1
|
Yair N, Yiapanis C, Ben-Amotz R, Meiner Y, Shapiro A, Milgram J. Determination of Isometric Points in the Stifle of a Dog Using a 3D Model. Vet Comp Orthop Traumatol 2023; 36:324-330. [PMID: 37487532 DOI: 10.1055/s-0043-1771191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
OBJECTIVE The aim of this study was to develop a three-dimensional (3D) model to identify the isometric component of the cranial cruciate ligament (CCL) in dogs. METHODS A static 3D model of the specimen was generated from a computed tomography scan of the stifle of a dog and a kinematic model was generated from data collected, every 5 degrees from full extension (131 degrees) through 80 degrees of stifle flexion, from four sensors attached to the tibia. Kinematic data were superimposed on the static model by aligning the points of interest, which were defined for both models. This allowed the tibia to rotate and translate relative to the femur based on the kinematic data. The contours of the distal femur and proximal tibia were converted into point clouds and the distance between each point in the femoral point cloud and all the points in the tibial point cloud were measured at each of the 15 positions. The difference between the maximum and minimum distances for each pair of points was calculated, and when it was less than 0.2 mm, points were illustrated as two red dots connected by a line at their locations on the femur and tibia. RESULTS A total of 3,681 pairs of isometric points were identified and were located at the origin and insertion of the CCL and on the lateral aspect of the stifle. CONCLUSION Isometric areas are present at the origin and insertion of the CCL and lateral aspect of the stifle. Better understanding of these locations may lead to refinements in techniques to replace the ruptured CCL.
Collapse
Affiliation(s)
- Nadav Yair
- Koret School of Veterinary Medicine, Robert H Smith Faculty of Agriculture Food & Environment, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Ron Ben-Amotz
- Koret School of Veterinary Medicine, Robert H Smith Faculty of Agriculture Food & Environment, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yaron Meiner
- Department of Mechanical Engineering, Ben Gurion University of the Negev, Beersheba, Israel
| | - Amir Shapiro
- Department of Mechanical Engineering, Ben Gurion University of the Negev, Beersheba, Israel
| | - Joshua Milgram
- Koret School of Veterinary Medicine, Robert H Smith Faculty of Agriculture Food & Environment, Hebrew University of Jerusalem, Jerusalem, Israel
| |
Collapse
|
2
|
Beaulieu ML, Ashton-Miller JA, Wojtys EM. Loading mechanisms of the anterior cruciate ligament. Sports Biomech 2023; 22:1-29. [PMID: 33957846 PMCID: PMC9097243 DOI: 10.1080/14763141.2021.1916578] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/08/2021] [Indexed: 01/26/2023]
Abstract
This review identifies the three-dimensional knee loads that have the highest risk of injuring the anterior cruciate ligament (ACL) in the athlete. It is the combination of the muscular resistance to a large knee flexion moment, an external reaction force generating knee compression, an internal tibial torque, and a knee abduction moment during a single-leg athletic manoeuvre such as landing from a jump, abruptly changing direction, or rapidly decelerating that results in the greatest ACL loads. While there is consensus that an anterior tibial shear force is the primary ACL loading mechanism, controversy exists regarding the secondary order of importance of transverse-plane and frontal-plane loading in ACL injury scenarios. Large knee compression forces combined with a posteriorly and inferiorly sloped tibial plateau, especially the lateral plateau-an important ACL injury risk factor-causes anterior tibial translation and internal tibial rotation, which increases ACL loading. Furthermore, while the ACL can fail under a single supramaximal loading cycle, recent evidence shows that it can also fail following repeated submaximal loading cycles due to microdamage accumulating in the ligament with each cycle. This challenges the existing dogma that non-contact ACL injuries are predominantly due to a single manoeuvre that catastrophically overloads the ACL.
Collapse
Affiliation(s)
- Mélanie L. Beaulieu
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - James A. Ashton-Miller
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Edward M. Wojtys
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
3
|
Shi Q, Wang H, He K, Tao M, Cheng CK. Comparison of the morphology of the anterior cruciate ligament and related bony structures between pigs and humans. Front Vet Sci 2022; 9:1045785. [PMID: 36467640 PMCID: PMC9716283 DOI: 10.3389/fvets.2022.1045785] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/03/2022] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION Pigs are widely used for clinical research on the anterior cruciate ligament (ACL) because of the similarity of the knee structure to the human knee. But evidence to support the suitability of using porcine samples to guide clinical practices is limited. This study aims to explore the qualitative and quantitative morphological features of the porcine knee and ACL, and to compare these with data on humans reported in literature. METHODS Nineteen porcine knees were used for this study. The bone structures were measured on coronal X-ray images. The length of the ACL was measured using a caliper. The ACL bone insertion sites were marked and measured on a digital photograph. The lengths of the long and short axis of the ACL isthmus were measured on the X-ray microscopy reconstructed images. The outcomes were compared with previously reported data on humans using an abstract independent-samples T test. RESULTS Qualitative observation indicated a similar location, orientation and general morphology of the porcine ACL to human ACLs. The major difference was the location of the ACL tibial insertion with respect to the anterior horn of the lateral meniscus (AHLM). The porcine ACL was split into AM and PL bundles by the AHLM, while the AHLM was adjacent to the anterolateral border of the ACL tibial insertion in human knees. The quantitative comparison showed no significant difference between the human and porcine ACL in terms of the length of the ACL, the width of the femoral condyle and tibial plateau, and the tibial interspinal width. However, the CSA, the lengths of the long and short axis of the ACL isthmus, and the femoral and tibial insertion areas of the porcine ACL were all significantly larger than the reported features in human knees. CONCLUSION The location, orientation and basic morphology of the porcine ACL and knee are similar to humans. However, the two-bundle structure is more distinct in a porcine ACL, and the dimensions of the porcine ACL are generally larger. This study may provide useful information to researchers when assessing the feasibility and limitations of using porcine samples for research on the human ACL and knee.
Collapse
|
4
|
Bascuñán A, Soula M, Millar KK, Biedrzycki A, Banks SA, Lewis DD, Kim SE. In vivo three-dimensional knee kinematics in goats with unilateral anterior cruciate ligament transection. J Orthop Res 2021; 39:1052-1063. [PMID: 32633844 DOI: 10.1002/jor.24795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 04/10/2020] [Accepted: 06/25/2020] [Indexed: 02/04/2023]
Abstract
Although the goat is an established animal model in anterior cruciate ligament (ACL) research, in vivo kinematics associated with ACL deficiency have not been previously described in this species. Three-dimensional knee kinematics were determined before and after unilateral ACL transection in eight goats. Fluoroscopic imaging of the knees during treadmill walking and force-platform gait analysis during over-ground walking were performed prior to ACL transection, and 2 weeks, 3 months, and 6 months after ACL transection. Transient lameness of the ACL-transected limb was noted in all goats but resolved by 3 months post-ACL transection. Increased extension of 8.7° to 17.0° was noted throughout the gait cycle in both the ACL-transected and the contralateral unaffected knees by 3 months post-ACL transection, in a bilaterally symmetric pattern. Peak anterior tibial translation increased by 3 to 6 mm after ACL transection and persisted over the 6-month study period. No changes in axial rotation or abduction angle were observed after ACL transection. Unilateral ACL deficiency in goats resulted in persistent kinematic alterations, despite the resolution of lameness by 3 months post-ACL transection.
Collapse
Affiliation(s)
- Ana Bascuñán
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Mariajesus Soula
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Kristina K Millar
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Adam Biedrzycki
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Scott A Banks
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, Florida
| | - Daniel D Lewis
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Stanley E Kim
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| |
Collapse
|
5
|
Kohn L, Rembeck E, Rauch A. [Anterior cruciate ligament injury in adults : Diagnostics and treatment]. DER ORTHOPADE 2020; 49:1013-1028. [PMID: 33084915 PMCID: PMC7653792 DOI: 10.1007/s00132-020-03997-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The anterior cruciate ligament (ACL) together with the posterior cruciate ligament is the central stabilizer of the knee. It stabilizes the tibia against increased anterior translation and internal rotation. With an incidence of 46/100,000 ACL tears are among the most common sports injuries in Germany. New prevention programs can reduce the risk of ACL injuries. Surgical treatment is recommended for young and athletic patients as it can also reduce the risk of further relevant injuries of the meniscus and cartilage. The standard of surgical treatment in Germany is the ACL reconstruction with an autologous tendon graft. In selected cases, the preservation of the ACL by arthroscopic refixation shows good results. Instead of the previously used purely time-based rehabilitation, function-based criteria are increasingly being included in the aftercare.
Collapse
Affiliation(s)
- L Kohn
- Klinik für Unfallchirurgie und Orthopädie, Krankenhaus Landshut-Achdorf, Landshut, Deutschland
| | - E Rembeck
- Sporttraumatologie und Kniechirurgie, ATOS-Klinik München, ECOM - Praxis für Orthopädie, Sportmedizin & Unfallchirurgie, München, Deutschland
| | - A Rauch
- Sporttraumatologie und Kniechirurgie, ATOS-Klinik München, ECOM - Praxis für Orthopädie, Sportmedizin & Unfallchirurgie, München, Deutschland.
| |
Collapse
|
6
|
Bascuñán AL, Biedrzycki A, Banks SA, Lewis DD, Kim SE. Large Animal Models for Anterior Cruciate Ligament Research. Front Vet Sci 2019; 6:292. [PMID: 31555675 PMCID: PMC6727067 DOI: 10.3389/fvets.2019.00292] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/15/2019] [Indexed: 12/13/2022] Open
Abstract
Large animal (non-rodent mammal) models are commonly used in ACL research, but no species is currently considered the gold standard. Important considerations when selecting a large animal model include anatomical differences, the natural course of ACL pathology in that species, and biomechanical differences between humans and the chosen model. This article summarizes recent reports related to anatomy, pathology, and biomechanics of the ACL for large animal species (dog, goat, sheep, pig, and rabbit) commonly used in ACL research. Each species has unique features and benefits as well as potential drawbacks, which are highlighted in this review. This information may be useful in the selection process when designing future studies.
Collapse
Affiliation(s)
- Ana Luisa Bascuñán
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Adam Biedrzycki
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Scott A Banks
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, United States
| | - Daniel D Lewis
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Stanley E Kim
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| |
Collapse
|
7
|
Quiles C, Constantino JA, Gañán Y, Macías D, Quiles M. Stereophotogrammetric surface anatomy of the anterior cruciate ligament's tibial footprint: Precise osseous structure and distances to arthroscopically-relevant landmarks. Knee 2018; 25:531-544. [PMID: 29705076 DOI: 10.1016/j.knee.2018.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 01/16/2018] [Accepted: 03/27/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND While femoral tunnel malposition is widely recognized as the main technical error of failed anterior cruciate ligament (ACL) surgery, tibial tunnel malposition is likely underrecognized and underappreciated. PURPOSE To describe more precisely the qualitative and quantitative anatomy of the ACL's tibial attachment in vitro using widely available technology for stereophotogrammetric surface reconstruction, and to test its applicability in vivo. METHODS Stereophotogrammetric surface reconstruction was obtained from fourteen proximal tibias of cadaver donors. Measurements of areas and distances from the center of the ACL footprint and the footprint of the obtained bundles to selected arthroscopically-relevant anatomic landmarks were carried out using a three-dimensional design software program, and means and 95% confidence intervals were calculated for these measurements. Reference landmarks were tested in three-dimensional models obtained with arthroscopic videos. MAIN FINDINGS The osseous footprint of the ACL was described in detail, including its precise elevated limits, size, and shape, with its elevation pattern described as a quarter-turn-staircase-like ridge. Its internal indentations were related to inter-spaces identified as bundle divisions. Distances from the footprint center to arthroscopically relevant landmarks were obtained and compared to its internal structure, yielding a useful X-like landmark pointing to the most accurate placeholder for the ACL footprint's "anatomic" center. Certain structures and reference landmarks described were readily recognized in three-dimensional models from arthroscopic videos. CONCLUSIONS Stereophotogrammetric surface reconstruction is an accessible technique for the investigation of anatomic structures in vitro, offering a detailed three-dimensional depiction of the ACL's osseous footprint.
Collapse
Affiliation(s)
- Carlos Quiles
- Department of Orthopaedic Surgery and Traumatology, University Hospital Infanta Cristina, Badajoz 06080, Spain.
| | - Juan A Constantino
- Department of Orthopaedic Surgery and Traumatology, University Hospital Infanta Cristina, Badajoz 06080, Spain; Department of Medico-Surgical Therapy, University of Extremadura, Badajoz 06080, Spain.
| | - Yolanda Gañán
- Department of Anatomy, Cell Biology, and Zoology, University of Extremadura, Badajoz 06080, Spain.
| | - Domingo Macías
- Department of Anatomy, Cell Biology, and Zoology, University of Extremadura, Badajoz 06080, Spain.
| | - Manuel Quiles
- Department of Orthopaedic Surgery and Traumatology, University Hospital Infanta Cristina, Badajoz 06080, Spain; Department of Medico-Surgical Therapy, University of Extremadura, Badajoz 06080, Spain.
| |
Collapse
|
8
|
Yapici C, Surer L, Keklikci K, Shi D, Sabzevari S, Linde MA, Smolinski P, Fu FH. Anatomic and non-anatomic anterior cruciate ligament posterolateral bundle augmentation affects graft function. Knee Surg Sports Traumatol Arthrosc 2018; 26:1343-1348. [PMID: 28756466 DOI: 10.1007/s00167-017-4659-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/24/2017] [Indexed: 01/16/2023]
Abstract
PURPOSE The purpose of this study is to compare knee laxity and graft function (tissue force) between anatomic and non-anatomic posterolateral (PL) bundle augmentation. METHODS Twelve (n = 12) fresh-frozen mature, unpaired porcine knees were tested using a robotic testing system. Four knee states were compared: (a) intact anterior cruciate ligament (ACL), (b) deficient PL and intermediate bundles, (c) anatomic PL augmentation, and (d) non-anatomic PL augmentation. Anterior tibial translation (ATT), internal rotation (IR) and external rotation (ER), and the in situ tissue force were measured under an 89.0-N anterior tibial load and 4.0-N m internal and external tibial torques. RESULTS Both anatomic and non-anatomic PL augmentation restored the ER, IR, and ATT of the intact knee at all knee flexion angles (n.s.). Both anatomic and non-anatomic PL augmentation restored the in situ tissue force of the ACL during ER and IR loading and ATT loading at all knee flexion angles except at 60° of knee flexion, where the non-anatomic PL augmentation did not restore the in situ tissue force of the ACL during external rotation loading and the anatomic PL augmentation did not restore the in situ tissue force of the ACL during IR loading. Furthermore, there were no differences in ATT, IR, ER, and in situ tissue force under anterior tibial loading, IR and ER loading between the two reconstruction groups. CONCLUSION There were no significant differences between anatomic and non-anatomic PL augmentation using the porcine knee model.
Collapse
Affiliation(s)
- Can Yapici
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA.,Department of Orthopedics, Via Hospital Group, Istanbul, Turkey
| | - Levent Surer
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA.,Department of Orthopedics, Acibadem Hospital Group, Mugla, Turkey
| | - Kenan Keklikci
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Dongliang Shi
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Soheil Sabzevari
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA.,Department of Orthopedic Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Monica A Linde
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Patrick Smolinski
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA.,Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA. .,Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
9
|
Emami A, Tepper J, Short B, Yaksh TL, Bendele AM, Ramani T, Cisternas AF, Chang JH, Mellon RD. Toxicology Evaluation of Drugs Administered via Uncommon Routes: Intranasal, Intraocular, Intrathecal/Intraspinal, and Intra-Articular. Int J Toxicol 2017; 37:4-27. [PMID: 29264927 DOI: 10.1177/1091581817741840] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
As the need for nasal, ocular, spinal, and articular therapeutic compounds increases, toxicology assessments of drugs administered via these routes play an important role in human safety. This symposium outlined the local and systemic evaluation to support safety during the development of these drugs in nonclinical models with some case studies. Discussions included selection of appropriate species for the intended route; conducting nonclinical studies that closely mimic the intended use with adequate duration; functional assessment, if deemed necessary; evaluation of local tissues with special histological staining procedure; and evaluations of safety margins based on local and systemic toxicity.
Collapse
Affiliation(s)
- Armaghan Emami
- 1 US Food and Drug Administration, Silver Spring, MD, USA
| | - Jeff Tepper
- 2 Tepper Nonclinical Consulting, San Carlos, CA, USA
| | - Brian Short
- 3 Brian Short Consulting, LLC, Trabuco Canyon, CA, USA
| | - Tony L Yaksh
- 4 Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA
| | | | | | | | - Jay H Chang
- 1 US Food and Drug Administration, Silver Spring, MD, USA
| | | |
Collapse
|
10
|
Cone SG, Warren PB, Fisher MB. Rise of the Pigs: Utilization of the Porcine Model to Study Musculoskeletal Biomechanics and Tissue Engineering During Skeletal Growth. Tissue Eng Part C Methods 2017; 23:763-780. [PMID: 28726574 PMCID: PMC5689129 DOI: 10.1089/ten.tec.2017.0227] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 07/14/2017] [Indexed: 12/17/2022] Open
Abstract
Large animal models play an essential role in the study of tissue engineering and regenerative medicine (TERM), as well as biomechanics. The porcine model has been increasingly used to study the musculoskeletal system, including specific joints, such as the knee and temporomandibular joints, and tissues, such as bone, cartilage, and ligaments. In particular, pigs have been utilized to evaluate the role of skeletal growth on the biomechanics and engineered replacements of these joints and tissues. In this review, we explore the publication history of the use of pig models in biomechanics and TERM discuss interspecies comparative studies, highlight studies on the effect of skeletal growth and other biological considerations in the porcine model, and present challenges and emerging opportunities for using this model to study functional TERM.
Collapse
Affiliation(s)
- Stephanie G. Cone
- Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
| | - Paul B. Warren
- Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
| | - Matthew B. Fisher
- Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
- Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| |
Collapse
|
11
|
Variation in the shape of the tibial insertion site of the anterior cruciate ligament: classification is required. Knee Surg Sports Traumatol Arthrosc 2017; 25:2428-2432. [PMID: 26658565 DOI: 10.1007/s00167-015-3891-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To propose a classification system for the shape of the tibial insertion site (TIS) of the anterior cruciate ligament (ACL) and to demonstrate the intra- and inter-rater agreement of this system. Due to variation in shape and size, different surgical approaches may be feasible to improve reconstruction of the TIS. METHODS One hundred patients with a mean age of 26 ± 11 years were included. The ACL was cut arthroscopically at the base of the tibial insertion site. Arthroscopic images were taken from the lateral and medial portal. Images were de-identified and duplicated. Two blinded observers classified the tibial insertion site according to a classification system. RESULTS The tibial insertion site was classified as type I (elliptical) in 51 knees (51 %), type II (triangular) in 33 knees (33 %) and type III (C-shaped) in 16 knees (16 %). There was good agreement between raters when viewing the insertion site from the lateral portal (κ = 0.65) as well as from the medial portal (κ = 0.66). Intra-rater reliability was good to excellent. Agreement in the description of the insertion site between the medial and lateral portals was good for rater 1 and good for rater 2 (κ = 0.74 and 0.77, respectively). CONCLUSION There is variation in the shape of the ACL TIS. The classification system is a repeatable and reliable tool to summarize the shape of the TIS using three common patterns. For clinical relevance, different shapes may require different types of reconstruction to ensure proper footprint restoration. Consideration of the individual TIS shape is required to prevent iatrogenic damage of adjacent structures like the menisci. LEVEL OF EVIDENCE III.
Collapse
|
12
|
An anatomic and histologic study of the origin and terminal points in the anterior and posterior cruciate ligaments in rats. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
13
|
Ingham SJM, de Carvalho RT, Martins CAQ, Lertwanich P, Abdalla RJ, Smolinski P, Lovejoy CO, Fu FH. Anterolateral ligament anatomy: a comparative anatomical study. Knee Surg Sports Traumatol Arthrosc 2017; 25:1048-1054. [PMID: 26713325 DOI: 10.1007/s00167-015-3956-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/15/2015] [Indexed: 01/24/2023]
Abstract
PURPOSE Some anatomical studies have indicated that the anterolateral ligament (ALL) of the knee is distinct ligamentous structure in humans. The purpose of this study is to compare the lateral anatomy of the knee among human and various animal specimens. METHODS Fifty-eight fresh-frozen knee specimens, from 24 different animal species, were used for this anatomical study. The same researchers dissected all the specimens in this study, and dissections were performed in a careful and standardized manner. RESULTS An ALL was not found in any of the 58 knees dissected. Another interesting finding in this study is that some primate species (the prosimians: the red and black and white lemurs) have two LCLs. CONCLUSION The clinical relevance of this study is the lack of isolation of the ALL as a unique structure in animal species. Therefore, precaution is recommended before assessing the need for surgery to reconstruct the ALL as a singular ligament.
Collapse
Affiliation(s)
- Sheila Jean McNeill Ingham
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, suite #1011, Pittsburgh, PA, 15213-3221, USA.,Department of Orthopaedic Surgery, Federal University of São Paulo, São Paulo, SP, Brazil
| | | | - Cesar A Q Martins
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, suite #1011, Pittsburgh, PA, 15213-3221, USA
| | - Pisit Lertwanich
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, suite #1011, Pittsburgh, PA, 15213-3221, USA.,Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rene Jorge Abdalla
- Department of Orthopaedic Surgery, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Patrick Smolinski
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - C Owen Lovejoy
- Department of Anthropology, School of Biomedical Sciences, Kent State University, Kent, OH, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, suite #1011, Pittsburgh, PA, 15213-3221, USA. .,Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
14
|
YAMAKAWA S, DEBSKI RE, FUJIE H. Strain distribution in the anterior cruciate ligament in response to anterior drawer force to the knee. ACTA ACUST UNITED AC 2017. [DOI: 10.1299/jbse.16-00582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Richard E. DEBSKI
- Departments of Bioengineering and Orthopaedic Surgery University of Pittsburgh
| | - Hiromichi FUJIE
- Graduate School of System Design Tokyo Metropolitan University
| |
Collapse
|
15
|
Skelley NW, Castile RM, York TE, Gruev V, Lake SP, Brophy RH. Differences in the microstructural properties of the anteromedial and posterolateral bundles of the anterior cruciate ligament. Am J Sports Med 2015; 43:928-36. [PMID: 25634908 DOI: 10.1177/0363546514566192] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tissue properties of the anteromedial (AM) and posterolateral (PL) bundles of the anterior cruciate ligament (ACL) have not been previously characterized with real-time dynamic testing. The current study used a novel polarized light technique to measure the material and microstructural properties of the ACL. HYPOTHESIS The AM and PL bundles of the ACL have similar material and microstructural properties. STUDY DESIGN Controlled laboratory study. METHODS The AM and PL bundles were isolated from 16 human cadaveric ACLs (11 male, 5 female; average age, 41 years [range, 24-53 years]). Three samples from each bundle were loaded in uniaxial tension, and a custom-built polarized light imaging camera was used to quantify collagen fiber alignment in real time. A bilinear curve fit was applied to the stress-strain data of a quasistatic ramp-to-failure to quantify the moduli in the toe and linear regions. Fiber alignment was quantified at zero strain, the transition point of the bilinear fit, and in the linear portion of the stress-strain curve by computing the degree of linear polarization (DoLP) and angle of polarization (AoP), which are measures of the strength and direction of collagen alignment, respectively. Data were compared using t tests. RESULTS The AM bundle exhibited significantly larger toe-region (AM 7.2 MPa vs. PL 4.2 MPa; P < .001) and linear-region moduli (AM 27.0 MPa vs. PL 16.1 MPa; P = .017) compared with the PL bundle. Average DoLP values were similar at low strain but were significantly larger (ie, more uniform alignment) for the AM bundle in the linear region of the stress-strain curve (AM 0.22 vs. PL 0.19; P = .036) compared with the PL bundle. The standard deviation AoP values was larger for the PL bundle at both transition (P = .041) and linear-region strain (P = .014), indicating more disperse orientation. CONCLUSION Material and microstructural properties of the AM and PL bundles of the ACL differ during loading. The AM bundle possessed higher tissue modulus and failure stress, as well as more uniform fiber alignment under load. CLINICAL RELEVANCE These insights into native ligament microstructure can be used to assess graft options for ACL reconstruction and optimize surgical reconstruction techniques.
Collapse
Affiliation(s)
- Nathan W Skelley
- Department of Orthopaedic Surgery, Barnes-Jewish Hospital/Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Ryan M Castile
- Department of Computer Science & Engineering, Washington University in St Louis, St Louis, Missouri, USA
| | - Timothy E York
- Department of Computer Science & Engineering, Washington University in St Louis, St Louis, Missouri, USA
| | - Viktor Gruev
- Department of Computer Science & Engineering, Washington University in St Louis, St Louis, Missouri, USA
| | - Spencer P Lake
- Department of Orthopaedic Surgery, Barnes-Jewish Hospital/Washington University in St Louis School of Medicine, St Louis, Missouri, USA Department of Mechanical Engineering and Material Science, Washington University in St Louis, St Louis, Missouri, USA
| | - Robert H Brophy
- Department of Orthopaedic Surgery, Barnes-Jewish Hospital/Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| |
Collapse
|
16
|
Triantafyllidi E, Paschos NK, Goussia A, Barkoula NM, Exarchos DA, Matikas TE, Malamou-Mitsi V, Georgoulis AD. The shape and the thickness of the anterior cruciate ligament along its length in relation to the posterior cruciate ligament: a cadaveric study. Arthroscopy 2013; 29:1963-73. [PMID: 24286796 DOI: 10.1016/j.arthro.2013.09.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 09/12/2013] [Accepted: 09/12/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the shape of the native anterior cruciate ligament (ACL) along its length in relation to the posterior cruciate ligament (PCL) and compare it with the size of the 3 commonly used autografts (bone-patellar tendon-bone [BPTB], single-bundle hamstring, and double-bundle hamstring). METHODS With the knee in extension, we filled the intercondylar notch with paraffin, fixing the cruciate ligaments in their natural position, in 8 cadaveric specimens. The ACL-PCL tissue specimen, embedded in paraffin, was removed en bloc. Gross sections were prepared in the coronal plane and were evaluated histologically. The width, thickness, and cross-sectional area of both the ACL and PCL were determined. The dimensions of the semitendinosus tendon (ST), gracilis tendon (GT), and BPTB grafts were measured and compared with those of the native ACL. RESULTS The PCL occupies the largest part of the intercondylar area, leaving only a small space for the ACL in knee extension. The ACL midsubstance has a width of 5 mm, resembling a band shape. Only before its tibial insertion does the ACL fan out and take the form of its tibial attachment. The BPTB graft has a thickness of 5.8 mm, whereas the ST and GT grafts have a thickness of 6.25 mm and 4.5 mm, respectively, and are comparable to the midsubstance of the ACL but undersized in the tibial insertion (P = .0016 for BPTB graft, P = .002 for ST graft, and P = .0003 for GT graft). A quadruple-looped ST-GT graft, with a diameter of 8 mm, is oversized in the midsubstance (P = .0002) but fits better in the tibial attachment. CONCLUSIONS The ACL midsubstance has a width of 5 mm, resembling a band shape. Before its tibial insertion, the ACL fans out like a trumpet, taking the form of its wide tibial attachment. CLINICAL RELEVANCE The dimensions of the native ACL have to be considered in graft selection for anatomic ACL reconstruction.
Collapse
Affiliation(s)
- Eleni Triantafyllidi
- Orthopaedic Sports Medicine Center of Ioannina, Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
| | | | | | | | | | | | | | | |
Collapse
|