[Treatment of the lesion of the ulnar collateral ligament of the 1st metacarpophalangeal joint].
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Adolescent↗
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[Nonoperative approach to injuries of the lateral collateral ligament of the ankle joint].
Patients in number of 185 were included in this study. All of them were treated nonoperatively. One group (64 patients) was treated with early mobilization treatment and the other one (121 patients) with three weeks cast immobilization. Checking examination was done twice: 5 weeks and one year after injury. Chi-square test was used for data processing. Patients treated with cast had shorter recovery, but three were not statistical differences. Positive ADS test one year after the injury (I group 4.7%, and II group 2.5%) was considered as poor result and so was functional instability a year after injury (positive Romberg test, I group 12%, and II group 6.6%). Repeated injury was poor result also. In the first group there were 13.33% repeated injuries and in the second 4.95%.
Adolescent↗
Ruptures of the fibular collateral ligaments of the ankle. Result study of immediate surgical treatment.
A recently published survey from this institution of the results of conservative treatment for severe injuries to the lateral ligaments of the ankle showed relatively disappointing results; only 58.8 per cent of patients were asymptomatic at follow-up. Influenced by this study, we utilized ankle arthrography, aimed at more exact diagnosis, and immediate open repair was done in selected patients (young, serious athletes). Over a two and one-half-year period, twenty-seven patients, an average of 19.7 years old, who had major injuries to the lateral ligaments of the ankle had immediate surgical repair. Greatly improved results were achieved.
Adolescent↗
[Results of fibular collateral ligament suture at the upper ankle in fresh rupture (author's transl)].
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Adolescent↗
[Mechanism of collateral-ligament lesions in the proximal interphalangeal joints of long fingers. Anatomical study].
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Finger Joint↗
Medial collateral knee ligament healing. Combined medial collateral and anterior cruciate ligament injuries studied in rabbits.
We examined the histological appearance and biochemical properties of the healing medial collateral ligament (MCL) of a rabbit knee after combined MCL and anterior cruciate ligament (ACL) injury treated with ACL reconstruction and with or without MCL repair. By so doing, we hoped to understand better our previous bomechanical observations (Ohno et al. 1995) and possibly learn where to focus future investigation into improving the quality of the healing MCL. Ligaments were examined at 6 and 12 weeks of healing. We found healing of all ligaments with hypercellularity and fibroblast elongation along the axis of loading, as expected. Unexpected, however, was the finding of multiple osteophytes in both the repaired and nonrepaired specimens at the medial borders of the joint and at the MCL insertions. These were felt to affect possibly the biomechanics of the MCL by causing stress risers at the point where they undermine the ligament. Biochemically, we demonstrated a correlation between collagen content and hydroxypyridinium crosslinks and modulus of elasticity. While this implies that the modulus is dependent on collagen content and hydroxypyridinium crosslink density, modulus is also probably dependent on other factors such as collagen organization, type and internal structure. Overall, the detailed characterization and correlation between the histological, biochemical, and biomechanical properties of the healing MCL in the severe knee injury model provide insight into the functional behavior of the healing MCL.
Animals↗
Radial instability of the metacarpophalangeal joint of the thumb. A biomechanical investigation.
Human cadaver thumbs were tested to evaluate stability of the radial side of the MP joint. The contributions of the dorsal capsule, radial collateral ligament, accessory collateral ligament, and volar plate were examined with the joint in 0 degrees and 30 degrees of flexion. At 0 degrees flexion, the average joint angulation increased 4 degrees following isolated radial collateral ligament transection and 6 degrees following isolated accessory collateral ligament transection. Release of both the accessory and radial collateral ligaments produced marked instability with joint angulation of at least 46 degrees. The accessory collateral ligament helped to stabilize the extended MP joint. There were no significant contributions to stability from the dorsal capsule and volar plate when the collateral ligaments were intact. In the laboratory setting, radial-side instability of the MP joint of the thumb requires transection of both the proper and accessory radial collateral ligament.
Biomechanical Phenomena↗
No effect of mop-ending on ligament healing. Rabbit studies of severed collateral knee ligaments.
We have tested the hypothesis that increasing the surface area of cut ligament ends by the creation of "mop-ends" may alter the mechanical properties of healing medial collateral ligaments. In one group of New Zealand white rabbits, a 4-mm midsubstance segment was removed from the right ligament creating a gap (sharp cut-end healing group). In the other group, a similar gap was created but, in addition, cut ligament ends were split longitudinally across the width of the ligament creating "mop-ends", roughly tripling the total injury surface area. In all animals, the contralateral (left) leg was not operated on and served as an internal control. At least 8 animals from each injury model were killed at 3, 6, 14, and 40 weeks post-operatively. Both histological and mechanical tests showed that sharp-cut and mop-end injuries healed at similar rates with similar material.
Animals↗
Knee dislocations: where are the lesions? A prospective evaluation of surgical findings in 63 cases.
OBJECTIVE: To evaluate soft-tissue injury patterns in a large series of patients with knee dislocations to identify frequency and associations that may aid in surgical planning. DESIGN: Prospective clinical study. SETTING: Two institutions, both level I trauma centers. PATIENTS: Sixty patients with 63 dislocatable knees. RESULTS: Cause of injury was motor vehicle injury in 34 patients, sports in 23 patients, and falls in 3 patients; 71% of knees studied had bicruciate injuries. Eight knees had associated major intraarticular fractures. Vascular disruption occurred in 14% of knees. Peroneal nerve palsies occurred in 14% of knees. All injured knees with complete peroneal nerve palsies had anterior cruciate ligament, posterior cruciate ligament, and lateral collateral ligament disruptions. The incidence of vascular injury was the same for patients injured in sports as for those injured in road trauma. Reattachable ligamentous avulsions occurred in 19% for anterior cruciate ligament, 51% for posterior cruciate ligament, 64% for medial collateral ligament, and 84% for lateral collateral ligament injuries. Certain injury patterns also had a high association of tendon and capsule avulsions. Proximal lateral collateral ligament injuries were commonly associated with popliteus tendon avulsions and seldom with distal biceps avulsions. Distal lateral collateral ligament injuries were commonly associated with distal biceps avulsions and seldom with popliteus tendon avulsions. Reattachable meniscal capsular avulsions off the tibia occurred predominantly when the collateral ligament injury was a distal avulsion. CONCLUSIONS: This study showed a wide variety of injury patterns. Knees had to have at least two ligaments injured to be dislocatable but not necessarily both cruciate ligaments. Sports injuries have the same pattern of injury as motor vehicle accidents, suggesting similar forces of injury. The study demonstrates a high incidence of reattachable avulsion injuries to ligaments and soft tissues in dislocatable knees. These may not be as easily dealt with if surgery is delayed beyond 3-4 weeks.
Adolescent↗
Ligament replacement with an absorbable copolymer carbon fiber scaffold--early clinical experience.
Eighty-two patients, average age 29 years, were surgically treated (during the period from April 1981 to July 1983) for both acute (8%) and chronic (92%) knee ligament instabilities. An absorbable copolymer-carbon fiber ligament prosthesis was used as a tissue scaffold. Seventy-five percent had anterior cruciate ligament reconstructions, 6% had anterior cruciate and posterior cruciate ligament reconstructions, 6% had just posterior cruciate ligament reconstructions, and 9% had other combinations of anterior cruciate ligament, medical collateral ligament, and lateral collateral ligament reconstructions. Preoperative and postoperative evaluation, consisting of questionnaires, physical examinations, and isoskinetic testing, revealed significant improvements in categories of stability, pain, function, and strength persisting to the end of the study at 24 months. Arthroscopic examination and histologic studies of retrieved specimens demonstrated well-vascularized reconstructions with collagenous tissue ingrowth into the carbon-copolymer implants.
Adolescent↗
Voluntary rotation in the human knee joint.
The structures responsible for the restriction of knee joint rotation were established by means of sequential destruction of the menisci, cruciate ligaments, capsular and collateral ligaments; the capsular and collateral ligaments restrict both medial and lateral rotation. The anterior cruciate ligament was also found to restrict medial rotation, thus acting as a synergist to the capsular and collateral ligaments. The posterior cruciate ligament was found to have no effect on rotation. Under no circumstances do the cruciates as a pair restrict medial rotation as this is drastically increased as a consequence of the removal of the capsular and collateral ligaments, and the lateral meniscus. The axis of medial rotation ran through the medial tubercle of the intercondylar eminence while that of lateral rotation was located slightly lateral to it.
Biophysical Phenomena↗
On the coupling between anterior and posterior cruciate ligaments, and knee joint response under anterior femoral drawer in flexion: a finite element study.
OBJECTIVE: To investigate the extent of coupling between the anterior and posterior cruciate ligaments as well as the role of the posterior cruciate ligament in the knee joint response under anterior femoral force at different flexion angles. DESIGN: A developed finite element model of the tibiofemoral joint is used to perform non-linear elastostatic analyses. BACKGROUND: The structural properties of the posterior cruciate ligament subsequent to an injury (either left untreated or replaced by a graft) would likely change, an event that alters the function of not only the ligament itself but also the other intact cruciate ligament and the entire joint. METHODS: The model consists of two bony structures and their articular cartilage layers, menisci and four principal ligaments. Under 100 N anterior femoral load at different flexion angles from 0 degrees to 90 degrees, kinematics, forces in ligaments and contact forces in the fully unconstrained joint were computed in intact cases and following alterations in joint ligaments. RESULTS: Collateral ligaments were the primary structures to resist the force at full extension under 100 N anterior femoral load with a moderate contribution from the posterior cruciate ligament. With joint flexion up to 90 degrees, however, force in the posterior cruciate ligament substantially increased whereas that in collateral ligaments diminished. CONCLUSIONS: A remarkable coupling was found between the posterior cruciate ligament and the anterior cruciate ligament in flexion; a structural alteration in one of them significantly influenced the mechanical role of both ligaments and not just the one affected. A tauter or stiffer ligament increased the force in both ligaments while an excessive laxity or rupture in one diminished forces in both. RELEVANCE: Alterations in ligament stiffness or initial tautness during reconstruction surgery or following injuries markedly influence the normal role of both cruciate ligaments. Consideration of cruciate ligaments coupled together rather than in isolation should be the rule in the management of ligament injuries towards a successful long-term outcome.
Anterior Cruciate Ligament↗
Abduction-traction injury of the knee.
Disruption of the major ligaments of the knee was seen in six young men, five parachutists and a house painter, after what we have termed abduction-traction injury. This unusual complaint results from the application of a sudden block to the ankle while falling head first, leading to traction and abduction of the knee. All the patients underwent operations, generally with unsatisfactory results. At operation tears of the anterior cruciate ligament, medial collateral ligament and posterior oblique ligament were seen in each case; in four patients the posterior capsule and in three the posterior cruciate ligament also were torn. In one patient the lateral collateral ligament was torn and the lateral meniscotibial ligament was avulsed. The compression component is absent in this type of injury and consequently the menisci and the osteochondral surfaces of the tibia and femur remained intact in each case.
Accidents, Occupational↗
Posterolateral elbow joint instability: the basic kinematics.
Thirty-five osteoligamentous elbows were included in a study on the kinematics of posterolateral elbow joint instability during the pivot shift test (PST) before and after separate ligament cuttings in the lateral collateral ligament complex (LCLC). Division of the annular ligament or the lateral ulnar collateral ligament caused no laxity during the PST. Division of the lateral collateral ligament caused maximal laxity of 4 degrees and 23 degrees during forced PST in valgus and external rotation (supination), respectively. Cutting of the LCLC at the ulnar or the humeral insertion was necessary for any PST stressed elbow joint laxity to occur. Total division of the LCLC induced a maximal laxity of 7.9 degrees and 37 degrees during forced PST in valgus and external rotation (supination), respectively. This study suggests the lateral collateral ligament to be the primary soft tissue constraint to PST stress and the annular ligament and the lateral ulnar collateral ligament to be only secondary constraints. This study indicates that the integrity of the medial collateral elbow ligaments should be evaluated during forced valgus in pronation or neutral forearm rotation. Furthermore an isometric lateral collateral ligament reconstruction was shown to correct the joint laxity introduced by total LCLC transection.
Aged↗
Knee injuries: high-resolution MR imaging.
Recent technologic advances have made high-resolution magnetic resonance (MR) imaging of the knee a clinical reality. Ten healthy volunteers and 30 patients with suspected knee injuries were imaged using receive-only surface coils and two-dimensional multisection or three-dimensional selective acquisition techniques. Arthroscopic and/or surgical correlation was available in 15 patients. Tears of the cruciate ligament, medial collateral ligament, and meniscus are illustrated. Nonorthogonal views of the anterior cruciate ligament are useful for demonstrating both femoral and tibial attachments in the same section. The posterior cruciate ligament is usually well seen on sagittal views. T2-weighted images are helpful for demonstrating collateral ligament tears and meniscal tears when joint effusion is present. Thin sections (1-5 mm) are necessary to define many meniscal and cruciate tears. High-resolution, thin-section MR imaging can be used to diagnose soft-tissue injuries of the knee and has the potential to become a major imaging method in the evaluation of knee injuries.
Adolescent↗
[Double-contrast arthrography of the knee in traumatic capsular-ligamentous lesions. A critical review].
The authors conducted a statistical study and a critical review on a series of 1,300 patients examined with double-contrast fluoroscopically guided knee arthrography using a simple examination technique. Arthrographic diagnoses were subsequently compared with arthrotomic (500 patients), arthroscopic (350 patients), and clinical (450 patients) diagnoses. The critical review pointed out the high diagnostic accuracy (90%) and the good sensitivity (87%) of arthrographic examination in patients affected with pathologic conditions of the cruciate ligaments. In collateral ligament diseases and in capsular ruptures arthrographic sensitivity was not as high but still acceptable (74%). Capsular tears and medial collateral ligament tears can be identified when contrast medium is seen leaking from the knee joint. Cruciate ligament tears may be partial or complete: if a tear is partial the synovial surface of the cruciate ligament cannot be identified the cruciate ligament is wavy, lumpy, or focally thin, while in complete tears the synovial surface of the cruciate ligament cannot be identified either entirely or partially.
Arthrography↗
Permeation from the synovial fluid as nutritional pathway for the anterior cruciate ligament in rabbits.
The anterior cruciate ligament of the knee receives its nutrition from a direct vascular supply and by permeation of nutrients from synovial fluid. In order to quantitate the relative importance of these two routes and to compare the anterior cruciate ligament with the medial collateral ligament, we injected [3H]methyl-glucose as a tracer intravenously or directly into the knee in rabbits. Tracer concentrations in plasma, synovial fluid, the anterior cruciate ligament and the medial collateral ligament were analysed by a pharmacokinetic compartment model developed for this study. The contribution of [3H]methyl-glucose permeation from the synovial fluid was calculated at 59.7% in the anterior cruciate ligament and at 18.1% in the medial collateral ligament. We concluded from these results that the nutrition for the medial collateral ligament, which is an extraarticular structure, is provided mainly by its vascular supply. In contrast, synovial fluid permeation is an important transport route for small molecules for the normal anterior cruciate ligament.
Animals↗
[Biomechanical evaluation of the valgus stability of elbow after reconstruction].
OBJECTIVE: To evaluate of the valgus stability of the elbow after excision of the radial head, release of the medial collateral ligament (MCL), radial head replacement, and medial collateral ligament reconstruction. METHODS: Twelve fresh human cadaveric elbows were dissected to establish 7 kinds of specimens with elbow joint and ligaments as follow: (1) intact (n=12); (2) release of the medial collateral ligament (n=6); (3) excision of the radial head (n=6); (4) excision of the radial head together with release of the medial collateral ligament (n=12); (5) radial head replacement (n=6); (6) medial collateral ligament reconstruction (n=6); (7) radial head replacement together with medial collateral ligament reconstruction (n=12). Under two-newton-meter valgus torque, and at 0, 30, 60, 90 and 120 degrees of flexion with the forearm in supination, the valgus elbow laxity was quantified: All analysis was performed with SPSS 10.0 software. RESULTS: The least valgus laxity was seen in the intact state and its stability was the best. The laxity increased after resection of the radial head. The laxity was more after release of the medial collateral ligament than after resection of the radial head (P<0.01). The greatest laxity was observed after release of the medial collateral ligament together with resection of the radial head, so its stability was the worst. The laxity of the following implant of the radial head decreased. The laxity of the medial collateral ligament reconstruction was as much as that of the intact ligament (P>0.05). The laxity of the radial head replacement together with medial collateral ligament reconstruction became less. CONCLUSION: The results of this study show that the medial collateral ligament is the primary valgus stabilizer of the elbow and the radial head was a secondary constraint to resist valgus laxity. Both the medial collateral ligament reconstruction and the radial head replacement can restore the stability of elbow. If the radial head replacement can not be carried out, the reconstruction of the medial collateral ligament is acceptable.
Arthroplasty, Replacement↗