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PubMedDate not supplied

The medial collateral ligament of the elbow is not isometric: an in vitro biomechanical study.

BACKGROUND: The anterior bundle of the medial collateral ligament (AMCL) of the elbow has been shown to be the most important valgus stabilizer of the elbow. However, the isometry of this band has not been quantified. HYPOTHESIS: Isometric fibers exist within the AMCL, and these fibers are located within its central region. STUDY DESIGN: Controlled laboratory study. METHODS: Twelve cadaveric elbow specimens were mounted in a testing apparatus in a valgus gravity-loaded orientation. Passive supinated flexion was performed and the motion recorded using an electromagnetic tracking device. Hundreds of attachment points for the AMCL of the elbow were recorded on the medial epicondyle and ulna. The overall change in length between each point on the ulna to every humeral point, throughout the arc of motion, was quantified (DeltaL = Lmax - Lmin). The locations of the smallest DeltaL values were determined relative to the attachment site of the AMCL on the medial epicondyle. RESULTS: True isometry was not found throughout the arc of flexion. The smallest DeltaL values averaged 2.8 +/- 1.2 mm (range: 0.7 mm to 5.2 mm). Isometric fibers do not exist within the AMCL; however, "nearly" isometric areas are located on the lateral aspect of the attachment site of the AMCL on the medial epicondyle, near the anatomic axis of rotation. CONCLUSIONS: We postulate that these nearly isometric areas would be the most ideal location for graft attachment during reconstruction of the AMCL.

Aged↗
PubMedDate not supplied

Functional anatomy of the lateral collateral ligament complex of the elbow: configuration of Y and its role.

A previous anatomic study has revealed that the lateral collateral ligament (LCL) complex of the elbow has a Y-shaped configuration, which consists of a superior, an anterior, and a posterior band. The LCL complex, including the annular ligament, functions as a 3-dimensional (3D) Y-shaped structure. On the basis of this concept, joint laxity after transection of the anterior band was studied in 5 normal, fresh-frozen cadaver elbows with a 3D kinematic testing apparatus. Cutting the anterior band produced significant laxity to varus torque with a mean 5.9 degree at 10 degree of elbow flexion and caused significant laxity to torque in external rotation with a mean 8.5 degree at 40 degree of flexion. No significant laxity was observed during application of valgus or internal rotational torque. Further transection of the posterior band resulted in gross instability with dislocation of the ulnohumeral joint. The laxity occurring after severance of the anterior band suggests that these fibers play a role in preservation of elbow stability against varus and external rotational torque. These results indicate that the LCL functions as a complex with a Y structure and not as an isolated linear ligament. A concept of conjoint point is hypothesized for the function of the LCL complex to restrain posterolateral rotatory instability.

Aged↗
PubMed2005

Permeability of human medial collateral ligament in compression transverse to the collagen fiber direction.

This study quantified the apparent and intrinsic hydraulic permeability of human medial collateral ligament (MCL) under direct permeation transverse to the collagen fiber direction. A custom permeation device was built to apply flow across cylindrical samples of ligament while monitoring the resulting pressure gradient. MCLs from 5 unpaired human knees were used (donor age 55 +/- 16 yr, 4 males, 1 female). Permeability measurements were performed at 3 levels of compressive pre-strain (10%, 20% and 30%) and 5 pressures (0.17, 0.34, 1.03, 1.72 and 2.76 MPa). Apparent permeability was determined from Darcy's law, while intrinsic permeability was determined from the zero-pressure crossing of the pressure-permeability curves at each compressive pre-strain. Resulting data were fit to a finite deformation constitutive law [Journal of Biomechanics 23 (1990) 1145-1156]. The apparent permeability of human MCL ranged from 0.40 +/- 0.05 to 8.60 +/- 0.77 x 10(-16) m(4)/Ns depending on pre-strain and pressure gradient. There was a significant decrease in apparent permeability with increasing compressive pre-strain (p=0.024) and pressure gradient (p<0.001), and there was a significant interaction between the effects of compressive pre-strain and pressure (p<0.001). Intrinsic permeability was 14.14 +/- 0.74, 6.30 +/- 2.13 and 4.29 +/- 1.71 x 10(-16) m(4)/Ns for compressive pre-strains of 10%, 20% and 30%, respectively. The intrinsic permeability showed a faster decrease with increasing compressive pre-strain than that of bovine articular cartilage. These data provide a baseline for investigating the effects of disease and chemical modification on the permeability of ligament and the data should also be useful for modeling the poroelastic material behavior of ligaments.

Anisotropy↗
PubMed1999

Emergency reconstruction of a collateral ligament of a metacarpophalangeal joint using Dacron material.

We present a case in which an open wound involving the ulnar collateral ligament of the metacarpophalangeal joint of the little finger was treated by ligament reconstruction using a strip of Dacron material, nerve grafting and coverage by a posterior interosseous artery pedicled flap. At a long term follow-up of 4 years, the joint was stable and had a full range of movement.

Bone Screws↗
PubMed1999

Combined injuries of the medial collateral ligament and the anterior cruciate ligament. Early ACL reconstruction versus late ACL reconstruction.

Aim of this retrospective study is to evaluate the effect of acute and late anterior cruciate ligament (ACL) reconstruction in patients with a combined injury of the ACL and the medial collateral ligament (MCL). All MCL injuries were treated non-operatively. In 27 patients (group I) we performed early ACL reconstruction (within the first 3 weeks after injury). The postoperative rehabilitation protocol included brace treatment for all patients over a period of 6 weeks. In 37 patients we performed late ACL reconstruction (after a minimum of 10 weeks). In this group initial non-operative MCL treatment (6 weeks brace treatment) was followed by a period of accelerated rehabilitation. Patients with late ACL reconstruction had a lower rate of loss of motion after finishing the postoperative rehabilitation programme and a lower rate of re-arthroscopies for a loss of extension (group I: 4 patients, group II: 1 patient). The difference in the mean quadriceps muscle strength (group I: 83.3%, group II: 86.3%) was not statistically significant. After a mean interval of 22 months, we saw no difference in the frequency of anterior or medial instabilities or in the loss of motion. The Lysholm score was significantly better in the group with late ACL reconstruction (group I: 85.3, group II: 89.9). The position on the Tegner activity scale decreased in both groups, to 5.5 in group I (preoperatively: 6.0) and to 5.6 in group II (preoperatively: 5.9). With regard to the lower rate of motion complications in the early postoperative period, the lower rate of re-arthroscopies, and the significantly better results in the Lysholm score, we prefer late ACL reconstruction in the treatment of combined injuries of the ACL and the MCL.

Adolescent↗
PubMed1980

Demonstrating the fibular collateral ligament.

A posture is described which allows palpation of the fibular collateral ligament of the knee as an isolated structure. Visual identification is also possible. This is of interest to the clinician and student of surface anatomy.

Fibula↗
PubMed2002

Medial collateral ligament autografts have increased creep response for at least two years and early immobilization makes this worse.

Recent evidence has shown that 10-40% of knee joints reconstructed with soft-tissue autografts have a recurrence of abnormal joint laxity over time. One possible explanation is the "stretching out" (or unrecovered creep) of the graft tissue. To test in vitro creep and creep recovery of fresh anatomic ligament autografts in an extra-articular environment, 16 rabbits underwent an orthotopic medial collateral ligament (MCL) autograft procedure to one hindlimb. Three subgroups of animals had either unrestricted cage activity for 1 year (n = 5) or 2 years (n = 5) or pin-immobilization for the first 6 weeks followed by cage activity for the remainder of 1 year (n = 6). Following laxity measurements, to test their creep response, isolated MCL grafts were cyclically and then statically creep tested in vitro at 4.1 MPa, allowed to recover at zero load for 20 min, and finally elongated to failure. Due to differences in cross-sectional area between the grafts and normal MCLs, two normal control groups were tested: stress-matched tested at 4.1 MPa (16.2 N; n = 7) and force-matched tested at 29.1 N (7.1 MPa; n = 6). Ligament grafts had normal laxity but significantly increased creep and decreased creep recovery compared to normal MCLs after I and 2 years of healing (p < 0.0004). Graft failure stress was also significantly less than normal (p < 0.0001). Immobilized grafts had significantly greater creep compared to non-immobilized grafts at 1 year of healing (p < 0.05). These results support previous observations concerning material inferiority of fresh anatomic rabbit MCL autografts, but add the concept that such grafts also have increased potential to creep with either slower or incomplete recovery when subjected to low stresses in vitro. Joint and ligament laxities in situ were normal in this model, however, suggesting either that in vivo MCL graft stresses are lower than those used here in vitro or that these tissues have other mechanisms by which they can recover their functional length in vivo.

Animals↗
PubMedDate not supplied

The medial collateral ligament of the elbow joint: anatomy and kinematics.

Eighteen osteoligamentous elbow joint specimens were included in a study of the medial collateral ligament complex (MCL). The morphologic characteristics of the MCL were examined, and three-dimensional kinematic measurements were taken after selective ligament dissections were performed. On morphologic evaluation the MCL is divided into the anterior bundle and the posterior bundle. The anterior bundle can be divided into anterior and posterior bands. The maximum valgus and internal rotatory instability after transection of the anterior band, 11.7 degrees and 11.2 degrees, respectively, were found at elbow flexions of 30 degrees and 40 degrees. Severance of the entire anterior bundle produced major valgus and internal rotatory laxity through the complete flexion arc of maximal 14.2 degrees and 18.5 degrees, respectively, at 70 degrees and 60 degrees of elbow flexion. Cutting both the posterior band and the posterior bundle resulted in only internal rotatory laxity of maximal 7.2 degrees at 130 degrees of elbow flexion. This study defines the anterior band as the primary constraint to valgus and internal rotatory forces, the posterior band as the secondary, and the posterior bundle as the tertiary constraint. The MCL was observed to be a complex of ligamentous fibers rather than individual bands that stabilizes the joint against valgus and internal rotatory forces.

Aged↗
PubMed2000

The effects of transection and reconstruction of the ulnar collateral ligament complex on the position of the proximal phalanx of the thumb during simulated tip pinch.

Injuries to the ulnar collateral ligament (UCL) of the metacarpophalangeal joint of the thumb are common and may result in functional instability of the joint. Eight cadaveric hands were studied. Physiologic levels of muscle loads were applied to the extrinsic flexor tendon of the thumb to simulate tip pinch of the thumb. We investigated the effects of transection of the UCL and accessory UCL (UCL complex) with and without transection of the dorsal capsule and volar plate and of reconstruction of the UCL, for 2 surgical techniques, on the position of the proximal phalanx with respect to the thumb metacarpal. The spatial positions of the metacarpal and proximal phalanx were measured with a 6 degrees of freedom digitizing system for flexion angles from 0 degrees to 60 degrees in 15 degrees increments. Transection of the UCL complex, dorsal capsule, and volar plate (ulnar capsuloligamentous structures) of the metacarpophalangeal joint did not affect radioulnar deviation or radioulnar shift, but did produce significant increases in supination by 8 degrees and volar translation by 2 mm at 45 degrees and 60 degrees compared with those found for the intact joint. The UCL was reconstructed with a tendon graft using the autogenous extensor digiti quinti. The first surgical technique, a traditional technique, and the second surgical technique, a technique based on anatomy, returned the position of the proximal phalanx on the metacarpal head to normal, with the exceptions of volar translation of the proximal phalanx at 60 degrees and trends toward abnormal supination of the proximal phalanx for flexion angels of 45 degrees and 60 degrees.

Adult↗
PubMed2005

The value of radial collateral ligament reconstruction and abductor digiti minimi release in metacarpophalangeal joint arthroplasty.

Rheumatoid arthritis is a chronic, progressive disease characterized by destructive synovitis commonly involving the hand. Ulnar drift deformity has been reported in up to 30% of these patients. Metacarpophalangeal (MCP) joint arthroplasty with soft-tissue reconstruction was described to correct this deformity, but recurrence is a common problem. This is a retrospective study of 18 patients who underwent 96 primary index to little finger MCP joint arthroplasties in Montreal General Hospital. Patients were divided into 2 groups. In group I, 60 MCP joints in 15 hands had silastic arthroplasty with radial collateral ligament reconstruction and abductor digiti minimi release. In group II, 36 MCP joints in 9 hands had silastic arthroplasty without soft-tissue reconstruction. All patients had the same postoperative rehabilitation, with a follow-up mean time of 63 months. Postoperative clinical and radiologic comparison was performed. Group I was found to have more severe wrist disease. No significant difference was seen between the 2 groups for ulnar drift (D2, P < 0.79; D3, P < 0.11; D4, P < 0.49; D5, P < 0.31), active range of motion, power grip, incidence of MCP subluxation, or functional ability. MCP arthroplasty with radial collateral ligament reconstruction and abductor digiti minimi release may recreate a short-term balance of forces around the MCP joint but does not prevent late postoperative deformity. This is a preliminary study with a small sample size but supported previous reports on MCP arthroplasty with soft-tissue reconstruction.

Adult↗
PubMed1996

An immunohistochemical study of enthesis development in the medial collateral ligament of the rat knee joint.

The changing distributions of collagens and glycosaminoglycans have been studied at the attachments of the medial collateral ligament during postnatal development. The ligament is of particular interest because it has a fibrocartilaginous attachment to the femoral epiphysis, but a fibrous one to the tibial metaphysis. Ligaments were examined in rats killed at birth and at 2, 4, 6, 8, 10, 20, 30, 45, 60, 90 and 120 days after birth. Cryosections were immunolabelled with monoclonal and polyclonal antibodies against types I and II collagen, chondroitin 4 and 6 sulfate, dermatan and keratan sulfate. Although the ligament is attached at both ends to bones that develop from cartilage, there was a striking difference in collagen labelling. Type II collagen was only found in spicules of calcified cartilage in bone beneath the tibial enthesis after ossification had commenced, but there was a continuous band of labelling at all stages of development at the femoral enthesis. Initially, the cartilage at the femoral attachment lacked type I collagen, but by 45 days labelling was continuous from ligament to bone. Continuity of labelling was seen much earlier at the tibial enthesis, as soon as bone had formed. There were also marked changes in glycosaminoglycan distribution. Keratan sulfate was present at both entheses up to 45 days, but only at the femoral enthesis thereafter. Both attachments labelled throughout life for dermatan sulfate, but chondroitin 4 and 6 sulfate were only found at the femoral end. The results suggest that enthesial cartilage at the femoral attachment was initially derived from the cartilaginous bone rudiment but was quickly eroded on its deep surface by endochondral ossification as bone formed at the attachment site. It was replaced by fibrocartilage developing in the ligament. This mechanism allows enthesis cartilage/fibrocartilage to contribute to the growth of a bone at a secondary centre of ossification in addition to dissipating stress at the ligament-bone junction.

Age Factors↗
PubMed1999

The effect of thumb metacarpophalangeal ulnar collateral ligament attachment site on joint range of motion: an in vitro study.

Although reconstruction of the torn thumb metacarpophalangeal (MCP) joint ulnar collateral ligament (UCL) has been shown to reduce symptoms, final joint motion may be different from that of the uninjured state. It was hypothesized that nonanatomic repositioning of the UCL might affect joint motion; therefore, the effect of UCL attachment site on MCP range of motion was investigated. The UCL and MCP joint capsule were visualized in each of 8 fresh cadaveric hands without otherwise disrupting the joint. The centers of the ligament attachments were marked with pins and each specimen was mounted on a testing frame capable of applying loads through the flexor and extensor tendons. After measuring the flexion, extension, and radial and ulnar deviation ranges of motion of the intact specimen, the origin of the ligament (on the metacarpal) and an attached bone block were elevated and repositioned 2 mm proximal and 2 mm palmar and range of motion was tested. The origin was reattached in its anatomic location and the insertion of the ligament was similarly elevated and displaced 2 mm in distal, dorsal, and palmar directions. Compared with the intact joint, palmar placement of the UCL origin on the metacarpal increased radial deviation (from a mean of 18 degrees to a mean of 27 degrees); proximal placement of the origin decreased it (from 18 degrees to 10 degrees). Similarly, dorsal placement of the UCL insertion on the phalanx increased radial deviation (from 18 degrees to 25 degrees) and distal positioning of the insertion decreased it (from 18 degrees to 11 degrees). Relative to intact joint flexion range of motion (mean, 57 degrees), distal placement of the UCL phalangeal insertion restricted motion (mean, 47 degrees), as did palmar placement (mean, 48 degrees). Extension and ulnar deviation motions were unaffected by ligament attachment position. This study demonstrates that nonanatomic reconstruction of the UCL alters normal MCP joint range of motion.

Biomechanical Phenomena↗
PubMed1997

The shear behaviour of the rabbit medial collateral ligament.

This study was conducted to determine whether load is transmitted via shear through the matrix between ligament fibres rather than solely as tension in the fibres. Thirty-six rabbit medial collateral ligaments were subjected to uniaxial tension tests. Twenty-four of these ligament complexes were incised laterally to create longitudinal shear planes, while the remaining 12 complexes served as controls. Data were used in conjunction with finite element models to determine how shear transfer, if any, occurred in the ligament. Non-linear, anisotropic, plane stress finite element models were able to simulate the non-linear structural behaviour shown by uncut control ligaments under normal tensile testing. The finite element models were also able to reproduce the ligament load deformation behaviour observed in the shear tests. Results indicated that some load was transferred between the collagen fibres and other constituents in the ground substance of these ligaments and possibly also through fibres missed during the cutting procedure. The exact manner in which the load was transmitted remains unclear and requires further investigation and quantification.

Animals↗
PubMed2006

Long-term effects of porcine small intestine submucosa on the healing of medial collateral ligament: a functional tissue engineering study.

Porcine small intestinal submucosa (SIS) was previously shown to enhance the mechanical properties of healing medial collateral ligaments (MCL), and the histomorphological appearance and collagen type V/I ratio were found to be close to those of normal MCL. We hypothesized that at a longer term, 26 weeks, SIS could guide a better organized neo-ligament formation, increasing mechanical properties and increasing collagen fibril diameters mediated by a reduction in collagen type V. A 6 mm gap injury in the right MCL was surgically created in 38 rabbits, while the contralateral intact MCL served as a sham-operated control. In half the animals, a strip of SIS was sutured onto the severed ends. In the other half, no SIS was applied. The cross-sectional area (CSA) was determined with a laser micrometer system. The femur-MCL-tibia complex was mechanically tested in uniaxial tension. Histomorphology was determined through H&E and immunofluorescent staining and transmission electron microscopy (TEM). Sodium-dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) was used to determine collagen type V/I ratio. SIS-treated MCLs displayed a 28% reduction in CSA, a 33% increase in tangent modulus, and a 50% increase in tensile strength compared with the nontreated group (p < 0.05). TEM showed groups of collagen fibrils with larger diameters in the SIS-treated ligaments in comparison with uniformly small fibrils for the nontreated group. H&E staining showed more densely stained collagen fibers in the SIS-treated group aligned along the longitudinal axis with more interspersed spindle-shaped cells. Immunofluorescent staining showed less collagen type V signals, confirmed by a 5% lower ratio of collagen type V/I compared with the nontreated controls (p < 0.05). The findings extend the shorter term 12-week results, and support the potential of porcine SIS as a bioscaffold to enhance ligament healing.

Animals↗
PubMedDate not supplied

Reconstruction of the medial collateral ligament for tarsocrural luxation in the dog: a preliminary study.

Seven cases of tarsocrural subluxation/luxation resulting from ruptures of the medial collateral ligament were treated by double prosthetic replacement. The technique was a revision of an earlier described method without the use of metallic implants. Six (100%) of six cases not involving additional joint fractures had excellent clinical results with minimal compromise to range of joint motion. In three (50%) of six cases where braided polyester sutures were implanted as the prosthesis, fistulating tracts developed. Drainage resolved with removal of the suture in each of these three cases, and two of the three proceeded to excellent results after replacing the braided suture with monofilament suture.

Animals↗