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PubMedDate not supplied

Isolated sectioning of the medial and posteromedial capsular ligaments in the posterior cruciate ligament-deficient knee. Influence on posterior tibial translation.

This study was undertaken to determine the contribution of various structures in the posterior cruciate ligament-deficient knee in resisting posterior tibial translation. With "isolated" injuries to the posterior cruciate ligament, the amount of posterior translation will decrease with the posterior drawer test as the knee is taken from neutral to internal tibial rotation. The present study was performed to conclusively determine the anatomic structure responsible for this clinical observation. The TestStar device was used to perform single-plane posterior drawer tests in 14 cadaveric knee specimens. The tests were performed with the knee in neutral tibial rotation and in 20 degrees of internal tibial rotation. The intact knee was tested and then the knee was tested after sequential sectioning of the meniscofemoral ligaments, the posterior cruciate ligament, the posteromedial capsule, and the superficial medial collateral ligament. With the knee in neutral rotation, posterior translation continued to increase as each structure was sectioned. With the knee in internal tibial rotation, posterior displacement was significantly less than in neutral rotation for each state until the superficial medial collateral ligament was sectioned; posterior translation was increased after its sectioning. Our data demonstrate that the superficial medial collateral ligament is the structure responsible for a decrease in posterior tibial translation in the posterior cruciate ligament-deficient knee.

Anterior Cruciate Ligament↗
PubMed1994

Kinematics of the trapeziometacarpal joint after sectioning of ligaments.

This study was designed to examine the roles of ligaments in the maintenance of the articular kinematics of the trapeziometacarpal joint. Circumduction of the trapeziometacarpal joint was studied in 12 hands from fresh human cadavera. With use of a magnetic tracking system, changes in the motion of the base of the first metacarpal after ligament sectioning were analyzed and compared with those of the normal joint. Two sets of ligaments were sectioned: (a) the anterior oblique and ulnar collateral ligaments and (b) the first intermetacarpal ligament and the ulnar joint capsule. Sectioning of the anterior oblique and ulnar collateral ligaments resulted in a significant dorsal-ulnar shift in the path of the base of the first metacarpal. However, sectioning of the first intermetacarpal ligament did not affect the movement pattern of the center of the base. The anterior oblique and ulnar collateral ligaments provided constraint of the trapeziometacarpal joint during circumduction of the thumb.

Humans↗
PubMed2004

Dynamic contributions of the flexor-pronator mass to elbow valgus stability.

BACKGROUND: Previous studies have indicated that the demands placed on the medial ulnar collateral ligament of the elbow when it is subjected to valgus torque during throwing exceed its failure strength, which suggests the necessary dynamic contribution of muscle forces. We hypothesized that the flexor-pronator mass assists the medial ulnar collateral ligament in stabilizing the elbow against valgus torque. METHODS: Six cadaveric elbows were tested at 30 degrees and 90 degrees of flexion with no other constraints to motion. A full medial ulnar collateral ligament tear was simulated in each elbow. Muscle forces were simulated on the basis of the centroids and physiological cross-sectional areas of individual muscles. The biceps, brachialis, and triceps were simulated during flexor carpi ulnaris, flexor digitorum superficialis, flexor digitorum superficialis and flexor carpi ulnaris, and pronator teres-loading conditions. Kinematic data were obtained at each flexion angle with use of a three-dimensional digitizer. RESULTS: Release of the medial ulnar collateral ligament caused a significant increase in valgus instability of 5.9 degrees +/- 2.4 degrees at 30 degrees of elbow flexion and of 4.8 degrees +/- 2.0 degrees at 90 degrees of elbow flexion (p < 0.05). The differences in valgus angulation between each muscle-simulation condition and the medial ulnar collateral ligament-intact condition were significantly different from each other (p < 0.05), except for the difference between the flexor carpi ulnaris contraction condition and the flexor digitorum superficialis-flexor carpi ulnaris co-contraction condition. This co-contraction provided the most correction of the valgus angle in comparison with the intact condition at both 30 degrees and 90 degrees of elbow flexion (1.1 degrees +/- 1.8 degrees and 0.38 degrees +/- 2.3 degrees , respectively). Simulation of the flexor carpi ulnaris alone provided the greatest reduction of the valgus angle among all individual flexor-pronator mass muscles tested (p < 0.05), whereas simulation of the pronator teres alone provided the least reduction of the valgus angle (p < 0.05). CONCLUSIONS: The flexor-pronator mass dynamically stabilizes the elbow against valgus torque. The flexor carpi ulnaris is the primary stabilizer, and the flexor digitorum superficialis is a secondary stabilizer. The pronator teres provides the least dynamic stability.

Adult↗
PubMed1994

The effects of a functional elbow brace on medial joint stability: a case study.

Medical elbow ligament sprains in athletics can be traumatic and disabling. In this case report, we outline the effect of a prototype functional elbow brace on joint stability in a female collegiate javelin thrower with an ulnar collateral ligament sprain. A valgus force to both elbows was applied using graded stress radiography (Telos GA-II/E stress device) at 0, 5, 10, and 15 kiloPascals (kPa) of pressure. The increase in gap width between the coronoid process and the medial epicondyle was measured from anteroposterior radiographs to determine medial displacement. The brace resulted in less displacement in both injured and noninjured ulnar collateral ligament; injured ulnar collateral ligament demonstrated greater displacement regardless of condition. The brace restored medial stability to the elbow joint by 49%, 38%, and 35% at 5, 10, and 15 kPa of pressure, respectively. The application of the brace may be useful in athletes with ulnar collateral ligament injuries.

Journal Article↗
PubMed1999

Metallic radial head arthroplasty improves valgus stability of the elbow.

The stabilizing influence of radial head arthroplasty was studied in eight medial collateral ligament deficient anatomic specimen elbows. An elbow testing apparatus, which used computer controlled pneumatic actuators to apply tendon loading, was used to simulate active elbow flexion. The motion pathways of the elbow were measured using an electromagnetic tracking device, with the forearm in supination and pronation. As a measure of stability, the maximum varus to valgus laxity over the range of elbow flexion was determined from the difference between varus and valgus gravity loaded motion pathways. After transection of the medial collateral ligament, the radial head was excised and replaced with either a silicone or one of three metallic radial head prostheses. Medial collateral ligament transection caused a significant increase in the maximum varus to valgus laxity to 18.0 degrees +/- 3.2 degrees. After radial head excision, this laxity increased to 35.6 degrees +/- 10.3 degrees. The silicone implant conferred no increase in elbow stability, with a maximum varus to valgus laxity of 32.5 degrees +/- 15.5 degrees. All three metallic implants improved the valgus stability of the medial collateral ligament deficient elbow, providing stability similar to the intact radial head. The use of silicone arthroplasty to replace the radial head in the medial collateral ligament deficient elbow must be questioned. Metallic radial head arthroplasty provides improved valgus stability, approaching that of an intact radial head.

Aged↗
PubMed1988

Instant centres of rotation of equine limb joints and their relationship to standard skin marker locations.

The instant centres of rotation (ICRs) of each limb joint, other than the coxofemoral joint and those of the digits, were calculated for eight clinically sound horses from tracings of radiographs according to the method of Reuleaux (1963). The majority of ICR positions coincided with the attachment sites of the collateral ligaments. The ICR of the scapulohumeral joint, which does not have collateral ligaments, was caudodistal to the caudal part of the greater tubercle of the humerus. The ICR for the femorotibial joint was located just caudal to the femoral attachment of the collateral ligament. The location of the ICRs calculated for the two joint carpal joint complex was displaced caudad during extreme flexion of the carpus and differed from those calculated separately for either the antebrachiocarpal joint or the intercarpal joint. Interpretation of these ICR positions was confounded by complex spatial motion changes which occur between the carpal bones. The sites used for skin marker positions in equine locomotion and conformation research generally agree with the ICR positions, particularly for the humeroradial, tarsocrural, and metacarpo- and metatarsophalangeal joints. Traditional marker sites used for the scapulohumeral and femorotibial joints would result in overstimation and underestimation respectively of the caudal joint angles. Inaccuracy of marker placement, together with movement of skin markers and non-planar motion during joint angulation, limit accurate biokinematic measurement of limb joint angles during locomotion and conformation analysis.

Animals↗
PubMedDate not supplied

The popliteofibular ligament. Rediscovery of a key element in posterolateral stability.

We have recently become aware of a strong direct attachment of the popliteal tendon to the fibula. To investigate the importance of this attachment, we examined 20 cadaveric knees. The popliteofibular ligament was identified in all 20 knees. The cross-sectional area of the popliteofibular ligament was 6.9 +/- 2.1 mm2, compared with 7.2 +/- 2.7 mm2 for the lateral collateral ligament. Biomechanical testing of these structures, simulating a purely varus stress on the knee, revealed that the lateral collateral ligament always failed first, followed by the popliteofibular ligament, and then the muscle belly of the popliteus. The mean maximal force to failure of the popliteofibular ligament approached 425 N (range, 204 to 778), compared with 750 N (range, 317 to 1203) for the lateral collateral ligament. Our results indicate that the popliteofibular ligament contributes to posterolateral stability.

Adult↗
PubMed1990

Experimental osteoarthritis in guinea-pigs.

Cartilage degeneration was induced in the hind knees of guinea-pigs by surgery. Partial medial meniscectomy induced rapidly progressing lesions whereas the lesions induced by section of the lateral collateral ligament with or without section of the medial collateral ligament developed later and progressed more slowly. In all cases the lesions were first seen focally on the medial tibial plateau where they extended both laterally and deeper into the cartilage. Later, lesions appeared on the medial femoral condyle and meniscus, and eventually also on cartilage in the lateral joint compartment. During the later stages, these models had many features of human osteoarthritis. The appearance and progression of spontaneous lesions in the hyaline cartilage of the hind knees of young guinea-pigs first reported by Bendele and Hulman (1988) has been confirmed. Extra ascorbic acid added to the drinking water had a slight chondroprotective effect on the development of spontaneous lesions but gave no significant protection against the development of lesions induced by lateral collateral ligament section.

Animals↗
PubMed1998

Fibrous structure and connection surrounding the metacarpophalangeal joint.

The fibrous components of the metacarpophalangeal (MP) joint including the palmar plate, the collateral ligament and the dorsal plate were studied with particular attention paid to the fibrous structure of the fibrous tendon sheath and the deep transverse metacarpal ligament. The tough fibrillar structure around the MP joint, especially the force nucleus, consisted of three types of mixed fibers: the fibrous tendon sheath of the A1 pulley, the deep transverse metacarpal ligament, and the palmar plate. The tendon sheath was located on the ulnar side in the index and middle fingers, on the central position in the ring finger, and on the radial side in the little finger. These fibrous connections among the fingers formed a transverse arch in the hand. The palmar plate of the MP joint was relatively rigid and appears to function as a cushion when flexed. A fold-like protrusion of the synovial layer of the palmar plate of the MP joint had a meniscoid function, which was larger than that of the proximal interphalangeal joint. The capsule of the MP joint was thicker at the dorsal area, forming a dorsal plate, which is a sliding floor of the extensor mechanism and has a meniscoid function for joint congruity. The main lateral stabilizer consisted of collateral ligaments and accessory collateral ligaments anchored to the palmar plate. These structures act together as a "phalangeal cuff", connecting the proximal phalanx to the metacarpal head and stabilizing the MP joint.

Aged↗
PubMed2000

A role for calcitonin gene-related peptide in rabbit knee joint ligament healing.

Knee joint ligament healing has been shown to be improved when the torn ligament ends remain in contact, however, the rationale for these effects is unknown. The sensory neuropeptide calcitonin gene related peptide (CGRP) has potent trophic and vasodilatatory properties and as such is thought to be advantageous in wound repair. In ascertaining a role for CGRP in rabbit medial collateral ligament healing, the present study examined changes in CGRP-like immunoreactivity (CGRP-LI) and CGRP-mediated vasomotor responses in gap injured (non-contact), Z-plasty apposed (contact), and sham operated control medial collateral ligaments. At 6 weeks post-trauma, CGRP-LI decreased in the healing zone of gap injured and Z-plasty apposed medial collateral ligaments compared with controls, and non-contact ligament nerve fibres exhibited an abnormal morphology. Topical administration of CGRP (10(-13) to 10(-9) mol) caused a dose-dependent increase in ligament perfusion in each experimental group of knees. The CGRP-mediated vasodilatation associated with gap injured ligaments was not significantly different from controls (P = 0.06), whereas apposed medial collateral ligaments showed an augmented response to the peptide (P < 0.0005). These findings indicate that the beneficial effects of ligament interposition post-trauma may be related to an enhanced responsiveness to CGRP in conjunction with a more typical re-innervation profile. Conversely, the aberrant characteristics of CGRP-LI nerves occurring in gap injured tissue is suggestive of impaired CGRP release which may explain the poor functional recovery associated with these ligaments.

Animals↗
PubMed1998

Increasing quadriceps loads affect the lengths of the ligaments and the kinematics of the knee.

The relationships between the lengths of the ligaments and kinematics of the knee and quadriceps load, for low to physiologic levels of quadriceps loads, have not previously been studied. We investigated the effects of increasing levels of quadriceps force, necessary to balance increasing levels of externally applied flexion moments, on the kinematics of the tibiofemoral joint and on the separation distances between insertions of selected fibers of the major ligaments of the knee in twelve cadavera. Static measurements were made using a six-degree-of-freedom digitizer for flexion angles ranging from 0 to 120 deg in 15 deg increments. Quadriceps generated extension of the knee was performed by applying loads to the quadriceps tendon to equilibrate each of four magnitudes of external flexion moments equivalent to 8.33, 16.67, 25.00, and 33.33 percent of values previously reported for maximum isometric extension moments. The magnitude of quadriceps force increased linearly (p < 0.0001) as external flexion moment increased throughout the entire range of flexion. Anterior translation, internal rotation, and abduction of the tibia increased linearly (p < 0.0001, p < 0.001, p < 0.001) as external flexion moment and, hence, quadriceps load increased. For the fibers studied, the anterior cruciate ligament (p < 0.0076), posterior cruciate ligament (p < 0.0001), and medial collateral ligament (p < 0.0383) lengthened linearly while the lateral collateral ligament (p < 0.0124) shortened linearly as quadriceps load increased. Based on these results for low to physiologic levels of quadriceps loads, it is reasonable to assume that the ligament lengths or knee kinematics expected with higher quadriceps loads can be extrapolated.

Adult↗
PubMed2002

[Complex instability of the anterior knee].

Complex knee instability involves the anterior cruciate ligament (ACL) and one or more major stabilizers of the knee [medial collateral ligament (MCL), lateral collateral ligament (LCL), posterior cruciate ligament (PCL)]. The medial side has a high healing potential and does not need operative treatment in most cases if ACL reconstruction is performed. Reconstruction of the medial ligament complex is indicated in gross instability of the medial meniscus fixation, dislocation of the MCL into the joint, and large dislocated bony avulsions. Injuries on the lateral side do not heal spontaneously and require acute operative treatment (first 2 weeks). Frank knee dislocations and gross multiligament injuries should be reduced acutely, and the integrity of the vascular structures must be examined closely. In a European multicenter study, operative treatment with reconstruction of both cruciate ligaments and functional rehabilitation gave better results than conservative treatment with immobilization of the joint.

Anterior Cruciate Ligament↗
PubMed2000

High-resolution MR imaging of the knee at 3 T.

PURPOSE: To examine the practical feasibility of using a 3.0-T MR unit to obtain high-quality, high-resolution images of the knee joint. MATERIAL AND METHODS: One human cadaveric and 5 porcine knees were imaged with the 3.0-T unit. Sets of T1-weighted spin echo images were obtained with in-plane resolution of 0.195x0.39 mm and an acquisition time of approximately 5 min. Two porcine knees were also imaged with the 1.0-T unit with an identical imaging protocol and the signal-to-noise (S/N) ratios were measured on images at 3 T and 1 T. RESULTS: The 3-T MR system provided detailed delineation of the knees. Deep layers of the medial collateral ligament and associated fine fibers beneath the medial and lateral collateral ligament were demarcated. We observed precise demonstration of the tibial attachment of the anterior cruciate ligament, irregularity of the meniscal free edge, and conjoint tendon formation together with the lateral collateral ligament and the biceps femoris tendon. Compared to the 1-T unit, the S/N ratio with the 3-T unit was increased by a factor of 1.39 to 1.72. CONCLUSION: Due to the potential advantage of obtaining detailed images, the 3-T MR system suggests a practical utility for fine demonstration of the knee morphology.

Animals↗
PubMed2007

Knee stability after resection of the proximal fibula.

Managing tumors of the proximal fibula may require en bloc resection of the fibular head with the attachment site for the lateral collateral ligament. These resections of the proximal fibula cause unavoidable knee instability. We describe a reconstructive technique intended to minimize that instability. We retrospectively reviewed 24 patients who had proximal fibular resections from 1987 to 2004 and analyzes their knee stability and functional outcome. Resections were less (Type I) or more (Type II) radical depending upon the tumor type. Reconstruction included stapling the lateral collateral ligament to the lateral tibial metaphysis, cast immobilization, and protected weightbearing for 3 weeks. MSTS function scores were available for 19 of the 24 patients. At their most recent followup, 20 patients had a stable knee, three had 1 to 5 mm lateral joint space opening, and one had 6 to 10 mm lateral joint space opening. Patients with Type I resection had a better stability and function than those with a Type II resection. Stapling the lateral collateral ligament was a reliable technique for reconstructing the lateral collateral ligament after resecting the proximal fibula.

Adolescent↗
PubMed1996

Lower extremity injuries in in-line skaters: a report of two cases.

In-line skating has become a very popular sport over the past several years. Previous studies examining the injuries associated with this sport have emphasized the incidence upper extremity injuries. Two cases are described in which patients suffered severe lower extremity injuries while in-line skating: one had a femoral shaft spiral fracture and the other bilateral anterior cruciate ligament and medial collateral ligament injuries. Although a predominance of upper extremity injuries associated with this sport has been widely noted, increased numbers of participants, higher speeds and changing skate designs may further predispose skaters to leg, knee and ankle injuries.

Adult↗
PubMed2006

Anatomical reconstruction of knee posterolateral complex with the tendon of the long head of biceps femoris.

BACKGROUND: There is no consensus about the best way to reconstruct the knee posterolateral complex. HYPOTHESIS: Anatomical reconstruction of the knee posterolateral complex with the tendon of the long head of biceps femoris can restore knee posterolateral stability. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Anatomical reconstruction of the fibular collateral ligament, popliteofibular ligament, and popliteus tendon was performed consecutively in 28 patients with chronic posterolateral knee injuries. Two distally pedicled tendon slips more than 16 cm long were created from the tendon of the long head of the biceps femoris. The posterior tendon slip was used to reconstruct the popliteofibular ligament and popliteus tendon, and the anterior slip were doubled to reconstruct the lateral collateral ligament. The patients were followed up for 2 to 4 years. RESULTS: At the latest follow-up, examinations showed that 96.4% (27/28) of the patients had a normal or nearly normal reconstructed fibular collateral ligament as judged by manual examination. All patients had a normal or nearly normal reconstructed popliteofibular ligament and popliteus tendon as judged by manual examination. CONCLUSION: Anatomical reconstruction of the knee posterolateral complex with the tendon of the long head of biceps femoris is effective in restoring knee posterolateral stability.

Adult↗
PubMed2005

Arthroscopic fixation of avulsion of the posterior cruciate ligament from femoral insertion.

Femoral avulsion of the posterior cruciate ligament (PCL) is not common, especially in adults. We present a case and an arthroscopic repair technique using 4 transfemoral tunnels; 2 anterior tunnels for fixation of the anterior bundle of the PCL and 2 posterior for the posterior bundle. Our case was that of a femoral avulsion of the PCL associated with tibial avulsion of the anterior cruciate ligament and femoral avulsion of the medial collateral ligament of the left knee in an adult. We repaired the tibial avulsion of anterior cruciate ligament using an arthroscopic transtibial suture technique and the femoral avulsion of the medial collateral ligament by using staple fixation.

Accidents, Traffic↗
PubMed1995

The natural history of untreated anterior cruciate tears in recreational athletes.

A followup study was performed to elucidate the natural course of acutely torn anterior cruciate ligaments in recreational athletes. Fifty-six consecutive patients had arthroscopy within 2 weeks of their initial injuries; however, no surgery was done on the torn anterior cruciate ligament. Twenty anterior cruciate ligament and medial collateral ligament combined ruptures occurred. Patient ages ranged from 14 to 50 years old (mean, 28.9 years). Followup periods ranged from 2 to 10 years (mean, 5 years 6 months). Through examination with the KT-1000 arthrometer, side-to-side differences of anterior translation of the tibia of > or = 3 mm in 72% patients at reexamination were seen. Eight of 46 patients had mild osteoarthritic changes of Grade 1 visible on radiographs, but only 1 patient reported knee trouble. Nine patients had repeat injuries, 3 of whom had late reconstructions and 4 late meniscectomies. Functional scores averaged 95 +/- 6.5 points. Activity scores averaged 4.8 +/- 1.6 points. Operative management for the medial structure did not improve the stability better than nonoperative management. Anterior translation and functional scores of patients with medial meniscectomies showed significant differences from those of other patients. Anterior cruciate ligament reconstruction for recreational athletes should be considered when the patients have reparable meniscal tears, and meniscal repairs should be performed simultaneously.

Adolescent↗