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PubMed1993

[Osteosuturing with the Mitek anchor system--experiences from the first 17 operations].

In September 1990, the Mitek Anchor System was introduced commercially in Denmark. Since the introduction of the system in our department in October 1991 and until June 1992, we have collected data consecutively from all operations, in which the anchors have been used. The registration has included pre-operative history, type of operation and findings per- and post-operatively. In the above mentioned period, Mitek anchors have been used in seventeen operations: Twelve Bankart-repairs, three fractures of the major tubercle of the humerus, one reattachment of the ulnar collateral ligament of the thumb and one reattachment of the medial collateral ligament of the knee. None of the patients operated for Bankart lesions have had redislocations, and none of the anchors were displaced on X-rays. The three fractures of the major tubercle of the humerus have all remained without dislocation after fixation. No side-instability was found in the operated thumb, and the operated knee was making progress in training. By presenting the patient-data and the temporary post-operative results we conclude, that the anchors seem highly usable not only in Bankart-operations. Follow-up will be continued.

Adolescent↗
PubMed1996

[Traumatic elbow joint luxation in the dog and cat: perioperative findings].

Thirty-eight cases (24 dogs, 14 cats) of elbow luxation were reviewed. Seventeen surgical treatments were necessary either after conservative reduction (14) or because conservative reduction was not possible (3). Medial instability of the elbow joint due to medial collateral ligamental damage or avulsion of the origin of the medial collateral ligament were the major indication for surgery. The type and frequency of perioperative lesions as well as their therapeutical and prognostical relevance are described.

Animals↗
PubMed1986

Rupture of the intercondylar ligament in intertarsal joints of broiler fowls.

On examination of the intertarsal joints of approximately 150 lame broiler fowls, the intercondylar ligament was found to be ruptured, either partially or totally, in 22 birds. In some cases, rupture of the intercondylar ligament occurred in joints with gross angulation and usually in association with collateral ligament instability. In other birds, intercondylar ligament rupture occurred in limbs with minimal angulation but often with concomitant ligament or tendon failure in the same or contralateral limb. A fibrovascular layer was frequently identified between collateral ligaments and their distal tibiotarsal attachment. Haemorrhage in the fibrovascular tissue appears to be responsible for the establishment of the cyst-like structures which were present in some distal tibiotarsi.

Animals↗
PubMed1998

Combined hyperextension and supination of the elbow joint induces lateral ligament lesions. An experimental study of the pathoanatomy and kinematics in elbow ligament injuries.

An epidemiological study suggested that the injury mechanism of 'handball goalie's elbow' may be hyperextension. The pathomechanics of hyperextension combined with supination was studied in ten macroscopically normal, male, cadaveric elbow joint specimens. The age of the donors was 28.8 years (range 18-45 years). Extension loading of the elbow was performed in an experimental three-dimensional (3D)-kinematic loading apparatus. The degree of extension increased by 16.7 degrees +/- 8.7 degrees after loading. Hyperextension loads induced significant joint laxity in joint flexion (< 50 degrees) during forced valgus, external and internal rotation, respectively, but not during forced varus. The hyperextension trauma produced three lesions: (1) anterior capsule rupture, (2) avulsion of the proximal insertion of both the medial and the lateral collateral ligaments, and (3) occasional single rupture of the lateral collateral ligament. The lesions indicate that combined hyperextension and supination represent a possible mechanism leading to 'handball goalie's elbow'.

Adolescent↗
PubMed1995

[Concomitant injuries with anterior cruciate ligament rupture. A retrospective study].

We identified 107 consecutive patients with anterior cruciate ligament (ACL) rupture who underwent arthroscopy after trauma. The results of the preoperative clinical examination and the arthroscopic findings of associated injuries to the knee are shown. Some 55% of the acute ACL ruptures involved a tear of the lateral meniscus, 45% of the medial meniscus, and 34% had a lesion of the medial collateral ligament. The most frequent combination of injuries with ACL rupture was a tear in both menisci and a lesion of the medial collateral ligament with a tear in the lateral meniscus. The preoperative examination revealed the ACL rupture in 94% of uses but the lateral meniscal lesion in only 32%. At the time of operation 29% of all associated injuries had not been discovered. These results show that--independent of the time of reconstruction of the thorn ACL--acute rupture of the ACL is an indication for arthroscopy.

Adolescent↗
PubMed1996

Stifle injuries in cattle.

Lameness of the hindlimbs originating from the stifle joint may be difficult to diagnose and treat. This article describes anatomic considerations and the diagnostic procedures necessary to accurately evaluate the bovine stifle joint. The emphasis is toward obtaining a diagnosis based on physical examination and simple diagnostic procedures in field situation. Specific treatments and/or management alternatives for cattle with various ligament injuries (cranial cruciate rupture, collateral ligament injuries), or with luxated patella, upward fixation of the patella, septic arthritis, and subchondral bone cysts are described. Current knowledge of the prognosis after various treatments is presented.

Animals↗
PubMed2002

Biologic characteristics of fibroblast cells cultured from the knee ligaments.

OBJECTIVE: To culture fibroblast cells from the knee ligaments and to study the biological characteristics of these cells. METHODS: Cells of the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) from New Zealand white rabbit were cultured in vitro. Cellular growth and expression of the collagen were analyzed. Moreover, an in vitro wound closure model was established and the healing of the ACL and the MCL cells was compared. RESULTS: Maximal growth for all these cells were obtained with Dulbecco's modified Eagle's medium supplemented with 10% fetal bovine serum, but RPMI 1640 and Ham's F12 media were not suitable to maintain these cells. Morphology of both ACL and MCL cells from New Zealand white rabbit was alike in vitro, but the MCL cells grew faster than the ACL cells. Both cell types produced similar amount of collagen in culture, but the ratio of collage type I to type III produced by ACL cells was higher than that produced by MCL cells. Wound closure assay showed that at 36 hours after injury, cell-free zones created in the ACL cultures were occupied partially by the ACL cells; in contrast, the wounded zone in the MCL cultures was almost completely covered by the cells. CONCLUSIONS: Although the ACL cells and the MCL cells from New Zealand white rabbit show similar appearance in morphology in culture, the cellular growth and the biochemical synthesis of collagen as well as the healing in vitro were significantly different. These differences in intrinsic properties of the two types of cells in vitro might contribute to the differential healing potentials of these ligaments in vivo.

Animals↗
PubMed1997

Avulsion fracture of the anteromedial bundle of the anterior cruciate ligament.

The avulsion fracture of the tibial attachment site of the anterior cruciate ligament is relatively rare among adults. Although partial avulsion fracture of this site is very rare, complex forces exerted on the knee joint could produce this type of fracture. We report on an adult patient with an avulsion fracture of the attachment site of anteromedial bundle of the anterior cruciate ligament associated with injuries of lateral and medial collateral ligament and fibular fracture. We speculate varus stress in a flexed knee coupled with rotation between the femur and tibia caused this type of injury.

Adult↗
PubMed2004

An analysis of an anatomical posterolateral knee reconstruction: an in vitro biomechanical study and development of a surgical technique.

BACKGROUND: To date, no surgical technique to treat posterolateral knee instability anatomically reconstructs the 3 major static stabilizing structures of the posterolateral knee: the fibular collateral ligament, the popliteus tendon, and the popliteofibular ligament. HYPOTHESIS: Static varus and external rotatory stability would be restored to the reconstructed knee with a posterolateral knee injury. METHODS: The anatomical locations of the original fibular collateral ligament, popliteus tendon, and popliteofibular ligament were reconstructed using a 2-graft technique. Ten cadaveric specimens were tested in 3 states: intact knee, knee with the 3 structures cut to simulate a grade III injury, and the reconstructed knee. RESULTS: For the varus loading tests, joint stability was significantly improved by the posterolateral reconstruction compared to the cut state at 0 degrees, 30 degrees, 60 degrees, and 90 degrees of flexion. There were no significant differences between the intact and reconstructed knees at 0 degrees, 60 degrees, and 90 degrees for varus translation. For the external rotation torque tests, external rotation was significantly higher for the cut state than for the intact or reconstructed posterolateral knee. There was no significant difference in external rotation between the intact and reconstructed posterolateral knees at any flexion angle. CONCLUSIONS: This 2-graft technique to reconstruct the primary static stabilizers of the posterolateral knee restored static stability, as measured by joint translation in response to varus loading and external rotation torque, to knees with grade III posterolateral injuries.

Aged↗
PubMed1988

A new method of measuring the cross-sectional area of connective tissue structures.

There appears to be no generally accepted method of measuring in-situ the cross-sectional area of connective tissues, particularly small ones, before mechanical testing. An instrument has therefore been devised to measure the cross-sectional area of one such tissue, the rabbit medial collateral ligament, directly and nondestructively. However, the methodology is general and could be applied to other tissues with appropriate changes in detail. The concept employed in the instrument is to measure the thickness of the tissue as a function of position along the width of the tissue. The plot obtained of thickness versus width position is integrated to provide the cross-sectional area. This area is accurate to within 5 percent, depending mainly on alignment of the instrument and pre-load of the ligament. Results on the mid-substance of the rabbit medial collateral ligaments are repeatable and reproducible. Values of maximum width and thickness are less variable than those obtained with a vernier caliper. The measured area is considerably less than that estimated assuming rectangular cross-section and slightly less than that estimated on the assumption of elliptical cross-section.

Animals↗
PubMed1997

Biomechanics of knee ligament healing, repair and reconstruction.

Injuries of the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) are common, accounting for 90% of all knee ligament injuries in young and active individuals. During the last decade, our research center has focused on MCL healing and ACL reconstruction. We have found that the MCL heals without intervention after an isolated injury, and that primary repair offers no apparent advantage. After a combined injury of the ACL and MCL, the ACL requires reconstruction, whereas primary repair again contributes little or nothing toward MCL healing. Midsubstance ACL injuries have limited healing ability. Hence, the treatment of choice for a torn ACL in a young, active patient is generally reconstruction with an autograft or allograft. However, the appropriate replacement graft and reconstruction technique to use are still debated. Current research efforts have been placed on investigating the magnitude and direction of in situ forces in the human ACL. We use a six-component universal force moment sensor combined with a six-degree-of-freedom (DOF) robotic manipulator to learn as well as to reproduce the six-DOF motion of the knee before and after ACL injury. This way, the in situ force in the ACL under an anterior posterior tibial load of 110 N was obtained. This methodology should make it possible to obtain the needed data to aid in better understanding of ACL reconstruction and possible development of improved clinical management.

Animals↗
PubMed1998

Suture anchor repair of chronic radial ligament injuries of the metacarpophalangeal joint of the thumb.

Five cases of chronic instability of the radial collateral ligament of the thumb metacarpophalangeal joint are presented. All patients were treated using the Mitek suture anchor to reattach the avulsed ligament to bone in its anatomical position. Tendon advancement or graft reinforcement was not used in conjunction with the repair. A stable thumb metacarpophalangeal joint was achieved in each case with no recurrent instability or pain found within 9 months of follow-up. Postoperatively, each patient exhibited a full return to activities of daily living within 2 to 3.5 months. Grip and pinch strength and range of motion were nearly the same as in the uninjured hand. We recommend the Mitek suture anchor as a simple and effective method of repairing the chronic radial collateral ligament injury. The importance of correct anatomical placement of the anchor is stressed, and guidelines for this are discussed.

Adolescent↗
PubMed2006

An in vivo injury model of posterolateral knee instability.

BACKGROUND: Posterolateral knee instability is a difficult clinical problem to diagnose and treat. To best evaluate its natural history and the effects of interventional treatments, it is important to develop an in vivo model in an attempt to validate human cadaveric and clinical observational studies. PURPOSE: To develop an in vivo model of posterolateral knee instability in the rabbit and to determine the natural history of untreated posterolateral knee injuries at 6 months postoperatively. STUDY DESIGN: Controlled laboratory study. METHODS: The fibular collateral ligament and popliteus tendon were surgically transected in 1 knee in each of 10 skeletally mature New Zealand White rabbits, with the contralateral knee serving as a control knee. At 6 months postoperatively, the rabbits were euthanized, the knees were removed, and biomechanical testing of knee joint stability was performed. After biomechanical testing, histological sections of each proximal tibia and distal femur were evaluated, and each proximal tibia was graded using an osteoarthritis grading scheme. RESULTS: Biomechanical testing revealed a statistically significant difference in amount of rotation in the operated knees compared with the unoperated control knees to varus moments at 30 degrees , 60 degrees , and 90 degrees and to external rotation torques at 30 degrees and 60 degrees . Morphological analysis revealed no significant difference in lesions of osteoarthritis in the medial compartment of the operated knees compared with the unoperated knees. CONCLUSIONS: Although the presence of posterolateral knee instability was validated 6 months after surgery in this model, the authors did not identify significant differences in lesions of osteoarthritis in the operated knees compared with the unoperated control knees. CLINICAL SIGNIFICANCE: This study confirms that posterolateral knee instability can be created in an animal model. It also recapitulates the clinical observation in humans that untreated posterolateral knee injuries do not heal. Similar to animal models of medial collateral ligament sectioning, further studies to validate a posterolateral instability knee model may lead to interventional studies to determine the best way to treat this complex knee instability pattern.

Animals↗
PubMed1995

Pellegrini-Stieda syndrome.

The Pellegrini-Stieda "sign" is commonly seen in patients who have a history of trauma to the medial collateral ligament of the knee. Although most are asymptomatic, a few patients will develop the characteristic Pellegrini-Stieda syndrome, which can be severely limiting. When conservative measures fail, surgical treatment consisting of excision of the bony fragment with careful repair of the medial collateral ligament can eradicate the symptoms. This syndrome is reviewed in detail, and an illustrative case report is included.

Accidents, Traffic↗
PubMed1997

Anatomy and magnetic resonance imaging of the posterolateral structures of the knee.

The purpose of the present study was to provide detailed information of the morphological and radiological characteristics of the posterolateral structures of the knee. Muscles and ligaments of the posterolateral part of the knee were studied by dissections of 50 adult cadaver knees and by Magnetic Resonance Imaging (MRI) before and after dissections for comparisons. Diverse morphological characteristics of the arcuate ligament were found. The fabellofibular ligament was present in 42.1% of the knees dissected, whereas the popliteofibular ligament was found in 37.5%. A ligamentous structure, which could be called the posterior tibial ligament, was found in 31.6% of the cases that originated from the lateral part of the capsule proximally and inserted distally on the mid portion of the proximal tibia. By comparing the cross sections and the dissections of the cadaver knees, the popliteus muscle, the arcuate ligament, the fibular collateral ligament, the popliteofibular ligament, and the fabellofibular ligament could be identified in MRI. Comprehensive understanding of the posterolateral anatomy of the knee and improved identification of the structures in MRI will help clinicians to make a more accurate and noninvasive diagnosis of posterolateral instability.

Adult↗
PubMed2005

An unusual rotational injury: Pantibial ligamentous injury.

Pantibial ligamentous injury including knee dislocation and tibiotalar joint subluxation is an uncommon severe rotational injury. A 21-year-old male injured his right knee falling from a motorcycle. Physical examination revealed effusion on the right knee and ankle, and posterior translation of the tibia as well. The MRI of the right knee and ankle demonstrated the following findings: a complete disruption of cruciate ligaments, the medial collateral ligament, posteromedial corner injury together with a peripheric tear in the medial meniscus, the ruptured deltoid ligament, ankle syndesmosis space widening (>5 mm) and lateral subluxation of talus. Deltoid ligament of the right ankle was repaired and ankle syndesmosis was fixed with a cortical screw. The PCL and ACL were reconstructed arthroscopically with autogeneous bone-patellar tendon-bone graft. The midsubstance tear of MCL, posteromedial corner and medial meniscus tear were primarily repaired with nonabsorbable sutures. 3 years after the surgery, the patient was called for the final examination. MRI and X-ray findings of the knee and ankle joint demonstrated the continuity of ACL, PCL, MCL, and deltoid ligament. The patient, who is a farmer, can go back to his job and perform his daily activities. We presented a previously unreported case that involves both simultaneous occurrence of knee dislocation and tibiotalar joint subluxation. We used the term "Pantibial ligamentous injury" for this case.

Accidental Falls↗
PubMed1998

A biomechanical assessment of ligaments preventing dorsoradial subluxation of the trapeziometacarpal joint.

Degenerative arthritis of the trapeziometacarpal joint is commonly associated with ligament laxity and joint subluxation. Specifically, key pinch in an affected joint often results in dorsoradial joint subluxation. This study examined the role the 4 ligaments of the trapeziometacarpal joint play in preventing dorsoradial subluxation. Six fresh-frozen cadaver hands were dissected of all soft tissue to expose the joint capsule and ligaments of the trapeziometacarpal joint. Serial random sectioning of the intermetacarpal ligament, anterior oblique ligament, palmar oblique ligament, and dorsoradial collateral ligament (RCL) was performed. Dorsoradial displacement of the metacarpal shaft in relation to the trapezium was measured using a linear variable dimension transformer. In all 6 specimens, sectioning of the RCL resulted in the greatest dorsoradial subluxation of the metacarpal. The mean displacement due to sectioning of the RCL was 1.4 mm, compared with 0.08 mm for the intermetacarpal ligament, 0.06 mm for the anterior oblique ligament, and 0.2 mm for the palmar oblique ligament. The importance of the RCL in preventing dorsoradial subluxation may have clinical significance. This study suggests that repairing or reconstructing the RCL during ligament reconstruction of the trapeziometacarpal joint should be considered.

Biomechanical Phenomena↗
PubMed2003

Healing ligaments have decreased cyclic modulus compared to normal ligaments and immobilization further compromises healing ligament response to cyclic loading.

Ligaments help maintain joint stability by resisting excessive strain during the repetitive loading experienced during daily activity. Healing ligaments may be less able to fulfill this role, straining more under equivalent loading than normal ligaments. We examined the cyclic stress-strain response of normal and healing ligaments to repetitive low loads (<10% of the normal ligament failure strength). Rabbit medial collateral ligaments (MCLs) were surgically gapped in either a unilateral (right MCL; n=23) or bilateral (right and left MCLs; n=17) fashion with immobilization of the right hindlimb in the bilateral group. These MCL scars were allowed to heal for 3, 6, and 14 weeks and were cyclic creep tested at 2.2, 4.1, and 7.1 MPa, respectively. Creep test stresses were a constant 30% of the failure strength of non-immobilized scars at the different healing intervals. Normal MCLs were creep tested at 4.1 and 7.1 MPa (n=13). The cyclic modulus of the non-immobilized scars was less than that of normal ligaments. The percent increase in modulus during cycling was greater for scars than for normal ligaments, likely related to increased viscous dissipation or material inferiorities in scars. Furthermore, immobilization significantly decreased the ability of scars to resist strain, with a majority of immobilized scars failing during repetitive loading. Such failures were preceded by a reduction in cyclic modulus indicating damage to the healing ligaments that was predictive of eventual total failure. The implications of this study are that joints with healing ligaments may have increased strain in joint structures while they are under stress, potentially leading to joint instability. Although immobilization could be used temporarily to maintain joint stability, remobilization would likely lead to total failure of the healing ligament.

Animals↗