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PubMed2003

Lateral collateral ligament reconstruction using a semitendinosus graft.

We evaluated 13 reconstructions of the lateral collateral ligament (LCL) of the knee associated with a reconstruction of the ACL (n=6) and PCL (n=7). In all cases the LCL was reconstructed using a semitendinosus tendon graft through a tunnel in the fibular head and fixed in anatomical insertion of LCL at lateral femoral condyle. Patients were evaluated using the IKDC form. Lateral joint opening and posterior tibial translation were studied by radiographic stress views. The follow-up average was of 60 months (38-93). In the ACL group five patient were symptoms free while one reported moderate pain after strenuous activity. The lateral stress radiographs showed lateral joint opening of 0-2 mm in five knees, and 3-5 mm in one. In the PCL group four patients were symptom free while three complained mild to moderate pain or swelling. Lateral joint opening was 0-2 mm in six knees and 3-5 in one. External rotation at 30 degrees of flexion was 10 degrees in one and between 0-5 degrees in the remainder. Eleven of 13 patients returned to their preinjury level and two returned to one level lower. These findings indicate that the LCL can be successfully reconstructed with a free ST graft at the time of ACL or PCL reconstruction.

Adolescent↗
PubMed1995

[Abductor pollicis brevis muscle-plasty for therapy of radial collateral ligament rupture of the thumb base joint].

Untreated radial collateral ligament rupture of the thumb metacarpophalangeal joint may lead to an impairment of thumb function. The treatment is basically similar to ulnar ligament trauma management. Due to the rarity of this lesion, consistent guidelines for therapy have not yet been described. In contrast to fresh injuries a re-fixation of the disrupted ligament usually is not possible when chronic instability has already occurred. Following functional-anatomic considerations a dynamic joint stabilization method has been developed by transposition and thus reestablishing the functional direction of the abductor pollicis brevis muscle. Thus the physiological radial ligament vector is replaced and a functional ligament replacement is achieved through a technically simple procedure.

Collateral Ligaments↗
PubMed1998

Acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint: an anatomical and clinical study.

Treatment of acute injuries of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb remains controversial owing to the difficulty involved in establishing an accurate diagnosis. Conservative treatment may be successful in sprains, but surgical repair has been advocated when the ligament is completely torn. The authors performed a comparative study of the anatomical lesions of the metacarpophalangeal joint of the thumb with respect to degrees of instability. The study was conducted on fresh specimens and retrospectively in surgically treated patients. Instabilities greater than 30 degrees were found to correspond to complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb, and the stump of the ligament was found on the adductor aponeurosis in 5 out of 20 cases. In 2 out of 9 cases of avulsion-fractures, the fragments were rotated 90 degrees although on x-rays they appeared slightly displaced. It is concluded that surgical repair is the treatment of choice for instabilities greater than 30 degrees and for avulsion-fractures.

Acute Disease↗
PubMed2000

Type V collagen is increased during rabbit medial collateral ligament healing.

To understand the reparative process of medial collateral ligament (MCL), fibrillar collagen and their relative ratios in healing MCL with anterior cruciate ligament (ACL) reconstruction were analyzed. Skeletally mature New Zealand white rabbits were subjected to a mop-end tear of MCL without repair with ACL reconstruction. Rabbits were killed 6 and 52 weeks after injury. Ligamentous tissues from the injury site and sham controls were soaked in 0.5 M acetic acid for 24 h, minced, and treated with pepsin to solubilize collagen. Pepsin solubilized about 80% of the total collagen as determined by hydroxyproline analysis of the pepsin residues. Sodium dodecyl sulfate polyacrylamide gel electrophoresis analysis of the solubilized collagen revealed presence of fibrillar collagen types I, III, and V. Densitometric scanning of the protein bands corresponding to types I, III, and V collagen indicated that in sham controls types III and V collagen represented about 8% and 12%, respectively, of the type I collagen whereas the healed MCL ligaments at 6 weeks showed significant increase in type III and V collagen to about 19% and 24%, respectively. By 52 weeks type III collagen in the healed MCL had returned to that of sham controls while type V collagen remained elevated at approximately 18%. These data suggest that presence of type V collagen in high concentration in healing ligaments may have an influence on collagen fibril diameters seen in healed ligament and should be included in the analysis when evaluating ligament healing.

Animals↗
PubMedDate not supplied

Medial collateral ligament knee sprains in college football. Brace wear preferences and injury risk.

In this prospective, multiinstitutional analysis of medial collateral ligament sprains in college football players, we categorized 987 previously uninjured study subjects according to frequency of wearing preventive knee braces, studied the patterns by which 47 of 100 injuries occurred to unbraced knees, and identified several extrinsic, sport-specific risk factors shared for both braced and unbraced knees. The attendance, brace wear choice, position, string, and session of each participant were recorded daily; medial collateral ligament sprains were reported whenever tissue damage was confirmed. Both the likelihood of wearing braces and risk of injury without them was highly dependent on session (games/practices), position group (line, linebacker/tight end, skill), and string group (players/nonplayers). Subjects wearing braces often faced a high injury risk to their unbraced knees, a finding compatible with the opinion that braces were a necessary evil, best worn when concern over danger of injury outweighed desire for speed and agility. It is concluded that to avoid misinterpretations due to the confounding influence of brace wear selection bias, accurate investigation of daily brace wear patterns is required. Then, before considing the impact of preventive knee braces, a repartitioning of the data base is essential to assure that only similar groups will be compared.

Athletic Injuries↗
PubMed1998

A randomized, prospective study of operative and non-operative treatment of injuries of the fibular collateral ligaments of the ankle.

One hundred and forty-six adults who had an isolated injury of the fibular collateral ligaments of the ankle were randomized to be managed operatively or non-operatively. Disruption of the ligaments was diagnosed by means of a physical examination and on the basis of stress radiographs of the ankle made with use of a specially designed device to hold the leg. Operative treatment, performed in seventy-three patients, consisted of suture repair of the disrupted ligaments within seventy-two hours after the injury, followed by immobilization of the ankle in a below-the-knee plaster cast for six weeks. Non-operative treatment, used for seventy-three patients, consisted of the use of an ankle orthosis for six weeks. After a minimum of two years of follow-up, we could detect no significant differences, with the numbers available, between the two groups with regard to the functional result or the degree of joint laxity that was evident on stress radiographs. The non-operative group lost a mean of 1.6 weeks from work, and the operative group lost a mean of 7.0 weeks. We concluded that non-operative treatment of an injury of the fibular collateral ligaments of the ankle yields results that are comparable with those of operative repair and is associated with a shorter period of recovery.

Adolescent↗
PubMed1991

Influence from stretch-sensitive receptors in the collateral ligaments of the knee joint on the gamma-muscle-spindle systems of flexor and extensor muscles.

In lightly alpha-chloralose anaesthetized cats, activity was recorded simultaneously from 2-4 primary muscle spindle afferents from triceps surae and/or posterior biceps and semitendinosus muscles. Increased tension in medial or lateral collateral ligament was found to evoke changes in the responses of the primary spindle afferents to sinusoidal stretching of their parent muscles. It is concluded that these changes were due to reflex actions of stretch/tension-sensitive receptors in the collateral ligaments on fusimotor neurones. Thus, receptor afferents from the collateral ligaments may contribute to the regulation of the activity in the gamma-motor-muscle-spindle system, and thereby also be of importance for the control of muscular stiffness and knee joint stability.

Animals↗
PubMed1998

Magnetic resonance imaging of the normal and injured lateral collateral ligaments of the ankle.

BACKGROUND AND AIMS: To study the role of MR Imaging in evaluating both normal and injured lateral collateral ligaments of the ankle. MATERIALS AND METHODS: Twenty-four patients with clinically diagnosed inversion injury to the ankle and 20 healthy volunteers underwent Magnetic Resonance Imaging (MRI) of the ankle with special emphasis on the lateral complex ligaments. RESULTS: The anterior talofibular (ATFL) and posterior talofibular ligaments (PTFL) were identified in 100% of the ankles of normal volunteers in the axial plane. The PTFL was identified in 100% in the coronal plane. The calcaneofibular ligament (CFL) was identified in 76% of the ankles in the axial, 84% in the coronal and 88% in the sagittal plane. Of the 24 patients with inversion injury, MRI showed ligament abnormalities in 16 patients, ten of these were isolated ATFL tears, five had combined ATFL and CFL tears and one case showed in addition abnormal signal in the PTFL. MRI revealed associated injuries to other ligaments and other soft tissue and osseous structures of the ankle in twelve patients. CONCLUSION: MRI is a non-invasive, accurate technique for evaluation of the normal and injured lateral collateral ligaments of the ankle.

Acute Disease↗
PubMed2006

Evaluation and treatment of chronic medial collateral ligament injuries of the knee.

Injuries to the medial collateral ligament (MCL) can occur as isolated injuries or in conjunction with injuries to other structures about the knee. Most grade I and II MCL injuries without meniscal avulsion, alone or in combination with anterior or posterior cruciate ligament injuries, can be treated nonoperatively. Grade III or complete tears also can be treated nonoperatively, but only after careful exclusion of any associated injuries that may require surgical treatment. Treatment recommendations also have been based on the location of the MCL tear and the associated injuries. Surgical treatment may include reconstruction of the anterior and posterior cruciate ligaments with primary repair of the MCL. Chronic medial knee injuries often are associated with concomitant ligament injuries, which also must be treated. Treatment options include nonoperative (bracing, activity modification, and rehabilitation) and operative reconstruction.

Biomechanical Phenomena↗
PubMed1955

Injuries to the knee; reconstruction of the collateral ligaments.

Review of a small group of cases in which the Mauck technique or a modification of it was used indicated that they were satisfactory solutions for many of the problems associated with reconstruction of the collateral ligaments of the knee. However, reconstruction of the collateral ligaments does not completely compensate for the lack of cruciate ligaments and a fully satisfactory repair is still being sought.

Collateral Ligaments↗
PubMed2005

Surgical anatomy of the medial collateral ligament and the posteromedial capsule of the knee.

The supporting structures on the medial side of the knee consist of a superficial fascial layer (I), a deep capsular layer (III) with the deep medial collateral ligament in it and in between the superficial collateral ligament (layer II). The attachment sites of the different ligaments and the functions of the various ligamentous structures are described and suggestions for surgical repair are given.

Humans↗
PubMed1981

Reconstruction of traumatic complete loss of the medial collateral ligament: a case report.

An unusual problem with traumatic complete loss of the medial collateral ligament in a 23-year-old man with a gunshot injury, was solved by transfer of the medial head of the gastrocnemius. At one-year follow-up the patient had returned to work with satisfactory functional results with respect to stability, strength, and range of motion. The medial head of the gastrocnemius provided a substantial buttress and effectively performed the function of the collateral ligament.

Adult↗
PubMed1991

Reconstruction of the anterior cruciate ligament alone in the treatment of a combined instability with complete rupture of the medial collateral ligament. A prospective study.

In a prospective study, 14 patients with a complete rupture of both the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) were treated by reconstruction of the ACL alone. The torn MCL was not addressed. The initial instability was documented clinically and by stress radiographs (20 kp) taken under anaesthesia. The postoperative management involved immediate mobilization and partial weight bearing for 6-8 weeks. Follow-up examination at an average of 14 months demonstrated excellent results in 11 cases, good in 2 cases, and fair in 1 case. With the exception of one residual anterior tibial translation of 8 mm, all knees showed almost normal stability in the frontal and sagittal plane, with full range of motion. These result confirm that ACL reconstruction utilizing the patellar tendon alone is sufficient in the treatment of combined instability due to ACL and MCL injuries.

Adult↗
PubMed1999

Intra-articular entrapment of the medial collateral ligament: radiographic and MRI findings.

Displacement of the medial collateral ligament (MCL) into the medial knee joint is an extremely rare finding associated with MCL tears, and is easily diagnosed on magnetic resonance imaging. A case of intra-articular interposition of the MCL during a severe knee injury is presented. A radiolucent "fat stripe" sign and adjacent skin dimpling on radiographs may be relatively specific indicators of this injury.

Arthrography↗
PubMed2001

The collateral ligaments of the elbow: anatomy and clinical correlation.

Stability of the elbow is provided by the congruous nature of the bony articulations and the medial and lateral collateral ligament complexes. The medial ligament provides additional support to valgus stress. The lateral ligament prevents rotational instability between the distal humerus and the proximal radius and ulna. Collateral ligament insufficiency typically is posttraumatic and can occur on either side of the joint. An understanding of the normal anatomy is required to make the correct diagnosis and complete a successful surgical reconstruction.

Athletic Injuries↗
PubMed1995

Rabbit medial collateral ligament scar weakness is associated with decreased collagen pyridinoline crosslink density.

This study was carried out to quantify the potential associations between material strength and both collagen concentration and pyridinoline collagen crosslink density in the healing medial collateral ligament of the rabbit and to compare these parameters with those of normal ligaments. The right hindlimbs of 24 skeletally mature (12-month-old) New Zealand White rabbits were subjected to a standardized 4 mm midsubstance "gap" injury to the medial collateral ligament. The animals were killed in groups of six at postoperative intervals of 3, 6, 14, or 40 weeks, and the femur-medial collateral ligament-tibia complexes were mechanically tested in tension to failure. Subsequent to mechanical testing, the failure sites of the ligaments were assessed for concentrations of hydroxyproline and hydroxylysyl pyridinoline. Nine additional rabbits served as age-matched normal controls. In healing ligaments, normal collagen concentrations were reached in less than 14 weeks, but the hydroxylysyl pyridinoline crosslink densities remained low and were only 45% of the control values after 40 weeks of healing. Similarly, mechanical values remained much less than the controls. Linear regression analysis of data on scar tissue alone showed a moderately strong positive correlation between hydroxyproline concentration and material strength (r2 = 0.51, p = 0.0001) but no correlation between crosslink density and strength of scar tissue. A similar pattern of correlation was obtained between the elastic modulus of the scar tissue and the biochemical variables, but the r2 values were lower.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acids↗
PubMed1997

Ligament creep cannot be predicted from stress relaxation at low stress: a biomechanical study of the rabbit medial collateral ligament.

In normal daily activity, ligaments are probably subjected to repeated loading rather than to repeated deformation. The viscoelastic response to repeated loading is creep; this effect has significance for ligament reconstructions, which potentially "stretch out" over time. However, most experimental studies have examined the viscoelastic response to repeated deformation, stress relaxation. We hypothesized that the creep of a ligament could be predicted from its stress-relaxation behaviour. Left and right medial collateral ligaments of eight skeletally mature rabbits were subjected to either creep or stress-relaxation testing under comparable conditions. The time-dependent increase in strain (creep) and reduction in load (relaxation) from the tests were modelled with use of the quasilinear viscoelastic theory and generalized standard linear solid modelling. Ligaments were found to creep distinctly less than would be predicted from relaxation tests. Although the reason for this behaviour remains unknown, we speculate that it is due to the progressive recruitment of collagen fibres during creep.

Animals↗
PubMed1996

Reinsertion of the ruptured ulnar collateral ligament of the metacarpophalangeal joint of the thumb with an absorbable self-reinforced polylactide mini tack.

Total rupture of the ulnar collateral ligament of the first metacarpophalangeal joint is a common injury and it needs to be operated on, otherwise the injured joint will be unstable and it will cause disability due to loss of pinch grip. A special absorbable device--self-reinforced poly-L-lactide mini tack--was used to stabilise this ruptured ligament. 140 patients were operated on because of this ligament injury. The preliminary results after six months' follow-up were good. Normal movement was regained in 118 out of 140 patients (84.3%) and stability in 138 patients (98.6%). Five reoperations (3.6%) were needed--one because of scar pain, one because of local infection nine months postoperatively, one because of instability and two because of late loosening of the tack six and nine months postoperatively. Overall the preliminary results were good. On the basis of these findings we consider this new absorbable fixation method suitable for clinical use for reinserting the ruptured ulnar collateral ligament of the first metacarpophalangeal joint of thumb.

Adolescent↗