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PubMedDate not supplied

Evaluation of collateral ligament injuries of the metacarpophalangeal joints with magnetic resonance imaging and magnetic resonance arthrography.

Injuries of the collateral ligaments of the metacarpophalangeal (MCP) joints of the hand require accurate diagnosis and prompt treatment to prevent loss of function. The most common and well-known collateral ligament injury is injury to the ulnar collateral ligament of the first MCP joint of the hand, often referred to as a gamekeeper injury. Although less common, injuries involving the collateral ligaments of the second through fifth digits and the radial collateral ligament of the first digit also occur. The diagnosis of collateral ligament injury is often made clinically, however, magnetic resonance imaging and magnetic resonance arthrography of the MCP joints can be very useful in the evaluation of severity of the injury. This provides important information for the hand surgeon and aids in treatment planning. Imaging of the collateral ligaments requires small fields of view and several technical considerations can provide improved image quality. These factors will be discussed and illustrated in this article.

Arthrography↗
PubMedDate not supplied

Histology and arthroscopic anatomy of the ulnar collateral ligament of the elbow.

The histology and arthroscopic anatomy of the ulnar collateral ligament of the elbow were studied in cadaveric specimens. The capsule consists of two layers of collagen fibers, with two distinct ligamentous bundles corresponding to anterior and posterior portions of the ulnar collateral ligament. The posterior bundle consists of distinct collagen bundles within the layers of the capsule; the anterior bundle consists of a similar thickening within the capsular layers, with an additional ligament complex superficial to the capsular layers. With arthroscopy only the anterior 20% to 30% of the anterior bundle of the ulnar collateral ligament could be visualized via the anterior portal. Only the posterior 30% to 50% of the posterior bundle could be seen via the posterior portals. After sectioning of the anterior bundle, joint instability was noted arthroscopically by an increased opening in the ulnohumeral joint with application of valgus stress. At arthroscopy ulnar collateral ligament tears may be visualized in part or not at all. To diagnose a tear or laxity in the ulnar collateral ligament, a demonstration of an increase in the opening of the ulnohumeral joint in response to valgus stress is useful.

Arthroscopy↗
PubMed2000

Effects of reconstructed radial collateral ligament on index finger mechanics.

Twenty fresh frozen hand specimens from cadavers were studied. Physiologic levels of extrinsic muscle loads were applied to the extrinsic flexor tendons of the index finger to simulate tip pinch of the finger on a fixed plate. The acute effects of transection of the radial collateral ligament and accessory radial collateral ligament (radial collateral ligament complex) with and without transection of the dorsal capsule and volar plate on the position of the proximal phalanx with respect to the metacarpal bone of the index finger were investigated. The acute effects of reconstruction of the radial collateral ligament, for each of two different surgical techniques, on the position of the proximal phalanx also were investigated. The spatial positions of the metacarpal bone and proximal phalanx were measured with a six-degree-of-freedom digitizing system for flexion angles from 0 degrees to 90 degrees in increments of 15 degrees. Transection of the radial collateral ligament complex resulted in significant increases in ulnar deviation (adduction) of the proximal phalanx and in volar translation. Additional transection of the dorsal capsule and volar plate caused significant increases in ulnar deviation, pronation, volar translation, and ulnar shift. The first surgical technique, one traditionally used to reconstruct the metacarpophalangeal joint of the thumb, failed to return the three-dimensional position of the proximal phalanx on the metacarpal head of the index finger to normal. The second surgical technique, based on anatomy, returned the position of the proximal phalanx to levels not statistically different from normal for most flexion angles.

Adult↗
PubMedDate not supplied

Biomechanics of a less invasive procedure for reconstruction of the ulnar collateral ligament of the elbow.

A reconstruction of the anterior bundle of the ulnar collateral ligament of the elbow using bone anchors was compared regarding strain and valgus load strength with the intact ulnar collateral ligament and the reconstructed ulnar collateral ligament using bone tunnels. In both normal and reconstructed elbows, the anterior band and posterior band were tight during only a portion of the range of motion. Toward extension, the mean peak strain in the anterior band was tight for the normal and bone anchor groups, but lax in the bone tunnel group. Toward extension, the mean peak strain in the posterior band was lax in all elbows. Toward flexion, the strain in the anterior band was lax in the normal and bone anchor groups, but tight in the bone tunnel group. The mean of the peak strains for the posterior band toward flexion was tight for all elbows. Mean valgus load strength of normal elbows was 22.7 +/- 9.0 N.m. The bone tunnel and bone anchor mean strengths were 76.3% and 63.5%, respectively, of normal elbow strength. We concluded that the bone anchor reproduced the normal anatomy and mechanical function of the ulnar collateral ligament more closely than the bone tunnel, and that both reconstruction methods were significantly weaker than the normal ulnar collateral ligament. However, we found no significant difference in reconstruction strength between bone anchor and bone tunnel.

Biomechanical Phenomena↗
PubMedDate not supplied

Kinematics of partial and total ruptures of the medial collateral ligament of the elbow.

In this study the kinematics of partial and total ruptures of the medial collateral ligament of the elbow are investigated. After selective transection of the medial collateral ligament of 8 osteoligamentous intact elbow preparations was performed, 3-dimensional measurements of angular displacement, increase in medial joint opening, and translation of the radial head were examined during application of relevant stress. Increase in joint opening was significant only after complete transection of the anterior part of the medial collateral ligament was performed. The joint opening was detected during valgus and internal rotatory stress only. After partial transection of the anterior bundle of the medial collateral ligament was performed, there was an elbow laxity to valgus and internal rotatory force, which became significant after transection of 100% of the anterior bundle of the medial collateral ligament and was maximum between 70 degrees to 90 degrees of flexion. No radial head movement was seen after partial or total transection of the anterior bundle of the medial collateral ligament was performed. In conclusion, this study indicates that valgus or internal rotatory elbow instability should be evaluated at 70 degrees to 90 degrees of flexion. Detection of partial ruptures in the anterior bundle of the medial collateral ligament based on medial joint opening and increased valgus movement is impossible.

Aged↗
PubMed2006

The modified docking procedure for elbow ulnar collateral ligament reconstruction: 2-year follow-up in elite throwers.

BACKGROUND: Ulnar collateral ligament injury is most common in the overhead-throwing athlete. Jobe et al published the first report of ulnar collateral ligament reconstruction in throwing athletes with a 62.5% success rate. Recently, Altchek developed a new docking technique for reconstruction of the ulnar collateral ligament. The authors report the first series using a further modification of the docking technique using a 4-strand palmaris longus graft for reconstruction of the ulnar collateral ligament. HYPOTHESIS: The modified docking technique yields a high rate of successful return to preinjury level of competition in elite baseball players. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The authors retrospectively reviewed 25 elite professional or scholarship collegiate baseball players who underwent elbow ulnar collateral ligament reconstruction using the modified docking procedure with a minimum 2-year follow-up. RESULTS: Twenty-three of 25 (92%) were able to return to their preinjury levels of competition. The mean time to return was 11.5 months (range, 10-16 months). Complications included 1 transient postoperative ulnar nerve neurapraxia and 1 stress fracture of the ulnar bone bridge that occurred at 14 months postoperatively, after a full return to pitching. CONCLUSION: The modified docking technique yields highly successful return to preinjury level of competition rates (92%) in a select group of elite baseball players.

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↗
PubMed1999

Reconstruction of the proximal interphalangeal joint collateral ligaments using the Mitek Micro Arc Anchor: an in vitro biomechanical assessment.

Proximal interphalangeal joint (PIP) collateral ligament injuries are common and sometimes result in painful, stiff fingers. A number of techniques have been utilized in the past to reconstruct complete collateral ligament injuries. Recently, bone anchor systems have been described that allow collateral ligament reconstruction without the necessity of pull-out wires and other more cumbersome methods to reconstruct these ligaments. The Mitek bone anchor system has been used successfully in a variety of anatomic locations throughout the body to reattach soft tissues to bone. The current study was conducted to evaluate the biomechanical effects of the use of the Mitek Micro Arc Anchor in collateral ligament injuries of the PIP joint. In cadaveric PIP joints, the collateral ligament was isolated and then transsected in its mid substance. The authors compared suturing the ligament alone in standard fashion to repair of the ligament using a bone anchor inserted in the base of the middle phalanx. The joints were stressed to failure, with a lateral load applied at the distal end of the middle phalanx on a materials testing machine. The mean tensile failure loads of the two groups were the following: Mitek anchor, 16.4 +/- 3.7 N; suture repair, 19.3 +/- 7.6 N. The authors found no significant difference in the force required for failure of the repair or in the pattern of failure in the two groups. The Mitek Micro Arc Anchor appears to be adequate biomechanically to reconstruct the collateral ligaments of the finger PIP joint.

Aged↗
PubMedDate not supplied

Nonoperative treatment of ulnar collateral ligament injuries in throwing athletes.

Ulnar collateral ligament injury of the elbow in throwing athletes is a common occurrence, and either operative or nonoperative treatment is an option. The results of operative repairs and reconstructions have been well documented in the literature; however, little information has been reported on the outcome of nonoperative treatment. From 1994 to 1997, we evaluated 31 throwing athletes with ulnar collateral ligament injuries. The purpose of this study was to determine what percentage of athletes could return to their sport without surgical intervention and to identify factors that would predict return to full competition by an athlete treated nonoperatively. The factors studied included acute versus insidious onset of symptoms, the duration of symptoms before treatment, and age. Nonoperative treatment, which included a minimum of 3 months' rest with rehabilitation exercises, allowed 42% of the athletes in our study (N = 13) to return to their previous level of competition. Those who did return did so at an average of 24.5 weeks after diagnosis. No predictive findings obtained either through the patient's history or physical examination were found that would assist the clinician or athlete in predicting the success of nonoperative treatment.

Adolescent↗
PubMed2006

[Relationship between anatomy of knee collateral ligament and geometry of posterior femoral condylar articular surface].

OBJECTIVE: To analyze the relationship between the collateral ligament attachment and the epicondylar axis with rotational alignment of the femoral component in the total knee arthroplasty(TKA). METHODS: Twenty normal cadaver knee joints were anatomized and 2 holes were drilled on the distal femur from the deep and superficial insertions of the medial collateral ligaments to the lateral condylar part, respectively. Then, all the knees were scanned by MRI on the sagittal plane, making the drilled hole located relatively to the posterior condylar joint surface on the axial plane, and the posterior condylar angle (PCA) and the condylar twist angle (CTA) were measured. RESULTS: The collateral ligament had the deep and superficial parts, and the deep part was strained during the knee flexing. PCA and CTA were 4.50 +/- 1.26 degrees and 7.10 +/- 0.30 degrees respectively, and there was a significant difference between them (P < 0.05), which were significantly greater than those reported abroad. On the sagittal plane, there was no significant difference between the radius of the posterior medial and lateral condylar circles (P > 0.05). The distance from the center of the posterior condylar circle to the deep insertion of the medial collateral ligament (MCL) (dl) was 4.22 +/- 0.20 mm, and the distance to the superficial insertion of MCL (d2) was 7.36 +/- 0.13 mm. The difference between dl and d2 was significant (P < 0.05). CONCLUSION: The center of the posterior condylar circle passes from the deep insertion of the collateral ligament, which can be regarded as a fixed flexion-extension axis of the knee. By releasing the different parts of the collateral ligaments, the balance of the flexion and extension gap can be obtained, and then varus, valgus or flexed contracture deformity of the knee can be realigned. Besides, the rotational orientation of the femoral prosthesis can be made by a reference to the epicondylar insertion of the collateral ligament.

Adult↗
PubMed2006

Conservative and postoperative rehabilitation of isolated and combined injuries of the medial collateral ligament.

Injuries to the medial collateral ligament (MCL) are very common and there seems to be a consensus supporting the conservative management of grade I and II tears. Grade III tears are also usually treated conservatively unless associated with injuries to the anterior cruciate ligament or posterior cruciate ligament. This article outlines rehabilitation programs for conservative treatment of MCL injuries, and postoperative programs after anterior cruciate ligament or multiple ligament reconstruction. In addition, the use of functional and prophylactic bracing for injuries of the MCL is reviewed.

Anterior Cruciate Ligament Injuries↗
PubMed1999

Primary repair of the cruciate and collateral ligaments after traumatic dislocation of the knee.

The management of traumatic dislocation of the knee in 40 patients (41 knees) with a mean age of 26.3 years is described. They were treated by primary repair and reconstruction with autologous grafting of the anterior (ACL) and posterior cruciate ligaments (PCL) and repair injuries to the collateral ligament and soft-tissue. The ACL and PCL were reconstructed using the patellar tendon and the gracilis and semitendinosus tendons, respectively. Early mobilisation using a continuous-passive-movement machine and active exercises was started on the second day after operation. At a mean follow-up of 39 months no patient reported 'giving way' and all except one had good range of movement. Of the 41 knees, 21 were rated as excellent, 15 good, four fair and one poor. Early reconstruction of the cruciate ligaments and primary repair of the collateral ligaments followed by an aggressive rehabilitation programme are recommended for these young, active patients.

Adolescent↗
PubMed1995

Integrin display increases in the wounded rabbit medial collateral ligament but not the wounded anterior cruciate ligament.

The differential capacities of the anterior cruciate and medial collateral ligaments to heal may be related to differences in cellular function. This study tested the hypothesis that differential expression of integrins occurs in these ligaments after injury. The integrins are a family of cell surface receptors that mediate adhesion, migration, and other cellular functions critical to the healing of a wound. A similar complement and amount of the beta 1 subfamily of integrins are known to be present on the unperturbed anterior cruciate and medial collateral ligaments in humans and rabbits. A partial laceration was surgically created in these two ligaments in 12 anesthetized New Zealand White rabbits. Immunohistochemistry was performed on sections from the ligaments at 1, 3, 7, and 10 days after injury, using monoclonal antibodies directed against the integrin subunits beta 1, alpha 5, alpha 6, and alpha v. Between 3 and 7 days, the wounded medial collateral ligament demonstrated a striking increase in staining for the beta 1, alpha 5, and alpha v subunits on the fibroblasts, within the repair site, and on capillary endothelium. Increased staining was most marked for the beta 1 subunit and less marked for the alpha 5 and alpha v subunits. The alpha 6 subunit stained exclusively vascular structures within the healing medial collateral ligament. In marked contrast, the anterior cruciate ligament, which does not mount an effective repair response, demonstrated no comparable alteration of integrin expression from baseline levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

MR imaging evaluation of knee collateral ligaments and related injuries: comparison of T1-weighted, T2-weighted, and fat-saturated T2-weighted sequences--correlation with clinical findings.

The objectives of this study were to compare the ability of T1-weighted (T1W), proton density/T2-weighted (PD/T2W), and fat saturation (FS) PD/T2W magnetic resonance (MR) sequences for depiction of the knee collateral ligaments and related injuries, and to compare MR findings with clinical findings. Ten subjects with normal knee ligaments and 64 patients with suspected collateral ligament injuries underwent coronal T1W, PD/T2W, and FS PD/T2W imaging. Abnormalities ranged from edema surrounding the collateral ligaments (grade I) to complete disruption of ligamentous fibers (grade III). FS PD/T2W images improved definition of the medial collateral ligament (MCL) and lateral collateral ligament (LCL) compared with other sequences in 78% and 81% of patients, respectively. While the apparent grade of collateral ligament injury was similar with all pulse sequences in most patients, depiction of such injury was usually most conspicuous on FS PD/T2W images (MCL, 92% of patients; LCL, 38% of patients). In no patients were clinically diagnosed collateral ligament injuries undetected or understaged with MR imaging. MR findings indicated higher-grade MCL and LCL injuries than did clinical examination in 24 and 15 patients, respectively.

Adipose Tissue↗
PubMed1997

Structural, material, and anatomic characteristics of the collateral ligaments of the canine cubital joint.

OBJECTIVE: To document gross and microscopic anatomic features of the collateral ligaments of the canine cubital joint and to determine their structural and material properties. ANIMALS: 37 canine cadavers. PROCEDURE: After measurement of ligament dimensions, the bone-collateral ligament-bone specimens were loaded in tension until failure, using a materials testing machine. Data from the load-displacement curves were used to determine the structural and material properties of the ligaments. Gross anatomic features were studied during dissection of the specimens from the medial collateral ligament (MCL) and lateral collateral ligament (LCL), which then were saved for microscopic examination. RESULTS: Failure load and stiffness values for the LCL were significantly (P < 0.05) greater than those for the MCL. The LCL had obvious cranial and caudal components that attached to the radius and ulna, respectively. The MCL also had cranial and caudal components; however, the cranial component was indistinct, appearing only as a slight thickening of the joint capsule. The caudal component was more prominent; as it extended distad, it had minor attachments to the interosseous and annular ligaments and attached principally on the caudolateral surface of the proximal portion of the radius. The caudal component did not have substantial attachment to the ulna in any of the specimens studied. Both ligaments were composed of closely packed, parallel fascicles of dense collagen, with scant amounts of fibrocartilage and no detectable elastin. CONCLUSIONS: Gross anatomic features of the collateral ligaments of the canine cubital joint indicate that they provide principal structural support to the joint; microscopic anatomic features are typical of other ligaments. The LCL is stronger and stiffer than the MCL; however, their material properties are similar. CLINICAL RELEVANCE: Knowledge of the sites of attachment of collateral ligament components is essential for surgeons undertaking repair or reconstruction of these structures.

Animals↗
PubMedDate not supplied

Lateral collateral ligament of the elbow joint: anatomy and kinematics.

The structure and kinematics of the lateral collateral ligament of the elbow joint were investigated in 10 cadaveric specimens. The lateral collateral ligament was observed to be a distinct part of the lateral collateral ligament complex. It contains posterior fibers that pass through the annular ligament and insert on the ulna. Three-dimensional kinematic measurements in different forearm rotations showed that joint puncture induced a 1 degree joint laxity significant in forced varus from 30 degrees to 80 degrees of flexion and in forced external rotation from 30 degrees to 120 degrees of flexion. Division of the posterolateral capsule caused no further laxity. Cutting the lateral collateral ligament induced a maximum laxity of 11.8 degrees at 110 degrees of flexion in forced varus and a maximum laxity of 20.6 degrees at 110 degrees of flexion in forced external rotation. The corresponding maximal posterior radial head translation was observed at 80 degrees to 100 degrees of flexion and was 5.7 mm in forced varus and 8.1 mm in forced external rotation. This study suggests the lateral collateral ligament to be an important stabilizer of the humeroulnar joint and the radial head in forced varus and external rotation. The humeroulnar stability is independent of forearm rotation.

Aged↗
PubMed1992

Collateral ligament reconstruction of the unstable metatarsophalangeal joint: an in vitro study.

Anatomic reconstruction of the collateral ligaments of the lesser metatarsophalangeal joints is proposed for certain cases of metatarsophalangeal instability. The suggested reconstruction involves replication of the attachments of the collateral ligaments. As an example of such a reconstruction, the interosseous tendon was used in this study as a graft for anatomic replacement of the collateral ligaments. The tendon was left attached distally where its attachments include the volar plate and proximal phalanx, thereby resembling the distal attachment of the collateral ligament. The proximal portion of the tendon was inserted into the metatarsal head, replicating the attachment of the collateral ligament at that location. Preliminary testing of such a reconstruction shows that it can re-establish stability caused by loss of the collateral ligaments. Such a procedure may be applicable in select cases of crossover toe deformity and straight vertical instability.

Humans↗
PubMed2003

US of the anterior bundle of the ulnar collateral ligament: findings in five cadaver elbows with MR arthrographic and anatomic comparison--initial observations.

PURPOSE: To characterize the ultrasonographic (US) appearance of the anterior bundle of the ulnar collateral ligament of the elbow by comparing US images with magnetic resonance (MR) arthrograms and anatomic slices. MATERIALS AND METHODS: The ulnar collateral ligament in four cadavers (eight elbows) was blindly evaluated with US by one musculoskeletal radiologist with experience in musculoskeletal US. These results were compared with standard arthrograms, MR arthrograms, and anatomic slices by consensus reading of two musculoskeletal radiologists. The criteria for an abnormal ulnar collateral ligament included contrast material extension into the ligament or fiber discontinuity, as documented by MR arthrography and anatomic slices. RESULTS: Standard arthrography, MR arthrography, and anatomic slices demonstrated the ulnar collateral ligament to be unequivocally normal in three specimens and abnormal in two. The remaining three elbows did not meet the criteria for classification as either normal or abnormal, and thus they were excluded from the study. With US, the normal ulnar collateral ligament was fibrillar and hyperechoic between the medial epicondyle and proximal ulna. In the two abnormal cases, abnormal hypoechogenicity and ligament fiber disruption were noted. In addition, the proximal aspect of the ulnar collateral ligament varied from a cordlike structure to a broad attachment to the undersurface of the medial epicondyle with variable fat. CONCLUSION: In this small sample, the anterior bundle of the ulnar collateral ligament is identified with US by its hyperechoic and compact fibrillar echotexture. The proximal attachment of the ulnar collateral ligament has a variable appearance. Hypoechogenicity and fiber disruption indicated ulnar collateral ligament abnormality.

Aged↗