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PubMed1999

Posterior peripheral sutures in meniscal allograft replacement.

In our experience, meniscal allograft transplantation does have a role after a total or a significant partial meniscectomy in young to middle-aged symptomatic patients. While the quality of the meniscal tissue is crucial to the success of the operation, it is equally important to duplicate the mechanical function of the original semilunar cartilage and assure a secure peripheral attachment of the meniscal implant. The technique for peripheral meniscal suture placement described in this article permits an easier and more secure attachment of the posterior third of the implant to the joint capsule.

Adult↗

PubMed1997

Direct measurement of strain in the posterolateral bundle of the anterior cruciate ligament.

The general objectives of the work reported in this article were to describe and validate a method for directly measuring strain in the posterolateral bundle (PLB) of the anterior cruciate ligament (ACL). The method is a procedure for gaining surgical access to the posterior fibers of the PLB through a portal incised in the joint capsule and then suturing a liquid metal strain gage (LMSG) on to these fibres. Because the incision possibly alters the load-displacement mechanics of the joint, validation included performing experiments to test the hypothesis that the incision did not significantly affect load-displacement relations. To illustrate the utility of the method, strains in both the anteromedial bundle (AMB) and PLB were measured and compared over the full range of flexion. Validation experiments revealed that the capsular incision as well as other incisions had no measurable effect on the load-displacement mechanics of the joint. Also, the PLB strain was significantly different from the AMB strain during passive flexion with a reciprocating function in load sharing evident between the two bundles.

Adult↗

PubMed1994

[Amyloid deposition in chronic joint disease].

As a screening procedure for the detection of amyloidosis secondary to rheumatoid arthritis, abdominal subcutaneous fat tissues were aspirated, and were examined after Congo red staining by polarized microscopy. Positive amyloid deposits were found in 7.1 percent of the rheumatoid patients, and the amyloid in the subcutaneous fat was determined to be AA type by permanganate oxidation. The occurrence of amyloid deposition was significantly correlated with the duration of the articular symptoms, the progression of the class, and also with proteinuria. Additionally the joint capsules, including the synovium and synovial fluid sediment, from patients with rheumatoid arthritis and osteoarthritis were examined for amyloid deposition. Deposits of amyloid in the hip and knee joints were found more frequently in those with rheumatoid arthritis than in those with osteoarthritis. In osteoarthritis, the frequency of amyloid deposition tended to increase with advancing age. However these amyloid deposits in the joint structure were discovered to be resistant to permanganate oxidation. Therefore it was suspected that these amyloid deposits were of a type different from AA amyloid.

Adipose Tissue↗

PubMed2003

The anatomy of the posterolateral aspect of the rabbit knee.

The purpose of this study was to determine the anatomy of the posterolateral aspect of the rabbit knee to serve as a basis for future in vitro and in vivo posterolateral knee biomechanical and injury studies. Twelve nonpaired fresh-frozen New Zealand white rabbit knees were dissected to determine the anatomy of the posterolateral corner. The following main structures were consistently identified in the rabbit posterolateral knee: the gastrocnemius muscles, biceps femoris muscle, popliteus muscle and tendon, fibular collateral ligament, posterior capsule, ligament of Wrisberg, and posterior meniscotibial ligament. The fibular collateral ligament was within the joint capsule and attached to the femur at the lateral epicondyle and to the fibula at the midportion of the fibular head. The popliteus muscle attached to the medial edge of the posterior tibia and ascended proximally to give rise to the popliteus tendon, which inserted on the proximal aspect of the popliteal sulcus just anterior to the fibular collateral ligament. The biceps femoris had no attachment to the fibula and attached to the anterior compartment fascia of the leg. This study increased our understanding of these structures and their relationships to comparative anatomy in the human knee. This knowledge of the rabbit's posterolateral knee anatomy is important to understand for biomechanical and surgical studies which utilize the rabbit knee as a model for human posterolateral knee injuries.

Animals↗

PubMed1982

[A contribution to the macroscopic anatomy of the innervation of the knee capsule (author's transl)].

Preparation of the kknee joint capsule nerve branches of 30 human lower extremities. The capsule nerves arise out of the muscular branches both of the femoral and the obturator nerves. Moreover, a large number of capsule branches originate from all skin nerves in the neighbourhood of the nee joint as well as from the tibial and the common peroneal nerves. Any attempt at desensibilizing the knee capsule by sectioning all the nerve branches appears to be impossible. A partial section of the capsule nerve branches, on the medial side, would be, from technical point of view, easy. Whether such a intervention would be efficacious must be left for clinics to decide.

Adult↗

PubMed2003

Joint compression alters the kinematics and loading patterns of the intact and capsule-transected AC joint.

High compressive loads are transmitted through the shoulder across the acromioclavicular (AC) joint to the axial skeleton during activities of daily living and can lead to early joint degeneration or instability. The objective of this study was to quantify the effect of joint compression on the biomechanics of the intact and capsule-transected AC joint during application of three loading conditions. A robotic/universal force-moment sensor testing system was utilized to apply an anterior, posterior or superior load of 70 N in combination with 10 or 70 N of joint compression to fresh-frozen cadaveric shoulders (n=12). The application of joint compression to the intact AC joint decreased the posterior translation in response to a posterior load (-6.6+/-2.5 vs -3.7+/-1.0 mm, p<0.05). Joint compression also decreased the in situ force in the superior AC capsule by 10 N while increasing the joint contact force by 20 N for all loading conditions (p<0.05). The application of joint compression to the capsule-transected AC joint significantly decreased the amount of posterior and superior translation during posterior (-12.7+/-6.1 vs -5.5+/-3.2 mm, p<0.05) and superior (5.3+/-2.9 vs 4.2+/-2.3 mm, p<0.05) loading, respectively, while significantly increasing the coupled translations (anterior-posterior, superior-inferior or proximal-distal) in all loading conditions (p<0.05). The joint contact force also significantly increased by 20 N for all loading conditions (p<0.05). This quantitative data suggests: (1) common surgical techniques such as distal clavicle resection, which initially reduce painful joint contact, may cause unusually high loads to be supported by the soft tissue structures at the AC joint; and (2) compressive loads transmitted across a capsule-transected AC joint could be concentrated over a smaller area due to the increased coupled motion and joint contact force.

Acromioclavicular Joint↗

PubMedDate not supplied

Second metatarsophalangeal joint arthrography: a cadaveric correlation study.

Arthrography of the second metatarsophalangeal joint is an important diagnostic tool to evaluate the integrity of the plantar plate and to aid in the decision process for surgical intervention. A variety of filling patterns have been identified with lesser metatarsophalangeal joint arthrography and their significance with soft-tissue pathology remains to be completely understood. The purpose of this cadaveric study was to evaluate dye patterns in a series of arthrograms of the second metatarsophalangeal joint and to correlate them with identifiable anatomic lesions or structural variants. Thirty-nine cadaveric specimens (including 28 matched pairs) underwent second metatarsophalangeal joint arthrography with a colored radiopaque dye. Arthrographic findings were observed and recorded. Specimens exhibiting dye extravasation outside of the capsular constraints of the joint were dissected to discover any soft-tissue abnormalities. Twenty-one percent of specimens exhibited abnormal extravasation of dye outside of the joint capsule. A plantar plate tear was identified in 2 of these specimens. Filling of the first intermetatarsophalangeal bursa occurred in 6 specimens. However, because this finding was identified in 2 matched pairs, an anatomic variance is suggested rather than a pathologic entity. This cadaveric study shows that anatomic variances exist concerning the second metatarsophalangeal capsule and that arthrography should be correlated with the clinical scenario.

Aged↗

PubMedDate not supplied

Neer Award 2001: nonrecoverable strain fields of the anteroinferior glenohumeral capsule under subluxation.

Although tears of the glenohumeral capsule have been observed in anteroinferior instability, prefailure, nonrecoverable deformation is suspected but has not been shown to exist after shoulder subluxation. The inferior glenohumeral ligament in the anteroinferior capsule (AIC) is a primary stabilizer in anteroinferior instability. The aim of this study was to examine the nonrecoverable strain field of the AIC due to shoulder subluxation. Nonrecoverable strains were calculated between a nominal strain state and a postsubluxed state. AIC marker coordinates were reconstructed from stereoradiographs, and strains were calculated from these coordinates. Nonrecoverable strain was shown to develop, varying from 3% to 7% through a range of joint subluxation. High strain tended to occur on the glenoid side of the AIC. Interestingly, strains were generally not oriented along major ligamentous bands. This is the first study to quantify planar nonrecoverable strain fields in the glenohumeral joint capsule.

Adult↗

PubMed2000

Glenohumeral kinematics and capsulo-ligamentous strain resulting from laxity exams.

OBJECTIVE: Identification and quantification of strain in shoulder capsular-ligamentous structures during clinical exams and validation of this testing on cadavers. METHODS: Mercury strain gauges were sutured in seven locations on shoulders from cadavers. An electromagnetic tracker quantified humeral head translations during laxity exams. Strain and humeral position were acquired during performance of Sulcus, Feagin, Apprehension, Load and Shift, Drawer, and Hawkins tests. RESULTS: Anterior humeral head translation in neutral position was primarily constrained by the coracohumeral ligament. With the arm abducted, anterior middle and inferior ligaments also became active. External rotation and abduction activated inferior and middle capsules. Posterior capsule constrained motion for posterior tests in neutral and abduction. Superior and inferior capsular ligaments were active during inferior tests in neutral position. With abduction, inferior ligaments provided primary translation constraint. CONCLUSION: Study of kinematics and strain evaluation on cadavers can yield useful information on mechanisms of glenohumeral instability. Relevance This study clarifies the contribution of specific structures of the shoulder to strain in the joint capsule. It also identifies which structures are challenged by provocative laxity exams commonly used by orthopaedic physicians.

Analysis of Variance↗

PubMed1987

Cystic adventitial disease of the popliteal artery and of other stem vessels in the extremities.

Two hundred and thirty-four cases of cystic adventitial disease were collected from over two hundred world literatures and were classified into two groups: first, typical cystic adventitial disease of the popliteal artery, and second, that of the stem vessels in extremities other than the popliteal artery. The nomenclatures, clinical and pathological features, and etiology were reviewed. From the etiological point of view, the group in which the cyst was connected with joint capsule was identified as the joint group. All cases reported are listed in the two tables except those cases listed already in Flanigan's table.

Adolescent↗

PubMed2003

Cranial cruciate ligament injury in the dog: pathophysiology, diagnosis and treatment.

Cranial cruciate ligament (CCL) disease in the dog is a multifactorial complex problem that requires a thorough understanding of the biomechanics of the stifle joint to be understood. Successful treatment of rupture of the CCL should be based on managing underlying anatomical and conformational abnormalities rather than attempting to eliminate the tibial cranial drawer sign. The cranial and caudal cruciate ligaments, the patella ligament and quadriceps mechanism, the medial and lateral collateral ligaments, the medial and lateral menisci and the joint capsule provide stability of the joint and load-sharing. The function of the stifle is also significantly influenced by the musculature of the pelvic limb. An active model of biomechanics of the stifle has been described that incorporates not only the ligamentous structures of the stifle but also the forces created by weight-bearing and the musculature of the pelvic limb. This model recognises a force called cranial tibial thrust, which occurs during weight-bearing, and causes compression of the femoral condyles against the tibial plateau. In middle-aged, large-breed dogs, forces acting on the CCL together with conformation-related mild hyperextension of the stifle and slightly increased tibial plateau slopes are suspected to cause progressive degeneration of the ligament. Palpation of craniolateral stifle laxity has become pathognomonic for CCL rupture; however, chronic periarticular fibrosis, a partial CCL rupture, and a tense patient, may make evaluation of instability of the stifle difficult. Surgical treatment is broadly separated into three groups: intracapsular, extracapsular, and tibial osteotomy techniques. Tibial osteotomy techniques do not serve to provide stability of the stifle but rather alter the geometry of the joint to eliminate cranial tibial thrust such that functional joint stability is achieved during weight-bearing. Visualisation of both menisci is a critical aspect of CCL surgery, irrespective of the technique being performed. Regardless of the surgical technique employed, approximately 85% of dogs show clinical improvement. However, many of these dogs will demonstrate intermittent pain or lameness. Post-operative management is an integral part of the treatment of CCL rupture, and significant benefits in limb function occur when formalised post-operative physiotherapy is performed.

Journal Article↗

PubMed2004

Open repair of the ulnar disruption of the triangular fibrocartilage complex with double three-dimensional mattress suturing technique.

Open repair technique of the ulnar disruption of the triangular fibrocartilage complex is described. This technique is indicated for a fresh or a relatively fresh (less than 1 year after the initial injury) ulnar foveal detachment tear, horizontal tear, and proximal slit tear of the triangular fibrocartilage complex, all of which are accompanied by severe dorsal, palmar, or multidirectional instability of the distal radioulnar joint. A chronic tear greater than 1 year from initial injury and a fresh triangular fibrocartilage complex tear without distal radioulnar joint instability, such as central slit tear, are excluded from our indications. A dorsal C-shaped skin incision, a longitudinal incision of the radial edge of the extensor carpi ulnaris subsheath and the dorsal distal radioulnar joint capsule, exposes the distal radioulnar joint. A small, 5-mm longitudinal incision at the origin of the radioulnar ligament exposes its fovea detachment and/or the proximal slit tear of the triangular fibrocartilage complex. The disrupted radioulnar ligament is sutured in a pullout fashion to the ulna with a 3-dimensional double mattress technique through 2 bone tunnels that is precisely made at the central portion of the fovea with 1.2-mm K-wire. An additional horizontal mattress suture is used for closure of the small incision made at the radioulnar ligament, then the extensor carpi ulnaris is repaired. This open-repair technique is complex and requires precise technical skills; however, early results have been more rewarding than the conservative treatment.

Journal Article↗

PubMed1987

Crossover second toe deformity.

The crossover second toe deformity occurs when the lateral collateral ligament and joint capsule of the second metatarsophalangeal joint deteriorate. The second toe initially deviates in a medial direction but with time deviates dorsally and crosses up and over the great toe. A total of 17 patients (22 toes) were evaluated and 11 patients (15 toes) underwent surgical correction. A 90 degree satisfactory rate was noted at 42 months follow-up.

Aged↗

PubMedDate not supplied

Ultrasonography of the metatarsophalangeal and talocrural joints.

The unechogenic space between the bone and the joint capsule in 280 metatarsophalangeal (MTP) joints and in 56 talocrural (TC) joints of 28 healthy adults was measured by ultrasonography. These normal values were compared with those of 40 arthritic MTP and of 15 arthritic TC joints. The unecogenic space in the MTP joints was more than 3 mm in 12 out of 280 healthy joints during dorsiflexion. In arthritic joints the space was more than 3 mm in 31 out of 40 joints, and the mean value was significantly higher than in the healthy joints. An unechogenic space could be demonstrated in all the arthritic but none of the healthy TC joints. An unechogenic space of more than 3 mm in a dorsiflexed MTP joint and demonstration of an unechogenic space in a TC joint are signs of intra-articular effusion or synovitis.

Adult↗

PubMed1985

[Proprioceptive sensitivity and orofacial functions].

Proprioceptive sensibility from stimulation of muscle, ligament articular and vestibular receptors plays a determining role in the regulation of tone, of the resting position of the mandible, of head posture and of the closure pathway of the mandible. Studies conducted on temporomandibular joints of fetuses and adult subjects failed to demonstrate the specialized corpuscles (a fact previously noted by Ramfjord) in the temporomaxillary joint capsule, described typically in other joints. In contrast, however, histology showed a particularly rich population of muscle receptors adjacent to this joint, this being only one of several particular characteristics.

Adult↗

PubMed1982

Radiographic and arthroscopic findings in the equine stifle.

The radiographic and arthroscopic findings in the equine stifle were compared. Survey radiography, contrast arthrography, and arthroscopy were performed on both stifles of 10 horses. Nine of the horses were euthanatized to evaluate the effects of the techniques on the joints. Techniques for double-contrast arthrography and arthroscopy were developed, and the findings were compared. Survey radiography identified only osseous structures. Double-contrast arthrography of the femoropatellar joint demonstrated articular surfaces of the trochlea, patella, and joint capsule. Those of the femorotibial joint defined the medial meniscus but not the lateral meniscus. On arthroscopy of the femoropatellar joint, intra-articular structures could be readily visualized. In the femorotibial sacs, structures were more difficult to identify. Gross examination of the stifle joint at necropsy revealed no overt effects of arthroscopy.

Animals↗

PubMed2003

The modified oblique Keller procedure: a technique for dorsal approach interposition arthroplasty sparing the flexor tendons.

A first metatarsophalangeal joint resection arthroplasty that combines a modest metatarsal cheilectomy with an oblique resection of the phalanx base (preserving the flexor hallucis brevis attachment) combined with interposition arthroplasty of the dorsal joint capsule sewn to the plantar soft tissues is presented. Numerous surgical procedures have been described for the treatment of hallux rigidus, including dorsal cheilectomy, resection arthroplasty, joint replacement, and arthrodesis. The Keller procedure has been abandoned by many because of shortening of the great toe and loss of push-off power. The modified oblique Keller technique described here allows for intraoperative transition from cheilectomy to resection arthroplasty with what appears to be a satisfactory outcome, maintaining plantarflexion power and hallux length.

Arthroplasty↗

PubMed2003

Endoscopic laser imaging of tissue perfusion: new instrumentation and technique.

BACKGROUND AND OBJECTIVES: New instrumentation, based on a previously established laser speckle perfusion imaging (LSI) technique is evaluated for its ability to capture and generate blood flow images during endoscopic surgery. STUDY DESIGN/MATERIALS AND METHODS: Investigations are detailed in an in-vitro blood flow model simulating physiological properties of vascularized tissue, and in-vivo in rabbit joint capsule tissue. RESULTS: In-vitro measurements showed a linear response of the instrument to blood flow in the range of 0-800 microl/minute, where data points were significantly correlated with an r(2) value of 0.96. In-vivo measurements showed a 58.7% decrease to the medial collateral ligament during occlusion of the femoral artery. CONCLUSIONS: Blood flow images demonstrate that the endoscopic LSI technique is capable of measuring relative tissue blood flow changes at high resolutions and rapid response times and incorporates well with endoscopic surgeries.

Animals↗