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At least 1,063 records · Page 59Linked to original sources
PubMed2001

Semitendinosus tenodesis for medial instability of the knee.

A new technique of semitendinosus tenodesis has been developed to treat medial instability of the knee. The semitendinosus tendon was sectioned at the musculotendinous junction. The accessory insertion of the tendon was dissected to be overlapping and parallel to the anterior band of the medial collateral ligament. An isometric point on the femur was located around the medial epicondyle. A bony trough was created just above the isometric point and a screw with washer was placed. The semitendinosus tendon was looped around the screw and the screw was tightened to hold the tendon in place. The free end of the tendon was pulled obliquely backward and passed through the insertion of the direct head of the semimembranosus tendon to reconstruct the posterior oblique ligament. The semitendinosus tendon reinforced both the medial collateral ligament and the posterior oblique ligament.

Bone Wires↗
PubMed2001

Kudo total elbow arthroplasty in patients with rheumatoid arthritis: a long-term follow-up study.

BACKGROUND: Improvements in the design of total elbow prostheses over the last two decades have led to better and more consistent results. The type-3 Kudo total elbow prosthesis was developed in 1980. The long-term results of use of this implant have not been reported. Because it is an unlinked prosthesis, it is not known whether preservation of the anterior oblique component of the ulnar collateral ligament at the time of implantation is important. METHODS: A type-3 Kudo total elbow arthroplasty with cement was performed in forty-seven patients (fifty elbows) with rheumatoid arthritis. Revision rates, clinical symptoms, postoperative complications, and radiographic changes were assessed eleven to sixteen years (mean, thirteen years) postoperatively. RESULTS: The overall survival rate of the prosthesis was 90% at sixteen years. The mean Mayo elbow performance scores were all poor (mean overall score, 43 points) initially. The overall score was substantially improved at both the intermediate follow-up examination (four to six years after the operation) and the late follow-up examination (eleven to sixteen years after the operation), to 81 and 77 points, respectively. The overall rate of radiolucency about the humeral component was 45% at the intermediate follow-up examination and 100% at the long-term follow-up examination. The rate of radiolucency about the ulnar component at the intermediate and late follow-up examinations was 4.3% and 8.9%, respectively. No great differences in results were found with preservation of the anterior oblique component of the ulnar collateral ligament. CONCLUSIONS: This long-term follow-up study showed acceptable results of the type-3 Kudo total elbow arthroplasty in patients with rheumatoid arthritis. Preservation of the ulnar collateral ligament does not seem to be necessary when performing this procedure.

Arthritis, Rheumatoid↗
PubMed2004

Ultrasonographic stress test of the metacarpophalangeal joint of the thumb.

The purpose of this study was to evaluate functional ultrasound as a tool for detecting an ulnar collateral ligament injury of the thumb. The feasability of using ultrasound for imaging the thumb joint space was tested in a pilot study, using ultrasound and dissection in 14 cadaveric hand specimens. To test this method clinically, both metacarpophalangeal joints of the thumb in 461 healthy volunteers were examined using ultrasound (11 MHz) under radial stress. The distance between the innominate tubercle of the first metacarpal head to the proximal phalanx was measured. The mean distance between the first metacarpal head and the proximal phalanx (n = 461) was 4.5 mm (standard deviation, 0.65 mm) on the right side and 4.6 mm (standard deviation, 0.61 mm) on the left side. These data were compared with data of 25 patients with an operative diagnosis of rupture of the ulnar collateral ligament of the thumb. The difference in joint space between the injured and uninjured sides was 2.25 mm (standard deviation, 0.46 mm). The metacarpophalangeal joint space can be reproducibly detected on high-frequency ultrasound. An increased gap seen on ultrasound is indicative of a rupture of the ulnar collateral ligament of the thumb.

Adolescent↗
PubMed1997

A musculoskeletal model of the knee for evaluating ligament forces during isometric contractions.

A model of the knee in the sagittal plane was developed to study the forces in the ligaments induced by isometric contractions of the extensor and flexor muscles. The geometry of the distal femur was obtained from cadaver data. The tibial plateau and patellar facet were modeled as flat surfaces. Eleven elastic elements were used to describe the mechanical behavior of the anterior and posterior cruciate ligaments (ACL and PCL), the medial and lateral collateral ligaments (MCL and LCL), and the posterior capsule. The model knee was actuated by 11 musculotendinous units, each muscle represented by a Hill-type contractile element, a series-elastic element, and a parallel-elastic element. Tendon was assumed to be elastic. The response of the model to anterior-posterior drawer suggests that the geometrical and mechanical properties of the model ligaments approximate the behavior of real ligaments in the intact knee. Calculations for a simulated quadriceps leg raise indicate further that the two-dimensional model reproduces the response of the three-dimensional knee under similar conditions of loading and constraint. During maximum isometric contractions of the quadriceps, the model ACL is loaded from full extension to 80 degrees C of flexion; the model PCL is loaded at 70 degrees of flexion and greater. For maximum isometric extension, ACL forces in the range 0-20 degrees of flexion depend most heavily upon the force-length properties of the quadriceps. At flexion angles greater than 20 degrees, cruciate ligament forces are determined by the geometry of the articulating surfaces of the bones. During isolated contractions of the hamstrings and gastrocnemius muscles, the model ACL is loaded from full extension to 10 degrees of flexion; the model PCL is loaded at all flexion angles greater than 10 degrees. Isolated contractions of the flexor muscles cannot unload the ACL near full extension, as the behavior of the ACL in this region is governed by the shapes of the bones. At 10 degrees of flexion or greater, the overall pattern of PCL force is explained by the force length properties of the hamstrings and by the geometrical arrangement of the flexor muscles about the knee.

Adult↗
PubMed1998

Effect of local application of basic fibroblast growth factor on ligament healing in rabbits.

OBJECTIVE: The effect of basic fibroblast growth factor (bFGF) on healing of a 4-mm defect in the medial collateral ligament of rabbits was studied. METHODS: Fibrin gel containing 0 (vehicle only), 0.1, 1, or 10 micrograms of recombinant human bFGF was applied to the defect during the surgical procedure. Controls did not receive fibrin gel. Four rabbits in each group were sacrificed 1, 2, 3, and 6 weeks after surgery. Repair tissues were subjected to gross and histologic examinations, and expression of type I procollagen messenger RNA was evaluated using in situ hybridization after 2 and 3 weeks. RESULTS: bFGF promoted formation of repair tissue and was associated with early filling of the ligament defect. Tissue maturation was significantly delayed after 3 and 6 weeks in the high-dose bFGF groups. In the low dose group, in contrast, tissue maturation was similar to that in controls at all time points, by both gross and histologic examination. In situ hybridization studies showed that type I procollagen mRNA expression was reduced in all bFGF groups. CONCLUSION: Our data demonstrate that a single local application of bFGF promoted early formation of repair tissue in injured medial collateral ligaments. High doses of bFGF reduced repair tissue maturation, suggesting that in clinical uses the dose may play a significant role.

Animals↗
PubMed2004

Irreducible lateral dislocation of the proximal interphalangeal joint--a case report.

We present a rare case of a lateral dislocation of the proximal interphalangeal joint that required open reduction. During an operation, we found the collateral ligament and the capsule interposing into the joint space. After reducing the soft tissue and reproducing the collateral ligament with a suture anchor, sufficient joint stability and full range of motion was achieved.

Collateral Ligaments↗
PubMed1994

Posteromedial pivot shift of the knee: a new test for rupture of the posterior cruciate ligament. A demonstration in six patients and a study of anatomical specimens.

A new test--the posteromedial pivot-shift test--was used to demonstrate a rupture of the posterior cruciate ligament of the knee in six patients. An anatomical study of seventeen specimens showed that in order for the posteromedial pivot shift to occur, the posterior collateral ligament, the medial collateral ligament, and the posterior oblique ligament must be cut; if one of these three ligaments is intact, the subluxation will not occur.

Adolescent↗
PubMed1984

Instability of cadaver knees after transection of capsule and ligaments.

The importance of the medial collateral ligament and the anterior cruciate ligament of the knee in relation to valgus and varus instability was investigated. Mobility patterns were drawn from ten osteoligamentous knee preparations after successive transections of the structures. Cutting the entire collateral medial ligament caused only slight valgus instability, even when the knee was flexed. Further transection of the anterior cruciate ligament increased the instability considerably, but the knee remained stable in extension. The valgus instability after the transections was maximal at about 60 degrees of flexion.

Biomechanical Phenomena↗
PubMed2002

Posterior dislocation of the elbow with fractures of the radial head and coronoid.

BACKGROUND: Posterior dislocation of the elbow with associated fractures of the radial head and the coronoid process of the ulna has been referred to as the "terrible triad of the elbow" because of the difficulties encountered in its management. However, there are few published reports on this injury. METHODS: Eleven patients with this pattern of injury were evaluated after a minimum of two years. The radial head fracture had been repaired in five patients, and the radial head had been resected in four. None of the coronoid fractures had been repaired, and the lateral collateral ligament had been repaired in only three patients. All eleven patients returned for clinical examination, functional evaluation, and radiographs. RESULTS: Seven elbows redislocated in a splint after manipulative reduction. Five, including all four treated with resection of the radial head, redislocated after operative treatment. At the time of final follow-up, three patients were considered to have a failure of the initial treatment. One of them had recurrent instability, which was treated with a total elbow arthroplasty after multiple unsuccessful operations; one had severe arthrosis and instability resembling neuropathic arthropathy; and one had an elbow flexion contracture and proximal radioulnar synostosis requiring reconstructive surgery. The remaining eight patients, who were evaluated at an average of seven years after injury, had an average of 92 degrees (range, 40 degrees to 130 degrees ) of ulnohumeral motion and 126 degrees (range, 40 degrees to 170 degrees ) of forearm rotation. The average Broberg and Morrey functional score was 76 points (range, 34 to 98 points), with two results rated as excellent, two rated as good, three rated as fair, and one rated as poor. Overall, the result of treatment was rated as unsatisfactory for seven of the eleven patients. All four patients with a satisfactory result had retained the radial head, and two had undergone repair of the lateral collateral ligament. Seven of the ten patients who had retained the native elbow had radiographic signs of advanced ulnohumeral arthrosis. CONCLUSIONS: Elbow fracture-dislocations that involve a fracture of the coronoid process in addition to a fracture of the radial head are very unstable and prone to numerous complications. Identification of the coronoid fracture is therefore important, and computed tomography should be used if there is uncertainty. With operative treatment, the surgeon should attempt to restore stability by providing radiocapitellar contact (preserving the radial head when possible and replacing it with a prosthesis otherwise), repairing the lateral collateral ligament, and perhaps performing internal fixation of the coronoid fracture.

Adolescent↗
PubMedDate not supplied

Ski injury statistics, 1982 to 1993, Jackson Hole Ski Resort.

A retrospective analysis was conducted on injury statistics compiled over 12 seasons, from 1982 to 1993 (2.55 million skier-days), at a Wyoming ski resort. The population at risk was determined by ticket sales per year. A total of 9749 skiing injuries was indexed by anatomic region and severity according to diagnosis on initial evaluation. Injury rates were then analyzed as a function of time. The injury rate remained constant at 3.7 injuries per 1000 skier-days during the 12 seasons. The rate of lower extremity to upper extremity injury decreased from 4:1 to 2:1 during the study period (P < 0.03). The ankle injury rate also decreased with time (P < 0.04). Ulnar collateral ligament sprains make up 7% of all injuries. Knee sprains in general account for 30% of all injuries. The incidence of anterior cruciate ligament tears increased as a function of time (P < 0.04) and accounted for 16% of all skiing injuries during the study period. The medial collateral ligament sprain was the most common injury, making up 18% of skiing injuries. Forty-seven snowboard injuries from the 1992 to 1993 season are also presented. Our injury statistics mirror those currently reported in North America, except our data reflect a higher incidence of knee sprains.

Ankle Injuries↗
PubMed1996

Changes in the distribution of fibrillar collagens in the collateral and cruciate ligaments of the rabbit knee joint during fetal and postnatal development.

The collateral ligaments can be clearly distinguished in the 25-day fetal rabbit knee joint. Type I and V collagens are present in the extracellular matrix between the cells of the lateral and medial collateral ligaments and this distribution persists until the rabbit is skeletally mature. From 8 months onwards type III collagen is also present, particularly around the cells. Type I collagen mRNA is expressed by the cells from the 25-day fetal to 8-month-old adult ligament. The ligament sheath is composed of types III and V collagens. The cruciate ligaments are present between the femur and tibia in the 20-day fetus. The matrix is composed of types I and V collagens from the 25-day fetus until at 12- to 14-weeks postnatal, type III collagen appears in the pericellular regions together with type V. At 8 months and 2 years the amount of type III collagen has increased. All the cells express the mRNA for type I collagen at 12- to 14-weeks, but only isolated cells express this mRNA at 8 months. Thus, both the collateral and cruciate ligaments undergo changes in their complement of collagens during postnatal development and ageing. The implications of these complex interactions of different types of collagen are discussed in relation to healing and the surgical replacement of torn ligaments by tendons.

Animals↗
PubMed1994

[Palmar dislocation of the metacarpophalangeal joint of the thumb. Apropos of a case initially treated by bilateral ligament suture with tendon reinforcement surgery].

We report a case of complete palmar dislocation of the metacarpophalangeal joint of the thumb with simultaneous rupture of the radial and ulnar collateral ligaments. This highly unstable condition needs a reliable augmentation ligamentoplasty which was achieved with a free palmaris longus tendon graft. This type of transosseous plasty reinforces the collateral ligaments at their anatomical sites. The 7 month end-results is promising: the metacarpophalangeal joint remains perfectly stable and painless in spite of a slight residual stiffness which causes no discomfort to the patient.

Adult↗
PubMed1984

[An experimental study on the stability of the knee joint. Special reference to the mechanisms of rotatory stability of the knee joint].

In order to evaluate the stabilizing mechanisms of the ligaments, menisci and the conformity of the condylar surface, six human knee joints and five dog's knee joints were tested by the rotatory stability testing machine devised by myself. The torque-rotation curve and the amount of the up hill movement were measured under various compressive loads. Internal and external rotation were applied to the knee joint with range of 0.2 radian respectively. During rotatory movement, various compressive loads (0 kgf, 20 kgf, 40 kgf, 60 kgf, 80 kgf) were applied on the tibio-femoral joint. The following results were obtained in this study. Within a range of 0.2 radian in internal and external rotation respectively, rotatory stability was almost unaffected by sectioning of the cruciate ligaments. Rotatory stability was affected significantly by sectioning the medial collateral ligament. Almost the same results were obtained by removal of the medial meniscus. The intrinsic factors, especially the medial collateral ligament and the medial meniscus, provided the stability of external rotation for the knee joint. The amount of the up hill movements were measured 0.5 mm in internal rotation, and 0.1-0.2 mm in external rotation respectively. Only after removal of the medial meniscus, the amount of the up hill movement were decreased obviously. This decreases of the up hill movement were observed in external rotation. So, it was concluded that medial meniscus has the stabilizing mechanism of external rotation by the up hill movement. The conformity of the condylar surface was an important factor in the stability of the knee joint under compressive load. Especially, it restricts internal rotation.

Adult↗
PubMed2003

Magnetic resonance imaging in diagnosis of chronic posterolateral rotatory instability of the elbow.

Posterolateral rotatory instability of the elbow can be difficult to diagnose and requires a high degree of clinical suspicion. Cases of chronic posterolateral rotatory instability (symptoms present more than 1 year) may be an even more perplexing subgroup. This is a case report of a patient with a 30-year history of intermittent elbow instability. Clinical examination was equivocal, and magnetic resonance imaging was unable to define any ligamentous injury around the elbow. Examination under anesthesia and surgical findings were consistent with complete disruption of the lateral ulnar collateral ligament. The 12-month follow-up after surgical reconstruction showed complete resolution of symptoms. Posterolateral rotatory instability is a diagnosis largely made by examination under anesthesia. A thorough history and a high clinical suspicion are necessary to support the physician's decision to place the patient under anesthesia. Confirmation of a chronic tear of the lateral ulnar collateral ligament of the elbow with magnetic resonance imaging can be difficult and sometimes misleading.

Adult↗
PubMed2006

Treatment of ligament laxity by electrothermal shrinkage or surgical plication: a morphologic and mechanical comparison.

Capsular plication or thermal shrinkage can be used to enhance surgical joint stabilization. We compared mechanical or morphologic properties of the medial collateral ligament of the rabbit knee treated by either bipolar radiofrequency electrothermal shrinkage or surgical plication. After 12 weeks, the medial collateral ligaments were procured from treated and contralateral knees to undergo viscoelastic (creep) testing, quantitative transmission electron microscopy, and immunohistochemistry. Creep strain in thermal (1.85% +/- 0.32%) and plicated (1.92% +/- 0.36%) ligaments was almost twice that of the control group (1.04% +/- 0.15%), although there was no difference between treatment modalities. The morphologic parameters of all 3 groups were significantly different (P < .001). The thermal ligaments demonstrated predominantly small fibrils, whereas the plicated group displayed an intermediate distribution of heterogeneous fibrils, suggesting a different pattern of remodeling. Viscoelastic properties are similar after thermal shrinkage or plication, though inferior to those of intact ligaments.

Animals↗
PubMed2003

Intentional marginal excision of osteosarcoma of the proximal fibula to preserve limb function.

Three cases of osteosarcoma (stage IIB) of the proximal fibula were successfully treated by marginal excision that preserved the common peroneal nerve and lateral stabilizers of the knee joint. Caffeine-assisted chemotherapy was administered to three boys, ages 15, 17, and 11 years, and resulted in a complete response. Two patients initially presented with peroneal nerve palsy that resolved completely with preoperative chemotherapy. The subsequent intentional marginal procedures resulted in preservation of the common peroneal nerves, lateral collateral ligaments, and biceps femoris tendons. In two cases the collateral ligament and biceps tendon were reattached to the tibia with a spike washer or suture anchors, and in the third case they were reattached by suture only to the ligamentous and capsular structure of the tibia. All three patients have normal ankle and knee joint function without evidence of recurrence 122, 120, and 61 months after surgery, respectively. Preservation of limb function without compromising the principles of tumor surgery is a desirable goal in any patient but particularly in young patients. For patients with osteosarcoma of the proximal fibula, this approach provides a better quality of life than conventional wide excision.

Adolescent↗
PubMed1984

The extensor retinaculum of the wrist.

The dorsal retinaculum of the wrist consists of two layers: the supratendinous and the infratendinous. The infratendinous layer is limited to an area deep to the ulnar three compartments. There are six compartments for the tendons dorsal to the wrist separated by six longitudinal vertical septa. Each septum originates from the supratendinous retinaculum and inserts onto the radius. The sixth compartment for the extensor carpi ulnaris is complex. The tendon of the extensor carpi ulnaris is enclosed in an independent fibrous tunnel formed by the supratendinous retinaculum superiorly, the infratendinous retinaculum inferiorly, the sixth septum laterally, and the ulnar insertion of the retinaculum reinforced by longitudinal fibers called the "linea jugata" medially. Our findings support the concept of an adaptable dynamic collateral ligament system rather than the traditional radial and ulnar collateral ligaments.

Fascia↗