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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Morphometric Measurements of Posterior Cruciate Ligament and its Clinical Implications: A Cadaveric Cross-sectional Study
Correspondence Address :
Dr. Abhinav Kumar Mishra,
PhD Scholar, Department of Anatomy, SBKSMIRC, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India.
E-mail: abhinavanatomy07@gmail.com
Introduction: Posterior Cruciate Ligament (PCL) is a band like structure which tightly adheres to femur and tibia with collagen fibres. It is considered as an active and primary stabiliser of the knee joint and it acts as the principal restraint against posterior tibial translation. Its anatomical knowledge is necessary for practicing surgeons.
Aim: To study the morphometric parameters of total length and width of Posterior Cruciate Ligaments (PCL) at three points (proximal, central and distal) on both knee joints and their clinical correlation.
Materials and Methods: The cross-sectional study was conducted at Smt. Bikhiben Kinjal Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India, from August 2021 to May 2022. This cadaveric study was conducted over 40 knee joints of 20 formalin-fixed cadavers of unknown sex and measured the length and width of PCL with the help of digital caliper. Total length and width (proximal, central and distal) of PCL were measured and Mean±Standard Deviation (Mean±SD) were recorded. Independent t-test and Karl Pearson’s correlation coefficient were used to find out any possible association and correlation for various morphometric measures of right and left knee at 5% and 1% level of significance, respectively. Statistical analysis was done by the trial version of Statistical Package for Social Sciences (SPSS) version 21.0.
Results: Total length of PCL of right and left knee was 33.19±3.09 mm and 33.12±3.40 mm, and range between 23.4-37.9 mm and 23.8-38.0 mm, respectively. The measurements of the width of PCL at different levels (proximal, central and distal) of right knee were 9.07±1.24 mm, 10.44±1.75 mm and 9.10±1.46 mm respectively, while in left knee they were 9.33±1.67 mm, 10.32±1.99 mm and 9.29±1.70 mm, respectively. T-test showed that there was no association for considered morphometric measures between right and left knee at α=5%. The correlation assessment showed strong positive correlations between left and right sides for both knees at different levels, which were significant p-value <0.001. However, no correlation was found between length and width (proximal, central and distal) for both knees.
Conclusion: This study gives the valuable result of parameters of length and width of PCL, which helps for orthopaedic surgeons in the surgery and grafting of ligament in the case of trauma.
Allograft, Agenesis, Restoration, Restrain, Surgery
Knee joint is one of the complex synovial joints in the body comprising of patello femoral joint and tibio femoral joint. The joint cavity is mainly formed by the tibia and femur, which are connected by four main ligaments: two collateral ligaments on the sides of the knee and two cruciate ligaments present inside the knee namely Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL). The PCL originates from the posterior part of lateral surface of medial femoral condyle in inter-condylar notch runs distally, posteriorly and gets inserted to a depression posterior to the upper part of intra-articular surface of tibia (1),(2),(3). It is considered as an extra capsular ligament because it is enclosed within its own synovial sheath (3),(4) which is 32-38 mm long and 11 mm wide (2),(5). The PCL is easily recognisable before the development of the ACL (6),(7). PCL is made up of two bundles, Anterolateral (AL) bundle is larger, stiffer and tighter in flexion while another bundle is Posteromedial (PM) which is smaller, short and taut in extension (8). Its thickness is double than ACL and it is innervated by tibial nerve and get nourishment from middle genicular artery (2). PCL acts as active and primary stabiliser of the knee joint and it is also the principal restraint against posterior tibial translation (9). In some of the cases, it was found that the agenesis of PCL over 0.017 per 1000 live births (10),(11),(12) which is associated with type-1 A fibular hemimelia (13). During the surgical repair of cruciate ligaments, the orthopaedic surgeon should have detailed knowledge about the different parameters of cruciate ligaments, which will guide them in appropriate size of the allografting procedure in surgical reconstruction (10). Various previous studies (14),(15),(16),(17),(18),(19),(20) evaluating the measurements of PCL and focus on its length and width only after separation from its femoral and tibial attachment areas. To knowledge of the present authors, there is no any specific anatomical study that evaluates the correlation between the length of PCL along its width (proximal, central and distal).Therefore, the present study was designed to consider all the morphometric measures of both the knee joints.
The study was a cross-sectional type which was carried out on 40 knee joints of 20 formalin-fixed cadavers obtained from the Department of Anatomy, Smt. Bhikhiben Kinjal Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India from August 2021 to May 2022 after prior Institutional Ethics Committee (SVIEC) approval (vide letter no. SVIEC/ON/MEDICAL/PhD/20016).
Normal knee joints were included in the present study however operative, traumatic and osteoporotic cases were excluded from the study. All the measurements of PCL were taken by a Digital caliper (Oleander OL 68595, Caliper Plastic, India). The length of the PCL was measured by the point mark between lateral border of the medial femoral condyle and the posterior aspects of the medial and lateral tibial plateau. Its width measured by their femoral (proximal), middle portion (central) and Tibial (distal) attachments (Table/Fig 1),(Table/Fig 2).
Statistical Analysis
Data has been entered in Microsoft Excel 2010. Statistical analysis done by the trial version of SPSS version 21.0. The data was checked for normality using Shapiro-Wilk test at 5% level of significance. Mean along with standard deviation has been produced for various morphometric measures of Right and Left knee. Further Independent t-test and Karl Pearson’s correlation coefficient was used to look for any possible association and correlation for various morphometric measures of right and left knee at 5% and 1% level of significance, respectively.
Total length of PCL of right and left knee were 33.19±3.09 mm and 33.12±3.40 mm respectively, the range between min-max were 23.4-37.9 mm and 23.8-38.0 mm, respectively. The width of PCL from proximal, central and distal level of right knee were 9.07±1.24 mm, 9.33±1.67 mm and 10.44±1.75 mm, respectively while 10.32±1.99 mm, 9.10±1.46 mm and 9.29±1.70 mm were the measurements for left knee respectively and the range was 6.6-11.7 mm, 6.4-13.0 mm and 8.1-13.9 mm for right knee whereas 6.0-13.0 mm, 6.7-12.6 mm and 6.9-13.6 mm for left knee respectively.
Independent t-test showed right and left knee were similar for considered morphometric measures with no statistically significant difference. p-value for total length PCL right vs left knees was 0.47 and proximal width of both knees were 0.28 which were not significant, p-value showing proximal width right and left knee (p-value=0.28), central width right and left knee (p-value=0.41) and distal width of both the knees (p-value=0.34) were also not significant at α=5% (Table/Fig 3).
Karl Pearson’s correlation coefficient between PCL total length right and left knees were 0.753 (p-value=0.001), between right knee central width and right knee proximal width were 0.757 (p-value=0.001), between left knee central width and left knee proximal width were 0.706 (p-value=0.001), between right knee distal width and right knee proximal width were 0.758 (p-value=0.001), between right knee distal width and right knee central width were 0.631 (p-value=0.004), between left knee distal width and left knee proximal width were 0.873 (p-value=0.001) and between left knee distal width and left knee central width were 0.585 (p-value=0.007) showing significant positive correlation.
While correlation between right knee proximal width and PCL total length of right knee (ρ=0.163; p-value=0.491), proximal width left knee and PCL total length of left knee (ρ=0.111; p-value=0.643), central width right knee and PCL total length of right knee (ρ=0. 363; p-value=0.116), central width left knee and PCL total length of left knee (ρ=0.441; p-value=0.052), distal width right knee and PCL total length of right knee (ρ=0.291; p-value=0.213), distal width left knee and PCL total length of left knee (ρ=0.077; p-value=0.747) were not significant (Table/Fig 4).
(Table/Fig 5) shows scatter plot graph showing the correlation between total length PCL and width at three points of PCL for both the knee joints.
The strongest ligament of the knee joints which are also very important clinically are cruciate ligaments which are two in number; one lies anteriorly and the other one in posteriorly (1). Morphometric analysis of PCL has great value during surgical treatment of injured PCL, in fact, it is observed that graft stretching or shortening with flexion when the tunnels are misplaced while reconstructing the PCL (21). Better conservative, surgical, and rehabilitative therapy options have been made possible by advances in our knowledge of PCL anatomy and biomechanics in recent years (22),(23),(24),(25),(26),(27). The present study results were in parallel with the findings of studies conducted by Minh DV et al., (2019) and Geetha Rani BG et al., (2019) (16),(17). The present study gives a valuable data which represent the correlation between the length and width of the ligament for finding out the interrelationship between their different widths. Pope T et al., reported that the length of PCL was 22 mm while Iyaji Pi and Soames Rw observed both the length and width of the AL and PM bundles at tibial insertion were 8.7 mm and 10.9 mm and 7.3 mm and 10.4 mm respectively (18),(19). The mean lengths and widths of PCL at femoral attachments were 9.4 mm and 12.8 mm for both AL and PL bundles were 7.5 mm and 11.4 mm on both the knee joints. Yelicharla AK et al., conducted their study in Maharashtra region and reported the mean length of PCL in males were 36.9±3.9 mm and in females 36.9±3.4 mm respectively (14). They also reported the mean width of PCL were 9.2±2.3 mm, 9.1±2.2 mm in males and females respectively which is higher in range than the present study and also found that the gender difference in morphometric parameters of cruciate ligament while executing the surgical repair whereas the study was conducted by Mishra S et al., reported that the mean length and width of Rt. knee were 20.08±1.130 mm and 6.22±0.851 mm, while on Lt. knee it was 20.10±1.129 mm and 5.90±0.777 mm, respectively which is lower to the present study and concluded that the study is helpful to know the exact size in grafting (15). The study conducted by Goyal T et al., reported that the mean area of femoral insertion were 17.4±14.3 mm2 and 98.1±7.4 mm2 found in tibial insertion, respectively (20). The study done by DV Minh et al., was 35.57±2.78 mm, reported that the length of PCL and Geetha Rani BG et al., reported that the length of PCL was 35.39±3.73 mm and the width was 5.93±0.778 mm, respectively which was similar to the present study, also compared between the length and width of PCL and concluded that, the clinical implications has been made for its knowledge is helpful in selection of quality and quantity while grafting (16),(17). Comparison of parameters of total length and width of PCL with previous studies can be seen in (Table/Fig 6) (14),(15),(16),(17),(18),(19),(20).
In the present study, we have included both the knee joints along with their length and width also in which the length of Rt. knee and Lt. knee were 33.19±3.09 mm and 33.12±3.40 mm, respectively. Also reported the width at three point in which the proximal, central and distal width of Rt. knee were 9.07±1.24 mm, 10.44±1.75 mm and 9.10±1.46 mm, respectively whereas on Lt. knee were 9.33±1.67 mm, 10.32±1.99 mm and 9.2±1.70 mm, respectively. Also, tried to measure the exact area of attachments from where the ligament arises. In the present study, the have shown the width at the three points, which is better representation for the width of entire PCL.
Limitation(s)
Limitations included scarcity of cadavers and tissue degeneration. So, the findings may be more accurate upon the availability.
There was no significant difference for considered morphometric measures of PCL between right and left knees. Various morphometric measurements of both knees were also showed strong positive correlations. In the event of any type of avulsion, accurate understanding is necessary for the grafting and restoration of the PCL, which will better direct the orthopaedic surgeons for the proper repair of the ligament.
Prof. (Dr.) Manoj Mohan Kulkarni, Professor and Administrative Officer and Prof. (Dr.) Achaleshwar Gandotra, Ex-Professor and PhD guide in the Institute are the stalwart of anatomy and helped a lot during authors’ research work. The authors would like to thank them for their continuous support.
DOI: 10.7860/JCDR/2022/60427.17241
Date of Submission: Oct 03, 2022
Date of Peer Review: Nov 02, 2022
Date of Acceptance: Nov 30, 2022
Date of Publishing: Dec 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA
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