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Anatomical Examination of The Ligamentum Cruciatum Posterior in Human Fetus

Year 2022, Volume: 13 Issue: 2, 311 - 322, 31.08.2022
https://doi.org/10.22312/sdusbed.1093180

Abstract

Objective: The aim of this study is to determine the presence, differentiation and morphological features of the anterolateral band (ALB) and posteromedial bands (PMB) of the ligamentum cruciatum posterior (PCL) in human fetuses and to map PCL.

Materials and Methods: The study was carried out on 40 fetal knees with gestational ages ranging from 13 to 25 weeks of gestation without any external pathology or anomaly. ALB and PMB distinction was made when the knees were in full flexion position, and morphometric measurements of origo and insertio, mid width and length of PCL, ALB and PMB were made. Data were analyzed with both descriptive and quantitative statistical methods.

Results: When the right and left side parameters were evaluated in all fetuses in the measurements of ALB, it was determined that there was a significant difference in the proximal width measurement of ALB (p<0.05). There was a strong correlation between right and left sides of PCL, distal width (r=0.668; p=0.001), proximal width (r=0.849; p<0.001) and length measurements (r=0.795; p<0.001). A strong correlation was found between the right and left sides and the proximal width of the ALB (r=0.758; p<0.001), midpoint width (r=0.832; p<0.001) and length (r=0.691; p=0.001) measurements (p=0.001). In addition, a strong correlation was found between the measurements of the proximal width (r=0.645; p=0.005) and length (r=0.675; p=0.001) of the PMB between the right and left sides.

Conclusion: A broad mapping was obtained about the characteristics of PCL and its bands in the fetal period.

Supporting Institution

Necmettin Erbakan University Scientific Research Projects Coordinatorship

Project Number

161318002

References

  • 1. Logterman SL, Wydra FB, Frank RM. Posterior cruciate ligament: anatomy and biomechanics. Current reviews in musculoskeletal medicine. 2018;11(3):510–4.
  • 2. Mejia EA, Noyes FR, Grood ES. Posterior Cruciate Ligament Femoral Insertion Site Characteristics: Importance for Reconstructive Procedures. Am J Sports Med. 2002 Sep 1;30(5):643–51.
  • 3. Matava MJ, Ellis E, Gruber B. Surgical treatment of posterior cruciate ligament tears: an evolving technique. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2009;17(7):435–46.
  • 4. Makris CA, Georgoulis AD, Papageorgiou CD, Moebius UG, Soucacos PN. Posterior cruciate ligament architecture: evaluation under microsurgical dissection. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2000;16(6):627–32.
  • 5. Harner CD, Giffin JR, Vogrin TM, Woo SLY. Anatomy and biomechanics of theposterior cruciate ligament and posterolateral corner. Operative techniques in sports medicine. 2001;9(2):39–46.
  • 6. Lynch TB, Chahla J, Nuelle CW. Anatomy and Biomechanics of the Posterior Cruciate Ligament. J Knee Surg. 2021 Apr;34(5):499–508.
  • 7. Chahla J, Williams BT, LaPrade RF. Posterior Cruciate Ligament. Arthroscopy. 2020 Feb;36(2):333–5.
  • 8. Schmidt EC, Chin M, Aoyama JT, Ganley TJ, Shea KG, Hast MW. Mechanical and Microstructural Properties of Native Pediatric Posterior Cruciate and Collateral Ligaments. Orthopaedic Journal of Sports Medicine. 2019;7(2):2325967118824400.
  • 9. Malempati C, Felder J, Elliott M, Brunkhorst J, Miller M, Johnson DL. Current arthroscopic concepts in repairing posterior cruciate ligament tibial-sided avulsions. Orthopedics. 2015;38(9):563–9.
  • 10. Schulz MS, Russe K, Weiler A, Eichhorn HJ, Strobel MJ. Epidemiology of posterior cruciate ligament injuries. Archives of orthopaedic and trauma surgery. 2003;123(4):186–91.
  • 11. LaPrade CM, Civitarese DM, Rasmussen MT, LaPrade RF. Emerging updates on the posterior cruciate ligament: a review of the current literature. The American journal of sports medicine. 2015;43(12):3077–92.
  • 12. Anderson CJ, Ziegler CG, Wijdicks CA, Engebretsen L, LaPrade RF. Arthroscopically pertinent anatomy of the anterolateral and posteromedial bundles of the posterior cruciate ligament. JBJS. 2012;94(21):1936–45.
  • 13. Lee DY, Kim DH, Park JS, Nam DC, Cho SH, Jeong JH, et al. Systematic review of cadaveric studies on anatomic posterior cruciate ligament reconstruction: the landmarks in anatomic posterior cruciate ligament reconstruction. Knee surgery & related research. 2014;26(4):191.
  • 14. Zarychta P. Features extraction in anterior and posterior cruciate ligaments analysis. Computerized Medical Imaging and Graphics. 2015;46:108–20.
  • 15. Narvy SJ, Pearl M, Vrla M, Yi A, Hatch III GFR. Anatomy of the femoral footprint of the posterior cruciate ligament: a systematic review. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2015;31(2):345–54.
  • 16. Acar B, Başarır K, Armangil M, Binnet MS. One-stage anatomic double bundle anterior and posterior cruciate ligament reconstruction. Int J Clin Exp Med. 2014 Oct 15;7(10):3710–3.
  • 17. Osti M, Tschann P, Künzel KH, Benedetto KP. Anatomic characteristics and radiographic references of the anterolateral and posteromedial bundles of the posterior cruciate ligament. The American journal of sports medicine. 2012;40(7):1558–63.
  • 18. Johannsen AM, Anderson CJ, Wijdicks CA, Engebretsen L, LaPrade RF. Radiographic landmarks for tunnel positioning in posterior cruciate ligament reconstructions. The American journal of sports medicine. 2013;41(1):35–42.
  • 19. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. New York: Routledge; 1988. 567 p.
  • 20. Amis AA, Bull AMJ, Gupte CM, Hijazi I, Race A, Robinson JR. Biomechanics of the PCL and related structures: posterolateral, posteromedial and meniscofemoral ligaments. Knee Surgery, Sports Traumatology, Arthroscopy. 2003;11(5):271–81.
  • 21. Davies H, Unwin A, Aichroth P. The posterolateral corner of the knee: anatomy, biomechanics and management of injuries. Injury. 2004;35(1):68–75.
  • 22. Zaffagnini S, Martelli S, Garcia L, Visani A. Computer analysis of PCL fibres during range of motion. Knee Surgery, Sports Traumatology, Arthroscopy. 2004;12(5):420–8.
  • 23. Amis AA, Gupte CM, Bull AMJ, Edwards A. Anatomy of the posterior cruciate ligament and the meniscofemoral ligaments. Knee Surgery, Sports Traumatology, Arthroscopy. 2006;14(3):257–63.
  • 24. Takahashi M, Matsubara T, Doi M, Suzuki D, Nagano A. Anatomical study of the femoral and tibial insertions of the anterolateral and posteromedial bundles of human posterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 2006 Nov 3;14(11):1055–9.
  • 25. Edwards A, Bull AM, Amis AA. The attachments of the fiber bundles of the posterior cruciate ligament: an anatomic study. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2007;23(3):284–90.
  • 26. Lopes OVJ, Ferretti M, Shen W, Ekdahl M, Smolinski P, Fu FH. Topography of the Femoral Attachment of the Posterior Cruciate Ligament. JBJS. 2008 Feb 1;90(2):249–55.
  • 27. MacDonald PB, Black B, Old J, Dyck M, Davidson M. Posterior cruciate ligament injury and posterolateral instability in a 6-year-old child. The American journal of sports medicine. 2003;31(1).
  • 28. Shen HC, Yang JJ, Chang JH, Wang SJ. Surgical treatment of injury of the posterior cruciate ligament and posterolateral instability in the knee of a 5-year-old child. The American Journal of Sports Medicine. 2007;35(5):831–4.
  • 29. Frank C, Strother R. Isolated posterior cruciate ligament injury in a child: literature review and a case report. Canadian Journal of Surgery. 1989;32(5):373–4.
  • 30. Ugutmen E, Sener N, Eren A, Beksac B, Altintas F. Avulsion fracture of the posterior cruciate ligament at the tibial insertion in a child: a case report. Knee Surgery, Sports Traumatology, Arthroscopy. 2006;14(4):340–2.
  • 31. Sørensen OG, Faunø P, Christiansen SE, Lind M. Posterior cruciate ligament reconstruction in skeletal immature children. Knee Surg Sports Traumatol Arthrosc. 2017 Dec 1;25(12):3901–5.
  • 32. Kongcharoensombat W, Nakamae A, Adachi N, Deie M, Mohamed A, Sumen Y, et al. Mid-substance tear of the anterior and posterior cruciate ligaments in children: a report of three patients. Knee Surgery, Sports Traumatology, Arthroscopy. 2009;17(8):964–7.
  • 33. Heath DM, Nguyen AV, Bullock TS, Ornell SS, Bartush KC, Hogue GD. Intact PCL is a potential predictor of ACL graft size in the skeletally immature knee and other anatomic considerations for ACL reconstruction. Journal of Experimental Orthopaedics. 2022;9(1):1–9.
  • 34. Strada NA, Vutescu E, Harrington R, Mojarrad M, Orman S, Evangelista P, et al. Can the Posterior Cruciate Ligament (PCL) Predict Anterior Cruciate Ligament (ACL) Size for Planning During ACL Reconstruction? Pediatrics. 2021;147(3_MeetingAbstract):781–2.
  • 35. Kim HK, Laor T, Shire NJ, Bean JA, Dardzinski BJ. Anterior and posterior cruciate ligaments at different patient ages: MR imaging findings. Radiology. 2008;247(3):826–35.

İnsan Fetuslarinda Ligamentum Cruciatum Posterior’un Anatomik İncelemesi

Year 2022, Volume: 13 Issue: 2, 311 - 322, 31.08.2022
https://doi.org/10.22312/sdusbed.1093180

Abstract

Amaç: Bu çalışmanın amacı insan fetüslerinde ligamentum cruciatum posterior (PCL) anterolateral bant (ALB) ve posteromedial bantlarının (PMB) varlığını, ayrımını ve morfolojik özelliklerini belirlemek ve PCL’nin haritalamasını yapmaktır.
Materyal ve Yöntemler: Çalışma gestasyonel yaşları 13-25 gebelik haftası arasında değişen, harici patolojisi ve anomalisi olmayan 40 fetal diz üzerinde gerçekleştirildi. Dizler tam fleksiyon pozisyonunda iken ALB ve PMB ayrımı yapılarak; PCL, ALB ve PMB’ın origo ve insertioları, orta genişlikleri ve uzunluklarının morfometrik ölçümleri yapıldı. Veriler hem tanımlayıcı hem de nicel istatistiksel yöntemlerle analiz edildi.
Bulgular: ALB’ye ait ölçümlerde sağ ve sol taraf parametreleri tüm fetüslerde değerlendirildiğinde ALB’nin proksimal genişlik ölçümünde anlamlı farklılık olduğu belirlendi (p<0.05). PCL’nin sağ ve sol taraflar arasında; distal genişlik (r=0,668; p=0,001), proksimal genişlik (r=0,849; p<0.001) ve uzunluk ölçümleri (r=0,795; p<0.001) arasında güçlü bir korelasyon saptandı. Sağ ve sol taraflar arasında, ALB'nin proksimal genişliği (r=0,758; p<0,001), orta nokta genişliği (r=0,832; p<0,001) ve uzunluk (r=0,691; p=0,001) dahil tüm ALB ölçümleri arasında güçlü bir korelasyon bulundu (p=0,001). Ayrıca sağ ve sol taraflar arasında PMB'nin proksimal genişliği (r=0,645; p=0,005) ve uzunluk (r=0,675; p=0,001) ölçümleri arasında güçlü bir korelasyon saptandı.
Sonuç: Fetal dönemde PCL’nin ve bantlarının özellikleri hakkında geniş bir haritalama elde edilmiştir.

Project Number

161318002

References

  • 1. Logterman SL, Wydra FB, Frank RM. Posterior cruciate ligament: anatomy and biomechanics. Current reviews in musculoskeletal medicine. 2018;11(3):510–4.
  • 2. Mejia EA, Noyes FR, Grood ES. Posterior Cruciate Ligament Femoral Insertion Site Characteristics: Importance for Reconstructive Procedures. Am J Sports Med. 2002 Sep 1;30(5):643–51.
  • 3. Matava MJ, Ellis E, Gruber B. Surgical treatment of posterior cruciate ligament tears: an evolving technique. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2009;17(7):435–46.
  • 4. Makris CA, Georgoulis AD, Papageorgiou CD, Moebius UG, Soucacos PN. Posterior cruciate ligament architecture: evaluation under microsurgical dissection. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2000;16(6):627–32.
  • 5. Harner CD, Giffin JR, Vogrin TM, Woo SLY. Anatomy and biomechanics of theposterior cruciate ligament and posterolateral corner. Operative techniques in sports medicine. 2001;9(2):39–46.
  • 6. Lynch TB, Chahla J, Nuelle CW. Anatomy and Biomechanics of the Posterior Cruciate Ligament. J Knee Surg. 2021 Apr;34(5):499–508.
  • 7. Chahla J, Williams BT, LaPrade RF. Posterior Cruciate Ligament. Arthroscopy. 2020 Feb;36(2):333–5.
  • 8. Schmidt EC, Chin M, Aoyama JT, Ganley TJ, Shea KG, Hast MW. Mechanical and Microstructural Properties of Native Pediatric Posterior Cruciate and Collateral Ligaments. Orthopaedic Journal of Sports Medicine. 2019;7(2):2325967118824400.
  • 9. Malempati C, Felder J, Elliott M, Brunkhorst J, Miller M, Johnson DL. Current arthroscopic concepts in repairing posterior cruciate ligament tibial-sided avulsions. Orthopedics. 2015;38(9):563–9.
  • 10. Schulz MS, Russe K, Weiler A, Eichhorn HJ, Strobel MJ. Epidemiology of posterior cruciate ligament injuries. Archives of orthopaedic and trauma surgery. 2003;123(4):186–91.
  • 11. LaPrade CM, Civitarese DM, Rasmussen MT, LaPrade RF. Emerging updates on the posterior cruciate ligament: a review of the current literature. The American journal of sports medicine. 2015;43(12):3077–92.
  • 12. Anderson CJ, Ziegler CG, Wijdicks CA, Engebretsen L, LaPrade RF. Arthroscopically pertinent anatomy of the anterolateral and posteromedial bundles of the posterior cruciate ligament. JBJS. 2012;94(21):1936–45.
  • 13. Lee DY, Kim DH, Park JS, Nam DC, Cho SH, Jeong JH, et al. Systematic review of cadaveric studies on anatomic posterior cruciate ligament reconstruction: the landmarks in anatomic posterior cruciate ligament reconstruction. Knee surgery & related research. 2014;26(4):191.
  • 14. Zarychta P. Features extraction in anterior and posterior cruciate ligaments analysis. Computerized Medical Imaging and Graphics. 2015;46:108–20.
  • 15. Narvy SJ, Pearl M, Vrla M, Yi A, Hatch III GFR. Anatomy of the femoral footprint of the posterior cruciate ligament: a systematic review. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2015;31(2):345–54.
  • 16. Acar B, Başarır K, Armangil M, Binnet MS. One-stage anatomic double bundle anterior and posterior cruciate ligament reconstruction. Int J Clin Exp Med. 2014 Oct 15;7(10):3710–3.
  • 17. Osti M, Tschann P, Künzel KH, Benedetto KP. Anatomic characteristics and radiographic references of the anterolateral and posteromedial bundles of the posterior cruciate ligament. The American journal of sports medicine. 2012;40(7):1558–63.
  • 18. Johannsen AM, Anderson CJ, Wijdicks CA, Engebretsen L, LaPrade RF. Radiographic landmarks for tunnel positioning in posterior cruciate ligament reconstructions. The American journal of sports medicine. 2013;41(1):35–42.
  • 19. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. New York: Routledge; 1988. 567 p.
  • 20. Amis AA, Bull AMJ, Gupte CM, Hijazi I, Race A, Robinson JR. Biomechanics of the PCL and related structures: posterolateral, posteromedial and meniscofemoral ligaments. Knee Surgery, Sports Traumatology, Arthroscopy. 2003;11(5):271–81.
  • 21. Davies H, Unwin A, Aichroth P. The posterolateral corner of the knee: anatomy, biomechanics and management of injuries. Injury. 2004;35(1):68–75.
  • 22. Zaffagnini S, Martelli S, Garcia L, Visani A. Computer analysis of PCL fibres during range of motion. Knee Surgery, Sports Traumatology, Arthroscopy. 2004;12(5):420–8.
  • 23. Amis AA, Gupte CM, Bull AMJ, Edwards A. Anatomy of the posterior cruciate ligament and the meniscofemoral ligaments. Knee Surgery, Sports Traumatology, Arthroscopy. 2006;14(3):257–63.
  • 24. Takahashi M, Matsubara T, Doi M, Suzuki D, Nagano A. Anatomical study of the femoral and tibial insertions of the anterolateral and posteromedial bundles of human posterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 2006 Nov 3;14(11):1055–9.
  • 25. Edwards A, Bull AM, Amis AA. The attachments of the fiber bundles of the posterior cruciate ligament: an anatomic study. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2007;23(3):284–90.
  • 26. Lopes OVJ, Ferretti M, Shen W, Ekdahl M, Smolinski P, Fu FH. Topography of the Femoral Attachment of the Posterior Cruciate Ligament. JBJS. 2008 Feb 1;90(2):249–55.
  • 27. MacDonald PB, Black B, Old J, Dyck M, Davidson M. Posterior cruciate ligament injury and posterolateral instability in a 6-year-old child. The American journal of sports medicine. 2003;31(1).
  • 28. Shen HC, Yang JJ, Chang JH, Wang SJ. Surgical treatment of injury of the posterior cruciate ligament and posterolateral instability in the knee of a 5-year-old child. The American Journal of Sports Medicine. 2007;35(5):831–4.
  • 29. Frank C, Strother R. Isolated posterior cruciate ligament injury in a child: literature review and a case report. Canadian Journal of Surgery. 1989;32(5):373–4.
  • 30. Ugutmen E, Sener N, Eren A, Beksac B, Altintas F. Avulsion fracture of the posterior cruciate ligament at the tibial insertion in a child: a case report. Knee Surgery, Sports Traumatology, Arthroscopy. 2006;14(4):340–2.
  • 31. Sørensen OG, Faunø P, Christiansen SE, Lind M. Posterior cruciate ligament reconstruction in skeletal immature children. Knee Surg Sports Traumatol Arthrosc. 2017 Dec 1;25(12):3901–5.
  • 32. Kongcharoensombat W, Nakamae A, Adachi N, Deie M, Mohamed A, Sumen Y, et al. Mid-substance tear of the anterior and posterior cruciate ligaments in children: a report of three patients. Knee Surgery, Sports Traumatology, Arthroscopy. 2009;17(8):964–7.
  • 33. Heath DM, Nguyen AV, Bullock TS, Ornell SS, Bartush KC, Hogue GD. Intact PCL is a potential predictor of ACL graft size in the skeletally immature knee and other anatomic considerations for ACL reconstruction. Journal of Experimental Orthopaedics. 2022;9(1):1–9.
  • 34. Strada NA, Vutescu E, Harrington R, Mojarrad M, Orman S, Evangelista P, et al. Can the Posterior Cruciate Ligament (PCL) Predict Anterior Cruciate Ligament (ACL) Size for Planning During ACL Reconstruction? Pediatrics. 2021;147(3_MeetingAbstract):781–2.
  • 35. Kim HK, Laor T, Shire NJ, Bean JA, Dardzinski BJ. Anterior and posterior cruciate ligaments at different patient ages: MR imaging findings. Radiology. 2008;247(3):826–35.
There are 35 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Araştırma Articlesi
Authors

Şule Güngörer 0000-0002-7201-5565

Mustafa Büyükmumcu 0000-0002-8475-6061

Duygu Akın Saygın 0000-0003-4260-9263

Anil Aydin 0000-0003-1594-0188

Emine Cihan 0000-0003-0699-3771

Project Number 161318002
Publication Date August 31, 2022
Submission Date March 25, 2022
Published in Issue Year 2022 Volume: 13 Issue: 2

Cite

Vancouver Güngörer Ş, Büyükmumcu M, Akın Saygın D, Aydin A, Cihan E. Anatomical Examination of The Ligamentum Cruciatum Posterior in Human Fetus. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi. 2022;13(2):311-22.

SDÜ Sağlık Bilimleri Dergisi, makalenin gönderilmesi ve yayınlanması dahil olmak üzere hiçbir aşamada herhangi bir ücret talep etmemektedir. Dergimiz, bilimsel araştırmaları okuyucuya ücretsiz sunmanın bilginin küresel paylaşımını artıracağı ilkesini benimseyerek, içeriğine anında açık erişim sağlamaktadır.