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PubMedDate not supplied

A study of the biological behavior of the meniscus as a transplant in the medial compartment of a dog's knee.

A surgical procedure was developed such that a meniscus could be reimplanted in the medial compartment of canine knees. The medial meniscus was removed and reimplanted in one group of seven animals, removed and reimplanted with a glutaraldehyde-preserved bioprosthesis in a second group of five animals, and removed and replaced by an allograft meniscus preserved 2 to 3 weeks in tissue culture in a final group of ten animals. All animals were autopsied at 2 months and the knees were examined by gross dissection and histologic study of the joint capsule meniscal interface. Results showed that implantation by the surgical technique was effective and no loose bodies or partial detachments were found in the reimplantation or tissue culture-stored allogenic menisci. Allogenic menisci preserved in glutaraldehyde and termed a bioprosthesis attached to the joint capsule less satisfactorily. There was minimal inflammation of the synovium in any group at 2 months; however, the glutaraldehyde group showed repeated effusions at 1 and 2 weeks.

Animals↗
PubMedDate not supplied

[The function of passive stabilizers of the glenohumeral joint--a biomechanical study].

UNLABELLED: In a biomechanical study we evaluated the passive stabilizing ligaments of 9 fresh shoulder specimens with mercury bands. While preparing the specimens we found two interesting entities: there are fibers of the coracohumeral ligament running from the humeral head to the coracoacromial ligament and there was an reproducible thickening in the posterior joint capsule. Functional evaluation shows that the coracohumeral ligament limits external rotation independently of the amount of abduction as well as inferior subluxation. The mediale glenohumeral ligament shows the highest tension in external rotation and 30 degrees abduction. The anterior inferior ligament strengthens the joint capsule in abduction and external rotation. The posterior inferior ligament shows the highest tension in abduction and internal rotation. CLINICAL RELEVANCE: Immobilization in internal rotation and adduction may lead to shortening of the coracohumeral ligament, which may result in severe limitation of external rotation and abduction. Resection of the coracoacromial ligament relaxes the coracohumeral ligament leading to an increased cranio-caudal instability. The posterior inferior ligament is complementary to the anterior inferior ligament thus stabilizing the shoulder joint in abduction and internal rotation. Sparing this structure in arthroscopy with dorsal portals and restoring in the case of a rupture seems to be of value for a normal joint function.

Acromioclavicular Joint↗
PubMed1996

The lateral synovial recess of the knee: anatomy and role in chronic Iliotibial band friction syndrome.

The tissue deep to the iliotibial band (ITB) and its relationship to the lateral knee joint capsule was studied anatomically and the histopathology of this tissue in chronic iliotibial band friction syndrome (ITBFS) was examined. Findings show that the tissue under the ITB consists of a synovium that is a lateral extension and invagination of the actual knee joint capsule and is not a separate bursa as described in the literature. Additionally, in cases of chronic ITBFS seen in young elite athletes, synovial tissue taken from this lateral synovial recess reveals histological evidence of inflammation and hyperplasia that suggests its involvement in the pathological process.

Adolescent↗
PubMed2000

Anatomy of the coracohumeral and coracoglenoidal ligaments.

The Ligg. coracohumerale and coracoglenoidale are constant anatomical structures, represented in all the 34preparations investigated. The Lig. coracoglenoidale is a strong band of dense connective tissue, running from the Processus coracoideus to the Tuberculum supraglenoidale. In 27 specimens out of 34 it was the continuation of the M. pectoralis minor tendon. The Lig. coracohumerale consists of two separate parts. The "inferior part" originates from the Processus coracoideus and the Lig. coracoglenoidale, which separates it from the base of the coracoid process. It is composed of the joint capsule anteriorly and a remnant of the M. pectoralis minor tendon posteriorly. The "superior part" arises from the medio-posterior surface of the Processus coracoideus, just below the Lig. coracoacromiale. Both parts of the Lig. coracohumerale run into the shoulder joint capsule under the M. supraspinatus tendon and insert into a capsular semicircular band. According to the shape and course of fibres between the greater and lesser tubercles of the Humerus, we propose to name it the "Lig. semicirculare humeri". None of the two parts of the Lig. coracohumerale begins from the base of the Processus coracoideus, and fibres of the Lig. coracohumerale do not reach the Tuberculum majus et minus directly.

Aged↗
PubMed1995

Origin of the calcitonin gene-related peptide-immunoreactive nerve fibers in the rat shoulder joint.

The rat shoulder joint capsule is innervated by thin sympathetic and sensory nerve fibers, most of which contain calcitonin gene-related peptide (CGRP). In order to establish the origin and distribution of CGRP-immunoreactive (IR) fibers, wheat germ agglutinin-conjugated horseradish peroxidase (WGA-HRP) was injected into the shoulder joints of rats via a dorsal surgical approach. After WGA-HRP injection, the cervico-thoracic dorsal root ganglia (DRG) were removed and processed using both HRP histochemistry and CGRP immunohistochemistry. In the C4 to C7 DRG, small to medium-sized neurons (20-40 microns) were labeled by this combined method. The number and size of the labeled neurons were measured in the cervical 4th-7th DRG. The number of double-labeled neurons was one quarter of the total number of HRP-labeled neurons and 1/20 of the CGRP-IR neurons. Most of the double-labeled cells were located in the C6 ganglion, and the mean number of double-labeled neurons was 13 at this level. This distribution and function of the CGRP-IR fibers in the rat shoulder joint capsule are discussed.

Animals↗
PubMed2000

[The frozen shoulder].

Painful stiffness of the shoulder is an ill-defined clinical entity that is difficult to assess and delicate to treat. The nomenclature used is broad and includes terms such as frozen shoulder, adhesive capsulitis, focal algodystrophy, stiff shoulder, contracted shoulder, and others. Apart from its idiopathic form, the disease can be initiated by trauma, infection, tumour, radiation, systemic and local metabolic disturbances. Pathoanatomically, the common denominator is an inflammatory vascular proliferation followed by thickening, scarring, and retraction of the joint capsule. The inflammatory process often starts at the rotator interval and may extend to the subacromial space. Clinical diagnosis is based on history and physical examination. Generally the onset of pain precedes the perception of a reduced range of motion by weeks or months. In early stages of the disease, the inflammatory type of pain dominates, i.e., the patient's main complaint ist pain at night. In the later stage, range of motion gradually decreases. Patients do not often complain about reduced motion, probably because of its slow onset. Treatment options are a combination of mobilisation exercises with intra-articular steroids, hydraulic distension of the joint capsule, manipulation under anaesthesia, arthroscopic and/or open arthrolysis. The appropriate choice of protocol is just as important as its correct timing. In the inflammatory phase, aggressive treatment protocols are probably contraindicated. Complications of invasive protocols are rare but deleterious and therefore have to be taken into consideration. New anti-anglogenetic agents may enhance functional results and shorten the rehabilitation phase.

Arthroscopy↗
PubMedDate not supplied

Coplaning of the acromioclavicular joint.

PURPOSE: Coplaning removes inferior spurs or portions of the distal clavicle to decrease injury to the rotator cuff. This study sought to determine if the presence or degree of coplaning influenced the results and if reoperations for distal clavicle symptoms were needed. TYPE OF STUDY: Nonrandomized control study. METHODS: A total of 76 patients undergoing arthroscopic subacromial decompression (ASD) followed for at least 25 months were divided into 3 groups. Group 1 included 28 patients who underwent ASD with removal of only an inferior clavicular osteophyte. Group 2 included 27 patients with resection of any inferior clavicle spur, violation of the inferior joint capsule, and removal of articular cartilage to a level adjacent with the resected acromion. As much as 50% of the articular cartilage was removed in some cases. Group 3 included 21 patients who underwent a complete distal clavicle excision. Radiographs, charts, and arthroscopic videotapes were reviewed and the degree of claviculectomy exactly determined. Follow-up evaluations included the Constant-Murley, American Shoulder and Elbow Surgeons (ASES), SANE, and Rowe shoulder scores, with special attention given to acromioclavicular (AC) joint pain and additional operations. RESULTS: The average age of the patients was 49 years (range, 19 to 81 years) and follow-up averaged 40 months (range, 25 to 68 months). Follow-up Constant, ASES, Rowe, and SANE scores for the various groups were calculated. Group 1 scores were 99.4, 98.7, 98.6, and 98.1, respectively; group 2 scores were 96.8, 98.7, 98.5, and 95.7, respectively; and group 3 scores were 98.4, 99.4, 99.3, and 98.6, respectively. No patient required any additional AC joint surgery. CONCLUSIONS: Violation of the AC joint capsule and partial distal clavicle resection to make it confluent with the resected acromion (coplaning), does not cause increased AC joint symptoms, compromise the results, or lead to additional surgery at an average 40-month follow-up.

Acromioclavicular Joint↗
PubMed1982

A lethal, Larsen-like multiple joint dislocation syndrome.

We describe here two isolated cases of lethal, Larsen-like multiple joint dislocation syndrome. Death occurred shortly after birth with pulmonary insufficiency due to tracheomalacia and/or lung hypoplasia. Both had abnormal dermal collagen bundles. In one case, histochemical studies showed abnormal cartilagenous matrix and striking deficiency in the dense collagen bundles of joint capsules; electronmicroscopic studies of the hyaline cartilage of the trachea documented a relative increase of the small, short fibers with decrease of the matrix collagen fibers. This study confirms that this Larsen-like syndrome is a disorder of connective tissue, possibly involving dysmaturity of the collagen fibers, with a predilection for joint capsules and tracheal cartilage. This lethal condition is characterized by pulmonary insufficiency, tracheomalacia, and collagen fiber dysmaturity.

Collagen Diseases↗
PubMed2000

[In Process Citation]

Painful stiffness of the shoulder is an ill-defined||| clinical entity that is difficult to assess and delicate to treat. The||| nomenclature used is broad and includes terms such as frozen shoulder, adhesive||| capsulitis, focal algodystrophy, stiff shoulder, contracted shoulder, and||| others. Apart from its idiopathic form, the disease can be initiated by trauma,||| infection, tumour, radiation, systemic and local metabolic disturbances.||| Pathoanatomically, the common denominator is an inflammatory vascular||| proliferation followed by thickening, scarring, and retraction of the joint||| capsule. The inflammatory process often starts at the rotator interval and may||| extend to the subacromial space. Clinical diagnosis is based on history and||| physical examination. Generally the onset of pain precedes the perception of a||| reduced range of motion by weeks or months. In early stages of the disease, the||| inflammatory type of pain dominates, i.e., the patient's main complaint ist||| pain at night. In the later stage, range of motion gradually decreases.||| Patients do not often complain about reduced motion, probably because of its||| slow onset. Treatment options are a combination of mobilisation exercises with||| intra-articular steroids, hydraulic distension of the joint capsule,||| manipulation under anaesthesia, arthroscopic and/or open arthrolysis. The||| appropriate choice of protocol is just as important as its correct timing. In||| the inflammatory phase, aggressive treatment protocols are probably||| contraindicated. Complications of invasive protocols are rare but deleterious||| and therefore have to be taken into consideration. New anti-anglogenetic agents||| may enhance functional results and shorten the rehabilitation||| phase.

Journal Article↗
PubMed2003

Effects of anterior lumbar spinal fusion on the distribution of nerve endings and mechanoreceptors in the rabbit facet joint: quantitative histological analysis.

The purpose of this study was to investigate the density and distribution of neural endings in rabbit lumbar facet joints after anterior spinal fusion and to evaluate the effects of intervertebral immobilization. An extraperitoneal approach was applied, and L5/6 was fixed with a plate and screws. Bilateral L4/5, L5/6, and L6/7 facet joint capsules were harvested from the rabbits 4, 8, and 16 weeks postoperatively. Capsular tissues were processed using a modified gold chloride staining method, and the specimens were sliced into 15-micro m sections. All sections were analyzed microscopically, and neural ending numbers per unit volume were calculated. Three types of neural ending were identified in each specimen: Pacinian corpuscles, Ruffini corpuscles, and free nerve endings. In the L5/6 fusion segment there was a significant decrease in the number of Pacinian corpuscles at 4 weeks and of Ruffini corpuscles at 4, 8, and 16 weeks after the fusion compared with the control; and in the L4/5 upper adjacent segment there was a significant increase in the number of free nerve endings. The number of Ruffini endings for the L6/7 lower adjacent segment was significantly lower more than 8 weeks after the fusion. These results suggest that immobilization of the intervertebral segment causes a reduction in the number of mechanoreceptors in the facet joint capsules because of the reduction in mechanical stimulation. Moreover, in the upper adjacent facet joint there may be neural sprouting caused by nociceptive stimulation.

Animals↗
PubMed2006

Sensory and sympathetic innervation of cervical facet joint in rats.

OBJECTIVE: To explore the patterns of innervation of cervical facet joints and determine the pathways from facet joints to dorsal root ganglions (DRGs) in order to clarify the causes of diffuse neck pain, headache, and shoulder pain. METHODS: Forty-two male-Sprague-Dawley rats, weighing 250-300 g, were randomly divided into three groups: Group A (n=18), Group B (n=18), and Group C (n=6). Under anesthesia with intraperitoneal pentobarbital sodium (45 mg/kg body weight), a midline dorsal longitudinal incision was made over the cervical spine to expose the left cervical facet joint capsule of all the rats under a microscope. The rats in Group A underwent sympathectomy, but the rats in Group B and Group C did not undergo sympathectomy. Then 0.6 microlitre 5% bisbenzimide (Bb) were injected into the C1-2, C3-4 and C5-6 facet joints of 6 rats respectively in Group A and Group B. The holes were immediately sealed with mineral wax to prevent leakage of Bb and the fascia and skin were closed. But in Group C, 0.9% normal saline was injected into the corresponding joint capsules. Then under deep re-anesthesia with intraperitoneal pentobarbital sodium (45 mg/kg body weight), C1-C8 left DRGs in all rats and the sympathetic ganglions in Group B were obtained and the number of the labeled neurons was determined. RESULTS: Neurons labeled with Bb were present in C1-C8 DRGs in both Group A and Group B, and sympathetic ganglions in Group B. In the C1-2 and C3-4 subgroups, labeled neurons were present from C1 to C8 DRGs, while in C5-6 subgroups they were from C3 to C8. The number of Bb(+) neurons after sympathectomy was not significantly different in the injected level from that without sympathectomy. But in the other levels, the number of Bb(+) neurons after sympathectomy was significantly less than that without sympathectomy. CONCLUSIONS: The innervation of the cervical facet joints is derived from both sensory and sympathetic nervous system, and DRGs are associated with sympathetic ganglions through nerve fibers outside the central nerve system.

Animals↗
PubMed1988

Responses of quadriceps motor units to mechanical stimulation of knee joint receptors in the decerebrate cat.

Recordings were obtained from single quadriceps motor units in decerebrate cats. Tonic discharges were induced in these units by stretch applied to the patellar tendon. The activity of these motor units was examined during repetitive mechanical indentation of the posterior aspect of the knee joint capsule. The amplitude of indentation could be graded to regularly elicit a volley of one or more action potentials from afferents travelling in the posterior articular nerve (PAN). Either repetitive indentation at a fixed frequency or random indentation resulted in entrainment of motor unit discharge with a latency of 6.5-17 ms from the onset of the first PAN spike. This effect was achieved in one case by a single joint afferent. Usually two or more afferents were required to produce entrainment. This effect was mediated by joint receptors as its reversibly abolished by application of lignocaine to the joint nerve. The modal reflex latency suggests that group II joint afferents were responsible for this effect. Stimulation of some areas of the joint capsule readily produced motor unit entrainment whereas other areas did not although PAN afferents were also activated at the latter sites, suggesting inhomogeneity in the synaptic actions of joint afferents.

Action Potentials↗
PubMed1993

Tissue response to the failed Gerard double-cup. Histologic analysis of 40 uncemented hip arthroplasties.

Femoral head remnants, joint capsules and acetabular membranes were retrieved at revision of 40 failed uncemented, Gerard double-cup hip arthroplasties. All femoral heads were covered with a fibrous membrane containing polyethylene and metal particles, macrophages, and giant cells. The same histopathologic features were found in the joint capsules and acetabular membranes. There was a relationship between the amount of polyethylene particles in the fibrous membrane of the femoral head and the presence of osteonecrosis. Resorption of necrotic bone contributed to failure of the arthroplasty, aided by granulomatous reactions to the wear particles that appeared to induce osteolysis. The overall findings indicate that the severity of the foreign body reaction in periprosthetic tissues is related to the amount of wear particles. Future designs of resurfacing hip arthroplasties should be focused on wear-resistant material combinations.

Biocompatible Materials↗
PubMed1983

Effects of tendon transfer on the canine scapulohumeral joint.

Surgical techniques for correcting medial or lateral instability of the scapulohumeral joint in conditioned research dogs were evaluated. Lateral instability was created by severing the lateral joint capsule and the tendon of insertion of the infraspinatus muscle. In 4 dogs, the tendon of origin of the biceps brachii muscle was then transferred to a position lateral to the greater tubercle in an effort to improve lateral stability. In 3 control dogs, lateral instability was induced, but attempt was not made to stabilize the joint. Medial instability was created by severing the tendon of insertion of the subscapularis muscle and the medial joint capsule. In 3 dogs, the tendon of origin of the biceps brachii muscle was transferred to a position under the lesser tubercle. In 2 dogs, a portion of the tendon of insertion of the supraspinatus muscle was transferred to a medial location. In 3 control dogs, attempt was not made to stabilize the joint. The control dogs (n = 6) demonstrated mild-to-moderate weight-bearing lameness for 7 to 14 days after surgical induction of joint instability and thereafter had normal limb usage. Dogs having had tendon transfer procedures recovered normal limb usage in 4 to 6 weeks and thereafter behaved normally. At necropsy, all joints appeared stable, and the surgical repairs were intact. A variety of joint surface abnormalities consistent with degenerative joint disease was observed, but no consistent pattern was assignable to any given surgical manipulation.

Animals↗
PubMed2003

Effect of selective capsulorrhaphy on the passive range of motion of the glenohumeral joint.

BACKGROUND: Capsulorrhaphy of the glenohumeral joint is a common surgical procedure for the treatment of instability caused by increased capsular laxity. The effect of capsulorrhaphy on the range of motion of the shoulder is poorly understood. METHODS: We simulated localized capsular contractures by selective capsular plications in eight human cadaveric shoulders and studied the effect of such plications on the passive range of glenohumeral abduction, flexion, and external and internal rotation in different degrees of abduction. A 0.5 or 1-N-m torque was applied to the humerus, and the range of glenohumeral motion was measured with electronic goniometers in three planes and compared with those of the intact shoulder. RESULTS: Anterosuperior capsular plication most markedly affected external rotation of the adducted arm, decreasing it by a mean of 30.1 degrees (p < 0.0001). Anteroinferior plication significantly reduced abduction by a mean of 19.4 degrees (p < 0.0001) and external rotation by a mean of 20.6 degrees (p = 0.0046). Posterosuperior plication mostly limited internal rotation of the adducted arm (mean decrease, 16.1 degrees, p = 0.0045). On the average, total anterior and total posterior plication each limited flexion by approximately 20 degrees (p = 0.005) and abduction by >or=15 degrees (p < 0.005), whereas total anterior plication limited external rotation by >30 degrees (p 20 degrees (p < 0.0001). Total inferior capsular plication restricted abduction (by a mean of 27.7 degrees, p = 0.0001), flexion, and rotation. Total superior plication restricted external rotation and flexion. CONCLUSIONS AND CLINICAL RELEVANCE: Localized plications of the glenohumeral joint capsule lead to predictable patterns of loss of glenohumeral mobility. If plication is planned, losses of movement can be anticipated. The findings of this study may assist surgeons in identifying the parts of the capsule that are contracted and that may need lengthening.

Biomechanical Phenomena↗
PubMed2001

The role of arthroscopic thermal capsulorrhaphy in the hip.

Arthroscopic thermal modification of collagen in the hip capsular tissue appears to be a treatment option for patients with hip instability. Traumatic hip instability is associated with frank dislocation or a subluxation, and labral tears. Atraumatic hip instability is associated with evidence of generalized ligament laxity. It can be associated with bone-collagen type disorders, including Ehlers-Danlos syndrome, Down syndrome, arthrochalasis multiplex congenita, developmental dysplastic hip, and idiopathic type. As previously discussed by Bellabarba et al, capsular laxity may be the underlying cause of dynamic hip instability. The capsule is a fibrous, thick, and strong structure that encircles the proximal femur and the acetabulum. The capsule is thicker anteriorly than posteriorly, and consists of two sets of fibers, circular and longitudinal. The capsule ligaments play a very important role in hip stability. The hip joint capsule is reinforced by the iliofemoral, pubofemoral, and ischiofemoral ligaments. It remains sensitive to stretch and serves as a mechanism for muscular feedback and pain. The iliofemoral ligament limits hyperextension and lateral rotation of the hip joint and is taut in full extension. Full extension of the hip exposes the capsule and ligaments to a twisting and shortening effect that forces the head onto the acetabulum. We are currently studying the effect of iliofemoral ligament deficiency and its relationship to instability. Many of the properties of synovial lubrication depend on contact with articular surfaces, and incongruency due to instability may have some functional role in distribution of synovial fluid, leading to stresses from weightbearing and eventually to rapid deterioration of the articular surfaces. The high-level athletes in this series include two professional baseball players, three professional golfers (PGA), one professional football player (NFL), one figure skater (Olympic gold medalist), one gymnast (Olympic level, bilateral hips), and one ballet dancer; they returned to their pre-injury level of activity. The other patients returned to their pre-injury functional lifestyle. Hip instability appears to present consistently with stable gait abnormalities and painful sensation of instability. Recognizing the various patterns of hip instability is complicated, and therefore management and outcome of these disorders are quite variable. Bellabarba et al concluded that physical therapy alone had been unsuccessful and that temporary success of a posterior capsular "plication" in one patient showed promise. Arthroscopic thermal modification of collagen in the hip capsular tissue appears to be a treatment option for patients with hip instability. The hip joint capsule is predominantly type 1 collagen, and the mechanism of tissue shrinkage through type 1 collagen alteration is well documented in the literature. Short-term results appear promising, however, more studies are required to determine the long-term efficacy of this procedure in the treatment of this challenging disorder.

Arthroscopy↗
PubMed1989

Ultrasonography of the adult hip joint.

The ultrasonographic distance between the hip joint capsule and femur was measured in 75 healthy adults. The mean distance was 5.1 (SD 0.7) mm. The shortest distance was 3.0 mm, the longest 7.0 mm. The difference between the right and left hip was 0.3 (SD 0.3, range 0-1.2) mm. No correlation was found between the ultrasonographic distance and the subjects' height, body weight, age or sex. The reproducibility of the measurement was good, and the interobserver correlation was 0.94. It is concluded that an ultrasonographic distance between the hip joint capsule and the femur of 7 mm or more, and a difference between the hips of 1 mm or more suggest an intracapsular effusion in the joint in adults.

Adolescent↗
PubMed1980

Comparison of in vivo temperatures produced by hydrotherapy, paraffin wax treatment, and Fluidotherapy.

The effectiveness of a new heat modality, Fluidotherapy, was compared with other superficial heat modalities by in vivo temperature measurements. The joint capsule and muscle temperatures in the hands and feet were measured in subjects treated with hydrotherapy, paraffin wax, and Fluidotherapy. Fluidotherapy is a dry heat modality consisting of finely divided solids suspended in an air stream. The dry heat modality, applied at 118 degrees F (47.78 degrees C), resulted in maximum joint capsule and muscle temperature rises of 16.2 degrees F (9 degrees C) and 9.5 degrees F (5.27 degrees C), respectively, compared to 13.5 degrees F (7.5 degrees C) and 8.1 degrees F (4.5 degrees C) for paraffin wax treatment and 10.8 degrees F (6.0 degrees C) and 7.7 degrees F (4.3 degrees C) for a 102 degrees F (38.89 degrees C) water bath, at a depth of about 0.5 cm beneath the skin. At depths down to 1.2 cm, superficial heat modalities are more effective than diathermy and much more effective than ultrasound in elevating temperature.

Calorimetry↗