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At least 991 records · Page 55Linked to original sources
PubMed2001

[Diagnosis of intra-articular fracture of the head of the tibia. A prospective comparative study].

Complete visualization of the joint surface is essential for correct assessment of tibial head fractures. Conventional tomography, computed tomography (CT), and magnetic resonance imaging (MRI) are compared in this prospective study. We examined 27 patients (19 suffering from B fractures and 8 from C fractures) from 1 January 1995 to 11 November 1998. Conventional tomography underestimated the fractures in 3 of the 19 cases of B fractures. Computed tomography underestimated two of these cases. MRI could not exactly depict the essential structures in three of the eight cases of C fractures because of edema and effusions. MRI identified complete cruciate ligament rupture in 6 of the 27 cases (18%) and 10 meniscal ruptures in 9 cases (33%: 6 medial meniscus, 4 lateral meniscus). Complete ruptures of the lateral collateral ligament were detected in five cases and medial collateral ligament ruptures in two cases. According to this, 63% of the patients suffered from relevant accompanying soft tissue injuries. The rate of soft tissue injuries increased up to 92% including the partial collateral ligament ruptures. Local hospital conditions permitting, X-ray-loaded conventional tomography should no longer be used in tibial head fractures. X-ray-free MRI is most efficient in cases of B fractures, which can in most cases be treated with a minimum of invasive techniques. Computed tomography is to be used in cases of C fractures that are regularly managed by open surgery accompanied by direct visualization of the inside of the knee joint.

Adult↗
PubMed1999

Modifications of the elbow induced by the practice of handball on radiography, US and MRI.

The objective of this study was to evaluate plain radiographs, US and MRI in detection of occult lesions of the elbow in asymptomatic handball players. Comparative plain films of both elbows were obtained in an anteroposterior and lateral projection. A bilateral comparative ultrasound examination was performed with measurement of the thickness of the flexor and extensor tendons, the triceps tendon, the lateral collateral ligament and the anterior bundle of the medial collateral ligament (MCL). Echogenicity of these structures was evaluated. Articular recesses were scanned for fluid and loose bodies. Axial and coronal MRI of the dominant elbow was performed using a T1W sequence after intravenous injection of gadolinium 30 minutes before the examination and by a FISP 3D T2W echo gradient sequence in coronal plane and reconstruction in a sagittal plane. Twenty-eight male asymptomatic members of the national handball team with 7 to 25 years of experience and undergoing 3 to 4 training sessions per week were studied. Paraphysiological modifications such as hypertrophy of bone and muscles were evidenced. Flexion deformity of the elbow was present even in the youngest players, but valgus deformity occurred preferentially in the more experienced players. US was more efficient in detection of small loose bodies and gave more precise information on the structure of the MCL and the tendons compared with MRI. Plain film and US were sufficient for the detection of chronic lesions of the elbow. MRI did not add significant findings.

Adolescent↗
PubMed1999

Metacarpophalangeal arthroscopy.

Although small joint arthroscopy has become commonplace over the past decade, relatively little attention has been paid to the investigation and clinical utility of metacarpophalangeal (MP) joint arthroscopy. The literature is scant in this area and consists of only a handful of case reports. In addition, the arthroscopic anatomy of the MP joint has not as yet been reported. Six cadaveric hands (24 joints) were rigorously studied in the laboratory using standard 2.5-mm small joint arthroscopic instrumentation and 5 lb of overhead traction. Radial and ulnar portals were used with care not to injure the extensor tendons. Arthroscopic anatomic landmarks include: (1) A consistent tripartite configuration of the main radial and ulnar collateral ligaments with characteristic changes in relative fiber orientation as the digit goes from extension to flexion, (2) nonvisualization of the accessory collateral ligament from inside the joint, (3) transitional amorphous capsular fibers connecting the collateral ligaments to the volar plate and dorsal capsule, (4) four synovial recesses (radial, ulnar, volar, and dorsal-proximal), (5) metacarpal head and proximal phalanx, (6) a consistent circumferential meniscal equivalent around the margin of the proximal phalanx articular surface, and (7) the sesamoid-metacarpal articulation in the thumb MPjoint. There are published case reports on the utility of MP joint arthroscopy for synovectomy in rheumatoid arthritis and hemachromatosis and realigning Stener lesions in gamekeepers' thumbs. The current clinical series reveals preliminary experience with the technique. MP joint arthroscopy was useful in relieving a locked MP joint from a loose osteochondral body and sagittal tear in the volar plate that enfolded into the joint surface. Intra-articular release of post-traumatic volar plate and dorsal capsular contracture were readily accomplished using this technique. Juxta-articular bone lesions such as osteoid osteomas can be removed with careful preoperative planning. Gamekeeper's thumbs that are unstable on stress radiographs can undergo arthroscopy with excellent sensitivity to determine the presence of a Stener lesion before an open or arthroscopic repair. The advantages of arthroscopic versus open techniques are similar to those experienced in larger joints. With time, more indications will emerge.

Arthroscopy↗
PubMed1982

The effect of immobilization on collagen turnover in connective tissue: a biochemical-biomechanical correlation.

Immobilization of the knee joint for 9 weeks results in a reduction of the mechanical properties in the lateral collateral ligament. Specifically, ligament stiffness is reduced in this tissue. No statistical change in collagen mass was detected for the medial collateral ligament (MCL) or patellar tendon. An increase in collagen turnover (synthesis and degradation) was, however, found in the immobilized medial collateral ligament and patellar tendon. It is thus proposed that stiffness reduction is due to a change in the ligament substance itself, rather than a result of tissue atrophy.

Animals↗
PubMed1977

[Experimental studies on the pathophysiology of knee ligament lesions (author's transl)].

The cruciates and the collateral ligaments of the knee compare well with a crossed four-joint chain. In surgery of the ligamentous lesions of the knee it is essential to reinsert the ligaments exactly at their anatomic position. Studies of cadaver knees have demonstrated that the medial collateral ligament ensures medial rotational stability to a greater degree than the meniscofemoral and meniscotibial bands. In every stage of medial and anterior ligamentous lesions, external rotation in 90 degrees of flexion shows the same amount of anterior laxity of the medial tibial condyle as the test of Slocum. In contrast to Nicholas the pivot point in anteromedial complex instability is situated posterolaterally.

Biomechanical Phenomena↗
PubMed1997

Posterolateral rotatory instability of the elbow: usefulness of MR imaging in diagnosis.

PURPOSE: To evaluate the efficacy of magnetic resonance (MR) imaging in the assessment of the normal and abnormal ulnar band of the lateral collateral ligament for diagnosis of posterolateral rotatory instability. MATERIALS AND METHODS: In nine symptomatic patients and nine asymptomatic subjects, MR imaging was performed with three-dimensional gradient-recalled and fast spin-echo sequences. The nine patients had clinical symptoms suggestive of subtle elbow instability. RESULTS: The components of the lateral collateral ligament were identified; tears of the ulnar band were noted in all symptomatic patients. The anterior fibers of the lateral collateral ligament, including the annular ligament, were intact. All symptomatic patients subsequently underwent surgical exploration and reconstruction. Positive clinical findings were demonstrated at examination performed while the patients were under anesthesia. All tears of the ulnar band were confirmed. CONCLUSION: With use of appropriate pulse sequences, MR imaging is an effective tool in the preoperative, noninvasive diagnosis of posterolateral rotatory instability.

Adolescent↗
PubMedDate not supplied

Prospective study of osseous, articular, and meniscal lesions in recent anterior cruciate ligament tears by magnetic resonance imaging and arthroscopy.

Fifty-four patients with anterior cruciate ligament tears that were arthroscopically reconstructed within 3 months of initial injury were prospectively evaluated. Patients with grade 3 medial collateral ligament, lateral collateral ligament, or posterior cruciate ligament tears were excluded. Eighty percent of our patients had a bone bruise present on the magnetic resonance image, with 68% in the lateral femoral condyle. Two of the latter findings--an abnormal articular cartilage signal (P = 0.02) and a thin and impacted subchondral bone (P = 0.03)--had a significant relationship with injury to the overlying articular cartilage. Meniscal tears were found in 56% of the lateral menisci and 37% of the medial menisci. A significant association was present between bone bruising on the lateral femoral condyle and the lateral tibial plateau (P = 0.02). Results of our study support the concept that the common mechanism of injury to the anterior cruciate ligament involves severe anterior subluxation with impaction of the posterior tibia on the anterior femur. Determination of the significance of bone bruising, articular cartilage injury, or meniscal tears will require a long-term followup that includes evaluation for arthritis, stability, and function. These 54 patients represent the first cohort evaluated in this ongoing prospective clinical study.

Adult↗
PubMedDate not supplied

Biceps tendon tenodesis for posterolateral instability of the knee. An in vitro study.

The effects of biceps tendon tenodesis on internal-external and varus-valgus laxity were measured using fresh-frozen cadaveric specimens that had undergone sequential sectioning of the posterolateral structures and of the fibular collateral ligament. Tenodesis (using 89 N graft tension and a fixation point located 1 cm anterior to the fibular collateral ligament's insertion on the femur) was effective in restoring external rotation and varus laxity; the procedure actually overconstrained external tibial rotation at all flexion positions and varus angulation at 60 degrees and 90 degrees of flexion. Internal rotation and valgus laxity were unaffected by the tenodesis procedure. The anterior fixation point was more effective in reducing laxity than a fixation point located 1 cm proximal to the fibular collateral ligament insertion. Tenodesis using the proximal fixation point, which was nonisometric, did not restore external rotation and varus laxities to intact values at 60 degrees and 90 degrees of knee flexion. Graft tension (45 or 89 N) had no measurable effect on the results of the tenodesis. This study has demonstrated that the biceps tenodesis procedure is effective for reducing static laxity in the knee with posterolateral instability.

Biomechanical Phenomena↗
PubMed1997

Spatial heterogeneity of the effects of calcitonin gene-related peptide (CGRP) on the microvasculature of ligaments in the rabbit knee joint.

1. Experiments were performed in anaesthetized rabbits to examine the effects of calcitonin gene-related peptide (CGRP) and the CGRP antagonist CGRP8-37 on blood flow to the medial collateral ligament of the knee joint. 2. Topical application of CGRP (10(-13) to 10(-9) mol) to the exposed external surface of eight knee joints resulted in dose-dependent dilatation of vessels in both the ligament and the joint capsule. The magnitude of this response varied significantly in different regions of the medial collateral ligament, with the 10(-9) mol dose of CGRP giving the maximum response (101.5 +/- 25.3% increase) at the femoral insertion site of the medial collateral ligament and lowest (23.1 +/- 8.8%) at the tibial insertion site. 3. Topical application of CGRP8-37 (0.1, 1 and 10 nmol) produced dose-dependent constriction of vessels in the ligament and the joint capsule in five knees, with a trend towards the greatest effect occurring at the femoral insertion site (45.8 +/- 8.1% reduction in blood flow). With the 10 nmol dose, the vasoconstrictor response at the femoral insertion site differed significantly (P<0.05) from the responses obtained at the tibial insertion and joint capsule sites. 4. Topical application of CGRP8-37 (0.1, 1 and 10 nmol) to four chronically denervated knees produced substantially smaller vasoconstrictor responses at all sites. At the femoral insertion site, where 10 nmol CGRP8-37 normally produces a 45.8 +/- 8.1% reduction in blood flow (n=8), ten days following denervation this response was reduced to 6.5 +/- 6.1%, this difference being significant (P=0.01). 5. Adrenaline was applied topically to augment blood vessel tone, in order to establish how effectively co-administration of CGRP would offset this increase in tone. Adrenaline (10(-10) mol) produced vasoconstriction at all sites (n=6). In the capsule this vasoconstriction was virtually abolished when CGRP (10(-9) mol) was co-administered with adrenaline but in the ligament vasodilatation occurred at all sites. This vasodilatation was significantly greater at the femoral insertion site compared to the tibial insertion and mid ligament sites (P<0.05 for both) and the capsule (P<0.01). 6. Topical application of substance P (10(-10) or 10(-9) mol) failed to elicit dilatation of ligament blood vessels. 7. These results suggest that endogenous CGRP may play an important role in regulating blood flow to different structures in and around the knee joint.

Animals↗
PubMed1987

A biomechanical evaluation of the Lenox Hill knee brace.

This study was conducted to determine the effectiveness of the Lenox Hill knee brace in limiting anterior translation and external rotation of the tibia in reference to the femur in normal and ligament-deficient knees. Four fresh cadaver knees were fitted with Lenox Hill knee braces according to the manufacturer's guidelines. A computer-assisted testing apparatus was constructed that allowed each knee to be tested as a function of knee flexion angle, joint load, and soft tissue integrity. Each knee served as its own control. While 45 kg of anterior force was applied to the tibia of the anterior cruciate ligament deficient knees, the Lenox Hill knee brace was able to decrease anterior translation from an average of 10 mm, to 5.7 mm, at 30 degrees of flexion when no vertical load was present. This limiting effect was lost when the medial collateral ligament was sectioned in addition to the anterior cruciate ligament or when both the medial and the lateral collateral ligaments were sectioned along with the anterior cruciate ligament. When 20 Newton-meters (Nm) of torque was applied to the femurs at 30 degrees of flexion without vertical load, the Lenox Hill knee brace limited external rotation of the tibia in all tested categories. For intact knees at 30 degrees of flexion and no vertical load, the Lenox Hill knee brace decreased external rotation from 18 degrees to 10 degrees. In the anterior cruciate ligament-sectioned knees, external rotation was decreased from an average of 20.2 degrees to 16.1 degrees. In the knees with sectioned anterior cruciate and medial collateral ligaments, the average reduction was from 21.2 degrees to 15.4 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical Phenomena↗
PubMed2001

The effects of severe femoral bone loss on the flexion extension joint space in revision total knee arthroplasty: a cadaveric analysis and clinical consequences.

Five revision total knee arthroplasties (TKAs) involving severe femoral bone loss were performed in 1994. Each had sufficiently severe femoral bone loss in which collateral ligament origins and posterior capsular attachments were violated. A paradoxical phenomenon was observed in each case. Unlike primary TKAs, in which larger distal femoral bone resection leads to laxity of the knee joint in extension, these cases with severe distal femoral bone loss, after initial component selection, developed the opposite situation, a flexion contracture. It was hypothesized that femoral bone loss involving collateral ligament origins would permit distraction of the tibia below the femur with the knee held in flexion, but when the knee was brought to full extension, intact posterior structures would maintain a normal tibial position. To investigate this hypothesis, six fresh-frozen cadaveric lower limbs were tested in full extension and 45 degrees and 90 degrees of flexion after release of the femoral attachments of the collateral ligaments and the posterior capsule from the femur. Joint space changes were measured via a motion tracking device. Results showed that with loss of collateral attachments, 17.2+/-8.9 mm of joint space is created in 90 degrees of flexion, whereas the joint space in full extension is conserved (1.5+/-1.7 mm). With additional loss of the posterior capsule, the joint space at 90 degrees of flexion increased to 26.2+/-6.1 mm, with minimal changes in the extension gap (3.4+/-0.8 mm). Distal femoral bone loss was associated with an increase in the flexion gap compared to the extension gap.

Aged↗
PubMedDate not supplied

Infantile dislocation of the elbow complicating obstetric palsy.

This is a report of three cases of complete dislocation of both the radius and ulna at the elbow in infants born with obstetric palsy. All three patients had painless elbow-flexion contractures. The pathologic anatomy included (a) medial and posterior displacement of the radius and ulna on the humerus, (b) laxity of the lateral capsule and collateral ligaments, (c) contracted medial capsule and collateral ligaments, (d) contracted biceps and triceps muscles, and (e) hypoplasia of the capitellum, trochlea, coronoid process, and olecranon fossa. Open reduction was attempted in all three of these patients and was successful in two.

Birth Injuries↗
PubMed1987

Management of severely displaced medial epicondyle fractures.

The role of surgical fixation of the displaced medial epicondyle fracture remains controversial. We reviewed 20 patients with displaced (mean 10 mm) fractures, all associated with elbow dislocation. All elbows were therefore unstable, and all were managed nonoperatively. Although all fractures healed by fibrous union, the functional results were good. Clinical and radiological tests were used to assess the static stability of the ulnar collateral ligament. All patients had demonstrable ulnar collateral ligament laxity, but only one patient had slight impairment of elbow function. None had late-onset ulnar neuritis. We have shown that even the severe forms of this injury can be managed without internal fixation.

Adolescent↗
PubMed1999

Injuries in cross-country skiing. Trail markers for diagnosis and treatment.

Cross-country skiers can suffer acute injuries, such as sprains of the ulnar collateral ligament of the thumb, the medial collateral ligament of the knee, and the ankle. They are also subject to overuse injuries, including arthritic changes in the great toe, and are at risk for cold-related injuries. Most of these injuries can be treated conservatively, and some can be avoided with adequate preparation and training.

Arm Injuries↗
PubMed1975

The anatomy of the metacarpo-phalangeal joints, with observations of the aetiology of ulnar drift.

One hundred normal fingers were dissected and arthrographs obtained by injection of chromopaque-gelatin mixture, allowing comparison between the radiographic and macroscopic configuration of the synovial capsule. Synovial recesses protruding from each side of every metacarpo-phalangeal joint were found in relation to the collateral ligaments and corresponding exactly with the site of radiological erosions. A group of bursae lying on the superficial aspect of collateral ligaments were also demonstrated. A rudimentary intra-articular meniscus was found. The results of examination of the insertions of the interossei showed differences from traditional descriptions. The cause of rheumatoid deformity was suggested to be the rheumatoid process arising in the lateral recesses and lateral bursae, weakening the collateral ligaments, which give way in the directions of the deforming forces. These are derived from the long flexor tendons, which were shown to exert an ulnar and volar strain on the metacarpo-phalangeal joint of every finger during grip.

Arthritis, Rheumatoid↗
PubMedDate not supplied

New-generation implant arthroplasties of the finger joints.

Prosthetic replacement in the hand must address such unique challenges as preservation of the collateral ligaments, tendon balancing, and stability. Some recently developed implant arthroplasties of the metacarpophalangeal and proximal interphalangeal joints have anatomically designed articular components; others have non-cemented, press-fit, carefully contoured intramedullary stems. The rationale behind developing the unlinked or semiconstrained prosthesis with anatomic geometry is that it would create balanced forces across the joint. Low-profile, anatomically designed implants limit the amount of bone removed and preserve the integrity of the collateral ligaments. A metacarpophalangeal joint implant with an elliptical metacarpal head and a nonfixed center of rotation can enhance stability in flexion through greater articular contact. A proximal interphalangeal joint implant that preserves the collateral ligaments also can achieve improved stability. Component loosening is not an early complication with these recent designs, and arc of motion is satisfactory.

Arthroplasty, Replacement↗
PubMed2001

Cartilage-like phenomenon in the anterior cruciate ligamenta.

OBJECTIVE: To detect histological characteristic of anterior cruciate ligament (ACL) and medial collateral ligament (MCL). METHODS: In each of 20 skeletally mature male mongrels and 4 men, the ACL and MCL were examined by standard hematoxylin-eosin procedure and toluidine blue staining for histologic observation. RESULTS: The fibroblasts in medial collateral are elongated to spindle shape and aligned in a row between the bundles of collagenous fibers. Toluidine blue staining is negative. The anterior cruciate ligament demonstrated more heterogenous cell types and arrangement. It had three major cell forms: spindle, round and ovoid type, which were shorter but greater than the cells in medial collateral ligament. Toluidine blue staining was positive in anterior cruciate ligament. Most cells in anterior cruciate ligament were enclosed within lacunae. CONCLUSION: This study suggests that the ACL has different histological characteristics from MCL, and is more cartilage-like in nature.

Animals↗