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Iwanaga J, Kikuchi K, Tabuchi K, Dave M, Anbalagan M, Fukino K, Kitagawa N, Reina MA, Reina F, Carrera A, Nonaka T, Rajaram-Gilkes M, Khalil MK, Matsushita Y, Tubbs RS. A histology guide for performing human cadaveric studies: SQIP 2024 what to look for with light microscopy. Clin Anat 2024; 37:555-562. [PMID: 38469731 DOI: 10.1002/ca.24156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/24/2024] [Accepted: 02/29/2024] [Indexed: 03/13/2024]
Abstract
Histological observation under light microscopy has long been used in human cadaveric studies. However, it can distort the interpretations of findings if not used appropriately; there is no guide for its proper use. The aim of this article is to revisit and discuss the correct use of histology in human cadaveric studies, following discussions with experts in multiple fields of medicine, and to create the first guide for such usage. We reached a consensus with the experts, agreeing that when this principle (structure, quantification, interaction, position: SQIP) is applied to histological observations, the findings will be interpreted correctly. Appropriate use of this recommendation can make human cadaveric studies more accurate and informative. This is the first histology guide for human cadaveric studies.
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Affiliation(s)
- Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
- Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Keishiro Kikuchi
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kosuke Tabuchi
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Mitesh Dave
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Muralidharan Anbalagan
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Keiko Fukino
- Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Norio Kitagawa
- Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Miguel A Reina
- CEU-San Pablo University School of Medicine, Department of Anesthesiology, Madrid-Montepríncipe University Hospital, Madrid, Spain
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Francisco Reina
- Medical Sciences Department, Clinical Anatomy, Embryology and Neuroscience Research Group (NEOMA), Faculty of Medicine, University of Girona, Girona, Spain
| | - Ana Carrera
- Medical Sciences Department, Clinical Anatomy, Embryology and Neuroscience Research Group (NEOMA), Faculty of Medicine, University of Girona, Girona, Spain
| | - Taichiro Nonaka
- Department of Cellular Biology and Anatomy, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
- Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Mathangi Rajaram-Gilkes
- Anatomical Sciences, Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Mohammed K Khalil
- Biomedical Sciences, University of South Carolina, School of Medicine Greenville, Greenville, South Carolina, USA
| | - Yuki Matsushita
- Department of Cell Biology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- University of Queensland, Brisbane, Queensland, Australia
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Totlis T, Tishukov M, Piagkou M, Vasiliadis AV, Tsiouris C, Domashenko P, Tsakotos G, Natsis K. The Anterolateral Ligament of the Knee Is a Nonisometric Thin Ligament With High Prevalence and Almost Constant Attachment to the Lateral Meniscus: A Systematic Review With Meta-analysis. Arthroscopy 2024; 40:1288-1299. [PMID: 37832743 DOI: 10.1016/j.arthro.2023.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 09/23/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE To provide comprehensive information about the anterolateral ligament (ALL) prevalence, morphometry, isometry, insertions, histology, and its relationship with the lateral meniscus (LM). METHODS The study was performed, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Eligible cadaveric studies investigating the frequency of the ALL presence, and anatomical features were identified through an online search of the PubMed, Scopus, and Cochrane Central databases from inception to June 2022. Statistical analysis was conducted with the open-source R programming language using the "meta" package. The Higgins I2 statistic was used for quantifying heterogeneity. RESULTS Thirty-three studies (1,478 cadaveric knees) were included. The ALL had a 79% prevalence. It was attached to the LM periphery in 97% of studies. Most studies reported a femoral insertion of the ALL, just proximal and posterior to the lateral epicondyle. Tibial attachment is constant at the midpoint between Gerdy's tubercle and fibular head. The mean ALL thickness at the joint line was 1.6 [1.2; 2.0] mm. The ALL length was found to significantly change across the knee flexion (P < .01). It was increased from 0° to 60° and decreased after 60° flexion. Seven histological studies demonstrated a typical ligamentous microstructure. CONCLUSION The ALL is a thin ligament, distinct to the knee capsule, which may be found in 79% of the knees having an almost constant attachment to the LM. The ALL is not isometric. It becomes tense during internal rotation and between 30° and 60° knee flexion. Pooled results should be interpreted with caution due to the high heterogeneity among the included studies. CLINICAL RELEVANCE This study sheds light on controversial issues and provides comprehensive and accurate information about the essential anatomical knowledge on ALL, which may contribute to optimizing ALL reconstruction surgical techniques and biomechanical settings.
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Affiliation(s)
- Trifon Totlis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece; Thessaloniki Minimally Invasive Surgery (TheMIS) Orthopaedic Center, St. Luke's Hospital, Thessaloniki, Greece.
| | - Maksim Tishukov
- Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Angelo V Vasiliadis
- Sports Trauma and Orthopaedics Department, St. Luke's Hospital, Thessaloniki, Greece
| | - Christos Tsiouris
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Philip Domashenko
- Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Tsakotos
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Natsis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Murgier J, Duthon V, Deygas A, Ehkirch FP. Does an early post traumatic knee brace reduce the incidence of knee rotational instability? Arch Orthop Trauma Surg 2024; 144:1161-1169. [PMID: 38253710 DOI: 10.1007/s00402-024-05206-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
PURPOSE Several anterolateral stabilization procedures have been developed recently to address rotational instability of the knee. Currently, these procedures tend to be systematically used by some practitioners. However, antero-lateral structures of the knee (including the anterolateral ligament, ALL) have a self-healing potential which can reduce the need to perform an antero-lateral procedure. In this study, it was hypothesized that early post-traumatic immobilization of the knee with a knee brace would allow partial healing of antero-lateral structures and also allow control of the pivot shift, thus avoiding antero-lateral extra-articular stabilization. The objective of this study was to compare the severity of pivot shift between two groups of patients who all experienced anterior cruciate ligament (ACL) tear and respectively underwent post-traumatic immobilization of the knee versus no immobilization. METHODS This was a comparative, multicentric (three centers' study) retrospective, consecutive study including 168 patients who underwent ACL reconstruction between May and September 2022. The application or not of post-traumatic immobilization and its duration, the severity of pivot shift observed in the operating room under general anesthesia, the presence of anterolateral lesions as revealed by MRI and the patients' pre-injury sport activity were recorded. RESULTS A grade 3 pivot shift was found in 44 patients (27%). It was more frequently observed in the group without a brace compared to the group with a knee brace (18 patients out of 36: 50% versus 26 patients out of 132: 19.7%; p = 0.0012). Wearing a brace, whether hinged (OR = 0.221, [0.070-0.652]; p = 0.006) or not (OR = 0.232, [0.076-0.667]; p = 0.0064), was protective from the risk of developing a significant pivot shift. CONCLUSION This study demonstrated that the presence of pivot-shift was lower in the patients that had an early post-injury knee brace before their ACL reconstruction. Based on this result, systematic brace placement could be advocated for in patients after knee trauma. LEVEL OF EVIDENCE III, prognostic retrospective case-control study.
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Affiliation(s)
- Jérôme Murgier
- Orthopedics Department, Aguiléra Clinic, 21 Rue de L'Estagnas, 64200, Biarritz, France.
| | - Victoria Duthon
- Centre de Médecine du Sport et de L'Exercice, Swiss Olympic Medical Center, Hirslanden Clinique La Colline, Geneva, Switzerland
| | - Aymeric Deygas
- Orthopaedic Department, Clinique Maussins-Nollet, Paris, France
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Stordeur A, Grange S, Servien E, Blache Y, Klasan A, Putnis SE, Boyer B, Farizon F, Philippot R, Neri T. Optimal Combination of Femoral Tunnel Orientation in Anterior Cruciate Ligament Reconstruction Using an Inside-out Femoral Technique Combined With an Anterolateral Extra-articular Reconstruction. Am J Sports Med 2022; 50:1205-1214. [PMID: 35244477 DOI: 10.1177/03635465221078326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The optimal orientation of the anterolateral extra-articular reconstruction (ALLR) femoral tunnel to avoid collision with the anterior cruciate ligament reconstruction (ACLR) femoral tunnel is not clearly defined in the literature. PURPOSE To define the optimal combination of orientations of the ALLR femoral tunnel and the ACLR femoral tunnel using an inside-out technique to minimize risk of collision between these tunnels. STUDY DESIGN Descriptive laboratory study. METHODS Three-dimensional reconstruction of magnetic resonance imaging scans of 40 knees after an isolated ACLR with an inside-out femoral technique was used to assess the collision risk between ACLR and virtual ALLR tunnels. The optimal ACLR tunnel orientation was defined as having the safest distance from the ALLR tunnel. A second collision analysis was performed on all patients presenting with an optimal orientation of the ACLR tunnel to then define the optimal ALLR tunnel orientation. The potential for trochlear damage was also studied. A collision risk of 0% to 5% was considered acceptable and referred to as "low risk." RESULTS The only ALLR tunnel orientation presenting a low risk of collision with the ACLR tunnel was with an axial angle of 40° anteriorly and a coronal angle of 0°. This orientation presented a 48% risk of trochlear damage with the guide wire of the ALLR tunnel. The more posterior the orientation of the ACLR, the larger the distance from the ALLR tunnel. Among the 22 patients presenting with an optimal ACLR tunnel (alpha angle superior to 40°), the ALLR tunnels aimed with 1 of these 3 orientations presented a low risk of tunnel collision and trochlear damage: 40° axial and 10° coronal, 35° axial and 5° coronal, or 30° axial and 0° coronal. CONCLUSION/CLINICAL RELEVANCE To minimize risk of tunnel collision or trochlear damage when combining an inside-out ACLR with an ALLR, the ACLR tunnel should be performed with a posterior orientation (alpha angle >40°), and the ALLR tunnel should be aimed with 1 of 3 orientations: 40° axial and 10° coronal, 35° axial and 5° coronal, or 30° axial and 0° coronal.
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Affiliation(s)
- Alban Stordeur
- Department of Orthopaedic Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Sylvain Grange
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Elvire Servien
- Hopital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Yoann Blache
- Laboratoire interuniversitaire de biologie de la motricité, Université de Lyon, Lyon, France
| | - Antonio Klasan
- Sydney Orthopaedic Research Institute, Chatswood, Australia
| | - Sven E Putnis
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - Bertrand Boyer
- Department of Orthopaedic Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Frédéric Farizon
- Department of Orthopaedic Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Rémi Philippot
- Department of Orthopaedic Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Thomas Neri
- Department of Orthopaedic Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
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Ferretti A, Monaco E, Redler A. The Segond's fracture and the anterolateral ligament. J Anat 2021; 239:1239-1240. [PMID: 34164812 PMCID: PMC8546511 DOI: 10.1111/joa.13494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/09/2021] [Indexed: 11/28/2022] Open
Abstract
The study of Mullins et al. reasonably explains how the Segond's fracture is probably the most frequent avulsion fracture of the tibia plateau, but it does not challenge the hypothesis of the existence of a discrete ligament (the ALL) strong enough to sometimes pull out its bony insertion as a result of a forced internal rotation and of an ACL failure.
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Affiliation(s)
- Andrea Ferretti
- Orthopaedic Unit and Kirk Kilgour Sports Injury CentreS. Andrea HospitalUniversity of Rome SapienzaRomeItaly
| | - Edoardo Monaco
- Orthopaedic Unit and Kirk Kilgour Sports Injury CentreS. Andrea HospitalUniversity of Rome SapienzaRomeItaly
| | - Andrea Redler
- Orthopaedic Unit and Kirk Kilgour Sports Injury CentreS. Andrea HospitalUniversity of Rome SapienzaRomeItaly
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Ramp Lesions of the Posterior Segment of the Medial Meniscus: What Is Repaired? A Qualitative Histological Study of the Meniscocapsular and Meniscotibial Attachments. Clin Orthop Relat Res 2020; 478:2912-2918. [PMID: 33009236 PMCID: PMC7899392 DOI: 10.1097/corr.0000000000001509] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lesions of the posterior segment of the medial meniscus are the most common intraarticular lesions associated with ACL injuries. Ramp lesions are tears in the peripheral attachment of the posterior horn of the medial meniscus. Such injuries are difficult to detect on preoperative MRI. Arthroscopically, the prevalence of these lesions can reach 24%. Anatomical descriptions of the posterior horn of the medial meniscus are becoming clearer, however, histological descriptions are lacking, especially with regard to the presence or absence of capillaries. QUESTIONS/PURPOSES The present qualitative histologic study focused on the posterior segment of the medial meniscus and the meniscocapsular and meniscotibial junctions. Specifically, the objective of this study was to analyze the posterior segment of the medial meniscus and the meniscosynovial junction and to determine whether the meniscus tibial ligament exists. METHODS We dissected 10 unpaired cadaveric knees (five male, five female, age range 55 to 66 years), five left and five right, from the French "Don du corps" body donation program via a posterior approach to the posteromedial capsule. We excluded specimens with intra-articular abnormalities (ACL rupture, meniscal tear, arthrosis) preceding dissection by arthrotomy. We thus accessed the posterior segment of the medial meniscus and the meniscosynovial junction. The proximal capsule, posterior segment of the medial meniscus, entire meniscal capsular-tibial junction, and a fragment of the tibia were removed en bloc. For each knee, three sagittal spaced sections of the posterior segment of the medial meniscus (Zone 4 as defined by Śmigielski) were performed. Two experienced pathologists performed qualitative histological analysis on the 30 samples after Hematoxylin and eosin staining, and Safranin O staining. RESULTS Macroscopically, the meniscotibial attachments were pellucid and homogeneous, as were the meniscocapsular attachments; however, the meniscocapsular attachments appeared to be denser in both the anterior and posterior regions of the capsule. Microscopy of the meniscosynovial junction revealed loose collagen fibers that were partially oriented but not parallel, a cellular network featuring a few fibroblasts and adipocytes, and several capillaries. No between-attachment histologic differences were apparent; both tissues shared a site of attachment to the posterior horn of the medial meniscus. We did not detect the meniscotibial ligament, macroscopically or microscopically. CONCLUSIONS A ramp lesion may not be a ligamentous injury because the meniscotibial ligament was not detected. Rather, it appears that a ramp lesion is a tear in the common attachment point between the posterior horn of the medial meniscus and meniscocapsular and meniscotibial junctions. This structure is vascularized, and contains nonoriented low cellularity collagen of moderate density. CLINICAL RELEVANCE Based on our results, a better rationale for the recommendation of surgical repair of a ramp appears to be needed, given the absence of a meniscotibial ligament, and the presence of capillaries in the meniscocapsular and meniscotibial attachments.
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Neri T, Cadman J, Beach A, Grasso S, Dabirrahmani D, Putnis S, Oshima T, Devitt B, Coolican M, Fritsch B, Appleyard R, Parker D. Lateral tenodesis procedures increase lateral compartment pressures more than anterolateral ligament reconstruction, when performed in combination with ACL reconstruction: a pilot biomechanical study. J ISAKOS 2020; 6:66-73. [PMID: 33832979 DOI: 10.1136/jisakos-2019-000368] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Given the common occurrence of residual laxity and re-injury post anterior cruciate ligament reconstruction (ACLR), additional anterolateral procedures are increasingly used in combination with an ACLR. Despite the perception that there is a risk of over-constraining the lateral tibiofemoral (LTF) compartment, potentially leading to osteoarthritis, assessment on their effect on intra-articular compartment pressures is still lacking. Our objective was therefore, through a pilot biomechanical study, to compare LTF contact pressures after the most commonly used anterolateral procedures. METHODS A controlled laboratory pilot study was performed using 4 fresh-frozen cadaveric whole lower limbs. Through 0° to 90° of flexion, LTF contact pressures were measured with a Tekscan sensor, located under the lateral meniscus. Knee kinematics were obtained in 3 conditions of rotation (NR: neutral, ER: external and IR: internal rotation) to record the position of the knees for each loading condition. A Motion Analysis system with a coordinate system based on CT scans 3D bone modelling was used. After an ACLR, defined as the reference baseline, 5 anterolateral procedures were compared: anterolateral ligament reconstruction (ALLR), modified Ellison, deep Lemaire, superficial Lemaire and modified MacIntosh procedures. The last 3 procedures were randomised. For each procedure, the graft was fixed in NR at 30° of flexion and with a tension of 20 N. RESULTS Compared with isolated ACLR, addition of either ALLR or modified Ellison procedure did not increased the overall LTF contact pressure (all p>0.05) through the full range of flexion for the IR condition. Conversely, deep Lemaire, superficial Lemaire and modified MacIntosh procedure (all p<0.05) did increase the overall LTF contact pressure compared with ACLR in IR. No significant difference was observed in ER and NR conditions. CONCLUSION This pilot study, comparing the main anterolateral procedures, revealed that addition of either ALLR or modified Ellison procedure did not change the overall contact pressure in the LTF compartment through 0° to 90° of knee flexion. In contrast, the deep and superficial Lemaire, and modified MacIntosh procedures significantly increased overall LTF contact pressures when the knee was internally rotated.
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Affiliation(s)
- Thomas Neri
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia .,Laboratory of Human Movement Biology (LIBM EA 7424), University of Lyon - Jean Monnet, Saint Etienne, France
| | - Joseph Cadman
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Aaron Beach
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia
| | - Samuel Grasso
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia
| | - Danè Dabirrahmani
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Sven Putnis
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia
| | - Takeshi Oshima
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia
| | - Brian Devitt
- OrthoSport Victoria, Richmond, Victoria, Australia
| | - Myles Coolican
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia
| | - Brett Fritsch
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia
| | - Richard Appleyard
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - David Parker
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia
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Anterolateral ligament in pediatric knees: A radiographic study. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Redler A, Miglietta S, Monaco E, Matassa R, Relucenti M, Daggett M, Ferretti A, Familiari G. Ultrastructural Assessment of the Anterolateral Ligament. Orthop J Sports Med 2019; 7:2325967119887920. [PMID: 31897411 PMCID: PMC6920591 DOI: 10.1177/2325967119887920] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: The anterolateral ligament (ALL) has been identified as a structure on the
lateral side of the knee, but debate exists regarding whether it is a
capsular thickening or a ligament. Hypothesis: A detailed ultrastructural characterization of the ALL and its ultrastructure
collagen arrangement will reveal it more closely resembles ligamentous
tissue than joint capsule. Study Design: Descriptive laboratory study. Methods: Eight paired knee samples from 4 fresh-frozen male cadavers were used for
this study. Samples were harvested from the ALL, the joint capsule, and the
medial collateral ligament (MCL). All samples were evaluated with light
microscopy (LM), transmission electron microscopy (TEM), and variable
pressure scanning electron microscopy (VP-SEM). With LM, the 3 tissues were
analyzed and their morphology described. With TEM, the ultrastructure and
collagen characteristics were quantified and compared among specimens. Then,
the 3-dimensional characteristics were compared with VP-SEM. Results: Ultrastructure analysis demonstrated similar morphology between the ALL and
MCL, with significant differences in these 2 structures as compared with the
joint capsule. On LM, the ALL and MCL were characterized by the presence of
a dense collagen fiber oriented in the longitudinal and transversal
directions of the fiber bundles, while the joint capsule was found to have a
more disorganized architecture. On TEM, the collagen fibers of the ALL and
MCL demonstrated similar ultrastructural morphology, with both having
collagen fibers in parallel, longitudinal alignment. A quantitative analysis
was also performed, with the mean (± SD) diameter of fibrils in the ALL and
MCL being 80 ± 2.66 nm and 150 ± 3.35 nm, respectively (all
P < .001). The VP-SEM highlighted that ALL and MCL
morphology demonstrated arrangements of fiber bundles that are densely
packed and organized, in contrast to the disorganized fibers of the joint
capsule. Conclusion: The ALL and MCL have comparable ultrastructures that are distinctly different
from the joint capsule, as visualized on LM, TEM, and VP-SEM. Clinical Relevance: The ALL should be considered a distinctive structure of the knee, although
strictly connected to the surrounding capsule.
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Affiliation(s)
- Andrea Redler
- Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, S. Andrea Hospital, University of Rome Sapienza, Rome, Italy.,Department of Anatomy, Histology, Forensic Medicine and Orthopaedics, University of Rome Sapienza, Rome, Italy
| | - Selenia Miglietta
- Department of Anatomy, Histology, Forensic Medicine and Orthopaedics, University of Rome Sapienza, Rome, Italy
| | - Edoardo Monaco
- Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, S. Andrea Hospital, University of Rome Sapienza, Rome, Italy
| | - Roberto Matassa
- Department of Anatomy, Histology, Forensic Medicine and Orthopaedics, University of Rome Sapienza, Rome, Italy
| | - Michela Relucenti
- Department of Anatomy, Histology, Forensic Medicine and Orthopaedics, University of Rome Sapienza, Rome, Italy
| | - Matthew Daggett
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri, USA
| | - Andrea Ferretti
- Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, S. Andrea Hospital, University of Rome Sapienza, Rome, Italy
| | - Giuseppe Familiari
- Department of Anatomy, Histology, Forensic Medicine and Orthopaedics, University of Rome Sapienza, Rome, Italy
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Neri T, Testa R, Laurendon L, Dehon M, Putnis S, Grasso S, Parker DA, Farizon F, Philippot R. Determining the change in length of the anterolateral ligament during knee motion: A three-dimensional optoelectronic analysis. Clin Biomech (Bristol, Avon) 2019; 62:86-92. [PMID: 30710797 DOI: 10.1016/j.clinbiomech.2019.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/11/2018] [Accepted: 01/23/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The variation of the anterolateral ligament (ALL) length during knee motion is still unclear, and the knee position in which a reconstruction graft should be tensioned remains controversial. The objective of this study was to determine the variation of the ALL length during knee motion using a three-dimensional optoelectronic system. METHODS Kinematic analyses of 20 cadaveric knees were performed using a Motion Analysis® system. The variability of the measurements made during the five acquisition cycles was studied. Reliability was evaluated by two separate measurement sessions, with complete system reinstallation, using different cadavers and a new operator. The ALL length was analysed from extension to full flexion in three rotational conditions. FINDINGS When analysing the reliability of the five cycles, 82% of the measurements we found to have an Intra Class Correlation (ICC) >0.85. The reproducibility of inter-sessional measures by different operators and different cadavers was either good (ICC >0.75) or excellent (ICC >0.85). The ALL length was maximum in full internal rotation with the knee at 25° of flexion. INTERPRETATION This three-dimensional optoelectronic protocol allowed us to analyse the variation of the ALL length during intact knee motion with good reliability and the required accuracy to analyse this variable. The maximal length and highest tension of the ALL was reported at 25° of knee flexion in internal rotation, suggesting this as the optimal position for the knee joint when tensioning an ALL reconstruction.
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Affiliation(s)
- Thomas Neri
- Univ Lyon - UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Science, EA 7424, F-42023 Saint-Etienne, France; Department of Orthopedic Surgery, University Hospital of Saint Etienne, France; Sydney Orthopaedic Research Institute, Sydney, Australia.
| | - Rodolphe Testa
- Univ Lyon - UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Science, EA 7424, F-42023 Saint-Etienne, France
| | - Loic Laurendon
- Department of Orthopedic Surgery, University Hospital of Saint Etienne, France
| | - Margaux Dehon
- Department of Orthopedic Surgery, University Hospital of Saint Etienne, France
| | - Sven Putnis
- Sydney Orthopaedic Research Institute, Sydney, Australia
| | - Samuel Grasso
- Sydney Orthopaedic Research Institute, Sydney, Australia
| | - David A Parker
- Sydney Orthopaedic Research Institute, Sydney, Australia
| | - Frederic Farizon
- Univ Lyon - UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Science, EA 7424, F-42023 Saint-Etienne, France; Department of Orthopedic Surgery, University Hospital of Saint Etienne, France
| | - Remi Philippot
- Univ Lyon - UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Science, EA 7424, F-42023 Saint-Etienne, France; Department of Orthopedic Surgery, University Hospital of Saint Etienne, France
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Smith T. When is a ligament really a ligament? Knee 2018; 25:351. [PMID: 29804750 DOI: 10.1016/j.knee.2018.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Toby Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford
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