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PubMed2005

[Functional tendon repair in orthopedic tumor surgery].

Large defects of functional soft tissue structures, e.g., extensor mechanism, ligaments, muscles, and joint capsule, may occur in tumor surgery or revision surgery following conventional joint replacement. Reconstruction can be performed using biological grafts such as free or pedicled tendon-muscle flaps, allografts, or synthetic material. Prerequisites for synthetic material are good biologic tolerance with fibroblastic ingrowth, mechanical resistance to fatigue, and a maximum of tension force with a minimum of elongation. In this study we used a nonresorbable band of longitudinal polyester fibers with a minimal rupture level of 4000 N and an elongation rate less than 7% of its original length. The shape of the band was designed for universal use with 40 cm length and 6 cm width. Its primary indication was augmentation or complete reconstruction of the extensor mechanism of the knee joint after large extra-articular tumor resections in primary bone tumors. Furthermore, its use for hip joint capsule reconstruction in luxation, coverage of megaprostheses of the humerus, and augmentation after biological reconstruction of tendons achieved excellent results.

Bone Neoplasms↗
PubMed2000

Frozen shoulder.

Stiffness is a consistent but nonspecific symptom of primary frozen shoulder, a condition defined by restriction of passive motion in all planes without glenohumeral abnormalities on plain radiographs. Since the first description by Duplay in 1872, theories and descriptions of the lesions have varied over time and across authors, with the main target of the condition being reported as the subacromial bursa in some studies and the rotator interval in others. Recent publications have pointed out similarities with Dupuytren's contracture. Magnetic resonance imaging has helped to understand the lesions by showing a specific pattern of postgadolinium enhancement during the first few months after symptom onset. Pain relief is the main objective of therapy. Oral medications have not been adequately evaluated, with the exception of glucocorticoids, which hasten the resolution of nighttime pain to a modest degree. Intra-articular glucocorticoid injections are effective and are best performed under arthrographic control. It has been suggested that intra-articular glucocorticoid injections should be combined with joint capsule distension. An additional injection into the subacromial bursa has been found useful in patients with refractory pain. Motion range recovery is not always complete after 18 to 24 months and can be improved by physiotherapy. Methodological difficulties have precluded demonstration in formal studies of the undeniable benefits of physiotherapy. Joint capsule distension, and even more so arthroscopic capsulotomy with gentle mobilization, have provided promising results in patients with persistent stiffness, although the optimal time for performing these techniques remains to be determined.

Bursitis↗
PubMedDate not supplied

Capsuloplasty for the treatment of recurrent anterior dislocation of the shoulder: long-term evaluations of the Putti-Platt method and Bankart method with anchors.

The authors compare two methods used for the treatment of recurrent anterior shoulder dislocations: Putti-Platt capsulomyoplasty, based on an overlapping suture of the free margins of the joint capsule and of the subscapularis muscle, and the Bankart method that uses anchors, based on the repair of the glenoid labrum, that is kept in site, together with the medial flap of the joint capsule, by suturing with the anchors previously stabilized to the neck of the glena. In this method, the subscapularis muscle is re-approximated without any overlapping or shortening. The Bankart method with anchors thus allows us to obtain anatomical repair of the lesion, with doubtless advantages for mobility, function and stability of the shoulder; this is confirmed by the comparison with results obtained out of 34 patients in this study, 15 of which submitted to the Putti-Platt method, 19 to the Bankart method with anchors. The latter had reduction of external rotation which in none of the cases exceeded 25% (a reduction that at times achieved 50% in patients submitted to the Putti-Platt method (p = 0.001); difficulties in work or sports were minimum or absent (p = 0.003), recovery time was more rapid, without compromising joint stability (p = 0.069); these data allow us to consider the Bankart method with anchors the surgical method that is most indicated for the treatment of anterior glenohumeral instability.

Adolescent↗
PubMed1983

Passive joint position sense after total hip replacement surgery.

Passive joint position sense was tested in 10 subjects after unilateral total hip replacement surgery (which included capsulectomy). Varied initial limb position, amplitude, and velocity of movement were used. The unoperated side was used as a control. Statistically barely significant errors (p less than 0.025) on the operated side were detected at 0.6 degrees per second but not at 2 degrees per second. No significant differences were noted among the different hip positions. The results indicate that the ability to detect passive hip joint position sense remains largely, but not completely, intact after hip joint replacement. The joint capsule, ligaments, and joint surfaces, although not essential for kinesthesia, may provide some limb movement and position information, the absence of which is not now clinically apparent.

Follow-Up Studies↗
PubMed1999

Post-traumatic and stress-induced osteolysis of the distal clavicle: MR imaging findings in 17 patients.

OBJECTIVE: To describe the MR imaging findings in patients with osteolysis of the distal clavicle and to compare the MR imaging appearance of clavicular osteolysis following acute injury with that related to chronic stress. DESIGN AND PATIENTS: MR imaging examinations were reviewed in 17 patients (14 men, 3 women; ages 16-55 years) with the diagnosis of post-traumatic or stress-induced osteolysis of the clavicle. A history of a single direct injury was present in seven patients and a history of weight-lifting, participation in sports, or repetitive microtrauma was present in 10 patients. RESULTS: MR imaging showed edema in the distal clavicle in 17 patients and, of these, eight also had edema in the acromion. The edema was most evident in STIR and fat-suppressed T2-weighted pulse sequences. Other findings about the acromioclavicular (AC) joint were prominence of the joint capsule in 14, joint fluid in eight, cortical irregularity in 12, and bone fragmentation in six patients. No differences in the MR imaging features of post-traumatic and stress-induced osteolysis of the distal clavicle were observed. CONCLUSION: Post-traumatic and stress-induced osteolysis of the distal clavicle have similar appearances on MR imaging, the most common and conspicuous MR imaging feature being increased T2 signal intensity in the distal clavicle.

Acromioclavicular Joint↗
PubMed2001

Gluteus minimus: observations on its insertion.

In 17 adult and 3 full term fetuses the hip joints were dissected to expose the insertion of gluteus minimus. An attachment of the deep surface of the tendon as it passes over the hip joint capsule was found in every case. Histological examination of this insertion confirmed the presence of short intramuscular tendons firmly anchoring the tendon to the capsule. It is suggested that this attachment retracts the capsule during hip joint motion, thereby preventing capsular entrapment.

Adult↗
PubMed2000

Changes in soleus motoneuron pool excitability after artificial knee joint effusion.

OBJECTIVE: To compare changes in the magnitude of soleus motoneuron excitability before and over a 4-hour period following artificial knee effusion. DESIGN: Before-after trial. SETTING: All measurements were collected in the Sports Injury Research Laboratory, Indiana State University. PARTICIPANTS: Eleven healthy and neurologically sound volunteers (mean age +/- SD, 24 +/- 3yr; height, 173.2 +/- 9.6cm; weight, 72.9 +/- 8.7kg) with no history of lower-extremity surgery and no lower extremity pathology in the last year. INTERVENTIONS: An area superolateral to the patella was cleaned and injected subcutaneously with 2mL of lidocaine for anesthetic purposes. With a second disposable syringe, 25mL of sterile saline was injected through the superolateral knee joint capsule into the joint space to mimic mechanical joint effusion. MAIN OUTCOME MEASURE: Hoffmann's reflex (H-reflex) was elicited by applying a percutaneous stimulus to the tibial nerve in the popliteal fossa. Seven to 12 stimuli were delivered at 20-second intervals with varying intensities to find the maximal H-reflex. The maximal H-reflex was measured five times at the same stimulus intensity with 20-second rest intervals. This measurement was recorded before injection and at 1-hour intervals following the injection for 4 hours. RESULTS: An overall difference between groups was found. Measurements from hours 3 and 4 were significantly higher than the preinjection measurements (p < or = .05). CONCLUSIONS: The soleus motoneuron pool was not inhibited as expected. The soleus was facilitated beyond the preinjection level, showing that the quadriceps and soleus do not respond in the same way to artificial knee effusion. Because the quadriceps are normally inhibited during knee effusion, this facilitation could be the result of a compensatory reaction by the soleus in response to inhibited quadriceps. Further studies must be performed to determine the extent and duration of soleus motoneuron pool excitability in relation to quadriceps inhibition elicited by artificial knee effusion.

Adult↗
PubMed1990

Age-related osteo-arthrotic degeneration of the temporomandibular joint in the mouse.

The light-microscopic and ultrastructural characteristics of the temporomandibular joints (TMJs) of female STR/IN mice, aged from 3 to 12 months, were studied. Every TMJ of an adult mouse starts to degenerate in early adulthood and subsequently suffers from osteo-arthrosis. Ageing of the TMJ is characterized by thinning out of its cartilaginous components. The chondrocytes are no longer distributed regularly in the ground substance but form clusters. Cracks and fissures invade the condylar cartilage and lead to the formation of cartilage islands, which finally become loose as free bodies in the lower joint chamber and joint capsule. The lower joint chamber diminishes, but no ankylosis is observed. Ultrastructurally, the number of vesicles around the degenerated chondrocytes increases. Aged chondrocytes contain more lysosomes. The condylar surface becomes irregular and reveals microscars. Its surface is covered by an electron-dense fine granular material, considered to be built up by proteoglycans. Compared to the male ICR mouse, the osteo-arthrotic destruction of the cartilage, the subchondral sclerosis and the deformation of the underlying bone exhibit only minor states in the female STR/IN mouse. Concerning the aetiology and pathogenesis, the very early degeneration of the mostly unloaded TMJ seems to be based on a genetically altered composition of the articular cartilage, possibly due to failing articular chondrocyte responses to stimuli connected with degeneration and repair.

Aging↗
PubMedDate not supplied

Anatomic and clinical significance of the first and most medial deep transverse metatarsal ligament.

A review of the related literature revealed ambiguity and inconsistency as to the location of the first and most medial deep transverse metatarsal ligament in relation to the adjacent soft tissue and osseous structures. Seventy right sided, mid-thigh cadaveric dissections were completed by the investigators. The results consistently identified the ligament as bifurcate, bearing a common stem with the medial aspect of the second metatarsophalangeal joint capsule and a split attachment to the lateral aspect of the first metatarsophalangeal joint capsule and sesamoidal apparatus. The conjoined tendon of the adductor hallucis muscle was consistently identified as passing between this bifurcation. Knowledge of the location of this anatomic structure bears importance in the podiatric surgeon's attempt to restore the alignment of the first metatarsophalangeal joint by means of soft tissue or osseous procedures.

Humans↗
PubMed2003

Sensory properties of articular afferents following Mycoplasma arthritis in the chicken.

The physiological properties of joint capsule mechanical nociceptors of monoarthritic chickens (Gallus domesticus) were studied by recording the electrical activity from single C (Group IV) and A-delta (Group III) fibres dissected from the parafibular nerve. By injecting live Mycoplasma gallisepticum cultures into the ankle joint a typical mycoplasma arthritis was induced which was restricted to a single joint. During the early stage of the disease (7-21 days after infection) there was histopathological evidence of an acute synovitis and the fibres showed evidence of sensitisation. Sensitisation was observed in the significantly increased receptive field size, decreased response thresholds, increased response to joint movement both noxious and innocuous, but only in the C-fibres was there an increase in spontaneous activity. During the more chronic stage of the disease (49-56 days after infection) there was pathological evidence of prolonged synovitis but the sensory fibres responded normally to mechanical stimulation and joint movement. These changes in sensitivity of the joint capsule mechanical nociceptors provides peripheral neural evidence of possible pain experienced during the acute stage of the disease but not at the chronic stage when the disease might be in period of remission. The absence of any clear correlation between pathology and receptor activity demonstrates the difficulty of trying to predict nociceptive consequences in animals on the basis of histopathology.

Action Potentials↗
PubMedDate not supplied

[Use of an improved transmission ultrasound camera for diagnosis of rheumatic joint diseases].

Transmission (TM) sonography allows a reliable and fast imaging of soft tissues like joint capsules and tendons, especially of hands and feet. Bony structures appear blurred, but serve as landmarks for easy orientation on the ultrasonic images. The quality of imaging allows a reproducible measurement of joint capsule parameters. Inflammatory alterations of joints are recognized earlier than with conventional x-rays. TM sonography contributes to the diagnostic panel for rheumatic diseases, which involve soft tissues and joints of hands and feet. Today, TM sonography cannot compete with conventional reflex sonography in general arthrosonography, but it is an interesting addition. Follow-up studies will show whether objective joint parameters available by TM sonography may help to both indicate disease progression and to monitor therapeutic interventions in rheumatic diseases.

Arthritis, Gouty↗
PubMed1990

Ultrasonography of the elbow joint.

The nonechogenic space between the bone and the joint capsule was measured in ultrasonographic scans at six different sites in 60 elbow joints of 30 healthy adults as well as in 35 joints with clinical arthritis. The space could be demonstrated in all healthy joints on the volar side at the levels of the trochlea and the capitulum of the humerus. The space was more than 2 mm in three out of the 60 healthy joints at these levels, and the space did not increase in 30 degrees flexion of the joint. The means of the measurements were significantly higher at all six sites in the arthritic joints than in the healthy joints and on the volar site the space increased in 30 degrees flexion of the arthritic joint. The space was more than 2 mm in all arthritic joints at the levels of either the trochlea or the capitulum of the humerus. An ultrasonographic distance of more than 2 mm on the volar side of the elbow joint between the joint capsule and the bone is with high probability a sign of intraarticular effusion or synovitis. The effusion in the olecranon fossa can also be demonstrated in all cases.

Adult↗
PubMed1984

Pathological aspects of osteoarthritis related to surgery.

Careful examination of existing information may promote a greater understanding of the pathogenesis of osteoarthritis. Alterations in venous drainage of the juxta-articular bone appear to produce disturbances in the joint capsule microcirculation. Histological evidence suggests a slowing down of the circulation; this might be the cause of proliferation and thickening of the capsule, and may also explain the experimental findings of increased oxygen pressure within the joint caused by reduced utilization of oxygen and increased glycolysis within the joint capsule. This increased consumption of glucose may lead to a reduced glucose concentration in the synovial fluid. This causes a reduction of glycolysis in the joint-cartilage, followed by decreased lactate concentration in the synovial fluid. With the inducer of hyaluronic acid production (lactate) absent, the joint consequently 'dries up'. Furthermore, during times of increased wear, friction-products of articular cartilage can irritate the synovial membrane and cause effusion; this may explain an apparent contradiction. It is therefore necessary to discuss the effectiveness of preventive and curative surgery in osteoarthritis. The biological effect of juxta-articular osteotomies reaches beyond the purely mechanical consequences. The hypothesis that an improved circulation following osteotomy may affect the metabolic changes within the osteoarthritic joint is discussed.

Bone and Bones↗
PubMed2006

Gentamicin concentrations in synovial fluid and joint tissues during intravenous administration or continuous intra-articular infusion of the tarsocrural joint of clinically normal horses.

OBJECTIVE: To compare gentamicin concentrations achieved in synovial fluid and joint tissues during IV administration and continuous intra-articular (IA) infusion of the tarsocrural joint in horses. ANIMALS: 18 horses with clinically normal tarsocrural joints. PROCEDURE: Horses were assigned to 3 groups (6 horses/group) and administered gentamicin (6.6 mg/kg, IV, q 24 h for 4 days; group 1), a continuous IA infusion of gentamicin into the tarsocrural joint (50 mg/h for 73 hours; group 2), or both treatments (group 3). Serum, synovial fluid, and joint tissue samples were collected for measurement of gentamicin at various time points during and 73 hours after initiation of treatment. Gentamicin concentrations were compared by use of a Kruskal-Wallis ANOVA. RESULTS: At 73 hours, mean +/- SE gentamicin concentrations in synovial fluid, synovial membrane, joint capsule, subchondral bone, and collateral ligament of group 1 horses were 11.5 +/- 1.5 microg/mL, 21.1 +/- 3.0 microg/g, 17.1 +/- 1.4 microg/g, 9.8 +/- 2.0 microg/g, and 5.9 +/- 0.7 microg/g, respectively. Corresponding concentrations in group 2 horses were 458.7 +/- 130.3 microg/mL, 496.8 +/- 126.5 microg/g, 128.5 +/- 74.2 microg/g, 99.4 +/- 47.3 microg/g, and 13.5 +/- 7.6 microg/g, respectively. Gentamicin concentrations in synovial fluid, synovial membrane, and joint capsule of group 1 horses were significantly lower than concentrations in those samples for horses in groups 2 and 3. CONCLUSIONS AND CLINICAL RELEVANCE: Continuous IA infusion of gentamicin achieves higher drug concentrations in joint tissues of normal tarsocrural joints of horses, compared with concentrations after IV administration.

Animals↗
PubMedDate not supplied

Flexible external fixation for craniodorsal coxofemoral luxations in dogs.

An external fixator consisting of two Ellis pins connected by a flexible band was developed and evaluated as a treatment for craniodorsal coxofemoral luxations in dogs. The technique for closed application of the fixator without injury to the coxofemoral joint or sciatic nerve was developed in six dog cadavers. The coxofemoral joints were then surgically destabilized and the limbs were manipulated through a full range of motion to assess the efficacy of the fixator in maintaining joint reduction. The fixator maintained joint reduction and stability after a surgically created craniodorsal luxation except when the femur was externally rotated 90 degrees. A flexible external fixator was then applied unilaterally in four healthy dogs. The dogs tolerated the fixator well and were bearing weight on the limb within 2 days after surgery; the range of motion was not limited by the fixator. The efficacy of a flexible external fixator in maintaining joint reduction after craniodorsal coxofemoral luxation was then evaluated in eight large dogs. The right coxofemoral joint in each dog was luxated surgically by removal of the dorsal joint capsule and transection of the ligament of the head of the femur and deep gluteal muscle. The joint was reduced and the fixator pins were applied in a closed fashion. In four dogs, a flexible external band was applied to the pins. Luxation did not reccur in these four dogs. The bands were not applied initially in four control dogs. Luxation occurred in three of the four control dogs within 24 hours of surgery. The joints that luxated were reduced and the flexible bands applied. Luxation did not recur after the bands were in place. The dogs tolerated the external fixators well, were bearing weight within 2 days of surgery, and walking with only minimal lameness 5 days after surgery. Luxation of the coxofemoral joints did not occur during the 2-week period in which the fixators were in place. The joints remained stable 1 week after removal of the fixators, at which time the dogs were euthanatized. Necropsy evaluation identified inflammation surrounding the pins and fibrous thickening of the dorsal joint capsule. The flexible external fixators were applied closed, maintained reduction of the coxofemoral joint after replacement of a craniodorsal luxation, and allowed weight bearing and limb usage soon after surgery. The flexible external fixator has several advantages over other methods of treating craniodorsal coxofemoral luxations. Complications noted in this study included pin tract drainage, pin loosening, and disruption of the flexible bands.

Animals↗
PubMed1975

Ultrastructure of the joint receptors of the tortoise (Testudo graeca. Emys orbicularis).

The ultrastructure of the spray-like ramified encapsulated corpuscles with the primitive inner core from the joint capsules of the large limb joints of the tortoise (Testudo graeca and Emys orbicularis) was examined. Each of the branches of the receptor consists of three components. Through the middle of the receptor branche runs the nerve terminal, containing in the receptor matrix numerous mitochondria, tiny light vesicles and neurofilaments and neurotubules running in the axial way. The nerve terminal gives off on some places among the inner core cells tiny finger-like processes. The axon is surrounded by the inner core cells and their irregular plasmatic processes. Among the inner core cells and their irregular plasmatic processes there is a labyrinth of spaces, connected centrally with the periaxonal space and with the boundary space on the periphery. The inner core cells are covered on the surface, turning to the boundary space by the basal membrane. The inner core has a very primitive structure, it still lacks the typical lamellar structure. The capsule of the receptor is formed by flat cells, which surround the inner core in 1--3 layers. Between the capsule of the receptor and the inner core is the boundary space, containihg sporadical collagenous fibrils. The structure of the spray-like ramified encapsulated corpuscles with the primitive inner core from the joint capsules of the tortoise is analogous to the simple lamellar receptors from the skin of some reptiles (Von Düring 1973, 1974). The primitive structure of the inner core of the joint receptors in the tortoise reminds of the structure of the inner core of the developing simple (paciniform) corpuscles (Poláĉek and Halata 1970) and Pacinian corpuscles (Malinovský 1974). The observed nerve endings represent a primitive, early stage in phylogeny development of the lamellar mechanoreceptors.

Animals↗
PubMedDate not supplied

Extensor retinaculum graft for chronic boxer's knuckle.

PURPOSE: Boxer's knuckle is a tear of the metacarpophalangeal (MCP) joint capsule that occurs while punching. Because of the nature of boxing, boxer's knuckle tends to be a chronic condition and often is associated with sagittal band rupture. Chronic cases often feature excessive scarring in the damaged area where the sagittal band and the MCP joint capsule become indistinguishable. The purpose of this study was to ascertain whether extensor retinaculum grafting to the defect is useful in treating chronic boxer's knuckle when direct repair of a capsular tear is not possible. METHODS: In 5 professional boxers with chronic boxer's knuckle in whom capsular repair could have impaired MCP joint flexion, scar tissue of the damaged capsule and the sagittal band-if ruptured-were removed and an oval extensor retinaculum graft was sutured in the capsule/sagittal band defect. The mean age of the patients was 22 years. In all patients, surgery was performed on the middle finger. The capsule was damaged on the ulnar side in 3 patients and on the radial side in 2 patients. RESULTS: All boxers reported alleviation of pain when punching. The range of motion for the MCP joint was not restricted after surgery in any patient. Tendon dislocation did not occur after surgery in any patient. All 5 patients were able to return to professional competition. CONCLUSIONS: Extensor retinaculum grafting is useful in treating chronic boxer's knuckle if the damaged capsule cannot be repaired directly. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Adult↗