SELVYA INDAH NURSHINTA DEWI

LIGAMENT

A ligament is a tough band of fibrous tissue that connects bone to bone or bone to
cartilage and supports and strengthens joints. The main function of ligaments are to keep the
bones of the skeleton in proper alignment and prevent abnormal movements of the joints.
While ligaments are extremely strong, they can be stretched or even torn. This usually
occurs during an extreme force such as a fall or another high impact. When a ligament is
injured because it is stretched too far from its normal position it is called a sprain.

Ligament of Knee





SELVYA INDAH NURSHINTA DEWI


ACL
Function
o prevents anterior translation of the tibia relative to the femur
Anatomy
o intraarticular and intrasynovial
o origin
lateral femoral condyle
PL bundle originates posterior and distal to AM bundle (on femur)
o insertion
broad and irregular
anterior and between the intercondylar eminences of the tibia
o structure
33mm x 11mm in size
two bundles
anteromedial
fibers are parallel in extension
fibers are externally rotated in flexion
tight in both flexion and extension
posterolateral
PL bundle prevents pivot shift
prevents internal tibial rotation with knee near extension
tight in extension, loose in flexion
Blood supply
o middle geniculate artery
Innervation
o contains significant innervation by posterior articular branches of tibial nerve
o contains mechanoreceptors (Ruffini, Pacini, Golgi tendon organs, free-nerve
endings)
o function of innervation
proprioception
modulation of quadriceps function
Composition
o 90% Type I collagen
o 10% Type III collagen
Biomechanics
o tensile strength
native ACL 2200 N
BTPB 3000N
quadrupled hamstring 4000N
SELVYA INDAH NURSHINTA DEWI


PCL
Function
o prevents posterior translation of the tibia relative to the femur
o PCL and PLC work in concert to resist posterior translation and posterolateral
rotatory instability
Anatomy
o origin
medial femoral condyle
o insertion
tibial sulcus
o structure
38mm x 13mm in size
two bundles
anterolateral
shorter, thicker and stronger
in double bundle reconstruction, tensioned in mid
flexion
posteromedial
longer, thinner, weaker
in double bundle reconstruction, tensioned in extension
and high flexion
tensioning in extension protects against
hyperextension
insertions
medial intercondylar ridge
marks proximal border of femoral insertion
medial bifurcate ridge
may separate the AL from AM bundle
variable meniscofemoral ligaments originate from the posterior horn of
the lateral meniscus and insert into the substance of the PCL. These
include
Ligament of Humphrey (anterior to PCL)
Ligament of Wrisberg (posterior to PCL)
o blood supply
middle geniculate artery
Biomechanics
o strength: 2500 N (vs posterior translation)
SELVYA INDAH NURSHINTA DEWI


MCL
Function
o to provide restraint to valgus angulation
o works in concert with ACL to provide restraint to axial rotation
Anatomy
o origin
MFC to medial tibia extending down several centimeters
o structure
two components
superficial portion (tibial collateral ligament)
lies just deep to gracilis and semitendinosus
originates from medial femoral epicondyle and inserts
into periosteum of proximal tibia (deep to pes
anserinus)
the superficial portion of the MCL contributes 57% and
78% of medial stability at 5 degrees and 25 degrees of
knee flexion, respectively.
the superficial MCL is the primary stabilizer to valgus
stress at all angles
deep portion (medial capsular ligament)
separated from supficial portion by a bursa
attaches to medial meniscus (coronary ligament)
divided into meniscofemoral and meniscotibial portions
posterior fibers of the deep MCL blend with
posteromedial capsule and POL
the deep MCL and posteromedial capsule act as
secondary restraints to valgus stress at full knee
extension.
Biomechanics
o strength: 4000 N (vs valgus stress)





SELVYA INDAH NURSHINTA DEWI


LCL (Lateral Collateral Ligament)
Function
o to provide support to varus angulation
o works in concert with MCL to provide restraint to axial rotation
o also known as "Fibular Collateral Ligament".
Anatomy
o origin
on lateral femoral condyle posterior and superior to insertion
of popliteus
o path
runs superficial to popliteus
o insertion
on the fibula anterior to the popliteofibular ligament on the fibula
capsule's most distal extent is just posterior to the fibula
o structure
cord-like
Biomechanics
o tight in extension and lax in flexion
o strength: 750 N (vs varus stress)