scholarly journals Correlation between Morphological Features of the Anterior Cruciate Ligament: A Quantitative Study Using a Porcine Model

2021 ◽  
Author(s):  
Huizhi Wang ◽  
Zhuoyue Zhang ◽  
Qinyi Shi ◽  
Yi-Ming Zeng ◽  
Cheng-Kung Cheng
Keyword(s):  
Porcine Model ◽  
Cruciate Ligament ◽  
Insertion Site ◽  
Morphological Features ◽  
Anatomical Reconstruction ◽  
Large Individual ◽  
Full Extension ◽  
Cross Sectional ◽  
Tibial Insertion ◽  
Insertion Sites

Abstract Background: Inadequate restoration of the rotational knee stability is often reported after ACL reconstruction, mainly due to insufficient restoration of the morphology of the ACL. This study aimed to explore the quantitative correlation between morphological features of the ACL, thus to provide useful information for improving anatomical reconstruction techniques and designing artificial ligaments. Methods: Porcine model was used in this study mainly because the morphology and function of porcine ACLs have been reported to be similar to those of the human ACL. 19 porcine knees (1 year, male) were fixed at full extension using 10% formalin and were dissected to expose the ACL. ACL lengths were measured using a caliper. Mid-substances of the ACL were cut and scanned using X-ray microscopy, and the cross-sectional area (CSA) was measured at the isthmus. Margins of direct and indirect bone insertion sites were distinguished and marked. Measurements were performed on digital photographs to obtain the areas of bone insertions. Statistical analysis using nonlinear regression was used to identify potential correlations among the measurements. Results: The results showed large individual differences on all of the measurements (e.g. the CSA at ACL isthmus ranged from 44.7 to 87.2 mm2, when the area of its femoral and tibial insertion sites ranged from 188.1 and 233.6 mm2 to 258.4 and 412.0 mm2, respectively). The CSA at the isthmus was significantly correlated with the total area of the bone insertion sites and the area of tibial insertion. The area of the tibial insertion was significantly correlated with the area of its direct insertion site. In contrast, the area of the femoral insertion was significantly correlated with the area of its indirect insertion site. The area of the indirect tibial insertion showed a weak correlation with the length of ACL, whereas the length of the ACL was not able to predict or be predicted by any other parameters.Conclusions: The CSA at the ACL isthmus might be more suitable for assessing the morphology of the ACL. However, ACL length has little correlation with the CSA of the isthmus or bone insertion sites, thus should be evaluated independently before surgery.

Determination of Graft Forces for Cranial Cruciate Ligament Reconstruction in the Dog

1996 ◽  
Vol 09 (04) ◽  
pp. 165-171 ◽  
Author(s):  
D. A. Hulse ◽  
M. R. Slater ◽  
J. F. Hunter ◽  
W. A. Hyman ◽  
B. A. Shelley
Keyword(s):  
Degrees Of Freedom ◽  
Cruciate Ligament ◽  
Insertion Site ◽  
Graft Fixation ◽  
Flexion Angle ◽  
Patellar Ligament ◽  
Graft Material ◽  
Test Apparatus ◽  
Cranial Cruciate Ligament ◽  
Tibial Insertion

SummaryA test apparatus that allowed the stifle to move in five degrees of freedom was used to determine the effect of graft location, graft preload, and flexion angle at the time of graft fixation on the tensile graft forces experienced by a replacement graft material used to simulate reconstruction of the cranial cruciate ligament deficient stifle. Two graft locations (tibial insertion site of the patellar ligament and tibial insertion site of the cranial cruciate ligament), two graft preloads (5 N and 20 N), and three flexion angles at the time of graft fixation (15°, 30° and 90°) were examined. The tibial insertion site and preload did not have as great an effect on graft force as did the flexion angle of the limb at time of graft fixation. Graft forces were highest when reconstructions were performed with the limb in 90° of flexion (ρ <0.0001). This study supports the notion that intracapsular grafts should be fixed with the limb in a normal standing angle.A five degree of freedom test apparatus was used to evaluate the effect of graft location, graft preload, and limb flexion angle at time of graft fixation on reconstructions of the cranial cruciate ligament deficient stifle. Our results suggest that intracapsular grafts should not be fixed with the limb in 90° of flexion, but in a normal standing angle.

Individualized Anterior Cruciate Ligament Graft Matching: In Vivo Comparison of Cross-sectional Areas of Hamstring, Patellar, and Quadriceps Tendon Grafts and ACL Insertion Area

2018 ◽  
Vol 46 (11) ◽  
pp. 2646-2652 ◽  
Author(s):  
Christoph Offerhaus ◽  
Márcio Albers ◽  
Kanto Nagai ◽  
Justin W. Arner ◽  
Jürgen Höher ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Quadriceps Tendon ◽  
Resonance Imaging ◽  
Graft Size ◽  
Cross Sectional ◽  
Tibial Insertion ◽  
The Mean ◽  
Anterior Cruciate ◽  
Insertion Area

Background: Recent literature correlated anterior cruciate ligament (ACL) reconstruction failure to smaller diameter of the harvested hamstring (HS) autograft. However, this approach may be a simplification, as relation of graft size to native ACL size is not typically assessed and oversized grafts may impart their own complications. Purpose: To evaluate in vivo data to determine if the commonly used autografts reliably restore native ACL size. Study Design: Descriptive laboratory study. Methods: Intraoperative data of the tibial insertion area and HS graft diameter were collected and retrospectively evaluated for 46 patients who underwent ACL reconstruction with HS autografts. Magnetic resonance imaging measurements of the cross-sectional area (CSA) of the possible patellar tendon (PT) and quadriceps tendon (QT) autografts were also done for each patient. The percentages of tibial insertion site area restored by the 3 possible grafts were then calculated and compared for each individual. Results: The mean ACL tibial insertion area was 107.2 mm2 (60.5-155.5 mm2). The mean CSAs of PT, HS, and QT were 33.2, 55.3, and 71.4 mm2, respectively. When all grafts were evaluated, the percentage reconstruction of the insertion area varied from 16.2% to 123.1% on the tibial site and from 25.5% to 176.7% on the femoral site, differing significantly for each graft type ( P < .05). On average, 32.8% of the tibial insertion area would have been filled with PT, 53.6% by HS, and 69.5% by QT. Based on previous cadaveric studies indicating that graft size goal should be 50.2% ± 15% of the tibial insertion area, 82.7% of patients in the HS group were within this range (36.9%, QT; 30.5%, PT), while 65.2% in the PT group were below it and 60.9% in the QT group were above it. Conclusion: ACL insertion size and the CSAs of 3 commonly used grafts vary greatly for each patient and are not correlated with one another. Thus, if the reconstructed ACL size is determined by the harvested autograft size alone, native ACL size may not be adequately restored. PT grafts tended to undersize the native ACL, while QT might oversize it. Clinical Relevance: These results may help surgeons in preoperative planning, as magnetic resonance imaging measurements can be helpful in determining individualized graft choice to adequately restore the native ACL.

scholarly journals Smaller Anterior Cruciate Ligament Diameter Is a Predictor of Subjects Prone to Ligament Injuries: An Ultrasound Study

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Parag Suresh Mahajan ◽  
Prem Chandra ◽  
Vidya Chander Negi ◽  
Abhilash Pullincherry Jayaram ◽  
Sheik Akbar Hussein
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Insertion Site ◽  
Acl Injury ◽  
Maximum Diameter ◽  
Tibial Insertion ◽  
Intercondylar Eminence ◽  
Ultrasound Study ◽  
Gender And Age ◽  
Anterior Cruciate

Purpose. To test if diameter of normal anterior cruciate ligament (ACL) can be measured by ultrasound (US), to see if there is a relationship between smaller ACL diameter and ACL injury, and to assess agreement between radiologists in measuring ACL diameter in cases and matched controls.Materials and Methods. In this ethics committee-approved study, maximum diameter of ACL near tibial insertion site was measured by static and dynamic US study in 25 normal contralateral knees of subjects who suffered noncontact ACL injury and in 25 matched control subjects.Results. ACL was visualized as a thick linear hypoechoic band inserted approximately 11 mm caudal to the tibial plateau and the intercondylar eminence. Maximum diameter of contralateral ACL near tibial insertion site among injured subjects was significantly smaller than in noninjured subjects (0.62 ± 0.07 cm versus 0.81 ± 0.06 cm;P<0.0001). In the regression analysis, the diameter of ACL near tibial insertion site was found significantly proportional to body weight and not significantly associated to height, gender, and age.Conclusion. Diameter of normal ACL near tibial insertion site can be measured by US and the maximum diameter is significantly smaller among subjects with noncontact ACL injury. US is a promising modality that can be used as an excellent screening test to detect subjects especially aspiring athletes prone to ACL injury. Very strong agreement was observed between radiologists in measuring ACL diameter.

Area of the tibial insertion site of the anterior cruciate ligament as a predictor for graft size

2016 ◽  
Vol 25 (5) ◽  
pp. 1576-1582 ◽  
Author(s):  
Daniel Guenther ◽  
Sebastian Irarrázaval ◽  
Marcio Albers ◽  
Cara Vernacchia ◽  
James J. Irrgang ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Insertion Site ◽  
Graft Size ◽  
Tibial Insertion ◽  
Anterior Cruciate

Variation in the shape of the tibial insertion site of the anterior cruciate ligament: classification is required

2015 ◽  
Vol 25 (8) ◽  
pp. 2428-2432 ◽  
Author(s):  
Daniel Guenther ◽  
Sebastian Irarrázaval ◽  
Yuichiro Nishizawa ◽  
Cara Vernacchia ◽  
Eric Thorhauer ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Insertion Site ◽  
Tibial Insertion ◽  
Anterior Cruciate

scholarly journals Sex-Specific Function and Morphology of the Anterior Cruciate Ligament During Skeletal Growth in a Porcine Model

2021 ◽  
Author(s):  
Danielle Howe ◽  
Stephanie G. Cone ◽  
Jorge A. Piedrahita ◽  
Bruce Collins ◽  
Lynn A. Fordham ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Porcine Model ◽  
Cruciate Ligament ◽  
Joint Laxity ◽  
Cross Sectional Area ◽  
Skeletal Growth ◽  
Sectional Area ◽  
Anteromedial Bundle ◽  
Cross Sectional ◽  
Anterior Cruciate

Pediatric anterior cruciate ligament (ACL) injuries are on the rise, and females experience higher ACL injury risk than males during adolescence. Studies in skeletally immature patients indicate differences in ACL size and joint laxity between males and females after the onset of adolescence. However, functional data regarding the ACL and its anteromedial and posterolateral bundles in the pediatric population remain rare. Therefore, this study uses a porcine model to investigate the sex-specific morphology and function of the ACL and its bundles throughout skeletal growth. Hind limbs from male and female Yorkshire pigs aged early youth to late adolescence were imaged using magnetic resonance imaging to measure the size and orientation of the ACL and its bundles, then biomechanically tested under anterior-posterior drawer using a robotic testing system. Joint laxity decreased (p<0.001) while joint stiffness increased (p<0.001) throughout skeletal growth in both sexes. The ACL was the primary stabilizer against anterior tibial loading in all specimens, while the functional role of the anteromedial bundle increased with age (p<0.001), with an earlier shift in males. ACL and posterolateral bundle cross-sectional area and ACL and anteromedial bundle length were larger in males than females during adolescence (p<0.01 for all), while ACL and bundle sagittal angle remained similar between sexes. Additionally, in situ ACL stiffness correlated with cross-sectional area across skeletal growth (r2=0.75, p<0.001 in males and r2=0.64, p<0.001 in females), but not within age groups. This study has implications for age and sex-specific surgical intervention strategies and suggests the need for human studies.

Paper # 160: Tibial Insertion Site Measurements on MRI and Arthroscopy in Anterior Cruciate Ligament Tears

2011 ◽  
Vol 27 (10) ◽  
pp. e177-e178
Author(s):  
Jeffrey Macalena ◽  
Kenneth David Illingworth ◽  
Brad Wasserman ◽  
Daniel Hensler ◽  
Freddie H. Fu
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Insertion Site ◽  
Tibial Insertion ◽  
Anterior Cruciate ◽  
Cruciate Ligament Tears

scholarly journals IS THE “U-SIGN” RADIOLOGIC FEATURE OF A POSTERIOR CRUCIATE LIGAMENT TIBIAL AVULSION FRACTURE?

2021 ◽  
Vol 29 (4) ◽  
pp. 189-192
Author(s):  
SERGIO ROCHA PIEDADE ◽  
DANIEL MIRANDA FERREIRA ◽  
MARK HUTCHINSON ◽  
NICOLA MAFFULLI ◽  
MARTHA MARIA MISCHAN ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Avulsion Fracture ◽  
High Reliability ◽  
Cruciate Ligament ◽  
Insertion Site ◽  
Radiographic Feature ◽  
Tibial Insertion ◽  
Tibial Avulsion Fracture ◽  
Kappa Agreement ◽  
Insertion Area

ABSTRACT Objective: By analyzing our cases of posterior cruciate ligament (PCL) tibial avulsion fracture, we noted that a U-shaped image was present in the anteroposterior plain radiographs view of the affected knee, even in cases where the profile view of the knee had been inconclusive as to tibial PCL avulsion fracture, a “hidden” fracture. Therefore, we aimed to investigate whether there was an anatomical correlation between this radiological U sign and the tibial insertion of the PCL and to ascertain the intra- and inter-rater reliability of this sign in clinical practice. Methods: The data of the widths and heights area of the PCL tibial insertion area, and the U sign area were measured and compared to the largest width of the tibia. Two moreover, the reliability and reproducibility of this imaging were analyzed. Results: The areas height of the U-sign area and the anatomical insertion area of the posterior cruciate ligament showed no difference, and both were topographically located in the two central quarters of the proximal end of the tibia. The radiographic assessment showed excellent Kappa agreement rates between interobserver and intraobserver, with high reliability and reproducibility. Conclusion: The U sign is a radiographic feature of PCL tibial avulsion fracture seen on the radiograph AP view, there is a high association between the ratios of the U-sign area height in the X-ray and the anatomical height of the PCL tibial insertion site MRI with the largest width of the proximal tibia. The radiographic U sign showed excellent rates of interobserver and intraobserver agreement with Kappa values higher than 0.8. Level of Evidence IV; Dignostic Studies - Investigating a Diagnostic Test.

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