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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↗
PubMed1997

MR imaging of ligamentous abnormalities of the elbow.

With high-resolution MR imaging, the collateral ligament of the elbow can be directly evaluated; thus ligamentous injuries can be detected, localized, and graded. The functional anatomy of the ligaments of the elbow is reviewed. The normal appearance of the ligaments on MR images as well as the clinical and MR imaging findings of medial and lateral collateral ligament injury are presented.

Adolescent↗
PubMed1998

Collagen fiber sliding during ligament growth and contracture.

It is hypothesized that the sliding of collagen fibers past one another plays an important role in changes of ligament length during growth or contracture. To explore this possibility, we used the fluorescent dye dichlorotriazinyl fluorescein to stain collagen fibers perpendicular to their orientation in a rat medial collateral ligament model. Growth, contracture, and control models (with rats weighing 50-75 g in the first and 500-600 g in the latter two groups) were studied. In the contracture model, the medial collateral ligament was transected distally. Marking sutures were used to verify the presence of growth or contracture in each medial collateral ligament. Fluorescence photomicrography after 2 weeks demonstrated stained collagen fibers protruding from either side of the original mark as one would expect, in either growth or contracture, if the fibers slid past one another and away from their initial location during changes in length. By measuring the initial and final widths of the growth and contracture model marks and correlating them to controls that had minimal growth (rats grow throughout their life) and were free of contracture, we have provided evidence that collagen sliding plays a significant role in changes in ligament length.

Animals↗
PubMed1995

Radial polydactyly: an outcome study.

Radial polydactyly is a relatively common congenital disorder that frequently occurs as thumb duplication. A paucity of information exists on outcomes of Bilhaut-Cloquet procedures. To evaluate clinical outcomes, the results of various operative and nonoperative treatments were reviewed. Follow-up by retrospective chart review was performed on 21 patients treated between 1979 and 1994 at the Shriners Hospital for Crippled Children in Erie, Pennsylvania. Patient interview or physical examination, or both, was performed on 16 of these patients. The study was comprised of 9 boys and 12 girls (average age, 7.8 years; range, 1.5-15.8 years) and included 26 thumbs. Ablation alone was performed in 6 thumbs (6 patients), a combined procedure consisting of ablation with radial collateral ligament reconstruction and shaving of the metacarpal in 10 thumbs (9 patients), and a Bilhaut-Cloquet procedure in 5 thumbs (4 patients). Five thumbs (4 patients) with Wassel type I classification were managed without surgical intervention and simply observed. Of the 6 thumbs treated with ablation alone, 5 required subsequent procedures (radial collateral ligament reconstruction). Ablation with collateral ligament reconstruction and articular surface shaving improved clinical alignment and stability but did not return normal interphalangeal joint motion. The Bilhaut-Cloquet procedure improved the overall cosmetic and functional appearance but likewise did not restore normal joint motion. Our findings support current literature that finds that ablation of the thumb without reconstruction is contraindicated because of the high reoperation rate. Although techniques have evolved that improve alignment and stability or appearance, none guarantee normal joint motion. All patients were satisfied, however, that the thumb was significantly improved compared with the preoperative condition.

Adolescent↗
PubMed2006

Effects of ligament repair on laxity and creep behavior of an early healing ligament scar.

BACKGROUND: Previous clinical studies have reported that conservatively managed medial collateral ligament (MCL) injuries remained unstable 9 years post injury with subjective complaints of muscle weakness, reinjuries, and post-traumatic osteoarthritis. Animal studies have also reported that healing MCLs were weaker and more lax than controls. Therefore, our purpose was to study the early effects of ligament repair on scar laxity, creep, and creep recovery in a rabbit model of bilateral medial collateral ligament (MCL) injury. METHODS: Each rabbit had one MCL cut in midsubstance which was not repaired, while the other MCL had a sagittal Z-plasty repair. Six weeks after surgery, isolated bone-MCL-bone complexes were biomechanically tested for MCL laxity, cyclic creep, creep recovery, and then loaded to ultimate failure. RESULTS: Nonrepaired scars were significantly more lax than both repaired Z-plasty scars and normal controls. In contrast, there was no significant difference in MCL laxity between repaired scars and normal controls. There were no significant differences between nonrepaired or repaired scars for either cyclic creep and creep recovery. Both crept significantly more and recovered significantly less than normal controls after the same load history. There were no significant differences in the failure load, stiffness, and tensile strength between gap scars and Z-plasty scars. All healing ligaments had significantly lower failure load, stiffness, and tensile strength than normal controls. CONCLUSIONS: The present study demonstrates that ligament repair is effective in decreasing short-term laxity of ligament scars. These 6-week scars would be prone to abnormal creep if loaded excessively.

Animals↗
PubMed2000

Matrix metalloproteinase-13 expression in rabbit knee joint connective tissues: influence of maturation and response to injury.

The hypothesis of the present work was that expression of matrix metalloproteinase-13 (MMP-13, collagenase-3) would be induced during conditions involving important matrix remodeling such as ligament maturation, scar healing and joint instability. Therefore, MMP-13 expression in the medial collateral ligament (MCL) during the variable situations of tissue maturation and healing was assessed. MMP-13 expression in three intra-articular connective tissues of the knee (i.e. articular cartilage, menisci and synovium) following the transection of the anterior cruciate ligament of the knee was evaluated at 3 and 8 weeks post-injury. MMP-13 mRNA (semi-quantitative RT-PCR) and protein (immunohistochemistry and Western blotting) were detected in all of the tissues studied. Significantly higher MCL mRNA levels for MMP-13 were detected during the early phases of tissue maturation (i.e. 29 days in utero and 2-month-old rabbits) compared to later phases (5- and 12-month-old rabbits). This pattern of expression was recapitulated following MCL injury, with very high levels of expression in scar tissue at 3 weeks post-injury and then a decline to levels not significantly different from control values by 14 weeks. Elevated mRNA levels correlated with increased protein levels for MMP-13 in both menisci and synovium following the transection of the anterior cruciate ligament and during medial collateral ligament healing. These results indicate that MMP-13 expression is regulated by a number of variables and that high levels of expression occur in situations when connective tissue remodeling is very active.

Animals↗
PubMed1985

Functional anatomy of the ligaments of the elbow.

Dissections of 10 fresh cadaver specimens revealed an important insertion of the posterior portion of the lateral collateral ligament to the ulna at the crista supinatoris. The humeral origin of the medial ligament attachments was found to lie posterior to the axis of elbow flexion; in this position a cam effect is created so that ligament tension varies with elbow flexion. The three-dimensional distance between the origin and the insertion of the anterior portion of the medial collateral ligament was found to increase slightly from extension to approximately 60 degrees of flexion; thereafter, it remained nearly constant. The distance of the posterior portion increased by about 9 mm from 60 degrees to 120 degrees of flexion. The flexion axis was shown to pass through the origin of the lateral collateral ligament, so the length of this structure was not changed during elbow flexion.

Aged↗
PubMed1995

Compression or distraction of the anterior cruciate injured knee. Variations in injury pattern in contact sports and downhill skiing.

100 consecutive patients with a recent anterior cruciate ligament injury were examined with respect to type of sports activity that caused the injury, mechanism of injury and the occurrence of collateral ligament and meniscal lesions. There were 53 medial collateral ligament injuries, 12 medial, 35 lateral and 11 bicompartmental meniscal lesions. 59 patients were injured during contact sports, 30 in downhill skiing and 11 in other recreational activities, traffic accidents or at work. An associated medial collateral ligament tear was more common in skiing (22/30) than during contact sports (23/59), whereas a bicompartmental meniscal lesion was found more frequently in contact sports (9/59) than in skiing (0/30). Weightbearing was reported by 56/59 of the patients with contact sports injuries and by 8/30 of those with skiing injuries. Non-weightbearing in the injury situation led to the same rate of MCL tears (18/28) as those reporting weightbearing (35/72) but significantly more intact menisci (19/28 vs 23/72). Thus, contact sports injuries were more often sustained during weightbearing, with a resultant joint compression of both femuro-tibial compartments as shown by the higher incidence of bicompartmental meniscal lesions. This might be an important prognostic factor for future joint disease and arthrosis. The classic "unhappy triad" was a rare finding (8/100) and we suggest that this entity should be replaced by the "unhappy compression injury".

Anterior Cruciate Ligament↗
PubMed1999

Chronic elbow instability.

Chronic elbow instability without fractures in adults can be broken down into three types: (1) valgus instability, (2) posterolateral rotator instability, and (3) isolated radial head instability. By far the most common is valgus instability, which usually occurs in throwing athletes as a result of repetitive microtrauma to the anterior band of the medial collateral ligament. Surgical treatment is aimed at reconstruction of the anterior band of the medial collateral ligament. Posterolateral rotatory instability is much less common and is diagnosed by the lateral pivot-shift test of the elbow. It is usually the result of an undiagnosed acute injury to the lateral ulnar collateral ligament. Surgical treatment is aimed at its reconstruction. Isolated radial head subluxation in adults is extremely rare. The essential lesion is a disruption of the annular ligament. Surgical treatment is either radial head resection or reconstruction of the annular ligament.

Chronic Disease↗
PubMed2005

The multiple-ligament injured knee: evaluation, treatment, and results.

The multiple-ligament injured knee is a complex problem in orthopaedic surgery. Most dislocated knees involve tears of the anterior and posterior cruciate ligaments (ACL/PCL) and at least 1 collateral ligament complex. Careful assessment of the extremity vascular status is essential because of the possibility of arterial and/or venous compromise. These complex injuries require a systematic approach to evaluation and treatment. Physical examination and imaging studies enable the surgeon to make a correct diagnosis and to formulate a treatment plan. Arthroscopically assisted combined ACL/PCL reconstruction is a reproducible procedure. Knee stability is improved postoperatively when evaluated using knee ligament rating scales, arthrometer testing, and stress radiographic analysis. Acute medial collateral ligament (MCL) tears, when combined with ACL/PCL tears, may in certain cases be treated with bracing. Posterolateral corner injuries combined with ACL/PCL tears are best treated with primary repair as indicated, combined with reconstruction using a post of strong autograft (split biceps tendon, biceps tendon, semitendinosus) or allograft (Achilles tendon, bone-patellar tendon-bone) tissue. Surgical timing depends on the ligaments injured, the vascular status of the extremity, reduction stability, and the overall health of the patient. We prefer to use allograft tissue for reconstruction in these cases because of the strength of these large grafts and the absence of donor site morbidity.

Achilles Tendon↗
PubMed2003

Cultures of ligament fibroblasts in fibrin matrix gel.

The cellular properties of anterior cruciate ligament (ACL) and medial collateral ligament (MCL) fibroblasts have been analyzed in a three-dimensional fibrin matrix gel (FMG) system. The MCL fibroblasts proliferated significantly faster than ACL fibroblasts in 10% fetal bovine serum (FBS). FMG contraction resembles soft-tissue wound contraction. Transforming growth factor-beta1 (TGF-beta1) (5 ng/ml) caused a significantly faster rate of FMG contraction than control (0.5% FBS) in both ACL and MCL fibroblasts. Unlike the cells in 10% FBS, this faster rate of FMG contraction was achieved without increasing the initial cell number. In the FMG, the MCL fibroblasts demonstrated significantly higher collagen synthesis per cell than ACL fibroblasts between the days 2 and 6 of culture. These differences in cellular properties of the ACL and MCL fibroblasts that were observed in vitro may explain the differences in the healing potential of these ligaments in vivo.

Animals↗
PubMed1998

Salter-Harris type III epiphyseal fractures of the proximal phalanx.

Of 823 pediatric hand fractures treated between 1981 through 1996, only 11 (1.3%) were Salter-Harris type III fractures of the proximal phalanx. We review the anatomic basis, etiology, age prevalence, treatment, and results of these epiphyseal injuries. The average age at injury was 14.9 years, with a narrow range from 14 years 2 months to 15 years 11 months. Nine of 11 fractures were displaced and treated with open reduction and internal fixation. At an average follow-up of 21 months, 9 of 11 had full joint motion. The other two had minimal loss of motion, and all had normal function and collateral ligament stability. The displacement and size of the epiphyseal fragment, avulsed and rotated by the collateral ligament, are often underestimated by radiographs. We found that anatomic reduction and fixation yielded good results in all displaced fractures. This restores both the stability of the collateral ligament and a smooth articular surface.

Adolescent↗
PubMedDate not supplied

A cyclooxygenase-2 inhibitor impairs ligament healing in the rat.

Celecoxib was the first of a new class of nonsteroidal antiinflammatory drugs, the cyclooxygenase-2 (COX-2) specific inhibitors, marketed as having the same antiinflammatory efficacy as other nonsteroidal antiinflammatory drugs without their increased risk of gastrointestinal ulceration. Among the widest uses of nonsteroidal antiinflammatory drugs is in the treatment of acute soft tissue injuries. Although the benefits of celecoxib have been shown when used for rheumatoid arthritis and osteoarthritis, we are unaware of any studies concerning its effect on soft tissues. We used the surgically incised medial collateral ligament of male Sprague-Dawley rats as an experimental model for acute ligament injuries to investigate the effects of celecoxib on ligament healing. Fifty rats underwent surgical transection of the right medial collateral ligament. Postoperatively, half were given celecoxib for the first 6 days of recovery, the other half were not. The animals were sacrificed 14 days after the operation, and both the injured and uninjured medial collateral ligaments were mechanically tested to failure in tension. Celecoxib-treated/injured ligaments were found to have a 32% lower load to failure than untreated/injured ligaments. The results of this study do not support use of cyclooxygenase-2 specific inhibitors in the treatment of ligament injuries.

Animals↗
PubMed1981

The role of incompetence of the anterior cruciate and lateral ligaments in anterolateral and anteromedial instability. A biomechanical study of cadaver knees.

UNLABELLED: The anterolateral and anteromedial stability of seventeen fresh frozen cadaver knees was studied in a test apparatus designed to simulate physiological conditions. Statistically significant increases in internal rotation occurred in seven knees when only the anterior cruciate ligament was sectioned, and these increases were enhanced by subsequent sectioning of the posterolateral complex and the lateral collateral ligament, singly or in combination. On the other hand, sectioning of the posterolateral complex and of the lateral collateral ligament, leaving the anterior cruciate intact, did not produce significant increases in internal rotation until the anterior cruciate ligament was sectioned in seven knees. When the entire anterolateral capsule was sectioned as far posterior as the lateral collateral ligament in three knees, no changes in internal or external rotation occurred. Only when the posterolateral complex was sectioned was there a significant increase in external rotation in any of the ligament-sectioning sequences. Thus, it appears that for pathological internal rotation of the tibia on the femur to occur, the anterior cruciate ligament must be incompetent. CLINICAL RELEVANCE: The test apparatus and the results are useful in assessing which ligament structures contribute to clinically noted rotational knee instabilities.

Biomechanical Phenomena↗
PubMed2004

Ligamentous reconstruction around the elbow using triceps tendon.

Posttraumatic instability of the elbow joint can be osseous or ligamentous. Ligamentous instability can be in valgus or in posterolateral rotatory direction. Rupture of both the lateral and medial collateral ligament of the elbow can be seen as an isolated injury, or it can be part of a more complex injury such as a dislocation. Persistent insufficiency of the lateral collateral ligament of the elbow results in posterolateral rotatory instability. Insufficiency of the medial collateral ligament, the anterior part in particular, results in valgus instability. Persistent symptoms after nonoperative treatment are an indication for reconstruction. In the past, ligamentous reconstruction at both the lateral and medial side was performed using palmaris tendon graft through bony drill holes. In this article I describe a new technique using ipsilateral triceps tendon, fixed in drill holes using bioabsorbable interference screws. This technique allows simplified graft tensioning and improved graft fixation, and avoids the risk of fracturing of the bony tunnels. An accelerated rehabilitation protocol can be applied. The final result depends on proper isometric reconstruction, associated lesions or degeneration of the elbow joint and adequate after-treatment. Taking these factors into account, the technique described shows promising short-term results.

Adult↗
PubMedDate not supplied

Occult knee ligament injuries associated with femoral shaft fractures.

Recognition of ligamentous injuries of the knee in the acute phase is essential for optimum treatment and prognosis. A multitraumatized patient with a fractured femur and occult knee ligament damage presents a difficult diagnostic challenge. This paper retrospectively reviews 52 patients with 54 midshaft femoral fractures. The high incidence (48%) of ipsilateral knee ligament damage, particularly of a severe nature (30%) evident at followup (mean 24.5 months) is alarming. In the 26 cases of knee ligament damage, the mean time from injury to documentation of instability is 12.8 months. Motor vehicle and athletic injuries and falls account for all of the injuries. The majority are dashboard impacts treated in balanced traction with subsequent case bracing. The anterior cruciate ligament (50%) is most often injured followed by the medial collateral ligament (31%), lateral collateral ligament (13%), and posterior cruciate ligament (6%). A Lachman test, aspiration of the effusions, examinations under anesthesia including stress films, and arthroscopy are recommended as diagnostic procedures. Acute ipsilateral knee instability is a strong relative indication for primary rigid immobilization of the fracture femur to allow early ligamentous repair.

Accidents, Traffic↗
PubMedDate not supplied

The efficacy of a prophylactic knee brace to reduce knee injuries in football. A prospective, randomized study at West Point.

The purpose of this prospective, randomized study was to determine the efficacy of a prophylactic knee brace to reduce the frequency and severity of acute knee injuries in football in an athletic environment in which the athletic shoe, playing surface, athlete-exposure, knee injury history, and brace assignment were either statistically or experimentally controlled. The participants in the study were 1396 cadets at the United States Military Academy, West Point, New York, who experienced a total of 21,570 athlete-exposures in the 1986 and 1987 fall intramural tackle football seasons. The use of prophylactic knee braces significantly reduced the frequency of knee injuries, both in the total number of subjects injured and in the total number of medial collateral ligament injuries incurred. However, the reduction in the frequency of knee injuries (total and medial collateral ligament) was dependent on player position. Defensive players who wore prophylactic knee braces had statistically fewer knee injuries than players who served as controls. This was not true of offensive players who served as controls; they had statistically no difference in the number of knee injuries from players who wore prophylactic knee braces. The severity of medical collateral ligament and anterior cruciate ligament knee injuries was not significantly reduced with the use of prophylactic knee braces.

Adult↗