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PubMed1997

Ultrasonographic stress testing of ulnar collateral ligament injuries of the thumb.

We compared ultrasonographic stress test evaluation to clinical examination of ulnar collateral ligament injuries to the thumb. The results of the sonographic and clinical examinations were compared to either operative findings or clinical follow-up results if conservative treatment was elected. Of 25 patients, the clinical grade injury was identified correctly in 25 with ultrasonography compared to 24 with clinical examination. Of the grade III tears, ultrasonography missed two patients with Stener tears and physical examination misidentified or missed four patients with Stener tears. These results confirm the experience of others that ultrasonography is a useful method to evaluate injury to the ulnar collateral ligament of the thumb.

Collateral Ligaments↗

PubMed2002

Denervation impairs healing of the rabbit medial collateral ligament.

Little is known about the contribution of innervation to ligament healing after traumatic disruption, although there is good evidence of an important role for the peripheral nervous system in the healing of fractures and skin injuries. Tissues such as ligament, with a low resting blood supply, are dependent on substantial increases in blood flow and vascular volume during the initial stages of repair. We hypothesized that this initial healing response would be strongly promoted by neurogenic inflammation. Since the saphenous nerve (a major sensory branch of the femoral nerve) supplies the medial half of the knee joint, we elected to use femoral nerve transection as a model to determine the role of sensory and autonomic innervation in the initial outcome of repair of the injured medial collateral ligament. Twelve adult, female NZW rabbits underwent right medial collateral ligament transection. Of these, six rabbits underwent right femoral nerve transection to disrupt the somatic sensory and autonomic nerve supply to the knee joint and six were kept neurologically intact (controls). At six weeks post-injury, the animals were assessed by laser Doppler perfusion imaging (LDI) to determine the local blood flow, at both the injury site and at the uninjured contralateral ligament. The animals were then killed, the knee joints were removed and the biomechanical characteristics of the healing bone-median collateral ligament (MCL)-bone complexes assessed. In a separate cohort of 16 rabbits, vascular volumes of the injured ligaments were measured by infusion of a carmine red/gelatin solution. At six weeks post-injury, in vivo measurement of perfusion with LDI revealed that normally innervated ligaments had an almost three-fold higher average blood flow. Carmine red/gelatin infusion revealed a 50% higher density of blood vessels as compared to denervated ligaments. The force required for ultimate failure was found to be 50% higher in normally innnervated MCL's as compared to denervated MCL's: 153.14 +/- 20.71 N versus 101.29 +/- 17.88 N (p < 0.05). Static creep was increased by 66% in denervated MCL's: 2.83 +/- 0.45% versus 1.70 +/- 0.12% (p < 0.05). Total creep was increased by 45% in denervated MCL's: 5.29 +/- 0.62% compared to 3.64 +/- 0.31% in innervated MCL's (p < 0.05). We conclude that intact innervation makes a critical contribution to the early healing responses of the MCL of adult rabbits.

Animals↗

PubMed1993

Collateral ligament injury and stifle luxation.

Isolated collateral ligament injury is uncommon in dogs and cats and often occurs concurrently with injuries to other stifle ligaments. These injuries are either treated with primary reconstruction of the individual ligaments or with transarticular pin or splint stabilization of the joint until adequate periatricular fibrosis is achieved. Prognosis is generally good if adequate joint stability has been achieved.

Animals↗

PubMed1989

The mechanoreceptor innervation of the human fibular collateral ligament.

The mechanoreceptor innervation of fibular collateral ligaments from human knee joints is described. While a small number of 'non-Paciniform' endings were identified in 5 optimally-stained ligaments, 'Paciniform' endings were not identified. These 'non-Paciniform endings' were variable in shape, but each consisted of an encapsulated arborisation of neurites embedded in a granular matrix. The significance of these findings is discussed as they relate to (i) discrepancies of the extent to which certain periarticular tissues are innervated, and (ii) the role of periarticular mechanoreceptors in initiating protective muscular reflexes.

Fibula↗

PubMedDate not supplied

Ten-year prognosis of isolated and combined medial collateral ligament ruptures. A matched comparison in 40 patients using clinical and radiographic evaluations.

In a matched-pair study of 40 patients, the prognoses of patients with acute isolated partial medial collateral ligament injuries and acute combined medial collateral and anterior cruciate ligament injuries were compared 10 years after initial treatment. All patients in the first group were treated nonoperatively. In the latter group, most medial collateral ligament injuries were total ruptures, which were thoroughly repaired; the torn anterior cruciate ligament was repaired with augmentation in half of the cases. At the follow-up evaluation, both patient groups had similarly high knee functions according to the Lysholm score and similar activity levels (recreational team sports). Knees with combined injuries had increased sagittal laxity at manual and instrumented assessment. Radiographic signs of knee osteoarthritis were present in half of the knees with combined injuries, but they were absent in knees with isolated injuries. The long-term functional prognosis was similarly good after isolated or combined medial collateral ligament injuries, but patients with combined ruptures had more reinjuries and repeat surgeries, increased sagittal laxity, and a higher incidence of radiographic osteoarthritis.

Female↗

PubMedDate not supplied

Replacement of the medial collateral ligament with polypropylene mesh or a polyester suture in dogs.

The medial collateral ligament of one stifle in 20 adult dogs was excised and replaced with polypropylene mesh or a polyester suture. After 26 weeks, the fibrous tissue-prosthesis composites were evaluated clinically, morphologically, and biomechanically. Clinical lameness was not significantly different after 10 days. The polypropylene mesh reconstructions consistently had more fibrous tissue and greater collagenous ingrowth than the polyester suture reconstructions. There were four complications related to fixation of the polypropylene mesh prosthesis and one to the polyester suture. The polypropylene mesh reconstructions had greater stability and were biomechanically more similar to the natural ligaments than the polyester suture reconstructions. Although the results with polypropylene mesh were favorable, more challenging biomechanical testing and alternative anchoring techniques are required before polypropylene mesh can be recommended as a collateral ligament replacement in dogs.

Animals↗

PubMed2002

[Natural history of anterior cruciate and medial collateral ligament healing--literature review].

The review discusses natural history of ligament healing of the knee. Medial collateral ligament heals by progressing through a series of inflammatory, proliferative and remodeling phases. Anterior cruciate ligament, after rupture, appears to retract initially, with no evidence of bridging scar formation. Why anterior cruciate ligament does not heal after rupture still remains unclear.

Anterior Cruciate Ligament↗

PubMed1994

The semimembranosus-tibial collateral ligament bursa. Anatomical study and magnetic resonance imaging.

A bursa that was deep to the tibial collateral ligament and adjacent to the semimembranosus tendon was studied in fifty cadaveric knees; a vinyl solution was injected into four of the specimens in order to facilitate a study of the relationship between the bursa and its surrounding structures. The bursa had the shape of an inverted U: the superficial arm was an elliptical pocket that was located between the semimembranosus tendon and the tibial collateral ligament, and the deep arm was a triangular pocket that was located between the semimembranosus tendon and the medial tibial condyle. The bursa measured, on the average, twenty-one millimeters in its greatest anteroposterior dimension and ten millimeters in its greatest superoinferior dimension. Magnetic resonance images were made of two patients, and they showed fluid in the bursa.

Adult↗

PubMed2006

The role of the medial collateral ligament and posteromedial capsule in controlling knee laxity.

BACKGROUND: The medial aspect of the knee has a complex capsular structure; the biomechanical roles of specific structures are not well understood. HYPOTHESIS: The 3 strong stabilizing structures, the superficial and deep medial collateral ligaments and the posteromedial capsule, make distinct contributions to controlling tibiofemoral laxity. STUDY DESIGN: Controlled laboratory study. METHODS: Changes in knee laxity under anterior-posterior drawer, valgus, and internal-external rotation loads were found by sequential cutting in 18 cadaveric knees. Three cutting sequences allowed the roles of the 3 structures to be seen in isolation and in combination. Some force contributions were also calculated. RESULTS: The posteromedial capsule controlled valgus, internal rotation, and posterior drawer in extension, resisting 42% of a 150-N drawer force when the tibia was in internal rotation. The superficial collateral ligament controlled valgus at all angles and was dominant from 30 degrees to 90 degrees of flexion, plus internal rotation in flexion. The deep collateral ligament controlled tibial anterior drawer of the flexed and externally rotated knee and was a secondary restraint to valgus. CONCLUSION: Distinct roles in controlling tibiofemoral laxity have been found for these structures that vary according to knee flexion and tibial rotation. CLINICAL RELEVANCE: The restraining functions demonstrated provide new information about knee stabilization, which may allow better evaluation of structural damage at the medial aspect of the knee.

Aged↗

PubMed2006

Evaluation and treatment of medial ulnar collateral ligament injuries in the throwing athlete.

Medial ulnar collateral ligament (UCL) injuries are common and are seen most frequently in baseball pitchers. Appropriate recognition, treatment, and rehabilitation are necessary to ensure the best chance for return to preinjury levels of participation. Participation in competitive sports may be disrupted for 6 months to 1 year when treated optimally. Abstinence from play may be prolonged when treatment is delayed or if conservative treatment fails; this delay carries significant consequences to the professional, collegiate, and high school athlete. The orthopedic literature is replete with recommendations for the care of these athletes. These recommendations are generally based on retrospective reviews. The purposes of this paper are 3-fold: to provide background knowledge on this injury, to synthesize the current knowledge on the diagnosis, treatment, and rehabilitation of athletes with medial UCL injuries, and lastly, to provide a treatment algorithm for athletes with UCL injuries.

Arm Injuries↗

PubMed2006

Ulnar collateral ligament reconstruction in elite throwing athletes.

PURPOSE: Ulnar collateral ligament (UCL) injuries may result in disabling valgus instability in throwing athletes. We evaluated the docking technique for UCL reconstruction and describe a modification to the technique. METHODS: UCL surgery was indicated in 20 high-level baseball players (13 professional and 7 collegiate) based on medial elbow pain preventing effective throwing, clinically apparent medial elbow laxity, and magnetic resonance arthrogram consistent with UCL injury. The mean age was 21.7 years (range, 17.9 to 25.3 years). One patient had previous UCL reconstruction. One had previous arthroscopic elbow debridement. The mean time between injury and treatment was 73 days. Reconstruction was performed via a muscle-splitting approach and the docking technique with palmaris or gracilis graft. For the initial 12 patients, a 2-strand construct was used; however, during the study period, we developed and began using a 3-strand construct with a double anterior bundle and a single posterior bundle, which was used in the next 8 patients. The ulnar nerve was not routinely transposed unless there were preoperative ulnar nerve symptoms (1 patient). Two patients had osteophyte debridement. One had removal of a loose body. RESULTS: Patients were followed up for a mean of 41.9 months (range, 6.4 to 67.1 months). One player was lost to follow-up and could not be identified on a professional roster. Of the remaining 19 patients, 18 returned to their previous level of participation or higher. Two were occasional pitchers who did not wish to return to pitching but continued to play other positions. They were clinically and functionally asymptomatic. The mean time to return to play was 13.1 months (range, 6.3 to 21.3 months). By use of the Timmerman-Andrews 100-point subjective scoring system, the mean preoperative score was 77.0 (range, 65 to 80) and the mean postoperative score was 98.2 (range, 85 to 100). By use of the Conway-Jobe scoring system, the outcome was rated as excellent in 17 patients and good in 2. One patient underwent subsequent ulnar nerve transposition and returned to the previous level of professional play. CONCLUSIONS: UCL reconstruction with the docking technique is a reproducible and safe operation that can reliably return athletes to a high level of participation with limited adverse effects. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Adult↗

PubMed2005

Use of volar plate for reconstructing the radial collateral ligament after metacarpophalangeal arthroplasty of fingers in rheumatoid arthritis: surgical technique.

We present a technique for reconstructing the radial collateral ligament using the volar plate after metacarpophalangeal arthroplasty of fingers in rheumatoid arthritis. This technique is indicated when the original collateral ligament is very attenuated and cannot be directly imbricated. The technique is surgically simple, has the advantage of using locally available tissue, and has produced results that are both clinically and radiologically satisfactory.

Aged↗

PubMedDate not supplied

Reconstruction of the lateral collateral ligament of the knee with patellar tendon allograft. Report of a new technique in combined ligament injuries.

This is a retrospective study of 10 patients with combined cruciate ligament and posterolateral instability who underwent surgical reconstruction between 1991 and 1994. All knees had at least 20 degrees increased external rotation at 30 degrees of knee flexion and from 1+ to 3+ varus instability. Five knees with posterior cruciate ligament ruptures had at least a 2+ Lachman test result. (One knee had both anterior and posterior cruciate ligament injuries). In all cases the lateral collateral ligament was reconstructed with a bone-patellar tendon-bone allograft secured with interference screws. Fixation tunnels were placed in the fibular head and at the isometric point on the femur. The cruciate ligaments were reconstructed with autograft or allograft material. The average follow-up was 28 months. Excessive external rotation at 30 degrees of flexion was corrected in all but one knee. Six patients had no varus laxity, and four patients had 1+ varus laxity at 30 degrees of flexion. The posterior drawer test result decreased, on average, to 1+, and the Lachman test result decreased to between 0 and 1+. The average Tegner score was 4.6, with five patients returning to their preinjury level of activity and four returning to one level lower. These results indicate that this is a promising new procedure for patients with instability resulting from lateral ligament injuries of the knee.

Adult↗

PubMed2006

Evaluation and treatment of medial collateral ligament and medial-sided injuries of the knee.

Injuries to the medial side of the knee are not always isolated injuries of the superficial medial collateral ligament. Medial-sided injuries can also involve the deep medial collateral ligament, the posteromedial corner, or the medial meniscus. Magnetic resonance imaging is a useful adjunct to the physical examination; however, the extent of medial-sided injuries is frequently underappreciated on these images. An understanding of the anatomy and biomechanics of the medial side of the knee and a thorough physical examination aids the physician in determining the full extent of injury and helping the physician to treat each unique injury pattern.

Biomechanical Phenomena↗

PubMed2006

Therapeutic ultrasound enhances medial collateral ligament repair in rats.

The purpose of this study was to evaluate the effects of therapeutic ultrasound (US) on medial collateral ligament healing. A total of 36 3-month-old male Sprague-Dawley rats with transected medial collateral ligaments were studied. Subjects were given 5-min pulsed US therapy (duty cycle; one application in 4 ms; 1:4) daily with different durations (1 day, 5 days and 10 days) and intensities (0, 0.5 and 2.3 W/cm2). After each treatment, the level of transforming growth factor beta-1 (TGF-beta1) of the ligament was measured. TGF-beta1 was not detected in the 1-day group. In the 5-day and 10-day groups, the levels of TGF-beta1 were significantly up-regulated in the high-dose subgroup (p < 0.05). The 10-day group also registered a significantly higher expression of TGF-beta1 than did the 5-day group (p < 0.05). The present findings suggest that pulsed US therapy may enhance ligament repair by up-regulating the extent of TGF-beta1 in a high-dose application. Long-term treatment with this therapy could obtain further improvement.

Analysis of Variance↗

PubMed2005

[Synovialectomy of the metacarpophalangeal joints with reconstruction of the radial collateral ligaments -- long-term results in patients suffering from rheumatoid arthritis].

Rheumatoid arthritis may lead to destruction of MP joints and severe alteration of grip and other hand functions. Due to the improvement in medical treatment, synovialectomy of the MP joints is necessary only in late stages. Most centres prefer alloarthroplasties in late stages, as erosion of the cartilage and loosening of the ligaments have already led to destruction of the MP joints and destabilization of grip functions. We do not use alloarthroplasties as our first choice, but pay special attention to the reconstruction of the radial collateral ligaments. Therefore, the elongated radial ligaments are detached near their origin after synovialectomy of the dorsal aspects of the MP joint. After detachment of the radial ligament, the palmar aspects can be cleaned easily. The radial collateral ligaments are shortened and reinserted dorsally to gain slight supination. This study shows the long-term results of our patients. In a period of ten years, 74 patients (87 hands, 347 MP joints) were reexamined after an average of 55 months postoperatively. The loss of active motion was 18 degrees and ulnar deviation could be reduced from 25 degrees to 7 degrees. 71 % of the joints showed stable ligaments, 14 % loose, 15 % unstable ligaments. We saw recurrence of synovialitis in 18 % (10 % mild, 7 % significant, 1 % severe). Radiographs showed amelioration in 14 % of cases and deterioration in 39 %. There was no correlation between active range of motion, synovialitis and X-rays. Results were constant when compared with exams before and five years after surgery. Our investigation shows good and stable results, which can be easily compared with the outcome of other studies after alloarthroplasty. The main advantage in our procedure is the easy access to all parts of the MP joint, which allows complete synovialectomy. By shortening and reinserting the elongated radial collateral ligament, we achieve a mild supination and amelioration of grip strength. The results are constant in long terms. In case of recurrent synovialitis or loosening of the ligaments any other type of auto- and alloarthroplasties can still be performed.

Adult↗

PubMed2003

Gene deletion of either interleukin-1beta, interleukin-1beta-converting enzyme, inducible nitric oxide synthase, or stromelysin 1 accelerates the development of knee osteoarthritis in mice after surgical transection of the medial collateral ligament and partial medial meniscectomy.

OBJECTIVE: To investigate the development of osteoarthritis (OA) after transection of the medial collateral ligament and partial medial meniscectomy in mice in which genes encoding either interleukin-1beta (IL-1beta), IL-1beta-converting enzyme (ICE), stromelysin 1, or inducible nitric oxide synthase (iNOS) were deleted. METHODS: Sectioning of the medial collateral ligament and partial medial meniscectomy were performed on right knee joints of wild-type and knockout mice. Left joints served as unoperated controls. Serial histologic sections were obtained from throughout the whole joint of both knees 4 days or 1, 2, 3, or 4 weeks after surgery. Sections were graded for OA lesions on a scale of 0-6 and were assessed for breakdown of tibial cartilage matrix proteoglycan (aggrecan) and type II collagen by matrix metalloproteinases (MMPs) and aggrecanases with immunohistochemistry studies using anti-VDIPEN, anti-NITEGE, and Col2-3/4C(short) neoepitope antibodies. Proteoglycan depletion was assessed by Alcian blue staining and chondrocyte cell death, with the TUNEL technique. RESULTS: All knockout mice showed accelerated development of OA lesions in the medial tibial cartilage after surgery, compared with wild-type mice. ICE-, iNOS-, and particularly IL-1beta-knockout mice developed OA lesions in the lateral cartilage of unoperated limbs. Development of focal histopathologic lesions was accompanied by increased levels of MMP-, aggrecanase-, and collagenase-generated cleavage neoepitopes in areas around lesions, while nonlesional areas showed no change in immunostaining. Extensive cell death was also detected by TUNEL staining in focal areas around lesions. CONCLUSION: We postulate that deletion of each of these genes, which encode molecules capable of producing degenerative changes in cartilage, leads to changes in the homeostatic controls regulating the balance between anabolism and catabolism, favoring accelerated cartilage degeneration. These observations suggest that these genes may play important regulatory roles in maintaining normal homeostasis in articular cartilage matrix turnover.

ADAM Proteins↗

PubMedDate not supplied

The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon.

BACKGROUND: Quantitative descriptions of the attachment sites of the main posterolateral knee structures have not been performed. PURPOSE: To qualitatively and quantitatively determine the anatomic attachment sites of these structures and their relationships to pertinent bony landmarks. STUDY TYPE: Cadaveric study. METHODS: Dissections were performed and measurements taken on 10 nonpaired fresh-frozen cadaveric knees. RESULTS: The fibular collateral ligament had an average femoral attachment slightly proximal (1.4 mm) and posterior (3.1 mm) to the lateral epicondyle. Distally, it attached 8.2 mm posterior to the anterior aspect of the fibular head. The popliteus tendon had a constant broad-based femoral attachment at the most proximal and anterior fifth of the popliteal sulcus. The popliteus tendon attachment on the femur was always anterior to the fibular collateral ligament. The average distance between the femoral attachments of the popliteus tendon and fibular collateral ligament was 18.5 mm. The popliteofibular ligament had two divisions-anterior and posterior-in all cases. The average attachment of the posterior division was 1.6 mm distal to the posteromedial aspect of the tip of the fibular styloid process and the anterior division attached 2.8 mm distal to the anteromedial aspect of the tip of the fibular styloid process. CONCLUSIONS: These structures had a consistent attachment pattern. This information will prove useful in the study of anatomic repair and reconstruction of the posterolateral structures of the knee.

Aged↗