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PubMed1992

[Experimental studies on vascularized allogeneic joint transplantation in rats].

Examination was made on the effects of Cyclosporine A, an immunosuppressive drug, on vascularized joint allografts. Genetically inbred DA and Lewis rats were used and a model of knee joint orthotopical transplantation across the major histocompatibility barrier was developed. Nine non-immunosuppressive allografts failed to acquire bony union. Twenty-seven short term immunosuppressive rats acquired solid union, but following withdrawal of immunosuppression, the grafts were soon rejected and joint function was lost due to pathological fractures of the grafted bone or joint instability. Thirteen allografts of continuous immunosuppression at a dose of 5 mg/kg/day showed no rejection, though the bone marrow did, and there was no impairment of function. The continuous administration of low and non-toxic dose of Cyclosporine A was necessary for maintaining grafted joint functions.

Animals↗
PubMed1980

[Ligamental injuries of MCP joints (author's transl)].

Injuries of the ligaments and capsule of the MCP joints are frequently seen in the hand surgical service. A great part of these injuries are caused by trauma during competitive athletic games. Capsule and ligamental injuries of the 3rd and 4th digit can be treated conservatively by fixation to the next digits. Ruptures of the collateral ligaments of the 1st, 2nd and 5th digit as well as injuries with accompanying fracture or joint instability have to be surgically repaired. The different types of ligamental ruptures and their surgical treatment are discussed.

Diagnosis, Differential↗
PubMed1995

Posterior tibial tendon dysfunction in rheumatoid arthritis.

Although hindfoot pathology in rheumatoid arthritis is a significant cause of disability for patients, the etiology of the planovalgus deformity is controversial. The present study surveys 99 patients with clinically proven rheumatoid arthritis for the presence and severity of hindfoot pathology. Specific attention was directed at the function of the posterior tibial tendon, as disruption of this structure has been implicated by some investigators as a cause of hindfoot deformity in rheumatoid arthritis. Assessment of posterior tibial function was by manual testing using two different grading scales, as well as by examination for several signs associated with posterior tibial tendon dysfunction. Between 13% and 64% of the study population could be considered to have posterior tibial tendon dysfunction, depending upon the specific diagnostic criteria used. Using the presence of all three of the most stringent criteria for diagnosis, 11% of patients were believed to have posterior tibial tendon dysfunction. These criteria were loss of the longitudinal arch, inability to perform a heel-rise, and lack of a palpable posterior tibial tendon. This study demonstrates that planovalgus deformity in rheumatoid arthritis can be due to clinically evident dysfunction of the posterior tibial muscle-tendon unit. There is a complex interplay between hindfoot joint disruption due to the inflammatory process and deformity due to tendinous dysfunction. If there is primary subtalar joint instability secondary to the inflammatory process, the posterior tibial tendon is rendered dysfunctional due to deranged hindfoot mechanics, as with primary posterior tibial tendon rupture. Since treatment of either condition (i.e., primary hindfoot instability or primary posterior tibial tendon rupture) is similar, the distinction is not important clinically.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1975

Kinematics of the knee after prosthetic replacements.

A method was developed for describing the flexion-extension motion of the knee joint in a sagittal plane, by employing ciné radiography and then plotting the loci of three points on the femur relative to the tibia. Normal knees displayed similar patterns, the curves were smooth, and flexion-extension curves superimposed. A standard knee outline with standard curves was defined, with which to compare the abnormal and prosthetic knees. Arthritic knee patterns differed significantly from the normals. The curves were irregular and the flexion-extension curves were different. Instability, joint surface irregularity and muscle spasm were thought to be the main causes. The curves for the MacIntosh tibial plateaus were abnormal in a similar way to the arthritics. This may have been due to residual instability and to the replacement of only one bearing surface. The condylar replacement prostheses (the uni-condylar, duo-condylar and Geometric) tended to produce close-to-normal knee patterns, probably due to restoration of a relatively normal geometry, and to replacement of both bearing surfaces. The knees with fixed hinge prostheses (Walldius, Shiers and Guépar) showed abnormalities of motion and of the relative postion of the femur on the tibia. These features would be undesirable for the correct functioning of soft tissues around the knee. The stabilo-condylar hinge, which did not require much bone resection, gave a motion comparable to the condylar replacements.

Adult↗
PubMed1984

C.S. Campbell: Gamekeeper's thumb.

Rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb is an injury frequently encountered by the emergency physician. The mechanism of injury is usually a fall onto the abducted thumb. The setting is frequently one of athletic endeavor, especially skiing, in which this is the most commonly encountered upper extremity injury. The physical findings typical of collateral ligament rupture may easily be overlooked on casual examination. When not appropriately managed, the injury may result in chronic pain, weakness, and joint instability. The eponym "gamekeeper's thumb" derives from a report of similar injuries described as occurring in a series of British gamekeepers.

Finger Injuries↗
PubMed1978

[Symptom dynamics in the surgical treatment of posttraumatic arthrosis deformans of the knee joint].

288 cases of posttraumatic deforming arthrosis of the knee-joint were examined. The further postoperative periodic examinations and checking of the late results of the treatment of 171 patients have proved that the symptoms of the disease are mainly due to the disorders in the knee-joint stability. The obtained data suggest the possibility of a secondary inflammatory origin of pain in deforming arthrosis and witness an important role played by the surgical prevention and correction of the joint instability in clinical remission of th disease.

Adult↗
PubMed1989

Postero-lateral subluxation of the superior tibio-fibular joint.

Foot drop resulting from subluxation of the superior tibio-fibular joint is described in a female dancer. Spontaneous resolution of the nerve injury occurred over two months with no residual joint instability. Expectant management is recommended for this injury. The potential for this unusual injury, in a wide variety of sports, is pointed out.

Adult↗
PubMed1988

The pathogenesis and treatment of rheumatoid wrist and hand deformities.

As rheumatoid arthritis progresses, pannus formation causes subchondral bone damage and later cartilage and bone destruction. Stretching of ligaments due to capsular distension causes joint instability, and infiltration. These processes are frequently responsible for deterioration in hand function. However, present surgical treatments of wrist and hand deformities allow a degree of independence.

Arthritis, Rheumatoid↗
PubMed1982

[A clinical study on arthrography of the elbow joint (author's transl)].

There are many patients who visit a clinic with some complaints at the elbow joint. In such cases, it is customary to evaluate radiographs in making diagnosis. However, it is often difficult to interpret the X-ray films due to structural complexity of the elbow joint. Although in some cases arthrography is performed, there is neither standard technique nor standard method of projection established, hence the evaluation of the arthrogram is often quite difficult. The purpose of this paper thereby is to study the role of the arthrography of the elbow joint as a diagnostic tool second to plain X-rays. The technique must be simple and interpretation of it must be easy as well. It also should provide much diagnostic informations. The author firstly set a standard procedure of the elbow joint arthrography and a standard series of radiographic projections which suffice the above-mentioned conditions. Secondly, analysis of the procedure was done and the normal arthrograms were shown using cadavers. Thirdly, the author performed this procedure in 250 patients who have various disorders in the elbow joint. Finally, the clinical significance of this procedure as a diagnostic tool to elbow joint diseases was discussed. The results are as follows: 1. One ml of positive contrast medium in a child or 2 ml in an adult was injected through postero-lateral puncture of the radio-brachial joint. Three X-ray films--A-P, lateral, 45 degrees ulnar oblique--were obtained. 2. It was found that the arthrograms taken by this procedure can give informations which cannot be obtained by plain X-rays. 3. This procedure of arthrography is very useful as a diagnostic tool in many occasions i.e. in making correct diagnosis in trauma of children such as fracture, dislocation and ligamentous injury; in finding the existence, the location and the grade of synovitis; in finding the location and the size of a tumor; in finding the precise location of the abnormal shadow at the elbow joint; in deciding the level of the osteotomy in cubitus varus deformity; in evaluating derangement, tardy ulnar palsy and joint instability due to osteochondritis, etc. 4. By the analysis of the arthrograms in 250 patients it was shown that this procedure of arthrography gives significant clinical informations.

Adult↗
PubMed1993

Pressure distribution at the knee joint. Influence of varus and valgus deviation without and with ligament dissection.

Traumata or repetitive microtraumata, malalignment with varus or valgus deviation, or chronic joint instability are discussed in the aetiology of osteoarthritis and osteochondritis dissecans of the knee. Biomechanical factors influencing the patterns of pressure distribution at the articular surface and the subchondral bone are suggested to be most important in the pathogenesis. Consequently, the patterns of pressure distribution at the femoral condyles of weight-bearing knee joints were investigated in a cadaveric biostatic model. The pressure in the articular joint space was evaluated with pressure-sensitive films of the knee in different joint positions in the coronal plane (10 degrees varus, 10 degrees valgus, and neutral position) without and with medial collateral ligament (MCL), lateral CL (LCL), MCL + anterior cruciate ligament (ACL) or LCL + ACL ligament division. Results demonstrated that the location of the contact area and the peak pressure depended on the joint position and stage of ligamentous division. Without ligament division, a maximum peak pressure was observed at the medial condyle in the neutral and varus positions. Only in the valgus position did the lateral condyle show a higher peak of pressure than the medial condyle. Ligament division of the LCL and LCL + ACL resulted in an increase of peak pressure at the medial condyle, particularly in the varus position. Division of the MCL and MCL + ACL ligament complex reduced the differences between the medial and lateral condyle. In the valgus position, the peak pressure was significantly higher at the lateral condyle. The absolute maximum peak pressure was measured in the varus position at the medial condyle after division of the LCL and ACL.(ABSTRACT TRUNCATED AT 250 WORDS)

Cadaver↗
PubMed1982

Intraepiphyseal osteotomy for progressive tibia vara: case report and rationale of management.

Tibia vara (Blount's disease) is characterized by two components, the epiphyseal, which is concerned with articular relationships, and physeal/metaphyseal, which may produce angulation of a long bone. Although the initial etiology is not known, it appears that asymmetrical pressure applied to the angulated proximal tibia results in progressive deformity. In the initial stages, medial and posteromedial pressure causes growth retardation of the epiphysis (articular instability) and the physis (tibia vara). Nonsurgical or surgical treatment that relieves the pressure generally permits reconstitution of normal growth. Continued abnormal pressure and shear forces applied to the physis may result in disorderly enchondral ossification and produce a true osteochondrosis, which may lead to permanent physeal arrest. Osteotomy alone to relieve medial pressure may allow the tibia to grow straight, but residual medial epiphyseal compression and joint instability may persist. A case is reported of a 13 1/2 year follow-up of a patient in whom intraepiphyseal osteotomy restored articular congruity without interfering with longitudinal growth. The risks and experimental nature of this procedure are emphasized.

Child↗
PubMed1995

Arthroscopy of the acromioclavicular joint.

For many years the Mumford procedure or open resection of the distal clavicle has been the procedure of choice for the treatment of recalcitrant acromioclavicular joint pain. With advancement in shoulder arthroscopy and bursoscopy, arthroscopic resection of the distal clavicle can reproduce similar excellent results, avoiding some of the risks of the open procedure, including joint instability and muscle weakness. The arthroscopist can select from two approaches, a direct or superior approach or the indirect or subacromial approach. Both approaches are effective if the resection is performed in a systematic fashion and the amount of resection measured post-operatively. The authors have attempted to describe the pertinent anatomy of the acromioclavicular joint, clinical indications, and surgical technique for arthroscopic resection of the distal clavicle.

Acromioclavicular Joint↗
PubMed2000

Arthrodesis procedures for salvage of the hallux metatarsophalangeal joint.

First metatarsophalangeal (MTP) fusion has been recommended as a means to salvage various great toe deformities. These deformities include failed hallux valgus procedures, failed silicon implants, previous infection, rheumatoid arthritis, post-traumatic conditions, hallux rigidus, severe hallux valgus deformities, and neuromuscular disorders. A variety of complications, such as hallux varus, first MTP joint instability, infection, recurrent hallux valgus, and avascular necrosis of the first metatarsal head can develop from hallux valgus deformity treatment procedures.

Adult↗
PubMed1994

Arthroscopic treatment of degenerative tears of the triangular fibrocartilage.

The arthroscope permits treatment of degenerative tears of the TFC and associated lesions. It lends itself to the assessment and treatment of both "primary" and "secondary" ulnar impaction syndromes. Ulnocarpal, radiocarpal, and midcarpal synovitis can be excised, as can partial tears of the lunatotriquetral interosseous ligament. The primum movens of the ulnar impaction syndrome, a long ulna, can be shortened arthroscopically if the positive ulnar variance is less than 4 mm and no distal radioulnar joint instability or degenerative changes are noted. Although an arthroscopic "wafer" procedure is possible, more clinical studies are needed to allow an accurate assessment of its efficacy.

Adult↗
PubMedDate not supplied

Special problems in limb-salvage surgery.

Limb-salvage surgery is a safe and effective treatment for malignancies of the musculoskeletal system. Careful evaluation and planning are necessary to avoid both early and late complications. Biopsy must be carefully performed to avoid unnecessary contamination and to obtain adequate tissue for an accurate diagnosis. Pathologic fractures present both a diagnostic and a therapeutic challenge, and evaluation strategies depend on the age of the patient. Treatment of a pathologic fracture depends on the location and the histology of the lesion and many host factors. Limb salvage may or may not be indicated. Instability is another problem with certain limb-salvage situations, e.g., when it is necessary to resect the scapula. Various approaches may obviate the problem. The salvage of failed limb-salvage procedures requires careful evaluation and planning. Patients with infections and local recurrences often require amputation surgery. Correctable problems following failed allograft reconstructions include collapse of the articular cartilage, joint instability, nonunion, and fracture of the allograft. Correctable problems following prosthetic arthroplasty include aseptic loosening, prosthetic fracture, and polyethylene wear. Approximately two thirds of patients with failed limb-salvage procedures will obtain a functional limb following revision surgery. Attention to these special problems may allow for greater success with limb-salvage surgery.

Biopsy↗
PubMed2005

Subchondral bone trauma causes cartilage matrix degeneration: an immunohistochemical analysis in a canine model.

UNLABELLED: Joint instability was believed to be the main cause of osteoarthritis following non-fracture articular trauma. However, sudden high impact load through articular cartilage onto subchondral bone may also cause osteoarthritic changes. OBJECTIVE: We asked whether early osteoarthritic changes following transarticular impact may be depicted using immunofluorescence on unfixed cryosections to contribute to a more detailed understanding of degenerative processes of joint impaction. DESIGN: Transarticular impacts were applied to patellofemoral joints of 12 skeletally mature beagle dogs (age: 15-16 months) using a drop tower. Biopsies of impact areas were sampled after 6 months and processed for standard light microscopy on formalin-fixed sections and for immunofluorescence for collagen type I (col I), type II (col II) and aggrecan (AC) on unfixed cryosections. Gross morphology and immunofluorescence on cryosections were documented using a semi-quantitative scaling system, compared to healthy controls and to standard light microscopy. RESULTS: Four biopsies showed almost entirely fibrocartilaginous morphology, four appeared to be of preserved hyaline morphology with only minor signs of fibrocartilaginous remodelling and four showed preserved hyaline appearance. We found decrease in col II and AC expression in highly degenerative specimens as well as increase of col I expression. Increased col I expression in the pericellular matrix could even be depicted in specimens with intact hyaline morphology. DISCUSSION/CONCLUSION: Observations suggest that joint impaction causes early osteoarthritic changes after 6 months. Collagen network disruption seems to lead to AC loss, although other researchers found isolated AC loss without denaturation of col II using immunofluorescence in formalin-fixed specimens. This is the first study on effects of transarticular impact using immunofluorescence on unfixed cryosections.

Aggrecans↗
PubMed2001

Sigmoid notch osteoplasty for chronic volar instability of the distal radioulnar joint: a case report.

Chronic recurrent volar dislocation of the distal radioulnar joint is a rare condition for which many operative procedures have been described. We describe a case of painful dislocation on supination. Investigation of the distal radioulnar joint revealed the absence of degenerative arthritis and a flat sigmoid notch that permitted dislocation. The case was successfully treated by osteoplasty of the volar lip of the sigmoid notch to create a buttress that prevented volar dislocation.

Adult↗
PubMed1993

Results of vascularized joint allograft under immunosuppression with cyclosporine.

The effects of cyclosporine (CsA), a strong immunosuppressive drug, on vascularized allogeneic joint transplantations were examined. An orthotopical transplant model of a vascularized knee joint allograft was developed using inbred DA and Lewis rats to investigate the fate of grafts following withdrawal of short-term immunosuppression compared to continuous immunosuppression with CsA. Five isograft controls acquired solid bone union at both femur and tibia sites within 4 weeks, and joint function as skeletal support was maintained until 25 weeks. Without immunosuppression, ten allografts were severely rejected within the first week, and joint destruction occurred immediately. Twenty-five short-term immunosuppressed rats acquired solid union, but, after withdrawal of immunosuppression, grafted joints showed gradual rejection and were destroyed due to pathological fractures or joint instability, although partial revascularization from the recipient occurred. Ten allografts under continuous immunosuppression at a dose of 10 mg/kg/day showed no rejection and remained viable for 12 weeks postoperatively, but thereafter all rats died. Death was considered to be a side effect of CsA. Fifteen animals, under continuous immunosuppression at a dose of 5 mg/kg/day, showed no rejection except in the bone marrow; the grafted joint function was not effected until 25 weeks. Continuous treatment with low and nontoxic doses (5 mg/kg/day) of CsA was necessary to maintain the functions of the grafted joint.

Animals↗