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At least 361 records · Page 20Linked to original sources
PubMed1998

Posterior cruciate ligament-sparing versus posterior cruciate ligament-sacrificing arthroplasty. Functional results using the same prosthesis.

The functional outcomes of 143 total knee arthroplasties performed by 1 surgeon between 1988 and 1992 were reviewed. Ninety-three procedures were carried out with sacrifice of the posterior cruciate ligament (PCL); in 50, the PCL was preserved. All cases were performed using the Kinemax prosthesis (Howmedica, Rutherford, NJ). Demographically, there were no differences between the 2 patient groups. Patients were evaluated over a mean follow-up period of 3 years (range, 2-6 years) using the 100-point Hospital for Special Surgery knee scoring system. The data revealed no difference in clinical or early radiographic outcome between PCL-sacrificing and PCL-retaining arthroplasties and support the argument that PCL sacrifice should be considered in cases in which extensive releases and complex ligamentous balancing are required.

Aged↗
PubMed1998

Surgical treatment for ossification of the posterior longitudinal ligament and the yellow ligament in the thoracic and cervico-thoracic spine.

This study analyzed the postoperative results of surgical treatment for thoracic and cervicothoracic myelopathy caused by ossification of the posterior longitudinal ligaments (OPLL) or ossification of the yellow ligaments (OYL) in 22 patients using magnetic resonance imaging (MRI), myelography and computed tomography (CT). Anterior procedures were performed in 11 patients for OPLL, while posterior approaches were adopted for the management of 11 patients for both OYL and OPLL combined with OYL lesions. Clinical symptoms were improved using both anterior and posterior techniques. MRI and myelo-CT studies, which show the direction of cord compression, the form and extent of the lesion, and the degree of thoracic kyphosis, are very useful when the surgical procedure for OPLL and OYL in the thoracic and cervico-thoracic spine is selected.

Adolescent↗
PubMedDate not supplied

The effect of cranial cruciate ligament insufficiency on caudal cruciate ligament morphology: An experimental study in dogs.

OBJECTIVES: To investigate the effect of cranial cruciate ligament (CrCL) insufficiency on morphology of the canine caudal cruciate ligament (CdCL). STUDY DESIGN: In vivo experimental study. ANIMALS: Five adult foxhounds. METHODS: Two years after CrCL transection, the histologic appearance of CdCLs from CrCL-deficient and unoperated contralateral control (CrCL-intact) stifle joints were evaluated using light and transmission electron microscopy. RESULTS: CdCLs from CrCL-deficient joints had extracellular matrix changes, characterized by chondroid metaplasia and disruption of cell architecture. Percent of small-diameter fibrils in CdCLs from CrCL-deficient joints was significantly greater (P <.05) than that in CdCLs from CrCL-intact joints. Collagen fibril density in CdCLs from CrCL-deficient joints (41.09 +/- 5.39%) tended to be less than that in CdCLs from CrCL-intact joints (52.96 +/- 6.92%); however, this difference was not significant (P =.056). Mean eccentricity (ratio of minor to major diameters) of collagen fibrils was significantly (P <.0001) lower for CdCLs from CrCL-deficient joints (0.85 +/- 0.016) when compared with that for CdCLs from CrCL-intact joints (0.87 +/- 0.015). CONCLUSIONS: Significant alterations were found in the morphology of CdCLs from CrCL-deficient joints. These changes may be associated with repetitive microtrauma to the CdCL secondary to instability or enzymatic degradation in the hostile synovial environment of an unstable joint. CLINICAL RELEVANCE: Regardless of the cause, the switch to a predominantly small-diameter collagen fibril profile may reflect compromised material properties of the CdCL. This should be taken into account when considering surgical techniques that rely on the CdCL to stabilize CrCL-deficient stifles.

Animals↗
PubMed2000

Simultaneous avulsion fracture of the insertion of the ulnar and radial collateral ligaments of the metacarpophalangeal joint of the thumb.

We present a case of simultaneous avulsion fracture of the insertion on the volar base of the proximal phalanx of the ulnar and radial collateral ligaments of the metacarpophalangeal joint of the thumb. To our knowledge this combination has never been published before. The mechanism of this injury is not clearly understood. (c) 2000 Harcourt Publishers Ltd Copyright 2000 The British Association of Plastic Surgeons DOI: 10.1054/bjps.1999.3227.

Journal Article↗
PubMed1977

[Xero-radiographic examination of the capsule and ligaments of the knee joint. II. Demonstration of injuries to the cruciate and lateral ligaments and menisci (author's transl)].

The value of xero-radiography for demonstrating injuries to the capsule and ligaments of the knee has been investigated. A tomographic method was used in conjunction with arthrography of the knee. The results have shown that, in vitro, injuries of the cruciate and lateral ligaments and of the capsule are well shown by xero-tomography and that it is possible to evaluate their extent. Simultaneous demonstration of injuries to the menisci is less certain. In order to show these accurately, special methods would have to be employed. Despite the higher radiation dose which must be expected, and the greater complexity of this technique, we consider that a clinical investigation of the method is indicated.

Cartilage, Articular↗
PubMed1981

Isokinetic thigh muscle strength after ligament reconstruction in the knee joint: results from a 5-10 year follow-up after reconstructions of the anterior cruciate ligament in the knee joint.

We evaluated the thigh muscle strength using an isokinetic dynamometer in 80 patients 5 to 10 years following anterior cruciate ligament reconstruction. Patients with good results also had good muscle function, both of their flexor and their extensor muscles. Patients with poor results demonstrated reduced muscle strength in both their hamstrings and their quadriceps. Patients with fair functional results demonstrated reduced strength of their extensor muscles compared to their normal leg. However, strength in their operated leg's flexor muscles was unchanged compared to their normal leg. This may be due to the fact that strong hamstring muscles can compensate for some instability of the anterior cruciate ligament.

Adolescent↗
PubMedDate not supplied

[Homologous cruciate ligament transplantation as intra-articular ligament replacement].

A multiplicity of surgical operations have been developed in an attempt to achieve satisfactory function after ACL repair. None of these procedures have been able to duplicate the fiber organization, attachment site anatomy, vascularity, or function of the ACL. 29 foxhounds received a deep frozen bone-ACL-bone allograft and a ligament augmentation device (LAD). Biomechanical, microvascular, and histological changes were evaluated 3, 6 and 12 months following implantation. The maximum load of the allograft/LADs were 34.3% (387.2 N) after 3 months, 49.3% (556.6 N) after 6 months and 61.1% (689.8 N) after a year. The maximal load was 69.1% (780 N). In general, after 6 months the allografts showed a normal collagen orientation. The allografts demonstrated no evidence of infection or immune reaction. No bone ingrowth into the LAD was observed. Polarized light microscopy and PAS-staining showed that the new bone/ligament substance interface had intact fiber orientation at the area of ligament insertion. Microvascular examination using Spalteholtz-technique revealed neovascularization and the importance of infrapatellar fat pad for the nourishment of the ACL-allografts.

Animals↗
PubMed1991

Age-related properties of medial collateral ligament and anterior cruciate ligament: a morphologic and collagen maturation study in the rabbit.

The medial collateral ligament (MCL) and anterior cruciate ligament (ACL) from New Zealand white rabbits ages 2, 12, and 36 mos were resected and utilized for analysis by light microscopy and electron microscopy, as well as for determinations of water content, collagen concentration, collagen crosslink (i.e., reducible, nonreducible) analysis, and collagen synthesis rates in vitro. Both modes of microscopy revealed substantial differences between the various age groups. Water content, as well as collagen concentration, decreased significantly from the 2-mo to the 12- or 36- mo groups. The concentration of the reducible crosslinks, associated with less mature tissue, was significantly greater in the younger tissues relative to the aged tissues. The nonreducible crosslink increased with maturation of the collagen in the 36-mo rabbits. Collagen synthesis rates fell from a highest value in the 2-mo group to the lowest in the 36-mo group.

Aging↗
PubMed1990

The autogenic ligament procedure: a technique for planned formation of an artificial neo-ligament.

A new surgical principle which can safely result in the formation of an artificial neo-ligament, and induce the adhesion of tissues is described. Under certain conditions, an implanted Mersilene tape may act as a template, provoking a controlled linear deposition of collagen which remained unchanged, even after removal of the tape. This was proven by retropubic implantation of Mersilene tapes in female dogs, in the position of the pubo-urethral ligament. The procedure relies on the normally negative aspects of wound healing for its effect, such as foreign body reaction, bacterial colonization, and continued tissue breakdown and regeneration.

Animals↗
PubMed1998

Periodontal ligament cell culture on the hydrophobic substrate coated with proteins of periodontal ligament fibroblast-conditioned medium.

In regenerating periodontal ligament (PDL) around the root of an artificial tooth, an important role is played by some physiologically active substance that promotes adhesion of the cells to the surface of the tooth root and induces cell proliferation and differentiation. In this study, the supernatant of the conditioned medium (CM) of dog periodontal ligament fibroblast (DPLF) was fractionated using an ion exchange chromatography-diethylaminoethyl (IEC-DEAE) column. DPLFs were cultured on hydrophobic dishes coated with each fraction. Cell proliferative activity and alkaline phosphatase (ALPase) activity, including electron microscopic features of the contact surface between the cells and the dish, were investigated. The DPLF-CM was separated by IEC-DEAE column into six fractions. Each fraction promoted an increase in DNA content and ALPase activity of the cultured DPLF, and especially remarkable were fractions 2 and 3. Fraction 2 at a molecular weight (Mw) of 210, 160, 85, 50 and 22 kD, and fraction 3 at Mw = 21 and 23 kD contained the type of proteins not found in other fractions. Electron microscopic analysis revealed that the cells in the coating group were in close contact with the surface of the dishes and that fine fibers protruding from the cell membrane clinged to the dishes. In the control group, a wide gap between the cells and the dishes was observed. These findings suggest that the DPLF-CM fractions contain specific physiological activating factors that induce proliferation and differentiation as well as cell adhesion of the DPLF cells.

Alkaline Phosphatase↗
PubMedDate not supplied

Cruciate reconstruction using freeze dried anterior cruciate ligament allograft and a ligament augmentation device (LAD). An experimental study in a goat model.

One ACL in each of 11 mature goats was replaced with a freeze dried bone-ACL-bone allograft and a ligament augmentation device (LAD). The LAD was released from its tibial fixation at 3 months postoperation. Biomechanical, microvascular, and histological changes were evaluated 1 year following implantation. The reconstructed knees had a significantly greater total AP translation (3.1 +/- 0.5 mm) (mean and SEM) than the contralateral controls (1.0 +/- 0.1 mm). Differences in primary AP translation were responsible for 59% of the difference in total translation, with only a 0.6 mm difference in secondary translation. Neutral stiffness in the reconstructive knee was 22% of control, while stiffness at 30 N of anterior force was approximately 35% of controls. Ligament stiffness in the linear region for the ACL allograft/LAD was 53% of the control value of 691 N/mm. The maximum load of the allograft/LADs was 1,052 +/- 145 N, or 43% of the contralateral ACL control strength (2,448 +/- 144 N). Five of the six allografts failed at the femoral insertion. Energy (39%) to maximum load was less for allograft/LADs than controls but elongation to maximum load was the same as control. Histologic evaluation of the allograft/LADs revealed soft tissue cellular ingrowth into the LAD in the extraarticular portions. No bony growth into the LAD was observed. The collagen fibers of the graft appear to be arranged in a longitudinal orientation although some areas show chaotic collagen fibers. Microangiography revealed a periligamentous and endoligamentous vascular pattern reminiscent of a normal ACL and complete revascularization of the bone plugs.

Animals↗
PubMed1989

Partial tears of the anterior cruciate ligament. Progression to complete ligament deficiency.

In a prospective seven-year study, we treated 32 patients with partial ruptures of the anterior cruciate ligament (ACL) verified by arthroscopy. Twelve knees (38%) progressed to complete ACL deficiency with positive pivot shift tests and increased anteroposterior translation on tests with the KT-1000 arthrometer. Patients with partial ACL tears frequently had limitation for strenuous sports, while those developing ACL deficiency had additional functional limitations involving recreational activities. Three factors were statistically significant in predicting which partial tears would develop complete ACL deficiency: the amount of ligament tearing--one-fourth tears infrequently progressed, one-half tears progressed in 50% and three-fourth tears in 86%; a subtle increase in initial anterior translation; and the occurrence of a subsequent re-injury with giving-way.

Acute Disease↗
PubMed2003

Laxity of the elbow after experimental excision of the radial head and division of the medial collateral ligament. Efficacy of ligament repair and radial head prosthetic replacement: a cadaver study.

We studied the stabilising effect of prosthetic replacement of the radial head and repair of the medial collateral ligament (MCL) after excision of the radial head and section of the MCL in five cadaver elbows. Division of the MCL increased valgus angulation (mean 3.9 +/- 1.5 degrees) and internal rotatory laxity (mean 5.3 +/- 2.0 degrees). Subsequent excision of the radial head allowed additional valgus (mean 11.1 +/- 7.3 degrees) and internal rotatory laxity (mean 5.7 +/- 3.9 degrees). Isolated replacement of the radial head reduced valgus laxity to the level before excision of the head, while internal rotatory laxity was still greater (2.8 +/- 2.1 degrees). Isolated repair of the MCL corrected internal rotatory laxity, but a slight increase in valgus laxity remained (mean 0.7 +/- 0.6 degrees). Combined replacement of the head and repair of the MCL restored stability completely. We conclude that the radial head is a constraint secondary to the MCL for both valgus displacement and internal rotation. Isolated repair of the ligament is superior to isolated prosthetic replacement and may be sufficient to restore valgus and internal rotatory stability after excision of the radial head in MCL-deficient elbows.

Aged↗
PubMedDate not supplied

[A new guide and 2 new cruciate ligament anchors for securing prosthetic cruciate ligaments to the femur].

A new drilling device for the correct localization of drilling holes has been developed for the fixation of cruciate ligament prostheses. We describe how the device is employed under surgical operating conditions. Its accuracy in application is demonstrated in a cadaver knee. The device has also been used clinically with success. Two new anchors for the fixation of the ligaments are proposed.

Anterior Cruciate Ligament↗
PubMed1985

Instability of knees with ligament lesions. Cadaver studies of the anterior cruciate ligament.

We studied the importance of the two parts of the anterior cruciate ligament (ACL), the medial collateral ligament (MCL), and the posterior medial capsule (PMC) to translatory and spontaneous axial rotatory instability in 15 osteoligamentous knee preparations. Instability was recorded continuously from zero to 90 degrees of flexion with application of a constant force to the tibia. Isolated cutting of the ACL caused a moderate anterior translatory movement, which increased if the MCL was also cut. Transection also of the PMC resulted in an even larger range of anterior translatory movement. Combined lesions to the MCL and the PMC and the posterolateral part of the ACL did not cause such instability provided the anteromedial part of the ACL was intact. Application of a valgus moment to specimens with injured ACL and medial structures induced a spontaneous anteromedial subluxation of the tibia in a semiflexed position. When flexion was increased to 70-80 degrees, a sudden reduction was observed.

Humans↗
PubMed1999

Ossification of the yellow ligament and spondylosis and/or ossification of the posterior longitudinal ligament of the thoracic and lumbar spine.

Combinations of varying degrees of spondylosis and/or ossification of the posterior longitudinal ligament (OPLL), and ossification of the yellow ligament (OYL) contribute to thoracic and lumbar neural compression in North Americans. Preoperative magnetic resonance and computed tomography examinations dictated the surgical approaches used to address spondylosis/OPLL in 11 patients, OYL in 12 patients, and spondylosis/OPLL and OYL in 3 patients. Myelopathy (4 patients), radiculopathy (13 patients), and cauda equina dysfunction (11 patients) were observed, 2 patients showing combined deficits. Outcomes (Odom's criteria) after laminectomy (24 patients) and circumferential thoracic procedures (2 patients) were good to excellent in the 73% of patients with spondylosis/OPLL, in 83% with OYL, and excellent for all 3 with spondylosis/OPLL and OYL. Full recognition of thoracic or lumbar spondylosis/OPLL and OYL ensure optimal surgical planning and outcomes.

Adult↗
PubMed1999

Laminectomy with posterior wiring and fusion for cervical ossification of the posterior longitudinal ligament, spondylosis, ossification of the yellow ligament, stenosis, and instability: a study of 5 patients.

Cervical laminectomy with posterior wiring and fusion is valuable for the management of cervical ossification of the posterior longitudinal ligament (OPLL), spondylosis, ossification of the yellow ligament (OYL), stenosis, and instability. Within 1.5 years, five patients averaging 73 years of age developed severe myelopathy. Dynamic radiographs confirmed an intact cervical lordosis with active subluxation and instability at one or two levels, whereas magnetic resonance and computed tomography scans showed OPLL, spondylosis, OYL, and stenosis. After multilevel laminectomy with posterior wiring and fusion and immobilization in cervicothoracic orthoses, patients fused in an average of 3.6 months. All patients improved, showing mild to moderate residual postoperative myelopathy an average of 13 months later (range, 6-19 months). With an intact cervical lordosis, laminectomy with posterior wiring and fusion was used successfully to manage five patients with OPLL, spondylosis, OYL, stenosis, and instability.

Aged↗