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PubMed1993

[Posterolateral rotatory instability of the elbow--a case report and anatomical study of the lateral collateral ligament].

A 20-year-old woman was referred to our clinic complaining of recurrent subluxation of her right elbow. A posterolateral rotatory instability test revealed that she had insufficiency of the lateral collateral ligament. She was surgically treated; the ligament was reconstructed by using the palmaris longus tendon. A year after operation, she had no pain in her elbow, and regained full range of elbow motion. The function of the lateral collateral ligament is often overlooked. We, therefore, dissected 24 elbow joints and studied anatomically in order to confirm the origin and insertion of the lateral collateral ligament. The ligament originates from the lateral epicondyle, and runs distally in fan shape. It further inserts partly to the annular ligament and partly to the supinator crest. After complete sectioning of the ligament, the forearm was fixed in supination, then flexed with valgus moment. This maneuver elicited subluxation of the radio-humeral joint, which was similar to what we observed in the clinical case. From these observations, we have concluded that the ligament is important for stability of elbow joint as well as the medial collateral ligament.

Adult↗
PubMed2001

Repair of collateral ligament instability in 2 foals by using suture anchors.

Instability of the collateral ligaments of the carpal or metacarpophalangeal joint occurred in 2 foals. The instability was repaired using commercial suture anchors. In foals, commercial suture anchors combined with external coaptation can be used successfully to repair collateral ligament instability of the carpus or the metacarpophalangeal joint.

Animals↗
PubMed1996

Combined injuries of the anterior cruciate and medial collateral ligaments of the knee. Effect of treatment on stability and function of the joint.

We performed a retrospective study of sixty-six patients (forty-one male and twenty-five female) who had a combined injury of the anterior cruciate and medial collateral ligaments. Our purpose was to determine the prevalence of late valgus instability of the knee. The mean age of the patients was thirty-five years (range, sixteen to sixty-three years). The mean follow-up interval was forty-five months (range, twenty-one to 108 months). Twenty patients had been injured while snow-skiing; twenty-four, during other sports activities; seven, in a motor-vehicle accident; and the remaining fifteen, during activities of daily living. Eleven patients had reconstruction of the anterior cruciate ligament and repair of the medial collateral ligament, thirty-three had reconstruction of only the anterior cruciate ligament, and twenty-two were managed non-operatively. There was no evidence of valgus instability on clinical examination at the most recent follow-up visit. However, there was evidence of instability on stress roentgenograms of the knee in eight (13 per cent) of sixty patients. With the numbers available, we could detect no relationship between the presence of valgus instability and the method of treatment of the ligamentous tears ( p > 0.4). We also compared the results for twenty-one of the thirty-three patients who had a combined ligamentous injury and reconstruction of only the anterior cruciate ligament with those for thirty-seven patients who had reconstruction of an isolated tear of the anterior cruciate ligament. After a mean follow-up interval of thirty-five months (range, twenty-one to sixty-six months), there was no difference in the anterior displacement, impairment of function, level of participation in sports activities, results of the one-leg-hop for distance test, or strength as determined by testing on a Cybex machine. On the basis of the findings in this study, we believe that, when there is mild or moderate valgus instability, an injury of the medial collateral ligament does not need to be repaired when the anterior cruciate ligament is repaired after a combined ligamentous injury.

Adolescent↗
PubMed2002

Treatment of "Gamekeeper's Thumb" by reconstruction of the ulnar collateral ligament.

This study examines the treatment of 22 thumbs with symptomatic laxity of the ulnar collateral ligament of the metacarpophalangeal joint by ligament reconstruction 1 week to 10 years after injury. The existing ligament remnants were repaired in 13 thumbs and were re-attached to bone, using a bone anchor, in seven cases. Two ligaments were reconstructed using the extensor pollicis brevis tendon. Patients were reviewed at a mean of 16 months. Functional stability was regained in all patients, but two thumbs had ongoing pain in the metacarpophalangeal joint. All but one patient returned to their original work and recreational pastimes. This study suggests that ligament reconstruction for chronic laxity of the ulnar collateral ligament is likely to achieve painless stability of the metacarpophalangeal joint even when reconstruction is delayed. This makes joint fusion unnecessary in most instances.

Adolescent↗
PubMed2004

Evaluation of the muscles around the knee in rabbits whose anterior cruciate and/or medial collateral ligaments were dissected.

INTRODUCTION: The biological response of the muscles around the knee in chronic ligamentous instability was investigated in an animal study. MATERIALS AND METHODS: There were four groups of 6- to 9-month-old adult New Zealand albino rabbits (2500-3300 g). The animals were divided into groups according to the ligament that was surgically sectioned: group A anterior cruciate ligament (ACL), group B medial collateral ligament (MCL), group C both ACL and MCL, and group D served as the control group undergoing no surgical intervention. Three months after surgery, biopsy specimens of the vastus lateralis, rectus femoris, biceps femoris, extensor digitorum longus, and gastrocnemius muscles of the rabbits were obtained. Electron-microscopic cross-sections of the biopsy specimens were evaluated using the new predetermined atrophy parameters. RESULTS: Atrophy was found in the biopsy specimens of the quadriceps muscles in groups A and C (p<0.005). Unimportant changes were seen in the hamstrings, extensor digitorum longus, and gastrocnemius muscles (p>0.05). Only in the group undergoing MCL dissection were no changes observed in the muscles (p>0.05). CONCLUSION: It is concluded that ACL lesions affect the biomechanics of the knee negatively and this situation causes atrophy, especially in the quadriceps muscle. An MCL lesion alone does not cause an important problem in the surrounding musculature, probably because of its spontaneous healing capacity. New criteria for assessment of atrophy in the muscles employing electron-microscopic evaluation are suggested.

Animals↗
PubMed2001

[Modified collateral ligament reconstruction with the tendon of the abductor pollicis tendon in treatment of chronic radial instability of the basal thumb joint].

Injuries to the radial collateral ligament of the MP joint of the thumb occur much less frequently than injuries to the ulnar collateral ligament. Ligament injury is usually a result of direct trauma. The resultant instability to the thumb usually impairs hand function. In acute lesions to the radial collateral ligament, direct repair is often possible. In cases of chronic radial joint instability, secondary ligament reconstruction with a free tendon graft, most commonly the palmaris longus tendon, is usually recommended. We describe another technique using the tendon insertion of the abductor pollicis brevis muscle. The tendon inserting distally can be used as a stable ligament after dividing it at the border to the muscle and attaching it to the head of the metacarpal bone with a wire. The follow-up for six patients treated by this method showed good and painless stability and function of the thumb in a time span of one year.

Chronic Disease↗
PubMed2001

Lateral collateral ligament reconstruction using quadriceps tendon-patellar bone autograft with bioscrew fixation.

The lateral collateral ligament is the primary stabilizer against varus stress and is also an important contributor in maintaining posterolateral knee stability. Quadriceps tendon-patellar bone autograft has been used for anterior or posterior cruciate ligament reconstruction. We introduce a reconstructive procedure to restore the lateral collateral ligament using a quadriceps tendon-patellar bone autograft. The procedure is designed for unstable knees with concomitant cruciate ligament tear and posterolateral complex injury. This is a reasonable choice especially when allograft tissue is not available or in patients who are not suited for the use of bone-patellar tendon-bone autograft.

Arthroscopy↗
PubMed2002

Ultrasonographic assessment of the ulnar collateral ligament and medial elbow laxity in college baseball players.

BACKGROUND: The prevalence of medial elbow instability is high in athletes who throw, such as baseball players. The aim of this study was to assess the medial aspect of the elbow with ultrasonography to detect changes in baseball players. METHODS: Ultrasonography of the medial aspect of the elbow was performed, while gravity stress was applied with the elbow in 90 degrees of flexion, on thirty college baseball players (twelve pitchers and eighteen fielders) to assess medial joint laxity and deformity of the ulnar collateral ligament. The dominant (throwing) extremity was compared with the contralateral extremity. Clinical data were correlated with ultrasonographic findings. RESULTS: The medial joint space was significantly wider on the throwing side than it was on the contralateral side (2.7 mm and 1.6 mm, respectively; p < 0.01), and the proximal part of the ulna was shifted significantly laterally on the throwing side (p < 0.01). Angular deformity of the ulnar collateral ligament was found in five subjects, and it was significantly associated with lateral shift of the proximal part of the ulna (p < 0.01). Medial elbow pain was associated with widening of the medial joint space (p < 0.05) and with the presence of angulation of the ulnar collateral ligament (p < 0.01). CONCLUSIONS: Medial elbow laxity and elbow valgus on the throwing side of baseball players were increased compared with those in nonplayers. Angular deformity of the ulnar collateral ligament suggests that the ligament bends over the distal-medial edge of the trochlea. Ultrasonography can provide useful information about the condition of the ulnar collateral ligament and about medial elbow laxity in athletes who throw.

Adolescent↗
PubMed2006

Medial collateral ligament insertion site and contact forces in the ACL-deficient knee.

The objectives of this research were to determine the effects of anterior cruciate ligament (ACL) deficiency on medial collateral ligament (MCL) insertion site and contact forces during anterior tibial loading and valgus loading using a combined experimental-finite element (FE) approach. Our hypothesis was that ACL deficiency would increase MCL insertion site forces at the attachments to the tibia and femur and increase contact forces between the MCL and these bones. Six male knees were subjected to varus-valgus and anterior-posterior loading at flexion angles of 0 degrees and 30 degrees. Three-dimensional joint kinematics and MCL strains were recorded during kinematic testing. Following testing, the MCL of each knee was removed to establish a stress-free reference configuration. An FE model of the femur-MCL-tibia complex was constructed for each knee to simulate valgus rotation and anterior translation at 0 degrees and 30 degrees, using subject-specific bone and ligament geometry and joint kinematics. A transversely isotropic hyperelastic material model with average material coefficients taken from a previous study was used to represent the MCL. Subject-specific MCL in situ strain distributions were used in each model. Insertion site and contact forces were determined from the FE analyses. FE predictions were validated by comparing MCL fiber strains to experimental measurements. The subject-specific FE predictions of MCL fiber stretch correlated well with the experimentally measured values (R2 = 0.95). ACL deficiency caused a significant increase in MCL insertion site and contact forces in response to anterior tibial loading. In contrast, ACL deficiency did not significantly increase MCL insertion site and contact forces in response to valgus loading, demonstrating that the ACL is not a restraint to valgus rotation in knees that have an intact MCL. When evaluating valgus laxity in the ACL-deficient knee, increased valgus laxity indicates a compromised MCL.

Aged↗
PubMed1987

Experimental elbow instability after transection of the medial collateral ligament.

In 12 osteoligamentous autopsy elbow preparations, the stability of the elbow was independent of the collateral ligament with flexion of less than 20 degrees and greater than 120 degrees. The anterior part of the collateral medial ligament was the prime stabilizer of the elbow in this range of motion, i.e., the flexion range of function. The maximum valgus and internal rotatory instability after transection of the medial collateral ligament, 20.2 degrees and 21.0 degrees, respectively, were found at elbow flexions from 60 degrees to 70 degrees. Selective repair or reconstruction of the anterior part of the elbow medial collateral ligament may prove to be effective in the treatment of acute or chronic elbow instability.

Biomechanical Phenomena↗
PubMed2004

Effect of distal humeral varus deformity on strain in the lateral ulnar collateral ligament and ulnohumeral joint stability.

BACKGROUND: Recent reports have implicated cubitus varus deformity as a risk factor for the development of late posterolateral rotatory instability of the elbow. The purpose of this study was to determine the biomechanical relationship between cubitus varus and strain in the lateral ulnar collateral ligament and subluxation of the ulnohumeral joint as it relates to posterolateral rotatory instability. METHODS: Eleven fresh-frozen cadaveric elbow joints were mounted in an apparatus that allowed active elbow motion. Supracondylar osteotomies were performed to create cubitus varus deformities of 0 degrees to 30 degrees in 5 degrees increments. Each elbow was loaded with a supination moment of 1.2 Nm and a resistive triceps extension force. Strain in the lateral ulnar collateral ligament and widening of the ulnohumeral joint were measured at each position of varus, and the resulting strain and joint-widening values were averaged. RESULTS: Strain in the lateral ulnar collateral ligament was found to increase as the cubitus varus deformity increased. Likewise, the ulnohumeral joint space was seen to progressively widen with increasing cubitus varus. Strain was significantly increased at 30 degrees of varus deformity (p = 0.03), and widening of the ulnohumeral joint space was significantly increased at 25 degrees of varus deformity (p = 0.004). When differences in the size of the cadaveric specimens were accounted for in an analysis of covariance, ligament strain was significantly increased at 25 degrees of varus (p = 0.005) and widening of the ulnohumeral joint space, at 20 degrees (p = 0.01). CONCLUSIONS: Cubitus varus deformity of the elbow increases strain in the lateral ulnar collateral ligament, with a corresponding increase in ulnohumeral joint-opening consistent with the posterolateral rotatory instability of the elbow seen clinically.

Aged↗
PubMed1993

Injuries of the ulnar collateral ligament of the thumb metacarpophalangeal joint. Biomechanical and prospective clinical studies on the usefulness of valgus stress testing.

In an effort to determine whether valgus stress testing of the thumb metacarpophalangeal joint is predictive of a torn and displaced ulnar collateral ligament, anatomic and prospective clinical studies were performed and the results correlated. In the anatomic study on autopsy specimens, dividing the proper collateral ligament resulted in a significant increase in valgus instability of the flexed metacarpophalangeal joint. Significantly less laxity was noted when the joint was tested in extension. When the accessory collateral ligament/palmar plate complex was also divided, valgus instability in extension increased to the extent that it no longer differed significantly from the values obtained when the joint was tested in 30 degrees flexion. In the clinical study, valgus instability of greater than 35 degrees when the joint was positioned in extension and then stressed consistently indicated the presence of tears of the proper and accessory collateral ligaments: A Stener's lesion was present in 15 of 17 such cases (87%). Values on valgus stress testing of the metacarpophalangeal joint in extension and 30 degrees flexion are highly predictive of both disruption and displacement of the ulnar collateral ligament of the thumb.

Biomechanical Phenomena↗
PubMedDate not supplied

Skier's thumb. Surgical treatment of recent injuries to the ulnar collateral ligament of the thumb's metacarpophalangeal joint.

Acute rupture of the ulnar collateral ligament of the metacarpophalangeal (MCP) joint of the thumb is often sustained in downhill skiing accidents an is hence called "skier's thumb." All complete ruptures seen at our hospital between 1975 and 1979 were operated using the "fishhook" pullout wire technique. Follow-up results 29 months after early operation are presented for 47 cases. The overall results are excellent in 29, good in 14, and fair in 3 patients. Our result had to be considered a failure. No patient had serious functional impairment or major constant pain. No patient took any pain medication. No reintervention was necessary. The distal bony avulsions showed the most favorable prognosis, and the ligamentous midsubstance tears, the least favorable. The fishhook pullout wire technique can be used in both ligamentous and bony avulsions of the ulnar collateral ligament and provides good or excellent results in 90% of the cases.

Athletic Injuries↗
PubMed1998

Immobilization increases the vulnerability of rabbit medial collateral ligament autografts to creep.

Rehabilitation after soft-tissue autograft reconstructions is controversial because there is indirect evidence that some grafts fail by creeping over time. The vulnerability of soft-tissue grafts to creep over healing time and the effects of the load environment during healing on this vulnerability have never been studied specifically. We hypothesized that immobilization would decrease the magnitude of the vulnerability of ligament grafts to creep. Thirty-nine skeletally mature New Zealand White rabbits underwent a standardized medial collateral ligament autograft procedure to the right hindlimb, and 19 of the rabbits also had the limb rigidly pinned into flexion. Subgroups were killed at 3 or 8 weeks, and all isolated tibia/medial collateral ligament/femur complexes were tested for creep at 4.1 MPa under a standardized protocol. Eight normal medial collateral ligament controls were tested similarly. Results showed that all grafts were quantitatively more susceptible to cyclic and static creep than were normal medial collateral ligament controls (p < 0.05). By 3 weeks of healing, immobilization significantly increased the magnitude of the vulnerability of the grafts to cyclic, static, and total creep (all: p < 0.05). Furthermore, the grafts had more unrecovered creep strain than did the controls following a 20-minute recovery period. Contrary to our hypothesis, immobilization resulted in increased vulnerability of these ligament autografts to creep even with this relatively nonprovocative test of short duration and low stress. We postulate that following immobilization, this increase in the magnitude of susceptibility of the grafts to creep will result in functionally significant elongation of the graft if it is exposed to higher loads and over longer periods of time in vivo.

Animals↗
PubMed1976

Instability of the metacarpophalangeal joint of the thumb. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon.

Reconstruction of the collateral ligaments of the metacarpophalangeal joint of the thumb was performed for fourteen ruptures of the ulnar and two ruptures of the radial collateral ligament, one to eighteen months after injury. The extensor pollicis brevis tendon was used to reinforce the resutured ligament. Symptoms were relieved in all cases after follow-ups ranging from one to seven years, even in two thumbs with mild degenerative arthritis of the metacarpophalangeal joint.

Adolescent↗
PubMed1994

[Reconstruction of the medial collateral ligament of the knee in rats using a free autogeneic transplant of fascia lata, ligament or tendon].

After resecting the lateral collateral ligament of the knee in 56 male mature rats, the authors replaced it by an autogenous transplant of the same size, made of fascia lata, ligament or patellar tendon. The authors then studied this transplant after an evolution of 2 days to 5 1/2 months. This lapse of time can be divided into three stages: an initial stage (first week), marked by transplant necrosis and acute inflammation--an early stage (from the second to the fourth week), which shows the migration of the cells from the host to the transplant and the rebuilding of collagen fibers. Tissues with a loose, extensible, but weak texture, such as the fascia lata, are totally colonized by the fibroblasts. Tissues with a dense, strong, but less extensible texture, as the patellar tendon, are soon destroyed and recolonized at the periphery, whereas their center is destroyed and recolonized by fibroblasts later and more irregularly--a late phase of consolidation (from the second to the fifth month), which shows the rebuilding of a dense collagen network and its reorientation. In fascia lata transplants, this new collagen is homogeneous and is made of parallel bundles. In tendon transplants, the network is not homogeneous. It has a persistent nodular aspect at the periphery and well-oriented bundles, separated by calcified or granulomatous foci at the center. In the case of ligament transplants, the new collagen network shows an intermediate aspect between the two described above. The weakest regular connective tissues are the best for ligamentoplasties, and tendons are the worst.

Animals↗
PubMed1990

Peripheral detachment of the medial meniscus with injury to the medial collateral ligament in 50 cattle.

In 50 cattle the periphery of the medial meniscus had separated from the joint capsule and medial collateral ligament. The meniscus was hypermobile when varus and valgus stress were applied to the stifle joint, and concurrent injury to the collateral ligament allowed the medial side of the stifle joint to gape. Separation of the medial collateral ligament from the joint capsule and medial meniscus was seen at arthrotomy in 34 animals. In addition to signs of stifle injury, the affected cattle tended to abduct the leg and bear weight on the medial claw.

Animals↗