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PubMed1998

Pregnancy alters the in vitro responsiveness of the rabbit medial collateral ligament to neuropeptides: effect on mRNA levels for growth factors, cytokines, iNOS, COX-2, metalloproteinases and TIMPs.

Explants of tissue derived from the medial collateral ligament (MCL) of normal and pregnant NZW rabbits cultured in the presence of substance P (SP), calcitonin gene-related peptide (CGRP), or both neuropeptides were found to have altered mRNA levels for a number of relevant molecules. Using a very efficient RNA isolation method, semi-quantitative RT-PCR and rabbit-specific primers, mRNA for growth factors (TGFbeta, bFGF, IGF-2, ET-1), cytokines (IL-1, TNF), enzymes (COX-2, iNOS), metalloproteinases (collagenase, stromelysin) and metalloproteinase inhibitors (TIMP-1, TIMP-2) were assessed after culture with or without neuropeptide. The results indicate that SP was effective in lowering mRNA levels for all of the molecules assessed in RNA from normal ligaments except IL-1beta, IGF-2 and TIMP-1, for which there was no significant effect. Similarly, CGRP was effective in lowering mRNA levels for all molecules except TNF, ET-1 and the TIMPs. The extent of the lowering of mRNA levels was both molecule-specific and neuropeptide-specific. When the experiments were repeated with ligament tissue from pregnant animals, a very different pattern of responsiveness to the neuropeptides was observed. While mRNA levels for 9/12 genes assessed were significantly affected by SP when normal MCL tissue was investigated, pregnancy abolished all significant responsiveness to this neuropeptide except for iNOS mRNA levels. In the case of iNOS mRNA, SP induced an increase in the steady-state levels, the opposite to what was observed with tissue from non-pregnant animals. For CGRP and SP+CGRP, tissue from pregnant animals was still responsive, but the pattern of responsiveness was changed from strictly a lowering of steady-state mRNA levels to elevations in mRNA levels for a number of genes. These findings indicate that mRNA levels for a number of genes can be influenced by neuropeptides known to be in ligaments. Thus, neuropeptides likely are important regulators of ligament cell metabolism. As the responsiveness to SP was nearly completely abolished during pregnancy, neuroregulatory influences mediated by this peptide are altered in the pregnant female. This loss of responsiveness to SP may also be one aspect of the analgesia associated with pregnancy.

Animals↗
PubMedDate not supplied

Treatment of the medial collateral ligament injury. II: Structure and function of canine knees in response to differing treatment regimens.

In order to assess the healing of the medial collateral ligament (MCL) and to detect the various effects of treatment regimens, in vivo animal experiments using a canine model were performed. Thirty-five canine MCLs were surgically transected and treated using three clinically popular regimens, e.g., no repair with cage and farm activities (Group 1), repair with 3 weeks immobilization (Group 2), and repair with 6 weeks immobilization (Group 3). The varus-valgus laxity of the knee joint, structural properties of the femur-MCL-tibia (FMT) complex and the mechanical properties of the MCL substance (healing site) were quantitatively measured at 6, 12, and 48 weeks postoperatively. It was found that Group 1 animals had the best results. The varus-valgus laxity of the knee joint and the structural properties of the FMT complex returned to values comparable with the contralateral control by 12 weeks. The recovery of the mechanical properties of the MCL substance was slower and not complete, even at 48 weeks. In confirmation with previous studies, prolonged immobilization was shown to have deleterious effects on MCL healing. The results of this study indicated that early mobilization is the treatment of choice in cases of isolated MCL injury. Also, this study emphasized the importance and effectiveness of using various biomechanical parameters in addition to the conventional ultimate values at failure to evaluate the progress of soft tissue repair.

Animals↗
PubMed1990

Effects of surgical treatment and immobilization on the healing of the medial collateral ligament: a long-term multidisciplinary study.

The long-term effects of surgical repair and immobilization on the healing of the transected medial collateral ligament (MCL) were studied biomechanically, biochemically and histologically in a canine model. Twelve adult canines were divided into two experimental groups and studied at 48 weeks postoperatively. For Group I, the transected MCL of the left knee was not repaired, and the joint was not immobilized. For Group II, the MCL was repaired and the joint was immobilized for six weeks. The right knee of each canine was sham-operated and served as the control. Histologically, the collagen fibers were less aligned in both of the experimental groups than in the controls. Furthermore, there were minimal differences in collagen and fibroblast alignment between the groups, although poorer alignment was observed for Group I at 12 weeks. Biochemically, the levels of types I and III collagen, reducible collagen cross-links and total collagen concentration for both groups returned to normal levels. Biomechanically, Group I achieved better results than Group II in terms of varus-valgus (V-V) knee rotation and ultimate load of the femur-MCL-tibia complex (FMTC), as these values returned to the level of controls. However, the mechanical properties of the healing MCLs did not compare well with the controls; the tensile strength was only 62% and 45% of controls for Groups I and II, respectively, at 48 weeks. These results suggest that conservative treatment (i.e., no surgical intervention) with early mobilization is better than surgical treatment with immobilization for an isolated Grade III MCL injury.

Animals↗
PubMed1988

[Injury of the collateral ligaments of the metacarpophalangeal joint of the thumb and therapy].

The authors report on their experience on 176 patients with lesions of the ulnar collateral ligaments. Two samples were compared: the fresh rupture and immediate suture, and the old lesion treated by a special plasty with palmaris tendon (Bäuerle/Reill). The long term results (at least 2 years) of both collectives were nearly identical. The authors recommend immediate repair.

Bone Wires↗
PubMed1986

Nonoperative management of isolated grade III collateral ligament injury in high school football players.

In a prospective study, 24 high school football players with isolated Grade III injuries of the medial collateral ligament (MCL) of the knee were treated by conservative management. This included an active rehabilitation program, progressing from immobilization and controlled motion in an orthotic rehabilitation knee brace, to muscle strengthening and agility exercise. A stable knee was achieved in 22 cases; the average recovery time was 29 days. The athletes returned to competitive sports at a mean time of 34 days. These results confirm previous reports of successful nonoperative management of isolated Grade III MCL injuries.

Adolescent↗
PubMed1994

Ulnar collateral ligament in the growing elbow: MR imaging of normal development and throwing injuries.

PURPOSE: To study the magnetic resonance (MR) imaging appearance of the ulnar collateral ligament (UCL) and its insertion into the medial epicondyle. MATERIALS AND METHODS: Sixteen normal and 20 symptomatic elbows were examined with a 1.5-T unit. Normal elbows were imaged with axial T2*-weighted three-dimensional Fourier transform sequences. Symptomatic elbows were imaged with coronal T1-, T2-, and T2*-weighted and/or short-inversion-time inversion-recovery sequences. RESULTS: In normal immature elbows, the ulnar periosteum was seen as an extension of the UCL, and its enthesis had signal intensity characteristics that differed from those of the mature ligament. In symptomatic elbows imaged before epiphyseal fusion, segmentation and subchondral bone resorption of the ossification center were seen with or without a capsular tear. After epiphyseal fusion, a full-thickness or a partial UCL tear at the site of its insertion, with or without subcortical bone resorption, was seen. CONCLUSION: The MR imaging characteristics of the developing elbow differ from those of the mature elbow. MR imaging is useful in assessing UCL damage.

Adolescent↗
PubMed1988

Osteoarthrosis in a knee joint due to chronic posttraumatic insufficiency of the medial collateral ligament. Nine-year follow-up.

The purpose of the present study was to examine and describe the osteoarthrotic changes that chronic, partial or complete medial collateral ligament (MCL) insufficiency causes to the knee joint. Forty-eight patients with partial and 25 with complete, isolated rupture of the MCL had a clinical and radiological reexamination of the knee on an average of nine years after the injury. In both groups the posttraumatic osteoarthrotic changes caused by the MCL insufficiency occurred very frequently on the medial side of the knee. The most characteristic findings were osteophytes and subchondral sclerosis of femoral and tibial medial condyles, tibial eminence and patella, ligament calcification of femoral medial condyle as well as narrowing of medial joint space. In patients with a partial tear 91% and in patients with complete tear 88% of all arthrotic changes caused by the insufficiency were one of these mentioned above, and other findings were only occasional. According to the radiological criteria of the authors none of the patients in the group with partial, but 17 (68%) of those with complete insufficiency of the MCL suffered from a clear posttraumatic osteoarthrosis of the injured knee. In complete tears the total extent of these pathological changes per patient was sixfold compared to the patients with a partial tear. It was concluded that chronic, posttraumatic insufficiency of the MCL causes characteristic medial side osteoarthrotic changes to the injured knee and that the amount of these changes seems to depend on the amount of the instability.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

The nonoperative treatment of grade I and II medial collateral ligament injuries to the knee.

A prospective investigation covering 8 years (1971 to 1978) at a major university was undertaken involving the nonoperative management of medial collateral ligament injuries to the knee. Rigid diagnostic criteria were used for each injury prior to inclusion in a program of functional rehabilitation without cast immobilization. Eighty-nine fresh ligamentous injuries were reviewed. Thirty-eight knees required surgery. The remaining 51 knees were classified as isolated Grade I or Grade II injuries. Forty-two (80%) successfully completed the program of rehabilitation. Nine (20%) were considered failures. These were attributed to inadequate diagnoses during the early period of the study. Average time required for the athletes to return to full competition was 21 days (range of 9 to 32 days.)

Athletic Injuries↗
PubMed1991

Functional splinting versus plaster cast for ruptures of the ulnar collateral ligament of the thumb. A prospective randomized study of 63 cases.

In a prospective randomized study that included 63 consecutive thumbs with injuries of the ulnar collateral ligament of the metacarpophalangeal (MCP) joint of the thumb, plaster cast immobilization was compared with functional treatment with a splint. The splint allowed flexion and extension of the MCP joint, but prevented ulnar and radial deviation of the thumb. The study included both operated on and nonoperated on cases where surgery was performed only when the torn ligament was regarded as displaced. Of 40 thumbs treated nonsurgically, 21 were treated with a cast and 19 with a splint. Of 23 thumbs treated surgically, 10 were immobilized postoperatively in a plaster cast and 13 were treated with the splint. At the follow-up examination after 15 (11-41) months, there was no difference between the treatment groups as regards stability, range of motion, strength of the injured thumb, and length of sick leave. However, the patients considered the splint more comfortable than plaster cast immobilization. We conclude that immobilization of the thumb after a ligamentous injury with a movable splint is strongly preferred by the patients and that the functional results of this technique are equal to plaster cast immobilization after both surgical and nonsurgical treatment.

Adolescent↗
PubMed1975

[Therapy of ulnar collateral-ligament injury at the metacarpophalangeal joint of the thumb].

We have compared the result of operative treatment with the results of conservative treatment of rupture of the ulnar collateral ligament of the thumb. We recommend immediate repair. 24 patients were examined: The 11 conservatively treated patients showed an unsatisfactory result as compared with the 13 operated patients, who demonstrated a successful repair with a stable joint and normal painless function.

Female↗
PubMed1990

Nonoperative management of complete tears of the medial collateral ligament of the knee in intercollegiate football players.

During five consecutive football seasons at a major university, 28 varsity football players sustained complete isolated tears of the medial collateral ligament of the knee. All were managed nonoperatively with early protected motion and physical therapy. Twenty-one patients returned for follow-up examination. The mean follow-up time was 46 months. Eighteen patients were followed for over two years after the original injury. Twenty patients had results ranging from good to excellent. The average time from injury to return to full-contact drills was 9.2 weeks. The key to success in the nonoperative management of complete tears of the knee is to exclude cases with damage to the anterior cruciate ligament.

Athletic Injuries↗
PubMed1988

Long-term results of conservatively treated medial collateral ligament injuries of the knee joint.

The purpose of the study was to determine the long-term healing potential of nonoperatively treated isolated sprains of the medial collateral ligament (MCL) of the knee joint. A multidimensional follow-up analysis was performed an average of nine years after injury, with 54 patients with Grade II sprains (partial tear of the MCL) and 27 patients with Grade III (complete tear) sprains. The methods used included four standardized knee scoring scales for subjective, objective, functional, and roentgenographic evaluations, as well as isokinetic and isometric strength evaluations. The outcome in Grade II sprains of the MCL was generally good, even though some residual medial laxity was common. In Grade III sprains the outcome was much worse, with a high frequency of persisting medial instability, dysfunction of the anterior cruciate ligament, muscle weakness, and posttraumatic osteoarthritis of the injured knee. Grade II sprains of the MCL respond acceptably to nonoperative treatment, whereas in Grade III sprains such treatment is not the method of choice.

Adolescent↗
PubMed1993

Changes in the cyclic and static relaxations of the rabbit medial collateral ligament complex during maturation.

There is at present no information on how the viscoelastic properties of bone-ligament-bone complexes change during maturation. Changes in the static and the cyclic relaxation behaviours of rabbit bone-medial-collateral-ligament-bone complexes at 3, 6, 9 and 12 months of age are described. These ages cover maturation and initial ageing of this complex. The specimens were subject to 30 cycles of uniaxial tension between zero and 0.68 mm extension at 10 mm min-1. Immediately after the cyclic test, the specimens were held at a constant 0.68 mm extension for 1200 s. The results showed that in both the cyclic and the static tests, specimens from 3-month-old animals relaxed significantly more than specimens at 6, 9 or 12 months of age, whereas those 6, 9 and 12 months old were not significantly different from each other. When the results of the cyclic tests were compared to those of the static tests, cyclic relaxation was higher than static relaxation for each of the 6-, 9- and 12-month-old specimens. For specimens 3 months of age, the opposite was observed. An explanation is offered whereby the total relaxation is suggested to be comprised of two parts: a material relaxation and a water flux component. Differing contributions by each of the two components at particular ages can explain the observed results.

Aging↗
PubMed1992

Ulnar collateral ligament repair of the metacarpo-phalangeal joint of the thumb: a study comparing two methods of repair.

25 patients were assessed following repair of an acutely ruptured ulnar collateral ligament of the thumb metacarpo-phalangeal joint. The patients were divided into two groups, repaired by either a horizontal mattress suture using 4/0 polybutylate (nine patients), or a pre-fashioned steel wire (16 patients). Assessment included a physical examination and functional testing at a mean of 12.9 months (range 4-36 months) after the operation. Both techniques were equally effective, and the use of the more expensive steel wire, while technically satisfying and easy to perform, offers no clinical advantage over simple suture. This pre-fashioned steel wire is, however, recommended in those cases with an avulsion fracture or where distal avulsion of the ligament is associated, since the technique allows easy secure reduction.

Adolescent↗
PubMed1986

[Stress test and anatomical study of the lateral collateral ligaments of the ankle].

UNLABELLED: Many authors have discussed on the instability of the ankle joint. We have therefore investigated the variety, courses and the functions of the lateral collateral ligament by dissecting 16 freshly amputated limbs. It was composed of 4 ligaments, i.e., the anterior talofibular, the posterior talofibular, the calcaneofibular and the lateral talocalcaneal ligaments. These ligaments have various courses and influence the stability of the ankle joint in various manners. Transection of the anterior talofibular ligament alone caused inversion and forward instability, and transection of calcaneofibular ligament alone caused adduction instability of the ankle and subtalar joint, but posterior talofibular and the lateral talocalcaneal ligament and other ligaments, however, played an important role in the stability of the ankle joint, so that injuries of the anterior talofibular ligament or the calcaneofibular ligament caused varying degrees of instability in this joint. CONCLUSION: To evaluate this injury the following methods of taking X-ray pictures are indispensable, namely, stress inversion, stress anterior drawer, and stress adduction radiography.

Adolescent↗
PubMed1979

Arthrography as a method of diagnosing tear of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb ("gamekeeper's thumb").

Arthrography of the metacarpo-phalangeal (MP) joint of the thumb was performed on 47 thumbs. The normal arthrographic appearance shows a closed joint space, whereas leakage of contrast material indicates tear of the joint capsule with or without an associated tear of a stabilizing ligament. Arthrographic demonstration of the heads of the adductor pollicis muscle was found to be specific for tear of the ulnar collateral ligament (UCL) of the MP joint, a tear which is commonly responsible for its instability. Arthrography is suggested as a safe and accurate diagnostic examination for the early detection of tears of the UCL of the MP joint.

Adolescent↗
PubMed1983

Strain measurement in the medial collateral ligament of the human knee: an autopsy study.

A strain transducer was developed which employs a magnetic field sensing device to detect linear displacement. The transducer was attached to the medial collateral ligament (MCL) of human autopsy specimens, minimally influencing their physiologic behavior. A strain 'map' of the MCL as a function of knee flexion (full extension to 120 degrees) both with and without abduction force was obtained. Our investigation revealed consistent differences in the strain patterns between proximal, middle and distal segments of the anterior and posterior borders of the MCL. Anatomic variations in the pattern of collagen fibers within the MCL, interactions between posterior oblique capsular fibers and the MCL, and the skeletal configuration may account for these varied strain patterns.

Humans↗