Anterior Rupture

A 28 year-old woman undergoing her first pregnancy developed a uterine rupture in the anterior fundal area of the uterus during the first trimester. Both tubes were normal. 

High levels of oestrogens then induce a positive feedback on the anterior pituitary in the late follicular phase to cause an increase in the level of LH. Following the LH surge, ovulation occurs and the ruptured follicle is converted to a corpus luteum. 

Approximately 85% of spontaneous SAHs are caused by ruptured aneurysm 10% are perimesencephalic and the remainder are caused by rare disorders (van Gijn and Rinkel 2001). The pattern of bleeding on CT is a clue to the underlying cause. Blood in the interhemispheric fissure suggests an anterior communicating artery aneurysm and in the sylvian fissure suggests internal carotid artery or middle cerebral artery aneurysm (Fig. 30.1). 

To confirm the stereotaxic orientation of sections in the brain used for this atlas, reference needle tracks were made perpendicular to the horizontal and coronal planes. For brains sectioned in the coronal plane, vertical needle insertions were made at 2.0 mm intervals through the brain, except for the penetrations at 0.7 mm anterior to the interaural line, which was chosen to avoid rupture of a venous sinus. Ten such needle tracks appear on coronal plates of this atlas. Three horizontal needle insertions perpendicular to the coronal plane were made from the posterior of the brain at 1.0, 3.0, and 5.0 mm above the interaural line and approximately 1.0 mm lateral to the midline. The reference tracks from the horizontal needles appear as small holes in coronal sections. 

Cora Nari has a lack of oxygen in the anterior and lateral walls of her heart caused by severe ischemia (lack of blood flow) resulting from clots formed at the site of ruptured atherosclerotic plaques. The limited availability of Oj to act as an electron acceptor will decrease proton pumping and generation of an electrochemical potential gradient across the inner mitochondrial membrane. As a consequence, the rate of ATP generation in her heart will decrease, thereby triggering events that lead to irreversible cell injury. 

The ACL resists anterior tibial translation and rotational loads. With a ruptured ACL, the anterior translation of the tibia relative to the femur can be four times greater than in normal knees. It also restrains internal rotation significantly and plays a minor role in controlling the external rotation and varus-valgus angulation. Moreover, the ACL prevents medio-lateral translation of the tibia. In an ACL-defident knee, this poor translation can lead to tears in the medial meniscus and hypertrophy of the tibial spine and notch, and it increases contact loading of the medial compartment of the knee. ... 

When an ACL is ruptured, the axis of rotation shifts more medially and the tibial rotation causes a coupled anterior tibial translation, magnifying the movements of the tibial plateau. The primary insult is thus to the lateral compartment, mainly the posterior aspect, and injury to the medial compartment occurs secondarily. The lateral compartment is most frequently injured mainly because it can sublux more easily. 

Konishi Y, Fukubayashi T and Takeshita D. Possible mechanism of quadriceps femoris weakness in patients with ruptured anterior cruciate ligament. Med Sci Sports Exerc. 2002 34 1414-1418. 

Mannel H, Marin F, Claes L and Durselen L. Anterior cruciate hgament rupture translates the axes of motion within the knee. Clin Biomech. 2004 19 130-135. 

Tsai KJ, Chiang H and Jiang CC. Magnetic resonance imaging of anterior cruciate ligament rupture. BMC Musculoskeletal Disord. 2004 5 21. 

Drogset JO, Grontvedt T, Robak OR, Meister A, Viser AT and Engebretsen L. A sixteen-year follow-up of three operative techniques for the treatment of acute ruptures of the anterior cruciate hgament. J Bone Joint Surg Am.2006 SS 944-952. 

Meunier A, Odensten M and Good L. Long-term results after primary repair or non-surgical treatment of anterior cruciate ligament rupture a randomized study with a 15-year follow-up. Scand J Med Sci Sports. 2007 17 230-237. 

Scavenius M, Hansen, S,Bak K,NorringK, Jensen KH and Jorgensen U. Isolated total ruptures of the anterior crudate Ugament - a cUnical study with long-term follow-up at 7 years. Scand J Med Sci Sport. 1999 9 114-119. 

Noyes FR and Barber SD. The effect of a ligament augmentation device on allograft reconstructions for chronic ruptures of the anterior cradate ligament. J Bone Joint SurgAm. 1992 74 960-973. 

Chmielewski TL, Hurd WJ, Rudolph KS, Axe MJ, Snyder-Mackler L (2005) Perturbation training improves knee kinematics and reduces muscle co-contraction after complete unilateral anterior raudate ligamcmt rupture. Phys Ther 85(8) 740-754... 

Odensten M, Lysholm J, Gillquist J (1985) The course of partial anterior cruciate ligament ruptures. Am J Sports Med 13 183-186... 

Sandberg R, Balkfors B (1987) Partial rupture of the anterior cruciate ligament natural course. Clin Orthop Relat Res 220 176-178... 

Colombet P, Dejour D, Panisset JC, Siebold R (2010) Current concept of partial anterior cruciate ligament ruptures. Orthop Traumatol Surg Res 96S S109-S118... 

Beard DJ, Kyberd PJ, Fergusson CM, Dodd CA (1993) Proprioception after rupture of the anterior cruciate ligament. An objective indication of the need fm surgery J Bone Joint Surg (Br) 75 311-315... 

Fig. 10.6 The proposed noncontact ACL injury mechanism, (a) An unloaded knee, (b) When valgus loading is applied, the MCL becomes taut and lateral compression occurs, (c) This compressive load causes a lateral femoral posterior displacement, probably due to the posterior slope of lateral tibial plateau, and the tibia translates anteriorly and rotates internally, resulting in ACL rupture, (d) After the ACL is tom, the primary restraint to anterior translation of the tibia is gone. This causes the medial femoral condyle to also be displaced posteriorly, resulting in external rotation of the tibia...

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