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PubMed1998

Evaluation of "neocollateral" ligament formation by magnetic resonance imaging after total excision of the proximal interphalangeal collateral ligaments.

The presence of palpable thickening and maintenance of stability within weeks of total excision of the proximal interphalangeal (PIP) joint collateral ligaments is an established, although somewhat mysterious, phenomenon. To further investigate this postoperative thickening, magnetic resonance imaging (MRI) scans were obtained on 10 joints in 9 patients who had undergone total ligament excision for posttraumatic stiff PIP joints 3 months to 14 years earlier. Although the ultrastructure of these newly formed structures is yet unknown, their palpable consistency, MRI contour, distribution, and signal intensity suggest the formation of a new soft tissue structure, albeit scar, which has all the attributes of a collateral ligament. This MRI of a "neocollateral ligament" would help explain the consistent observation of complete joint stability within weeks following total excision of both PIP joint collateral ligaments. All patients from the 14-year span sampled were found to have a similar, consistent, linear low signal density structure crossing the joint margins and essentially identical to that of a normal collateral ligament.

Adult↗
PubMed1994

New procedures for tightening knee collateral ligaments in conjunction with knee realignment osteotomy.

Collateral ligament laxity has recently been recognized as an important component of frontal plane malalignment. The authors have developed new surgical techniques to re-tension lax collateral ligaments. Twenty-three collateral ligament re-tensioning with bony alignment were carried out in 17 patients, with 19 knees being graded excellent, 2 fair, and 2 poor. Recurrence of significant laxity was noted in one patient.

Adolescent↗
PubMed2006

Operative and nonoperative treatments of medial collateral ligament rupture with early anterior cruciate ligament reconstruction: a prospective randomized study.

BACKGROUND: The apparent consensus is that solitary medial collateral ligament rupture can be treated nonoperatively, but treatment of severe combined ruptures of the medial collateral ligament and anterior cruciate ligament remains controversial. HYPOTHESES: Nonoperative and early operative treatments of grade III medial collateral ligament rupture lead to similar results when the anterior cruciate ligament is reconstructed in the early phase. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1. METHODS: Forty-seven consecutive patients with combined anterior cruciate ligament and grade III medial collateral ligament injuries were randomized into 2 groups. The medial collateral ligament injury was treated operatively in group 1 (n = 23) and non-operatively in group 2 (n = 24). In both groups, the anterior cruciate ligament injury was treated with early reconstruction, using bone-patellar tendon-bone graft and interference screw. Two years postoperatively, knee stability was measured with a KT-1000 arthrometer and Telos valgus radiography and knee extension strength with a Biodex dynamometer and a 1-legged hop test. An International Knee Documentation Committee evaluation form and Lysholm score were completed. RESULTS: All 47 patients were available for clinical evaluation for a mean of 27 months (range, 20-37 months) after surgery. There were no statistically significant differences between the 2 groups with respect to subjective function of the knee, postoperative stability, range of motion, muscle power, return to activities, Lysholm score, and overall International Knee Documentation Committee evaluation. The subjective outcome and Lysholm score were good and anteroposterior knee stability excellent in both groups. CONCLUSION: Nonoperative and operative treatments of medial collateral ligament injuries lead to equally good results. Medial collateral ligament ruptures need not be treated operatively when the anterior cruciate ligament is reconstructed in the early phase.

Adult↗
PubMedDate not supplied

Effect of hemorrhage on medial collateral ligament healing in a mouse model.

BACKGROUND: Medial collateral ligament injuries heal by a scar response. HYPOTHESIS: Increased hemorrhage at the site of medial collateral ligament injury improves healing. STUDY DESIGN: Controlled laboratory study. METHODS: Ninety-six mice were divided into two groups. Group 1 mice underwent knee medial collateral ligament transection with the opposite knee as a sham-operated control and group 2 animals additionally had 0.25 ml of tail cut blood pipetted to the medial collateral ligament transection site and sham-operated opposite knee. Ligament specimens were harvested at 3, 7, 21, and 28 days. RESULTS: Immunohistochemical analysis demonstrated peak macrophage counts at day 7 in all transected specimens. Macrophage counts were higher in group 2 than in group 1 at all time points, with a statistically significant increase of macrophages noted at day 7. In situ hybridization demonstrated increased collagen gene expression, with peaks at 7 and 28 days after transection. Group 2 animals showed increased gene expression at all time points as compared with group 1, with a statistically significant increase noted at 7 and 28 days. Biomechanical testing demonstrated progressive healing at each time point. At 28 days, the load to failure was 67% that of the sham-operated knee. CONCLUSIONS: This study suggests there is an increased healing response with bleeding at the ligament injury site. CLINICAL RELEVANCE: Identification of the factors involved with increased healing may allow manipulation of the healing response in the clinical setting.

Animals↗
PubMed2004

Influence of a mono-centric knee brace on the tension of the collateral ligaments in knee joints after sectioning of the anterior cruciate ligament--an in vitro study.

OBJECTIVE: To analyze the influence of knee bracing on the tension of the medial and lateral collateral ligaments in anterior cruciate ligament deficiency. DESIGN: The tension of the collateral ligaments in anterior cruciate ligament deficient knees was measured with and without knee bracing using an in vitro model. BACKGROUND: Anterior cruciate ligament deficiency increases the tension in both collateral ligaments at the knee joint. Therefore knee braces should reduce that tension increase. However, that effect has never been proven quantitatively. METHODS: After anterior cruciate ligament-transection, the forces of the medial (anterior/posterior part) and lateral collateral ligament were measured in ten fresh human cadaver knees at 0 degrees, 20 degrees, 40 degrees, 60 degrees, 80 degrees and 100 degrees of flexion, with and without application of a mono-centric knee brace. To quantify the ligament forces, strain gauges were fixed at the bony origins of the ligaments. RESULTS: Bracing led to a significant decrease of ligament forces (20-100 degrees: P < 0.0001) in the anterior part of the medial collateral ligament in all joint positions. In the posterior aspect, this effect was observed only at 40 degrees (P < 0.0001) and 80 degrees (P = 0.001) of flexion. In the lateral collateral ligament, bracing caused a strain reduction from 60 degrees to 100 degrees of flexion (P < 0.0001). Therefore a flexion angle dependent effect of knee bracing on the strain was seen in the posterior aspect of the medial and in the lateral collateral ligament in anterior cruciate ligament deficient knee joints. CONCLUSIONS: Application of a mono-centric knee brace leads to a significant position dependent reduction of collateral ligament tension after anterior cruciate ligament-rupture.

Anterior Cruciate Ligament Injuries↗
PubMed2006

Biomechanical evaluation of 2 techniques for ulnar collateral ligament reconstruction of the elbow.

BACKGROUND: Elbow medial ulnar collateral ligament tears often result in pain and instability that may be career threatening in overhead-throwing athletes. Surgical reconstruction is frequently chosen to treat this injury. Ulnar collateral ligament reconstruction as described by Jobe is the most commonly used technique. Testing of this construct has not demonstrated that the biomechanical parameters of the native ligament are restored. A more recent construct, the docking technique, may more reliably reproduce these factors. HYPOTHESIS: Increasing the number of strands of palmaris longus tendon graft used in ulnar collateral ligament reconstruction and tensioning them using the docking technique result in a construct with improved biomechanical parameters as compared with the Jobe technique. STUDY DESIGN: Controlled laboratory study. METHODS: Thirty-three fresh-frozen human cadaveric elbows were randomized into 3 subgroups: Jobe (11), docking (12), and native (10). The Jobe and docking groups underwent reconstruction using their described palmaris tendon graft constructs. The ulnar collateral ligament was left intact in the native group. Elbows were potted and tested using a servohydraulic materials testing machine to apply a valgus moment at 30 degrees of elbow flexion. Maximal moments to failure, stiffness, and strain at maximal moment and with a 3 N.m force applied were determined using a 2-camera motion analysis system to track reflective markers spanning the site. RESULTS: The docking (14.3 N.m) and native (18.8 N.m) subgroups resulted in higher maximal moment to failure than did the Jobe (8.9 N.m) subgroup (P < .001). There was no significant difference between native and docking groups (P > .05). Native ligaments were stiffer (301.4 N.m) than were Jobe (74.3 N.m) or docking (80.8 N.m; P < .001). Native ligaments demonstrated lower strain at maximal force (0.087 mm/mm) and 3 N.m forces (0.030 mm/mm) than did the Jobe (0.198/0.057 mm/mm) or docking (0.287/0.042 mm/mm) subgroups. There was no difference in stiffness or strain between the Jobe and docking subgroups (P > .05). CONCLUSION: Neither technique reproduced the biomechanical profile of the native ulnar collateral ligament; the findings of this study suggest that the docking construct may offer initial biomechanical advantage over the Jobe construct.

Analysis of Variance↗
PubMed1993

Factors affecting knee motion after total knee arthroplasty: a cadaveric study of the collateral ligament.

Many of the factors affecting postoperative knee motion are related to collateral ligament imbalance. In a cadaveric knee model, the center of origin of either the medial or lateral collateral ligament was found to be located at the center of the quarter circle of the posterior femoral condyle. Two distances were identified: OD (from the center of origin of the collateral ligament to the distal tibiofemoral articulation) and OP (from the center of origin of the collateral ligament to the posterior tibiofemoral articulation). The effect of the collateral ligaments on knee motion was demonstrated by stimulating joint line elevation and ligamentous stretching in a cadaveric knee model. In the knee with an elevated joint line without concomitant anterior displacement (OD reduced, OP unchanged), the flexion limit was reduced. When the collateral ligaments were stretched in a knee with constant OD and OP, both the flexion and extension limits were reduced. A correct joint level can be achieved by measuring the OD, OP and the tension of the collateral ligaments during total knee arthroplasty.

Arthroplasty↗
PubMed2003

[The compare disquisition of the collateral ligaments: normal and pathologic appearances on MRI].

OBJECTIVE: To evaluate the MR findings of normal and abnormal collateral ligament and the meaning of medical jurisprudence appraisal. METHODS: The MR findings of 12 normal and 13 surgically confirmed injured collateral ligaments were retrospectively reviewed and compared. RESULTS: The normal tibial and fibular collateral ligaments were hypointense string on both T1 and T2 coronal MR images, with average length of 6.8 cm for tibial collateral ligament and 5.7 cm for fibular collateral ligament.13 collateral ligaments were injured, including 6 tibial and 3 fibular collateral ligaments. Two cases(4 ligaments) had both tibial and fibularcollateral ligaments injuries. The injury of collateral ligament was classified as: Grade I(5 ligaments), Grade II(5 ligaments), and Grade III(3 ligaments). The complications of anterior cruciate ligament sprains(3 cases), posterior cruciate ligament sprains(4 cases), meniscal tear(2 cases) were found in 7 patients(63.6%). CONCLUSION: Coronal MR imaging can clearly demonstrate the structure of the knee collateral ligaments, accurately diagnose and classify the ligament injury, and correctly detect the complications, MRI is very valuable for medical jurisprudence appraisal.

Adult↗
PubMed1995

Soft-tissue "flaws" are associated with the material properties of the healing rabbit medial collateral ligament.

This study evaluated microscopic flaws in the healing rabbit medial collateral ligament and their significance in terms of the material properties of this ligament during healing. A gap injury was created in the midsubstance of the medial collateral ligament in the right hindlimb of 15 skeletally mature (12 months old) New Zealand White rabbits. At postoperative intervals of 3, 6, or 14 weeks, histomorphometric analysis of the flaws was carried out in subgroups of animals. The medial collateral ligaments from four of the left hindlimbs (randomly selected) were used as uninjured contralateral controls. In one histologic section of each area of scar tissue and the analogous area in the controls, specified tissue flaws (blood vessels, fat cells, hypercellular areas, loose matrix, disorganized matrix, or a combination of these) were measured by four independent and blinded observers. The results showed that the mean total area of the flaws, as a percentage of the total section, and the mean area of the largest flaw decreased with healing time in each healing group but did not achieve control values by 14 weeks. Because it was not possible to test the healing medial collateral ligaments mechanically prior to measurement of the flaws (due to the destructive nature of failure testing), the data on the flaws were compared with the material strength and stiffness of a separate series of similarly injured and mechanically tested medial collateral ligaments (data published previously). A maximum likelihood statistical analysis showed a very strong functional association between the mean area of the largest flaw and the stress at failure (p < 0.004) and between the mean flaw area as a percentage of the total section area and the elastic modulus (p < 0.001). This study therefore demonstrates that it is possible to quantify material flaws in scar tissue in rabbit medial collateral ligaments, that these flaws become smaller with healing time as the scar remodels, and that flaws are functionally associated with the material properties of the ligament in this model (larger flaws with less tensile strength and more flaws with less stiffness).

Analysis of Variance↗
PubMed2006

Medial ulnar collateral ligament reconstruction of the elbow in throwing athletes.

BACKGROUND: Medial ulnar collateral ligament insufficiency of the elbow can be a devastating injury in the throwing athlete. Reconstruction of the medial ulnar collateral ligament was initially described by Jobe and associates; good clinical results have been described after this procedure. The authors' experience with this technique raised several concerns, and thus the "docking" procedure was developed as an alternative method for medial ulnar collateral ligament reconstruction of the elbow. The early results of the docking technique were good. The authors wish to investigate the intermediate-term clinical results of this method in a large group of athletes. HYPOTHESIS: The docking technique can return overhead-throwing athletes to sport with minimal perioperative morbidity. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: During a 3-year period, 100 consecutive overhead-throwing athletes were treated with surgical reconstruction using the docking technique. The inclusion criteria were as follows: (1) a history of medial elbow pain that prevented throwing, (2) a preoperative standard noncontrast magnetic resonance image demonstrating medial ulnar collateral ligament injury, (3) clinically apparent medial ulnar collateral ligament insufficiency, and (4) an overhead-throwing athlete. At the time of surgery, all patients underwent routine arthroscopic assessment. The ulnar nerve was transposed in 22 cases. The mean follow-up was 36 months (range, 24-60 months). RESULTS: Ninety of 100 (90%) patients were able to compete at the same or a higher level than before medial ulnar collateral ligament injury for more than 12 months as noted at the follow-up interval; 7 patients were able to compete at a lower level. Only 3 patients suffered postoperative complications. CONCLUSION: The docking technique reliably returns athletes to competitive throwing with a low perioperative morbidity.

Adolescent↗
PubMed1981

Collateral ligaments of the canine stifle joint: anatomic and functional analysis.

The anatomic features and functions of the collateral ligaments of the canine stifle joint were investigated, using cadaver specimens. The structure of the collateral ligaments was examined by dissection, with attention given to the spatial relationships existing between the collateral ligaments and their neighboring structures, such as the menisci and joint capsule. The relative tension of the ligaments was determined by identifying the points of attachment with lead markers and taking a series of radiographs of the joint throughout its range of motion. The distance between the points was measured, and the change in length was determined as a function of joint position. Measurements of internal and external rotation, varus angulation, and valgus angulation were made before and after severance of one or both ligaments. The medial collateral ligament was taut in extension, with only the caudal portion of the ligament becoming lax in flexion. The lateral collateral ligament was also taut in extension; however, its entire bulk because lax as the joint was flexed. In extension, the ligaments were primary restraints preventing varus and valgus angulation, and they functioned to limit internal and external rotation of the tibia. In flexion, the cranial portion of the medial collateral ligament remained taut and prevented external rotation of the tibia, whereas the relaxation of the lateral collateral ligament allowed the tibia to rotate internally, with further rotation limited by the cruciate ligaments.U

Animals↗
PubMed2005

Anatomical dimensions of anterior bundle of ulnar collateral ligament and its role in elbow stability.

OBJECTIVE: To study the anatomical dimensions of the anterior bundle of ulnar collateral ligament and its role in elbow instability. METHODS: We studied 20 elbows of 10 cadavers. Anterior bundle of ulnar collateral ligament was dissected in all elbows and its anatomical length and width were measured. After measuring it, we assessed the role of the anterior bundle of ulnar collateral ligament in the medial elbow joint stability, with the capsule, the radial head and anterior bundle of ulnar collateral ligament being cut. RESULTS: The mean right length of the anterior bundle of ulnar collateral ligament was 21.10 +/- 6.29 mm and the mean left length was 21.70 +/- 5.31 mm. The mean right width of the anterior bundle of ulnar collateral ligament was 12.70 +/- 2.79 mm and the mean left width was 13.90 +/- 2.37 mm. Anterior bundle of ulnar collateral ligament was found to be the main stabilizer of the valgus stress. The anterior capsule and the radial head also make contributions to this stability. However, when anterior bundle of ulnar collateral ligament is cut, the radial head and the anterior capsule fails to maintain the stability against valgus stress. CONCLUSIONS: The anatomical dimensions of the anterior bundle of ulnar collateral ligament are important for a surgeon when graft is used in reconstructing this ligament. Our study is an initiator of this topic and we believe that with larger series, more reliable anatomical measurements can be obtained. We also showed that the anterior bundle of ulnar collateral ligament is the main medial stabilizer of the elbow joint.

Biomechanical Phenomena↗
PubMed2006

[The effect of the plantar plate and the collateral ligaments on the flexion of the metatarsophalangeal joints].

OBJECTIVE: To explore the effect of the collateral ligaments and the plantar plate on the flexion of the metatarsophalangeal (MP) joints. METHODS: Twenty-four preserved human No. 2-4 digits were obtained from embalmed cadaver feet, which were divided into 2 groups at random. In group A, the bilateral collateral ligaments were cut first, and then the plantar plate was sectioned. They were cut in opposite sequence in group B. Angle of the flexion of MP joint was observed in the same load after the bilateral collateral ligaments and the plantar plate were sectioned in different sequence. From 1994 to 2000, 11 cases were used with this technic, including plantar section in 2 cases and both plantar section and bilateral collateral ligaments cut in 9 cases. RESULTS: The angle of flexion of the MP joint before operation in group A is 37.30 +/- 5.42 degrees, it increased 11.29 +/- 2.36 degrees and to 48.60 +/- 2.98 degrees when the bilateral collateral ligaments were cut, and there was significant difference. Later the cut of the plantar plate increased another 5.30 +/- 1.59 degrees and to 53.35 +/- 2.76 degrees. Both have an increasing trend for the angle of flexion of the MP joint (P < 0.01). While in group B, the angle of flexion of the MP joint before operation is 34.59 +/- 5.32 degrees, it increased 6.29 +/- 2.98 degrees and to 40.89 +/- 2.36 degrees when the plantar plate were cut, later the cut of the bilateral collateral ligaments increased another 9.71 +/- 1.94 degrees and to 50.60 +/- 2.01 degrees. Both had an increasing trend for the angle of flexion of the MP joint (P < 0.01). The bilateral collateral ligaments had more influence than the plantar plate (P < 0.01). There was the same effect in different sequence (P > 0.05). In 2 cases with plantar section, the flexion angle of MP joint could achieve 15 degrees to 45 degrees in 2 months. The other 9 cases with both plantar section and bilateral collateral ligaments cut, the MP joint flexion achieved 10.3 degrees to 58.4 degrees in 26.3 months. CONCLUSION: The flexion angle of the MP joint can be increased by cutting the bilateral collateral ligaments and the plantar plate.

Adult↗
PubMed2001

Primary repair of intraoperative disruption of the medical collateral ligament during total knee arthroplasty.

BACKGROUND: Intraoperative disruption of the medial collateral ligament during total knee arthroplasty is an uncommon complication that is frequently treated by implanting a prosthesis with varus-valgus constraint. To our knowledge, no data have been published on primary repair or reattachment of the medial collateral ligament and implantation of a minimally constrained posterior-stabilized or cruciate-retaining prosthesis. This retrospective study evaluates the hypothesis that satisfactory clinical results, at a minimum of two years, can be achieved with immediate repair or reattachment of the medial collateral ligament and without a constrained total knee prosthesis. METHODS: Of 600 knees treated with primary total knee arthroplasty, sixteen (in fourteen patients) sustained either a midsubstance disruption of the medial collateral ligament or an avulsion of the ligament from bone during the procedure. Preoperatively, all patients had either neutral or varus alignment and an intact medial collateral ligament. Midsubstance tears were treated with direct primary repair, and avulsions of the ligament off the tibia or femur were treated with suture-anchor reattachment to bone. All patients wore a hinged knee brace, with no limit to the range of motion, for six weeks postoperatively. Clinical and radiographic data were gathered prospectively as part of a database that was ongoing throughout the period of study; the cohort of patients was assembled retrospectively by searching that database. RESULTS: No patients were lost to follow-up. The mean duration of follow-up was forty-five months (range, twenty-four to ninety-five months). The Hospital for Special Surgery knee scores increased from a mean of 47 points (poor) preoperatively to a mean of 93 points (excellent) at the time of final follow-up. On physical examination, no patient had a Hospital for Special Surgery score in the fair or poor range and all patients had regained normal stability in the coronal plane both at full extension and at 30 degrees of flexion. No patient required knee-bracing beyond the initial six-week postoperative period. The range of motion at the time of final follow-up averaged 108 degrees (range, 85 degrees to 125 degrees ), although one knee required manipulation under anesthesia to obtain a satisfactory range of motion. No arthroplasties required revision. Radiographic examination demonstrated appropriate limb alignment in all patients at the time of final follow-up. CONCLUSIONS: Intraoperative disruption of the medial collateral ligament can be treated with primary repair or reattachment of the ligament to bone and postoperative bracing with good results; this avoids the potential disadvantages associated with the use of varus-valgus constrained implants.

Aged↗
PubMedDate not supplied

Elbow medial ulnar collateral ligament insufficiency alters posteromedial olecranon contact.

BACKGROUND: The effect of elbow medial ulnar collateral ligament injury on posteromedial compartment contact is unknown. HYPOTHESIS: Medial ulnar collateral ligament injury causes altered contact area and pressure in the posteromedial compartment of the elbow. STUDY DESIGN: Controlled laboratory study. METHODS: Seven elbow cadaveric specimens were tested in an apparatus that positioned the elbow at 30 degrees and 90 degrees of flexion. Partial and full tears were simulated by releasing the medial ulnar collateral ligament. Pressure-sensitive film was placed in the posteromedial compartment for each condition. Valgus torques of 1.25 and 2.0 N.m were applied for each ligament condition, and kinematic data were obtained at each flexion angle using a 3-dimensional digitizer. RESULTS: Both ligament condition and valgus load had significant effects on contact area and pressure (P<.05). For a given load and flexion angle, the contact area decreased and the pressure increased with increasing medial ulnar collateral ligament insufficiency. Within these trends, statistical significance was found at 30 degrees of elbow flexion for both area and pressure (P<.05); at 90 degrees of elbow flexion, increasing medial ulnar collateral ligament insufficiency did not significantly affect contact area or pressure (P>.05). DISCUSSION: Medial ulnar collateral ligament insufficiency alters contact area and pressure between the posteromedial trochlea and olecranon and helps explain the development of posteromedial osteophytes.

Athletic Injuries↗
PubMed1996

Medial collateral ligament injuries of the knee: ultrasonographic findings.

The aims of our study were (1) to describe the ultrasonographic findings of the injured medial collateral ligament of the knee and (2) to assess the usefulness of ultrasonography in both evaluating the presence and location of the medial collateral ligament injuries and predicting the prognoses for the patients. The study group consisted of 16 patients with the clinical diagnosis of medial collateral ligament injury. We also examined 20 knee joints in 10 volunteers who had no history of injury to the knee. To predict prognoses, we divided the patients into two groups on the basis of the location of medial collateral ligament injuries. A thickened and heterogeneously hypoechoic appearance of the medial collateral ligament was considered abnormal. The normal medial collateral ligament was a thin and moderately homogeneous hypoechoic band with an average thickness of 4.3 mm (range, 3.3 to 5.6 mm) at the femoral attachment and of 2.3 mm (range, 1.3 to 3.2 mm) at the tibial attachment. All injured medial collateral ligament structures were thickened and heterogeneously hypoechoic. According to the criteria for grading of medial collateral ligament injury with stress view, 10 patients had grade III medial collateral ligament tears, three had grade II tears, and none had grade I injuries. In 15 (94%) of 19 knees, a correct diagnosis could be made with ultrasonography. Ultrasonography is useful in evaluating isolated medial collateral ligament injuries and in predicting patient outcome on the basis of the location of the medial collateral ligament injuries.

Adult↗
PubMedDate not supplied

Anatomic and histologic studies of lateral collateral ligament complex of the elbow joint.

We studied the gross and histologic anatomic characteristics of the lateral collateral ligament complex of the elbow joint from 15 cadavers to demonstrate its cross-sectional anatomy. The lateral ulnar collateral ligament adheres closely to the supinator, the extensor muscles, its intermuscular fascia, and the anconeus muscle and lies posterior to the radial collateral ligament. The lateral ulnar collateral ligament itself was identified with microscopy as a slender, poor structure consisting of the thick area of the posterolateral capsuloligamentous layer and a poorer structure than the anterior bundle of the medial collateral ligament as the primary stabilizer of the elbow joint. We believe that the lateral ulnar collateral ligament contributes to rather than is a major constraint to the posterolateral rotatory instability as part of the lateral collateral ligament complex with the surrounding tissues.

Aged↗
PubMed1994

Healing of the rabbit medial collateral ligament following an O'Donoghue triad injury: effects of anterior cruciate ligament reconstruction.

The effects of healing time and anterior cruciate ligament reconstruction on healing of the medial collateral ligament and stability of the knee joint were evaluated in a rabbit model of an O'Donoghue triad injury (rupture of the medial collateral ligament with removal of the anterior cruciate ligament and part of the medial meniscus). At time 0 and at 6 and 12 weeks postoperatively, the anterior-posterior translation and varus-valgus rotation of the knee, the structural properties of the femur-medial collateral ligament-tibia complex, and the mechanical properties of the substance of the medial collateral ligament were evaluated. Although anterior-posterior translation increased significantly with time, we could not demonstrate a significant temporal effect on varus-valgus rotation. The ultimate load, elongation at failure, and energy absorbed to failure improved with time. In addition, with time, failure of the complex occurred more often in the ligament substance than at the osseous insertion. Because healing time did not affect the cross-sectional area or modulus of the medial collateral ligament, the improved structural properties of the complex resulted not from improvements in the mechanical properties of the tissue but rather from healing of the tibial insertion site. By 12 weeks, the reconstructed knees had only minor signs of osteoarthrosis on the tibiofemoral surfaces; this is in contrast to the findings in anterior cruciate ligament-deficient knees in our earlier study. Additionally, at 12 weeks, the stiffness of the complexes from the reconstructed group was 1.3 times that of the anterior cruciate ligament-deficient group (p < 0.05), and te ultimate load had increased by a factor of 1.6 (p < 0.05). Our findings demonstrate that reconstruction of the anterior cruciate ligament in the rabbit helps to stabilize the joint, improves healing of the medial collateral ligament, and may decrease the incidence of early-onset osteoarthrosis after an O'Donoghue triad injury.

Animals↗