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PubMed1990

The developmental morphology of a "periosteal" ligament insertion: growth and maturation of the tibial insertion of the rabbit medial collateral ligament.

The structural properties of ligament insertions change dramatically during growth and maturation, but little is known about their developmental anatomy. This study describes and quantifies changes in the gross and microscopic anatomy of the tibial insertion of the rabbit medial collateral ligament (MCL) during development and at skeletal maturity. Eighty animals were used for growth and descriptive studies. From this group, 27 animals, ranging in age from 1 to 24 months, were injected with fluorescent bone markers and their tibial insertions were processed undecalcified for histology. Sections were examined by polarized light and fluorescence microscopy to identify matrix and cells and to quantify mineral formation. Results showed that animals achieved histological skeletal maturity between 9 and 12 months of age. Body weights were a poor index of skeletal maturity. The tibial insertion was composed of five tissue layers, which changed proportions during growth and maturation. In immature animals, MCL fibers entered the periosteum; in older animals, MCL fibers were cemented to the tibia by advancing mineral. The tibial attachment of the MCL was thus transferred from the periosteum to the cortex during growth, suggesting that the term "periosteal insertion" is imprecise in adults. The hypothesis is put forward that these structural changes account for the reported increase in tensile failure of this insertion near skeletal maturity.

Aging↗
PubMed2006

Radial collateral ligament injury of the index metacarpophalangeal joint: an underreported but important injury.

PURPOSE: To present the results of various treatment modalities based on injury grade of radial collateral ligament (RCL) injuries to the index metacarpophalangeal (MP) joint. METHODS: Fourteen patients were evaluated (4 male, 10 female) with RCL injuries to the index MP joint. We defined injuries as Grade 1 (tenderness over RCL, no instability), grade 2 (laxity compared to the contralateral digit with a definite endpoint), or grade 3 (laxity without endpoint). Early presentation is defined as less than four weeks and late greater than four weeks. RESULTS: The average follow up was 24 months. Grade I-II injuries seen early (4 patients) treated with 4-6 weeks splinting had excellent results (normal ROM, stable pinch, pain free). There were no Grade I-II injuries seen late. Of Grade III injuries seen early (2 patients), attempted treatment in a removable splint was unsuccessful secondary to patient noncompliance; subsequently requiring primary repair of the collateral ligament which resulted in good outcomes. No Grade III injury seen early had attempted treatment in a cast. Eight patients presented late with Grade III injuries (4 elected for surgical intervention, 4 for nonsurgical management) and all had fair or poor outcomes. CONCLUSIONS: The significance of this injury remains underestimated and requires a high index of suspicion. Stable injuries seen early should be treated with prompt immobilization. Casting may be more effective than a removable splint. Grade III injuries seen early could possibly be treated with cast immobilization though close follow up is mandatory as surgical repair may be necessary in the high demand hand. All Grade III injuries treated late yielded fair to poor results requiring tendon reconstruction or fusion with significant alteration in hand function.

Adult↗
PubMed1993

[Conservative therapy of ruptures of the medial collateral ligament of the knee. Results of a comparative follow-up study].

The rupture of the medial collateral ligament of the knee joint due to sports injuries is the most common lesion of ligaments of the knee in athletes. The treatment is usually non-operative. We compared in a retrospective study the conservative treatment of these ruptures by two different methods. One group of patients was immobilised in a plaster cast for six weeks, one group of patients was partially immobilised with a brace, initiating early functional therapy. The results proved that the group of early mobilisation was significantly better in late results, in shorter rehabilitation and in all other aspects regarded as important for the treatment of such an injury. Therefore we feel the treatment with plaster casting for isolated ruptures of medial collateral ligaments as the knee should be abandoned.

Adult↗
PubMed2005

Thumb metacarpophalangeal ulnar collateral ligament injuries: a biomechanical simulation study of four static reconstructions.

PURPOSE: To determine the optimal tunnel placement positions for tendon graft reconstruction of chronic thumb metacarpophalangeal (MCP) ulnar collateral ligament injuries that would stabilize the joint while maintaining motion. METHODS: Four commonly used tunnel placement methods were simulated on a cadaveric model using fresh-frozen thumbs and a suture/screw construct. The methods were as follows: (1) triangular configuration with apex proximal, (2) triangular configuration with apex distal, (3) cruciate configuration, and (4) parallel configuration. Stability was tested by valgus loading at 0 degrees and 30 degrees , and range of motion was tested by loading the thumb tendons. Statistical analysis was performed by 1-way analysis of variance testing. RESULTS: Valgus load stability testing at 0 degrees and 30 degrees showed that all 4 reconstruction methods stabilized the MCP joint compared with the fully sectioned state. The amount of stability achieved was not significantly different between the 4 methods. Only the reconstruction method, however, with a triangular configuration with the apex proximal restored flexion/extension range of motion not significantly different from the intact state. The other 3 methods resulted in significantly decreased range of motion. CONCLUSIONS: The reconstruction tunnel positioning of triangular configuration with apex proximal stabilizes the thumb MCP joint while maintaining flexion/extension range of motion. We recommend this configuration for chronic MCP joint injuries in which the native ulnar collateral ligament is inadequate and tendon graft reconstruction is performed.

Biomechanical Phenomena↗
PubMed1997

Spatial variation in sympathetic influences on the vasculature of the synovium and medial collateral ligament of the rabbit knee joint.

1. Laser Doppler perfusion imaging was used to assess the role of the sympathetic nervous system in the control of blood flow to the medial collateral ligament and capsule (synovium and overlying fibrous tissues) of the rabbit knee joint. 2. Electrical stimulation of the saphenous nerve (width 1 ms; amplitude 20V; 1-30 Hz) produced a frequency-dependent vasoconstriction of knee joint vasculature. The response was maximal at 30 Hz and gave the greatest fall in perfusion at the femoral insertion of the ligament (by 33.8 +/- 7.4%, mean +/- S.E.M.; n = 5-6) and the smallest decrease at the tibial insertion of the ligament (by 10.6 +/- 2.9%). 3. Topical application of phentolamine (10(-6) mol) had no significant effect on basal knee joint blood flow. However, it abolished the nerve-mediated constrictor responses in all regions of the medial collateral ligament and synovium at all frequencies. 4. Topical administration of adrenaline (10(-14) to 10(-7) mol) caused a dose-dependent decrease in knee joint blood flow with the highest dose producing > 75% reduction in perfusion at all areas. 5. There was no evidence of a reactive hyperaemia in the 5 min following a 5 min period of femoral artery occlusion. Artificial manipulation of arterial blood pressure by intravenous infusion or withdrawal of blood caused a proportional change in ligament and synovial blood flow. These observations may indicate a lack of autoregulation in the joint and its exclusion from baroreflex modulation. 6. These results suggest a potential role for the sympathetic nervous system in the control of knee joint blood flow. Neuromodulation of ligament perfusion appears to predominate at the femoral insertion and this could prove to have functional significance.

Adrenergic alpha-Agonists↗
PubMed1990

The effect of damage to the lateral collateral ligaments on the mechanical characteristics of the ankle joint--an in-vitro study.

Injuries to the lateral collateral ligaments of the ankle joint are among the most frequently occurring injuries at the lower limb. The present study was conducted for the purpose of establishing the basis for the development of a quantitative diagnostic procedure for such injuries. To achieve this goal, the effect of four types of ligament injuries on the three-dimensional mechanical characteristics of the ankle were investigated. These types of injuries consisted of: 1) isolated tear of the anterior talofibular ligament; 2) isolated tear of the calcaneofibular ligament; 3) isolated tear of the posterior talofibular ligament; and 4) combined tear of both the anterior talofibular ligament and the calcaneofibular ligament. The experiments were conducted on 31 amputated lower limbs and consisted of comparing the three-dimensional load-displacement and flexibility characteristics of the ankle joint prior to and following sectioning of selected ligaments. The experimental and analytical procedures used to derive these characteristics was developed previously by the authors. From the results of this study it was concluded that the three-dimensional flexibility characteristics of the ankle joint are strongly influenced by damage to the lateral collateral ligaments. Furthermore, it was found that each type of ligament injury produced unique and identifiably changes in the flexibility characteristics of the ankle. These unique changes, which are described in detail in this paper, can be used to discriminate between the different types of ligament injuries. Consequently, it was concluded that it is feasible to develop a quantitative diagnostic procedure for ankle ligament injuries based on the effect of the injury on the flexibility characteristics of the ankle.

Aged↗
PubMed1982

Endoscopic total one-piece medial meniscectomy: its effect on the medial collateral ligament.

Meniscus specimens from 10 patients subjected to endoscopic total medial meniscectomy were examined for remnants of the collateral ligament. Very small amounts were found in the postero-medial area of the specimens. None exceeded 2 mm in length or breadth and could be formed in only one of the sections. With our technique for endoscopic total meniscectomy the integrity of the medial collateral ligament is not violated and ligamentous instability can be avoided.

Adolescent↗
PubMed2002

Medial collateral ligament reconstruction with allograft using a double-bundle technique.

Medial collateral ligament (MCL) reconstruction has been a topic of controversy in regard to the need for surgical reconstruction as well as the type of surgical reconstruction to be performed. Combined anterior cruciate ligament (ACL) and MCL reconstruction has been found to be associated with a higher incidence of postoperative arthrofibrosis than isolated ACL reconstruction; performing these reconstructions in a staged format has been proposed to avoid this devastating complication. We present a technique for MCL reconstruction that physiometrically re-establishes both anterior and posterior stabilizing components of the MCL and is performed with a limited soft-tissue dissection. This technique can easily be combined with an ACL allograft or hamstring reconstruction without need for staged or significantly delayed procedure. The technical details of this technique allow for stable fixation of an allograft reconstruction to allow for immediate postoperative knee range of motion with low patient morbidity because of the limited surgical approach.

Anterior Cruciate Ligament↗
PubMed1983

Double contrast arthrography of the knee in acute injury of the medial collateral ligament.

The double contrast arthrography with horizontal beam method was carried out in 133 cases with acute medial collateral ligament injuries of the knees and its findings were compared with those from arthroscopy and/or surgery. The double contrast arthrography demonstrated the level of the rupture in capsular ligament in relation to the meniscal attachment, accompanying meniscal tear or detachment, and intrusion of the free end of the torn ligament into the joint. It also revealed the magnitude of the medial instability and facilitated to distinguish an isolated from a combined injury. A therapeutic regime can be proposed on the basis of the arthrographic findings. We conclude that the double contrast arthrography for the acute injuries of the medial collateral ligament is indispensable in the selection of the optimal treatment.

Adolescent↗
PubMed1994

Anterior cruciate and medial collateral ligament injury. ACL reconstruction and functional treatment of the MCL.

Since August 1989 we have treated acute anteromedial instabilities with medial instability of 1+ and 2+ by augmented anterior cruciate ligament (ACL) reconstruction alone. Subsequently, functional therapy for the lesion of the medial collateral ligament (MCL) was carried out. In a follow-up examination, we evaluated Lysholm, Marshall, OAK and IKDC scores, measured stability with the KT 1000, and tested isokinetic muscle function in 28 patients. The majority demonstrated stable healing of the MCL and ACL and good or excellent knee functions and muscle strength.

Adolescent↗
PubMed2005

Differential sensitivity to NO-induced apoptosis between anterior cruciate and medial collateral ligament cells.

It is well known that the anterior cruciate ligament (ACL) of the knee joint has poorer healing responses than the medial collateral ligament (MCL). Nitric oxide (NO) induces free radicals and plays a key role in the induction of apoptosis in various wound-healing models. We hypothesized that the poor healing response of the ACL may be ascribed to high susceptibility to apoptosis, and we investigated the difference in susceptibility to apoptosis between ACL and MCL cells after treatment with sodium nitroprusside, a NO donor. Apoptosis was evaluated by phase contrast microscopy, electron microscopy, DNA gel electrophoresis, and flow cytometric analysis. Although morphological changes and DNA ladders were observed in both ACL and MCL cells after 2 mM sodium nitroprusside treatment, ACL cells were more prone to apoptosis at 1 mM. Based on flow cytometric analysis, DNA fragmentation at 1 mM sodium nitroprusside was significantly greater in ACL cells than in MCL cells (58.6% +/- 1.6% vs. 11.9% +/- 2.2%). Caspase-3 inhibitor (Ac-Asp-Glu-Val-Asp-CHO) and caspase-9 inhibitor (Ac-Leu-Glu-His-Asp-CHO) completely inhibited this DNA fragmentation. In conclusion, the ACL and MCL cells exhibit essential differences, and the differential sensitivity to NO-induced apoptosis between the ACL and MCL cells may be a reflection of these differences.

Animals↗
PubMed1995

Intraoperative graft tensioning alters viscoelastic but not failure behaviours of rabbit medial collateral ligament autografts.

The effects of three different degrees of intraoperative graft tensioning on measures of ex vivo laxity, viscoelastic behaviour, and structural and material failure of isolated healing medial collateral ligament autografts were investigated in a rabbit model. The grafts were orthotopically replaced at one of three different loads (too tight, anatomic, or too loose) and were mechanically evaluated after 0, 12, 24, and 48 weeks of healing. Laxity of the ligament was influenced by intraoperative graft tensioning at time zero. However, after 12 weeks of healing, values for laxity were indistinguishable among the experimental groups. Cyclic load relaxation, a measure of viscoelastic behaviour, was significantly influenced by intraoperative graft tensioning, and this effect persisted even after 48 weeks of healing. Grafts placed under excessive tension relaxed one-third less than grafts placed under abnormally low in situ tension. The relevance of these differences remains to be determined. Intraoperative tensioning had no significant influence on characteristics of structural or material failure of the graft during the first year of healing. These results suggest that, in this model, control of graft tension at the time of placement and fixation does not improve the failure characteristics of the medial collateral ligament. The structural strength of the grafts collectively improved to nearly normal values after 48 weeks; however, material recovery was less complete. Failure loads averaged 89% of control values, whereas failure stress averaged only 52% after 48 weeks of healing.

Analysis of Variance↗
PubMed1998

Localization and characterization of porcine patellar tendon xenograft antigens in a rabbit model of medial collateral ligament replacement.

BACKGROUND: Ligament injuries of the knee are common and, if severe, can predispose to joint pain, instability, reinjury, and, ultimately, osteoarthritis. Xenograft replacement of ligaments could have potential; however, a limited understanding of the immunology of ligament xenograft rejection has inhibited their use. The purpose of this study was to characterize the antigenic elements of a fresh porcine tendon xenograft in a rabbit model and to provide a better understanding of what would need to be done to either block or extract these antigenic elements. METHODS: Three experimental situations were evaluated in a pig to rabbit ligament transplantation model: subcutaneous implantation of fresh porcine patellar tendon (PPT), implantation of fresh PPT into a medial collateral ligament midsubstance gap, and replacement of the entire medial collateral ligament complex with either fresh or guanidinium hydrochloride-extracted PPT. Preimmune and immune sera were collected from rabbits and used to localize antigenic targets in PPT, meniscus, and cartilage with indirect immunofluorescence techniques. The reactivities of the same rabbit sera towards tissue extracts of PPT, meniscus, and cartilage by Western immunoblot analyses were used to characterize the antigenic components. RESULTS: Indirect immunofluorescence with preimmune rabbit sera on PPT showed staining of tendon fibroblasts. Immune sera from rabbits transplanted with xenografts stained regions of the extracellular matrix of PPT. Fresh PPT induced antibodies that consistently recognized six extracellular matrix components with molecular masses of >200 kDa, 180 kDa, 135 kDa, 108 kDa, 63 kDa, and 59 kDa. CONCLUSIONS: Our results suggest that naturally occurring rabbit anti-pig antibodies of the IgG isotype recognize immunogenic components on tendon fibroblasts, whereas induced rabbit anti-pig antibodies recognize a specific subset of six extracellular matrix components of PPT. PPT xenografts appeared to induce a similar humoral immune response irrespective of graft location. Finally, our results indicate that selective extraction of PPT xenograft components before implantation altered the induced rabbit anti-pig antibody response; however, such extraction did not change the ultimate fate of the transplant tissue.

Animals↗
PubMed1996

Myofibroblasts in the healing lapine medial collateral ligament: possible mechanisms of contraction.

The specific objective of this study was to determine the chronology of the appearance of the myofibroblast in the healing ligament. The overall goal of our work is to elucidate the cellular mechanism of contraction in this tissue. The myofibroblast has been found to be responsible for wound contraction in many tissues and to be the cause of the contracture in several pathological conditions. This cell type contains the actin isoform previously thought to be unique to smooth muscle cells and displays certain characteristic features at the ultrastructural level. In 26 New Zealand White male rabbits, the right medial collateral ligament was transected, whereas the left medial collateral ligament received a sham operation. The central third of the ligament (ligament scar tissue) was evaluated at 2, 3, 6, 8, 10, and 12 weeks postoperatively by immunohistochemical techniques, transmission electron microscopy, and Western blot analyses. Three other rabbits served as anatomic controls. During the early reparative phase (2 and 3 weeks after transection), there was an increase in the number of cells containing alpha-smooth muscle actin as well as augmentation of the alpha-smooth muscle actin content within each cell--a finding attributed to smooth muscle cells and pericytes associated with neovascularity. No myofibroblasts were detected at this stage, immediately postoperatively, or in the sham-operation controls. Ligaments in the remodeling phase of healing (6, 8, 10, and 12 weeks) exhibited alpha-smooth muscle actin in fibroblasts (myofibroblasts) as well as in vascular pericytes and smooth muscle cells. During this stage of healing, transmission electron microscopy demonstrated an increase in the number of cells displaying myofibroblastic features. It was estimated that at 12 weeks of healing 10% of the cells at the site of injury were myofibroblasts. This is the first definitive finding of myofibroblasts in the injury site of the healing ligament, to our knowledge. The appearance of myofibroblasts in the 6-12 week healing period, the interval during which the ligament has been shown to contract in studies by other investigators, is a rationale for a hypothesis that a cellular contractile apparatus comprising alpha-smooth muscle actin (i.e., the myofibroblast) may contribute to the recovery of original ligament length (and normal in situ strain).

Actins↗
PubMedDate not supplied

Ulnar collateral ligament reconstruction in athletes: muscle-splitting approach without transposition of the ulnar nerve.

Eighty-three athletes with medial elbow instability underwent reconstruction of the anterior band of the ulnar collateral ligament with a muscle-splitting approach without transposition of the ulnar nerve. The purposes of this study were to describe postoperative neurologic outcomes in all 83 athletes and to describe the 2-year follow-up in 33 athletes. Postoperatively, 5% of this group had transient ulnar nerve symptoms, all of which resolved with nonoperative management. There were no reoperations for nerve dysfunction and no permanent nerve problems. At 2- to 4-year follow-ups, 93% of the highly competitive athletes who had not had a prior surgical procedure had an excellent result. All athletes, regardless of whether they had a prior procedure, were able to return to their sport. These surgical modifications to the ulnar collateral ligament reconstruction yielded a decreased postoperative complication rate and improved outcomes compared with the results of prior procedures.

Adult↗
PubMed2005

Low-level laser therapy improves early healing of medial collateral ligament injuries in rats.

OBJECTIVE: This study sought to investigate whether or not low-level laser therapy (LLLT) with a helium-neon laser increased biomechanical parameters of transected medial collateral ligament (MCL) in rats. BACKGROUND DATA: It has been reported that LLLT can enhance tendon healing. METHODS: Thirty rats received surgical transection to their right MCL, and five were assigned as the control group. After surgery, the rats were divided into three groups: group 1 (n = 10) received LLLT with 0.01 J/cm(2) energy density per day, group 2 (n = 10) received LLLT with 1.2 J/cm(2) energy density per day, and group 3 (sham = exposed group; n = 10) received daily placebo laser with shut-down laser equipment, while the control group received neither surgery nor LLLT. Biomechanical tests were performed at 12 and 21 days after surgery. The data were analyzed by one-way analysis of variance. RESULTS: The ultimate tensile strength (UTS) of group 2 on day 12 was significantly higher than that of groups 1 and 3. Furthermore, the UTS and energy absorption of the control (uninjured) group were significantly higher than those of the other groups. CONCLUSIONS: LLLT with a helium-neon laser is effective for the early improvement of the ultimate tensile strength of medial collateral ligament injuries.

Animals↗
PubMed2006

Collateral ligament injuries of the metacarpophalangeal joints of the fingers.

Although complete collateral ligament tear and instability involving the metacarpophalangeal joints of the fingers, especially those on the radial aspect of the index finger, are rare, they may be underdiagnosed, underestimated, and potentially disabling. Awareness and suspicion of the injury, coupled with careful physical and imaging examinations, confirm the diagnosis and its extent. Early operative repair results in favorable outcomes in most cases. Chronic instability may lead to pain, weakness, and arthritis. Late ligament repair or reconstruction is typically slightly less reliable than acute repair, yet often improves outcomes. Arthritic joints may require reconstruction.

Collateral Ligaments↗
PubMedDate not supplied

Long-term prognosis of isolated partial medial collateral ligament ruptures. A ten-year clinical and radiographic evaluation of a prospectively observed group of patients.

We prospectively observed 38 patients with nonoperatively treated isolated partial ruptures of the knee medial collateral ligament at 3 months, 4 years, and 10 years after the initial trauma using clinical and radiographic examinations. The initial diagnoses were based on clinical and arthroscopic examinations. Three months after injury, 28 patients (74%) had regained nearly normal knee function and muscle strength, and 75% of these patients could perform at their preinjury activity level (competitive team sports). Five patients (13%) had increased valgus laxity (grade 1) in the injured knee. After 4 years, the patients had a median Lysholm score of 100 (range, 64 to 100). Thirty-three patients (87%) had normal knee function during strenuous activities. Repeat injuries to the medial collateral ligament occurred in two patients (5%), and another two patients sustained cruciate ligament injuries during the follow-up period. After 10 years, the Lysholm score (median, 95; range, 73 to 100) was lower compared with the 4-year score (P < 0.03), but the patients still performed on a similarly high activity level. Five patients (13%) had distinct signs of beginning osteoarthritis (Fairbank's signs) on radiographs, but none had joint space reduction.

Child↗