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PubMed1985

Biomechanical characteristics of human ankle ligaments.

The purpose of this study was to define the biomechanical characteristics of the isolated, individual bone-ligament-bone complexes of the human ankle. Twenty human ankles were dissected of all soft tissues to leave only the tibia, fibula, talus, and calcaneus with their intact anterior talofibular, calcaneofibular, posterior talofibular, and deep deltoid ligaments. Specimens were mounted and tested in a Minneapolis Testing System. Protocol consisted of cyclic loading of each isolated bone-ligament-bone preparation, followed by several constant velocity load-deflection tests at varying deflection rates, followed by a final, extremely rapid load to failure test. All ligaments exhibited nonlinearity and strain rate dependence in their load-deflection data. These properties were correlated with ligament function and trauma. The anterior talofibular ligament, the most commonly injured ankle ligament, had the lowest mean maximum load of the specimens tested, whereas the deep deltoid ligament, the least frequently completely disrupted ankle ligament, had the highest load to failure.

Adult↗
PubMed1995

Influence of ligament transection on tibial and calcaneal rotation with loading and dorsi-plantarflexion.

The purpose of this study was to quantify the effect of sequential ligament transection (anterior talofibular, calcaneofibular, posterior talofibular, deltoid, and subtalar interosseous ligaments) on the rotational movement of the tibia and the calcaneus as associated with axial loading and dorsi-plantarflexing the foot. Eight cadaver foot-leg specimens were investigated using a unconstrained testing apparatus. As the ankle complex was axially loaded, almost the same internal rotation of the tibia and the same calcaneus eversion was found with and without the various degrees of lateral and medial ligament release; additional sectioning of the subtalar interosseous ligament tremendously increased the resulting tibial and calcaneal rotation. While tibial and calcaneal rotation from foot dorsi-plantarflexing did not alter significantly with transection of the lateral ligaments, almost no tibial and calcaneal rotation occurred after additional sectioning of the deltoid and subtalar interosseous ligament. These results indicate that, after release of the lateral ligaments, the foot becomes partially mechanically disconnected from the tibia by additional transection of the medial ligaments and even further disconnected after transection of the subtalar interosseous ligament.

Aged↗
PubMed1991

Muscle-ligament interactions at the knee during walking.

A two-dimensional mathematical model of the knee is used with gait analysis to calculate muscle, cruciate ligament and tibio-femoral contact forces developed at the knee during normal level walking. Ten normal adult subjects--four females and six males--participated. The knee model is based upon a four-bar linkage comprising the femur, tibia and two cruciate ligaments. It takes account of the rolling and sliding of the femur on the tibia during flexion/extension and the changes in direction of the ligaments and muscle tendons. We considered forces transmitted by six elements: quadriceps, hamstrings, gastrocnemius, anterior and posterior cruciate ligaments, and tibio-femoral contact. The equations of mechanics can be used to determine the absolute values of only three of the knee forces simultaneously, so that twenty limiting solutions of three of the six forces were considered. A limiting solution was rejected if any of the three forces were negative, corresponding to compressive muscle or ligament forces, or tensile contact forces. These constraints always reduced and at times removed the redundancy of the knee structures. The high incidence of predicted single muscle activity, supported by electromyography, suggested that the ligaments play a significant role in load transmission during gait. The temporal patterns of muscle and ligament activity and ligament force magnitudes were sensitive to the choice of model parameters. The analysis showed that each of four possible minimum principles of muscle selection--minimal muscle force, muscle stress, ligament force and contact force--was unlikely to be valid throughout the walking cycle.

Adult↗
PubMed1996

Fibre recruitment and shape changes of knee ligaments during motion: as revealed by a computer graphics-based model.

A computer graphics-based model of the knee ligaments in the sagittal plane was developed for the simulation and visualization of the shape changes and fibre recruitment process of the ligaments during motion under unloaded and loaded conditions. The cruciate and collateral ligaments were modelled as ordered arrays of fibres which link attachment areas on the tibia and femur. Fibres slacken and tighten as the ligament attachment areas on the bones rotate and translate relative to each other. A four-bar linkage, composed of the femur, tibia and selected isometric fibres of the two cruciates, was used to determine the motion of the femur relative to the tibia during passive (unloaded) movement. Fibres were assumed to slacken in a Euler buckling mode when the distances between their attachments are less than chosen reference lengths. The ligament shape changes and buckling patterns are demonstrated with computer graphics. When the tibia is translated anteriorly or posteriorly relative to the femur by muscle forces and external loads, some ligament fibres tighten and are recruited progressively to transmit increasing shear forces. The shape changes and fibre recruitment patterns predicted by the model compare well qualitatively with experimental results reported in the literature. The computer graphics approach provides insight into the micro behaviour of the knee ligaments. It may help to explain ligament injury mechanisms and provide useful information to guide the design of ligament replacements.

Computer Graphics↗
PubMed2001

Primary repair of intraoperative disruption of the medical collateral ligament during total knee arthroplasty.

BACKGROUND: Intraoperative disruption of the medial collateral ligament during total knee arthroplasty is an uncommon complication that is frequently treated by implanting a prosthesis with varus-valgus constraint. To our knowledge, no data have been published on primary repair or reattachment of the medial collateral ligament and implantation of a minimally constrained posterior-stabilized or cruciate-retaining prosthesis. This retrospective study evaluates the hypothesis that satisfactory clinical results, at a minimum of two years, can be achieved with immediate repair or reattachment of the medial collateral ligament and without a constrained total knee prosthesis. METHODS: Of 600 knees treated with primary total knee arthroplasty, sixteen (in fourteen patients) sustained either a midsubstance disruption of the medial collateral ligament or an avulsion of the ligament from bone during the procedure. Preoperatively, all patients had either neutral or varus alignment and an intact medial collateral ligament. Midsubstance tears were treated with direct primary repair, and avulsions of the ligament off the tibia or femur were treated with suture-anchor reattachment to bone. All patients wore a hinged knee brace, with no limit to the range of motion, for six weeks postoperatively. Clinical and radiographic data were gathered prospectively as part of a database that was ongoing throughout the period of study; the cohort of patients was assembled retrospectively by searching that database. RESULTS: No patients were lost to follow-up. The mean duration of follow-up was forty-five months (range, twenty-four to ninety-five months). The Hospital for Special Surgery knee scores increased from a mean of 47 points (poor) preoperatively to a mean of 93 points (excellent) at the time of final follow-up. On physical examination, no patient had a Hospital for Special Surgery score in the fair or poor range and all patients had regained normal stability in the coronal plane both at full extension and at 30 degrees of flexion. No patient required knee-bracing beyond the initial six-week postoperative period. The range of motion at the time of final follow-up averaged 108 degrees (range, 85 degrees to 125 degrees ), although one knee required manipulation under anesthesia to obtain a satisfactory range of motion. No arthroplasties required revision. Radiographic examination demonstrated appropriate limb alignment in all patients at the time of final follow-up. CONCLUSIONS: Intraoperative disruption of the medial collateral ligament can be treated with primary repair or reattachment of the ligament to bone and postoperative bracing with good results; this avoids the potential disadvantages associated with the use of varus-valgus constrained implants.

Aged↗
PubMed2001

Insulin secretory response is positively associated with the extent of ossification of the posterior longitudinal ligament of the spine.

BACKGROUND: Glucose intolerance is frequently found in patients with ossification of the posterior longitudinal ligament of the spine. This study was undertaken to examine the relationship between glucose intolerance and the extent of ossification in patients with ossification of the posterior longitudinal ligament. METHODS: A total of 100 patients with ossification of the posterior longitudinal ligament (the overall study group), including fifty-two inpatients who were scheduled to have an operation (the inpatient group) and forty-eight outpatients who had undergone an operation, were analyzed. Indices of glucose metabolism-fasting plasma glucose and serum insulin levels, hemoglobin A1c level, and insulinogenic index (a ratio of the increment of the serum level of insulin to that of glucose)-as well as age and body-mass index were correlated with the extent of ossification, as determined by the number of vertebral levels affected with ossification of the posterior longitudinal ligament (extent of ossification), in the inpatient group. In addition, a similar analysis was performed in twenty-eight inpatients (the selected inpatient group) whose ages and body-mass indices were within one standard deviation of the mean values of those of the inpatient group. Association of a polymorphism in the gene of insulin receptor substrate-1, an essential substrate in insulin signaling, with the extent of ossification was evaluated with genomic DNA extracted from the overall study group. RESULTS: Multiple-regression analysis revealed direct correlations of age (p = 0.038), body-mass index (p = 0.006), and insulinogenic index (p = 0.0003) with the extent of ossification of the posterior longitudinal ligament in the inpatient group. The fasting plasma glucose level, the hemoglobin A1c level, and the stage of glucose tolerance were not associated with the extent of ossification. In the analysis of the selected inpatient group, only the insulinogenic index was correlated with the extent of ossification (p = 0.002). However, no significant association was seen between the insulin receptor substrate-1 polymorphism and the extent of ossification. CONCLUSIONS: The insulin secretory response was associated with the extent of ossification of the posterior longitudinal ligament. Since insulin receptor substrate-1 is expressed both in the spinal ligament and in the tissues regulating glucose metabolism, we speculate that some other molecules related to insulin signaling that are impaired only in the tissues regulating glucose metabolism may be responsible for the progression of ossification. We also speculate that the upregulation of insulin production due to the impairment of insulin action may stimulate osteoprogenitor cells in the ligament to induce ossification. CLINICAL RELEVANCE: The insulinogenic index may be useful as a serum marker for the prediction of progression of ossification of the posterior longitudinal ligament. This study may serve as a stimulus for evaluation of the use of various drugs that may improve the response to insulin in the tissues regulating glucose metabolism to prevent the progression of ossification.

Adult↗
PubMed1999

Treatment of acute lateral ankle ligament rupture in the athlete. Conservative versus surgical treatment.

Acute lateral ankle ligament sprains are common in young athletes (15 to 35 years of age). Diagnostic and treatment protocols vary. Therapies range from cast immobilisation or acute surgical repair to functional rehabilitation. The lateral ligament complex includes 3 capsular ligaments: the anterior tibiofibular (ATFL), calcaneofibular (CFL) and posterior talofibular (PTFL) ligaments. Injuries typically occur during plantar flexion and inversion; the ATFL is most commonly torn. The CFL and the PTFL can also be injured and, after severe inversion, subtalar joint ligaments are also affected. Commonly, an athlete with a lateral ankle ligament sprain reports having 'rolled over' the outside of their ankle. The entire ankle and foot must be examined to ensure there are no other injuries. Clinical stability tests for ligamentous disruption include the anterior drawer test of ATFL function and inversion tilt test of both ATFL and CFL function. Radiographs may rule out treatable fractures in severe injuries or when pain or tenderness are not associated with lateral ligaments. Stress radiographs do not affect treatment. Ankle sprains are classified from grades I to III (mild, moderate or severe). Grade I and II injuries recover quickly with nonoperative management. A non-operative 'functional treatment' programme includes immediate use of RICE (rest, ice, compression, elevation), a short period of immobilisation and protection with a tape or bandage, and early range of motion, weight-bearing and neuromuscular training exercises. Proprioceptive training on a tilt board after 3 to 4 weeks helps improve balance and neuromuscular control of the ankle. Treatment for grade III injuries is more controversial. A comprehensive literature evaluation and meta-analysis showed that early functional treatment provided the fastest recovery of ankle mobility and earliest return to work and physical activity without affecting late mechanical stability. Functional treatment was complication-free, whereas surgery had serious, though infrequent, complications. Functional treatment produced no more sequelae than casting with or without surgical repair. Secondary surgical repair, even years after an injury, has results comparable to those of primary repair, so even competitive athletes can receive initial conservative treatment. Sequelae of lateral ligament injuries are common. After conservative or surgical treatment, 10 to 30% of patients have chronic symptoms, including persistent synovitis or tendinitis, ankle stiffness, swelling, pain, muscle weakness and 'giving-way'. Well-designed physical therapy programmes usually reduce instability. For individuals with chronic instability refractory to conservative measures, surgery may be needed. Subtalar instability should be carefully evaluated when considering surgery.

Acute Disease↗
PubMed2006

Anatomic variations and MRI of the intermalleolar ligament.

OBJECTIVE: The purpose of this study was to identify the intermalleolar ligament morphologically and to correlate its shape with MR images. MATERIALS AND METHODS: Seventy-seven ankles were used in this study. After the intermalleolar ligament had been located in the posterior ankle space, its medial and lateral attaching sites were identified, and its length, width, and thickness were measured. MRI was performed on 26 ankles before they were dissected (20 specimens) or serially sectioned (six specimens). The serial sections were taken at a thickness of 2 mm in the sagittal and horizontal directions. RESULTS: The intermalleolar ligament was observed in 81.8% of the specimens and was composed of more than two bundles of fibers in all cases. The medial arising sites of the ligament were diverse (e.g., from the medial malleolus to the floor of the fibrous tunnel of the flexor hallucis longus). The ligament narrowed laterally and attached with the posterior talofibular ligament to the medial fossa of the lateral malleolus. Their morphologic shapes were also diverse, depending on their medial arising sites, the number of the composing fiber bundles, and the degree of bundle compactness. The intermalleolar ligament appeared as a thick string or as more than two fine parallel stripes on coronal MR images and as a linear structure on axial images. On sagittal images, the ligament appeared as scattered dots in the medial part and as a thin flat or nodular structure in the lateral part. CONCLUSION: The intermalleolar ligament seemed to be an almost invariably present anatomic entity with diverse morphologic features on MR images.

Adult↗
PubMed1993

Intrinsic and extrinsic carpal ligaments: evaluation by three-dimensional Fourier transform MR imaging.

OBJECTIVE: As evaluation of the anatomic and functional integrity of intrinsic and extrinsic carpal ligaments with conventional imaging methods is difficult, we designed a study to evaluate the ability of three-dimensional Fourier transform MR imaging to show the carpal ligaments. SUBJECTS AND METHODS: We obtained coronal MR images of 15 cadaveric wrists and 15 wrists of patients, using three-dimensional volume acquisition with a gradient-recalled echo sequence and a 1.5-T magnet. The MR findings were compared with the findings on dissection in the 15 cadaveric wrists and with the surgical findings in eight patients. RESULTS: All the volar ligaments had a striated appearance on MR images, with alternating bands of low and intermediate signal intensity. No tears of the extrinsic ligaments were seen. The intrinsic scapholunate and lunotriquetral ligaments were seen as structures with more homogeneously intermediate intensity attaching to their adjacent bone through high-signal-intensity hyaline cartilage. For the cadaveric wrists, MR indications of a tear of the scapholunate ligament were true-positive in three and false-negative in three; indications of a tear of the lunotriquetral ligament were true-positive in five, false-positive in two, and false-negative in one. For the eight patients with surgical confirmation, the MR findings regarding tears were true-positive in two and true-negative in six. Neither surgery nor MR imaging showed any tears of the scapholunate ligament. CONCLUSION: Three-dimensional Fourier transform MR imaging with thin slices provides the resolution necessary to visualize the anatomic detail of the extrinsic and intrinsic ligaments of the wrist, but additional clinical experience with this technique will be required to determine its diagnostic capabilities.

Carpal Bones↗
PubMed2002

Sonography of the scapholunate ligament in four cadaveric wrists: correlation with MR arthrography and anatomy.

OBJECTIVE: The objective of our study was to sonographically characterize the dorsal aspect of the scapholunate ligament in cadaveric wrists using arthrography, MR arthrography, and anatomic correlation as the gold standard. MATERIALS AND METHODS: The dorsal aspect of the scapholunate ligament in four cadaveric wrists was evaluated on sonography without knowledge of the findings from standard arthrography, MR arthrography, and anatomic sectioning. The sonographic findings were compared with the findings from other modalities. The criteria for an abnormal scapholunate ligament included an abnormal contrast communication between the radiocarpal and midcarpal joints on arthrography and a discontinuity of the dorsal aspect of the scapholunate ligament that was documented both on MR arthrography and at anatomic sectioning. RESULTS: Arthrography, MR arthrography, and anatomic sectioning showed the dorsal aspect of the scapholunate ligament to be normal in one specimen and abnormal in three specimens. On sonography, the normal scapholunate ligament was hyperechoic between the scaphoid and lunate bones. In the three cases of abnormality, a normal scapholunate ligament was not visualized, and an abnormal hypoechogenicity was present. CONCLUSION: The dorsal aspect of the scapholunate ligament can be depicted on sonography; abnormality is present in patients in whom the normally hyperechoic fibrillar ligament is hypoechoic or absent.

Aged↗
PubMed1987

Extracellular matrix-induced synthesis of a low molecular weight collagen by fetal calf ligament fibroblasts.

Fetal calf ligamentum nuchae fibroblasts, cultured from animals of different gestational age, synthesize a unique, low molecular weight collagen termed FCL-1 (Sage, H., Mecham, R., Johnson, C., and Bornstein, P., 1983, J. Cell Biol. 97:1933-1938). Previous studies on the elastogenic differentiation of these cells in vitro demonstrated that the extracellular matrix (ECM) protein elastin was specifically induced in undifferentiated fibroblasts when they were grown on ligament ECM isolated from animals at later stages of development (Mecham, R.P., Madaras, J.G., and Senior, R.M., 1984. J. Cell Biol. 98:1804-1812). To investigate the expression of FCL-1 as a function of developmental age, we grew fetal calf ligament fibroblasts from an 85 d (first trimester) animal (FCL 85d) on three different substrata: ligament from a 120 d (second trimester) animal, ligament from a 270 d (term) animal, and unmodified plastic tissue culture dishes. FCL 270d fibroblasts were grown on plastic substrata and served as a differentiated cellular control. Analysis of metabolically radiolabeled proteins from both the culture media and the cell layers showed that the synthesis of FCL-1 was selectively increased in those cells cultured on ligament ECM. For FCL 85d fibroblasts grown on 120 d and 270 d ligaments, FCL-1 comprised 17% and 22%, respectively, of the culture medium proteins that precipitated at concentrations of ammonium sulfate from 20-50%. FCL 85d and 270d fibroblasts grown on plastic substrata yielded values of 2.5% and 1.0%, respectively. This effect appeared to be specific for this collagen and did not reflect a general increase in the synthesis of connective tissue proteins of the ECM (e.g., types I and III procollagen). As percent of total newly-synthesized cellular protein, the output of FCL-1 was 10-fold higher by FCL 85d cells grown on 270d ligament ECM (5.8%) as compared to that of the same cellular population grown on a plastic surface (0.56%). The presence of the ligament ECM also altered the levels and distribution of secreted proteins between the culture medium and the cell layer. These studies provide evidence for differential expression of the novel collagen FCL-1 by FCL fibroblasts during development and suggest that such expression is affected, at least in part, by interaction of the cell with a ligament ECM.

Animals↗
PubMed1983

Experimental ankle injuries. Analysis of the traumatology of the ankle ligaments.

On 32 osteoligamentous ankle preparations forced movements were performed in varying, accurately defined directions. The sequence in which this caused rupture of the individual ligamentous structures of the ankle is described. Dorsiflexion traumas predominantly injured the posterior part of the deltoid ligament, while in plantar flexion traumas the injuries primarily involved the anterior capsule and the anterior talofibular ligament. Internal rotation traumas injured the anterior talofibular ligament and the short, anterior fibres of the posterior talofibular ligament before the calcaneofibular ligament was damaged, whereas in adduction traumas the calcaneofibular ligament ruptured first. Forced external rotation primarily caused rupture of the deep structures of the deltoid ligament, while conversely abduction traumas first caused rupture of the superficial part of this ligament.

Ankle Injuries↗
PubMed2001

The denticulate ligament: anatomy and functional significance.

OBJECT: The authors conducted a study to examine the detailed anatomy of the denticulate ligaments and to assess their classic role in spinal cord stability within the spinal canal. METHODS: Detailed observation of the denticulate ligaments in 12 adult cadavers was performed. Stress was applied in all major planes to discern when the ligaments would become taut, and at the same time, gross motion of the cord was observed at sites distal to the stresses applied. Tension necessary for avulsion of the ligaments in various areas of the spinal cord was also measured. CONCLUSIONS: These results show that the denticulate ligaments do not inhibit cord motion to such discrete areas of the cord as was once thought. The authors have determined that the ligaments are stronger in the cervical region and that they decrease in strength as the spinal cord descends. These findings are demonstrative of the denticulate ligaments being more resistant to caudal compared with cephalad stresses in the cord. Anterior and posterior motion is constrained by these ligaments but to a limited degree, especially as one descends inferiorly along the cord. Further embryological and functional studies of these ligaments is needed in non-formalin fixed tissues.

Aged↗
PubMed1995

Ligamentous contributions to pelvic stability.

The purpose of this study was to examine the ligamentous contributions to pelvic stability. Thirteen fresh frozen cadaver pelves were loaded in an MTS materials testing machine, and the supporting ligaments were sequentially cut. After each ligament was cut, measurements of pelvic stability were made. Pelvic stability was maintained most effectively when the pelvic ring remained intact. The sacrotuberous and sacrospinous ligaments contributed little to overall pelvic stability. The posterior sacroiliac ligament and the pubic symphyseal ligaments contributed most to pelvic stability, but overall it was clear that a ligament's contributions to pelvic stability depended not only on the ligament's size, but also on the other ligament remaining intact and the mode in which the pelvis was loaded.

Biomechanical Phenomena↗
PubMed1999

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

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

Aged↗
PubMed2002

Injuries to the posterior cruciate ligament and posterolateral instabilities of the knee.

Unlike anterior cruciate ligament (ACL) injury, disability from isolated posterior cruciate ligament (PCL) injury varies from no interference with life style to severe impairment of daily activities. Therefore, management of isolated PCL injuries remains controversial. High-energy vehicular accidents often cause more-serious PCL injuries, while less-severe injuries result from low-energy trauma including sports. The natural history and prognosis of PCL injury are correlated with the type and extent of instability and the development of degenerative changes in the knee. Indications for surgery include pain and instability of the knee. Arthroscopic single-bundle PCL reconstruction improved the function and stability of the knee with 77.4% satisfactory results in medium-term follow-up. Complete restoration of ligament stability was achieved in only 52% of knees, while 1/3 of the knees showed mild and 9.7% showed moderate residual ligament laxity. The incidence of degenerative changes was 52%, and the rate was correlated with duration of injury and severity of ligament laxity. Therefore, the significance of PCL injury has been overly simplified, and the functional disability of knees with PCL injury underestimated. Early surgical reconstruction of knees with grade III PCL injury is recommended. PCL injury is frequently associated with multiple ligamentous injuries. Combined PCL and posterolateral instabilities are serious knee injuries and frequently result in severe functional disability due to pain, instability, and degenerative changes in the knee. Unlike isolated PCL injury, there is a consensus of opinion that surgical reconstruction is indicated in knees with combined PCL and posterolateral instabilities. Commonly employed methods of reconstruction of the posterolateral corner include popliteus reconstruction, lateral collateral reconstruction or advancement, and a combination of the two. Combined arthroscopic PCL reconstruction and posterolateral reconstruction achieved 64% satisfactory (24% excellent and 40% good) and 36% unsatisfactory (24% fair and 12% poor) results over an average of 32 months of follow-up. Complete restoration of ligament stability was noted in only 44% of knees. The incidence of degenerative changes was 44%, and the rate was correlated with duration from injury to surgery and severity of ligament laxity. Despite the fact that currently employed surgical techniques only achieve modest success in restoration of ligament stability, early surgical reconstruction in knees with combined PCL and posterolateral instabilities achieved the best clinical results and a high rate of patient satisfaction.

Biomechanical Phenomena↗
PubMed2002

Benign anatomical mistakes: inferior pulmonary ligament.

The term inferior pulmonary ligament needs to be revised. There is no superior component to oppose the inferior. By all means the pulmonary ligament is not a ligament, and the term ligament should be reserved for regularly oriented thick connective tissue bundles between bones. The term triangular ligament describes its shape but not its topography. For most surgeons the broad ligament refers, rather, to the ligament of the uterus. Embryologically pulmonary ligament is a "meson" i.e., a remnant of the developmental pathway--the pleural fold in this case--and taking this into consideration the most convenient term seems to be mesopneumonium. Its upper part is related to the hilar area, and its lower free border is what we call pulmonary ligament. We suggest the term mesopneumonium to describe the whole "meson" from the mediastinum to the hilum, which corresponds better to topography, embryology, and function.

Epithelium↗
PubMed2004

[An evaluation of knee ligament injuries encountered in skiers at the Uludag Ski Center].

OBJECTIVES: We evaluated the frequency, anatomic types, and predisposing factors of knee ligament injuries that occur in skiers during a winter season at the Uludag Ski Center, Bursa, Turkey. METHODS: A total of 215 patients (240 knees) presented to the Uludag University-Sabanci Health Center after sustaining a skier knee injury during the 2003-2004 winter season. The mean patient age was 31 years (range 9 to 55 years). Knee ligament injuries were assessed according to the AOSSM (American Orthopaedic Society for Sports Medicine) criteria. Cumulative data were collected from patient records and from a questionnaire administered to 100 healthy skiers. RESULTS: The mean knee injury rate was 1.14 injuries per 1000 skier-days. The mean length of time between the occurrence of knee injuries was 875 skier-days. The most frequently injured ligament was the interior cruciate ligament (35.4%) followed by the anterior cruciate ligament (27.1%). Knee ligament injuries were significantly more common in skiers than in snowboarders (odds ratio 6.83, p<0.001). Hard and steep pists were associated with a two-fold risk for knee ligament injuries (odds ratio 2.28, p<0.001). For the occurrence of knee injuries, no significant differences were found with respect to sex and age. CONCLUSION: The interior and the anterior cruciate ligaments are the most commonly injured ligaments in skiers. Two risk factors concerning the equipment (ski) and the environment (hard pists) play a significant role in the occurrence of knee injuries.

Adolescent↗