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PubMed2001

The hip joint: the fibrillar collagens associated with development and ageing in the rabbit.

The fibrillar collagens associated with the articular cartilages, joint capsule and ligamentum teres of the rabbit hip joint were characterised from the 17 d fetus to the 2-y-old adult by immunohistochemical methods. Initially the putative articular cartilage contains types I, III and V collagens, but when cavitation is complete in the 25 d fetus, type II collagen appears. In the 17 d fetus, the cells of the chondrogenous layers express type I collagen mRNA, but not that of type II collagen. Types III and V collagens are present throughout life, particularly pericellularly. Type I collagen is lost. In all respects, the articular cartilage of the hip joint is similar to that of the knee. The joint capsule contains types I, III and V collagens. In the fetus the ligamentum teres contains types I and V collagens and the cells express type I collagen mRNA; type III collagen is confined mainly to its surface and insertions. After birth, the same distribution remains, but there is more type III collagen in the ligament, proper. The attachment to the cartilage of the head of the femur is marked only by fibres of type I collagen traversing the cartilage; the attachment cannot be distinguished in preparations localising types III and V collagens. The attachment to the bone at the lip of the acetabulum is via fibres of types I and V collagens and little type III is present. The ligament is covered by a sheath of types III and V collagens. Type II collagen was not located in any part of the ligamentum teres. The distribution of collagens in the ligamentum teres is similar to that in the collateral ligaments of the knee. Its insertions are unusual because no fibrocartilage was detected.

Aging↗

PubMedDate not supplied

Ludloff's open reduction of the hip: long-term results.

Long-term results of Ludloff's open reduction of the hip were studied in 62 joints of 56 children with an average follow-up of 11 years (range 5-18 years). Results were considered good in 76% and poor in 24%. A decisive factor in assessing long-term results was a proper centric reduction of the femoral head. The most frequent obstacles to proper reduction were a shortened inferomedial part of a joint capsule with the transverse ligament pulled into the joint cavity (14%), joint capsule contracture (100%), and an inverted limbus (92%), which was accompanied in 17% of patients by an impression of reflected head of the rectus femoris. Earlier nonoperative treatment affected the success of the reduction as well as long-term results.

Female↗

PubMed1996

Fiber type composition of articular branches of the tibial nerve at the knee joint in man.

BACKGROUND: We examined the fiber type composition of the articular branches of the tibial nerve in human cadavers. Our primary motivation was to assess the suitability of these nerve branches for making neural recordings by using an interface, such as a nerve cuff electrode or a microelectrode array. Articular branches of the tibial nerve innervate primarily the posterior joint capsule of the knee (Gardner, 1948. Anat. Rec, 101:109-130); the main branch corresponds anatomically to the posterior articular nerve (PAN), which has been studied extensively in animals such as the cat. MATERIALS AND METHODS: By using light microscopy, we counted the numbers of myelinated fibers in articular branches of the tibial nerve removed from eight cadavers. Unmyelinated fibers were counted in the same specimens by using electron microscopy, and the percentage of unmyelinated fibers was calculated. RESULTS: We found on average 2,280 myelinated fibers in the main articular branch and 279 fibers in individual capsular ramifications. Myelinated fiber diameter histograms showed either bimodal (peaks at 3-4 and 9 microns) or unimodal (peak at 3-4 microns) distributions, depending on the specimen. These histograms were similar in appearance for both the individual capsular ramifications and the main articular branch of the tibial nerve. Numbers of unmyelinated fibers ranged from 4,176 to 5,200 in the main tibial nerve branch (average percentage of unmyelinated fibers = 69.6%) and from 750 to 2,250 in the individual capsular ramifications (average percentage of unmyelinated fibers = 78.5%). CONCLUSIONS: The percentage of unmyelinated fibers is comparable to that found in articular nerves in other species. We discovered that the main articular branch of the tibial nerve contains a branch projecting distal to the knee joint capsule; therefore, the best location for placement of a neural recording interface to record from capsular afferents appears to be the well-defined ramifications of the articular branch that penetrate the joint capsule. Branches that contain only these ramifications are 0.5-1.0 mm in diameter and, on average, have 658 myelinated axons, which should be a sufficient number from which to record.

Aged↗

PubMed2006

[Allogenic meniscus transplantation].

OBJECTIVE: Total replacement of the meniscus to reduce pain and improve joint function. INDICATIONS: Symptomatic early arthrosis of the lateral compartment in young patients after loss of the lateral meniscus. Loss of the medial meniscus and anterior knee instability in young, active patients. CONTRAINDICATIONS: Advanced cartilaginous damage. Malalignment of the longitudinal axis. Knee ligament instability. SURGICAL TECHNIQUE: Preparation of the allogenic meniscal transplant. Placement of sutures to the "horn ligaments". Lateral or medial arthrotomy. Osteotomy of the femoral epicondyle with the collateral ligament. Excision of meniscal residues leaving only a narrow outer rim. Holes are drilled from the anterolateral or anteromedial tibial metaphysis to the horn insertions. The horn ligaments are pulled into the drill holes. Fixation of the meniscal transplant by insertion of vertical sutures at the outer rim and joint capsule. Tightening and temporary fixation of the meniscal horn sutures at the exit sites of the drill holes. The function of the transplanted meniscus is evaluated, the tension in the sutures adjusted as required and, finally, the ends are knotted. Refixation of the epicondyle with a 6.5-mm cancellous bone screw. POSTOPERATIVE MANAGEMENT: Active and passive exercises from extension to 90 degrees flexion. Partial loading in a brace in extension on two crutches for the first 6 weeks postoperatively. No full squat for a further 3 months. Sports activities not before the end of the 1st postoperative year. RESULTS: Good results for correct indications with a survival rate of the transplant of 70-80% after 3-7 years and significant improvement of joint function and pain reduction. An effect on the results related to arthroscopically assisted or open technique and/or related to anchorage of the meniscal horns in the bone or soft tissue could not be shown. In biomechanical terms, the stable fixation of the meniscal horns is decisive. Fixation of the periphery of the meniscus to the joint capsule by vertical sutures alone is not sufficient but does play an important role in the incorporation of the meniscal tissue. Anterior cruciate ligament reconstruction should be performed at the same time; correction osteotomy should be performed at a separate operation prior to meniscal allograft transplantation.

Bone Screws↗

PubMed2001

Safe placement of proximal tibial transfixation wires with respect to intracapsular penetration.

OBJECTIVES: To determine the safe zone for transfixation wires in the proximal tibia to avoid intracapsular penetration. METHODS: The material consisted of five fresh cadaver knees (two paired) and seven knees of volunteer subjects (three paired). High-resolution magnetic resonance imaging (MRI) was performed on each knee after distension with a gadolinium solution. The distance d from the subchondral bone to the insertion of the reflected joint capsule was measured. Selected cadaver knees were then anatomically sectioned to correlate the MRI findings with anatomic measurements. RESULTS: On the anteromedial side of the knee, the distance from the reflected joint capsule to the subchondral bone was less than eleven millimeters in all specimens except one. Posteromedially, d was smaller and ranged from two to four millimeters. On the lateral side of the knee anterior to the proximal tibiofibular joint, this distance ranged from six to nine millimeters. In all knees but two, d was greatest at the posterior aspect of the proximal tibiofibular joint, ranging from eight to thirteen millimeters. In one volunteer knee, the septum that separates the knee joint from the proximal tibiofibular joint was either torn or attenuated, resulting in complete communication between these two synovial cavities. CONCLUSIONS: Proximal tibial transfixation wires away from the tibiofibular joint are likely to be extraarticular if kept greater than fourteen millimeters from the subchondral bone. In the region of the proximal tibiofibular joint, a safe distance is unclear because it is difficult to know preoperatively which knee has a torn septum.

Bone Wires↗

PubMed1993

Acute inflammation in the rat knee joint attenuates sympathetic vasoconstriction but enhances neuropeptide-mediated vasodilatation assessed by laser Doppler perfusion imaging.

The effect of sympathetic nerve stimulation and topical application of substance P and calcitonin gene-related peptide on the blood flow of the exposed rat knee joint capsule was investigated. The responses of normal animals were compared to those of animals with acutely inflamed joints induced by intra-articular injection of 2% carrageenan. Laser Doppler perfusion imaging was used to examine the spatial distribution of blood flow in the knee joint capsule. Animals with acute joint inflammation showed markedly reduced vasoconstrictor responses to sympathetic nerve stimulation, but enhanced vasodilator responses to both substance P and calcitonin gene-related peptide when compared to normal. Prior application of either substance P or calcitonin gene-related peptide to the normal joint attenuated sympathetic vasoconstrictor responses. In the acutely inflamed knee, sympathetic vasoconstriction was replaced by a vasodilator response in the presence of neuropeptides. The reduced effectiveness of sympathetically mediated vasoconstriction and enhanced responsiveness to substance P and calcitonin gene-related peptide could contribute to the hyperaemia characteristic of inflamed joints.

Animals↗

PubMed1986

Posterior capsulitis of the temporomandibular joint.

Posterior capsulitis, which is characterized by pain and inflammation localized above and behind the condyle of the mandible, usually develops as a result of premature contacts in dental occlusion. The pain at the affected side is related to the severe spasm of M. Pterygoideus Lateralis or the splinting action of the masticatory muscles. This condition can be readily treated by occlusal grinding of these premature contacts after a definite diagnosis. The amount of grinding on the teeth varies according to the localization of premature contacts and the pain at the joint. This study covers 123 patients diagnosed as having posterior capsulitis and the results are presented.

Arthritis↗

PubMed1995

Electromyographic response of the porcine multifidus musculature after nerve stimulation.

STUDY DESIGN: In this study, a porcine model was used to study whether a nerve reaction in the anulus fibrosus of a lumbar disc or in a facet joint capsule could cause a muscular response in the multifidus musculature. OBJECTIVES: To determine if there is an interrelationship between the intervertebral disc and facet joint innervation and the multifidus musculature as a possible pain mechanism. SUMMARY OF BACKGROUND DATA: The innervation of the anulus fibrosus of the intervertebral disc and the capsule of the facet joint is well described in the literature, although the functions of these nerves are poorly understood. An interrelationship between this innervation and the paraspinal musculature has not been previously described. METHODS: Fifteen adult pigs were used to measure the electromyographic response in the multifidus musculature to electrical stimulation of the lateral region of the disc anulus and the facet joint capsule in the L1-L2 motion segment. Motor unit action potentials were recorded using three sets of bipolar needle electrodes placed into the deepest fascicles of the multifidus, bilateral to the L2, L3, and L4 spinous processes. The effect of lidocaine injection into the facet joint and subperiosteal muscle detachment on the electromyographic response were studied. RESULTS: Stimulation of the disc anulus fibrosus induced reactions in the multifidus on multiple levels and on the contralateral side, whereas stimulation of the facet joint capsule induced reactions predominantly on the same side and segmental level as the stimulation. Introduction of lidocaine into the facet joint resulted in a significantly reduced electromyographic response to either stimulation, with the most drastic reduction seen when stimulating the facet joint capsule. Subperiosteal detachment of the paraspinal muscles prevented any muscular response. CONCLUSIONS: Stimulation of the disc and the facet joint capsule produced contractions in multifidus fascicles. The clinical implications are that there may be interactive responses between injured or diseased structures, i.e., disc or facet joints, and the paraspinal musculature. Activation of the multifidus muscles may have a stabilizing effect, constraining the motion of the lumbar spine. Longstanding muscular contraction may produce ischemic conditions and may be a potential source of pain.

Animals↗

PubMedDate not supplied

Management of an unusual extreme extension contracture of the wrist: role of a custom-designed exercise program in achieving a good range of movement and prevention of recontraction.

An extreme extension contracture of wrist with dorsal contracture of fingers 15 years after burn injury is described. Shortening of extensor tendons, secondary lengthening of flexor tendons, contracted wrist joint capsule, unusual dislocation of carpals, dorsal dislocation of metacarpophalangeal joints of fingers, and provision of sufficient amount of good-quality skin were some of the issues that had to be addressed in treatment. The contracture was released, the carpals and metacarpophalangeal joint dislocations were corrected and fixed with K wires, and the resulting defect was covered with a sheet split-thickness skin graft. An exercise program was designed that consisted of isotonic, isokinetic, and isometric resistance exercises and passive, active, and active-assistive range of motion exercises. These exercises were pursued with the intention of increasing dynamic strength, endurance, and overall functional recovery of the flexor muscles by exploiting the immature nature of early scar tissue. The resultant enhanced flexor muscle power from exercises along with the dynamic splint helped in lengthening of extensor tendons, wrist joint capsule, and split-thickness skin graft. It also helped in resisting the recontracting tendency, with further recovery of good range of wrist and fingers movements, obviating the need of tendon-lengthening surgery and flap coverage. One and half years of follow up didn't show any sign of recontracture, and the patient was able to perform his routine activities. Postburn wrist contractures of such magnitude have been seldom described. Emphasis is put on simple contracture release and a postoperative exercise program.

Adolescent↗

PubMed1991

Effects of paracetamol and aspirin on neural activity of joint mechanonociceptors in adjuvant arthritis.

1. The effects of paracetamol and lysine acetylsalicylate (L-AS) on high-threshold mechanonociceptors have been investigated by recording neural activity from the inflamed ankle joint in anaesthetized rats with mild adjuvant-induced monoarthritis. 2. Paracetamol (50 mg kg-1, i.v.) and L-AS (100 mg kg-1, i.v., equivalent to 50 mg kg-1 aspirin) both caused a maximal reduction of about 40% in mechanically-evoked discharge and of 30% in ongoing (spontaneous) activity by about 15 min after the injection: a second dose of either drug did not have any significant additional effect on discharge. 3. The prostanoid IP receptor agonist, cicaprost (0.1-0.5 micrograms), increased both mechanically-evoked and ongoing discharge to pre-paracetamol levels when injected close-arterially 30-50 min after paracetamol, whereas prostaglandin E2 (PGE2) was relatively ineffective at restoring activity. 4. The results suggest that prostacyclin (PGI2) contributes to the sensitization of high-threshold joint mechanonociceptors in adjuvant-induced monoarthritis, and that paracetamol and L-AS both act to reduce discharge by inhibiting the synthesis of prostacyclin in the joint capsule. 5. Paracetamol has a direct peripheral action affecting joint capsule mechanonociceptors in rat adjuvant-induced arthritis which is very similar to that of the soluble aspirin preparation, L-AS. These findings, together with the existing literature concerning the anti-arthritic effects of paracetamol, are relevant to the treatment of chronic inflammatory disorders such as rheumatoid arthritis.

Acetaminophen↗

PubMedDate not supplied

Capsular interposition for the Keller bunionectomy with the use of soft-tissue anchors.

The Keller procedure has been used during the past century for the treatment of first metatarsophalangeal joint pathology. Many modifications to the procedure have been made, including interposition of the joint capsule into the first metatarsophalangeal joint space. Capsular interposition is often the most difficult step in performing the Keller bunionectomy. This article describes a new, simplified technique for capsular interposition with the use of a dorsal capsular flap and soft-tissue anchors.

Hallux Valgus↗

PubMed1990

Elastic fibre damage induced by low-dose D-penicillamine.

We have studied 23 patients receiving penicillamine for the treatment of rheumatoid arthritis to determine the prevalence of penicillamine-induced elastosis. One female patient had pseudoxanthoma elasticum-like skin changes and bramble-bush elastosis without calcification in the involved skin. Penicillamine elastosis was present in the joint capsule in 62% of eight patients or 64% of II joints examined and was detected in joint capsules after as little as I year of treatment.

Adult↗

PubMed2005

Glenohumeral elevation-dependent influence of anterior glenohumeral capsular lesions on passive axial humeral rotation.

The purpose of this study was to assess the effect of standardized anterior glenohumeral capsular lesions on axial humeral rotation in a full arc of glenohumeral elevation. Using a testing apparatus, the range of internal and external humeral rotation was assessed in an arc of glenohumeral elevation in the scapular plane with steps of 15 degrees in six isolated shoulder joint specimens. Cutting of the glenohumeral joint capsule 1 cm laterally from, and parallel to the glenoid rim was performed in seven steps of 1 cm till the anterior capsule was cut. Capsular lesions were made in three ways: from inferior, from superior and from the middle of the capsule. Anterior capsular lesions resulted in significant increase of external humeral rotation. This occurred particularly at 15-60 degrees glenohumeral elevation. Lesions of the inferior part of the capsule mainly increased external rotation at 30-60 degrees glenohumeral elevation, lesions of the superior part mainly in lower elevation angles and lesions of the middle more gradually in the range till 60 degrees of glenohumeral elevation. Cutting of the anterior glenohumeral capsule barely increased passive axial humeral rotation at elevation angles over 60 degrees. Above 60 degrees glenohumeral elevation, tightening of the inferior posterior glenohumeral joint capsule prevented both internal and, increasingly, external humeral rotation. From these observations it is concluded that increased external rotation correlates with progressive anterior capsular lesions, mainly below 60 degrees glenohumeral elevation. To assess anterior glenohumeral capsular lesions in patients, axial humeral rotation tests should probably not exceed 60 degrees glenohumeral elevation, i.e. 90 degrees thoracohumeral elevation.

Aged↗

PubMed2004

Gender- and region-dependent local facet joint kinematics in rear impact: implications in whiplash injury.

STUDY DESIGN: Localized facet joint kinematics resulting from whiplash acceleration were analyzed in the dynamic domain during the time of cervical S-curvature using intact head and neck specimens and a pendulum mini-sled loading apparatus. OBJECTIVES: To determine the effects of gender, impact severity, cervical level, and anatomic joint region on shear and distraction motion of lower cervical facet joints. SUMMARY OF BACKGROUND DATA: Clinical and experimental studies identify cervical facet joints to be a likely location of whiplash injury. Epidemiologic studies report that female occupants sustain a greater percentage of whiplash injuries. Previous experimental studies have not analyzed facet joint motion as a function of variables such as gender. METHODS: Intact head and neck complexes were subjected to whiplash acceleration using a pendulum mini-sled apparatus at four impact severities. Facet joint kinematics were analyzed using digital high-resolution video at 1000 frames per second during the time of maximum cervical S-curvature. Shear and distraction motions were analyzed in the ventral and dorsal joint regions from C4-C5 to C6-C7 levels. Analysis of variance techniques were used to analyze biomechanical data. RESULTS: Intact head and neck complexes sustained cervical S-curvature during whiplash loading. Lower cervical facet joints demonstrated dorsally directed shear motion with distraction in the ventral and compression in the dorsal regions of the joint. Magnitudes of distraction and compression were significantly lower than shear motion (P < 0.05). Facet joint shear and distraction motion increased with impact severity. Lower cervical facet joint shear and distraction motions in female specimens were greater than in male specimens. This difference reached statistical significance at C4-C5 (P < 0.05). CONCLUSIONS: Secondary to whiplash loading, lower cervical facet joints responded with a shear plus distraction mechanism in the anatomic ventral and shear plus compression mechanisms in the dorsal region. Injury to the ventral region stems from tensile failure of the joint capsule. Injury to the dorsal region stems from pinching of the joint capsule or synovial fold and contact between subchondral bone of superior and inferior facet processes. Because excess spinal motion is biomechanically related to abnormalities and because lower cervical facet joints sustain greater motion in female specimens, this population is more likely to be injured under whiplash loading. Potential contributors for the susceptibility of females to injury, including genotypic (apolipoprotein APOE-epsilon4), hormonal, structural, and tolerance factors, are discussed.

Biomechanical Phenomena↗

PubMed2002

Arthroscopy of the proximal interphalangeal and metacarpophalangeal joints in rheumatoid hands.

PURPOSE: To describe our experience with arthroscopy of the proximal interphalangeal (PIP) and metacarpophalangeal (MP) joints and to assess the value of this technique. TYPE OF STUDY: Case series. METHODS: Arthroscopy was performed on 27 PIP joints and 16 MP joints of 21 patients with rheumatoid arthritis (mean age, 47.2 years; range, 26 to 62 years). After arthroscopic examination, 24 joints were treated with joint irrigation only and 19 were treated with arthroscopic synovectomy. All procedures were performed on an outpatient basis. The diameter of the arthroscope was 1.5 mm, and mini-forceps and a mini-shaver system with a 2.5-mm cutter were used for biopsy and synovectomy. We developed new portals for the PIP joints on the dorsal-lateral aspect, more lateral than previously reported portals. RESULTS: The articular cartilage and synovial membrane of the PIP and MP joints were well visualized, and arthroscopy revealed cartilage changes and synovial proliferation. Because the PIP joint space was not wide enough to insert the arthroscope into the palmar cavity, the palmar part of the articular surfaces and the volar synovium could not be inspected. Synovial biopsy of the dorsal joint capsule was easily performed under arthroscopic visualization. Synovectomy of the dorsal joint capsule and both the radial and ulnar recesses was also possible using the 2-portal technique with a mini-shaver system. No intraoperative or postoperative complications were encountered. CONCLUSIONS: Arthroscopy of the PIP and MP joints is useful in assessing articular cartilage and synovium and for synovial biopsy. Arthroscopic synovectomy can be performed safely with the 2-portal technique.

Adult↗

PubMed1985

The posterior cruciate ligament and rotatory knee instability. An experimental study.

The importance of the posterior cruciate ligament in relation to valgus-varus and axial rotatory stability in the knee joint was investigated. Mobility patterns were drawn from 20 osteoligamentous preparations after successive transection of the posterior cruciate ligament (PCL), the medial and lateral collateral ligaments, and the posterior joint capsule. The knee joint remained grossly stable after isolated transection of the PCL, and further cutting of either one of the collateral ligaments or of the posterior capsule yielded no greater instability than one should expect from isolated cutting of each of these structures. The posterior cruciate ligament was the stabilizing factor in flexion and external rotation after injury to the lateral collateral ligament and the posterolateral capsule, and it restricted internal rotation after cutting of the medial cruciate ligament and the posteromedial capsule. Valgus instability was markedly increased during the whole range of movement when PCL was included in injury to the medial compartment ligaments, and when included in a lateral compartment injury a further varus instability was found, though only in the flexed or semiflexed knee. No hyperextension could be demonstrated after these injuries.

Biomechanical Phenomena↗

PubMed2006

[Arthroscopic meniscal suture].

OBJECTIVE: Restoration of the function of the meniscus by suturing a tear to prevent long-term degeneration. INDICATIONS: Unstable longitudinal meniscal tear in the red and red-white zones with an intact central fragment. Dislocated bucket-handle tear near the base in the presence of good-quality tissue. CONTRAINDICATIONS: Lesion of the central meniscal fragment. Meniscal tears in the white, avascular zone. Degenerative meniscal lesions. Complex meniscal lesions. Untreated knee ligament instability. Uncooperative patient. SURGICAL TECHNIQUE: Standard anterior arthroscopy approach. Revitalization of the tear margins and the perimeniscal synovial membrane, trephination of the base of the meniscus to promote healing. Fixation of the tear with a resorbable or nonresorbable suture size 2-0 to 0 USP by means of different suture techniques. "Outside-in technique": the suture is introduced from outside the joint through the base of the meniscus using a cannulated needle and is then pulled back out using a suture loop inserted with another cannulated needle. The U-suture is knotted over the joint capsule through a stab incision. "Inside-out technique": the suture is introduced using a needle through a guide cannula from outside the joint through the meniscus and joint capsule and then brought out of the joint. The U-suture is knotted over the capsule through a short skin incision. "All-inside technique": the suture loop is passed through the meniscal tear and knotted within the joint using a posterior arthroscopy approach. POSTOPERATIVE MANAGEMENT: Full weight bearing without a brace for short tears with one suture. For tears with two sutures, partial weight bearing for 4 weeks without a brace. For large tears with three to four sutures, partial weight bearing up to 20 kp for 6 weeks and restricted knee motion in a brace up to 0/0/60 degrees . RESULTS: The healing rate for knee joints with stable ligaments and an isolated meniscal tear is between 50% and 75%. In cases with simultaneous ACL (anterior cruciate ligament) plasty, the healing rate is > 75%; for unstable knee joints it is < 50%.

Adolescent↗

PubMed1975

[The meniscus from embryonal and functional points of view (author's transl)].

The menisci are not secondary developments of the joint capsule. Rather they develop quite separately from the parenchyma, independently of the joint capsule, that lies in the interrupted zone of the central bar of the primary anlage of the extremities. In this functional unit of the knee joint, only selective intervention must be carried out in predisposition to disturbances, symptoms of disease or injury, and not unplanned interference. Only then will the joint become capable of carrying a load once more and be spared from further secondary damage. Consequently the die is already cast at the first examination for a systematic and successful treatment.

Female↗