic, Soetomo General Hospital, Surabaya, on 9 isolated anterior cruciate ligament (ACL) patients, which hasunderwent ACL reconstruction procedure. Each patient will become control for themselves. Subjects were treated with standardized Kinesio Taping technique for anterior cruciate ligament injury in additionto standard rehabilitation program for anterior cruciate ligament reconstruction. Response to treatment was evaluated with two evaluations: 1) Joint position sense of the knee for predetermined angle (30°,45° and 60°) 2) Threshold to detect of passive knee motion on 90° moving into extension. Measurements were taken two times within 3 days of interval, with and without Kinesio Taping application. Errorof angular displacement of active angle reproduction (joint position sense) and threshold to detect of passive motion (TTDPM) were measured in three condition: before Kinesio Taping application, afterKinesio Taping application and without Kinesio Taping application. Results : Nine patients (mean age 20.33 ± 4.062 y) who had anterior cruciate ligament reconstruction were included for this study. There were no other knee ligament injuries.There were significant different in active angle reproduction (joint position sense) at 30° and 45° extension between affected and unaffected knee (p = .030 and p= .15 respectively). Kinesio Taping application showed significant effect in active angle reproduction at 30° of knee extension (p=0.028). There were no significant different in TTDPM between all condition. Conclusions: Kinesio Taping application improves active angle reproduction (joint position sense) at 30° of knee extension. There is no difference in joint position sense at 45° and 60° with Kinesio Tapingapplication. There is no difference in TTDPM in all condition.Keywords: Kinesio Taping, rehabilitation, knee joint proprioception, anterior cruciate ligament reconstruction.

The management of ruptures of the medial and cruciate ligaments of the knee is discussed. The importance of capsular damage and consequent rotational instability in combined ruptures of the medial and anterior cruciate ligament is emphasised. Direct suture repair of ruptured cruciate ligaments is often impossible, and intra-articular procedures to provide a replacement for the ligament are complicated and have proved disappointing.The importance of capsular laxity is emphasised and two new operations to correct this are described. One is a simple medial capsular advancement to correct minor rotational instability: the other is a reinforcement of the capsule with strips taken from each side of the ligamentum patellae. These operations are simple and initial results have been promising.

In thirty-eight dogs anterior cruciate repairs were performed and in twenty dogs anterior cruciate reconstructions using the iliotibial band were done. The results were studied for six months to four years postoperatively to determine tensile strength and microscopic anatomy. The results were as fol

A method of assessment of cases of rupture of the anterior cruciate ligament with a view to prescribing either surgical or conservative treatment is described. The results of treatment of the cases after such an assessment indicates that the majority of small dogs will recover to satisfactory function after 2 months enforced rest, but large breed and working dogs require surgical intervention for successful treatment. Resume. Les auteurs decrivent une methode propre a evaluer les ruptures du ligament cruci-forme anterieur en vue de prescrire soit l'intervention chirurgicale, soit le traitement conserva-teur. Les resultats therapeutiques obtenus sur la base de cette evaluation portent a conclure que chez le chien de petite taille, 2 mois de repos force permettent le plus souvent d'obtenir un retablissement fonctionnel satisfaisant, tandis que chez les chiens de grande taille et chiens d'utilite, l'intervention chirurgicale s'impose. Zusammenfassung. Es wird eine Methode zur klinischen Beurteilung von Fallen einer Ruptur des vorderen Kreuzbandes im Hinblick auf die Moglichkeit einer chirurgischen oder konservativen Behandlung beschrieben. Die Behandlungsergebnisse bei den Fallen nach einer solchen Beurteilung zeigen, dass die Mehrzahl von kleinen Hunden sich in 2 Monaten Zwangsruhe zu einer zufriedenstellenden Funktion erholt, grosse Rassen und Arbeitshunde aber einen chirurgischen Eingriff zur erfolgreichen Behandlung benotigen.

A histochemical study has been made of muscle biopsy material from 11 patients with injuries of the anterior cruciate ligament of the knee-joint. The material consists of 1 case of acute injury and 10 with long-standing injury. All biopsies were made from the vastus medialis. The muscle fibres were divided into two groups on the basis of staining reactions for myofibrillar ATPase and the groups were measured separately when assessing muscle fibre areas in cross section. Eight of the cases, with clinical evidence of muscular atrophy, showed marked differences in size between the red and white muscle fibres. These differences were expressed as a quotient between the mean value for cross-sectional area of the white and red fibres in each particular case. In these cases the quotients were 1.48-1.97. The red fibres exhibited a comparatively low mean value, which was interpreted as being due to selective atrophy of this group of fibres. The patient with an acute injury and two with more long-standing injury, all of whom lacked clinical signs of atrophy of the quadriceps, showed roughly equally-sized red and white fibres with quotients of 0.90-1.12. These size relationships conformed to those obtained in the normal quadriceps muscle. The results are discussed in relation to earlier and similar studies of muscle biopsy material obtained from patients with upper motor neurone lesions and Parkinsonism.

The anatomy, function, and surgical repair of the posteromedial capsular and ligamentous structures, called here the posterior oblique ligament, are described on the basis of anatomical dissections of seventeen amputated lower limbs and on the analysis of the operative findings and results of repair in fifty patients treated for ligament and capsular tears in the medial compartment. In addition, the anterior cruciate ligament was torn in some patients but not the posterior cruciate.

The anterior cruciate ligament was cut in ten dogs (unilaterally in nine, bilaterally in one). The dogs were killed in two groups, one at seven to nine months and the other at nineteen to twenty-three months. The dogs were clinically and roentgenographically examined at various intervals. At varying times before death they were given bone-seeking fluorochromes and necropsy was performed in all cases. Macroscopic, histological, and microroentgenographic examinations revealed proliferative and degenerative changes in the joints in which the anterior cruciate ligament was cut. These changes became increasingly severe for about a year. The osteophytes, which originated periarticularly, took part in remodeling of the condyles. The osteophytcs increased in size for about a year. There was persistent pain as long as marked instability remained. The knees became less unstable in time, apparently by means of an increase in the thickness of the joint capsule. Most of the clinical signs disappeared with decreasing instability. The conclusion was drawn that early stabilization is indicated in cases of rupture of the anterior cruciate ligament.

One hundred patients with instability of the knee-joint due to old rupture of the anterior cruciate ligament have been operated on. The injury was mostly acquired during athletics. Nineteen per cent of the cases had an isolated rupture of the anterior cruciate ligament. In the other cases there was either a rupture of the medial or lateral meniscus or an old rupture of the medial collateral ligament causing considerable abduction instability. Two patients had a rupture of the lateral collateral ligament. The medial third of the patellar tendon was transposed into the joint through a drill hole in the tibia. The end of the ligament was fastened in a drill hole on the inside of the lateral femoral condyle as near the posterior attachment of the anterior cruciate ligament as possible. The medial collateral ligament was sutured in most of the cases. All patients were examined clinically and 69 by arthrography about 6 months after the operation. The results were generally good with considerable improvement in the stability and function of the joint. Seventy per cent of the patients considered themselves completely cured and the remaining 30 per cent were better than before the operation. In 6 patients with new accidents 1–3 years after the operation, it was possible to inspect the transplanted ligament at arthrotomy. The ligament was functioning well. It was ensheathed by synovium, and blood-vessels were seen to enter from both ends.

— A review is presented of thirty cases, in the dog, where repair of rupture of the anterior cruciate ligament was undertaken using skin as a ligament substitution material. The results of this series are examined and the authors recommend the employment of whole thickness skin grafts for cruciate ligament replacement. Resume— Une etude est presentee de trente cas de reparation de la rupture du ligament croise anterieur chez le chien, utilisant la peau come materiel de substitution de tissu ligamentaire. Les resultats obtenus dans ce groupe sont etudies et les auteurs recommandent l'emploi de greffes de peau entiere pour le remplacement de ligaments croises. Zusammenfassung— Es werden dreissig Falle beschrieben, in denen bei Hunden ein Riss des vorderen Kreuzbandes unter Verwendung von Haut als Ligamenturnersatz ausgebessert wurde. Die Ergebnisse dieser Serie wurden untersucht, und die Autoren empfehlen, Hauttransplantate ganzer Dicke zur Ausbesserung des gerissenen Kreuzbandes zu verwenden.

1. The nature of flexion contractures of the knee joint is discussed. 2. It is suggested that division of the anterior cruciate ligament will help in the correction of the deformity when conservative methods have failed. 3. The results of the treatment of twelve such knees are mentioned and illustrative cases are described. 4. It must be emphasised that this method of treatment should be undertaken only when conservative methods have failed.

Forty-eight patients with suspected acute rupture of the anterior cruciate ligament were examined under anesthesia and by arthrography. Thirty-five had complete and thirteen had Partial ruptures of the cruciate ligament. Thirty-three patients with complete rupture were treated by suture and the rest by conservative measures. Arthrography performed by a special technique was found to be a very good method of diagnosing acute ruptures of the cruciate ligaments. If the arthrogram suggests a cruciate-ligament rupture, the injured joined should always be examined under anesthesia. The results of operative treatment to date have been excellent.

Five knees with congenital dislocation were explored. The cruciate ligaments were found to be absent or hypoplastic. The results obtained by reconstructing an anterior cruciate ligament appear to be good. On the basis of dissections of foetal knees we believe that the cruciate ligaments are the main structures preventing an anterior dislocation of the knee in early foetal life; this deviation from the adult pattern is due to the bony configuration of the foetal knee. We therefore postulate that the basic defect in congenital dislocation of the knee is an absence or hypoplasia of the cruciate ligaments.

A different method for anterior-cruciate ligament reconstruction is presented which utilizes the heavy segment of the iliotibial tract at its lower end (where the tract crosses from the femur to the tibia) for the intra-articular portion of the ligament. Eighteen patients treated by this operation, combined with medial-collateral ligament reconstruction, and eleven patients treated by anterior cruciate reconstruction alone were reviewed one to four and one-half years after operation. The over-all results seem to justify the procedure. The average degree of improvement of 2.2 was calculated on a scale of zero to 4.

Major improvement in the management of injuries to athletes can be assured by early diagnosis and prompt definitive treatment. Nowhere is this better illustrated than in the surgical management of serious injury to the medial collateral ligament, anterior cruciate ligament, and medial meniscus of the knee.

The effects of training in a running machine were studied on nineteen rabbits while seventeen of the same stock were used as controls. The rabbits were at the start of the training period about three months old and the mechanical tests were performed forty weeks later. Tensile strength and elasticity tests were performed on anterior cruciate ligaments from their knee joints utilizing the femur and the tibia as fixture points. It is concluded that the weakest point in the system of tibia-ligamentum cruciatum anterius—femur is one of the bony attachments and most often the tibial one. The energy required to break the system is increased by training and so are the maximun load and the deformation at that point. All these phenomena can be accounted for by strengthening of the bones. The elasticity tests, however, show a larger load-relaxation phenomenon in the ligaments from the trained animals and it occurs with a higher speed, indicating altered viscous properties. It is concluded that these changes must be qualitative changes occurring in the ligamentous tissue.

1. Arthrography of the knee is a valuable diagnostic procedure. In 225 consecutive knees examined and operated on by the same surgeon, the preoperative arthrograms, all performed and interpreted by the same radiologist, demonstrated meniscal tears correctly in 97.5 per cent of the 200 knees with such lesions, giving an accuracy of 99.7 per cent in the 143 lesions of the medial meniscus and of 93 per cent in the fifty-seven lesions of the lateral meniscus. Five tears found at operation were not demonstrated by arthrography, four in the lateral and one in the medial meniscus. In six patients, tears of both menisci, unsuspected on the basis of the clinical examination, were demonstrated correctly on the arthrograms. In no instance did an arthrogram indicate a tear in a meniscus which was not corroborated at surgery. In twenty-five patients with lesions other than meniscal tears, the arthrograms were helpful but not diagnostic for all types of lesions. 2. Prolonged observation and procrastination in the treatment of patients with symptomatic knees were avoided. The surgeon and patient were assured of a correct preoperative diagnosis, especially when the clinical signs were not specific and the symptoms were intermittent and not disabling. 3. Unnecessary surgery was reduced. 4. Arthrography revealed residual portions of the meniscus left after previous meniscectomy in eight patients, one of the retained fragments being itself torn. Reoperation resulted in cure in all eight patients. Osteochondral fractures were also demonstrated as well as loose fragments more than eight millimeters in diameter. 5. In this series, one-half of the thirty-four tears of the anterior cruciate ligament were demonstrated by arthrography. We are still developing the technique to demonstrate the cruciate ligaments on arthrograms. 6. Four patients with no anteroposterior instability were shown to have anterior cruciate tears by arthrography. 7. There were no complications of arthrography in this series. All patients returned to work immediately after the procedure.

Es wird uber 32 Patienten berichtet, bei denen ein plastischer Ersatz einer veralteten Kreuzbandruptur nach Bruckner durchgefuhrt wurde. Von 29 nachuntersuchten Patienten waren 14 zufrieden, 3 bedingt zufrieden und 12 unzufrieden. Eine Analyse der Grunde fur die Fehlergebnisse wird vorgenommen. Masgeblich erscheint einmal der Schweregrad der Verletzung, die Zeitdauer bis zur endgultigen operativen Versorgung und die damit verbundene Gonarthrose infolge einer pathologischen Roll-Gleit-Bewegung des Kniegelenkes zu sein. Zum anderen ist die optimale Transplantatlange ein wesentliches Problem, da lediglich in 13% der Falle die Lange des gestielten Transplantates ausreicht, um eine fur den ungestorten Bewegungsablauf erforderliche Verankerung am anatomischen Ansatz- und Ursprungsort des vorderen Kreuzbandes zu gewahrleisten. Durch die Entnahme des medialen Patellarsehnendrittels kann auserdem eine Storung der die Patella fuhrenden Zugkrafte entstehen. Die veranderten Druckverhaltnisse verursachen einen hoheren Flachenpresdruck im lateralen femoro-patellaren Gelenkanteil, rontgenologisch nachweisbar durch eine lokale Arthrose bzw. Subluxation der Patella. Wir glauben deshalb, die Kreuzbandplastik nach Bruckner durch Verwendung des mittleren Patellarsehnendrittels als freies Transplantat modifizieren zu mussen.

Over a period of 8 years 124 patients were operated upon for cruciate ligament injuries. Of these 17·7 per cent had isolated rupture of the anterior cruciate ligament and 51·6 per cent had complete rupture, together with partial rupture of the medial collateral ligament. About half the patients had an associated tear over the medial meniscus. Seventeen per cent had complete or partial rupture of the anterior cruciate and complete rupture of the medial collateral ligament. In 4·8 per cent there was complete rupture of the lateral ligament together with complete or partial rupture of the anterior cruciate. Six and a half per cent had complete rupture of the posterior cruciate, in some cases with associated rupture of the medial collateral ligament. There was complete dislocation of the knee in 2·4 per cent. The diagnosis and treatment are described and the results assessed at a follow-up time which averaged 3·1 years from the time of the accident. The indications for operations are discussed on the basis of these results.

J.H., a man aged 24 years, was knocked down by a car and admitted to hospital on January 13, 1961. His injuries were:a comminuted fracture of ,he mid-shaft of the right femur, an open comminuted fracture of the shaft of the right tibia, a fractured right fibula, a rupture of the anterior cruciate ligament of the right knee, and a fracture of the base of the terminal phalanx of the right hallux. His femur was reduced and immobilised on a splint on the day of admission. The following day an open reduction and screwing of the fractured right tibia

The five cases of the unstable knee due to old rupture of the anterior cruciate ligament and the medial collateral ligament were operated by following method;1) the tendon of the semitendinosus muscle was cutted out at proximally about 15cm length, 2) a hole was penetrated from the medial condyle of the femur—passed through the intercondyloideal fossa and further through the articural surface of the tibia—to part of the tuberositas tibiae cutted off previously, 3) the tendon as above mentioned was inserted in this hole and pull out to the tibia, 4) the tendon was tightly sutured and fixed to entrance and exit of this hole.Satisfactory results were obtained in our all cases.

Skin, fascia, and tendon are this tissues most commonly used as free autologous grafts for replacing the ligaments of the knee. We have little experience in the use of fascial and tendon grafts for this purpose, but for 20 years we have regularly employed autologous skin for the replacement or reinforcement of ligaments. We can therefore speak with some competence on the use of autologous skin as a material for grafts. In this contribution we shall, therefore, confine our remarks to the replacement of knee ligaments with autologous skin.

A survey of cadaver material was undertaken in order to determine the prevalence of arthritis of the canine stifle joint. One hundred and fifty unselected cadavers were obtained from veterinary practices for this purpose, and their stifle joints were radiographed and dissected to discover abnormalities. Thirty-one dogs (20 per cent) had stifle arthritis and in all except one the lesions were characteristic of osteoarthritis. In the exceptional case infection was the cause. A mechanical derangement was present in 20 of the 54 affected joints, in the form of rupture of the anterior cruciate ligament (10), meniscal tears (9) and patellar dislocation (1). The cause of the arthritis in the other 33 joints is unknown.

1. The anterior drawer is a test of anterior cruciate ligament integrity. 2. The anterior cruciate ligament is composed of two parts: the anteromedial band and the posterolater bulk. 3. The anteromedial band is the primary check against anterior drawer. 4. Other structures may contribute to the resistance of anterior drawer only if the anteromedial band has been injuried. 5. The posterior cruciate ligament is a check against posterior drawer. 6. In long term follow-up, the presence of anterior drawer is associated with poor overall results.

The basic principle of treatment of acute knee ligament injuries is the restoration and preservation of joint stability. Ligament healing must be accompanied by careful attention to the surrounding muscles. In each case the importance of the injured structure, the degree of injury, and the measures necessary to obtain rapid healing must be taken into careful consideration.

The assessment of an unstable knee and of the resulting handicap is governed by the demands made on the knee by the individual’s activities.

We use pedicled grafts almost exclusively for the replacement of ligaments in the knee. In our opinion they are almost ideal for this purpose [14]. The strong fascia lata, a large selection of tendons, and even the menisci are available. It is surprising that pedicled grafts were described and adopted later than other techniques [5].

In each of four dogs, teno-osseous autogenous grafts were used to reconstruct the anterior cruciate ligament. The transplanted strips first underwent ischemia and cellular death, with necrosis of both bone and tendon. Ingrowth of tissues then occurred rapidly, but complete incorporation of the tendon or the bone did not occur at one year. However, the tunnel-to transplant bone was functional and provided sufficient stability to the knee so that disruption of the reconstructed anterior cruciate ligament did not occur.

The mechanical properties of ligamentous tissue are described in a mechanical model consisting of idealized elements, the properties of which are discussed together with their mathematical equations. The model consists of two parts, one of which accounts for an initial building-up process. This method suggests a possibility for linking morphological structure and mechanical behavior although further research on the parameters of the model is required.