Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound

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Query: EC:2.7.10.1 (ERK)
95,504 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the present study, the matrix components of 100 cruciate ligaments were analyzed by conventional electron microscopy, immunohistology, morphometry, and immunoelectron microscopy. The anterior (ACL) and the posterior (PCL) cruciate ligaments contained collagen types III, IV, and VI. Several structural glycoproteins, like fibronectin, laminin, entactin, tenascin, and undulin were detected using monoclonal antibodies. Whereas laminin and entactin were higher concentrated in the PCL, type VI collagen was more frequently found in the ACL. The ACL had a critical nourishment in its distal and middle thirds. In all ligament parts the PCL revealed a better vascular supply with strong correlation to type IV collagen expression. The normal matrix of the cruciate ligaments represented a complicated regulatory network of proteins, glycoproteins, elastic systems, and glycosaminoglycans with multiple functional interactions.
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PMID:Structure and function of matrix components in the cruciate ligaments. An immunohistochemical, electron-microscopic, and immunoelectron-microscopic study. 1045 82

The present cadaver study examined the probability of accurate ultrasound guided insertion of electrodes into the anterior (ACL) and posterior (PCL) cruciate ligament with a fine needle. Visualisation of the structures appeared clearest from the posterior approach. From this approach 24 electrodes were inserted into the PCL and six into the ACL. From the anterior 16 were inserted into the ACL and six into the PCL. Twenty-one out of 24 electrodes were placed correctly into the PCL from the posterior view, and four out of six were placed correctly from the anterior view. From the posterior view four out of six were placed correctly in the ACL, and eight electrodes out of 16 were placed correctly from the anterior view. In conclusion, ultrasound guided insertion of electrodes from the posterior view can be performed with high accuracy into the PCL, whereas insertion into the ACL seems to be less accurate, probably because it is more difficult to visualise.
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PMID:Sonographic guided insertion of electrodes into the cruciate ligaments of the knee. 1050 39

The objective of this study was to provide quantitative data on the insertion sites of the cruciate ligaments. In the first part of the study, we determined the shapes and sizes of the insertions of the anterior and posterior cruciate ligaments (ACL and PCL), and further compared these data with the midsubstance cross-sectional areas of the ligaments. The cross-sectional area of the ACL and PCL midsubstance of 5 human knees was measured using a laser micrometer system. The insertion sites of each ligament were then digitized and the 2-dimensional insertion site areas were determined. Relative to the ligament midsubstance, the PCL tibial and femoral insertions were approximately 3 times larger, whereas those of the ACL were over 3.5 times larger. In the second part of the study, the ACLs and PCLs of 10 knees were each divided into their 2 components and the areas of each insertion were determined. Each component was approximately 50% of the total ligament insertion area and no significant difference between the 2 could be shown.
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PMID:Quantitative analysis of human cruciate ligament insertions. 1052 22

The purpose of this article is to evaluate the incidence and to give a general review of the examination of the posterior ligament complex. At least ca. 8-10 % of all severe ligament injuries concern the posterior cruciate ligament, which means, that an estimated 4,000-5,000 Germans suffer a PCL rupture every year. Motor-vehicle accidents are the most common cause of the injury, but sports-related traumas (football, skiing) have increased in recent years. The high number of high-energy mechanisms involved (up to 90 %), cause ligament ruptures often to be associated with other injuries, especially fractures of the femur and tibia head. In polytrauma patients PCL ruptures are frequently recognized very late, because the possibility of this kind of injury is often not considered during the clinical examination. The same holds for the diagnosis of monotrauma patients. The initial step in the evaluation is to obtain a thorough history (including the mechanism of injury) and to perform a physical examination. The instability after a PCL rupture may present as an ACL rupture, because the anterior drawer test seems to be positive. The anterior/posterior drawer test must be assessed with other evaluation procedures to distinguish between anterior und posterior instabilities. The posterior sag sign, the quadriceps active test or the reversed pivot-shift may indicate a PCL rupture. A correct roentgenogram can reveal an avulsion of the tibia and can prove posterior instability due to a posterior translation of the tibia. A quantitative examination (clinical or X-ray) of the instability and the indication of combined injury of the posterior cruciate ligament and the posterolateral complex are necessary for the therapeutic decision (operative/conservative). A rupture of the PCL may occur occasionally as a result of a luxation of the knee (reduced spontaneously) before the medical evaluation. A thorough neurovascular examination is essential. Magnetic resonance imaging can be important to the diagnosis of an acute injury, but it is not essential for the choice between operative and non-operative treatment. Arthroscopy has been found to have a high degree of accuracy in the diagnosis of ligament ruptures of the knee, but it is still an operative treatment, so that it can only be used if an operation of repair or reconstruction is planned anyway. Before operative treatment of chronic complex instability, potential osseous abnormalities (varus morphotype) must be revealed; in case of uncertainty, an X-ray control is necessary.
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PMID:[Diagnostic and incidence of the rupture of the posterior cruciate ligament]. 1052 18

We established a simultaneous reconstruction method for ruptured anterior and posterior cruciate ligaments (ACL, PCL) using a single-incision technique. Residual PCL was used to determine the position of bone tunnel for ACL reconstruction. The bone tunnel position on the tibia for PCL reconstruction was arthroscopically confirmed by conducting through debridement from the posteromedial portal. Reconstruction substitutes were patellar-tendon bone-tendon-bone for ACL, and semitendinosus tendon for PCL. In the fixation procedure, the PCL substitute was fixed using the Endobutton (Smith & Nephew, Andover, MA) and a ceramic button, and the ACL substitute was fixed with an interference screw. During the surgery, radiographic monitoring and the PCL guide system were not required.
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PMID:A new arthroscopic method for reconstructing the anterior and posterior cruciate ligaments using a single-incision technique: simultaneous grafting of the autogenous semitendinosus and patellar tendons. 1056 68

Knee dislocation remains a devastating injury with many complications. It necessitates prompt diagnosis, reduction if needed, and emergent repair of any vascular injury. Serial physical examinations and frequent use of arteriograms are necessary to avoid late vascular complications. Many authors are concerned that normal pulses, normal Doppler signals, and normal ABIs have preceded late ischemia and documented intimal tear, demonstrated by arteriography. More recently, other authors have challenged the gold standard of mandatory arteriography by describing studies in which physical examination was 100% accurate in diagnosing patients without operative vascular injury. If pedal pulses, Doppler signals, or ABIs are asymmetric before or after reduction then either immediate operative exploration or arteriography should be performed. If the initial physical examination is normal, serial examinations are used in the hospital to check for late artery thrombosis. Opponents of mandatory arteriography point to a 5% false-negative rate, high cost, and an 8% complication rate, such as contrast allergy, pseudoaneurysm, local hematoma, and arteriovenous fistula. Today a consensus is that repair and reconstruction of the PCL and posterolateral corner injuries are the primary concerns in the multiple-ligament injured knee after dislocation. The ACL may be repaired later if instability persists, but some investigators believe it should not be repaired acutely, thereby avoiding increased surgical trauma and possible stiffness. Recently one of the goals of ligamentous repair and reconstruction has been to provide stability with the least invasive surgical technique to avoid postoperative stiffness. Recent treatments have focused on early arthroscopic-assisted allograft reconstruction of the ACL and PCL. Allograft provides a less invasive means of graft support than autograft. Early, limited range of motion in a brace helps to maintain flexion and extension.
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PMID:Historic perspectives of treatment algorithms in knee dislocation. 1091 56

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

ACL-PCL-posterolateral corner injuries most frequently are seen in multiple trauma patients but do occur in the athletic injury population. Acute three-ligament-injured knees may have been tibiofemoral dislocations with spontaneous reduction in the field. Careful documentation of the neurovascular status is essential in these cases to avoid the complications associated with limb ischemia. Systematic evaluation of these patients with history, physical examination, imaging studies, examination under anesthesia, and diagnostic arthroscopy will aid in the correct diagnosis and treatment plan formulation. Arthroscopically assisted, combined ACL-PCL-posterolateral complex reconstructions, using strong graft material, and performed in a timely fashion, have provided consistent and predictable results with few complications.
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PMID:Treatment of combined anterior cruciate ligament-posterior cruciate ligament-lateral side injuries of the knee. 1091 62

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

A three-dimensional model of the knee is used to study ligament function during anterior-posterior (a-p) draw, axial rotation, and isometric contractions of the extensor and flexor muscles. The geometry of the model bones is based on cadaver data. The contacting surfaces of the femur and tibia are modeled as deformable; those of the femur and patella are assumed to be rigid. Twelve elastic elements are used to describe the geometry and mechanical properties of the cruciate ligaments, the collateral ligaments, and the posterior capsule. The model is actuated by thirteen musculotendinous units, each unit represented as a three-element muscle in series with tendon. The calculations show that the forces applied during a-p draw are substantially different from those applied by the muscles during activity. Principles of knee-ligament function based on the results of in vitro experiments may therefore be overstated. Knee-ligament forces during straight a-p draw are determined solely by the changing geometry of the ligaments relative to the bones: ACL force decreases with increasing flexion during anterior draw because the angle between the ACL and the tibial plateau decreases as knee flexion increases; PCL force increases with increasing flexion during posterior draw because the angle between the PCL and the tibial plateau increases. The pattern of ligament loading during activity is governed by the geometry of the muscles spanning the knee: the resultant force in the ACL during isometric knee extension is determined mainly by the changing orientation of the patellar tendon relative to the tibia in the sagittal plane; the resultant force in the PCL during isometric knee flexion is dominated by the angle at which the hamstrings meet the tibia in the sagittal plane.
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PMID:A Three-Dimensional Musculoskeletal Model of the Human Knee Joint. Part 2: Analysis of Ligament Function. 1126 9


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