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PubMed1986

Tensile properties of the medial collateral ligament as a function of age.

The biomechanical properties of the rabbit medial collateral ligament (MCL) as a function of maturation and age were investigated. Femur-MCL-tibia (F-M-T) preparations were obtained from rabbits of different age groups (open or closed epiphysis). Parallel increases in the animal body weight and ligament cross-sectional area were recorded with age. Cyclic and tensile failure tests were performed to obtain the structural properties of the F-M-T complex and the mechanical properties of the MCL substance. There were significant increases in the load at failure, energy-absorbing capability of the bone-ligament junction, and in the tensile strength of the ligament substance as a result of maturation and subsequent aging. Increases in the area of hysteresis obtained during cyclic loading-unloading were also documented. At the closing of the epiphysis, the mode of failure of the F-M-T structure progressed from tibial avulsion to failure in the midsubstance of the ligament. An asynchronous rate of maturation was observed between the structural properties of the bone-ligament complex and the mechanical properties of the ligament substance.

Aging↗
PubMed1983

A morphologic study of the relationship of collateral ligaments to growth plates in the digits.

The precise origin and insertion of collateral ligaments to metacarpals and phalanges prior to growth plate closure is not clearly described in textbooks or journals. This study delineates such attachments by gross dissection and microscopic evaluation. Middle and distal phalangeal attachments are to epiphyses and metaphyses, whereas attachments at the metacarpophalangeal joint are almost entirely to the epiphyses of metacarpal and proximal phalanges. The clinical significance of these differences is not known.

Adolescent↗
PubMed1992

[MR tomography of injuries of the medial collateral ligaments of the knee joint].

Frequency and characteristics of lesions of the medial collateral ligaments (MCL) were studied by MRI in 155 patients with trauma to the knee. There were abnormalities of the MCL in 38% of cases with ligamentous injuries and in 27% these were combined with meniscal tears. 11% of these patients showed isolated rupture of MCL and as a result of the MRI findings were treated conservatively. By means of T2*-weighted images the individual lesions could be accurately localised. Characteristic findings have been defined.

Humans↗
PubMed1989

Medical collateral ligament healing subsequent to different treatment regimens.

The response of transected canine medical collateral ligaments (MCL) to clinical treatment regimens was investigated. These regimens included no surgical repair with no immobilization and surgical repair with various periods of immobilization. The biomechanical, biochemical, and histological properties of the healing MCL were examined 6 and 12 wk postoperatively. At 6 wk, all healing MCLs had increased cellularity with decreased levels of total collagen and increased amounts of reducible Schiff base cross-links and type III collagen. Biomechanically, the varus-valgus (V-V) knee laxity was significantly increased, and no group achieved normal structural or mechanical properties. At 12 wk the histological appearance of the MCL became more normal but still had increased cellularity. Biochemically, the total collagen levels in experimental MCLs were not statistically different from the controls, but these MCLs still had high amounts of type III collagen and an even higher number of reducible cross-links. From knees in which the MCL was not treated, the V-V knee laxity and the ultimate loads of the femur-MCL-tibia complex achieved normal values. However, the stress-strain properties for these MCLs and those treated with repair and immobilization did not completely recover.

Animals↗
PubMed2007

Sonographic diagnosis of acute injuries of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb.

PURPOSE: To evaluate the significance of the ultrasonographic appearance of the aponeurosis for deciding the best treatment for ulnar collateral ligament (UCL) injuries of the thumb metacarpophalangeal joint. METHODS: Fourteen patients (11 men, 3 women; mean age, 41 years; range, 15-66 years) who had an acute UCL tear were included. All patients were examined by ultrasonography (US) with a 7.5-MHz transducer and subsequently underwent surgery. The ultrasonographic findings were compared to the intraoperative findings. RESULTS: UCL injuries were classified into two types by US according to the appearance of aponeurosis and its spatial relationship with the UCL: the intra-aponeurosis type (5 patients) and the extra-aponeurosis type (9 patients). In the 5 patients with intra-aponeurosis, ultrasonographic findings were well consistent with intraoperative findings. In contrast, extra-aponeurosis cases contained two different pathologies: of the 9 patients, 7 had so-called 'Stener lesions', one showed folding of a ruptured capsule, and one showed a ruptured aponeurosis. CONCLUSIONS: Because US is highly reliable in differentiating intra-aponeurosis from extra-aponeurosis types of injuries, the aponeurosis is a more reliable reference than Stener lesion for treatment decision by US.

Adolescent↗
PubMed2003

Dynamic US of the anterior band of the ulnar collateral ligament of the elbow in asymptomatic major league baseball pitchers.

PURPOSE: To determine whether dynamic ultrasonography (US) can reveal abnormalities of the anterior band of the ulnar collateral ligament (UCL) of the elbow in asymptomatic major league professional baseball players. MATERIALS AND METHODS: US was performed in 26 asymptomatic major league professional baseball pitchers before spring training. Images were obtained in both pitching and nonpitching arms with a multifrequency 13-MHz linear-array transducer. The thickness of the anterior band of the UCL and the width of the joint it spans (the ulnohumeral joint) were measured with the elbow at 30 degrees of flexion, both at rest and with valgus stress. The thickness of the anterior band of the UCL and the width of the joint space were compared for pitching and nonpitching arms by using the Student t test. The prevalence of hypoechoic areas and calcifications within the anterior band of the UCL in pitching and nonpitching arms was compared by using the McNemar test. The average time of the US examinations was recorded. RESULTS: At rest, the mean thickness (+/- 1 SD) of the anterior band of the UCL was 6.3 mm +/- 1.1 in pitching arms and 5.3 mm +/- 1.0 in nonpitching arms. This difference was statistically significant (P <.01). With stress, the anterior band thickness was 6.3 mm +/- 1.4 in the pitching arms and 4.8 mm +/- 0.9 in the nonpitching arms (P <.001). The joint space width at rest was 2.8 mm +/- 1.0 in the pitching arms and 2.5 mm +/- 0.7 in the nonpitching arms (not statistically significant). When stress was applied, however, the joint space width was significantly greater in the pitching arms than in the nonpitching arms (4.2 mm +/- 1.5 vs 3 mm +/- 1.0, respectively; P <.01). Hypoechoic foci within the anterior band of the UCL were seen in 18 of 26 (69%) pitching arms and three of 26 (12%) nonpitching arms (P <.001). Calcifications were detected in nine of 26 (35%) pitching arms but in none of the nonpitching arms (P <.001). The average time for bilateral US was 10.4 minutes. CONCLUSION: Dynamic US provides a rapid means for evaluating the anterior band of the UCL in professional baseball pitchers. In pitching arms, this band is thicker, is more likely to have hypoechoic foci and/or calcifications, and demonstrates more laxity with valgus stress.

Adult↗
PubMed2005

Heterotopic ossification of the ulnar collateral ligament: a description of a case in a top level weightlifting athlete.

The purpose of this paper is to describe a case of heterotopic ossification of the ulnar collateral ligament in a 29-year-old top level weightlifter. Plain radiography of the elbow determined the extent and location of heterotopic ossification. Ultrasound and MR imaging completed the instrumental set-up. This symptomatic case had the resolution of pain after 2 months of a supervised rehabilitation program. At one year follow-up the athlete is asymptomatic referring occasional minor pain only in the periods of vigorous training.

Adult↗
PubMed2003

MR imaging of calcification of the lateral collateral ligament of the knee: a rare abnormality and a cause of lateral knee pain.

OBJECTIVE: Our objective was to describe the radiologic appearances of calcification of the lateral collateral ligament (LCL) of the knee in four patients who presented with acute atraumatic lateral knee pain. This rare abnormality has not, to our knowledge, been previously shown on MR imaging. CONCLUSION: Calcification of the LCL of the knee is a rare cause of lateral knee pain and is thought to reflect underlying hydroxyapatite deposition. On MR imaging, calcification of the LCL may be associated with an aggressive appearance that can be mistaken for other knee abnormalities.

Adult↗
PubMed2006

Collateral ligaments of the distal sesamoid bone in the digit of Equus: re-evaluating midstance function.

The distal forelimb of the horse has a complex array of ligaments that play a critical role in determining function of the digit and are often associated with the initiation of foot pathologies. The collateral ligaments of the distal sesamoid bone (CLDS) play an important role in digit stabilization near the end of foot contact and there is also limited evidence to suggest that the CLDS stabilize the proximal interphalangeal joint (PIPJ) during weight bearing. By virtue of their anatomical attachments where the ligaments pass dorsal to the axis of rotation of the PIPJ, it is reasonable to assume that the CLDS prevent flexion of the PIPJ during weight bearing or midstance in a moving horse. To test this functional hypothesis, forelimb specimens from three mixed-breed horses were loaded in compression in a materials testing frame. Limb loading was applied with the CLDS intact and following transection. Average PIPJ angle and metacarpophalangeal joint (MCPJ) angle at maximum load (approximately 3000 N) were calculated from angular changes of proximal and middle phalanges and the third metacarpal, which were compared between intact and transected trials. PIPJ angles were found to be the same (175 degrees) at maximum load for intact and transected trials. The proximal and middle phalanges rotated together remaining aligned, regardless of the CLDS condition. Contrary to expectation, however, the combined proximal and middle phalanges unit rotates less relative to the third metacarpal under load after transection, indicating less digit extension at the metacarpophalangeal (fetlock) joint without the influence of CLDS. Since the mechanical properties of the fetlock joint are unchanged by CLDS transection, observed proximal and middle phalanx motion is dependent on increased rotation of the distal phalanx after transection. The original hypothesis was not supported and the results suggest that at midstance the CLDS function primarily to stabilize the articulation of the middle phalanx about the distal phalanx to limit distal interphalangeal joint extension during weight bearing. Establishing the functional role of the CLDS may help to better understand the biomechanical consequences of ligament injuries and diseases of the pastern.

Animals↗
PubMed1995

Ulnar collateral ligament: differentiation of displaced and nondisplaced tears with US.

PURPOSE: To determine the usefulness of ultrasound (US) in the differentiation of displaced and nondisplaced tears of the ulnar collateral ligament (UCL). MATERIALS AND METHODS: A 7.5-10-MHz linear-array transducer was used to examine 69 patients in whom a UCL tear was suspected, 43 of whom also underwent surgery. The US findings were compared with those obtained at surgery. RESULTS: Results of US corresponded to results of surgery in 37 of 43 patients. Findings were false-positive in six patients. Twenty-six patients were treated conservatively with thumb casts. These patients showed stability and free range of motion at the first metacarpophalangeal joint at clinical follow-up (9-13 months). CONCLUSION: Sonography is useful for evaluating nondisplaced and retracted tears of the UCL and determining the need for surgery.

Adolescent↗
PubMedDate not supplied

Kinetics of osmotic water movement from rabbit patellar tendon and medial collateral ligament fibroblasts.

The present study is part of a program to optimize the cryopreservation ligament and tendon allografts for the biological remodeling that occurs following transplantation. The osmotic behavior of fibroblasts from the medial collateral ligament (MCL) and the patellar tendon (PT) of new zealand white rabbits was measured to obtain the hydraulic conductivity (and its temperature dependence) as well as the osmotically inactive volume. MCL fibroblasts were found to have an isotonic cell volume of 3800 (m(3), an osmotically inactive volume of 1300 (microm(3), and a hydraulic conductivity of 0.56 (microm/min/atm at 20 degrees C with an activation energy of 10.9 kcal/mol. PT fibroblasts were found to have an isotonic cell volume of 6300 (microm(3), an osmotically inactive volume of 2000 (microm(3), and a hydraulic conductivity of 0.71 (m/min/atm at 20 degrees C with an activation energy of 10.1 kcal/mol.

Animals↗
PubMed1995

Ulnar collateral ligament injury in the throwing athlete: evaluation with saline-enhanced MR arthrography.

PURPOSE: To determine whether magnetic resonance (MR) arthrography of the elbow can demonstrate precisely an ulnar collateral ligament (UCL) abnormality in the throwing athlete. MATERIALS AND METHODS: Forty college-level and professional throwing athletes (age range, 18-40 years) underwent saline-enhanced MR arthrography of their injured elbows. MR findings were compared with the surgical findings. RESULTS: Saline-enhanced MR arthrography was positive in 24 of 26 individuals with UCL tear confirmed at the time of surgery. Eighteen (95%) of 19 complete UCL tears and six (86%) of seven partial UCL tears were diagnosed with MR arthrography. Two false-negative findings and no false-positive findings were obtained. CONCLUSION: Saline-enhanced MR arthrography of the elbow is a new application of a previously described technique used in the shoulder. It is useful for demonstration of subtle and gross UCL abnormalities in the throwing athlete.

Adolescent↗
PubMed2003

Grade III radial collateral ligament injuries of the thumb metacarpophalangeal joint: treatment by soft tissue advancement and bony reattachment.

PURPOSE: The purpose of this study is to report the results of intact radial collateral ligament (RCL) soft tissue sleeve advancement with bony reattachment without additional soft tissue reinforcement as the sole surgical repair technique for the treatment of grade III RCL injuries to the thumb metacarpophalangeal (MCP) joint in acute, chronic, and late cases. METHODS: During a 20-year period, 38 of 45 patients (84%) with grade III RCL injuries were found to have tears at or adjacent to the metacarpal head (25 patients) or the proximal phalanx (13 patients) and underwent surgical repair at a mean of 10.8 months after injury. Patients were evaluated at a mean follow-up time of 3.8 years (minimum, 1 year), comparing pre- and postoperative standard thumb x-rays, varus (adduction) MCP joint stress x-rays, joint range of motion, pinch and grip strengths, clinical deformity, and subjective symptoms. RESULTS: Thirty-three patients (87%) were symptom free. Thirty-five patients (92%) regained normal pinch and grip strength. Thirty patients (79%) had full range of motion at the MCP joint, and no patient lost any interphalangeal joint motion. No recurrent symptomatic MCP joint instability was noted. Three patients (8%) had mild residual asymptomatic MCP joint volar subluxation. One patient had progression of pre-existing degenerative joint changes. CONCLUSION: Acute, chronic, and late grade III RCL instability of the thumb MCP joint can be successfully treated in the majority of cases by RCL soft tissue sleeve advancement and bony reattachment alone without the need for other soft tissue reinforcement.

Adolescent↗
PubMed1997

Repair of the ulnar collateral ligament of the thumb. Technique and outcome in 21 patients followed for minimum 1.5 years.

21 patients were surgically managed using pull-out technique for acute rupture of the ulnar collateral ligament of the thumb. Clinical examinations and stress radiography in extension has been performed in all patients. Function at a mean follow up time of 3 (1.5-6) years showed excellent results in 18 patients, good in 1, and fair in 2. No complications occurred.

Adult↗
PubMed2001

MR imaging of the medial collateral ligament bursa: findings in patients and anatomic data derived from cadavers.

OBJECTIVE: The purpose of this work was to define the MR imaging findings of fluid collections confined to the medial collateral ligament (MCL) bursa and to correlate these findings with anatomic features shown in cadaveric specimens. MATERIALS AND METHODS: The anatomic location of the MCL bursa was investigated by MR-anatomic correlation in seven cadaveric knees. The MR imaging studies and clinical charts of six patients with fluid collections confined to the MCL bursa were reviewed. RESULTS: On anatomic sections, the MCL bursa was located between the superficial and deep portions of the MCL. Separate femoral and tibial compartments were seen in most specimens. CONCLUSION: The anatomy of the MCL bursa is shown with MR imaging in cadaveric specimens and patients. Understanding the compartmentlike distribution of fluid in the MCL bursa at MR imaging allows accurate diagnosis and differentiation from other conditions.

Adult↗
PubMed2004

Collagen fibrillogenesis and mRNA levels in the maturing rabbit medial collateral ligament and patellar tendon.

This study compared collagen fibril diameter and mRNA changes in a subset of molecules involved in collagen fibrillogenesis during postnatal development and at maturity of rabbit medial collateral ligament (MCL) and patellar tendon (PT). Tissue was analyzed by RT-PCR for mRNA levels and collagen fibril diameters were measured using transmission electron microscopy. Collagen fibril diameters increased from 3 to 14 weeks with mean fibril diameters of PT significantly greater than MCL at 9, 12, and 14 weeks and maturity. RT-PCR analysis showed decorin and lumican mRNA levels were significantly higher in PT than MCL at all ages. Type I collagen, MMP-11, and procollagen C proteinase enhancer mRNA levels also were higher in the PT than the MCL between 3 and 14 weeks but not at maturity. Further understanding of collagen fibrillogenesis by studying protein synthesis and matrix turnover during maturation may provide insight into the mechanism(s) by which fibrils accrete in maturing connective tissues and how they are altered during healing following injury.

Animals↗
PubMed2003

The biomechanical response to doses of TGF-beta 2 in the healing rabbit medial collateral ligament.

Ligament injuries result in significant disability in over 100,000 patients each year. Despite current methods of treatment, 13% of patients with medial collateral ligament (MCL) injury develop early signs of arthritis, suggesting an incomplete return of knee stability. The principal hypothesis of this work was that the addition of TGF-beta 2 to the healing MCL would accelerate the development of scar strength and stiffness. Forty-four rabbits were divided evenly into four groups, with each group receiving either 0.1, 1 or 5 microg of TGF-beta 2 and the fourth group receiving 1 microg TGF-beta 2 and 1 microg of PDGF. Each rabbit underwent bilateral transection of the MCL, with one side having treatment with one of four doses of growth factor and the other side left untreated. All animals were sacrificed at 6 weeks and the structural properties of maximum load at failure, stiffness, and energy absorbed at failure measured. All treatment groups demonstrated an increase in scar mass, but no group had a significant increase in scar load at failure at 6 weeks. The addition of 0.1 microg TGF-beta 2 led to a significant increase in scar stiffness. The addition of PDGF had no significant effect on any of the parameters studied. This study suggests the mechanical stiffness, but not the load at failure, of ligament scar can be significantly altered by the administration of TGF-beta 2.

Animals↗
PubMed1995

Sonography of the injured ulnar collateral ligament of the thumb.

We used high-resolution ultrasonography to image the ulnar collateral ligament in 39 patients who had sustained recent injuries of the metacarpophalangeal joint of the thumb. All the patients were subsequently operated on and the lesions of the ligament were recorded. In 36 patients the preoperative ultrasonographic diagnosis was correct. Five of these showed no rupture of the ligament. In the other 31, ultrasonography correctly distinguished between rupture in situ (15) and rupture with dislocation of the ligament (16). Misdiagnosis by ultrasonography in three cases was due to delay of the investigation (three weeks after injury) in one, to technical error in one and to misinterpretation of the image in one.

Adolescent↗