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At least 667 records · Page 37Linked to original sources
PubMed2006

A risk-factor model for anterior cruciate ligament injury.

The incidence of non-contact anterior cruciate ligament (ACL) injury is reported to be 6-8 times greater in females than males competing in the same activities. Injury to the ACL occurs as a result of insufficient stability of the tibiofemoral joint, which fails to prevent posterior dislocation of the femur on the tibia. The stability of the tibiofemoral joint is maintained by passive (non-contractile) and dynamic (contractile) mechanisms. The passive mechanisms include the shape of the articular surfaces, the menisci, the ligaments and the joint capsule. The dynamic mechanisms consist of the muscle-tendon units that cross the joint, in particular, the quadriceps and hamstrings. The relative significance of the various passive and dynamic mechanisms in maintaining the stability of the tibiofemoral joint is not clear. A number of intrinsic and extrinsic risk factors have been proposed to account for the sex difference in the incidence of ACL injuries. However, most of the proposed risk factors have arisen from univariate correlation studies based on relatively small samples.

Anterior Cruciate Ligament↗
PubMed1990

[Diagnosis and therapy of injuries of the lamina fibrocartilaginea of the hand (palmar plate)].

Authors studied a frequent injury of the finger joints. The anatomy, the mechanism of the injuries, the diagnostic possibilities of the lamina fibrocartilaginea ("palmar plate") and of the palmar ligaments of the joints are described. In the diagnosis a special significance is attached to the stressed and tangential X-ray pictures. They take the part of the conservative treatment of the injury. In cases of dislocations, that cannot be reduced, of open "palmar plate" injuries and of major hyperextension and dislocations of the broken bone scale, operative treatment is thought necessary. In the treatment of the injuries of the "palmar plate" of the PIP joint they use the so called rein method, that keeps the palmar cartilaginous joint capsule, torn at the injury, on its original place, it enables however the active joint movements, the gymnastics and hinders this way the development of the joint contracture.

Adolescent↗
PubMed1988

Patellar instability with recurrent dislocation due to patellofemoral dysplasia. Results after surgical treatment.

Twenty-one patients (25 knees) with recurrent dislocation of the patella due to patellofemoral dysplasia were treated with a combined distal and proximal realignment of the extensor mechanism of the knee. In addition to traditional medial transfer of the tibial tuberosity, lateral release, and medial joint capsule duplication, vastus medialis transposition and deepening of the intercondylar sulcus on the proximal joint surface of the femur were done. A follow-up ranging from 1-14 years (mean 6 years) found the results excellent or good in 22 knees, fair or poor in three. One redislocation occurred after trauma. There were two minor complications which had no effect on the end result. The use of computerized tomography over the patellofemoral joint to assess patellar subluxation and patellofemoral dysplasia is an important part of the diagnostic preoperative evaluation.

Adult↗
PubMed1980

[Immobilization of the injured hand].

The so-called "functional position" of the hand for immobilization of an injured hand or finger may in many cases lead to stiffness of the finger joints by shrinkage of the joint capsule and -ligaments. This process can be minimized by immobilization of the small finger joints in a position where the most important ligament structures are under maximum tension. Basically this is the intrinsic-plus-position for the long fingers and palmar abduction and extension of the thumb. Immobilization in this so-called protective position of the hand minimizes immobilization damages of the small finger joints. The underlying basic principles of the anatomy are explained.

Casts, Surgical↗
PubMed1995

Projections of ankle joint afferents to the spinal cord and brainstem of the chicken (Gallus g. domesticus).

The projections of the ankle joint capsule afferents were studied by transganglionic transport of horseradish peroxidase injected directly into the ankle joint. The number and size of the labelled dorsal root ganglion cells were measured from synsacral nerves 2-9. In the dorsal root ganglia, all sizes of sensory neurones were labelled, and the largest number of labelled cells was in ganglia 5-7. The extensive sympathetic innervation of the ankle joint was identified by the large number of cell bodies labelled in the sympathetic ganglia of the paravertebral chain. Labelled afferent fibres projected to the spinal cord from the 2nd to the 8th synsacral nerves, with the rostral projection mainly via Lissauer's tract and the dorsal funiculus. Terminal labelling in the dorsal horn was identified in laminae I-III and VI, with a slight projection to V. Two areas of dense labelling, which did not correspond with the largest number of labelled dorsal root ganglion cells, were identified. A rostral area with the highest density of label was observed at the level of synsacral nerves 3-4 and a second slightly less dense area between synsacral nerves 7-8. In the caudal medulla, diffuse terminal labelling was observed in the nucleus gracilis et cuneatus, nucleus of the tractus solitarius, and the nucleus cuneatus externus. These results are discussed in a comparative context to identify similarities and differences between different primary afferent projections in birds and mammals and to highlight the possible functional significance of the avian articular afferent projection.

Afferent Pathways↗
PubMed2002

In vitro and in vivo dissolution behavior of a dysprosium lithium borate glass designed for the radiation synovectomy treatment of rheumatoid arthritis.

Dysprosium lithium borate (DyLB) glass microspheres were investigated for use in the radiation synovectomy treatment of rheumatoid arthritis. In vitro testing focused on weight loss and cation dissolution from glass microspheres immersed in simulated synovial fluid (SSF) at 37 degrees C for up to 64 days. In vivo testing was performed by injecting glass microspheres into the stifle joints of Sprague-Dawley rats and monitoring the biodegradability of the microspheres and the tissue response within the joints. The DyLB microspheres reacted nonuniformly in SSF with the majority of lithium and boron being dissolved, whereas nearly all of the dysprosium (>99.7%) remained in the reacted microspheres. Because the DyLB glasses released negligible amounts of dysprosium while reacting with SSF, they are considered safe for radiation synovectomy from the standpoint of unwanted radiation release from the joint capsule. Furthermore, the DyLB microspheres fragmented, degraded, and reacted with body fluids while in the joints of rats without histologic evidence of joint damage.

Algorithms↗
PubMed2004

Displacement of the medial meniscus within the passive motion characteristics of the human knee joint: an RSA study in human cadaver knees.

The objective of this study was to validate an in vitro human cadaver knee-joint model for the evaluation of the meniscal movement during knee-joint flexion. The question was whether our model showed comparable meniscal displacements to those found in earlier meniscal movement studies in vivo. Furthermore, we determined the influence of tibial torque on the meniscal displacement during knee-joint flexion. Three tantalum beads were inserted in the medial meniscus of six human-cadaver joints. The knee joints were placed and loaded in a loading apparatus, and the movements of the beads were determined by means of RSA during knee-joint flexion and extension with and without internal tibial (IT) and external tibial (ET) torque. During flexion without tibial torque, all menisci moved in posterior and lateral direction. The anterior horn showed significantly greater excursions than the posterior horn in both posterior and lateral direction. Internal tibial torque caused an anterior displacement of the pathway on the tibial plateau. External tibial torque caused a posterior displacement of the pathway. External tibial torque restricted the meniscal displacement during the first 30 degrees of knee-joint flexion. The displacements of the meniscus in this experiment were similar to the displacements described in the in vivo MRI studies. Furthermore, the application of tibial torque confirmed the relative immobility of the posterior horn of the meniscus. During external tibial torque, the posterior displacement of the pathway on the tibial plateau during the first 30 degrees of flexion might be restricted by the attached knee-joint capsule or the femoral condyle. This model revealed representative meniscal displacements during simple knee-joint flexion and also during the outer limits of passive knee-joint motion.

Aged↗
PubMed2004

Pathophysiology and treatment of atraumatic instability of the shoulder.

The shoulder is stabilized mainly by negative intraarticular pressure when the arm is at the side of the body with all the muscles relaxed. During arm motion in the midrange of motion, the contraction force of the muscles provides dynamic stability. In shoulders with atraumatic instability, the joint capsule is thin and enlarged, making it more difficult to maintain the negative pressure. Decreased joint volume by capsular imbrication results in creating the negative intraarticular pressure. Imbalance of muscle forces may cause decreased abduction of the scapula during arm elevation or decreased concavity compression (or both), either of which may result in instability. Muscle exercises are effective in most cases of atraumatic instability. Congenital hypoplasia of the glenoid also contributes to decreased concavity compression. Glenoid osteotomy is the treatment of choice in such cases. One of these factors may play a role in the occurrence of atraumatic instability by itself or in combination. Better understanding of the pathophysiology of atraumatic shoulder instability is useful when selecting the best treatment option in each case.

Arm↗
PubMed1986

An unusually aggressive Mycobacterium marinum hand infection.

An unusually aggressive Mycobacterium marinum infection of the hand that progressed despite surgical and medical treatment is presented. The infection progressed over a 3-week period after the patient had surgical treatment and received isoniazid (INH), rifampin, and ethambutol hydrochloride. The patient had a collar-button abscess, destruction of the metacarpophalangeal (MCP) joint capsule, flexor and extensor tenosynovitis, and metacarpal and proximal phalanx bone destruction at the MCP joint and metacarpal shaft. Although atypical mycobacterial infections of the hand are usually indolent but persistent, this Mycobacterium marinum hand infection progressed rapidly, even with surgical and medical treatment. A judgment was made to perform an index ray amputation. With a more complete excision of the infected tissue, there was a higher probability of controlling this severe infection. The patient was treated with antituberculosis medications for 6 months and is doing well 1 year after the operation.

Amputation, Surgical↗
PubMed1998

The proteoglycans and glycosaminoglycan chains of rabbit synovium.

The synovial lining of joint capsules is important because it controls the flow of fluid into and out of the joint cavity. Physiological studies have shown that the glycosaminoglycans, particularly hyaluronan, have an important role in the control of fluid flow. The distribution of the glycosaminoglycans and proteoglycans in the synovium and subsynovium of rabbits (approximately 12 weeks old) was, therefore, determined immunohistochemically. Hyaluronan, chondroitin-4- and chondroitin-6-sulphates and keratan sulphate are present in the synovium and subsynovium; chondroitin-4-sulphate is at higher concentrations than chondroitin-6-sulphate. The core proteins of the chondroitin sulphate proteoglycans, biglycan and decorin, and of the keratan sulphate proteoglycan, fibromodulin, are also present. To date, fibromodulin has not been located in other synovial linings, and its presence corroborates that of keratan sulphate.

Animals↗
PubMed1997

Hyaluronan in joint disease.

Hyaluronan is a major component of synovial fluid. It is synthesized in the joint and partly degraded in joint capsule and partly carried by lymph to lymph nodes and the general circulation. During various joint disorders, especially inflammatory ones, the amount of hyaluronan in the joint and its turnover rate are increased leading to pathologically high serum levels of the polysaccharide. These levels are a complex function of synovitis mass and the physical activity of the patient. Intra-articular injection of hyaluronan has been used in the treatment of osteoarthritis. Although it results in a relief of pain, controlled clinical trials have not yet convincingly shown any beneficiary effects of the treatment.

Humans↗
PubMed1982

[Contrast arthrography in the diagnosis of soft tissue injuries round the elbow joint (author's transl)].

Based on the experience of 115 examinations, the authors first describes the normal radiological appearances on arthrography of the elbow joint. Subsequently, the radiological criteria are discussed which permit a diagnosis of intra- and para-articular soft tissue lesions due to closed trauma of the elbow joint. Arthrography with positive (water-soluble) contrast media enables one to diagnose rupture of the joint capsule and ligaments, and to diagnose with certainty subluxations of the various parts of the joint. Is is also possible to demonstrate haematomas between the muscles, which may lead to a reduction in joint function. Negative contrast medium (carbon dioxide, oxygen) permits the diagnosis of rupture of the insertion of the biceps.

Adolescent↗
PubMed2006

The structure, location, and function of perlecan, a prominent pericellular proteoglycan of fetal, postnatal, and mature hyaline cartilages.

The aim of this study was to immunolocalize perlecan in human fetal, postnatal, and mature hyaline cartilages and to determine information on the structure and function of chondrocyte perlecan. Perlecan is a prominent component of human fetal (12-14 week) finger, toe, knee, and elbow cartilages; it was localized diffusely in the interterritorial extracellular matrix, densely in the pericellular matrix around chondrocytes, and to small blood vessels in the joint capsules and perichondrium. Aggrecan had a more intense distribution in the marginal regions of the joint rudiments and in para-articular structures. Perlecan also had a strong pericellular localization pattern in postnatal (2-7 month) and mature (55-64 year) femoral cartilages, whereas aggrecan had a prominent extracellular matrix distribution in these tissues. Western blotting identified multiple perlecan core protein species in extracts of the postnatal and mature cartilages, some of which were substituted with heparan sulfate and/or chondroitin sulfate and some were devoid of glycosaminoglycan substitution. Some perlecan core proteins were smaller than intact perlecan, suggesting that proteolytic processing or alternative splicing had occurred. Surface plasmon resonance and quartz crystal microbalance with dissipation experiments demonstrated that chondrocyte perlecan bound fibroblast growth factor (FGF)-1 and -9 less efficiently than endothelial cell perlecan. The latter perlecan supported the proliferation of Baf-32 cells transfected with FGFR3c equally well with FGF-1 and -9, whereas chondrocyte perlecan only supported Baf-32 cell proliferation with FGF-9. The function of perlecan therefore may not be universal but may vary with its cellular origin and presumably its structure.

Age Factors↗
PubMed2004

Perlecan immunolocalizes to perichondrial vessels and canals in human fetal cartilaginous primordia in early vascular and matrix remodeling events associated with diarthrodial joint development.

The aim of this study was to ascertain how perlecan was localized in human fetal cartilaginous joint rudiment tissues. Perlecan was immunolocalized in human fetal (12-14-week-old) toe, finger, knee, elbow, shoulder, and hip joint rudiments using a monoclonal antibody to domain-1 of perlecan (MAb A76). Perlecan had a widespread distribution in the cartilaginous joint rudiments and growth plates and was also prominent in a network of convoluted hairpin loop-type vessels at the presumptive articulating surfaces of joints. Perlecan was also present in small perichondrial venules and arterioles along the shaft of the developing long bones, small blood vessels in the synovial lining and joint capsules, and in distinctive arrangements of cartilage canals in the knee, elbow, shoulder, and hip joint rudiments. Perlecan was notably absent from CD-31-positive metaphyseal vessels in the hip, knee, shoulder, and fingers. These vessels may have a role in the nutrition of the expanding cell populations in these developing joint tissues and in the establishment of the secondary centers of ossification in the long bones, which is essential for endochondral ossification.

Antibodies, Monoclonal↗
PubMed2004

BMP receptor signaling is required for postnatal maintenance of articular cartilage.

Articular cartilage plays an essential role in health and mobility, but is frequently damaged or lost in millions of people that develop arthritis. The molecular mechanisms that create and maintain this thin layer of cartilage that covers the surface of bones in joint regions are poorly understood, in part because tools to manipulate gene expression specifically in this tissue have not been available. Here we use regulatory information from the mouse Gdf5 gene (a bone morphogenetic protein [BMP] family member) to develop new mouse lines that can be used to either activate or inactivate genes specifically in developing joints. Expression of Cre recombinase from Gdf5 bacterial artificial chromosome clones leads to specific activation or inactivation of floxed target genes in developing joints, including early joint interzones, adult articular cartilage, and the joint capsule. We have used this system to test the role of BMP receptor signaling in joint development. Mice with null mutations in Bmpr1a are known to die early in embryogenesis with multiple defects. However, combining a floxed Bmpr1a allele with the Gdf5-Cre driver bypasses this embryonic lethality, and leads to birth and postnatal development of mice missing the Bmpr1a gene in articular regions. Most joints in the body form normally in the absence of Bmpr1a receptor function. However, articular cartilage within the joints gradually wears away in receptor-deficient mice after birth in a process resembling human osteoarthritis. Gdf5-Cre mice provide a general system that can be used to test the role of genes in articular regions. BMP receptor signaling is required not only for early development and creation of multiple tissues, but also for ongoing maintenance of articular cartilage after birth. Genetic variation in the strength of BMP receptor signaling may be an important risk factor in human osteoarthritis, and treatments that mimic or augment BMP receptor signaling should be investigated as a possible therapeutic strategy for maintaining the health of joint linings.

Alleles↗
PubMed1997

Subtalar realignment in congenital clubfoot using the Cincinnati approach.

GOAL OF SURGERY: Surgical correction of clubfoot through an extensive and meticulous posterior, lateral, medial, subtalar, and plantar release. INDICATIONS: Failed conservative treatment of clubfoot at 6 months of age. CONTRAINDICATIONS: Previous failed surgery with a different incision. PREOPERATIVE WORK UP: Radiographs of both foot and ankle in the anterior-posterior and lateral projections. POSITIONING AND ANAESTHESIA: Supine. Tourniquet. General anaesthesia. Free draping above the knee. SURGICAL TECHNIQUE: Through a Cincinnati incision the Achilles tendon is exposed and lengthened and the posterior capsule excised. The talofibular and the calcaneofibular ligaments are incised and released. The plantar aponeurosis is divided and the small plantar muscles are detached. Finally a medial release is achieved having excised the abductor hallucis muscles. Release of the dorsal talonavicular joint capsule. In severe cases the calcaneoucuboid joint must also be released. The corrected position is maintained with Kirschner wires. POSTOPERATIVE MANAGEMENT: Long leg cast with the knee bent at 90 degrees . Cast changed after 10 to 14 days. Eight weeks postoperatively removal of cast and Kirschner wires and prescription of a Dennis-Brown boot to be worn for 12 to 18 months. POSSIBLE COMPLICATIONS: Injury to neurovascular structures. Pin tract infection. Tightness, loosening or slipping of cast. Inadequate correction and damage to articular surfaces. RESULTS: From 1985 to 1992 60 infants (70 feet) were operated. Average follow-up was 5 years (1 to 7). Assessment of clinical and functional results was based on the Magone rating system: 60% excellent, 18.6% good, 11% fair results were obtained; 2 infants had a minor skin breakdown, 7 were undercorrected and 2 were overcorrected.

Journal Article↗
PubMed2002

[Diseases of the hip joint in childhood and adolescence--ultrasonic differential diagnoses].

A total of 329 children with hip pain were examined by ultrasound, which indicated transient synovitis (n = 161), rheumatoid arthritis (n = 16), tuberculoid arthritis (n = 3), septic arthritis (n = 16), Legg-Calvé-Perthes disease (n = 102), and slipped capital femoral epiphysis (n = 31). Using the standard planes described by DEGUM and DGOOC, it is possible to analyze the joint capsule, the surface of the femoral head, and the periarticular structures. In cases of synovitis or joint effusion, a capsular distension can be diagnosed by ultrasound. This distension is typical in transient synovitis, septic and tuberculoid arthritis, juvenile rheumatoid arthritis, and the onset phase of Perthes disease. Because capsular distension exhibits no significant differences in the various diseases, differentiation is not possible with ultrasound in the absence of osseous abnormalities. In cases with both capsular distension and osseous abnormalities, ultrasound usually allows a differentiation between slipped capital femoral epiphysis and Perthes disease as well as septic and unspecific arthritis.

Adolescent↗
PubMed1997

[Septic coxitis in childhood. Differential ultrasound diagnoses].

The efficiency of ultrasound was tested in septic arthritis. A total of 259 children with hip pain, septic arthritis (n = 14), transient synovitis (n = 120), juvenile rheumatoid arthritis (n = 12), Legg-Calvé-Perthes disease (n = 92) and slipped capital femoral epiphysis (n = 21) were examined by ultrasound. By using the standard planes described by the DEGUM, it is possible to analyze the joint capsule, the surface of the femoral head and the periarticular structures. In cases with synovitis or joint effusion, capsular distention can be diagnosed by ultrasound. This distention is typical in septic arthritis, transient synovitis, juvenile rheumatoid arthritis, and in the onset phase of Perthes disease. Because capsular distention and osseous abnormalities in the various diseases are similar differentiation is not possible. Therefore, ultrasound cannot distinguish between septic and non-specific arthritis; capsular distention is a non-specific ultrasound sign. Immediate diagnostic puncture is necessary if septic arthritis is suspected (possible by ultrasound control). In cases with both capsular distention and osseous abnormalities, ultrasound usually allows differentiation between slipped capital femoral epiphysis/Perthes disease and septic/non-specific arthritis.

Arthralgia↗