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PubMed2005

Characterization of sulfate, proline, and glucose transport systems in anterior cruciate and medial collateral ligament cells.

The present study was undertaken to define the nature of key transport processes for sodium, glucose, proline, and sulfate in primary culture of canine anterior cruciate ligament (ACL) and medial collateral ligament (MCL) cells. Uptake studies using radiolabeled isotopes were performed and Na,K-ATPase activity was determined in cell lysates. At 25 degrees C both ACL and MCL cells showed a significant uptake of 86Rb. Ouabain inhibited Rb uptake by 55% in ACL cells and by 60% in MCL cells. The transport activity of Na,K-ATPase in intact cells was calculated to be 57 and 71 nmol.(mg protein)-1.(15 min)-1, respectively. The enzymatic activity of Na,K-ATPase in cell lysates was observed to be 104 for ACL cells and 121 nmol.(mg protein)-1.(15 min)-1 for MCL cells. Cytochalasin B, a known inhibitor of sodium-independent D-glucose transport, completely inhibited D-glucose uptake in ACL and MCL cells. Removal of Na+ or addition of 10-5 mol/L phlorizin, a potent inhibitor of the sodium-D-glucose cotransporter, did not alter D-glucose uptake, suggesting that glucose entered the cells using a sodium-independent pathway. Both ACL and MCL cells exhibited high sulfate uptake that was not altered by replacement of Na+ by N-methyl-D-glucamine, whereas DIDS, an inhibitor of sulfate/anion exchange abolished sulfate uptake in both cell types. Thus, neither cell type seems to possess a sodium-sulfate cotransport system. Rather, sulfate uptake appeared to be mediated by sulfate/anion exchange. Proline was rapidly taken up by ACL and MCL cells and its uptake was reduced by 85% when Na+ was replaced by N-methyl-D-glucamine, indicating that proline entered the cells via sodium-dependent cotransport systems. The data demonstrate that both ACL and MCL cells possess a highly active sodium pump, a secondary active sodium-proline cotransport system, and sodium-independent transport systems for D-glucose and sulfate.

Animals↗
PubMedDate not supplied

Role of collateral ligaments in the GSB-linked total elbow prosthesis.

The GSB III elbow prosthesis is a loose-hinged type of elbow implant. The introduction of such hinged elbow arthroplasty expanded the indications for elbow replacement to patients with more deficient bone and ligaments. The purpose of this study was to compare the kinematics and stability of the GSB III elbow prosthesis with that of the normal elbow and to investigate the role of the collateral ligaments in the kinematics and the stability of the GSB III total elbow prosthesis in an in vitro model. The results could show a semiconstrained kinematic pattern of the GSB III implant. The mean laxity for varus/valgus stress of the implant without collateral ligament support was significantly greater for all flexion angles when compared with intact elbows (mean, 12.7 degrees versus 5.4 degrees ) and with elbows treated with a standard implantation technique (mean, 9.5 degrees ). The release of the collateral ligaments increased the already observed varus shift after standard implantation of a GSB III elbow prosthesis. The laxity measured without collateral ligaments during loaded movement reached the maximum varus/valgus laxity of the GSB III prosthesis of 12 degrees degrees. The study confirms the role of the collateral ligaments in stabilizing the GSB III elbow prosthesis. Missing collateral ligaments may overload the implant-cement-bone interface and may be one factor contributing to early aseptic loosening of this device.

Aged↗
PubMed2003

The effect of medial collateral ligament insufficiency on the reconstructed anterior cruciate ligament: a study in the rabbit.

The treatment for severe combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) ruptures is disputed. Using a rabbit model, we examined the effect of insufficiency of medial structures on the reconstructed ACL in combined ACL and MCL injury. 40 rabbits were divided into 2 groups. In both groups, ACL was subjected to in situ freeze-thaw treatment. In group F, only freeze-thaw treatment of ACL was given. In group FM, partial resection of MCL was also done. We killed 5 rabbits on each of 4 occasions: immediately after the operation (time 0), at 6, 12 and 24 weeks postoperatively. At each time, we measured valgus instability and mechanical properties of the ACL. Valgus instability in group FM persisted from time 0 to 24 weeks, and was significantly greater than that in group F. The tensile strength and tangent modulus of the ACL in group FM were lower than those in group F. We found that continuous valgus instability reduces the mechanical properties of the in situ frozen ACL.

Animals↗
PubMed1988

The collateral ligaments of the knee joint in the cat and man. Morphological and functional study of the internal arrangement of fibers.

The present investigation of fiber arrangement in the collateral ligaments of the knee was carried out in cats and man in various positions of flexion and extension, without compression load. In all knee joint positions, the fibers of the collateral ligaments are twisted except for the fibers in the meniscal part of the medial collateral ligament which have a parallel arrangement. Furthermore, most of the fibers in the collateral ligaments are taut in all positions of the knee joint in both cat and man. By means of planar models representing different fiber arrangements, the kinematic behavior of the collateral ligaments was analyzed. It appears that a crossed (twisted) arrangement of the fibers is most effective in rotatory movements, whereas a parallel orientation is most effective in translation. Our data further indicate that, in measuring the changes in lengths of ligaments during joint motion, one cannot neglect the internal arrangement of fibers and the geometry of the articular surfaces and menisci.

Animals↗
PubMed2006

Posterolateral knee reconstruction with an anatomical bone-patellar tendon-bone reconstruction of the fibular collateral ligament.

BACKGROUND: The authors have long advocated a graft reconstruction of the fibular collateral ligament, believing that direct suture repair or augmentation procedures do not provide a stable construct. PURPOSE: To describe an operative technique and determine the clinical outcome of a bone-patellar tendon-bone graft anatomical replacement of the fibular collateral ligament in a consecutive series of knees. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A consecutive group of knees undergoing anatomical posterolateral reconstruction that included a fibular collateral ligament reconstruction with a bone-patellar tendon-bone graft was prospectively followed to determine the functional outcome and failure rate. Thirteen patients (14 posterolateral reconstructions) were observed 2 to 13.7 years postoperatively. All major posterolateral structures were surgically restored. The procedure represented a primary reconstruction in 7 patients and a revision in 6 patients. Anterior cruciate ligament ruptures were found in 7 patients and bicruciate ruptures in 5 patients, all of which were reconstructed. The rehabilitation protocol allowed immediate knee motion from 0 degrees to 90 degrees but included protection against lateral joint loads to prevent graft stretching and failure. The results were determined by a knee examination, stress radiography, KT-2000 arthrometer, the Cincinnati Knee Rating System, and the International Knee Documentation Committee Rating System. RESULTS: Significant improvements were found at follow-up for pain (P = .0001), swelling (P = .02), patient rating of the overall knee condition (P < .001), walking (P < .05), and stair climbing (P < .05). Thirteen of the 14 (93%) reconstructions restored normal or nearly normal lateral joint opening and external tibial rotation and 1 failed. The anterior cruciate ligament reconstructions were normal or nearly normal in 11 knees and abnormal in 1 knee. CONCLUSIONS: The anatomical posterolateral procedure was effective in restoring normal limits to lateral joint opening and external tibial rotation, allowed immediate knee motion, and appeared to protect other soft tissue repairs.

Adolescent↗
PubMedDate not supplied

Tibial collateral ligament bursitis.

In 91 patients evaluated between 1982 and 1985, tibial collateral ligament bursitis was diagnosed. This entity has not been described since the work of Brantigan and Voshell in 1943. The diagnosis was based on the findings of tenderness over the tibial collateral ligament at the joint line, without a history of mechanical symptoms. With a nonsurgical program, 62% of the patients improved and subsequently required no further treatment. Fifteen percent did not improve; of this group, one-third had a negative arthrogram or arthroscopy. Another 23% did not improve and ultimately underwent an arthroscopic partial medial meniscectomy. Tibial collateral ligament bursitis is an entity that should be considered in any patient with medial joint pain in the knee. Treatment is simple, effective, and offers low morbidity.

Adult↗
PubMed2006

Calcific tendonitis of the fibular collateral ligament.

This article describes calcific tendonitis within the fibular collateral ligament, presumably from hydroxyapatite deposition, a rare cause of acute, severe lateral knee pain. Imaging findings confirmed calcifications in an intact but thickened fibular collateral ligament with adjacent soft-tissue reaction, consistent with calcific tendonitis. Magnetic resonance imaging can appear aggressive, and therefore the findings often can be mistaken for other knee abnormalities; specifically, the presentation following a twisting injury that requires avulsion fracture or ligamentous injury be excluded. Confirmation of crystal deposition with thin-section CT is helpful when suspected on MRI because it is unequivocal in depicting calcifications and bony detail.

Calcinosis↗
PubMed2005

The effects of low-intensity ultrasound on medial collateral ligament healing in the rabbit model.

BACKGROUND: Ruptured medial collateral ligaments are capable of healing over time, but biomechanical and biochemical properties remain inferior to normal tissue. Low-intensity ultrasound may improve healing. HYPOTHESIS: Medial collateral ligaments treated with ultrasound will demonstrate superior healing. STUDY DESIGN: Controlled laboratory study. METHODS: Twenty-one late-adolescent male rabbits underwent bilateral ligament transection. One ligament from each rabbit received ultrasound treatment every other day for 6 total treatments. Contralateral ligaments received sham treatments. After 3 or 6 weeks, ligaments were evaluated biomechanically and assayed for collagen concentration and the relative proportions of types I and III collagen. RESULTS: Areas of sonicated specimens were significantly larger (10.6% +/- 4.90%) at 6 weeks. Ultimate load (39.5% +/- 17.0%), ultimate displacement (24.5% +/- 8.0%), and energy absorption (69.1% +/- 22.0%) were significantly higher for sonicated specimens at 6 weeks. No significant biomechanical differences were observed at 3 weeks. The relative proportion of type I collagen was significantly higher in sonicated ligaments at 3 weeks (8.61% +/- 4.0%) and 6 weeks (6.91% +/- 3.0%). No significant differences in collagen concentration were observed at either 3 or 6 weeks. CONCLUSION: Subtle improvement with ultrasound treatment may be apparent by 3 weeks after injury, suggested by increased proportion of type I collagen. Ultrasound appears to improve some structural properties and to modestly increase scar cross-sectional area and type I collagen present at 6 weeks after injury in this model. CLINICAL RELEVANCE: Ultrasound treatments after ligament injury may facilitate earlier return to activities and decrease risk of reinjury.

Animals↗
PubMed1999

Technical pitfalls of collateral ligament surgery.

The technical pitfalls of collateral ligament surgery include: Failure to properly diagnose and appropriately recommend surgery; posterolateral instability is the most commonly missed acute associated instability pattern Failure to correct all components of the injury (see Table 1): lateral meniscus, arcuate ligament, and popliteus, lateral gastrocnemius, and biceps muscles Failure to properly reattach and repair the damaged structures Peroneal nerve damage during the surgical approach and repair Wound problems: breakdown, hematoma Loss of motion This article presented a concise introduction to the anatomy of the collateral and capsular ligaments of the knee. This information should prove valuable in avoiding pitfalls in the diagnostic and surgical approach to the knee. To fully appreciate the anatomy, one must study it in the anatomy laboratory by performing repeated dissections. Only then can one appreciate how beautifully all of the structures function in unison. Application of this knowledge will help surgeons continue to improve and refine their approach to knee injuries.

Athletic Injuries↗
PubMed2004

Medial collateral ligament strain with partial posteromedial olecranon resection. A biomechanical study.

BACKGROUND: Partial resection of the posteromedial aspect of the olecranon in the treatment of valgus extension impingement osteophytosis is a well-described technique. It has been hypothesized that removal of the normal olecranon process, beyond the osteophytic margin, increases the strain in the anterior bundle of the medial collateral ligament. METHODS: We used an electromagnetic tracking device to investigate the strain in the anterior bundle of the medial collateral ligament as a function of increasing applied torque and posteromedial resections of the olecranon in seven cadaveric elbows. Applied torques under valgus stress consisted of hand weight, hand weight plus 1.75 Nm, and hand weight plus 3.5 Nm. Resections were conducted in sequential 3-mm increments, from 0 to 9 mm. We measured changes in the length of the anterior and posterior bands of the anterior bundle of the medial collateral ligament with strain gauges. The strains of the two bands were averaged, and the average was reported. RESULTS: The strain in the anterior bundle of the medial collateral ligament was found to increase with increasing flexion angle, valgus torque, and olecranon resection beyond 3 mm. In two elbows, the anterior bundle of the medial collateral ligament ruptured during testing following the 9-mm resection. There was a significant difference between the strain following the 6-mm resection and that following the 3-mm resection at 110 degrees of flexion with 3.5 Nm of added torque (p = 0.004). CONCLUSIONS: In this in vitro cadaver study, an increase in flexion angle, an increase in valgus torque, and resection of > or =6 mm led to an increase in strain in the anterior bundle of the medial collateral ligament. The non-uniform change in strain related to 3 mm of resection suggests that resections of the posteromedial aspect of the olecranon of >3 mm may jeopardize the function of the anterior bundle.

Aged↗
PubMed2005

[The effect of fibroblast growth factors and epidermal growth factors on the proliferation of rabbit anterior cruciate and medial collateral ligament cell in vitro].

OBJECTIVE: To investigate the effect of acid, basic fibroblast, growth factor (aFGF, bFGF) and epidermal growth factor (EGF), and their combination on the proliferation of rabbit anterior cruciate ligament (ACL) and medial collateral ligament (MCL) in vitro. METHODS: The cells of ACL and MCL were isolated and subcultured from the knee joints of ten-week-old New Zealand white rabbits. The cells were seeded into 96-well corning cluster plates. Three growth factors of different concentration alone or in combination were added into the culture medium respectively, which were 0, 1, 5, 10, 50 and 100 ng/ml for aFGF, bFGF and 0, 1.56, 3.13, 6.25, 12.5, 25 and 50 ng/ml for EGF. The proliferation of the fibroblasts was measured for 48 h with XTT method. RESULTS: All of the three growth factors alone promoted the cell proliferation of ACL and MCL fibroblasts. The concentration of aFGF had a significant effect on the proliferation of both ACL and MCL fibroblasts. The concentration of 1 ng/ml bFGF and 5 ng/ ml EGF was most effective in promoting the proliferation of ACL, and both bFGF and EGF had a significant effect on MCL. 5 ng/ml aFGF with 50 ng/ml EGF had effect on ACL. 1 ng/ml aFGF with 3.13 ng/ml EGF had effect on MCL. CONCLUSION: The three growth factors may promote the cell proliferation of ACL and MCL. These findings suggest that topical application of aFGF, either alone or in combination with EGF may have the potential to promote the proliferation of rabbit ACL and MCL,and aFGF of low concentration in combination with EGF is more effective than single growth factor.

Animals↗
PubMed2000

Early medial collateral ligament scars have inferior creep behaviour.

Recent evidence suggests that ligaments are subject to repetitive loads in vivo. Hence, the creep behaviour (increase in strain under constant or repetitive stress) of ligament scars is of significance, since healing ligaments may elongate permanently over time. A rabbit medial collateral ligament model was used to assess the creep behaviour of healing ligaments at stresses corresponding to 30% of the scar failure strength at 3 (n = 6), 6 (n = 6), and 14 (n = 5) weeks of healing. The stresses for the creep tests of scars (and contralateral controls) were 2.2, 4.1, and 7.1 MPa for the 3, 6, and 14-week healing intervals, respectively. Normal medial collateral ligaments from comparable rabbits were tested at two of the corresponding stresses: 4.1 (n = 7) and 7.1 (n = 6) MPa. Total creep strain-the cumulative increase in strain resulting from serial cyclic and static creep testing-was independent of the order of testing and was compared between scars and controls. Water contents after testing were also quantified. Water contents before testing were assessed for additional animals: six normal animals and three from each healing interval. At 3 weeks of healing, the total creep strain of medial collateral ligament scars was four times greater than that for contralateral controls tested at the same stress. Although there was improvement from 3 to 14 weeks, the total creep strain of scars remained more than two times greater than that of controls at 14 weeks. Scar water content decreased with healing from elevated initial values, possibly contributing to the marginally improved creep response. Comparisons of this deficiency in scar creep with previously published scar abnormalities in the same model suggest that collagen crosslink density, proteoglycan content, soft-tissue flaws, and the combined effect of collagen fibre changes may be mechanistic factors involved in scar creep.

Animals↗
PubMed2004

Surgical approaches to the metacarpophalangeal joint of the thumb for repair and reconstruction of the collateral ligaments and capsule.

Surgical repair and reconstruction of the ulnar and radial collateral ligaments at the thumb metacarpophalangeal joint require an adequate exposure to identify and repair or reconstruct the disrupted collateral ligaments. The authors have used the approach to be described with safety and convenience over a several year period for repair and reconstruction of both the ulnar and radial collateral ligaments at the thumb metacarpophalangeal joint. This dorsal approach gives a comprehensive exposure without significant disruption of the extensor tendons or hood mechanism.

Journal Article↗
PubMed2000

The use of ultrasound in the diagnosis of injuries of the ulnar collateral ligament of the thumb.

We describe the use of a specialist referral clinic and ultrasound assessment for all injuries to the ulnar collateral ligament of the metacarpophalangeal joint of the thumb presenting to an Accident and Emergency (A&E) department. Senior House Officers in the A&E department were able to correctly diagnose only 45% of the ruptures of the ulnar collateral ligament. The overall agreement between specialist clinic examination and ultrasound for injury to the ulnar collateral ligament was 85% (kappa 0.647). When compared with the operative finding ultrasound had a positive predictive value for rupture of 94%. An algorithm is presented for the assessment of injuries to the ulnar collateral ligament in A&E departments.

Adolescent↗
PubMed2002

Low-intensity pulsed ultrasound enhances early healing of medial collateral ligament injuries in rats.

OBJECTIVE: To investigate the effect of low-intensity pulsed ultrasound exposure on the healing of injured medial collateral ligaments. METHODS: Thirteen male Sprague Dawley rats were used in the study. After surgical transection of the bilateral medial collateral ligaments, the ligament of 1 knee received low-intensity pulsed ultrasound exposure (30 mW/cm2 for 20 minutes daily), whereas no ultrasound was applied to the contralateral knee (control side). Eight rats were killed at 12 days after surgery, and 5 rats were killed at 21 days. The bilateral knees of 5 rats were used for mechanical testing at each of the 2 periods, and 12-day specimens of the remaining 3 rats were prepared for the electron microscopic examination. The knees of 5 additional rats were used to obtain mechanical data of the normal uninjured medial collateral ligament. RESULTS: On the 12th day, the low-intensity pulsed ultrasound-treated side exhibited significantly superior mechanical properties when compared with the control side in ultimate load, stiffness, and energy absorption (P < .05). However, the treatment did not afford any mechanical advantage when tested on the 21st day. The mean diameter of the fibril was significantly larger on the treatment side than on the control side (P < .05). CONCLUSIONS: Low-intensity pulsed ultrasound exposure is effective for enhancing the early healing of medial collateral ligament injuries.

Animals↗
PubMed1999

Ultrasonography may be misleading in the diagnosis of ruptured and dislocated ulnar collateral ligaments of the thumb.

To find out if a non-invasive technique (ultrasonography) was able to identify a dislocated ligament of a metacarpophalangeal joint of the thumb with instability of the ulnar collateral ligament, 14 consecutive patients with clinical rupture of the ulnar collateral ligament were examined with ultrasonography before the ligament was explored. At exploration all ligaments were ruptured, and only five out of the 14 were dislocated. Ultrasonography recognised only two of the dislocated ligaments, and in half of the 14 patients the ultrasound scan gave incorrect information about the position of the ligament. We conclude that ultrasonography is not adequate for identifying dislocated ulnar collateral ligaments of the metacarpophalangeal joint of the thumb, and exploration is indicated in those with clinical instability in which palpation either suggests a dislocated ligament or is inconclusive.

Collateral Ligaments↗
PubMed2000

The use of a polypropylene mesh for treatment of ruptured collateral ligaments of the equine metatarsophalangeal joint: a report of two cases.

The prognosis of ruptured collateral ligaments of the metacarpophalangeal or metatarsophalangeal joint in horses is usually considered to be poor, especially for future athletic performance. The main problem is the development, due to joint instability, of osteoarthritis, which may result in persistent lameness. In this paper a surgical technique is described in which joint stabilisation is realised by using a polypropylene mesh as a substitute for the ruptured ligaments, with the subsequent application of a cast for 7 weeks. The technique was successfully performed in 2 horses with ruptured lateral collateral ligaments of a metatarsophalangeal joint. Fifteen months after surgery both horses resumed exercise. Performance could be classified as fair in one case and good in the other. It is concluded that the preliminary results obtained with this surgical technique to stabilise ruptured collateral ligaments of the fetlock joint are promising.

Animals↗
PubMed1995

Injury location affects ligament healing. A morphologic and mechanical study of the healing rabbit medial collateral ligament.

Based on the heterogeneity of the rabbit medial collateral ligament (MCL) along its length, we tested the hypothesis that injury location would affect its healing response. The right MCL of 80 skeletally mature New Zealand white rabbits was sectioned adjacent to bone at the femoral end (40 rabbits) or the tibial end (40 rabbits) and reapposed with sutures. Animals were killed after 3, 6, 14, or 40 weeks of healing to examine wounds histologically (2 rabbits per healing interval) and mechanically (8 rabbits per healing interval). Results of the mechanical tests were compared to midsubstance MCL repairs (24 rabbits) and to uninjured normal MCLs (20 rabbits). The morphology of the near-insertion repairs was characterized by abnormal callus-like formation and patchy bone resorption, particularly at the tibial insertion. Mechanically, insertional injuries remodeled towards normal MCL low-load, viscoelastic and failure properties more slowly than midsubstance injuries at the early healing intervals. After 40 weeks of healing, few injury-specific differences persisted. All injured ligaments had ultimate strengths 15-35 percent short of normal at 40 weeks and the femorally-injured ligaments were weaker than normal at this time. These results suggest that rabbit MCLs, injured near either end, heal more slowly than those injured in their midsubstance and develop abnormal insertion morphology.

Animals↗