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PubMed1994

Optimal attachment site for reconstruction of the ulnar collateral ligament. A cadaver study.

To determine the isometric points for ulnar collateral ligament (UCL) reconstruction, we performed a kinematic study of 15 cadaver elbows. The margins of the anterior and posterior oblique ligaments of the UCL were measured. Five humeral and three ulnar attachment sites were also selected and grouped in pairs for measurement. The distances from the proximal center of the trochlea to three ulnar points were recorded. Measurements were obtained for pairs of attachment sites for flexion of 0 degree, 30 degrees, 60 degrees, 90 degrees, and 120 degrees. We found that the anterior margin of the anterior oblique ligament (AOL) tended to lengthen as flexion increased from 0 degree to 60 degrees, and to shorten as flexion exceeded 60 degrees. The posterior margin tended to lengthen with flexion up to 120 degrees. It therefore appears that the AOL consists of functionally different components that remain taut throughout flexion. In all experiments, the location of the humeral attachment site affected the lengths through 120 degrees of flexion. At flexion of 0 degree-120 degrees, isometricity was observed in the approximate center of the trochlea, apparently the optimal attachment site. We conclude that conventional ligament reconstruction methods that locate the attachment site in the AOL origin provide inadequately for the isometricity observed in the natural anatomy.

Adult↗
PubMed2001

Hemidigital resection with collateral ligament transplantation in the treatment of macrodactyly: a case report.

Macrodactyly is a rare congenital anomaly of the hand that is difficult to treat. We describe a new technique consisting of hemidigital, longitudinal, and transverse en bloc resection with collateral ligament transplantation to the proximal interphalangeal joint that we used in a case of macrodactyly. Four years after the procedure the digit's appearance was largely improved with preservation of complete motion at the proximal interphalangeal joint. Transplantation of the collateral ligament ensured a stable joint. Fingertip sensibility was maintained.

Adult↗
PubMed1986

Rupture and displacement of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Preoperative diagnosis.

The evaluation and treatment of injuries of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb remain controversial. In a retrospective study that was done to assess our ability to determine whether displacement of the ligament (a Stener lesion) was present, we reviewed our accumulated experience with patients who had an injury of this ligament who were treated surgically between 1972 and 1984. Since our method of evaluation changed in 1977, we compared the preoperative and operative diagnoses in the twenty patients who were treated surgically from 1972 through 1976 with those in the twenty patients who were so treated from 1977 through 1984. Considering all forty patients who were treated operatively, sixteen (40 per cent) had a typical Stener lesion, and in two others (5 per cent) the ulnar collateral ligament was rolled up on itself and lying beneath the adductor aponeurosis. From 1972 through 1976, stability was tested with the metacarpophalangeal joint in complete extension or in varying amounts of flexion. Of the twenty thumbs that were evaluated by this technique and were treated surgically, 20 per cent had a Stener lesion. From 1977 through 1984, stability was tested with the joint in full flexion because of the findings in anatomical studies that were completed in 1977; the incidence of a Stener lesion in the twenty thumbs that were treated by repair or reattachment of the ligament during this time was 70 per cent.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Collagens in an adult bovine medial collateral ligament: immunofluorescence localization by confocal microscopy reveals that type XIV collagen predominates at the ligament-bone junction.

To understand the structure and function of medial collateral ligament, collagens present in an adult bovine ligament were determined. The mid-section of the ligament was powdered and extracted with 4M guanidinium hydrochloride, and the residue was digested with pepsin to solubilize the collagens. Type I collagen was the major fibril collagen recovered in the pepsin solubilized fraction, with types III and V each representing about 5% and 2%, respectively. Type VI collagen was the major collagen present in the guanidinium hydrochloride extract, and it accounted for about 40% of the proteins in the extract or 4% of the tissue dry weight. Type XII and XIV collagens were also detected in the guanadinium hydrochloride extract as minor components. Immunofluorescence localization using confocal microscopy showed that type XII and XIV collagens are associated with the ligament fibrillar network and that type XIV collagen was prominent at the ligament-bone junction. These data reinforce the notion that these collagens are associated with the type I collagen fibrillar network in connective tissues. In view of high mechanical stresses that exist at the ligament-bone interface, presence of type XIV collagen in high concentration at this junction may contribute to the modulation of the biomechanical properties of this tissue.

Animals↗
PubMedDate not supplied

Operative treatment of ulnar collateral ligament injuries of the elbow in athletes.

Over a 6-year period, the senior author (JRA) performed 91 ulnar collateral ligament reconstructions (N = 78) or repairs (N = 13). All patients were male and between the ages of 15 and 39 years (average, 21.6). Thirty-seven patients (41%) were professional baseball players, 41 (45%) were collegiate baseball players, and 7 (7.7%) were high school or recreational players. Subcutaneous ulnar nerve transposition with stabilization of the nerve with fascial slings of the flexor pronator mass was performed in all patients, and additional procedures were performed in 27 patients (29.7%), including 22 excisions of posteromedial olecranon osteophytes. Average follow-up was 35.4 months. Ten patients had preoperative ulnar nerve symptoms, nine of whom had complete resolution of symptoms after surgery. Complications occurred in eight patients. The average time from surgery to initiation of the interval throwing program was 3.4 months, and the average time to return to competitive throwing was 9.8 months. Sixty-seven patients (74%) were available for follow-up; of these, 53 (79%) had returned to their previous levels of competition or to a higher level. Reconstruction of the ulnar collateral ligament, with transposition and stabilization of the ulnar nerve and appropriate rehabilitation, was found to be effective in correcting medial instability of the elbow and allowed most athletes to return to previous levels of play in less than 1 year.

Adolescent↗
PubMed2004

Ulnar collateral ligament injury in the overhead athlete: diagnosis and treatment.

The ulnar collateral ligament (UCL) is more commonly injured than previously suggested. Injury to this ligament can result in secondary symptoms and problems in other parts of the elbow, including the ulnar nerve, the flexor-pronator musculotendinous unit, the radiocapitellar joint, and the posterior compartment of the elbow, in addition to being a cause of loose bodies within the elbow. This article briefly reviews the anatomy, biomechanics, and pathophysiology of injury, in addition to discussing evaluation and treatment of the athlete with an injured UCL.

Athletic Injuries↗
PubMed1995

Variations in rupture site and surface strains at failure in the maturing rabbit medial collateral ligament.

The relationship between the pattern of surface strain and the site of failure in maturing rabbit ligaments was studied in vitro. Bone-medial collateral ligament (MCL)-bone complexes of 24 female New Zealand White rabbits at 3, 6, 9 and 12 months of age (n = 6 rabbits, 12 MCLs per group) were tested in tension to failure. A video dimension analysis (VDA) system was used to map the surface strain at failure across the width and along the length of the medial side of each MCL during testing. Results showed that the highest strains were consistently located at the femoral insertion decreasing towards the midsubstance, with the highest strain occurring in the anterior portion of the MCL immediately adjacent to the femoral insertion. Strains of the complex at failure increased with rabbit maturation. The strain distribution however, did not change dramatically, even though the locations of MCL failure changed from exclusively tibial avulsion in the three month old rabbits to predominantly midsubstance failures in the 12 month old rabbits. In the six month old rabbits, there was a particular dissociation with all MCLs failing near the tibial insertion while femoral strains were apparently the highest. These results suggest two possibilities beyond that of some unknown artifacts of optical strain measurement. First, since failure sites rarely correlated with areas of maximum surface strain in this study, it seems possible that higher strains could exist deeper in the tissue, particularly at the bone-ligament interface of the tibial insertion in immature animals and somewhere within the midsubstance of the MCL in the adult. Secondly, it is possible that the ligament material may be heterogeneous.

Age Factors↗
PubMed2006

Magnetic resonance imaging evaluation of the ulnar collateral ligament in young baseball pitchers less than 18 years of age.

INTRODUCTION: It has been shown that the asymptomatic, dominant elbow of professional baseball pitchers can demonstrate magnetic resonance (MR) imaging signal abnormalities of the ulnar collateral ligament (UCL) consistent with a strain. The purpose of this study was to determine if younger, asymptomatic, adolescent baseball pitchers exhibit similar signal abnormalities in the UCL. METHODS: Magnetic resonance images of both elbows of 14 asymptomatic, young male baseball pitchers (ranging in age from 12 to 20 years) were performed on an outpatient basis using a 1.5-T Sigma MRI unit with a dedicated extremity coil to obtain T1 and T2 coronal and axial images which were subsequently evaluated by a musculoskeletal radiologist. Chronic tears of the UCL were suspected if the signal was attenuated or absent. Magnetic resonance images of the UCL were also evaluated for high-intensity signal or thinning. Morphologic changes such as complete tears, avulsions or thickening were identified. The images were classified into 4 grades from 0 to 3 depending on the degree of signal abnormality. RESULTS: No discrete tears were found in any of the subjects. For the dominant pitching arm, 4 of 14 subjects had increased thickness of the ulnar collateral ligament, 3 of 14 demonstrated Grade 1 changes, and 11 of 14 demonstrated no abnormal signal within the ligament. No focal tears were present in any of the subjects. Contralateral elbows in 13 of 14 patients demonstrated Grade 0 signals with 1 patient demonstrating morphological thickening of the ligament without increased signal. DISCUSSION: Signal abnormalities in the throwing elbow of asymptomatic, adolescent pitchers were uncommon. These pitchers may not have experienced sufficient pitching time to develop changes in the UCL.

Adolescent↗
PubMed2003

Correlation of healing capacity with vascular response in the anterior cruciate and medial collateral ligaments of the rabbit.

In clinical terms, functional recovery after anterior cruciate ligament (ACL) injury is generally poorer than after medial collateral ligament (MCL) injury. In experimental studies of injury, the early phases of ligament healing require an augmented blood supply. We hypothesized that the differences in healing properties of the ACL and MCL would be reflected in the magnitude of their vascular responses to partial injury. This study is the first to quantify and define the time course of changes in blood flow and vascular volume following hemisection of the rabbit ACL and MCL. Adult female rabbits were assigned to control, sham operation, ACL hemisection or MCL hemisection groups. Standardized ACL or MCL injuries were surgically induced. About 2, 6 or 16 weeks later, blood flow and vascular volume of the ACL and MCL were measured. The MCL of the rabbit responded to hemisection with a large significant increase in blood flow and a substantial angiogenic response associated with inflammation and scar formation. During subsequent matrix remodelling, blood flow and vascular volume returned towards control values. In contrast, the ACL showed only a 2-fold increase in vascular volume, no increase in blood flow and atrophied after hemisection. The superior capacity of the MCL to increase its blood supply through angiogenesis and increased flow is essential for ligament healing to occur, and may be the major difference in healing potential between the ACL and MCL.

Animals↗
PubMed2005

Operative treatment of ulnar collateral ligament insufficiency of the elbow in female athletes.

BACKGROUND: As women become more involved in athletic activity, injuries specific to this population also increase. No data exist regarding operative treatment of female patients with elbow instability secondary to ulnar collateral ligament insufficiency. HYPOTHESIS: Women with symptomatically unstable elbows who failed nonoperative treatment will improve after surgical intervention. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Nineteen women were retrospectively evaluated using the Andrews and Carson Elbow Outcome Score. Patients were included if they underwent repair or reconstruction of the ulnar collateral ligament for symptomatic instability that precluded them from participation in their desired sport or activities, despite nonoperative treatment. RESULTS: The mean age was 22.0 years (range, 15.1-37.2 years). The mean follow-up was 38.8 months (range, 12.4-68.6 months). Of the 19 patients, 14 were softball players, gymnasts, and tennis players. Only 1 was a pitcher. Eighteen women underwent repair by one of the following procedures: plication (n = 6), repair to bone using anchors (n = 11), or drill holes (n = 1). One patient underwent a palmaris graft reconstruction. The mean overall preoperative outcome score of 120 improved to 191 postoperatively (P < .0001). Seventeen of 18 athletes were able to return to their sport at a mean of 2.5 months postoperatively. One patient did not participate in athletics. CONCLUSION: This study demonstrated excellent overall results in 16 and good results in 3 female patients after medial elbow repair or reconstruction. Women appear to be able to consistently return to a high level of function after repair or reconstruction for medial elbow instability.

Adult↗
PubMedDate not supplied

Treatment of isolated medial collateral ligament injuries in athletes with early functional rehabilitation. A five-year follow-up study.

A prospective study was designed to provide 5-year followup of the treatment of isolated grade III sprains of the medial collateral ligament with early functional rehabilitation in 35 athletes. After injury, patients were placed in lateral hinged braces to provide valgus support without restricting flexion or extension of the knee. Treatment was initiated with range of motion exercises performed in a whirlpool or swimming pool. Patients were then started on quadriceps setting and leg raises. When 90 degrees of flexion was present, resistive exercises were added. Upon recovery, patients were allowed to return to unrestricted sports. Followup consisted of both questionnaires and physical examination and was graded on the 50-point Hospital for Special Surgery scale. Mean followup was 5.3 years (range, 2.5 to 8); mean Hospital for Special Surgery knee rating score was 45.9 points (range, 41 to 50). These results are comparable with those achieved with surgery or immobilization by earlier investigators. Thus, early functional rehabilitation treatment of complete medial collateral ligament sprains produces results comparable with those achieved with surgery or immobilization while minimizing treatment-related morbidity and allowing more rapid return to sports participation.

Adolescent↗
PubMedDate not supplied

The early effect of ibuprofen on the mechanical properties of healing medial collateral ligament.

We tested the hypothesis that injured ligaments in rabbits treated with ibuprofen would have decreased values of mechanical properties compared with the values of those treated with a placebo. In 24 New Zealand White rabbits, the medial collateral ligament of one hindlimb was ruptured; the contralateral ligament served as an internal control. The rabbits were treated orally, twice daily, with a 14-day course of either 35 mg of ibuprofen per kilogram of body weight or a placebo. The rabbits were sacrificed at 14 or 28 days, and the ligaments were tested in tension to failure at 0.15 mm/sec. There was no statistically significant difference in the values of mechanical properties of ligaments from rabbits treated with ibuprofen versus those treated with placebo at either 14 or 28 days after injury. Our findings suggest that there is no early deleterious effect of a short course of ibuprofen on the mechanical behavior of medial collateral ligaments.

Administration, Oral↗
PubMed1987

The combined anterior cruciate and medial collateral ligament replacement by various materials: a comparative animal study.

On 30 sheep, a combined replacement of the anterior cruciate and medial collateral ligament of the right knee was performed with four different materials. Dacron prostheses and glutaraldehyde-preserved bovine tendon prostheses as well as braided ligament prostheses made of carbon fibers and braided resorbable polydioxanone fibers surrounded by lyophilized dura in their intra-articular part were used. Ten unoperated sheep served as a control group. After 1 year the animals were sacrificed and the knee joints were explanted and biomechanically as well as histomorphologically investigated. The gross inspection of the joints showed no ruptured medial collateral ligament replacement but did show partially and totally ruptured anterior cruciate ligament replacements. The Dacron prosthesis was broken in 50% of the cases, whereas for the other materials one ruptured ligament replacement each (12.5%) could be observed. The anterior drawer test and the determination of the tensile stiffness of the remaining ligament replacements revealed that none of the operated knees achieved the properties of the normal control knees. However, the carbon fiber implants had the best result of all prostheses tested. For all materials except the resorbable polydioxanone, abrasion particles could be found in the anterior cruciate ligament and in the synovial membrane. The tissue reaction to these particles was a mild synovitis for carbon fragments, a strong synovitis for Dacron particles, and a chronic inflammatory response to bovine tendon fragments with macrophage granulomas and fibrosis.

Animals↗
PubMed1990

Diagnosis of displaced ulnar collateral ligament of the metacarpophalangeal joint of the thumb.

In a prospective study of 24 consecutive patients with posttraumatic instability of the metacarpophalangeal joint of the thumb, clinical examination including instability tests and palpation of displaced ulnar collateral ligaments was used to separate the patients into two groups--nondisplaced and displaced ruptures. Palpable displaced ruptures were treated surgically, whereas nonpalpable ruptures were interpreted as nondisplaced and were treated with plaster, irrespective of the instability. At follow-up 1 year later both groups showed similar results with respect to stability, strength, and function. Our results indicate that a clinical examination with palpation of the torn ligament ends identifies displaced ruptures of the ulnar collateral ligament, i.e., those cases needing surgery. Nondisplaced ruptures might be treated nonoperatively.

Adolescent↗
PubMed2002

Exogenous transforming growth factor beta 1 alone does not improve early healing of medial collateral ligament in rabbits.

OBJECTIVE: To determine whether transforming growth factor beta 1 (TGF-beta1) improves early ligament healing. DESIGN: Experimental, controlled study of medial collateral ligaments (MCLs) in rabbits' knees. SETTING: Research laboratory. SUBJECTS: Sixteen skeletally mature, New Zealand White female rabbits. INTERVENTIONS: Ten rabbits had a standardized gap injury made in the MCL of both knees. Three weeks later, a second operation was performed to inject 7 microg of TGF-beta1 in a carrier solution into the right knee MCL, while the left knee MCL was injected with carrier alone. The rabbits were killed 3 weeks after the injection of TGF-beta1 (6 weeks after the original injury). Six of the rabbits (12 knees) had no operation on the MCL and served as external normal controls. OUTCOME MEASURES: Biomechanical measures of the femur-MCL-tibia complex. Histologic evaluation of MCL cell and matrix organization. Transmission electron microscopy measures of MCL fibril diameters. RESULTS: There were no statistically significant differences in the biomechanical measures, fibril diameter distributions and histologic evaluation of the injured MCLs treated with TGF-beta1 or carrier alone. Both groups of injured MCLs were significantly different from normal MCLs. CONCLUSIONS: The results indicate that the dosage and route of delivery of TGF-beta1 did not lead to overt improvement in the healing of the injured MCL. Whether different doses or delivery methods, alone or in combination with TGF-beta1, or other growth factors would lead to improvement remains to be determined.

Animals↗
PubMed2002

Ultrasound: a powerful tool in the diagnosis of ulnar collateral ligament injuries of the thumb.

Proper treatment for injuries to the ulnar collateral ligament (UCL) of the metacarpophalangeal joint of the thumb relies on an accurate diagnosis of the pathology of the ligament. The current study evaluates the accuracy of ultrasonography to diagnose the specific pathology related to UCL injuries. The charts of 16 patients who underwent 21 studies of the UCL were reviewed. Ten patients had studies that indicated a complete tear, and eight of those patients underwent surgical exploration. Intraoperatively, 7 of the 8 patients were found to have ruptured ligaments. Six patients had studies that indicated intact ligaments. Four patients were treated with immobilization and a fifth patient underwent surgical treatment for a separate pathology. All patients regained stability of the ligament. The final patient had a repeat examination that indicated a rupture and the patient was found to have a markedly attenuated ligament on exploration. In conclusion, ultrasound is a useful modality for making a correct diagnosis of UCL pathology.

Adolescent↗
PubMed1993

Gamekeeper thumb: differentiation of nondisplaced and displaced tears of the ulnar collateral ligament with MR imaging. Work in progress.

Ulnar collateral ligament (UCL) injury of the first metacarpophalangeal joint (gamekeeper thumb) is common. If the UCL becomes displaced superficially to the adductor pollicis aponeurosis, surgical treatment has been advocated. Radiography cannot help differentiate between displaced and nondisplaced tears. The authors investigated the use of magnetic resonance (MR) imaging in the evaluation of UCL injury. Ten displaced and six nondisplaced UCL tears were surgically created in 16 nonembalmed cadaveric specimens. Twelve unaltered specimens served as controls. Coronal MR images were obtained and interpreted by two observers. The MR images were compared with corresponding anatomic slices. MR imaging depicted UCL displacement in all 10 specimens with displaced tears. A displaced tear was interpreted in one control specimen. Non-displaced tears were diagnosed in four control specimens. Although MR imaging was only 67% specific for all tears, it was 100% sensitive and 94% specific for depicting UCL displacement and, therefore, may be useful for evaluating gamekeeper thumb.

Adult↗
PubMedDate not supplied

Medial collateral ligament healing. A multidisciplinary assessment in rabbits.

Medial collateral ligament healing without treatment has been studied in a rabbit model. Complete midsubstance gaps were found to heal by distinct scar formation over time. This healing process was fast since the gap was bridged quickly; however, more subtle changes in appearance of the healing tissue continued for many months. The ligament "scar" was found to be structurally abnormal chemically and mechanically even at long-term followup. A plateau in its improvement suggests that the scar may never approach normal ligament characteristics (without treatment). A baseline of ligament healing by scar formation has been established.

Animals↗