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At least 343 records · Page 19Linked to original sources
PubMed2000

[Atlanto-axial rotation and distance in small children. A postmortem study].

The aetiology of atlanto-axial rotatory subluxation is obscure. Therefore, a post mortem investigation was designed in order to evaluate the C 1-2 rotation and translation mobility and to clear the borderline between mobility and instability and to clear the role of the atlanto-axial joints in atlanto-axial rotatory subluxation. C 1-2 specimen of 2 months, 9 months and 53 months old children were used. In the intact specimen and after sequential decision of the atlanto-axial joint capsule, the atlanto-axial membrane, the transverse ligament of the atlas, and eventually the alar ligaments, the atlas was rotated and anteriorly translated over the axis. The end point of the movements was recorded radiographically. Decision of the anatomic structures increased the rotation of up to 25 degrees. The joint capsules are lax and wide thus allowing rotation with almost complete subluxation. The subluxation of atlanto-axial joints probably stays within the normal range of motion and is not a factor of atlanto-axial rotatory subluxation. Interlocking of the facets could not be observed. In atlanto-axial rotatory subluxation the atlanto-dental interval becomes asymmetric. Its radiographic projection is variable and therefore ist does not present a valuable radiographic parameter.

Age Factors↗
PubMed2004

A new approach to studying angiogenesis in rheumatoid arthritis by means of power Doppler ultrasonography and measurement of serum vascular endothelial growth factor.

OBJECTIVE: To evaluate angiogenesis as an essential component of pannus formation and cartilage destruction in rheumatoid arthritis (RA) using power Doppler ultrasonography (PDUS) and serum vascular endothelial growth factor (VEGF) measurement. METHODS: Twenty-one RA patients with a painful and swollen wrist and 12 healthy controls were examined with ultrasound. By means of standard scans, vascularity near and inside the joint capsule was visualized with PDUS. Two trained investigators performed sonography. Representative video clips were stored and read by two independent investigators, under blinded conditions, with regard to the microvascular Doppler flow being either inside or outside the joint capsule and with respect to a qualitative estimate of the intensity of blood flow, according to a grading from 1 to 3. Serum levels of VEGF were measured with a standard quantitative sandwich ELISA. RESULTS: The power Doppler mode identified increased synovial microvascular blood flow inside the joint capsule in 17 of 21 RA patients (81%) vs one of the healthy controls. We found large variation in serum VEGF levels in RA patients and in healthy controls. The degree of synovial vascularity determined by PDUS showed no correlation with the immediate serum VEGF level in the same patient. CONCLUSION: The high correlation between intra-articular microvascular power Doppler flow and clinical synovitis in RA patients (P<0.0001) indicates that PDUS may be helpful in studying the role of synovial blood vessels in rheumatoid inflammation.

Adult↗
PubMedDate not supplied

Pharmacokinetics of ketoprofen in rabbit after a single topical application.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used by topical application in management of joint pain and inflammation. Little is known, however, about their pharmacokinetics, especially in the synovial compartment versus the plasma compartment, following topical administration. Ketoprofen, a NSAID, was delivered by a single topical application (KETUM 2.5% gel) on the rabbit knee-joint region of one hind limb. Concentrations of ketoprofen were measured in plasma, synovial fluid, joint capsule and synovial fat tissue at 2, 4, 6 and 12 hours after application. Whatever the time period after application, ketoprofen concentrations in synovial fluid were much higher than in plasma. The time-course of the decrease in ketoprofen plasma concentrations was more rapid than that in synovial fluid. Similarly, concentrations in joint capsule were higher than those found in synovial fat tissue. Finally, while ketoprofen concentrations decreased rapidly in plasma and in synovial fat tissue, concentrations in joint capsule and particularly in synovial fluid were more sustained. The increase in residence time of ketoprofen in synovial fluid could be in favour of its efficiency in the management of joint pain and inflammation.

Administration, Topical↗
PubMed1996

The sensory innervation of the shoulder joint of the mouse.

The ultrastructure and location of sensory nerve endings in the shoulder-joint capsule, its tendinous reinforcements and in the periarticular connective and muscle tissue have been studied by means of light and electron microscopy in adult female white NMRI-F2 laboratory mice, aged 2.5-13 months. Most of the sensory nerve endings were detected in the fibrous layer of the joint capsule or in the inserting tendons. The identified lamellated corpuscles of the Pacini type are small and sometimes associated with Golgi tendon-organs. Large Vater-Pacini corpuscles were not detected. Ruffini corpuscles are found in small numbers only in the moderately dense connective tissue of the joint capsule. Golgi tendon organs were found mainly at the muscle-tendon junction of the muscles surrounding the joint. Muscle spindles have been identified mainly in periarticular muscles close to the muscle-tendon junctions. The number and distribution of the different types of mechanoreceptors investigated in the present study suggest that periarticular corpuscular sensory nerve endings play an important role in shoulder-joint control and mobility. The occurrence of small uniformly shaped lamellated corpuscles of the Pacini type in qualitatively different areas of surrounding tissue implies that they are susceptible to different kinds of mechanical stimuli.

Afferent Pathways↗
PubMed2004

[The effects of arthrographically detected femoral head lateralization and soft tissue interposition during closed reduction of developmental dislocation of the hip on mid-term results].

OBJECTIVES: In a prospective, non-randomized evaluation of patients who underwent surgery under general anesthesia for developmental dislocation of the hip (DDH) at or below 18 months of age, we assessed the mid-term effects of arthrographically documented femoral head lateralization and soft tissue interposition under the acetabular labrum during reduction without opening the hip joint capsule. METHODS: The study included 31 unstable hips of 21 children (mean age 12 months; range 4 to 18 months). After the iliopsoas and adductor longus tendons were sectioned by a medial approach, hip joint arthrography was performed. According to the criteria of Tönnis, all the patients had grade 2 arthrographic reduction and the hip joint capsule was left intact. The mean follow-up was 6.5 years (range 3 to 9.5 years). RESULTS: Avascular necrosis of the femoral head (AVN), redislocation, and secondary operation were seen in 42%, 19%, and 29%, respectively. The physeal plate was involved in nearly half of the hips with AVN. The occurrence of AVN was less in hips treated at the age of below one year. Complications were more frequent in cases in which more than one intraarticular soft tissue obstacles had been documented by arthrography. Avascular necrosis and redislocation were more commonly encountered in hips in which the medial pool size of contrast material exceeded 7 mm than those with sizes between 3 to 7 mm. CONCLUSION: Our mid-term complication rates suggest that the hip joint capsule be opened in order to achieve an anatomical reduction through eliminating intraarticular obstacles when arthrography shows lateralization of the femoral head, soft tissue interposition, and medial pooling of the contrast material following closed reduction of DDH.

Arthrography↗
PubMed1996

Cervical myelopathy caused by calcium pyrophosphate dihydrate crystal deposition in facet joints. A case report.

STUDY DESIGN: This report illustrates a case of cervical myelopathy caused by degenerative changes of the facet joints in which calcium pyrophosphate dihydrate crystals were found histologically. OBJECTIVES: To evaluate the treatment of this patient, which involved the principles of laminoplasty and posterolateral fusion, and to analyze surgical specimens and preoperative radiographs taken after the patient's surgery. SUMMARY OF BACKGROUND DATA: Calcium pyrophosphate dihydrate deposition occurs in cartilage, ligaments, tendons, and joint capsules. Radiographic changes of the cervical facet joints caused by such deposition have already been reported in cadaveric studies. Cases with neurologic compromise rarely occur. METHODS: Surgical specimens that were obtained from the cervical facet joints, i.e., capsule and synovium, were analyzed histopathologically. RESULTS: The preoperative radiographic study showed severe degenerative changes of the cervical facet joints, and analysis of the surgical specimens indicated the presence of calcium pyrophosphate dihydrate crystals. CONCLUSIONS: The cervical facet joints can be involved in calcium pyrophosphate dihydrate crystal deposition and this involvement may accelerate the degenerative changes of the facet joints.

Adult↗
PubMed1988

Mechanoreceptors in articular tissues.

The morphology, distribution, and function of mechanoreceptors in joint capsules, ligaments, knee-joint menisci, and articular disks of the temporomandibular joints of animals, including humans, have been reviewed. In addition to free nerve endings, three types of joint receptors are present in most animal joints: 1) a Ruffini-like receptor situated in the capsule, 2) a Golgi tendon organ situated in a ligament; and 3) the encapsulated Pacinian-like corpuscle. In the anterior cruciate ligament, nerve fibers enter from the subsynovial connective tissue and terminate in receptors. Most of the receptors are found in the distal portion of the ligament. In the meniscus, nerves penetrate the outer and middle one-third of the body and the horns from the perimeniscal tissue, with a greater concentration at the horns. In the temporomandibular articular disk, the mechanoreceptor density is greatest at the periphery and progressively decreases toward the center. If a joint has an intra-articular structure, mechanoreceptors undoubtedly are present within it. The concentration of mechanoreceptors appears greater in areas related to the extremes of movement and probably represents the first line of defense in sensing these extremes. These afferent discharges elicit support from discharging mechanoreceptors located in the joint capsule and subsequently from those in the surrounding muscles. This total afferent output alerts the central nervous system of impending injury, which can then be averted through reflex mechanisms.

Animals↗
PubMed2000

Evaluation of a method for experimental induction of osteoarthritis of the hip joints in dogs.

OBJECTIVE: To evaluate a method for experimental induction of osteoarthritis in the hip joints of dogs. ANIMALS: 12 mixed-breed dogs. PROCEDURE: A unilateral triple pelvic osteotomy was performed. In 6 dogs, the iliac osteotomy was repaired with 45 degrees of internal rotation, reducing coverage of the femoral head by the acetabulum. In the other 6 dogs, the fragments were repaired in anatomic alignment. Radiography, force plate evaluations, and subjective lameness evaluations were performed before and after surgery. Dogs were euthanatized 7 months after surgery, and samples of cartilage and joint capsule were examined histologically. RESULTS: Subjective lameness scores, radiographic appearance of the hip joints, and Norberg angles were not significantly different between groups; however, force plate evaluations did reveal significant differences in vertical ground reaction forces. Femoral head coverage was significantly decreased with rotation of the acetabulum. Mild inflammatory changes were discernible in the joint capsule and articular cartilage of some dogs in both groups. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that 45 degrees internal rotation of the acetabulum does not consistently induce biologically important osteoarthritic changes in the hip joints of dogs.

Acetabulum↗
PubMed2001

Rapidly destructive arthropathy of the hip in haemophilia.

The aetiology of rapidly destructive arthropathy is still being debated. We report a 48-year-old male haemophiliac who exhibited hip arthropathy that was similar to rapidly destructive arthropathy. The hip joint was destroyed 6 months after the onset of symptoms. Results of clinical and laboratory examinations did not show any features of neuropathic, inflammatory or septic arthropathy, except for coagulopathy. Magnetic resonance imaging revealed an expansive joint capsule with synovial proliferation in the affected hip joint. Total hip arthroplasty was carried out successfully with total resection of the synovial tissue and joint capsule. A histological examination revealed bone necrosis, nonspecific inflammation, haemosiderosis and synovial hypertrophy. The recurrent bleeding into the hip joint induced pronounced inflammation with synovial proliferation and acute destruction of bony tissue.

Hemophilia A↗
PubMed2005

Radiographic anatomy of the soft tissue attachments of the equine stifle.

REASONS FOR PERFORMING STUDY: Radiography is a very important aspect of equine stifle imaging. The precise radiographic anatomy of the soft tissue structures of the equine stifle has not been described previously. OBJECTIVE: To describe the anatomical relationship between sites of attachment of soft tissue structures of the equine stifle and their locations on standard radiographic views. METHODS: The sites of bony attachments of the tendons, ligaments and fibrous portion of the joint capsules of equine stifles were determined by gross dissection. These sites of attachment were transposed onto one set of bones deprived of soft tissue and mapped using radiopaque markers. This specimen was then radiographed in the standard radiographic projections (lateromedial, caudocranial and caudal 60 degrees lateral-craniomedial oblique) to determine the position of the attachment sites on the radiographs. RESULTS: Two radiographic maps were drawn per radiographic projection, one for the attachment sites of the ligaments and tendons and one for the attachment sites of the joint capsules. CONCLUSIONS AND POTENTIAL RELEVANCE: The radiographic maps of the precise position of the soft tissue attachments of the tendons, ligaments and joint capsules of the equine stifle should assist interpretation of equine stifle radiographs.

Animals↗
PubMed2004

The effect of capsular tightening on humeral head translations.

UNLABELLED: Idiopathic or surgical tightening of the glenohumeral joint capsule may cause displacement of the humeral head relative to the glenoid fossa and favor the development of instability and/or osteoarthritis. In the present investigation the relative position of the humerus to the glenoid fossa was determined at the end of the ranges of eight different passive movements before and after selective capsular plication in eight cadaveric shoulders to study the effects of selective capsular plications on the kinematics of the shoulder. While the capsule was in its unaltered state, translation of the humeral head was 3.8 mm superiorly in abduction, 7.3 mm antero-superiorly in flexion. In internal rotation in 0 degrees, 45 degrees and 90 degrees of abduction the head moved 6.1, 8.0 and 12.0 mm antero-inferiorly. In external rotation at 0 degrees of abduction the translation was 0.9 mm antero-inferiorly, at 45 degrees and 90 degrees of abduction it was 4.3 and 5.6 mm postero-inferiorly, respectively. Plications of the anterior part of the capsule reproducibly and significantly either increased or decreased translations during flexion (up to 5.9 mm anteriorly and up to 3.8 mm inferiorly), external rotation (up to 2.9 mm posteriorly and 1 mm inferiorly) and internal rotation (from 5.5 mm posteriorly to 2 mm anteriorly and up to 2.2 mm superiorly). Posterior plications had only little effect on translations (mainly a decrease of anterior translation during flexion of 2.8 mm). CLINICAL RELEVANCE: The 'obligate' glenohumeral translations which occur towards the end of passive shoulder movements are altered in a reproducible fashion by tightening specific parts of the glenohumeral joint capsule, as often carried out in treatment of shoulder instability. These alterations of the kinematics of the glenohumeral joint may be relevant for the development of static subluxation and osteoarthitis as seen after too tight plication in the treatment of instability [Int. Orthop. (SICOT) 67-B (1985) 709; J. Bone Joint Surg. Am. 72 (1990) 1193; J. Bone Joint Surg. Am. 66-A (1984) 169; J. Bone Joint Surg. Am. 65 (1983) 456].

Humans↗
PubMed1997

Spatial heterogeneity of the effects of calcitonin gene-related peptide (CGRP) on the microvasculature of ligaments in the rabbit knee joint.

1. Experiments were performed in anaesthetized rabbits to examine the effects of calcitonin gene-related peptide (CGRP) and the CGRP antagonist CGRP8-37 on blood flow to the medial collateral ligament of the knee joint. 2. Topical application of CGRP (10(-13) to 10(-9) mol) to the exposed external surface of eight knee joints resulted in dose-dependent dilatation of vessels in both the ligament and the joint capsule. The magnitude of this response varied significantly in different regions of the medial collateral ligament, with the 10(-9) mol dose of CGRP giving the maximum response (101.5 +/- 25.3% increase) at the femoral insertion site of the medial collateral ligament and lowest (23.1 +/- 8.8%) at the tibial insertion site. 3. Topical application of CGRP8-37 (0.1, 1 and 10 nmol) produced dose-dependent constriction of vessels in the ligament and the joint capsule in five knees, with a trend towards the greatest effect occurring at the femoral insertion site (45.8 +/- 8.1% reduction in blood flow). With the 10 nmol dose, the vasoconstrictor response at the femoral insertion site differed significantly (P<0.05) from the responses obtained at the tibial insertion and joint capsule sites. 4. Topical application of CGRP8-37 (0.1, 1 and 10 nmol) to four chronically denervated knees produced substantially smaller vasoconstrictor responses at all sites. At the femoral insertion site, where 10 nmol CGRP8-37 normally produces a 45.8 +/- 8.1% reduction in blood flow (n=8), ten days following denervation this response was reduced to 6.5 +/- 6.1%, this difference being significant (P=0.01). 5. Adrenaline was applied topically to augment blood vessel tone, in order to establish how effectively co-administration of CGRP would offset this increase in tone. Adrenaline (10(-10) mol) produced vasoconstriction at all sites (n=6). In the capsule this vasoconstriction was virtually abolished when CGRP (10(-9) mol) was co-administered with adrenaline but in the ligament vasodilatation occurred at all sites. This vasodilatation was significantly greater at the femoral insertion site compared to the tibial insertion and mid ligament sites (P<0.05 for both) and the capsule (P<0.01). 6. Topical application of substance P (10(-10) or 10(-9) mol) failed to elicit dilatation of ligament blood vessels. 7. These results suggest that endogenous CGRP may play an important role in regulating blood flow to different structures in and around the knee joint.

Animals↗
PubMed2003

Anatomic structures involved in early- and late-stage sacroiliitis in spondylarthritis: a detailed analysis by contrast-enhanced magnetic resonance imaging.

OBJECTIVE: To localize inflammatory and chronic changes to defined areas in the sacroiliac joints in patients with early-stage compared with late-stage spondylarthritis (SpA), using magnetic resonance imaging (MRI). METHODS: Using MRI, 93 patients with SpA and inflammatory back pain who had radiographs of the sacroiliac joints were examined, comprising 31 patients with ankylosing spondylitis (AS) and 62 with other SpA subsets, including 48 with undifferentiated SpA (uSpA). MRI was performed using T1-weighted, T2*-weighted, STIR, and dynamic contrast-enhanced (gadolinium diethylenetriaminepentaacetic acid) sequences. Two readers retrospectively analyzed the images by differentiating 9 areas of the sacroiliac joints: the ventral and caudal joint capsule, cavum, subchondral bone, bone marrow, ligament entheses, and ligaments; the sacral and iliac sides were tabulated separately. RESULTS: By MRI, sacroiliitis was more often bilateral in AS (84%) than in uSpA (48%) (P = 0.01). Inflammatory changes were found in a mean +/- SD 4.7 +/- 2.9 regions/joint, with involvement of 4.5 +/- 3.2 regions in early disease versus 5.2 +/- 2.3 regions in late disease (P not significant [NS]). Involvement of the iliac side of the sacroiliac joints was found to be more frequent than the sacral side in early disease (58% versus 48%; P < 0.01) as compared with that in late disease (58% versus 63%; P NS). The dorsocaudal parts of the synovial joint and the bone marrow were the most frequently inflamed structures in early disease (P < 0.001 for ventral versus dorsal joint capsule). In contrast, involvement of the entheses was more common in advanced disease (early 43% versus late 86%; P < 0.001). Similarly, the ligaments were more frequently involved in the late stages (early 26% versus late 40%; P = 0.06). Both patterns of bone marrow inflammation (focal and diffuse) were observed in equal frequencies in early and late disease (17% and 42% versus 26% and 43%, respectively; P NS). HLA-B27-positive patients (n = 80) had more entheseal involvement than did HLA-B27-negative patients (n = 13) (60% versus 39%; P = 0.05). HLA-B27-negative patients had a shorter disease duration (2.2 years versus 4.4 years; P = 0.05) and were more often female (62%; P = 0.02). When all pathologic changes were assessed, the STIR sequence (performed in 62 patients) was less sensitive than the contrast-enhanced sequences in that it was not able to show all relevant changes in 27% of these patients (n = 17), failing to reveal inflammation of the cavum in 15 patients and of the bone marrow and joint capsule in 1 patient each. CONCLUSION: As visualized by MRI, sacroiliitis in SpA is characterized by involvement of different joint structures. Whereas the iliac and the sacral side of the sacroiliac joints are almost equally affected, the dorsocaudal synovial part of the joint is involved significantly more often than the ventral part, especially in early disease. Sacroiliac enthesitis is not a special feature of early sacroiliac inflammation.

Adult↗
PubMed1982

Intra-articular synovial protrusions in the lower lumbar apophyseal joints.

Two types of joint inclusions are demonstrated in the lumbosacral facetal joints--a large, fat-filled, vascular intra-articular synovial protrusion projecting into the medial part of the joint from below, and a dense, fibrous, intra-articular synovial protrusion projecting from the joint capsule into the upper medial part of the joint. Although nerve fibers have not yet been demonstrated in the intra-articular synovial protrusions, it is reasonable to assume their presence in such a rich vascular network. These intra-articular synovial protrusions are vulnerable to being nipped between moving parts of the joints, in this way possibly transmitting traction forces to the related parts of the fibrous joint capsule. This could constitute a likely source of low back pain with resultant reflex muscle spasm.

Adolescent↗
PubMed1996

[Clinicoradiologic anatomy of the shoulder region].

Besides the skeletal elements, i.e., the clavicle, scapula and humerus, several muscles and soft tissues also participate in the construction of the human shoulder. These elements from and surround the shoulder girdle joints, which are the acromioclavicular and glenohumeral joint. Towards the trunk a connection is achieved by the sternoclavicular joint. Ossification of the clavicle, scapula and humerus begins within the 5th to 7th embryonic week. Around the age of 20 years ossification is completed. Parallel to this development and during adulthood, age-dependent changes take place in the composition and mixture of the bone marrow from red to yellow marrow. The shoulder girdle joints are constructed to permit a wide range of motion of the arm against the trunk. At the glenohumeral joint the spherical humeral head glides within the concave groove of the glenoid cavity. Stability is attained by the fibrocartilaginous glenoid labrum, which enlarges the articulating areas and the joint capsule with its strengthening ligaments. Variation of the joint capsule insertion, the glenoid labrum or the bony surfaces may predispose to luxation. Additional support to prevent luxation is obtained by the glenohumeral ligaments and the long biceps tendon. Active movement is provided by the superficial muscles and the rotator cuff muscles. Several bursae support free movement and decrease friction of the musculotendineous systems near the joint. Despite this complex construction several degenerative diseases can impair free movement of the human shoulder.

Acromioclavicular Joint↗
PubMed2001

In vitro distribution of ketoprofen enantiomers in articular tissues of osteoarthritic patients.

The distribution of ketoprofen enantiomers in joint tissues was studied as a function of their relative tissular affinities using the multi-chamber distribution dialysis system described by Bickel et al. Selected off-cuts of synovial membrane, joint capsule, cartilage and ligament were obtained from ten patients suffering from osteoarthritis of the knee (n=3) or hip (n=7). Sörensen solution (4 ml) spiked with racemic ketoprofen (2 microg ml(-1)) was dialysed against 1 ml of the four solutions of tissue homogenates (0.4 g ml(-1)). Ketoprofen enantiomers were quantified in buffer and tissue solutions by high-performance liquid chromatography. The distribution of ketoprofen enantiomers in the Bickel's multi-compartment model indicated that there was a non-stereoselective affinity of ketoprofen enantiomers for their potential target tissues. Despite the interindividual variability in articular tissues, the concentrations (+/-S.D.) of R- and S-ketoprofen were significantly higher in synovial membrane (8.69 (4.76) microg g(-1) for S, 9.14 (5.57) microg g(-1) for R), joint capsule (5.71 (2.49) microg g(-1) for S, 5.49 (2.62) microg g(-1) for R) and ligament (6.28 (3.61) microg g(-1) for S, 6.40 (3.64) microg g(-1) for R) than in articular cartilage (3.67 (1.75) microg g(-1) for S, 3.70 (1.67) microg g(-1) for R). There were no significant differences in the distribution of R- and S-ketoprofen between the solutions of joint capsule, synovium and ligament tissues. These data may be related to differences in ketoprofen affinity for the different constituents of joints. This in vitro distribution profile is similar to that reported in vivo for other non-steroidal anti-inflammatory drugs.

Adult↗
PubMed1996

The insertion of the extensor digitorum tendon on the proximal phalanx.

Review of the literature reveals that the relationship between the extensor digitorum muscle tendon to the proximal phalanx and the metacarpophalangeal joint capsule remains unclear. The present study presents data about these relationships and consists of three parts: dissection of the region, high-gradient magnetic resonance imaging, and functional study. A total of 50 hands were used. Dissection was performed on 30, magnetic resonance studies were performed on 10, and the remaining 10 hands were used for the functional analysis. Dissection did not reveal an insertion of the extensor digitorum tendon on the base of the proximal phalanx. An extension of the dorsal part of the metacarpophalangeal joint capsule running proximally toward the palmar side of the extensor tendon was observed in eight hands. In the remaining 22 hands, only loose connective tissue was found between the articular capsule and the tendon. The development of this tissue was variable. These observations were correlated using a 7T magnetic resonance installation. The results of the functional study showed that hyperextension of the proximal phalanx increased after resection of the metacarpophalangeal structures lying under the extensor tendon. In conclusion, no real tendinous insertion of the extensor digitorum tendon on the base of the proximal phalanx could be found. Loose connective tissue was observed between the metacarpophalangeal joint capsule and the palmar aspect of the tendon, which seemed to play a secondary role in the extension of the proximal phalanx.

Biomechanical Phenomena↗
PubMed1989

Surgical correction of congenital medial patellar luxation in a llama.

Unilateral congenital medial patellar luxation in a young llama was corrected by medial joint capsule release, tibial crest transposition, trochleoplasty, and lateral joint capsule imbrication. The techniques used were the same as described in the dog. One year after surgery, the llama was not lame, but had a valgus deformity originating at the stifle, most likely caused by lateral femoral condyle hypoplasia.

Animals↗