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At least 973 records · Page 54Linked to original sources
PubMed2003

[MRI of the lateral ankle ligaments: value of three-dimensional orientation].

PURPOSE: To determine the three-dimensional orientation of the lateral ankle ligaments with MRI. MATERIALS AND METHODS: Twenty healthy volunteers without previous injury to the ankle were included in the study. With the right ankle in the normal anatomic position stabilized in a splint, coronal T2-weighted spin-echo sequences (TSE) were obtained. The three-dimensional orientation was determined by placing paths through the ligaments and by measuring the angles between corresponding tangents and the three main imaging planes. RESULTS: Using the calculated angles, full-length visualization of the lateral ligaments of the ankle was achieved. The angles deviating from the axial imaging plane were 18.0 degrees for the anterior talofibular ligament, 52.3 degrees for the calcaneofibular ligament and 28.2 degrees for the posterior talofibular ligament. CONCLUSION: MRI enables the exact determination of the three-dimensional orientation of the lateral ankle ligaments. Orienting the imaging planes according to the calculated angular deviation allows the full-length visualization of the ligaments and is the basis for optimal imaging of the lateral ankle ligaments.

Adult↗
PubMed2005

[Synovialectomy of the metacarpophalangeal joints with reconstruction of the radial collateral ligaments -- long-term results in patients suffering from rheumatoid arthritis].

Rheumatoid arthritis may lead to destruction of MP joints and severe alteration of grip and other hand functions. Due to the improvement in medical treatment, synovialectomy of the MP joints is necessary only in late stages. Most centres prefer alloarthroplasties in late stages, as erosion of the cartilage and loosening of the ligaments have already led to destruction of the MP joints and destabilization of grip functions. We do not use alloarthroplasties as our first choice, but pay special attention to the reconstruction of the radial collateral ligaments. Therefore, the elongated radial ligaments are detached near their origin after synovialectomy of the dorsal aspects of the MP joint. After detachment of the radial ligament, the palmar aspects can be cleaned easily. The radial collateral ligaments are shortened and reinserted dorsally to gain slight supination. This study shows the long-term results of our patients. In a period of ten years, 74 patients (87 hands, 347 MP joints) were reexamined after an average of 55 months postoperatively. The loss of active motion was 18 degrees and ulnar deviation could be reduced from 25 degrees to 7 degrees. 71 % of the joints showed stable ligaments, 14 % loose, 15 % unstable ligaments. We saw recurrence of synovialitis in 18 % (10 % mild, 7 % significant, 1 % severe). Radiographs showed amelioration in 14 % of cases and deterioration in 39 %. There was no correlation between active range of motion, synovialitis and X-rays. Results were constant when compared with exams before and five years after surgery. Our investigation shows good and stable results, which can be easily compared with the outcome of other studies after alloarthroplasty. The main advantage in our procedure is the easy access to all parts of the MP joint, which allows complete synovialectomy. By shortening and reinserting the elongated radial collateral ligament, we achieve a mild supination and amelioration of grip strength. The results are constant in long terms. In case of recurrent synovialitis or loosening of the ligaments any other type of auto- and alloarthroplasties can still be performed.

Adult↗
PubMed1996

[Biomechanics of the ligaments of the unstable ankle joint].

Ligament rupture occurs at the maximum breaking load. During ligament healing, contraction and remodeling of the scar is sufficiently advanced at 6 weeks to reach 60 to 70% of the initial strength. There is evidence of an early improvement in biomechanical properties of repaired ligaments. This advantage, however, may not be sustained as, after one year, sutured and unsutured ligaments have nearly equal length when measured at rest and comparable failure strength when subjected to exercise. Each of the ankle ligaments has a role in stabilizing the ankle and/or subtalar joint. Beside of maintaining lateral ankle stability, the lateral ankle ligaments have been shown to play a significant role in providing rotational ankle stability. This is especially true for the anterior talofibular ligament. A loss of this ligament does allow for an increase in foot inversion and external rotation of the leg to occur, without any tilting of the talus or subtalar gapping. It is this increase in foot inversion which may lead to a symptomatic instability. When treating ankle instability, it is therefore important for the clinician to take the alteration of hindfoot biomechanics into consideration. This is especially the case for any surgical repair of injured ankle ligaments. Unphysiological tenodesis procedures should be avoided.

Ankle Injuries↗
PubMed1996

[Weber fibular ligament-plasty with plantar tendon with Segesser modification].

UNLABELLED: Ankle joint injuries are one of the most frequently diagnosed sports injuries. In our clinic we observed between 1981-92 18% ankle joint injuries in 11.350 patients. The acute injury was generally handled conservatively by functional treatment with a special shoe; only comminute injuries like fractures, luxations or tendon injuries would lead to the decision to perform surgery. The ratio of acutely performed surgery compared to late surgery was decreasing: 1981 1:3, compared to 1992 1:50. Reconstructive surgery of the lateral ligament complex is indicated under the following conditions: patient suffering from recurrent trauma and feeling of instability and/ or in case of comminuted overuse injuries caused by instability like the entrapment of the tibial nerve in the tarsal tunnel, achilodynia caused by instability of the rearfoot or luxation of the peroneal tendons. Reconstruction of the lateral ligaments of the ankle should be done anatomically, operations with effect of tenodesis should be avoided. TECHNIQUE: We modified the technique of Weber to reconstruct the lateral ligaments. An autograft (plantaris tendon) is used for this procedure. The plantaris tendon is removed through a medial sided minimal incision on the injured leg with a special stripper. Through the lateral incision on the lateral malleolus drill wholes are made at the anatomical ligament insertions of the calcaneus, talus and fibula. The graft is passed through the drill wholes this way the Lcf and Ltfa are anatomically reconstructed. The tendon sheat of the peroneal tendons will be closed if needed with residual plantaris tendon. The postoperative treatment is the same as conservative treatment with full-weight-bearing in a special shoe three days after surgery with 30 degrees (10-0-20) range of motion. ROM will be increased to 50 degrees after three weeks. For the first three weeks the leg will be positioned in a 90 degrees splint over night. Two series of patients altogether 584 patients in the time from 1981-1991 were operated. The difference of the two groups lied in the technique of surgery (in group 2 the calcaneofibular ligament was reconstructed as well as the peroneal tendon sheat) as well as the postoperative treatment was altered (group one removable cast for the first three weeks versus functional treatment after surgery in group 2 as described in the postop treatment). RESULTS: 443 (76%) out of 584 operated patients were followed at least one year after OP. Working ability: 19% (group 1)/25% (group 2) of the patients after two weeks, 31/42% after 2-4 weeks and 79/88% after 4-6 weeks. Full sports activity to previous sport 8/17% after 4-6 weeks, 26/38% after 6-8 weeks, 65/70% after 8-12 weeks. The group 2 achieved full sports activity and working ability on average two weeks before the patients of group one. Personal evaluation: 88/90% felt their ankle joint to be more stable postoperatively, 10/9% as stable as before and 2/1% described it as less stable. Clinical evaluation: The modified Benedetto score showed in 76/81% very good results, in 9/7% good and 13/8% bad results. In conclusion the described reconstruction of the fibular ligaments without damaging the active stabilizing muscles is a valid technique. The reconstruction of the calcaneofibular ligament improved the long term results of surgery. The functional postoperative rehabilitation (special shoe and night brace) does shorten the time for the patients working ability as well as the return to full sports activity. The long term results on the other hand appeared to be similar for both groups. The advantage of our technique using the plantaris tendon as a graft. The use of autograft material having the same tensile strength as the original ligaments anatomically reconstructed. Surgery with tenodesis effects should be abandoned. The good results occurring while performing late surgery leave the chance for primary conservative treatment of lateral ligament injuries.

Adult↗
PubMedDate not supplied

Anatomic variance of the coracoclavicular ligaments.

The coracoclavicular ligaments vary widely in morphology and anatomic descriptions. Few authors have adequately described the coracoclavicular ligaments' anatomy, and a number of discrepancies exist in the anatomy literature. This study examines the complex anatomy of the coracoclavicular ligaments and their relationships to clinically important bony landmarks. The geometric dimensions of 24 coracoclavicular ligament specimens from fresh human cadaveric shoulders were examined and quantified with 13 different measurements. Particular attention was given to any inter-specimen anatomic variance. The coracoid insertions of the conoid ligaments displayed high variance, with 33% (8/24) being confluent with the lateral fibers of the superior transverse scapular ligament. A further 15% (3/24) presented an additional lateral fascicle. The distance from the lateral trapezoid ligament to the distal clavicle averaged 15.3 mm. Three distinct and previously unreported conoid ligament variants lend themselves to an anatomic classification (types I, II, and III). A safety margin of 15 mm is suggested for distal clavicle resection in incomplete acromioclavicular joint injuries to preserve the intact coracoclavicular ligament.

Acromioclavicular Joint↗
PubMed1999

Ultrasonography may be misleading in the diagnosis of ruptured and dislocated ulnar collateral ligaments of the thumb.

To find out if a non-invasive technique (ultrasonography) was able to identify a dislocated ligament of a metacarpophalangeal joint of the thumb with instability of the ulnar collateral ligament, 14 consecutive patients with clinical rupture of the ulnar collateral ligament were examined with ultrasonography before the ligament was explored. At exploration all ligaments were ruptured, and only five out of the 14 were dislocated. Ultrasonography recognised only two of the dislocated ligaments, and in half of the 14 patients the ultrasound scan gave incorrect information about the position of the ligament. We conclude that ultrasonography is not adequate for identifying dislocated ulnar collateral ligaments of the metacarpophalangeal joint of the thumb, and exploration is indicated in those with clinical instability in which palpation either suggests a dislocated ligament or is inconclusive.

Collateral Ligaments↗
PubMed2000

Anatomy of the iliolumbar ligament.

Information is lacking in the literature on the precise anatomy of the iliolumbar ligament and its individual differences. The morphologic pattern, length, and width of the iliolumbar ligament were determined in 56 embalmed lumbosacral spines from human cadavers. It was possible to classify the iliolumbar ligament into two groups: Type A (74 ligaments), in which anterior and posterior ligaments had separate courses; and Type B (32 ligaments), in which anterior and posterior ligaments moved together as one band. The angle of the posterior iliolumbar ligament in Type A was oriented significantly more posteriorly than that in Type B. The posterior iliolumbar ligament was significantly shorter and oriented more posteriorly in male anatomic specimens than in female ones.

Aged↗
PubMed2002

Anatomy and function of the glenohumeral ligaments in anterior shoulder instability.

The anatomy of the glenohumeral ligaments has been shown to be complex and variable and their function is highly dependent on the position of the humerus with respect to the glenoid. The superior glenohumeral ligament with the coracohumeral ligament was shown to be an important stabilizer in the inferior direction, even though the coracohumeral ligament is much more robust than the superior glenohumeral ligament. The middle glenohumeral ligament provides anterior stability at 45 degrees and 60 degrees abduction whereas the inferior glenohumeral ligament complex is the most important stabilizer against anteroinferior shoulder dislocation. Therefore, this component of the capsule is the most frequently injured structure. An appropriate surgical procedure to repair the inferior glenohumeral ligament complex after shoulder dislocation must be considered. In addition, a detached labrum can lead to recurrent anterior instability and a compromised inferior glenohumeral ligament complex. However, additional capsular injury usually is necessary to allow anterior dislocation.

Biomechanical Phenomena↗
PubMed2004

Reduction of initial tension in the in situ frozen anterior cruciate ligament.

The purposes of this study were to develop a new method to measure in situ tension in the anterior cruciate ligament, and to show degradation changes in the tension applied to the in situ frozen-thawed anterior cruciate ligament during a 12-week period postoperatively. Eighteen mature Beagles were used in the current study. Each dog had the in situ freeze and thaw treatment to its anterior cruciate ligament, and an initial tension of 20 N was applied to the anterior cruciate ligament. The in situ tension in the anterior cruciate ligament was measured immediately after surgery (n = 4) and at 6 and 12 weeks (n = 5, respectively) with a method developed specifically for this study. A commercially available force transducer, the utility and the validity of which were established in previous studies, was inserted into the anterior cruciate ligament, and the transducer was calibrated in situ using a tensile tester after sacrifice. The four remaining animals were used for histologic examinations. The average tension in the anterior cruciate ligament decreased from 19.1 N immediately after surgery to 14.2 N and 4.7 N at 6 and 12 weeks, respectively. There were significant differences among the times. At 12 weeks, histologically, degenerative changes were seen with asteroid-shaped cells and vacuoles in the anterior cruciate ligament. The current study showed that the high initial tension applied to the in situ frozen anterior cruciate ligament gradually decreased with time until 12 weeks.

Analysis of Variance↗
PubMed1983

Transcutaneous stitch for transperiosteal identification of the medial canthal ligament.

This paper presents a technique whereby the canthal ligament can be identified through the periosteum without creating an external incision. Prior to releasing the tendon from the bones, the assistant will stretch the lateral canthal ligament while the surgeon places a stitch through the medial canthal ligament and tattoos the ligament and the underlying bone. After the forehead flap is mobilized and the ligament is detached from the bone by elevation of the periosteum, the previous stitch on the medial canthal ligament is pulled, which will provide a firmer consistency to the ligament, thereby facilitating the differentiation of the ligament from the surrounding soft tissue. Using this and the tract tattooed previously, the ligament can be identified easily without creating any external scars.

Face↗
PubMed1997

Transverse carpal ligament: its effect on flexor tendon excursion, morphologic changes of the carpal canal, and on pinch and grip strengths after open carpal tunnel release.

A three-part study is described that examines postoperative weakness after open carpal tunnel release and investigates the role of the transverse carpal ligament in the digital flexor pulley system. The effect of this ligament on flexor tendon excursion is evaluated in a cadaver study. Magnetic resonance imaging analysis is used to determine whether division of the transverse carpal ligament promotes volar migration of the median nerve and flexor tendons. Finally, the effects of ligament division and various methods of transverse carpal ligament reconstruction on the return of grip and pinch strengths after open carpal tunnel release are evaluated. The authors were able to determine that transverse carpal ligament reconstruction, particularly the transposition flap repair technique, after open carpal tunnel release confers a mechanical advantage and that the transverse carpal ligament is an important pulley for flexor tendon excursion. Based on the magnetic resonance imaging studies, volar displacement of carpal contents is reduced in patients undergoing transverse carpal ligament reconstruction by means of a transposition flap compared with those undergoing no ligament reconstruction and those undergoing reconstruction using the palmar aponeurosis. Postoperative grip and pinch strength values for the transposition flap repair group surpassed those of the other two groups at 12 weeks.

Carpal Tunnel Syndrome↗
PubMed2002

Topographic mapping of the superior transverse scapular ligament: a cadaver study to facilitate suprascapular nerve decompression.

Division of the superior transverse scapular ligament for decompression of suprascapular nerve entrapment can be curative. However, the superior transverse scapular ligament can be difficult to locate, and large incisions are often required. This study was designed to determine the topographic coordinates of the superior transverse scapular ligament to permit reproducible surgical localization and reduce incision size. In 20 cadavers, the superior transverse scapular ligament was identified through a superior approach. Measurements were obtained from the superior transverse scapular ligament to external landmarks. The superior transverse scapular ligament was located 1.3 +/- 0.3 cm (+/- SD) posterior to the posterior border of the clavicle and 2.9 +/- 0.8 cm from the acromioclavicular joint in a two-dimensional surface plane. The depth of the superior transverse scapular ligament from the skin surface was 3.9 +/- 0.7 cm. An incision (mean length, 6.3 +/- 0.7 cm) derived from a novel system of planning marks facilitated access to the superior transverse scapular ligament. The authors conclude that the superior transverse scapular ligament can be located consistently through an incision located on the superior aspect of the shoulder on the basis of palpable topographic landmarks. The superior approach permits small incision size and the maintenance of local muscle anatomic integrity.

Cadaver↗
PubMed1987

Functional anatomy of the alar ligaments.

Nineteen upper cervical spine specimens were dissected to examine the macroscopic and functional anatomy of alar ligaments. They are on both sides, symmetrically placed, approximately 10-13 mm long and elliptical in cross-section 3 X 6 mm in diameter. The fiber orientation is dependent on the height of dens axis, mostly in the cranial caudal direction. In 12 specimens there was a ligamentous connection between dens and lateral mass of the atlas as a part of the alar ligament. In 2 specimens anterior atlanto-dental ligament was identified. The computerized tomographic (CT) images can clearly show alar ligaments in axial, coronal, and sagittal planes. The ligaments limit the axial rotation in the occipito-atlanto-axial complex (to the right by left alar and vice versa) as well as in side bending. The ligament is most stretched, and consequently most vulnerable, when the head is rotated and in addition flexed. This mechanism, common in whiplash injuries, could lead to irreversible overstretching or rupture of the ligaments especially as the ligaments consist of mainly collagen fibers.

Adult↗
PubMed1990

The role of the iliolumbar ligament in the lumbosacral junction.

The biomechanical function of the iliolumbar ligament in the human lumbosacral junction was investigated by analyzing the three-dimensional movements of the whole lumbar and lumbo-sacral-ilium specimens. The experiment was repeated in the following three conditions: 1) intact iliolumbar ligament, 2) right iliolumbar ligament transected, and 3) bilateral iliolumbar ligaments transected. The representative values of the increased motions, compared with intact, after transection of the bilateral iliolumbar ligaments were 1.7 degrees (23%) in flexion, 1.1 degrees (20%) in extension, 0.3 degrees (18%) in axial rotation, and 1.2 degrees (29%) in lateral bending. The most restricted motion governed by the iliolumbar ligament in the lumbosacral junction was lateral bending. The bilateral iliolumbar ligament specimen could restrict flexion and extension of the lumbosacral junction, but the unilateral iliolumbar ligament preparation alone could not restrict these motions. The iliolumbar ligament also had the function of restricting the rotational movement of the lumbosacral junction.

Adult↗
PubMed1996

New insight into the mechanics of the lumbar interspinous ligament.

STUDY DESIGN: Repeated in vitro mechanical tests were performed on porcine and human interspinous ligament specimens with progressive disruption of the collagen fiber network to evaluate the existence of mechanical interactions between collagen fibers. OBJECTIVE: To evaluate the existence of a load pathway in the interspinous ligament whereby loads are transmitted between collagen fibers. SUMMARY OF BACKGROUND DATA: Mechanical tests demonstrate that the interspinous ligament resists spinal flexion, but the collagen fibers are not oriented to oppose separation of the spinous processes. This seeming contradiction could be explained by the existence of mechanical interactions between collagen fibers of the interspinous ligament. METHODS: In vitro mechanical tests were performed on porcine and human bone-interspinous ligament-bone specimens. The collagen network of the ligament substance was disrupted by passing a scalpel blade though the ligament substance. Repeated tests were performed with progressive disruption of the collagen fiber network. RESULTS: The stiffness of the interspinous ligament specimens was reduced as the collagen fiber network was disrupted, but approximately half of the initial stiffness was maintained when the collagen fiber network was severely disrupted. In this case, no intact collagen fibers remained. CONCLUSIONS: Mechanical interactions exist between collagen fibers in the interspinous ligament. The mechanism of the interactions is unknown.

Animals↗
PubMed1997

Identification of the location, extent, and pathway of sensory neurologic feedback after mechanical stimulation of a lateral spinal ligament in chickens.

STUDY DESIGN: This study traced the location, extent, and pathway of sensory feedback after the mechanical stretching of a lateral spinal ligament in young chickens. The pathway was traced by locating the sites of Fos protein production in neuronal cell bodies at various sites in the nervous system. OBJECTIVES: To trace the location, extent, and pathway of sensory feedback after the mechanical stretching of a lateral spinal ligament in young chickens. SUMMARY OF BACKGROUND DATA: The innervation of ligaments is thought to form part of a protective feedback mechanism to provide stability for joints. The precise pathway and extent of the feedback for spinal ligaments is currently unknown. Such information would provide a clear focus for future studies, especially for diseases such as scoliosis where it has been suggested that there is abnormality in perception of sensory feedback. METHODS: The intertransverse ligament on the right side at T3-T4 in 4-week-old chickens was exposed by blunt dissection. After Fos production resulting from the surgery had been stopped, the ligament was stretched mechanically and repeatedly for 60 minutes using a 300-g weight. Various areas of the nervous system then were sectioned and processed immunohistochemically to identify areas of Fos production in nerve cell bodies. The presence of Fos indicated neurons that had been stimulated by the stretching the ligament, including interneurons along the feedback pathway. RESULTS: Fos protein was identified in nerve cell bodies in the dorsal root ganglia and intermediate gray matter of the spinal cord at the level of stimulation as well as at several spinal cord levels above and below the site of stimulation. Identification was made on the ipsilateral and the contralateral sides, although the extent of Fos production was less on the contralateral side. Fos presence also was identified in sympathetic ganglia at these sites. Nerve cell bodies in the combined nucleus cuneatus and gracilis in the medulla oblongata, the vestibular nuclei, and the thalamus also contained Fos-positive particles. CONCLUSIONS: Stretching a single lateral ligament of the spine produces a barrage of sensory feedback from several spinal cord levels on both sides of the spinal cord. This sensory information also is transferred to higher levels in the brain, including the nucleus gracilis and cuneatus, the vestibular nuclei, and the thalamus. These sites of Fos production suggest the locations of pathways for this sensory information, which include the dorsal columns and the spinocerebellar tracts. The information obtained from this study provides a clear focus for future studies in this area, particularly for diseases such as scoliosis where it is thought that incorrect perception of sensory information from the ligaments might be a major contributing factor.

Animals↗
PubMed2006

Extensor retinaculum augmentation reinforces anterior talofibular ligament repair.

Repair of the anterior talofibular ligament often is augmented with the inferior extensor retinaculum because it is thought to reinforce the primary ligament repair. The additional dissection and suturing extend the duration of surgery, and not all surgeons routinely include inferior extensor retinaculum augmentation in anterior talofibular ligament repairs. To determine whether there is a reasonable basis for this surgery, we ascertained the degree to which inferior extensor retinaculum augmentation reinforced the primary anterior talofibular ligament repair. Matched pairs of cadaveric ankles had controlled inversion while monitoring resistance to inversion, first with the anterior talofibular ligament sectioned, then with primary anterior talofibular ligament repair alone or with inferior extensor retinaculum augmentation. The resistance to ankle inversion was greater at 5 degrees, 10 degrees, 15 degrees, 20 degrees, and 25 degrees rotation in ankles that had inferior extensor retinaculum augmentation. Anterior talofibular ligament failure occurred at similar inversion angles in both treatment groups, but the primary anterior talofibular ligament repair required more torque to fail in the augmented group. With these ankle loading conditions, inferior extensor retinaculum augmentation provided protection to the primary anterior talofibular ligament repair, indicating that broader clinical use of augmentation may be warranted.

Adolescent↗
PubMed2001

Does deep endometriosis infiltrating the uterosacral ligaments present an asymmetric lateral distribution?

OBJECTIVE: To investigate whether deeply infiltrating endometriosis occurs with equal frequency between left and right uterosacral ligaments. DESIGN: Retrospective analysis of consecutive cases. SETTING: Department of gynaecological surgery in a tertiary care university hospital in Paris, France. POPULATION: One hundred and thirty consecutive women with laparoscopic resection of histologically proven deep endometriosis infiltrating the uterosacral ligaments. METHODS: Laterality, intraoperative aspect of the uterosacral ligaments, and associated endometriosis were recorded during laparoscopy. Deep endometriosis infiltrating the uterosacral ligaments was considered as histologically proven in the presence of endometrial glands and stroma. MAIN OUTCOME MEASURE: Frequency of left- and right-sided deep endometriosis infiltrating the uterosacral ligaments. RESULTS: The left uterosacral ligament alone was involved in 69 cases; the right uterosacral ligament alone was involved in 38 cases; both were involved in 23 cases. For patients with unilateral deep endometriosis infiltrating the uterosacral ligaments the observed proportion of endometriosis involving the left uterosacral ligament (69/107, 64.5%) was significantly different from the expected proportion of 50% (chi2 = 8.98; P < 0.01). CONCLUSION: Anatomical differences between left and right hemipelvis and differences in the frequency of ovulation between right and left ovary could explain these results.

Adult↗