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At least 109 records · Page 6Linked to original sources
PubMed2005

The "moving valgus stress test" for medial collateral ligament tears of the elbow.

BACKGROUND: The diagnosis of a painful partial tear of the medial collateral ligament in overhead-throwing athletes is challenging, even for experienced elbow surgeons and despite the use of sophisticated imaging techniques. HYPOTHESIS: The "moving valgus stress test" is an accurate physical examination technique for diagnosis of medial collateral ligament attenuation in the elbow. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Twenty-one patients underwent surgical intervention for medial elbow pain due to medial collateral ligament insufficiency or other abnormality of chronic valgus overload, and they were assessed preoperatively with an examination called the moving valgus stress test. To perform the moving valgus stress test, the examiner applies and maintains a constant moderate valgus torque to the fully flexed elbow and then quickly extends the elbow. The test is positive if the medial elbow pain is reproduced at the medial collateral ligament and is at maximum between 120 degrees and 70 degrees. RESULTS: The moving valgus stress test was highly sensitive (100%, 17 of 17 patients) and specific (75%, 3 of 4 patients) when compared to assessment of the medial collateral ligament by surgical exploration or arthroscopic valgus stress testing. The mean shear range (ie, the arc within which pain was produced with the moving valgus stress test) was 120 degrees to 70 degrees. The mean angle at which pain was at a maximum was 90 degrees of elbow flexion. CONCLUSIONS: The moving valgus stress test is an accurate physical examination technique that, when performed and interpreted correctly, is highly sensitive for medial elbow pain arising from the medial collateral ligament.

Adolescent↗
PubMed1999

Functional anatomy of the lateral collateral ligament complex of the elbow.

Postero-lateral instability of the elbow joint is a rare clinical condition, commonly related to a disruption of the lateral collateral ligament complex of the elbow. Twenty elbow joint specimens were studied in order to describe the morphologic characteristics of this complex, and to determine the role of its different components in the stability of the elbow. After a morphologic and morphometric investigation, serial divisions of the medial bundle of the lateral collateral ligament were performed, with or without section of the annular ligament and the anterior bundle of the lateral collateral ligament. The anterior and medial bundles of the lateral collateral ligament had close relationships with the annular ligament and a common proximal course. Isolated section of the medial bundle of the lateral collateral ligament induced only minor laxity of the elbow joint. Combined divisions of the medial and the anterior bundles at their humeral insertion, or the medial bundle and the annular ligament at their ulnar insertion resulted in a reproducible subluxation of the ulno-humeral joint. Thus, postero-lateral rotatory stability of the elbow joint is largely maintained by the lateral collateral ligament complex, composed of three elements: the anterior and medial bundles of the lateral collateral ligament, and the annular ligament. In clinical practice, chronic postero-lateral instability is best treated by a ligamentous reconstruction, that must take into account all these anatomic considerations. We report here a new technique of ligamentoplasty using the fascia of the extensor carpi ulnaris muscle.

Aged↗
PubMedDate not supplied

Collateral ligaments of the ankle: high-resolution MR imaging with a local gradient coil and anatomic correlation in cadavers.

Findings at high-resolution magnetic resonance (MR) imaging of the lateral and medial collateral ligaments of the ankle were compared with findings in anatomic sections from cadavers. MR imaging of six cadaveric feet was performed with a newly developed local gradient coil and axial and coronal T1-weighted spin-echo sequences. Axial imaging provided optimum views of the anterior and posterior talofibular ligaments, the deep layers of the medial collateral ligament, and the tibionavicular ligament. Coronal imaging allowed complete visualization of the calcaneofibular, posterior talofibular, tibiocalcaneal, and posterior tibiotalar ligaments. In both imaging planes, differentiation of the deep and superficial layers of the medial collateral ligament was possible. Differentiation between the syndesmotic complex and the lateral collateral ligament was accomplished easily; in particular, differentiation of the posterior tibiofibular ligament from the posterior talofibular ligament was not difficult because of the differing insertions of these ligaments. The inhomogeneous appearance of the medial collateral ligament and the posterior talofibular ligament on MR images correlated with areas of fatty tissue on corresponding microscopic sections. High-resolution MR imaging with a newly developed local gradient coil allows excellent visualization of the lateral and medial collateral ligaments of the ankle.

Adipose Tissue↗
PubMed2005

Structural properties of lateral collateral ligament reconstruction at the fibular head.

BACKGROUND: Anatomical reconstruction of a ruptured lateral collateral ligament using allograft tissue secured within the fibular head with an interference screw has been described. HYPOTHESIS: Interference fixation at the fibular head does not reproduce the strength of the intact ligament. STUDY DESIGN: Controlled laboratory study. METHODS: Ten intact lateral collateral ligaments were tested to failure. The distal fixation of 11 ligaments reconstructed with a graft including a bone plug and 11 ligaments reconstructed with a graft without a bone plug were also tested. RESULTS: The reconstructed ligaments consistently failed at the fibular head. The intact specimens predominately failed through ligament rupture. The mean strength and stiffness values were 460 +/- 163 N and 82 +/- 25 N/mm, respectively, for the intact ligaments, 113 +/- 40 N and 36 +/- 10 N/mm, respectively, for reconstruction with a bone plug, and 135 +/- 81 N and 34 +/- 14 N/mm, respectively, for reconstruction without a bone plug. The strength and stiffness were significantly (P < .05) greater for the intact ligaments than for either reconstruction group. The variation in strength was significantly larger for reconstruction without a bone plug than for reconstruction with a bone plug. CONCLUSION: Tension applied to lateral collateral ligaments reconstructed using fibular interference fixation should be limited immediately after surgery. Soft tissue fixation should be employed with care because of the inconsistency in the failure strength. CLINICAL RELEVANCE: Although fibular interference fixation is increasingly being described in the literature, the properties of reconstructed lateral collateral ligaments have not previously been quantified.

Bone Screws↗
PubMed1995

Treatment of thumb ulnar collateral ligament ruptures with the Mitek bone anchor.

Complete thumb ulnar collateral ligament (UCL) injuries usually require primary repair. The ulnar collateral ligament is often torn from its insertion site and reattachment is difficult. Seven patients underwent repair with the Mitek bone anchor (Mitek Surgical Products, Norwood, MA) for complete ulnar collateral ligament disruptions. A Stener lesion was found in four patients. Follow-up examination was at approximately 1 year. All patients regained a stable metacarpophalangeal joint to valgus stress. X-ray films demonstrated accurate placement of the bone anchor with protraction of the metallic wings within cancellous bone. Range of motion revealed a 7% loss of metacarpophalangeal flexion-extension and a 21% loss of interphalangeal motion. Pinch strength in apposition averaged 98% and in opposition 97% of the uninvolved hand. Grip strength was 96% of the contralateral extremity.

Adult↗
PubMedDate not supplied

Preoperative evaluation of the ulnar collateral ligament by magnetic resonance imaging and computed tomography arthrography. Evaluation in 25 baseball players with surgical confirmation.

A prospective study was completed on 25 baseball players with medial side elbow pain. They were evaluated preoperatively with both computed tomography arthrogram and magnetic resonance imaging examinations of the elbow to assess the ulnar collateral ligament. At surgery, 16 of 25 patients had an abnormal ulnar collateral ligament and 9 patients had a normal ulnar collateral ligament. The computed tomography arthrogram detected abnormalities in 12 of the 14 patients with ulnar collateral ligament tearing (sensitivity, 86%). The magnetic resonance imaging scan indicated abnormalities in 8 of 14 patients (sensitivity, 57%). The specificity of the computed tomography arthrogram was 91% and the magnetic resonance imaging was 100%. A newly described "T-sign" was seen on the computed tomography arthrogram in the patients with an undersurface tear of the ulnar collateral ligament. This represented the dye leaking around the detachment of the ulnar collateral ligament from its bony insertion but remaining contained within the intact superficial layer of the ulnar collateral ligament and capsule. Both the computed tomography arthrogram and the magnetic resonance imaging scan were accurate in diagnosing a complete tear of the ulnar collateral ligament preoperatively in all cases. The main advantage of the computed tomography arthrogram was in evaluating the partial undersurface tear.

Adolescent↗
PubMedDate not supplied

Biomechanical evaluation of a new ulnar collateral ligament reconstruction technique with interference screw fixation.

BACKGROUND: Techniques for ulnar collateral ligament reconstruction have evolved. HYPOTHESIS: Ulnar collateral ligament reconstruction with interference screw fixation restores elbow kinematics and failure strength to that of the native ligament. STUDY DESIGN: Controlled laboratory study. METHODS: Of 10 matched pairs of cadaveric elbows, one underwent kinematic testing under conditions of an intact, released, and reconstructed ligament. Single 5-mm diameter bone tunnels were created at the isometric anatomic insertion sites on the medial epicondyle and sublime tubercle. Graft fixation was achieved with 5 x 15 mm soft tissue interference screws. The reconstructed and contralateral intact elbows were then tested to failure. RESULTS: Average stiffness for intact elbows (42.81 +/- 11.6 N/mm) was significantly greater than for reconstructed elbows (20.28 +/- 12.5 N/mm). Ultimate moment for intact elbows (34.0 +/- 6.9 N.m) was not significantly different from reconstructed elbows (30.6 +/- 19.2 N.m). Release of the ulnar collateral ligament caused a significant increase in valgus instability. Reconstruction restored valgus stability to near that of the intact elbow. CONCLUSIONS: With this reconstruction method, failure strength was comparable with that of the native ligament and physiologic elbow kinematics were reliably restored. CLINICAL RELEVANCE: This technique returns elbow kinematics to near normal, with less soft tissue dissection and risk of ulnar nerve injury and ease of graft insertion, tensioning, and fixation.

Adult↗
PubMed1999

MR imaging findings of lateral ulnar collateral ligament abnormalities in patients with lateral epicondylitis.

OBJECTIVE: The purpose of this paper was to use MR imaging to determine whether a relationship exists between lateral epicondylitis and abnormalities of the lateral ulnar collateral ligament. SUBJECTS AND METHODS: The study group comprised 35 consecutive patients who were referred for MR imaging to rule out lateral epicondylitis. On MR imaging, "lateral epicondylitis" was defined as increased signal intensity of the extensor tendons close to their insertion on the lateral epicondyle. The severity of the lateral epicondylitis was graded as mild, moderate, or severe. The origin of the lateral collateral ligamentous complex was characterized, and the lateral ulnar collateral ligament was graded as normal, thickened, partially torn, or torn. Eleven patients underwent elbow surgery after the initial MR examination. RESULTS: In 15 patients, MR imaging revealed characteristics of mild lateral epicondylitis. In 13 of these patients, the lateral ulnar collateral ligament was normal; one patient showed a thickened ligament; and one patient had a thinned ligament. In 11 patients, MR imaging showed features of moderate lateral epicondylitis. In eight of these patients, the lateral ulnar collateral ligament was thickened, and in the remaining three patients the ligament was normal. All nine patients with severe lateral epicondylitis showed abnormalities of the lateral ulnar collateral ligament on MR imaging. In one of these patients the lateral ulnar collateral ligament was thickened, in three patients we saw a partial tear, and in the remaining five patients we saw a complete tear of the ligament. CONCLUSION: In our study, MR imaging features of lateral epicondylitis were often associated with thickening and tears of the lateral ulnar collateral ligament.

Adult↗
PubMedDate not supplied

The effects of increased tension on healing medical collateral ligaments.

The effects of motion and increased levels of stress on the biomechanical, biochemical, and morphological properties of healing medial collateral ligaments were assessed in a rabbit model. In one group, the medial collateral ligament of the left hindlimb was transected and allowed to heal with cage activity for either 6 or 12 weeks. In another group, the transected ligaments were permitted to heal for 4 weeks and then were placed under increased stress by inserting a stainless steel pin perpendicularly underneath the healing medial collateral ligament. The animals were allowed cage activity for an additional 2 or 8 weeks. The varus-valgus joint laxity and the stress-strain properties of the medical collateral ligament substance were obtained. Further, the quantity of total collagen, amount and ratio of the collagen cross-links, dihydroxylysinonorleucine and hydroxylysinonorleucine, and the histologic appearance of the healing medical collateral ligaments were evaluated for all groups. At 6 weeks, knees with a transected medial collateral ligament were twice as lax as the controls. However, joints with the stainless steel tension pin had varus-valgus values approximately 1.5 times those of the controls. At 12 weeks, joints with increased stress were not statistically different from the controls. The group that had healing with increased stress for 12 weeks produced the highest stress for a given strain compared to any other group. Also, the total collagen levels and the ratio of dihydroxylysinonorleucine/hydroxylysinonorleucine were the closest to normal of any transected group. Finally, qualitative histologic improvements were seen, including a more longitudinal arrangement of collagen fibers and decreased cellularity.

Animals↗
PubMedDate not supplied

Biomechanics of elbow instability: the role of the medial collateral ligament.

The anterior oblique component of the medial collateral ligament of the elbow is the mainstay of joint stability. Fractures of the medial epicondyle must be anatomically reduced, open if necessary. A fibrous union of a minimally displaced fractured medial epicondyle may result in lengthening and functional compromise of the medial collateral ligament. Chronic elbow instability is an unusual lesion. Repair of chronic elbow instability is best performed by restitution of medial collateral ligament function.

Adolescent↗
PubMed1992

Origin of the medial ulnar collateral ligament.

The anatomic features of the origin of the anterior medial collateral ligament of the elbow were studied in 10 cadaver elbows to determine the percentage of the medial epicondyle that can be removed without violating the ligament, and whether or not this ligament attaches to the condyle as well as to the epicondyle. In all specimens the anterior medial collateral ligament originated exclusively from the anteroinferior surface of medial epicondyle and had no attachment to the condyle. Only 20% of the width of the medial epicondyle in the coronal plane can be removed without violating a portion of the origin of the anterior medial collateral ligament, an essential stabilizer of the elbow. Excision of the entire epicondyle for ulnar neuropathy would completely detach this ligament from its origin and might therefore potentiate instability. Since the ligament originates on the anteroinferior surface of the epicondyle, more bone can be removed with less violation of the anterior medial collateral ligament origin if the plane of the osteotomy lies between the sagittal and coronal planes.

Cadaver↗
PubMed1996

Medial collateral ligament injuries in athletes.

Medial collateral ligament (MCL) sprains are tension injuries to the medial ligamentous structures of the knee. They are usually the result of an acute blow to the lateral aspect of the knee. The diagnosis can usually be made on the basis of a characteristic clinical examination. The treatment of these injuries has evolved over several years. Current recommended treatment for isolated MCL sprains is lightweight support and an aggressive early functional rehabilitation programme. In combined injuries, cruciate ligaments are usually surgically reconstructed and the MCL treated non-operatively. Although many braces have been developed to prevent MCL sprains, their effectiveness is uncertain.

Anterior Cruciate Ligament Injuries↗
PubMed2005

Structural properties of the medial collateral ligament complex of the human knee.

The anatomy of the medial collateral ligament (MCL) complex consists of three identifiable passive restraining structures: the longitudinal fibres of the superficial medial collateral ligament (sMCL), the deep medial collateral ligament (dMCL), and the posteromedial capsule (PMC). The purpose of this study was to measure and compare the structural properties of these three individual structures. Eight human cadaveric knees (age 72-89 years, mean = 77 years, S.D. 5.3) were harvested and bone-ligament-bone tensile testing specimens prepared. After preconditioning, the specimens were extended to failure at 1000 mm/min in an Instron tensile testing machine. Ligament bundles failed either mid-substance or at their bony attachments. The ligament bundles had maximum loads of 534 N (sMCL), 194 N (dMCL), 425 N (PMC) and failed at 10.2, 7.1, and 12.0 mm mean extension, respectively. The maximum load and linear stiffness of the sMCL were significantly higher than those of the dMCL but not the PMC. The maximum load of the PMC was significantly higher than that of the dMCL; the linear stiffness of the PMC was higher than that of the dMCL but this did not reach statistical significance. The dMCL failed at a significantly lower extension than the other structures. The sMCL bundles that failed at their bony attachment were remounted using a freezing clamp fixture and again extended to failure, resulting in mid-substance failure at 884 N (74% higher). This study has shown that the PMC of the knee has comparable structural properties to the long superficial MCL and the short, deep MCL. In summary, the structural properties of the different component structures of the medial ligament complex indicate possible functional significance.

Aged↗
PubMed1992

A biomechanical study of the collateral ligaments of the proximal interphalangeal joint.

Collateral ligament injuries of the proximal interphalangeal joint are common. A significant number of these injuries result in complete rupture of the ligament. The forces that damage the ligaments are abduction and adduction stresses. Previous studies have investigated laxity, angulation, and patterns of failure, but detailed biomechanical rupture studies are scant. Sixty-eight proximal interphalangeal joints from fresh human cadaver fingers (average age, 67 years) were stressed at velocities of 1 mm/sec, 4 mm/sec, and 10 mm/sec. Sectioning studies were also done. Four distinct rupture patterns were noted: midsubstance tear, proximal detachment, distal detachment, and distal avulsion fracture. The prevalence of these patterns differed with the rate at which the ligaments were stressed. Lower speeds tended to produce midsubstance tears, while higher speeds yielded distal damage. The study confirmed that the lateral collateral ligament is the primary restraint against medial-lateral stress and that other supporting structures (the extensor hood and the palmar plate) did not contribute significantly to side-to-side stability.

Analysis of Variance↗
PubMedDate not supplied

The effects of platelet-derived growth factor-BB on healing of the rabbit medial collateral ligament. An in vivo study.

We report a biologic approach to improve medial collateral ligament healing using growth factors normally expressed in healing tissue. Our previous in vitro work demonstrated that platelet-derived growth factor-BB and transforming growth factor-beta 1 promoted fibroblast proliferation and matrix synthesis, respectively. There-fore, these growth factors were used in vivo to determine whether they could improve medial collateral ligament healing, whether this effect was dose-dependent, and if combinations of growth factors could improve healing more than individual growth factors. Thirty-seven rabbits had various doses of growth factors applied to the ruptured right medial collateral ligaments using a fibrin sealant delivery vehicle. The five groups consisted of 1) two groups receiving two doses of platelet-derived growth factor-BB, 2) two groups receiving two doses of this growth factor plus transforming growth factor-beta 1, and 3) one group receiving fibrin sealant only. After sacrifice at 6 weeks, biomechanical and histologic evaluations of the healing ligament were performed. Femur-medial collateral ligament-tibia complexes of the knees given the higher dose of platelet-derived growth factor-BB had ultimate load, energy absorbed to failure, and ultimate elongation values that were 1.6, 2.4, and 1.6 times greater than the same complexes of the control group. Adding transforming growth factor-beta 1 did not lead to any further increase in the structural properties of the complex compared with treatment with platelet-derived growth factor-BB. These encouraging results suggest that use of platelet-derived growth factor-BB may improve the quality of the healing medial collateral ligament, and that it may also have a similar potential for promoting healing of other ligaments.

Analysis of Variance↗
PubMed1995

Increased expression of the beta 1, alpha 5, and alpha v integrin adhesion receptor subunits occurs coincident with remodeling of stress-deprived rabbit anterior cruciate and medial collateral ligaments.

The biomechanical, biochemical, and morphological properties of the anterior cruciate and medial collateral ligaments are dramatically altered in response to deprivation of normal physical forces and joint motion. Integrin adhesion receptors are known to play important roles in the tissue remodeling that occurs in the course of normal wound repair. We propose that integrins play a similar role in the remodeling of the extracellular matrix in stress-deprived periarticular ligaments. This study tests the hypothesis that altered expression of integrins on ligament fibroblasts accompanies this remodeling. The left knees of 15 New Zealand White rabbits were surgically immobilized in acute flexion and the right knees served as controls (no operation). The anterior cruciate and medial collateral ligaments were harvested at 1, 3, 5, 9, or 12 weeks after immobilization. Sections from the ligaments were immunostained with monoclonal antibodies specific for the integrin subunits beta 1, alpha 5, alpha 6, and alpha v, as well as with a negative control antibody. Fibroblasts within both the stress-deprived anterior cruciate and medial collateral ligaments demonstrated markedly increased staining for the beta 1, alpha 5, and alpha v subunits, as compared with the controls. The increased staining was greatest at 9 weeks in the anterior cruciate ligament and at 12 weeks in the medial collateral ligament. Western blot study of ligament proteins extracted with sodium dodecyl sulfate demonstrated an increased amount of beta 1 subunit protein in both ligaments from knees that were stress deprived for 9 and 12 weeks, as compared with the control ligaments.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

Arthroscopic assessment of the medial collateral ligament complex of the elbow.

The extent that the medial collateral ligament complex could be visualized by arthroscopy was determined in 10 fresh cadaveric elbows from 10 individuals. We carefully exposed the medial collateral ligament complex through a muscle-splitting incision before performing arthroscopy. The anterior and posterior bundles were identified and marked by placing 4.0 nylon sutures deep to the bundles to aid in arthroscopic visualization. A portion of the anterior bundle was visible in only one elbow and in that elbow only the most anterior 25% of the anterior bundle was seen. Attempts to visualize the anterior bundle through additional portals were unsuccessful. Varying the flexion angle of the cadaveric elbow from 0 degrees to 130 degrees also failed to improve visualization. Conversely, the entire posterior bundle, including humeral and ulnar insertion sites, could be seen in all 10 specimens using the posterior portals. We also noted that direct pressure was placed on the ulnar nerve in all specimens when the arthroscope or any arthroscopic instrument was advanced into the posteromedial gutter in contact with the posterior bundle because of its proximity immediately adjacent to the ulnar nerve. The inability to reliably see the anterior bundle and the humeral or ulnar insertion sites of this ligament may limit the value of the arthroscope when assessing medial collateral ligament injuries. Additionally, great care should be taken when using the arthroscope or other instruments in the posteromedial gutter because the ulnar nerve lies immediately adjacent to the thin posterior bundle and capsule.

Arthroscopy↗
PubMed2003

Medial collateral ligament and partial anterior cruciate ligament transection: mRNA changes in uninjured ligaments of the sheep knee.

Following knee ligament injury, clinical and experimental investigations usually focus on the injured ligament, and uninjured ligaments of the same joint are largely ignored and presumed to remain unchanged. The purpose of this study was to characterize changes in mRNA levels for a relevant subset of molecules in the uninjured knee ligaments following combined unilateral medial collateral ligament (MCL) and partial anterior cruciate ligament (ACL) transection in sheep. Semiquantitative reverse transcription-polymerase chain reaction was performed for collagen types I, III, and V; matrix metalloproteinase-13 (MMP-13); and tissue inhibitor of metalloproteinase-1 for both injured and uninjured knee ligaments at 6 and 12 weeks after injury. Collagen type I, III, and V mRNA levels were significantly increased in MCL scars at 6 weeks as well as in the uninjured lateral collateral ligament and the anteromedial band of the ACL (AM-ACL). MMP-13 mRNA levels were also elevated in the MCL at 6 and 12 weeks and in the AM-ACL 6 weeks after injury. In contrast, significant changes in the posterior cruciate ligament were not detected at either time point, indicating specificity in the transient alterations. These results suggest that following injury, responses occur in uninjured ligaments that are specific although transient in nature. These responses may be an adaptive attempt to preserve function until the scar tissue can stabilize the mechanical environment following injury.

Animals↗