Optimal Replacement of the Cruciate Ligaments from the Functional-Anatomical Point of View

Abstract

By means of a combined technique of dissection andradiography the function of cruciate ligament fibers was analyzed for motions in the sagittal plane, and different functional fiber bundles were reconstructed in cadaver knees. In order to grant permanent stability, crucial replacement must be concentrated on the reconstruction of the constantly taut ‘guiding bundle’ of each cruciate ligament. The femoral attachment point of each guiding bundle was found to be in a constant position within the femoral attachment of the respective cruciate ligament. The femoral attachment areas of different functional fibers are also defined geometrically, and the consequences of improper guiding bundle replacement are discussed.

Strain Measurement at the Knee Ligament Insertion Sites. Dehnungsmessung, der Kniegelenksbänder an deren knöchernen Insertionsstellen

“…The improvement of die mentioned technique can also be seen in die fact that the measurement results of our experiment are similar to other experiments where at least muscle strength is simulated (Fuss, 1991;Friederich etal., 1992). Aldiough there is an enormous ränge of literature about die topic of ligament tension measurement that we exemplary show for the posterior cruciate ligament most sources can not be compared äs they are based on experiments without action of muscle strength and axial force.…”

Integración tendinosa de plastias autólogas en túneles de diferente calibre. Estudio experimental en ovejas

“…Los ligamentos de la articulación de la rodilla humana son estructuras compuestas por colágeno distribuido de forma no homogénea [93]. Los fascículos anteriores de todos los ligamentos contienen más colágeno por unidad de volumen que los fascículos posteriores y, además, en los ligamentos cruzados, la porción central contiene más colágeno que la distal o proximal y su densidad es menor en el LCA que en el resto de los ligamentos [172].…”

“…Los estudios biomecánicos han demostrado que cada uno de ellos tiene una función determinada en el movimiento de flexo-extensión de la rodilla [93]. Según Kurosawa et al [141] el fascículo AM se tensa en extensión completa, está relajado entre 20º y 60º de flexión y, de nuevo, se tensa a partir de los 90º de flexión.…”

Experimental Evaluation of 3-Dimensional Kinematic Behavior of the Cruciate Ligaments

“…In agreement with this fact are Boisgard et al, 20 Bradley et al, 21 Sakane et al, 13 and Li et al 23 who also described an isometric pattern for these bundles. On analyzing these results, attention was called to the fact that these fiber bundles comprise a standard similar to the "guide bundle" described by Fuss,3,4 being determined by this researcher as "the most anterior bundle of the ACL" because, as described by the researcher, these bundles remain with their length practically unchanged, giving a clear demonstration that they are important articular stabilizers in all angular moments of the movement.…”

“…For Fuss 3,4 and Mommersteeg et al, 5 it is evident that the state of tension of a ligament being constant or variable depends on the distance between its bone insertions points, such as collagen fibers that only tension when the distance between insertion points increases. These researchers consider this to be the key point for a functional description of cruciate ligaments.…”