膝关节板股韧带的解剖观测及其意义

目的：为膝关节检查提供形态学依据。方法：对76例经福尔马林固定的关键解剖,观测膝关节板股韧带的出现率和形态学特点。结果：在76例膝关节中均有前/和后板股韧带,其中前、后板股韧带均存在的占23.68%（有18例）,仅有后板股韧带的占65.79%(有50例),仅有前板股韧带的占10.53%(有8例)。后板股韧带的长度、中点宽度均大于前板股韧带。结论：板股韧带在人膝关节中普遍存在,并在运动中对外侧半月板起保护作用。     

膝横韧带和板股前、后韧带的MRI观测及其在外侧半月板“假撕裂征”诊断中的应用

目的 探讨膝横韧带(TLK)和板股前、后韧带(aMFL、pMFL)的MRI影像解剖学特征,及其对鉴别膝关节外侧半月板真假撕裂的价值。方法 回顾性分析2014年8月―2015年8月在广西医科大学第三附属医院关节外科行膝关节MRI检查,且关节镜排除半月板真性撕裂的101例患者的影像资料,其中男60例,女41例,平均年龄42(18~75)岁。行MR多序列、多平面扫描,观测TLK、aMFL、pMFL的出现率、中点径、走行方式及“假撕裂征”出现率等,应用χ²检验对“假撕裂征”出现率行性别及侧别间比较。结果 TLK的出现率为67.3%(68/101),横断面多呈卵圆形、圆形,其平均中点矢状径(1.88±0.35)mm、冠状径(1.79±0.60)mm,于外侧半月板前角“假撕裂征”出现率为2.9%(2/68)。aMFL、pMFL的出现率分别为13.9%(14/101)、77.2%(78/101),横断面呈卵圆形、扁平形及不规则形等多种形状;aMFL平均中点矢状径(1.53±0.39)mm、冠状径(2.8±0.92)mm,pMFL平均中点矢状径(2.04±1.03) mm、冠状径(3.10±1.08)mm;板股韧带于外侧半月板后角“假撕裂征”出现率为18.5%(17/92)。外侧半月板“假撕裂征”出现率在性别、侧别间差异均无统计学意义(P值均﹥0.05)。结论 在膝关节MRI检查中,外侧半月板有时显示“假撕裂征”;通过对TLK及aMFL、pMFL进行影像形态学研究,根据其在MRI上的形态、走行及外侧半月板假撕裂的方向、位置,可鉴别外侧半月板后角撕裂的真假属性,从而减少不必要的手术治疗。     

An initial qualitative study of dual-energy CT in the knee ligaments

OBJECTIVE: To study the clinical application of dual-energy CT (DECT) in the knee ligaments. METHODS: Twelve cases (24 knees) were scanned using dual-energy CT for the knee. Two- and three-dimensional images were used for display in all cases by means of multi-planar reformation (MPR) and volume rendering technique (VRT). All images were ranked by two radiologists according to the grade of knee ligament displayed, the definition of edge and attachment points of the knee ligament. RESULTS: The partial ligaments of 24 knees, such as the patellar ligament, fibular collateral ligament, anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) were clearly displayed; the tibial collateral ligament was not satisfactorily displayed. The transversal ligaments, such as lateral patellar retinaculum and medial patellar retinaculum, and the posterior ligament, such as oblique popliteal ligament could not be shown clearly. CONCLUSION: The dual-energy CT is a new and valuable tool to qualitatively display the main ligaments of the knee.     

The meniscofemoral ligaments: magnetic resonance imaging and anatomic correlations

Summary Examination of the knee joint by magnetic resonance imaging (MRI) is a noninvasive technique of proven reliability as regards lesions of the menisci and ligaments [3, 4, 11]. It provides good definition of the different anatomic structures [10]. The meniscofemoral ligaments have been observed with varying frequency and may be responsible for false images [5, 16, 17]. However, it is important to detect them in cases of hypermobile discoid menisci of the Wrisberg ligament type in order to guide the surgeon in their excision during total meniscectomy [2, 7]. We have attempted to assess the ability of MRI to visualise the meniscofemoral ligaments in correlation with an anatomic study and to identify certain anatomic pitfalls. This study will allow better investigation of the hypermobile menisci associated with the meniscofemoral ligaments. A clinical case is reported to illustrate its practical importance.

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Les ligaments méniscofémoraux: Etude en imagerie par résonance magnétique et corrélations anatomiques

Resumé L'exploration du genou en imagerie par résonance magnétique (IRM) est une technique non agressive qui a fait la preuve de sa fiabilité en pathologie ménisco-ligamentaire [11, 4, 3]. Elle permet d'obtenir une bonne définition des différentes structures anatomiques [10]. Les ligaments méniscofémoraux ont été observés avec une fréquence variable et peuvent être responsables d'images pièges [5, 16, 17]. Leur détection est cependant importante en cas de ménisques discoïdes hyper-mobiles, Wrisbergligament-type, afin de guider le chirurgien dans leur exérèse au cours de la méniscectomie totale [7, 2]. Nous nous proposons d'évaluer les capacités de l'IRM à visualiser les ligaments méniscofémoraux en correlation avec une étude anatomique, et de déterminer certains pièges anatomiques. Cette étude permettra une meilleure exploration des ménisques hypermobiles associés aux ligaments méniscofémoraux. Un cas clinique est rapporté illustrant cet intérêt pratique.

     

正常人骨盆骶棘韧带的解剖学及MRI成像研究

目的　明确骶棘韧带MRI最佳扫描平面角度并探讨其临床意义。 方法　（1）正常成人新鲜尸体骨盆标本8具,观察骶棘韧带起止点及其形态特点;（2）利用36例正常人骨盆CT数据,测量骶棘韧带在矢状面上的投影与冠状面的角度;（3）对10名志愿者进行3D MRI扫描,记录骶棘韧带角度并与CT数据对比;比较斜冠状面与常规3个面的显像效果。 结果　（1）骶棘韧带起于骶尾部连接至坐骨棘。（2）骶棘韧带在矢状面上的投影与冠状面的角度CT数据测量结果为（61.32±8.71）°, 在双侧及性别上无统计学差异（P>0.05）;（3）MRI测量结果为（57.53±2.12）°。CT数据与MRI数据比较无统计学差异（P>0.05）;斜冠状面的成像优于常规扫描（P <0.05）。 结论　骶棘韧带MRI扫描在（60.0±5.0）°斜冠状面上显像较好,是常规扫描的重要补充。     

Biomechanics of the ligaments of the human knee and of artificial ligaments

Summary The treatment of serious sprains and chronic laxity of the knee calls for a knowledge of the mechanical properties of the stabilizing structures. The mechanical characteristics indicate an elasticity rate of from 21 to 30% for the cruciate ligaments and average of 11% for the lateral ligments. Preservation methods markedly influence mechanical properties. In the case of chronic laxity, natural ligaments can be replaced by artificial ones. This comparative biomechanical study of natural and artificial ligaments provides a classification to help the user in his choice.

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Biomécanique des ligaments du genou humain et des ligaments artificiels

Résumé Les méthodes thérapeutiques des entorses graves et des laxités chroniques du genou nécessitent une connaissance des propriétés mécaniques des structures de stabilisation. Les caractéristiques mécaniques des ligaments croisés objectivent un pourcentage d'élasticité compris entre 21 et 30% pour les ligaments croisés et 11 % en moyenne pour les ligaments latéraux. Les propriétés mécaniques sont influencées par les méthodes de conservation. Un ligament artificiel remplace un ligament naturel dans le cas d'une laxité chronique. Le résultat d'une étude biomécanique comparative entre ligaments naturels et artificiels permet d'optimiser le choix de l'utilisateur.

     

Morphologic study of the lateral and medial collateral ligaments of the human knee

The collateral ligaments of the knee are important in maintaining knee stability. Numerous studies have been described the morphology and function of the ligaments of the knee. However, little data was given about the lateral and medial collateral ligaments simultaneously. The objective of the present study was to compare the morphology of the lateral (LCL) and medial (MCL) collateral ligaments in human knees. We dissected 34 cadaver knees and examined the size, attachment and inclination of the LCL and the MCL. In both of them, the posterior bundle was longer than that of the anterior bundle. The anterior and posterior bundles of the MCL were longer than that of the LCL. The proximal attachment of the MCL situated more anterior and superior than that of the LCL. As compared with the LCL, the distal attachment of the MCL located a little forward and inferior. The longitudinal diameter of the attachment of ligaments was longer than the transverse one, except for the proximal attachment of the MCL. The size of the attachments of the MCL was larger than that of the LCL except for the longitudinal diameter of the proximal attachment. At full extension of the knee, the inclination of the MCL was backward, while that of the LCL was forward. These data showed that the LCL and MCL had the different structural properties. It may provide a better understanding of the function of the collateral ligaments.     

枕寰枢关节韧带断层与MR图像的对照研究

目的：为临床MRI诊断枕寰枢关节韧带损伤提供断层解剖学依据。方法：利用低温冰冻技术，将枕寰枢关节制成3．5mm厚的薄层断层标本，并与该区的磁共振图像相对照。结果：寰椎横韧带在横断位和矢状位，翼状韧带在斜冠状位和矢状位，齿突尖韧带在矢状位和斜冠状位能清楚观察各韧带的形态和毗邻关系。结论：在MRI上能清楚显示枕寰枢关节的各条韧带。     

Development of the human knee joint ligaments

ABSTRACT Background: Many studies have been published on the development of the human knee joint, but scant attention has been given to the development of the knee joint ligaments. The only elements that have received much attention are the cruciate ligaments and their relationships with the synovial membrane. Methods: We summarize our observations on the development of the knee joint ligaments in 50 serially sectioned human embryonic and fetal lower limbs (26 embryos and 24 fetuses). Results: The patellar ligament begins to form in O'Rahilly stage 20, with the muscle fibers of the quadriceps muscle being attached inferiorly to the tibial tuberosity. The cruciate ligaments (beginning with the posterior) arise from the articular interzone in O'Rahilly stage 21. Subsequently, with the organization of the Wrisberg's meniscofemoral ligament, in week 10 of development, the cruciate ligament system is completed. The lateral collateral ligament begins to form in O'Rahilly stage 23, and from its first appearance it is independent of the knee joint capsule. At this time, development of the tendon of the popliteus muscle begins. The medial collateral ligament begins to develop in week 9 of development as a condensation of the joint capsule. Two weeks later, the intra-articular pad of fat begins to form from mesenchymal tissue below the patella and between the cruciate and the patellar ligaments. With the organization of the suprapatellar bursa in week 14 of development, knee joint development is complete. Conclusions: The morphogenetic time table of the knee joint ligaments was established. Anat. Rec. 248:259-268, 1997. © 1997 Wiley-Liss, Inc.     

Mechanoreceptors of the ligaments and tendons around the knee

Proprioceptive inputs from the joints and limbs arise from mechanoreceptors in the muscles, ligaments and tendons. The knee joint has a wide range of movements, and proper neuroanatomical organization is critical for knee stability. Four ligaments (the anterior (ACL) and posterior (PCL) cruciate ligaments and the medial (MCL) and lateral (LCL) collateral ligaments) and four tendons (the semitendinosus (STT), gracilis (GT), popliteal (PoT), and patellar (PaT) tendons) from eight fresh frozen cadavers were harvested. Each harvested tissue was divided into its bone insertion side and its tendinous part for immunohistochemical examination using S100 staining. Freeman–Wyke's classification was used to identify the mechanoreceptors. The mechanoreceptors were usually located close to the bone insertion. Free nerve endings followed by Ruffini endings were the most common mechanoreceptors overall. No Pacini corpuscles were observed; free nerve endings and Golgi‐like endings were most frequent in the PCL (PCL‐PaT: P = 0.0.1, PCL‐STT: P = 0.00), and Ruffini endings in the popliteal tendon (PoT‐PaT: P = 0.00, Pot‐STT: P = 0.00, PoT‐LCL: P = 0.00, PoT‐GT: P = 0.00, PoT‐ACL: P = 0.09). The cruciate ligaments had more mechanoreceptors than the medial structures (MS) or the patellar tendon (CR‐Pat: P = 0.000, CR‐MS: P = 0.01). The differences in mechanoreceptor distributions between the ligaments and tendons could reflect the different roles of these structures in the dynamic coordination of knee motion. Clin. Anat. 29:789–795, 2016. © 2016 Wiley Periodicals, Inc.     

膝关节交叉韧带和侧副韧带的断面解剖学研究及其意义

目的研究膝关节交叉韧带和侧副韧带的断面形态特征和变化规律,为诊断膝部韧带病变提供更为详尽的形态学资料。方法利用27例正常成人膝关节标本制作连续断面,其中矢状断面9例,冠状断面12例,横断面6例。通过横、矢、冠状断面标本,观测膝关节韧带的断面形态特征及定量测量。结果矢状面上测量前、后交叉韧带长度分别为(29.66±4.21)mm、(40.26±6.81)mm,厚度分别为(10.03±1.97)mm、(11.24±3.50)mm。冠状面上前、后交叉韧带长径分别为(15.18±3.25)mm、(18.79±3.35)mm,短径分别为(6.37±1.32)mm、(8.03±1.46)mm;胫、腓侧副韧带长度分别为(102.85±19.64)mm、(45.52±14.91)mm,厚度分别为(2.63±0.72)mm、(3.43±1.04)mm。髁间隆起的横断面上胫、腓侧副韧带长径分别为(21.98±11.95)mm、(5.25±1.93)mm,短径分别为(2.03±0.59)mm、(2.87±0.64)mm。结论 (1)观测交叉韧带最好的断面是膝关节正中矢状面,其次是正中旁开1个矢状断面。除厚度外,在矢状面上前后交叉韧带长度、股、胫骨附着区宽度均有明显差异。(2)胫、腓侧副韧带在连续的冠状断面及横断面上均可显示,以冠状断面配合横断面相对为佳。     

Signification of the unusual delineation of the anterior meniscofemoral ligament of Humphrey during knee arthro-CT

BACKGROUND: Meniscofemoral ligaments (MFLs) are recognized as stabilizing and protective structures for the posterolateral meniscocondylar compartment of the knee, and as secondary restraints to tibial posterior translation. PURPOSE AND PATIENTS: We report the 64-row arthro-MDCT findings of 10 patients (8 males, 2 females; mean age 43.8 years) in which the anterior MFL of Humphrey (aMLF) was atypically well delineated by an unusual circumferential effusion of iodine contrast. We discuss a possible physiopathologic mechanism for this effusion, describe the MDCT anatomy of the aMLF and review the literature about the anatomy and physiology of the MFLs. RESULTS: In each of our ten patients an unusual effusion of articular contrast was found delineating a posterior oblique ligamentar bundle, which was running in front of the posterior cruciate ligament (PCL). This bundle was best appreciated on posterior coronal oblique and sagital MPR views, and was recognized as the aMFL. The finding was associated with a partial tear of the tibial insertion of the posterior horn (PH) of the lateral meniscus (LM) in three patients, and with a partial (two cases) or subtotal (three cases) tear of the PCL in five patients. A swollen-probably oedematous-PCL was found in another patient and in the last case the anomaly was minimal and remained isolated. All patients were treated conservatively. CONCLUSION: Since the aMFL inserts inferiorly into the posterior horn of the LM and runs in very close anatomic and functional relation with the PCL, we hypothesize that a trauma producing a tear in these structures may also occasionally sufficiently stretch the aMFL to produce a peripheral loosening allowing a circumferential effusion of opacified synovial fluid around the ligament. Our report offers the opportunity to illustrate the "in vivo" anatomy of the aMFL through original unpublished figures. It also contributes to reinforce the literature data concerning the potential fine mechanical role played by the LM-MFLs-PCL complex, in which the centrally located MFLs act laterally as stabilizing and protective structures for the posterolateral meniscocondylar compartment and medially as secondary restraints to tibial posterior translation.     

Fetal development of the transverse atlantis and alar ligaments at the craniovertebral junction

Although the fetal development of the craniovertebral junction has long been of major interest to embryologists from the viewpoint of segmentation, development of the associated ligaments has received scant attention. Using semiserial horizontal sections from 18 embryos and fetuses (six embryos with a crown-rump length (CRL) of 20-26 mm or ~6-7 weeks of gestation; five fetuses with a CRL of 32-58 mm or 8-9 weeks; seven fetuses with a CRL of 90-115 mm or 14-15 weeks) without any abnormalities of cartilage configuration such as atlas assimilation, we studied the ligamentous structures along and around the odontoid process of the axis. The transverse atlantis and alar ligaments originated from a common mesenchymal condensation possibly corresponding to the proatlas segment: the former started to develop slightly earlier than the latter, and the morphologies of both were established at 7 weeks of gestation. Development of the joint cavitation around the odontoid process began in the mid-anterior area at 6 weeks, but was not fully completed even at 15 weeks (115 mm CRL). The presumptive joint cavity expressed vimentin and CD34 and contained abundant CD68-positive macrophages. We always found a mid-anterior joint cavitation facing the basi-occipital, but the embryological meaning remained unclear. The apical ligament appeared most likely to originate from the notochord sheath. The notochord was exposed from the tip of the odontoid process toward the loose epidural tissue and entered the occipital bone, but was difficult to trace to the anterior surface of the basi-occipital.     

The posterior meniscofemoral ligament: morphologic study and anatomic classification

The meniscofemoral ligaments (MFLs) run from the medial femoral condyle to the posterior horn of the lateral meniscus and consist of anterior MFL (aMFL) and/or posterior MFL (pMFL) components according to whether it passes anterior or posterior to the posterior cruciate ligament (PCL). The purpose of this study was to analyze the incidence and morphologic features of the MFLs in Koreans and formulate an anatomic classification system of MFLs to aid the detailed interpretation of medical imaging or biomechanical data. One hundred knees from 52 cadavers were studied. Eighty-seven knees had pMFLs, whereas an aMFL was only found in one knee from a male cadaver. The pMFLs and PCLs were longer in males than in females (P < 0.05). The most common type of MFL was the high crossing of a typical pMFL against the PCL in both genders. Regarding other types, the incidence of absent pMFLs was higher in males than in females and the oblique bundle of the PCL was easily confused with the pMFL in several cases in both genders. These results provide the basis for the classification system of the MFL and will contribute to better outcomes for evaluating the MFL and PCL when using medical imaging such as arthro-CT scan or MRI through a better understanding of the anatomy of the MFL and PCL.     

踝、距下关节外侧韧带断层与MRI图像的对照研究及临床意义

目的 :为临床MRI诊断踝、距下关节外侧韧带损伤提供断层解剖学依据。方法 :利用低温冰冻技术 ,当足呈自然放松位时 ,将踝、距下关节制成 3 .5mm厚的薄层断层标本 ,并与该区的磁共振图像相对照。结果 :距腓前韧带在轴位 ,跟腓韧带在冠状位和斜轴位 ,距腓后韧带在四个方位 ,颈韧带在冠状位和矢状位 ,距跟骨间韧带在冠状位、矢状位和斜轴位 ,伸肌下支持带浅束在冠状位和矢状位 ,中束和深束在冠状位 ,能清楚观察各韧带的形态和毗邻关系。结论 :在MRI上能清楚显示踝、距下关节外侧区的各条韧带。     

A biochemical study of the distribution of collagen and its crosslinks in knee ligaments and the patellar tendon

Purpose: The purpose of this study was to investigate biochemical differences in collagen crosslinks from different locations within the ligaments and a tendon of the human knee.

Materials and Methods: The anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), lateral collateral ligament (LCL), and patellar tendon (PT) were obtained from 24 cadavers (13 men and 11 women) whose average age at the time of death was 84.8 years. Ligaments and PT samples were obtained from the femoral and tibial insertions and the midsubstance. Hydroxyproline (Hyp) and collagen crosslinks, including pyridinoline (Pyr) and pentosidine (Pen), were compared among the different sites.

Results: The midsubstance Hyp concentration was greater than at the femoral and tibial insertions in the ACL (p?=?0.00124 and 0.000255, respectively) and PCL (p?=?0.00036 and 0.042, respectively). The Pyr:collagen ratio did not differ among sites in any of the ligaments or PT. The Pen:collagen ratio at the midsubstance was greater than at the femoral and tibial insertions in the ACL (p?=?0.00022 and 0.00025, respectively) and LCL (p?=?0.000081 and 0.000021, respectively) and was greater at the femoral insertion in the MCL (p?=?0.00010).

Conclusions: The mature collagen crosslink Pyr was not different in distribution in knee ligaments and the PT. Pen increased at the midsubstance ligaments and the PT. As increased Pen may represent ligament degeneration, this may indicate that degeneration may progress more rapidly at the midsubstance than at the insertion sites of a ligament.     

Structure and vascularization of the cruciate ligaments of the human knee joint

The structure and vascularization of the human anterior and posterior cruciate ligament were investigated by light microscopy, transmission electron microscopy, injection techniques and by immunohistochemistry. The major part of the anterior and posterior cruciate ligament is composed of bundles of type I collagen. Type III collagen-positive fibrils separate the bundles. The major cell type is the elongated fibroblast, lying solitarily between the parallel collagen fibrils. The histologic structure of the cruciate ligaments is not homogeneous. In both ligaments there is a zone where the tissue resembles fibrocartilage. In the anterior cruciate ligament the fibrocartilaginous zone is located 5–10 mm proximal of the tibial ligament insertion in the anterior portion of the ligament. In the posterior cruciate ligament the fibrocartilage is located in the central part of the middle third. Within those zones the cells are arranged in columns and the cell shape is round to ovoid. Transmission electron microscopy reveals typical features of chondrocytes. The chondrocytes are surrounded by a felt-like pericellular matrix, a high content of cellular organelles and short processes on the cell surface. The pericellular collagen is positive for type II collagen. The major blood supply of the cruciate ligaments arises from the middle geniculate artery. The distal part of both cruciate ligaments is vascularized by branches of the lateral and medial inferior geniculate artery. Both ligaments are surrounded by a synovial fold where the terminal branches of the middle and inferior arteries form a periligamentous network. From the synovial sheath blood vessels penetrate the ligament in a horizontal direction and anastomose with a longitudinally orientated intraligamentous vascular network. The density of blood vessels within the ligaments is not homogeneous. In the anterior cruciate ligament an avascular zone is located within the fibrocartilage of the anterior part where the ligament faces the anterior rim of the intercondylar fossa. The fibrocartilaginous zone of the middle third of the posterior cruciate ligament is also avascular. According to Pauwel’s theory of the ”causal histogenesis” (1960) the stimulus for the development of fibrocartilage within dense connective tissue is shearing and compressive stress. In the anterior cruciate ligament this biomechanical situation may occur when the ligament impinges on the anterior rim of the intercondylar fossa when the knee is fully extended. Compressive and shearing stress in the center of the middle third of the posterior cruciate ligament may result from twisting of the fiber bundles. Accepted: 12 March 1999     

Degeneration of the human lumbar spine ligaments. An ultrastructural study

The fine structural alterations in human lumbar spine ligaments were studied in tissue samples obtained from 8 young patients operated upon for idiopathic scoliosis and from 10 adult patients operated upon for herniated discs. The ultrastructure of the scoliotic ligaments was found to be normal. The majority of cells encountered were the fibroblastic-like cells. The collagen-proteoglycans interaction was similar to that described in other normal soft tissues. However, two forms of degenerative changes were demonstrated in posterior ligaments of patients with herniated discs. Metaplasia of ligamentous tissue into fibrocartilage was a common finding. The fibroblasts were replaced by chondrocytes. A few cells which had suffered necrosis were found. Alterations in the collagen-proteoglycans arrangement were also evidenced. This form of degeneration resembled that commonly associated with wear and tear phenomena. A second form of degeneration due to ageing was found to coexist with the aforementioned alterations.     

Medial and lateral arcuate ligaments of the diaphragm: attachment to the transverse process

According to current anatomy textbooks, the diaphragmatic medial and lateral arcuate ligaments are attached to the transverse process of the first lumbar vertebra. In dissections of 15 human cadavers we found both arcuate ligaments attached to the transverse process of L2 (10 cases and L3 (5 cases). In no case were they attached to the transverse process of L1.