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Knowing that the injured MCL and PCL can heal and that the injured ACL and lateral side, predictably, will not heal are the bases for the treatment approach to these injuries. (1) Allow MCL healing nonoperatively. (2) Allow PCL healing to occur as long as PCL laxity is 2+ or less (reconstruct the PCL acutely if posterior drawer is > 2+ initially). (3) Initially delay ACL treatment and reconstruct later, if needed posterior drawer. (4) Perform acute lateral side repair to reattach structures to their distally torn site.
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PMID:Low-velocity knee dislocation with sports injuries. Treatment principles. 1091 59

Rehabilitation for a patient with a multiple-ligament knee injury should be designed to reduce pain and swelling, restore range of motion, strength, and endurance, and to enhance proprioception, and dynamic stability of the knee, with the goals of restoring function and minimizing disability. The biomechanics of the knee must be considered when designing a rehabilitation program. General guidelines for rehabilitation of the multiple-ligament-injured knee include considerations for promoting tissue healing, decreasing pain and swelling, restoring full motion, increasing muscular strength and endurance, improving proprioception, enhancing dynamic stability of the knee, and reducing functional limitations and disability. A patient's progression through this sequence must be individualized and depends on the pattern of ligament injury or surgical procedure that was performed, and the principles of tissue healing. Specific guidelines for rehabilitation following ACL reconstruction combined with MCL repair, PCL reconstruction, combined ACL-PCL reconstruction, and reconstruction of the LCL and posterolateral corner have been provided.
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PMID:Rehabilitation of the multiple-ligament-injured knee. 1091 65

Pantibial ligamentous injury including knee dislocation and tibiotalar joint subluxation is an uncommon severe rotational injury. A 21-year-old male injured his right knee falling from a motorcycle. Physical examination revealed effusion on the right knee and ankle, and posterior translation of the tibia as well. The MRI of the right knee and ankle demonstrated the following findings: a complete disruption of cruciate ligaments, the medial collateral ligament, posteromedial corner injury together with a peripheric tear in the medial meniscus, the ruptured deltoid ligament, ankle syndesmosis space widening (>5 mm) and lateral subluxation of talus. Deltoid ligament of the right ankle was repaired and ankle syndesmosis was fixed with a cortical screw. The PCL and ACL were reconstructed arthroscopically with autogeneous bone-patellar tendon-bone graft. The midsubstance tear of MCL, posteromedial corner and medial meniscus tear were primarily repaired with nonabsorbable sutures. 3 years after the surgery, the patient was called for the final examination. MRI and X-ray findings of the knee and ankle joint demonstrated the continuity of ACL, PCL, MCL, and deltoid ligament. The patient, who is a farmer, can go back to his job and perform his daily activities. We presented a previously unreported case that involves both simultaneous occurrence of knee dislocation and tibiotalar joint subluxation. We used the term "Pantibial ligamentous injury" for this case.
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PMID:An unusual rotational injury: Pantibial ligamentous injury. 1618 54

The knee is an anatomically and biomechanically complex joint. Few studies have been published reporting the type and frequency of knee injuries. However, this information that may help to prevent, diagnose, and treat knee joint injuries. We have documented 17,397 patients with 19,530 sport injuries over a 10-year period of time. 6434 patients (37%) had 7769 injuries (39.8%) related to the knee joint. 68.1% of those patients were men and 31.6% were women. Almost 50% of the patients were between the ages of 20-29 (43.1%) at the time of injury. The injuries documented were ACL lesion (20.3%), medial meniscus lesion (10.8%), lateral meniscus lesion (3.7%), MCL lesion (7.9%), LCL lesion (1.1%), and PCL lesion (0.65%). The activities leading to most injuries were soccer (35%) and skiing (26%). LCL injury was associated with tennis and gymnastics, MCL with judo and skiing, ACL with handball and volleyball, PCL with handball, lateral meniscus with gymnastics and dancing, and medial meniscus with tennis and jogging.
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PMID:Epidemiology of athletic knee injuries: A 10-year study. 1660 63

During the past few years, mastocytosis research has reached important milestones, including the formulation of diagnostic criteria, definition of markers, and targeting of mutated KIT. Important aims for the future are to standardize diagnostic assays and techniques, and to achieve harmonization among centers as a basis for the design of multicenter clinical trials in SM, including the rare ASM and MCL subvariants.
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PMID:Diagnostic evaluation and classification of mastocytosis. 1693 Dec 91

Tendons and ligaments are similar in composition but differ in function. Simple anatomical definitions do not reflect the fact individual tendons and ligaments have unique properties due to their adaptation to a specific role. The patellar tendon is a structure of particular clinical interest. A null hypothesis was declared stating that the patellar tendon is not significantly different in terms of matrix composition and collagen fibril diameter to other tendons. The lateral and medial collateral ligaments (LCL, MCL), anterior and posterior cruciate ligaments (ACL, PCL), together with the long digital extensor, superficial digital extensor, and patellar tendons (LDET, SDFT, PT) were harvested from three cadaveric ovine hindlimbs. The extracellular matrix was assessed in terms of water, collagen, and total sulphated glycosaminoglycan (GAG) content. The organization of the collagen component was determined by an ultrastructural analysis of collagen fibril diameter distributions, together with values for the collagen fibril index (CFI) and mass-average diameter (MAD). There were significant differences between ligaments and tendons. The PT had a bimodal collagen fibril diameter distribution with CFI 72.9%, MAD 202 nm, water content 53.1%, GAG content 2.3 microg/mg, and collagen content 73.7%, which was not significantly different from the other tendons. The results of this study support the null hypothesis suggesting that the patellar tendon is similar to other tendons and demonstrate that tendons have different characteristics to ligaments.
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PMID:Tendons and ligaments are anatomically distinct but overlap in molecular and morphological features--a comparative study in an ovine model. 1720 54

The purpose of this study is to investigate the effects of anterior bundle of ACL (aACL), anterior portion of PCL (aPCL), anterior and deep portions of MCL (aMCL, dMCL) and the tibio-femoral articular contacts on to passive knee motion. A three-dimensional simplistic anatomical dynamic model, based on the literature was used as a reference. This reference model attaches the bundles of the ligaments on medial and the lateral spherical condyles of the femur and tibial plateau giving us a representation close enough to a normal natural tibio-femoral joint, but does not allow to study abnormalities of the knee kinematics due to the assumptions of the femur shape. The proposed three-dimensional dynamic tibio-femoral model, however includes the isometric fascicles, aACL, aPCL, aMCL, dMCL, and irregularly shaped medial-lateral contact surfaces. The approach taken in this model is capable of ligament and bone surface modifications that will enable us to analyze bone shape and ligament related abnormalities of knee kinematics.
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PMID:Interaction of ligament bundles and articular contacts for the simulation of passive knee flexion. 1800 52

The use of computer navigation in ACL reconstruction was first established in the mid- 1990s. Initial applications of this new technology focused on improving the accuracy and repeatability of tunnel placement. More recent indications focus on intraoperative assessment of knee ligament dynamic laxity measurements. Computer navigation has been used increasingly as a quantitative measurement tool to assess ACL graft obliquity or visualization of the pivot-shift phenomenon. Applications for PCL and MCL reconstruction have not been extensively studied thus far, although specific isometric or laxity measurements could be performed. Future applications include noninvasive registration techniques to use navigation as a combined preoperative, intraoperative and postoperative measurement tool. The purpose of this review is to provide an overview of the current applications and limitations of navigation in knee ligament reconstruction by reviewing the currently available literature.
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PMID:Surgical navigation in knee ligament reconstruction. 1906 64

The ectoenzyme E-NPP3 (CD203c) has recently been identified as a novel activation-linked cell surface antigen on basophils. In the present study, we examined expression of CD203c on normal mast cells (MC)and bone marrow (bm) MC derived from 85 patients with systemic mastocytosis (SM), including cases with indolent SM (ISM, n=72), SM with associated clonal hematologic non-MC-lineage disease (SM-AHNMD, n=6), aggressive SM (ASM, n=3), and mast cell leukemia (MCL, n=4). Surface expression of CD203c was analyzed by multicolor flow cytometry. In patients with SM, bm MC expressed significantly higher amounts of CD203c compared to normal bm MC (median MFI in controls: 260 versus median MFI in SM: 516, p<0.05). Slightly lower amounts of CD203c were detected on MC in SM-AHNMD and ASM compared to ISM. To demonstrate CD203c expression in MC at the mRNA level, neoplastic MC were highly enriched by cell sorting, and were found to express CD203c mRNA in RT-PCR analysis. Cross-linking of the IgE receptor on MC resulted in a substantial upregulation of CD203c, whereas the KIT-ligand stem cell factor (SCF) showed no significant effects. In conclusion, CD203c is a novel activation-linked surface antigen on MC that is upregulated in response to IgE receptor cross-linking and is overexpressed on neoplastic MC in patients with SM.
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PMID:CD203c is overexpressed on neoplastic mast cells in systemic mastocytosis and is upregulated upon IgE receptor cross-linking. 1914 65

The aims of this study were to predict and explain the patterns of ligament forces in the stump of a left trans-tibial amputee during walking, and to study the effects of the prosthetic alignment. Musculoskeletal modeling and computer simulation were combined to calculate ligament forces. The prosthesis was aligned to be in optimal position for the subject and then changed by +/-6 degrees in the sagittal plane. The results showed most ligaments bearing the maximum tension forces around both heel-strike and toe-off. The PT force was the biggest in all of the ligaments which were studied. The load patterns of ACL and PCL were opposite in the gait cycle, but the load patterns of MCL and LCL appeared similar. The above results showed that the ligament forces increased at the incorrect alignment, because the incorrect alignment could break the relative translation of the femur and tibia, and that would generate the extra ligament strains. As a result, the ligament forces increased, and the long-duration fatigue occurred more easily. This finding suggests that the proper prosthetic alignment is very important for the normal activities of the stump ligaments.
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PMID:Simulation of the ligament forces affected by prosthetic alignment in a trans-tibial amputee case study. 1934 86


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