ACL injuries identifiable for pre-participation imagiological analysis: Risk factors

Identification of pre-participation risk factors for noncontact anterior cruciate ligament (ACL) injuries has been attracting a great deal of interest in the sports medicine and traumatology communities. Appropriate methods that enable predicting which patients could benefit from pre- ventive strategies are most welcome. This would enable athlete-specific training and conditioning or tailored equipment in order to develop appropriate strategies to reduce incidence of injury. In order to accomplish these goals, the ideal system should be able to assess both anatomic and functional features. Complementarily, the screening method must be cost-effective and suited for widespread application. Anatomic study protocol requiring only standard X rays could answer some of such demands. Dynamic MRI/CT evaluation and electronically assisted pivot-shift evaluation can be powerful tools providing complementary information. These upcoming insights, when validated and properly combined, envision changing pre-participation knee examination in the near future. Herein different methods (validated or under research) aiming to improve the capacity to identify persons/athletes with higher risk for ACL injury are overviewed.

Anatomic and histological study of the anterolateral aspect of the knee: a SANTI Group investigation

Background: The structure and function of the anterolateral aspect of the knee have been significantly debated, with renewed interest in this topic since the description of the anterolateral ligament (ALL). Purpose: To define and describe the distinct structures of the lateral knee and to correlate the macroscopic and histologic anatomic features. Study Design: Descriptive laboratory study. Methods: Twelve fresh-frozen human cadavers were used for anatomic analysis. In the left knee, a layer-by-layer dissection and macroscopic analysis were performed. In the right knee, an en bloc specimen was obtained encompassing an area from the Gerdy tubercle to the posterior fibular head and extending proximally from the anterior aspect to the posterior aspect of the lateral femoral epicondyle. The en bloc resection was then frozen, sliced at the level of the joint line, and reviewed by a musculoskeletal pathologist. Results: Macroscopically, the lateral knee has 4 main layers overlying the capsule of the knee: the aponeurotic layer, the superficial layer including the iliotibial band (ITB), the deep fascial layer, and the ALL. Histologically, 8 of 12 specimens demonstrated 4 consistent, distinct structures: the ITB, the ALL, the lateral collateral ligament, and the meniscus. Conclusion: The lateral knee has a complex orientation of layers and fibers. The ALL is a distinct structure from the ITB and is synonymous to the previously described capsulo-osseous layer of the ITB. Clinical Relevance: Increasingly, lateral extra-articular procedures are performed at the time of anterior cruciate ligament reconstruction. Understanding the anatomic features of the anterolateral aspect of the knee is necessary to understand the biomechanics and function of the structures present and allows surgeons to attempt to replicate those anatomic characteristics when performing extra-articular reconstruction

The anterolateral ligament of the knee: unwrapping the enigma. Anatomical study and comparison to previous reports.

It has been suggested that the anterolateral ligament (ALL) of the knee may have importance in limiting rotational instability, and reconstruction may prevent a continued pivot-shift following anterior cruciate ligament surgery. However, the anatomy of this ligament has not been consistently reported in recent publications. We describe our experience of cadaveric dissection with reference to other published work.This article is freely available via Open Access. Click on the 'Additional Link' above to access the full-text from the publisher's site.Published (Open Access

Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament - deficient knee

Purpose of this paper is to provide an overview of the latest research on the anterolateral ligament (ALL) and present the consensus of the ALL Expert Group on the anatomy, radiographic landmarks, biomechanics, clinical and radiographic diagnosis, lesion classification, surgical technique and clinical outcomes. A consensus on controversial subjects surrounding the ALL and anterolateral knee instability has been established based on the opinion of experts, the latest publications on the subject and an exchange of experiences during the ALL Experts Meeting (November 2015, Lyon, France). The ALL is found deep to the iliotibial band. The femoral origin is just posterior and proximal to the lateral epicondyle; the tibial attachment is 21.6 mm posterior to Gerdy's tubercle and 4-10 mm below the tibial joint line. On a lateral radiographic view the femoral origin is located in the postero-inferior quadrant and the tibial attachment is close to the centre of the proximal tibial plateau. Favourable isometry of an ALL reconstruction is seen when the femoral position is proximal and posterior to the lateral epicondyle, with the ALL being tight upon extension and lax upon flexion. The ALL can be visualised on ultrasound, or on T2-weighted coronal MRI scans with proton density fat-suppressed evaluation. The ALL injury is associated with a Segond fracture, and often occurs in conjunction with acute anterior cruciate ligament (ACL) injury. Recognition and repair of the ALL lesions should be considered to improve the control of rotational stability provided by ACL reconstruction. For high-risk patients, a combined ACL and ALL reconstruction improves rotational control and reduces the rate of re-rupture, without increased postoperative complication rates compared to ACL-only reconstruction. In conclusion this paper provides a contemporary consensus on all studied features of the ALL. The findings warrant future research in order to further test these early observations, with the ultimate goal of improving the long-term outcomes of ACL-injured patients. Level of evidence Level V-Expert opinion

Miokardno premošćavanje prednje međukomorne arterije (r. interventricularis anterior) i njenih grana u malog zelenog majmuna (Cercopithecus aethiops sabeus)

Myocardial bridges (MBs) are structures consisting of heart muscle fibers running above the subepicardially positioned coronary arteries. In the light of previous studies, MBs are most often associated with the ramus interventricularis anterior (RIA) which put this vessel into the focus of our research. The purpose of the present study was to determine the frequency of occurrence and quantitative analysis of myocardial bridges over the RIA and its lateral branches. The studied material consisted of 55 Cercopithecus aethiops hearts, of both sexes, preserved in formaldehyde solution. Standard anatomical methods were used in the analysis, with the help of a stereomicroscope. The presence of MBs over the RIA was confirmed in a total of 70.9% samples, with no statistically significant differences related to the gender. In 2 hearts (3.6%) multiple bridges were revealed. The length of the bridges varies in the range of 0.5 mm - 31.6 mm, the distance from the origin of RIA varies between 0.5 mm - 25 mm which makes the proximal third of the anterior (paraconal) interventricular groove most frequently tunneled. The lateral branches of RIA were overbridged in 5.4%, with a single muscular band. The lenght of MBs varied from 6.2 mm - 12.5 mm, and they were localized over the first lateral branch in all cases.Fenomen miokardnog premošćavanja subepikardnih koronarnih krvnih sudova je proučavan na 55 srca malog zelenog majmuna (Cercopithecus aethiops sabeus). Koristeći standardne metode disekcije, identifikovali smo prisustvo miokardnih mostova (MM) na prednjoj međukomornoj arteriji (RIA) na 39 od 55 srca (70.9%), od kojih su 25 (71.4%) bila srca ženki, a 14 (70%) srca mužjaka, što nije pretstavljalo statistički značajnu razliku vezanu za pol (p>0.05). U najvećem broju slučajeva, 96.4% zabeležili smo jedan MM nad RIA, a samo na 2 srca (3.6%) RIA je bila premošćena sa dva MM. Ukupan broj MM u našoj seriji je 41, a njihova najčešća lokalizacija je proksimalna trećina krvnog suda. Dužina MM je varirala između 0.5 mm i 31.6 mm, a češće smo nalazili kraće strukture (do 15 mm). Udaljenost MM od mesta nastanka RIA je varirala od 0.6 mm do 25 mm. MM nad (levim) bočnim granama RIA (r. laterales) smo uočili na 3 od 55 srca (5.4%), i to na 2 srca ženki (5.7%) i na 1 srcu mužjaka (5%), što nije predstavljalo statistički značajnu razliku u odnosu na pol (p>0.05). Dužina MM je varirala od 6.2 mm do 12.5 mm. U svim slučajevim smo našli po jedan MM nad prvom bočnom granom RIA

Effects of tetra hydro cannabinol to the dendritc tree and synapses of the accumbens nucleus of wistar rats

Cannabis is one of the most widely used intoxicants; almost half of all 18 year olds in the USA and in most European countries admit to having tried it at least once, and ~10% of that age group are regular users. Δ9-Tetrahydrocannabinol (THC), the principal psychoactive ingredient in marijuana, produces euphoria and relaxation and impairs motor coordination, time sense, and short term memory. In the hippocampus, CBs inhibit GABA release from a subset of interneurons and inhibit glutamate release from principal neurons. Cannabinoids are reported to produce both rapid and long-term changes in synaptic transmission. Our study was carried out on ten male rats out of which brains of six of them were used as the representative sample for electron microscope analysis, while 4 were used for light microspcopy performed by Golgi method. Three were exposed to THC and 3 were controls. Axodendric synapses in the core and shell of the accumbens nucleus (AN) were studied under electron microscope. The results have shown widening of the synaptic cleft in the shell of AN. This result is a leading point to our further investigations which are going to involve a behavioral component, and different aspects of morphological studies. [Projekat Ministarstva nauke Republike Srbije, br. III 41020