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PubMed1981

The time and history-dependent viscoelastic properties of the canine medical collateral ligament.

The viscoelastic properties of the canine medial collateral ligament (MCL) were investigated. Stress-strain relationships at different strain rates, long-term stress relaxation and cyclic stress-strain curves of the MCL were obtained experimentally using a bone-MCL-bone preparation. The experimental data were used in conjunction with the quasi-linear viscoelastic theory as proposed by Fung [15] to characterize the reduced relaxation function, G(t) and elastic response sigma e (epsilon) of this tissue. It was found that the quasi-linear viscoelastic theory can adequately describe the time and history-dependent rheological properties of the canine medial collateral ligament.

Animals↗
PubMed2006

Fashioning a new radial collateral ligament during arthroplasty of the finger metacarpophalangeal joints in rheumatoid arthritis.

We describe a technique for reconstructing the radial collateral ligament of the finger metacarpophalangeal joints in patients with rheumatoid arthritis during arthroplasty. This technique is used in cases where the original collateral ligament is unfit for imbrication. In this method, a new collateral ligament is created using the volar plate of the concerned metacarpophalangeal joint. The technique is surgically simple, has the advantage of using locally available tissue, and has produced results that are both clinically and radiologically satisfactory. These advantages make this procedure a useful tool to have in one's surgical armamentarium.

Arthritis, Rheumatoid↗
PubMed1991

The effect of section of the medial collateral ligament on force generated in the anterior cruciate ligament.

Ten fresh-frozen knees from cadavera were instrumented with a specially designed transducer that measures the force that the anterior cruciate ligament exerts on its tibial attachment. Specimens were subjected to tibial torque, anterior tibial force, and varus-valgus bending moment at selected angles of flexion of the knee ranging from 0 to 45 degrees. Section of the medial collateral ligament did not change the force generated in the anterior cruciate ligament by applied varus moment. When valgus moment was applied to the knee, force increased dramatically after section of the medial collateral ligament; the increases were greatest at 45 degrees of flexion. Section of the medial collateral ligament had variable effects on the force generated in the anterior cruciate ligament during internal rotation but dramatically increased that generated during external rotation; these increases were greatest at 45 degrees. Section of the medial collateral ligament increased mean total torsional laxity by 13 degrees (at 0 degrees of flexion) to 20 degrees (at 45 degrees of flexion). Application of an anteriorly directed force to the tibia of an intact knee increased the force generated in the anterior cruciate ligament; this increase was maximum near the mid-part of the range of tibial rotation and minimum with external rotation of the tibia. Section of the medial collateral ligament did not change the force generated in the anterior cruciate ligament by straight anterior tibial pull near the mid-part of the range of tibial rotation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1979

[Surgical treatment of the ruptured ulnar collateral ligament of the metacarpophlangeal joint of the thumb].

The diagnosis of ruptured ulnar collateral ligament of the metacarpo-phalangeal joint of the thumb is made from characteristic findings and special radiograms. Without treatment, impairment of hand function will result. Only in a few cases will conservative treatment be successful; the reasons are explained. 26 cases of total rupture of the collateral ligament and their surgical treatment are reported. 16 fresh ligamentous injuries were treated by suturing directly (n = 2), by pull-out wire technique (n = 10), and by screw osteosynthesis (n = 4). The ligament was reconstructed with a free tendon graft in 8 cases of old ligamentous injuries, while the remaining 2 cases were repaired using a pull-out wire. After treatment, all metacarpo-phalangeal joints showed full stability and all patients without discomfort. Restriction of mobility results much more from secondary than from primary treatment. Therefore, we recommend primary surgical treatment of the ruptured ulnar collateral ligament of the metacarpo-phalangeal joint of the thumb.

Adolescent↗
PubMed1998

The medial collateral ligaments of the human ankle joint: anatomical variations.

This study aimed to investigate anatomical variations within the medial collateral ligament complex of the human ankle joint. Osteoligamentous preparations of 40 ankles from 20 cadavers were studied. Six different component bands of the medial collateral ligament complex were observed: four superficial bands (tibiospring, tibionavicular, superficial posterior tibiotalar, and tibiocalcaneal ligaments), of which only the tibiospring and tibionavicular ligaments were constant, and two deep bands (deep posterior tibiotalar and deep anterior tibiotalar ligaments), of which only the deep posterior tibiotalar ligament was constant. No pattern was observed in the distribution of additional bands. A consistent and universally accepted system for naming the various bands of the medial collateral ligament is necessary to enable easy and accurate comparisons between studies. We suggest that this system should be based on the attachments of the ligaments.

Aged↗
PubMed1999

The effect of hyperbaric oxygen on medial collateral ligament healing in a rat model.

Hyperbaric oxygen has been shown to promote healing in bone and some soft tissues. This study was undertaken to determine its effect on ligamentous healing. Forty-eight Sprague-Dawley rats underwent a standardized surgical laceration of the right (divided) medial collateral ligament, whereas the left (undivided) medial collateral ligament was not surgically lacerated. A control group of 24 rats recovered without intervention. An experimental group consisting of the other 24 rats was exposed to hyperbaric oxygen at 2.8 atmospheres for 1.5 hours a day for 5 days after the surgery. Six rats from each group were euthanized at 2, 4, 6, and 8 weeks. The stiffness and final force to failure were recorded for the divided and undivided medial collateral ligaments. At 4 weeks, a statistically greater force was required to cause failure of the previously divided ligaments that had been exposed to hyperbaric oxygen than those that had not. The stiffness and force to cause failure of previously divided ligaments were statistically greater at 4 weeks than at 2 weeks, whether or not hyperbaric oxygen was used. No additional statistical increases in stiffness or force were observed at 6 weeks.

Animals↗
PubMed1995

[Clinical and radiologic evaluation of the integrity of medial and lateral collateral ligaments of the elbow in dogs].

Closed reduction is the best therapy in most cases of luxation of the elbow. Clinical retrospective studies showed the presence of arthrosis in 50% of the cases treated with closed reduction (Meyer-Lindenberg et al., 1991) and persisting medial instability after the reduction in more than 50% of the cases. In the present study, the biomechanic of both medial and lateral collateral ligaments was analyzed after selective severing of those ligaments. Severing of the medial collateral ligament led to an average increase of the pronation of 30 degrees with the presence of crepitus on the lateral aspect of the elbow during passive motion. The medial instability of the elbow could be evidenced clinically as well as radiographically. Severing of the lateral collateral ligament resulted in an average increase of the supination of 15 degrees. No evidence of subluxation could be diagnosed using palpation or radiology. Craniocaudal stressed radiographic views of the elbow in pronation are the most helpful to document damages of the collateral ligaments of the elbow.

Animals↗
PubMed2004

Comparative effects of monopolar radiofrequency energy and conservative management of mechanical properties of elongated lateral collateral ligament in rabbits: an experimental study.

OBJECTIVE: We examined the biomechanical effects of shrinkage in elongated rabbit lateral collateral ligament. DESIGN: This study was designed in an attempt to evaluate the energy effects of monopolar radiofrequency on strained but not ruptured ligaments. BACKGROUND: In treatment of ligament injuries difficulty in reducing increased laxity after trauma and recurrence of instability are important factors for failure. METHODS: Ligament elongation and laxity were achieved in operating room by applying varus stress for multiple times. In Group C ( n = 8 ), elongated lateral collateral ligaments were treated only with above-knee cast, while in Group S ( n = 8 ), they were treated with shrinkage and above-knee casts. The un-operated sides were labeled as control groups. At the 12th week after surgery the animals were sacrificed and hind limbs were disarticulated. Removing the other soft tissues around knee, only lateral collateral ligaments were left intact. Biomechanical analyses of the effects of two different treatment methods were compared by performing a pulling-out test. RESULTS: Considering maximum load and stiffness, conservatively treated ligaments were stronger and stiffer than shrunken ligaments ( P < 0.05 ). CONCLUSION: Biomechanical values were altered by both treatment methods. Reflecting an alteration in intra-molecular structure, the main alteration was the decrease of strength in shrunken ligaments. In ligament injuries, we concluded shrinkage not to be superior to conservative treatment.

Animals↗
PubMed1986

The effects of immobilization on the ultrastructure and mechanical properties of the medial collateral ligament of rats.

Rat medial collateral ligaments from one group of animals were tensile tested following immobilization. Ligaments from a second group of animals were examined using transmission electron microscopy to determine collagen fibril cross-sectional area and density. Immobilized and contralateral control ligaments were compared to determine the effect of immobilization on these parameters. There was a significant decrease in the linear stress, maximum stress, and stiffness of immobilized ligaments. There was no significant difference in the strain values reported. There was a significant decrease in the proportion of smaller, cross-sectional area fibrils (0-10,000 nm2) following immobilization. There was also a significant increase in the proportion of larger (30,000-40,000 nm2 and 40,000-50,000 nm2) fibrils following immobilization. This finding was attributed to a decreased synthesis and decreased degradation of collagen during immobilization; post-immobilization, the density of collagen fibrils in the ligament decreased. There may be a relationship between ultrastructural and mechanical alterations following immobilization. Significant clinical implications are apparent in the altered mechanical properties following immobilization.

Animals↗
PubMed1994

The collateral ligament flexion-extension test (CLEFT) in total knee replacement.

We present a simple preoperative clinical test, the collateral ligament extension-flexion test (CLEFT). In patients undergoing total knee arthroplasty, with a preoperative valgus or varus deformity, this test establishes which knees have balanced collateral ligaments. It predicts which knees will not require soft tissue adjustment during the course of their surgery despite, in some cases, large deformities. The mechanism of the test is based on the observation that, in certain patients, a deformity present in extension is seen to correct in flexion. The sensitivity of this observation was checked in 44 consecutive patients undergoing total knee arthroplasty, and who had either a valgus or varus deformity in extension greater than 10 degrees. In 34 patients the test was positive, and none of these required ipsilateral collateral ligament release. All of the 10 patients with a negative test required soft tissue adjustment. In patients undergoing unconstrained total knee arthroplasty this test is reliably predictive of those knees with preoperative deformity which can be corrected simply by correctly aligned bone cuts. It supports the principle of bony resection prior to soft tissue adjustment in this form of surgery.

Biomechanical Phenomena↗
PubMed1993

[Treatment of collateral ligament ruptures of the knee joint].

Functional treatment of the medial collateral ligaments (grades I and II) gives the best results. Both, experimental results and clinical experience thus far, show that such treatment leads to a short period of morbidity and always gives a good functional result. Any minimal residual instability can be successfully compensated for. Functional treatment is only possible if the cruciate ligaments are intact. Severe ruptures (grade III) can also be treated with functional therapy, but with certain qualifications (not in the presence of axial deviation, cruciate instability or previous meniscectomy). Isolated lesions of the lateral collateral ligaments are very rare; severe combined ruptures of the capsule and ligaments are treated surgically.

Follow-Up Studies↗
PubMed2001

Reconstruction of chronic collateral ligament injuries to fingers by use of suture anchors.

AIM: To evaluate the effectiveness of suture anchors in the reconstruction of chronic collateral ligaments of fingers. METHODS: We treated 8 patients, 6 with chronic instability of the collateral ligament of the thumb and 2 with the instability of the fifth finger, using the Statak suture anchor. A stable joint was achieved in each case, with no recurrent instability or pain within a mean of 14 months of the follow up. RESULTS: Postoperatively, each patient returned to his or her original job, their daily activities, and sports. There was no significant difference on manual stress testing measurements between operated and uninjured fingers. Mean pinch strength and range of motion were 90% (range, 78-104%) and 94% (range, 70-100%), respectively, compared to uninjured fingers. CONCLUSION: Suture anchor technique can be recommended as a simple and effective method of repairing the collateral ligament of fingers.

Adult↗
PubMedDate not supplied

Anatomic relation between the medial collateral ligament of the elbow and the humero-ulnar joint axis.

The anatomic relation between the proximal attachment of the medial collateral ligament of the elbow joint and the humero-ulnar joint axis has not been clearly shown in a published study. We examined cadaveric specimens to find the exact relation between them. The medial collateral ligament was microscopically dissected to isolate specific fiber bundles. The length of each bundle was measured with a charge-coupled device camera system that faced the medial side of the elbow joint. The measurements indicated that the projected length of the deep middle bundle of the anterior oblique ligament, which is the strong cord-like part of the medial collateral ligament, is isometric during elbow flexion. The proximal end of the deep middle bundle was thus considered to be located almost on the humero-ulnar joint axis.

Cadaver↗
PubMedDate not supplied

Medial collateral ligament reconstruction of the elbow using the docking technique.

BACKGROUND: Medial collateral ligament insufficiency of the elbow with resultant valgus instability in throwing athletes is typically treated with free tendon graft reconstruction as described by Jobe. HYPOTHESIS: Improved results could be obtained with the use of the docking technique. STUDY DESIGN: Uncontrolled retrospective review. METHODS: The study group consisted of 36 athletes who had symptomatic insufficiency of the medial collateral ligament confirmed by magnetic resonance imaging and by surgical findings. Average follow-up was 3.3 years. Key elements of the docking technique included a muscle-splitting approach without routine transposition of the ulnar nerve, routine arthroscopic assessment, treatment of associated lesions, and docking the two ends of the tendon graft into a single humeral tunnel. RESULTS: Thirty-three of 36 patients (92%) returned to or exceeded their previous level of competition for at least 1 year, meeting the Conway-Jobe classification criteria of "excellent." All 22 professional or collegiate athletes returned to or exceeded their previous competition level. CONCLUSIONS: The docking technique allowed simplified graft tensioning and improved graft fixation.

Adolescent↗
PubMedDate not supplied

Anatomy and kinematics of the lateral collateral ligament of the knee.

The anatomy and kinematics of the lateral collateral ligament were studied in 10 unembalmed limbs and 20 isolated femurs and fibulas. The ligament's average overall length was 66 mm (range, 59 to 74) and the average greatest dimension of its thin middle portion was the anteroposterior dimension of 3.4 mm (range, 3 to 4). The center of the femoral attachment site was 3.7 mm posterior to the ridge of the lateral epicondyle, not at it apex. A potential radiographic technique for operatively locating the femoral attachment site to within 3 mm is described. During knee flexion in neutral rotation the distance between the femoral and fibular attachment sites of the lateral collateral ligament decreased to 88% of its value in full extension. With 6.5 N x m of applied external rotation force, beyond 30 degrees of flexion the attachment sites rapidly approximated. With the same internal rotation force, beyond 15 degrees of flexion the attachment sites separated. From 60 degrees to 105 degrees they were greater than 100% of the value in full extension, suggesting significant distraction between the attachment sites. These changes correlated well with the ligament's change from an 11 degrees posterior slope in extension to a 19 degrees anterior slope in flexion with no applied rotation.

Aged↗
PubMed2004

Sonography of injury of the ulnar collateral ligament of the elbow-initial experience.

OBJECTIVE: The purpose of this study is to describe the sonographic appearance of injuries of the ulnar collateral ligament (UCL) of the elbow. DESIGN AND PATIENTS: Eight non-professional male baseball pitchers, ages 13-35 years, with medial elbow pain and clinical suspicion of ulnar collateral ligament injury, were referred for imaging. All eight underwent sonography of the affected and contralateral asymptomatic elbow, and six also underwent MR imaging. Neither valgus stress nor power Doppler was used during the sonographic examinations. Time from onset of symptoms to imaging was 1.5 weeks to 6 months. Three patients had surgical confirmation of their injuries, with time from imaging to surgery of 2 days to 9 months. RESULTS: In four patients, the UCL was ruptured, manifest sonographically in three cases as discontinuity of the normally hyperechoic ligament with anechoic fluid in the gap and in one case as non-visualization of the ligament with heterogeneous echogenicity in the expected location of the ligament. Two adolescent patients had avulsions of the UCL from the medial epicondyle, with sonographic demonstration of the avulsed echogenic bony fragment in both cases. One patient had a mild sprain, manifest as mild thickening and decreased echogenicity of the ligament sonographically compared with the contralateral normal elbow, with mild surrounding hypoechoic edema. The eighth patient had a small partial tear of the deep surface of the distal aspect of the ligament, visualized as a hypoechoic focus between the deep surface of the ligament and its ulnar attachment. CONCLUSION: Tears of the ulnar collateral ligament are manifested sonographically as non-visualization of the ligament or alteration of the normal morphology.

Adolescent↗
PubMedDate not supplied

Evidence of subclinical medial collateral ligament injury and posteromedial impingement in professional baseball players.

BACKGROUND: Recognition and treatment of elbow conditions such as medial collateral ligament injury and posteromedial impingement are increasing in throwing athletes. Magnetic resonance imaging may provide pivotal information in the management of these athletes. Knowledge of the utility of magnetic resonance imaging has become widespread throughout the baseball community. However, data on the frequency and extent of asymptomatic magnetic resonance imaging findings in the elbows of this throwing population are lacking . HYPOTHESIS: Abnormalities in the throwing elbows of asymptomatic professional baseball players compared to the nonthrowing elbows are frequently seen in magnetic resonance images. STUDY DESIGN: Descriptive anatomical study. METHODS: Sixteen asymptomatic professional baseball players with no history of injury underwent bilateral elbow magnetic resonance imaging using a standardized sequencing protocol. The magnetic resonance images were reviewed, in a blinded fashion, by 2 musculoskeletal radiologists and 1 orthopaedic surgeon. RESULTS: Medial collateral ligament abnormalities (including thickening, signal heterogeneity, or discontinuity) were present in 87% of players' dominant elbows. Findings consistent with posteromedial impingement were present in 13 of 16 subjects. There was a significant correlation between medial collateral ligament thickening and posteromedial subchondral sclerosis (P = .04). The throwing elbow was correctly identified in all 16 subjects. No significant correlation between magnetic resonance imaging findings and age could be detected. CONCLUSIONS: This study demonstrates a high rate of abnormal magnetic resonance imaging findings in asymptomatic throwers' elbows. These baseline findings must be considered when magnetic resonance imaging is being used as a factor in treatment decisions.

Adolescent↗