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PubMed1996

MR arthrography of elbow: evaluation of the ulnar collateral ligament of elbow.

OBJECTIVE: The purpose of this study was to evaluate ulnar collateral ligament (UCL) injury of the elbow in throwing athletes by MRI and MR arthrography. DESIGN: Ten elbows of throwing athletes were examined on both plain MRI and MR saline arthrography and the injuries subsequently surgically proven. Spin-echo (SE) T1-weighted and fast SE T2-weighted coronal images were obtained. RESULTS: The UCL was unclear in all ten cases on T1-weighted MRI. In five cases an avulsion fracture was also found on T1-weighted MRI. On T2-weighted MRI, abnormal high-intensity areas were identified in or around the UCL. On T2-weighted MR arthrography images, extracapsular high-intensity areas, which represent extracapsular leakage, were found in four of five cases with avulsion fracture. At surgery, all these four cases showed avulsion fractures with instability; the other case had a fracture but it was stable and adherent to the humerus. On T2-weighted MR arthrography images, an extracapsular high-intensity area was found in one of the five cases without avulsion fracture. At surgery this patient had a complete tear of the UCL itself. CONCLUSION: MR arthrography provided additional information for evaluating the degree of UCL injury.

Adolescent↗
PubMedDate not supplied

Gamekeeper thumb: diagnosis of ulnar collateral ligament injury using magnetic resonance imaging, magnetic resonance arthrography and stress radiography.

Ulnar collateral ligament (UCL) tears may be nondisplaced or displaced relative to the adductor pollicis aponeurosis. Nondisplaced tears typically heal with immobilization whereas displaced tears require surgery. Nineteen patients with UCL injuries were evaluated using MR Imaging (MRI), MR arthrography, and stress radiography (SR) to determine the efficacy of these techniques in differentiating nondisplaced from displaced UCL tears. Nineteen patients with UCL Injuries were evaluated. MRI was utilized in 5 patients, and MR arthrography in 14, with 12 of these 14 undergoing SR. They were followed until resolution of symptoms; those without relief, and those with suspected displaced UCL tears were surgically explored. Surgery and imaging was correlated. Eight patients underwent surgical repair. SR was abnormal in six patients treated surgically, but was negative in four of six conservatively treated patients with MR findings of nondisplaced tears. All patients with MR or MR arthrographic findings interpreted as being normal or as having a nondisplaced tear improved after conservative treatment. Based on surgical findings and clinical followup, MR arthrography accurately diagnosed 13 of 14 UCL injuries, with one false-positive interpretation. SR is often falsely negative. MR imaging with or without intra-articular contrast injection proved to be accurate in a small series of patients with UCL injuries.

Adult↗
PubMed1997

Evaluation of knee-joint cartilage and menisci ten years after isolated and combined ruptures of the medial collateral ligament. Investigation by weight-bearing radiography, MR imaging and analysis of proteoglycan fragments in the joint fluid.

PURPOSE: To compare radiography, MR imaging, and chemical analysis in posttraumatic knees. MATERIAL AND METHODS: Ten matched pairs with either isolated partial rupture of the medial collateral ligament or combined medial collateral ligament/anterior cruciate ligament rupture were compared with matched controls 10 years after trauma. Weight-bearing radiographs and MR examinations were compared with proteoglycan fragment concentrations in the joint fluid. RESULTS: The chemical analyses were similar in both trauma groups. The radiographs showed mild signs of arthrosis in half the patients with combined injury. MR images showed almost all injured knees to have degenerative changes of various degrees in the cartilage and menisci. More frequent and more advanced changes were found after combined injury than after isolated injury (p < 0.01). There were no changes in the controls. CONCLUSION: MR imaging is the best method for detecting and differentiating early posttraumatic knee arthrosis.

Adolescent↗
PubMed1998

Semiquantitative reverse transcription-polymerase chain reaction analysis of mRNA for growth factors and growth factor receptors from normal and healing rabbit medial collateral ligament tissue.

Growth factors and their receptors play an essential role in the development, maturation, and response to injury of all tissues. A number of studies have explored the possibility of improving ligament healing with exogenous growth factors. However, limited data is available regarding the endogenous growth factor network in ligaments on which any exogenous growth factors must impact. The purpose of this study was to assess the endogenous growth factor network with molecular techniques. By the sensitive reverse transcription-polymerase chain reaction technique, transcripts for a number of growth factors and receptors were detected with RNA isolated from normal and healing rabbit medial collateral ligament tissues. These include transforming growth factor-beta1, insulin-like growth factors I and II, basic fibroblast growth factor, endothelin-1, and the receptors for insulin and insulin-like growth factor II. Semiquantitative reverse transcription-polymerase chain reaction analysis of RNA from normal and scar tissues from the medial collateral ligament revealed that the levels of several transcripts were elevated in the scar tissue. It was not possible to confirm biological activity because of the hypocellularity of the tissues; however, the results obtained indicate that the reverse transcription-polymerase chain reaction approach to defining the endogenous growth factor-receptor phenotype is feasible, and further definition should contribute to the development of rational approaches to exogenous therapy to improve healing.

Animals↗
PubMed2005

Strength of medial structures of the knee joint are decreased by isolated injury to the medial collateral ligament and subsequent joint immobilization.

Past studies of the healing of the medial collateral ligament (MCL) in animal models have been conducted over a variety of healing intervals, some as early as 1 week. One concern with testing at early healing intervals is the difficulty in identifying and isolating the tissues that carry load. The purpose of this study was to determine if isolation of the MCL and healing time are critical factors in the assessment of structural strength in this model. Furthermore, the effect of immobilization on these critical factors was investigated. Our approach was to calculate the load-sharing ratio between the MCL and the MCL plus capsule. A 4 mm gap was created in the midsubstance of both hindlimb MCLs of 52 female New Zealand White rabbits (n=104). Of these, 29 rabbits had their right hindlimb pin immobilized (immobilized group), leaving the left hindlimb non-immobilized. Testing was performed at 3 (n=12), 6 (n=22), and 14 (n=24) weeks. The remaining 23 rabbits, which had both limbs non-immobilized (non-immobilized group), were tested at 3 (n=10), 6 (n=12), 14 (n=12), and 40 (n=12) weeks. For both groups, half of the specimens at each healing interval were used to test the MCL alone and half to test the MCL plus capsule, except for 3 week immobilized joints where only the MCL plus capsule was tested. Additionally, MCL (n=12), MCL plus capsule (n=6), and capsule alone (n=5) were tested from normal animals. The load-sharing ratio at MCL failure for the normal joint was 89%, suggesting an MCL-dominated response. For the non-immobilized group, the load-sharing ratio was 24% at 3 weeks of healing, suggesting a capsule-dominated response. At and after 6 weeks of healing, an MCL-dominated response was observed, with the ratio being 68% or greater. Thus, at less than 6 weeks of healing, the structural strength capabilities of the joint may be better represented by the medial structures rather than the isolated MCL. Immobilization delayed the transition from a capsule-dominated response to an MCL-dominated response in this model.

Animals↗
PubMed1999

Collagen fibril diameter distributions in rabbit anterior cruciate and medial collateral ligaments: changes with maturation.

This study presents morphometric analyses of the collagen fibril diameters of rabbit anterior cruciate and medial collateral knee ligaments of New Zealand White rabbits (young, age two months and adult, age thirty-six to forty months). Measurements were made from transmission electron micrographs of transverse ligament sections of approximately 50,000x magnification. Statistically significant differences in the mean fibril diameters were found between the anterior cruciate and medial collateral ligaments of the thirty-six to forty month old animals (.069 +/- .005, .092 +/- .016 mm, p < .1); however, no statistical significance was found for differences between these ligaments in two month old animals (.077 +/- .006, .082 +/- .009, p > .1). These data support the idea that known differences in fibril distributions of adult rabbit anterior cruciate and medial collateral ligaments develop with maturation, and may reflect both the cellular environment in which the fibrocytes of these ligaments are subject to, as well as the developmental genetic program of these cell populations.

Animals↗
PubMedDate not supplied

Magnetic resonance imaging of injury to the medial collateral ligament of the elbow: a cadaver model.

The purposes of this study were to evaluate the usefulness of thin-section 3-dimensional Fourier Transform (3DFT) gradient echo imaging of the medial collateral ligament and to evaluate the usefulness of intraarticular gadolinium for the detection of tears of the ligament. Magnetic resonance imaging was performed on 5 fresh-frozen cadaveric elbows through use of T1-weighted and 3DFT gradient echo T2-weighted sequences. The elbows were then arthroscoped, and lesions were created in the medial collateral ligaments. Magnetic resonance imaging was then repeated with the T1 and 3DFT sequences. In addition, dilute gadolinium was then injected intra-articularly, and fat-suppressed T1-weighted images and 3DFT images were obtained. Magnetic resonance imaging findings were correlated with the appearance of the dissected ligament. We found that in the prearthroscopy specimens, the ligament was best seen on the 3DFT images reformatted into a slightly posteriorly obliqued coronal plane. In the post-arthroscopy elbows, 4 full-thickness perforations were detected with the 3DFT sequence; fat-suppressed T1-weighted images with intraarticular gadolinium detected these 4 as well as 1 partial inner surface tear. In conclusion, fat-suppressed T1-weighted magnetic resonance arthrography with gadolinium can provide information regarding inner surface partial tears and small full-thickness perforations.

Cadaver↗
PubMed1986

Patient-induced stress test of the first metacarpophalangeal joint: a radiographic assessment of collateral ligament injuries.

The metacarpophalangeal (MCP) joint of the thumb is frequently injured, and the extent of soft-tissue injury is sometimes difficult to determine clinically. Routine radiographs are often normal, without evidence of a fracture. Radiographs obtained during patient-induced stress of the first MCP joint can show significant collateral ligament injury. It is important to make an early diagnosis of collateral ligament rupture.

Adolescent↗
PubMed2005

Medial collateral ligament bursitis in a 12-year-old girl.

A 12-year-old female athlete, training for an international career in pentathlon, was referred to our clinic because of 2 years of recurrent localized swelling and activity-related pain in the medial aspect of her right knee, since falling from a horse and hitting her knees on the ground. She had been examined by a number of doctors over this period and treated with physiotherapy without a proper diagnosis and with no improvement. She could run only very limited distances before excruciating pain and swelling, and she had to abandon participation in competitions. During rest, the swelling decreased but never disappeared entirely. Clinical examination revealed minor effusion and localized tenderness on palpation around the medial joint line. Magnetic resonance imaging showed fluid between the medial capsule and medial collateral ligament, but could not identify any connection to the joint. Arthroscopy revealed a cleavage in the posterior medial joint capsule, superior and close to the medial meniscus, that was connected to the medial collateral ligament bursa. The cleavage was simply expanded, which emptied the bursa, followed by compression bandage and ice for 2 weeks. An immediate positive effect was observed and she could run pain free without swelling within 3 weeks of surgery. Six months after surgery, there has been no recurrence. To our knowledge, this is the first time this injury has been described in a child.

Arthroscopy↗
PubMed1987

The biomechanical and morphological changes in the medial collateral ligament of the rabbit after immobilization and remobilization.

The effects of immobilization and remobilization on the biomechanical and morphological properties of the femur-medial collateral ligament-tibia complex and each of its components were investigated in the rabbit. Specimens that had been obtained after periods of unilateral immobilization of the knee and remobilization were evaluated for structural properties. In addition, the mechanical properties of the substance of the medial collateral ligament and the histological characteristics of both the substance of the ligament and its sites of insertion were evaluated. After immobilization, there were significant reductions in the ultimate load and energy-absorbing capabilities of the bone-ligament complex, and an increased number of failures occurred by tibial avulsion. The tissue of the medial collateral ligament also became less stiff as a result of immobilization. Histologically, the femoral and tibial insertion sites showed increased osteoclastic activity, resorption of bone, and disruption of the normal attachment of the bone to the ligament. With remobilization, the ultimate load and energy-absorbing capabilities of the bone-ligament complex improved but did not return to normal. Failure by tibial avulsion became less frequent, and the stress-strain characteristics of the medial collateral ligament returned to normal. Histologically, the sites of insertion of the ligament also showed evidence of recovery.

Animals↗
PubMed1999

Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor.

Eighteen acute grade III collateral ligament injuries were treated by using the Mitek bone suture anchor. Seven were thumb metacarpophalangeal joint injuries, and eleven were finger proximal interphalangeal joint injuries. Seventeen patients were followed more than 12 months after surgery. All patients were able to use the digits in daily living activities within 5 weeks after surgery, and return to their original work or sports activities within 12 weeks. Pain was completely relieved in 15 patients. Loss of joint motion averaged 7 degrees. In all joints the postoperative lateral stress angle was within 10 degrees of that of the contralateral digit.

Adolescent↗
PubMed1991

Evaluation of a new injury model to study medial collateral ligament healing: primary repair versus nonoperative treatment.

The medial collateral ligament (MCL) of the rabbit left hindlimb was ruptured by a rod placed beneath it, resulting in a "mop-end" tear of the ligament substance with simultaneous injury to the insertion sites. Using this model, we compared primary ligament repair and nonoperative treatment using biomechanical and histologic techniques at time zero, 10 days, and 6 and 12 weeks postoperatively. Biomechanical evaluation included measurement of varus-valgus (V-V) knee rotation, in situ load on the MCL, and tensile testing of the femur-MCL-tibia complex (FMTC). The V-V rotation of all experimental knees decreased over time. At 12 weeks, V-V rotation of experimental knees was still 1.3 times larger than that of controls. Primary repair initially decreased V-V rotation, but at 6 and 12 weeks there was no statistical difference between operated and nonoperated knees. The in situ load on the MCL followed the same trends. There was no significant effect of MCL repair on any of the tensile properties. However, postoperative healing time significantly improved the FMTC structural properties in both experimental groups. Failure modes of the FMTCs and histologic sections of the ligament insertion sites indicated that after injury the ligament insertion to bone recovered more slowly than the ligament substance. Tensile testing of the FMTC showed that even at 12 weeks postoperatively the mechanical properties of the healed ligament material remained significantly different from those of the controls.

Animals↗
PubMed2006

A constitutive law for the failure behavior of medial collateral ligaments.

A constitutive model is proposed for the description of the tensile properties of medial collateral ligaments (MCLs). The model can reproduce the three regions -- the toe region, the linear region, and the failure region -- of the stress-stretch curve of ligamentous tissues. The collagen fibers are assumed to be the only load-bearing component of the tissues. They are all oriented along the physiological loading direction of the ligament. They are crimped in the slack configuration and are unable to sustain load. After becoming taut and before failing, each collagen fiber exhibits a linear elastic behavior. The fiber straightening and failure processes are defined stochastically by means of Weibull distributions. Published experimental data for the MCLs are employed to validate the constitutive relationship. Finally, the constitutive model is generalized in order to describe the three-dimensional mechanical behavior of the ligaments by following he structural approach.

Algorithms↗
PubMed1988

Further studies on collateral ligaments of knee and intertarsal joints in domestic fowl.

Collateral ligament attachments in distal femora and distal tibiotarsi were examined in broilers on ad libitum and restricted feeding and in laying strain fowls fed ad libitum. Histopathological studies revealed morphological changes in ligaments of ad libitum-fed broilers which were less apparent or absent in other birds examined. One such change was loss of crimp pattern in collagen bundles of ligaments, which suggested that structural derangement had occurred. Chondroid metaplasia and foci of hyaline cartilage were observed in ligaments of ad libitum-fed broilers and may result from tissue ischaemia. Similarities were noted between ligament attachments in broilers and Osgood-Schlatter disease in man; lesions in broilers may well have a similar aetiology. It is concluded that although feed restriction restores some semblance of normality in broiler ligaments, the propensity for abnormality remains and becomes apparent in heavier birds. Such reasoning casts doubt on the wisdom of modern broiler breeding practice where feed restriction can mask genotypic predisposition to clinical disease.

Animal Husbandry↗
PubMed1991

Tibial collateral ligament bursa: MR imaging.

The bursa of the tibial collateral ligament (TCL) may be visualized at magnetic resonance (MR) imaging when it becomes distended with fluid. In the authors' experience, this finding signifies a pathologic condition either in the medial capsuloligamentous complex or in the bursa itself. Such a finding may indicate TCL bursitis. TCL bursitis can be suspected in the setting of isolated pain in the medial joint line in the absence of mechanical symptoms. Prolonged relief of symptoms after injection of steroid into the bursa is supportive of the diagnosis. Seven cases are presented in which a fluid-filled TCL bursa was identified at MR imaging. In five cases, TCL bursitis was suspected. The differential diagnosis for the MR findings is discussed.

Adult↗
PubMed1996

Strain in the medial collateral ligament of the human knee under single and combined loads.

Strain within the medial collateral ligament (MCL) was measured in 13 human knee specimens to determine both the single and combined external loads most likely to cause injury. Using a load application system which allowed six degrees of freedom with flexion angle being fixed, both single loads of anterior/posterior force, medial/lateral force, varus/valgus torque, and internal/external axial torque and all pairs of these loads were applied at flexion angles of 0 degrees and 30 degrees. Liquid mercury strain gages were used to measure strain at four sites in the MCL. Two of the sites were the anterior fibers superior and inferior to the joint line and the other two were posterior of the two anterior sites. A factorial analysis revealed a significant interaction between the site experiencing the greatest strain and flexion angle. The posterior superior site experienced significantly greater strain at 0 degree flexion whereas strains was significantly greater at the anterior superior site at 30 degree flexion. Of the single moments, external axial was more damaging than valgus in that the strain developed at equivalent load was significantly greater. None of the moment-moment combinations was identified as being significantly more damaging. A similar result held for the force-moment combinations.

Adult↗
PubMed2005

Local anaesthetic infiltration increases the accuracy of assessment of ulnar collateral ligament injuries.

OBJECTIVE: To assess the effectiveness of a systematic examination of the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal joint (MCPJ) prior to and post infiltration of local anaesthetic. METHODS: During the study period from 24 October 2001 to 22 February 2002, 51 patients with clinical signs suggestive of UCL injuries were identified prospectively from initial ED attendances and attendances at a subsequent review clinic. Patients were formally assessed a mean of 6.6 days post injury. A single ED Senior House Officer carried out examination before and after direct infiltration of local anaesthetic around the site of injury. Stress radiography was also performed as the 'gold standard' diagnostic test of UCL instability. RESULTS: Forty-seven patients were enrolled in the study. When reviewed by the single observer, examination prior to and post local anaesthetic infiltration revealed a degree of joint stability in 28% (95% CI 16-43%) and 98% (95% CI 88-100%) cases, respectively, compared to the gold standard. Post infiltration, this technique had a specificity of 100% (95% CI 94-100%) and a sensitivity of 87.5% (95% CI 74-95%) (P < 0.001). Stress radiography offered additional information in one patient. A total of eight patients previously underdiagnosed in the ED were found to have unstable thumb MCPJs. CONCLUSION: This simple technique improves assessment of suspected UCL injuries approximately 1 week post injury. Further studies are indicated to determine its effectiveness in the ED immediately post injury.

Adolescent↗
PubMedDate not supplied

Traumatic hallux valgus following rupture of the medial collateral ligament of the first metatarsophalangeal joint: a case report.

Metatarsophalangealjoint injuries of the great toe are receiving increasing attention in athletes. Significant disability and long-term morbidity can result from these focal injuries. The entity known as turf-toe is widely recognized. Rupture of the medial collateral ligament of the first metatarsophalangeal joint is less common. A case of traumatic rupture of the medial collateral ligament in the great toe of a soccer player, which progressed to hallux valgus deformity, is presented.

Adolescent↗