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PubMed1997

Alternative method of repairing collateral ligament injuries at the metacarpophalangeal joints of the thumb and fingers. Use of the Mitek anchor.

Injuries to the joints of the thumb and fingers frequently cause complete or partial tears of the collateral ligaments, resulting in marked instability of the involved joint. Twelve patients with 12 unstable metacarpophalangeal joints were treated surgically with a Mitek metal suture anchor. At the last postoperative follow-up (range 6 weeks-6 months) 11 of 12 patients had good to excellent results subjectively and had regained 75% of the strength of the uninjured side.

Adolescent↗
PubMed2006

New hamstring fixation technique for medial collateral ligament or posterolateral corner reconstruction using the mosaicplasty system.

In this study, we describe a new hamstring fixation technique with a bone graft using the Mosaicplasty system for the reconstruction of the medial collateral ligament (MCL) or posterolateral corner (PLC) of the knee. In this technique, a cylindrical bone plug (6.5 mm in diameter, 15 mm in length) is harvested from the anatomical femoral attachment of the MCL or popliteal tendon using the Mosaicplasty system. After placing the autologous semitendinosus or gracilis tendon as a graft in the created bone socket, the bone plug is replaced over the graft. The graft is secured with a spike staple after appropriate tension is applied to the graft. This fixation technique can provide rigid and less invasive fixation, because the distance between the fixation sites can be shorter than that in the Endobutton technique. Compared to fixation with only a staple with no bone graft, the bone graft may enhance tendon to bone healing.

Arthroplasty↗
PubMed2004

Ultrastructural comparison of medial collateral ligament repair after single or multiple applications of GaAlAs laser in rats.

BACKGROUND AND OBJECTIVES: To examine single versus multiple applications of a gallium aluminum arsenide (GaAlAs) laser on the ultrastructural morphology of surgically injured medial collateral ligaments (MCLs) in rats. STUDY DESIGN/MATERIALS AND METHODS: Sixteen rats were studied with 12 receiving right MCL transection and 4 receiving sham injury. Group 1 (n = 4) received one session of laser (31.6 J/cm(2)) immediately after injury. Group 2 (n = 4) received 9 doses of transcutaneous laser (3.5 J/cm(2)). The controls (Group 3, n = 4) received one session of placebo laser, while the sham Group 4 (n = 4) received no treatment. Ultrastructural analyses were done with electron microscopy at 3 weeks. RESULTS: The mass-averaged diameters of collagen fibril in the core and periphery of MCLs treated with multiple laser were larger than the control and those with single laser treatment (P < 0.05). However, the sham injured group had larger fibrils than all other groups (P < 0.05). CONCLUSIONS: The repairing MCLs had smaller collagen fibrils than the sham injured ligaments. Multiple laser treatments enhanced the collagen growth in the repairing MCLs at 3 weeks after injury, which are superior to a single treatment with similar dosage.

Animals↗
PubMed2002

Dynamic sonography with valgus stress to assess elbow ulnar collateral ligament injury in baseball pitchers.

Sonography is a valuable method for imaging superficial tendons and ligaments. The ability to obtain comparison images easily with dynamic stress allows assessment of ligament and tendon integrity. We studied the medial elbow joints of two baseball pitchers using MR imaging and dynamic sonography. Both sonography and MR imaging identified the ulnar collateral ligament tears. Dynamic sonography uniquely demonstrated the medial joint instability.

Adolescent↗
PubMed2001

Noncontrast MR imaging and MR arthrography of the ulnar collateral ligament of the elbow: prospective evaluation of two-dimensional pulse sequences for detection of complete tears.

OBJECTIVE: To compare MR imaging techniques with differing contrast and spatial resolution for evaluation of complete disruption of the ulnar collateral ligament (UCL) anterior bundle in a cadaveric elbow model. DESIGN: Complete UCL tears were surgically created at the typical location for clinical tears in eight of 28 fresh frozen cadaveric elbow specimens. All specimens underwent 1.5 T MR imaging in the oblique coronal plane, using an extremity coil. The sequences employed were: T1-weighted spin echo (T1 SE), proton density-weighted (PD) fast spin echo (FSE), fat-suppressed T2-weighted FSE (T2 FSE), gradient recalled echo (GRE) with a high matrix, PD FSE with a high matrix (HRPD), and fat suppressed T1-weighted SE with intra-articular gadolinium (MRAr). Two radiologists independently graded the UCL with separate and side-by-side assessments. RESULTS: Sensitivity/specificity pairs were as follows for reader A and reader B, respectively: T1 SE: 0.25/0.95, 0.50/0.95; PD FSE: 0.38/1.00, 0.25/1.00; T2 FSE: 0.50/0.95, 0.63/0.95; GRE: 0.63/0.85, 0.63/0.60; MRAr: 0.88/1.00, 1.00/0.80; HRPD: 0.50/1.00, 0.88/0.80. Kappa statistics for measuring interobserver reliability for each sequence were poor under T1 SE (-0.13) and GRE (0.19), moderate under HRPD (0.41) and T2 FSE (0.44) and good under MRAr (0.62) and PD FSE (0.78). For both readers, the rating for overall image quality was highest for HRPD, and the rating for UCL lesion conspicuity was the highest for MRAr. CONCLUSIONS: Of the MR imaging pulse sequences tested, MRAr showed the greatest ability to identify complete ligamentous injuries with good agreement between readers and had the highest subjective preference for lesion conspicuity. However, HRPD had the least interobserver variability and the highest subjective preference for overall image quality.

Aged↗
PubMed2006

Proprioception in the ACL-ruptured knee: the contribution of the medial collateral ligament and patellar ligament. An in vivo experimental study in the cat.

In the absence of anterior cruciate ligament (ACL), secondary restraints such as menisci, ligaments, and tendons restrict anterior knee laxity. Strain detection at these sites could define the contribution of this alternative signalling system to knee proprioception after ACL injury. The hypothesis in this study questions if measurements of anterior tibial translation (ATT) from surface strain gauges on the insertions of the medial collateral ligament (MCL) and the patellar tendon (PT) are sufficiently sensitive and specific to differentiate normal, stable knees from acutely unstable knees due to ACL section. Twelve cats received miniaturized strain gauges on the surface of MCL and PT distal insertions. A purpose-made receiver transformed into measurements any voltage variation obtained during passive knee flexion-extension and anterior tibial translation manoeuvres. Variables under evaluation included first peak latency, normalized amplitude, and slope of voltage along time. Femorotibial displacements were video recorded, digitized, and used as the ATT reference. The proposed system detected significant changes in the slope of the voltage/time signal, with higher specificity and sensitivity during ATT after experimental ACL section. Changes were not significant during flexion or extension. It was found that a pattern of earlier and more intense strain in MCL and PT distal insertions was found during ATT in the ACL deficient knee. Enhanced pattern recognition learning from these structures could be a future target for proprioceptive training after ACL injury.

Animals↗
PubMed1995

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

PURPOSE: To compare the usefulness of ultrasound (US) and magnetic resonance (MR) imaging in the differentiation of displaced and nondisplaced tears of the ulnar collateral ligament (UCL). MATERIALS AND METHODS: Seventeen patients (eight female and nine male, aged 14-70 years) with clinically diagnosed tears underwent examination with US and MR imaging. T1-weighted, spin-echo (SE) and T2-weighted, turbo SE sequences were used. MR and US findings were compared with those of surgery. Normal UCLs in 21 volunteers were also examined with MR imaging. RESULTS: The results of US were correct in 15 patients, but displaced and nondisplaced ruptures were misinterpreted in two patients (sensitivity, 88%; specificity, 83% for displaced, 91% for nondisplaced). Sensitivity and specificity were both 100% for MR imaging. The T2-weighted sequence was more useful because the normal UCL is rarely homogeneously hypointense. CONCLUSION: MR imaging is better than US, but both methods are useful in the evaluation of the torn UCL.

Adolescent↗
PubMed1983

Natural history of healing in the repaired medial collateral ligament.

The purpose of this study was to assess morphologically the healing of repaired medial collateral ligaments (MCLs) in a rabbit model. Healing ligaments were examined grossly and histologically at various intervals, from 3 days to 2 1/2 years after injury, and compared with the appearances of normal age-, sex-, and activity-matched controls. Results show that all ligaments healed by bridging scar formation rather than true ligament regeneration. Increases in cellularity and temporary matrix disorganization along the entire length of the ligaments during healing suggest a combination of diffuse mechanical damage from their failure in tension and regional inflammatory injury (in excess of surgical exposure alone) from the processes of degradation and replacement. Substance that was not injured physically in this model demonstrated complete recovery, while that replaced by scar did not. Healing processes were similar to those of other highly specialized soft tissues (e.g., tendons), with short phases of hemorrhage and inflammation, an intermediate phase of proliferation, and a prolonged phase of remodeling. Failure of repairs to maintain anatomical apposition of torn ends may have contributed to the delay of these healing processes by increasing scar mass. Incomplete scar remodeling at 2 1/2 years, however, suggests much slower MCL healing than previously reported and probably, therefore, a longer period for potential treatment influence.

Animals↗
PubMed1990

Aging and sex-related changes in the biomechanical properties of the rabbit medial collateral ligament.

The effects of aging and sex on the tensile properties of the rabbit medial collateral ligament (MCL) were examined. The femur-MCL-tibia complex (FMTC) of male and female rabbits, of representative ages before and after epiphyseal closure up to the onset of senescence (i.e., 3.5, 6, 12 and 36 months of age) were examined. A group of 48-month-old female rabbits was also tested. The specimens were tensile tested to failure in order to obtain both the load-elongation curve of the FMTC (structural properties) and the stress-strain curve of the MCL substance (mechanical properties). Significant increases in the linear stiffness, ultimate load and energy absorbed at failure of the FMTC were noted in both the males and females during skeletal maturation, but the FMTCs of the older rabbits began to show a slight decrease in these properties. The ultimate load of the FMTC for the male rabbits reached its plateau at approximately 6 months of age, while that of the females did not plateau until 12 months of age. The modes of failure correlated well with closure of the epiphyses in both sexes, i.e., tibial avulsion failure for the skeletally immature groups and mid-substance for the skeletally mature groups. The modulus of the MCL substance increased during maturation for both sexes until 12 months, and then gradually declined until 48 months. The tensile strength remained relatively constant after 12 months of age but was slightly reduced at 48 months for the females. Thus, the rate of skeletal maturation contributed in part to the differences in the tensile properties of both the male and female rabbits.

Aging↗
PubMed1998

[Medial collateral ligament of the knee and its surroundings: MRI findings of normal and abnormal structures].

Normal and abnormal structures of the medial corner of the knee were evaluated with coronal and axial MR images. MRI revealed 35 medial collateral ligament (MCL) tears and 61 medial meniscus (MM) tears in 200 consecutive examinations. Just under the MCL, little or no fluid retention was identified between the superficial and deep layers of the MCL or between the MM and MCL in normal knees and in cases of MM tears. At the anterior aspect of the MCL, the deep layer merges with the capsule of the suprapatellar bursa, potentially leaving space for fluid retention. Fluid collection posterior to the MCL was demonstrated in a few cases. Fluid retention with edematous swelling just under the MCL was noted in the cases of MCL tears. MM-MCL distances in the cases of normal structure, MM tears and MCL tears were 2.1 mm, 2.7 mm and 4.7 mm, respectively. The deep layer of the MCL, which was enhanced by the presence of joint fluid, was identified in 71% of cases.

Adult↗
PubMed2000

Treatment of chronic injuries of the ulnar collateral ligament of the thumb using a free tendon graft and bone suture anchors.

We report the results of a simple technique, using bone suture anchors and free tendon graft, for the reconstruction of chronic injuries of the ulnar collateral ligament complex at the thumb metacarpophalangeal (MP) joint. Our series includes 20 patients, with a mean age of 29 years. The mean follow-up period was 42 months. Using the Glickel grading system, 14 patients had excellent results and six had good results. Seventeen patients had no pain and three complained of mild pain with weather changes. Fourteen patients regained full stability of the MP joint and six had mild laxity. The mean loss of pinch strength was 18% compared with the contralateral thumb. The mean loss of motion at the metacarpophalangeal joint was 21%.

Adolescent↗
PubMed1976

Tension studies of human knee ligaments. Yield point, ultimate failure, and disruption of the cruciate and tibial collateral ligaments.

Ultimate failure strengths of human tibial collateral and anterior and posterior cruciate ligaments were determined at two different loading rates (12.5 and fifty centimeters per minute) using an Instron Tension Analyzer. The posterior cruciate ligament was significantly stronger than the tibial collateral and anterior cruciate ligaments, which were of equal strength. At ultimate failure the ligaments were intact macroscopically but electron microscopy revealed widespread disruption of the collagen fibrils. Only after further application of stress did actual macroscopic disruption occur, suggesting that microscopic failure of the collagen fibrils in grossly intact ligaments may be a significant cause of clinical instability.

Collagen↗
PubMed2002

Therapeutic low energy laser improves the mechanical strength of repairing medial collateral ligament.

BACKGROUND AND OBJECTIVES: Low energy laser therapy has been shown to enhance collagen production but its effect on tissue strength is not well reported. We tested the effects of therapeutic laser on the strength of healing medial collateral ligaments (MCLs) in rats. STUDY DESIGN/MATERIALS AND METHODS: Twenty-four rats received surgical transection to their right MCL and eight received sham operation. After surgery, 16 received a single dose of gallium aluminum arsenide laser to their transected MCL for 7.5 minutes (n = 8) or 15 minutes (n = 8) and eight served as control with placebo laser, while the sham group didn't receive any treatment. The MCLs were biomechanically tested at either 3 or 6 weeks post-operation. RESULTS: The normalized ultimate tensile strength (UTS) and stiffness of laser and sham groups were larger than control (P < 0.001). The UTS of laser and sham groups were comparable. Laser and sham groups had improved in stiffness from 3 to 6 weeks (P < 0.001). CONCLUSIONS: A single dose of low energy laser therapy improves the UTS and stiffness of repairing MCL at 3 and 6 weeks after injury.

Animals↗
PubMed1996

[Injuries of the medial collateral ligament and anterior cruciate ligament of the knee joint and Lemaire surgical functional treatment. Long-term outcome].

The present paper reports the results of 112 extraarticular ligamento-plasties performed on the knee with the procedure proposed by Lemaire. The series includes isolated tears of the anterior cruciate and medical collateral ligament as well as combined tears of both ligaments. The clinical and radiological results with a mean follow-up time of 11.5 years are compared with the results obtained in a first assessment 8 years ago. Good clinical results are in contrast with increasing osteoarthrosis in 1/3 of the knees radiologically assessed. The operation for a torn anterior cruciate ligament should be performed as soon as possible to avoid secondary meniscal lesions with subsequent severe osteoarthrosis. Presence or absence of arthrotic signs in the X-rays mainly determine the long-term result after ligamento-plasties of the knee. The Lemaire plasties are well tolerated even by elderly still active people and need little postoperative care.

Adult↗
PubMedDate not supplied

Significance of the suspensory and collateral ligaments in lesser metatarsal neck surgery.

In this study the authors have endeavored to define more closely the distinct nature of the collateral and suspensory ligaments of the lesser metatarsophalangeal joints and to propose a mechanism through which the ligaments confer stability to the metatarsal head. The lesser metatarsal neck dorsal V-osteotomy is one surgical procedure that has the potential of disrupting the intracapsular ligaments, depending on the placement of the "V" cut. The angulation of the "V" cut redirects the capital fragment in the sagittal plane while maintaining stability in the transverse and frontal planes. The authors contend that the sagittal stability of the free capital fragment after a V-osteotomy is maintained, as well, by the attachment of the newly defined suspensory ligaments and the collateral ligaments of the metatarsophalangeal joint. Disruption of these ligaments, such as occurs when placing the apex of the V-osteotomy proximally, serves to increase the instability within the metatarsal head, ultimately leading to a potential increase in number of complications.

Evaluation Studies as Topic↗
PubMed1994

Analysing nuclear shape as a function of relative spatial position in the femoral insertion of the medial collateral ligament.

Quantification of biological structure by morphometry facilitates the correlation of structure to biological function. To test a hypothesis concerning the correlation of a gradient in cell and nuclear shape and a corresponding gradient in mechanical stress within a ligament insertion into bone, a computerized approach was developed for quantifying mean nuclear shape as a function of position within this insertion. Three femoral insertions of the medial collateral ligament of the rabbit were prepared for histology. Commercially available software was used to measure nuclear perimeter and area by video-based planimetry on microscopic images, then custom software was used to define an overlying mesh of polygons on each insertion, to normalize the geometry of the insertion, and to calculate the mean nuclear roundness (a function of area and perimeter) for each polygon in the mesh. This approach allows the comparison of mean nuclear roundness of different polygons and among different animals that would be extremely difficult to do manually. In addition, these morphometry results can be used to correlate with functional data.

Animals↗
PubMed2004

Anterior bundle of ulnar collateral ligament: evaluation of anatomic relationships by using MR imaging, MR arthrography, and gross anatomic and histologic analysis.

PURPOSE: To evaluate the gross and microscopic anatomy and the magnetic resonance (MR) imaging and MR arthrographic appearance of the anterior bundle of the ulnar collateral ligament (UCL) of the elbow. MATERIALS AND METHODS: The origin and insertion of the anterior bundle of the UCL, the bundle's relationship to the overlying flexor tendons, and the presence of a layered configuration were assessed through inspection and dissection of an elbow specimen. T1-weighted spin-echo MR imaging and MR arthrography in standard imaging planes and a coronal oblique plane were performed in eight other elbow specimens. Additional MR arthrography was performed in four specimens by using the coronal plane with the elbow in 20 degrees of flexion. The specimens were then cut in planes corresponding to those of the MR images. Histologic analysis of two specimens was performed. RESULTS: The anterior bundle of the UCL appeared as a low-signal-intensity structure on T1-weighted spin-echo MR and MR arthrographic images. It consisted of a uniform layer of parallel collagen fibers attaching proximally to the base of the medial epicondyle of the humerus and distally to the medial aspect of the coronoid process of the ulna (sublime tubercle). A layer of synovium separated the anterior bundle from the more superficial tendon of the flexor digitorum superficialis muscle. MR imaging-anatomic comparison in four (50%) specimens revealed separation between the anterior bundle of the UCL and the sublime tubercle. Results of histologic analysis of two of these specimens confirmed insertion of the anterior bundle of the UCL 3 and 4 mm distal to the articular margin. Ligamentous degeneration was detected in only one of these specimens. CONCLUSION: There is variability in the distal insertion of the anterior bundle, and this suggests that caution should be exercised in the diagnosis of its partial detachment from the sublime tubercle of the ulna.

Aged↗