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PubMedDate not supplied

The effect of a nonsteroidal antiinflammatory drug on the healing of ligaments.

Because of the increasing number of ligament sprains being treated with nonsteroidal antiinflammatory drugs (NSAIDs), this study was undertaken to document the effects of one such drug on ligament healing in an experimental setting. Male Sprague-Dawley rats weighing between 400 and 500 g were used to evaluate the effect of the NSAID piroxicam on the healing of an experimental injury to the medial collateral ligament (MCL). The following factors were varied in the experiments: dosage, days of treatment, and the day postinjury when treatment was begun. Piroxicam-treated rats were compared to placebo-treated rats in terms of the drug's effect on the mechanical strength of the healing ligament. The ligaments were mechanically tested in tension to failure at a constant deformation rate of 0.25 mm/sec on a materials testing machine. Administration of piroxicam on Days 1 to 6 postinjury resulted in a 42% increase in strength at Day 14 postinjury for the piroxicam-treated ligaments (P less than 0.01) when compared with the placebo-treated controls. Neither doubling nor halving the standard piroxicam dose significantly altered this increased healing strength. Biochemical analysis of collagen synthesis demonstrated a suggestive, although not statistically significant, increase in collagen synthesis and collagen content in the piroxicam-treated healing ligament. In separate experiments, piroxicam had no effect on the healed ligament at 21 days or on the strength of uninjured ligaments. In conclusion, piroxicam increased the early strength of healing ligaments in the rat when the drug was administered for short periods of time after injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

The effect of enforced exercise on the healing of ligament injuries.

Previous studies have documented that mobilization ad libitum has a beneficial effect on the healing of ligaments as compared to immobilization. This study was undertaken to determine whether enforced exercise (over and above motion ad libitum) would have a further beneficial effect or, instead, an adverse effect on the healing of ligaments. Large male Sprague-Dawley rats with unrepaired transections of the medial collateral ligament were separated into five groups of similar mean weights. Two of these groups had the anterior cruciate ligament and the medial capsule transected in addition to the medial collateral ligament, rendering the knee unstable. The groups were then subjected to varying regimens of enforced exercise (swimming). After 12 days, the mechanical characteristics of the femur, medial collateral ligament, and tibia complex were evaluated. Rats with intact secondary valgus stabilizers (medial capsule and anterior cruciate ligament) that swam daily for either 5 (moderate) or 15 (near exhaustion) minutes were found to have increases in the tensile strength of the femur, medial collateral ligament, tibia complex as compared to rats that did not swim. Unstable knees (with transected secondary valgus stabilizers) did not show an increase in the tensile strength of the femur, medial collateral ligament, tibia complex when subjected to moderate increase in enforced exercise (swimming 5 minutes). The unstable groups were, however, significantly more lax than the groups that underwent identical exercise regimens but had intact secondary valgus stabilizers. Significant differences in the stiffness of the ligaments in the different groups were not detected.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

The contribution of the glenohumeral ligaments to anterior stability of the shoulder joint.

The purpose of this study was to investigate the ligamentous stabilizing mechanisms preventing anterior instability in the glenohumeral joint. Six freshly thawed, unembalmed cadaveric shoulders were dissected, preserving the joint capsule and glenohumeral ligaments, the coracohumeral ligament, and the subscapularis tendon. Hall-effect strain transducers were placed on the superior, middle, and inferior glenohumeral ligaments. The humerus and scapula were fixed in a specifically designed mounting apparatus that allowed the glenohumeral joint to be placed in 0 degree, 45 degrees, or 90 degrees of abduction. The mounting apparatus was placed in a model TTC Instron Universal Testing Instrument, which applied an external rotation torque to the humerus. Strain produced in the three glenohumeral ligaments was recorded on a three-channel X-Y chart recorder. At 0 degree of abduction, the superior and middle glenohumeral ligaments developed the most strain. At 45 degrees of abduction, the inferior and middle glenohumeral ligaments developed the most strain, with considerable strain also being developed in the superior glenohumeral ligament. At 90 degrees of abduction, the inferior glenohumeral ligament developed the most strain, with strain also seen in the middle glenohumeral ligament.

Biomechanical Phenomena↗
PubMedDate not supplied

Intercondylar notch size and anterior cruciate ligament injuries in athletes. A prospective study.

Published reports agree that there is a strong association between intercondylar notch stenosis and anterior cruciate ligament injuries. In a previously published retrospective study on bilateral anterior cruciate ligament injuries and associated intercondylar notch stenosis, we formulated the notch width index to measure and compare intercondylar notch width. The purpose of this prospective study was to establish a normal range for the notch width index and to correlate intercondylar notch size and anterior cruciate ligament injuries. We gathered data on 902 high school athletes, including range of motion, thigh girth, ligament stability and intercondylar notch width using the notch width index. The population was then followed prospectively and anterior cruciate ligament injuries were recorded and correlated with notch width index in a blind manner. Two-year results showed that the overall anterior cruciate ligament injury rate was 3%. The normal intercondylar notch ratio was 0.231 +/- 0.044. Intercondylar notch width index for men was larger than that for women. Athletes sustaining noncontact anterior cruciate ligament tears have statistically significant intercondylar notch stenosis (notch width index, 0.189). Ten of 14 athletes with noncontact anterior cruciate ligament injuries had a notch width index that was at least 1 SD below the mean. Athletes with contact anterior cruciate ligament injuries had a mean of 0.233. We conclude that athletes with a stenotic intercondylar notch are at significantly greater risk for sustaining noncontact anterior cruciate ligament injury.

Adolescent↗
PubMedDate not supplied

Anterior cruciate ligament strain behavior during rehabilitation exercises in vivo.

Before studying the biomechanical effects of rehabilitation exercises on the reconstructed knee, it is important to understand their effects on the normal anterior cruciate ligament. The objective of this investigation was to measure the strain behavior of this ligament during rehabilitation activities in vivo. Participants were patient volunteers with normal anterior cruciate ligaments instrumented with the Hall effect transducer. At 10 degrees and 20 degrees of flexion, ligament strain values for active extension of the knee with a weight of 45 N applied to a subject's lower leg were significantly greater than active motion without the weight. Isometric quadriceps muscle contraction at 15 degrees and 30 degrees also produced a significant increase in ligament strain, while at 60 degrees and 90 degrees of knee flexion there was no change in ligament strain relative to relaxed muscle condition. Simultaneous quadriceps and hamstrings muscles contraction at 15 degrees produced a significant increase in ligament strain compared with the relaxed state but did not strain the ligament at 30 degrees, 60 degrees, and 90 degrees of flexion. Isometric contraction of hamstrings muscles did not produce change in ligament strain at any flexion angle. Exercises that produce low or unstrained ligament values, and would not endanger a properly implanted graft, are either dominated by the hamstrings muscle (isometric hamstring), involve quadriceps muscle activity with the knee flexed at 60 degrees or greater (isometric quadriceps, simultaneous quadriceps and hamstrings contraction), or involve active knee motion between 35 degrees and 90 degrees of flexion.

Adult↗
PubMedDate not supplied

Functional anatomy of the medial collateral ligament of the ankle joint.

The calcaneotibial and posterior talotibial ligaments slacken and the naviculotibial ligament tightens as the ankle plantarflexes; the reverse occurs in ankle extension. The naviculotibial ligament increases its length and the posterior talotibial ligament relaxes in abduction. The cutting of the posterior talotibial ligament repercutes on other parts of the medial collateral ligament. The cutting of other parts of the medial collateral ligament produces very little change on the posterior talotibial ligament. When the whole medial collateral ligament is severed, there is a lateral displacement of the talus. This may be important in the diagnosis and surgical treatment of a torn medial collateral ligament.

Ankle Joint↗
PubMed1998

Elongation behavior of calcaneofibular and cervical ligaments during inversion loads applied in an open kinetic chain.

The cervical ligament plays a significant role in lateral stability of the subtalar joint but has received little attention compared with other ankle and subtalar joint ligaments. The purpose of this research was twofold. First, the elongation behavior of the cervical ligament was assessed with the calcaneofibular ligament intact and cut during two different types of inversion loads (manual and mechanical). Second, inversion range of motion was determined concomitantly with inversion loading and the difference in inversion range of motion between the calcaneofibular ligament intact to cut state was compared. The mean elongation of the cervical ligament with the calcaneofibular intact was 0.58 mm (+/- 0.33 mm) and 0.46 mm (+/- 0.23 mm) for manual and mechanical methods, respectively, and 0.88 mm (+/- 0.37 mm) and 0.78 mm (+/- 0.37 mm), respectively, for the same methods in the absence of the calcaneofibular ligament. This difference was statistically significant (P < 0.05 manually and P < 0.02 mechanically). An average increase in the inversion range of motion was noted with both methods [7.5 degrees manually (+/- 2.75 degrees) and 7.7 degrees mechanically (+/- 2.95 degrees)] after lesioning of the calcaneofibular ligament. This difference was statistically significant (P < 0.001) for both manual and mechanical range of motion testing. The results of this study indicate that there is a significant increase in elongation of the cervical ligament in the absence of the calcaneofibular ligament during manual and mechanically applied inversion loads in a open kinetic chain. Clinical and theoretical implications of this data are discussed.

Aged↗
PubMed1992

A model of human knee ligaments in the sagittal plane. Part 2: Fibre recruitment under load.

A mathematical model of the knee ligaments in the sagittal plane is used to study the forces in the cruciate and collateral ligaments produced by anterior/posterior tibial translation. The model is based on ligament fibre functional architecture. Geometric analysis of the deformed configurations of the model ligaments provides the additional compatibility conditions necessary for calculation of the statically indeterminate distributions of strain and stress within the ligaments and the sharing of load between ligaments. The investigation quantifies the process of ligament fibre recruitment, which occurs when fibres made slack by passive flexion/extension of the knee stretch and change their spatial positions in order to resist applied loads. The calculated ligament forces are in reasonable agreement with experimental results reported in the literature. The model explains some subtleties of ligament function not incorporated in models that represent the ligaments by a small number of lines.

Biomechanical Phenomena↗
PubMed2003

Anatomy of the spring ligament.

BACKGROUND: The spring ligament has been reported to be composed of the inferior calcaneonavicular and superomedial calcaneonavicular ligaments. We investigated the lower layer of the spring ligament fibrocartilage complex under the fibrocartilaginous surface, identified three distinct structures, and examined the morphology and running patterns of their fiber bundles. METHODS: Forty-eight cadaveric feet were examined. After ablation of the ankle joint and extirpation of the talus, the surface cartilage of the spring ligament fibrocartilage complex was carefully removed with forceps, and the length, width, and thickness of the three components of the complex were measured with calipers. RESULTS: The three components of the spring ligament complex are the superomedial calcaneonavicular ligament, the inferior calcaneonavicular ligament, and a structure that we termed the third ligament, which comprises fibers running from the notch between the calcaneal facets to the navicular tuberosity. CONCLUSIONS: We demonstrated a third component of the spring ligament; this component runs from the notch between the anterior and middle calcaneal facets to the tubercle of the navicular in the lower layer of the spring ligament complex, lying beneath the cartilaginous surface of the complex.

Foot↗
PubMed2005

The spinoglenoid ligament. Anatomy, morphology, and histological findings.

BACKGROUND: Dysfunction of the distal branch of the suprascapular nerve has been reported in athletes involved in throwing or overhead sports. The consistent presence of a dynamic anatomic structure, the spinoglenoid ligament, overlying the nerve in the spinoglenoid notch may be a contributing factor to the dysfunction of this nerve. The purpose of this study was to report the anatomy, morphology, and histological characteristics of the spinoglenoid ligament. METHODS: The spinoglenoid ligaments of fifty-eight fresh-frozen cadaver shoulders were dissected to evaluate their anatomic dimensions, histological characteristics, and relationship to the suprascapular nerve, the posterior part of the capsule, and the glenoid rim. The spinoglenoid ligament was harvested, with its insertions on the scapular spine and on the capsule and glenoid left intact, for the histological analysis. RESULTS: Dissection revealed that a spinoglenoid ligament was present in all specimens. The ligament was found to form an irregular quadrangular shape. On gross examination, the deep fibers of the ligament extended from the lateral aspect of the scapular spine to the posterior part of the glenoid and the superficial fibers blended with the posterior aspect of the shoulder capsule. Histological sections demonstrated Sharpey fibers inserting into bone at the scapular spine and blending with the posterior aspect of the shoulder capsule to insert into the posterior surface of the glenoid, findings that confirmed the ligamentous nature of this structure. CONCLUSIONS: This study revealed the presence of the spinoglenoid ligament in all of the shoulders that were examined, with some variation in the size of the ligament.

Adult↗
PubMed2006

Anterior cruciate ligament deficiency alters the in vivo motion of the tibiofemoral cartilage contact points in both the anteroposterior and mediolateral directions.

BACKGROUND: Quantifying the effects of anterior cruciate ligament deficiency on joint biomechanics is critical in order to better understand the mechanisms of joint degeneration in anterior cruciate ligament-deficient knees and to improve the surgical treatment of anterior cruciate ligament injuries. We investigated the changes in position of the in vivo tibiofemoral articular cartilage contact points in anterior cruciate ligament-deficient and intact contralateral knees with use of a newly developed dual orthogonal fluoroscopic and magnetic resonance imaging technique. METHODS: Nine patients with an anterior cruciate ligament rupture in one knee and a normal contralateral knee were recruited. Magnetic resonance images were acquired for both the intact and anterior cruciate ligament-deficient knees to construct computer knee models of the surfaces of the bone and cartilage. Each patient performed a single-leg weight-bearing lunge as images were recorded with use of a dual fluoroscopic system at full extension and at 15 degrees , 30 degrees , 60 degrees , and 90 degrees of flexion. The in vivo knee position at each flexion angle was then reproduced with use of the knee models and fluoroscopic images. The contact points were defined as the centroids of the areas of intersection of the tibial and femoral articular cartilage surfaces. RESULTS: The contact points moved not only in the anteroposterior direction but also in the mediolateral direction in both the anterior cruciate ligament-deficient and intact knees. In the anteroposterior direction, the contact points in the medial compartment of the tibia were more posterior in the anterior cruciate ligament-deficient knees than in the intact knees at full extension and 15 degrees of flexion (p < 0.05). No significant differences were observed with regard to the anteroposterior motion of the contact points in the lateral compartment of the tibia. In the mediolateral direction, there was a significant lateral shift of the contact points in the medial compartment of the tibia toward the medial tibial spine between full extension and 60 degrees of flexion (p < 0.05). The contact points in the lateral compartment of the tibia shifted laterally, away from the lateral tibial spine, at 15 degrees and 30 degrees of flexion (p < 0.05). CONCLUSIONS: In the presence of anterior cruciate ligament injury, the contact points shift both posteriorly and laterally on the surface of the tibial plateau. In the medial compartment, the contact points shift toward the medial tibial spine, a region where degeneration is observed in patients with chronic anterior cruciate ligament injuries.

Adult↗
PubMed1993

Spring ligament of the ankle: normal MR anatomy.

The plantar calcaneonavicular or spring ligament is visualized inconsistently and incompletely on routine MR images of the foot. This ligament is a vital stabilizer of the longitudinal arch of the foot, providing support for the head of the talus, which rests on the ligament's central portion. Laxity or rupture of the spring ligament permits plantar flexion of the talus. This motion results in valgus alignment of the calcaneus and a flatfoot deformity (pes planovalgus). Laxity or rupture of the spring ligament can develop in cases of chronic dysfunction of the posterior tibial tendon. In rupture of the posterior tibial tendon, surgical management may include plication of the spring ligament in addition to repair or reconstruction of the tendon to stabilize the medial column of the foot. Thus, the status of the spring ligament can be a significant consideration in preoperative planning. This pictorial essay illustrates the normal MR anatomy of the spring ligament, the planes of imaging required for optimal depiction of the ligament, and the neighboring structures with which the ligament can be confused.

Ankle↗
PubMed2003

Sonography of the medial collateral ligament of the elbow: a study of cadavers and healthy adult male volunteers.

OBJECTIVE: We assessed the ability of high-resolution sonography to reveal the size and echogenicity of the anterior bundle of the normal medial collateral ligament of the elbow in cadavers and uninjured male volunteers. MATERIALS AND METHODS: The anterior bundle of the medial collateral ligament in five cadaveric elbows was imaged and injected with contrast material by experienced musculoskeletal radiologists using a 12-MHz linear array transducer. Immediate ligament dissection was performed. The bilateral ligaments in 30 healthy 21- to 34-year-old male volunteers were imaged with gravitational stress. Of these, five randomly selected subjects also received approximately 5 lb (11.3 kg) of applied stress. RESULTS: Contrast material was injected directly into all five cadaveric ligaments. The anterior bundle of the medial collateral ligament in all 30 asymptomatic male volunteers was hyperechoic in comparison with surrounding muscle and had a fibrillar pattern and fanlike shape. Its mean dimensions were 2.6 +/- 0.31 x 2.2 +/- 0.47 x 4.0 +/- 0.88 mm on the right and 2.6 +/- 0.36 x 2.1 +/- 0.42 x 4.0 +/- 0.86 mm on the left, in longitudinal short, transverse short, and transverse long axes, respectively. Differences in ligament measurements in sidedness, stress application, and hand dominance did not approach statistical (Bonferroni corrected, p > 0.01) or clinical (all differences, <0.2 mm) significance. CONCLUSION: Radiologists can accurately use sonography to identify and measure the size of the anterior bundle of the normal medial collateral ligament of the elbow. These baseline parameters for the normal ligament may prove useful when evaluating the injured ligament.

Adult↗
PubMed2005

Ultrastructural and immunocytochemical evaluation of the effects of extracorporeal shock wave treatment in the hind limbs of horses with experimentally induced suspensory ligament desmitis.

OBJECTIVE: To evaluate the effects of extracorporeal shock wave therapy (ESWT) on affected ligaments in the hind limbs of horses with experimentally induced suspensory ligament desmitis by use of ultrasonographic, ultrastructural, and immunocytochemical techniques. ANIMALS: 10 horses. PROCEDURE: Suspensory ligament desmitis was induced in both hind limbs of each horse by use of 2 collagenase injections (administered 2 weeks apart) in each suspensory ligament. Two weeks after the second injection, the right hind limb of each horse was treated with ESWT (3 treatments at 3-week intervals); the left hind limb was not treated (control limb). Periodically during the study, the healing process was monitored ultrasonographically and the proportions of ligaments affected with lesions were assessed. Four weeks after the last ESWT treatment, biopsy specimens were collected from all ligaments for ultrastructural evaluation and immunocytochemical analysis of transforming growth factor beta-1. RESULTS: The difference in the proportion of the lesion-affected ligament between ESWT-treated and control limbs was significant (P < 0.05) from 3 weeks after the second ESWT treatment to the end of the study. Compared with control ligaments, ESWT-treated ligaments had more small, newly formed collagen fibrils and greater expression of transforming growth factor beta-1 4 weeks after the last ESWT treatment was administered. CONCLUSIONS AND CLINICAL RELEVANCE: Results have indicated that ESWT appears to facilitate the healing process in horses with experimentally induced hind limb suspensory ligament desmitis.

Animals↗
PubMed1991

Healing of ligaments in synovial fluid. An experimental study in rabbits.

To investigate the importance of nutritive environment in the healing of reconstructed ligaments, the morphology of sutured free patellar ligaments in synovial fluid of the contralateral knee joint, without re-establishment of microcirculation, was studied in rabbits. After two weeks (n = 6) and one (n = 6) and three (n = 5) months, the sutured ligament was removed from the joint and fibroblasts were seen growing into the suture gap. The ligaments were enveloped in a capsule of fibroblasts, which was more developed in those ligaments that were studied three months after operation. The collagen of the piece of ligament was disorganised at all time points, and tensile strength (n = 6) was low compared with non-sutured patellar ligament. Some ligaments disappeared or were partly attached to the synovial membrane and revascularised. The findings indicate that diffusion of nutrients may be important for the survival and healing of reconstructed ligaments, as the ligaments can heal in synovial fluid without re-establishment of the microcirculation.

Animals↗
PubMed1982

Distal tibiofibular ligaments. Analysis of function.

The function of the anterior tibiofibular ligament, of the syndesmosis between the distal parts of the tibia and fibula, and of the posterior tibiofibular ligament was elucidated by tracing mobility patterns before and after successive ligament transection in varying sequence. Eighteen osteoligamentous preparations were studied. Mobility was only minimally influenced by isolated cutting of the anterior tibiofibular ligament, and even complete cutting of the distal tibiofibular ligaments involved only minor abnormality in motion. However, external rotation was greatly increased by further cutting of the anterior part of the deltoid ligament or of the posterior talofibular ligament. This indicates that isolated injury of the anterior tibiofibular ligament must be rare, and total rupture of the distal tibiofibular structures is presumably as a rule combined with lesions of the anterior part of the deltoid ligament and/or of the posterior talofibular ligament.

Ankle Joint↗
PubMed1989

Replacement of the anterior cruciate ligament. A comparison of autografts and allografts in dogs.

To compare the efficacy of allograft versus autograft replacement of the anterior cruciate ligament, 15 dogs had the ligament cut and replaced 1 month later: 11 dogs received a frozen bone-ligament-bone allograft cruciate ligament, while 4 dogs received a standard autogenous replacement with iliotibial band. Three of 11 allograft dogs developed postoperative infections and were removed from the study; and two of the remaining eight allograft ligaments were absent at autopsy. All the autograft ligaments were present. From serial clinical and radiographic examinations, there were no differences observed in the two groups. Autopsy studies at 4 months, however, showed an increased inflammatory, pannus-like reaction about the origins and insertions of the six allograft ligaments as compared with the four autografts. The ligament hydroxyproline uptake was lower in the allograft group, averaging 60 percent of the contralateral unoperated on control versus equal to the control in the autograft group. The tensile strength of the allografts reached only 17 percent of the control value versus 41 percent for the autografts. Lymphocytotoxicity testing at 1 month revealed a donor-specific antibody response in 4 of 8 allograft dogs; however, no histologic evidence of immune response was observed in the ligaments. The synovial fluid leukocyte count was elevated in the allograft group at 4 months. The increased synovial leukocyte counts and joint cartilage erosion, the decreased strength and metabolic activity of the grafts, and the evidence of an immune response in the allograft dogs do not support implantation of cadaver cruciate ligaments clinically at this time.

Animals↗
PubMed2003

Healing in transplanted teeth with periodontal ligament cultured in vitro.

Regeneration of connective tissue attachment is the ultimate goal of periodontal therapy. It has been suggested that periodontal ligament cells possess the potential to create new connective tissue attachment. However, as cells from gingiva and alveolar bone occupy the root surface during initial wound healing, population by periodontal ligament cells is limited in vivo. We have been developing a new periodontal regeneration technique using in vitro tissue culture of periodontal ligament remaining on a periodontally involved root. The purpose of this study was to examine the periodontal healing after transplantation of teeth with reduced periodontal ligament that had been cultured in vitro. Twenty-five incisors from four beagles were used. After the teeth were extracted, the periodontal ligament and cementum were removed from coronal part of the roots and the roots were planed. The periodontal ligament of the apical part was retained. Fourteen teeth of the experimental group were transplanted following culture for 6 weeks. Eleven teeth of the control group were similarly prepared and immediately transplanted without tissue culture. Four weeks after transplantation, the specimens were prepared for histological analysis. Downgrowth of junctional epithelium on the root of experimental group was significantly less than control. Most of the root planed surfaces of experimental group were covered with periodontal ligament fibers oriented parallel or inclined to the root surfaces and limited new cementum formation was observed near the apical end of the planed root. There was no significant difference between groups in observations on the root surface with remaining periodontal ligament. From the above results, it was concluded that periodontal tissue culture of teeth with root planed surface and remaining periodontal ligament could reduce the extent of epithelium downgrowth and increase connective tissue adhesion on the root planed surface, as well as minimize damage to remaining periodontal ligament, after transplantation of teeth.

Animals↗