DETERMINATION OF THE STRESS OF ANTERIOR CRUCIATE LIGAMENT IN VARIOUS DEGREES OF KNEE FLEXION, COMPARISON OF NORMAL AND RECONSTRUCTED LIGAMENT

Background: Knee joint stability is enhanced by ligamentus structures such as anterior cruciate (ACL), posterior cruciate (PCL), medial collateral (MCL) and lateral collateral ligaments (LCL). Rupture of ACL is the most common knee injuries, especially in sport related activities. The aim of this study is to evaluate the stress developed in knee joint structures in various degrees of knee flexion in ACL ruptured compared to normal condition. Method: CT scan images of knee joint were used to create 3d model of knee joint by use of Mimics software. Abaqus software was used to evaluate the stress developed in knee joint in normal and in ACL reconstructed conditions in various degrees of knee flexion. Results: The stress developed in ACL and other knee joint structures increased significantly by increase in knee joint flexion. The stress of knee joint structures (especially in ACL) in ACL reconstructed condition was more than that of normal condition. Conclusion: It is recommended to immobilize the knee joint in extension up to [Formula: see text] of knee flexion in those with ACL injuries. The stress of ACL increased due to an increase in tibia translation associated with knee flexion.

Validated Ultrasound Speckle Tracking Method for Measuring Strains of Knee Collateral Ligaments In-Situ during Varus/Valgus Loading

Current ultrasound techniques face several challenges to measure strains when translated from large tendon to in-situ knee collateral ligament applications, despite the potential to reduce knee arthroplasty failures attributed to ligament imbalance. Therefore, we developed, optimized and validated an ultrasound speckle tracking method to assess the in-situ strains of the medial and lateral collateral ligaments. Nine cadaveric legs with total knee implants were submitted to varus/valgus loading and divided into two groups: “optimization” and “validation”. Reference strains were measured using digital image correlation technique, while ultrasound data were processed with a custom-built speckle tracking approach. Using specimens from the “optimization” group, several tracking parameters were tuned towards an optimized tracking performance. The parameters were ranked according to three comparative measures between the ultrasound-based and reference strains: R2, mean absolute error and strains differences at 40 N. Specimens from the “validation” group, processed with the optimal parameters, showed good correlations, along with small mean absolute differences, with correlation values above 0.99 and 0.89 and differences below 0.57% and 0.27% for the lateral and medial collateral ligaments, respectively. This study showed that ultrasound speckle tracking could assess knee collateral ligaments strains in situ and has the potential to be translated to clinics for knee arthroplasty-related procedures.

The Effects of External Loads and Muscle Forces on the Knee Joint Ligaments during Walking: A Musculoskeletal Model Study

A musculoskeletal model was developed to analyze the tensions of the knee joint ligaments during walking and to understand how they change with changes in the muscle forces. The model included the femur, tibia, patella and all components of cruciate and collateral ligaments, quadriceps, hamstrings and gastrocnemius muscles. Inputs to the model were the muscle forces, estimated by a static optimization approach, the external loads (ground reaction forces and moments) and the knee flexion/extension movement corresponding to natural walking. The remaining rotational and translational movements were obtained as a result of the dynamic equilibrium of forces. The validation of the model was done by comparing our results with literature data. Several simulations were carried out by sequentially removing the forces of the different muscle groups. Deactivation of the quadriceps produced a decrease of tension in the anterior cruciate ligament (ACL) and an increase in the posterior cruciate ligament (PCL). By removing the hamstrings, the tension of ACL increased at the late swing phase, while the PCL force dropped to zero. Specific effects were observed also at the medial and lateral collateral ligaments. The removal of gastrocnemius muscles produced an increase of tension only on PCL and lateral collateral ligaments. These results demonstrate how musculoskeletal models can contribute to knowledge about complex biomechanical systems as the knee joint.

Magnetic resonance imaging of the normal dromedary camel tarsus

Background Magnetic resonance imaging (MRI) is the most versatile and informative imaging modality for the diagnosis of locomotor injuries in many animal species; however, veterinary literature describing the MRI of the dromedary camel tarsus is lacking. Our purpose was to describe and compare the MRI images of twelve cadaveric tarsi, examined in a 1.5 Tesla MRI scanner, with their corresponding anatomical gross sections. Turbo spin-echo (TSE) T1-weighted (T1), T2-weighted (T2), proton density-weighted (PD), and short tau inversion recovery (STIR) sequences were obtained in 3 planes. Tarsi were sectioned in sagittal, dorsal, and transverse planes. MRI images from different sequences and planes were described and compared with the anatomical sections. Results The soft and osseous tissues of the dromedary camel tarsus could be clearly defined on MRI images and corresponded extensively with the gross anatomic sections. The obtained MRI images enabled comprehensive assessment of the anatomic relationships among the osseous and soft tissues of the camel tarsus. Several structure were evaluated that cannot be imaged using radiography or ultrasonography, including the transverse inter-tarsal ligaments, the talocalcaneal ligament, the short dorsal ligament, branches of the short medial and lateral collateral ligaments and the tarsometatarsal ligaments. Specific anatomical features regarding the dromedary camel tarsus were identified, including the fused second and third tarsal bone, an additional bundle of the short medial collateral ligament connecting the talus and metatarsus and the medial and lateral limbs of the long plantar ligament. Conclusions MRI images provided a thorough evaluation of the normal dromedary camel tarsus. Information provided in the current study is expected to serve as a basis for interpretation in clinical situations.

Magnetic resonance imaging of the normal dromedary camel tarsus

Background: Magnetic resonance imaging (MRI) is the most versatile and informative imaging modality for the diagnosis of locomotor injuries in many animal species; however, veterinary literature describing the MRI of the dromedary camel tarsus is lacking. Our purpose was to describe and compare the MRI images of twelve cadaveric tarsi, examined in a 1.5 Tesla MRI scanner, with their corresponding anatomical gross sections. Turbo spin-echo (TSE) T1-weighted (T1), T2-weighted (T2), proton density-weighted (PD), and short tau inversion recovery (STIR) sequences were obtained in 3 planes. Tarsi were sectioned in sagittal, dorsal, and transverse planes. MRI images from different sequences and planes were described and compared with the anatomical sections.Results: The soft and osseous tissues of the dromedary camel tarsus could be clearly defined on MRI images and corresponded extensively with the gross anatomic sections. The obtained MRI images enabled comprehensive assessment of the anatomic relationships among the osseous and soft tissues of the camel tarsus. Several structure were evaluated that cannot be imaged using radiography or ultrasonography, including the transverse inter-tarsal ligaments, the talocalcaneal ligament, the short dorsal ligament, branches of the short medial and lateral collateral ligaments and the tarsometatarsal ligaments. Specific anatomical features regarding the dromedary camel tarsus were identified, including the fused second and third tarsal bone, an additional bundle of the short medial collateral ligament connecting the talus and metatarsus and the medial and lateral limbs of the long plantar ligament. Conclusions: MRI images provided a thorough evaluation of the normal dromedary camel tarsus. Information provided in the current study is expected to serve as a basis for interpretation in clinical situations.

The lateral ligament is injured preferentially in posterolateral dislocation of the elbow joint

Aims The purpose of this study was to evaluate the relationships between the degree of injury to the medial and lateral collateral ligaments (MCL and LCL) and associated fractures in patients with a posterolateral dislocation of the elbow, using CT and MRI. Methods We retrospectively reviewed 64 patients who presented between March 2009 and March 2018 with a posterolateral dislocation of the elbow and who underwent CT and MRI. CT revealed fractures of the radial head, coronoid process, and medial and lateral humeral epicondyles. MRI was used to identify contusion of the bone and collateral ligament injuries by tear, partial or complete tear. Results A total of 54 patients had a fracture; some had more than one. Radial head fractures were found in 25 patients and coronoid fractures in 42. Lateral and medial humeral epicondylar fractures were found in eight and six patients, respectively. Contusion of the capitellum was found in 43 patients and rupture of the LCL was seen in all patients (partial in eight and complete in 56), there was complete rupture of the MCL in 37 patients, partial rupture in 19 and eight had no evidence of rupture. The LCL tear did not significantly correlate with the presence of fracture, but the MCL rupture was complete in patients with a radial head fracture (p = 0.047) and there was significantly increased association in those without a coronoid fracture (p = 0.015). Conclusion In posterolateral dislocation of the elbow, LCL ruptures are mostly complete, while the MCL exhibits various degrees of injury, which are significantly associated with the associated fractures. Cite this article: Bone Joint J 2020;102-B(2):227–231.

The Function of the Short Lateral Collateral Ligaments of the Canine Tarsus: A Cadaveric Study

ABSTRACT Information on the clinical behavior and treatment of cases with an isolated rupture of the short collateral ligaments of the canine tarsus is sparse and contradictory in the veterinary literature. Our objective was to evaluate the function of the short lateral collateral ligaments (SLCLs) of the tarsocrural joint in 90° flexion. Eight canine cadaveric limbs were tested for internal/external rotation and valgus/varus before and after transection of one or both SLCLs. In one group, the fibulocalcaneal ligament was transected first, followed by the fibulotalar. In the second group, the order of ligament transection was reversed. Angular changes between two k-wires were measured and compared. External rotation increased significantly after transection of one or both SLCLs (P = .009 and P < .0005), as did varus (P = .021 and P = .001). Lateral subluxation was only possible when both SLCLs were cut. Unlike the long lateral collateral ligament, which stabilizes against deviation toward medial, both SLCLs are major stabilizers against subluxation toward lateral. This important difference must be considered in clinical patients with isolated rupture of the SLCLs.

Transarticular hinged external skeletal fixation for revision surgery of stifle subluxation associated with multiple ligament injuries in a cat

Stifle subluxation with multiple ligamentous injuries are a rare but catastrophic injury seen most commonly in cats in the veterinary literature. There is often damage to both cruciate ligaments, the medial and lateral collateral ligaments and the menisci. The long-term prognosis for this injury is guarded due to the development of marked osteoarthritis after the injury. This paper describes the use of a commercially available range of motion hinge used as a secondary stabilisation for a failed primary anatomical stabilisation. None of the primary implants were removed or augmented at the time of revision surgery. A transarticular fixator was placed and increasing range of motion was allowed by adjusting the hinge at varying intervals over 8 weeks. This allowed fibrous tissue to stabilise the stifle while preventing articular cartilage degeneration. From this case report, transarticular hinge fixation can be considered a method of stabilisation in patients with stifle subluxation.

Kinematic Alignment in Cruciate Retaining Implants Improves the Biomechanical Function in Total Knee Arthroplasty during Gait and Deep Knee Bend

Kinematic alignment (KA), which co-aligns the rotational axes of the components with three kinematic axes of the knee by aligning the components to the prearthritic joint lines, has been a recently introduced surgical technique. However, whether KA and cruciate retaining (CR) implants provide better biomechanical function during activities than mechanical alignment (MA) in posterior stabilized (PS) implants is unclear. We evaluated the biomechanical functions during the stance phase gait and deep knee bend, with a computer simulation and measured forces in the medial and lateral collateral ligaments and medial and lateral contact stresses in the polyethylene insert and patellar button. The forces on the medial collateral ligament in KA were lower than those in MA in both CR and PS TKA in the stance phase gait and deep knee bend conditions, whereas those on the lateral collateral ligament did not show any difference between the two surgical alignment techniques in the stance phase gait condition. The maximum contact stresses on the medial PE inserts in KA were lower than those in MA in both CR and PS TKA in the stance phase gait and deep knee bend conditions. However, the maximum contact stresses on the lateral PE inserts and the patellar button did not differ between MA and KA. The biomechanical function was superior in KA TKA than in MA TKA, and KA was more effective in CR TKA. This comparison could be used as a reference by surgeons to reduce the failure rates by using KA TKA instead of MA TKA.