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PubMed2000

Type V collagen is increased during rabbit medial collateral ligament healing.

To understand the reparative process of medial collateral ligament (MCL), fibrillar collagen and their relative ratios in healing MCL with anterior cruciate ligament (ACL) reconstruction were analyzed. Skeletally mature New Zealand white rabbits were subjected to a mop-end tear of MCL without repair with ACL reconstruction. Rabbits were killed 6 and 52 weeks after injury. Ligamentous tissues from the injury site and sham controls were soaked in 0.5 M acetic acid for 24 h, minced, and treated with pepsin to solubilize collagen. Pepsin solubilized about 80% of the total collagen as determined by hydroxyproline analysis of the pepsin residues. Sodium dodecyl sulfate polyacrylamide gel electrophoresis analysis of the solubilized collagen revealed presence of fibrillar collagen types I, III, and V. Densitometric scanning of the protein bands corresponding to types I, III, and V collagen indicated that in sham controls types III and V collagen represented about 8% and 12%, respectively, of the type I collagen whereas the healed MCL ligaments at 6 weeks showed significant increase in type III and V collagen to about 19% and 24%, respectively. By 52 weeks type III collagen in the healed MCL had returned to that of sham controls while type V collagen remained elevated at approximately 18%. These data suggest that presence of type V collagen in high concentration in healing ligaments may have an influence on collagen fibril diameters seen in healed ligament and should be included in the analysis when evaluating ligament healing.

Animals↗
PubMed1999

Blood and lymph supply of the posterior cruciate ligament: a cadaver study.

Injection techniques, immunohistochemical (antibodies against laminin), and histochemical (5'-nucleotidase activity) methods were employed to describe the vascular pattern of the human posterior cruciate ligament (PCL); in parallel we used conventional light microscopy and immunohistochemical techniques to visualize the histological structure of the PCL. The blood supply of the PCL mainly arises from the middle geniculate artery. The ligament is covered by a synovial fold where the terminal branches of the middle geniculate artery form a periligamentous network. From the synovial sheath, the blood vessels penetrate the ligament in a horizontal direction and anastomose with a longitudinally orientated intraligamentous network. Within the ligament the blood vessels are located in the loose connective tissue that is sited between longitudinal fibre bundles. Histologically the longitudinal fibre bundles of the ligament consist of dense connective tissue. Lymphatics accompany most of the smaller blood vessels, showing similar regional distribution. Compared to the surrounding synovial layer, the amount of vessels in the substance of the ligament is lower. The distribution of blood vessels within the PCL is not homogenous: we detected three avascular areas within the ligament. Both fibrocartilaginous entheses of the PCL are devoid of blood vessels, and a third avascular zone is located in the central part of the middle third. The histological structure of this zone varies from the rest of the PCL which consists of the characteristic dense connective tissue. In the central part of the PCL the tissue resembles fibrocartilage: the cell shape is round, the pericellular matrix of those cells is rich in acid glycosaminoglycans and the immunohistochemical demonstration of type II collagen is positive. The occurrence of an avascular zone within the central part of the middle third of the PCL where the tissue consists of fibrocartilage has not been described in the literature.

Aged↗
PubMed2006

Axial oblique MR imaging of the intrinsic ligaments of the wrist: initial experience.

OBJECTIVE: To evaluate two separate MR sequences acquired in the axial oblique plane, parallel to the long axis of the scapholunate (SL) and lunotriquetral (LT) ligaments, to determine whether the addition of these sequences to the standard MR wrist examination improves visualization of the intrinsic ligaments, and the evaluation of their integrity. To our knowledge, this plane has not been described in the literature previously. DESIGN AND PATIENTS: In total we evaluated 26 patients with chronic wrist pain or instability, referred for MR imaging following assessment by an orthopedic surgeon or physiatrist. All patients underwent initial conventional tri-compartment wrist arthrography, which served as the reference standard. This was immediately followed by MR arthrography, in the standard coronal and true axial planes, as well as in the axial oblique plane. The SL and LT ligaments were initially assessed for the presence or absence of tear, using the standard coronal and true axial sequences, and subsequently re-evaluated with the addition of the axial oblique planes. RESULTS: A total of ten intrinsic ligament tears were identified with conventional arthrography: six SL and four LT tears. Five of the six SL tears were identified on the standard sequences. All six were diagnosed with the addition of the oblique sequences. There were three false-positive SL tears identified using standard MR imaging, and two false-positives with the addition of the oblique sequences. No LT tear was identified on standard sequences, whereas all four were confidently seen with the addition of oblique images. No false-positives of the LT ligament were recorded with either standard or axial oblique sequences. CONCLUSION: The study suggests that the addition of axial oblique MR sequences helps identify tears to the intrinsic ligaments of the wrist, particularly the LT ligament. In addition, the axial oblique images assist in localization of the tear.

Adolescent↗
PubMed2006

Comparison of CT and MRI in patients with tibial plateau fracture: can CT findings predict ligament tear or meniscal injury?

OBJECTIVE: (1) To determine the accuracy of computed tomography (CT) in the evaluation of ligament tear and avulsion in patients with tibial plateau fracture. (2) To evaluate whether the presence or severity of fracture gap and articular depression can predict meniscal injury. DESIGN AND PATIENTS: A fellowship-trained musculoskeletal radiologist retrospectively reviewed knee CT and MRI examinations of 41 consecutive patients presenting to a level 1 trauma center with tibial plateau fractures. Fracture gap, articular depression, ligament tear and footprint avulsions were assessed on CT examinations. The MRI studies were examined for osseous and soft tissue injuries, including meniscal tear, meniscal displacement, ligament tear, and ligament avulsion. RESULTS: CT demonstrated torn ligaments with 80% sensitivity and 98% specificity. Only 2% of ligaments deemed intact on careful CT evaluation had partial or complete tears on MRI. Although the degree of fracture gap and articular depression was significantly greater in patients with meniscal injury compared with those without meniscal injury, ROC analysis demonstrated no clear threshold for gap or depression that yielded a combination of high sensitivity and specificity. CONCLUSIONS: In the acute setting, CT offers high sensitivity and specificity for depicting osseous avulsions, as well as high negative predictive value for excluding ligament injury. However, MRI remains necessary for the preoperative detection of meniscal injury.

Adolescent↗
PubMed2001

Functional anatomy of the medial ligamentous complex of the elbow. Its role in anterior posterior instability.

The question remains unanswered regarding the role of repair of medial ligament injuries associated with subluxation of the elbow and non-reconstructable radial head fracture and whether or not this will decrease the risk of chronic instability and cubitus valgus. The goal of this study was to define the role of the medial ligamentous complex of the elbow in elbow instability and to describe the anatomy of the complex in 35 fresh-frozen cadaver elbows. We documented medial ligamentous complex anatomy and compared our results to those in the literature. 25 elbows were dissected in order to describe the different bundles of the medial ligament complex and to precise the positions of the elbow that placed each in tension; section of the different ligamentous bundles was done to study the role of each in elbow stability. 10 other elbows were dissected and used for the ligamentous section studies which were performed subcutaneously. We found two bundles at the level of the anterior portion and termed them superficial and deep. Section of the anterior bundle lead to posterior subluxation of the elbow at 30-100 degrees flexion in both supination and pronation. Posterior subluxation was obtained after an anterior capsulotomy; medial epicondylectomy did not compromise the stability of the elbow after a complete section of the insertion of the deep fibers of the anterior bundle. Elements thus required for stability of the elbow are integrity of the articular surface of the humerus and the ulna, and the anterior bundle of the medial ligamentous complex.

Adult↗
PubMed2003

Anatomical study on the morphology and blood supply of the falciform ligament and its clinical significance.

The purpose of this study was to understand the clinical significance of the morphology and blood supply of the falciform ligament in laparoscopic surgery. The structure, blood vessel distribution and anastomoses of the falciform ligament were observed in 20 cases of living laparoscopy, 30 cadaveric specimens injected with latex and five cadaveric specimens with Indian ink and hyaline. The falciform ligament was formed by two sides of peritoneum and its length, largest and smallest width were 8.3+/-1.6 cm, 4.9+/-0.8 cm and 1.1+/-0.3 cm, respectively. The left inferior phrenic artery and middle segment artery of the liver formed a vessel that arched and gave off 6-12 branches to the falciform ligament. The veins of the falciform ligament drained into the left inferior phrenic vein, and were not accompanied by any artery. In conclusion, the vessels of the falciform ligament anastomose with multiple vessels and form a significant pathway of the collateral circulation in the liver. The falciform ligament is an important landmark in laparoscopic surgery.

Cadaver↗
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↗
PubMed2006

Laparoscopic uterosacral ligaments plication for the treatment of uterine prolapse.

OBJECTIVE: To present preliminary results of a simple, minimally interventional, uterus-sparing procedure for uterine prolapse repair. METHODS: This prospective study was undertaken on women with symptomatic uterine prolapse >/=2nd stage, who declined hysterectomy at the time of prolapse surgery. A 10 mm laparoscope and three 5 mm ancillary trocars were used to perform the procedure. The uterosacral ligament was invested with a nonabsorbable suture. A total of three helical type sutures were placed full-thickness in the uterosacral ligament, beginning in the distal third of the ligament. The ends of the suture were tied with an extra-corporeal knot-tying technique on each side, thus shortening the ligaments. Finally, the round ligaments were plicated to restore the uterus to its correct anatomic position. No additional surgical procedure was performed concomitantly. RESULTS: Ten patients underwent laparoscopic uterosacral ligaments plication for the treatment of symptomatic uterine prolapse. The median (range) patients age was 45.5 years (36-66). Five (50%) patients were premenopausal and 3 (60%) had not completed their family. The median operating time was 22.5 min (20-45). No intraoperative complications occurred. The median follow-up time was 21 months (range 15-33). The median postoperative difference in POP-Q point C was -3 cm (range 0 to -5). Eight (80%) patients were objectively cured at the last follow-up evaluation and all of them reported a complete resolution of their symptoms. Two women had prolapse recurrence and underwent vaginal hysterectomy 7 and 24 months after primary surgery, respectively. CONCLUSION: Laparoscopic uterosacral ligaments plication is a minimally invasive and straightforward simple procedure that appears to be a safe and effective treatment option for women with uterovaginal prolapse who desire uterine preservation.

Adult↗
PubMed1998

Osteogenic inhibition by rat periodontal ligament cells: modulation of bone morphogenic protein-7 activity in vivo.

Periodontal ligament width is precisely maintained throughout the lifetime of adult mammals but the biological mechanisms that inhibit ingrowth of bone into this soft connective tissue are unknown. As bone morphogenic proteins strongly stimulate osteogenesis and can induce ectopic bone formation in vivo, we tested the hypothesis that topical application of this powerful osteogenic agent will overwhelm the osteogenic inhibitory mechanisms of periodontal ligament cells and induce ankylosis. Wounds through the alveolar bone and periodontal ligament were created in 45 male Wistar rats. Defects were filled with either a collagen implant or collagen plus bone morphogenic protein (BMP-7), or were left unfilled (controls). Three animals per time period were killed on days 2, 5, 10, 21 and 60 after surgery for each wound type. Cellular proliferation and clonal growth in periodontal tissues were assessed by 3H-thymidine labeling 1 h before death, followed by radioautography. Cellular differentiation of soft and mineralizing connective tissue cell populations was determined by immunohistochemical staining of alpha-smooth muscle actin, osteopontin and bone sialoprotein. In regenerating periodontium, BMP-7 induced abundant bone formation by 21 days (2.5-fold greater than controls or collagen implant only; P<0.001), but by day 60 the volume of the newly formed bone had returned to baseline levels and was similar for all groups. Independent of the type of treatment, periodontal ligament width was unchanged throughout the experimental period (P>0.05). Animals treated with BMP-7 implants showed greatly increased cellular proliferation in the periodontal ligament adjacent to the wound site and in the regenerating alveolar bone at days 5 and 10 after wounding compared to the other treatment groups (P<0.005). Animals in the BMP-7 group exhibited similar spatial and temporal staining patterns for alpha-smooth muscle actin, osteopontin and bone sialoprotein as controls. Collectively, these data show that BMP-7 promoted the proliferation of precursor cells in the periodontal ligament but did not induce osteogenic differentiation in this compartment. Consequently a powerful osteogenic stimulus like BMP-7 cannot significantly perturb the mechanisms that regulate periodontal ligament width and maintain periodontal homeostasis.

Administration, Topical↗
PubMed2002

Regional differences within the human supraspinous and interspinous ligaments: a sheet plastination study.

The extent to which neighboring muscles and the fascia contribute to the formation of the supraspinous and interspinous ligaments is not clear from the literature. The purpose of this investigation is to examine the midline attachments of tendons and the posterior layer of thoracolumbar fascia in order to determine their respective contributions to the formation of these ligaments throughout the thoracolumbar spine. Study of the dense connective tissue organization in the posterior ligamentous system was carried out on two cadavers serially sectioned into thin (2.5-mm) epoxy resin plastinated slices. Additional observations were taken from a gross anatomical study of the midline anatomy in two adult cadavers. The results show that the spinal attachments of trapezius, rhomboideus major and splenius cervicis combine with the deep fascia to form the supraspinous ligament in the upper thoracic spine. The posterior layer of the thoracolumbar fascia makes a major contribution to the supraspinous and interspinous ligaments in the lower thoracic spine. In addition to the posterior layer of thoracolumbar fascia, longissimus thoracis and multifidus combine to form the lumbar supraspinous and interspinous ligaments. Their spinal attachments produce a system of dense connective tissue with marked regional variation in fiber orientation and arrangement. The findings support the description of the supraspinous and interspinous ligaments as structures formed by both muscle tendons and aponeuroses along the length of the thoracic and lumbar spine, with regional differences in their connective tissue architecture.

Aged↗
PubMed1998

Morphological study of mechanoreceptors on the coracoacromial ligament.

We performed gold chloride staining of coracoacromial ligaments removed at operation, observed the peripheral nerve endings in the ligament, and studied their distribution and changes with aging in order to clarify the proprioception of the shoulder joint. The coracoacromial ligament was found to contain four types of typical nerve endings: Pacinian corpuscles, Ruffini receptors, Golgi tendon organ-like receptors, and free nerve endings. In addition, non-typical Pacinian corpuscles and Ruffini receptors with non-typical morphology were present. There were also unclassifiable nerve endings with a morphology which did not fit any of the above categories. These typical, non-typical, and unclassifiable nerve endings were all widely distributed on the surface of the subacromial side at the insertion into the acromion and around the coracoid process in the ligament. Free nerve endings were found sporadically on the surface of the subacromial bursal side in the ligament. The resected coracoacromial ligaments (23 specimens) were divided into two groups based on the disorder that required surgery: a fracture group without subacromial impingement (5 specimens) and a group with subacromial impingement (18 specimens). Age-related changes in the number of nerve endings were compared in each group. The total number of nerve endings decreased with age in both groups. The number of Pacinian corpuscles, Ruffini receptors, Golgi tendon organ-like receptors, and free nerve endings of typical morphology tended to decrease with age. The data from the fracture and subacromial impingement groups were not analyzed statistically because of the difference in the number of specimens in each group. However, the total number of nerve endings was lower in the subacromial impingement group than in the fracture group at all ages. The typical nerve endings of the coracoacromial ligament in both groups tended to decrease in the elderly, suggesting that the proprioception of the shoulder joint may become impaired with aging.

Acromioclavicular Joint↗
PubMed2001

Semiquantitative analysis of types I and III collagen from tendons and ligaments in a rabbit model.

The present study presents a simple and reliable micro-method for the semiquantitative analysis of types I and III collagen in tendons and ligaments in a rabbit model. After pretreatment of the analytical material by homogenization, a double cyanogen bromide cleavage was performed and the peptide fragments were visualized by polyacrylamide gel electrophoresis and silvcr staining. On the basis of this procedure, the method presented here can be used to analyze very small amounts of sample material (less than 10microg) by electrophoresis. The results of the study showed that type I collagen is predominant in the ligaments and the tendons of the knee, e.g., medial and lateral collateral ligaments. anterior and posterior cruciate ligaments. patellar tendon, achilles tendon, and semitendinosus tendon. However, a markedly higher proportion of type III collagen was detected in the ligaments (approximately 10%) than in the tendons (approximately 5%). The ligaments differ markedly from the tendons in biochemical mapping; the ligaments are functionally and metabolically the more active tissue and have a higher adaptation potential.

Animals↗
PubMed1994

The anatomy of the iliolumbar ligament.

During routine autopsies and anatomical dissections the anatomy of the iliolumbar ligament was studied and determined. In previous studies and literature, the ligament has been described to consist of three to five parts. We found the ligament to consist of only two parts: the anterior part and the posterior part, both attaching to the L5 transverse process. The insertion of the ligament has also been mentioned previously as attaching to the iliac crest. Both parts of the ligament were found to inset to the upper part of the iliac tuberosity, significantly lower than the iliac crest. The iliolumbar ligament cannot be visualized from the dorsal side before dissecting through all the lower back muscles and their fascias. We also found no evidence of any ligament part attaching to the L4 transverse process.

Adolescent↗
PubMed1986

Further studies on knee ligament failure in broiler breeding fowls.

A group of 88, predominantly male, broiler breeding fowls was examined and, in 38, knee ligament failure was identified. All birds were aged between 15 and 60 weeks when examined. Although derangement of the caudal cruciate ligament was the most frequent finding (25 birds), partial or total rupture of the cranial cruciate ligament was also identified (10 birds). Medial (10 birds) and lateral (5 birds) collateral ligament failure was also noted. Knee ligament failure may, in part, be age related. The most frequent concomitant finding in individual birds was tendon or ligament failure elsewhere in the same skeleton. It can therefore be assumed that male broiler breeding fowls are predisposed to ligament and tendon failure and a high proportion will have lesions at more than one skeletal site.

Animals↗
PubMed1988

Two methods of ligament injury: a morphological comparison in a rabbit model.

Our purpose in this study was to compare morphologically the reproducibility and control of two common methods of ligament injury. Polarized light and scanning electron microscopy were used to quantify the injury patterns and the extent of ligament damage caused by scalpel division and wire rupture of rabbit medial collateral ligaments. Results demonstrate that the scalpel cut and wire rupture methods of ligament injury are each controllable and reproducible in location, pattern, and extent of ligament damage. The wire rupture technique, however, produced consistently more extensive midsubstance ligament damage than the scalpel cut and thus created an injury pattern that better simulated the extent of damage seen in clinical injuries. Although neither technique was an ideal simulation of clinical injuries, results suggest that the wire rupture technique is a more relevant technique to study ligament injury and healing in this model.

Animals↗
PubMed1988

An anatomic guide for arthroscopic visualization of the wrist capsular ligaments.

Wrist arthroscopy allows examination of the palmar capsular wrist ligaments without extensive exposure. Arthroscopic examination of the wrist requires an accurate knowledge of the ligamentous anatomy as seen from inside the joint. In this study 13 fresh cadaver wrists were examined from the inside out to provide a visual guide for ligament identification during arthroscopy. The major palmar capsular ligaments seen from the inside of the wrist at the radiocarpal joint include the radioscaphoid, radioscaphocapitate, radiolunate, radioscapholunate, ulnolunate, ulnotriquetral ligaments, and the ulnar capsule. At the midcarpal joint, the scaphocapitate, radioscaphocapitate, triquetrocapitate, and triquetrohamate ligaments are identified palmarly. Dorsally, constant capsular structures at the radiocarpal joint are the radiolunate and radioulnotriquetral ligaments along with a prominent synovial fold.

Aged↗
PubMed1990

Radiographic analysis of selective ligament sectioning at the carpal scaphoid: a cadaver study.

Although scapholunate diastasis with rotatory subluxation of the scaphoid (stage I perilunar instability determined by Mayfield's classification) has been studied by several investigators, the exact contribution of the supporting ligaments is still being defined. We designed and executed an experimental study using six fresh-frozen cadaver specimens to demonstrate the radiographic changes seen on standard and stress wrist radiographs that correlate with the sequential sectioning of the scapholunate stabilizing ligaments. The radioscapho-lunate ligament, the palmar scapholunate interosseous ligament, the dorsal scapholunate interosseous ligament, and the radiocapitate ligament were sectioned sequentially to simulate a progressive wrist injury caused by an extension, intercarpal supination and ulnar deviation force. The results showed significant ligamentous injury must occur before commonly used radiographic limits are exceeded. The lateral scapholunate angle most closely reflected the progressive nature of this injury.

Humans↗
PubMed1992

Coracoacromial ligament release for shoulder impingement syndrome using the Universal Subcutaneous Endoscope system.

We developed a new operative procedure of coracoacromial ligament release for shoulder impingement syndrome. The operative procedure was confirmed by cadaveric studies and applied to clinical cases in 40 shoulders of 37 patients who suffered from shoulder impingement without bony abnormalities. The subacromial space was observed under local anesthesia using the Universal Subcutaneous Endoscope (USE) system on an outpatient basis. A popping phenomenon was observed between the coracoacromial ligament and the greater tuberosity of the humerus, which was covered by the rotator cuff, and the coracoacromial ligament was resected with a rongeur under endoscopic visualization in all shoulders. Resection of the coracoacromial ligament relieved the impingement and clinical signs, as in open or arthroscopic resection of the coracoacromial ligament. Resection of the coracoacromial ligament using the USE system is a safe and less-stressful surgical invasion than open or standard arthroscopic resection of the coracoacromial ligament.

Anesthesia, Local↗