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At least 505 records · Page 28Linked to original sources
PubMed1993

Total collateral ligament excision for contractures of the proximal interphalangeal joint.

The complete excision of scarred proximal interphalangeal collateral ligaments as the cornerstone of surgical treatment for proximal interphalangeal joint contractures was evaluated. Supplemental palmar plate distal release, extensor tenolysis, and flexor sheath release were performed as needed. Sixteen patients with primary proximal interphalangeal joint contractures treated by this method were reviewed with the use of preoperative data obtained from chart review and postoperative data from direct patient examination. The average range of motion increased from 38 degrees to 78 degrees. No patients had instability of the proximal interphalangeal joints on manual testing and x-ray examination. This radical surgical approach to contracted proximal interphalangeal joints is justified by the improved range of motion without instability.

Adult↗
PubMed2004

Effects of the adductor pollicis and abductor pollicis brevis on thumb metacarpophalangeal joint laxity before and after ulnar collateral ligament reconstruction.

PURPOSE: The intrinsic muscles and ulnar capsuloligamentous structures (UCLS), which consist of the ulnar collateral ligament (UCL), accessory UCL, dorsal capsule, and volar plate of the thumb metacarpophalangeal (MCP) joint are important for controlling the motion and stability of the MCP joint during pinch. The purpose of this cadaveric study was to determine the effects of the adductor pollicis (AdP) and abductor pollicis brevis (APB) on the 3-dimensional MCP joint laxity before transection of the UCLS and after reconstruction of the UCL and repair of the dorsal capsule. METHODS: Loads were applied to the flexor pollicis longus (FPL) alone, to the AdP and FPL in combination, and to the APB and FPL in combination in 11 cadavers. This was done in the intact joint after the UCLS were transected and after the UCL was reconstructed for flexion angles of 0 degrees, 15 degrees, 30 degrees, and 45 degrees. The spatial positions of the proximal phalanx and the metacarpal of the MCP joint were measured with a 6-degrees-of-freedom digitizing system. RESULTS: In the intact joint combined loading of the AdP and FPL did not affect the position of the proximal phalanx. Combined loading of the APB and FPL changed the position of the phalanx from an ulnar to a radial shift and from an ulnar to a radial deviation and it increased pronation. After transection of the UCLS combined loading of the FPL and AdP increased supination of the MCP joint and combined loading of the FPL and APB increased radial shift, radial deviation, and pronation of the joint. Reconstruction of the UCL restored normal laxity to the MCP joint. CONCLUSIONS: The AdP failed to affect MCP joint motion. The ABP produced a radial shift and radial deviation of the MCP joint and increased pronation of the thumb. Transection of the UCLS increased joint laxity for each of the combined loadings and reconstruction of the UCL restored normal laxity to the MCP joint.

Aged↗
PubMed1988

Injury to collateral ligament of the metacarpophalangeal joint of a finger.

Twenty-two patients with injury to the collateral ligament of the metacarpophalangeal (MP) joint of a finger are reported. Thirteen cases were acute injuries and nine cases were chronic injuries. In all cases arthrography was performed. The arthrographic findings correlated with the grade of joint stability. Arthrographics of the unstable joint gave useful information for elucidating the mechanism of injury and deciding whether surgical treatment was indicated. At exploratory surgery, a Stener lesion was identified in one case in which the ruptured end of the ligament was trapped by the proximal portion of the expansion hood and sagittal band.

Adult↗
PubMed1995

Treatment of lateral collateral ligament sprains of the ankle: a critical appraisal of the literature.

Although sprains of the lateral collateral ligaments of the ankle are extremely common, controversy still exists over the proper treatment. Some authors recommend early mobilization of the ankle, others recommend cast immobilization for 1-6 weeks, and others insist that sprains should be treated with primary surgical repair. A critical appraisal of the literature supports the concepts of early mobilization with a proper rehabilitation program. The review of treatment is followed by a discussion of the potential causes of persistent pain and functional instability.

Adolescent↗
PubMed1989

Operation for collateral ligament ruptures of the metacarpophalangeal joints of the fingers.

Ten cases of complete rupture of the collateral ligaments of the metacarpophalangeal finger joints are reported. The nature of this injury, the pre-operative morbidity and the intra-operative pathology are analysed. In all cases surgery was performed with satisfactory results. Operation is indicated for joint stability, grip and pinch strength, pain control and early functional recovery.

Finger Joint↗
PubMed1983

Healing of the medial collateral ligament of the knee. A morphological and biochemical assessment in rabbits.

Complete midsubstance injuries of medial collateral ligaments of matched New Zealand white rabbits were allowed to heal without repair or immobilization for various lengths of time. Morphological and biochemical parameters were used to evaluate healing as compared with normal unoperated and sham operated ligaments. Results showed incomplete healing at the longest term follow-up (14 weeks) with significant biochemical abnormalities. Although there was a trend toward normal, recovery from injury was much slower than previously reported.

Animals↗
PubMed1991

The ulnar collateral ligament of the human elbow joint. Anatomy, function and biomechanics.

The posterior portion of the ulnar collateral ligament, which arises from the posterior surface of the medial epicondyle, is taut in maximal flexion. The anterior portion, which takes its origin from the anterior and inferior surfaces of the epicondyle, contains three functional fibre bundles. One of these is taut in maximal extension, another in intermediate positions between middle position and full flexion while the third bundle is always taut and serves as a guiding bundle. Movements of the elbow joint are checked by the ligaments well before the bony processes forming the jaws of the trochlear notch lock into the corresponding fossae on the humerus.

Biomechanical Phenomena↗
PubMed1988

Knee flexor and extensor strength ratios with deficiency of the lateral collateral ligament.

This investigation studied the peak torque and total work hamstring/quadriceps (HQ) ratios of 24 lateral collateral ligament (LCL) insufficient knees, and clarified the possible associations between different HQ ratios and the long-term outcomes of patients. Peak torque values were recorded at low (60 degrees/sec) and high (180 degrees/sec) speed of isokinetic movement, and the maximal isometric extension and flexion outputs were measured at the knee angle of 60 degrees from straight. Three standardized knee scoring scales were used to determine the subjective, functional, clinical, and radiologic outcomes of these LCL insufficient knees. In every test a great interpersonal variation of the HQ ratios was noticed, even in the healthy knees (range 24% to 154%). On the injured side the HQ ratios were in every test higher than on the healthy side, because of the weaker quadriceps muscle of the injured leg. In most cases, followup scores did not differ significantly between the groups with low (less than 50%), optimal (50% to 80%), or high (greater than 80%) HQ ratios of the LCL insufficient knees. However, in every test the scores were significantly (p less than 0.005 to 0.0001) better in the patients who had the HQ ratio of the injured knee near the uninjured side (less than 15%) compared with those with a clear difference (greater than 15%). These findings suggest that the HQ ratio is a very individual parameter, and therefore any general recommendation about the optimal value is very difficult to give. With regard to long-term outcome, the most ideal HQ ratio of an LCL insufficient knee seems to be the HQ ratio of the opposite, healthy extremity.

Adolescent↗
PubMed1986

Ulnar collateral ligament tears of the elbow joint.

The functions of the elbow in 13 cases of ulnar collateral ligament (U.C.L.) tears without gross intraarticular complications were retrospectively evaluated. Ten cases had been surgically repaired, and the remaining three cases were treated conservatively. Follow-up examinations were performed on all of the patients. There was a significant difference in valgus instability between operatively treated patients and conservatively treated patients (operatively treated patients averaged 5.1 degrees, while conservatively treated patients averaged 8 degrees). Two cases of conservatively treated patients complained of elbow joint pain while playing sports or working. Conversely, one of the operatively treated patients complained of numbness in the fifth finger. However, the remaining cases had no symptoms, even while playing sports or working. Valgus instability of the elbow joint results in little inconvenience in daily life, but it is disabling in patients performing heavy labor or vigorous sports.

Adolescent↗
PubMed1977

[Osseous rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb (author's transl)].

Osseous ruptues of the ulnar collateral ligament in the metacarpophalangeal joint of the thumb are to be found more frequently in experimental ruptures at an isolated preparation than they are described in clinical examinations. It must positively be achieved to re-affix also a small avulsion fragment to do not remove the entire compound attachment of the ligament. The own surgery technique is described.

Adult↗
PubMed1977

The specification and design of a substitute medial collateral ligament.

In this paper attempts are made to define the properties necessary for a substitute medial collateral ligament (MCL). The boundaries that envelope the desired load-extension curve of the MCL are extracted from existing research results and are complemented by in vivo experiments on a knee analyzer. A substitute MCL is designed, manufactured, and tested. The element mimics the action of the natural tissue and it produces a load-extension curve that fits within the prescribed boundaries. Proposals for the fixation design and the further testing of the substitute ligament are made. The possibilities for the application of the material as a substitute for other ligaments are discussed.

Humans↗
PubMed2004

Effect of ultrasound on acute inflammation of transected medial collateral ligaments.

OBJECTIVE: To evaluate the effect of therapeutic ultrasound on the acute inflammation of soft-tissue injuries by measuring the levels of prostaglandin E(2) (PGE(2)) and leukotriene B(4) (LTB(4)). DESIGN: Randomized, case-control study. SETTING: Laboratory animal facility. ANIMALS: Thirty 3-month-old male Sprague-Dawley rats. INTERVENTION: Rats with medial collateral ligament transection were given 5 minutes of pulsed ultrasound therapy (1:4) daily, with different durations (1, 5, 10d) and intensities (0, 0.5, 1.5, 2.3W/cm(2)). MAIN OUTCOME MEASURES: Levels of PGE(2) and LTB(4). RESULTS: The levels of PGE(2) and LTB(4) were higher in all intensity subgroups that received 2.3W/cm(2) intensity on postinjury day 2. On postinjury day 11, LTB(4) was significantly decreased, but PGE(2) was significantly increased. CONCLUSIONS: Pulsed ultrasound therapy may stimulate inflammation of acute ligament injury.

Analysis of Variance↗
PubMed2005

Partial release of the superficial medial collateral ligament for open-wedge high tibial osteotomy. A human cadaver study evaluating medial joint opening by stress radiography.

To perform an open-wedge high-tibial osteotomy (HTO), the medial proximal tibia is frequently exposed by partial distal release of the overlying insertion of the medial collateral ligament (MCL). Biomechanically, any release of the MCL can increase knee laxity when valgus stress is applied. Clinically however, post-surgical valgus instability following HTO with partial MCL release is an uncommon complication. It is known that the open-wedge procedure can re-tention an intact MCL by the width of the base of the wedge. However, this re-tentioning effect is uncertain in small wedge sizes, preexisting medial compartment laxity and in the presence of a partially detached MCL. Considering the good clinical results after HTO, we hypothesized that a partial release of the superficial MCL for HTO does not play a crucial role in stabilizing valgus forces in the human knee. We therefore measured the effect of partial versus complete release of the superficial MCL to determine medial knee laxity represented by the amount of medial joint opening (MJO) under valgus stress in this human cadaver study. In ten knee pairs, the superficial and deep MCL were sectioned in sequence with a standardized abduction force of 15 kp with a Scheuba apparatus applied. In group 1 (5 knee pairs), the superficial MCL was completely sectioned whereas in group 2 (5 knee pairs), sectioning of the superficial MCL was restricted to the anterior border to mimic the surgical exposure for an HTO. To account for the interindividual variability of ligamentous laxity, only increments of MJO within knee pairs were statistically evaluated. Stress radiography did not reveal any significant differences in increments of MJO between knee pair specimens with complete versus partial release of the superficial MCL. We disproved our hypothesis and concluded that the anterior fibers of the superficial MCL do play a crucial role in maintaining valgus stability in this biomechanical setting. Therefore, the release of the superficial MCL for open-wedge HTO should be kept to a minimum to decrease the potential of late valgus instability. This is especially important in patients with small wedge sizes and medial compartment laxity since the anterior MCL fibers are the main contributor to medial joint stability and the re-tentioning effect of the remaining MCL fibers is presumably decreased.

Adult↗
PubMed2004

The use of porcine small intestinal submucosa to enhance the healing of the medial collateral ligament--a functional tissue engineering study in rabbits.

INTRODUCTION: Small intestinal submucosa (SIS) from porcine has been successfully used as a collagen scaffold for the repair of various tissues, including those of the human vascular, urogenital, and musculoskeletal systems. The objective of this study was to evaluate whether SIS can be used to enhance the healing process of a medial collateral ligament (MCL) with a gap injury in a rabbit model. METHODS: A 6 mm wide gap was surgically created in the right MCL of 20 skeletally mature, female New Zealand White rabbits. In 10 rabbits, a strip of SIS was sutured onto the two ends of the MCL, while for the other 10 animals their injured MCL remained untreated and served as a non-treated group. The left MCL of all animals was exposed and undermined serving as the sham-operated side. At 12 weeks post-healing, eight hind limbs from each group were used for mechanical testing. The cross-sectional areas (CSA) of the MCLs were measured. The femur-MCL-tibia complex (FMTC) was tensile tested to failure. The load-elongation curves representing the structural properties of the FMTC and the stress-strain curves representing the mechanical properties of the healing MCL were obtained. The remaining two animals from each group were prepared for histological evaluation. RESULTS: The CSA between the SIS-treated and non-treated groups were not significantly different (p>0.05). Both treatment groups appeared to increase by nearly 40% compared to the sham-operated side, although statistical significance was not found for the non-treated group (p>0.05). The stiffness of the FMTC from the SIS-treated group was 56% higher than the non-treated group (45.7+/-13.3 N/mm vs. 29.2+/-9.2 N/mm, respectively, p<0.05) and the ultimate load also nearly doubled (117.434.5 N vs. 66.4+/-31.4 N, respectively, p<0.05). These values were lower compared to the sham-operated side (89.7+/-15.3 N/mm and 332.0+/-50.8 N, respectively). The tangent modulus of the healing MCL (279.7+/-132.1 MPa vs. 149.0+/-76.5 MPa, respectively) and stress at failure (15.7+/-4.1 MPa vs. 10.2+/-3.9 MPa, respectively) both increased by more than 50% with SIS treatment (p<0.05). Yet, each remained lower compared to the sham-operated side (936.3+/-283.6 MPa and 75.6+/-14.2 MPa, respectively). Blinded histological comparisons between the SIS-treated MCL and the non-treated control demonstrated qualitatively that the SIS treated group had increased cellularity, greater collagen density, and improved collagen fiber alignment. CONCLUSION: Healing of a gap MCL injury was significantly enhanced with SIS. The improved mechanical properties and histological appearance of the MCL suggest that SIS treatment improves the quality of tissue and renders the possibility for future studies investigating functional tissue engineering of healing ligaments.

Animals↗
PubMed1993

Rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb.

The results after operations for rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb are reported to be good. Few authors describe the measurements used to assess the postoperative function of the thumb. We review the results of 15 patients, who underwent surgery between 1982 and 1987. We found that the number of patients satisfied with the operation was consistent with that reported in the literature. On the other hand, we found poor agreement between the subjective complaints and the objective findings. We therefore propose and describe a scoring system to assess subjective impressions of the result and the objective findings. Surgical procedures are not discussed. However, the duration of immobilization of the thumb should, perhaps, be reconsidered. Further studies may show that a shorter period of immobilization in plaster, the use of dynamic bandaging, or early starting of physiotherapy produce better results.

Adolescent↗
PubMed1993

Acute and late radial collateral ligament injuries of the thumb metacarpophalangeal joint.

Eighteen patients were treated surgically for injuries to the radial collateral ligament of the thumb metacarpophalangeal joint. Late repairs were performed in 12 and immediate repairs in 6. At follow-up after a mean of 6 years, 94% of the patients were completely satisfied with the results. No patients had significant pain in their thumbs, and none were limited in work or avocational activities. A stable repair was maintained in all patients. There was no difference in grip or pinch strengths between the immediate and late groups. Loss of thumb motion in the late group (mean = 77% of normal) was slightly more than that in the immediate group (mean = 89% of normal). Late repair gives equally good subjective results and causes a slightly greater loss of thumb motion than immediate repair.

Acute Disease↗
PubMed1988

Biochemical heterogeneity within the maturing rabbit medial collateral ligament.

The purpose in this investigation was to determine the biochemical composition of the normal rabbit medial collateral ligament (MCL) along its length during growth and maturation. Water content and hexosamine concentration as an index of glycosaminoglycan content and collagen concentration were quantified and results compared statistically for anatomically identified MCL segments at various ages. These data demonstrate differences in all parameters at different locations along the ligament and at different ages. Biochemical differences were noted between midsubstance and periinsertional areas. There were subtle differences between the two insertion sites of this ligament at all ages. These results indicate that the rabbit MCL is not homogeneous biochemically along its length and that its matrix composition changes with growth and maturation.

Aging↗