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Morales-Avalos R, Torres-González EM, Padilla-Medina JR, Monllau JC. ACL anatomy: Is there still something to learn? Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00071-7. [PMID: 38508380 DOI: 10.1016/j.recot.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The different bony and soft tissue reference points and the micro and macroscopic structures of the knee continue to be the object of focused study and analysis. Upon reviewing the most recent literature, we saw the wide spectrum of studies that seek to define the different anatomical aspects of the anterior cruciate ligament (ACL). PURPOSE The purpose of this paper is to review the most recent publications on the ACL and its morphology in which its microscopic composition and macroscopic anatomy are addressed. RESULTS The ACL consists of typeI (90%) and typeIII (10%) collagen matrix. Its length ranges from 27 to 38mm and its width from 10 to 12mm. The ACL cross-section area measures an average of 44mm2, and its shape resembles that of an hourglass or a bow tie. ACL bundles have been defined as anteromedial, intermediate, and posterolateral. Femoral and tibial footprints were seen to present a high degree of variability in shape and size. Furthermore, the blood supply is given by the medial genicular artery and innervation by the tibial nerve branches. Additionally, the ACL functionally prevents anterior translation of the tibia and stabilizes against the internal rotation of the tibia and valgus angulation of the knee. CONCLUSIONS There is great variability in the anatomy of the ACL as well as its attachment sites. At the same time, the shape and size of its footprint has become a factor in determining individualized ACL reconstruction. The persistence of morphological variability in the aging of the ACL and important aspects of surgical planning and decision making with respect to anatomical risk factors suggest that further studies are called for.
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Affiliation(s)
- R Morales-Avalos
- Departamento de Fisiología, Facultad de Medicina, Universidad Autónoma de Nuevo León (UANL), Monterrey, Nuevo León, México; Departamento de Cirugía Ortopédica, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
| | - E M Torres-González
- Departamento de Cirugía Ortopédica y Traumatología, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León (UANL), Monterrey, Nuevo León, México; Departamento de Cirugía Ortopédica, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - J R Padilla-Medina
- Departamento de Cirugía Ortopédica y Traumatología, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León (UANL), Monterrey, Nuevo León, México; Departamento de Cirugía Ortopédica, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - J C Monllau
- ICATKnee (ICATME), Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, España; Departamento de Cirugía Ortopédica, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
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Morales-Avalos R, Torres-González EM, Padilla-Medina JR, Monllau JC. ACL anatomy: Is there still something to learn? Rev Esp Cir Ortop Traumatol (Engl Ed) 2023:S1888-4415(23)00070-X. [PMID: 36787832 DOI: 10.1016/j.recot.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND The different bony and soft tissue reference points and the micro and macroscopic structures of the knee continue to be the object of focused study and analysis. Upon reviewing the most recent literature, we saw the wide spectrum of studies that seek to define the different anatomical aspects of the anterior cruciate ligament (ACL). PURPOSE The purpose of this paper is to review the most recent publications on the ACL and its morphology in which its microscopic composition and macroscopic anatomy are addressed. RESULTS The ACL consists of type I (90%) and type III (10%) collagen matrix. Its length ranges from 27 to 38mm and its width from 10 to 12mm. The ACL cross-section area measures an average of 44mm2, and its shape resembles that of an hourglass or a bow tie. ACL bundles have been defined as anteromedial, intermediate, and posterolateral. Femoral and tibial footprints were seen to present a high degree of variability in shape and size. Furthermore, the blood supply is given by the medial genicular artery and innervation by the tibial nerve branches. Additionally, the ACL functionally prevents anterior translation of the tibia and stabilizes against the internal rotation of the tibia and valgus angulation of the knee. CONCLUSIONS There is great variability in the anatomy of the ACL as well as its attachment sites. At the same time, the shape and size of its footprint has become a factor in determining individualized ACL reconstruction. The persistence of morphological variability in the aging of the ACL and important aspects of surgical planning and decision making with respect to anatomical risk factors suggest that further studies are called for.
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Affiliation(s)
- R Morales-Avalos
- Physiology Department, Faculty of Medicine, Universidad Autónoma de Nuevo León (U.A.N.L), Monterrey, Mexico; Department of Orthopedic Surgery, Hospital del Mar, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - E M Torres-González
- Department of Orthopedic Surgery and Traumatology, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León (U.A.N.L), Monterrey, Mexico; Department of Orthopedic Surgery, Hospital del Mar, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - J R Padilla-Medina
- Department of Orthopedic Surgery and Traumatology, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León (U.A.N.L), Monterrey, Mexico; Department of Orthopedic Surgery, Hospital del Mar, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - J C Monllau
- ICATKnee (ICATME), Hospital Universitari Dexeus, Universitat Autónoma de Barcelona, Barcelona, Spain; Department of Orthopedic Surgery, Hospital del Mar, Universitat Autónoma de Barcelona, Barcelona, Spain
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Morales-Avalos R, Rodríguez-Torres RA, Martínez-Manautou LE, Rivera-Zarazúa S, Requena-Araujo P, Blázquez-Saldaña J, Peña-Martínez VM. [External fixation with reconstruction rail system as a treatment for pseudoarthrosis of the distal femur]. Acta Ortop Mex 2020; 34:309-312. [PMID: 33634635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Distal femur pseudoarthrosis also called «distal femur non-union» (DFNU) represents a rare complication associated with a fracture caused by high-energy trauma; its treatment is controversial, as there is a wide variety of surgical techniques that can be implemented, from open reduction plus internal fixation with plates, to the use of fixed angle plates combined with bone autograft. We expose the case of a 24-year-old man who shows up for consultation with the history of having presented a left femoral supracondylar fracture with a year of evolution, treated by osteosynthesis of the distal femur with dynamic condylar screws (DCS plate); developed a torpid evolution with severe pain in the distal third of the left thigh and functional limitation, developed a progressive varus deformity of the left thigh that caused a shortening of 3.8 cm of the limb. A focus of pseudoarthrosis was identified, which was surgically removed, the intramedullary canal was recanalized, and a lateral closed wedge osteotomy was performed to correct the angulation and allow reduction. 5.5 mm (three proximal and three distal) hydroxyapatite screws and an external fixator were placed. In addition, a review of the literature focused on the use of external fixation was carried out as a treatment for the pseudoarthrosis of the distal femur.
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Affiliation(s)
- R Morales-Avalos
- Módulo de Politrauma, Reconstrucción y Fijación Externa. Departamento de Ortopedia y Traumatología, Hospital Universitario «Dr. José Eleuterio González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - R A Rodríguez-Torres
- Módulo de Politrauma, Reconstrucción y Fijación Externa. Departamento de Ortopedia y Traumatología, Hospital Universitario «Dr. José Eleuterio González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - L E Martínez-Manautou
- Módulo de Politrauma, Reconstrucción y Fijación Externa. Departamento de Ortopedia y Traumatología, Hospital Universitario «Dr. José Eleuterio González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - S Rivera-Zarazúa
- Módulo de Politrauma, Reconstrucción y Fijación Externa. Departamento de Ortopedia y Traumatología, Hospital Universitario «Dr. José Eleuterio González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - P Requena-Araujo
- Módulo de Politrauma, Reconstrucción y Fijación Externa. Departamento de Ortopedia y Traumatología, Hospital Universitario «Dr. José Eleuterio González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - J Blázquez-Saldaña
- Módulo de Politrauma, Reconstrucción y Fijación Externa. Departamento de Ortopedia y Traumatología, Hospital Universitario «Dr. José Eleuterio González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - V M Peña-Martínez
- Módulo de Politrauma, Reconstrucción y Fijación Externa. Departamento de Ortopedia y Traumatología, Hospital Universitario «Dr. José Eleuterio González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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García-Pérez MM, Martínez-Rodríguez HG, López-Guerra GG, Soto-Domínguez A, Said-Fernández SL, Morales-Avalos R, Elizondo-Omaña RE, Montes-de-Oca-Luna R, Guzmán-López S, Castillo-Galván ML, Mendoza-Lemus OF, Vílchez-Cavazos F. A modified chemical protocol of decellularization of rat sciatic nerve and its recellularization with mesenchymal differentiated schwann-like cells: morphological and functional assessments. Histol Histopathol 2016; 32:779-792. [PMID: 27858399 DOI: 10.14670/hh-11-844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The functional reconstruction of large neural defects usually requires the use of peripheral nerve autografts, though these have certain limitations. As a result, interest in new alternatives for autograft development has risen. The acellular peripheral nerve graft is an alternative for peripheral nerve injury repair, but to date there is not a standardized chemical decellularization method widely accepted. The objective of this study was to propose a modified chemical protocol of decellularization of rat sciatic nerve and its recellularization in vitro with mesenchimal differentiated Schwann-like cells. After the transplantation, an evaluation of its regeneration was performed using morphological and functional tests. The study consisted of two phases; in phase 1, different concentrations and times of exposure of rat sciatic nerves to detergents were tested, to establish a modified chemical protocol for nerve decellularization. The chemical treatment with 3% triton X-100 and 4% sodium deoxycholate for 15 days allowed a complete decellularization whilst conserving the extracellular matrix of the harvested nerve. In phase 2, the decellularized and recellularized alografts were compared against autografts. The morphological analysis showed a higher positivity to specific myelin antibodies in the recellularized group compared to the autograft. There were no differences in this parameter between the control limb and the experimental limb (recellularized group). The functional analysis showed no statistical differences at week 15 in the Sciatic Function Index in the autograft group vs the other groups. This study sets the morphological and functional bases for posterior studies about nerve defects regeneration in humans.
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Affiliation(s)
- M M García-Pérez
- Plastic Surgery Service, University Hospital "Dr. José. Eleuterio González", University Autonomous of Nuevo León (U.A.N.L.), Monterrey, Nuevo León, México
| | - H G Martínez-Rodríguez
- Department of Biochemistry and Molecular Medicine, Faculty of Medicine, University Autonomous of Nuevo León (U.A.N.L.), Monterrey, Nuevo León, México
| | - G G López-Guerra
- Department of Biochemistry and Molecular Medicine, Faculty of Medicine, University Autonomous of Nuevo León (U.A.N.L.), Monterrey, Nuevo León, México
| | - A Soto-Domínguez
- Department of Histology, Faculty of Medicine, University Autonomous of Nuevo León (U.A.N.L.), Monterrey, Nuevo León, México
| | - S L Said-Fernández
- Department of Biochemistry and Molecular Medicine, Faculty of Medicine, University Autonomous of Nuevo León (U.A.N.L.), Monterrey, Nuevo León, México
| | - R Morales-Avalos
- Bone and Tissue Bank, Orthopedics and Traumatology Service, University Hospital "Dr. José. Eleuterio González", University Autonomous of Nuevo León (U.A.N.L.), Monterrey, Nuevo León, México.,Department of Human Anatomy, Faculty of Medicine, University Autonomous of Nuevo León (U.A.N.L.), Monterrey, Nuevo León, México
| | - R E Elizondo-Omaña
- Department of Human Anatomy, Faculty of Medicine, University Autonomous of Nuevo León (U.A.N.L.), Monterrey, Nuevo León, México
| | - R Montes-de-Oca-Luna
- Department of Histology, Faculty of Medicine, University Autonomous of Nuevo León (U.A.N.L.), Monterrey, Nuevo León, México
| | - S Guzmán-López
- Department of Human Anatomy, Faculty of Medicine, University Autonomous of Nuevo León (U.A.N.L.), Monterrey, Nuevo León, México
| | - M L Castillo-Galván
- Department of Human Anatomy, Faculty of Medicine, University Autonomous of Nuevo León (U.A.N.L.), Monterrey, Nuevo León, México
| | - O F Mendoza-Lemus
- Bone and Tissue Bank, Orthopedics and Traumatology Service, University Hospital "Dr. José. Eleuterio González", University Autonomous of Nuevo León (U.A.N.L.), Monterrey, Nuevo León, México
| | - F Vílchez-Cavazos
- Bone and Tissue Bank, Orthopedics and Traumatology Service, University Hospital "Dr. José. Eleuterio González", University Autonomous of Nuevo León (U.A.N.L.), Monterrey, Nuevo León, México.
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Morales-Avalos R, Re Elizondo-Omaña RE, Vílchez-Cavazos F, Martínez-Ponce de León AR, Elizondo-Riojas G, Delgado-Brito M, Cortés-González P, Guzmán-Avilán RI, Pinales-Razo R, de la Garza-Castro O, Guzmán-López S. [Vertebral fixation with a transpedicular approach. Relevance of anatomical and imaging studies]. Acta Ortop Mex 2012; 26:402-411. [PMID: 24712211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The number of patients with spine conditions has grown exponentially in recent years leading to an increase in the number of cases requiring surgical treatment. Currently vertebral fusion surgery with a transpedicular approach represents the most commonly used technique to treat any type of vertebral disorder. The morphometric characteristics of vertebrae, particularly the pedicle, determine the size of pedicular implants, including width and length, as well as the shape and direction of the screw and its ideal angulation at the time of introduction. Knowing these characteristics is important to prevent injuring important adjacent structures and to decrease the postoperative complication rate. In recent decades numerous studies on the morphometric characteristics of the vertebral pedicle have been conducted in different populations to determine its real dimensions by means of direct measurement and imaging methods. These studies have concluded that there are significant differences in these measurements among the different ethnic groups, races, genders, ages and the vertebral regions studied. This paper analyzes the different morphometric studies of the pedicle and all the other vertebral elements studied in Mexico and the rest of the world and explain the importance of their knowledge and surgical application for the correct development of vertebral fusion surgery with a transpedicular approach.
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