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PubMedDate not supplied

Physiologic strains in the lumbar spinal ligaments. An in vitro biomechanical study 1981 Volvo Award in Biomechanics.

For understanding of the mechanical causes of low-back pain, knowledge of the biomechanics of the various spinal elements is essential. In this in vitro biomechanical study, in situ behavior of spinal ligaments of the L3-4 and L4-5 functional spinal units during physiologic activities was studied in a three-stage procedure. First, 72 load-displacement curves were obtained to determine the three-dimensional flexibility characteristics of the spinal units. Second, three-dimensional morphometric measurements were made of all the spinal ligament attachment points. Finally, a mathematical model was constructed to combine the flexibility and morphometric data and compute the ligament length changes and strains as functions of various spinal movements. In flexion movement, the interspinous and supra-spinous ligaments were found to be subjected to the highest strains, followed by the capsular ligaments and the ligamentum flavum. During extension, it is the anterior longitudinal ligament that has the maximum strain. In lateral bending, the contralateral transverse ligaments carried the highest strains, while the interspinous and supraspinous ligaments were relatively unstrained. In rotation, the capsular ligaments were by far the most strained ligaments.

Adult↗
PubMed1991

Transections of the C1-C2 joint capsular ligaments in the cadaveric spine.

The purpose of this study was to examine the mechanical function of the C1-C2 capsular ligaments. Physiologic torques of up to 1.5 Nm were applied to human fresh cadaveric specimens (C0-C1-C2-C3) in three dimensions, and the three-dimensional motion of C1 relative to C2 was recorded. Two groups of cadaveric specimens were used to study the effect of two different sequential ligamentous transections. In the first group (n = 4), the transection of the left capsular ligament was followed by transection of the right capsular ligament. In the second group (n = 10), the transection of the left capsular ligament was preceded by transection of the left and right alar and transverse ligaments. The greatest changes in motion occurred in axial rotation to the side opposite the transection. In the first group, left capsular transections resulted in a significant increase in axial rotation range of motion to the right of 1 degree. After the right capsular ligament was transected, there was a further significant increase of 1.8 degrees to the left and 1.0 degree to the right. Lateral bending to the left also increased significantly by 1.5 degrees after both ligaments were cut. In the second group, with the nonfunctional alar and transverse ligaments, transection of the left capsular ligament resulted in greater increases in range of motion: 3.3 degrees to the right and 1.3 degrees to the left. Lateral bending to the right also increased significantly by 4.2 degrees.

Cadaver↗
PubMed1996

Restriction fragment length polymorphism of genes of the alpha 2(XI) collagen, bone morphogenetic protein-2, alkaline phosphatase, and tumor necrosis factor-alpha among patients with ossification of posterior longitudinal ligament and controls from the Japanese population.

STUDY DESIGN: The present study analyzed the restriction fragment length polymorphism patterns of alpha 2(XI) collagen, bone morphogenetic protein-2, alkaline phosphatase, and tumor necrosis factor-alpha genes in patients with ossification of the posterior longitudinal ligament. This study investigates the genetic polymorphism of bone-induced factors in patients with ossification of the posterior longitudinal ligament and compares it with healthy control subjects. OBJECTIVES: To clarify the genetic markers linked to ossification of the posterior longitudinal ligament. SUMMARY OF BACKGROUND DATA: Ossification of the posterior longitudinal ligament is a genetic disease associated with abnormal calcium metabolism involving the posterior longitudinal ligament. Previous genetic studies have not identified the pathologic mechanism of ossification of the posterior longitudinal ligament. Histopathologic studies of ossification of the posterior longitudinal ligament and the animal model, the spinal hyperostotic mouse, have revealed an increase in Type XI collagen and bone morphogenetic protein-2 expression. METHODS: Eighteen Japanese patients with ossification of the posterior longitudinal ligament and 51 healthy, unrelated control subjects were investigated for the restriction fragment length polymorphism patterns of COL11A2, bone morphogenetic protein-2, alkaline phosphatase, and tumor necrosis factor-alpha, genes with various restriction endonucleases. RESULTS: The gene frequencies of COL11A2 obtained with BamHl (10.0 kb fragment) and HindIII (19.0 kb fragment) observed in patients with ossification of the posterior longitudinal ligament were higher compared with control subjects (0.43 and 0.14, respectively). These differences were statistically significant (BamHl P = 0.018; Hindlll P = 0.046). Two new restriction fragment length polymorphism patterns were detected of the bone morphogenetic protein-2 gene with Mspl and Taql and one already known restriction fragment length polymorphism pattern of the tumor necrosis factor-alpha gene with Ncol. However, they were not significantly different from the control subjects. CONCLUSIONS: Seven restriction fragment length polymorphisms of COL11A2 gene were identified. Two of them (BamHl, 10.0/10.0 kb genotype; HindIII, 19.0/19.0 kb genotype) were significantly different in patients with ossification of the posterior longitudinal ligament.

Alkaline Phosphatase↗
PubMed2000

Reliability of magnetic resonance imaging in detecting posterior ligament complex injury in thoracolumbar spinal fractures.

STUDY DESIGN: Prospective study of 34 patients with thoracolumbar spinal fractures. OBJECTIVES: To assess the reliability of magnetic resonance imaging (MRI) for posterior ligament complex injury in thoracolumbar spinal fractures. SUMMARY OF BACKGROUND DATA: Some researchers have studied posterior ligament complex injury in spinal fracture using MRI. However, most did not evaluate the findings of MRI compared with the operative findings. METHODS: Thirty-four patients with thoracolumbar spinal fracture were evaluated by palpation of the interspinous gap, plain radiography, and MRI before operation. In addition to conventional MRI sequences, a fat-suppressed T2-weighted sagittal sequence was performed. Surgery was performed by a posterior approach. During the operation, posterior ligament complex injury was carefully examined. RESULTS: A wide interspinous gap was palpated in 14 patients and was found in 21 patients on plain radiography. Magnetic resonance imaging raised suspicion of injury to the posterior ligament complex in 30 patients. According to interpretation of MRI, injury to the supraspinous ligament was suspected in 27 patients, the interspinous ligament in 30 patients, and the ligamentum flavum in 9 patients. There were 28 supraspinous ligament injuries, 29 interspinous ligament injuries, and 7 ligamentum flavum injuries in operative findings. There was a significant relation between MRI interpretation and operative findings. CONCLUSION: A fat-suppressed T2-weighted sagittal sequence of MRI was a highly sensitive, specific, and accurate method of evaluating posterior ligament complex injury. Based on the results of this study, a fat-suppressed T2-weighted sagittal sequence of MRIs is recommended for the accurate evaluation of posterior ligament complex injury and would be helpful in the selection of treatment options.

Adolescent↗
PubMed2004

The effect of agility ankle prosthesis misalignment on the peri-ankle ligaments.

In the Agility total ankle replacement system, motion is constrained by the implant's articulating surfaces and the peri-ankle ligaments. The effects of plausibly occurring implant malpositioning on peri-ankle ligament functional extension during walking were explored in this study. The intent was to determine whether certain ligaments could serve as guides to assist in proper component positioning at implantation. Using a cadaver preparation with simulated physiologic motion and loading, we monitored change of ligament length of the anterior talofibular, posterior talofibular, calcaneofibular, and tibiocalcaneal ligaments resulting from controlled malpositioning of the tibial component relative to a neutral position. During a simulated walking cycle, effects of mediolateral and anterior/posterior translation, internal and external rotation, inversion and eversion, and elevation of the component were evaluated. In all cases, tibial component displacement from the neutral position caused atypical length change in one or more of the peri-ankle ligaments. In particular, anterior/posterior displacement significantly changed the lengthening behavior of all four tested ligaments. The anterior talofibular ligament was sensitive to transverse plane displacements, whereas the tibiocalcaneal ligament was sensitive to coronal plane displacements. For the Agility prosthesis, these two ligaments seem to be sensitive guides for tibial component positioning at implantation.

Ankle Joint↗
PubMedDate not supplied

The intercarpal ligaments of the equine midcarpal joint, Part 3: Clinical observations in 32 racing horses with midcarpal joint disease.

OBJECTIVE: To characterize the clinical features of intercarpal ligament pathology and to determine the relationship among palmar intercarpal ligament tearing, dorsomedial intercarpal ligament (DMICL) hypertrophy, and other intraarticular lesions. STUDY DESIGN: Prospective clinical observations. ANIMALS OR SAMPLE POPULATION: Twenty-eight thoroughbred and four standardbred race horses. METHODS: Clinical, radiographic, and arthroscopic examination of 53 midcarpal joints of 32 horses. RESULTS: Palmar intercarpal ligament tearing was observed in 30 joints of 22 horses. Some tearing of the medial palmar intercarpal ligament (MPICL) was present in 27 joints of 20 horses, and tearing of the lateral palmar intercarpal ligament in 9 joints of 7 horses. There was no correlation between the severity of clinical signs recorded and the degree of MPICL tearing. Joints with grade 2-4 MPICL tearing had significantly less cartilage and bone damage than joints with grade 1 or no ligament damage (P < .05). There was a significant inverse relationship between the number and size of intra-articular fractures, as assessed radiographically, and ligament damage (R = -.31). The DMICL was identified in all joints, and in 18 joints the ligament was enlarged. There was a significant correlation between MPICL damage and hypertrophy of the DMICL (R = .35). There was no correlation between DMICL hypertrophy and articular cartilage damage or subchondral bone damage. CONCLUSIONS: Severe subchondral bone and MPICL damage rarely occur in the same joint and DMICL hypertrophy may be associated with, rather than a cause of, joint disease. CLINICAL RELEVANCE: There are no clinical or radiographic findings that will differentiate intercarpal ligament injury from other carpal injuries. Diagnosis is only possible by arthroscopic examination of the midcarpal joint.

Animals↗
PubMed1989

Exophytic spread of hepatobiliary disease via perihepatic ligaments: demonstration with CT and US.

Eight cases of hepatobiliary disease located adjacent to or within the perihepatic ligaments (peritoneal reflections surrounding the liver) with exophytic spread along these ligaments (three abscesses from cholecystitis, two bilomas, two hepatic abscesses, and one hematoma from a ruptured hepatocellular carcinoma, with 16 ligamentous lesions: five in the hepatoduodenal ligament, four in the ligamentum teres, three in the falciform ligament, two in the gastrohepatic ligament, one in the transverse mesocolon, and one in the duodenocolic ligament) were studied with sonography and computed tomography. The locations of underlying diseases were the inferior aspect of the left lobe of the liver (three patients), the gallbladder (three patients), and the right hepatic duct (two patients). An understanding of the anatomic detail of the ligamentous attachments of the liver and the continuity of peritoneal ligaments is important in recognizing the ligamentous spread of hepatobiliary disease. This mode of spread of disease should be kept in mind in diagnostic imaging of the abdomen.

Abscess↗
PubMed1992

MR imaging of the most commonly injured ankle ligaments. Part I. Normal anatomy.

To determine the optimum foot position and imaging plane at magnetic resonance (MR) imaging of each ankle ligament, 10 cadaver ankles were dissected to visualize the orientation, precise attachment sites, and relationships of each ligament. Then eight cadaver ankles were studied with MR imaging and were cryosectioned in the optimum imaging planes. The ankles of 12 healthy volunteers were imaged to ensure consistency in identifying the normal ligaments. With the foot taped into full dorsiflexion of 10 degrees-20 degrees, axial imaging provided optimum views of the anterior, posterior, and inferior tibiofibular ligaments and of the anterior and posterior fibulotalar ligaments and provided an overview of the deltoid ligament. Coronal images provided full-length views of the tibiospring, tibiocalcaneal, and posterior tibiotalar parts of the deltoid ligament. With the foot taped into full plantar flexion of 40 degrees-50 degrees, axial imaging optimized visualization of the fibulocalcaneal ligament and of the tibionavicular and anterior tibiotalar parts of the deltoid ligament. Sagittal images provided the best full-length views of the spring ligament.

Adult↗
PubMed1996

Radioscaphocapitate ligament of the wrist: volar filling defect during radiocarpal arthrography.

PURPOSE: To determine whether a filling defect seen at radiocarpal arthrography represents the volar radioscaphocapitate ligament and to establish how frequently this finding is seen in patients referred for wrist arthrography. MATERIALS AND METHODS: Radiopaque markers were surgically placed along the borders of the radioscaphocapitate ligament in three cadaveric wrist specimens. Each cadaveric wrist was examined at arthrography. Seventy contrast material-enhanced wrist arthrograms were retrospectively reviewed for visualization of the radioscaphocapitate ligament. The arthrographic appearance of the ligament was compared with its reported appearance at dissection, radiography, and magnetic resonance arthrography. RESULTS: The cadaveric study, together with an analysis of the appearance of the ligament, confirmed that the radioscaphocapitate ligament can be seen as a filling defect at radiocarpal arthrography. Fifty-five (78%) of the 70 clinical arthrograms unequivocally demonstrated the radioscaphocapitate ligament. The ligament was most conspicuous early during the injection, especially with the wrist in ulnar deviation. CONCLUSION: The radioscaphocapitate ligament of the wrist can be visualized during routine radiocarpal arthrography. Future studies will need to determine whether abnormalities of the radioscaphocapitate ligament can be diagnosed at arthrography.

Adult↗
PubMed1991

Intrinsic innervation of the rat knee joint articular capsule and ligaments.

In spite of the practical importance of having a detailed knowledge of knee joint innervation to understand the pathophysiologic aspects, little information is now available concerning the density and pattern of the nerve fibres which are distributed to it. The present study has been designed to investigate the density and distribution of nerve fibres and receptor corpuscles in the knee joint articular capsule, cruciate and collateral ligaments in the rat, using the acetylcholinesterase (AChE) histochemical in toto staining technique. The investigation was performed on male Wistar rats of 3 months of age, some of which had been treated with capsaicin to deplete their afferent 'C' fibres of their content of neuropeptides. AChE-positive nerve fibres and different types of receptor corpuscle endings were found within articular capsule and ligaments. The highest density of AChE-positive nerve fibres was noticeable in the fibular collateral ligament followed by the tibial collateral ligament, the posterior cruciate ligament, the anterior cruciate ligament and the articular capsule. In the articular capsule the number of type I endings was higher than in the ligaments. The opposite is true for the other type of receptor corpuscles found as well as for nerve endings. Capsaicin treatment significantly reduced the density of AChE-positive nerve fibres in knee joint ligaments but did not affect nerve fibres in the articular capsule. Moreover, it caused the disappearance of some kind of receptor corpuscles within the collateral and cruciate ligaments. The above data collectively suggest that the AChE in toto staining technique may represent a good method for investigating joint innervation and that a significant percentage of nerve fibres supplying knee joint ligaments is represented by C fibre afferents.

Acetylcholinesterase↗
PubMed2004

The anatomy and isometry of the medial patellofemoral ligament: implications for reconstruction.

BACKGROUND: Several techniques have been described for reconstruction of the medial patellofemoral ligament. However, the isometry of the medial patellofemoral ligament has not been studied. PURPOSE: To define the anatomy and isometry of the medial patellofemoral ligament. STUDY TYPE: Cadaveric study. METHODS: The authors dissected the medial patellofemoral ligament in 11 cadaveric knees and recorded its anatomic relationships. They evaluated the isometry of the medial patellofemoral ligament by obtaining measurements between various anatomic pairings at certain fixed angles of knee flexion. RESULTS: During knee flexion from 0 degrees to 90 degrees, the portion of the medial patellofemoral ligament from the inferior patellar attachment to the superior femoral attachment was nearly isometric, demonstrating an average change in length of only 1.1 mm. Statistical analysis showed the superior femoral attachment to be most significant in determining isometric behavior. CONCLUSIONS: The most isometric portion of the medial patellofemoral ligament is the inferior portion of its patellar attachment extending to the superior portion of its femoral attachment, with the superior femoral attachment having the most notable influences on isometry. CLINICAL RELEVANCE: This study provides a detailed description of the anatomy of the medial patellofemoral ligament, as well as an evaluation of the isometric behavior of the ligament. Application of these data during reconstruction of the medial patellofemoral ligament may help to optimize patellofemoral stability.

Biomechanical Phenomena↗
PubMed2004

Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations.

BACKGROUND: Surgical treatments of complete acromioclavicular joint dislocations replace or reconstruct the coracoclavicular ligaments with a single structure and do not account for the anatomical variance of each ligament in the design. PURPOSE: To evaluate the cyclic behavior and structural properties of an anatomic tendon reconstruction of the coracoclavicular ligament complex after a simulated acromioclavicular joint dislocation. STUDY DESIGN: Controlled laboratory study. METHODS: Cyclic loading followed by a load-to-failure protocol (simulated dislocation) of the normal coracoclavicular ligament complex was performed and repeated after an anatomic reconstruction on the same specimen (n = 9). The anatomical reconstruction consisted of a semitendinosus tendon that replicated the direction and orientation of both the trapezoid and conoid ligaments. RESULTS: The coracoclavicular ligament and anatomical reconstruction complexes had clinically insignificant (<3 mm) permanent elongation after cyclic loading. The stiffness and ultimate load of the coracoclavicular ligament complex (60.8 +/- 12.2 N/mm and 560 +/- 206 N) were significantly greater than for the anatomical reconstruction complex (23.4 +/- 5.2 N/mm and 406 +/- 60 N), respectively (P < .05). Further analysis of the complexes revealed a 40% decrease in the bending stiffness of the clavicle after the simulated dislocation and failure of the normal coracoclavicular ligament complex (P < .05), which contributed to the diminished properties of the anatomic reconstruction. CONCLUSIONS: The low level of permanent elongation after cyclic loading suggests that the anatomic reconstruction complex could withstand early rehabilitation; however, the decrease in the structural properties and stiffness of the clavicle should be considered in optimizing the anatomic reconstruction technique. CLINICAL RELEVANCE: Despite the differences compared to the normal coracoclavicular ligament complex, the anatomical reconstruction complex more closely approximates the stiffness of the coracoclavicular ligament complex than current surgical constructs, and the incorporation of biological tissue could improve the overall structural properties with healing.

Acromioclavicular Joint↗
PubMed2005

Intercondylar notch stenosis is not a risk factor for anterior cruciate ligament tears in professional male basketball players: an 11-year prospective study.

BACKGROUND: The value of femoral notch size and the notch width index in predicting anterior cruciate ligament injury has been debated. This study examined the relationship between the notch width index and anterior cruciate ligament injury in professional basketball players. HYPOTHESIS: No significant difference exists between the notch width index of anterior cruciate ligament-injured and noninjured professional basketball players. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Using a notch view radiograph, the authors prospectively measured the femoral notch and the condylar widths and then calculated the notch width index of 615 male athletes who participated in the National Basketball Association's combine workouts between 1992 and 1999. Players who participated in at least 1 professional game were included. After an 11-year follow-up period, the National Basketball Association's leaguewide injury database was reviewed to identify injured players. The players were then categorized into anterior cruciate ligament-injured or noninjured groups. Notch width, condylar width, and notch width index were compared between the 2 groups. RESULTS: A total of 305 players were followed for a period of up to 11 years. Anterior cruciate ligament trauma was suffered by 14 (4.6%) of the subjects. The average notch width index was 0.235 +/- 0.031 for anterior cruciate ligament-injured players and 0.242 +/- 0.041 for noninjured players (t305=-0.623, P=.534). This difference was not significantly different. Two (3.9%) of the subjects with critical notch stenosis (notch width index 0.20) had noncontact anterior cruciate ligament injuries. CONCLUSIONS: The notch width index did not predict the rate of anterior cruciate ligament injury. A level of critical notch stenosis was not detected. Anterior cruciate ligament injury could not be predicted by the absolute measurement of the femoral inter-condylar notch. Use of a preparticipation notch view radiograph in male professional basketball players as a predictor of anterior cruciate ligament injury is not recommended.

Adult↗
PubMed2005

Anterior cruciate ligament injury in national collegiate athletic association basketball and soccer: a 13-year review.

BACKGROUND: Female collegiate athletes have been reported to have a higher rate of anterior cruciate ligament injury compared to male collegiate athletes. This finding has spawned a branch of research focused on understanding and preventing this injury pattern. PURPOSE: To determine if the trends reported in 1994 have continued. STUDY TYPE: Descriptive epidemiology study. METHODS: The National Collegiate Athletic Association Injury Surveillance System database was reviewed for all data relating to men's and women's basketball and soccer anterior cruciate ligament injuries for 1990 to 2002. RESULTS: No significant difference was seen in basketball comparing frequency of contact versus noncontact injuries between men (70.1%) and women (75.7%). Male basketball players sustained 37 contact injuries and 78 noncontact injuries. Female basketball players sustained 100 contact injuries and 305 noncontact injuries. In soccer, there was a significant difference in frequency of injury for male (49.6%) and female (58.3%) athletes when comparing contact and noncontact injuries (chi2=4.1, P<.05). Male soccer players sustained 72 contact injuries and 66 noncontact injuries. Female soccer players sustained 115 contact injuries and 161 noncontact injuries. The magnitude of the difference in injury rates between male and female basketball players (0.32-0.21, P=.93) remained constant, whereas the magnitude of the difference in the rate of injuries between male and female soccer players (0.16-0.21, P=.08) widened. Comparing injury within gender by sport, soccer players consistently sustained more anterior cruciate ligament injuries than did basketball players. The rate of anterior cruciate ligament injury for male soccer players was 0.11 compared to 0.08 for male basketball players (P=.002). The rate of anterior cruciate ligament injury for female soccer players was 0.33 and for female basketball players was 0.29 (P=.04). The rates for all anterior cruciate ligament injuries for women were statistically significantly higher (P<.01) than the rates for all anterior cruciate ligament injuries for men, regardless of the sport. In soccer, the rate of all anterior cruciate ligament injuries across the 13 years for male soccer players significantly decreased (P=.02), whereas it remained constant for female players. CONCLUSIONS: In this sample, the rate of anterior cruciate ligament injury, regardless of mechanism of injury, continues to be significantly higher for female collegiate athletes than for male collegiate athletes in both soccer and basketball. CLINICAL RELEVANCE: Despite vast attention to the discrepancy between anterior cruciate ligament injury rates between men and women, these differences continue to exist in collegiate basketball and soccer players. Also demonstrated is that although the rate of injury for women is higher than for men, the actual rate of injury remains low and should not be a deterrent to participation in sports.

Analysis of Variance↗
PubMed2005

Posterior cruciate ligament revision reconstruction, part 1: causes of surgical failure in 52 consecutive operations.

BACKGROUND: Posterior cruciate ligament reconstructions have not shown uniformly predictable results in restoration of normal posterior tibial translation. The authors are unaware of any study that has assessed the causes of failure of these operations, and they investigated 52 prior unsuccessful posterior cruciate ligament procedures to determine the factors that contributed to failure of the operations. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The authors studied 52 prior failed posterior cruciate ligament surgeries that had been done in 41 knees (40 patients). Graft reconstructions had been done in 31 cases, primary repairs in 14, synthetic replacements in 4, and thermoplasties in 3. Medical records, operative notes, radiographs, and magnetic resonance imaging scans were reviewed, and a comprehensive knee examination was conducted. RESULTS: A single factor that caused the operations to fail was identified in 23 (44%) of 52 operations, and multiple factors were identified in 29 (56%). The most common probable causes of failure were associated posterolateral ligament deficiency (40%), improper graft tunnel placement (33%), associated varus malalignment (31%), and primary suture repair (25%). Sixteen of 21 (76%) prior posterolateral ligament procedures had failed, as had 9 of 19 (47%) prior anterior cruciate ligament reconstructions. Twenty-nine knees (71%) presented with pain with activities of daily living. Thirty-four knees (83%) had compounding problems of joint arthritis, prior meniscectomy, associated ligament deficiencies, or varus malalignment. Posterior cruciate revision surgery was done in 22 knees (54%). Eleven knees (27%) had severe joint damage that contraindicated revision, and 8 (19%) declined further operations. CONCLUSIONS: Failure to restore associated ligament instabilities and incorrect tunnel placement were major factors contributing to surgical failure. The results suggest the need for greater emphasis on the initial reconstruction in graft tunnel placement, correction of associated ligament instabilities, and correction of varus osseous malalignment. Failure of concurrent posterolateral ligament reconstructions was frequently encountered, suggesting the need for higher strength augmentation procedures or anatomical graft replacement.

Adolescent↗
PubMed2005

Ligamentous posttraumatic ankle osteoarthritis.

BACKGROUND: Ankle sprains are the most common injuries in sports and recreational activities. HYPOTHESIS: Ankle osteoarthritis can be caused by ankle ligament lesions. Latency time between injury and osteoarthritis is influenced by the type and side of the injured ligaments. The side of the ligamentous lesion correlates with the hindfoot alignment. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Of a cohort of 247 patients with ankle arthritis, we reviewed data from 30 patients (33 ankles; mean age, 58.6 years) with ligamentous end-stage ankle osteoarthritis. The patients were evaluated etiologically, clinically, and radiologically. RESULTS: Etiologic analysis: 55% had a ligamentous lesion from sports injuries (soccer, 33%); 85% injured the lateral ankle ligaments, and 15% injured the medial and medial-lateral ligaments. The mean latency time between injury and osteoarthritis was 34.3 years. The survivorship rate for single severe ankle sprains was worse than that for chronic recurrent ligamentous lesions (mean latency time, 25.7 vs 38.0 years; P < .05), and the rate for medial sprains was worse than for lateral sprains (mean latency time, 27.5 vs 35.0 years; P < .05). At follow-up, the American Orthopaedic Foot and Ankle Society hindfoot score was 23.0 points, 52% had varus malalignment, 52% had persistent instability, and the mean ankle arthritis grade was 2.6 points. There was a correlation between chronic lateral ankle instability and varus malalignment. CONCLUSION: Lateral ankle sprains in sports are the main cause of ligamentous posttraumatic ankle osteoarthritis and correlate with varus malalignment. At the time of end-stage ligamentous ankle osteoarthritis, persistent instability may be encountered.

Adult↗
PubMed2006

The anterior cruciate ligament tear rate varies by race in professional Women's basketball.

BACKGROUND: Female basketball players are more likely to tear their anterior cruciate ligament than are their male counterparts. Many causes are postulated for the difference observed in the rate of anterior cruciate ligament tears between genders. However, little is known about the differences in tears within gender. HYPOTHESIS: The rate of anterior cruciate ligament tears is different in White European American female basketball players and non-White European American players. STUDY DESIGN: Cohort study (Prevalence); Level of evidence, 2. METHODS: The authors investigated the differences in anterior cruciate ligament tears by risk exposure in women of different racial or ethnic backgrounds playing in the Women's National Basketball Association for the 1999 through 2003 seasons. Using the injury surveillance data from the Women's National Basketball Association, the authors compared anterior cruciate ligament injuries in White European American and non-White European American players to determine differences in the rate of anterior cruciate ligament tears between racial groups. RESULTS: The anterior cruciate ligament tear rate for White European American players was 0.45 per 1000 athletic exposures, whereas for non-White European American players (black or African American, Hispanic, and Asian players) the rate was 0.07. The odds ratio of anterior cruciate ligament tears in White European American versus non-White European American players was 6.55 (95% confidence interval, 1.35-31.73). CONCLUSION: Our retrospective study shows that the anterior cruciate ligament tear rate for White European American players was 0.45 per 1000 athletic exposures, whereas tear rates in the Women's National Basketball Association vary by racial group, with White European American players having more than 6 times the anterior cruciate ligament tear rate of other ethnic groups combined. Further prospective studies of athletes are needed to validate this finding and shed light on possible reasons.

Black or African American↗
PubMed2006

Low-intensity pulsed ultrasound accelerates and a nonsteroidal anti-inflammatory drug delays knee ligament healing.

BACKGROUND: Low-intensity pulsed ultrasound and nonsteroidal anti-inflammatory drugs are used to treat ligament injuries; however, their individual and combined effects are not established. HYPOTHESES: Low-intensity pulsed ultrasound accelerates ligament healing, a nonsteroidal anti-inflammatory drug delays healing, and the nonsteroidal anti-inflammatory drug inhibits the beneficial effect of low-intensity pulsed ultrasound. STUDY DESIGN: Controlled laboratory study. METHODS: Sixty adult rats underwent bilateral transection of their knee medial collateral ligaments. Animals were divided into 2 drug groups and treated 5 d/wk with celecoxib (5 mg/kg) mixed in a vehicle solution (NSAID group) or vehicle alone (VEH group). One to 3 hours after drug administration, all animals were treated with unilateral active low-intensity pulsed ultrasound and contralateral inactive low-intensity pulsed ultrasound. Equal numbers of animals from each drug group were mechanically tested at 2 weeks (n = 14/group), 4 weeks (n = 8/group), and 12 weeks (n = 8/group) after injury. RESULTS: Ultrasound and drug intervention did not interact to influence ligament mechanical properties at any time point. After 2 weeks of intervention, ligaments treated with active low-intensity pulsed ultrasound were 34.2% stronger, 27.0% stiffer, and could absorb 54.4% more energy before failure than could ligaments treated with inactive low-intensity pulsed ultrasound, whereas ligaments from the NSAID group could absorb 33.3% less energy than could ligaments from the VEH group. There were no ultrasound or drug effects after 4 and 12 weeks of intervention. CONCLUSIONS: Low-intensity pulsed ultrasound accelerated but did not improve ligament healing, whereas the nonsteroidal anti-inflammatory drug delayed but did not impair healing. When used in combination, the beneficial low-intensity pulsed ultrasound effect was cancelled by the detrimental nonsteroidal anti-inflammatory drug effect. CLINICAL RELEVANCE: Low-intensity pulsed ultrasound after ligament injury may facilitate earlier return to activity, whereas non-steroidal anti-inflammatory drugs may elevate early reinjury risk.

Animals↗